| In spite of all the advertising touting "home-like" | | | | this are many. One of the most common for |
| birthing rooms in hospitals, for most women, a | | | | healthy full-term women, is fear of going too far |
| hospital birth will be nothing like a home birth. | | | | past the "due date" and having a baby with |
| Interventions are routine in the hospitals in my | | | | postmature syndrome or meconium staining. |
| state. Every laboring woman will be hooked up for | | | | Another reason is fear of having a big |
| some period of time to an electronic fetal | | | | baby.Benefits of inducing would seem to be |
| monitor, given vaginal exams, and be told where | | | | avoiding postmature syndrome, attempting to |
| and in what position she must give birth. If her | | | | deliver a baby that had grown too big for the |
| membranes are ruptured, she will be required to | | | | mother and bypassing meconium staining. |
| deliver her baby within a certain time period. If | | | | However, studies fail to confirm this line of |
| her labor is moving too slowly, she will be given | | | | thought. The actual amount of time needed for a |
| pitocin to augment it or have her water artificially | | | | baby to grow to term varies and figuring an |
| ruptured. She will be told how many companions | | | | exact due date for each baby has not yet been |
| she may have with her. If she has other children | | | | done. Ultrasounds have at best a 10 day window |
| she may or may not include them at the birth. | | | | of error if done in the first trimester. The |
| How long she is kept in the hospital will vary | | | | phenomenon of postdates, is poorly understood. |
| depending on her physician and the particular | | | | Macrosomia occurs prior to postdates as |
| hospital. How soon her baby will be released also | | | | does"postmature syndrome." (p. 181) The entity |
| will depend on the baby's pediatrician and hospital | | | | of postmature syndrome is based on a single |
| policy. Some of the more common interventions | | | | physicians "subjective evaluation of 37 babies." |
| that take place during hospital births are discussed | | | | Research seems to indicate that watchful waiting |
| below.AMNIOTOMYArtificially breaking the amniotic | | | | is the more prudent course of action for healthy |
| sac is done routinely at many hospitals to speed | | | | women. 14IVAt a great many U.S. institutions, one |
| labor up, get labor going, to test the fluid or to | | | | of the first items of care to be rendered to the |
| get it out of the way so that an internal monitor | | | | obstetric patient will be her IV, "just in case." Just |
| can be screwed into the baby's head. It was | | | | in case she needs drugs or surgery or her veins |
| believed that breaking the water would speed up | | | | collapse making insertion of an IV impossible. |
| labor by 30 to 60 minutes but the only | | | | Nancy Wainer Cohen and Lois Estner interviewed |
| randomized control trial done disproved this. This | | | | many labor and delivery nurses to find out how |
| procedure causes cord prolapse, a serious | | | | frequently a laboring woman's veins collapsed. |
| complication for the baby and increases the | | | | They learned that this does not happen. This is |
| chances of an infection. With less amniotic fluid in | | | | not the way birth happens in other nations, where |
| the uterus during labor, the baby has a greater | | | | a laboring woman is permitted to eat and drink |
| risk of cord compression problems leading to fetal | | | | lightly. This cultural warping began in the 1940's |
| distress and malpositions of the head. 1, 2DRUGS | | | | when anesthesia was being given to nearly all |
| & EPIDURALSNearly every woman giving birth in | | | | birthing women by mask and vomiting and food |
| a hospital will receive a drug at some point during | | | | aspiration were risks associated with this. |
| her stay. Pitocin is frequently used to induce or | | | | Eliminating food and drink, they felt would eliminate |
| augment labor. Because it causes abnormally | | | | this risk. Today, however, anesthesia methods |
| strong contractions, many women receive a | | | | have improved and this is no longer the problem it |
| pain-relieving drug such as a narcotic. | | | | once way. Improved intubation techniques make |
| Unfortunately, narcotics also are received by the | | | | this problem virtually a thing of the past. Doris |
| baby and can affect the condition of the baby at | | | | Haire, a maternity care writer, in looking at 20 |
| birth and for years after. Some of these side | | | | years of medical literature on aspiration during |
