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Six Birth Blogs Every Childbirth Educator Should Be Reading

September 17th, 2013 by avatar

Today on Science & Sensibility, I wanted to share with readers some of my favorite birth related blogs, after Science & Sensibility of course! I subscribe to over 400 blogs, on a variety of topics, not just birth. I hope that someone has a larger blog list then I do, otherwise I will start to worry about how this might be an obsession.

I really enjoy reading what experts in the field of maternal and infant health have to say on their blogs and frequently find myself sharing information in my classes and with the families that I work with as well as with other professionals. I appreciate the effort, the research, the time and the energy that goes into making my favorite blogs so rich and useful for me, and so relevant to the work I do as an LCCE. 

Here are six of my favorite blogs, in no particular order:

1. Spinning Babies Blog

Midwife Gail Tully has long been well known for her website, Spinning Babies and her blog is an added bonus!  Gail frequently answers questions from readers, describes some new research she came across or shares a new technique to help babies move easier through the pelvis.  Here you can frequently find a video snippet you can use in your childbirth class, a book review or an inspiring birth story usually related to babies who chose to do things their way, as they work to be born.  

2. Evidence Based Birth

This blog burst onto the scene in mid-2012, and has been a fantastic resource ever since.  Rebecca Dekker, PhD, RN, APRN is an assistant professor of nursing at a research university in the U.S. She teaches pathophysiology and pharmacology, but has a strong personal interest in birth, and hence the blog was created.  The mission of Evidence Based Birth is to “promote evidence-based practice during childbirth by providing research evidence directly to women and families.”  Rebecca takes a look at the big issues (failure to progress, big babies, low AFI, for example) that face women during their pregnancy and birth, and does a thorough job of evaluating all the research and explaining it in a logical, easy to understand post.  Rebecca sums up her posts with recommendations based on the evidence and gives readers the bottom line and take-away.  Additionally, there are “printables” that are concise versions of some of her blog posts that families can print out and take to appointments with their healthcare providers in order to help facilitate discussions about best practice.

3.  VBAC Facts

Jennifer Kamel has created a plethora of useful information on vaginal birth after cesarean (VBAC) facts and statistics.  She founded her blog after doing a huge amount of research on the benefits and risks of VBAC, after her first birth ended in a Cesarean and she prepared for her second.   The amount of information, statistics, research summaries and discussion found on her blog is amazing.  Jen is a “numbers gal” and does a great job of explaining risks and numbers in an easy to understand presentation.  I frequently find myself going to her blog when I want to know the risk of placental complications after a cesarean or to better understand some of the new research and policy statements from ACOG and other professional organizations.  When 1 in 3 women in the US will give birth by Cesarean, it is good to have a resource such as VBACFacts.com to go to that can help me understand and explain options to families birthing after a cesarean.

4. The Well-Rounded Mama

Pamela Vireday has written “The Well-Rounded Mama” blog since 2008 and it has been a valuable resource for women of all sizes, when they are looking for answers and facts about options for birth.  The mission of the blog is “to provide general information about pregnancy, birth, and breastfeeding, to discuss how to improve care for women of size, to raise awareness about the impact of weight stigma and discrimination on people of size, and to promote health by focusing on positive habits instead of numbers on a scale.” Pamela does an awesome job of gathering, explaining and summarizing research, particularly related to women of size, but in all honestly, extremely relevant to all birthing women.  I appreciate her plus size photo galleries of pregnant and breastfeeding women of size. If you might be a  woman who is larger than many of the models in today’s pregnancy magazines, seeing the gallery of women who look beautiful pregnant and breastfeeding, with a wide range of body shapes, can be comforting.  In addition to providing evidence based information,  Pamela answers some of the questions that plus sized mothers might have, but are hesitant to ask their healthcare provider, such as concerns about about whether fetal movement will be noticeable if they are larger sized.  A great blog, with relevant articles for all women!

5. Midwife Thinking

This blog is written by Rachel Reed, an Australian PhD midwife, who enjoys taking a look at the research and sharing her thoughts on how well the research is applied to application.  I enjoy reading her blog for that reason, and often find myself amazed that she chooses to write about the very topics that I wonder about and want to learn more on.  Rachel’s aim is to “stimulate thinking and share knowledge, evidence and views on birth and midwifery. ”  I also appreciate her “Down Under” perspective and celebrating the commonalities of birth across the many miles.  Rachel is not afraid to agree when the science backs up the “less popular” treatment and care amongst childbirth advocates, allowing the evidence to speak for itself and carefully explaining why.   Rachel does a great job of normalizing many of the topics that bog women down during labor and birth, such as the “anterior cervical lip” or “early labor and mixed messages.”  I like to share Rachel’s posts with families who are experiencing the very situation she is writing about.

