Tuesday, October 30, 2007

Protecting Your Pelvic Floor

Researchers grouped seventy women according to whether they exercised regularly, did postpartum exercises only, or never exercised, and measured the strength of their pelvic floors one year after childbirth.
Regular exercisers fared the best, postpartum exercisers fell in between, and non-exercisers had the weakest pelvic floors. Exercise regimens included fitness classes, walking, jogging, running, dancing, swimming, and yoga.

Gordon H and Logue M;Perineal muscle function after childbirth.
Lancet 1985; 2:123-125

Researchers evaluated perineal and pelvic floor outcomes in 460 first-time mothers according to how much they exercised. Women engaging in weight-bearing exercise more than three time weekly were equally likely to have an episiotomy, but only 16 percent experienced anal injury, compared with more than one-quarter of those exercising less often.

Klein MC, et al.; Determinants of vaginal-perineal and pelvic floor functioning in childbirth. American Journal of Obstetrics & Gynecology 1997; 176(2):403-410

Tuesday, October 23, 2007

What Do Women Really Want in Birth?

What do women really want in birth?

The answer to this question influences billions of dollars of business in our country every year.

Every wise business person knows that in order to be successful, s/he must develop a product that is what the consumer WANTS and/or NEEDS.

If the consumer wants it, but doesn't need it, s/he may or may not buy it.

If the consumer needs it, doesn't really want it or find the product attractive, s/he probably will go elsewhere to get what they need.

When you combine need and want, you have a powerful product.

Our current maternity care system has convinced most of their customers that what they offer is what the customers need and want.
But is it really?

What basic things have they convinced the majority of mothers to need and want?


Avoiding unnecessary pain

If you ask nearly any woman why she's having her baby in the hospital, her biggest reason will be "safety."
Ask her what other reasons, and you may get an assortment of answers, but most likely the most frequent answer will be "for pain relief" if she takes a moment to think about what her hospital and obstetrician offer her.

These are two good things for women to want.
Who wouldn't want their baby to be safe?
Who wouldn't want to know that if anything goes wrong, someone will know how to fix it?
And who wants to suffer unnecessary pain?

But are women really getting what they think they are?

Sometimes I see many pregnant women in our society akin to a man who keeps driving his little Chevy truck that breaks down frequently, and is convinced that his truck is the best that can be had, because all of his friends say so. Even books about buying a good truck say so. The man who sold it to him told him that it was the best kind of truck he could drive. Sure, he doesn't like the breakdowns, but he's been told that his truck is the best, so he does his best to live with the aspects he doesn't like and pride himself that he is driving the best truck anyone could buy.

How many women are taken by the marketing that occurs in this country? We tell them that if they would only come to the hospital, they might experience a few breakdowns and inconveniences, but their experience will be the best they will find anywhere - safe and comfortable.

That's what we say.
But is it true, or is our modern maternity care system not all its cracked up to be?

Saturday, October 20, 2007

Research on the Stillbirth-Cesarean connection

From the Lancet 2003; 362: 1779-84:

Stillbirth linked to cesarean section

Investigating the relationship between previous cesarean delivery and subsequent stillbirth.

Cesarean section can increase the risk of stillbirth in subsequent pregnancies, claim researchers, in findings that add to the growing debate over the acceptability of elective cesareans.

Professor Gordon Smith (University of Cambridge, UK) and colleagues studied data on 120,633 births in Scotland between 1992 and 1998. They found that the proportion of stillbirths was greater in women who had previously delivered by cesarean section (2.4 per 10,000 women) than among women who had only delivered vaginally (1.4 per 10,000 women).

The increased risk of stillbirths with unknown causes began at around week 34 of the pregnancy in women who had undergone a cesarean for a previous birth, regardless of the reason for the procedure.

The association is "biologically plausible," the team comments, reasoning that previous cesarean delivery may influence uterine blood flow and mechanisms of placentation in future pregnancies.

Friday, October 19, 2007

An OB's opinion on C-section

From www.obgyn.net

There are many benefits of vaginal delivery, for both mother and baby. During a vaginal delivery the amniotic fluid is squeezed from the baby's lungs, making it easier for him or her to breathe. This does not happen as much during c-section.

