Monday, August 15, 2011

Maternity Thought Process Swings Toward Health

It has been brewing for several years. 
It has been spoken about in professional journals and at childbirth conferences.
And now, it is finally here.

The maternity thought process in the media and in established care facilities such as WIC and hospitals is changing and gratefully, the media is reporting it.  Jumping on the bandwagon (literally) of the Big Pink Bus for breastfeeding awareness, local communities, LLLI and WIC offices promoted World Breastfeeding Week and then Breastfeeding Month (August).

More and more hospitals are realizing that the increase in NICU admissions is NOT a good thing for fiscal management and that they are a BAD thing for society.  From coast to coast, hospitals are banning - yes, banning - early elective cesareans and early elective inductions.  To say that early elective inductions and cesareans rates had gotten out of hand is a small statement.  With the CDC confirming the US cesarean rate of 34% and also the US slipping further in maternal/infant morbidity and mortality was a clear indicator that the increase in interventions were NOT saving lives - if nothing else, contributing to the catastrophic morbidity and mortality rates.

Of course, we need quanitifying data to show us what we and Mother Nature have known since the beginning of time: vaginal birth has extensive benefits for mother and baby.  In a 2006 published report in Clinical Obstetrics and Gynecology (Buhimschi et al Advantages of Vaginal Delivery CLINICAL OBSTETRICS AND GYNECOLOGY Volume 49, Number 1, 167–183), the authors finally admit it:  Despite an impressive amount of effort and extensive research, our knowledge of parturition remains limited. Scientists have exhaustively investigated ‘‘the timing of birth’’; yet, we still have a limited understanding of the biologic mechanisms that control the events initiating delivery, and consequently, we lack tools to prevent these mechanisms from acting inappropriately.

Further the state:

Thus, it is not surprising to see that the overall rate of labor induction 
overall rate of labor induction has doubled 
as part of our efforts to ‘‘save life.’’ 
Although there is compelling evidence to suggest elective induction of labor significantly 
increases the risk of cesarean delivery 
the concept of elective primary cesarean section is not anymore a ‘‘myth.’’

While it is abundantly clear that for most care providers the ultimate goal is a safe and healthy mother/baby dyad, it is also clear that humans really do not have as firm a grip on the power of the mother's body during labor and birth NOR do we have an extensive knowledge base of the impact of the birth process on the newborn and ultimately breastfeeding.  For if we did, our statistical data would be reflective of it.

The authors' final statement does give hope to those of us who've championed evidence-based maternity care and education:  
Therefore, we all have to rely on high-quality studies that can guide our
decision-making and make obstetric practice safer for both the short- and the longterm future. We believe that establishment of clinical protocols aimed at identifying cases appropriate for vaginal delivery or for cesareans should become a clear objective of each department, and that consistent implementation of these guidelines would significantly improve maternal and infant outcomes.


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