ACOG Smartens Up While DONA Throws Baby Boys To The Wolves...

I know. Has the world gone mad?! You read the post title right. I woke up this morning to find a published position from ACOG that discourages elective inductions and cesareans overall, and especially discourages either for macrosomia (big baby). Whaa??

Here are a few highlighted quotes from ACOG's statement:

“Let nature take its course.” Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born."  - James Breeden, President of ACOG

Wait. Did you read that too? He said to let nature take its course. Sadly, I fear that these words are going to fall on the deaf ears of women who will still believe, due to long-time conditioning by Obstetricians themselves, that as long as baby is "term" then baby is ready. The funny thing is, state medical boards are ALL OVER regulating Midwives, citing the safety of women and babies as the reason. Where has the regulation been with Obstetricians who are happy to perform elective inductions and cesareans, which put baby's life at higher risk than home birth does? Where is the outcry for public safety?

Okay, okay...I give ACOG serious credit for taking a stance on this again. Yep, ACOG has long since discouraged elective anything, in favor of labor starting naturally. But, it seems that Obstetricians have not been held responsible when they do otherwise. Here's another quote from an article on Improving Birth:

"For one, induction or surgery for “suspected big baby” (macrosomia) is not medically indicated. This is one myth we hear about all the time, even though ACOG has been talking about the “imprecise” nature of diagnosing macrosomia for at least ten years. Bottom line: induction for big babies is NOT medically indicated.

Elective inductions prior to 39 weeks gestation is, again, not recommended. Studies have shown that babies do better when they are able to remain in utero until 39 weeks. In the article above, ACOG sais, “Early-term infants have higher rates of respiratory distress, respiratory failure, pneumonia, and admission to neonatal intensive care units compared with infants born at 39 to 40 weeks gestation. Infants born at 37 to 38 weeks also have a higher mortality rate than those born later." - Dr. Capetenakis, OBGYN in Encinitas, CA

So again, I have to ask where the accountability is? I am very excited that ACOG has published this. However, I am skeptical that all of a sudden Obstetricians will start practicing evidence-based medicine when it is more profitable for them and the hospital in which they have privileges to keep doing what they've been doing. And going back to the factor of women in all of this - it's going to take a LOT of effort if there is ever going to be a hope of women waking up and realizing that being uncomfortable is better than putting their baby at risk.

I was recently told a story. A friend of a friend is a L&D nurse. She kept saying that she was not going to term. She got a stomach bug at 36 weeks, contracted from the vomiting, and went in to L&D. Even though it was not causing any cervical change, she decided it was just time to get baby out. Because she was 36.6 though, they waited until just before midnight to induce, because otherwise it was against hospital policy. But she went ahead with it, with an epidural in place before the induction was started. Kept saying that she KNEW she wasn't going to term. After the delivery, she told everyone about what a blessing it was that she was in the hospital (and not at home, like my crazy friend) because baby ended up having complications.

I will keep my comments to myself here, because they aren't nice. They even include much foul language. But THIS - THIS is the type of system that women are in. The one where it's perfectly acceptable to choose to rip your baby out of the womb, just because you don't feel like being pregnant anymore. The one where it's perfectly acceptable for Obstetricians to manipulate, coerce, and even FORCE women into intervention, procedures, and consent when they had previously denied consent. My heart is heavy in knowing that we have a loooong way to go.

I also woke up this morning to a find that DONA (Doula certification organization) has published an article in their magazine that is in favor of routine infant circumcision.

"A family's decision about circumcision should come from personal values. Religious and cultural reasons usually win out over all other arguments. Otherwise, you can make the case that circumcision is mainly a cosmetic procedure, with some potential medical benefits. It typically takes less than five minutes, and complications are very rare."

:scream:  Actually, the medical need for a circumcision later in life is less than the risk of DEATH from routine circumcision. Complications are not, "very rare". From Dr.Momma.org:

Out of 100 Circumcised boys:

75 will not readily breastfeed post-op

55 will have adverse reactions from the surgery

35 will have post-op hemorrhaging to one degree or another

31 will develop meatal ulcers

10 will need to have the circumcision surgery repeated to fix prior surgical problems/error
8 will suffer infection at the surgical site

3 will develop post-operative phimosis

2 will have a more serious complication (seizure, heart attack, stroke, loss of penis, death)

1 will require additional immediate surgery and sutures to stop hemorrhage

1 will develop fibrosis

1 will develop phimosis

1 will be treated with antibiotics for a UTI (urinary tract infection)

1 will be treated with antibiotics for surgical site infection

Of those who do receive pain medication for the surgery (about 4% of those boys undergoing circumcision in the U.S.) some will have adverse reactions to the pain medication injected

Out of 100 Intact boys: 

2 will be treated with antibiotics for a UTI (fewer if the foreskin is never forcibly retracted)

1 will be told to get cut later in life for one reason or another (fewer if the foreskin is never forcibly retracted)

Note: One reader of these statistics (a man cut against his will at birth with 4 intact sons today) critiqued (quite accurately) that it is actually 100 of 100 circumcised boys who experience negative consequences as a result of circumcision. Each and every one has lost an organ responsible for a great deal of his life-long normal health and functioning.

DONA is taking a defensive stance, saying that the article does not reflect the organization's belief as a whole. If that's the case, I wonder if they would allow a guest post about elective inductions and cesareans being a perfectly acceptable choice? Or, as Gloria Lemay put it to them, what about an article endorsing the cutting of females? They have now pissed off a whole lot of people. Personally, I'm not a fan of DONA. Or of any organization, really, that capitalizes on making labor-support a certified position. I've always found that to be completely and utterly ridiculous, especially when said organizations are clear in restricting many Doulas from attending women who choose to birth unassisted, and who have made it a thing of status and income in disproportionate ways. And, as I have heard Nancy Wainer speak about the atrocities that occur in hospitals every day, and the doulas who stand by and are essentially part of the rape and injuries that happen, by holding the woman's hand and telling her that "it's okay".

But this is really a low point for DONA. Another quote from the doctor who wrote the article:

"Often dads have strong feelings about circumcision, so fathers should definitely be included in the decision-making. If the parents care about their son looking different from other boys in the neighborhood, they may research the rate of circumcision in the area." 

Right. Forgot about teaching our children that they need to look like everyone else. Except for the fact that intact is, right now, the majority. Does this apply to girls in the neighborhood who have smaller or larger breasts than average? Should we encourage breast enhancements or reductions in order for our daughters to not be made fun of? Should we start young children on contact lenses so that they will not be made fun of for wearing glasses? What about those who need to wear braces? What about children with Autism and Downs Syndrome? Should they be hidden from the general public so that they never face teasing?

This is a really shitty reason to permanently alter an infant's body without his consent. Period.

Another gem:

"But once they decide, they should be encouraged not to drive themselves crazy with second guesses - in the long run, it will probably be fine either way." - Marjorie Greenfield, MD. 

Yes. We wouldn't want parents to consider the gut feeling that they may be doing the wrong thing. After all, that's lost money! Err, I mean a child who might be ridiculed by his peers! I'm sorry, am I the only one seeing dollar signs here?!? Am I the only one seeing, "Doulas, keep your mouths shut. Do not encourage in-depth research into circumcision."?

