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Consumer Reports Takes on Maternity Care

I have always seen a lot of misconceptions surrounding birth, but I must say I was truly impressed when Consumer Reports took on the issue of maternity care in late 2008. Since then I have always kept the link to the quiz around to pass on to all mothers I come across.

From doctors verses midwives, to labor inductions and even due dates, the information is certainly valuable for mothers world wide, but especially here in the United States where most of these practices are common, and inaccurate information is everywhere.

So what did they take on?

An obstetrician will deliver better maternity care, overall, than a midwife or family doctor?
(I, myself, of course, would guess false because of my personal experience with an OB/GYN and midwife for deliveries.)

False. Studies show that the 8 percent to 9 percent of U.S. women who use midwives and the 6 to 7 percent who choose family physicians generally experienced just-as-good results as those who go to obstetricians. Those who used midwives also ended up with fewer technological interventions. For example, women who received midwifery care were less likely to experience induced labor, have their water broken for them, episiotomies, pain medications, intravenous fluids, and electronic fetal monitoring, and were more likely to give birth vaginally with no vacuum extraction or forceps, than similar women receiving medical care. Note that an obstetric specialist is best for the small proportion of women with serious health concerns.

Ah! Great modern maternity myth debunked! On we move to another great one!

Induced labor can halt fetal development?
(Again I would say true, but if you asked me three years ago, I probably would have said false.)

True. The vital organs (including the brain and lungs) continue to develop beyond the 37th week of gestation. There is also a five-fold increase in the brain’s white matter volume between 35 and 41 weeks after conception. Inducing labor (with synthetic oxytocin, for example) might stop this growth if the fetus is not fully developed. Between 1990 and 2005, the number of women whose labor was induced more than doubled.

With that information, I would hope the amount of women considering elective labor inductions for no medical reason will re-evaluate their choice and consider this fact.

Due-date estimates can be wrong by up to two full weeks?
(Wait, you mean ultrasound dating isn’t 100 percent accurate??)

True. This inaccuracy can lead to a baby being delivered by induction or cesarean section up to two weeks earlier than its estimated due-date, cutting off important weeks of fetal development.

Another reason why standard of care practices have changed recently in most reputable hospitals excluding any kind of elective delivery before 39 weeks gestation at a minimum.

Breaking the “waters” helps hasten labor?
(Of course it does… right?)

False. There is no evidence to support the fact that this common practice (about 47 percent of women) shortens labor, increases maternal satisfaction or improves outcomes for newborns.

The next one I wish I could re-word but since I am sampling this from the Consumer Reports survey, I am not going to change the way they have things.

Induced labor increases the likelihood of a cesarean section in a first time mother?
(I believe this is true, but I believe personally and through research that it extends further than just in first time mothers, and has increased risks for all mothers having a labor induction.)

True. The cervix may not be ready for labor. Other effects of induced labor include an increased likelihood of an epidural, an assisted delivery with vacuum extraction or forceps, and extreme bleeding postpartum.

Another favorite of mine!

Once you have had a cesarean section, it is best to do it again?
(Or in other terms, once a cesarean, always a cesarean… something we ignorantly hear often today.)

False. Studies show that, as the number of a woman’s previous c-sections increased, so did the likelihood of harmful conditions, including: trouble getting pregnant again, problems delivering the placenta (placenta accreta), longer hospital stays, intensive-care (ICU) admission, hysterectomy and blood transfusion.

Yay! Thanks to Consumer Reports for showing women that VBAC or a trial of labor after a cesarean section is the safest option for most women!

Labor itself can benefit a newborn’s immunity?

True. When babies do not experience labor (if the mother has a c-section before entering into labor, for example), they fail to benefit from changes that help to clear fluid from their lungs. That clearance can protect against serious breathing problems outside the womb. Passage through the vagina might also increase the likelihood that the newborn’s intestines will be colonized with “good” bacteria after the sterile womb environment.

Labor is great for babies!  And even better to tackle next… epidurals!

Epidural anesthesia is a low-risk way to make labor easier?
(Well, I wouldn’t really consider having a needle placed in your spine low risk… but that is me!)

False. Many women welcome the pain relief, but might not be well-informed about the increased risk of its side-effects, including lack of mobility, sedation, fever, longer pushing and serious perineal tears.

And those are among the most common risks we see, not the more serious complications that can happen.

Epidural anesthesia presents risks to newborns?
(Another one where I would say “true,” but if you asked me years ago, I would have said it is 100 percent false.)

True. Babies whose mothers received epidurals during labor are at risk for rapid heart rate, hyperbilirubinemia (the presence of an excess of bilirubin in the blood), need for antibiotics and poorer performance on newborn assessment tests.

Another reason why mothers should be fully informed of all risks of epidurals before going in to have their baby. Research and education are key!
The last one here is probably one of my favorites since I have done a lot of research and learning about episiotomies.

Episiotomies reduce the risk of perineal tearing?
(Ha! Yeah, cutting is going to stop tearing right? Pffft!)

False. Evidence shows that routine use of episiotomy offers no benefits but rather increases women’s risk of experiencing perineal injury, stitches, pain and tenderness, leaking stool or gas, and pain during sexual intercourse. Yet in 2005, 25 percent of women with vaginal births continued to experience this intervention. Episiotomy is one of several obstetric practices adopted into common usage before being adequately studied.

In fact in recent years, most providers have phased out the use of episiotomies altogether because of the lack of evidence supporting their use.

Again taken from the Consumer Reports survey, the source of their information:

Source: “Evidence-Based Maternity Care: What It Is and What It Can Achieve,” a detailed review of clinical evidence by Carol Sakala and Maureen P. Corry published by the Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund, October 2008.

I think all women planning to have children can truly learn from this!

photo: flickr.com/Daquella manera

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