brighid

However, the mortality rate is not the true contention here but the higher rate of c-sections and episiotomies that cause unneccessary damage and/or complications for the mother or long-term damage - such as the case with recto-vaginal fistulas, or third and fourth degree perenial tearing.

Finlad, France, Germany, Iceland, Japan, Norway, Spain and Sweden have significantly lower morbidity rates then the US and they have less invasive, more "natural" procedures. What this tells me is that many women and children in the US are dieing unneccessarily and that we are behind the times with our European counterparts. Those women also have fewer complications postpartum and have greater maternal and child care after the birth.

There seems to be credible evidence that in the US we have room for improvement and people are rightfully questioning the complete conventional package and NO ONE has suggested that medical intervention is unneccessary, but it has become too common and that the evidence suggests much room for improvement.

Doctors, nurses and hospitals are very necessary to the pregnancy and delivery process, but possibly should only be used in high-risk situations such as done in Sweden (that has the lowest morbidity rate of 3.47 p/1000 deliveries as opposed to 6.76 p/1000 in the US.) The reasons should be investigated and improved upon for the health and welfare of mother and child.

Believe me, you never want to experience a 3rd or 4th degree tear that opens you up all the way to your rectum and beyond that requires extensive reconstruction, further surgery and a very long recovery time. If episiotomies cause this, rather then prevent it shouldn't we be questioning the wisdom and the traditional practice in hospitals? Why do European women have a different experience and how can American medicine change to improve?

This man simply doesn't want his wife to endure an unneccessary pain, complications, or otherwise that will endanger her future health. There are other ways to have a baby then confined to a hospital bed in a conventional setting. He wants to explore those options and wonders why we as Americans seem to be a bit behind. I think that is commendable and we should explore the topic a bit more openly.

Brighid

Jamie_L

Brighid,

The trouble I see in the U.S. is that all too often people go overboard in the other direction, scoffing at doctors and entrusting their health to laymen who study untested or unproven psuedoscience and psuedomedicine. Obviously there is a middle ground that must be sought and achieved.

The trick is to achieve the right level of skepticism of the medical profession while not turning our backs on it and listening to the siren song of new-age quacks (of whom my wife and I encountered one as we sought our middle ground).

So, we seem to have the same advice for everyone: be active in your medical treatments. Learn. Ask questions of everything you don't understand, and even those you think you do.

Trust but verify.

Jamie

Dr Rick

A population-based, retrospective cohort study using the national perinatal mortality data for 1995-1997 assembled by the National Center for Health Statistics was used to assess perinatal mortality in the US and to specifically determine the effects that the lack of prenatal care has on the fetal death rate. It was published this past March.

Of 10,560,077 singleton births registered in the US, 29,469 (2.8 per 1000) resulted in fetal death. Fetal death rates were higher for blacks than whites in the presence (4.2 versus 2.4 per 1000) and absence (17.2 versus 2.5 per 1000) of prenatal care. Lack of prenatal care increased the (adjusted) relative risk for fetal death 2.9-fold in blacks and 3.4-fold in whites. Blacks were 3.3 times more likely to have no prenatal care compared with whites.

Lack of prenatal care, which is much greater in the US than in most Eurpoean countries, is the primary cause of the disparity in the fetal death rates between the two groups, and is one of the leading causes of deliver-related complications. The greater incidence of substance abuse among pregnant women in the US, the higher obesity levels in the US, and the higher percentage of Blacks in the US further impact these rates (Blacks are more prone to pregnancy related complications such as gestational hypertension and gestional diabetes than whites).

Rick

brighid

Thanks for posting Dr. Rick. I knew you would be able to provide information that most of us might miss, and I very much appreciate your input. What are your professional thoughts on episiotomies and the difference in c-section rates? As well as your professional thoughts on a certified nurse mid-wife, OBGYN team?


Brighid

Dr Rick

Hi Brighid and all;

The aggregate evidence suggests that episiotomies are not beneficial under most circumstances and may increase both the risk and severity of delivery-related perineal lacerations. The theory behind episiotomies is that a "controlled" incision is likely to be less injurious and smaller than a traumatic tear, but the clinical evidence does not support this supposition.

C-sections have been over-utilized in the US; tradition, financial incentives, and physician convenience have been just some of the bad reasons that this is so. Even with greater patient and physician awareness of these issues, however, the c-section rates in the US will probably continue to be higher than those in most of Europe due to the relative lack of prenatal care access and our country's demographics, both of which create more high-risk pregnancies.

Legal issues remain a major barrier to decreasing the c-section rates, as well. In the US, if you deliver a "less-than-perfect" baby, you will likely be sued, no matter the cause of the bad outcome. If you didn't deliver the less-than-perfect baby by C-section, even if there was no good medical indication to do so at the time of delivery, a lay-jury is more likely to find in favor of the plantiff than if you did perform a c-section. In other words, malpractice issues continue to favor intervention.

Nurse mid-wives are a good thing; studies show that they provide a very satifying delivery experience for most healthy babies and moms.

Rick

[ September 04, 2002: Message edited by: rbochnermd ]</p>

alek0

Rick,
if it is obvious that episiotomies are not beneficial, why are there so many assholes who cut them for no reason? I can understand doing an episiotomy during delivery if baby is in danger, but I just don't get it how can anyone say to a three months pregnant woman who asks questions about delivery that she'll need one. And why some people just accept it as true only because their health provider told them so?

Dr Rick

I don't know.

Rick

brighid

Dr. Rick,

Thank you very much for your professional input. I, personally value and appreciate it. It also makes me feel a bit better knowing that a more objective, educated party has confirmed our future course of action (if or when we become pregnant) to be a better choice, or atleast the best choice for us.

Thanks again,
Brighid

eldar1011

Allow me to echo brighid's sentiment to Dr. Rick. I'm just starting to feel out how responsive our OBGYN is to what we've learned in the Bradley Method. It's a little intimidating.

Also, allow me to express gratitude to brighid for her posts. I haven't posted much in this thread, despite being the originator, simply because I can't possibly say it as well as she has.

Thank you, brighid <img src="graemlins/notworthy.gif" border="0" alt="[Not Worthy]" />

Dr Rick

You're both welcome.

I just reviewed the OP and have an additonal observation to make:

External fetal monitoring has been found to not improve either fetal or maternal outcome in uncomplicated labor of normal pregancy; at least that was the case several years ago when I last looked at the issue. The only significant effect it seems to have is that it slightly increases the chance that a c-section delivery will be performed. In other word, fetal monitoring in most pregancies has no discernable benefit but makes intervention more likely.

As far as I know, external fetal monitoring has only been found to have a positive impact on outcomes when labor had to be induced.

So why are fetal monitors still used in other situations? I believe it's a legal issue. A bad outcome in the absence of fetal monitoring, even though there is no discernable advantage to using the technology in most pregnancies, would be difficult to defend in a malpractice suit.

Rick

[ September 05, 2002: Message edited by: rbochnermd ]</p>