Shame on you, DONA. Shame on you for allowing an article of this type in your print. Shame on you for essentially agreeing with the idea that Doulas should NOT be encouraging parents to keep their sons whole. I'm not sure it's possible, but I'm less of a supporter now, than I was before. You just made a joke of your entire organization.

Brilliant Repeat Cesarean Patient Plan

Step 1:

Convince first time moms that pregnancy and childbirth is so dangerous and so scary that they need to hire a trained surgeon (OB) to care for them. Even though pregnancy and childbirth are physiologic events. After all, things can go wrong at ANY MINUTE, right?

Step 2:

Convince women that heavy monitoring and/or induction and/or epidural and/or cesarean is going to be necessary. Small pelvis. Past due date. Low fluid. Big baby. Small baby. One or two higher blood pressure readings. Water broke without labor.

Step 3:

If women refuse labor induction, find a reason to scare the shit out of them. Most often? "YOUR BABY WILL DIE IF YOU DON'T ACQUIESCE!" Your baby will be too big, and will get stuck in the birth canal. Your baby is in distress because we found meconium on the bio-physical profile at 41 weeks. Your baby has little to no fluid left, and can die. Your pelvis is just too narrow...we'll LET YOU TRY, but you will probably need a cesarean. If you attempt a vaginal birth with a breech baby, you will kill/harm/damage him. If you attempt a vaginal birth with twins, you will kill/harm/damage them.

Step 4:

Begin induction on a woman whose Bishops Score is unfavorable. Crank up the pitocin, even though the woman's cervix is not low, soft, or dilated. (Or barely so) Recommend an epidural so that the pain of the unnaturally strong (and unnaturally occurring) contractions can be taken away. Break her water artificially. Do internal exams every 2-4 hours.

Step 5:

As soon as the baby goes into distress as planned as you knew he would unexpectedly/mom gets a fever/placenta abrupts, explain to woman that she needs an emergency cesarean NOW, otherwise baby will die/be harmed. You DO WANT WHAT'S BEST FOR BABY, DON'T YOU?

Step 6:

Do not share with woman that according to evidence based research, it was a failed induction because her baby was not ready to be born. Or that inducing for "suspected macrosomia" is going against evidence based protocols. Or that inducing at 12/18/24 hours after water breaks is not evidence based. Or that inducing with a low Bishops Score is formula for cesarean. Or that inducing for low/no fluid is not evidence based.

Step 7:

Convince the woman that it was her body's fault, or baby's fault, that she had a cesarean. Your pelvis wasn't large enough. Your labor wasn't fast enough. Your body didn't create enough fluid at the end. Your baby didn't tolerate labor well. Your baby was too big. Your baby didn't come out when he was supposed to. Your baby wasn't in the right position.

End result?

Scenario 1:

A woman who is now even more scare of pregnancy, labor, and birth. A woman who believes that her body is broken, and that her body put her baby in danger. A woman who will be far too terrified to plan for a normal birth with the next baby. Who will plan her repeat cesarean for 39 weeks, since her body is too dangerous to try again.

Scenario 2:

A woman who will ask her "wonderful, natural friendly" OB (surgeon) if she can "try" for a VBAC, and will not do so because her OB (surgeon) reminds her that her body didn't do well the first time around, and it's safer to have repeat surgery.

Scenario 3:

A woman who will plan a VBAC, but will once again hire a trained surgeon (even though she's trying to AVOID surgery) and most likely will allow interventions in a normal pregnancy and/or labor (VBAC is still normal!) for the same reasons listed above.


Obstetrics, even though 2/3 of their protocols are NOT based on scientific evidence (according to the latest research), continues to claim 99% of women as "patients". Some people wonder why our cesarean rate is so high nationally, and our infant mortality rates are inexcusable. It's really pretty simple. Take healthy, low risk women with healthy, low-risk babies and convince them that they need Obstetric (surgical) care. Add this to the above formula, and you have almost guaranteed repeat cesarean clients. Higher revenue for doctors, insurance companies, and hospitals. (Let's not forget that with cesareans comes a higher rate of NICU admission - even more revenue)

Women - start thinking wisely. Research your options more carefully than you research the car seat, crib, diaper bag, or latest accessories. Childbirth is nothing to fear. Really.

Due Date : It ain't nothin' but a number!

If there is one thing that I would choose to educate women on nation-wide, just one topic that I could choose to cover for all women to hear, it would be the due date fallacies. So many unnecessary inductions are because of due date fears, misconceptions, and downright false information. So many unnecessary cesareans are due to "failed" ( see Failed Induction Means That Your Body Works! ) inductions. Not because there was something wrong with the woman's body, as MOST are told, but because her body and her baby simply were NOT ready.

There are so many false beliefs about due dates. One is that it is the magical number around which the baby is supposed to be born. I recently did an informal poll on CafeMom and so far ( I will post final results when they are in ), the VAST MAJORITY of women who have responded, have said that it's not normal to go past 40/41 weeks, and that they would absolutely induce so that they didn't risk baby dying or getting too big! Our society has done a great job of ignoring actual statistics and just following what their doctor tells them, or what their friends tell them. Why research when you can just ask? A commercial for Johnson and Johnson baby wash today started out with: "Your Doctor's guidance, your Mother's advice, your own intuition...." What does that tell us? Where do our securities lie when it comes to our children? According to most people in our society, doctors first.

And yet, the medical community and having a medical mindset in birth is what has gotten us into our 31.8% cesarean rate. Trusting your doctor first, instead of doing individualized research ( did your mom have a history of postdates? Did your grandma? Aunt? What might be normal for YOU and YOUR baby? ) is what is leading women to be cut open by the millions. And the worst part is - instead of it being viewed as a horror that needs to stop - it's seen as normalcy.

NORMAL gestation is anywhere from 38-42 weeks, and if you want to get technical, to 42 *completed* weeks. What now seems like long ago, women were given "due months". I like this idea! Let's take the "magical" number out of things, and let women know that they have a 4 week period of time in which their baby could be born. Maybe then we'd have less inductions. Maybe then we'd have less cesareans, and less women being told that there was something wrong with her body ( PELVIS too small KILLS me, "FAILURE" to progress, BABY too big...notice a theme? ). Depending on which statistics you look at, one study showed the stillbirth rate to be higher at 38 weeks than at 42 weeks. So then, should we induce at 37 weeks to avoid that higher curve at 38 weeks? Of course not! That would be just silly, right? ...

The MAIN thing with pregnant women is their due date. They get bombarded with highly personal questions starting as soon as 36 weeks. "When are you going to have your baby?" ( Did you GIVE me a crystal ball? ) "Are you dilated?" ( Are YOU dilated? What about YOUR bowel movements - have any soft ones lately? ) "When will your doctor induce you?" ( When did yours give you a lobotomy? ) "You look HUGE!" ( So do you, but it's rude for ME to say so! ) "Are you having twins?" ( Are YOU going to recover from my fiery wrath from being asked that for the one millionth time? )

Women are hardly ever reassured. Rarely is a woman told "Baby will come in perfect timing! Don't worry.", or "Your baby is just the right size! YOU made him/her after all." Women are rarely told that they DON'T need to be induced, and rarely are they NOT asked if their doctor has shoved a hand up their vagina to check the status of their cervix. People don't understand that they are continuing the common fears surrounding due dates and labor. They are doing NOTHING to help, but only cause worry, doubt, and possibly fear. "WILL I ever go into labor on my own? Maybe there IS something wrong with me?"