6. ACOG President’s Blog

Every week, the current president of the American Congress of Obstetricians and Gynecologists (ACOG) writes a blog post on a matter of importance to women.  Not all the posts are on birth related topics, but I find it very interesting to see what Dr. Jeanne A. Conry, M.D. PhD shares with readers.  While some of her blogs are directed at her fellow physicians, many of the posts highlight information and resources directly related to women’s health, especially during the reproductive years.  I enjoy learning more about what Dr. Conry feels is important, and especially what messages and information she is directing to her colleagues. I appreciate her middle of the road approach and look forward to a new post every week.

I hope that you might consider following some of the blogs I mentioned here, if you are not already doing so.  I would also love if you shared your favorite blogs with myself and our Science & Sensibility readers.  I always have room for more good birth related blogs in my blog reader!  What blogs do you read?

ACOG, Authoritative Knowledge, Breastfeeding, Cesarean Birth, Childbirth Education, Continuing Education, Evidence Based Medicine, Maternity Care, Midwifery, Research, Science & Sensibility , , , , , , , , , , , , , ,

Celebrating Mother’s Day: Part Two: Infant Attachment

May 10th, 2012 by avatar

this is a guest post by Jessica Zucker, Ph.D.

Part Two: Fortifying Parenthood: Know Yourself

Part Two is about the importance of knowing yourself as a step towards developing healthy parenting practices.

Q: How can I prepare to become a parent who offers my child(ren) a different experience than I had growing up?

Awareness is essential. Having a reflective stance and carving out time to consider your attachment relationship history can have far-reaching effects on your future parenting patterns.

Research has found that their baby’s emergent attachment security is more likely when parents have been honest with themselves about the realities of their own childhood experiences. This means we need not have experienced perfect, flawless childhoods ourselves in order to ensure our future offspring with secure relationships.

What is vital, however, is having a curiosity about the realities of how you were raised, your formative relationships, and how you were impacted by your experiences- the good, the bad, and everything in between.

Reviewing our lives through a raw and honest lens will allow us to more deeply understand why we are who we are. This type of reflection is a natural springboard for cultivating additional insight, mourning difficulties in childhood relationships, and honing aspects of your person-hood that may create a more harmonious babyhood for your children.

Cultivating a sense of reciprocal intimacy in the ever-changing relationship relies, in part, on how you navigate the many feelings that arise each day. It is not a danger to the budding relationship with your child to experience complex feelings. It is what you do with these poignant moments, how you understand the feelings, and the way you react to them that matters most.

There is no more powerful a way to invoke the memory of your childhood than to become a parent yourself. And the opposite of this is true as well.

Getting a taste of what you didn’t get from your parents while parenting your newborn can stir enigmatic feelings that viscerally catch us off guard, leaving us potentially panic-stricken.

Our childhood histories don’t simply fade into the background upon becoming a parent. In fact, entering the maze of motherhood often stimulates memories seemingly long forgotten. Though they might not be consciously remembered, early experiences get stored deep in the crevices of our psyches and in the muscle memory of our bodies.

A potentially daunting task, swimming in the complicated pools of our past ensures a smoother childhood for our offspring. Research states that “experiences that are not fully processed may create unresolved and leftover issues that influence how we react to our children” (Siegel & Hartzell, 2003).

Attempting to make connections between the ways in which the past impacts the present awards us a freedom and flexibility of being with ourselves and with our children. Invariably, when we model for our children an embodiment of authentic reflexivity we provide them with opportunities for deepening connection. Developing a clearer sense of how we have been shaped by the parenting we received fosters a more conscientious parenting path.

Consistency builds healthy attachment. Predictability yields trust. Bonding strengthens connection.

Engendering these experiences in your child might require you to dig deep–to excavate your own childhood experiences with the aim of being the best parent you can be.

Book References:

Siegel, D. J. & Hartzell, M. (2003). Parenting from the inside out: How a deeper understanding can help you raise children who thrive. New York: Penguin Books.

Siegel, D. & Payne Bryson, T. (2011). The whole-brain child. New York: Random House.

Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (2008). S. D. Stone and A. E. Menkin (Eds).

 New York: Springer Publications.