| effects are respiratory problems, impaired | | | | surgery found that the cause was not eating or |
| muscular, visual and neural development in the | | | | drinking prior to the surgery, but caused by |
| first week of life and in the following years, lower | | | | incompetence of the anesthesiologist.General |
| reading and spelling scores, difficulty in solving | | | | anesthesia is given to approximately 4% of those |
| problems or performing tasks when they pose a | | | | who undergo cesarean section. Approximately |
| challenge.The new drug of choice at many | | | | 0.3% cesarean surgeries will require intubation that |
| hospitals is the epidural. It must be administered | | | | will be difficult to do yet not all women who |
| by an anesthesiologist and requires the mother to | | | | require intubation will aspirate. This translates into |
| remain in bed afterward. She must be flushed | | | | denying all laboring women food and drink because |
| with an IV fluid prior to getting it to keep her | | | | 1 cesarean sectioned woman out of 10,000 may |
| blood pressure up. A needle is inserted into the | | | | aspirate.Although IV's are supposed to keep the |
| woman's back and small catheter is left in place | | | | stomach empty, a glucose IV actually works to |
| where the medication is injected. It numbs the | | | | slow down the emptying of the stomach. It also |
| woman's body from the ribs to the toes. Many | | | | may encourage tissues to swell so that it makes |
| women ask for this drug because they do not | | | | it more difficult to intubate, if that becomes |
| want to deal with the pain of childbirth and believe | | | | necessary. IV fluid accumulates in the bladder and |
| it is safe for themselves and their babies because | | | | that may slow down labor. Some women may |
| the physician who administered it, their | | | | have sensitivities to the IV and have a reaction |
| obstetrician and the labor and delivery nurses all | | | | from one. It restricts the woman's mobility. The |
| encourage the use of it and give no information | | | | needle in the arm is painful and inhibits free |
| regarding side effects.The known complications | | | | movement. The baby also may suffer from the |
| are many ranging from requiring EFM, IV, | | | | mother's IV, as studies are being done to |
| immobility, urinary catheterization. An epidural also | | | | determine if the excessive sugar administered |
| may allow no sensation of labor or the pushing | | | | through a glucose IV may harm the baby. 14, 15, |
| urge, lower blood pressure, abnormally relax the | | | | 16LITHOTOMYThis used to be the position of |
| pelvic muscles which may encourage the baby to | | | | choice for physicians doing hospital births. The |
| adopt malpositions of the head, may decrease the | | | | mother lies flat on her back with her knees in the |
| production of oxytocin at critical times, and | | | | air. It is a most unphysiologic position for mom |
| increase the need for forceps and cesarean | | | | and baby, but it does give the physician a good |
| section. Epidurals cause some serious complications | | | | view of the mother's perineum. While in this |
| such as heart attack, spinal damage, and spinal | | | | position, the mother must push the baby out uphill. |
| headache. After the birth, chronic backache is a | | | | It is known to cause fetal distress due to the |
| common complaint as well as backache. | | | | baby lying on the mother's arteries and veins. |
| The baby may be exposed to narcotic drugs | | | | Most women will not choose this position if given |
| given to enhance the effect of the epidural and | | | | alternatives.Dr. Roberto Caldeyro-Barcia is |
| which if given alone can compromise the baby's | | | | considered an expert on this position for labor and |
| respiratory efforts as well as require the newborn | | | | delivery. He and his researchers found that this |
| to metabolize the drugs. We do not know the | | | | lithotomy or supine position is the worst one for |
| short or long term effects of the epidural or | | | | laboring women because it adversely affects |
| other drugs on the baby. Some claim that the | | | | every facet of birth: makes labor more painful, |
| baby is unaffected unless the mother becomes | | | | reduces uterine activity, and can dangerously |
| hypotensive. | | | | lower blood pressure. He says, "Except for being |
| Some non-interventionist birth attendants | | | | hanged by the feet, the supine position is the |
| recognize that occasionally epidurals may be useful | | | | worst conceivable position for labor and delivery." |
| for certain situations. Some examples when an | | | | 17, 18MONITORINGElectronic fetal monitoring is |
