Preventing brain diseases


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Risks And Benefits Of Hospital Procedures

In spite of all the advertising toutingtoo big for the mother and bypassing meconium
"home-like" birthing rooms in hospitals, forstaining. However, studies fail to confirm
most women, a hospital birth will be nothingthis line of thought. The actual amount of
like a home birth. Interventions are routinetime needed for a baby to grow to term varies
in the hospitals in my state. Every laboringand figuring an exact due date for each baby
woman will be hooked up for some period ofhas not yet been done. Ultrasounds have at
time to an electronic fetal monitor, givenbest a 10 day window of error if done in the
vaginal exams, and be told where and in whatfirst trimester. The phenomenon of postdates,
position she must give birth. If heris poorly understood. Macrosomia occurs prior
membranes are ruptured, she will be requiredto 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 orevaluation of 37 babies." Research seems to
have her water artificially ruptured. Sheindicate that watchful waiting is the more
will be told how many companions she may haveprudent course of action for healthy women.
with her. If she has other children she may14IVAt a great many U.S. institutions, one of
or may not include them at the birth. Howthe first items of care to be rendered to the
long she is kept in the hospital will varyobstetric patient will be her IV, "just in
depending on her physician and the particularcase." Just in case she needs drugs or
hospital. How soon her baby will be releasedsurgery or her veins collapse making
also will depend on the baby's pediatricianinsertion of an IV impossible. Nancy Wainer
and hospital policy. Some of the more commonCohen and Lois Estner interviewed many labor
interventions that take place during hospitaland delivery nurses to find out how
births are discussedfrequently a laboring woman's veins
below.AMNIOTOMYArtificially breaking thecollapsed. They learned that this does not
amniotic sac is done routinely at manyhappen. 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 waypermitted to eat and drink lightly. This
so that an internal monitor can be screwedcultural warping began in the 1940's when
into the baby's head. It was believed thatanesthesia was being given to nearly all
breaking the water would speed up labor by 30birthing women by mask and vomiting and food
to 60 minutes but the only randomized controlaspiration were risks associated with this.
trial done disproved this. This procedureEliminating food and drink, they felt would
causes cord prolapse, a serious complicationeliminate this risk. Today, however,
for the baby and increases the chances of ananesthesia methods have improved and this is
infection. With less amniotic fluid in theno longer the problem it once way. Improved
uterus during labor, the baby has a greaterintubation techniques make this problem
risk of cord compression problems leading tovirtually 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 womanof medical literature on aspiration during
giving birth in a hospital will receive asurgery found that the cause was not eating
drug at some point during her stay. Pitocinor drinking prior to the surgery, but caused
is frequently used to induce or augmentby incompetence of the
labor. Because it causes abnormally stronganesthesiologist.General anesthesia is given
contractions, many women receive ato approximately 4% of those who undergo
pain-relieving drug such as a narcotic.cesarean section. Approximately 0.3% cesarean
Unfortunately, narcotics also are received bysurgeries will require intubation that will
the baby and can affect the condition of thebe difficult to do yet not all women who
baby at birth and for years after. Some ofrequire intubation will aspirate. This
these side effects are respiratory problems,translates into denying all laboring women
impaired muscular, visual and neuralfood and drink because 1 cesarean sectioned
development in the first week of life and inwoman out of 10,000 may aspirate.Although
the following years, lower reading andIV's are supposed to keep the stomach empty,
spelling scores, difficulty in solvinga glucose IV actually works to slow down the
problems or performing tasks when they pose aemptying of the stomach. It also may
challenge.The new drug of choice at manyencourage tissues to swell so that it makes
hospitals is the epidural. It must beit more difficult to intubate, if that
administered by an anesthesiologist andbecomes necessary. IV fluid accumulates in
requires the mother to remain in bedthe bladder and that may slow down labor.
afterward. She must be flushed with an IVSome women may have sensitivities to the IV
fluid prior to getting it to keep her bloodand have a reaction from one. It restricts
pressure up. A needle is inserted into thethe woman's mobility. The needle in the arm
woman's back and small catheter is left inis painful and inhibits free movement. The
place where the medication is injected. Itbaby also may suffer from the mother's IV, as
numbs the woman's body from the ribs to thestudies are being done to determine if the
toes. Many women ask for this drug becauseexcessive sugar administered through a
they do not want to deal with the pain ofglucose IV may harm the baby. 14, 15,
childbirth and believe it is safe for16LITHOTOMYThis used to be the position of
themselves and their babies because thechoice for physicians doing hospital births.
