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