On the back of my recent column about informed choices in healthcare I have been speaking to a number of women about birthing interventions. A number of them commented that women are often not truly informed about the risks and adverse effects of some birth interventions and that they are often put on the spot (with little information) at the time that they are most vulnerable.
Now I don't want to tell any mum how to have her baby or what is best for her so please let's not open up that can of worms. What I do want to do is share with you some statistics so that when you do make a decision you are absolutely sure that you have made an informed decision and that it is the absolute best one for you. As a chiropractor I often see the after effects of stressful births on babies' spines and nervous systems and so often the mums tell me that they had no idea that birth could be so stressful on their little bubs.
We tend to assume that if a doctor is recommending a procedure that it is in the best interests of your baby's safety and that it is very safe, or at the very least that the risks are far outweighed by the benefits, but once you look into the actual stats they can tell a much different story. And often the cascade of events has started before the mother even realises it has. In this column I want to talk about two of the earliest interventions that are commonly assumed to be perfectly safe and ‘normal' but that nevertheless can lead to a cascade of events that may otherwise have been avoided.
The first intervention into the labour process is often an induction. Now it is worth noting here that almost all experts recognise that a pregnancy lasts from 38 to 42 weeks. The focus on one specific due date in our society is unnecessary and often unhelpful. After all 95% of babies are not born on their due date, so why do we get so hung up if a baby is a couple of days late? As a result the rate of inductions in Australia is unnecessarily high, in fact the most common stated reason for inductions is "prolonged pregnancy" (most of which would fall into the textbook normal 38-42 week duration). Now I know there will be mums here yelling at their computer screen telling me that I haven't carried a baby around for nine months and they are absolutely right. Once again I am not telling you what you should do, just sharing the stats I would want to know if I was pregnant (unlikely though apparently not impossible nowadays). So why is an induction a big deal? Well once again it increases the risk of further interventions. It leads to a more intense labour and so increases the usage of pain relief and epidurals and it drastically increases your chance of ending up with a caesarean birth. This is why the World Health Organisation says that the total rate of inductions should not be above 10% (in Australia we almost triple that figure!)
The second step is often the electronic foetal monitoring device which is used to monitor the baby's heart rate during labour. Seems like a sensible thing to do, doesn't it? The problem with it though (other than the fact that the internal monitoring involves screwing an electrode into your baby's head) is that it has a really high rate of false positives which can lead to many unnecessary further interventions. In fact the Cochrane database has stated that while there is no clear benefit to electronic foetal monitoring there is a clear increase in forceps, vacuum extractions and caesarean deliveries. So you can see that something as simple as monitoring the baby can be the first in a cascade of interventions that have a wide variety of side effects and risks.
Now I could delve much deeper here and go on to talk about pain relief, forceps and vacuum extractions but I will leave those for another time. Suffice to say that all parents should start researching birthing interventions and create a birth plan well before they get to the hospital so that they can make an informed decision about the kind of birth that is right for them. It is also worth noting here that regular chiropractic care during pregnancy has been shown to not only reduce labour time and pain but also reduce the need for medical intervention. I also want to point out that I am not totally against birth interventions. They have a time and a place and when they are needed thank god they are there, as they literally save babies' lives.
I will leave you with this quote from a Dutch Professor of Obstetrics: "Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine - nil nocere [do no harm]." - G. Kloosterman
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Could you give some references for these studies please?