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#61 of 229 Old 04-12-2012, 05:11 PM
 
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I was talking about fundal massage, not cord traction. I agree that there may be times when cord traction is indicated. The point is having the knowledge to know when that is. It is not unusual for a placenta to come spontaneously within a normal window of time! 

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#62 of 229 Old 04-12-2012, 05:17 PM
 
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I'm not being snarky here, are you saying that gentle cord traction should be used if the placenta isn't out in X time?  Or are you saying that every single birth should follow with gentle cord traction?



It's my philosophy that every single birth should follow with gentle cord traction. I follow the WHO guidelines on active management of the third stage. I catch baby. Baby immediately goes to mom. Cord pulses. Cord pulsations slow or cease. Clamp, clamp, cut. Gentle cord traction with brandt-andrews. Deliver placenta. Pit running in IV (or injected IM if woman does not have IV). Fundal massage. Assess for bleeding. If uterus is not firm after delivery of placenta with fundal massage, follow with sweep of lower uterine segment to evacuate any remaining clots and consider other uterotonics such as cytotec, methergine or hemabate.


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#63 of 229 Old 04-12-2012, 05:25 PM
 
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Yep, she is saying *every* single birth that takes place no matter what the circumstances absolutely *must* have a medically managed, active third stage complete with drugs, traction, and massage. No room at all for treating each birth individually and waiting to see how mom handles third stage on her own. 

 

Thankfully, this attitude does not yet seem to have spread completly through the medical community.

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#64 of 229 Old 04-12-2012, 05:45 PM
 
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Google 'who active management of third stage of labour' and you should get a bulletin from them with details on their study...

 

7 countries, none of them western, and various methods of 'management' are reported, including multiple different drugs. Scroll down to the discussion section where you will find this gem... 'Poetentially harmful practices which can increase postpartm hemorage or other 3rd stage complications are observed in up to 94% of deliveries.'

 

They also state that their study suggests that there is a lack of sufficient watch over the women when it is needed most.

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#65 of 229 Old 04-12-2012, 06:25 PM
 
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Yep, she is saying *every* single birth that takes place no matter what the circumstances absolutely *must* have a medically managed, active third stage complete with drugs, traction, and massage. No room at all for treating each birth individually and waiting to see how mom handles third stage on her own. 

 

Thankfully, this attitude does not yet seem to have spread completly through the medical community.



Should it be considered "medically managed" if the ACNM and the International Confederation of Midwives endorse it?


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#66 of 229 Old 04-12-2012, 06:44 PM
 
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Huh??? Why would it matter who endorses it. Giving a woman medication to manage her birth makes it medically managed. Your aren't seriously suggesting that it isn't???

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#67 of 229 Old 04-12-2012, 06:50 PM
 
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What I am saying is that it's within the midwifery model of care as the ACNM and the ICM endorse the practice.


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#68 of 229 Old 04-12-2012, 06:59 PM
 
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Originally Posted by fruitfulmomma View Post

Google 'who active management of third stage of labour' and you should get a bulletin from them with details on their study...

 

7 countries, none of them western, and various methods of 'management' are reported, including multiple different drugs. Scroll down to the discussion section where you will find this gem... 'Poetentially harmful practices which can increase postpartm hemorage or other 3rd stage complications are observed in up to 94% of deliveries.'

 

They also state that their study suggests that there is a lack of sufficient watch over the women when it is needed most.


http://www.sciencedirect.com/science/article/pii/S0140673697094099 :done in the UK

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1991.tb10364.x/full done in the Netherlands, and it's a randomized, double blinded, placebo controlled study

http://ukpmc.ac.uk/abstract/MED/22071837 A 2011 Cochrane review. 6 of the 7 studies they used were in "high income" countries

 

I'm sure I could keep going. Use google scholar. It's not a small body of research supporting these recommendations.

 

The evidence is pretty clear that using a uteronic (IM or IV pitocin is the recommended one to start with; methergine and cytotec are associated with more side effects like vomiting and lowgrade fever), quick delivery of the placenta, and fundal massage following the placenta done on everyone, even low risk women, significantly reduces the rate of PPH. Immediate clamping of the cord does not seem to be terribly important- for example it was not part of the Netherlands study protocol and their results were consistent with the others. 

