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