Fantastic Kangaroo Care and Skin-to-Skin Contact Resources

One of my friends emailed this to a childbirth educators list I’m on, and I thought it was fantastic, so wanted to share with others.

First, is a Power-Point presentation (in pdf format) from  Dr. Bergman on the importance of skin-to-skin contact for full-term newborns, and even greater importance of kangaroo care for preemies. Drawing on developmental curves of other mammals, Dr. Bergman points out that humans are basically born immature — dogs, cats, monkeys, etc., are all born more highly developed (as measured by percentage of brain growth, etc.); and preemies are born more on the “marsupial” level of immaturity and prematurity. Animals are born with brains that are 80% of the size of adult brains; humans are not. Based on brain development (as a percentage of the adult size, compared to newborn/adult brains of animals), humans don’t reach the 80% marker until about a year after full-term birth. When born premature, they are even less that. The presentation presents powerful and compelling arguments for attachment parenting concepts (such as, sleeping with the baby, carrying the baby in an infant carrier on the mother or father, breastfeeding on demand, skin-to-skin contact, not crying it out which can be harmful, etc.), and even stronger arguments for “kangaroo care” for preemies.

The second resource is the Kangaroo Mother Care website which has even more links, stories, research, etc., on kangaroo care and premature birth. Dr. Bergman draws a distinction between “Kangaroo Care” as practiced in U.S. hospitals (“This has been defined as “intra-hospital maternal-infant skin-to-skin contact”. KC is generally started later, and on stabilised prematures, and is used an adjunct to technological care”) and “Kangaroo Mother Care” which in part includes NEVER separating the mother and the baby — if the baby needs additional care, then technology is brought to him, rather than him taken away from the mother to go to the technology.

Dr Nils Bergman was the Doctor who introduced Kangaroo Mother Care (KMC) to South Africa. He has recently published the results of a strict scientific trial (in Acta Paediatrica) comparing skin to skin immediately after birth to incubator care . What he found was that skin to skin care was much better for the newborn than the incubator. Babies were warmer and calmer, breathed better and had a more stable heart rate with skin to skin care.

Surprisingly, the smaller the baby was-down to 1200grams- the more stable they were, and the more unstable in the incubator! This is opposite to what people think!

In fact there is other research suggesting that the incubator is harmful! Babies’ brain development requires skin to skin contact and being held and carried, and eye to eye contact to form the right brain pathways. Depriving babies of this skin to skin care makes alternative stress pathways which can lead to ADD, colic, sleep disorders etc.

Surprisingly incubators are still used for the very reason of stabilizing the baby when they in fact do the opposite!

There is a lot of information on the website, and I can’t do it justice, so just explore it for yourself, share with friends, and remember for future reference. Although the following story is anecdotal (although if a doctor wrote it, it would not be a mere “anecdote” but would be a “case study”), this woman saved her baby’s life by instinctively picking her up and putting her on her chest. The baby was born at 24 weeks gestation, weighing 20 oz (566 grams), and doctors didn’t believe she would live — her heart was beating only every 10 seconds and she wasn’t breathing.

She said: “I didn’t want her to die being cold. So I lifted her out of her blanket and put her against my skin to warm her up. Her feet were so cold.

“It was the only cuddle I was going to have with her, so I wanted to remember the moment.” Then something remarkable happened. The warmth of her mother’s skin kickstarted Rachael’s heart into beating properly, which allowed her to take little breaths of her own.

Miss Isbister said: “We couldn’t believe it – and neither could the doctors. She let out a tiny cry.

The baby was eventually taken and put on a respirator, but “Her heart rate and breathing would suddenly sometimes drop without warning” — which reminds me of one of the graphs in either the PDF or the website — that the baby’s heart rate and breathing and temperature were all more stable and regular when on the mother than in an incubator.

I don’t think that this doctor is suggesting that the only thing a premature baby needs, no matter how early it is born, is to be put on his mother’s chest — after all, he pointedly says that technology needs to be brought to the mother-baby when needed. But what if the interventions that are currently being done on premature infants are actually harmful, or at least, would be more helpful if the baby is on his mother’s chest (unless that is totally impossible). Yes, I’m sure there is a ton of research showing that babies receiving the current standard of care do better than babies in a “control group” — but what if standard interventions done on the mother’s chest were vastly superior than standard interventions done in a plastic box?

