Tzipp-ity-dou-la

Popular Childbirth Procedures, scrutinized. May 20, 2012

Filed under: Uncategorized — Tzippitydoula @ 7:37 pm

I had a chance to read a fantastic article today, “Top Ten Pregnancy Procedures to Reject“. It was a rather long, and extensive article to say the least–but it left me both nodding and wanting a little more clarity. I thought I would share a few of my own ideas here as well.

Although some women turn to home births as an alternative, our experts say that isn’t a good idea in this situation. “The risk of uterine rupture is low,” Main says, “but if it happens, it can be catastrophic.”

I’m not entirely sure who the “experts” they reference are, but I did feel this to be a slightly misleading and incomplete statement as there are actually MANY factors in deciding which is the right care provider for a VBAC. Examples of such factors would be–but are not limited too–the length of time between last cesarean and the following pregnancy, how many cesareans you have had,  and if you’ve ever had a successful VBAC before.

… if you had a C-section, find out whether your obstetrician and hospital are willing to try a VBAC. Let them know that you understand that you your baby will be monitored continuously during labor, and ask what the hospital would do if an emergency C-section became necessary

I would instead recommend not just finding out *if* your hospital is willing to try a VBAC, but to go out a find a hospital and care provider which best align to your birthing goals. Much as it would be silly for someone to expect to buy a mini van from a coupe dealer, it is not wise to expect a hospital with a high cesarean rate and low VBAC rate to assist you in your VBAC. Being a responsible parent starts with finding the best care provider for your particular situation.

Late preterm babies “may look like full term babies,” she says, “but they are different in important ways.

I don’t think any parent would feel that the risk of your baby ending up in NICU because of no better reason than impatience for labour to start is worth the risk of early induction. I would also think the parents of NICU babies would appreciate their own sick or premature children being given the best treatment they can–and that’s simply not possible when the nurses are bogged down with babies that would otherwise have had no problems. Common sense is that NOBODY *wants* their baby in NICU just avoid another week or two of pregnancy discomforts. Let’s leave the NICU for the babies who truly need it.

It turns out that carrying an infant to term has health benefits for both moms and babies. Research shows that babies born at 39 weeks or later have lower rates of breathing problems and are less likely to need neonatal intensive care. Full-term babies may also be less likely to be affected by cerebral palsy or jaundice, have fewer feeding problems, and have a higher rate of survival in their first year. Some research even suggests that full-term infants benefit from cognitive and learning advantages that continue through adolescence.

Perhaps because late preterm infants have more problems, mothers are more likely to suffer from postpartum depression. In addition, the procedures required to intentionally deliver a baby early—either an induced labor or a C-section—also carry a higher risk of complications than a full-term vaginal delivery. ‘There is just much more chance of things going wrong if you interrupt the normal course of pregnancy,’ Spong says.

What amuses me about these types of things is that it always seems to come back to nature. Do we really need scientific studies to tell us that we should allow our babies to grow inside of us as long as they need to? A few days or a week in the womb might not seem like a lot to us here on the outside, but it can be to a newborn. Likewise, with all of the changes a women goes through right before labour, it truly is no wonder that such matters as risk of post partum hemorrhage increase when a mother is forcefully induced into labour before her body begins the process on it’s own. I truly disheartens me by how little is explained to new parents by hospital staff regarding the decisions to induce early. It is simply not a decision to make lightly and with out thoroughly planning for possible undesirable outcomes.

Unless there is a specific condition your provider is tracking, you don’t need an ultrasound after 24 weeks. Although some practitioners use ultrasounds after this point to estimate fetal size or due date, it’s not a good idea because the margin of error increases significantly as the pregnancy progresses. And the procedure doesn’t provide any additional information leading to better outcomes for either mother or baby, according to a 2009 review of eight trials involving 27,024 women. In fact, the practice was linked to a slightly higher C-section rate.”

