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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 Mandy Gibbs on August 5, 2010 at 3:31pm
Okay...I finally posted my birth story!
Comment by Katie on July 27, 2010 at 1:26pm
How wonderful, Mandy!! So so proud of you...congrats to you and your growing family! Like Sara said, you'll be a pro in no time!
Can't wait to hear the birth story! (But take your time...)
Comment by Sara on July 27, 2010 at 1:16pm
Congrats on your new little man! And on your natural delivery. you should feel very proud of yourself!!! I have 3 kiddos and I found that going from 1 to 2 was much harder than from 2 to 3. Guess by the 3rd your such a pro that it seems easier. But no worries, soon you will fall into a routine and it will get easier. before long the memories of "easier" days w/just one will be gone and you will be a pro at the 2 you have and not able to imagine or remember your life w/just 1. ;)
Comment by Meredith Paige Browning Lovell on July 27, 2010 at 9:18am
Congratulations Mandy!!
Comment by Mandy Gibbs on July 27, 2010 at 9:13am
Hey Ladies...just thought I would let everyone know that my little man has arrived. He was born July 14th at 1:43pm...might I add NATURALLY...go me!! I will be posting my birth story soon...just have to find the time and energy to do it!! Being a mommy of 2 is kicking my butt...i'm not really sure how mommies do it with more than 2!! My hat goes off to them!!!
Comment by naomi on July 15, 2010 at 7:13pm
a lot of woman wait until three month point to feel more comfortable. I'm sure everything will be fine good luck
Comment by Jane Doe on July 15, 2010 at 11:25am
I'm leaning towards waiting till the three month point just to feel more secure about telling everyone. I just don't like the idea of having to 'un-tell' everyone if something happens. Thanks for the advice, I appreciate it!
Comment by naomi on July 14, 2010 at 9:52am
i had period like cramps and bloating with my first and second this one bloating not cramping. I did feel a preassure in lower abdomin that startede around week 12 was told it was my uterus stretching I still feel it time to time never worsens though they did all kinds of checks on ultrasound to make sure it was nothing else. With my daughter I told everyone right way I was five weeks way to excited. Second time same thing seven weeks waited few more weeks but we miscarried that one and after having to tel lour four year old and the whole famile I vowed never to do that again I waited until about 11 and half weeks to tell everyone with this baby. Everyone is different you just need to do what you feel is best. I know a lot people that say they tell everyone because god forbid something happens theylll want that family support. I think you'll be fine and you just have to do what's best fo ryou if you want to tell I say just go for it why not it's very exciting time!. good luck.
Comment by Katie on July 14, 2010 at 9:01am
Glad you're feeling better, Jane! As far as "spilling the beans", I pretty much told my immediate family right away with the disclaimer that "it's really, really early, but..." After my 8 week ultrasound (I wanted to confirm it was just ONE baby, and that it had a good heartbeat), I told close friends and more extended family. I didn't make an "official" public announcement until 13 weeks. Everyone's risk tolerance is different, but I'm a bit of a blabbermouth, so...:)
You'll know what's the best timing for your comfort level. Best to you!
Comment by Jane Doe on July 14, 2010 at 7:59am
Thanks for the advice Katie, it feels better today. It sure is hard to not worry about the smallest things. This is my first pregnancy so I don't really know what's normal vs what isn't. I'm going with the idea that if it isn't severe/worsening pain then I shouldn't worry. Easier said than done of course. I'm looking forward to being at 3 months so I can be more assured that I'll carry to term. You're right, I am due around mid-March. I never wanted to see the winter come so badly!;) I wanted to ask everyone, when did you tell all your friends and family about the pregnancy? Did you wait till 3 months or tell them right away?
 

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