As an example of what I’m angling at, consider a hypothetical research project: babies are born, and divided into two groups — the first group is put in an orphanage where their physical needs are met (they are fed, clothed, and given diaper changes) but are basically kept in cribs all the time. The second group is put in a different orphanage where their physical needs are met and they also receive some social interaction, playing with other orphans and also sometimes the caregivers who are not as overwhelmed and busy as in the first orphanage. Obviously, the second group is likely going to do much better. However, neither of these settings is natural or normal — consider that there is also the possibility of babies not taken from the mother at all, but are given the level of maternal care and attention that you and I take for granted — breastfed, lovingly held and cared for, played with on a one-to-one basis, read to, etc. (in addition to the basic physical needs being met). Don’t you think that this third group would greatly excel either of the first two groups? Of course! So, is it not possible that our current standard of care, while better than that of the 70s or 80s, still pales in comparison to what might be possible if the technology (breathing assistance, drugs, fluids, nourishment, etc.) were done in the context of kangaroo care, rather than KC being more or less an afterthought?

“First, do no harm.” If, as that newspaper article demonstrated, it could shown that a mother’s natural inclination is to hold her premature infant on her chest, and that it holds some benefit to the baby (in this case, warming her, starting her breathing, and regulating her heartbeat), then that should be promoted — not necessarily at the expense of technology that has also been proven beneficial, but in conjunction with that technology to attain even better outcomes.

Several months ago, Reality Rounds posted a couple of heart-wrenching posts. She got a lot of flak, too, for it — all of it undeserved. I’m linking to them so that you can get a better idea of what’s involved in extremely preterm birth care; but, as my mother always says, “If you don’t have something nice to say, don’t say it at all.” First, “For they know not what they do” — which describes the extreme fragility of tiny babies, and the great caution the NICU team must employ not to hurt the baby as they try to help and save the baby:

We do everything.  Dry the infant with towels.  Careful.   Not too rough.  Do not want the gelatinous, friable skin to break and bleed unto the blankets. Listen for heart sounds.  Heart rate is barely 60 beats per minute.  No need for chest compressions.  We breathe air and oxygen into the tiny lungs.  Careful.  Too much air can blow a hole in the tiny lungs.  Too much oxygen can cause lung damage and blindness. We walk the wire.

It must be so extremely difficult to do everything that can be done to save the babies, knowing that it is hurting them physically (needles hurt! and worse for preemies — not to mention everything else). I liken it to what nurses in burn units must go through, as they try to save people who are badly burned — knowing that what they are doing, while necessary, is torture. And that even in the best of circumstances, the patient will endure untold pain, and be scarred for life — perhaps even unrecognizably scarred, perhaps losing fingers or toes or arms or legs. And perhaps when all is said and done and the patient is released to go home, he may even wish himself dead. Yet some people beat the odds and their injuries are not as life-altering or as scarring as they might have been; and many people are glad to be alive. But some people die in burn units, in spite of all the care given; and nurses and doctors must occasionally feel guilty that they did not “let nature take its course,” because then the person’s pain would have been shorter — when people die despite the best care given them, and die in pain, we can say in retrospect that it “would have been better” for them to have had no care at all and died quickly, than to have had their pain dragged out over days and weeks. But until we have a crystal ball to know which ones will have good results and which will not, we have to take care of them all.

The second post is NICU is a war zone — stressful for the parents, stressful for the baby, stressful for the workers. Finally, “Is letting a 21-week baby die health care rationing?” which includes the following paragraph on “Benevolent Injustice”:

I have cared for many infants at the edge of viability.  It is always emotionally draining.  There is no justice to it.  The extreme measures involved to keep a 22-23 week infant alive is staggering, and it is ugly.   I once had a patient who had an IV placed on the side of her knee due to such poor IV access.  When that IV infiltrated, I gently pulled the catheter out, and her entire skin and musculature surrounding the knee came with it, leaving the patella bone exposed.  I have seen micro-preemies lose their entire ear due to scalp vein IV’s.  I have watched 500 gram infants suffer from pulmonary hemorrhages, literally drowning in their own blood.  I have seen their tiny bellies become severely distended and turn black before my very eyes, as their intestines necrose and die off.  I have seen their fontanelles bulge and their vital signs plummet as the ventricles surrounding their brains fill with blood.  I have seen their skin fall off.  I have seen them become overwhelmingly septic as we pump them with high powered antibiotics that threatened to shut down their kidneys, while fighting the infection.  I have seen many more extremely premature infants die painful deaths  in the NICU, then live.

