Consumer Reports Health Condemns Common Obstetric Practices

Consumer Reports Health is a new public service from the well-known Consumer Reports. They are now providing reporting data on medical procedures and treatments in an effort to assist consumers of health care to be more informed. I am impressed, and pleasantly surprised, that they are present the research-based evidence regarding obstetric practice, instead of what the American College of Obstetrics and Gynoecologists is promoting. This is what Consumer Reports Health have to say about basic obstetric practice:

Despite growing evidence of harm, many obstetricians and maternity hospitals still overuse high-tech procedures that can mean poorer outcomes for baby and Mom. Test your knowledge with our quiz below.

T/F: An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.False. Studies show that the 8 percent to 9 percent of U.S. women who use midwives and the 6 to 7 percent who choose family physicians generally experienced just-as-good results as those who go to obstetricians. Those who used midwives also ended up with fewer technological interventions. For example, women who received midwifery care were less likely to experience induced labor, have their water broken for them, episiotomies, pain medications, intravenous fluids, and electronic fetal monitoring, and were more likely to give birth vaginally with no vacuum extraction or forceps, than similar women receiving medical care. Note that an obstetric specialist is best for the small proportion of women with serious health concerns.

Induced labor can halt fetal development.
True. The vital organs (including the brain and lungs) continue to develop beyond the 37th week of gestation. There is also a five-fold increase in the brain's white matter volume between 35 and 41 weeks after conception. Inducing labor (with synthetic oxytocin, for example) might stop this growth if the fetus is not fully developed. Between 1990 and 2005, the number of women whose labor was induced more than doubled.

Due-date estimates can be off by up to two weeks.
True. This inaccuracy can lead to a baby being delivered by induction or Caesarean section up to two weeks earlier than its estimated due-date, cutting off important weeks of fetal development.

"Breaking the waters" helps hasten labor.
False. There is no evidence to support the fact that this common practice (about 47% of women) shortens labor, increases maternal satisfaction, or improves outcomes for newborns.

Induced labor increases the likelihood of Caesarean section in first-time mothers.
True. The cervix may not be ready for labor. Other effects of induced labor include an increased likelihood of an epidural, an assisted delivery with vacuum extraction or forceps, and extreme bleeding postpartum.

Once you've had a C-section, it's best to do it again.
False. Studies show that, as the number of a woman's previous C-sections increased, so did the likelihood of harmful conditions, including: trouble getting pregnant again, problems delivering the placenta (placenta accreta), longer hospital stays, intensive-care (ICU) admission, hysterectomy, and blood transfusion.

Labor itself can benefit a newborn's immunity.
True. When babies do not experience labor (if the mother has a C-section before entering into labor, for example), they fail to benefit from changes that help to clear fluid from their lungs. That clearance can protect against serious breathing problems outside the womb. Passage through the vagina might also increase the likelihood that the newborn's intestines will be colonized with "good" bacteria after the sterile womb environment.

Epidural anesthesia is a low-risk way to make labor easier.
False. Many women welcome the pain relief, but might not be well-informed about the increased risk of its side-effects, including lack of mobility, sedation, fever, longer pushing, and serious perineal tears.

Epidural anesthesia presents risks to newborns.
True. Babies whose mothers received epidurals during labor are at risk for rapid heart rate, hyperbilirubinemia (the presence of an excess of bilirubin in the blood), need for antibiotics, and poorer performance on newborn assessment tests.

Episiotomies reduce the risk of perineal tearing.
False. Evidence shows that routine use of episiotomy offers no benefits but rather increases women's risk of experiencing perineal injury, stitches, pain and tenderness, leaking stool or gas, and pain during sexual intercourse. Yet in 2005, 25 percent of women with vaginal births continued to experience this intervention. Episiotomy is one of several obstetric practices adopted into common usage before being adequately studied.

Source: "Evidence-Based Maternity Care: What It Is and What It Can Achieve," a detailed review of clinical evidence by Carol Sakala and Maureen P. Corry published by the Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund, October 2008.

The truth about epidurals?

This article was passed on to me by Carla Hartley, founder of the Trust Birth Initiative.

A new book says that women should routinely have epidurals in labour. Experts on both sides of the ‘pain is gain' divide give their views
Anyone who has had a baby knows that childbirth as a competitive sport puts the Olympics in the shade. I'll never forget the “post-match analysis” at my antenatal class, where intelligent, educated women offered grovelling apologies to our childbirth instructor for their “second rate” (i.e, anaesthetised) births. I couldn't help feeling that two thirds of the class had forked out £150 to be made to feel like bad mothers before their babies had taken their first breath.

