Birth American Style
The United States has the highest per capita spending on health care in the world, with care for mothers and newborns combined as the fourth largest category of hospital expenses, and childbirth as the most common reason for hospitalization of women in the US - and yet we rank 29th of developed countries in infant mortality! Read this fact sheet based on figures from 2005 - 2006. Note that there has been no improvement in recent years. As of 2006 the Cesarean rate has gone up to 31.1%, while our rates of prematurity and low birth weight are increasing!
In order to truly make informed choices about interventions in normal pregnancy and birth in the United States parents need to be informed of the potential risks or complications that can result. This information is often not presented or explained completely to parents, or it is presented during a stressful time, such as active labor. Read about these things BEFORE you need to make an informed decision.
FISH CAN’T SEE WATER:
THE NEED TO HUMANIZE BIRTH
Marsden Wagner, MD, MSPH
International Journal of Gynecology and Obstetrics, 75, supplement s25-37, 2001
Humanizing birth means understanding that the woman giving birth is a human being, not a machine and not just a container for making babies. Showing women---half of all people---that they are inferior and inadequate by taking away their power to give birth is a tragedy for all society. On the other hand, respecting the woman as an important and valuable human being and making certain that the woman’s experience while giving birth is fulfilling and empowering is not just a nice extra, it is absolutely essential as it makes the woman strong and therefore makes society strong.
Humanized birth means putting the woman giving birth in the center and in control so that she and not the doctors or anyone else makes all the decisions about what will happen. Humanized birth means understanding that the focus of maternity services is community based primary care, not hospital based tertiary care with midwives, nurses and doctors all working together in harmony as equals. Humanized birth means maternity services which are based on good scientific evidence including evidence based use of technology and drugs.
But we do not have humanized birth in many places today. Why? Because fish can’t see the water they swim in. Birth attendants, be they doctors, midwives or nurses, who have experienced only hospital based, high interventionist, medicalized birth cannot see the profound effect their interventions are having on the birth. These hospital birth attendants have no idea what a birth looks like without all the interventions, a birth which is not dehumanized. This widespread inability to know what normal, humanized birth is has been summarized by the World Health Organization:.....
To read this article in its entirety: Fish Can't See - Humanizing Birth
Patient-Choice Vaginal Delivery?
An excellent essay written by Lauren A. Plante, MD and published in the May-June issue of Annals of Family Medicine asks the extremely important question: If patients have the right to "choose" a cesarean delivery for no medical indication, why are patients not being allowed to choose vaginal birth?
Patient-choice vaginal delivery? (Full Text)
Ann Fam Med. 2006 May-Jun;4(3):265-8.
Leeman LM, Plante LA.
Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM, USA. firstname.lastname@example.org
Patient-choice cesarean delivery is increasing in the United States. The American College of Obstetricians and Gynecologists supports this option, citing ethical premises of autonomy and informed consent, despite a lack of evidence for its safety. This increase in patient-choice cesarean delivery occurs during a time when women with a breech-presenting fetus or a previous cesarean section have fewer choices as to vaginal birth. Patient-choice cesarean delivery may become widely disseminated before the potential risks to women and their children have been well analyzed. The growing pressure for cesarean delivery in the absence of a medical indication may ultimately result in a decrease of women's childbirth options. Advocacy of patient-choice requires preserving vaginal birth options as well as cesarean delivery.
Listening To Mothers II
from the Childbirth Connection
Childbirth Connection issued a press release on October 24, 2006 announcing the release of their second national survey of women's childbearing experiences. In the press release it states that the data show many mothers and babies experienced inappropriate care that does not reflect the best evidence, as well as other undesirable circumstances and adverse outcomes. An Executive Summary PDF can be downloaded free of charge from Childbirth Connection.
Continuous Electronic Fetal Monitoring
Has continuous monitoring of the fetal heart during labor resulted in better outcomes for these babies? NO. Study after study has shown it does NOT improve outcomes for babies. It has however, resulted in worse outcomes for the mother! Even the American College of Obstetrician and Gynecologists states that outcomes are just as good using intermittent monitoring of the fetal heart by auscultation (listening with a fetascope or hand-held doppler) and this is an acceptable method of fetal monitoring during normal labor. However, the practice continues to be routine in all hospitals in the United States, no matter how many times these facts are presented.