Wallin,D. (2007). Attachment in psychotherapy. New York: The Guilford Press.

Wiegartz, P. (2009). The pregnancy and postpartum anxiety workbook. Oakland, California: New Harbinger Publications.

Web Reference:

Early Moments Matter: PBS Toolkit

http://www.earlymomentsmatter.org/

Dr. Jessica Zucker is a clinical psychologist in Los Angeles specializing in women’s reproductive and maternal mental health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and parent-child attachment. Jessica studied at Harvard University and New York University. She is an award-winning writer and a contributor to The Huffington Post and PBS This Emotional Life. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). Jessica consults on numerous projects pertaining to the motherhood continuum.

Web: www.drjessicazucker.com
Twitter: @DrZucker

Authoritative Knowledge, Babies, Guest Posts, Infant Attachment, Maternal Mental Health, Parenting an Infant, Uncategorized , , ,

Celebrating Mother’s Day: Part One: Infant Attachment

May 8th, 2012 by avatar

This is a guest post by Jessica Zucker, Ph.D.

Part One: Fortifying Parenthood: Infant Attachment

Part One is about managing expectations about infant attachment and how to foster the infant bond

Infant attachment: Easier than we think

Parents are often burdened by internalized expectations surrounding attachment. Cultural pressures seep into our pores, clogging our hearts and minds with a million different ideas of how we “should” raise our children.

Super Mommy messages drain the life force out of genuine connection and intuitive responsiveness. Cultural pressures egg women on to embody unattainable perfection from head to toe, leaving us feeling compass-less and insecure when we need to trust ourselves most.

Laying the groundwork for healthy attachment relationships with our children may be easier than we think.

If we strip away the external frills, media hype, and ever-present “shoulds” of baby-dom we can plunge into the basic elements that make up healthy connection and fruitful development.

Let’s focus our energies on the burgeoning relationship with our children rather than culturally-bound trends handed down from generation to generation. We find presence of mind is the most powerful conduits for connection with our children.

What follows are some enriching tidbits about attachment and simple steps you can take with the aim of laying a foundation of emotional health in the relationship with your child.

Q: What is attachment

Attachment is the process, as well as the quality, of the relationship an infant forms with caregivers. Attachment can occur with biological and adoptive mothers, fathers, stepparents, grandparents, and any other consistent person in the child’s life.

A baby’s initial relationship experiences with primary caregivers creates the infrastructure for subsequent relationships, How the child views connection, how she experiences her self, and the world around her, is influenced by her early relationships.

With repeated experiences of predictable care, the infant learns about trust and security. Growing up in an environment infused with safety and intentionality ensures healthy social and emotional development.

“Children with a history of secure attachment show substantially greater self-esteem, emotional health and ego resilience, positive affect, initiative, social competence, and concentration in play than do their insecure peers” (Wallin, 2007).

Q: What are some concrete ways to set the stage for my child(ren) to experience a secure attachment?

Research shows it is the quality of the infant-caregiver interaction rather than the quantity of care that establishes the health in the attachment bond.

In other words, the caregiver’s sensitivity to the infant’s gestures and expressions during interactions is of paramount importance.

Repeated instances of feeling cared for results in a child’s establishment of behavioral expectations for future interactions, inside and outside of the home. Optimally, she learns to expect that people can provide safety, spontaneity, and continuity.

Research shows the number of hours spent together is not necessarily equated with security of attachment. For example, if a mother is home with her child full-time feeling depressed, notably overwhelmed, and appreciably disconnected from her infant, the distressing quality of their interactions may deleteriously impact the child’s sense of poise and/or interpersonal security. Thus, having a nuanced sense of what makes you feel the most present with your child will benefit the emotional health of your family.

The caregiver-infant patterns of communication hold great potential in establishing a secure attachment. Consistent maternal attunement facilitates the infant’s ability to freely explore the world around her, engage in spontaneous play, and rely on the caregiver to provide loving responses.

Security is further felt when the caregiver illustrates thoughtful actions and mindful behaviors.

Positive behaviors to reinforce secure attachment include:

  • narrating for your child the events of the day as you move from one activity to the next,
  • prolonged gazing and smiling, cuddling and comforting, skin to skin gentle touch,
  • calmly and consistently tolerating the variety of emotional states your baby exhibits as she begins to take in the world around her.

