Home vs. Hospital
Robert Gale
In article <smm$95111...@cony.gsf.de> Sgu...@ix.netcom.com (Steven Gulie) writes:
> Rather a large number of studies have been done on this. To date, the
> studies show, without exception, a lower rate of mortality and morbidity
> for mothers and infants in all risk categories with home birth.
Do any of these control for who was attending at that hospital (midwife or
MD)? Does any study show that a home birth is safer than a hospital birth
attended by a MIDWIFE?
-Robert Gale
Robert Gale
In article <smm$95111...@cony.gsf.de> h...@chinook.halcyon.com (Henry W. Meyerding) writes:
> Fought with doctors who said "baby is breathing a little fast,
> we want to do some tests." Forced to go to major medical
> center 40 miles away and undergo tests . . . Baby was fine,
> despite their best efforts . . .
>
> I guess you could say we learned our lesson.
Anyone who ridicules aggressive medical care for newborns in distress has
never experienced the heartache of a sicknewborn baby. Illness in
newborns progress rapidly. If untreated, the result is frequently tragic.
Rapid breathing in a newborn usually subsides on its own, but is also not
uncommonly a sign of pneumonia, if not something much worse. How would
you have felt if you ignored your doctor's advice and your baby died?
Nobody can bring studies showing that sick newborns are better off without
medical care, because this is false. Before modern medicine, a very
significant percentage of newborns died before the age of 30 days.
A newborn is vulnerable! Listen to your doctor! If you don't trust her,
get another one!
-Robert Gale
Robert Gale
In article <smm$951111...@cony.gsf.de> eaan...@alpha.delta.edu (Elizabeth Ann Andrews) writes:
> I don't really have any stats either except that my sister has 4
> children, the first she had in the hospital, and ended up with numerous
> stitches, and a horrible infection because the doctor left a sponge in
> her. The other three were all home births, and there were minimal
> stitches with the second and third, and no stitches with the fourth. . .
>
> I had both my children at the hospital, but if I ever have any
> more, I will have them at home. I am too tired of the medical interference.
Your logic is flawed. Her problem with the first birth was the
practicioner, not the place.
-Robert Gale
Elizabeth Ann Andrews
Robert Gale (ga...@hardy.hpc.pko.dec.com) wrote:
: Your logic is flawed. Her problem with the first birth was the
: practicioner, not the place.
If my logic is flawed, how do you explain problems with THREE
different practitioners, in TWO different states and THREE different
hospitals (for three of the six children), and minimal to no problems
with TWO certified nurse midwives in two different states (for the other
three)? The flawed logic is in thinking that pregnancy is a disease to
be 'treated' instead of a natural process. Birth is very personal to
every woman, and I was only giving my opinions and insights to that person.
--
**************************************************************
* =/\= Liz Andrews (eaan...@alpha.delta.edu) *
* Mommy to Robbie (1/13/93) & Mum-Mum-Mum to Ryan (11/21/94) *
**************************************************************
Robert Gale
> Robert Gale (ga...@hardy.hpc.pko.dec.com) wrote:
>
> : Your logic is flawed. Her problem with the first birth was the
> : practicioner, not the place.
> If my logic is flawed, how do you explain problems with THREE
> different practitioners, in TWO different states and THREE different
> hospitals (for three of the six children), and minimal to no problems
> with TWO certified nurse midwives in two different states (for the other
> three)? The flawed logic is in thinking that pregnancy is a disease to
> be 'treated' instead of a natural process. Birth is very personal to
> every woman, and I was only giving my opinions and insights to that person.
Elizabeth,
Sorry for the strident tone--birth is indeed very personal.
What I meant was that her problem was using OBs instead of midwives. It
has nothing to do with being at the hospital. The problems that you
describe do not happen at midwife-attended hospital births.
-Robert Gale
Robert Gale
In article <smm$95112...@cony.gsf.de> fred...@GDEsystems.COM (Don Fredricks) writes:
> >Anyone who ridicules aggressive medical care for newborns in distress has
> >never experienced the heartache of a sicknewborn baby. Illness in
> >newborns progress rapidly. If untreated, the result is frequently tragic.
>
> This is one of the best arguments I've yet heard in favor of home
> birth (as opposed to hospital birth, regardless of who attends).