I do not claim any knowledge much less prowess in the field of premature birth. I do not blame anyone for allowing their extremely preterm baby die a natural death, rather than be subjected to these procedures. Nor do I blame parents who request that “everything” be done to save their babies. But care for premature babies is heart-wrenching either way, and painful. But what if there is a better way? I don’t know if this Kangaroo Mother Care extends to the micro-preemies, or there is some sort of cut-off point where it no longer helps — previously, I quoted that “babies down to 1200 grams” did better with KMC — which is about 2.5 pounds, and probably all late-second or early-third-trimester, much bigger than 20-23 week babies, for the most part (which is primarily the focus of the above blog posts). But what if current care is like the hypothetical orphanage study above — better than nothing, but not as good as kangaroo care in conjunction with life-saving interventions.

Sr Agneta Jurisoo studied what little literature was available on KMC during 1987. The following year she and Dr Bergman arrived at a small mission hospital in Zimbabwe, where premature births were common. There were no incubators, poor transport over great distances, and overloaded referral centres: only one of ten premature babies survived.

In the absence of incubators, they started a care plan in which the mother became the incubator. Instead of waiting for the baby to “stabilise”, the mother was used to stabilise premature infants immediately after birth. It was immediately clear this was highly effective, no matter how small or how premature, stabilisation took a mere six hours. With this care, now five of ten very low birth weight babies survived.

One problem is that current care is so entrenched, that it is very scary (and may even seem to be malpractice) to make the huge paradigm shift from taking the baby away from the mother for care, to putting the baby on the mother for care. Obviously, doctors and nurses are trained to take care of the baby alone, in an incubator — much like doctors are trained to have the mother on her back with her legs in stirrups when she gives birth. It can be very disorienting to have the baby come out “the wrong way” when the mother is on hands-and-knees or is squatting or kneeling. In the same way (only much, much bigger), it will take someone with a lot of guts to bring the NICU to the mother-baby pair, instead of taking the baby to the NICU. Who am I kidding? — it is a big shift to have full-term healthy babies put directly on the mother’s chest and kept there, instead of being put almost immediately into the warmer. Technology is very deeply entrenched in normal births and normal postpartum, and much more so in premature births! But “first do no harm” — first make sure that what you’re doing that is not physiologically normal (taking the baby from the mother) is going to first be not harmful, and second be beneficial. Certainly, there are times when babies need immediate surgery or other care that is not feasible or practical to be done on the mother. But I think steps need to be taken to keep mothers and babies together, if possible.

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Elective Induction Brochure

The Agency for Healthcare Research and Quality has recently issued a brochure on elective induction [ok, it looks like it went 404 on me, but here is a webpage with I think the same information on it, just not in brochure form]. The Family Way Publications has a good response about what’s wrong with the brochure. I would merely add that any time you choose an elective medical procedure, it only serves to introduce risk without a balancing or over-riding benefit. I agree with the rebuttal that the risks should be talked about in stronger terms, unless the brochure is not intending to dissuade women from an elective induction. I agree with being “fair and balanced” and trying to present both sides of the story, if that’s possible; but sometimes it’s not possible. What this brochure is doing is making it sound like a coin toss between waddling around for a few more days or weeks (which as far as I know, poses only mild and short-term discomfort for most women, and no long-term medical problem; if there is a medical problem necessitating induction, then that’s not elective), or choosing a medical procedure with known risks (including iatrogenic prematurity, more problems for both mother and baby during and after labor and birth, an increased risk of C-sections in first-time moms or those with unfavorable cervices) for no medical benefit. It shouldn’t be a coin toss. Weighing both sides of the issue in a balance, elective induction is a clear loser, and women should be dissuaded from that. The brochure does not seem to do that. It mildly mentions that women should wait until 39 weeks to be electively induced, but without a strong demonstration of the reasons why that is the best choice (certainly for the baby, who faces a doubled risk of NICU admissions, etc., at 38 weeks and a quadrupled risk at 37 weeks), women are left with the idea that the risks are about equal to the benefits, when that’s just not the case.