I recently watched Pregnant In America. I LOVED all of the wonderful information that they were providing. Studies, statistics ( the list of risks for inductions and epidurals would make your toes curl! ), alternatives. But then, just as I was ready to advertise this movie to every woman I know....the producer's wife ( who had been filmed as she planned a home birth for their first child ) decides to have her midwife strip her membranes at a mere 3 days past her due date. WHAT?!?! Didn't I JUST watch nearly 2 hours of "A woman's body does better in labor when left unhindered." "A woman's body knows just what to do on its own." "Intervention is a slippery slope." - GAH!

There seems to be this idea, even within some midwifery/home birth circles that birth is normal...unless you get to/past 40 weeks. But yet, according to medical literature ( you know, the stuff put out and IGNORED by OBs? ) we know that normal gestation is all the way until 42 completed weeks. WHY are women doing this to themselves, and why are care providers doing this to women?

If I could erase one incredibly WIDESPREAD belief - it would be that a due date is a magical number. A date to count down to, and worry when it passes. A date that will *surely* bring us baby, because isn't that what it's supposed to do?

Will we ever get back to the belief and knowledge that our bodies know just what to do without inducing, augmenting labor?

From Home Birth to Interventions?

My heart drops into a big ball into my stomach when I hear of women allowing unnecessary intervention in pregnancy - but especially more so when I hear that they allow it from a home birth midwife. Women seem to want to trust birth, and want a safe and healthy birth for their baby, but then allow some of the most arbitrary and unnecessary intervention, not realizing that it can completely shape and transform the rest of their pregnancy.

What are the top two interventions I see with homebirthers?

Routine Vaginal Exams

Why is this done, especially by home birth midwives, starting as early as 36 weeks? Does it make the baby come sooner? Does the body not know what to do unless a midwife has a hand inside of her client's vagina and cervix? Do these midwives explain the risk of infection, accidental ( or purposeful, sadly ) membrane strip or artificial rupture of membranes, disappointment when mom "hasn't made any progress", false hope of a labor soon to come? If the midwife is not explaining these risks, then her clients are NOT giving informed consent. It blows me away when women allow this. It saddens me. It makes me wonder just what their midwife is telling them, or why a mom requests this.


"Natural" Induction

Ladies, there is NO such thing as a natural induction. Either you are trying to force labor to begin before it is happening naturally, or you are not. There's really no in between. Having a healthy sex life in the end of pregnancy is wonderful! But if the goal is to get it done as many times as possible in hopes of causing the cervix to ripen...you may be sorely disappointed. A ripening cervix does NOT guarantee a close labor day. It simply means that it is ripening. There is a lot more to the hormonal dance of labor preparation than a ripening cervix. Doing spicy foods may do nothing more than irritate your uterus, cause you to have diarrhea and heartburn. Pineapple needs to be *fresh* pineapple. You have no idea how many women try the out of the can stuff. LOL And even then, it does *nothing* unless your body is ready anyway....so why not wait until labor starts naturally? Nipple stimulation does indeed release oxytocin in the body, but so does some good love from your spouse. A nice massage, a cuddle and nice long kiss. This releases oxytocin as well. Why aren't more couples cuddling, instead of playing with nipples? Evening Primrose Oil *can* help to soften the cervix, but nothing more.
The problem with trying to do things to induce labor, is that it often will not work. When it doesn't work, you've wasted precious last days/weeks of your pregnancy that you could have been simply enjoying with your partner, instead of stressing out over trying to get labor to begin. Or even if not stressing, *thinking* about getting labor going. Your body knows what to do, and knows exactly the right time to do it in. I won't even go into castor oil induction, as I believe this is highly irresponsible and a waste of time unless it's a true last ditch effort. Inducing labor, no matter what label you want to put on it, is putting yourself before the safety and health of your baby...unless of course it is a TRUE medically warranted induction ( example - pre eclampsia, PIH, etc ).


Women, if you've chosen a home birth, you are in a low-risk pregnancy. If you are in a low-risk, normal pregnancy...why are you allowing intervention? It drove me crazy when I watched Pregnant In America, and saw them advocate for normalcy in pregnancy, believing in birth and trusting the body...and then the producer's wife having her midwife strip her membranes at a mere few days after 40 weeks. I was BAFFLED! How can you claim to be a NATURAL pregnancy and labor advocate, if you allow unnecessary induction techniques? There was no problem. She was simply a few days past 40 weeks. Not even to the high end of the normal gestation period, but smack dab in the middle! It was her first baby, and statistically first time moms will go about 8 days past their EDD, IF ALLOWED TO. :sigh:

In our society, we rush through so many things. We want to rush to get to the end of pregnancy, we want to rush to get into labor, we want to rush to birth the baby. We want to rush to see the baby sit up, eat solid food, crawl, talk, walk...

And when you get to the point of understanding how quickly it all goes by, it's too late to take it back.

Choose wisely, for some decisions are irreversible.

When a Woman's Body Fails Her

Within the past month, I have heard more than a handful of stories where planned vaginal births ended up in "emergency" cesareans, and mom was given a diagnosis of either FTP or CPD. More horrifying, I keep hearing of *ELECTIVE* cesarean surgery, to avoid the pain or possible injury of a vaginal birth, because a woman is led to believe that a VBAC is just too risky, or because she "cannot" find a care provider to support her in one. I continue to be utterly baffled by the mentality in our society, surrounding cesarean sections, ie, major abdominal surgery. The risks are pasted all over the internet, warning women about choosing such a dangerous mode of delivery, and yet...we have the highest cesarean rate that we've ever had as a country. There's absolutely no excuse for a 31.1% ( and that was 2006, we don't know 2007's rates yet! ) cesarean rate. The WHO has recommended a national cesarean rate of NO MORE than 10-15%, which means that roughly 1/2-2/3 of *all* cesareans done are unnecessary!

I'll say it again. Roughly 1/2 - 2/3 of ALL cesareans done right now are unnecessary.

Does that not bother anyone? Ah, but I get the myriad stories of "My body wouldn't dilate", "My baby was too big", "My pelvis was too small", "I have already had a cesarean, and my OB ( SURGEON! ) wouldn't 'do' a VBAC".

I did a recent poll on a mommy-site, to see what reason women were given for their "emergency" c-section. 85% of them said that it was an induction ended in either FTP ( Failure to Progress ), or CPD ( CephaloPelvic Disproportion...pelvis too small, baby too big ). And they believed their diagnosis, because why would their doctor lie to them? They tried *everything*, and their baby just could not come out naturally.

Why is it that women are so ready to believe that their body failed them, rather than the SURGEON that they hired, screwed them over? Maybe not intentionally, no. I'm not saying that all Obstetricians are evil, and I'm also not saying that ONLY Obstetricians are the cause for unnecessary cesareans. Midwives can be just as bad, if not more damaging, IMO. But, let's face it. Women are hiring trained surgeons, but begging to avoid surgery. Why?

Let's go over a VERY common scenario:

First time mom, hires an OB because that's "just what's done". Plans a hospital birth. Really wants a natural birth, or as natural as she can "handle". Excitedly prints up her birth plan, that includes "No cesarean unless absolutely necessary", and has her doctor sign it, who is happy to do so, and says to patient "I ONLY do cesareans when necessary!". Patient gets to her due date. Doctor begins to check her cervix, that is yet "not doing anything". Cervix is high, thick, and closed. Doctor begins planting seeds about induction being necessary if patient is still pregnant by 41 weeks, because her body may need a jump start. And, baby might be a bit bigger since the baby has not dropped.

