Oh knowledgeable mamas, I come seeking statistics and studies

[BoobyJuice]

OK, OK, I know the first answer to my question is going to be - have a homebirth. Due to circumstances currently beyond my control my birth choices are very limited. We are 20 miles from the one - and only 1 - hospital in the area, there are no birth centers or homebirth midwives within 100 miles. There are only two Dr’s that deliver at that hospital, no midwives and no doulas. I have chosen the much more natural, less interventionist Dr. (family practice not the OB).

At 20 weeks I showed him a rough draft of a birth plan to get an idea of what we might need to work on. He was OK with almost everything. I am now looking for studies, statistics and brilliant arguments for the few things he wasn’t. I also think some of these are just, most unfortunately, not going to be changeable.

1) Delayed cord cutting. He said he has always cut before the placenta was even out and has never had a problem in 13 years.

2) Electronic fetal monitoring! This is a big one for me. I requested doppler or fetalscope; the hospital doesn’t have either. (The hospital only has 3 OB nurses and they only have about one delivery a week.) They also don’t have telemetry monitors. They want 20 minutes per hour. If I refuse, I would be refusing all monitoring since they have no alternatives. Ideas?



(And, yes, I have read The Thinking Woman's Guide to a Better Birth, but so much of that is her analysis, I can't really quote it for an argument to present the dr and hospital.)

Thanks!

[plantmommy]

There was a link to an excellent article online written by a fellow of the amer. college of obgyn on the pregnancy board a few days ago. It gave excellent info on early cord cutting. Give it a look-see.

Check here: http://www.cordclamping.com/

Could you buy a fetoscope?

[doctorjen]

1. Cord cutting - does he have any studies to show you that delaying cord cutting would cause any harm? There aren't many, to my knowledge. There is one study that suggested the rate of postpartum hemorrhage was less when the cord was cut early, but that's the only one I know of. Many other studies have indicated a benefit to the baby by delaying cord cutting. Even if the data is just neutral, there is no great evidence delaying cord cutting harms anyone. If he can't prove it's a must, why can't he be flexible about it?

2. There is no reason that an electronic fetal monitor can't be used like a doppler for intermittent monitoring. I frequently monitor moms for 5 minutes every 30, during and after a contraction, and shut the monitor off in the meantime. We figure out where the best place to hear the baby is and put a mark on the spot on mom's belly, then mom can walk, or be in whatever position she chooses, as long as she comes back to the monitor every 30 minutes for 1 contraction. The monitor can be held in place for that contraction, while mom stands, sits, or whatever. Intermittent monitoring is the gold standard to which all other monitoring techniques are measured. It has consistently been shown to provide superior outcomes in moms having normal labors. Asking for the gold standard seems reasonable, rather than expecting you to make due with a lesser choice. If there are that few births, the nurses don't probably have any other responsibility other than you while you're in labor, so they can certainly help you hold a monitor in place for 10 minutes total an hour.

The Thinking Woman's Guide lists all the actual studies she bases her analysis on in the back of the book. You can look those studies up directly and quote those if you want to. The National Library of Medicine provides free searching, and often the abstracts of individual papers are available online. (www.nlm.nih.gov)

[Lula's Mom]

Yeah, I really liked that article! It's about halfway down on www.cordclamping.com (which has tons of other useful info too). The direct link is:
http://www.mercola.com/2002/mar/20/clamp.htm

I don't think it's good enough for him to say "I've done it this way for 13 years and never had a problem!" Yeah, because the injuries that can be caused by early cord clamping are practically regarded as normal for a newborn. He wouldn't see a "problem" or an "abnormality", because he's doing it to all of them. So, perhaps he could just humor you. After all, what harm can he see in letting you have it your way and cut after the placenta is out?

I'm sorry I haven't got any advice about the monitoring. I'm not really familiar with hospitals. But it seems ridiculous that they wouldn't at least have a fetoscope. What if one machine wasn't working, and all of the other machines were in use by other patients? Don't they need some sort of backup method? It reminds me of the teenage store clerks who are completely unable to make change if the cash register computers are down. I agree, ask him if he'd use it if you brought your own.

