Reducing Infant Mortality

[thanka2]

I am very interested in this discussion because I agree with the basic premise of the video that interventions are on the whole over used. I did a natural birthing course before the birth of my first child and a number of the very same points were raised, in the context that it was important to understand this medicalisation of child birth when aiming for a natural birth in a medical setting. As I was giving birth at a private hospital with very high casesarean rates and also being an older first time mother the odds were not in my favour, but I wouldn't be accepted at a birthing centre (due to my medical history and age). The aim was to help me and others understand that the priority for many in that hospital setting was not an invervention free birth and therefore both myself and my husband would likely have some work to do to achieve this. As a result we bought our own private midwife along to the birth as a doula and it made a hugh difference. Unfortunately I didn't achieve an intervention free birth the first time, but having her there made me totally confident that we have done all that we could (at least in that setting) to avoid it and so I was very comfortable with the outcome.
I also realised going into the birth that it would be very, very painful and hard work (the course was very blunt about this and we saw lots of vidoes etc which made it clear it would not be easy) and so I really understand what thanka2 is sayng in this context; I think most people would say they wanted a drug free birth but because of their lack of knowlege about what is actually involved - totally normal- and how long they are likely to be in a lot of pain for when labour actually starts (and you can labour for a very long time before you are even 3 cm and ?fficially' in labour) and the fact that it is likely you will be offered an epidural or pain relief when you are at your most vulnerable, means it is very difficult to achieve unless you have fully prepared yourself - and even then you may not.
Having said all that I totally understand the 'screaming for an epidural' situation - I did this myself at transition with my second birth. Luckily for me the very supportive midwife who recognised I was in transition and knew how important a drug free birth was to me suggested I go the the toilet before the anaesthatist arrived; being in this position lead to 3 massive contractions which meant I was fully dilated and ready to push. The other midwife was ready to give me the epidural (they were both from the hospital this time, but one I had met several times before the birth and we had discussed birth and interventions in details) and if she had been the only one there, I would've accepted it at the time and regreted it later. The enviroment and people involved can make all the difference.
I did not have either of my babies in HK and if I had one here I would be making a lot of enquiries to carefully choose my ob as for many of the reasons given by thanka2 I think it would very hard to achieve for a first time mum here, having done it before gives both the mother and the dr greater confidence that it is possible.

I appreciate your input TNT. You said very well many things that I was thinking, actually. We also attended a lengthy natural birthing course (would be interesting to know which one you did--you can PM me if you like) that lasted 12 weeks and required a lot of research and homework as well as practical practice for labor. I feel like I was also well-prepared (as much as I could be for a first birth) for the painful reality of labor and a gameplan for how I was going to deal with it. And I chose to commit early on to a natural childbirth, despite the pain. I didn't leave myself "a way out" (so to speak) but just set in my mind that "Okay, labor is going to be painful and difficult and unpredictable but no matter what, as long as it is within my power to choose (barring true emergencies) I choose a non-intervention birth." I think having that mindset changed my entire perspective for the duration of my pregnancy and birth.

I felt I was also educated about the medicalisation of labor and birth as well as interventions. We watched numerous videos on c-sections, epidurals and augmentation just to prepare myself mentally. I felt it was important that although my choice was not to utilize any of the above, to have a knowledge of what they are and how they are administered should an emergency arise that required some intervention. I guess I didn't give myself the "benefit" of remaining in the dark on these subjects. (and I HATE to see blood and surgeries in videos so it really took some effort to watch these!)

And your point about the hospital systems having different goals from that of a couple seeking to go through an non-intervention birth is spot on! It really is a collision of different views and schools of thought when it comes to this topic, I think. The training that OBGYNs, midwives and doulas go through is similar in some ways but differs on key points. It's a difference in approach and priorities, I think. And yes, yes, yes, I agree that the setting makes a HUGE difference. For example, a relaxing, calming atmosphere with professionals who see you as a person and not a medical problem to be dealt with, coupled with a woman's confidence in herself, her body and her choice of medical personnel can create a more stress-free atmosphere which is conducive to birth. I think the psychological impact of the birthing environment are far too often downplayed and we all know the power that our mind has over our bodies. If a woman is stressed because she starts to experience major birth pain that she had not mentally anticipated and then medical personnel are all too willing to try to work things out for her, this can create a fear response and in the throes of labor it's simply too overwhelming to mentally sort things out--the body tenses up which inhibits labor and in turn makes things more painful--it's a vicious cycle.

