Routine Interventions in Labor & Birth in Canada

Wiley InterScience is offering a free copy of the journal Birth, and this was one of the articles in it (if you can’t see it, you may need to get the free sample — sometimes Wiley is a bit weird about their links popping up as expired cookies or something). It was a study of randomly chosen women in Canada, asking about their experiences during labor. Very interesting to see the responses. I could talk about a lot of things, such as the rates of inductions, episiotomies, epidurals, C-sections, etc., but the thing that really got me the most was that 19% of women had a pubic/perineal shave! Really?? I thought that went out in the late 70s or early 80s! My mom said that was the most humiliating and embarassing thing she had to endure during labor, and it hampered her recovery as well, because it was very itchy and uncomfortable growing back in.

It’s studies like this that make me, “Oh, really?” when I hear certain people claim that doctors and hospitals practice evidence-based medicine. Not when almost 1 in 5 Canadian women (and perhaps a similar percentage here in the States) are shaved when they give birth. Ugh.

Under the Influence?

One of my readers sent me a link to a study that concluded that about 10% of Certified Registered Nurse-Anesthetists (CRNAs) “misused” controlled drugs. It noted that the results were comparable to other studies of anesthesiologists and registered nurses, except for the drugs of choice.

Pharmacists may also be prone to this (although having worked as a pharmacy tech for many years, I only ever heard of one pharmacist in our area who became addicted to drugs). But think about it (and I’ll speak of this from the perspective of being in a pharmacy) — there are shelves and shelves full of drugs that are controlled because they are addictive or highly addictive, and/or produce some sort of “high” or other desirable effect to some people.

I was never tempted to take drugs — I rarely even take over-the-counter drugs — but it could be a very tempting environment to many people. It would have been easy to take a few pills without being noticed; or perhaps even a few bottles and think it would not be found out. Just as pharmacy employees can be tempted, so can other people who are around drugs a lot. And anesthesiologists and anesthetists are certainly around controlled substances a lot.

In one way, you might think they’d be less likely to be tempted, because they see first-hand the negative aspects of drugs. Although I was not tempted to take drugs, if I had been, seeing the druggies coming in on a daily basis trying to get just a few pills to keep going would have been enough to turn me off. It was really quite sad having people come in practically begging to get their pain pills filled “just a little bit early,” and I never wanted to end up in that place, so never set foot down that path to start with. But in another way, having easy and constant access to drugs can become a great temptation.

The likelihood is that every health care professional you meet will be completely sober, not under the influence of any drugs or alcohol. (The study did not say whether these CRNAs actually operated while under the influence, or if they kept their illicit drug activity restricted to “off duty” hours. Still, considering that they likely abused drugs they used on other patients, it is a possibility that they were abusing drugs on hospital property. Which is scary.) However, there is the possibility that someone you meet — whether doctor, nurse, anesthesiologist, anesthetist, pharmacist, pharmacy tech, etc. — will be operating under the influence of some sort of controlled substance. So always be alert when interacting with people (especially those who are giving you drugs and are in charge of keeping you safe), to make sure that they are completely sober. Most likely, you’ll never need to use this advice. But it’s good to remember anyway.

Hospital Promotes Midwifery Approach

North Adams Regional Hospital in Vermont  has achieved…

  • an average of 18% C-section birth rate
  • better-than-average prenatal care (9 or more prenatal visits)
  • about 10% primary C-section rate
  • 7% repeat C-section rate

How?

“I think what is being reflected in our numbers is that we are taking a more ‘midwifery’ approach with our practice then before,” Robin Rivinus, a certified nurse midwife with Northern Berkshire Obstetrics & Gynecology at the hospital, said last week. “It means that we do fewer unnecessary interventions — inductions, Cesarean sections, episiotomies. We treat childbirth as the normal, natural thing that it is. We only step in when it’s medically necessary, which is much better for both the mother and the baby.”

Read the whole article here.

World Record Moms

After hearing about the Brazilian 9-year-old girl whose twins were aborted because they were supposedly life-threatening (although the first hospital this girl was taken to said her case was not life-threatening), I wondered if this was the youngest confirmed pregnancy for a girl in the world. It was not. Care to guess how old the youngest mother was when she gave birth?

