Thursday
May062010
Cite 'em if you've got 'em
Thursday, May 6, 2010 at 5:26AMPosted by Jill—Unnecesarean
I got a request for U.S. statistics and sources on the following items for a project that someone is working on.
- Induction
- Accuracy of ultrasounds in determining due dates
- Percentage of women that give birth on their backs
- Percentage that have IV’s
- Shaving?
- Enemas?
- Amniotomy
- Fetal monitors
- Epidurals/pain relief
- Pitocin – during/after
- Episiotomy
- Forceps/vacuum
- c-section – rate – 32.3, cost compared to vaginal delivery, european rate
- immediate cord clamping
- separation of mother/baby after birth
If you can think of a source and have the time to link it up, it would be appreciated.
By the way, who knows anyone that’s had an enema in the hospital in recent years? The only enemas I ever hear about are “Triple H” enemas occasionally recommended by some midwives. I don’t know anyone who’s been shaved in recent years, either.
Reader Comments (19)
I don't know about shaving for vaginal deliveries, but I think it is routine for them to shave at the site of the incision for the c-section... I know they did that for me...
This isn't helpful to you, but I'm also curious as to what % of those who get an epidural end up with a fine vaginal birth with no other complications. That is, while I know x% will end up with a c/s, spinal headache, only one side numb, instrument delivery, etc etc etc (well, I don't actually know off hand but I imagine I could find it?), I would like to be able to say something like, "yes, it is true that x% of women who opt for an epidural manage to use it as an effective tool and the rest of the birth goes fine with no other interventions or complications." Maybe this is too hard to tease out? Thanks a million for all you do.
I got VBAC, C-Sections, and Episiotomies for all of Connecticut by Hospital
Weird - I posted earlier but it must have gotten eaten by the internet gods.
The Listening to Mothers Survey is the most reliable source for all of the above except timing of cord clamping, shaving, ultrasound for fetal weight estimate and possibly enema (they may have recorded that - can't remember.) http://www.childbirthconnection.org/article.asp?ck=10396
When I was a midwifery student, I did some shifts at North Central Bronx which is a haven for midwife-led care in a low-income section of NYC. They used enemas frequently. Not routine, but it was their first-line intervention for anyone whose labor slowed down.
Ahhh, just realized my lack of post earlier was because I didn't see the capcha (sp?). Is that an example of "gotcha capcha-ism"?
Induction - here is one citation:
"Induction of labor is increasing in the United States—from 9.5% of births in 1990 to 22.1% of births in 2004."
http://www.annals.org/content/151/4/252.long
Ultrasound for fetal weight estimation:
"Among term parturients, clinical estimates had significantly higher accuracy than ones derived sonographically."
http://www.ncbi.nlm.nih.gov/pubmed/10804488
"For one in four women, however, the fetal weight estimation was more than 10% different from the actual birth weight of their infant."
http://www.nzma.org.nz/journal/119-1241/2146/
Amy, I'm sorry about the eaten comments. Squarespace comments are consistently unreliable and their repeated attempts to fix the ongoing problem have failed. It's very frustrating.
I am really starting to become skeptical of pretty much any stats anymore. If they're not reporting maternal deaths properly, who's to say that they're reporting anything else properly?
When my sister had her second child, my mother asked the nurse, "What percentage of your moms get pitocin?" She said, "80% during labor, and 100% for the management of 3rd stage." I seriously, seriously, seriously doubt that their stats would reflect that.
At the risk of being obvious, the researcher should make sure to do some work with Google Scholar. I consider myself an excellent googler, due in part to an RA-ship in college -- but I never realized how valuable Google Scholar was until I was writing my most recent paper. Filtering out non-academic search results makes it soooo much easier.
I use NIH's PubMed a lot, too.
I had an enema (asynclitic baby) that was recommended and administered by a midwife. But I gave birth in Germany.
Everything I know about researching, I learned form Andrea Lythgoe.
Dr. Buckley's article, Weighing the Risks: What You Should Know about Ultrasound, cites the following about ultrasound dating:
O. Olsen et al., "Routine Ultrasound Dating Has Not Been Shown to Be More Accurate Than the Calendar Method," Br J Obstet Gynaecol 104, no. 11 (1997): 1221-1222.
H. Kieler, O. Axelsson, S. Nilsson, and U. Waldenstrom, "Comparison of Ultrasonic Measurement of Biparietal Diameter and Last Menstrual Period as a Predictor of Day of Delivery in Women with Regular 28-Day Cycles," Acta-Obstet-Gynecol-Scand 75, no. 5 (1993): 347-349.
One might find chapter 8 (PDF) of A Guide to Effective Care in Pregnancy and Childbirth helpful.
You'll have to pay to read this article, Prenatal assessment of gestational age, but all of the references for it are cited below the intro to the article. Plug the ones that sound interesting into PubMed and see what comes up.
The Cochran Library has a review which may be helpful.
