The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly 1 million cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, half of the cesareans could have been avoided. Clearly, there are times when cesareans are necessary. However, cesareans increase the risk to both mothers and babies. These are suggestions of things you can do to avoid an unnecessary cesarean and can help insure that your birth experience is as healthy and positive as possible.

BEFORE LABOR

• Read and educate yourself, attend classes and workshops inside and outside the hospital.
• Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center.
• Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest?
• Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor.
• Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc.
• Become aware of your rights as a pregnant woman.
• Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of cesarean.
• Help ensure a healthy baby and mother by eating a well-balanced diet.
• If your baby is breech, ask your care provider about exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion.
• If you had a cesarean, seriously consider VBAC. According to the American College of Obstetricians & Gynecologist, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesareans can go on to birth their subsequent babies vaginally.

DURING LABOR

• Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you.
• Continue to eat and drink lightly, especially during early labor, to provide energy.
• Avoid pitocin augmentation for a slow labor. As an alternative, you may want to try nipple stimulation.
• If your bag of water breaks, don’t let anyone do a vaginal examination unless medically indicated for a specific reason. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection.
• Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.
• Avoid using an epidural. Medical research has shown that epidurals can slow down labor and cause complications for the mother and baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing.
• Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest.
• Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on you and your baby, and what are your other options.
• Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.

This may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All Rights Reserved.

*Note from Brenda: The cesarean rate in Texas for 2006 was 33.2% and is much higher in certain hospitals in our area. This is an issue that every pregnant woman needs to be informed about.

Cesarean Fact Sheet

I highly recommend this DVD to help educate yourself about birth in the USA today and what your options are. For those women who choose to give birth in the hospital, education is extremely important to help you make informed decisions about your care. Having good support from your doula has been shown to dramatically decrease the rate of major interventions during labor and birth. Your doula will be an information source in helping you navigate through the many decisions that you will be asked to make during your labor, and she will also be able to help advocate for you at a time when it is commonly very difficult for you to advocate for yourself.

Top 5 Most Luxurious Hospitals In The Usa

The demand for good hospitals is nothing new. After all, where your health is concerned you want the best care you can get, and if you can afford to pay more to get it, you will.

There has been an increasing demand however, in the wealthier sector of the population, for health care centers and hospitals that not only offer excellent medical care but also greater luxury, the best amenities and of course great food, as hospital cuisine has developed a poor track record down the years.

 Those who can pay up are more than willing to do so, and as a result more hospitals are catering to this lucrative market.

CEDARS-SINAI, LA
Hospital to the stars, this is where Hollywood goes to get healed! With Warhol’s and Picasso’s gracing the walls, a gourmet chef in the kitchen and views of the Hollywood hills, the Cedars Sinai certainly offers a luxurious stay. There are 32 Super Deluxe Suites at $912 apiece. The 4 OB suites are extremely popular with expecting celebrity moms who book the rooms as soon as they conceive! Here new moms can enjoy gourmet meals served with wine, fluffy robes, superior bed linens, and a ‘doula’ is on hand to assist in every possible way.

JOHNS HOPKINS HOSPITAL, BALTIMORE
With 15 rooms priced from $325 to $1,300, the luxury extras on offer here include waffle-weave robes, oriental throw rugs, and cherry headboards on beds. In-house attendants are trained in customer-service principles based on those of the Disney and Ritz-Carlton groups. Each room has a fax machine and a CD player in the clock radio. The unit is secure, with I.D. card-access only. The gourmet food is served by waiting staff decked in tuxedos.

MOUNT SANAI, NYC
The Eleven West Pavilion at the Mount Sinai has 19 rooms including four suites, priced from $395 to $1,400. This luxury unit has the feel of a resort rather than a hospital and employs managers with hospitality experience to help achieve this. The views are incomparable with windows overlooking Central Park and Madison Avenue. The elegantly-served gourmet meals are prepared by a registered dietician. While the suites offering even more extras such as DVD players and a bidet in the bathroom, other patients can still delight in Frette robes and 250-thread-count sheets. The medical service is renowned as among the highest-rated country-wide. “We don’t say no,” is the motto here.