 


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#69 of 229 Old 04-12-2012, 07:00 PM
 
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And??? That does not change the fact that it is medical management. If some midwife group started endorsing inductions at 40 weeks for all women that won't change induction from medical management to natural birth.

 

For those of you who have made it through this far and are interested in choices this looks like a good site... www.thirdstageoflabour.org.

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#70 of 229 Old 04-12-2012, 07:09 PM
 
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http://www.sciencedirect.com/science/article/pii/S0140673697094099 :done in the UK

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1991.tb10364.x/full done in the Netherlands, and it's a randomized, double blinded, placebo controlled study

http://ukpmc.ac.uk/abstract/MED/22071837 A 2011 Cochrane review. 6 of the 7 studies they used were in "high income" countries

 

I've only had chance to look at one, ttp://ukpmc.ac.uk/abstract/MED/22071837/reload=0;jsessionid=79lEXsgjeLs7bSbrzT11.4, but this already jumped at me.

Quote:
CONCLUSIONS: Although there is a lack of high quality evidence, active management of the third stage reduced the risk of haemorrhage greater than 1000 mL at the time of birth in a population of women at mixed risk of excessive bleeding, but adverse effects were identified. Women should be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management.

 

ETA: the one in the Netherlands -

Quote:
To compare the effect on post partum bloodloss of the postpartum prophylactic administration of oxytocin or sulprostone in low risk women having an expectant management of the third stage

 = (no cord traction)

 

....and the first link:

 

Quote:

Interpretation

Active management of the third stage reduces the risk of PPH, whatever the woman's posture, even when midwives are familiar with both approaches. We recommend that clinical guidelines in hospital settings advocate active management (with oxytocin alone). However, decisions about individual care should take into account the weights placed by pregnant women and their caregivers on blood loss compared with an intervention-free third stage.

 

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#71 of 229 Old 04-12-2012, 07:16 PM
 
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Even this http://www.ncbi.nlm.nih.gov/pubmed/10908457 which seems to support active management...

 

 

Active versus expectant management in the third stage of labour.

 

Quote:
Routine 'active management' is superior to 'expectant management' in terms of blood loss, post partum haemorrhage and other serious complications of the third stage of labour. Active management is, however, associated with an increased risk of unpleasant side effects (eg nausea and vomiting), and hypertension, where ergometrine is used. Active management should be the routine management of choice for women expecting to deliver a baby by vaginal delivery in a maternity hospital. The implications are less clear for other settings including domiciliary practice (in developing and industrialised countries).

 

Most of these studies are dealing with hospital births, and I didn't read the specifics of how most of those births went down, if they were provided in the abstracts, I did not see...

 

.... and most still advocate for giving the birthing woman informed decision making and personalized care!!!

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#72 of 229 Old 04-12-2012, 07:29 PM
 
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Originally Posted by slmommy View Post

Even this http://www.ncbi.nlm.nih.gov/pubmed/10908457 which seems to support active management...

 

 

Active versus expectant management in the third stage of labour.

 

 

Most of these studies are dealing with hospital births, and I didn't read the specifics of how most of those births went down, if they were provided in the abstracts, I did not see...

.... and most still advocate for giving the birthing woman informed decision making and personalized care!!!

Well, DUH, they advocate for informed decision making and personalized care. If it's more important to you to have a pristine all-natural 3rd stage than to avoid a hemorrhage, then by all means refuse active management! That's your right. But don't lie to yourself about what the research is telling you. You're missing the forest for the trees. Maybe if you tried digging past the abstracts, you'd learn more.
 

ETA: Placebo controlled studies are going to be nearly impossible to do on this topic now because it wouldn't be ethical to not give a morbidity-decreasing treatment. There are several but most of them were done in the '80s and '90s.

 


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#73 of 229 Old 04-12-2012, 07:37 PM
 
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And I repeat that UCers should not run out and get pit and prepare to give themselves injections and mess with the birth of the placenta. That would be crazy.


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#74 of 229 Old 04-12-2012, 07:42 PM
 
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And I repeat that UCers should not run out and get pit and prepare to give themselves injections and mess with the birth of the placenta. That would be crazy.


I totally agree, as a ucer. 

 

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#75 of 229 Old 04-12-2012, 07:50 PM
 
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Well, DUH, they advocate for informed decision making and personalized care. If it's more important to you to have a pristine all-natural 3rd stage than to avoid a hemorrhage, then by all means refuse active management! That's your right. But don't lie to yourself about what the research is telling you. You're missing the forest for the trees. Maybe if you tried digging past the abstracts, you'd learn more.
 