In fact, I wonder why they even put together this brochure at all. It seems to me that the only reason to do so would be to dissuade women from choosing an elective induction — after all, if the doctor suggests an induction, most women would think there would be some medical reason or benefit to doing it, and at the least would just be following the doctor’s lead. That may fit the definition of “elective” in that anything that is undertaken for no medical benefit is “elective”; but it doesn’t fit the narrower definition, of it being the mother’s choice, and I might add, the mother’s idea. Rather, it is the doctor’s idea, and the mother acquiesces. If I were to put together a brochure about elective induction, it would be with the idea of giving it out to women who are contemplating asking their doctor or midwife to end their pregnancy early, to dissuade them from so doing, not to leave them with the impression, “Six of one, half-dozen of the other.”

Win a copy of Breastfeeding with Comfort and Joy

Today, I reached 200,000 hits on my blog stats!  Woo-hoo!! To thank all of my readers, I am going to be doing another giveaway:

a copy of the book Breastfeeding with Comfort and Joy: A Photographic Guide for Mom and Those Who Help Her, by Laura Keegan!

Here is the review I wrote when I first read the book, and you can read other glowing reviews at Stand and Deliver, Permission to Mother, and Best for Babes.

And, here is photographic proof that it works — check out those fat rolls! 🙂

IMG_4251

Breastfed with comfort and joy!

This baby actually had to spend her first two weeks in the NICU due to a breathing issue, but her mom was able to pump and give her breastmilk, and then to fully breastfeed. Her mom said that the book helped out a lot, because although she had a lactation consultant in the hospital to help at first, after a few days, the LC didn’t come around any more, but she still had the book to help her out. Although the baby has started on table food, she rarely eats it, preferring to nurse. In fact, she is now over nine months old, but still almost exclusively breastfed. I’d call that a success story! 🙂

Now, onto the rules…

I will pick one winner at random from all entries received, and you can have more than one entry, to increase your chances. Here are all the different ways to enter:

  • Blog about the giveaway, linking both to this post and the book’s website: www.breastfeedingwithcomfortandjoy.com. Because Breastfeeding with Comfort and Joy is self-published, it’s only available at this website.
    [If you have more than one blog, you can write a post about the giveaway and get one entry for each blog!]
  • If you’ve read the book, write a review! If you’ve already written a review, link to it in your blog entry about the giveaway.
  • Add Laura Keegan’s breastfeeding blog to your blogroll, if you have a blog; and/or add it to your reading list, subscriptions, Google Reader, bookmarks, etc. — however you keep up with the blogs you read — you get the idea! [if you do both, you’ll get two entries]
  • Spread the word – share about the giveaway and/or the book on email lists, bulletin boards, as a comment on other blogs [but, please, not in a spammy way!], internet chat rooms, Facebook, MySpace, Twitter, Del.icio.us, Digg, Mixx, etc., etc.,  or just good old-fashioned phone calls or in-person conversations.
  • Contest open to U.S. residents only.

As you do these things, drop me an email at kathy_petersen_283 at yahoo dot com or leave a comment on this post letting me know you’ve done it. If you tell someone about the book — whether through the internet or in person — please tell me a little about why you mentioned the book — is your friend a fellow birth junkie? a mom who has had trouble breastfeeding in the past? expecting twins? a new mom? a pregnant cashier at the grocery store? your midwife or doctor, or your baby’s pediatrician?

There is no limit to how many entries you can have, so the more you tell others about the book, in any way of communication, the more entries you will get. BUT, this is very important — you must tell me that you’ve done it, in order for me to know that you’ve done it! :-) The contest will run for two weeks (closing at midnight of Nov. 25, the day before Thanksgiving), and I will pick the winner at random. I will put each person’s name on a piece of paper, one time for every entry, and will put all the paper in a hat or bowl, and pull out one piece of paper. I will announce the winner the following day, which will be pretty cool since it’s Thanksgiving, it will give someone a little extra to be thankful for! 🙂

Good luck, everybody!!