Mom may not necessarily want to be induced, but trusts that her doctor knows more about childbirth than she does, because she's never given birth before, and he's seen thousands of deliveries.

Does this sound familiar yet?

Patient gets to 41 weeks, cervix is still high, thick, and closed. Baby has not dropped. Doctor fails to inform patient of her Bishop's Score ( chart that can predict the likely success of an induction ), and says to head over to the hospital for an induction the next morning. Doctor also fails to tell patient that the labor hormones are more potent at night ( which is why women usually begin laboring at night ), because it's more convenient to schedule an induction during business hours.

Patient is excited, and nervous, and doesn't do any research, because she believes that she will go in, have baby, and leave hospital happy. She arrives at the hospital between 6 and 7 am, signs paperwork, is monitored, blood drawn, and cervadil is usually administered. For doctors who don't care about the risk of DEATH, cytotec might be administered instead. Patient must lie in bed for roughly an hour, and then is *allowed* to walk the halls if she wishes. But, needs to sport her IV pole and sexy hospital gown as well. Patient is checked a few hours later, and the cervadil has softened the cervix a bit, but hasn't done much dilation wise, so she is informed that the Pitocin is being ordered, and will be started shortly. With the pitocin comes constant monitoring, because of the risk of overstimulation to the uterus, though she isn't told this risk.

Sometimes, the doctor will also suggest breaking the bag of waters, to get things moving more. Patient is not told the risk of causing, or cementing, a malposition along with this procedure, nor of the risk of distress to baby by causing head to hit pelvis unnaturally. ( Meaning before it would have broken on its own ) So now, patient is in bed ( or in a chair if she's *allowed* to be out of bed ), dealing with the unnatural contractions that pitocin brings, and will shortly ask for the epidural that she didn't really want to resort to, just a few weeks ago.

She is given her epidural, and left to lie/sit in bed, while not being able to feel much from the hips down. She is likely not told of the risks ( both short and long term ) of the epidural anesthesia, to both her and baby. However, she signs a blanket consent form, without reading, and happily gets a very long needle inserted into her dural space. She is checked a few more times, and is told that she is making progress, but slowly. So, the doctor is ordering that the unit of pitocin is turned up a bit. Sometimes they will then insert an internal monitor for both contractions, and for the baby's heartrate. The one for baby is a monitor that *screws into the baby's scalp*. Patient is not told of the risk of infection to baby in doing so.

When she is checked again and found at the same dilation as the last two checks, the Obstetrician comes in and talks to her about CephaloPelvic Disproportion, or CPD. He explains to her that her pelvis is not large enough to allow the baby to drop, nevermind be born through it. He tells her how good of a job she has done in labor, and that she gave it her absolute best. He explains that if they continue, there is a risk of injury to the baby, since her pelvis is too small to allow him/her to pass through. He tells the patient and her partner, that he can do a cesarean section, and they can see their baby within 30 minutes. He has a team waiting in the OR.

Or, alternate outcome....patient is finally found to be 10cm, preparations for the birth begin. The bed is broken down, the stirrups are pulled out, and the doctor dons the facemask, surgical gown, gloves, and turns on a very bright light. Mom is told when to push, where and how to push, and for how long. The baby's descent is seen, but baby continues to go back up after mom pushes. After a few of these, the doctor explains that he is going to help mom out, by using a set of forceps, or a vacuum extractor. The "aid" is placed, and doctor pulls on baby, to try and assist in the delivery. After a few tries, the doctor tells the patient that her pelvis is not large enough to allow the baby to pass, and that is why the baby never descended, and that is why the baby was not able to be born, despite the aid of forceps or vacuum. Patient is rushed off to an "emergency" cesarean.


I'm sure anyone reading this has heard a story ( or several! ) that runs along these exact lines. Is it that there are now so MANY women who cannot deliver their own baby, or have screwed up bodies that fail them in the one thing that they were LITERALLY designed for? Or is it that Doctors and Midwives are failing women in not informing them of the risks of the things that they walk into willingly, and equally, the fault of the women for not doing research for the most important thing they will ever do?

It makes me so incredibly sad, and so incredibly angry that women would rather believe that their body is broken, rather than understand that they weren't given a fair shot, and that their choices ( in care provider, place of birth, interventions ) failed them instead. I will agree though that it is MUCH harder to take responsibility. I didn't want to believe that I could have avoided my cesarean, or that I could have avoided my son being in the NICU. That was one of the hardest things that I have ever done. To realize that my choices led to what happened to my body and my son, was heartbreaking.

I don't wish heartbreak on every woman out there who had an obviously unnecessary cesarean, but I do wish that women would become educated. I would rather heartbreak, than elective repeat cesareans. I would rather heartbreak than the belief that a woman's body just didn't work for them, and failed them in becoming a mother.

So above, what went wrong, and why?

* First time moms with a low Bishop Score, is up to 80% more likely to have a cesarean section due to the body not being ready for birth.

* Pitocin is known for causing distress in a baby, as it causes unnaturally strong contractions. If a baby wasn't ready to be born to begin with, the baby was not ready for *any* labor, nevermind unnaturally strong labor.

* Artificially Rupture Of Membranes ( AROM ) is known to sometimes cause a malposition in baby ( if baby is not low in pelvis ), or cement a bad position such as posterior, asynclitic, transverse. It can also cause distress, as the baby's head could have gone from outside the pelvis, to rammed *onto* the pelvis, with no cushion.

* Drugs or Epidural anesthesia are known for slowing or stalling labor progression. The medication also passes through the placenta, and into the baby's blood stream. This can lead to breathing depression, lethargy, problems nursing, and lower apgar scores in baby. Epidural anesthesia can also lead to a spike or drop in blood pressure for mom, fever ( which will be treated as possible infection ), headache ( that can last for weeks ), infection at the injection site ( that can lead to Staph ), nerve damage to the back, and in extreme cases...paralysis.

Epidurals also inhibit the pushing phase. Not only is mom unable to get up into varying positions to facilitate a larger pelvic opening ( lithotomy position causes the pelvis to be up to 20% smaller than in other positions for birth ), has a high risk of instrumental delivery, and perineal injury. Controversially, epidurals increase the risk for cesarean delivery because of these factors. When a woman has an epidural, she cannot efficiently feel when/where/how to push. She loses the ability to push effectively, therefore leading to the risk of higher rates of instrumental delivery.

* Vacuum delivery comes with a list of its own risks to baby. The most common is a hematoma, or a pocket of blood underneath fibrous covering of the skull bone. This can result in a "lump" the size of the vacuum cap. Also common are "superficial" markings to the scalp, or splits in the skin. Less commonly, these can be open to infection. Less common risks include neonatal jaundice, intracranial hemorrhage, and retinal hemorrhage.


But the most damaging risks, in my opinion, are the risks that come with a woman believing that she did everything she could, and that her body just didn't work right. Women anymore have so little belief in their body's ability, and don't look at the risks that come with each of the interventions that are allowed into a normal labor.

