Monday, August 02, 2010

2 + 2 Is Still = 4, So Don't Discourage Childbirth Classes

I can remember sometime between junior high and high school, new math was introduced.  It would revolutionize math as we knew it ~ we would be math geniuses, plus run faster and jump higher (insert some sarcasm here).  But alas, 2 + 2 still equalled 4.

For years, (ok perhaps decades), childbirth educators have been discussing, exploring, documenting, investigating, mulling-over, speaking about, shouting about, and jumping up/down about the link between early induction of labor, the rise in the cesarean rate and near term infant births.

Dr. Deborah Ehrenthal of Christiana Care Health System published a study in the July issue of the journal Obstetrics & Gynecology found that among more than 7,800 women giving birth for the first time, those whose labor was induced were twice as likely to have a C-section delivery as those who experienced spontaneous labor.

In today's Time Magazine article  Are C-Sections Overused? Rethinking Induced Labor, author Tiffany O'Callaghan states that "the (high) rate (of induction) is significant because ACOG guidelines, which have been in place since 1982, recommend against elective inductions in the early term, or anytime before 39 weeks."  She hits a home run when she also states that "Despite studies showing VBAC to be safe for most women — ACOG data suggests that 60% to 80% of women who attempt VBAC will succeed — many hospitals have urged women to undergo a repeat cesarean over the past decade, largely to avoid medical risks and malpractice suits."

In discussing the relationship between early induction and the need for cesareans, O'Callaghan reported that researchers found that under the new policy the overall induction rate dropped 33% and the rate of elective inductions fell by roughly the same amount. What's more, the total number of C-sections among first-time mothers who underwent elective induction dropped 60%. The results of the Magee-Womens study were published in April 2009 in the journal Obstetrics & Gynecology.

Near the close of the article, Dr. Ehrenthal advised that patients should be informed and included in the decisionmaking process.  That is something, too, that childbirth educators have been including in their classes for decades.  

However, with the amount of clout that physicians/obstetricians do have with their patients, they must certainly understand that discouraging attendance at childbirth education classes interferes with the amount of birthing information, knowledge of alternatives and exposure to informed consent.  Since we all live in a mobile society, many of us do not have the luxury of learning about birth from the wise women in our families, nor do we have the opportunity to attend the births of our aunts or siblings.  Hence, we read books (some questionable at best), view birth related television shows (now those are factual, aren't they ~ oops, sarcasm again), or surf the internet. I think it would be fair to say that perhaps none of the above 3 information gathering techniques (books, tv or the internet) would lead to definitively lead a pregnant women to the Healthy Care Practices from the World Health Organization or those crafted by Lamaze International.

As Mary Kroeger stated in the book Impact of Birthing Practices on Breastfeeding, "Solid scientific evidence shows that returning to birthing practices that preserve normalcy can accomplish many things: faster, easier births; healthier, more active and alert mothers and newborns; and mother-baby pairs physiologically and optimally ready to breastfeed."

The information in the ACOG revision and the Time Magazine article (plus thousands of other media publications) regarding inductions/cesareans/VBACs is not new.  2 + 2 still = 4.  If physicians would be willing to work together with childbirth educators to achieve Dr. Ehrenthal's suggestion (and that of Healthy People 2010) that patients should be informed and included in the decisionmaking process, then we just would not only lower the U.S. cesarean rate, but also impact the health of newborns with fewer admissions to the NICU, higher breastfeeding rates, AND maternal morbidity/mortality rates that are better than some third world countries.

1 comment:

Kathryn said...

Here, here !!!! (applauding wildly )