physician who administered it, theirThe mother lies flat on her back with her
obstetrician and the labor and deliveryknees in the air. It is a most unphysiologic
nurses all encourage the use of it and giveposition for mom and baby, but it does give
no information regarding side effects.Thethe physician a good view of the mother's
known complications are many ranging fromperineum. While in this position, the mother
requiring EFM, IV, immobility, urinarymust push the baby out uphill. It is known to
catheterization. An epidural also may allowcause 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 thewill not choose this position if given
pelvic muscles which may encourage the babyalternatives.Dr. Roberto Caldeyro-Barcia is
to adopt malpositions of the head, mayconsidered an expert on this position for
decrease the production of oxytocin atlabor and delivery. He and his researchers
critical times, and increase the need forfound that this lithotomy or supine position
forceps and cesarean section. Epidurals causeis the worst one for laboring women because
some serious complications such as heartit 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 commonactivity, 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 drugsconceivable position for labor and delivery."
given to enhance the effect of the epidural17, 18MONITORINGElectronic fetal monitoring
and which if given alone can compromise theis required at nearly every hospital for at
baby's respiratory efforts as well as requireleast a short time. When it was first
the newborn to metabolize the drugs. We doavailable, it was used only for the most high
not know the short or long term effects ofrisk situations. However, it is now used for
the epidural or other drugs on the baby. Someeveryone regardless of risk status. A large
claim that the baby is unaffected unless thereason 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 attendantskinds of monitors: external and internal. The
recognize that occasionally epidurals may beexternal monitors are attached to a heavy
useful for certain situations. Some exampleselastic band that is strapped across the
when an epidural may permit a normal birthmother's abdomen. She must lie quietly so the
are for maternal exhaustion, severe backmonitors do not slip. The baby's heart beat
labor, certain malpresentations oris 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 orinternal monitor does the same things, but it
unsafe, they have no definition of safe andis attached directly into the baby's head by
do not guarantee safety of drugs. Many whoa metal screw. The uterine contractions are
work with brain damaged children, wonder ifmonitored 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 theaccurate  reading.
drug choice if they were given complete
information about side effects. The AmericanDuring most labors and deliveries, no other
Academy of Pediatricians discourages themethod 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 routinelyinfant deaths, improve outcomes or give
at many hospitals, although no researchinformation that permits potentially bad
proves any benefits for the mother or baby.situations to be corrected or avoided. The
Home birth and natural birth advocatesstrips are frequently mis-read. One study
recognize that for the vast majority offound that 71-95 % of babies diagnosed by EFM
women, the process of labor will empty theas distressed were not. Additionally, studies
bowels. 8, 9EPISIOTOMYAlthough many believehave shown that most causes of brain damage
that an ep[isiotomy is necessary to have aare 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 andprior to labor. In spite of near universal
the cut will heal faster and prevent 3rd anduse of EFM, little evidence exists that any
4th degree tears, no research supports thesechange has taken place in the numbers of
myths. Shiela Kitzinger writes that 9 out ofbrain damaged babies being born.Auscultation
10 American women will have an episiotomywith a fetascope, stethoscope, pinard horn
with her first baby although in Holland, onlyand other low-tech devices for listening to
2 or 3 out of 10 will. The facts are thatthe baby have been found to be as effective
episiotomy is a cultural phenomena. Researchfor monitoring most laboring women.The risks
shows that episiotomy is done because theof using EFM are well known: higher
doctor was trained to do it, not because itintervention rate of all kinds due to
was a necessary procedure. It can be avoidedmisinterpretation of strips leading to a
by using more physiologic positions to givemisdiagnosis of fetal distress. The use of
birth (not lithotomy), pushing only when momEFM may increase the risk of cerebral palsy
feels need to, giving birth gently, slowly toby increasing the risk of infection. More
the head, preparing for the birth by doingbabies have abnormal fetal heart rate
perineal massage and Kegel exercise, avoidingpatterns when monitored by EFM than by
forceps delivery. 10FORCEPS & VACUUMauscultation, and it may be that this finding
EXTRACTORForceps are obstetrical tools whichis caused by EFM rather than simply being
are shaped like large spoons have been in usedetected by it. Mothers may report not
since the 1500's. Years ago, forceps wereremembering parts of their labors due to
used for many problems which are now handledanxiety that was created by using the
by cesarean section. Today, most forcepsmonitors.One of the greatest risks to the
deliveries are low forceps, which means theybaby who receives an internal monitorying
are applied when the babies head is low inelectrode is that of infection at the
the pelvis and birth is imminent. Accordinginsertion site. The woman with a history of
to Henci Goer, "There is no research toherpes may be wise to forego internal
support the elective use of forceps."Themonitoring our of concern of passing this
risks to the mother are perineal trauma,disease on to her baby via the scalp
extensive episiotomy, possible extensionelectrode.191. Cohen & Estner, Silent Knife,
tearing from episiotomy, hematoma and nervepage  168.