> Robert, you must know that pathogens are present in hospitals that
> cannot be found anywhere else. This leads to an increased likelihood of
> illness in the hospital-born baby and in the mother, who may have many
> pathways for infection opened up by the unnecessary interventions
> accompanying hospital birth. Prevention is the key.
There are risks to home birth, and risks to hospital birth. The real
issue is RELATIVE risk--which is a riskier location, home or the hospital?
What is more of a risk, contracting a secondary illness because of the
proximity to very sick people (which won't happen at home), or severe
hemmoraging of the mother (which can be controlled only in the hospital)?
My guess is that the hospital is the safer location (provided, of course,
that the hospital birth is attended by a midwife, not an OB), for two
reasons:
1) I would guess that hemmorage in the mother happens more frequently
than newborns getting sick because of unusual pathogens in the
hospital (medical practicioners: am I right?).
2) Hemmoraging can be a grave emergency that does not allow time for
transport. Whereas if a newborn does get sick in the hospital, the
facilities to care for the baby's illness are right there.
Of course, location is a minor risk factor compared with the type of
practicioner. Unless the mother or baby is known in advance to have
special problems, a midwife-attended birth is safer than an OB-attended
birth, regardless of location.
-Robert Gale
ewe...@execpc.com
In article <smm$95112...@cony.gsf.de>, <ga...@agway.hpc.pko.dec.com>
writes:
> 2) Hemmoraging can be a grave emergency that does not allow time for
> transport.
Dear Robert -
Why do you think hemorrhage cannot be handled at home?
If a woman (or her husband) has great fear about homebirth,
they certainly should not birth there.
I've been following your comments, and wondering why you have
such a strong opposition to homebirth.
Edie
Apprentice Midwife
Training to do homebirth because I completely believe it is a
safe alternative for those who choose it.
P.S. Although I am (obviously) a midwifery proponent, we have to
remember that just because someone calls him or herself a midwife
(whether attending births in home or hospital) it does not
mean that they have a philosophy of non-intervention in the
birth process. There are many types of intervention, and each
midwife practices in a way that she feels is best. Client and
midwife need to communicate their expectations to one another.
Elizabeth Ann Andrews
Robert Gale (ga...@agway.hpc.pko.dec.com) wrote:
: Sorry for the strident tone--birth is indeed very personal.
:
: What I meant was that her problem was using OBs instead of midwives. It
: has nothing to do with being at the hospital. The problems that you
: describe do not happen at midwife-attended hospital births.
:
Robert,
I am sorry to have to disgree with you again, by my first birth was
done in the hospital with a certified nurse midwife. She was good, but
she was not always there, so I would find myself fighting with the nurses
for what I knew was right for me. These problems occured both during and
after labor. It was very stressful for me, and I believe also for my
son. I had nurses telling me that I was breathing wrong, that I didn't
know what I was talking about, and that I was taking chances with my
baby's life while in labor; and then telling me where to sit and when to
nurse the baby after. One nurse even tried to convince me that putting a
bottle nipple over my nipple would help my son to nurse because my breasts
are large.
My second birth was in a different hospital, but was better only
because I was older and more prone to stand up for myself. I had an OB,
but he didn't arrive until 45 minutes after the baby was born, and I had
a lay midwife, who actually ended up delivering the baby. But still I
eventually had to sign a release form taking all responsibility for
complications, because the nurses would NOT leave me alone. The reason
the doctor was so late is because the nurse decided that I was not ready
to have the baby and told him not to hurry. Just after she hung up, I
delivered the head. She later lied to the doctor telling him that the
midwife was encouraging me to deliver before he arrived. My doctor was
wonderful. That was not the problem. He knew exactly how I wanted the
birth to be, and had it in my file, and supported all my reasoning for
it. The problem id that the staff in the hospitals usually don't care.
It interferes with their birthing techniques. I had a birth plan signed
by my doctor, when I handed it to the nurse, she did not read it. I had
a problem which required me to eat about every two hours, but the
hospital policy is that you can not eat during labor, unless your doctor
specifies otherwise. Mine did, both verbally and in my signed birth
plan. In front of the doctor the nurse was very agreeable. Five minutes
after he left, I asked for something to eat and was told by that same
nurse that I could not have anything. So I don't see the problem as you
do of being doctor vs. midwife. If doctors still delivered at home,
there would be less problems. But until hospitals are ready to loosen
their grip on women in labor, those of us who want to be in control of
our own births are better off staying at home.
