City Pages March 2014 Article
http://issuu.com/citypageskuwait/docs/cp_april_2014_online
* see page 32
http://issuu.com/citypageskuwait/docs/cp_april_2014_online
* see page 32
Do you want to get the most out of your birth experience? Be
savvy. Understand the language used during birth and make informed decisions.
While birth is a normal process and research shows that many of
the routines at hospitals today are not necessarily beneficial and may even be
harmful[1], the fact remains that
birth today has become intervention-intensive and the majority of moms in
Kuwait will likely experience one or more intervention during their birth. Most
of the statistics for these interventions are not publicly available in Kuwait,
so I will use the most recent statistics for women in America. The most recent
Listening to Mothers Survey[2] showed that the majority
of women surveyed experienced one or more of the following interventions during
labor:
• Continuous
electronic fetal monitoring (EFM)(93 percent)
• Restrictions
on eating (87 percent)
• IV
fluids (86 percent)
• Restrictions
on drinking (66 percent)
• Episiotomy
(35 percent)
• Epidural
anesthesia (63 percent)
• Artificially
ruptured membranes (55 percent)
• Artificial
oxytocin augmentation (53 percent)
• Cesarean
surgery (24 percent)
What would those numbers look like in Kuwait? Perhaps some would
be higher and some would be lower. The point is that you should be familiar
with some technical medical terminology before you give birth. This is the
second of two articles designed to empower moms to make informed decisions
during birth. The previous article discussed Continuous Electronic Fetal
Monitoring (EFM), Restrictions on Eating and IV Fluids, and Episiotomies. In
this article we will discuss Artificial Induction or Augmentation (Syntocin),
Epidurals, and Cesarean Surgery.
Artificial Induction or
Augmentation (Syntocin):
Oxytocin is
the central hormone that orchestrates a normal birth. It is nicknamed the
hormone of “love” and is essential to bonding, creating feelings of euphoria,
and produces uterine contractions. More than 50% of moms give birth using
synthetic oxytocin (Syntocin or Pitocin), either to induce the beginning of the
labor or to augment their labor once it has already begun.
While synthetic
oxytocin and natural oxytocin are chemically identical, their affect on the
body has significant differences. For example, natural oxytocin that is
produced in the brain circulates in the cerebral-spinal fluid, whereas
synthetic oxytocin is pumped into the veins and never crosses the blood-brain
barrier. In addition, the body only produces enough oxytocin to meet its needs,
where as synthetic oxytocin is pumped by steadily increasing amounts over a
short period of time to much higher levels than what the body would naturally
produce. Furthermore, while naturally produced oxytocin is responsible for
creating the mothers powerful and rhythmic contractions that eventually birth
her baby, it also has a softer side: oxcytocin floods a mothers body, reaching its
highest peaks during the most intense part of labor, and helping the mother
move into an alternative state of mind ((elation) in order to cope with labor
and filling her body with love and affection for her baby and partner. A whole
series of feedback hormones are also triggered with the natural production of
oxytocin, including endorphins (euphoria) and prolactin (for milk production)
to prepare her for the final moments of birth and her initial encounters with
her baby. This feedback process does not accompany artificial oxytocin.
Synthetic
oxytocin, on the other hand, produces more intense contractions over a shorter
period of time, without the softening effects of natural oxytocin or the
benefits of endorphins. This does more than just change the quality of the
contractions- making them more intense and painful for the poor mother. It
also increases the mother and baby’s risks for harm, necessitating continuous
fetal monitoring. These risks include postpartum hemorrhage through what is
called uterine atony: essentially, synthetic oxytocin has a diminishing return
of effectiveness by the end of labor, leaving the uterus soft and weak, unable
to contract to stop postpartum bleeding; and fetal distress: the sudden-hard
and fast-squeezing contractions produced by synthetic oxytocin induced
contractions diminishes the baby’s placental oxygen supply more often and for
longer periods of time than natural contractions creating disturbing fetal
heart rate patterns and necessitating continuous fetal monitoring, vaccum/forceps
assisted deliver, and cesarean surgery.
The best
way to avoid the use of synthetic oxytocin in your labor is to wait for your
labor to begin on it’s own and to use movement throughout your labor to keep
your labor progressing, and use a doula or other support person throughout your
labor.
Epidurals:
I’m just
going to skip other pain medication options and speak directly to the most
commonly used pain medication: Epidurals. Epidurals are popular because they allow
women to be awake and aware yet free from pain during labor and birth. They
permit an exhausted woman to rest or sleep. And while their usual effect is to
slow labor, the profound relaxation they offer can sometimes put a stalled
labor back on track. They can be very effective.
But like
all medical interventions, epidurals also have potential harms, including an
increased risk of
·
a vacuum or forceps delivery
·
a drop in blood pressure, which may pose a risk to the
baby
·
nausea and itching attributed to the narcotics in
epidurals
·
difficulty with breastfeeding, linked to fentanyl, a
common narcotic component in most epidurals
·
developing a life-threatening complication
·
breathing problems or difficulty swallowing
·
a baby who experiences a prolonged episode of abnormally
slow fetal heart rate
Still,
labor is unpredictable, and you want to keep all your options available. Just be
sure that you make your decision freely, not because you feel pressure or lack
an alternative. Here are some ways to do that as well as minimize potential
harms:
Choose a
care provider with a cesarean surgery rate of 15% or less. Studies show that in
the hands of care providers with low rates, epidurals do not increase cesarean
odds.
Choose a mother-friendly birth environment. In most hospitals,
confinement to bed, continuous fetal monitoring, and restricting labor support
companions such as doulas, along with lack of amenities such as showers, deep
tubs, and birth balls make it difficult to cope with labor without an epidural.
