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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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Comment by Dasha Narog on May 7, 2009 at 11:50am
I just found a midwifery clinic close by and contacted them for an appointment. They seem to take my insurance and offer a more individual-oriented approach, which I like. So I'm in the process of switching to a midwife.
Homebirth is a whole new concept to me, since before I was pregnant, I wasn't aware of it even being something "regular" people do. I have a couple of friends who have had their babies in hospitals the "regular" way - with an induction and an epidural. So I just thought I'd do the same, and then started doing research and bumping into concerning bits of information. So my concern with homebirth is, I don't have the space required to be able to accomodate everything that's necessary - and I think it would be kind of messy in terms of lots of blood... I very well could be wrong on this whole thing, but isn't birth generally a messy undertaking? I probably will ask all those questions during the midwife appointment, maybe she'll fill me in.
Comment by Darcel on May 7, 2009 at 11:39am
Hey Dasha, congrats on your pregnancy and welcome to the group!
Your doing the best thing right now and that is researching on the type of birth you want. I suggest starting out with what you know for sure that you DO want. Also can you switch to a midwife?

What is it about homebirth that you would like to know?
You can even call some local homebirth midwives and have consults with them to ask questions and find the one that is right for you.
Comment by Dasha Narog on May 7, 2009 at 10:42am
Hi everyone, I'm new to the idea of a natural, low-intervention birth and newly pregnant (11 wks).
I'm looking forward to figuring out how to have a low-intervention birth and just got a book on hypnobirthing. Anyone out there with experience - I welcome your advice!
I'm currently seeing an OB for my prenatal check-ups, and a birthing center isn't available to me due to my location and insurance policies (the closest to me is at least 30 mins away and doesn't accept my insurance). So I'm kind of stuck between a hospital birth I don't want and a home birth I'm slightly afraid of due to lack of positive information.
Comment by Darcel on May 6, 2009 at 7:42pm
I want as little intervention as possible but in Las Vegas it is really hard to find a doctor that agrees.
It will help a lot if you change your way of thinking. You've been through a homebirth before, you know what your body and baby are capable of. Don't let anyone least of all a nasty OB try to tell you any different. They work for you not the other way around.

Midwife said today that I am 40% effaced and at a +1 station whatever that means!!
I'm no expert so I can't be exact, but it means your cervix is thinning(very good thing) and the stations let you know your baby is moving down.
Comment by hba2chopeful on May 6, 2009 at 7:07pm
My EDD with my third is May 31st. This will be a HBA2C and I am very excited!! Midwife said today that I am 40% effaced and at a +1 station whatever that means!!
Comment by Leslie de Santiago on May 6, 2009 at 4:26pm
Just saw Rikki on Today show and came to the sight. I am due anytime this month with my second. First is 7 years old, girl and this one is also a girl. We had a first at home with a midwife and a very long labor (40 hours) but would not change it for the world. This one will be at the hospital because hubby was a little nervous. I am kinda anxoius and pray all goes well. I want as little intervention as possible but in Las Vegas it is really hard to find a doctor that agrees. My OB with my daughter wrote me a nasty letter when I did not follow doctors orders and go to a scheduled C-section that he scheduled without me even knowing. I told my hubby that if everything goes okay with this one we will do the home birth again on the next one. Well, I am happy i found this site and good luck to all those preg and those trying.
Comment by Jamie M. Ackerly on May 6, 2009 at 1:45pm
Just wanted to say hello!!..I am a certified postpartum Doula and would be happy to answer any questions you amy have!!
Comment by Liz Wolkowicz on May 6, 2009 at 1:06pm
Pregnant with our first baby, due in August, delivering in a Birth Center with a midwife. Had decided before I saw BOBB, but it pretty much sealed the deal for me!
Comment by Andrea Rose on May 6, 2009 at 11:24am
Not pregnant yet... just had a miscarriage but thought I would join the group!
Comment by Kayla Dolan on May 6, 2009 at 9:04am
Hi all! I'm expecting my fourth child in four years right now! I have Mason, 4, Brayden, almost 3, Aizy, 16 mos, and #4 due sometime in June. I like the "sometime in June response" because it keeps people from calling me around my due date! LOL Wanted to go for a homebirth this time as I have this FABULOUS jacuzzi tub I could deliver in. LOL But, my husband is not on board at all with that. Too many "what ifs" for him. Even with a hospital 3 blks away from us. So, I chose another option that still makes him angry...I chose a CNM at a hospital 30 minutes away. He wants me to "just get an OB" for the hospital 3 blks away (as they don't offer privilege to midwives), but I refuse to compromise further. He'll just have to get over it.
 

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