Colleen Proctor
I am a senior nursing student at Humboldt State University in Calif. and
plan to pursue graduate work in midwifery. I also have given birth to
healthy babies at home(x2) and in the hospital(x5). Safety is the
primary consideration here, if you have an experienced midwife who is in
tune with your wishes and prepared (with oxygen and pitocin) to handle a
minor emergency, than home is probably safer. I had the same lay midwife,
an RN, for births 1 and 3 at home and was very satisfied with the
experience. Birth 2 was 3 weeks overdue and came the day after the
midwive's cutoff date, we understood her reasons and had an uneventful
hospital birth although it was not as nice as home. Our 3rd son died of
sids at 6 weeks, and my husband felt more comfortable using a hospital
setting for our next birth, with a CNM who was very empathetic and worked
with us to ensure the birth happened our way, with our other children
present. We used the same midwife for the next two births also. With
the seventh, we considered having a home birth as our CNM was due to be
out on maternity leave during the EDC, but I had a persistently low iron
level and we used another CNM, also a very positive experience. We were
able to have my husband cut the cord at all births and give each child
their first bath LeBoyer style with warmed sterile H20 thanks to the
advocacy of the CNM's. As I said before, make sure that safety needs are
addressed first, then communication nd empathy between both parents and
the health practitioner you choose. Setting is NOT the priority here.
Sincerely,
Colleen M. Proctor, SN, HSU
[cm...@humboldt.axe.edu]
Ask me in June how school is going!!!
Ronnie Falcao
Robert Gale <ga...@agway.hpc.pko.dec.com> wrote:
> 2) Hemmoraging can be a grave emergency that does not allow time for
> transport. Whereas if a newborn does get sick in the hospital, the
> facilities to care for the baby's illness are right there.
Yes, hemorrhage can be a grave emergency - fortunately, all of
the ways of stopping a hemorrhage (short of a hysterectomy)
available in the hospital are also available at home.
Regarding the advisability of relying on hospitals as a
place to treat newborns for hospital-acquired illnesses:
Extracted from the on-line AP news feed Nov 20 1995:
" Ordinary infections that used to be cured with penicillin or
similar drugs now cause serious illness, particularly among
patients in hospitals, where bacteria flourish, and among those
with weak immune systems. "
. . .
" The American Society for Microbiology has called drug resistance
a public health emergency. "
. . .
" Every year, Cannon writes, 60,000 to 70,000 people die from
hospital infections, half of which are caused by ``drug-resistant
superbugs.'' "
Does anyone have any statistics on how many of these deaths
were newborns? One would think they'd represent a rather high
proportion, given their immature immune systems.
I couldn't find the information in Williams Obstetrics, but
I did find the interesting statistic that 7% of maternal deaths
are caused by anesthesia (used exclusively in hospitals) and
another 3.5% are caused by infection, which is a significantly
higher risk in the hospital than at home.
>Of course, location is a minor risk factor compared with the type of
>practicioner. Unless the mother or baby is known in advance to have
>special problems, a midwife-attended birth is safer than an OB-attended
>birth, regardless of location.
Hmmm, aren't most hospital-based midwives required to have
obstetric backup and malpractice insurance? The protocols
prescribed by these seemingly monolithic forces are often
cited as the cause of the epidemic of unnecessary cesareans.
I certainly agree that hospital midwives are likely to
provide more personalized care than obstetricians and
will see the better outcomes associated with reduced
intervention, but aren't they still constrained
by obstetric protocol?
- Ronnie Falcao
Ronnie Falcao - labor coach, hypnotherapist,
homebirth midwife in training
Mountain View, near San Francisco, CA, USA
fal...@cs.stanford.edu
BabyRNC
>From the message of the pathogens and nosocromial infections that are at
risk in the hospital setting. Although I do advocate the home birth
choice, the fact of the matter is that the infants and mothers are pushed
from the hospitals so fast that the risk of the nosocromial infection is
greatly dimished. Also, what would you say to the family that has the flu
or colds that have been running rampid this season? Isn't the risk of the
mother or infant contracting this as bad as the hospital?
Ben Warner
>A newborn is vulnerable! Listen to your doctor! If you don't trust her,
>get another one!