Do you wanna foot the bill for purchasing the whole article for me to be able to read past the abstracts?

 

I suppose I did have a "pristine all-natural 3rd stage" AND avoided hemorrhage. Must be one in a million, as apparently all women are incapable of decision making and unworthy of personalized care with fundamentally flawed uteri which will always kill them. oh yeah, and as Holly suggested, as a ucer, I am liable to be stupid enough to try ripping my own placenta out or attempting my own manual extraction... all while she stated before that a ucer would be incapable of fundal massage...

 

The research you cited is telling me nothing... I never intend on having a hospital or medicalized birth, so most of the research is not relevant. One of the ones you posted is totally irrelevant as it involved expectant management and pit, not expectant vs. active management. Did you read past the abstracts? Or even the abstracts?

And, I didn't see 100% pph rates for the expectant management women in the other studies... (... and if a hb or uc turned transfer, yes, my expectations would change, well heck, I'm pretty sure I would just be c/s walking through the door in a country with 90% c/s rate for all women with private insurance). 

 

I'm not against fundal massage, pit, helping placenta, WHEN actually necessary, I am against it, for myself, when not indicated, JUST because some paper somewhere says there may be a percental difference in situations that do not apply to me, maybe, sometimes, kinda, and causes other issues too.

 

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Here's the thing: there are risk factors and then there's the luck of the draw. Being low risk does not mean it can't happen to you. Being high risk does not mean it must happen to you. For what it's worth, I'm not a fan of immediate cord clamping or routine cord traction. A large, multi center study just came out in the Lancet in March showing no difference in rates of PPH between women who had active management with or without cord traction, and the "with" group had a case of uterine inversion. But a skilled provider, a shot of pit, and fundal massage after the placenta... it's good sense. You know what gets in the way of loving up a new baby? Recovering from major blood loss. It sucks. I know, personally.


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They did not do this to me. I had 2 c-sections due to breech babies and abruption. My first c-section I was very bruised all over my abdomen for some reason. I had some minor complications and an incredibly rough recovery. I couldn't move without pain for months. I remember my mom telling me that the nurses pushed on her abdomen after her two still births (6 month old fetuses) and she almost punched them out it was so painful!  

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#78 of 229 Old 04-13-2012, 04:34 AM
 
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I am shocked to be reading any of this.  Frankly, you lost me at Cytotec for all.  Yeah, that's evidence-based...


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#79 of 229 Old 04-13-2012, 04:45 AM
 
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Originally Posted by Katie8681 View Post

Here's the thing: there are risk factors and then there's the luck of the draw. Being low risk does not mean it can't happen to you. Being high risk does not mean it must happen to you. 


Thanks I realize this. As someone who had a uc birth, I was extremely aware of that fact, since any complication was going to fall onto my shoulders to act = go to hospital. Last I knew, ucers were allowed to receive medical care if transfer... unless some of you would like to suggest decision to uc should disqualify one from ever receiving medical assistance at any point.

 

I am getting so sick of seeing this characterization around here that any woman who has *certain ideas* or wants about her pregnancy/birth (which someone disagrees with - uc/hb/cpm apparently now not active management 3rd stage) is a stupid, selfish, uppity, wanna-be-hippie-birth-goddess who at all times will make terrible choices. Yes, I understand birth does not always go how we want... but as to why unnecessary procedures should be done, or why our medical decisions should be invalid, I'm at a loss. I also don't know why, but I guess accept, that some people want automatic robot healthcare and not a hcp who is going to evaluate and treat you as an individual instead of a statistic. 

 

I'm also sick of this attitude around here that someone is so stupid or selfish for going against "evidence based" whatever, (yes I am speaking in general terms for many subjects as it is not just this thread or board). Who the heck makes all their decisions solely based on "scientific evidence" (possibly biased, corrupted, irrelevant, poorly conducted, etc.) in a vaccum without weighing personal experience, observation, gut feelings, advice and anecdotes of peers, family, friends, professionals, and other forms of information? oh yeah and other "scientific evidence" which states or implies the opposite of said position.

