Saturday, September 8, 2012
Louisiana has a 40% c-section rate, one of the highest in the country. The World Health organization recommends a c-section rate of 15%. Anything above this should be alarm us that something is wrong. Giving birth, in your average U.S. hospital, sadly has turned into a business. Inductions and c-sections are scheduled Monday thru Friday. Sometimes women come in in labor, but even then it is common speed up their labor with pitocin. Waters are broken. Mom's cry for epidurals. And if baby doesn't come by a certain time, it's time for a c-section. It is safe? In my opinion, not nearly. Many times we have a emergency c-section, it was preceded by a hospital intervention. Here I want to review some of the culptrits.
1) Pitocin. A synthetic form of oxytocin, the hormone that causes uterine contractions, is the most frequently used drug to induce or speed up labor. Despite the manufacture stating that is not to be used for "social" reasons to induce labor (no true medical need), it is heavily prescribed. Nearly every mom that walks in the door gets "pit." Pitocin has the ability to cause "tetanic" contractions, huge contractions that are spaced too closely and can actually cut off the babies blood supply, causing the baby's heart rate to drop dramatically. Some babies get to a point where they can't tolerate those unnatural contractions any more, their heart rate drops and an emergency begins. You do have a choice. Say no to induction unless medically necessary.
2) Pain meds. I will tell you that I have not seen a baby sectioned due to pain medication mom got in her IV, but I will tell you that a nurse can definitely read the signs of it on the monitor. I remember being told, when I delivered my first baby, the pain medication did not reach the baby and it was perfectly safe. However, it is well-documented that babies whose mothers receive pain medication are often lethargic and more sleepy than their counterparts. If you're watching the fetal heart rate on a monitor strip, literally minutes after mom gets a dose of IV Nubain/Phenergan, you will see that babies heart rate stop jumping up and down (we call this "reactivity," a sign of a healthy, alert baby) and it will fade into a straight line. His heart rate is still within normal limits, but his heart rate looks the same as one who is sleeping. Basically, he's knocked out. I personally haven't seen any c-sections from this. But you have to really consider whether you want your baby to receive the same narcotic (via your bloodstream), so that you can have a few minutes of pain relief.
3) Epidural. Again, I was never told that the epidural could have such a profound effect on the baby. To read what the epidural is and how it works click here. The epidural causes the mother's blood vessels to vasodilate, causing her blood pressure to drop. This is why before most women can get the epidural they are "pre-loaded" or pumped with 1-2 liters of IV fluid beforehand. The drop in blood pressure can be dangerous for the baby because it decreases mom's blood flow to him. If not enough of mom's blood flow reaches the baby, oxygen doesn't either. Often after a mom gets an epidural the nurse will struggle to keep the mom's blood pressure up. They will give her IV fluids, lay her on her side, give her oxygen or resort to IV medication to cause a spike in blood pressure. But sometimes a baby just can't tolerate the lack of blood flow and oxygen, so it needs to be delivered by c-section.
A secondary way the epidural may lead to a non-vaginal birth, is the absence of optimal positioning. A mom can't really move her pelvis, rock her hips or use gravity to help baby descend through the birth canal. She is left laying on her back, with baby pushing his/her way through the pelvic bones all by his self. This could explain why some moms make it to complete dilation, yet their babies get stuck in the birth canal and have to be delivered by surgery.
These are all things I have seen and reinforce my thinking that "the less intervention the better," for women who aren't high risk.
If you have a low-risk pregnancy and you are a healthy, I highly recommend midwifery care or seeking out a physician who will only intervene when necessary. The midwife model of care views pregnancy as a normal, natural event that only needs to be intervened by surgery, on rare occasions. Whatever you choose, educate yourself on all of your options. As a patient you have a right to informed consent by your health care providers. As long as there is no emergency going on you have the right to being informed about all of your treatments risks and benefits and ultimately you are the decision maker and key component in your own care and that of your sweet baby.