Medical Consumerism

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Buyer Beware

Wednesday, October 7th, 2009

With the information highway expanding more and more everyday, we as consumers need to discern legitimate information sorted out from all the other “stuff” that’s presented.

With childbirth, everyone and their brother will tell you lovely tidbits of information that happened to their wife or whoever and even that, you need to take with a grain of salt.  There are just too many stereotypes to pregnancy and every woman is different.  With my first pregnancy, I loved being asked “are you learning how to breathe” in regards to childbirth classes.  Now on my third pregnancy, I still get comments like “oh, you get to eat anything you want now”.

There are so many websites regarding childbirth and natural childbirth but as with choosing your own birth plan, you also have to choose which sources are presenting you correct information.  Be a good consumer and do the necessary research.  Educate yourself and then you won’t just have take someone else’s word on it.  This includes, questioning doctors as to why they are suggesting a route for your care.

The similar goes to attending childbirth classes.  Make sure (especially if you are paying) that the teacher for your class(es) is certified by an organization.  This ensures that they have received some formal training other than perhaps their own first hand experience, however applicable it is.  There are way too many quote on quote natural childbirth teachers who are just utilizing material from one method without receiving the training which is what ensures that they are current and up to date with the latest information.  Always go to the organization’s website for teachers in your area, don’t trust posters or website that you just happen across.

Remember, you are the only one responsible for your medical care.  You owe it to yourself and to your baby to find the best path for your birth.

Posted in In the News, Medical Consumerism, Natural Childbirth, Preparation & planning | No Responses »
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Epidural does NOT = no pain

Thursday, August 27th, 2009

Did you know the rate of drugged babies at birth in the U.S. is about 98%?  So that leaves 2% to natural births.  Definitely the minority.

A lot of pro epidural people think natural childbirth participants are crazy.  They think and feel that childbirth was painful enough with the medication, why would anyone want to do it without?

Well, maybe we should ask these questions first of the medicated delivery:

  • When were the drugs administered (after you’ve labored almost to 10cm)?
  • Was the administration of the medication painful (after all, it is injected with a very long needle into a very sensitive area)?
  • Did you feel the drugs decreased your ability to function (feel the urge for pushing, urination, no sensation in your legs, etc.)?
  • Did you feel out of it (the medication causes sleepiness)?
  • Were you conscious enough after delivery to breastfeed and bond with your baby (emotional disconnect causes pain as well)?
  • Did you take any classes or receive training for birth, whether it be natural or not (preparation reduces fear which reduces pain)?

So pain is really a subjective thing and perhaps in labor, more of the “pain” that epidural users report is due to some of the items mentioned above and not just to the act of childbirth.

I am not saying natural childbirth is for everyone as we all have our own pain tolerance but let’s at least investigate our options, explore why it is better for us and our babies and perhaps at least try to labor before signing up for the epidural at our first office visit.

Posted in Labor & Delivery, Medical Consumerism, Medical Procedures, Natural Childbirth, Pain Management | 2 Responses »
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EFM: hinderance or help?

Tuesday, August 18th, 2009

Fetal monitoring comes in all shapes and sizes these days.  From a simple stethoscope and kick counts to the ultrasound, doptone and electronic fetal monitoring; each has it’s own pros and cons in checking in on your little one’s vitals.

Throughout your pregnancy, your medical professional probably uses a stethoscope or doptone to listen for your baby’s heartbeat.  You will also keep track of how active your baby is by noticing the kicks and movements inside your belly.  During labor, however, the trend has been towards a more technical method of monitoring.

If you have a hospital birth, odds are they will use an external fetal monitor (EFM) to track the baby.  The EFM is composed of an electronic transducer that is strapped to your belly by means of an elastic belt that send an electronic reading of the fetal heart rate (FHR) and mother’s contractions to a base station in your birthing room.  Anytime there are any dips or raises outside of the normal range (120-160 bpm), indicating stress, an alarm beep sounds.  This also goes off if the disks slide around while you are busy laboring or if it gets wet from your water breaking, etc. which usually causes nurses to rush in to see what is happening.

An obvious benefit to fetal monitoring is in diagnosing early fetal distress and being able to closely assess a high risk mother/pregnancy.

But the risk of the rate of high false-positives are an important one to weigh when allowing EFM.  Of course, no one has good data to back this up but it is noted that out of 1000 births, an extra 30 cesarean sections and an extra 38 forceps extractions occur in continuous EFM versus intermittent auscultation.  If a alarm situation does arise, changing positions, relaxing and giving mother oxygen can all help to relieve any stressors to baby.