ST LUKE’S EPISCOPAL, HOUSTON
The spacious rooms of the 6th-floor unit, known as the Terrace Suites, were remodeled in 1995. There are nine rooms priced from $300 to $700 each. Eye-catching floor-to-ceiling views of the Texas Medical Center are a feature of every room which also have DVD and CD players. The granite counters in the bathrooms complement the earthy tones of the decor. The chef prepares each meal in consultation with the clientele, taking health requirements and personal preferences into account. There is excellent security at the unit, attracting many international clients. The cardiac program at St Luke’s is highly rated around the world.

WASHINTON HOSPITAL CENTRE, WASHINTON DC
Another hospital offering exceptionally high standards of security, with screened telephone calls and a Protective Service which works in conjunction with the Secret Service. The 5 Northwest Pavilion comprises 12 deluxe suites priced from $415 to $830 each. The rooms feature views of the National Cathedral and the Shrine of the Immaculate Conception. Carefully selected attendants have annual training in order to be prepared for the most demanding of patients. The kitchen is able to cater for most requests, no matter how unusual. Luxurious extras include tuxedo-clad waiters and 300-thread-count sheets.

By: Francois L. Botha -

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Francois Botha is a well known author of many shoulder surgery newsletters and is also an editor at the leading South African shoulder problems portal.

Brenda’s Birth Story – Baby #1

My first baby was born on November 10, 1997. His due date was November 6th. I have birthed five more children since then, in 1999, 2001, 2003, 2006, and 2008. We interviewed a midwife at the beginning of my pregnancy, thinking about the possibility of a home birth. But in the end we decided on a hospital birth with our OB/GYN, and we wrote a birth plan, hoping for a natural birth.

I worked as a Kindergarten teacher throughout my pregnancy. My last day was November 7th, when I finally decided to stop working. That was a Friday, and on Sunday night I had trouble sleeping. I was having mild contractions about every 10 minutes for an hour or so, and then at about 1 AM my water broke. My mom, husband and I drove to the hospital, arriving at about 3 AM. I got into bed to be hooked up to the fetal monitor, and the nurses left us alone for several hours. I stayed in bed the whole time, the contractions were fairly strong and I was tired from not having any sleep. I had very much wanted to have a totally natural birth, but at some point I started thinking that I wanted an epidural. I couldn’t decide; my mind was fighting with what my body was feeling. I was just about at the point to ask for it, when my doctor came in, around 6:30 AM. She examined me and said that I had made a lot of progress. She gave me a hug, looked me in the eye, and said “I know you can do this, you’re almost there!”  Her encouragement was just what I needed at that moment. She suggested I get up and take a shower, which I did for quite awhile. The hot water was very soothing and relaxing to me.

After I got out of the shower and back into the bed, things started moving faster, and I went into transition. At that point I knew that my baby would be coming soon because my cervix was dilating quickly, and the nurses started making preparations for the birth. I started feeling the urge to push, and the doctor came back and said that I was completely dilated. I felt the urge to push very strongly, and I grunted loudly as I pushed. I only pushed for about 10 minutes when his head came out at 9:15 AM, followed right away by the rest of his body. They put him on my chest and said “It’s a boy!” I didn’t know it at the time, but later I found out that the doctor had done a local anesthetic right at the last. I also needed just a few stitches for a small tear. Matthew was wide awake and nursed beautifully almost right away! This was also very important to me as I wanted to breastfeed exclusively; I was very much against using formula or any kind of supplementation. We stayed in the hospital for just over 24 hours, with my husband staying with us.

 After Matthew’s birth, I felt so empowered, and stronger than I had ever felt in my life – I felt like I could do anything! I loved being a mama, and stayed home with him for 3 months. I then went back to work for 3 months and have been at home with my children ever since.

Study: Fetal oxygen monitors don’t help

newborns, moms

A large government study has concluded that monitoring fetal oxygen levels during labor does not lead to healthier newborns or reduce unnecessary Caesarean deliveries.

Fetal monitoring has long been controversial. Since the 1970s, doctors have routinely listened to fetal heartbeats despite no real evidence that it did any good. In fact, some research found that it increased the number of C-sections by making doctors nervously reach for a scalpel whenever the monitor showed an abnormal blip.

