The Birth Book (continued)

I finished reading The Birth Book last night.  I plan on getting the newest edition to carry with me in my doula bag and will keep this one for my Lending Library.  See previous posts regarding this book here and here.  And, here are some of the most memorable things from the rest of the book …

This book has a great section on Cesarean Births … the history, why there are so many, what happens before, during, and after the cesarean, when they are necessary, how to avoid one, and how to achieve a VBAC.

“Obstetricians we have interviewed believe that the number of surgical births could be cut in half if this courtroom cloud were not hanging over every obstetrician attending a laboring mother.  The fear that “the only cesarean I’ll be sued for is the one I don’t do” is a powerful force that scars women’s bodies and memories and drives up the cost of medical care.”

“A benefit of epidural analgesia is that you can have regional pain control immediately postpartum.  Before you leave the operating room [in the case of a cesarean delivery], the anesthesiologist can inject a long-acting morphine pain reliever into your epidural tubing.  This analgesic lasts 24 hours and relieves postoperative pain without the groggy, drugged feeling you get from pain medications injected intravenously or into your muscles.  Feeling less pain helps you get moving and into mothering sooner.  After the epidural analgesic wears off, you can take pain pills that won’t interfere with breastfeeding.”

“Second best is do-it-yourself analgesia (PCA).  You administer your own medication through your I.V. by way of a pump that you can turn on and off as you need relief.  Research has shown that when using this innovative method, mothers use less medication but get more consistent pain relief than if given scheduled doses by nurses.”

“If mothers, using the methods suggested in chapter 7, can increase VBACs from a national average of 20 percent (in 1990) to at least 70 percent, there would be a 20 percent overall decrease in the number of cesarean sections.  In addition, if the number of mothers who “fail to progress” could be cut in half, another 15 percent of babies would come out the way they were designed to.  Knock off another 5 percent with more accurate diagnosis of fetal distress, and we have a 40 percent reduction in cesareans.  This translates into 400,000 American women each year avoiding surgery (and saving over one billion dollars).”  Wow!

“Ten Ways to Avoid a Cesarean
1.  Choose your birth attendants and birth place wisely.
2.  Bring a birth buddy.  If you choose the obstetrician-hospital birth system, as most mothers do, your chances of having a surgical birth go way down when you employ a professional labor assistant [doula].
3.  Think upright.
4.  Take a walk.
5.  Use electronic fetal monitoring and interventions wisely.  Numerous controlled studies of low-risk mothers have shown no difference in infant outcome whether electronic fetal monitoring or a person monitoring the baby’s heartbeat with a fetoscope is used.  Furthermore, these studies found that mothers who had the “benefit” of this new technology were twice as likely to have a surgical birth.  In some cases, however, EFM can spare a mother a cesarean.  If your doctor suspects a complication, but the EFM suggests baby is not bothered by this long labor, your doctor may be inclined to let you labor longer instead of rushing to a cesarean.  Technology can be your friend if appropriately used; your foe if misused.
6.  Consider the epidural carefully.
7.  Take your time.
8.  Use discernment about managed births.
9.  Lobby for legal letups.  Obstetricians we interviewed believe the cesarean rate could be cut from 25 percent (30 percent or more in some areas) to less than 10 percent if there was no fear of being sued.  There once was a time in medicine when the obstetrician was able to make decisions based only on what was in the best interest of mother and baby, without taking into account what a jury might believe.  Until such a change, obstetricians aren’t going to do any risky vaginal deliveries.  Doctors aren’t going to lower cesarean rates; women must.
10.  Remember  your vulnerability.  Be sure you understand the risks and benefits of interventions and are aware of alternative ways of handling your birth should things not be going as planned.  Here is where having a professional labor assistant [doula] helps.”