Whitworth M, Bricker L, Neilson JP, Dowswell T. Ultrasound for fetal assessment in early pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD007058. DOI: 10.1002/14651858.CD007058.pub2.
http://emedicine.medscape.com/article/260036-overview
Author: Yvonne Cheng, MD, MPH, Adjunct Assistance Professor, Division of Maternal-Fetal Medicine, Departments of Obstetrics, Gynecology and Reproductive Science, University of California at San Francisco School of Medicine
Coauthor(s): Aaron B Caughey, MD, PhD, MPH, MPP, Associate Professor in Residence, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of California at San Francisco; Medical Director of Diabetes and Pregnancy Program, Director of Perinatal Research, Program Director of Maternal-Fetal Medicine Fellowship, University of California at San Francisco
Updated: Oct 26, 2009
The good news: Say goodbye to the Friedman Curve!
"Data from number a studies have suggested that normal labor can progress at a rate much slower than that Friedman and Sachtleben4,5 had described. Zhang et al examined the labor progression of 1,162 nulliparas who presented in spontaneous labor and constructed a labor curve that was markedly different from Friedman's: The average interval to progress from 4-10 cm of cervical dilatation was 5.5 hours compared with 2.5 hours of Friedman's labor curve.17 Kilpatrick et al6 and Albers et al7 also reported that the median lengths of first and second stages of labor were longer than those Friedman suggested."
"While nulliparity is associated with a longer labor compared to multiparas, increasing parity does not further shorten the duration of labor.19 Some authors have observed that the length of labor differs among racial/ethnic groups. One group reported that Asian women have the longest first and second stages of labor compared with Caucasian or African American women20 , and American Indian women had second stages shorter than those of non-Hispanic Caucasian women.7 However, others report conflicting findings.21,22"
The bad news: Active management of the third stage with oxytocin management, controlled cord traction, and early cutting and clamping of the cord SHOULD BE ROUTINE.
"Delivery of the placenta usually happens within 5-10 minutes after delivery of the fetus, but it is considered normal up to 30 minutes after delivery of the fetus. Excessive traction should not be applied to the cord to avoid inverting the uterus, which can cause severe postpartum hemorrhage and is an obstetric emergency.... active management involves administration of uterotonic agent (usually oxytocin, an ergot alkaloid, or prostaglandins) before the placenta is delivered. This is done with early clamping and cutting of the cord and with controlled traction on the cord while placental separation and delivery are awaited."
"A review of 5 randomized trials comparing active versus expectant management of the third stage demonstrated that active management was associated with lowered risks of maternal blood loss, postpartum hemorrhage, and prolongation of the third stage, but it increased maternal nausea, vomiting, and blood pressure (when ergometrine was used)."
"*****However, given the reduced risk of complications, this review recommends that active management is superior to expectant management and should be the routine management of choice." (Emphasis mine.)
Also from the above article: Women's preferences should be considered, but there appears to be no mention of a concrete right to refusal.
"The patient and her family or support team should be consulted regarding the risks and benefits of various interventions, such as the augmentation of labor using oxytocin, artificial rupture of the membranes, methods and pharmacologic agents for pain control, and operative vaginal delivery (including forceps or vacuum-assisted vaginal deliveries) or cesarean delivery. They should be actively involved, and their preferences should be considered in the management decisions made during labor and delivery.2"
I'd like to see something about clots in the lower uterine segment. I'm seeing a lot of that lately, and honestly, I think it is caused by "gentle" cord traction. I watched a resident do this yesterday, and it really looked to me like the placenta had not released yet, but rather the resident was slowly pulling it off the wall of the uterus. Removing the clots is quite excruciating.
Knitted in the Womb...I would like to see this as well. I'm a birth doula and 80% of the clients I've seen have had clots whereas the OB had to go in and remove them even after a gorgeous natural birth. It is so heartbreaking to see someone manage labor and birth beautifully and then force to be in agony afterward to remove the clots. One client had to actually go in the OR to have them removed. I'm curious to know how normal this really is or if there is third stage management issue going on.
I'm not sure if the EU collects statistics like this centrally - you'd be more likely to get them by country.
For Ireland, we have the ESRI e.g.: 2007 Perinatal report http://www.esri.ie/publications/search_for_a_publication/search_results/view/index.xml?id=2859
(26% c-section rate; nearly 72,00 births, less than 200 of which were at home,)
Also Cuidiú (the irish childbirth trust): http://www.cuidiu-ict.ie/frulcrum.html?ep=13&ad=24&to=0
National Center for Health Statistics
http://www.cdc.gov/nchs/
Birth data specifically (from this source)
http://www.cdc.gov/nchs/data_access/vitalstats/VitalStats_Births.htm
Birth and natality data runs about 2 years behind. You can access preliminary data for 2008 at http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_16.pdf
which would tell you that the CS rate was 32.3%, preterm birth rate 12.3%.
If you search the website you can find rates of labor induction (I recall 18%, and another 17% for "augmentation" with pitocin) and epidural.