New technology that measures oxygen levels in the blood of a fetus was thought to offer a better way to tell which babies were truly at risk. In 2000, the Food and Drug Administration conditionally approved one such device, but required further study before allowing it into general use.

The study, published in Thursday’s New England Journal of Medicine, was the biggest to date, involving more than 5,000 women, and was meant to be the definitive word. It was halted early because of overwhelming evidence that the technology was ineffective.

“There’s no reason to use it,” said lead author Dr. Steven Bloom, chief of obstetrics and gynecology at the University of Texas Southwestern Medical Center. “We didn’t find any evidence of harm, but why should we invest valuable health care dollars in something that doesn’t have a proven benefit?”

In an accompanying editorial, Dr. Michael Greene of Massachusetts General Hospital, who had no role in the research, noted that for once, an expensive technology can be stopped before it finds its way into widespread use. Fetal oxygen monitors are not part of routine care.

“This genie has not yet escaped from the bottle,” he wrote.

In fact, Pleasanton, California-based Nellcor, which received FDA approval to market its OxiFirst devices, stopped selling them earlier this year because of a lack of demand, said company spokeswoman Kristin Garvin.

Garvin could not say how many fetal oxygen machines are installed in U.S. hospitals. In a news release 18 months after gaining FDA approval, Nellcor estimated that more than 400 devices have been used to monitor the births of about 9,000 U.S. babies.

Fetal oxygen machines are designed to be used with traditional electronic monitors, which track heart rate to determine whether the fetus is experiencing stress or lacking oxygen.

In the study, doctors monitored the fetal oxygen levels in 5,341 women pregnant for the first time at 14 university hospitals in the United States. Once a woman’s water breaks, a sensor is inserted into her uterus and placed against the fetus’ temple or cheek. The sensor provides an up-to-the-minute reading of the fetus’ oxygen levels. (The fetal oxygen monitors cost about $10,000 each and the sensors about $150 apiece.)

The women were then randomly separated into two groups. In one group, doctors could read the oxygen levels. For the other group, the information was hidden.

In each group, about 26 percent of deliveries were done by C-section. Doctors also found no difference between the two groups in stillbirths, infections or other newborn problems.

The research was funded by the National Institute of Child Health and Human Development, part of the National Institutes of Health. Researchers had planned on enrolling 10,000 women, but the study was discontinued because no benefit was seen.

In a statement, the FDA said it was reviewing the study and may revise the label on the monitors or inform hospitals about the findings. The agency said it is unlikely it would withdraw its approval of OxiFirst based on this study alone.

Source: http://edition.cnn.com/2006/HEALTH/11/22/fetal.monitors.ap/index.html?eref=yahoo

Brenda’s note: I was unable to open this link the last time I checked, I think it must be too old. I would like to give credit to the author of this article if anyone ever finds another good reference for it. Thanks!

In spite of all the advertising touting “home-like” birthing rooms in hospitals, for most women, a hospital birth will be nothing like a home birth. Interventions are routine in the hospitals in my state. Every laboring woman will be hooked up for some period of time to an electronic fetal monitor, given vaginal exams, and be told where and in what position she must give birth. If her membranes are ruptured, she will be required to deliver her baby within a certain time period. If her labor is moving too slowly, she will be given pitocin to augment it or have her water artificially ruptured. She will be told how many companions she may have with her. If she has other children she may or may not include them at the birth. How long she is kept in the hospital will vary depending on her physician and the particular hospital. How soon her baby will be released also will depend on the baby’s pediatrician and hospital policy. Some of the more common interventions that take place during hospital births are discussed below.

AMNIOTOMY

Artificially breaking the amniotic sac is done routinely at many hospitals to speed labor up, get labor going, to test the fluid or to get it out of the way so that an internal monitor can be screwed into the baby’s head. It was believed that breaking the water would speed up labor by 30 to 60 minutes but the only randomized control trial done disproved this. This procedure causes cord prolapse, a serious complication for the baby and increases the chances of an infection. With less amniotic fluid in the uterus during labor, the baby has a greater risk of cord compression problems leading to fetal distress and malpositions of the head. 1, 2

DRUGS & EPIDURALS

Nearly every woman giving birth in a hospital will receive a drug at some point during her stay. Pitocin is frequently used to induce or augment labor. Because it causes abnormally strong contractions, many women receive a pain-relieving drug such as a narcotic. Unfortunately, narcotics also are received by the baby and can affect the condition of the baby at birth and for years after. Some of these side effects are respiratory problems, impaired muscular, visual and neural development in the first week of life and in the following years, lower reading and spelling scores, difficulty in solving problems or performing tasks when they pose a challenge.