Anyway, thank you for sharing. Appreciate it!

 

[thanka2]

My question is are women really informed of the facts in detail? Is that common practice? Is it required? Are they given the facts and studies about the drugs in some abridged form to look over before they even set foot in a hospital so they can truly make an informed choice? In my country, even when I go to the supermarket pharmacy to pick up my prescription drugs, the law dictates, that I must have a consultation with the pharmacist in which they go over the specifics of the medication and any possible side-effects/dangers of taking it. Then, I must sign a form stating that I was informed. This is simply if I want to pick up an antibiotic for strep throat. It would be interesting to know if the same sort of system exists when it comes to informed consent with birth interventions.

Women do and will make their own decisions as it should be. My problem arises from a system that seems to skim over topics that should be discussed in more detail. It's one thing to say, "I was informed. I know and I choose this for myself and my child" (in the case of elective interventions) than to say, "Well, it can't possibly do any harm--my doctor/nurse/midwife etc. did not present any information to the contrary so I make this decision believing that the risks are nil." And from my experiences with doctors in Hong Kong that often do a lot to scare their patients right off the bat ("you'd better do this, this and this or your child will end up with this, this and this"), it is strange to me that they wouldn't make it a point to really paint use of interventions in the most graphic light possible as it seems they have a knack for, and for lack of a better expression, fear mongering.

"Because I'm an obstetrician...I read the American College of Obstetricians and Gynecologists website--and throughout the website for their physicians there is sentence after sentence about the sanctity of the woman's right to self-determination and how we should never interfere with her ability to either choose or refuse a procedure. What happens, though, in modern medicine is that patients are not given true informed consent...what they're given is skewed informed consent."- Stewart Fishbein, MD, FACOG, Obstetrician

 

[thanka2]

The Other Side of the Glass

 

[thanka2]

 

[thanka2]

Why Mothers Die (UK)

 

[thanka2]

 

[thanka2]

[video]http://www.zshare.net/videoplayer/player.php?SID=dl033&FID=62983863&FN=The%20Business%20of%20Being%20Born.avi.flv&iframewidth=648&iframeheight=415&width=640&height=370&H=62983863bf35922e&ISL=1[/video]

 

[thanka2]

As for the stress, I read or heard somewhere that each contraction is not only painful for the mother, but also for the baby, as he get pushed through the birth canal. It may be more difficult for my baby due to the cephalopelvic disproportion. Forceps doesn't sound fun either. This was going to be my first one, and we know that usually it takes longer time for the first one to come out... and we are not talking about how his little head may get stuck on the birth canal! Also my sister got induced at week 42, and after long hours of pain, she didn't dilate enough and had to go for an emergency C section. So I didn't want to suffer in vain. I really wish labor were like in the movies! On the movies, they are always fast!

It's total misinformation that vaginal birth, in itself is stressful or more harmful/painful for a baby than a c-section. There are many benefits of the labor process for baby and mother and some are listed below.

The fact that your sister was induced set her up for a c-section. It is a well-known phenomenon that women who go in to be induced often end up with a c-section because basically they are forcing their bodies into labor before the cervix is really ready--it is not surprising that she didn't dilate. That c-section was an emergency that might have been prevented by not inducing and waiting for the body to go into labor naturally. There are a lot of "man-made" (doctor-made) emergencies happening in the labor and delivery departments of the world for this very reason.

In the movies labor is made out to be this horrifying and catastrophic event that women need doctors to rescue them from. Just like most things in Hollywood--couldn't be further from the truth. And it needn't be that way.

Vaginal Birth Benefits for Baby from here.

1.

