Test Your Natural Childbirth Know-How!
--from November 2, 2006 meeting--
Read the questions and decide which are true statements, and which are myths. Then scroll down to find the answer, as well as a referenced quote about that topic.
Myth or Fact?
1) Epidurals are completely safe for mother and baby. Epidural anesthesia does not cross over into the placenta, so it does not affect the baby.
2) You don’t get a medal for having a natural childbirth.
3) All that matters is a healthy mother and a healthy baby.
4) Natural Childbirth can help facilitate a quicker labor and birth.
5) Routine hospital procedures inhibit bonding between mother and baby.
6) Extended contact between mother and baby after birth may significantly affect the subsequent behavior of a mother towards her baby.
7) Babies who are separated from their mothers at birth will not form as strong of an attachment.
8) The lithotomy position is the best birthing position for mom and baby.
9) Birth in the U.S. is safer than it has ever been.
10) Forty weeks is the average time of gestation. Mothers who go beyond 40 weeks are ‘overdue’ and are at greater risk of complications.
11) Homebirth is just as safe for low-risk mothers as hospital births.
12) Pain in childbirth can be beneficial.
13) You wouldn’t get your teeth pulled without anesthesia. Why suffer the pain of labor if you don’t have to?
14) An ultrasound shows my baby is going to be too big for me to deliver. So, I need to be induced before my due date or have a cesarean.
15) If my doctor suggests induction, it must be necessary.
16) It is safe and beneficial for a mother to eat and drink while in labor.
17) Vaginal Birth After Cesarean is safer than elective repeat cesarean.
18) A straight, clean episiotomy heals better and faster than a jagged tear.
19) Medical interventions impact a newborn’s ability to breastfeed.
20) Continuous electronic fetal monitoring provides a beneficial safety net for laboring mothers.
1) Myth. “The Physician’s Desk Reference cautions that local anesthetics –the type used in epidurals- rapidly cross the placenta… (and) can cause varying degrees of maternal, fetal, and neonatal toxicity which can result in the following side effects: hypotension, urinary retention, fecal and urinary incontinence, paralysis of lower extremities, loss of feeling in the limbs, headache, backache, septic meningitis, slowing of labor, increased need for forceps and vacuum deliveries, cranial nerve palsies, allergic reactions, respiratory depression, nausea, vomiting, and seizures… Epidurals have also been linked to an overall increase in operative deliveries: cesareans, forceps deliveries, and vacuum extractions…Eight primary studies revealed that the rate of cesarean section was 10 percentage points higher in the women who had received epidural anesthesia. One study actually found that the cesarean rate increased to 50 percent when the epidural was given at 2 cm dialation, 33 percent at 3 cm, and 26 percent at 4 cm.” (“Epidural Epidemic-Drugs in Labor: Are They Really Necessary…Or Even Safe?” By Joanne Dozer and Shannon Baruth, Mothering Magazine issue 95, July/August 1999)
2) True. No medals are awarded if you have a drug-free labor and birth. However: “…women who experience natural childbirth not only report greater satisfaction with their birth experience than those who do not, but also feel less pain and discomfort during the early weeks and months of motherhood.” (Having a Baby, Naturally, by Peggy O’Mara, p. xviii) And: “Circulating throughout your body are natural hormones that relax you when stressed and relieve pain when you hurt…endorphin levels go up during contractions in active labor and are highest just after birth…endorphin levels were found to be highest during vaginal deliveries, less high in cesarean births in which the mother had also labored, and lowest in cesarean births performed before mother’s labor had begun…As an added benefit, endorphins stimulate the secretion of prolactin, the relaxing ‘mothering’ hormone that regulates milk production and gives a woman a boost in interacting with her baby. Researchers believe that it is a combination of these hormones that contribute to the ‘birth high.’ (The Birth Book, by William Sears, M.D. & Martha Sears, R.N., p. 138)
3) Myth. “In several large studies dealing with mothers’ attitudes toward their birth experiences, researchers have found that the most important factor contributing to a positive perception of delivery is the mothers’ sense of control: the feeling that they participated actively in the decisions that were made and that they were not merely a passive object of care… It appears that any time a woman is forced into a passive, helpless, sick role, she feels a lowered sense of self-esteem. In particular, women who are given significant amounts of drugs or who are separated from their baby soon after birth often feel that they have been cheated or failed and have questions about their ability to mother. Research has shown that whenever a birth, either vaginal or cesarean, causes a mother to doubt herself, she is likely to carry this over to her feelings about her baby and her ability to care for it.” (The New Well Pregnancy Book, by Mike Samuels, M.D. and Nancy Samuels, p. 371)