All of the studies you posted Katie, were, as far as I can tell, (you can still purchase the entire article for me if you would like so I can "learn more" as you pointed out I so obviously need to do), not really relevant to my birthing situation or even perhaps comparable as to what my situation reaching 3rd stage would be. Most suggested women still have choice about management of 3rd stage. One was even expectant management with pit and measured blood loss and did not give numbers about pph. Even if I bleed a bit more without a shot of pit, perhaps I am in health condition to do so without having any major issues, and still manage to avoid immediate cord clamping, cord traction, medication and fundal massage - (get more cord blood to my baby, avoid unnecessary additional pain, and possibly decrease risk of uterine inversion per your last lancet ref?) Honestly, I would be an idiot to make my birthing decisions solely based off of that "evidence" you provided.

 

I hope women reading this can see how important it is to find out these issues when choosing a hcp. You are paying them, find a hcp whose philosophy/practice more closely aligns with your own. I'll also state for the record, one more time, if I had retained placenta, major blood loss, pph during UC, guess what, I would've gone to the hospital. 

 

I am going to be without internet for the next few days, so sulkoff.gif probably for the best... this thread is making me censored.gif

 

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I am shocked to be reading any of this.  Frankly, you lost me at Cytotec for all.  Yeah, that's evidence-based...


Apparently WHO finds it fine for 3rd stage management.

 

Quote:

Misoprostol is also used to prevent and treat post-partum hemorrhage, but it has more side effects and is less effective than oxytocin for this purpose.[21] However, it is inexpensive and thermostable (thus does not require refrigeration like oxytocin) making it a cost effective and valuable drug to use in the developing world.[22]

 

But one of Katie's posted studies states:

 

Quote:
We recommend that clinical guidelines in hospital settings advocate active management (with oxytocin alone)However, decisions about individual care should take into account the weights placed by pregnant women and their caregivers on blood loss compared with an intervention-free third stage.

 

But hey, we should all always have cytotec because it is evidence based! even if it is also evidence based to create more problems too! Expecting our hcp to use oxytocin or perhaps monitor us through intervention-free 3rd stage and use their expertise to act should major blood loss/pph arise, would just make us stupid, selfish, ignoring evidence based medicine and asking too much.

 

(and just because cytotec may be a godsend for some woman with pph in a developing nation with crappy living conditions and limited medical resources, does not make me selfish or stupid for trying to avoid cytotec use in my births)

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Eh, at least WHO is honest about why they recommend it right? Never mind that it is not FDA approved for such use nor that the manufacturer has stated very clealry that it should never be used in such a manner, that it was never tested for such purpose but that there are clear risks, and that they have no idea what the long term effect is, but hey it's cheap, so we're totally cool.

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OKay...re: cytotect: I don't know whether to puke in my lap or punch myself in the face. Are you people on heroin? That doesn't even make SENSE...yeah, that's exactly what we need, more mothers taking cytotec. Ahhhhh!!! Where is a pulling your hair out while you smash your face into a brick wall over and over again smiley when you need one?? Same goes for pitocin after every birth...are you people crazy?? That's CRAZYYYYY talk..I mean, REALLY!

 

 

Holly: I was not saying the WHO has anything to gain by tricking mothers. I was merely speaking to the shitty state of research these days.

 

 

As for everything else. Gulp. Well, okay guys..I guess you just see birth in a completely different light than I do. drink.gif Cytotec and cord traction for all, I guess. drink.gif

I think now I've *officially* seen it all on MDC.

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I had a hospital birth with no intervention in the third stage, which surprised me.  The CNM who delivered my older dd used traction on the placenta, and administered pitocin, and I recall quite a bit of fundal massage.  The OB who delivered my younger dd didn't touch the cord until it stopped pulsing, waited for the placenta, and we proceeded without pitocin or fundal massage. 

 

Given a treatment location at a US hospital, I would definitely decline cytotec in favor of pit, but I would only accept either if I was bleeding excessively or if delivery of the placenta was taking an unusually long time.  WHO recommendations are not always the best options to apply in care settings in the developed world.  I can see how cytotec is a great option for active management of the third stage for a midwife who is biking around rural Southeast Asia, but I think the risk/benefit analysis on waiting for the placenta and using pitocin are different in hospitals in the US. 

 

 

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 drink.gif Cytotec and cord traction for all, I guess. drink.gif

I think now I've *officially* seen it all on MDC.



This made me laugh! Especially with the little avatars. Thanks Broody - you brightened my day. 