My desperate goal is to get women to make more careful choices in care provider, place of birth ( What is your doctor's cesarean rate? What is the hospital's cesarean rate? What is your doctor's track record with NATURAL - not just vaginal - births? What is your doctor's instrumental delivery rate? What's your doctor's episiotomy rate? ) Women need to make truly INFORMED decisions. Not just take the word of their care provider ( whether this be OB, Hospital Midwife, Birth Center Midwife, Home Birth Midwife ), friends, family members, and online pregnancy sites. Women need to understand the possible consequences of their decisions.

So many women believe that inductions are harmless, and therefore don't research the MANY possible risks. Many women believe that epidurals are harmless, and therefore don't research. Many women sign up for repeat cesarean sections, believing that it's safer than a VBAC ( Vaginal Birth After Cesarean ), without actually doing the research.

Women, we're smarter than this. And yet, we allow our instincts to be overridden by a care provider with a medical degree, or a mom who has had more children than we have. We allow our empowerment to be taken away by believing that the hospital is the safest place for ANY birth, and hand over our autonomy as soon as we check in.

I feel helpless so often, because it's constantly pointed out that I have no medical degree. It's true, I don't. But I have devoted the past 4 years to study pregnancy, childbirth, and ALL that goes along with it. Four years to this alone. Every aspect that comes with each. I have attended women in birth who had previously been duped into believing that their body didn't work, and watched as they labored beautifully, and then reached down to welcome their baby into their own hands. The incredible moment where they learned that their body worked just as it was designed to do. When they didn't have any separation from their baby. No nurse taking baby off to the nursery for "observation". No separation, but immediate bonding. Immediate smell, touch, love. Breastfeeding as soon as baby is ready, not when a nurse says it's okay.

I have the honor of attending women in birth, and watching as they unfold in childbirth, and regain their power.

Here is a video of women who were told that their body failed them...and went on to discover that it was their care provider, rather than their body, that failed them.




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Bishop Score and Risk of Cesarean Delivery after Induction of Labor in Nulliparous Women

http://www.ncbi.nlm.nih.gov/pubmed/15802392

Risks of Epidural Anesthesia

http://www.healing-arts.org/mehl-madrona/mmepidural.htm

http://www.breastfeeding.com/helpme/epidural_anesthesia.html

http://www.transitiontoparenthood.com/ttp/foreducators/ceinfo/Side%20Effects%202.htm


Risks of Vacuum - Assisted Deliveries:

http://www.fda.gov/cdrh/fetal598.html

http://childbirth---labour-delivery.suite101.com/article.cfm/the_truth_about_vacuum_deliveries

http://jama.ama-assn.org/cgi/content/full/289/1/46

http://content.nejm.org/cgi/content/extract/341/23/1758

Pregnant In America

I had a great time this past weekend. I was finally able to get out to Southern Utah, to visit a very dear friend of mine. I was supposed to go this past October, and then had to cancel. It was a wonderful weekend, and a total adventure. ;)

While there, we sat and watched the new documentary, Pregnant In America ( I'll put the trailer at the end of this post )

Over all, it was a great film. It was a bit more in depth than The Business of Being Born, covering more topics, and even traveling to other countries to see how babies are born there. It covered the topic of Cyotec, and the unwillingness of the FDA to offer more help to stop the use of Cytotec in labor, which has caused multiple maternal and fetal deaths. It covered a small bit on breech births, and how Obstetricians are not being trained in this art anymore. It covered VBAC bans, insurance problems, and Obstetricians pushing for more cesarean sections.

Steve ( the producer and husband of the wife being followed in pregnancy ) randomly interviewed both men and women on the streets of California and New York, to see where there beliefs were in childbirth. Many of the men said, hands down, that the hospital was certainly the safest place to be, but couldn't pinpoint why. Women said that they couldn't have done labor without an epidural, even though a few admitted that the epidural was likely to have caused some of the problems that either they faced, or friends had faced. It was all very interesting, and yet I found myself saddened, and even outraged at the utter lack of education by women in childbirth. The utter lack of power that they had, by statements like "I don't have any choice". I hear this all the time, but this struck more with me in this film for some reason.

It stated, and kept reiterating, that pregnancy, labor, and childbirth are natural processes. What was said a few times was "Mother Nature knows best". I was SO happy to hear this being said over and over...hoping that any viewers would have this sink in.

To my utter frustration, anger, sadness, and confusion....the producers wife had her membranes stripped by her midwife at a mere 3 days past her due date.

Wait, what? Didn't we just spend over an hour speaking about leaving labor and birth alone? Allowing it to continue naturally? Speaking of "Guess Date" instead of "DUE Date", and saying that pregnancy was normal two weeks before AND two weeks AFTER said guess date?

They researched everything else mentioned in the film, and yet failed to speak of the risks of stripping membranes. Or did they not research that? Granted, the risks are small. But it's highly confusing seeing this, when they spoke over and over again about NATURAL labor being best, sans intervention. Did they NOT understand that stripping membranes is not only an intervention, but a form of induction?

Risks, albeit small, of membrane stripping are:

Risk of infection
Risk of weakening Amniotic Sac, leading to PROM
Risk of PROM
Risk of beginning false labor that will exhaust mom, only to stop when she's now emotionally ready to have baby
Risk of causing a longer labor, because the body wasn't in labor on it's own before this induction technique

And sadly, her labor was pretty long, and she sounded to be in more pain than what is typical for most home births that I see.

What angered me about this, was wondering if they understood / understand what message this may send to women. "Pregnancy and labor is natural, and should be left alone....unless you get past your due date.", despite the admittance that pregnancy is normal two weeks before AND two weeks AFTER a given "Guess Date". She was 3 *days* past, and allowed intervention.

Is this "Homebirth Lite", or "Mainstream Homebirth"?

It was said at the end of the film that she is pregnant again, and that they will be using the same midwife. I only hope that this time they will follow their own words of wisdom, and let this baby come when he/she is absolutely ready, and not add any interventions or "natural" ( don't get me started on this! ) induction techniques.

Labor Induction

I've ranted and raved about this subject more than a dozen times before...and it never gets old. There is always new material out and about for me to rant about, when it comes to the practice of women forcefully evicting their unborn babies, mostly out of either convenience or coercion.

Rarely anymore do I hear of an induction that is actually medically warranted. Usually, it's because mom is so sick and tired of being pregnant, that she just wants baby out. Or, due to the holiday season, the OB is leaving on vacation...and well, you wouldn't want another doctor to attend your birth, would you? :sigh:

What gets me is the continuing cycle of ignorance. Women really don't get, or care to understand, that inductions without medical reason do more harm than good to their baby. But why would you listen to a crazy ranting lady, instead of your WONDERFUL *coughTrainedSurgeoncough*...err, I mean OB? Is an extra couple of days, or an extra week or two REALLY worth putting your baby at risk? Is it worth putting your body at risk for so many things? Is it worth the greater risk of ending up with a c-section, and possibly a baby in the NICU? Really?

What kills me is that I recently read the birth story of a woman I used to know. She has NEVER been patient enough to allow her babies to come in their own time, and always made herself sound like an idiot with the "I'm not trying to be a hero", in regards to forgoing that precious epidural. So she has never gone into labor on her own, and she has never allowed herself to actually FEEL any of her babies be birthed. This last baby was no exception. And this time? This time she allowed them to use Cytotec to induce her...and her incredibly ignorant explanation was that Cytotec is a much more "gentle" way of inducing labor, in comparison to Pitocin.

