Are your beliefs about birth supported by facts?

Where do your beliefs about birth come from? Think for a moment about what you believe you know about birth and where you heard it from. Was it from hearing horror stories from women? Was it from watching TV sitcoms or dramas like ER or A Birth Story? Was it from taking independent birth classes or reading birth books? Are there things you've heard so many times you've assumed it's a fact? Did you have interventions or complications in your birth experience? Do you believe that if something is a standard, routine procedure in hospitals then it must be because there is a good reason for it?

It may be interesting to compare your beliefs about birth with some facts about birth and see how well the two align. What are your beliefs about the safety of birthing with an OB versus a midwife? How helpful or harmless are the interventions and medications used in labor? Is birth a normal, natural event or a disaster waiting to happen?

Consumer Reports put out a maternity quiz with some facts that may or may not align with your beliefs about birth. Want to see where you stand?

www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/maternity-care-quiz/maternity-care-quiz.htm

OR...

You could just read it below since I did a cut and paste from the page :)
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Despite growing evidence of harm, many obstetricians and maternity hospitals still overuse high-tech procedures that can mean poorer outcomes for baby and Mom. Test your knowledge with our quiz below, and then learn more in our report:

www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/overview/maternity-care.htm

An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.

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.

Induced labor can halt fetal development.

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.

Due-date estimates can be off by up to two weeks.

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

“Breaking the waters” helps hasten labor.

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

Induced labor increases the likelihood of Caesarean section in first-time mothers.

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.

Once you’ve had a C-section, it’s best to do it again.

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.

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.

Epidural anesthesia is a low-risk way to make labor easier.

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.

Epidural anesthesia presents risks to newborns.

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.

Episiotomies reduce the risk of perineal tearing.

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.
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I didn't write it, folks. That's Consumer Reports talking there. I highly encourage you to follow the link to their report: "Back to basics for safer childbirth: Too many doctors and hospitals are overusing high-tech procedures."

Informed Consent Requires Being Informed

I am a huge proponent of informed consent and this is an area that does not get the attention it deserves. The choice of care provider and birth location are two of the biggest factors in determining the course and outcome of your birth. Are you interested in having a natural birth (free of medications and interventions) but you've chosen a care provider and birth location with a high rate of standard, routine interventions and a high cesarean rate? Remember that OB's are trained surgeons. If you don't want surgery, don't go to a surgeon.

It isn't enough to cross your fingers and hope that against the odds, you will be able to have the birth experience you're wanting. You need to learn your options and act on them. This means choosing a provider who is truly supportive of your informed choices, not one who says they only intervene "when absolutely necessary" but has intervention and cesarean rates significantly higher than the recommendations. Actions speak louder than words. To learn about providers and birth facilities in your area visit www.thebirthsurvey.com and read the overall results. If you've given birth in the last 3 yrs you are invited to take the survey to share your experience and provide access to information for other parents to make informed choices! For more about this project, which is aimed at providing transparency in maternity care, see my entry below entitled "The Time Has Come for Transparency in Maternity Care" and check out www.motherfriendly.org

In order to make an informed decision, don't forget your B.R.A. Huh?! That means Benefits, Risks, and Alternatives. If you find out this information for whatever test/procedure/intervention/medication is being suggested to you, you will have a good basis to make an informed decision. Do your own independent research on what has been determined to be safe and effective maternity care and then compare this to how your care provider and birth location operate. For information on what is considered Evidence-Based Maternity Care, you can look at these:

www.milbank.org/reports/0809MaternityCare/0809MaternityCare.html

www.who.int/reproductive-health/publications/evidence_led_obstetric_care/text.pdf

If you get your information from ACOG (American College of Obstetricians and Gynecologists) and think you're getting unbiased, factual information--this is most definitely not the case. ACOG is a union, by and for the best interest of OB/GYN's and making sure their livelihood continues, while trying to make their competition (Licensed Midwives practicing out of hospital) illegal. They do this by arguing that birth, by it's very nature, is dangerously unpredictable and that out-of-hospital birth is a risky choice to make. They do not argue with the studies showing that planned out-of-hospital birth for low-risk moms is as safe (if not safer) than hospital birth for low-risk moms with healthy babies. In fact, they offer absolutely no evidence whatsoever for their assertion that out-of-hospital birth for low-risk moms is dangerous. FYI: The only study ever conducted that contradicts the safety of planned out-of-hospital birth is one that stated it compared planned out-of-hospital births with planned hospital births but this is not the case. The study actually included ANY out-of-hospital birth (unplanned births including those in cars on the way to the hospital, teen moms who hid their pregnancy, birthed secretly and abandoned the baby, etc). Without including these unplanned out-of-hospital births, they could not attain the results they wanted.

Don't forget that you are the only voice for your baby. You hire your care provider with the assumption he/she will provide the care that is in the best interest of you and your baby. Although I believe most providers have the best of intentions, they are also acting on behalf of their own interests. You need to act on your and your baby's behalf. If that means changing providers to one that is more supportive and respectful of your birth preferences, than so be it. You should not stay in a situation that is likely to end in an unwanted outcome because of fear or guilt of switching to a new provider. Women do it all the time--it has even happened during labor! This is a day in the life of your provider. It's also your baby's birthday and the one opportunity you have to welcome this child into the world. You have the authority to make the informed choices that you see fit in order to have YOUR best birth.

