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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!

Discussion Forum

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Comment by Darcel on September 15, 2009 at 6:48pm
I've been horribly sick the past few days. Nothing seems to help. I eat whatever sounds good at the time, and usually only take 2-3 bites.

I get cramping from time to time, but it doesn't worry me because I had the same thing with my girls. I take it as a cue to lie down and rest :)
Comment by Bonnie P on September 15, 2009 at 6:33pm
Brittany,
I'm 6 weeks and for a few weeks already I've had some sharp cramping when I get up out of bed or do a sit up. I'd be worried, but I had the exact same thing when I was pregnant with my first, and there was absolutely no problems with him. Although it may have to do with my inverted uterus? Mine flops the opposite way that most people's do - curls back instead of forward. If I remember correctly, it went away when I was 8 or 9 weeks with my first, so I hope it's the same with this one. Although now that I think about it, it hasn't happened for a few days now, so maybe it's over and done with already!
Laura, I hope you find something that works! Feeling like that is the worst!
Jenn, did you get that tea at a health food store? And is there any other name for it?
Comment by Brittany Tubb on September 15, 2009 at 6:01pm
how far along is everyone!? and has anyone else had any tingly pains that come and go when u get up or pick something up that it like over 5 lbs?! i know i'm not that far along..but im kinda worried already. i called the doc that i used with kaleb and he told me that its prolly just my uterus being streched back to the way it was before i had my d&c with my mc that i had 6 months ago. he also said for me to try to take it easy, drink plenty of water, and not pick up a lot of stuff...now i'm kinda scared...cuz i don't want to lose this baby. but its kinda hard not to do things that need to get done around the house!!? has anyone else felt the same thing as me at nearly 5 weeks pregnant?
Comment by Laura Morales on September 15, 2009 at 5:36pm
I've been sick as a dog today, The worst day yet, Guess I need to start trying some of these things.
Comment by Brittany Tubb on September 15, 2009 at 8:39am
hi ladies! i'm super excited about finally getting to join this group! :)
Comment by Laura Morales on September 14, 2009 at 8:56am
yay, glad you found somthing thats working for you. Mine hasen't been too bad overall but today has been a little rough so far.
Comment by Bonnie P on September 13, 2009 at 8:55pm
Good news - Vitamin B6 combined with ginger tablets has really worked to get rid of my nausea! I feel like an actual person again! Which was really nice for today, we were celebrating my son's 1st birthday!
Comment by Bonnie P on September 12, 2009 at 8:01am
Oh, that makes sense!
Comment by Laura Morales on September 11, 2009 at 8:16pm
No its not routine, I had a miscarriage at 10 weeks in 2006 and they do miscarriage prevention testing and treatment if you want it. so I had her do it. She was doing blood work that day anyways so it wasn't any big deal just another vial of blood. But if it would have been low they would have but me on progesterone and some special herbs to try and prevent it. I am actually drinking an herb tea that is supposed to help prevent miscarriage and I will continue drinking it till 12 weeks.
Comment by Bonnie P on September 11, 2009 at 6:07pm
Laura, just a silly question I have - why would your midwife be testing your progesterone levels? Is that routine practice where you are? My midwife didn't say anything about confirming my pregnancy. I told her that I took a HPT and that was enough for her. Which I was a bit surprised at; when I was preg with my first, my doctor did a urine test in the office and them requested a blood test as well when I went to the lab. But with the midwife, we discussed everything that was on the requisition for my blood work and progesterone was definitely not there.
 

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