Re: OB: Home births - keeping it normal - low section rates
From: Jamie (ajfields@pine-net.com)
Fri Nov 18 15:32:37 2005
I want to apprentice with her. That's how my births went, even my
hospital birth. I was given a lot of concessions (no continuous EFM, up
after ROM, ate and drank through labor, baby never went to nursery,
early discharge) b/c I previously worked at the hospital and my doctor
trusted me. (btw, Dr. Meenan, the doctor who caught my last baby was
the FP who backed me up for #3 and #4). I'm sort of stuck in the middle
of this debate b/c I've seen it from both perspectives. As a L&D nurse,
I saw how easily medical professionals are blamed for everything. As a
mother who believes intervention is best used only when absolutely
necessary, I've seen how hard it is to get a low intervention birth in
the U.S.
So much for lurking:)
At Fri, 18 Nov 2005, Anna Meenan, MD wrote:
>
>Can I come practice with you, Gail?
>
>--
> Anna Meenan, MD
>
>At Thu, 17 Nov 2005, GA12L@aol.com wrote:
>>
>>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
>
--
JFields, RN, BSN
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