Safety/Optimal Care

The Official Lamaze Guide “What Hinders Labor”
The Official Lamaze Guide “Myths/Facts”

SAFETY

“In 1997, the University of Copenhagen looked at the outcomes of 24,000 births. In that study, those who delivered at home actually faired better; infants were in better condition, and the mothers had fewer lacerations, a lower rate of induction, and fewer interventions, including the use of forceps, than those in the hospital. There were no maternal deaths. A 1996 Dutch study of 2,000 births also showed that birthing at home was safer than the hospital, especially for women having their second or third babies.” Birth pg. 73

“Both of these statements, reiterated in 2006 by the executive board, come on the heels of the largest, most scientifically rigorous study of out-of-hospital birth in the United States to date, the study of 5000 planned home births attended by certified professional midwives in 95% of women gave birth vaginally and babies were born just as safely as those in the hospital.” Pushed pg. 264

“It is important to remember that it has never been scientifically proven that the hospital is a safer place than the home for a woman who has had an uncomplicated pregnancy to have her baby.” Pushed pg.217

“Deliveries at home and in birth centers have been statistically proven to be as safe as those in hospitals, where not incidentally, one’s chances of having a cesarean soar just because you walk through the door.” Birth pg. 75

“Then again, traditionally managed, unphysiological childbirth (i.e. birthing in a hospital with a doctor)…is the norm, and most women, especially first time mothers, face a significant risk of a long labor followed by cesarean or trauma to the perineum. This leaves women “choosing” between poor labor management and major surgery.” Pushed pg.72

OPTIMAL CARE

“Optimal maternity care, according to the systematic evidence reviews conducted by the Cochrane Collaboration, can be distilled into six characteristics. 1) Labor begins spontaneously 2) Women have freedom of movement during labor 3) Interventions are medically justified rather than routine 4) Women have continuous emotional and physical support 5) Pushing occurs in any position but flat-on-back 6) Mother and baby are not separated. Among the women surveyed in 2005 by Childbirth Connection, just 2% had an optimal experience. The survey suggests another disparity. Although 80% of women agreed that they should be informed of every possible side effect before consenting to a procedure, less than half could correctly identify the risks of induction, and less than one third were familiar with the risks of caesarean section. This suggested that they were not fully informed, and the responses to another question suggested that they were not solicited for consent: only 17% of women who got an episiotomy reported having a choice in the matter.” Pushed pg. 153-154

“What’s best for women is best for babies. And what’s best for women and babies in minimally invasive births that are physically, emotionally, and socially supported. This is not the experience that most women have. In an age of evidence-based medicine, women need to know that standard American maternity care is not primarily driven by the health and well-being of their babies. Care is constrained and determined by liability and financial concerns, by a provider’s licensing regulations and malpractice insurer. The evidence often has nothing to do with it.” Pushed pg. 271

Many caregivers and hospitals in the U.S.: assume all expectant mothers want a full range of prenatal tests, induce labor before forty-two weeks (sometimes as early as 37 weeks), speed up labor when they think its taking too long, routinely use continuous electronic fetal monitoring and intravenous fluids, separate mothers and babies after birth, restrict movement and position during labor, support elective cesarean surgery, do cesareans when they think labor has gone on too long, discourage vaginal birth after cesarean (VBAC)” OLG pg. 168

“But for the most part, drugs simply are used as they have been ever since women were brought into modern hospitals for childbirth: they are used to replace human caring and support. They make it possible for administrators to staff maternity units so that nurses can care for three or four patients at a time, and for physicians to continue on with  their office hours or their nighttime sleep while their patients labor somewhere else.” ID2 pg. 78

“In a birth center worthy of the name, there is: 1) no induction 2) no augmentation of labor with Pitocin 3) no electronic fetal monitoring except for Doppler ultrasound 4) no drugs for pain relief except local analgesia 5) very few episiotomies 6) no operative deliveries…” BYW pg. 60 “Women in the birth center were four times more likely to have an intact perineum: that is, no tear and no episiotomy.” BYW pg. 66

Today more than 70 percent of American women give birth in supine positions (lying on their backs) They’re encouraged to give birth this way even though research shows its harmful. Lying on the back can lower a laboring woman’s blood pressure, and the weight of her uterus on major blood vessels can reduce blood flow to her baby…Studies show that pushing in upright postures shortens the pushing stage and decreases incidence of severe maternal pain and abnormal fetal heart rate. OLG pg.121

“Women in the birth center were four times more likely to have an intact perineum: that is, no tear and no episiotomy.” BYW pg. 66

“Ask your midwife or doctor not to clamp the cord until it stops pulsating. Immediate clamping may reduce the baby’s red blood cells by over 50 percent.” CBPC pg. 365

“Today, however, young girls in the United States inherit a toxic legacy of attitudes about childbirth that poisons their natural self-esteem. They grow up fearing and not understanding what it means to have a baby. What separates most birthing women today from women in the past is the loss of familiarity with the birth process, the loss of community with other women, and the loss of traditional feminine wisdom. “ ID2 pg. 26