[cottonwood]

(Some of these may repeat information and references...)

http://www.cordclamping.com/Buckley.htm -- lots of references, written by a doctor

http://www.mothering.com/experts/ode...#cord-clamping -- no references, but offers the theory that to clamp early interferes with the hormonal process, thus making hemorrhage more likely (also written by a doctor)

http://www.hulmeandassociates.com/bj/thirdstage.htm -- has references, plus points out that the World Health Organization endorses the practice of delayed cord clamping.

http://www.gentlebirth.org/archives/...s.html#Delayed -- Just a bunch of stuff, studies and articles

[cottonwood]

"He said he has always cut before the placenta was even out and has never had a problem in 13 years."

Righhhht. :LOL He must be defining "problem" different than the rest of us. Or is he really claiming that he has never had babies start slow and need help breathing, never had mothers bleed too much?

[BoobyJuice]

Or is he really claiming that he has never had babies start slow and need help breathing, never had mothers bleed too much?

Well off the top of my head (hence the need for references) all I could say was that the babies didn't get all the blood from the placenta. Probably he figures if they don't need a blood transfusion, it isn't from the cord. Who know?

Thanks for all the references on cord cutting. I'm definitely going to read through all of the studies. Does anyone have anything I could use on EFM?

[2+twins]

To avoid EFM, I know someone asked if you could buy a fetoscope. You could also rent a doppler. I know Baby Beat rents them.
For stats on EFM, I tracked down some articles & info online. Hope something in here helps:

http://www.collegeofmidwives.org/pra...es01/ia99a.htm
http://www.awhonn.org/awhonn/?pg=873...7000-4730-4750
http://bmj.bmjjournals.com/cgi/conte.../322/7300/1436
http://www.drspock.com/article/0,1510,10601,00.html

Quote taken from the second link listed:

Background: An ACOG technical bulletin holds that the judicious application of intermittent auscultation of fetal heart rate is equivalent to continuous electronic monitoring in the assessment of fetal condition for the low risk laboring woman.(ii) The Society of Obstetricians and Gynecologists of Canada (SOGC) stated that intermittent auscultation is the recommended method of FHR surveillance for low risk women during labor.(iii)

The Birth Book also discusses this issue on pages 78-79 and I quote:

Originally Posted by page 78

Twenty years of experience and nine randomized prospective studies (the most respected kind) have all concluded that electronic fetal monitoring has, in most cases, been of no benefit to mothers and babies. After studying thousands of births and babies, researches concluded that electronic fetal monitoring offered no benefits to mother or baby compared to periodic listening to heart tones with a Doptone (a hand-held ultrasound device) or the old-fashioned fetoscope (a stethoscope designed to be placed on the abdomen to hear the baby's heartbeat). Overwhelmed by the research showing the non-usefulness of EFM, in 1989 the American College of Obstetricians and Gynecologists announced its position statement concerning routine EFM: "It has been shown in well-controlled research studies that intermittent auscultation of the fetal heart at intervals of fifteen minutes during the first stage of labor and five minutes during the second stage is equivalent to continuous electronic fetal monitoring in the assessment of fetal condition."

Originally Posted by page 78-79

The same studies that show no benefits from EFM confirm the risks. Continuous electronic fetal monitoring is responsible for the following unnecessary trauma:
* more cesarean births, as obstetricians react to the results
* more forceps deliveries, as obstetricians attempt to get the baby out quickly
* more maternal and fetal infections from insertion and constant presence of the internal monitoring tubing and wires, which provide easy access for bacteria to travel up into the mother's body, putting her and the baby at risk for infection
* infection of baby's scalp from electrode placement
Besides these measurable risks, there are more subtle ones. Most of the time EFM means mother is tethered to a machine and is not free to walk during labor or encouraged to change positions. This lack of freedom often results in a more painful labor that progresses slower. Also, the mother's lying on her back (so that the electrodes can be placed more precisely) can itself cause abnormal tracings. The machine is not a labor-friendly companion. The constant clicking is annoying, and the discomfort and worrying about what the blips on the paper mean don't really help relax a laboring mother. Maternal stress can decrease uterine blood flow and compromise the baby. In fact, studies show that mothers having electronic fetal monitoring have significantly higher levels of stress hormones in their blood than mothers not electronically monitored. Some mothers find that the belt around their abdomen or the wires in their vagina interfere with their ability to cope with labor.

