OBs play very influential roles in women’s lives during pregnancy, childbirth, and postpartum. Having the right or wrong person at your birth can make or break your vagina. Literally. Unfortunately, sometimes the doctor or midwife a woman chooses in thefirst trimesterturns out not to be such a great fit as pregnancy progresses. But how should you know when it’s time to fire your OB or midwife? Glad you asked.
I gave birth seven years ago in a Boston-area hospital where I generally consider the care to be excellent. I arrived near the end of my labor, my cervix almost fully dilated. After an hour of moving freely around my hospital room, my midwife and labor nurse said, “It’s time for you to get into bed now.” And then they said, “Let’s have you get onto your back.”
Even though I had read the medical research that found that lying supine carries risks to a fetus — which is why pregnant women are advised not to sleep on their backs — I behaved like any woman in the suggestible state of labor: I did what I was told, though it went against my instincts and my preference.
(click link at top to read the blog post on wbur.org)
For more than 60 years, it has been the standard of care to try to speed up childbirth with drugs, or to perform a cesarean section if labor was seen as progressing too slowly.
Now a new set of recommendations is changing the game.
In February, the World Health Organization released a set of 56 recommendations in a report called Intrapartum Care for a Positive Childbirth Experience. One key recommendation is to allow a slow labor to continue without trying to hurry the birth along with drugs or other medical interventions. The paper cites studies showing that a long, slow labor — when the mother and baby are doing well — is not necessarily dangerous.
A little history is required to understand the importance of that one recommendation, says Dr. Aaron Caughey, chair of the Department of Obstetrics and Gynecology at Oregon Health & Science University, who did not work on the report. In 1955, Dr. Emanuel Friedman studied 500 women and concluded that labor is normal when, during the intense phase of contractions, the cervix opens at a rate of at least one centimeter (about 0.4 inches) an hour. “Dr. Friedman showed that 95 percent of women progressed” at this rate, says Caughey. “And that became the standard of care.”
When I read the January 11thNew York Times Well blog, titled When A Big Baby Isn’t So Big, I looked back on my career as a labor nurse and thought, “Yep – happens all the time.” Predictions for a “too big baby” were among the most common reasons I heard from women admitted to my labor unit for induction of labor or scheduled cesarean sections. In most cases, once the baby was delivered, either vaginally or surgically, they weren’t all that big after all.
The New York Times blog is centered around a recent study based on Childbirth Connection’s national survey of 1,960 new mothers, called Listening to Mothers III. The survey indicates that four out of five mothers who were warned they might have large babies gave birth to infants who were not large, and weighed less than 8 pounds 13 ounces (which defines macrosomia – a larger than average baby). These mothers were almost twice as likely to have interventions like medical induction of labor or attempt to self-induce labor, presumably so their baby wouldn’t get too big to deliver vaginally. They were also nearly twice as likely to have planned C-sections, though as the blog mentions, researchers say that increase fell just short of being statistically meaningful.
(click link to read the blog on the Every Mother Counts website)
There are nearly 4 million births a year in the United States and 98% still arrive in hospitals, but the increase in birth centers run by midwives has obstetricians, health insurers and hospitals taking notice. The number of babies born annually in birth centers has jumped 56% since 2007 to about 16,000, while total U.S. births have dropped nearly 10% in the same time, according to federal data.
When Kate Kellogg became pregnant with her third child, she decided to give birth on The Farm, a midwifery center in Summertown, Tennessee, run by world-renowned midwife Ina May Gaskin. Some might think this is a surprising decision, given that Kellogg, 33, is a doctor. But after watching the documentary Birth Story and learning that The Farm’s 1,700 acres were just an hour from where they were living at the time, Kellogg and her husband became intrigued with the idea of giving birth there.