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Childbirth Protoocol: Florida Earns an “F” | Mother Rising

I read this article today by the March of Dimes Florida Chapter. Go ahead and you read it too. Done? (MOD removed the article…)

Now, let’s start thinking.

UPDATE:  Six years later Florida earned a “C”. Excellent improvement!

Florida Earns an “F”

13.8% of babies in Florida were born too soon. They were born before their lungs, brain or other organs were fully developed.

To top it off, this is the third year in a row that Florida received an “F” from the March of Dimes for its preterm birth rate.

In the same article, proven solutions were presented.

“There are known strategies that can lower the risk of an early birth, such as smoking cessation, preconception care, early prenatal care, progesterone treatments for women with a history of preterm birth, avoiding multiples from fertility treatments and avoiding unnecessary c-sections and inductions before 39 weeks.”

I’m going to talk about the last solution “avoiding unnecessary c-sections and inductions before 39 weeks” and add my two cents to how to make this happen.

Scheduling Birth

Convenience inductions and cesarean births are and should be a big no-no at any point in pregnancy.

I am going to include a post-dates induction/cesarean birth under this category. The small “risk” of being overdue is far less than the risk and what goes along with an induction/cesarean birth. So, it is still a convenience induction if a mama goes past 41 weeks and opts (even under her care provider’s guidance) for an induction/cesarean birth. Hospitals and doctors LOVE rules, so why not just add that one in there? Unless there is an urgent and dangerous medical condition, convenience inductions and cesarean births should not be allowed.

Big Baby ≠ Induction or Cesarean

Suspected fetal macrosomia does not warrant early induction or a scheduled cesarean birth.

Women can birth big babies thank you very much. It’s true! And guess what, women with small babies can have difficulties pushing their babies out too. The solution here is to allow healthy women to go into labor naturally and allow babies to be born when they’re ready. Also, safer ways to resolve shoulder dystocia like the Gaskin Maneuver should become the “go-to” for all care providers. If this were the case, there would be less fear-based scheduled inductions and cesarean births.

But First, Labor

For those who must have a cesarean birth, opt to go into labor first instead of scheduling surgery.

The obvious benefit here is that by allowing your body to go into labor on your own, you KNOW your baby is ready to be born. Just because you reach 37 or 39 weeks and are full term, does not mean your baby is ready. So often, babies born too early have breathing difficulties as the lungs are the last major organ to finish. Also, labor contractions are GOOD for babies. Baby gets a massage of sorts which helps the lungs prepare to breath and also expel mucus. Vaginal birth is the ultimate “lung mucus squeeze out” (that is an AMAZING technical term I just created), but if that is not possible, labor will definitely be better than nothing. Finally, labor introduces the cocktail of hormones necessary for bonding between mama and baby.

Midwives Rock

Women should be educated on and choose the midwifery model of care versus the techno-medical model of care.

Do you feel like your OB looks at you like a ticking time bomb just waiting for you to explode? You’re not alone. Physicians are trained to look for problems and potential problems (and thank God for them!). They do not believe babies are safe until they are delivered from the perilous woman’s body. It’s sad, and very true. The midwifery model of care views birth as safe, natural and normal. Nutrition is used to prevent pregnancy complications, not technology.

“The techno-medical model of maternity care, unlike the midwifery model, is comparatively new on the world scene, having existed for barely two centuries. This male-derived framework for care is a product of the industrial revolution. As anthropologist Robbie Davis-Floyd has described in detail, underlying the technocratic mode of care of our own time is an assumption that the human body is a machine and that the female body in particular is a machine full of shortcomings and defects. Pregnancy and labor are seen as illnesses, which, in order not to be harmful to mother or baby, must be treated with drugs and medical equipment. Within the techno-medical model of birth, some medical intervention is considered necessary for every birth, and birth is safe only in retrospect.” – Ina May, Ina May’s Guide to Childbirth

Those are my ideas. What are yours? Would it be too optimistic to hope for at least a “D” next year? 😉

Love ya,

Lindsey

Erinn

Sunday 21st of November 2010

I'd also like to throw this hat in the ring: the research which the gestational diabetes diagnosis is based upon is very flawed. I'm not saying that GD doesn't exist; I'm just saying that until better research is performed, optimal screening and treatment protocols won't be developed. This means care providers are potentially treating pregnant mothers like there's something wrong which can only be fixed by induction or surgery, when a simpler, less invasive approach could be used.

At the risk of making a generalization (to which there are always exceptions), I gotta say: midwives have been known to advise moms to take a proactive nutritional approach to solving any issues which either put mom at risk or have potentially caused GD. Note my use of the word 'proactive' - which means, in this instance, providing clear resources and information on how moms can achieve a nutritionally-dense eating pattern which also fits the financial constraints and other situational factors of each individual mom. I can't tell you how many moms I've talked with who were just told by an OB, "Eat right and you'll be fine," without any additional information provided to them.

Lindsey (Mother Rising)

Wednesday 17th of November 2010

@Ali - thanks for the good information!

Ali

Wednesday 17th of November 2010

@ Felicia- In the interest of not spreading mis-information, pre-eclampsia is not caused by a mother 'getting big'. We are not sure what causes it, in fact. And the most typical true pre-eclamptic or eclamptic women is young and thin. There are plenty of women with gestational hypertention (not the same as PreE) and many of them are overweight, but as I said before we have no definitive cause. An interesting point Ina May brings up is using a high protein diet in pregnancy and better nutritional counseling in an effort to decrease the incidents of PreE. I would love to see some more research on that. Also, most inductions for 'postdates' are being done between 40 and 42 weeks, which is still 'on time'. True post date inductions (after 42wks) we rarely see, unless a pt really pushes for it. And I have never heard that the rationale had anything to do with meconium. I'd have to see some research on that especially given that the incidence of meconium aspiration is very, very low when you consider how many babies have meconuim stained fluid at any gestational age. I couldn't agree more with your last paragraph.

@ Lindsey, great summary of some important things for women to consider!

Lindsey (Mother Rising)

Wednesday 17th of November 2010

@Felicia - I see it too. It's so sad that women don't care. I saw it while working for the census, and while subbing in at our local birth center for a week. However, that is why I'm writing here... maybe someone will read something that will change their pregnancy/birth for the better. Here's hoping!

Felicia

Wednesday 17th of November 2010

I do agree with a lot of what you are saying but doing ultrasounds and working with the doctors you see a lot of things. There are a lot of uneducated mothers that dont seem to care what they do to their bodies.

I see it time and time again where they "eat for two" and end up with gestational diabetes. Risk of that is you have big babies and the lungs mature slower. It would be great to keep those babies in longer but a lot of time the mother is at risk herself with the potential risk of getting high blood pressure(preclampsia) the bigger she gets. Babies are so much bigger putting stress on the mother's body.

As for post dates, you have a higher risk of meconium aspiration. Which is why being induced for post dates isnt really a bad thing to avoid that risk.

In a perfect world, mother's would do their research before having babies. Losing weight, exercising during pregnancy, eating healthy, not doing drugs, prenatal care, etc. If people would educate themselves there wouldnt be such a huge increase in premature/pre-term birth. Mother and baby would both be healthy.