Maybe she's never read the reports of women and babies *DYING* after Cytotec inductions, or the fact that the FDA pulled it off the "Accepted Drug" lists, along with issuing an extreme warning about its use. :shrug:



The sad part is, there are so many babies out there who are not allowed to be birthed gently, in their own time. They are forced out with harsh drugs, and then more drugs are poured into their tiny systems just so their mother doesn't have to "suffer" birth pains. So baby is left to go through a forced labor, on their own.


What are the risks of an induction?

Failure. Your body does what it's supposed to do, and protects the baby who is not yet ready to be born.

Fetal Distress. In forcefully trying to get baby out when baby is not ready, many respond to induction drugs by going into distress.

Hemorrhage. When your body has been forced to do something it's not ready to, the uterus can become over-stimulated, and exhausted, causing problems with it contracting after a birth, leading to hemorrhage.

Instrumental Delivery. Since women rarely withstand inductions without drugs or an epidural, inductions have a very high rate of instrumental ( forceps, vacuum ) delivery, which would also come with iatrogenic perineal injury.

Cesarean Section. The fact is, inducing labor comes with a high risk of a cesarean delivery. If you weren't in labor, your body and your baby weren't ready. Forcing it may work for some, but definitely not for all. You will likely spend the time recovering from major abdominal surgery ( and a harder time getting baby to breastfeed if baby spent any time in the NICU ), that you could have spent in the remainder of the pregnancy, and birthing a baby who was ready to be born.

When will women learn? When will women regain the patience that women USED to have, and rest in the knowledge that babies know when it's the best time to come?

And for those who love to argue for arguments' sake...I'm not speaking of medically necessary inductions. ( Eclampsia, true IUGR, etc ) I'm speaking of the women who get to 40,41,42 weeks and don't want to be pregnant anymore. I'm speaking of the women who have been "stuck" at 1,2,3,4cm "forever" and like to believe that they'll never go into labor on their own. I'm speaking of the women who allow their doctors to schedule induction because they're ready to go out of town, or have a Tee Time to make it to. Or for women who believe it's safest to induce at 39/40 weeks because their baby will be TOO HUGE to birth within a week or two....because we all know that baby's head and shoulders hit an INCREDIBLE growth spurt past then. ;)

And for the Prodromal Laboring women....Prodromal labor SUCKS, but it still doesn't mean you're in actual labor for weeks on end, or that your baby will never come out. It doesn't mean that baby is ready. It doesn't mean that induction is okay because you're tired, frustrated, or hurting. Have patience. Your baby will come, and often, there's a VERY good reason for prodromal labor, or intense Braxton Hicks contractions.

Women, slow down. Have patience, and allow your babies to come in the time that they're meant to, naturally.

Postdates - Separating Fact from Fiction

Postdates: Separating Fact from Fiction
By Birthkeeper

What is one of the first things that a pregnant woman hears once she reaches 40 weeks?

“When will your doctor induce you?”


Is there evidence behind this practice to support the routine induction of pregnancies that go beyond 40-41 weeks? What are the usual assumptions and beliefs surrounding this?

• There is a higher risk of the baby being born still
• The placenta will stop functioning
• There will be a decrease in amniotic fluid
• The baby will grow too large

We are going to take a look at the validity of these claims and beliefs, and compare them with what the research has to say. After all, your doctor would never do anything that wasn’t in your or your baby’s best interest, correct?
The first things to really look at are the definitions of the two key words with the pregnancy that goes past 40 weeks. Postdates, and Postmaturity. But is it accurate to start with these terms at 40 weeks?

• Postdates – Defined as a pregnancy that goes beyond 42 weeks, based on LMP. The problem with this is that it’s not the same for every woman. Due dates are calculated depending on LMP, but does not usually take into account a woman who has shorter or longer than 28 day cycles. The pregnancy wheel that is commonly used by doctors and midwives, is based on 28 day cycles. If you have a longer cycle, days will need to be added to your EDD ( Estimated Due Date ). This is rarely done however, and women who have longer cycles are held to the same due date estimation as women with shorter cycles. So on paper, you might be 42 weeks according to the estimated due date, when in actuality you would only be 41 weeks. A more accurate way of dating pregnancy is by solidly known conception dates.

• Postmaturity – Postmaturity, or Postmaturity Syndrome (PMS) can only be diagnosed after delivery and is defined as a postdates pregnancy accompanied with a combination of the following newborn assessments:

a) No lanugo ( fine body hair )
b) Long nails
c) Abundant hair on head
d) Calcified fetal skull
e) Hanging or wrinkled skin, with the appearance of weight loss
f) Dehydrated
g) Peeling skin

Postmaturity Syndrome also only affects less than 10% of pregnancies that go beyond 43 weeks. The vast majority of pregnant women do not go beyond 42 weeks with correct dates. Some studies show that less than 3% of women go beyond 43 weeks. So if the risk of postmaturity is less than 10% of pregnancies that go beyond 43 weeks, and the percentage of women who go beyond 43 weeks is less than 3% - how big of a risk is it really?

The problem with assessing risk for postmaturity is that modern Obstetrics, and even modern Midwifery, tends to treat all women as equal in pregnancy. Seldom is personal or familial gestation history taken into account, or abnormal cycle and ovulation schedules. These things are important to consider! How healthy would a midwife’s policy of inducing at 41 weeks , be for a woman who has a personal or familial history of going to 44 weeks? We are talking about potentially trying to induce a baby who will be 3 weeks “early” according to their own biological gestation clock. And if the induction “fails”? It will likely result in stress for both mother and baby and lead to more invasive intervention, and possibly a cesarean.

The condition of a baby and placenta all depends on the health and personal history of the mother, as well as the health of the baby – at any gestation. A placenta does not begin to deteriorate automatically beyond 42 or 43 weeks. A placenta can begin to deteriorate at 36 weeks, once again, depending on the health and over all well being of the mother and baby. I have often heard the fear in women of “placental deterioration” after 40 weeks. But as it has been seen, this has nearly nothing to do with length of gestation, as much as it has to do with overall health and maturity of the individual pregnancy and baby. I personally have seen a baby born at 43 weeks, solid dates, absolutely covered in vernix and attached to a very healthy placenta. In contrast, I attended the birth of a 37 week baby who had dry, wrinkly skin, and a calcified and very old looking placenta.

Other important factors include unhealthy habits and complications such as:

• Smoking
• Alcohol
• Drugs
• Diabetes ( Mellitus, NOT Gestational )
• Hypertension

When did 40 weeks become the magical number?