And: “A good birth is not just a matter of safety, or of achieving the goal of a live and physically healthy mother and baby. We want birth to be as safe as we can make it, but should not take it for granted that delivery in an operating room is necessarily the best way to achieve this. Childbirth has to do with emotions as well… Everything that happens during a birth influences the way in which a woman perceives herself afterward. It can affect the relationship between her and the baby, and between both parents and their baby, for years after the actual birth.” (Birth Your Way, by Sheila Kitzinger, p. 8)
4) True. “…it is good to know that most women in labor need to be able to change position and to move around freely. Movement greatly helps cervical dilation during the early part of labor and helps bring the baby into the most advantageous position for passage through the pelvis…If your movement is not hampered by intravenous lines, electronic fetal monitoring, and most forms of epidural anesthesia, you will generally have an easier time assuming the positions that favor cervical dilation and, when that is complete, descent of your baby.” (Ina May’s Guide to Childbirth, by Ina May Gaskin, p. 226)
5) True. “Procedures that Affect Bonding: Interventionists may briefly take the baby to weigh, measure, and examine it; suction out its nose and throat; and give a vitamin K shot and eyedrops. Some hospitals may routinely separate the newborn from its mother and place it in a nursery for variable amounts of time. This procedure does not allow bonding to take place in the critical period of the first hour after birth.” (The New Well Pregnancy Book, by Mike Samuels, M.D. and Nancy Samuels, p.198)
6) True. “Now it is recognized that the events of the first hour play a key role in the attachment that develops between parent and infant…Mothers who had greater early exposure to their infants showed more soothing, fondling, and eye-to-eye contact with their babies at one month and still showed more soothing behaviors at one year…This study provided the earliest evidence of a sensitive period as the time ‘during which the parents’ attachment to their infant blossoms… [and during which] complex interactions between the mother and infant help lock them together… A review of the studies at this time supports the view that extended contact after birth has positive effects, has no negative effects, and may significantly affect breast-feeding and subsequent behavior of a mother toward her baby. Therefore, it is advisable for a hospital to promote bonding.” (The New Well Pregnancy Book, by Mike Samuels, M.D. and Nancy Samuels, p. 434-436)
7) Myth. “It is also important to mention that when a mother is not able to bond because of illness or hospital policy, she should realize that she can overcome any effects of the separation. Human behavior is flexible enough and motherhood powerful enough to create love easily through later contact.” (The New Well Pregnancy Book, by Mike Samuels, M.D. and Nancy Samuels, p. 436)
8) Myth. “There are a number of problems generated by this position: (1) it focuses most of the woman's body weight squarely on her tailbone, forcing it forward and thereby narrowing the pelvic outlet, which both increases the length of labor and makes delivery more difficult (Balaskas and Balaskas 1983:8); (2) it compresses major blood vessels, interfering with circulation and decreasing blood pressure, which in turn lowers oxygen supply to the fetus (for example, several studies have reported that in the majority of women delivering in the lithotomy position, there was a 91% decrease in fetal transcutaneous oxygen saturation (Humphrey et al. 1973, 1974; Johnstone et al. 1987; Kurz et al. 1982); (3) contractions tend to be weaker, less frequent, and more irregular in this position, and pushing is harder to do because increased force is needed to work against gravity (Hugo 1977), making forceps extraction more likely and increasing the potential for physical injury to the baby; (4) placing the legs wide apart in stirrups can result in venous thrombosis or nerve compression from the pressure of the leg supports, while increasing both the need for episiotomy and the likelihood of tears because of excessive stretching of the perineal tissue and tension on the pelvic floor (McKay and Mahan 1984). (excerpt from Birth as an American Rite of Passage, by Robbie Davis-Floyd, PhD, http://www.birthingnaturally.net/barp/lithotomy.html)
9) Myth. “In fact, the risk of a woman in this country dying from maternal mortality… has not decreased in more than 25 years…The data also suggest an increase in recent years in the number of women dying during pregnancy and birth in the US. We have known for some time that maternal mortality in the US is underreported… ‘The actual pregnancy-related death rate could be more than twice as high as that reported in 1990.’” (“Revealing the Real Risks: Obstetrical Interventions and Maternal Mortality”, by Marsden Wagner, Mothering Magazine Issue 118, May/June 2003.)