Field Notes in Obstetrics and Maternal-Fetal Medicine
Unnecessary Testing in Obstetrics, Gynecology, and General Medicine: Causes and Consequences of the Unwarranted Use of Costly and Unscientific (Yet Profitable) Screening Modalities
by Martin Donohoe, MD, FACP
posted April 30, 2007 [on Medscape]
"Certain once-broadly accepted monitoring tests that were used routinely have not been supported by outcome data. Examples from obstetric practice include electronic fetal heart rate monitoring and fetal pulse oximetry. Routine electronic fetal heart rate monitoring has not been demonstrated to decrease the rate of cerebral palsy, but has been linked to increases in the overall rate of cesarean delivery.[8,9] It has also been determined that routine use of fetal pulse oximetry is not associated with either reduced rates of cesarean delivery or improvement in the condition of newborns. Although these tests are not recommended for routine assessment, they remain in use in many hospitals in the United States."
The Lancet 2003; 361:445-446
Revisiting the use of the electronic fetal monitor
Concerns about the efficacy and safety of routine electronic fetal monitoring in labour have led expert panels in the USA and Canada1,2 to recommend that such monitoring be limited to high-risk pregnancies. The latest systematic review supports that concern;3 yet, the use of electronic fetal monitoring in low-risk pregnancies continues to expand globally. …..
It is important to explore new and better uses of technologies in medicine. However, technology must not be allowed to diffuse unchecked. The use of electronic fetal monitoring in low-risk pregnancies is of limited effectiveness and carries an increased risk of interventions including instrumental delivery, caesarean delivery, augmentation of labour, and epidural anaesthesia.3….
To read this article: "Revisiting the use of the electronic fetal monitor"
A Cesarean Section, or C-Section, is not just an alternative method of having a baby. It is major abdominal surgery and includes risks and side effect you experience with any major surgery. Cesarean section also has certain risks and potential consequences that are unique to this particular surgery - risks to your baby, and to future pregnancies and babies. While a cesarean can be a life-saving surgery when used appropriately, it should never be considered as 'routine' and risk-free. The number one cause of maternal deaths in developed countries (United States) are complications related to cesarean delivery and anesthesia. Figures released on December 5, 2007 report that the national c-section rate for all births in 2006 in the US was 31.1%, and Childbirth Connection's Listening To Mother's II survey found that 1 out of every 3 women delivered by cesarean section.
A new study of nearly six million births has found that the risk of death
to newborns delivered by voluntary Caesarean section is much higher than
previously believed. The study included 5,762,037 live births and 11,897 infant deaths in the United States from 1998 through 2001.
Researchers found that the neonatal mortality rate for Caesarean delivery among low-risk women is over 2 1/2 times higher than that of babies born vaginally to low-risk women. Their findings were published in the September 2006 issue of Birth: Issues in Perinatal Care. Read the abstract:
Infant and Neonatal Mortality for Primary Cesarean and Vaginal Births to Women with "No Indicated Risk"
Top 15 studies reported in 2006 on cesarean section
What Every Pregnant Woman Needs To Know About Cesarean Section
The C-Section Fact Sheet
19 Ways to Avoid An Unnecessary Cesarean
Vaginal Birth and Cesarean Birth: How Do the Risks Compare?
News - The latest trend that leaves women caught in the middle - An ICAN press release:
Insurance Companies Rejecting Women with History of Cesarean
- Some Companies Require Surgical Sterilization for Coverage -
There are incredible risks associated with Epidurals which are seldom mentioned. If you are considering an epidural you should at the very least educate yourself on the potential and considerable risks to both you and especially your baby. All drugs cross the placenta and affect the delicate developing brain of the of the baby.
Epidurals cross the placenta and cause the following effects in the newborn:
less alert at birth, cry more, poorer visual skills, all resulting in interference with maternal-infant bonding - these affects frequently last for up to 6 weeks
increased likelihood of breastfeeding failure
decreased muscle tone
lowered neurobehavioral scores
increased incidence of jaundice
risk of damage to the central nervous system
There has even been a high correlation found between mothers who received some drugs during labor and later drug abuse in their teenagers. ("Opiate addiction in adult offspring," Jacobson et al.)
Epidurals have been shown to:
slow down labor
lead to an increased use of pitocin to strengthen contractions
lead to an increased incidence of the baby in a posterior position
increase the likelihood of forceps or vacuum extraction
increase the chance of having a cesarean section
increase the mother's body temperature, resulting in her and the baby receiving antibiotics and invasive tests
cause the mother's blood pressure to drop, sometimes to dangerous levels
cause other complications including long-term chronic problems such as headache, and even death
For more information:
Everything you want and need to know about epidurals - benefits, risks, side effects. A great article by Henci Goer.
Epidurals For Labor Pain
Epidurals and Breastfeeding
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