>
I am speaking for myself now, but perhaps others will echo this
feeling. We chose a home-birth midwife (after MUCH
research and study) because the risks associated with
a hospital birth (and hospital procedures!) are greater than
at a home birth. Our first two children were born in a
hospital. After fighting with the bureaucratic nonsense
(and worse than nonsense) that threatened our
children, and being told time and again "it's
hospital policy - all hospitals do this" I firmly feel
that a hospital birth does not sufficiently protect the
child or the mother. Examples: Our newborns were
bathed immediately after birth, then were taken away
because they were "chilled," which meant they had to stay under
heat lamps to warm up. What chilled them? The immediate
bath-after-birth. Why was this done? "It is hospital
policy to bathe all newborns immediately after birth to
decrease the risk of HIV infection among hospital
staff." Never mind that we don't have it. Never mind
that it hurts the baby. Never mind that our baby is handled in
plastic gloves all day long. Check out "hospital policies" -
routine episiotomies, 25% C-section rates, poking and
pinching and stabbing the newborn then encouraging the baby
to cry, force feeding sugar water into the baby after
birth, etc. They hurt the baby! And I didn't mention
iatrogenesis, misplaced charts, overworked and hurried
nurses, students, assistants, etc. who refuse/don't have time
to look at the chart, then do the exact opposite. The loss
of personal power and dignity, the medicalization of
the entire birth, the rushing of the birth to fit the hospital
schedule.... I could go on forever.
Having a midwife there means (1) constant companionship
and (2) a lonely voice to fight the bureaucratic, lawsuit- and
insurance-driven monster that is a hospital in our current medical
system. It does not guarantee that her voice will be heard, that
unnecessary and harmful tests will not be done, that your wife
and child will not be hurt by the experience. It helps to
have a midwife there, but her presence is insufficient. If you
can, get home for the birth! We did and it was wonderful!
I'll get the sources of the research for you on midwives.
The history of midwifery is interesting.
Ben Warner
Jacksonville, FL
BabyRNC
>What is more of a risk, contracting a secondary illness because of the
>proximity to very sick people (which won't happen at home), or severe
>hemmoraging of the mother (which can be controlled only in the hospital)?
>
>My guess is that the hospital is the safer location (provided, of course,
First off, as a practitioner in the Maternal / Child field for 8 years
(rather a short time in the grand scheme of things) and a certified
Neonatal High - Risk Nurse, the OB / GYN floors of most all hospitals are
considered "clean" units. This means that there are not patients on these
floors who are considered "dirty" (cancer pts, etc..). Also, remember
with the ever shortening lengths of stays this risk of infection is
greatly diminishing.......
Post partum hemmorhaging is a very rare case indeed, and if the patient is
properly educated in the home enviroment (to check their own fundal
involuting) they can assist themselves in moving to the proper medical
environment as quickly as a person in the hospital (remember, the staff is
not as full as it used to be and teaching is not as good)
Baby RNC
[ moderator's note: ]
I added an attribution line ("Robert Gale ... wrote:") and prepended the
">" markers to make a clear distinction between quoted and original material.
I hope you don't mind this interference of mine, but I felt that your article
could easily be misunderstood by a casual reader who didn't recognize Robert's
statements as his.
Vicky Hansen
BabyRNC (bab...@aol.com) wrote:
: Post partum hemmorhaging is a very rare case indeed, and if the patient is
: properly educated in the home enviroment (to check their own fundal
: involuting) they can assist themselves in moving to the proper medical
: environment as quickly as a person in the hospital (remember, the staff is
: not as full as it used to be and teaching is not as good)
This post really struck a chord with me. I bled profusely for a full month
after my first birth but did not realize that was unusual so I did not
question it. Noone asked about it -- maybe a midwife would have noticed?
It was only after my second child that I found out it might have been a
problem since I did not bleed for even a full day after that one. Being in
a hospital does not necessarily protect a person from medical problems!
Robert Gale
> Hmmm, aren't most hospital-based midwives required to have
> obstetric backup and malpractice insurance? The protocols
> prescribed by these seemingly monolithic forces are often
> cited as the cause of the epidemic of unnecessary cesareans.
> I certainly agree that hospital midwives are likely to
> provide more personalized care than obstetricians and
> will see the better outcomes associated with reduced
> intervention, but aren't they still constrained
> by obstetric protocol?