Furthermore, it is a misconception that c-section is always safer for babies than vaginal delivery. Scalpel injuries and trauma to babies during c-section, although rare, can certainly occur. In most cases vaginal deliveries are safer for mothers than c-sections, with some medical studies indicating that the chance of death for a mother is 7 times higher when delivered by c-section versus vaginally.

Contrary to popular belief, a c-section is a major operation, not unlike a hysterectomy in it's complexity and potential complications! These complications may include infection, hemorrhage, scar tissue formation (which may produce lifelong abdominal or pelvic pain), anesthesia complications, opening of the skin incision leading to a very large scar, damage to the bladder or intestines, and the formation of blood clots within blood vessels or the lungs.

These complications are usually much more common with c-sections than vaginal deliveries, although as with all medical issues the patient's individual situation will dictate which complications are more, or less, likely.

An unfortunate side effect of our legal system is that many women are led to believe by malpractice lawyers that a c-section will prevent any and all problems for their baby. This is simply untrue and is a very unsophisticated way of looking at this major operation and pregnancy in general.

D. Ashley Hill, M.D.
Associate Director Department of Obstetrics and Gynecology
Florida Hospital
Family Practice Residency Orlando, Florida

Thursday, October 18, 2007

Cesarean section - the way to go?

More and more women are choosing to go the "cesarean route." After all, most plan to have only one or two babies, and they'd rather put up with recovery after major surgery once or twice than "ruin a perfectly good vagina" as one woman put it.

But does cesarean really preserve a woman's body more than vaginal birth?
Is it really less painful?
Are the risks the same?
If I had all the information on risks and benefits, would I choose a C-section for myself?

A doctor friend of mine whose wife recently gave birth by cesarean to her only child, remarked over dinner the other day (as I was discussing natural birth with someone else), "There's nothing quite like a c-section. Slit it open. Take the baby out. Sew it back up and you're done. No sweating, and moaning, and hours of misery. No natural birth for me. I don't find it compelling!"

Is a c-section really akin to just "unzipping," pulling the baby out and sewing the uterus shut again?

Well, not exactly, according to some nursing students who I was visiting with a couple of weeks ago. They were just finishing their eight weeks of Labor and Delivery in their RN training. One of them was lamenting that she had only seen c-sections, during her clinical days, and never witnessed a vaginal birth in the hospital. (She had seen vaginal births in South America, totally unmedicated, and unassisted by any "professional.")

"So," I said, "What do you think of C-sections? Would it scare you to have one, or does it look better than vaginal birth?"

"Oh, my goodness!" she replied. "If women only got a ten second 'behind the scenes' look at c-sections, they would never opt for one. They look awful! The whole uterus, tugged out of the body, lifted up and set on top of the abdomen for repair. The blood loss... it just looks like you tipped over a cup of water and it's pouring out. And then they stuff a rag inside the uterus and..." she shuddered. "I've helped people with severed limbs and stuff, but a c-section was just really gross."

My friend, Jason, and his wife just had an elective cesarean this week. He called to tell me the baby's weight and all the "proud father" news. I asked him if his wife was into recovery yet.
"Oh, yeah, C-sections don't take long. It only took about 10 minutes and we had a baby!" he exclaimed.
"Except that the c-section looked really awful. She didn't feel a thing. But it took the doctor pulling on the baby's head for all he was worth and three people holding her down on the table to get the little six pound guy out! Afterwards, it all looked... uh, just gross. I tried not to hurl, and couldn't watch the rest of it."

Dr. Deirde Lyell, assistant professor of Maternal-Fetal Medicine at Stanford University in California, has this to say:
"Unless a woman has a compelling reason for needing a C-section, vaginal delivery is still the way to go. A C-section is major abdominal surgery and carries a greater risk of severe bleeding, infection, re-hospitalization and blood clots."

Tuesday, October 2, 2007

Why Do Women Put Up With Birth the Way We Serve It?

The question deserves raising: Why do women put up with [the options they are offered for childbirth]?
"Americans trust doctors and they trust hospitals, and they equate the two with health. And people want what's best for their babies. They assume that you decrease your risk by going to a hospital and having a top-flight doctor. What they don't understand is that obstetricians are surgeons, and they know pathology, but they really suck at wellness." (-Judith Lothian) They are trained to sew up a tear, but not to prevent one.

- Excerpted from "Pushed: The Painful Truth About Childbirth
and Modern Maternity Care,"

by Jennifer Block

Photo Credit: photographer Lindsey Woessner, copyright Molly Remer