10) Myth. “…inducing for exceeding your due date is a textbook case of how mainstream obstetric care keeps narrowing the definition of normal until practically no one fits, which then creates the ‘need’ for intervention…there are problems with the due date itself…when researchers in a 1990 study followed a group of healthy, white women, they discovered that pregnancy in first-time mothers averaged eight days longer than this [40 weeks], and the average was three days longer in women with prior births…ultrasonography…does not reliably establish due dates. Even in the first trimester, the date is plus or minus 5 days. This means the actual due date falls within a 10-day window…While even the forty-two-week limit isn’t sound, in recent years, the ‘time’s up’ date has backed up to forty-one weeks, with some researchers recommending forty weeks. Based on the above study, first-time mothers are not only not ‘late’ at forty-one weeks, they haven’t even reached the average pregnancy length.” .” (The Thinking Woman’s Guide to a Better Birth, by Henci Goer, p.55-56)
11) Myth. Homebirth is actually safer than hospital birth. “Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.” (Abstract from Outcomes of planned home births with certified professional midwives: large prospective study in North America, British Medical Journal Dot Com, http://bmj.bmjjournals.com/cgi/content/abstract/330/7505/1416)
12) True. “The pain and stress of normal labor have value for both you and your baby…Pain guides you. Usually, the positions and activities you find most comfortable are also those that promote good labor progress to help shift the baby into the best position for birth. Your body responds to labor pain by secreting adrenalines and endorphins. Adrenalines give you stamina. Endorphins relieve pain and elevate mood…The normal pain and stress of labor also benefit your unborn baby. The stress hormones produced in response to labor trigger the final preparation of your baby’s lungs to breathe air, mobilize glucose for energy, and, by shunting your baby’s blood away form the limbs and to the brain and heart, protect your baby against lack of oxygen during labor.” (The Thinking Woman’s Guide to a Better Birth, by Henci Goer, p.137-138)
13) Myth. “Labor will hurt. Probably a lot. But whether this is negative is another matter. Pain and suffering differ, as anyone who engages in activities demanding strength and endurance can tell you. A laboring woman can be in a great deal of pain, yet feel loved and supported and exhilarated by the power of the creative forces flowing through her body and her ability to meet labor’s challenges. Conversely, a woman with an epidural may experience no pain, yet feel intensely distressed because she feels ignored or helpless. Of course, pain and suffering may coincide, as many women who have labored will hasten to tell you. Still, the key seems to be who controls the pain medication decision. Pain becomes a drawback only when pain medication is being withheld or when a woman is not getting the support and help she needs to master it… the pain and effort are gloriously rewarded, making labor more like running a marathon or climbing a mountain than experiencing an injury or illness.” (The Thinking Woman’s Guide to a Better Birth, by Henci Goer, p.139-140)
14) Myth. “…ultrasound weight estimates are so inaccurate that if your caregiver suspects a large baby, he or she could equally well flip a coin as order a sonogram. Moreover, studies comparing induced women with women allowed to begin labor on their own all show that induced women have more cesareans and equal numbers of shoulder dystocias…It turns out that shoulder dystocia isn’t very tightly tied to weight, and while it’s a dangerous situation, handled properly it rarely results in permanent injury.” (The Thinking Woman’s Guide to a Better Birth, by Henci Goer, p.139-140)
15) Myth. “Many studies agree that fewer than 10 percent of women require labor induction for medical reasons… The U.S. induction rate doubled between 1989 and 1998 (from 9 percent to 19.2 percent) and is apparently still rising, although there was no corresponding rise in the size of babies, the length of pregnancies, or the incidence of maternal illnesses requiring induction. With so many inductions taking place, a common misperception has arisen that obstetricians are now able to start labor at will, with no disadvantages from the procedures used…Labor involves an extremely complex interplay of hormones that cannot be altered without upsetting the normal physiological pattern.” (Ina May’s Guide to Childbirth, by Ina May Gaskin, p. 207-208)
16) True. “In three large U.S. studies totaling seventy-eight thousand women in labor who ate and drank freely, there was not one case of aspiration. The anesthesia-related maternal mortality rate in England and Wales, where oral intake in labor is usual, is identical to the rate in the United States, where it is not. Nor is aspiration a problem in other countries that permit eating and drinking in labor, such as Japan and the Netherlands.” (The Thinking Woman’s Guide to a Better Birth, by Henci Goer, p.139-140)
