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Friday
Jul082011

Five Hot Topics in Labor and Delivery in the Last Ten Years

 

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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!

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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!!

July 8, 2011 | Unregistered CommenterDiana

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

July 8, 2011 | Unregistered CommenterSarah Ericson

Inductions/Sections/Interventions causing the average gestational age at birth to be earlier and earlier...it's not 40 weeks anymore, folks. Wtf.

July 8, 2011 | Unregistered CommenterLaurel

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

July 8, 2011 | Unregistered CommenterLeigh Anne

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.

July 8, 2011 | Unregistered CommenterRebecca

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

July 8, 2011 | Unregistered CommenterCarrie

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!

July 9, 2011 | Unregistered CommenterRomy

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

July 9, 2011 | Unregistered CommenterAron

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.

July 9, 2011 | Unregistered CommenterTara
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