Risks And Benefits Of Hospital Procedures

In spite of all the advertising touting "home-like"for doing this are many. One of the most common
birthing rooms in hospitals, for most women, afor 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 state.postmature syndrome or meconium staining. Another
Every laboring woman will be hooked up for somereason is fear of having a big baby.Benefits of
period of time to an electronic fetal monitor, giveninducing would seem to be avoiding postmature
vaginal exams, and be told where and in whatsyndrome, attempting to deliver a baby that had
position she must give birth. If her membranes aregrown too big for the mother and bypassing
ruptured, she will be required to deliver her babymeconium staining. However, studies fail to confirm
within a certain time period. If her labor is moving toothis line of thought. The actual amount of time
slowly, she will be given pitocin to augment it or haveneeded for a baby to grow to term varies and
her water artificially ruptured. She will be told howfiguring an exact due date for each baby has not yet
many companions she may have with her. If she hasbeen done. Ultrasounds have at best a 10 day
other children she may or may not include them atwindow of error if done in the first trimester. The
the birth. How long she is kept in the hospital will varyphenomenon of postdates, is poorly understood.
depending on her physician and the particular hospital.Macrosomia occurs prior to postdates as
How soon her baby will be released also will dependdoes"postmature syndrome." (p. 181) The entity of
on the baby's pediatrician and hospital policy. Some ofpostmature syndrome is based on a single physicians
the more common interventions that take place"subjective evaluation of 37 babies." Research seems
during hospital births are discussedto indicate that watchful waiting is the more prudent
below.AMNIOTOMYArtificially breaking the amnioticcourse of action for healthy women. 14IVAt a great
sac is done routinely at many hospitals to speed labormany U.S. institutions, one of the first items of care
up, get labor going, to test the fluid or to get it outto be rendered to the obstetric patient will be her IV,
of the way so that an internal monitor can be"just in case." Just in case she needs drugs or
screwed into the baby's head. It was believed thatsurgery or her veins collapse making insertion of an
breaking the water would speed up labor by 30 toIV impossible. Nancy Wainer Cohen and Lois Estner
60 minutes but the only randomized control trial doneinterviewed many labor and delivery nurses to find
disproved this. This procedure causes cord prolapse,out how frequently a laboring woman's veins
a serious complication for the baby and increases thecollapsed. They learned that this does not happen.
chances of an infection. With less amniotic fluid in theThis is not the way birth happens in other nations,
uterus during labor, the baby has a greater risk ofwhere a laboring woman is permitted to eat and
cord compression problems leading to fetal distressdrink lightly. This cultural warping began in the 1940's
and malpositions of the head. 1, 2DRUGS &when anesthesia was being given to nearly all birthing
EPIDURALSNearly every woman giving birth in awomen by mask and vomiting and food aspiration
hospital will receive a drug at some point during herwere risks associated with this. Eliminating food and
stay. Pitocin is frequently used to induce or augmentdrink, they felt would eliminate this risk. Today,
labor. Because it causes abnormally stronghowever, anesthesia methods have improved and
contractions, many women receive a pain-relievingthis is no longer the problem it once way. Improved
drug such as a narcotic. Unfortunately, narcotics alsointubation techniques make this problem virtually a
are received by the baby and can affect thething of the past. Doris Haire, a maternity care writer,
condition of the baby at birth and for years after.in looking at 20 years of medical literature on
Some of these side effects are respiratory problems,aspiration during surgery found that the cause was
impaired muscular, visual and neural development innot eating or drinking prior to the surgery, but caused
the first week of life and in the following years,by incompetence of the anesthesiologist.General
lower reading and spelling scores, difficulty in solvinganesthesia is given to approximately 4% of those
problems or performing tasks when they pose awho undergo cesarean section. Approximately 0.3%
challenge.The new drug of choice at many hospitals iscesarean surgeries will require intubation that will be
the epidural. It must be administered by andifficult to do yet not all women who require
anesthesiologist and requires the mother to remain inintubation will aspirate. This translates into denying all
bed afterward. She must be flushed with an IV fluidlaboring women food and drink because 1 cesarean
prior to getting it to keep her blood pressure up. Asectioned woman out of 10,000 may
needle is inserted into the woman's back and smallaspirate.Although IV's are supposed to keep the
catheter is left in place where the medication isstomach empty, a glucose IV actually works to slow
injected. It numbs the woman's body from the ribsdown the emptying of the stomach. It also may