Babies often feel distressed and unequipped to modulate their changing feelings. Infants depend on the attachment figure to help them manage and tolerate their emotional experiences. This requires caregivers to “bear within herself, to process, and to re-present to the baby in a tolerable form what was previously the baby’s intolerable emotional experience” (Wallin, 2007).

Ideally, during the initial months of your baby’s life, she learns that caregivers are able to gracefully navigate challenging moments with love and understanding.

Caregiver consistency, responsiveness, and sensitivity yields infant flexibility, resilience, and a sense of attachment security.

Q: How do the earliest moments between infant and caregiver impact future relationships?

Healthy development and attachment security flourish when resonant, competent, attuned, loving, and consistent parental behaviors mark the initial months of a baby’s life.

Babies bask in a comforting balance between connection and exploration as a direct result of environmental safety and trustworthy role modeling.

Sensing that the world is a safe place reinforces self-confidence, trust in others, and a feeling that love and growth are generative.

Conversely, when infants experience their caregiver as threatening or regrettably unstable, fear of closeness can prevail.

Our internal compass for establishing and navigating relationships is initially arranged through seminal infant-caregiver interactions.

Simply put, when early life feels melodic and predictable, the world and others in it feel approachable. The template for how we come to understand what it means to be in relationship with others is set up during infancy and into toddlerhood. These formative relational patterns persist as we journey into adolescents and adulthood.

Book References:

Siegel, D. J. & Hartzell, M. (2003). Parenting from the inside out: How a deeper understanding can help you raise children who thrive. New York: Penguin Books.

Siegel, D. & Payne Bryson, T. (2011). The whole-brain child. New York: Random House.

Perinatal and Postpartum Mood Disorders: Perspectives and Treatment Guide for the Health Care Practitioner (2008). S. D. Stone and A. E. Menkin (Eds).

 New York: Springer Publications.

Wallin,D. (2007). Attachment in psychotherapy. New York: The Guilford Press.

Wiegartz, P. (2009). The pregnancy and postpartum anxiety workbook. Oakland, California: New Harbinger Publications.

Web Reference:

Early Moments Matter: PBS Toolkit

http://www.earlymomentsmatter.org/

Dr. Jessica Zucker is a clinical psychologist in Los Angeles specializing in women’s reproductive and maternal mental health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and parent-child attachment. Jessica studied at Harvard University and New York University. She is an award-winning writer and a contributor to The Huffington Post and PBS This Emotional Life. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). Jessica consults on numerous projects pertaining to the motherhood continuum. Visit Dr. Zucker’s website at  www.drjessicazucker.com

Twitter: @DrZucker

Authoritative Knowledge, Babies, Guest Posts, Infant Attachment, Parenting an Infant, Uncategorized , ,

Part Three: Positive Actions & Words that Heal: Perinatal Mental Illness for Birth Professionals

May 4th, 2012 by avatar

Childbirth Professionals: Positive Actions and Words that Heal

 As I write this, I wonder how the childbirth community feels about this issue? I would certainly understand if it brings up discomfort. I’d love to hear your point of view!

 You can help a lot by becoming educated about perinatal mood/anxiety disorders, having a list of community and online resources, and working with your clients to update their Birth Plan with a section on Postpartum Planning. These are ways to be of help without overstepping your personal, certification or licensure boundaries.

The best positive actions are empathic understanding, education, prevention by preparation, and providing resources.

 Prevention by Preparation!

 Sample Postpartum Support Plan – Add Your Own Information!

1. Social Support

Family & friends can offer the first line of support, but sometimes it’s not enough. Keep in mind alot of people do not have a safe home or a safe family to go to.

Local support groups in your community will vary by location

Online support groups:

There are many online websites & forums that are free, to address any

type of situation, including preemie, bedrest, birth trauma, infidelity.

2. Professional Support

Phone/Email List

3. Practical Support

Meals for the first month?

Many towns have local delis or restaurants with a special menu with different pricing (less complex food) for people who are experiencing an illness or need some extra help. You can collect money and order from this menu, if there is no time for people to participate in a meal preparation chain.

Sleep?

Provide options for infant sleep methods, including information about infant fourth trimester or babymoon. Hiring a postpartum doula or getting family help can get the mom some good sleep.

There are many good compromises to co-sleeping and feeding on demand. Research Dr. Karp, Mrs. Pantley, Mrs. Kurcinka and even Dr. Weissbluth has some positive messages. You don’t have to agree with everything the author says, just take away the points you wish and integrate them into your parenting style. Secure emotional attachment really can occur in a wide range of healthy parenting styles. My business blog has reviews of most of the current infant sleep methods, so your clients don’t have to read all those books.