Midwives who do hospital deliveries rely on their obstetric back-ups
chiefly when complications arise. Using obstetric back-up is analogous to
calling for transport to a hospital at a home birth. Except in very
remote locations, everyone uses some form of obstetric back up, whether at
home or in the hospital.
The main reason for the "epidemic of unnecessary cesareans" is OBs calling
for a c-section for "failure to progress". Women birthing with midwives,
whether at home or in the hospital, generally have very low c-section
rates. My impression is that a c-section rate in the range of 5% to 7% is
typical for midwife-attended hospital births, which is not too different
from the transport rate at home births.
As for malpractice insurance, it is widely known that midwives, wherever
they practice, are rarely sued for malpractice. OBs are frequently sued.
Besides, do midwives who attend home births practice without insurance?
All the evidence I have seen is that the c-section epidemic is related to
the type of practitioner, not to the location (home or hospital) of the
birth.
-Robert Gale
Robert Gale
> I am sorry to have to disgree with you again, by my first birth was
> done in the hospital with a certified nurse midwife. She was good, but
> she was not always there, so I would find myself fighting with the nurses
> for what I knew was right for me.
Why on earth would a midwife not advocate for her patient? Even if she
had to step out for a short time, she should take up your cause as soon as
she returns! It sounds like you had a very irresponsible midwife. My
impression is that this is unusual.
The only thing worse than having an irresponsible midwife at a hospital is
having an irresponsible midwife at a home birth.
-Robert Gale
Robert Gale
In article <smm$951124...@cony.gsf.de> ewe...@execpc.com writes:
> Why do you think hemorrhage cannot be handled at home? . . .
I am not a medical practitioner. I was told by my wife's CNM that the
risk of hemorrhage was one of the reasons she does not do home births.
Perhaps there is a difference of informed opinions on this subject.
> I've been following your comments, and wondering why you have
> such a strong opposition to homebirth.
I am not really an opponent of homebirth. I think it is clear that home
birth attended by a responsible midwife is statistically safer than the
option chosen by most women in the USA (OB-attended hospital birth).
The reason for my advocacy of midwife-attended hospital birth is to
counteract all of the unsupported claims that this option is less safe
than home birth. I have not seen one shred of evidence that
midwife-attended hospital birth is less safe than home birth. Does anyone
know of any studies that isolate the risk of midwife-attended hospital
births?
-Robert Gale
Elizabeth Ann Andrews
Robert Gale (ga...@wind.hpc.pko.dec.com) wrote:
:
: Why on earth would a midwife not advocate for her patient? Even if she
: had to step out for a short time, she should take up your cause as soon as
: she returns! It sounds like you had a very irresponsible midwife. My
: impression is that this is unusual.
: The only thing worse than having an irresponsible midwife at a hospital is
: having an irresponsible midwife at a home birth.
The problem was , she was a certified nurse midwife (I made a
mistake in one of my original posts. Those who attended the home births
in my family were lay midwives) and therefore was more like an O.B. than
a midwife. She agreed with most hospital policies for medical
intervention, but understood when I didn't want them. Being as tired and
vulnerable as I was at the time, she was able to talk me into most of it
though. About the only thing that was the way I wanted was that I didn't
have an episiotomy. As I did state before though, most of the problems
occur AFTER the birth. Then, the midwife or doctor is not required to be
there any more except for the next day checkup, and young, tired mothers
are left to fend for themselves against the hospital staff.
Robert Gale
In article <smm$951129...@cony.gsf.de> eaan...@alpha.delta.edu (Elizabeth Ann Andrews) writes:
> The problem was , she was a certified nurse midwife . . . and therefore
> was more like an O.B. than a midwife. She agreed with most hospital
> policies for medical intervention, but understood when I didn't want
> them.
CNMs, is this an accurate portrayal of typical CNM practice? The CNMs
that I know advocate for the birthing mother, and try to resist
unnecessary intervention.
-Robert Gale
wolf450
>plastic gloves all day long. Check out "hospital policies" -
>routine episiotomies, 25% C-section rates, poking and
>pinching and stabbing the newborn then encouraging the baby
>to cry, force feeding sugar water into the baby after
>birth, etc. They hurt the baby! And I didn't mention
>iatrogenesis, misplaced charts, overworked and hurried
>nurses, students, assistants, etc. who refuse/don't have time
>to look at the chart, then do the exact opposite. The loss
>of personal power and dignity, the medicalization of
>the entire birth, the rushing of the birth to fit the hospital
>schedule.... I could go on forever.