The new drug of choice at many hospitals is the epidural. It must be administered by an anesthesiologist and requires the mother to remain in bed afterward. She must be flushed with an IV fluid prior to getting it to keep her blood pressure up. A needle is inserted into the woman’s back and small catheter is left in place where the medication is injected. It numbs the woman’s body from the ribs to the toes. Many women ask for this drug because they do not want to deal with the pain of childbirth and believe it is safe for themselves and their babies because the physician who administered it, their obstetrician and the labor and delivery nurses all encourage the use of it and give no information regarding side effects.

The known complications are many ranging from requiring EFM, IV, immobility, urinary catheterization. An epidural also may allow no sensation of labor or the pushing urge, lower blood pressure, abnormally relax the pelvic muscles which may encourage the baby to adopt malpositions of the head, may decrease the production of oxytocin at critical times, and increase the need for forceps and cesarean section. Epidurals cause some serious complications such as heart attack, spinal damage, and spinal headache. After the birth, chronic backache is a common complaint as well as backache. The baby may be exposed to narcotic drugs given to enhance the effect of the epidural and which if given alone can compromise the baby’s respiratory efforts as well as require the newborn to metabolize the drugs. We do not know the short or long term effects of the epidural or other drugs on the baby. Some claim that the baby is unaffected unless the mother becomes hypotensive. Some non-interventionist birth attendants recognize that occasionally epidurals may be useful for certain situations. Some examples when an epidural may permit a normal birth are for maternal exhaustion, severe back labor, certain malpresentations or psychological dystocia. Although the FDA approves drugs as safe or unsafe, they have no definition of safe and do not guarantee safety of drugs. Many who work with brain damaged children, wonder if the disability is due to obstetric drug use. They also question if women would make the drug choice if they were given complete information about side effects. The American Academy of Pediatricians discourages the routine use of obstetric drugs. 3, 4, 5, 6, 7

ENEMAS

This procedure is still done routinely at many hospitals, although no research proves any benefits for the mother or baby. Home birth and natural birth advocates recognize that for the vast majority of women, the process of labor will empty the bowels. 8, 9

EPISIOTOMY

Although many believe that an ep[isiotomy is necessary to have a baby to prevent damage to the baby’s head, prevent trauma to the mother’s perineum and the cut will heal faster and prevent 3rd and 4th degree tears, no research supports these myths. Shiela Kitzinger writes that 9 out of 10 American women will have an episiotomy with her first baby although in Holland, only 2 or 3 out of 10 will. The facts are that episiotomy is a cultural phenomena. Research shows that episiotomy is done because the doctor was trained to do it, not because it was a necessary procedure. It can be avoided by using more physiologic positions to give birth (not lithotomy), pushing only when mom feels need to, giving birth gently, slowly to the head, preparing for the birth by doing perineal massage and Kegel exercise, avoiding forceps delivery. 10

FORCEPS & VACUUM EXTRACTOR

Forceps are obstetrical tools which are shaped like large spoons have been in use since the 1500′s. Years ago, forceps were used for many problems which are now handled by cesarean section. Today, most forceps deliveries are low forceps, which means they are applied when the babies head is low in the pelvis and birth is imminent. According to Henci Goer, “There is no research to support the elective use of forceps.”