Babies born naturally are usually born when they are ready. Elective caesareans typically take place a week or two before the expected due date. However, many babies if left to be born naturally are born at 41 or 42 weeks. If there was any miscalculation, a baby removed surgically could be at risk for prematurity and encounter respiratory problems as a result of under-developed lungs.

2.

Babies born by vaginal birth have considerable lower risk of respiratory problems. The compression of the baby?s thorax expels the amniotic fluid during the birth process and helps to prepare the lungs to breathe air. There is a high risk of respiratory distress syndrome in babies born by cesarean and a high risk of asthma.1
3.

The passage through the birth canal stimulates the baby?s cardiovascular system, which boosts blood circulation and primes the baby for birth. There is evidence that this process also has long term benefits for the baby?s co-ordination. Cranial osteopaths are reported to be able to determine whether a baby was born vaginally or by caesarean.

4.

Babies born vaginally receive protective bacteria as they pass through the birth canal. These bacteria colonise in the intestine and are crucial for developing a balanced immune system, from childhood right through to adulthood.2

5.

During a natural, vaginal birth babies benefit from hormonal surges in catecholamines during labor, which results in them being more alert and able to connect with their mothers at birth.3

6.

Similarly, endorphins, nature?s ?feel-good hormones, which are secreted during an unmedicated childbirth have been found in the placenta and umbilical cord. These hormones may help the baby adjust to life outside the womb as well as make the birth passage more comfortable for baby.

7.

Babies born by vaginal birth exhibit more interest in pre-breastfeeding behaviours such as sucking and massaging the mother's breasts. They are also reported to nurse for longer periods within the first 90 minutes after birth, which has many benefits for both the mother and the baby.
8.

A European study in 2008 found that babies born vaginally had a 20% lower risk of developing type 1 diabetes than babies born surgically.

9.

The process of labor is reported to enable babies born vaginally to cope with stress better than those born dramatically by cesarean. Cesarean birth triggers a dramatic stress response which could set up a child to always over-respond to stress.4

10.

If the vaginal birth was drug-free, the baby will not experience any side-effects of medication administered during the process.
11.

Skin-to-skin contact between the mother and baby can occur easily after a natural birth. This has many physiological benefits to the baby including optimal brain development as well as better attachment and breastfeeding success.
12.

Newborns are less likely to be admitted to the intensive care unit if delivered vaginally.

 

[thanka2]

Time Magazine (January 31, 2011):
Too Many Babies Delivered Too Early: Doctors Should Just Say No

 

[MommyTo3]

Time Magazine (January 31, 2011):
Too Many Babies Delivered Too Early: Doctors Should Just Say No

I thought that was a very good article. I am all for intervention when needed, but the bottom line is that there should be NO intervention unless medically necessary. Doctors shouldn't push, mothers shouldn't ask! I know a lot of doctors want to schedule things, but way too often I have heard moms whining about the fact that they're soooooo tired, and they're pushing their doctors for c-sections or inductions at 37 weeks (which is just an estimate in the end) since it's full term! That's just absolutely crazy. And then they give birth to a 6-7 pound baby, wow!? What's 2, 3, 4 weeks more if there is no medical reason to do anything, when mom and baby are doing just fine?! Isn't there a reason the baby isn't coming out? The difference in outcome between a 37 and 39+ weeker are substantial.

I have 3 children. Oldest was born naturally 9 days late at 9lbs2oz. With the twins I was induced at 38w2d, because most doctors believe there the risks start outweighing the benefits with multiples past 38 weeks. Plus I was being monitored for having blood clots in my legs since one leg was severely swollen, but nothing was found at 36 and 37 weeks. They were born naturally and were close to 8lbs (almost 3500 grams each) and came home with me 2 days later. Leg was back to normal within 6 hours after giving birth (weight issue pushing on some blood vessels). Of course, it wasn't great, it was tiring, I didn't sleep much after 32 weeks (they were estimated 9lbs combined at 30 weeks), but what can you do? You make the best of it. You do what you need to do, you go on, for the sake of your children, because you never want to regret anything.