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#85 of 229 Old 04-13-2012, 04:54 PM
 
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I guess I'm missing where in the thread anyone advocated for "Cytotec for all"? I never said that. I don't think the other poster did either. Cytotec takes longer to work than Pitocin, so Pitocin should always be your first line drug if it's available. I don't give Cytotec unless there is excessive bleeding. You can do 200 sublingual or 800-1000 per rectum. I prefer the 1000 per rectum, which will produce a good amount of cramping but will so a great job at stopping the bleeding. Methergine and hemabate are really third line drugs. They have contraindications that the other drugs don't have and hemabate, especially, can have some nasty side effects (massive uncontrollable diarrhea for hemabate).

 

The issue is that Cytotec is cheap and has very little contraindications/side effects, so in a third world country it's easier to store, carry and administer compared to an IM injection of pitocin. So the WHO says that in those situations it's okay to use Cytotec routinely instead of pitocin. But we have pit readily available here so there's no need to go to Cytotec as your first line. Pit works better anyway.

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OKay...re: cytotect: I don't know whether to puke in my lap or punch myself in the face. Are you people on heroin? That doesn't even make SENSE...yeah, that's exactly what we need, more mothers taking cytotec. Ahhhhh!!! Where is a pulling your hair out while you smash your face into a brick wall over and over again smiley when you need one?? Same goes for pitocin after every birth...are you people crazy?? That's CRAZYYYYY talk..I mean, REALLY!

 

 

Holly: I was not saying the WHO has anything to gain by tricking mothers. I was merely speaking to the shitty state of research these days.

 

 

As for everything else. Gulp. Well, okay guys..I guess you just see birth in a completely different light than I do. drink.gif Cytotec and cord traction for all, I guess. drink.gif

I think now I've *officially* seen it all on MDC.



 


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First of all, I think there are a lot of people who would beg to disagree with your assertion that cytotec has very little side effects. A ton of those people would be women who almost died, women missing a uterus who may or may not have been done having kids and families missing a mother/daughter/sister/aunt. Second, okay...so you prefer pit. You still said you prefer it for every birth.

THAT. IS. CRAZY. drink.gif

I don't care what "evidence" you have to point to...it's just freaking nuts. Every birth absolutely DOES. NOT. NEED the type of "care" you've described and CERTAINLY doesn't need pitocin. Frankly, of the women who do end up benefiting from such an over-"managed" third stage, I can only BEGIN to guess at what percentage of them have had their births completely screwed up (physiologically speaking) from the word go, by drug and intervention happy "care providers" (like you?). Yeah, it stands to reason that an overtaxed, drugged half to death uterus is going to have a hard time performing its function in the third stage. I'm not saying that the only women who ever experience PPH are women who have had intervention heavy births....obviously that's not the case. But in a time when the GIGANTIC majority of women giving birth are doing so with some form of synthetic hormone severely augmenting their "progress" and putting the uterus through a completely atypical birth experience, I have to wonder really hard at the sanity in saying that the fact that so many women "need" such active management in the third stage points to broken birth. I think it speaks more to broken birth management.  You can disagree...in fact I know you do.
But when I look at the numbers around this issue, that's what stands out at me.

 

I can't see where you have posted exactly what kind of birth professional you are...but I'm guessing from some of what you have said that you are some sort of midwife or OB. I've got to be honest, that scares me a little. I'm just imagining a new mom sitting in front of you, asking you questions about how you operate....and having the pants scared off of her as you tell her all about how you are going to pump her full of powerful drugs to save her from the wretched death-in-a-box that is birth. A birth professional with a perspective on the process which makes you feel most comfortable with EVERY mother receiving the care you've described as "optimal" in the third stage makes me shiver...like, with an *actual* cold chill up my spine.

My research, core values and personal experience with birth (both my own two *awesome* out of hospital births and others I've witnessed/attended as a lay person only) have led me to a perspective that is so far away from yours, we may as well be on different planets. So...you know, who am I to say you're wrong. But man, I really REALLY feel like you are wrong on this.

I'm not saying that there is not a potential for death, injury or drama in every birth......but there is also potential for natures perfect work to be done. And really, when left alone...the properly nourished, supported mama really does have a better chance of meeting success than she does danger in birth. I've had two 90 minute births that started with my waters breaking and then thirty hours of absolutely *nothing*, before active labor sprung upon me and got the whole job done in one and a half hours. My mother before me had all four of her babies in the *exact* same way.

