werner@aecom.UUCP (Craig Werner) (07/08/85)
In a recent request for topics, I got two requests related to childbirth, so the article summarized below caught my eye: From Parade Magazine, July 7, 1985, pp. 12-13. "Are Today's Birth Techniques Neccessary: What Doctor's Don't Tell You." by Diana Korte. [I thought the title needlessly incediary, but the content is reasonable.] Some common misunderstandings: 1. Shaving reduces infection. Studies do not back this up, and some indicate (not only for childbirth but for all surgery) that it may increase infection by irritating the skin. 2. An enema during labor eases the baby through the birth canal by stimulating the uterus to contract; it also reduces the chance of fecal contamination. In 1982, a British study found none of these claims to be true, and concluded "such rectal assaults on women in labor should be discouraged." [Among all things listed , this is the one practice I had never heard of] 3. All women should be hooked up to IV feeding during labor. The argument for this is that if a complication occurs during delivery (i.e. shock), putting an IV in then would be more difficult. It is routine in many hospitals. Others (more reasonably) only do it for women at high risk. 4. Women belong in bed during labor. Wrong. The supine (lying on back) position lowers maternal blood oressure, and may decrease blood supply to the Uterus, and hence Fetus. It also decreases the strength of contractions and slows labor. Also lying down, the mother has to work against gravity. Better would be standing with support, sitting, kneeling, or lying on the side. 5. An Episiotomy hastens labor and healing. It may also prevent later bladder problems. Actually, there is no evidence it shortens labor, or reduces severe tearing. It quotes, "Women who have episiotomies have a higher percentage of deep tears in the vagina." [The last statistic can be misleading, since women at risk for tearing are more likely to have an Episiotomy. Also, the surgeon who taught us anatomy remarked in lecture that the true reason for doing it is not to eliminate tearing, but rather to deflect it away from where it would do the most damage.] 6. Electronic fetal monitors accurately chart the fetus's heart rate during labor, resulting in better outcomes for babies. They do provide more information that a stethoscope, but it has not been proved that this neccessarily translates into a better outcome. It does result in a higher Ceasarian rate - since more information translates into more things to worry about on the part of the delivery team. 7. The amniotomy is a simple, efficient way to start or speed up labor. At best, it speeds labor by half an hour, which is negligible. This is offset by the loss of the Amniotic Fluid as a shock absorber for the baby's head. A better way to speed up labor would be simply have the woman stand up or walk around, assuming a normal birth. 8. A Ceasarian Delivery is often lifesaving. This IS true. The problem, however, is that Ceasarians are often performed when minor, not major, problems occur during birth. One reason is the fear of malpractice suits. [Obsetricians in NY currently must pay over $100,000/yr in malpractice insurance premiums.] [Except for those passages in square brackets, none of the above article represents my opinion. I just post what passes my way.] -- Craig Werner !philabs!aecom!werner "The world is just a straight man for you sometimes"
jeand@ihlpg.UUCP (AMBAR) (07/10/85)
Many of the items mentioned in the referenced article were expounded
on at length by Dr. Robert Mendelsohn (sp?) in his book MALEPRACTICE,
about the abuse of women by the medical profession at large. If half
of what he says is true, NOW should be suing the AMA.
