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Hospitals and Obstetricians Provide Questionable Standard Care


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  #1  
October 4th, 2008, 12:36 PM
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(Copied with permission from author ) The link at the bottom has info from the survey, which is very interesting also!

<div align="center">Hospitals and Obstetricians Provide Questionable Standard Care</div>
Normally when a patient goes to a doctor or has to visit a hospital, a patient expects up-to-date quality care. Unfortunately, from surveys and research, this does not seem to be the case for mothers labouring in hospitals. Hospitals across the country observe similar protocols taken from the American College of Obstetricians and Gynecology (ACOG) for treatment of newborns and their mothers. However, a lot of practices and standard protocols are set on customary traditions and are not in the best interest for the infant and mother. The standard care obstetricians and hospitals provide in the United States are not deemed best for the health of mother and infant when birth takes place in hospitals.

According to historical data, it shows that death rates actually rose when women started having their babies in the hospitals. In 1915, a majority of births were in the home attended by midwives. At this time, the maternal death rate was at 60 per 10,000. By 1932, a majority of women, regardless of income, were birthing at hospitals attended by a physician. Death rates increased to 74 per 10,000. Also, infant death and injuries increased 40% to 50%. According to practicing Midwife Jennifer McFar, “these increases in rates were due to unnecessary interventions and cross contamination caused by medical staff which continues to happen even today" (interview). It was not until the late 1930`s, that, "more stringent controls were placed on obstetric training and practices" (Goer 202) and with the introduction of sulfa drugs, antibiotics that the rate went down to 63 women per 10,000. However, this was still higher than the maternal death rates in 1915. In the early 1900`s hygiene and health were improving which attributed to even lower maternal deaths with out of hospital birthing. A look at British data from the Isle of Man showed that in the early 1900`s, in midwife attended births in the home, death rates actually dropped from 70 women per 10,000 to below 30 women per 10,000 because of the improved hygiene and conditions. However, by 1929, when hospital births were predominant, the death rate of mothers promptly rose back up to 70 per 10,000. The only recorded changes during this time were the change of attendants of births, from midwives to physicians, and the setting from the home to the hospital. According to author Henci Goer in her book A Thinking Woman’s Guide to a Better Birth, the data from the United States coupled with the data from the Isle of Man concludes that it was the move of women into the hospitals for birthing that substantially increased the number of deaths of mothers and morbidity and death of infants (202).

Some of the common procedures used in hospitals such as enemas and IVs are not best for a labouring woman yet hospitals routinely use them. An enema is when liquid is squirted in the bowels via the rectum to cause the colon to empty. This is usually used in cases of constipation. However, in the 1940`s, the procedure was commonly performed on women being admitted for labour and delivery. Even though this procedure has phased out amongst the northern and western hospitals in the United States, it is still commonly practiced in the southern states. The issue with this procedure is it depletes a woman of much needed liquids and nutrients needed for successful labour thus leaving the risk of exhaustion and a difficult labour. The only possible positive that comes of this is the woman does not pass any type of bowel movement while in the pushing phase. However, the passing of a bowel movement during labour is a positive indicator that the woman is pushing correctly. If a woman does have a bowel movement, it is usually minute and has actually been shown to help the newborn infant. The mother’s fecal matter helps the newborn colonize beneficial bacteria that aids the newborn in digesting food and acclimating to the environment. Another common procedure still practiced across the entire United States is the use of IV (intravenous) fluids, fluids intravenously put into the woman via a catheter (a small tube) left in a vein. According to the 2006 survey Listening to Mothers II, an intravenous drip is performed on 83% (Childbirth Connection 1) of the women giving birth in the hospital despite the numerous risks associated with IV usage. In a hospital, medical staff frequently overdose labouring women with fluids when it is done intravenously. Commonly, hospitals have standing orders for all women to receive IV fluids at the rate of 125-150 ml per hour if they are admitted for birthing (Goer 241). However, the average rate a woman receives fluid is 360 ml per hour with some women receiving 600 ml per hour (Goer 241). During the actual birth the average rate increases to 750 ml per hour. Averaging the amount given, with 1,000 ml equaling 1 liter, women are given the equivalent of a 2 liter soda every 5 hours (Goer 241). Even with the correct amount given or the average bolus (1 or more liters) amount given, the use of IV drips cause a lot of problems in both the mother and newborn. In the mother, IVs can cause the build up of fluids in the lungs called pulmonary edema. It also dilutes the blood rendering most IV recipients anemic or some severely anemic. Anemia is the low levels of iron due to not there not being enough red blood cells. Red blood cells are essential for the carrying of oxygen throughout the body and to the baby in utero. When anemia is caused by bolus amounts of fluids it also increases the chances of excess bleeding. When excessive amounts of IV fluids are used on the mother before the baby is born, the issues on the newborn happen substantially more often as well. The newborn can develop neonatal tachypnea, a build up of fluid in the lungs which results in breathing difficulties. This also can lead to anemia in the infant as well. Also, with the build up fluids in the newborn, more weight is lost after birth. Additionally, cases of jaundice more than tripled. Jaundice is a medical condition that can be dangerous with symptoms such as eyes to becoming yellow as well as the skin. The use of these types of procedures with various others are consistently performed despite the evidence shows that it is not beneficial for mother and baby.