Keep thinking.

Keep guessing.

She was five years old. Yikes. Read more about her amazing case here, as well as some other mothers who hold world records in various things, such as Bobbi McCaughey who gave birth the first surviving septuplets, the woman who gave birth to the closest two children in two different pregnancies (a scant 7 months apart), the woman who gave birth over the longest span (41.5 years apart), and the woman who had the most surviving children. (I’ll just tell you, she had several sets of quadruplets, triplets and twins, but even the number of pregnancies is still amazing, not to mention the fact that almost all but two of her children survived infancy — in the 1700s in Russia!)

“Nothing by mouth?” — not so fast!

Often when women are in labor, they are forbidden by the hospital from eating or drinking anything — perhaps they may be allowed to suck on ice chips or a popsicle or something like that, but everything else is forbidden. (Not every hospital is like that; and some hospitals have “official policies against it” but nurses may say “you’re not supposed to eat, but of course if I don’t see it, I can’t stop you”).

This arcane policy goes back to the days when women were routinely knocked out for birth, and of course before any planned surgery (in this case, the only “surgery” planned was the routine episiotomy — and, yes, the cutting of vaginas is technically a surgery) or any other procedure in which a person is given general anesthesia, it is accepted practice to prevent the patient from eating or drinking, to minimize nausea and vomiting while unconscious, and particularly the danger of breathing in the vomit, which may result in serious complications or even death. Of course, it is also standard practice to put a breathing tube down a person’s throat when s/he’s put under so as to eliminate even this small risk — especially since the stomach is never completely empty, and inhaling straight gastric juice is not good for you either!

But, even as routine “knock ’em out & drag ’em out” births went the way of the dodo, the practice of “nothing by mouth” (npo, non per os) remained. The technical reasoning for this was that some women may require general anesthesia during or after birth (emergency C-section, hysterectomy, etc.), so it was considered safer to keep all women from eating and drinking anything. Of course, the actual likelihood of these things happening (especially with local anesthesia and epidurals being much more common than general anesthesia), as opposed to risks and downsides from women and babies starving for hours is usually not discussed — interventions are easily begun but terribly difficult to stop.

Hypothetically, had the practice of food restriction never begun and become engrained and entrenched in American birth, do you think it would be started today? Food for thought. Why or why not? And furthermore, do you think that before it became widespread, it would be subjected to rigorous study before being implemented? I would like to think that, no, it would not even get started; but that if somebody had the “bright idea” to start it, that it would be subjected to studies before it became widespread. (Hey, I can hope, can’t I? Obstetrics is supposed to be evidence-based medicine, after all!)

But now, like so many things, something that is normal and natural (eating when hungry, drinking when thirsty) is forced to defend itself, and to prove that it is either beneficial or at least not harmful. At least they’re studying it! This is not the first study to look at maternal eating and drinking during labor, but it is the most recent one. The World Health Organization (see pp. 13-14 for the specific discussion on this) says that while a few women who are at high risk for the potential of general anesthesia may need to restrict food and drink in anticipation of such surgery, that restriction should not be extended to all women, since labor “requires enormous amounts of energy. As the length of labour and delivery cannot be predicted, the sources of energy need to be replenished in order to ensure fetal and maternal well-being.” They conclude the section by saying, “The correct approach seems to be not to interfere with the women’s wish for food and drink during labour and delivery, because in normal childbirth there should be a valid reason to interfere with the natural process. However, there are so many die-hard fears and routines all over the world that each needs to be dealt with in a different way.”

If you don’t want to eat or drink during labor, then that’s fine — I didn’t in my first labor, and threw up every time the midwife made me drink apple juice. (Being a first-time mom, she figured I’d take a long time to labor, so she wanted to make sure I didn’t dehydrate or get too weak or otherwise have a problem and end up having to transfer to the hospital.) And if you choose to eat or drink, make sure that whatever you consume will also come back up easily — in other words, no orange juice, because it’s nasty when vomited back up! If you’re trying to figure out what you should eat or drink in labor, pretend you’ve got a stomach virus and choose accordingly — nothing greasy or heavy — that sort of thing.