--
AMBAR
{the known universe}!ihnp4!ihlpg!jeand
"You shouldn't let people drive you crazy when you know it's within
walking distance."ron@brl-tgr.ARPA (Ron Natalie <ron>) (07/10/85)
> 3. All women should be hooked up to IV feeding during labor. > The argument for this is that if a complication occurs during > delivery (i.e. shock), putting an IV in then would be more difficult. It is > routine in many hospitals. Others (more reasonably) only do it for women > at high risk. > I know you are just quoting the article here but it shows even more mis- conceptions. The IV is not a "feeding" line. The IV is provided for two purposes: one, to replace blood volume that is one of the major shock problems, and two, to provide a rapid avenue for the administration of drugs (including anethesia). When their are no shock signs or the administration of drugs is not required, these lines are kept at a KVO (keep vein open) level that assures that the line will still be viable when it is necesary to use higher rates of infusion. I don't know about pregnancy, but it's standard procedure for surgery procedures at most hospitals around here. The amount of liquid infused via a KVO drip is less than a millimeter per minute. The liquid infused is mostly water with enough stuff in it to make it similar to blood (if you infused straight water, you'd cause cellular rupture). However the amount of time saved if you need to administer drugs or if the mother starts to exhibit shock problems can be enourmous. Just this morning it took two attempts to try to start an IV on a man with sever circulatory depression. He needed the IV, he needed the large course of drugs that we followed into that line. If you think you may need to have an IV, it's best to have the catheter in and the fluid running KVO because you don't want to be fussing with it when the shit hits the fan. -Ron Natalie, EMT-A, Intraveous Therapist.
betsy@dartvax.UUCP (Betsy Hanes Perry) (07/12/85)
> > 3. All women should be hooked up to IV feeding during labor. > > The argument for this is that if a complication occurs during > > delivery (i.e. shock), putting an IV in then would be more difficult. It is > > routine in many hospitals. Others (more reasonably) only do it for women > > at high risk. > > > > don't know about pregnancy, but it's standard procedure for surgery > procedures at most hospitals around here. The amount of liquid > infused via a KVO drip is less than a millimeter per minute. The liquid > infused is mostly water with enough stuff in it to make it similar to > blood (if you infused straight water, you'd cause cellular rupture). > However the amount of time saved if you need to administer drugs or if > the mother starts to exhibit shock problems can be enourmous. > > > -Ron Natalie, EMT-A, Intraveous Therapist. Yes, but delivery is different from surgery in that it is not unreasonable for the patient to expect to be mobile. (Uh, Doc, mind if I walk around the room while you do that appendectomy?) An IV line drastically restricts a woman's freedom to sit, squat, pace, or do whatever comes naturally. I suspect that's why the originally-cited article suggested that IV lines should not be mandatory in all cases. In a high-risk pregnancy, obviously, the rules are different; I think the major complaint about modern obstetrics is that some OBs behave as if all pregnancies were high-risk by definition. -- Elizabeth Hanes Perry UUCP: {decvax |ihnp4 | linus| cornell}!dartvax!betsy CSNET: betsy@dartmouth ARPA: betsy%dartmouth@csnet-relay "Ooh, ick!" -- Penfold
reh@aplvax.UUCP (Ron E. Hall) (07/15/85)
> > > 3. All women should be hooked up to IV feeding during labor. > > > The argument for this is that if a complication occurs during > > > delivery (i.e. shock), putting an IV in then would be more difficult. It is > > > routine in many hospitals. Others (more reasonably) only do it for women > > > at high risk. Elizabeth Hanes Perry- > An IV line drastically restricts a woman's freedom to sit, squat, > pace, or do whatever comes naturally. I suspect that's why the > originally-cited article suggested that IV lines should not be mandatory > in all cases. In a high-risk pregnancy, obviously, the rules are different; > I think the major complaint about modern obstetrics is that some OBs > behave as if all pregnancies were high-risk by definition. Recent malpractice awards here in Maryland and the concommitant rise in medical malpractice insurance premiums have made even normal pregnancy high risk for the OB. Failure to take all precautions may leave him vulnerable to legal action if mother or child are injured or die during delivery. An OB can afford to listen to many complaints about unnecessary IV's or restricted mobility for the price of a single malpractice suit. It's hard to blame the OB for choosing to protect his career, even at minor discomfort to the patient. He's really in a dilemma: the same people who criticize him for doing too much when all goes well will sue the socks off him for doing too little when all does not go well. Ron Hall JHU/APL ...decvax!harpo!seismo!umcp-cs!aplvax!reh ...rlgvax!cvl!umcp-cs!aplvax!reh -- Ron Hall JHU/APL ...decvax!harpo!seismo!umcp-cs!aplvax!reh ...rlgvax!cvl!umcp-cs!aplvax!reh