Doctor and Fear of Nipple Stimulation - Mothering Forums

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#1 of 40 Old 07-12-2009, 04:57 PM - Thread Starter
 
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How common is this? For a doctor to tell a mother that she can try other alternative ways to start induction but not to use nipple stimulation no matter what. This doctor just told my clients (primip with twins, 35 weeks) that it was too dangerous to use nipple stimulation while not on a monitor. I asked if the mom could try it on the monitor before pit was given, but the doctor said there wouldn't be time for that and that the contractions caused by nipple stim are so strong that they could cause the babies to be in distress.

I thought for sure this mama would be induced right then and there because of what the doctor was saying (slightly elevated BP) but the couple asked for a few minutes alone to discuss things. I was there with them too. Anyway, I was so proud of them for questioning things and trying to really think it through. The next time the mom's BP was taken I told her to try to go inwards and really relax and breathe, and she was on her left side this time when it was taken. It was lower and the next time it was lower too. Yeah! Anyway, they were sent home and are to go back in on Tuesday for another appointment and most likely will be induced on Wednesday or Friday. I still want to help them get things going naturally if they can, but I feel like I'm walking such a fine line too. I was a bit aghast when the doctor was so dead-set against nipple stimulation! I had to totally bit my tongue. The doctor can't seem to wait to get this mom on pitocin but some how nipple stimulation would be dangerous.

I'm wondering how I should discuss this with the couple again if it comes up. I certainly don't plan to say to them do it anyway, but I feel like if they were to research a little more on their own they may be more comfortable. It just pisses me off when I feel like a doctor is unnecessarily freaking a mom out, like telling her that she is going to do something bad to her body and her babies just be touching her own nipples. The doctor had to add at the end too that nipple stimulation REALLY hurt. A little bit of fear-mongering in my opinion. But I know I need to keep these thoughts to myself.

Is it common for doctors to be so afraid of nipple stimulation? And any other suggestions on how I can help this couple and possible help them get labor started before they are induced, straight away with pitocin?

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#2 of 40 Old 07-12-2009, 05:05 PM
 
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Not a birth professional but my doc discouraged using nipple stim for my labor bc I was vbacing. His feeling is that nipple stim contractions could put the scar at higher risk of rupturing
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#3 of 40 Old 07-12-2009, 05:08 PM
 
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My guess would be less that he is afraid and more that he is just uncomfortable with the whole idea, and probably impatient ("there won't be TIME once she's on the monitor???)

If nipple stim is so dangerous, then what happens when a pregnant women is nursing an older child or during sex?
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#4 of 40 Old 07-12-2009, 05:30 PM
 
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Personally, and I'm not a BP or have studies to back this up, but it seems to me that nipple stim would be better than pit to get things moving simply b/c it's produced by the body rather than artificial.

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Not a birth professional but my doc discouraged using nipple stim for my labor bc I was vbacing. His feeling is that nipple stim contractions could put the scar at higher risk of rupturing
what?!? my proVBA#C dr in Atlanta was all about the nipple stim for ALL his clients... vbac or not. Even my first OB, who was unsupportive of VBAC, didn't have anything to say about nursing while pg when I was pg with my 2nd and still nursing #1. This time, I'm rather looking forward to my nursling helping get my labor going this time around. The CNM I'm seeing this time around (I moved from Atlanta ) thinks it's just fine to be a vbac and still nursing.

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If nipple stim is so dangerous, then what happens when a pregnant women is nursing an older child or during sex?
the misinformed docs tell the mothers to wean b/c it "causes m/c." ugh.

I can see where avoiding nipple stim & sex could be advisable when a mother is truly at a higher risk for preterm labor, but to not even try when they're about to induce anyway? when she's in hospital and on monitors? ridiculous. I'd be demanding studies from the dr that show the dangers they're claiming.

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#5 of 40 Old 07-12-2009, 05:42 PM
 
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#6 of 40 Old 07-12-2009, 06:24 PM
 
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With pitocin you start slow with a controlled dose and can turn it off if contractions are too strong. You cannot control the release of natural oxytocin; you can turn the pump off which may or may not stop the contractions.
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#7 of 40 Old 07-12-2009, 06:32 PM
 
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you might investigate the difference between nipple stimulation by a partner, or by mom and the use of the breast pump, which seems to be the stimulation offered in a hospital setting.

