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Consumer Reports: Back to Basics for Safer Childbirth

http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/overview/maternity-care.htm

When it’s time to bring a new baby into the world, there’s a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment. Childbirth without technical intervention can succeed in leading to a good outcome for mother and child, according to a new report. (Take our maternity-care quiz to test your knowledge.)


“Evidence-Based Maternity Care: What It Is and What It Can Achieve,” co-authored by Carol Sakala and Maureen P. Corry of the nonprofit Childbirth Connection analyzed hundreds of the most recent studies and systematic reviews of maternity care. The 70-page report was issued collaboratively by Childbirth Connection, the Reforming States Group (a voluntary association of state-level health policymakers), and Milbank Memorial Fund, and released on Oct. 8, 2008.
OVERUSE OF HIGH-TECH MEASURES

The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:

Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005


Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization’s recommended national rate of 5 to 10 percent
Electronic fetal monitoring, unnecessarily adding to delivery costs
Rupturing membranes (”breaking the waters”), intending to hasten onset of labor

Episiotomy, which is often unnecessary

In fact, the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give
birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth.

Convenience for health care workers and patients might be another factor. Naturally occurring labor is not limited to typical working hours. Evidence also shows that a disproportionate amount of tech-driven interventions like Caesarean sections occur during weekday “business hours,” rather than at night, on weekends, or on holidays.

UNDERUSE OF HIGH-TOUCH, NONINVASIVE MEASURES

Many practices that have been proven effective and do little to no harm are underused in today’s maternity care for healthy low-risk women. They include:

Prenatal vitamins
Use of midwife or family physician
Continuous presence of a companion for the mother during labor
Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one’s back
Vaginal birth (VBAC) for most women who have had a previous Caesarean section
Early mother-baby skin-to-skin contact
The study suggests that those and other low-cost, beneficial practices are not routinely practiced for several reasons, including limited scope for economic gain, lack of national standards to measure providers’ performance, and a medical tradition that doesn’t prioritize the measurement of adverse effects, or take them into account.





3 Responses to ““Back to Basics for Safer Childbirth” Consumer Reports Article”

February 24th, 2009 at 11:09 pm edit
Isis says:
Thanks for posting this its about time the rest of the media caught up to this.

February 26th, 2009 at 9:39 am edit
rachel moses says:
it is so great to see this issue of mistreatment of birth being addressed in the mainstream media. having had 2 home births myself, i am totally horrified disgusted by the invasive abusive treatment i see most of the women around me receiving at their hospital births. lets get this straightened out ladies! walking through the doors of a hospital as a pregnant woman put you/baby way too much danger. drugged up moms and newborns and 30+% c-section rate? come on, this is just not acceptable. Also in serious question ought to be all this “scanning” of babies in the womb; just 30 years ago x-rays were supposdly safe and we now know of course taht they are not. How about the pathetically low (1%) of babies who are breastfed to the World Health Organzation’s reccommended TWO FULL YEARS. And further, what is up with all this machine milking women to bottle feed babies with? its disgusting, and even the La Leche league organization seems to accept it as an equivalent when it clearly is NOT. It negates all of the importance of the MOTHER being with the baby. What no one is talking about either are the far reaching effects. lets hear more about these issues!

February 27th, 2009 at 1:22 am edit
Kate Quick says:
Machine milking women to bottle feed babies? Well, if women who want to breastfeed don’t hook themselves up to machines, they have three options. 1)Take their babies to work with them, which most employers won’t allow and which probably isn’t that feasible once babies can crawl, at least not without a playpen, which is a whole different argument. 2) Take a much much longer maternity leave than any employer I’ve ever heard of will pay for or even grant unpaid. 3) Stay at home with her babes. It all comes down to economics and misplaced priorities. The same is true of maternity care…economics and mislplaced priorities. It’s time to reprioritize. Let’s put moms and babes first, for a change. Longer maternity leaves for working women, respect for midwives and women who use them, and a little more anger at the mistreatment of women birthing in a hospital setting. Oh yeah, and a little more faith in our bodies’ ability to give birth!

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You need to be a member of Pregnancy to add comments!

Comment by Mel on September 6, 2012 at 11:06pm

Hi.  Quick question ladies.

I am planning to deliver in a hospital again because the birthing center in my area doesnt accept my insurance.

I plan to hire a doula incase I dont get lucky enough to have the same wonderfull midwife I had last time. 

At what point in your pregnancy should you start checing out, interviewing, and hire a doula? 

Comment by Amy Coffield on November 14, 2011 at 7:12pm

After an emotionally traumatic hospital birth I am just weeks away from a natural homebirth and I am so excited about it.  Can't wait to have a positive birth story to share with your Carmen.

Comment by Jessica Fox on November 14, 2011 at 6:32pm

Hi Carmen, 

That is great, I'm natural minded (more on the attachment parenting side), sadly my birth story is not positive but hope you get a good turnout.

Comment by Carmen Malcolm on November 14, 2011 at 5:58pm

Hi ladies! I am new to the group! I am a natural birth and parenting blogger and I need some NATURAL mama followers. It seems that everyone who follows is not exactly my target audience. 

I am also planning to do a series of POSITIVE natural birth stories to show women how awesome childbirth really can be!  If you would like to share your story please let me know!

Thank you so much!

http://carmen-mommytalk.blogspot.com/

Comment by Jessica Fox on November 14, 2011 at 9:29am

Good thing I didn't leave this group as I just found out that I'm expecting #2 on 7/23/12!

Comment by Erin Oliver on November 11, 2011 at 1:26pm

Hello There ladies! I am a doula in the south bay of California (I.e San jose, palo alto but also close enough to San Francisco etc)  MTV is doing a documentary about Doula's and about cultural differences and so we are working together in finding the right couple to be filmed for this documentary. We are looking for an interracial couple that would be due now or sometime before march. It would be approximately 10 hours of shooting. Anyway. If you live in this area, and you are interested. Please get in touch!

Comment by Mandy Gibbs on August 29, 2011 at 1:44pm
Oh Boy. I just found out today that I am pregnant with my 3rd kid. I am super SHOCKED, nervous, stressed! All this will wear off and I will get excited!! Since we had only planned on having 2, this is a super shocker. What can you do though? I have a 4 year and a 13 month old...so one more to add to the bunch!
Comment by naomi savoir on July 17, 2011 at 5:06am
so I have two girls 5 and ten months and just found out I'm pregnant again. inbetween my two girls I had blighted ovums or ambryonic pregnancys and had to have dnc. I'm am very scrared for it to happen again. I was wondering I had gotten a test at doller store and it came out negative then  four days later I bought a test at cvs and it was positive. Maybe this sounds silly but should I take the fact that the first test came out neg as a sighn somethings wrong. first time I had blighted ovum I used doller store test it was positive went to dr his came back neg so makes me nervous it's happening again. anyone ever have this happen to them? I'm probobly 5 weeks I can't remember when my last period was last month but last few times I was pregnant I found out when I was five weeks along so in fact that test should of been positive on monday. any input I would appreciate. thanks.
Comment by Jessica Fox on May 19, 2011 at 6:11pm
Congratulations Rhoda!
Comment by Amy Coffield on May 19, 2011 at 12:45pm
Just found out I'm pregnant after trying for a year. Going natural this time around and so glad to have this website as a support. I have an orientation at the bryn mawr birth center tonight. Any pa moms know anything about this birth center or have midwives to recommend?
 

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