damage. Lasting effects of forceps or vacuum
extraction to the mother may be anal2. Korte & Scaer, A Good Birth, A Safe
incontinence in spite of a repaired thirdBirth,  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 and4. Birth Gazette, "On Epidurals: Pros and
arms. However, an article written by aCons", Vol. 9, No. 1, Winter 1992, pages 19,
physician which appeared in Parents magazine21.
claims, "Medical studies comparing outlet
forceps deliveries with spontaneous (no5. Davis-Floyd, Robbie, Birth as an American
forceps) deliveries have shown that there isRite  of  Passage,  1992,  pages  113-116.
no difference in risk to the baby." (Emphasis
mine)Vacuum extraction is a newer technology6. Hillard, Paula Adams, "As they Grow
that sometimes takes the place of forceps. AsPregnancy and Birth, Forceps Delivery,"
with low forceps, the baby's head must beParents  magazine,  July  1990, pages 94, 97.
very low in the pelvis before the suction cup
can be attached. It has the benefit of not7. Gross & Ito, "All about Anesthesia,"
requiring an episiotomy and maternal perinealParents, Vol. 65, April 1990, pages 213, 218,
trauma is less than with forceps, but the221.
baby still has the possibility of trauma to
the  head  and  face.8.  Cohen  &  Estner,  page  162.
Chiropractors also recognize that pulling a9.  Korte  &  Scaer,  page  108.
baby out by the head changes the spinal
alignment, although this is not recognized in10.  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 difficult12. Sultan, A.H., "Third degree obstetric
if you have internal and external fetaland sphincter tears: risk factors and outcome
monitors attached to your body, an IV runningof primary repair," as abstracted in the
into your arm and after a narcotic drug wasJournal of the AMA, May 25, 1994, Vol. 217,
given to "take the edge off." It goes withoutpage  15520.
saying, that if you had an epidural, you
would not be going anywhere at all as your13.  Korte  &  Scaer,  pages  105-106.
legs would have no feeling.Some hospitals
encourage walking and moving around. Others14. Goer, Henci, Obstetric Myths versus
do not like you to be out of your room, whichResearch  Realities,  page  179-202.
may be quite small and loaded with equipment,
making any real walking about nearly15.  Cohen  &  Estner,  pages  162-168.
impossible. Studies have shown that moving
about and being upright can shorten labor as16.  Korte  &  Scaer,  pages  106-107.
well as changing positions.
13INDUCTIONAccording statistics from the17.  Goer,  page  109.
health department in Wisconsin, one-third of
all births in that state are the result of18.  Cohen  &  Estner,  pages  158-159.
induction, the artificial starting of labor.
Most inductions are accomplished using19.  Goer,  pages  131-153.
pitocin in an intravenous solution or
artificially rupturing the amniotic sac. The20. Korte & Scaer, pages 1, 38-39, 64, 77,
reasons for doing this are many. One of the83, 90, 109-113, 134, 150, 156, 164, 187,
most common for healthy full-term women, is199-200.Yvonne Cryns has degrees in nursing
fear of going too far past the "due date" andand law. She is the co-founder of Nursing
having a baby with postmature syndrome orPrograms - Midwives.net - Yvonne also
meconium staining. Another reason is fear ofproduced  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 growna professional homebirth midwife.



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