There is no recommendation of EFM in low-risk mothers and it does not show an improvement in maternal or fetal outcomes.  So why is it such a common occurance (about 75% of births)?  It then becomes an issue of staffing as it is recommended that it be a 1:1 ratio of nurse to patient when using intermittent monitoring but obviously if a machine is doing the work for the nurse, then they can divide their time between more patients.

Besides the risk of unnecessary medical interventions, including cesarean section, continuous EFM can be cumbersome and an annoyance, especially if you wish to labor or deliver in a tub.  It can be discussed previous to birth to perhaps have intermittent monitoring.  I do however feel that if the labor is induced, it can be a great benefit to use continuous EFM as intermittent monitoring may not pick up on all the ups and downs that baby is experiencing due to the manufactured, chemical contractions from the pitocin.

As with any medical procedure, just be informed and aware of all the benefits and risks.  Ask why do I need this?  What can happen if I don’t have it done?  Are there any other alternatives?

Posted in Complications, Labor & Delivery, Medical Consumerism, Medical Procedures | No Responses »
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Male midwife bashing

Monday, July 27th, 2009

Denis Walsh, a male midwife in England, has been receiving a lot of bad press in the blogosphere about an article that has not even been published yet.  The paper in question, “Epidural Culture” is only in peer review for the Royal College of Midwives’s journal, Evidence Based Midwifery.

Some of the statements he has made are, “A large number of women want to avoid pain.  Some just don’t fancy the pain [of childbirth].  More women should be prepared to withstand pain,” he [said].  ”Pain in labour is a purposeful, useful thing, which has quite a number of benefits, such as preparing a mother for the responsibility of nurturing a newborn baby.” The rest of the piece goes on to state epidurals carry serious risks, impede bonding and interfere with birth as a rite of passage.

Many women bloggers are up in arms saying a man cannot chime in on such a subject.  They’ve said there is one thing worse than a painful labor and that is listening to someone who will never know the pain of labor describing it as a “rite of passage”.  A lot of people think that concept goes back to biblical references regarding the pain of childbirth as a symptom of our sin (look for a future post regarding the misconception of translating the word “travail”).

I applaud Mr. Walsh’s comments.  I do not think his gender has any part in the scientific and factual information that he is presenting.  His experience as a midwife is not diminished just because he has not experienced the pain of childbirth himself.  After all, there are female midwives out there who have never given birth as well.

I believe any good birth support professional will never judge a woman for the choices she makes for her own body and her baby but we all want to make sure we are making the information accessible to all consumers of obstetrics so informed decisions can be made.

Posted in Childbirth Professionals, In the News, Medical Consumerism, Natural Childbirth, Pain Management | No Responses »
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Location, location, location

Wednesday, June 10th, 2009

Another part of being a good consumer of medical care is knowing your options in birth locations.  Location may be determined by where you live, what your insurance will cover, reputation or where your birth support professional can/will assist.  Let’s go over the basics of what’s available (in most areas) within the birthing world and the pros and cons of having a natural birth at these locations (Dr. Sears covers this well in The Birth Book and The Pregnancy Book in which I’ve gotten some of the supporting information below from).

Hospital

In recent years hospitals have become more labor friendly with many even having a LDR room meaning you labor, deliver and recover in the same room and baby stays too.   You still need to consider that the attitude of the staff is that birth is a natural, normal process and that the atmosphere is one that you would find to be conducive to giving birth.  Don’t be turned off from a hospital based alone on the “tour” that may be offered because I had an otherwise great experience at my hospital even though the staff person who showed us around couldn’t answer most of our questions and even told us we could pre-sign our epidural forms right then.

Pros:

  • technology is available
  • staffed with experienced, licensed professionals
  • equiped for emergencies and complications
  • usually provides a certified lactation consultant

Cons:

  • may be influenced by insurance, pharmaceutical companies, boards
  • obligated to follow protocol
  • decisions by staff can be dictated by bottom line or personal schedule
  • can be overly concerned with liability instead of patients’ wishes
  • may have limited freedom to move around
  • not likely to have laboring tub (although some allow you to bring in a rental)
  • atmosphere
  • interruptions during labor
  • strangers

Alternative Birth Center (ABC)

Birth centers tend to provide a low-tech/high-touch environment for labor.  There are free standing birth centers that are located outside of a hospital and are mostly staffed by certified nurse-midwives with backup from obstetricians.  An in-house birthing center is within a hospital’s labor and delivery ward but staffed primarily by nurse-midwives.  Birth centers are as safe as hospitals.