So it was a relief to come across the book, Enjoy your labor: A new approach to pain relief for childbirth, by Dr Gilbert Grant, director of obstetric anaesthesia at New York University Medical Center. He says that the biblical edict to women to “bring forth children in sorrow” is simply no longer applicable.

So which theory is right? I decided to ask experts on both sides to share their views on the “best” way to give birth.

Dr Grant believes that women should get an epidural, even before pain starts. According to him, much of the information that women receive is incomplete or inaccurate, and that the lucrative “natural childbirth industry” creates fear and guilt about epidurals. He believes that opposition to anaesthesia during childbirth is the result of a deep-seated misogyny: “There is no other situation in medicine in which pain relief is routinely withheld. No man would be asked to undergo an appendectomy, which lasts about 24 minutes, without pain relief, yet the pain of labour, which can last for more than 24 hours, is viewed as something women have to endure.

“Natural childbirth has become a multimillion-dollar industry. The fear of epidurals is promoted by those who discourage their use - and who have a vested interest in doing so.

“Childbirth instructors describe epidurals as unnecessary, or even harmful, interventions and make women feel that requesting one is a sign of weakness that may harm their baby. Labour is seen as an extreme sport - ‘no pain, no gain' - and yet this quasi-religious fervour is based on myth and misconception. The founders of natural childbirth movements NCT and Lamaze, both men, incidentally, claimed that women in primitive cultures experienced no pain in labour. Pain in childbirth, they claimed, is a product of Western civilised society - a learned phenomenon. The implication was that if women breathed ‘properly' or assumed the ‘correct' positions, the labour would be pain-free. Women were made to feel they had failed if they asked for pain relief. There is evidence that in all cultures giving birth has been a painful experience,” says Grant.

“Opponents of the epidural also claim that it may impact negatively on breast-feeding, but there is little data to prove this. On the other hand, there is evidence that unrelieved pain is one of the risk factors for post-natal depression.

“Modern low-dose ‘walking epidurals' allow women to remain active while retaining the muscle strength to push out the baby. Technological advances mean that women are able to administer their own dosage and this makes them feel more in control. Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth.

“Women should be allowed to choose if they want pain relief, but should have access to accurate information. It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth.”

I'd love to hear some responses to these words. I'm not an expert when it comes to the birth research, although I do what I can to weed out the truth from the myths about treatment for pregnancy and birth.

I just find it fallacious that a doctor would compare the sensations of childbirth to an apendectomy which is an invasive surgery where flesh and muscles are being manually cut through. It takes me back to a previous argument: the female body is biologically manufactured for a baby to pass through it, but it is not a natural process for body parts to be cut out. If we wanted to compare apples to apples in this situation, we'd say of course, pain relief is neccessary for a Cesarean birth because its surgery where the baby is being artifically removed from the mothers body.

Also, I believe the author undermines his own argument by stating that the orginators of the natural childbirth techniques are men, as the author of the above article is also a man. If he's going to pull out the gender card, he can also recognize the fact that he himself would not understand or truly be able to appreciate what childbirth feels like from a woman's perspective.

And to address the above mentioned studies, I'd like to see where epidural and analgesia use in childbirth do not contribute to breastfeeding difficulties, or that epidural babies are in "better shape" than those babies who were not exposed to drugs in the mother's system.

Evidently, the obstetrician quoted in the above article is not familiar with the biomedical research done by Dr. Michel Odent and Dr. Sarah J. Buckley(see article the real risks of epidurals are discussed for both mom and babies) who eloquently describe the importance of an undisturbed, psyiological birth where drugs are not being used.

To conclude, I will also point out that, it may be true that "natural childbirth" is a multi-million dollar industry each year, but let's also remember that medicalized childbirth is a multi-billion dollare industry each year, where the belief that women's bodies were evolutionarily made to give birth is ignored and belittled with every procedure and intervention. And let's not forget, the revenue generated from epidurals: over $1000 for each one, and that's not including the incidentals to it: the electronic fetal monitoring, the cathedar, and the prerequisite IV. And this OB is saying that $150 for a childbirth education class is money gouging.

I'm sure that others could address the fallacies in logic and fact in this article better than I. I mentioned some of the points that I felt I could discuss with some intelligence. I'm open to hearing the thoughts and birth truth that others are knowledgeable of.