17) True. “Cesarean surgery is just as risky as any other major abdominal surgery for the mother—a considerably higher risk for her than vaginal birth. With repeat cesarean, she has three times the chance of dying and roughly five to ten times the risk of suffering complications such as infection; dangerous blood loss; transfusion; complications from anesthesia; injuries to the bladder, intestines, or urethra; and future bowel obstruction, hysterectomy, ectopic pregnancies, infertility, and dangerous placental complications. The more cesareans a woman has, the more the risks to her increase…According to Marsden Wagner, a neonatologist and perinatal scientist who worked for WHO for fifteen years, if women lose the option of VBAC, we can expect there to be at least twelve maternal deaths every year in the United States because of unnecessary cesarean section, not to mention thousands of cases of injury and illness. VBAC on the other hand, is safe when other risk factors, such as Cytotec or other prostaglandin induction, aren’t added. The risk of uterine rupture in a woman with a previous transverse lower-uterine incision (the safest location on the uterus for incision) has always been and remains about 0.5 percent.” (Ina May’s Guide to Childbirth, by Ina May Gaskin, p. 294-295)
18) Myth. “The belief that a cut made by scissors heals better than a natural tear has failed the research test. It is true that a surgical cut is easier to repair than a jagged tear, but since many women suffer no tears and need no stitches at all, why cut? And any smaller tears that do occur heal more quickly and better (sometimes without any stitching) than the larger episiotomy incisions, which include more layers of muscle than most tears…Women usually heal more quickly and experience less discomfort with their own tears than with an episiotomy.” (The Birth Book, by William Sears, M.D. & Martha Sears, R.N., p. 89-90)
19) True. “Now, a Swedish study has produced evidence that ‘caine drugs, the family of anesthetics used in epidurals, do, in fact, profoundly disturb instinctive newborn breastfeeding behavior…In the group not exposed to pain medication, all ten newborns successfully self-attached and suckled. Only two, or one-third, of the six babies in the pudendal block group, and three, or one-quarter, of the twelve babies exposed to narcotic, epidural anesthetic, or some combination of narcotic, pudendal block, and epidural block, did the same. Moreover, one of the two successful breastfeeders in the pudendal block group was helped by the mother and one of the four in the combination group suckled, but was not properly latched onto the nipple. In addition, the babies of medicated mothers cried substantially more, which the authors attributed to frustration. They also ran significantly higher temperatures, which could have been due to crying and is disadvantageous in that it means a greater expenditure of calories.” (“Epidurals: Can They Impact Breastfeeding?” by Henci Goer, http://parenting.ivillage.com/pregnancy/plabor/0,,h1nz-1,00.html)
“Epidural labor analgesia is only one of the many intrapartum interventions that may affect breastfeeding. Interventions such as maternal intravenous fluids, vacuum extraction, operative deliveries, and infant oral suctioning may also alter suckling.(16) Sorting out which intervention has the greatest impact on suckling is the next step for researchers in this area. Epidural labor analgesia puts mothers and infants at risk for a variety of health problems that are not encountered in an unmedicated labor. Added to these is evidence that epidurals hinder early breastfeeding. Instead of incurring the risks of labor epidurals, women may use non-pharmacological methods of pain control that do not hinder suckling.” (Epidurals and Breastfeeding, Jan Riordan, RN, EdD, IBCLC, FAAN, Wichita, Kansas from Breastfeeding Abstracts, November 1999, Volume 19, Number 2, pp. 11-12, http://www.lalecheleague.org/ba/Nov99.html)
20) Myth. “Recent research has not borne out the case for routine continuous fetal monitoring…First, it has been found that a majority of fetuses have heartbeat irregularities during labor and are still normal. This means that the tracings are very difficult to interpret…Studies have shown that if tracings are shown to a group of experts, they agree only part of the time…Evidence from all the monitoring trials still shows no advantage for continuous electronic fetal monitoring over intermittent fetal monitoring…The review of all studies to date gives the evidence that continuous electronic fetal monitoring has no clear benefit to the fetus. Continuous electronic fetal monitoring does, however, definitely raise the mother’s chances of having a cesarean section by about one third. In addition, the monitor changes the relationship of the caregivers to the mother…” (The New Well Pregnancy Book, by Mike Samuels, M.D. and Nancy Samuels, p.339-340)
Comments
Add Comment