Pros:

  • personalized
  • free from hospital bureaucracy
  • has easy access to hospital
  • cesarean section rates are very low
  • usually lower cost than hospital
  • family is encouraged to take part

Cons:

  • not for high risk mothers or with a preexisting condition
  • added risk?
  • does not handle complications and could mean a transfer during labor or delivery
  • may not be covered by insurance

Home

With the increasing desire for women wanting no medical interventions with their births, home births are making a rise.

Pros:

  • free to move around with privacy
  • familiar surroundings
  • no anxiety from being in a hospital
  • no strangers
  • uninterrupted labor
  • no time constraints
  • risk of infection is lower
  • usually lower cost than hospital

Cons:

  • not for high risk mothers or with a preexisting condition
  • no organized transport for emergencies
  • usually no obstetrical backup
  • unforeseen complications
  • may not be covered by insurance

In the 1900’s at least 95% of births took place at home.  By the 1990’s that same percentage represented hospital births.  We have options now.  Consider them all before choosing.  It could mean the difference to your natural birth.

Posted in Medical Consumerism | No Responses »
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Sometimes no news is good news

Friday, June 5th, 2009

needleBefore you consent to prenatal genetic screenings, you need to ask yourself what would you do with the results.  One test may spiral into another and realistically, these tests have an all too high rate of false positive which will cause worry for no reason.  The tests can also pose risks to the pregnancy.  If the results of testing for genetic abnormalities would not change the course of your pregnancy, then unless you feel you need to prepare mentally in advance, the test might not be worth taking.  It is a personal decision but should benefits should be weighed against the risks before you proceed.

Chronic Villus Sampling is done around 10 to 12 weeks gestation and it looks for chromosomal abnormalities which could indicate birth defects.  Down’s syndrome, cystic fibrosis and sickle cell anemia can be determined from this test but CVS does have a risk of false positive and if it is positive, an amniocentesis is usually the next step.  Also, doing this invasive test (a needle is inserted into your abdomen or vagina to collect a sample) too early in pregnancy can cause developmental problems in the baby and miscarriage.

Amniocentesis takes a small amount of fluid out of the amniotic sac to test for birth defects.  Many women over 35 are pressured into taking this invasive test which has risks to baby and mother (infection, bleeding, fluid leak, premature labor, fetal distress, miscarriage) where statistics indicate a higher chance of birth abnormalities.

Maternal serum screening tests (Alpha-fetoprotein, triple screen) are done around 15 to 20 weeks gestation.  They check for proteins or hormones in your blood that may indicate a genetic or developmental problem in the baby.  Again, there is a high rate of false positives.

The mental and emotional strain (and sometimes physical) that these tests have on the mother can “ruin” the pregnancy for her only to have a healthy, normal baby at the time of delivery.  Be a good consumer of the statistics and remember, you have the right to refuse any medical procedure.

Posted in Medical Consumerism, Medical Procedures, Tests | No Responses »
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Hoozadoula and other Seussian characters in the birthing world

Tuesday, May 5th, 2009

A part of being a good consumer of medical care is knowing your options in birth attendants.  Some of the choices of caregivers are dependant upon the location you choose to give birth in.  Let’s go over the basics of who’s who within the birthing world and the pros and cons of having them attend your natural birth.

Obstetrician (aka Captain of the Guards*)

A person having a M.D. or D.O. degree who has completed at least 4 years of specialty training in the field of obstetrics and gynecology.  They must be licensed as a physician and may be board certified in obstetrics and gynecology. 

Pros:

  • medical background
  • usually affiliated with and has access to a hospital
  • experienced
  • specialized in medicine related to woman’s health, pregnancy and birth
  • trained for emergencies and complications. 

Cons:

  • typically not present throughout all of your labor
  • obligated to follow protocol
  • sometimes decisions are based on bottom line or personal schedule
  • some will only deliver at a hospital

Family Practitioner (aka Drum-tummied Snumm*)

A person having a M.D. or D.O. degree who cares for the medical needs of the whole family.  Training includes obstetrics, pediatrics and adult medicine but there is no specialization.  They must be licensed as a physician and may be board certified in family medicine.  Family doctors do regular vaginal deliveries and some, with additional training, do operative vaginal deliveries.  Very rarely do family practitioners perform cesarean section deliveries.  They generally refer mothers with anticipated complications to obstetricians.  A family doctor can take care of the baby after birth and give regular medical care to all family members.