Hope this helps!

[True Blue]

Ina May's Guide to Childbirth also lists several reasons and references about why EFM isn't useful, and actually leads to more unnecessary c-sections for babies who are thought to be in distress but actually are not.

[watermamma]

You have gotten some great responses I love Dr. Jen's response to the EFM, there is no reason that could not be done!

I just wanted to add, you might want to gently remind your Dr. that it is your birth, your cord, and your baby. I can't fathom why he would be so anxious about cutting that cord, other than his hurry to move on to something else. Maybe you could remind him that your birth is very important to you, and something you will remember the rest of your life, and that while safety is of course top priority, you are not asking for anything "unsafe", and would like to have a pleasant, empowering, healthy experience. It is your experience after all

[Eman'smom]

What DrJen said is what they did with me, a nurse came in, held the EFM to my belly through a contraction, while I was leaning over the birth ball, heard everything was A-ok and then left, there is no reason someone can't hold it for a contraction, you don't have to be strapped down.

Just FYI, I had hospital births for similar reasons to you, and dd's birth was perfect and amazing. You can have a great and rewarding hospital birth

[BoobyJuice]

Thanks everyone. I'm going to try to write something up - with reasons - for my dr and the hospital. So far my dr has been very flexible but I've been told the hospital is pretty set
in it's ways. Hopefully I'll be able to convince one of the nurses to hold the monitor for me while I sit or stand. (I dislocated my tailbone with my first and being on my back in
labor is excruciating.) My first two labors were both extremely fast, precipitous labors. After about a month of contractions, I start “real” labor with about 60 seconds contractions that are about every 75 seconds. So the thought of “only 20 minutes” is a really long time; I much prefer the idea of being monitored through one contraction. (My husband keeps saying that all the hospital regs won’t matter when I’m crowning as we pull into the parking lot!)

Anyway, thanks all. I have my next appt in 3 weeks and I’m hoping to have something convincing written by then.

I had hospital births for similar reasons to you, and dd's birth was perfect and amazing. You can have a great and rewarding hospital birth

And thanks for the words of encouragement. I'm really nervous about this. This is my 3rd birth but my first in the hospital and I'm trying to talk myself out of dreading it - doesn't seem like a very good state to approach labor in.

[Eman'smom]

I too have fast labors, I don't think it makes labor easier, but it can make it easier to get away with stuff, especially if they don't expect you to have the baby that fast. I birthed at a great hospital, but it seems that lots of hospitals do stuff because nobody says "hey don't" have you considered having a friend or doula run interferance?

[ilovebeingamom]

Just wanted to add...My mw is about 1 1/2 hours away. I know you said that there aren't any within 100 miles, are there any close to that? For me, it is well worth the drive! I don't want to have to fight anyone while I am in labor!

[BoobyJuice]

have you considered having a friend or doula run interferance ?

There actually aren't any doulas up here either. You'd have to picture a little 1950's like town where getting a Super Walmart is the most exciting thing to happen in years. When I called the hospital to ask questions they had no idea what to do with me; there is no choice here. If you are pregnant you go to the one hospital and put up with what they do.

We moved here almost a year ago (was supposed to be quite a bit more temporary than it is turning out to be), but I do't know anyone well enough to have them at my birth.

My mw is about 1 1/2 hours away. I know you said that there aren't any within 100 miles, are there any close to that?

There are midwives about 100 miles away but when I said fast labors, I meant fast labors. My first was about 5 hours - 3 of those were pushing. So fully dialated in 2 hrs. My second labor was 45 minutes. If this is like the first two, I'm more worried about making it the 20 miles to the hospital!