to the toes. Many women ask for this drug becauseencourage tissues to swell so that it makes it more
they do not want to deal with the pain of childbirthdifficult to intubate, if that becomes necessary. IV
and believe it is safe for themselves and their babiesfluid accumulates in the bladder and that may slow
because the physician who administered it, theirdown labor. Some women may have sensitivities to
obstetrician and the labor and delivery nurses allthe IV and have a reaction from one. It restricts the
encourage the use of it and give no informationwoman's mobility. The needle in the arm is painful and
regarding side effects.The known complications areinhibits free movement. The baby also may suffer
many ranging from requiring EFM, IV, immobility,from the mother's IV, as studies are being done to
urinary catheterization. An epidural also may allow nodetermine if the excessive sugar administered
sensation of labor or the pushing urge, lower bloodthrough a glucose IV may harm the baby. 14, 15,
pressure, abnormally relax the pelvic muscles which16LITHOTOMYThis used to be the position of choice
may encourage the baby to adopt malpositions offor physicians doing hospital births. The mother lies
the head, may decrease the production of oxytocinflat on her back with her knees in the air. It is a most
at critical times, and increase the need for forcepsunphysiologic position for mom and baby, but it does
and cesarean section. Epidurals cause some seriousgive the physician a good view of the mother's
complications such as heart attack, spinal damage,perineum. While in this position, the mother must push
and spinal headache. After the birth, chronic backachethe baby out uphill. It is known to cause fetal distress
is a common complaint as well as backache.due to the baby lying on the mother's arteries and
The baby may be exposed to narcotic drugs givenveins. Most women will not choose this position if
to enhance the effect of the epidural and which ifgiven alternatives.Dr. Roberto Caldeyro-Barcia is
given alone can compromise the baby's respiratoryconsidered an expert on this position for labor and
efforts as well as require the newborn to metabolizedelivery. He and his researchers found that this
the drugs. We do not know the short or long termlithotomy or supine position is the worst one for
effects of the epidural or other drugs on the baby.laboring women because it adversely affects every
Some claim that the baby is unaffected unless thefacet of birth: makes labor more painful, reduces
mother becomes hypotensive.uterine activity, and can dangerously lower blood
Some non-interventionist birth attendants recognizepressure. He says, "Except for being hanged by the
that occasionally epidurals may be useful for certainfeet, the supine position is the worst conceivable
situations. Some examples when an epidural mayposition for labor and delivery." 17,
permit a normal birth are for maternal exhaustion,18MONITORINGElectronic fetal monitoring is required
severe back labor, certain malpresentations orat nearly every hospital for at least a short time.
psychological dystocia.When it was first available, it was used only for the
Although the FDA approves drugs as safe ormost high risk situations. However, it is now used for
unsafe, they have no definition of safe and do noteveryone regardless of risk status. A large reason
guarantee safety of drugs. Many who work withwhy EFM is used so extensively is that staff is in
brain damaged children, wonder if the disability is dueshort supply and this technology allows for fewer
to obstetric drug use. They also question if womencare-givers.There are two kinds of monitors: external
would make the drug choice if they were givenand internal. The external monitors are attached to a
complete information about side effects. Theheavy elastic band that is strapped across the
American Academy of Pediatricians discourages themother's abdomen. She must lie quietly so the
routine use of obstetric drugs. 3, 4, 5, 6,monitors do not slip. The baby's heart beat is
7ENEMASThis procedure is still done routinely atrecorded on a machine that documents the moment
many hospitals, although no research proves anyto moment heart rate on graph paper along with the
benefits for the mother or baby. Home birth andmother's contractions. The internal monitor does the
natural birth advocates recognize that for the vastsame things, but it is attached directly into the baby's
majority of women, the process of labor will emptyhead by a metal screw. The uterine contractions are
the bowels. 8, 9EPISIOTOMYAlthough many believemonitored by a probe that is inserted into the uterus.
that an ep[isiotomy is necessary to have a baby toSome feel that this is a more accurate reading.
prevent damage to the baby's head, prevent traumaDuring most labors and deliveries, no other method
to the mother's perineum and the cut will heal fasterof monitoring the baby's heart rate will be used.
and prevent 3rd and 4th degree tears, no researchHowever, EFM does not reduce infant deaths,
supports these myths. Shiela Kitzinger writes that 9improve outcomes or give information that permits
out of 10 American women will have an episiotomypotentially bad situations to be corrected or avoided.