The interesting part in the discussion of postdates, postmaturity, and all that it involves, is the thought that 40 weeks is some sort of magical number. In the past, there was a general “due month”. Women were given an estimation of when they would deliver, based on the known fact that normal gestation is anywhere from 37 to 42 weeks. So when did 40 weeks become this magical number that women fret over and worry once they go beyond it? It has always been that 40 weeks is the general time frame when babies were “due”. But it wasn’t until a study by McClure-Brown came out with date collected from 1958, that showed the perinatal mortality rate doubled from 40 weeks to 42 weeks – from 10/1000 to 20/1000. So it might be logical to assume that inducing labor before 42 weeks would cut back the risk of stillbirth, correct?
The problem is, this study is inaccurate and too old to continue to be of use. Modern obstetrics contradicts the findings in the study published in 1963. And yet, the findings continue to be cited. If we accepted the outcomes in the McClure study, we would also have to accept a 10/1000 mortality rate at 40 weeks! And we know that is not correct. We know that in the 1950s, the majority of women were put under general anesthesia, or twilight sleep, and forceps were commonly used.
Modern Obstetric research actually shows there to be not much of a difference in perinatal mortality rates between 38 and 42 weeks, with a decline in between.
An identically set-up chart to the 1963 study, published in 1982 ( Williams, Creasy ) reads:

• 7/1000 at 38 weeks
• 6/1000 at 40 weeks
• 8/1000 at 41 weeks
• 9/1000 at 42 weeks
• 10/1000 at 43 weeks
• 11/1000 at 44 weeks

A graph from 1987 statistics ( Eden, Sefert ) shows:

• 6/1000 at 38 weeks
• 2/1000 at 40 weeks
• 2.3/1000 at 41 weeks
• 3/1000 at 42 weeks
• 4/1000 at 43 weeks
• 7/1000 at 44 weeks

So according to the second set of statistics gathered above, women were at higher risk of stillbirth at 38 weeks, than they were at 42. Interesting! In the first set, there was only a steady increase, resulting in a very small risk increase. Is the slightly increased risk worth the myriad risks that come with labor induction?

A large study done by Weinstein, et al. , compared nearly 1,800 reliably dated post-term pregnancies with a matched group of on-time deliveries ( between 37 and 41 weeks ). The outcomes were surprising. Perinatal mortality was similar in both groups ( 0.56 / 1000 in the post-term and 0.75 / 1000 in the on-time group ). The rates of meconium, shoulder dystocia, and cesarean were almost identical. What was most interesting, however, was that the rates of fetal distress, instrumental delivery and low Apgar scores were actually lower in the post-term group than in the on-time group.



What about the Amniotic Fluid?

There is a flawed belief that the amniotic fluid will somehow begin to “run out” beyond 40 weeks. There is a belief that women will have a “dry” birth. Let’s start with some basics.
What is amniotic fluid?

• Beyond 36 weeks, amniotic fluid is comprised of mostly fetal urine. When the baby’s kidneys are functioning properly, the baby will continuously produce and process amniotic fluid. The fluid is swallowed by the baby, and then urinated out, once processed by the kidneys.

As long as the mother is adequately hydrated, and there are no congenital abnormalities in the baby, the baby will continue to create amniotic fluid until birth. Whether this be at 37 weeks, or 44. If decreased amniotic fluid is suspected through palpation, an ultrasound can be done to measure the volume found. However, this is not an exact science, as the volume found can – and usually will – vary from ultrasound technician to ultrasound technician, and can also sometimes be dependent on baby’s position. If the levels are found to be on the low side, evidence based protocols suggest having mom orally re-hydrate and return within 24 hours for another AFI ( Amniotic Fluid Index ), preferably by a different technician. This has shown repeatedly to have improved outcomes, versus immediate induction for low AFI levels.
A study published in the Journal of Reproductive Medicine found a significant increase in amniotic fluid after maternal oral rehydration, as well as intravenous hydration, with neither one better than the other. In all, 62.5% and 44.0% demonstrated improved AFI levels.

What if the baby grows too large?

First, who defines “too large”? What is “too large” for one woman, might be the next woman’s smallest baby size. The most important thing to remember is that there is no fool proof way of knowing whether or not your body can naturally birth a baby of whatever size, until you have tried. Ultrasound has a 20% error rate in either direction, and many women have allowed an induction after being told that their baby would be nearly 10 pounds, only to give birth to an 8 pound baby. And, there is no reason for a woman to doubt her ability to birth a 10 pound baby unless she tries. I, for one, never would have believed that I could have birthed my nearly 11 pound baby, especially because I was told that I could not safely birth my 8 ½ pound baby that I was scared into a cesarean with. You never know until you give it a full chance.
Women are often told that a baby will gain approximately a ½ pound per week in the end of pregnancy. However, this is simply an approximation. Once again, this is NOT the same for every woman, or for every baby.

According to a fetal growth rate chart comprised by four studies , a baby will only put on approximately 0.56 pounds – that’s just over half of a pound – between 40 weeks and 43 weeks. And since we’ve shown that most women go into labor before 43 weeks, it can be assumed that it is even less than that. Babies hit a plateau with weight gain around 40 weeks. So really, is there a huge concern to be had over a baby being birthable at 40 weeks, but not at 42 if we’re talking about less than half of a pound? And, does less than half of a pound change the shoulder width or head size of a baby? Hardly. It may give baby chubbier cheeks, or chubbier buns, but will not change the overall structure of the baby, making baby automatically “too large” to birth between those two weeks.

When Should Monitoring a “Post Dates” Pregnancy Begin?

This may be different for each individual pregnancy, each individual woman, which makes cookie cutter policies surrounding post dates, arbitrary. To begin, we have now shown that according to research, doctors, and all basic “rules” that a pregnancy is not even considered postdates until after 42 weeks. Not 40. So if the pregnancy is not postdates until 40 weeks, why do doctors often begin Non-Stress Tests ( NSTs ), Biophysical Profiles ( BPPs ), and Amniotic Fluid Index ( AFI ) at 40 weeks? It goes back to the very flawed study from 1963.

It is up to each individual woman to decide if she is comfortable waiting on monitoring, but if a woman understands that there is virtually no risk difference from 38 weeks to 42 weeks, it should clarify that testing before 42 weeks is mainly unnecessary unless other pregnancy complications are present (i.e. Hypertension, Diabetes Mellitus, IUGR suspicion, Congenital Abnormalities ).

So, let’s take a look at what type of monitoring is available, and how effective they are in finding possible problems.

• Biophysical Profile ( BPP ) – A BPP checks fetal body tone, fetal movement, amniotic fluid volume, and fetal “breathing” practices. Each of these are given a score, and then it is added up to give an overall score. A high score of 8-10 usually shows a baby in good health, while a baby who scores 0-4 indicates a baby who needs to be more closely monitored, or needs to be outside of the womb. Scores in between will usually come with more monitoring, including another BPP within 24 hours.

According to Enkin et al., in A Guide to Effective Care in Pregnancy:
There is some evidence that these tests can detect pregnancies in which there is 'something wrong,' but less evidence that their use improves outcome, or can eliminate the additional risk of post-term pregnancy. The only controlled trial shows no advantages of complex fetal monitoring with computerized cardiotocography, amniotic fluid index, assessment of fetal breathing tone, and gross body movements over simple monitoring with standard cardiotocography and ultrasound measurement using maximum amniotic fluid pool depth.

So as you can see, even the detailed testing may not prevent issues that may arise.
According to several studies that researched the accuracy of the BPP, the false positive rates were quite high, resulting in unnecessary induction or further monitoring.

One in particular showed a 21.3% false positive rate for the BPP, and a 39.3% false positive rate for the Non-Stress Test ( NST ). More studies have shown much higher false positive rates for the Non-Stress Test, which is the most common for women who go beyond 40 weeks in care under an Obstetrician.