The risks to the mother are perineal trauma, extensive episiotomy, possible extension tearing from episiotomy, hematoma and nerve damage. Lasting effects of forceps or vacuum extraction to the mother may be anal incontinence in spite of a repaired third degree tear. The baby may have damage to the head, eyes, the nerves that lead to the face and neck and arms. However, an article written by a physician which appeared in Parents magazine claims, “Medical studies comparing outlet forceps deliveries with spontaneous (no forceps) deliveries have shown that there is no difference in risk to the baby.” (Emphasis mine)

Vacuum extraction is a newer technology that sometimes takes the place of forceps. As with low forceps, the baby’s head must be very low in the pelvis before the suction cup can be attached. It has the benefit of not requiring an episiotomy and maternal perineal trauma is less than with forceps, but the baby still has the possibility of trauma to the head and face. Chiropractors also recognize that pulling a baby out by the head changes the spinal alignment, although this is not recognized in any medical texts. 6, 11, 12

IMMOBILITY

Along with the lithotomy position comes immobility. It is impossible to move around when you are flat on your back. It’s even more difficult if you have internal and external fetal monitors attached to your body, an IV running into your arm and after a narcotic drug was given to “take the edge off.” It goes without saying, that if you had an epidural, you would not be going anywhere at all as your legs would have no feeling.

Some hospitals encourage walking and moving around. Others do not like you to be out of your room, which may be quite small and loaded with equipment, making any real walking about nearly impossible. Studies have shown that moving about and being upright can shorten labor as well as changing positions. 13

INDUCTION

According statistics from the health department in Wisconsin, one-third of all births in that state are the result of induction, the artificial starting of labor. Most inductions are accomplished using pitocin in an intravenous solution or artificially rupturing the amniotic sac. The reasons for doing this are many. One of the most common for healthy full-term women, is fear of going too far past the “due date” and having a baby with postmature syndrome or meconium staining. Another reason is fear of having a big baby.

Benefits of inducing would seem to be avoiding postmature syndrome, attempting to deliver a baby that had grown too big for the mother and bypassing meconium staining. However, studies fail to confirm this line of thought. The actual amount of time needed for a baby to grow to term varies and figuring an exact due date for each baby has not yet been done. Ultrasounds have at best a 10 day window of error if done in the first trimester. The phenomenon of postdates, is poorly understood. Macrosomia occurs prior to postdates as does”postmature syndrome.” (p. 181) The entity of postmature syndrome is based on a single physicians “subjective evaluation of 37 babies.” Research seems to indicate that watchful waiting is the more prudent course of action for healthy women. 14

IV

At a great many U.S. institutions, one of the first items of care to be rendered to the obstetric patient will be her IV, “just in case.” Just in case she needs drugs or surgery or her veins collapse making insertion of an IV impossible. Nancy Wainer Cohen and Lois Estner interviewed many labor and delivery nurses to find out how frequently a laboring woman’s veins collapsed. They learned that this does not happen. This is not the way birth happens in other nations, where a laboring woman is permitted to eat and drink lightly. This cultural warping began in the 1940′s when anesthesia was being given to nearly all birthing women by mask and vomiting and food aspiration were risks associated with this. Eliminating food and drink, they felt would eliminate this risk. Today, however, anesthesia methods have improved and this is no longer the problem it once way. Improved intubation techniques make this problem virtually a thing of the past. Doris Haire, a maternity care writer, in looking at 20 years of medical literature on aspiration during surgery found that the cause was not eating or drinking prior to the surgery, but caused by incompetence of the anesthesiologist.

General anesthesia is given to approximately 4% of those who undergo cesarean section. Approximately 0.3% cesarean surgeries will require intubation that will be difficult to do yet not all women who require intubation will aspirate. This translates into denying all laboring women food and drink because 1 cesarean sectioned woman out of 10,000 may aspirate.

Although IV’s are supposed to keep the stomach empty, a glucose IV actually works to slow down the emptying of the stomach. It also may encourage tissues to swell so that it makes it more difficult to intubate, if that becomes necessary. IV fluid accumulates in the bladder and that may slow down labor. Some women may have sensitivities to the IV and have a reaction from one. It restricts the woman’s mobility. The needle in the arm is painful and inhibits free movement. The baby also may suffer from the mother’s IV, as studies are being done to determine if the excessive sugar administered through a glucose IV may harm the baby. 14, 15, 16

By: Yvonne Lapp Cryns -

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Yvonne Lapp Cryns is the owner of Midwives .net – www.midwives.net Yvonne is the co-founder of Nursing Programs Online at www.nursingprogramsonline.com and a contributor to The Compleat Mother Magazine at www.compleatmother.com .
Yvonne is also a law school graduate, a registered nurse and a Certified Professional Midwife.