Sunday, March 24, 2013

Let Nature Take It's Course

 James T. Breeden, MD, President of ACOG wrote the article following : 

My comments are in italics

“Let nature take its course.”
I couldn't agree more. 

"Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born. The start of natural labor is the main sign, but we’re not always patient enough to wait for it."

My personal experience also has been when we wait for labor to begin on it's own, birth is much more straightforward and effective. My clients also get tired of being pregnant and uncomfortable. As a midwife, I too sometime grow weary of waiting for God's perfect timing. 
I also find it difficult when we approach that 42 week mark, not because I don't think mom's are capable of delivering at that point, but because I know if we have a transport into the hospital, we are all going to be looked at like we have 3 heads. "nothing good happens after 40 weeks" is a popular quote at our local hospital. Although I find this statement untrue and very restrictive, I certainly understand why it is said. We as people like to be in control, allowing women to go into labor on their own shows lack of control. That can be very frightening if you are then going to be held responsible for the outcome.

 "Today, one in three babies in the US are born by cesarean—the delivery of a baby through an incision in the mother’s abdomen and uterus."

This stat is staggering! But TRUE! Let's break that down...three babies are born in your neighborhood this is going to be by C-Section.  This rate should be 10% or less. In midwifery run birth centers, the rate is 6%

"The rate of labor induction is also at an all-time high. Unfortunately, many of these births occur before the pregnancy is considered “term” at 39 weeks. These upward trends have long been a source of concern in the medical community, especially considering the increased risks to a baby who may not be fully developed at delivery."

I don't know that rate of induction at our local hospital, but informally I know my clients are under a microscope by their friends and family to be induced. They are often pressured, even before their due date at 40 weeks with statements like "when are you going in for your induction?" or "how long is your midwife going to let you go?" As if that would be my call... Our birth culture is one of fear and control. Bad things are going to happen if we don't intervene. The TRUTH: Bad things happen when we DO intervene. 

" Among cesarean deliveries, an estimated 2.5% (more than 100,000 births each year) are scheduled on a designated date by the mother and her doctor. Some women cite reasons such as a lower risk of future incontinence, better sexual functioning after childbirth, and fear of pain as motivations to schedule cesareans. Inevitably, some cesareans (and labor inductions, too) are scheduled before a pregnancy is full term, increasing the risk of negative outcomes for the newborn, including respiratory problems and time spent in the neonatal intensive care unit. The fact remains that due dates are estimates, and you can never be sure that the infant will have reached optimal maturity at the time of a scheduled delivery."

All excellent points and let's add to that the cost. 
This quote is from a study published in the  Journal of Midwifery and Women's Health

The cesarean birth rate in this cohort was 6% versus the estimated rate of 25% for similarly low-risk women in a hospital setting. Had this same group of 15,574 low-risk women been cared for in a hospital, an additional 2934 cesarean births could be expected. The Medicare facility reimbursement for an uncomplicated cesarean birth in a hospital in 2011 was $4465.49 Given the increased payments for facility services for cesarean birth compared with vaginal birth in the hospital, the lower cesarean birth rate potentially saved an additional $4,487,524. In total, one could expect a potential savings in costs for facility services of more than $30 million for these 15,574 births.

" Women should keep in mind that cesarean delivery is no walk in the park. While it’s a safe option, cesarean delivery is a major surgery and comes with a number of risks, such as placental complications in future pregnancies, problems with anesthesia, infection, and longer recovery times. Certain urgent situations—such as preeclampsia, eclampsia, multiple fetuses, fetal growth restriction, and poorly controlled diabetes—may make it necessary to deliver the baby before the onset of natural labor."

Again, totally agree. There is a time and place for everything. Good midwifery care involves transferring care to an appropriate care provider if then mom and baby are no longer low risk. Good collaborative care is essential.

"However, newly issued guidelines from ACOG remind women and ob-gyns that in uncomplicated pregnancies, a vaginal birth that occurs after the natural onset of labor is ideal."

Say it again!!! 

"Additional new ACOG guidelines reaffirm that cesareans and labor inductions should only be performed when medically-necessary. Delaying delivery until labor starts naturally may not make ob-gyns too popular with a patient who’s uncomfortable and near the end of her pregnancy, but it’s a decision that will pay dividends by giving the baby the extra time it needs to face the world. 

So hoping more and more OBGYNs latch on to this concept and support women with low risk pregnancies. 
In the meantime, this is the philosophy midwives has held to for all of history.

 We trust women, 
We trust God in His perfect design. 
We trust the TRUTH is be told with all the research being done.

1 comment:

Julia Mangan said...

This is great! I know with my first birth I most likely would have had a C-section if I had not had midwifery care since my water broke and labor did not begin until 15 hours later. I'm guessing I would have been induced and then a c section would have been that much more possible. And I very much appreciated that going 5 days past my "due" date was a complete and total non issue with my second birth.