Five Hot Topics in Labor and Delivery in the Last Ten Years
Friday, July 8, 2011 at 7:34PM
By Romy McMaster
I have a fun little assignment for you all, if you’re interested. Recently, I was assigned a work project that involves writing a general overview of ‘what’s been going on in the field of labor and delivery in the last ten years’. Yeah, not too much been going on, right?
Although I have a pretty good idea of what general topics I’d like to write about, I wanted to get a feel for what a large group of passionate maternal health advocates would think, and of course thought of the readers of this blog. Thankfully, Jill has graciously allowed me to hijack her blog with this post.
So….my first question for you is this:
What would you choose as the five biggest (most important, most influential) topics related to labor and delivery in the last ten years? Can be national or international.
And second:
What would you choose as the five major studies or papers that you feel have most influenced maternal health relating to labor and delivery in the last ten years or so?
There are no right or wrong answers of course, and I just want to see what the consensus of a large group of very interested people would be. Don’t spend too much time thinking about your answers, just pick whatever comes to mind.
Here are my thoughts, just to get the old birth ball rolling. Oh yeah, I went there with the birth ball. It’s late on a Friday night after a long week so please just go with it.
I’ll get my thoughts together on how I would reply to the two questions and share with you all in the comments section shortly.
Look forward to all your replies!
Reader Comments (31)
- Risks of immediate cord clamping, benefits of delayed cord clamping
- Rising Cesarean rate
- Cytotec controversy
- Rise of convenience births, i.e. convenience sections and inductions, and subsequent rise of iatrogenic prematurity
- VBAC issues
Also, patient rights, patient autonomy, rise of homebirth midwifery
Good luck!!
Cord clamping to delay or not
rise in homebirth/ Business of Being Born a fad?
cytotec
elective c-births
legalizing mdiwifery/required liscensure of CPM's
CPM's vs CNM's vs OB's and overall outcomes
Inductions/Sections/Interventions causing the average gestational age at birth to be earlier and earlier...it's not 40 weeks anymore, folks. Wtf.
Doctors against delayed cord clamping
Induction epidemic
Home birth
C-section rates increasing in brazil and china
Preventing the first c-section
Cytotec articles by Ina may gaskin and Marsden Wagner
Canadian study on vaginal breech birth
The Hanna study that pretty much killed vaginal breech birth in the US and Canada. The Wax "study" of homebirth.
VBAC & elective induction (especially before 39 weeks) are two that have been getting a lot of attention the past few years.
I imagine the perspective of people who actually practice in L&D would be different from that of birth advocates and would be intrigued to see specifically what those differences are.
VBAC, for sure
The rise rate of c-sections
Elective induction
American women's lack of knowledge about birth
The almost universal acceptance of cytotec in the mainstream birth community
Thanks everyone, for the comments so far.
My picks are:
Rise in CSections or increase in birth interventions in general
'Early' births - early induction, CS prior to 37 weeks (esp. iatrogenic prematurity)
VBAC
Midwifery
Internet, social media
Papers/Studies:
Wax (homebirth)
The Term Breech Trial
The Listening to Mothers Survey (US) and Maternity Experiences Survey in Canada
I had not thought of cytotec but I'll add it my list. As for the Business of Being Born, I haven't watched it....I tried to watch it when I was about 38 weeks pregnant and it scared the crap out of me. Not sure how the popularity bubble of that dvd effected maternal health....good or bad?
I hope there are more comments but these are great so far!
What about the BMJ Homebirth study from 2006? Especially in comparision to the Wax "study". ACOG's recent position paper on VBAC vs. Canada's stance? Canada's encouragement of vaginal breech deliveries?
As far as individual topics, my top 5 picks are:
Lack of qualified breech attendants,
Lack of cohesive collaboration between midwives and physicians (making referrals and transfers in many places nightmarish),
VBAC access
the push for GD diagnoses and interventions that follow
ever decreasing time limits on labor after membrane rupture
Increased inductions-a woman should actually gestate for about 41-42 weeks ON AVERAGE! Then doctors decided it should actually be 40 weeks as an average, now doctors are saying it is ok to induce at 39 weeks. Where does this end? Just because a baby "can survive" outside the womb at 39 weeks does not mean he/she is actually ready to be born. "Due dates" can also be off by a week or two. So we actually have mother's getting voluntary inductions when their babies are only 36-38 weeks.
Inductions are becoming so mainstream that I hear women as other women all the time "When is your baby going to be born?" As if they should know the exact date (because of induction). I also hear women all the time asking other women when they are 36-37 weeks "Have you talked to your doctor about induction? You must be getting tired of being pregnant!". Women are not informed on the dangers of induction and the increased risk of c-sections.
VBAC is a big issue. Even though they are now recognized as a safe alternative to a repeat c-section a lot of hospitals still do not allow them.
Insurance companies making birthing decisions for women and doctors. This is a huge one to me. You now have insurance companies tell medical doctors and patients what they can and can not do. For example, VBACS, must give c-section a certain number of hours after water breaking, ect. This is very dangerous and disturbing.
Epidurals are now the standard. I can only name on one hand the number of women I know who have birthed naturally and can name about 50 who all received epidurals (many of which ended in c-section).