MindBody Methods Can Help Manage Emotions

Substantial research supports mindbody therapies as a way to manage your emotions. Yoga, mindfulness, massage/shiatsu/acupressure, exercise and counseling have all been shown to help alleviate symptoms of depression and anxiety.

I think that many types of mindbody methods can help some people, but for clinical depression, you need to help her not be ashamed to seek professional help.

Sometimes, some social support and mindbody methods are enough for an individual and sometimes they are not.

Some people are too depressed /anxious to be proactive enough to try these methods and they may need medication. Others are able to manage their emotions with their own individualized plan. It is difficult to make a blanket statement about all people.

But I urge you not to judge how the person chooses to treat his or her mental illness.

There is no shame in asking for help and getting treatment.

Visitors?

Create a family & friend support chain. This can be coordinated on line – get people to commit to a few hours/days a week at a time, to protect the mental health of the mother. LotsAHelpingHands is an online website where this type of community support can be arranged. Tasks such as: going over the house and holding the baby, to let Mom take a shower, cooking a meal, driving the Mom to a psychiatrist appt, etc. can be listed in private projects on this site.

Words that Heal

Please share your own Words That Heal in the comments area!

You are not alone, you are not to blame, with help you will get better.

You are a good mother.

You guys are good parents.

You are doing this “right”.

All moms are tired, this is normal. You are not unusual.

You baby looks so attached to you!

There is a broad range of parenting practices that produce securely attached human beings, you are allowed to take a break from mothering, and it will not harm the attachment bond.

You know, nobody goes it alone.

You are a good mother!

You are a good person going through a rough patch.

You know, nobody goes it alone. Maybe you can take a look online at some resources. Let me help you, you need professional help, it’s ok. Everyone needs help now & then, you are a good mother.

If you had diabetes, you would get help for that. It’s the same sort of thing, so there’s help available.

Getting help is not a sign of weakness, don’t wait it out, get help, you are not alone, there is no need to suffer.

Actions that Heal

  • Encourage the mother to increase self-care.
  • Encourage the father or a friend to organize a support chain.
  • Encourage the mother to release self-blame and accept help.
  • Help the mother get some sleep, give her a list of postpartum doula resources. It is worth it to spend the money to hire a postpartum doula to help with the night shift for a month so.
  • If she is exhausted, assure there are many methods of raising a securely attached and emotionally health infant. If she is invested in attachment parenting, there may be a way to compromise so she can get sleep.
  • Refer her to professional treatment in your local area.

Helpful Hints About Professional Treatment

Primary care can diagnose depression. PCPs can offer a first line of antidepressant treatment and referrals to therapists in the area. A true depression is most effectively treated with a combination of antidepressants and therapy, not just medication alone. Sometimes just a few sessions of therapy help immensely. If the PCP does not give a referral to a therapist, then there is no use in lamenting the practice did not give you a referral. Just help her pursue one yourself.

Psychology Today has listings. Sometimes her insurance company or company EAP will work with their clients to do some preliminary screening. It is worth the phone call to see if this service is offered. I frequently get such calls. It is ok to couch shop by telephone. It can feel frustrating, but it is worth the effort to find someone with whom you feel a connection.

If the medication is not right, she will know by how she feels. She can trust her inner feelings. If she doesn’t feel right, if she feels more anxious, if she feels worse, she needs to speak up. She needs to re-visit the prescribing doctor. In some cases, it is necessary to see a psychiatrist about psychotrophic medications. There is no shame in seeing someone in this specialty. It does not mean the person is “crazy.” It just means this particular, individual balance of psychotrophic medication needs a specialist’s eye.

I hope the readers of this blog, the childbirth educators have found this three-part series about perinatal mental illness to be helpful and I sure hope it demystifies things! I am very curious to hear your feedback/input! Any and all questions are welcome!

Online Perinatal Mental Health Resources:

Postpartum Support International

#PPDCHAT

BirthTouch, LLC

Organization of Teratogen Information Specialists

Befrienders Worldwide

Lotsa Helping Hands

Helpful Mom to Mom Blogs – Add More in the Comments!

My Postpartum Voice

 Ivy’s PPD Blog

Authoritative Knowledge, Childbirth Education, Depression, Different Methods for Different Questions, Evidence Based Medicine, Maternal Mental Health, Perinatal Mood Disorders, Postpartum Depression, Pregnancy Complications , , , ,

How Long Can Labor Safely Be?

