"The charge nurse at St. Barnabas guesstimates that 40% of the women who labor end up w/ cesareans. "Some women just aren't willing and active participants in the labor process," is how one doctor explains it, "including pushing." Then again, once a woman is fully dialated, she is likely to have been immobile for hours, with a paralyzing agent and narcotics streaming into her spine and artificial oxytocin pumping her uterus, and she hasn't eaten or had anything to drink since she got the to the hospital. Her body's own labor sequence has been hijacked, for all intents and purposes. She has been made passive, yet she is expected to be active."
"Jonathan Kotch, MD, a professor of public health at the University of North Caroline, is familiar with Daviss and Johnson's study; as chair of the Maternal and Child Health section of the American Public Health Association, he used the data to argue for a resolution endorsing certified professional midwives. "Being a hardnosed scientific critic, it doesn't meet the standards of a randomized controlled trial," he says of the study. "But at the end of the day, 5000 women had their deliveries at home by certified professional midwives did just as well or better than women who delivered in hospitals," he says. "This isn't a proof. But it's the next best thing." And it's simply the best that can be done. "A randomized controlled trial for childbirth cannot be done. You can't ask women to take a chance based upon a flip of a coin," says Kotch."
"In 2006 the American College of Nurse-Midwives developed a research tool to evaluate maternity care. Like the Apgar, the Optimality Index is a score. But rather than measuring an individual outcome, the index is intended to measure the quality of care across an instituion or population. The index defines optimal care as the World Health Organization does: essentially, "no interference." Points are deducted for induction or augmentation, early vaginal exams, epidural, continuous electronic fetal monitoring, directed pushing, flat-on-back pushing, episiotomy, and separation of mother and baby.
Judith Fullertone, PhD, a certified nurse-midwife for 35 years is one of the index's creators. She says the index values evidence-based care, and the goal is to measure the gap between evidence and practice, between normal and optimal. "Between 5 and 6 o'clock at night the traffic is normal at 5 miles per hour, but that is hardly optimal," she says. "Normal is customary and usual, but it may not be necessarily what the evidence shows is best."
"A contraction is stressful on both mother and baby. Labor is essentially spring training; that is, a contraction is followed by a resting period, during which the fetus replenishes oxygen and the laboring woman gets a literal breather. As labor progresses, the contractions become stronger and more frequent, culminating in the "ejection reflex" documented by Odent. Pitocin has no such intelligence. And with an epidural deadening the body's natural pain threshold, staff can keep upping the dose, which can lead to contractions that fire like a machine gun or last for minutes, during which time the fetus is oxygen deprived. This is called hyperstimulation. It is not uncommon and would be considered trauma - beyond what is normal. In half of the cases of hyperstimulation, the fetal heart rate drops below normal (this is called a "non-reassuring" heart-tone). If it stays there, it's fetal distress."
"Oxytocin (natural Pitocin) is but one hormone in the bath of birth. Endorphins, natural piates that are also secreted during sex, reach peak levels during birth and are responsible for the altered state of consciousness that woman often describe toward the end of labor - a reproductive version of the "runner's high." The endorphins stimulate release of prolactin, which is central to breastfeeding. Adrenaline and nonandrenaline, the fight or flight hormones, are released in both mother and baby. In the birth, these prime the lungs and protect the brain against the stress of birth.
Epidural anesthesia blocks adrenaline as well as the endorphins, which can be advantageous in the first stage of labor because it melts fear and anxiety, which keeps oxytocin's pathway clear. Toward the end, however, it is counterproductive, because it thwarts that final energy burst. "A woman giving birth with an epidural will thus miss out on the fetal ejection reflex, with its strong contractions designed to birth her baby quickly and easily." writes Sarah Buckley. Studies have also shown that epidural anesthesia causes a drop in prostaglandin, yet another hormone involved in the birth process, which keeps the uterus supple enough to contract and bounce back. This can result in a less responsive uterus, a mispositioned fetus, longer labor, and a higher risk of hemorage."