Finally, the increase in the number of doctors, articles, papers written on the trend of home birth that always include a doctor saying 'well I had x number of patients transferred in because of failed home births". I would like to ask those same doctors how many c-sections each month they give. I can GUARANTEE it is MUCH MUCH higher than the number of home birth transfers a midwife has. To me, a doctor giving a c-section IS THE EXACT same thing as a midwife transferring in a patient. BOTH FAILED to delver a natural birth that did not end in MAJOR surgery. If nothing else, this show how safe home birth is. The midwives are trained and educated enough to get the patient (who is now in need of a MEDICAL doctor) to the hospital for treatment.
Elective induction and premature birth
Rising Cesarean rate/low VBAC rate
Hospital formula supplementation and distribution among breastfeeding mothers/infants
Homebirth (particularly the Wax study and reactions to it)
Amnesty International report on maternal and infant mortality in the US
I'm just going to spout off the topics since I can't name any papers!
1) Rising c/s rate
2) vbacs
3) rise of inductions
4) over-medicalization/treatment of pregnancy, labor, and delivery
5) the epidural epidemic
I'll throw in one that I haven't seen listed yet - hospitals closing maternity departments because they are losing too much money on them.
I'll be snarky and ask what constitutes an "epidural epidemic?" Most of us want epidurals and we're pleased that they're readily available in America's hospitals. We're glad that we don't have to justify that we "need" them to some kind of epidural gatekeeper. We don't want to have take a test to prove to the epidural gatekeper that we're sufficiently "informed" about the risks of epidurals before we're allowed to have them.
Which brings me to one of the "hot topics" I see which is the demonization of epidurals.
"high risk" pregnancies - Which includes every IVF baby
The continuing move back of "term" for multiples and high risk babies. eg 36 weeks
Bed rest for every mom working w/ an OB
The rise of high risk births, especially shedding light on pregnancy complications such as preeclampsia, HELLP Syndrome, early contractions, and interventions
"Bed rest for every mom working w/an OB?" What? Is "every" the right word to use here? I worked with an OB and was not put on bedrest. In fact, I can't think of any of my friends who have been put on bedrest by their OBs?
And "IVF baby?" Parents who have conceived their children through IVF don't refer to their children as "IVF babies." It's not a different kind of baby. The only difference is how the child was conceived.
"I'll be snarky and ask what constitutes an "epidural epidemic?" Most of us want epidurals and we're pleased that they're readily available in America's hospitals. We're glad that we don't have to justify that we "need" them to some kind of epidural gatekeeper. We don't want to have take a test to prove to the epidural gatekeper that we're sufficiently "informed" about the risks of epidurals before we're allowed to have them.
Which brings me to one of the "hot topics" I see which is the demonization of epidurals."
I don't think there is anyone demonizing epidurals. I think the issue is that a lot of women are not informed that there are many risks associated with them. For example, higher risk of stalled labor= higher risk of c-sections. If I would have known that I would not have received an epidural with my second or third baby. I think that women do have the right to an epidural if they are making an informed decision on the matter. I DO WANT someone to test me and ensure that I know literally every possible downside to the epidural before I get it. The issue also comes when you have doctors that are telling women "they must" receive an epidural. And YES this happens. It happened to me on my third baby. I don't think any woman should be forced to have an epidural.
I guess where my issue comes is that the "fear" of birth comes a lot from other women. I know before I birthed my babies I had so many people tell me YOU WILL WANT THE EPIDURAL including my doctor. Come to find out the people who told me this DID NOT birth without one and most had received the epidural immediately upon entering the hospital. I wish women would stop trying to scare each other with birth horror stories. I birthed my first baby without an epidural and it was not a negative experience. In fact, it was a positive one. With baby two, I was in a long labor and opted for an epidural. I had more pain, complications, ect after the baby was born with number 2 so on number 3 I decided I wanted to do it without the epidural again. However, when I got to the hospital my labor was lasting "longer than they thought it should for baby number 3" so they told me I had to get an epidural because I was "probably just too tense".
The epidemic is that it is not really a choice to birth naturally for most women anymore. IT IS VERY hard to birth "naturally" if you are confined to a bed and induced. Induction made my contractions stronger and being confined to a bed made it unbearable. If women could walk around and do what they wanted during pregnancy I think more women would choose to avoid the epidural. So the epidemic to me is that women are treated like they are "ill" when admitted to the hospital. Most are put on IVs and are limited in movement and therefore need more intervention.
"Increased inductions-a woman should actually gestate for about 41-42 weeks ON AVERAGE!" Outcomes are significantly poorer after 41w gestation. Recommendations are at a minimum to incorporate fetal monitoring past 41w gestation.
As a physician:
1) Advance maternal age and impact on prenatal care
2) Access to VBAC
3) Gestational diabetes
4) Primary elective cesarean
5) Fetal monitoring
I love cytotec, btw. It is a wonderful and cheap drug.
and for the millionth time - EPIDURALS ARE NOT ASSOCIATED WITH A HIGHER RATE OF CESAREAN DELIVERY. Read the data people.