Saturday, April 12, 2008

Giving Birth, so far

I'm about a third of the way through Giving Birth: A Journey into the World of Mothers and Midwives, by Catherine Taylor. So far, I find it fascinating! It is exactly what it says it is--a journey into the world of mothers and midwives. It has opened my eyes to just how unique each mother and each midwife/doctor is. Though we can say that most midwives have common philosophies, they are by no means a uniform group. Midwives' practices vary widely depending upon where they deliver, who their back-up physicians are, what insurance companies they're affiliated with (if any), and where they received their midwifery training. Even within ONE midwifery practice each midwife will have her own style and leanings. Catherine Taylor also masterfully weaves-in statistics and research about birth and various medical interventions. Here are some excerpts I found informative, eloquent, right on, or though-provoking...
I don't understand the hospital's need to separate mother and child; I don't understand their need to immediately quantify everything about the baby. Can't that wait an hour? And couldn't any observations that need to be done to assess the newborn's health be done with the baby lying with or on the mother if she wants it there? (p. 38)
"Most clients ask about ultrasound," Sarah comments. "A decade ago we did them routinely. But the cost to the system is high, and routine use has not been shown to improve birth outcomes," she explains. In situations where the doctor bills for every service and the patient's insurance pays for these kinds of tests, some doctors still order them automatically. In fact, I have one friend whose doctor ordered an ultrasound for every visit. When she asked why this was necessary, he brushed her off, saying, "Oh, it gives us important information," without explaining what that information might be or what they might be expected to do with it. In fact, the American College of Radiology recommends that ultrasound screening be done only when there is a "valid medical reason," and the World Health Organization finds that "routine ultrasound assessment has not been shown to decrease morbidity and mortality" (p. 42-43).
On this final item [epidural-induced fevers], Nancy's statements are backed up by research done by Dr. Ellice Lieberman of Harvard University and published in the journal Pediatrics that shows epidurals are indeed associated with a hugely increased frequency (fourteen-fold) of fevers in birthing mothers and finds that the resulting "neonatal sepsis workups and administration of antibiotics are not necessarily benign." . . . She concludes, "Given the cost, risk, and pain to the newborn, the higher proportion of sepsis workups that may be attributable to epidural use is cause for concern" (p. 58).
[Liz] explained, "If you have a midwife manage the same population as a physician, the midwife is going to order fewer tests, she's going to have fewer expensive interventions and procedures, and she's going to have better outcomes, despite the fact that she didn't throw all this technology at the patients" (p. 73).
More good stuff to come!

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