Tuesday, July 21, 2009

Not That You Asked: Birth

Or: In Which I Feel A Need To Express Myself

I'm sure many of my fine crop of 2 readers (just kidding! I know there's at least 5 of you!) have children. And I'm sure the rest of you have no need for my unsolicited opinions on giving birth. But, you know, my blog, my subject matter. (Potentially related side note: I have a friend on Medicaid, who has a potentially-dangerous-or-fatal complication, and her OB care is making me tear my hair and scream.)

Did you know that doctors often don't believe in evidence-based medicine? And even those who do tend to suck at it? (My favorite quote from the book that's linked: "The vast majority of surgeons believe the mortality rate for their patients to be lower than the average.")

(Another side note: Did you know that the Needed-Number-to-Treat for cholesterol-lowering drugs is somewhere between 100 and 300?)

Anyhow. About birth. What I think applies ONLY to low-risk, healthy pregnancies. I'm not talking about multiples, histories of bad outcomes, pre-eclampsia, gestational diabetes, or unmarried single mothers who use drugs. I'm talking about your average normal delivery.

-Remember that OBs are surgeons. To the person with a hammer, the whole world does look like a nail. OBs are trained primarily in intervention. Most low-risk births do not require interventions. Every unnecessary intervention is a risk.

-The average length of a first labor, according to my midwives, is 26 hours. Let me repeat: 26 hours of contractions. If it's been shorter than 26 hours, you're still doing great. If it's been longer, well, you and half of everyone else, dear. (Other places say maybe 15 hours or 19. Whatever. It takes a while. Don't be surprised.)

-Related: My midwives advised, upon having regular contractions, to go home, eat something light but sustaining (oatmeal, yogurt, fruit), have a glass of wine and a nice bath, and take a nap.

-The US government does not recommend continuous electronic fetal monitoring; intermittent works just as well. Continuous has a high false-positive rate and it causes unnecessary interventions; amnioinfusion can help prevent the need for C-sections. Also continuous EFM does not prevent cerebral palsy.

-Having the doctor break your waters probably doesn't shorten labor. And it's not recommended. It increases the risk of cord prolapse (very, VERY dangerous!) and, oh yes, doesn't help anything.

-You know what does shorten labor? Walking around. Laying on your back, unless of course you have a burning desire to do so, is not so great. Also, if your baby is posterior, bending over or going on hands-and-knees actually helps. (Personal note: spent three hours bent over at 90-degree angle in the shower with posterior baby; he turned. Plus, that was the only way it wasn't agonizing.)

-It's frequently hospital policy to strap every woman to an EFM and an IV. And then you can't walk around. Do you really need an IV? Chances are, no. (Unless you have GBS, and even then you don't need a continuous IV.) If you really need an epidural, they can push a bag. If, God forbid, you're having an emergency, an IV will be the least of your worries.

-It's also frequently hospital policy that women in labor shouldn't eat. In case they need to be intubated. There are a lot of studies showing that it doesn't increase risks. Anecdotally, women who don't eat get exhausted. I personally recommend fruit or yogurt.

-Episiotomy and associated interventions? Probably not a good idea.

-The antibiotic eye goo right after birth only prevents chlamydia, and can interfere with breastfeeding: how can baby find boob if baby can't see? It's great public health policy, but maybe not so good personal policy. If you don't have chlamydia (most jurisdictions require prenatal testing, or a signed waiver) and your partner doesn't have chlamydia, and neither of you has done anything to get it since you were last tested...

-The HepB vaccine, likewise, is given at birth as a matter of public health policy. However, it can also be given at 1-2 months. If you don't have HepB... well, see above.

-You should breastfeed within 1 hour of giving birth, unless there's an emergency. Someone who knows what they're doing should check latch and positioning.

Modern medicine is wonderful. It saves lives. The trick is to have a medical practitioner who knows when you need interventions, not one who thinks you look just like a nail.

Next Soapbox: Breastfeeding!