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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 Nicole A. Tucker, Lic. LCC on February 3, 2011 at 12:25pm

Hi Naomi,

 

Your body is still going through postpartum adjustment and may have changed since taking the pill.  Follow up with a qualified healthcare professional for more answers.

 

Nicole

Founder/Organic Mommy & Baby Healthcare Solutions 

Comment by naomi on January 14, 2011 at 7:03am
Okay I just had a baby four months ago I had two periods already and I just skipped this one I did take pregnancy test just to make sure two as a matter of fact and it was what I thought negative. SO my question to all of you out there is if I'm bottle feeding why would I skip a period>? This never happend with my first daughter but I went on the pill after her this time I'm not taking a contraceptive. any insight would help as I am a tad worried. wasen't sure were else to go to ask this thanks .
Comment by Aqueelah T. Davis on December 24, 2010 at 4:55am
I have not been on the site in a few weeks and is happy to see all the new comments. I am currently just under 13 weeks with baby #1. This is hard. I worry all the time. I don't know how to stop. I feel like I need to look into my belly every two days just to check on the little one. You would think I would be a bit calmer since I rarely have any cramping, no nausea, so spotting or anything. Just hungry and sleepy all the time. If found to be in no danger of miscarriage and clearly getting bigger, how do I relax? If anyone has any techniques please tell me. I think Im totally hopeless! 
Comment by Marina Bunnell on November 5, 2010 at 4:09pm
Thanks Cynthia, very informative article...sounds like what I am having :-)
Comment by Cynthia Crossett-Powell on November 5, 2010 at 1:40pm
yep! round ligament pain - it slows down, your right on time:)

http://www.babycenter.com/0_round-ligament-pain_205.bc
Comment by Marina Bunnell on November 5, 2010 at 12:15pm
Hi, my name is Marina and I am still new to this group...
I am about 14 weeks pregnant with my first child...and i haven't been to the doctor yet...going next thursday for the first time.
I feel fine,no nausea at all, just very slow digestion and all the fun that comes with it :-),...tired most of the time... But sometimes i get these different weird pains (not too strong) in my lower abdomen and mostly on my one side and then the other, sort of like nagging pain in my ovaries. I've read before on forums that pregnant women often feel different little pains here and there and that it's usually nothing bad...just uterus expanding or something to do with hormones... Most of the time I just ignore it...but some times it makes me worried a bit...
So, a question for you guys... Did any of you had any pains like that when you were/are pregnant and what did it turned out to be?
Happy day to everyone :-)
Comment by Chelsea on October 17, 2010 at 12:01pm
@Tarrah--such a beautiful story! You are amazing.

@Everyone- I've been away from this site for awhile, but it's nice to be connecting back now. I'm one week overdue today. It's such an interesting sort of limbo to wait for the baby to make it's entrance into the world. Especially because I haven't had any contractions at all yet, I still just feel great like I have most of the pregnancy. I feel like when the baby decides to come it's going to be all the sudden, you know?
Comment by Tarrah Carmon on September 24, 2010 at 7:14pm
i felt like a rockstar in that moment thats for sure...TOTALLY an awesome feeling to do something that i wasnt totally sure i could do....and im glad rebecca left out some key words i used when TELLING her i was getting that epidural lol im so glad that i waited to go in or i might have gave into meds...i cant wait to read your story Katie!
Comment by Katie on September 24, 2010 at 2:50pm
Yay, Tarrah!!! You are a rockstar...congratulations on that beautiful baby who came with such a beautiful birth story. Your doula seems fabulous! I chuckled when I read the part about you asking for the epidural as you got out of the car...little did you know that you were probably going through transition on that ride to the hospital! That must have been tough! lol
But you did awesome...congrats! :)
Comment by Tarrah Carmon on September 24, 2010 at 11:25am
thank you!
 

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