• Amniotic Fluid Index ( AFI ) – An AFI is basically a mini Biophysical Profile. It measures the maximum amniotic fluid pool depth in the uterus. However, as was shown in the beginning of this article, the AFI in a pregnancy can be contingent on several factors. Being dehydrated can lessen the AFI found. The baby’s position can affect how much amniotic fluid is seen. The skill of an ultrasonographer can make a difference in the AFI level found.
It was also shown that AFI levels can be improved with maternal oral rehydration. Often in modern obstetrics, this protocol is ignored, and induction is recommended very much against proven evidence.

• Non-Stress Test ( NST ) – The NST is the most commonly used test with women who go beyond 40/41 weeks pregnant, under the average Obstetric care. An NST is electronic fetal monitoring for contractions, fetal heart rate variability, and overall heart rate strength. If a baby is found to be sleeping, stimulation is often used in the form of vibration, a cold drink with sugar ( such as orange juice or soda ), or palpation stimulation.

The NST comes with the highest false positive rates of all of the tests, which is why it has become a controversial test amongst some groups.
Studies have been done that conclude anywhere from a 50%-75% false positive rate on average, sometimes reaching as high as 80-90%. False positives will lead to more testing, more stress, and possibly unnecessary intervention in the pregnancy.
Conclusion

Facts:
• A pregnancy is NOT “Postdates” until after 42 weeks.
• The risk of stillbirth is nearly a flat line between 38 weeks and 43.
• Amniotic fluid is dependent on maternal hydration, in the absence of congenital abnormalities.
• A baby’s weight virtually plateaus after 40 weeks.

Some things to think about :
• If I am not “overdue” until after 42 weeks, should I allow testing or intervention before this point?
• If NSTs come with very high false-positive rates, is it a test worth submitting to?
• If my baby will not put on much weight within a 3 week period, is it logical to worry about my baby being “too large” within a probable 2 week period?

Please, please always do your own research. Question what you are told - and go study the subject – regardless of whether your OB, Midwife, Family Member, or Friends are the ones giving you the information. Make informed decisions, and take charge of your prenatal care!


_______________________________________________________________________________________

McClure-Browne, J.C. 1963. Comparison of perinatal mortality rates versus gestational age through the past three decades. Postmaturity, Am J Obstet Gynecol 85: 573–82.
Journal of Fetal Medicine 1996 Sep-Oct. 5(5): 293-97. Expectant Management of Post-Term Patients: Observations and Outcome. Weinstein D. et al.
Journal of Reproductive Medicine 2000 volume 4 pp 337-340. Effect of Oral and intravenous hydration on oligohydramnios. CHANDRA P. C.; SCHIAVELLO H. J. ; LEWANDOWSKI M. A. ;
(1)Doublet PM, Benson CB, Nadel AS, et al: "Improved birth weight table for neonates developed from gestations dated by early ultrasonography." Journal of Ultrasound Medicine. 16:241, 1997.
(2)Hadlock FP, Shah YP, Kanon DJ, et al. "Fetal crown rump length: Reevaluation of relation to menstrual age with high resolution real-time US Radiology." 182:501, 1992.
(3)Usher R, McLean F. "Intrauterine growth of live-born Caucasian infants at sea level: Standards obtained from measurements in 7 dimensions of infants born between 25 and 44 weeks of gestation." Pediatrics. v.74, 1969.
(4)Wigglesworth JS. Perinatal Pathology, Second Edition. W.B. Saunders Company. 1996. page 24.
Hassan S. Kamel, Ahmed M. Makhlouf, Alaaeldin A. Youssef. Gynecol Obstet Invest 1999; 47: 223-228
Evertson LR, Gauuthier RJ, Schifrin BS, et al., Antepartum fetal heart rate testing. I. Evolution of the non-stress test. Am J Obstet Gynecol 1979;133:29-33
Miller, David A MD; Rabello, Yolanda A MSEd; Paul, Richard H. MD. Americal Journal of Obstet and Gynec. 174(3):812-817, March 1996.

Novelty Births

Wouldn't it be horrifying if you heard of someone surgically removing the babies of animals on a certain day because it was considered a fun delivery date? No thought to the fact that the babies were probably not ready for life outside of the womb, no thought to the fact that at least half would probably end up needing extra medical care because of being pulled out early.

Imagine a baby, safe and warm inside of his mother. He hears her heartbeat, her breath sounds, her soft voice. He is safe, he is comfortable. He is growing and practicing breathing movements for the day that his body signals labor inside of his mother's body.

Now imagine that baby, warm and snuggly, all of a sudden has drugs coursing through his system. Lots of drugs. Drugs that make him sleepy and possibly jittery at the same time. Imagine this little baby, all of a sudden having a bright light shine through his warm cocoon as a surgeon cuts through the uterine wall. Imagine now, that without the hormones to prepare him for this change, his home is drained of the warm fluid that has surrounded him for the past 9 or so months. Now there is very cold air coming inside of his cocoon along with the bright light. Baby doesn't know what's going on - this isn't supposed to happen yet. There was nothing to prepare him for any of this. Someone grabs a hold of his head, very roughly. They're pulling on his head, extending his neck. A nurse is at the top of mom's fundus, practically sitting on her to apply enough pressure to push him out of his cocoon, since there were no contractions to do this job. Instead of a slow build up of contractions that wrap around the baby to further stimulate hormones, slowly squeeze fluid out of the lungs...it's all quick, forceful, and violent. As mom and dad anxiously await for their baby to cry, to see that little being, with a smile on their face...the baby has a shock to his system. No more warm cocoon, dim lights. Now it's a freezing cold operating room, very bright lights, strange hands and voices. Since his little lungs weren't squeezed out as in a vaginal birth, now he will have a tube sent down his nasal canal and his throat, causing him to gag, all to suction out this fluid that should have been naturally expelled. He is handled roughly, instead of the gentle way that every baby deserves. Instead of being on his mother's bare chest, once again hearing the familiar and comforting heartbeat and voice or having the benefit of feeling her regulated breathing - he is sent to the NICU in a plastic box. More strangers, more unfamiliar voices and sounds. Instead of being warmed by his mother's breasts and touch, he is put under heat lamps while strangers talk around him. He will not again see the woman who carried him, nourished him, loved him for *at least* an hour or more.

Mom and dad know nothing of what he will go through ...

... They just want him to have a cool birthday.

Seem like a ridiculous notion? Sadly, it's a reality. On the date of 8-8-08 this year, many babies were forced to go through the scenario above, all for the sake of mom wanting to have a cool delivery date. Some had this elective cesarean three or more weeks before their estimated due date. The average is roughly two weeks before the due date. Inductions were scheduled on this date, forcing the baby to endure violent contractions and drugs coursing through his system....

... All for a cool birthday.

This is a quote from a woman on a mothering site I am on:

Well its about 5 o'clock in the morning here and I am getting ready to go to the hospital! I am having a c-section today at 8! So our little boy will be born in less than 4 hours if all goes well! The cool thing is the doctor is going to aim for 8:08 am as the birth time! Wouldn't that be neat!!! 8-8-08 at 8:08 am! I'll be back on to add some photos when I can!! WISH ME LUCK!!!

There were elective c-sections talked about all over the world, for this "cool" birthdate.

Am I the only one that is horrified for these poor babies? Has the medical community and ignorant parents done THAT good of a job convincing people that elective cesareans are no big deal? Despite medical study after medical study that is released saying that the maternal and newborn mortality and morbidity rates are soaring high?

Is a "cool" birthday really worth possibly sacrificing your child's health - both short and long term? How very, very sad.