What’s the Rush?

Reality Rounds has been posting on different issues with her role as a NICU nurse, and a recent comment inspired this post. The post itself was on the realities of prematurity, and the struggles that the babies (and their parents, nurses, and doctors) face when they’re born too soon.

The comment was from a mother whose two children were both born early — at 30 and 31.5 weeks. She relates:

As a side note, one day when my second was still in the NICU, I was taking the elevator up to the NICU floor and another NICU mom was in there with me. There were a couple of pregnant women going to see their OBs on a higher floor and they were lamenting that they wished their babies would just come *now*. As the elevator doors opened at the NICU floor, the other NICU mom and I gave each other knowing looks and as we walked out the door, we simultaneously said “No, you don’t.”

Yes, indeed! I remember what it’s like to be “great with child,” getting anxious for the pregnancy to be done, to meet the baby, to no longer have him kicking you 24/7, to get your body back, to not have your back hurt any more, etc., etc. But you don’t really want your baby born too soon!

I think it may would probably cut down on the numbers of elective inductions (and requests for early inductions or C-sections that are not medically indicated), if women were to be given a tour of the NICU sometime in their second trimester (much like they might take a tour of the L&D unit prior to giving birth), so that they could see the realities of premature birth. And it doesn’t even have to be really preterm birth — even slightly preterm may have problems, as At Your Cervix attests:

A [fetal lung maturity] test was done and showed “mature” levels for a recent “near term” gestation infant. Baby was delivered. Guess what? Baby had respiratory distress shortly after birth and was sent to the NICU. Baby was NOT ready to be born. The lungs were NOT fully ready for life outside the confines of his former uterine home. One can only wonder how much brain growth and development was also lost, from not having the last few precious weeks in the womb.

[Make sure you read all the comments at AYC, especially “Lonely Midwife.”]

Plus, there is research to show that babies born by elective C-section at 37 weeks have double the risk of problems as those born at 38 weeks; and the 38-weekers have double the problems of those born at 39 weeks. So, what’s the rush?!?

I don’t know. Have we gotten so arrogant, that we are doing what Jeff Goldblum’s character said in Jurassic Park? — “Your scientists were so preoccupied with whether or not they could, they didn’t stop to think if they should.”

Obviously, doctors will not induce before 36 weeks for no maternal or fetal indication. At least, I hope that would not be the case! So, it’s not like most preemies are intentional. Yet, if a baby is born before his due time, but is born just because “well, it’s term, and you’re tired of being pregnant, so why not?” he will likely have complications that he would not have had, had birth started naturally. While the worst and most difficult NICU stays are likely to be unavoidable, there are some that could be avoided — like the one AYC mentioned — by waiting on nature. What’s the rush?

“Optimal Time of Delivery”

This was an interesting abstract, which makes me want to read the full article. The objective was, “To estimate the gestational age ranges that result in optimal birth outcomes for each of four risk-defined groups.” What was most intriguing to me is that this is the first time I’ve seen an attempt made to look at “the best time for birth” for different risk groups, rather than putting everyone in the same category. The problem that occurs sometimes is that if there isn’t a proper delineation by risk factors, is that everyone gets “tarred by the same brush.” For instance, it’s known that smoking causes health problems for all people, including second-hand smoke in children, and maternal smoking in fetuses and neonates. I’ve previously talked about the risk of maternal smoking for babies — the infant mortality rate for the year 2000 was 10.7/1000 for smokers but 6.5/1000 for nonsmokers. If a study that looks at infant mortality rate doesn’t take into account maternal smoking, it may reach the wrong conclusion. Let’s say that a study looking at maternal hypertension and neonatal mortality finds that maternal hypertension increases the rate of neonatal mortality, but it didn’t look at only women who smoke or women who don’t smoke, or didn’t properly adjust the risk of neonatal mortality based on the known risk factor of smoking. The study may wrongly conclude that maternal hypertension alone may raise the risk of neonatal mortality X%, when the real cause of much of the increased risk is maternal smoking, and maternal smoking increases the risk of maternal hypertension and also neonatal death.

