smallRW.gif (2706 bytes) Four Routine Childbirth Procedures that Don't Help and Can Hurt
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NEW YORK, Jan. 21 /PR Newswire/ -- "Unfortunately, what some obstetricians think they know can hurt you," says Henci Goer, who distilled information from hundreds of medical studies for her book, "The Thinking Woman's Guide to a Better Birth," recently published by Berkley/NAL Publicity. "The research does not support many routine labor practices." These include:

-- Snipping the vaginal opening for birth (episiotomy): Nearly half of women birthing vaginally still have episiotomies despite overwhelming evidence that episiotomies don't do any of the things claimed for them--prevent deep tears, preserve the strength of the pelvic floor muscles, prevent fetal distress. In fact, episiotomies cause deep tears, as any woman who has ever snipped a piece of fabric to tear off a length will understand. Episiotomy complications include pain, increased blood loss, and sometimes infection. Mainly because they lead to rectal tears, episiotomies can also result in long-term or chronic pain or pain during intercourse, stool incontinence, and the formation of an opening between the vagina and the rectum.

-- Continuous electronic fetal monitoring: Once hailed as the technology that would save babies from brain injury during labor, the use of continuous monitoring has steadily grown even as study after study concluded that it doesn't work. When compared with periodically listening to the baby's heart, continuous monitoring increases the odds of cesarean section and instrumental delivery without improving newborn outcomes. Hospital staffs now argue that hospitals don't have enough nurses to listen as often as they should or that the monitor strip provides evidence in malpractice suits. The first rationale says that hospitals don't have enough nurses to look after laboring women properly, the second that hospitals are willing to subject women to something that benefits hospitals at their patients' expense.

-- Rupturing membranes: Breaking the bag of waters can shorten labor by an hour or so, but the point of speeding up labor is to prevent cesarean section for poor progress. However, nine studies randomly assigning women to have membranes routinely ruptured or not all found a slight increase in cesareans in the "rupture membranes" group. Meanwhile, walking in labor and pushing in an upright position may do more to shorten labor than rupturing membranes and pose no risks whatever.

-- I.Vs./no food or drink in labor: According to many doctors, women must not eat or drink in labor in case they suddenly need general anesthesia. Women could vomit while unconscious and choke. An I.V. is supposedly a risk-free replacement. However, in three large U.S. studies totaling 78,000 laboring women who ate and drank freely, not one woman choked under anesthesia. Also, anesthesia-related complication rates in countries permitting eating and drinking in labor don't exceed U.S. rates. This is because modern anesthetic technique requires putting a tube down the throat to protect the airway. In addition, few cesareans these days are done under general anesthesia. Meanwhile, I.V.s cause pain and inhibit mobility. They not infrequently overload fluids, which can lead to blood chemistry imbalances in mother and baby, fluid in mothers' and babies' lungs, and anemia in the mother, which increases the odds of heavy bleeding after the birth. Sugar-containing I.V.s can raise mothers' and babies' blood sugar to diabetic levels. This has its own complications. 

"All procedures have risks as well as benefits," Goer warns. "If they are used routinely rather than to treat specific problems, there are no benefits, and only risks remain."

SOURCE: Berkley/NAL Publicity

ST: New York


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Posted January 21, 2000.

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