“And physicians are still in the grip of the nineteenth-century belief that childbirth is too risky and painful, and women too fragile, for birth to be allowed to proceed on its own. The fears of women and the fears of physicians have been playing off each other right to the present day, and the underlying belief in the inadequacy of women feeds the fear.” ID2 pg. 37

“The average hospital environment provides the worst possible start for breastfeeding.” BYW pg. 184

 

Official Lamaze Guide “What Hinders Labor”

1. Continuous Electronic Fetal Monitoring: Routine continuous EFM provides no benefit for babies and increases the risk of cesarean for mothers.
2. Routine Intravenous Fluids and Oral Intake Restriction:
Routine IV restricts movement, decreases confidence, may over-hydrate mothers and may contribute to low blood sugar in newborns.
3. Movement restrictions:
Research shows that restricting movement reduces the effectiveness of contractions, prolongs labor, and increases Pitocin use.
4. Artificial rupture of membranes:
Artificially rupturing the sac increases your risk of infection and interventions (Pitocin, EFM, IV, restricted movement, cesarean)
5. Directed pushing:
Research shows that routine directed pushing, breath holding, and limiting pushing during labor are not beneficial, and that prolonged breath holding may reduce fetal oxygenation.
6. Induction or augmentation with Pitocin:
Pitocin increases stress on your baby and your uterus and makes contractions more difficult to manage. Pitocin use necessitates an IV and continuous EFM, restricts your mobility, and raises your risk of epidural and cesarean.
7. Epidural Anesthesia and Analgesia:
Epidural use…can prolong labor…increases the risk of instrument delivery and may increase the risk of cesarean…raises the risk of fever and postpartum separation to rule out infection. Epidural drugs do reach your baby.
8. Episiotomy:
Research provides no evidence that an episiotomy reduces the risk of perineal injury, improves perineal healing, prevents birth injury to babies, or reduces the risk of future incontinence. Rather, the evidence shows that routine use of episiotomy is likely to be ineffective of harmful.
9. Cesarean Surgery: Cesarean surgery increases your short-term risk of blood clots, stroke, surgical injury, infection, pain, separation from your baby, physiological trauma, longer hospital stay, emergency hysterectomy, and death. In the long-term, it increases your risk of pelvic pain, bowel obstruction, infertility, and future pregnancy problems like ectopic pregnancy, placenta previa, and uterine rupture. OLG pg 144-154

Official Lamaze Guide Myths/Facts

Myth 1: Pregnancy and childbirth are terribly risky.
Fact: Having a baby is a normal, natural, healthy event. The World Health Organization believes that 85 to 95 percent of pregnancies can be expected to go perfectly.

Myth 2: Birth is safest in a hospital with a doctor.
Fact: For most women, birth at home or at a birth center is as safe as- or safer than- at a hospital. Continuous EFM is just one of many routine interventions that disrupt and create problems in otherwise normal labor and births. The medical attitude of expecting trouble, and the hospital policies that support this attitude, prevent women from giving birth easily and safely in the typical hospital and contribute to the alarming U.S. cesarean rates.

Myth 3: Giving birth outside a hospital or with a midwife means suffering needlessly.
Fact: There are many ways to find comfort in labor without drugs, and this search for comfort helps move labor along. When allowed and encouraged to, a woman will naturally move, moan, sway, change her breathing pattern, and rock to cope with contractions, eventually finding the right rhythm for her unique needs. Such active comfort seeking helps her baby rotate and descend and helps prevent her labor from stalling.

Myth 4: Choosing midwifery care is an all-or-nothing decision.
Fact: A good midwife is a skilled member of a care giving team. This line of thinking springs from inadequate understanding of the training and role of midwives. Most midwives in the U.S. today are certified nurse-midwives (CNMs). A CNM has advanced training (often a master’s degree) beyond her nursing degree and has passed a rigorous certification exam.

2 Responses to Safety/Optimal Care

  1. Jaime says:

    My fear is that something will go wrong and my baby will die at home and I will NEVER be able to live it down… but yet i’m completely terrified once I step into the hospital I will automatically be stuck poked and prodded until I just GIVE INTO interventions…. ugh why do we have to go through this… the medical community should be WAY more supportive of natural birth.

    It’s like the more interventions they do the less likely it is to get sued… wow i’m glad that is what is dictating my care. :(

    • admin says:

      @Jaime: if you have a skilled certified midwife at your birth at home, she will be able to recognize if something about your labor is not progressing normally. She will be listening to your baby’s heartbeat with a fetal doppler and making sure everything is ok. If at any point during your birth at home the midwife recognizes that you or the baby might be at risk, they will transfer you to a hospital immediately. Think about it this way: with a midwife, you have someone experienced with you the entire time observing your labor for any sign or trouble. At a hospital, you have only a machine (that’s been proven to be incorrect 50% of the time) and nurses and doctors who only pop their head in to check on you every couple hours. There are also many studies that prove that infant mortality is EXACTLY the same when comparing home births and hospital births, so birthing at home does not put your baby at greater risk.

Leave a Reply

Your email address will not be published. Required fields are marked *

*

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Couldn't connect to server