I could go on, but I'd just urge you to pick up the book. On the cover it says "Extraordinarily readble - No woman who is pregnant, has been pregnant, or plans to be pregnant should set foot inside the office of her OB/GYN before reading this" - Women's Review of Books.
I agree.
"Jonathan Kotch, MD, a professor of public health at the University of North Caroline, is familiar with Daviss and Johnson's study; as chair of the Maternal and Child Health section of the American Public Health Association, he used the data to argue for a resolution endorsing certified professional midwives. "Being a hardnosed scientific critic, it doesn't meet the standards of a randomized controlled trial," he says of the study. "But at the end of the day, 5000 women had their deliveries at home by certified professional midwives did just as well or better than women who delivered in hospitals," he says. "This isn't a proof. But it's the next best thing." And it's simply the best that can be done. "A randomized controlled trial for childbirth cannot be done. You can't ask women to take a chance based upon a flip of a coin," says Kotch."
"In 2006 the American College of Nurse-Midwives developed a research tool to evaluate maternity care. Like the Apgar, the Optimality Index is a score. But rather than measuring an individual outcome, the index is intended to measure the quality of care across an instituion or population. The index defines optimal care as the World Health Organization does: essentially, "no interference." Points are deducted for induction or augmentation, early vaginal exams, epidural, continuous electronic fetal monitoring, directed pushing, flat-on-back pushing, episiotomy, and separation of mother and baby.
Judith Fullertone, PhD, a certified nurse-midwife for 35 years is one of the index's creators. She says the index values evidence-based care, and the goal is to measure the gap between evidence and practice, between normal and optimal. "Between 5 and 6 o'clock at night the traffic is normal at 5 miles per hour, but that is hardly optimal," she says. "Normal is customary and usual, but it may not be necessarily what the evidence shows is best."
"A contraction is stressful on both mother and baby. Labor is essentially spring training; that is, a contraction is followed by a resting period, during which the fetus replenishes oxygen and the laboring woman gets a literal breather. As labor progresses, the contractions become stronger and more frequent, culminating in the "ejection reflex" documented by Odent. Pitocin has no such intelligence. And with an epidural deadening the body's natural pain threshold, staff can keep upping the dose, which can lead to contractions that fire like a machine gun or last for minutes, during which time the fetus is oxygen deprived. This is called hyperstimulation. It is not uncommon and would be considered trauma - beyond what is normal. In half of the cases of hyperstimulation, the fetal heart rate drops below normal (this is called a "non-reassuring" heart-tone). If it stays there, it's fetal distress."
"Oxytocin (natural Pitocin) is but one hormone in the bath of birth. Endorphins, natural piates that are also secreted during sex, reach peak levels during birth and are responsible for the altered state of consciousness that woman often describe toward the end of labor - a reproductive version of the "runner's high." The endorphins stimulate release of prolactin, which is central to breastfeeding. Adrenaline and nonandrenaline, the fight or flight hormones, are released in both mother and baby. In the birth, these prime the lungs and protect the brain against the stress of birth.
Epidural anesthesia blocks adrenaline as well as the endorphins, which can be advantageous in the first stage of labor because it melts fear and anxiety, which keeps oxytocin's pathway clear. Toward the end, however, it is counterproductive, because it thwarts that final energy burst. "A woman giving birth with an epidural will thus miss out on the fetal ejection reflex, with its strong contractions designed to birth her baby quickly and easily." writes Sarah Buckley. Studies have also shown that epidural anesthesia causes a drop in prostaglandin, yet another hormone involved in the birth process, which keeps the uterus supple enough to contract and bounce back. This can result in a less responsive uterus, a mispositioned fetus, longer labor, and a higher risk of hemorage."
I could go on, but I'd just urge you to pick up the book. On the cover it says "Extraordinarily readble - No woman who is pregnant, has been pregnant, or plans to be pregnant should set foot inside the office of her OB/GYN before reading this" - Women's Review of Books.
I agree.
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