This one actually disturbs me a lot and I’m glad it was brought up. In my experience as a doula I can’t tell you how often a client has been induced because of an ultrasound saying the baby was “too big”. In my personal experience, I have yet to see one of these clients have a baby bigger than 8 lbs. I have, unfortunately, seen babies pulled from the womb far too early and suffer from the common side effects–difficulty with breath, latching and bonding. The danger to moms, of course, is also in that these inductions often sadly end in non-emergency related surgical births which comes with their own set of risks. Sadly, despite this 2009 review, this seems to be happening more and more in hospital managed births.

“Continuous monitoring, during which you’re hooked up to monitor to record your baby’s heartbeat throughout labor, restricts your movement and increases the chance of a cesarean and delivery with forceps.”

There is a very interesting fact that many childbirthing women don’t knows– electronic fetal monitoring was never meant to be standard practice for healthy births, but it was created to help prevent cases of CP (Cerebral Palsy–thought to stem from lack of adequate oxygen at birth). It was later not only proven to be unsuccessful in preventing CP, but then adopted to help avoid lawsuits in the event of an undesirable outcome once medical providers realized that the tape reading–no matter how accurate a picture if gave of what was going on inside the uterus–was the best evidence that could be used to prevent legal problems on their end.*

Not only has EFM evolved into “normal hospital procedure”, it has actually decreased the level of one-on-one care to nurses. As it would seem, since nurses can track your fetal heartbeat from the main station, there is less need to come and speak with patients directly. The results of this aren’t just less medical attention for the baby, but also less emotional attention for the mom. Often moms start to feel more like a number than a patient, and nurses lose valuable experience in basic childbirthing techniques for pain management, speeding lulling labours along, and last but not least–bedside manner. Even considering the amount of losses the EMF may have prevented, it’s hard not to wonder just how many complications it is responsible for causing.

In other words, despite the common misunderstanding that EFM (electronic fetal monitoring) is primarily for the benefit of the mother and baby, it is firstly there for the obstetrician. Giving mothers this clearer understand should help make decisions about fetal monitoring a little easier. Unless in the case of a real need for continuous monitoring, one can always request intermittent monitoring by their obstetrician. Most baby-friendly hospitals are willing to work with moms to find a compromise that makes both patient and hospital feel comfortable.

Doctors sometimes rupture the amniotic membranes or “break the waters,” supposedly to strengthen contractions and shorten labor. But the practice doesn’t have that affect and may increase the risk of C-sections, according to a 2009 review of 15 trials involving 5,583 women. In addition, artificially rupturing amniotic membranes can cause rare but serious complications, including problems with the umbilical cord or the baby’s heart rate.

In truth, AROM (artificial rupture of membranes) often *does* help strengthen contractions which *can* shorten labours… but it also comes with many possible risks. Though it sounds “natural” to break someone’s waters, it is actually an intervention in the labouring process. It is important to make sure you are aware of the possible risks before deciding this is the right step for you.

“Get labor support. Women who receive continuous support are in labor for shorter periods and are less likely to need intervention. The most effective support comes from someone who is not a member of the hospital staff and is not in your social network—a doula, or trained birth assistant, for example—according to a systematic review of 21 studies involving more than 15,000 women in a range of circumstances and settings. Ask your provider for a referral, and see if your insurance company will cover doula care.”

Of course I agree wholeheartedly with this! Though I would say, not everyone needs nor wants a professional doula. Birthing support can come in a variety of forms and needn’t be limited to one person. Some prefer a whole support team, whilst others prefer the privacy and meditative feel of only having one or two trusted people help them through their births.  Birthing support teams can be built from a combination of trust friends, family members, spouses, doulas, midwives and nurses. Deciding what type of birth you would like to have should come first, followed by finding the right place for your birth, and next in line is to find the complimentary team to assist you in your goals. Once all of these are in order you can begin to hash out the details to help you attain the healthiest and safest birth for you and your little one.

 

*http://www.gehealthcare.com/usen/education/clinical_best_practices/docs/Reprint_Intrapartum_Fetal_Monitoring_David%20MillerMD_Contemporary_OBGYN.pdf

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