I’ve seen some people say that “the best time” for a baby to be born is 39 weeks, based on different factors (the people who have said that haven’t linked to studies, and I’m not sure I’ve read them, so I don’t know how they determine that — whether the “best” time is due to how many women have C-sections versus vaginal births, or perinatal deaths, or what), although I have recently read and blogged about a study that shows that elective C-sections at 37 and 38 weeks increase problems with neonatal morbidity compared to those done at 39 weeks. This study indicates that 39 weeks may not be the best for individual risk groups even if (and that’s a big “if”) it may be the case for the entire United States as a whole.

The restrospective study divided the women into four risk groups — the regular or low-risk group, maternal hypertension, advanced maternal age, and diabetic women — then looked at various outcomes (NICU admissions, Apgar scores, C-sections, etc.) to see which births on which gestational days had the best outcomes based on the day. The results were intriguing:

  • The low-risk group OTD (optimal time of delivery) was calculated to be 37 weeks 1 day to 41 weeks 0 day
  • the advanced maternal age group OTD was 38 weeks 5 days to 39 weeks 6 days
  • the hypertension group OTD was 39 weeks 2 days to 40 weeks 1 day
  • and the diabetes mellitus group OTD was 40 weeks 3 days to 41 weeks 1 day.

So it doesn’t appear that low-risk women should be offered an induction or C-section at 39 weeks, nor should the scare tactics start at going past 40 weeks 0 days, like it sometimes does. What is most interesting to me is that the DM group has better outcomes if the birth happens after the due date, but this seems to be the group that is typically induced or sectioned due to their risk status — typically “big baby” fears. But this seems to reject that notion. And the other two groups seem to do better closer to their due dates, but many women are induced (or offered an induction or C-section, or the doctors don’t turn down requests for inductions) at 37 or 38 weeks, because “well, you’re ‘term’ now so the baby can safely be born now, with no problems, and aren’t you tired of being pregnant?” In fact, it appears from these numbers that only babies born to low-risk moms do well if born in the first week and a half of term — that perhaps babies born to these higher-risk mothers benefit from more “womb time” than low-risk babies. Interesting.

More is not always better

This is a thoroughly interesting article (to me, anyway!) — The Cost Conundrum. It is pretty long, and doesn’t talk about birth at all, but is still pertinent to the subject, because it talks about the cost of health care, and why “more” is not always “better”. The author compares one county in Texas with the highest per capita medical costs in the United States with other areas (including the Mayo Clinic and other counties which both have much lower medical costs, though a similar or higher-risk patient profile), and notes that although the quality of health care the residents in this county in Texas receives is not better (based on things like rates of death, patient satisfaction, mobility [after surgery, for example]), and may in fact be worse. It has bearing on the area of birth because the author points the finger at unnecessary tests being performed for one of two motives — defensive medicine or increasing profits, with the emphasis being the latter. The author notes that 15 years ago, doctors in that county would have likely taken a much more conservative “wait and see” approach for things like gall-stones or chest pain, to see if the patient would get better on his/her own, with dietary or medication changes (of course, observing the patient, if necessary); but now they are much more likely to jump straight to surgery or to order many tests just to see what the problem is, even if the very great likelihood is that the problem is mild or self-limiting. This is similar to what happens in labor, birth and postpartum — the likelihood is that everything is going right and will go right; but out of defensive medicine or to have more billable procedures (or just because the technology exists), birth has become a highly technological and interventive process; and rates of things like C-sections, NICU admissions, labor inductions, etc., have been increasing at a rapid pace, although a lot of objective measures (such as rates of cerebral palsy or neonatal death) do not show much if any improvements.

But, even if it doesn’t improve things, people may say, “Ok, so it costs more, but there is no harm done; and all these test may pick up on something for one person who might otherwise be missed, so the benefit, even if it’s very small, is worth the cost, because there is no risk.” But that’s not necessarily the case. Every medical procedure carries with it some risk — for example, if a person has an unnecessary gallbladder surgery, the likelihood is that everything will go just fine, but surgery is an invasive and harmful procedure unless necessary. It’s just hard on the body to be cut open; and it also introduces the possibility of an unintentional error (like nicking an artery) or an infection, plus the patient has to recover. And even if it’s just non-invasive tests, it may still be a stressful or painful experience, and costs the patient time and money. In the case of unnecessary NICU admissions, it separates the mother and baby unnecessarily which may stress or even harm the baby or the relationship, leads to lower rates of breastfeeding (which is also worse for the baby), and keeps the baby in the hospital where an infection is more likely to happen. In the case of labor, “just in case” interventions require the mother to be still, quiet, and generally supine, when normal or natural labor usually impels a woman to be active, mobile, and generally vertical. When that happens, one intervention may lead to another, causing what could have been a perfectly normal birth to morph into a technological nightmare, and perhaps even spiralling into a C-section.