I did have a client who did not consult me and used the breast pump for 10 minutes, both breasts, and went from no contractions to excruciating contractions every minute without a break for many hours. It was not a pleasant way to start labor...
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#8 of 40 Old 07-12-2009, 07:16 PM - Thread Starter
 
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Thanks everyone for all responses. I'm learning more and more.


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Originally Posted by nashvillemidwife View Post
With pitocin you start slow with a controlled dose and can turn it off if contractions are too strong. You cannot control the release of natural oxytocin; you can turn the pump off which may or may not stop the contractions.
In response to this, I have actually heard the opposite that, that if contractions are too strong with nipple stimulation that you just stop and then they will mellow out again. But most likely you know more than I do. What I have read is that you start with one nipple, gently, and see if it starts to bring on a contraction and then if it does, stop and let the contraction take place. If no contraction is brought on then you can try stimulating both nipples, again gently and slowly at the beginning to see if you can't get things started or intensified if you are augmenting labor. What do others know about this?

I guess what I'm struggling with is this whole idea that somehow the body could do damage to itself. I just believe so strongly in the way the pregnant body works and it seems to me like most of the time nature is designed as such that natural stimulation would be preferable to artificial. Is nipple stimulation somehow an exception to this?

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#9 of 40 Old 07-12-2009, 09:25 PM
 
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I have not really noticed a rash of hospitalizations for tentanic contractions brought on by sex or nipple stimulation (including tandem nursing) I really don't think it is that dangerous - now if the mom were having preterm labor- then I would recommend no nipple stimulation, no sex or orgasms and no contact with sperm -but at 35 weeks with twins I don't know that I would worry so much- term for most twins is considered to be 38 weeks. is she scheduled for a c-section? and the doc doesn't want her going into labor before that?
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#10 of 40 Old 07-12-2009, 09:58 PM - Thread Starter
 
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Thanks for the response mwherbs, and thank you for sharing the term tetanic contractions as well. I love learning new words.

The mom is not scheduled for a cesarean birth. Hopefully she will still be able to have a vaginal birth, both babes are vertex. The doctor is talking about inducing with pitocin on Wednesday morning but it won't be decided until Tuesday, maybe, or perhaps even Friday if the appointment on Tuesday goes really well. She has had some high BP readings and she has gestational diabetes and the twins weren't growing at the same rate, and they are measuring a little "small."

Anyway, the couple (and I) were wondering if she is going to be scheduled for induction if there weren't some things they could try at home first to get things started before she goes in. They know it is a long shot but they had really wanted an un-medicated birth, which they also know probably won't happen because the doctor wants the mom to have a "just-in-case" epidural in case baby B flips breech after baby A is born. They are now planning to have an epidural but they are hoping to wait until later in labor to do so. We'll see how that plays out.

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#11 of 40 Old 07-12-2009, 11:58 PM
 
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She can always try castor oil!

Having presided over many a breastpump-induction (typically after PROM) I think it is ridiculous to be terrified of nipple stim in favor of pit! I've simply never seen it be THAT "effective." (It is very effective, but in a slow progressive sort of way.)

Nashville, is this your experience you speak of, or a theory? Have you seen women hyperstimulate their uterus with nipple stimulation? I'd be very interested to hear more about this if so.

I agree that the "there won't be time" for nipple stim on the monitor argument sounds rIdIcUlOuS. What does that even MEAN?

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#12 of 40 Old 07-13-2009, 12:13 AM
 
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Tell us again the impetus for getting the babies out?

Mom's blood pressure? Her gd is is not under control? Babies measure small?

Is there a defined reason, or is her primary careprovider feeling impatient and casting about for justification?