“In a survey of thirty-six thousand women attempting VBAC, no mothers died from uterine rupture, regardless of type of prior uterine incision.  And researchers studying the medical literature on VBAC over the last forty years found that not a single mother died from rupture of a scarred uterus.  (But mothers have died due to complications of repeat cesarean sections.)  In a study of seventeen thousand women attempting VBACs, no infants died as a result of uterine rupture.  And uterine “rupture” doesn’t mean a mother will suddenly explode.  Instead, in the rare cases that a scar does pull apart, it does so gradually and incompletely.  Considering the that the estimated risk of death from cesarean section is around one in one thousand (two to four times that of a vaginal birth), there is no reason to advise a mother to have a repeat cesarean section because of the risk of uterine rupture.  According to the numbers game, the risk of death or damage to mother or baby is higher with a cesarean birth than during a VBAC labor.  Experts in VBAC, backed up by thorough medical research, don’t consider VBAC high-risk, so neither should you.”

“It is amazing to us how few women take the time to research thoroughly whether or not they truly need elective major surgery.”  It is amazing to me, too.

“Improving Your Chances [of a VBAC]
–  Select birth attendants supportive of VBAC.
–  Choose a VBAC-friendly birth place.
–  Employ a professional labor assistant [doula].
–  Join a support group.
–  Learn from your past cesarean.
–  Prepare a birth plan.
–  Prepare for flashbacks.
–  Get over the hurdle.
–  Resist induction.  Educate yourself on Induction and Active Management of Labor.”

“We have noticed that women who know that they really needed to have a cesarean, and who participated in the decision, are better able to handle their disappointment.”

“This happy mother told us that the single most important factor in getting the birth she wanted was the continuous support of a professional labor assistant throughout labor.”

This book also does a great job and goes into great detail about all of the available ways to ease pain in labor, both natural and medical.  With the medical interventions, it explains how the procedures are completed.

“Television and movies portray the pain of birth but seldom the pleasure.  Birth is surrounded with mystery, and people fear what they don’t understand.  Women who know more about birth fear it less.”

“Educate yourself about all the pain-relieving options in birth, along with their risks and benefits.  Select what best fits your desires for a birth experience and your obstetrical situation.  Then, create your own birth strategy.”

“The responsibility for pain relief must remain with the laboring woman.”

“Narcotics given during labor have been detected in babies’ bloodstreams eight weeks after birth.  While some studies reassuringly conclude analgesics and anesthetics do not harm the baby, some researchers believe the contrary.  The fact is, no one knows for sure!”

“Varying amounts of a drug may persist in a baby’s body for weeks after birth and result in temporary feeding difficulties and disorganized behavior.”

“And we have witnessed this scenario:  A mother is so exhausted her labor stalls.  For the reason of “failure to progress” the doctor advises a cesarean and the mother is so worn out she will agree to anything that will get the baby out.  In preparation for the cesarean she has an epidural.  But while the surgical staff is making preparation for the operation, to the surprise of everyone, including herself, she pushes out her baby.  This mother had nothing to lose by having an epidural as she would need one for the operation anyway.  This is an example of how the epidural can be a trade-off in choosing one intervention to avoid another.”

“There are also medical situations that would indicate an epidural as the best choice, including very high blood pressure as a result of toxemia of pregnancy.  The stress of labor may push the mother’s already high blood pressure into a danger zone resulting in a cesarean section.  By accepting an epidural not only would her stress level be decreased but the epidural may decrease her blood pressure enough to buy some time to deliver vaginally safely.”

“Fewer than one percent of babies reach forty-three weeks’ gestation, the point at which complications significantly increase.  It’s important to monitor the postterm baby responsibly, but not to overdo either the anxiety or the interventions.”  So, why aren’t women considered ‘past due’ at 43 weeks instead of 40 weeks?

The book also has some excellent sample birth plans, including a sample birth plan in case a cesarean becomes necessary.

“Couples who have special pregnancies (infertility, surrogates, senior parents, and so on) often become convinced that they need high-tech obstetrics all the way.  They seek out the “best,” often feelign more secure at a prominent university hospital under the care of a widely published doctor.  The price of this birth security may often be a less than satisfying birth experience.  While some special pregnancies need this kind of intensive care, others don’t.”

~ by cmb0414 on April 13, 2010.

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