"You can't change what you don't acknowledge" -Dr. Phil

This year, Childbirth Connection released "New Mothers Speak Out: National Survey Results Highlight Women’s Postpartum Experiences." A result from one of their surveys has determined that up to 9% of women who have given birth meet the criteria for PTSD, and this is likely under-reported as many women aren't willing to admit what is happening. There is an even higher incidence of birth trauma, although not diagnosable as PTSD. What is going on?

Reform of the current U.S. Maternity Care System is an absolute necessity as evidenced by the fact that despite spending more on every birth than any other nation in the world, the U.S. has the 2nd highest infant mortality rate of all industrialized nations (the maternal mortality rate is the highest it's been in decades as well). Cesareans account for 31.8% of total births in our country despite the World Health Organization stating Cesarean rates should account for only 10-15% of all births and that rates higher than this do more harm than good for moms and babies. 85% of low-risk mothers (the majority of women) could give birth perfectly well with no interventions or medications, yet our system pushes routine interventions and medications on healthy women resulting in further interventions being required, and often ending in a Cesarean birth. This is commonly referred to as the "cascade of interventions" and is a frequent scenario in hospitals across the country. The medical establishment is then applauded for "saving" a mom and baby from the dangers of childbirth. Mom is told, “good thing this baby was born in the hospital since you needed a cesarean!” What we are overlooking is the fact that the many of these problems are caused by the inappropriate use of technology on healthy moms having normal, healthy labors. This technology can save lives for high-risk moms and babies, but for low-risk moms and babies, it can lead to problems and may be more harmful than beneficial.

Did you know that 6 of the 15 most common hospital procedures are childbirth-related? People need to get informed and speak up for what is best for moms and babies. If we value natural childbirth (even if it is not your personal preference), we need to refuse to accept what has inaccurately come to be considered "normal" and reclaim our right to birth as nature intended without requiring medical interventions where they are not only unnecessary but often harmful. If a mom makes an informed choice to use medications or interventions, that is her choice to make. If a mom does not want to use medications or interventions, she has to sign waivers, sometimes face hostile care providers and may be accused of being selfish or putting her baby in harm's way. The fact is that every single medication or intervention mom has in labor affects her baby either directly or indirectly (and often not in a good way). The evidence of what is considered safe practice in maternity care is overwhelming but it's being ignored on a daily basis in hospitals across the country. Out of all of the medical specialties, Obstetrics uses the least amount of evidence-based care.

Many believe that the only safe way to give birth is in the hospital with an OB. Obstetricians are trained surgeons. They are absolutely NOT trained in normal, physiological birth. They are trained in birth pathology, interventions, medications and cesarean delivery. Using an OB for normal, healthy birth is overkill. It's like going to a neurosurgeon for a tension headache. Midwives are trained in normal birth and they are trained to see red flags as they arise and to handle them. If they are not able to provide the care needed, mom is transferred to the hospital. It is very rare that a true "life or death" emergency arises in birth (despite what you may believe from watching ER or A Birth Story). Did you know that hospitals are supposed to be able to get a birthing mom into the operating room for a Cesarean within 30 minutes of the decision to operate being made and that only about 60% of hospitals surveyed actually have the capacity to be ready to operate in 30 minutes? There isn't a team of surgeons with a sterile operating room just waiting in case a mom needs a cesarean. Moms birthing at home or in birth centers are usually close enough to a hospital if a transfer is needed to get there within that 30 min. window if a cesarean is required. As for true "life or death" emergencies that require a cesarean (cord prolapse, placental abruption, uterine rupture), these account for a very small number of births. These are the complications a cesarean was originally intended to resolve. Due to the dangerous nature of these complications, the outcomes are usually the same for both hospital and out-of-hospital births. The vast majority of cesareans are either planned or non-emergencies that arise during birth. Some of these cesareans are necessary, but many are not medically necessary and could have easily been avoided using the midwifery model of care rather than the medical model of care for low-risk birthing women. Birth is a natural, normal and healthy event. It is not a medical condition, nor is it a disaster waiting to happen. But this is how birth has come to be viewed and I find it sad and scary.

The time has come for transparency in Maternity Care!

CIMS (Coalition for Improving Maternity Services) has a project called The Birth Survey, which is intended to create a higher level of transparency in maternity care so that women will be better prepared to make informed decisions about where and with whom to birth. This is an ongoing survey and the more feedback they get, the better the results for everyone! If you've given birth in the last 3 yrs, you are invited to take the survey at www.thebirthsurvey.com but you can still look at some of the preliminary results for all states who've had respondents by going to the website. You can search on providers and hospitals and birth centers in your area to see how they compare with others across the nation.

Please participate in the free survey to share your birth experience. The more women who respond, the more information birthing moms will have to make the best choices for them.

The second part of this transparency project is to get intervention rates from all facilities providing birth care across the country. If you'd like to learn more about CIMS or The Birth Survey, visit www.motherfriendly.org

Nothing will change until we speak up and demand better. Have your voice heard by taking the survey. Empower yourself by researching what others experienced and learn about your options. If you don't like your provider/birth location then look around and find one you feel is more compatible with your vision of pregnancy, labor and birth. It's your birth.