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#13 of 40 Old 07-13-2009, 01:02 AM - Thread Starter
 
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Originally Posted by momileigh View Post
I agree that the "there won't be time" for nipple stim on the monitor argument sounds rIdIcUlOuS. What does that even MEAN?
I don't know what this means either, except that I think she (the doctor) just wants to start with pitocin right away. It does seem really ridiculous because on the one hand she said that alternative forms of induction don't work and are a waste of time, but then she seems genuinely scared of nipple stimulation. I suppose it is not considered efficient on the part of the doctor or the hospital to allow this woman to try to get things started on her own. Personally I thought like that sounded like a nice balance, but I bet there is some rule about only being able to be admitted for an induction when you are getting pitocin or cervidil. I guess you can't be admitted and just hang out for a bit feeling yourself up.

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#14 of 40 Old 07-13-2009, 01:05 AM - Thread Starter
 
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Tell us again the impetus for getting the babies out?

Mom's blood pressure? Her gd is is not under control? Babies measure small?

Is there a defined reason, or is her primary careprovider feeling impatient and casting about for justification?
My gut is telling me that the doctor was feeling a bit impatient. She later added how she would be off the next two days, when my couple suggested being induced tomorrow morning instead of this morning.

Her blood pressure was up the first two readings but came down the second two. Babies have been a little small but growing according to their own curve, at least this is what the mom has told me. Gd seems under control.

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#15 of 40 Old 07-13-2009, 01:10 AM
 
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Nashville, is this your experience you speak of, or a theory? Have you seen women hyperstimulate their uterus with nipple stimulation? I'd be very interested to hear more about this if so.
This is what my consulting physician said. He is a very educated, wise, and patient man.

My personal experience is that I induced my own labor with the breast pump - in 90 minute sessions - after first ripening my cervix with 3 bottles of castor oil.
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#16 of 40 Old 07-13-2009, 01:19 AM - Thread Starter
 
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Just curious . . . anyone have any articles or book citations that might talk about this? I am still having trouble with this idea that by manually stimulating ones nipples that a situation could be created in which the body on its own is contracting to an unnatural or artificial degree. Wouldn't there be some kind of fail safe switch? Haven't women been doing this for centuries to start labor? I thought this was a relatively standard method of natural or alternative induction.

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#17 of 40 Old 07-13-2009, 08:11 AM
 
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The thing is, about whether or not doing something 'natural' like nipple stim, could actually cause the body to hurt itself: we are not talking about utilizing nipple stim in a natural way at all. Using a breast pump at all; even using hands/mouth to stimulate the nipples continuously for more than several minutes at a time, is not so natural. Nursing, even tandem nursing, is natural of course, but then most nursing sessions with tots don't last the 90 min breast pump session that Nashvillemw described, for instance. I tried to induce myself with manual nipple stim once, but just wouldn't stick with it because my mw wanted me to do continuous and VERY strong stim--really uncomfortable for my nipples!



I'm undecided, myself. As a mw I'd probably take it on a case by case basis, carefully. I also would not believe a word from that doc, who sounds both ignorant and willing to say anything to get what s/he wants. Ignorance is ok if you own it and are willing to be taught; parading ignorance as a 'safety' or 'time' concern is to me both lying, and an inappropriate use of authority.

Nashvillemw's doc might be onto something; she at least believes he has actually studied the topic and speaks from informed belief. There just aren't many docs like this though, when it comes to non-medical/natural measures.

I also wonder why a 35 wk induction is needed, and unless babies or mom seem to be in trouble I'd encourage mom to try to keep them in another few weeks if possible. If this means working on her b/p or whatever, seems to me that is the safer place to start than making the assumption that at 35wks they are definitely cooked enough to be 'better off' on the outside/in the hospital than they are in utero right now.
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#18 of 40 Old 07-13-2009, 09:31 AM
 
