3/25/09

The Mother-Friendly Childbirth Initiative

If you are pregnant or know someone who is I highly suggest that you see if your local hospital or birth center follows these guidelines that have proven to create optimal outcomes for moms and babies.

A mother-friendly hospital, birth center, or home birth service offers all birthing mothers:
  • Provides culturally competent care -- that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother's ethnicity and religion.
  • Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
  • Has clearly defined policies and procedures for: collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary; linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
  • Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following: shaving; enemas; IVs (intravenous drip); withholding nourishment; early rupture of membranes; electronic fetal monitoring; Other interventions are limited as follows: Has an induction rate of 10% or less; Has an episiotomy rate of 20% or less, with a goal of 5% or less; Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals; Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
  • Educates staff in non-drug methods of pain relief and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
  • Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
  • Discourages non-religious circumcision of the newborn.
  • Strives to achieve the WHO-UNICEF "Ten Steps of the Baby-Friendly Hospital Initiative" to promote successful breastfeeding: Have a written breastfeeding policy that is routinely communicated to all health care staff; Train all health care staff in skills necessary to implement this policy; Inform all pregnant women about the benefits and management of breastfeeding; Help mothers initiate breastfeeding within a half-hour of birth; Show mothers how to breast feed and how to maintain lactation even if they should be separated from their infants; Give newborn infants no food or drink other than breast milk unless medically indicated; Practice rooming in: allow mothers and infants to remain together 24 hours a day; Encourage breastfeeding on demand; Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants; Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics.

...Sadly, if you took the time to see if your local hospital follows these guidelines that have proven to create optimal outcomes for moms and babies, you'd find very few of them do. Why? Other factors (outlined below) besides what is best for the mother baby unit are influencing labor and birth practices in the United States.

What is the Guiding Philosophy Behind Maternity Care in the United States Today?

Birth in America is guided by the false belief that it is a fundamentally flawed process.

According to this belief, during childbirth women's bodies are inefficient, ineffective and a potential danger to the baby. Birth is only seen as normal in retrospect. This philosophy serves as the foundation for the dominant model of maternity care in America today, the technocratic medical model. As Robbie Davis-Floyd describes in her book "Birth As An American Rite of Passage," birth in this model is doctor and technology centered, only safe inside of a hospital when technology is used, restricted to arbitrary time lines that are not research supported, and the pain of labor is perceived as unproductive and unnecessary. The technocratic medical model ignores an integral part of birth, the importance of the labor and birth environment and how birthing women feel psychologically. The interventions deemed necessary and safe by this model of care are largely not supported by the medical research. Unfortunately the technocratic model of maternity care has far reaching effects. About four million women give birth each year in the United States. According to data released by the Center for Disease Control in 2003, 99% of births occurred in a hospital and 91.4% of all births were attended by a physician, who tend to employ the technocratic model of maternity care. Only 8% of births were attended by a midwife, who generally practice a more holistic, women centered approach to pregnancy and birth. The vast majority of women are being cared for by providers whose beliefs and practices are founded on the technocratic medical model of maternity care, which does not support birth as a natural, normal, healthy process.

Other factors such as convenience and fear of litigation help to explain how our system has wandered so far away from what birth really should look like:

Women making informed choices about their health, in a comfortable environment of her choice, where she is not put on a timeline as to when her baby must be born and she is not told her body isn't working well enough, she is able to move unrestricted with the birth attendants of her choosing present, soothing and guiding her emotionally and physically during the birth experience.

The Birth Experience The Listening to Mothers Survey conducted in 2002 by the Maternity Center Association surveyed 1,538 women regarding their childbirth experience. According to this survey "a majority of women reported having each of the following interventions while giving birth: electronic fetal monitoring (93%), intravenous drip (86%), epidural analgesia (63%), artificially ruptured membranes (55%), artificial oxytocin, or pitocin, to strengthen contractions (53%), bladder catheter (52%), and stitching to repair an episiotomy or a tear (52%)." [5] While these interventions are sometimes necessary and important in birth, their prevalence and the risks associated with each are alarming.

Research demonstrates the following risks:

• Continuous electronic fetal monitoring increases the risk of cesarean and has been shown to have no benefit to the baby's health. Instead, the American College of Obstetricians and Gynecologists recommend intermittent auscultation be used for healthy, low-risk women.

• "Routine IV use restricts movement (an important tool and comfort measure in natural childbirth), decreases confidence, may over-hydrate mothers, and may contribute to low blood sugar in newborns."

• Epidurals have a tendency to increase the first stage of labor, induce potentially life threatening hypo tension (low blood pressure) and fever which can't be differentiated from an infection and must be treated automatically with antibiotics, as well as the use of pitocin, which carries its own risks. Several studies have shown an increase of vacuum and forcep vaginal deliveries, again each carrying its own set of risks to the mother and baby. Epidurals may also be associated with an increase in cesarean sections.

• "An intact amniotic sac protects the baby's head and a woman's vagina during labor. Artificially rupturing the sac increases a woman's risk of infection and interventions like pitocin, EFM, IV, and cesarean."

• "There is no evidence that the prevention of prolonged labor by the liberal use of oxytocin in normal labor is beneficial." Because pitocin artificially increases the strength of contractions it puts more stress on mothers and their babies. "Pitocin use necessitates the use of an IV and continuous EFM, restricts (a mother's) mobility, and raises (the mother's) risk of epidural and cesarean. And so begins the cascade of unnecessary interventions often resulting in less optimal outcomes for mom and baby.

Keep in mind that most of the time these interventions are being used in the absence of medical necessity, thus arbitrarily introducing unnecessary health risks. More poignantly - obstetricians and midwives (obviously not practicing midwifery care) are actually introducing risk to a normal process that would work better and be more beneficial to mother and baby if left alone. Cesarean births are another major intervention with numerous risks to women that is on the rise in the United States. Our current cesarean rate of 31.1% is disturbing given that the World Health Organization (WHO) states that cesarean births should comprise no more than 10-15% of all births. Any more means less optimal health outcomes. C-section rates in the United States have increased 50% in the last 10 years.

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