Where epidurals are the norm, nurses may not know how to support a laboring
woman without one, and staff may actively promote their use. And finally, delay
an epidural until active, progressive labor (6-7 cm dilation) to reduce your
risk of complications arising from epidurals.
Cesarean Surgery:
When the
cesarean rate is between 10-15%, maternal mortality goes down and lives are
saved. However, when a cesarean rate goes above 15%, there are no overall
improvements for maternal or infant health outcomes. The risks of harm increase
for both mother and baby, future pregnancies can be endangered, and health care
resources are squandered on interventions that do not provide a positive net
gain in health outcomes. The World Health Organization states that cesareans
should only be performed for medically indicated reasons. These include
placenta previa, malformed or injured pelvis, severe pre-eclampsia, active
genital herpes, advanced HIV, transverse (side-lying) baby, twins if the first
baby is breech and triplets, certain birth defects, medical problems with the
baby or mother (emergency or chronic), placental abruption, prolapsed cord, or
uterine rupture.
The
following are NOT necessarily a medically indicated reason for a cesarean:
prior cesarean, breech presentation, failure to progress, CPD (Cephalo-pelvic
disproportion, or your baby's head is too big), twins if the first baby is
presenting head down, large baby, fear, convenience, or wanting to give birth
on a particular day.
Risks to the
mother include:
• 4xs higher risk
of death than vaginal birth
• 20%-40% mothers
after cesareans have post-operative complications - uterine, wound or urinary
tract infections are the most common.
• increased risk of
serious infections such as pelvic abcess, septic shock and pelvic thromboembolism.
• up to 1 in 10
have a surgical laceration in their uterus.
• 6xs increase in
postpartum depressions three months after surgery.
• reduced fertility
• increased risk of
ectopic (outside of uterus) pregnancy
• increased risk of
unexplained still birth
• increased risk of
rupture of the uterus before or during labor, 2-4xs higher when subsequent
labors are induced or augmented with pitocin.
• risk of placental
problems (placenta praevia or low-lying placenta; placental abruption where
placenta separates early; placenta accreta, where placenta won't separate)
increased by 2-4xs.
• 7-15xs increased
risk of emergency hystorectomy after birth for the above reasons
• increased risk of
bleeding after birth, severe anaemia, blood transfusion, repeat cesarean, and
infection, for all the reasons mentioned.
Risks to the
baby include (for non-emergency cesareans):
• 5xs increased
risk of needing intensive care treatment after birth
• increased risk of
prematurity; even with ultrasound scans, around 10% of babies are born more
than two weeks early
• increased risk of
breathing difficulties after birth: minor problems around 6% compared to 3%
vaginal delivery, even when born at term.
• with ceasareans,
1.6% of babies require a machine for severe breathing difficulties compared to
.3% of vaginal births.
• Persistent
pulmonary hypertension. of which 40%-60% of affected babies die, can affect up
to 4 per 1,000 cesarean babies, compared to .8 per 1,000 vaginal babies.
• 1-2% risk of
laceration (surgical cut) during the operation
• all future
pregnancies have an increased risk of prematurity, low birth weight, poor
condition at birth, and death, for the reasons mentioned above.
To
decrease your risk of having an unnecessary cesarean surgery, find a care
provider with a low cesarean rate, let your labor begin on it’s own, move
around and stay active during labor, work with a doula or other labor support,
avoid unnecessary medical interventions, and push your baby out in an upright
position.
• IV
fluids (86 percent)
• Episiotomy
(35 percent)
• Artificially
ruptured membranes (55 percent)
• Cesarean
surgery (24 percent)
Artificial Induction or Augmentation (Syntocin):
Epidurals:
·
nausea and itching attributed to the narcotics in
epidurals
·
developing a life-threatening complication
·
a baby who experiences a prolonged episode of abnormally
slow fetal heart rate
Choose a mother-friendly birth environment. In most hospitals, confinement to bed, continuous fetal monitoring, and restricting labor support companions such as doulas, along with lack of amenities such as showers, deep tubs, and birth balls make it difficult to cope with labor without an epidural. Where epidurals are the norm, nurses may not know how to support a laboring woman without one, and staff may actively promote their use. And finally, delay an epidural until active, progressive labor (6-7 cm dilation) to reduce your risk of complications arising from epidurals.
Cesarean Surgery:
The following are NOT necessarily a medically indicated reason for a cesarean: prior cesarean, breech presentation, failure to progress, CPD (Cephalo-pelvic disproportion, or your baby's head is too big), twins if the first baby is presenting head down, large baby, fear, convenience, or wanting to give birth on a particular day.
• increased risk of
serious infections such as pelvic abcess, septic shock and pelvic thromboembolism.
• 6xs increase in
postpartum depressions three months after surgery.
• increased risk of
ectopic (outside of uterus) pregnancy
• increased risk of
rupture of the uterus before or during labor, 2-4xs higher when subsequent
labors are induced or augmented with pitocin.
• 7-15xs increased
risk of emergency hystorectomy after birth for the above reasons
Risks to the baby include (for non-emergency cesareans):
• increased risk of
breathing difficulties after birth: minor problems around 6% compared to 3%
vaginal delivery, even when born at term.
• Persistent
pulmonary hypertension. of which 40%-60% of affected babies die, can affect up
to 4 per 1,000 cesarean babies, compared to .8 per 1,000 vaginal babies.
• all future
pregnancies have an increased risk of prematurity, low birth weight, poor
condition at birth, and death, for the reasons mentioned above.