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OMama,
You're a fellow BFW mentor, right? Maybe you could work with the couple on trying to figure out what the doc's positive intentions are. Tie it in with doing some work on communicating with their care provider. Their doc might be getting impatient, yes. But what is the reason behind this impatience? What is the reason behind her fear of nipple stim? Maybe she had a bad experience with it and she doesn't want the same thing to happen to another patient? IDK. Anyway, if you could approach it like this with your clients, then maybe they could approach their doc with a very honest conversation. Something along the lines of:
"Talk to us a little more about the reason to induce at 35 weeks? GD is under control, the babes are small, but growing at their own curve, sometimes my BP is a little off (but nothing major).... is there a medical reason that we shouldn't wait a little bit?" see what the doc says. If induction really is medically necessary then have a question about the type of induction. The parents can raise their own concerns with pit (if they have them) and ask more specifically about the doctor's experience with nipple stim. "We are a little concerned about a pitocin induction because we know that there is a risk of the contractions being too strong and causing the babes to go into distress. We would also really like to have an unmedicated labor because we feel that that is safest for the babies and we know that often times a pitocin induction leads to narcotics or an epidural. So if induction really is necessary, we would like to try more natural methods. We know that you recommended against nipple stim. Can you talk to us a little more about that? It seems to really make you nervous. What has your professional experience with nipple stim been?
Then see what doc says and go from there. Maybe if your clients could validate and listen to where the OB is coming from (remember, they don't have to agree), then maybe the OB would be a little more relaxed about how she is approaching your clients? IDK, maybe not... but it might be worth a shot. I mean, if your clients can listen to the doc "from the belly" maybe they would be able to see past the fear mongering to what the doc is really trying to say and that might give you some insight on how to approach the situation???? But then, I've a very new birth professional, and this might not work or be the best approach at all... it's just a thought.

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#19 of 40 Old 07-13-2009, 11:04 AM
 
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I will look for documentation about the effects of nipple stimulation. I believe at least some of the evidence stems from the days of using nipple stimulation to produce contractions for stress tests.

I personally did 90 minute sessions because I researched it and that's what I found to be an effective protocol according to the literature. I believe it was 90 minutes, three times a day. I think I did three sessions, then contractions started immediately when I started a fourth session so I stopped.
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#20 of 40 Old 07-13-2009, 01:37 PM
 
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I do think this might (in general) be a control thing. Doctors are trained to want to be in control of what is happening in the pt's body - generally, I'm all for this! If someone is doing surgery on my, I darned well want him/her to be in as much control of what is happening as possible.

Problem is, I don't believe this always works so well in birth, which is not a disease or injury process, but a health process which may sometimes be affected by disease or injury.

It makes sense from a doctor perspective to prefer pit, which is (theoretically) controllable, to any form of nipple stim which produces natural oxytocin, which is (theoretically) not in the doctor's control.

However, from my perspective, it seems really unlikely that most women's bodies, stimulated to produce oxytocin, will do so to a harmful extent. Besides, doesn't using pit often stimulate the body's own production of oxytocin anyway?

I wouldn't accept the argument this doctor is making for myself. And I'm a very direct person - if it were my doctor, she'd hear what I thought about it up front in all likelyhood. But I think that if I were working with the OP's clients, I'd try to come at it from the kind of perspective ShannieSue is suggesting (I'm a BFW mentor, too!)

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#21 of 40 Old 07-13-2009, 02:09 PM
 
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Just to throw out some alternatives - if the doc. is really wanting to induce, you can also suggest acupuncture and/or acupressure as alternatives to nipple stimulation. Maybe those would be more palatable/less threatening, and it's been my experience (both personal and observational) that these are not induction methods that achieve "0-60 in 5 seconds" type results, but if your body is ready, they can certainly help things along in the right direction.

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#22 of 40 Old 07-13-2009, 07:32 PM - Thread Starter
 
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Thanks again all!

I am definitely trying to have my BFW beliefs guide me in working with these parents too. Much of what has been suggested is how I have interacted with this couple so far and suggested they interact with their doctor too. I am totally trying to check myself as well for certain "triggers" which are related in part to having seen this doctor speak at a conference and the fact that this doctor has also told this couple that it is safer for her (the mom) to have an epidural and that she could be putting her babies at risk if she doesn't. There are definitely a lot of things going on here.

Then, there is this other part about simply wanting to learn more about how truly useful and/or dangerous nipple stimulation may be, whether or not it applies to this couple. In fact, as far as this couple is concerned I think there isn't much more to decide or even share with them on this. Anyway, I just kind of want to know in regards to expanding my own knowledge about birth.

