Saturday, October 11, 2008

Testing, Procedures, and Interventions in Pregnancy and Birth

This list is really long -- so long, in fact, I am not going to even begin to touch on them. This is like a teaser. I talk extensively about all these things in class. If I explained them all here, you wouldn't have to take my class! Gather as much information as you can on these topics, and more.

Wasn't the Consumer Reports article great? aternity-care/overview/maternity-care.htm?loginMethod=auto There are a few things I'd like to hit on from that article:  
1) Electronic Fetal Monitoring, or EFM, "unnecessarily adds to delivery costs." While this is true, it is used, largely, for 2 reasons, neither of them being medical. (In fact, intermittent monitoring has been found to be just as effective, maybe more than EFM.) The first reason is for legal reasons -- if you were to come back and sue them, they have documentation of what the baby's heart rate was doing. Ever since the introduction of EFM (early 80s), the c-section rate has risen dramatically. It has a very high false-positive rate. Babies heart rates fluctuate in labor. This is much less likely to be a problem if you do not have drugs of any kind in your system. The other reason EFM is used so often is because hospitals are short on nurses. One or two nurses can monitor several women at once from the nurse's station. You are now being watched by a machine, not a human being. Isn't that great health care? Also, if you have drugs in your system, you have to be on a monitor because drugs do affect the baby and your labor.

2)Never let anyone break your water! This may speed labor, and it may not. You should hesitate to do anything that is not a part of the natural process. There are several reasons to not break water. Suffice to say, I've seen many c-sections occur because of this poorly-handled situation. It should be a part of the natural process, letting it break on it's own. Women need to be told what to do and what not to do when their water breaks -- not be put on a time clock that eventually leads to surgery.

3)The use of epidurals is so much more far reaching that just causing "adverse effects" of baby's heart rate and newborn assessment tests. It is a cascading downward spiral of events all started because a mom was afraid of the "pain" of childbirth. You are putting your baby and yourself at risk when you choose to have an epidural. I make no apologies for that statement. It is the absolute truth. Get informed, not drugged!

4)Inducing labor is a huge problem in this country. Your baby does not have a little calendar in utero with the date circled in red pen like you do! He has no idea when he is expected. Some babies will show up early and some will easily be "overdue." If you have a doctor who is excited about induction and happy to schedule you an induction date even before the baby is due, you have a lousy doctor. Now, I've heard women say things like, "He's a great doctor. He won't make you go over your due date." Like a doctor is torturing you by "making" you stay pregnant! Give me a break! Trust me, he is doing what is best for you and the baby. You actually have a doctor who is to be respected, as least from the standpoint that he respects the onset of labor. Remember, if you are induced, especially with a first baby, you are twice as likely to have a c-section. I could go on and on about induction. One more thing before I move on, though: the baby triggers labor when he/she is ready. Be patient. You will not stay pregnant forever!

5)C-sections. This is its own post. Another day.

I really liked what the article had to say about the "normal, hormone-driven changes in the body that naturally occur during delivery..." No one ever gives those hormones credit! In the end, they were advocating high-touch, instead of high-tech! Just a recap of what is good for mom is good for baby: 1) Prenatal vitamins;  
2) Use of midwife or family doc;
3) Hiring a doula;  
4) laboring and birthing upright; 
5) VBAC (Vaginal Birth After Cesarean) is encouraged; 
6) Early mother-baby skin-to-skin contact. This is what I believe in!

Other procedures and testing that I think are not necessary, and even possibly harmful, include, but are not limited to: ultrasound (EFM is continuous ultrasound -- another reason to avoid it), vaginal exams in pregnancy and in labor, IV if you are having an unmedicated birth -- just drink water!, restricted food and drink in labor -- you need energy!, episiotomy -- should only be done if baby is in trouble, and immediate cord cutting depriving baby of 1/4 of its blood volume, etc.

There are lots of tests done in pregnancy. Find out what they are for! Is it routine, or is there a reason they think you, personally, should have it? Even the American Diabetes Association has stated that not all pregnant women should be given the glucose test at 28 weeks. Only those who are at risk or there is an indication that she may develop or have gestational diabetes. This is a very small percentage of women, yet, it is routine testing for 100% of pregnant women.

Remember years ago, not all women had a 20-week ultrasound? It depended on if insurance would cover it, in most cases, or if the doctor found a reason to order one. Now, it is deemed necessary 100% of the time. Do you know a single woman who has been denied an ultrasound in the last 10+ years? The jury is still out on the effects of ultrasound. We just don't know. Let's think about some diagnosis that are very common today, that weren't around, or at least not common, years ago. For example, autism. We always talk about the link between vaccines and autism. What about ultrasound? 1 in 150 children will be diagosed with autism. Nearly all babies are exposed to ultrasound in utero, some much more than others. It is also linked to left-handedness. This may not seem like a big deal (2 out of 4 of my kids are left-handed), but things didn't connect within the brain the same way they do with the majority of people. My lefties are my hospital births. With routine ultrasounds, EFM, and listening to the heartrate with a doptone, they were exposed to much more ultrasound than my other babies. Another diagnosis we hear so much about these days -- ADD and ADHD. The numbers are through the roof and it didn't even exist 30 years ago! Is it possible that ultrasound could be a contributing factor? Again, food for thought...

Know your hospital's policy on monitoring. Fight it if they want you on continuous monitoring. This is not good health care. Evidence is on your side. You need to be upright and mobile to help your baby out. You must be proactive if you live in North Texas and don't want a c-section! If they won't budge on the monitoring, find another place to birth your baby. This is your birth, your baby, and your body. Doctors do not necessarily have your best interests at heart. They will always think of themselves and their practice before they think of you. They will not think twice about doing a c-section. You probably won't be their first of the day.

I really could talk a lot more about this topic, obviously. I love to talk about interventions and how unnecessary most of them are. Ultimately, the bottom line is this -- question your doctor or midwife about every test, procedure, and intervention that they want to do. Know the benefits, and especially the risks, of having it done.

1 comment:

April said...

I loved the consumer reports article! Short, sweet and straight to the point.
I am loving your blog. :)