| epidural may permit a normal birth are for | | | | required at nearly every hospital for at least a |
| maternal exhaustion, severe back labor, certain | | | | short time. When it was first available, it was used |
| malpresentations or psychological dystocia. | | | | only for the most high risk situations. However, it |
| Although the FDA approves drugs as safe or | | | | is now used for everyone regardless of risk |
| unsafe, they have no definition of safe and do | | | | status. A large reason why EFM is used so |
| not guarantee safety of drugs. Many who work | | | | extensively is that staff is in short supply and this |
| with brain damaged children, wonder if the | | | | technology allows for fewer care-givers.There are |
| disability is due to obstetric drug use. They also | | | | two kinds of monitors: external and internal. The |
| question if women would make the drug choice if | | | | external monitors are attached to a heavy elastic |
| they were given complete information about side | | | | band that is strapped across the mother's |
| effects. The American Academy of Pediatricians | | | | abdomen. She must lie quietly so the monitors do |
| discourages the routine use of obstetric drugs. 3, | | | | not slip. The baby's heart beat is recorded on a |
| 4, 5, 6, 7ENEMASThis procedure is still done | | | | machine that documents the moment to moment |
| routinely at many hospitals, although no research | | | | heart rate on graph paper along with the mother's |
| proves any benefits for the mother or baby. | | | | contractions. The internal monitor does the same |
| Home birth and natural birth advocates recognize | | | | things, but it is attached directly into the baby's |
| that for the vast majority of women, the | | | | head by a metal screw. The uterine contractions |
| process of labor will empty the bowels. 8, | | | | are monitored by a probe that is inserted into the |
| 9EPISIOTOMYAlthough many believe that an | | | | uterus. Some feel that this is a more accurate |
| ep[isiotomy is necessary to have a baby to | | | | reading. |
| prevent damage to the baby's head, prevent | | | | During most labors and deliveries, no other |
| trauma to the mother's perineum and the cut will | | | | method of monitoring the baby's heart rate will be |
| heal faster and prevent 3rd and 4th degree tears, | | | | used. However, EFM does not reduce infant |
| no research supports these myths. Shiela Kitzinger | | | | deaths, improve outcomes or give information |
| writes that 9 out of 10 American women will | | | | that permits potentially bad situations to be |
| have an episiotomy with her first baby although in | | | | corrected or avoided. The strips are frequently |
| Holland, only 2 or 3 out of 10 will. The facts are | | | | mis-read. One study found that 71-95 % of |
| that episiotomy is a cultural phenomena. Research | | | | babies diagnosed by EFM as distressed were not. |
| shows that episiotomy is done because the | | | | Additionally, studies have shown that most causes |
| doctor was trained to do it, not because it was a | | | | of brain damage are not related to actual distress |
| necessary procedure. It can be avoided by using | | | | during the birth process but rather due to distress |
| more physiologic positions to give birth (not | | | | prior to labor. In spite of near universal use of |
| lithotomy), pushing only when mom feels need to, | | | | EFM, little evidence exists that any change has |
| giving birth gently, slowly to the head, preparing | | | | taken place in the numbers of brain damaged |
| for the birth by doing perineal massage and Kegel | | | | babies being born.Auscultation with a fetascope, |
| exercise, avoiding forceps delivery. 10FORCEPS & | | | | stethoscope, pinard horn and other low-tech |
| VACUUM EXTRACTORForceps are obstetrical | | | | devices for listening to the baby have been found |
| tools which are shaped like large spoons have | | | | to be as effective for monitoring most laboring |
| been in use since the 1500's. Years ago, forceps | | | | women.The risks of using EFM are well known: |
| were used for many problems which are now | | | | higher intervention rate of all kinds due to |
| handled by cesarean section. Today, most | | | | misinterpretation of strips leading to a misdiagnosis |
| forceps deliveries are low forceps, which means | | | | of fetal distress. The use of EFM may increase |
| they are applied when the babies head is low in | | | | the risk of cerebral palsy by increasing the risk of |
| the pelvis and birth is imminent. According to Henci | | | | infection. More babies have abnormal fetal heart |
| Goer, "There is no research to support the | | | | rate patterns when monitored by EFM than by |