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#23 of 40 Old 07-13-2009, 07:54 PM
 
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Originally Posted by mwherbs View Post
term for most twins is considered to be 38 weeks
A little OT, but why would a twin necessarily mature faster than a singleton? I mean, I know many twin moms deliver earlier, but I had always heard that this was frequently due to other factors, such as inadequate nutrition or complications.

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#24 of 40 Old 07-13-2009, 08:04 PM
 
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I don't know that they necessarily do mature faster, but statistically outcomes for twins are better when they are delivered around 37-38 weeks.
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#25 of 40 Old 07-13-2009, 08:25 PM
 
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Serendipity? I was going through a stack of papers and found this!

From Obstetrics and Gynecology, October 1984
Characteristics of uterine activity during the breast stimulation stress test

Quote:
Characteristics of uterine activity produced by nipple stimulation were studied in 185 consecutive breast stimulation stress tests. Adequate contractions were produced in 95.6% of tests. Exaggerated uterine response (contractions occurring more than once every two minutes or lasting more than 90 seconds) was present in 45.5% of the patients. Twenty-one percent of the patients with such uterine activity also had a fetal heart rate (FHR) deceleration (hyperstimulation breast stimulation stress test), without adverse fetal outcome. The time in minutes from start of nipple stimulation to the first contraction (stimulation contraction interval) was recorded for each patient. Significant difference was not observed in the stimulation contraction interval distribution between the groups with and without exaggerated uterine activity. The authors conclude that there is a relatively high incidence of exaggerated uterine activity response to the breast stimulation stress test and that close surveillance of mother and fetus is warranted during antepartum nipple stimulation.
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#26 of 40 Old 07-13-2009, 10:53 PM
 
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That sounds crazy to me!

Why is it that I've never seen this happen, nipple stim being standard protocol for PROM where I trained?

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#27 of 40 Old 07-13-2009, 11:47 PM
 
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Originally Posted by nashvillemidwife View Post
Serendipity? I was going through a stack of papers and found this!

From Obstetrics and Gynecology, October 1984
Characteristics of uterine activity during the breast stimulation stress test
Just to clarify...so 21% of the 45.5% that experienced exagerrated uterine contractions also had fetal heart rate decels, without adverse outcome. 185 women were tested... 45.5% would be 84.175 women. 21% of that is 17.67 women with FHR decels... that is 9.5% of women in the study had exagerrated uterine contractions AND FHR decels. I think that 9.5% is considerable enough to warrant a little extra monitoring... but if I'm reading it correctly, using the 21% number makes it sound more extreme than it is... of course maybe I'm not reading it correctly?

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#28 of 40 Old 07-14-2009, 08:03 AM
 
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With pitocin you start slow with a controlled dose and can turn it off if contractions are too strong. You cannot control the release of natural oxytocin; you can turn the pump off which may or may not stop the contractions.
Well, in that case we better make sure to begin EVERY woman's labor with synthetic oxytocin, because heaven only knows what will happen if we allow her own natural hormones to get going....my goodness, ANYthing could happen! And we wouldn't be able to turn it off!

Edited to add: sorry, I didn't realize we were discussing this seriously. It sounds like the study did not clarify how nipple stim was done (was it natural or pump induced? was it stopped once contractions were started? was it stopped once exaggerated contractions were noticed?) and also it says that even the ones with exaggerated contractions and decels - even then there were no adverse outcomes. Or maybe I'm reading that wrong?
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#29 of 40 Old 07-14-2009, 09:03 AM
 
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I wonder how they define adverse outcomes in that study. Like I'm wondering if those women who had FHR decels had cesareans and the babies were fine after the birth? Or does it mean there were decel that they monitored closely and the women birthed vaginally?

mommy to Christopher 2/29/08
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#30 of 40 Old 07-14-2009, 10:23 AM
 
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The women weren't in labor. The results were garnered from contraction stress tests; they induced contractions using a breast pump them put them on the monitor to see how the baby responded to the contractions.
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