I agree. Our first child was born in the hospital - these are the
reasons our second was born at home. We refused to subject ourselves and
our children to this kind of treatment - we wanted the choices to have our
baby the way we saw fit. Who pays for the damages caused by these "health
services"? We do. Forever. We felt, after our first baby, that to have
a child in a hospital is irresponsible on the part of the parents. Parents
should become educated about birth and understand what is going on, rather
than just hand over the care of their most precious gift to some profit-driven
organization and a group of people they most likely have never seen, and, after
the damage is done, will never see again. I realize this seems like a radical
view, but when it comes to our children, we consider every possibility and
take responsibility for them. Our culture supports this less and less, as
huge unseen companies would prefer you left decisions about your life to them
in order to form a nice homogenous blob of consumers. We want to participate
in our own lives - this is why we had our second child at home. We want to
live normal lives by our own standards, and that is why we become more and
more often disillusioned by treatment we receive - especially medical.
Sherman Dorn
In article <smm$95112...@cony.gsf.de>,
ga...@agway.hpc.pko.dec.com (Robert Gale) wrote:
>There are risks to home birth, and risks to hospital birth. The real
>issue is RELATIVE risk--which is a riskier location, home or the hospital?
>What is more of a risk, contracting a secondary illness because of the
>proximity to very sick people (which won't happen at home), or severe
>hemmoraging of the mother (which can be controlled only in the hospital)?
With a major exception, I agree that this is the question.
>
>My guess is that the hospital is the safer location (provided, of course,
>that the hospital birth is attended by a midwife, not an OB), for two
>reasons:
[other material deleted]
What surprises me most about this thread is that no one seems to be talking
about different appropriate locations for different women. For women who do
not have high-risk factors, I would argue that home births or birth centers
would be safer in general. (Isn't the research on home births based on women
with no known major risk factors?) Yet there may be reasons to go to a
hospital for other women who have clear risk factors. There's no reason to
say "home births are better, period," or "hospitals are better, period."
__________
Sherman Dorn
Vanderbilt University
dor...@ctrvax.vanderbilt.edu
Tracy Lee Murphy
ga...@wind.hpc.pko.dec.com (Robert Gale) wrote:
>
>
>CNMs, is this an accurate portrayal of typical CNM practice? The CNMs
>that I know advocate for the birthing mother, and try to resist
>unnecessary intervention.
>
>-Robert Gale
>
partners the other worked directly in an office with an OB). The
partners had "sold out" in my opinion. Hospital policy came before
mother's wishes, fetal monitoring was more important than being upright.
But, from what I could tell that was the *only* way they could get their
hospital to let them practice there. The psychological and emotional
support was there, but I expected more (or less, if you want to look at
it that way) medically. They were NOT advocates for the mother.
The other midwife (who we eventually caught our son) practices in a
different hospital. She has earned the respect of the LD nurses and it
only takes her name appearing on the patient board for the nurses to
offer to take her patients. They know she's very good, has well prepared
mom's and absolutely doesn't want her patients "bothered". *My* care
during labor was perfect--all my labor support was there (five people),
no vaginal exams, and no monitor except when *I* wanted to rest in bed.
The only drawback was that she didn't explain to me that the *baby*
becomes a patient under a different person's care immediately after
birth. He was taken from me within three minutes; and the nurses
"forced" him to cry because "He hadn't yet and really needed to". Since
this otherwise wonderful midwife doesn't do homebirths and my insurance
won't cover it, who knows what we'll do when we approach this situation
(I hope) again next year.
tracy
--
tracy lee murphy * Rescue a Retired Racing Greyhound!
tr...@softedge.com * Pregnancy & Childbirth reading list.
and tom and thomas russell * Pointers on my home page.
and goblin and s'more * Greyhounds are FAST friends.
http://www-leland.stanford.edu/~tlmurphy *
AR midwife
In article <smm$951129...@cony.gsf.de>, bdwa...@jax.jaxnet.com (Ben
Warner) writes:
>Episiotomies and C-section rates have
>>to do with the practitioner, not the hospital
C-section rates have to do with epidural usage. If a doc doesn't
encourage natural childbirth, he is going to have higher section rates.
