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