Oh, and print out a copy of pertinent documents to take with you to the hospital, so that if they pull the “it’s not safe for you to eat or drink while you’re in labor,” you can say, “Oh, yeah? Who says? — Not according to this!” 🙂


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C-section Poem

Click here to read a touching poem that demonstrates the feelings a woman was left with after her Cesarean.

While I’ve been reading her blog for many months, and have read other things she and other women have said about the feelings of loss and pain after their C-sections, this poem opened my understanding in a deeper and fuller way.

Getting your tubes tied

No, I’m not planning a tubal ligation; I think that there will be more children in my future (although not any planned for the immediate future). I read a blog post about women wanting to be sterilized, and being turned down because they were childless and single and “may change their minds in the future.”

While I understand that people change their minds, and the way they feel today does not prove that they will always feel that way (look at how people are keeping tattoo removal places in business!), I wonder at the condescending attitude displayed by the doctors who refuse to sterilize a woman who absolutely does not want children. The kicker of this blog post is that it displayed comments by women who had undergone multiple abortions, and were desperately trying to find a doctor to do a ligation so that they could not get pregnant again. There were comments from women who had had 5 and even 10 abortions. Some of the women had been on chemical birth control and/or used condoms all the time, yet still ended up pregnant. Sometimes they said they used the birth control perfectly; other times they did not (a week late for a Depo-Provera shot, for example).

I can understand doctors being reluctant to perform such an procedure that will forever prevent a man or a woman from having a child (reversals happen, but they’re not guaranteed), but it almost sounds like the doctors are “patting the little girl on the head” — “Oh, honey, I know you say you don’t want children, but you’re young and single and you’ve never had a child — how do you know you won’t change your mind some day when you meet Mr. Right?” It’s not a procedure to be taken lightly; but neither is an abortion — which was the alternative these women chose. They seemed to be commiserating how difficult it was to get their records to prove their past abortions, in order for them to show a doctor just how serious they were about not wanting children and never wanting children.

Tubal ligation is an elective procedure, like plastic surgery or gastric bypass — it’s not to be taken lightly, and the patients should be screened to make sure they’re serious and that they understand what they’re going to be going through — protecting patients and doctors — informed consent and all that. But why is there such a hurdle for these women?

There is no guarantee that a married woman with children will not change her mind, regret her tubal ligation decision, and wish she had more children. My mom had her tubes tied after she had me, because 4 kids in 6 years was just plain tough… but she said she sometimes regretted her decision and wished she could have had more children. At the time, she didn’t know anyone with larger families, but when I was about 6 we changed churches and met families that had 5, 6, 8, 9, and even 12 kids. Had she had such a group around her, she may have made a different decision at the time. Then there are women who get divorced and remarried and wish they could have a child with the new husband. Or women who lose their child(ren) in some way and wish they could have more — when the tsunami hit Asia a few years ago, there were thousands of women like that — all of their children died in the wave, but they were sterilized and couldn’t have any more. Or a child gets cancer or some other disease and the parents wish to try for another child for a good donor match of some sort, since full siblings have the greatest likelihood of being good matches.

When one of my friends had her first baby, she was asked as a matter of form after the birth if she wanted her tubes tied; she said yes (she’s not a big fan of birth, to say the least). Her husband shook his head, so she changed her answer. She didn’t really want her tubes tied — she was just asked that question at a vulnerable time for her. Going into her second labor, she told her doctor not to even ask the question, because she knew she’d say yes but wouldn’t really mean it. It’s just surprising to me that one doctor would ask a first-time mom right after birth if she wanted her tubes tied while another doctor would refuse that procedure to a woman who had had multiple abortions because just didn’t want children.

And you know what’s even worse? Doctors performing C-sections on mothers and then refusing VBACs, which may effectively limit the size of their family to two or three children, for little to no good reason. I’ve heard some women be told that they could only have 3 C-sections; and the risks increase exponentially with every surgery. But why do doctors refuse a tubal ligation for one gyne patient because “she may want [more] children later” while doing an unnecessary C-section on another patient despite the fact that she may want a large family? Just ridiculous.