Childbirth News and Recent Research
Los Angeles Times: Inducing labor for convenience gets a second look
New studies show the practice has a role in rising costs and the risk of complications
...NOW, some hospital administrators are saying, "Enough." Intermountain Healthcare, which operates 21 hospitals in Utah and Idaho, implemented strict guidelines on elective labor induction eight years ago. Today, the company's results are held up as a model for reining in birth practices that cannot be medically or financially justified.
The chain, which delivers 53% of all babies in Utah, told its doctors they must seek permission from a supervisor before inducing labor prior to 39 weeks. Doctors must also make sure the cervix is favorable for delivery.
When the cervix is optimal (it must be opened and thinned out enough to allow the baby's head to pass through the vagina), labor averages about nine hours in a first-time pregnancy, according to Intermountain. If the cervix is not ready, however, an average labor is about 22 hours. The guidelines have reduced rates of elective labor inductions performed before 39 weeks gestation from 28% in 1999 to 3.4% in 2006. The percentage of first-time moms with an elective induction has fallen from 15% in 2003 to 4.7%.
Hospital administrators no longer see sudden spikes in deliveries before major holidays, three-day weekends and Jazz basketball playoff games.
The program has resulted in plunging C-section rates, fewer newborns in intensive care and fewer medical interventions in delivery. Length of labor has decreased by an average of two hours per patient. That's important, Wilson says, because length of labor is linked to a higher risk of dehydration and infection.
Evidence-Based Practices for the Fetal to Newborn Transition
Many common care practices during labor, birth, and the immediate postpartum period impact the fetal to neonatal transition, including medication used during labor, suctioning protocols, strategies to prevent heat loss, umbilical cord clamping, and use of 100% oxygen for resuscitation. Many of the care practices used to assess and manage a newborn immediately after birth have not proven efficacious. No definitive outcomes have been obtained from studies on maternal analgesia effects on the newborn. Although immediate cord clamping is common practice, recent evidence from large randomized, controlled trials suggests that delayed cord clamping may protect the infant against anemia. Skin-to-skin care of the newborn after birth is recommended as the mainstay of newborn thermoregulation and care. Routine suctioning of infants at birth was not been found to be beneficial. Neither amnioinfusion, suctioning of meconium-stained babies after the birth of the head, nor intubation and suctioning of vigorous infants prevents meconium aspiration syndrome. The use of 100% oxygen at birth to resuscitate a newborn causes increased oxidative stress and does not appear to offer benefits over room air. This review of evidence on newborn care practices reveals that more often than not, less intervention is better. The recommendations support a gentle, physiologic birth and family-centered care of the newborn.
C is for Caution: C-sections on the Rise
Or it may be for convenience, critics say. The surgery, once risky, now is used in about a third of U.S. births. To learn more about C-section, read:
What Every Woman Needs to Know About Cesarean Section 2004
Silent Knife (by Nancy Wainer Cohen & Loise Estner):The definitive book on caesarean prevention and vaginal birth after caesarean section. Thoroughly researched and emminently readable.
Why Does the National U.S. Cesarean Section Rate Keep Going Up?
Expect Better Reading List
Why not expect better than what is usually expected?
Here are some good books to get information from for every thinking pregnant (or about to be pregnant) couple.
Hey, Who Having This Baby Anyway? by Breck Hawk, RN |
Gentle Birth, Gentle Mothering by Sarah J. Buckley |
Mother's Intention: How Belief Shapes Birth by Kim Wildner |
Prenatal Parenting by Dr. Frederick Wirth |
The Thinking Woman's Guide to a Better Birth by Henci Goer |
Ina May’s Guide to Natural Childbirth by Ina May Gaskin |
Journey Into Motherhood: Inspirational Stories of Natural Birth by Sheri Menelli |
Excellent book for you to read throughout the pregnancy
Spontaneous Creation by Jock Doubleday |
The Nursing Mother's Companion by Kathleen Huggins |
The Breastfeeding Answer Book by La Leche League |