| elective use of forceps."The risks to the mother | | | | auscultation, and it may be that this finding is |
| are perineal trauma, extensive episiotomy, | | | | caused by EFM rather than simply being detected |
| possible extension tearing from episiotomy, | | | | by it. Mothers may report not remembering parts |
| hematoma and nerve damage. Lasting effects of | | | | of their labors due to anxiety that was created |
| forceps or vacuum extraction to the mother may | | | | by using the monitors.One of the greatest risks |
| be anal incontinence in spite of a repaired third | | | | to the baby who receives an internal monitorying |
| degree tear. | | | | electrode is that of infection at the insertion site. |
| The baby may have damage to the head, eyes, | | | | The woman with a history of herpes may be |
| the nerves that lead to the face and neck and | | | | wise to forego internal monitoring our of concern |
| arms. However, an article written by a physician | | | | of passing this disease on to her baby via the |
| which appeared in Parents magazine claims, | | | | scalp electrode.191. Cohen & Estner, Silent Knife, |
| "Medical studies comparing outlet forceps | | | | page 168. |
| deliveries with spontaneous (no forceps) deliveries | | | | 2. Korte & Scaer, A Good Birth, A Safe Birth, |
| have shown that there is no difference in risk to | | | | pages 108-109. |
| the baby." (Emphasis mine)Vacuum extraction is a | | | | 3. Korte & Scaer, pages 119-124. |
| newer technology that sometimes takes the | | | | 4. Birth Gazette, "On Epidurals: Pros and Cons", |
| place of forceps. As with low forceps, the baby's | | | | Vol. 9, No. 1, Winter 1992, pages 19, 21. |
| head must be very low in the pelvis before the | | | | 5. Davis-Floyd, Robbie, Birth as an American Rite |
| suction cup can be attached. It has the benefit of | | | | of Passage, 1992, pages 113-116. |
| not requiring an episiotomy and maternal perineal | | | | 6. Hillard, Paula Adams, "As they Grow Pregnancy |
| trauma is less than with forceps, but the baby still | | | | and Birth, Forceps Delivery," Parents magazine, |
| has the possibility of trauma to the head and | | | | July 1990, pages 94, 97. |
| face. | | | | 7. Gross & Ito, "All about Anesthesia," Parents, |
| Chiropractors also recognize that pulling a baby | | | | Vol. 65, April 1990, pages 213, 218, 221. |
| out by the head changes the spinal alignment, | | | | 8. Cohen & Estner, page 162. |
| although this is not recognized in any medical | | | | 9. Korte & Scaer, page 108. |
| texts. 6, 11, 12IMMOBILITYAlong with the | | | | 10. Korte & Scaer, pages 127-128. |
| lithotomy position comes immobility. It is | | | | 11. Korte & Scaer, page 129. |
| impossible to move around when you are flat on | | | | 12. Sultan, A.H., "Third degree obstetric and |
| your back. It's even more difficult if you have | | | | sphincter tears: risk factors and outcome of |
| internal and external fetal monitors attached to | | | | primary repair," as abstracted in the Journal of the |
| your body, an IV running into your arm and after | | | | AMA, May 25, 1994, Vol. 217, page 15520. |
| a narcotic drug was given to "take the edge off." | | | | 13. Korte & Scaer, pages 105-106. |
| It goes without saying, that if you had an epidural, | | | | 14. Goer, Henci, Obstetric Myths versus |
| you would not be going anywhere at all as your | | | | Research Realities, page 179-202. |
| legs would have no feeling.Some hospitals | | | | 15. Cohen & Estner, pages 162-168. |
| encourage walking and moving around. Others do | | | | 16. Korte & Scaer, pages 106-107. |
| not like you to be out of your room, which may | | | | 17. Goer, page 109. |
| be quite small and loaded with equipment, making | | | | 18. Cohen & Estner, pages 158-159. |
| any real walking about nearly impossible. Studies | | | | 19. Goer, pages 131-153. |
| have shown that moving about and being upright | | | | 20. Korte & Scaer, pages 1, 38-39, 64, 77, 83, |
| can shorten labor as well as changing positions. | | | | 90, 109-113, 134, 150, 156, 164, 187, |
| 13INDUCTIONAccording statistics from the health | | | | 199-200.Yvonne Cryns has degrees in nursing and |
| department in Wisconsin, one-third of all births in | | | | law. She is the co-founder of Nursing Programs - |
| that state are the result of induction, the artificial | | | | Midwives.net - Yvonne also produced a video |
| starting of labor. Most inductions are accomplished | | | | about midwives: |
| using pitocin in an intravenous solution or artificially | | | | Yvonne is a nationally-credentialed CPM, a |
| rupturing the amniotic sac. The reasons for doing | | | | professional homebirth midwife. |