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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 Laura Morales on September 11, 2009 at 1:23pm
Just got a call from the midwife, she says my progesterone levels are sky high and everything else looks really good! I am super excited! That makes me feel a little more pregnant!lol
Comment by Laura Morales on September 11, 2009 at 8:40am
I'm not loving the 1st tri. I don't look prego, and most of the time I just feel bad or strange. I can't wait til I start showing so I can actually look preg and not feel bad any more. My hubby said it's hard for him, till I start showing, to get into me being pregnant cause it's not real to him. I told him I def feel preg but it's hard for me too.
Comment by Darcel on September 9, 2009 at 8:56am
My nausea peaks in the morning and early evening. I've been sipping sprite, always have crackers on hand.

I really need to eat more, but I don't have much of an appetite, and when I do I only take a few bites of something.
I am pretty sure dd2 is going to continue to nurse through this pregnancy, so I really need to keep my energy up.

I used Vit B with dd1, tried it with dd2. Ginger ale helps with nausea too.
It also helps if I stick to bland fooods. Hot dogs, mac and cheese. I can't eat anything greasy, ugh!
Comment by Bonnie P on September 9, 2009 at 8:28am
Thanks for the tips, ladies. I find I need to eat something asap when I get up too, and that helps a little with the rest of the day. I've never heard of the Vit B thing before, I'll have to test that one out!
Comment by Laura Morales on September 9, 2009 at 6:43am
I've been having a little nausea too, yesterday was really bad but today not bad at all. It helps me if I make sure and eat soon after I get up. If I wait too long I'll feel sick and I can't really feel better for a while, at that point eating makes it worst.
Comment by Cherylyn on September 8, 2009 at 11:31pm
Bonnie: ginger is great, and peppermint can help too. There are also acupressure points that help with nausea, 3 of your finger widths up your arm from your wrist. Just hold light pressure over this point and it can help ease the nausea. You can do it on either arm and it works the same. Vitamin B is also really good to help with morning sickness, so make sure you're getting plenty of it. You can't overdose on vitamin B because your body will flush out any excess you get. If I can remember any more tips, I'll let you know. Good luck!
Comment by Bonnie P on September 8, 2009 at 11:09pm
Terri, yes, thanks for the input! I'll have to keep that book in mind once I get closer to the end of my pregnancy. We'll see then if my son is still nursing or not, but I hope he is!

Laura, glad you made a good connection with your midwife! I meet one of the midwifes on my team on Thursday and I'm very excited!

So does anyone have any suggestions on ways to calm nausea? With my last pregnancy I was put on Diclectin, but if there's things that help, I'd like to avoid unnecessary medications this time around. I've seen ginger tablets out there, has anyone had any success with those? I took some a while ago for motion sickness and it worked very well, I wonder if it would be the same in pregnancy? And in case the natural route doesn't work, do midwives write prescriptions, or would I have to see a physician for that? Thanks in advance for any advice!
Comment by Cherylyn on September 8, 2009 at 10:52pm
Terri, I appreciate your advice. I still regret that I wasn't able to nurse through my entire pregnancy. I feel I did my best, but I also feel that I needed more information and better support. I think any information to help others is wonderful!
Comment by Laura Morales on September 8, 2009 at 6:21pm
On Friday I had an appt just to meet the midwife and it went great, I loved her so I decided to go with her. So today I had a real 1st appt and it went great, EDD is April 24th. They did some blood work but I won't know the results til Friday. Hoping for a good report. There was a question about my blood pressure, I have low blood pressure normally, but she's just gonna watch it, she thinks it will get higher as the pregnancy progresses, I sure hope so!
Comment by Terri Henry on September 8, 2009 at 5:28pm
Hi Bonnie, I'm 8 months pregnant and have been nursing my girl who is just 14 months throughout the entire pregnancy. It's not been easy as the milk is less and it brings it's own uncomfortable issues sometimes but I really didn't want her to wean . I keep reminding myself and her that by next month the full flow of milk will be here!

As for 2 prenatal vitamins...no! You don't want to overdose! Make sure you eat well and get enough rest though as this helps. An amazing book on the subject is 'Adventures in Tandem Nursing' by Hilary Flower. It's an incredible book filled with information and stories about tandem nursing. I wrote a review of it on my blog http://onelovelivity.com/childofnatureblog/?p=615 and I highly recommend it! Best of luck with the pregnancy and breastfeeding. onelove
 

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