April 18th, 2012 by avatar

How Long Can Labor Safely Be?

By regular contributor, Henci Goer

A few weeks ago Kathy Morelli wrote an S&S blog post about a study comparing labor patterns in the 1960s with labor patterns today. The contemporary data were collected by the U.S. Consortium on Safe Labor (CSL), a collection of 19 hospitals, 17 of them teaching institutions, whose primary purpose is “to describe contemporary labor progression and to evaluate the timing of Cesarean delivery in women with labor protraction and arrest.” The study compared women with spontaneous labor onset at term who were carrying singleton, head-down babies and found that after adjustment for differences in maternal and pregnancy characteristics, labors take longer today despite substantially increased use of oxytocin augmentation. The authors attributed the increased length to changes in management practices and concluded: “Since labor times are longer today than in the past, the benefit of extensive interventions such as oxytocin and cesarean delivery in modern labor management needs further evaluation”(Laughon, Branch, Beaver and Zhang, p. 14).

The question still on the table is at what point does increased risk of morbidity from continuing a prolonged labor outweigh the risks of cesarean surgery or instrumental vaginal delivery to curtail it? The CSL study doesn’t answer that question, but we have two studies, one in a single institution and the other a multicenter study, that provide means and extremes for duration of physiologic labor. Both studies were conducted in healthy women in spontaneous labor at term with a singleton, head down fetus who were cared for by midwives. No woman had oxytocin augmentation, epidural analgesia, or an instrumental vaginal or cesarean delivery. Let’s compare data on first-time mothers since they are much more likely to experience progress delay.

 

CSL
n = 43,576

Albers 1999
n = 806

Albers 1996
n = 556

4 cm -> 10 cm
CSL: median (95th percentile)*
Albers: mean (95th percentile)
6.5 (24.0) hr 7.7 (17.5) hr 7.7 (19.4) hr
2nd stage
CSL: median (95th percentile)**
Albers: mean (95th percentile)
0.9 (3.1) hr 0.9 (2.4) hr 0.9 (2.5) hr
epidural 60% 0% 0%
oxytocin augmentation 37% 0% 0%
instrumental vaginal delivery 10% 0% 0%
intrapartum cesarean 16% 0% 0%
5-min Apgar < 7 2% 0.8% 1.1%

*data only from women reaching full dilation
** data only from women having spontaneous birth

As you can see, labor averaged even longer in the physiologic groups without doing any harm to the newborns. As you can also see, the midwifery data blow active management concepts, now enshrined in partograms, out of the water. Setting 1 cm per hour as the threshold for abnormally slow progress—which allows 6 hours to go from 4 cm to 10—means augmenting first-time mothers dilating faster than the average rate!

The CSL investigators point out that half the cesareans in the entire CSL cohort were performed for “failure to progress” or “cephalopelvic disproportion” and reference another study of the cohort finding that “a large percentage of women” (p. 12) had cesareans prior to active-phase labor. Indeed they did. Among first-time mothers with spontaneous labor onset who had cesareans for delayed progress, more than a quarter of them (28%) had the surgery at 5 cm dilation or less. Among induced labors, the percentage soared to half (53%).

Despite their concern about over use of oxytocin augmentation and operative delivery, the CSL investigators also note that the extra two hours of average labor duration in first-time mothers (compared with the 1960s cohort) cost Intermountain Healthcare hospitals, which managed 5439 vaginal births in first-time mothers in 2010, an extra $110.40 per labor, amounting to an annual excess cost of $600,466. They continue: “The implications for healthcare systems and payors are obvious and should drive a reconsideration of modern-day labor process management with an eye towards process improvement” (p. 13). One wonders just what that process improvement might be. The “time is money” argument certainly doesn’t augur for recommendations to have patience and avoid intervening—especially not when intervening via cesarean surgery increases revenue as well as saves money.

They don’t come right out and say so, but clearly the CSL investigators know they have documented a gross overuse of cesarean surgery to cut short (pun intended) perfectly normal labors that pose no excess risk to mothers or babies. The Consortium on Safe Labor has, in fact, exposed that labor in their participating hospitals isn’t very . . . well, . . . safe. Women are ending up with major interventions they don’t really need and, no doubt, some of them are experiencing unnecessarily their consequent complications. What is more, economics provides a perverse incentive for keeping it that way.

 

 

Authoritative Knowledge, Cesarean Birth, Systematic Review, Uncategorized , , ,