Be a Savvy Birth Consumer Part I

City Pages February 2014 Article 
http://issuu.com/citypageskuwait/docs/cp_feb_2014_online
* see page 34

Do you want to get the most out of your birth experience? Be savvy. Understand the language used during birth and make informed decisions.

While birth is a normal process and research shows that many of the routines at hospitals today are not necessarily beneficial and may even be harmful[1], the fact remains that birth today has become intervention-intensive and the majority of moms in Kuwait will likely experience one or more intervention during their birth. Most of the statistics for these interventions are not publicly available in Kuwait, so I will use the most recent statistics for women in America. The most recent Listening to Mothers Survey[2] showed that the majority of women surveyed experienced one or more of the following interventions during labor:

•   Continuous electronic fetal monitoring (EFM)(93 percent)

•   Restrictions on eating (87 percent)

•   IV fluids (86 percent)

•   Restrictions on drinking (66 percent)

•   Episiotomy (35 percent)

•   Epidural anesthesia (63 percent)

•   Artificially ruptured membranes (55 percent)

•   Artificial oxytocin augmentation (53 percent)

•   Cesarean surgery (24 percent)

What would those numbers look like in Kuwait? Perhaps some would be higher and some would be lower. The point is that you should be familiar with some technical medical terminology before you give birth. In the next two articles we will provide you with a brief explanation of the terms you should be familiar with before you give birth:

Continuous Electronic Fetal Monitoring (EFM):

You know the machine they hook you up to by wrapping stretchy cloth around the top and bottom of your belly to hold in place two little circles? Yep, that is the EFM machine. The EFM was designed to continuously monitor the baby’s heart rate in an effort to detect fetal distress and prevent injury. Sounds innocuous, yes? However, research shows that one of the unintended consequences of the routine use of continuous EFM is an increase in cesareans without any improved outcomes for babies.[3] (Translation: harmful for mom, no benefit to baby.)

The key words are: Routine and Continuous. The WHO and ACOG (American College of Obstetrics & Gynecologists) recommend intermittent monitoring with a Doppler or stethoscope during labor for low-risk healthy moms, every 30 minutes during active labor and every 15 minutes during pushing.[4] This also allows mom to be active and upright during labor which will help keep her comfortable and move things along.

Research shows that there are benefits to continuous EFM if you are using Syntocin/Pitocin, have an epidural, your baby is experiencing changes in heart rate, or if your or your baby are not in good health. But if you are a healthy low-risk mom, research shows that you would benefit more if your doctor monitored you and your baby intermittently with a Doppler or stethoscope.

Restrictions on Eating and IV Fluids:

OK, so doesn’t it sound a little crazy in the same sentence: Restricting normal eating and drinking, but then trying to keep mom nourished through an IV? The practice of restricting moms eating and drinking began when the majority of moms gave birth under anesthesia and the accompanying fear of aspiration. In addition, studies have confirmed that that are no medical benefits to routinely restricting eating and drinking during labor.[5] Instead it deprives a woman of energy when she needs it most. In addition, routinely hooking up mom to an IV during labor restricts movement, may adversely impact labor progression if mom becomes over-hydrated, and increases risk of low blood sugar in babies.[6] The WHO and ACOG recommend fluids be offered to mom by mouth, and the routine use of IV fluids be eliminated. If you are a healthy low-risk mom ask your doctor about a hep-lock, an IV started in your hand/arm that is capped off so that it is in place and available but does not interfere with mom’s movement and normal labor progression.

Episiotomy:

This is a controversial procedure with no easy explanation. Sometimes when moms are pushing their babies out, the doctor makes an incision to widen the birth canal (yeah- they cut down there!) This is a controversial procedure because research has provided 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 (these are all reasons cited by doctors for the routine use of episiotomies).[7][8] Research does show that routine or liberal use of episiotomy is likely to be ineffective and harmful to mother[9] (the list of risks to mom are too long for this article). In addition, the WHO recommends eliminating routine or liberal episiotomy.

Of course there are times an episiotomy would be beneficial. For example, if a change of position or taking a break from pushing does not resolve signs of distress in your baby, or if your baby is very large or in an unusual position (again, first try changing your positions to see if it helps) an episiotomy might be necessary. If you want to avoid an episiotomy, discuss your concerns with your doctor before hand and choose your care provider carefully, push in an upright position that lets your birth canal stretch gently as your baby descends, change positions often while you’re pushing, push spontaneously when you feel urges rather than directed, and remember your body knows how to give birth and be patient!

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[1] Lamaze Healthy Birth Practice 4: Avoid Interventions That Are Not Medically Necessary, The Official Lamaze Guide: Giving Birth With Confidence

[2] Declerq ER, Sakala C, Corry MP, Applebaum S, Herrlich A. Listening to Mothers℠III: Pregnancy and Birth. New York: Childbirth Connection, May 2013

[3] Goer, H., Leslie, M. S., & Romano, A. (2007). The Coalition for Improving Maternity Services: Evidence basis for the ten steps of mother-friendly care. Step 6: Does not routinely employ practices, procedures unsupported by scientific evidence. The Journal of Perinatal Education, 16(Suppl. 1), 32S– 64S.

[4] American College of Obstetricians and Gynecologists [ACOG]. (2005). ACOG practice bulletin #70: Intrapartum fetal heart rate monitoring. Obstetrics and Gynecology, 106(6), 1453–1460.

[5] Goer, et al, (2007)

[6] Enkin, M., Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., et al. (2000). A guide to effective care in pregnancy and childbirth. New York: Oxford University Press.

[7] Goer et al, (2007)

[8] Hartmann, K., Viswanathan, M., Palmieri, R., Gartlehner, G., Thorp, J., & Lohr, K. N. (2005). Outcomes of routine episiotomy: A systematic review. Journal of the American Medical Association, 293(17), 2141–2148.

[9] Klein, M., Gauthier, R., Robbins, J., Kaczorowski, J., Jorgensen, S., Franco, E., et al. (1994). Relationship of episiotomy to perineal trauma and morbidity, sexual dysfunction, and pelvic floor relaxation. American Journal of Obstetrics and Gynecology, 171(3), 591–598.