A birth worker with your perspective would never have given me those 30 hours my body, apparently, needed. I can only imagine what would have happened to me in your hands. Makes me sick, when I think of the perfection my body displayed during my births, to think that had I been in your care....you would have been telling me that something was wrong, that something was broken...as you pumped me full of some shit and told me "Don't worry, we doctors are gods and can make everything happen just as we think it should" - it's a disgrace, really. It's a mockery.

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#87 of 229 Old 04-13-2012, 06:07 PM
 
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Well, the only way to really know that I'm wrong is by conducting a study on active management of third stage versus expectant management of third stage. Only they already DID that (multiple times), and they determined that active management of third stage led to superior outcomes. The "evidence" that you so abhor is the ONLY way to determining what works and what doesn't. Anecdotes, intuition, etc. they aren't at all quantitative. N=1 is meaningless. You can say to me, "I had an UBA8C and I didn't rupture!" and that does nothing to tell me that UBA8C is safe. You need a sample size with sufficient power. You must have evidence to back up your claims or your claims are nothing. That's the basis of science. And if we're not applying science to our management plans, you just live in a world full of magical thinking. I don't believe in magic. I believe in science.  And Science. Works. If Science is KoolAid, then I drink at the fountain. If science is wrong, I don't want to be right. All hail evidence based practice.

 

Originally Posted by BroodyWoodsgal View Post

First of all, I think there are a lot of people who would beg to disagree with your assertion that cytotec has very little side effects. A ton of those people would be women who almost died, women missing a uterus who may or may not have been done having kids and families missing a mother/daughter/sister/aunt. Second, okay...so you prefer pit. You still said you prefer it for every birth.

THAT. IS. CRAZY. drink.gif

I don't care what "evidence" you have to point to...it's just freaking nuts. Every birth absolutely DOES. NOT. NEED the type of "care" you've described and CERTAINLY doesn't need pitocin. Frankly, of the women who do end up benefiting from such an over-"managed" third stage, I can only BEGIN to guess at what percentage of them have had their births completely screwed up (physiologically speaking) from the word go, by drug and intervention happy "care providers" (like you?). Yeah, it stands to reason that an overtaxed, drugged half to death uterus is going to have a hard time performing its function in the third stage. I'm not saying that the only women who ever experience PPH are women who have had intervention heavy births....obviously that's not the case. But in a time when the GIGANTIC majority of women giving birth are doing so with some form of synthetic hormone severely augmenting their "progress" and putting the uterus through a completely atypical birth experience, I have to wonder really hard at the sanity in saying that the fact that so many women "need" such active management in the third stage points to broken birth. I think it speaks more to broken birth management.  You can disagree...in fact I know you do.
But when I look at the numbers around this issue, that's what stands out at me.

 

I can't see where you have posted exactly what kind of birth professional you are...but I'm guessing from some of what you have said that you are some sort of midwife or OB. I've got to be honest, that scares me a little. I'm just imagining a new mom sitting in front of you, asking you questions about how you operate....and having the pants scared off of her as you tell her all about how you are going to pump her full of powerful drugs to save her from the wretched death-in-a-box that is birth. A birth professional with a perspective on the process which makes you feel most comfortable with EVERY mother receiving the care you've described as "optimal" in the third stage makes me shiver...like, with an *actual* cold chill up my spine.

My research, core values and personal experience with birth (both my own two *awesome* out of hospital births and others I've witnessed/attended as a lay person only) have led me to a perspective that is so far away from yours, we may as well be on different planets. So...you know, who am I to say you're wrong. But man, I really REALLY feel like you are wrong on this.

I'm not saying that there is not a potential for death, injury or drama in every birth......but there is also potential for natures perfect work to be done. And really, when left alone...the properly nourished, supported mama really does have a better chance of meeting success than she does danger in birth. I've had two 90 minute births that started with my waters breaking and then thirty hours of absolutely *nothing*, before active labor sprung upon me and got the whole job done in one and a half hours. My mother before me had all four of her babies in the *exact* same way.

A birth worker with your perspective would never have given me those 30 hours my body, apparently, needed. I can only imagine what would have happened to me in your hands. Makes me sick, when I think of the perfection my body displayed during my births, to think that had I been in your care....you would have been telling me that something was wrong, that something was broken...as you pumped me full of some shit and told me "Don't worry, we doctors are gods and can make everything happen just as we think it should" - it's a disgrace, really. It's a mockery.