Deb Phillips
Midwife
Alexander M Tanter
AR midwife (armi...@aol.com) wrote:
: In article <smm$951129...@cony.gsf.de>, bdwa...@jax.jaxnet.com (Ben
: Warner) writes:
: Deb Phillips
: Midwife
I don't understand what you mean, Deb. I know lots of women who had epidurals
but only one other person (besides me) who had a section, all at the same
hospital and most of us had the same practice (tho not same providers every
time). My section was emergency after 26 hrs with my CNM and the other woman
who had a section was also emergency (I don't remember if she had a CNM, I
don't think she did). Most of the epidurals I know (!) had them to get sleep.
I know a woman who just had a baby and she had an epi that didn't fully take
but her OB never suggested a section....
Marcy Tanter
mummy to Robyn (7-4-93) and Laura (4-8-95)
Tracy Lee Murphy
it's Pitocin that leads to an epidural and then a section. Epidurals can
be a great way to "survive" a long, difficult labor. If given at the
right time and for the right reasons it can lead to a simple, vaginal
birth.
The unnatural contractions that Pitocin brings seem to lead to epidurals
to stop pain at unnatural points during labor. More than one of my
friends had a section after screaming for multiple epidurals after the
Pitocin drip was turned up every hour because they were "not
progressing".
One of the many reasons we decided against having our baby at the
"closest" hospital was their extremely high use of Pitocin and their
adherance to the "one centimeter per hour" dilation requirement. Instead
of imposing this requirement they now "offer it as an option". Yeh,
really? It's still "Active Management of Labor" without the
midwife/doula half of the perscription.
tracy
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Docvhobbs
TAN...@frost.oit.umass.edu (Alexander M Tanter) wrote:
I don't understand what you mean, Deb. I know lots of women who had
epidurals
but only one other person (besides me) who had a section, all at the same
hospital and most of us had the same practice (tho not same providers
every
time). My section was emergency after 26 hrs with my CNM and the other
woman
who had a section was also emergency (I don't remember if she had a CNM, I
don't think she did). Most of the epidurals I know (!) had them to get
sleep.
I know a woman who just had a baby and she had an epi that didn't fully
take
but her OB never suggested a section....
Marcy:
The information on epidurals and increased C-sec is well documented and
articulated in a book by Suzanne Arms called Immaculate Deception II. What
you have experienced is called anecdotal evidence, that is, what you have
seen. When you compile large numbers, they are compelling. Epidurals lead
to a rise in complications, including a higher incidence of fetal distress
(one "emergency"). I urge you, and most list readers who wish to
understand better these issues of home vs hospital, OB vs midwife to read
this book. The book is $16.95 and available widely in the US. One mail
order supplier is Cascade HealthCare Products, 141 Commercial St NE, Salem
OR 97301, 800-443-9942.
AnyaTeal
The increased rate of c/section with epidurals has to do with the fact
that once you get an epidural, you are basically on the road to a
multitude of other interventions. Many times ladies get epidurals and find
that their labor has slowed down, so then they get pitocin, which
increases the rate of section, not to mention that once you have an
epidural you can no longer walk or change positions. It is also very hard
to get effective pushing from a mom who has had an epidural because she
can no longer work with her body to get the baby out.
OB journals talk about the increased risk of section in ladies with
epidurals, I don't know the percentages offhand, but it is fairly high.
naomi pardue
AnyaTeal (anya...@aol.com) wrote:
> The increased rate of c/section with epidurals has to do with the fact
> that once you get an epidural, you are basically on the road to a
> multitude of other interventions. Many times ladies get epidurals and find
> that their labor has slowed down, so then they get pitocin, which
> increases the rate of section, not to mention that once you have an
> epidural you can no longer walk or change positions. It is also very hard
> to get effective pushing from a mom who has had an epidural because she
> can no longer work with her body to get the baby out.
I believe that much of this is dependent on WHEN the epidural is given.
Very early epidurals (before 3 cm.) have a high rate of other
interventions. Very late ones will obviously interfere with pushing.
The rate of interventions for epidurals offered in the middle part of
labor (4-6 cm.) are not as high. (I don't remember where I read this.)