Unfortunately, about the only way to keep unnecessary procedures from happening to you is to know enough to know when they are necessary and when they are not. But unless you went to med school or know your own health issues well enough to know which are necessary and which are not, you are more or less at the mercy of your doctor. With an issue like birth, women can educate themselves in a general way, if they will; and doulas are professionals who are well-versed in birth. Aside from that, you have to have an ethical doctor who will not order unnecessary tests and procedures and will take a conservative approach — which shows better results with lower costs in most cases. [Which is the way all doctors should be, but many are not.] But a lot of people simply don’t realize that more is not always better and assume that they should pull out all the stops “just in case.” Like the mom who insists on getting her child an antibiotic for every cold or sniffle, even though most illnesses of that nature are caused by viruses which are not touched by antibiotics, and should be treated with comfort measures, many people insist on getting a full battery of tests so they know “for sure” and so they can rest in the knowledge that they’ve “done all they could do.” But we need to understand that sometimes it’s better to do as little as possible, rather than as much as possible. Counter-intuitive, but true.

Op-Ed Piece on Elective Cesareans

This opinion piece was written by the CEO of UnitedHealthcare of New Jersey, a health insurance carrier, on elective C-sections and NICU admissions, etc., which I’ve blogged about previously, and I’ve seen it blogged about extensively on other blogs.

I’ll pull a few quotes from here, but I urge you to read the whole thing [any bold or italics will be mine]:

It turns out that in an audit of all UnitedHealthcare-insured ba bies admitted to the NICU in one market, 48 percent of all newborns admitted to NICU were delivered by elective admission for delivery including scheduled C-sections (cesareans), many taking place before 39 weeks of pregnancy, or full term.

Note that “elective admission” includes scheduled C-sections as well as inductions of labor — inductions which may ultimately have failed and then required a C-section to complete the birth of the baby. While I find it extremely interesting, not to mention unsettling, that almost half of the NICU admits were due to “elective admission” for birth (I would assume from the language that these are all not medically necessary; although I could be wrong in that), I will point out that “full term” is not usually defined as 39 weeks of pregnancy, but rather 37 weeks — although not too many years ago it was 38 weeks. Still, in another way of looking at it, I only consider “full term” to be when labor begins spontaneously — there is so much we don’t know about labor and birth and a baby’s maturity, that to cause the baby’s birth prior to natural onset of labor is to risk prematurity — regardless of the week of gestation.

When we shared this startling data about C-sections and health problems in newborns with a pilot group of physicians and hospitals, they significantly reduced the number of elective admissions for delivery prior to 39 weeks, including C- sections. The result: There was a 46 percent decline in NICU admis sions in three months, a decline that has held stable for more than a year. That’s almost half the number of newborns with potential health problems, almost half the number of distraught parents, almost half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous.

Reducing elective admissions prior to 39 weeks significantly reduced the number of babies that needed to have intensive care in a hospital setting. Not only does this translate into significant cost savings (which is of high importance to an insurance provider, naturally), but think of how many lives have been altered, perhaps tragically, by these unnecessary inductions and C-sections which led to many days or even weeks in the NICU, for no medical reason!

There is evidence that reducing the overall number of Cesarean deliveries would significantly reduce health risks for mothers and their newborns. More than 1.2 million C- sections are performed annually in the United States at a cost of more than $14.6 billion per year, according to the federal Agency for Healthcare Research and Quality (AHRQ). While some women do need C-sections because of fetal distress and other medical issues, AHRQ says that more than half of all Cesareans are medically unnecessary.

My thanks to Empowering Birth for originally blogging about this article, thus bringing it to my attention.