with her first baby although in Holland, only 2 or 3 outThe strips are frequently mis-read. One study found
of 10 will. The facts are that episiotomy is a culturalthat 71-95 % of babies diagnosed by EFM as
phenomena. Research shows that episiotomy is donedistressed were not. Additionally, studies have shown
because the doctor was trained to do it, notthat most causes of brain damage are not related to
because it was a necessary procedure. It can beactual distress during the birth process but rather due
avoided by using more physiologic positions to giveto distress prior to labor. In spite of near universal
birth (not lithotomy), pushing only when mom feelsuse of EFM, little evidence exists that any change has
need to, giving birth gently, slowly to the head,taken place in the numbers of brain damaged babies
preparing for the birth by doing perineal massage andbeing born.Auscultation with a fetascope,
Kegel exercise, avoiding forceps delivery. 10FORCEPSstethoscope, pinard horn and other low-tech devices
& VACUUM EXTRACTORForceps are obstetricalfor listening to the baby have been found to be as
tools which are shaped like large spoons have been ineffective for monitoring most laboring women.The
use since the 1500's. Years ago, forceps were usedrisks of using EFM are well known: higher intervention
for many problems which are now handled byrate of all kinds due to misinterpretation of strips
cesarean section. Today, most forceps deliveries areleading to a misdiagnosis of fetal distress. The use of
low forceps, which means they are applied when theEFM may increase the risk of cerebral palsy by
babies head is low in the pelvis and birth is imminent.increasing the risk of infection. More babies have
According to Henci Goer, "There is no research toabnormal fetal heart rate patterns when monitored
support the elective use of forceps."The risks to theby EFM than by auscultation, and it may be that this
mother are perineal trauma, extensive episiotomy,finding is caused by EFM rather than simply being
possible extension tearing from episiotomy,detected by it. Mothers may report not remembering
hematoma and nerve damage. Lasting effects ofparts of their labors due to anxiety that was created
forceps or vacuum extraction to the mother may beby using the monitors.One of the greatest risks to
anal incontinence in spite of a repaired third degreethe baby who receives an internal monitorying
tear.electrode is that of infection at the insertion site. The
The baby may have damage to the head, eyes, thewoman with a history of herpes may be wise to
nerves that lead to the face and neck and arms.forego internal monitoring our of concern of passing
However, an article written by a physician whichthis disease on to her baby via the scalp
appeared in Parents magazine claims, "Medical studieselectrode.191. Cohen & Estner, Silent Knife, page 168.
comparing outlet forceps deliveries with spontaneous2. Korte & Scaer, A Good Birth, A Safe Birth, pages
(no forceps) deliveries have shown that there is no108-109.
difference in risk to the baby." (Emphasis3. Korte & Scaer, pages 119-124.
mine)Vacuum extraction is a newer technology that4. Birth Gazette, "On Epidurals: Pros and Cons", Vol.
sometimes takes the place of forceps. As with low9, No. 1, Winter 1992, pages 19, 21.
forceps, the baby's head must be very low in the5. Davis-Floyd, Robbie, Birth as an American Rite of
pelvis before the suction cup can be attached. It hasPassage, 1992, pages 113-116.
the benefit of not requiring an episiotomy and6. Hillard, Paula Adams, "As they Grow Pregnancy
maternal perineal trauma is less than with forceps,and Birth, Forceps Delivery," Parents magazine, July
but the baby still has the possibility of trauma to the1990, pages 94, 97.
head and face.7. Gross & Ito, "All about Anesthesia," Parents, Vol.
Chiropractors also recognize that pulling a baby out65, April 1990, pages 213, 218, 221.
by the head changes the spinal alignment, although8. Cohen & Estner, page 162.
this is not recognized in any medical texts. 6, 11,9. Korte & Scaer, page 108.
12IMMOBILITYAlong with the lithotomy position10. Korte & Scaer, pages 127-128.
comes immobility. It is impossible to move around11. Korte & Scaer, page 129.
when you are flat on your back. It's even more12. Sultan, A.H., "Third degree obstetric and sphincter
difficult if you have internal and external fetaltears: risk factors and outcome of primary repair," as
monitors attached to your body, an IV running intoabstracted in the Journal of the AMA, May 25, 1994,
your arm and after a narcotic drug was given toVol. 217, page 15520.
"take the edge off." It goes without saying, that if13. Korte & Scaer, pages 105-106.
you had an epidural, you would not be going14. Goer, Henci, Obstetric Myths versus Research
anywhere at all as your legs would have noRealities, page 179-202.
feeling.Some hospitals encourage walking and moving15. Cohen & Estner, pages 162-168.
around. Others do not like you to be out of your16. Korte & Scaer, pages 106-107.
room, which may be quite small and loaded with17. Goer, page 109.
equipment, making any real walking about nearly18. Cohen & Estner, pages 158-159.
impossible. Studies have shown that moving about19. Goer, pages 131-153.
and being upright can shorten labor as well as20. Korte & Scaer, pages 1, 38-39, 64, 77, 83, 90,
changing positions. 13INDUCTIONAccording statistics109-113, 134, 150, 156, 164, 187, 199-200.Yvonne
from the health department in Wisconsin, one-third ofCryns has degrees in nursing and law. She is the
all births in that state are the result of induction, theco-founder of Nursing Programs - Midwives.net -
artificial starting of labor. Most inductions areYvonne also produced a video about midwives:
accomplished using pitocin in an intravenous solutionYvonne is a nationally-credentialed CPM, a
or artificially rupturing the amniotic sac. The reasonsprofessional homebirth midwife.