Yesterday’s session Highlights:
“Third and Fourth Stage of Labor: Usual Practices under Heavy Criticism”- AND “How Normal is Birth Today?”-Penny Simkin.
*When physicians are making policy for their practices, generally it has an “order” to it.
1.RCT’s (Random controlled studies)
2. Observational Studies
3. Expert Opinion
Those are the scientifically “accepted” method of deciding what practices you do. But someone came up with a fourth criteria that seems to be jumping on the list:
4. Adverse outcome. And sometimes, even if the RCT’s and science supports a particular practice, if a doctor sees an adverse outcome they will ban it from their practice all together.
(EX: if there is a 1% chance of uterine rupture, and they will ban VBACS all together. Rather than accepting that the opposite is true-per the same study- that there is a 99% chance that you won’t experience a uterine rupture).
*Daddy Skin to skin- even 15 minutes in the first 24 hours: promotes protectiveness, more likely to call the baby by name (instead of “it” or “the baby.”), better understanding of babies cues and promotes closeness toward the baby.
ONLY 6% of ALL births have “NO complication” according to the 2011 review of Insurance billing records of 2008. There is a high incentive to bill more instead to promote health or prevention.
*In the 94% reported as complication here is a breakdown of some by definition: “complicating conditions high rates of minor or modifiable risk factors and preventable complications”- Nukal cord 18%, maternal age12%, prolonged pregnancy-12%
*High prevalence of diagnoses based on unreliable screening tests or subjective clinical judgment – gestational diabetes-17%, abnormal fetal heart tones-17% (meaning these are diagnoses based on interpretation.. different doctors can look at the same EFM strip and make different diagnoses).
*the high % of “complications” were caused by overuse of questionable medical procedures (induction, c/s, episiotomy)
*Payment tied to number or procedures-incentive to dx high risk & disincentive to promote health and prevention
FOR THE DOULA:
* Even telling a mom, “you’re breathing too fast,” “keep those sounds low”. . she may feel shame “Oh I’m not doing it ‘right’.” . we must be careful not to do that. Rather word it “with the next one try this..” We are doing everything we can to help the flow of oxytocin and shame will cut it off. Yes, there are times where we do have to ask mom to give a little more effort (ex: pushing) but we must know how to communicate that positively).
*Pushing-If she is squatting.. she should not be doing the hard bearing down counting to 10. Sometimes we do have to ask for her to give some more effort if the baby is malpositioned. But there is enough pressure on her perineum that she does not need to force it. Let the baby rock back and forth, in and out of the “crowning”.. good for babies head and for stretching moms muscle.
*Penny Simkin does not like the words “tear or rip” and prefers to re-frame it as a “tissue separation.”
*We know that intravenous hydration may lead to: inconvenience and discomfort to mother, fluid overload, hyponatremia (loss of sodium= foot and hand swelling that can last for days), mother feeling deprived of basic comfort. But there is a CAUTION: too much oral fluid can lead to fluid overload and hyponatremia as well (Moem Study). We can trust the mom on whether she wants to drink or not. Don’t “make” her, suggest it to her.
*Penny Simkin loves epidurals for exhaustion. For the mom that has labored over 24 hours. (if they are exhausted). Because the epidural keeps a mind/body split. When the mind is out of it for labor, the epidural allows her to relax and frees her up to labor (especially during exhaustion).
Anything interesting to you??