 

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#88 of 229 Old 04-13-2012, 06:19 PM
 
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OKay Holly....and I'm telling you, that science can take what "they" call birth and poke it and test it and draw all kinds of conclusions...but the "birth" that science is testing, is not the birth I had in my kitchen...it's not the birth I'm about to have under my trees on my back porch. The research you think is so freaking rad, is based MOSTLY on the experiences of:

1. Malnourished women living in third world scenarios, and

2. Women with physiologically completely atypical births

 

So...okay. Whatever. Cling to that science. Lap it up. I'm not sitting over here "thinking magically" - I'm looking at the science and I'm saying "That science sucks".
 

As for drinking the kool-aide...well, all I can say about that is that I love science too....but you should be sure not to let science become a religion for you.

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#89 of 229 Old 04-13-2012, 09:26 PM
 
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I'd like to point out that the Cochrane review (I looked at
http://summaries.cochrane.org/CD007412/delivering-the-placenta-with-active-expectant-or-mixed-management-in-the-third-stage-of-labour )
does not in fact state that active management leads to superior outcomes. It looks to me that the reason they recommend informed choice is because:

The risk of PPH and anemia was not decreased for low risk women, although it was for the larger group of all women;

Active management led to increased risk for a number of other outcomes, including "maternal diastolic blood pressure, vomiting after birth, after-pains, use of analgesia from birth up to discharge from the labour ward and more women returning to hospital with bleeding".

Where risks are complicated and conflicting it is clear that women should be able to assess them for themselves. If they are at low risk for bleeding and want to avoid the negative effects of active management, then it seems like a reasonable decision. Equally, if they want to stick with mixed management and avoid, say, early cord clamping or other procedures that may be questionable or more problematic, then that would make sense too. Or, of course, if bleeding is a big concern or risk for them they may opt for active management. The point is that not every case, nor every set of risks, is the same.

On a separate note, I would also like to express my concern at the frequent referrals to certain (unspecified) countries as "third world" or "non-western" with the implication that they are war-torn, famine-stricken, and generally terrible and uncivilized. While of course there are plenty of places with dreadful problems for all sorts of reasons, I do not think it is helpful to just write off half the world and lump it together in contrast to our supposed first world paradise. I'm sure I don't need to tell anyone here that there are plenty of women in the USA, for example, who are malnourished and lacking education, resources and access to health care.

It could perhaps be more useful to talk about specific factors that may influence risk factors such as income or education levels, and avoid sweeping statements about how terrible everything is for women in the 'third world". It feels a bit imperialist.
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#90 of 229 Old 04-14-2012, 08:22 AM
 
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Appreciate your thoughts Miranda, just a quick response sine this is getting way off topic but references to women in other countries were not made in a we are better than them sort of way but to point out that you can not take a study from a country where the birthing culture and health infrastructure is vastly different than our own and apply to everyone across the board with no account of the differences whichmay includes things like war, famine, malnourishment, lack of clean water, lack of prenatal care, no access to emergency care, etc... When I stated that the ountries in a study were not western it was because they were places I am not really familiar with in regards to their birth culture, again only only pointing out that cultural differences are indeed relevant when deciding if a study applies to me or not. The same sort of issues would apply if we were to try to take a study done in one very high risk US hospital and apply it equally  to all low-risk home birthing mothers. I am also certain that if you went and studied some hospitals here that you would find many that were practicing in ways that put women at higher risk for pph, though the bulletin I referenced to did not specify what practices they had observed. We have several friends who have or are practicing middwifery in other countries and the problems the women face in birthing, wwhile not the same in every single one, do have at least some of the elements listed above, things I have never encountered and in all likelyhood never will. 

 

To Holly and (was it?) Katie, I appreciate the conversation even if we vastly disagree on the issues. My background is in the homebirthing community as a mother and sincerly your ideas are completely outside the midwifery model of care that I am familiar with. This discussions has gonea little too far and gotten pretty heated so I am bowing out but plan to follow up the issue with some of the women (and men) who I am more familiar with in homebirth and maternity care to get their opinions. I think we all, obs included, agree that whatever practices are done mustb be in the best interest of mom and baby and that reducing pph and maternal mortality is necessary.

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