Technology in perinatal care
Birth Trauma Has Lasting Psycological
Effects
Although alomst addressing trauma to the nervous system when looking at birth
trauma, there is growing evidence that the traumas of birth have lasting psycological
effects.
"Although controversy can still be generated, especially among persons who are
not acquainted with contemporary findings, we should not proceed arrogantly with
the routine traumatization of our infants at birth! Fortunately, an increasing
number of therapists are being privately trained to recognize and work to resolve
prenatal/perinatal trauma, but there could never be enough of them to do the
work that is piling up. It would take an army of therapists to keep up with endless
production line of trauma at birth! Their work could be--and should be--eliminated
with the prevention of unnecessary traumas of contemporary obstetrics. But there
is no end in sight at this time."
David B. Chamberlain, Ph.D. Birth
Trauma is Real! Birth Psychology
The Due Date Dilemma
A recent report in the OB/Gyn Journal Dec. 2001 states that eliminating the
concept of a due date, "may be helpful to all involved."
The process of calculating due dates may be flawed as not all women ovulate
14 days from the onset of their menstruation. Additionally, other health factors
of the mother play a role in delivery time. In reality, only 5% of all babies
are born "on schedule", anyway.
Because of the due date women feel pressured, become anxious and are led into
inductions by their practitioners. Inductions usually lead to further interventions
in birth. Interventions in birth frequently lead to trauma for both the mother
and baby.
Dr. Vern Katz suggests that doctors expand the concept of a due date to a "due
week." In doing so, "it may allow biology to take its course a bit more."
Katz VL, Farmer R, Tufariello J, Carpenter M Why
we should eliminate the due date: a truth in jest Obstet
Gynecol 2001 (Dec); 98 (6): 1127-1129
Incontinence Due to Forceps and Vacuum Extraction
Births:
The relative risk of new mothers developing persistent urinary incontinence
was 2.8 at one year following forceps delivery and 0.8 following vacuum delivery,
compared with the risk of incontinence following spontaneous delivery, according
to a study of 315 women. Of the group, 150 had spontaneous delivery, 90 had
forceps assistance, and 75 had vacuum extraction. The rate of incontinence
at two weeks postpartum was 13.3% in the vaginal delivery and vacuum extraction
groups and 12.2% in the forceps group. The rate at three months postpartum
was 6.8% and 6.7% in the vaginal and vacuum groups, respectively, and 12.5%
in the forceps group. The trend continued for one year postpartum, with 3.7%
in the spontaneous vaginal group and 2.8% in the vacuum group, compared with
9.8% in the forceps group.
- OB/GYN News, April 15, 2001
Is More Neonatal Intensive Care Always Better?
Compared with the other 3 countries, the United States has more neonatal intensive
care resources yet provides proportionately less support for preconception
and prenatal care. Low birth weight rates were notably higher in the United
States, partially explaining the high crude mortality rates.
The United States has significantly greater neonatal intensive care resources
per capita, compared with 3 other developed countries, without having consistently
better birth weight-specific mortality. Despite low birth weight rates that
exceed other countries, the United States has proportionately more providers
per low birth weight infant, but offers less extensive preconception and prenatal
services. This study questions the effectiveness of the current distribution
of US reproductive care resources and its emphasis on neonatal intensive care
Thompson LA, Goodman DC, Little GA Is
More Neonatal Intensive Care Always Better? Insights From a Cross-National
Comparison of Reproductive Care Pediatrics 2002 (Jun); 109
(6): 1036-1043
High level of resources for neonatal intensive care does not give
US better outcomes
The United States has more neonatologists and neonatal intensive care beds
per person than the United Kingdom, Canada, or Australia but higher rates of
low birth weight and death among neonates,
The study compared neonatal intensive care resources, preconception care and
prenatal care, rates of low birth weight and neonatal deaths (deaths within
the first month), and infant mortality (deaths within the first year).
Janice Hopkins Tanne High
level of resources for neonatal intensive care does not give US better outcomes Brit
Med Jou 2002 (Jun 8); 324 (7350): 1353
Should obstetricians see women with normal pregnancies?
A multicentre randomised controlled trial of routine antenatal care by general
practitioners and midwives in Scotland compared with shared care led by obstetricians.
The results concluded with these findings: Routine obstetric visits for women
initially at low risk of pregnancy complications offer little or no clinical
or consumer benefit.
Care by general practitioners and midwives improved continuity of care: there
were fewer carers, non-attendances, and hospital admissions, and marginally
fewer routine visits than with specialist led shared care; incidences of hypertension,
proteinuria, pre-eclampsia, and induction of labour were also lower.
Should
obstetricians see women with normal pregnancies? A multicentre randomised
controlled trial of routine antenatal care by general practitioners and midwives
compared with shared care led by obstetricians Brit Med
Jou 1996 (Mar 2); 312: 554-559