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Re: OB: Home births - keeping it normal - low section ratesFrom: GA12L@aol.comThu Nov 17 12:30:05 2005
In a message dated 17/11/2005 18:29:26 GMT Standard Time, ajfields@pine-net.com writes: It's next to impossible to give birth in a hospital without continuous EFM, which makes labor absolutely miserable for a lot of women. That's why section rates are high. We stopped doing routine admission traces over here and our section rate dropped without compromising the mum or her baby. These are some of the things I have learned that have contributed to low c/s rates. 1. The safest place to give birth is where there is least intervention, i.e. home or birth centre. 2. Keep the woman upright and mobile. 3. Do NOT encourage a woman to push until she has an urge to push. It will exhaust her. 4. Do NOT ask her to breath hold during second stage it is dangerous. It cuts off oxygen to the fetus and to the uterus. No oxygen to the uterus and it stops contracting as it is muscle and all muscles need oxygen to work properly. 5. No arbitrary time limits on second stage. Research done in the US shows there is no deleterious outcomes whether 2nd stage is 1, 2 or 3 hours long. 6. Recognise the latent phase of second stage. It is a phenomenon that occurs in a lot of labours. The contractions will come back. 7. Encourage the woman to eat and drink what she wants when she wants. An engine won't work without fuel! 8. Do NOT do continuous EFM on low risk women, it will lead to intervention. 9. Do not rupture membranes unless clinically indicated. Amniotic fluid is there for a reason. Most of the woman I care for rupture their membranes just before they give birth and many babies are born with them still intact (looks very strange). 10. Empower the woman, give her the confidence and support to labour without an epidural. Recent work over here shows that epidurals lead to instrumentals and sections. 11. Use birthing balls, birthing pools, massage and aromatherapy to help her cope. Of course I practise in a culture of no blame and therefore feel confident practising in this way. Because I know the normal inside out I know immediately that something is not going as it should and am glad of a good OB to refer to. Gail
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