Pros:

  • all in one service (ob, pediatrician)
  • possible lifelong caregiver
  • knows family philosophy and beliefs

Cons:

  • typically not present throughout all of your labor
  • does not handle complications

Certified Nurse-Midwife (aka Star-Belly Sneetch*)

A person with a degree in nursing and experience as a labor and delivery nurse as well as hands-on training in midwifery.  They must be licensed as a nurse and be certified as a nurse-midwife (ACNM) in the state they practice.  They must practice in conjunction with a physician in case of complications.

Pros:

  • extensive training for the care of healthy, low-risk women
  • care for mother throughout the course of normal pregnancy and delivery
  • can provide basic gynecological care
  • oriented towards natural childbirth
  • will stay with you throughout your entire labor
  • do not administer pain relief medications
  • can deliver in hospitals, birthing centers and at your home

Cons:

  • not trained for complications or emergency care (although they are trained to recognize signs)
  • may not be covered by insurance

Lay Midwife (aka Lolla-Lee-Lou*)

A person experienced with childbirth and care of pregnant women but are not certified or regulated by the government in most states.

Pros:

  • experienced
  • will stay with you throughout your entire labor

Cons:

  • not monitored
  • no requirement in specific training
  • no test of competency
  • cannot deliver at most birth centers and hospitals due to no credentials
  • not covered by insurance

Doula (aka Fizza-ma-wizza-ma-dill*)

Per Webster’s Dictionary, a doula is “a woman experienced in childbirth who provides advice, information, emotional support, and physical comfort to a mother before, during, and just after childbirth”.  The word means female helper or maidservant.  May be certified (DONA).

Pros:

  • an extra support person for the woman and her partner
  • will stay with you throughout you entire labor
  • support beyond birth
  • trained in emotional and physical support
  • studies show doula presence lowers cesarean section rate and epidural usage 

Cons:

  • does not provide medical care
  • does not deliver babies
  • may not be covered by insurance

Obstetrical Nurse (aka Chief-in-charge-of-fish*)

A registered nurse who has completed school, passed state board exams to be licensed and specialized in labor and delivery.

Pros:

  • experienced
  • provides nursing and medical care during labor
  • may function as additional coach
  • offers breastfeeding support
  • has “seen it all”  

Cons:

  • may have multiple patients
  • will not be able to stay at your side
  • some support natural birth, some are more used to epidurals

Natural Childbirth Educator (aka Hopp-Soup-Snoop Group*)

A person trained to teach an expectant mother (as well as her partner and sometimes other children or birth attendees) all aspects of normal labor and childbirth.  This can include nutrition, exercise, pain relief methods, breastfeeding, postpartum care, newborn care, complications, medical consumerism and communication.  Natural childbirth educators provide the tools for parents to make informed decisions about their desired birth and help prepare the family for a drug-free, safe, positive and joyous birth day. 

Pros:

  • supporter of unmedicated birth
  • experienced
  • can act as a doula
  • offers advice
  • good resources
  • trained to recognize signs of labor
  • helps to ease discomfort
  • knowledgeable in pain relief methods, various birthing positions, prenatal/postnatal and newborn care and breastfeeding.
  • may make home visits
  • are affordable

Cons:

  • makes no medical decisions
  • does not provide medical care

No matter what birth professional(s) you choose to assist in your birth, their number one job is to act as your advocate and on behalf of your well-being.  So take the time and put in the research to determine if the person you’ve chosen is right for you.  If you feel any twinge of doubt or discomfort with your professional’s principles, then question it.  If there is no resolution to your reasonable expectations and standards, seek care elsewhere – it is your right and duty as a parent.

*All “also known as” names were borrowed from numerous Dr. Seuss children’s books.  They were chosen strictly for their creative sounding Seussian names and are not related to the character’s personality from the story whatsoever.  Nor were the chosen names meant to offend or sway anyone to one particular childbirth caregiver.  Additionally, Hoozadoula was a creation of this blogger and will not be in any future Dr. Seuss books to the gratitude of children everywhere.

Posted in Childbirth Professionals, Medical Consumerism | No Responses »
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