> OB journals talk about the increased risk of section in ladies with
> epidurals, I don't know the percentages offhand, but it is fairly high.
(Oh, and in some cases the epidural can actually speed up labor, for
example, if the woman is so exhausted and tense that she is fighting the
contractions.)
Epidurals have their place. They are unquestionably overused, but they
have their place.
Naomi
emb...@pacificnet.net
> >: C-section rates have to do with epidural usage. If a doc doesn't
> >: encourage natural childbirth, he is going to have higher section rates.
> >
> >: Deb Phillips
> >: Midwife
> >
epidurals
> >but only one other person (besides me) who had a section, all at the same
> >hospital and most of us had the same practice (tho not same providers every
> >time). My section was emergency after 26 hrs with my CNM and the other woman
> >who had a section was also emergency (I don't remember if she had a CNM, I
> >don't think she did). Most of the epidurals I know (!) had them to get
sleep.
> >I know a woman who just had a baby and she had an epi that didn't fully take
> >but her OB never suggested a section....
> >
Marcy and Deb,
Epidurals do play a part in increased C-Section rates and significant
birth trauma for newborns in the following way:
We know that epidurals administered to mothers in active labor that did
not have a 1000-1500cc IV fluid load prior to administration will
experience a sudden and severe drop in maternal blood pressure usually
requiring immediate medical intervention. The fetus responds to the sudden
decrease in maternal oxygenation by exibiting "fetal distress" and a
sustained lowered heart rate thus triggering a "crash C-Section" which of
course is rarely if ever necessary.
If a mother is not in active labor or is in early labor, the epidural
stops the contractions. She usually ends up on a pitocin drip or
"augmentation". This increases the number of vaginal exams and increases
the risk for maternal fever and susbequent infection. It also increases
the risk for medical intervention such as scalp suction and forcep
delivery and of course an internal fetal monitor. Mom can't get out of bed
with an epidural so she gets catheterized at some point leading to a
bladder infection.
Of course at delivery, mom can't feel much and often can't push
affectively. Her cervix can swell and cervical tearing can easily occur
with pushing.
I could go on and on with my first-hand experience as a manager of a large
medical center and proctitioner but suffice it to say that epidurals just
line the pockets of the anesthesiologists that administer them!
E.
CNMPAT
>>OB journals talk about the increased risk of section in ladies with
>epidurals, I don't know the percentages offhand, but it is fairly high.>>
It seems to depend upon when the epidural is given. If given early, I've
seen it as high as 25 % increased chance. Your comments are correct. A
good reference is:
Goer, Henci. Obstetric Myths Versus Research Realities
Bergin & Garvey, 1995. Discusses issues facing expectant
parents and supports issues with research abstracts. A
compact, accurate and understandable reference.
Occasionally an epidural will provide such good pain relief a mom will go
on and deliver very easily. The more likely scenario is as you describe.
Lee Green MD MPH
> Epidurals do play a part in increased C-Section rates and significant
> birth trauma for newborns in the following way:
... (stuff deleted)
Well, we don't really know that that is the way it happens, but those are
the leading hypotheses. It is clear that epidurals increase C-section
rates.
>
> I could go on and on with my first-hand experience as a manager of a large
> medical center and proctitioner but suffice it to say that epidurals just
> line the pockets of the anesthesiologists that administer them!
I'm afraid I have to say that's just as cynical in the non-intervention
extreme as the OBs are in the intervention extreme. Many women choose,
benefit from, and do fine with epidurals. The important thing is to be
sure women understand the potential consequences of their decisions, the
risks and benefits, and make their own decisions. I am not a fan of
epidurals and do not recommend them, but I am obligated to discuss them as
an option. If my patient chooses one, knowing and accepting the increased
risk of a C-section, I will support her in that decision.
The point is different people have different needs and make different
value judgements, they're entitled to do so, and should be supported in
*their* choices not pushed to accept *our* view of how childbirth should
be. Rigid dogma against interventions is as inappropriate as rigid dogma
requiring interventions.
--
Lee Green MD MPH Disclaimer: Information for general interest
Family Practice and discussion only. I can't examine you via
University of Michigan the Internet, so you should ALWAYS consult
gre...@umich.edu your personal physician. These posts are my
KF8MO personal doings, not a service of nor the
responsibility of the University of Michigan.
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