Another point about the lack of best care is the elective usage of non-FDA (Food and Drug Administration) approved medications on women. One of the more commonly used medications that are used on women is Pitocin (a synthetic oxytocin). As indicated from the 2006 "Listening to Mothers Survey II", 47% of the women were subjected to Pitocin to speed up labour. This is not including the usage of Pitocin on women to induce labour nor the routine use after the babies are delivered. The problem is Pitocin is not FDA approved for low risk labouring women. Pitocin is only approved for medically necessary inductions or stimulation of labour, not elective inductions or stimulation of labour (FDA). With 47% of women given Pitocin to speed up labour, that is saying roughly 1 out of 2 women are having medical complications enough to warrant the risk of using Pitocin. According to FDA labeling there are numerous risks to the mother and infant. A few of the maternal risks of Pitocin are: spasmodic uterine contractions, uterine rupture, convulsions, coma, fatal oxytocin-induced water intoxication (undue retention of water marked by vomiting, depression of temperature, convulsions, coma and may end in death). Some of the newborn risk are; slow fetal heart rate, heart action that was not normal, neonatal jaundice, permanent central nervous system damage or brain damage, and even fetal death. The manufactures label of Pitocin even warns "Maternal deaths due to hypertensive episodes [high blood pressure], subarachnoid hemorrhage [bleeding of the brain], rupture of the uterus, fetal deaths and permanent CNS [Central Nervous System] or brain damage of the infant due to various causes have been reported to be associated with the use of parenteral oxytocic drugs for induction of labor for augmentation in the first and second stages of labor."

Furthermore, Cytotec (also known as misoprostol) is frequently used despite the FDA specifically warning this product to not be used on pregnant women. The common use of Cytotec, a synthetic hormone that is put on the cervix by an obstetrician, is even specifically warned by the company to not use on pregnant women. The medication is for patients with debilitating ulcers. Searle, the manufacturer of Cytotec, even went so far as to mail a letter to the FDA saying this product can cause severe detrimental reactions even to the point of death of mother and fetus and for obstetricians to cease using the product for inducing labour. However, ACOG recommends the usage of this medication. Hence, hospitals continue to use it in their customary practice. Unlike Pitocin, there are no regulated standards of dosages to be admitted to women in labour. Thus, it is completely to the doctors` discretion on dosage. Pitocin and Cytotec are used in ways that are not approved, yet hospitals continue to use them consistently in obstetrics. There are not even studies as to the short-term or long term effects on either the mother or infant.

Despite the solid research that has proven that some of the medical orthodox methods of handling labour and delivery can cause short term and long term complications or even death, there is a continuance of these procedures. Why exactly this is persistent in care that is trusted in general by Americans is not known. What is known is that giving birth is a natural function that is best left alone in most cases.

Works Cited
Goer, Henci. A Thinking Woman’s Guide to a Better Birth. New York: Berkley Publishing Group, 1999.
McFar, Jennifer. Personal interview. 01 Oct. 2008.
“Technology-Intensive Childbirth is the Norm for Great Majority of Primarily Healthy Women: Listening to Mothers II National Survey.” ChildbirthConnection. 19 Oct. 2006. 23 Sept. 2008. http://www.childbirthconnection.org/...pres srelease
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  #2  
October 4th, 2008, 03:42 PM
Alissa&Isabelle'sMommy's Avatar Platinum Supermommy
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That's interesting thanks for sharing.
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  #3  
October 8th, 2008, 02:30 PM
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  #4  
October 31st, 2009, 09:44 AM
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I wish I would have know this when I was pregnant with my first.
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  #5  
November 15th, 2009, 08:20 AM
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I'm glad that I read this. I'll add these things to my birth plan. TFS!
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  #6  
December 12th, 2009, 07:44 AM
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thanks for this informative article!
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  #7  
December 31st, 2009, 06:06 PM
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Good article.
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