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Episiotomy is Obsolete: All Perineal Damage At Vaginal Birth Is Preventable


Episiotomy is Obsolete: All Perineal damage at vaginal birth is preventable with motivated mother and practitioner

Episiotomy confers no benefits. The most effective way to prevent perineal damage is to avoid episiotomy. Episiotomy, albeit rarely, has resulted in the death of the woman from necrotizing fasciitis.

Episiotomy increases all the bad outcomes it was supposed to prevent. In a 1983 review of episiotomy during the years 1860-1980, this review found that episiotomy has no benefits and causes more 3rd and 4th degree tears, more short and long term fecal incontinence, more bleeding, more pain, and more short and long term sexual discomfort than not cutting an episiotomy. (1)

Should A Woman Having Twins Have A Home Birth Or Hospital Birth?


Should A Woman Having Twins Have A Home Birth Or Hospital Birth?

Why Homebirth is 1,000 Times Safer Than Hospital Birth for Low Risk US Women

Why Homebirth is 1,000 Times Safer Than Hospital Birth for Low Risk US Women

Why Homebirth is 1,000 Times Safer Than Hospital Birth for Low Risk US Women

Oft quoted research studies state 3X to 10X more babies die in the first week after low risk homebirth than hospital birth.  In order for low risk homebirth to have higher perinatal mortality rates there would have to be a theory to explain this. There would have to be one or more complications of low risk homebirths that result in death in the first week that can be prevented by being in hospital, and death from these complications would have to occur more often than low risk deaths at planned hospital births.        

Am Journal of ObGYN's Anti-Homebirth Campaign Sacrifices Lives of 100 US Women Per Year

Am Journal of ObGYN's Anti-Homebirth Campaign Sacrifices Lives of 100 US Women Per Year

Dr. Amos Grunebaum, ObGyn at Cornell Medical Center New York publishes an article in American Journal of Obstetrics and Gynecology which will indirectly kill 100 U.S. birthing mothers per year.

Re: Grunebaum A, McCullough LB, Sapra KJ, et al. Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol 2013;209:  

The Evidence For and Against Birth Induction

The Evidence For and Against Birth Induction
When is the fetus better off outside the mother's uterus, and if so, how should that be brought about?

Abstract: Smith (2003) found unexplained stillbirth occurs once in 2000 births (0.5/1000) after 34 weeks among low risk second pregnancies, following a first vaginal birth in the absence of induction for postdates.  If induction for postdates could prevent stillbirth by expediting the deliver, one would expect to save 0.5/1000.   Four systematic reviews performing meta-analysis of the data regarding the effect of induction for postdates draw three different conclusions.  Cochrane (2012) concludes that inducing at 41 weeks can prevent 1 stillbirth/perinatal death for every 410 inductions or 2.5/1000 perinatal deaths, a number exceeding the rate of unexplained stillbirth at term without induction. Hussain (2011) looking at inductions after 41 weeks concludes that performing  inductions at 41 weeks does not prevent stillbirth but does prevent 1 perinatal death in the first week of life for every 650 inductions (1.5/1000) performed. None of the studies look at mortality after 7 days. Therefore it is not known whether those 'saved' babies die after the one week mark.  Wennerholm (2009) and Sanchez-Ramos (2003) look at the same data for inductions after 41 weeks and found no evidence supporting induction for postdates, stating, that induction for postdates is not supportable from a scientific point of view.   There is limited and inconsistent data suggesting that induction might improve outcomes in the cases of: Postdates, Oligohydramnios, Suspected worsening of fetal anomaly at 34-39 weeks, Fetal Demise, Multiple gestation with fetal death, Poorly controlled diabetes, Hypertension at 38-39 weeks, Maternal Chronic Pulmonary disease, Maternal Chronic Renal disease, Intrahepatic cholestasis of pregnancy, Mild (after 37 weeks) or Severe (after 34 weeks) preeclampsia,  Isoimmunization, and Premature rupture of membranes-  after 34 week. There is a complete lack of research evidence suggesting that induction improves outcomes in the case of: History of unexplained stillbirth after 39 weeks, logistical such as distance from hospital or risk of precipitous labor, Antiphospholipid antibody, severe growth restriction or chorioamnionitis. Consistent reliable evidence is lacking for all justifications for induction.

What is Doppler Velocimetry?

What is Doppler Velocimetry?

   Although unexplained intrauterine growth retardation is related to smoking, drugs and alcohol, missing nutrients or micronutrients and/or stress, that is not where obstetrics looks to improve outcomes.  Instead of refusing care to heavy smokers or using frequent visits to enforce life style changes in nutrition and exercise, the protocol is to do Doppler velocimetry to measure the velocity of fetal blood flow for pregnancies at high risk of suspected intrauterine growth restriction (IUGR).

  In 1995 Alfirevic called Doppler velocimetry 'promising'.( Alfirevic 1995) But after it had been studied on 10,225 at risk pregnancies, the 2010 review by Alfirevic found the effectiveness of Doppler velocimetry questionable due to the poor quality of the studies and publication bias. (Alfirevic et al. 2010)  Only small retrospective studies of extremely low birth weigh babies reflect a possible benefit of Doppler studies. (Chalubinski 2012)   

  IUGR is said to be the result of an undefined term called: placental insufficiency. This appears to be an undefined catch all phrase for lacking an explanation for stillbirths.  Placentas might always be sufficient.

Why The Fuss Over Homebirth?

Why The Fuss Over Homebirth?

How To Eliminate Postpartum Hemorrhage

How To Eliminate Postpartum Hemorrhage

It's hard to compete with 20 billion years of evolutionary selection, but the current medical management of the birth of the fetus and the placenta attempts to do just that, albeit rather unsuccessfully.   For eons, all animals including humans passed on genes and habits that ensured delivering a live healthy newborn without bleeding excessively or dying of postpartum hemorrhage at birth.  Among mammals, bleeding to death would not result in successful reproduction, until recently, because a live mother was required to nurse the newborn. 

Bleeding heavily makes a mother more prone to dying of infection.   Bleeding would attract predators near the newborn. No animal or mammal, other than humans, bleeds more than a spoonful postpartum. (1)  Only humans bleed and only humans bleed excessively after birth.   It is not clear when this started, but the first documentation of excessive postpartum bleeding, not death from bleeding, is from 1400 stating, "Women sometimes bleed too much after childbirth and this makes them very weak."(2)

UnneCesareans: Documented Causes of a Disturbing Trend

UnneCesareans: Documented Causes of a Disturbing Trend

Abstract: A recently coined term, unneCesareans, describes the mode of delivery for 25% of low-risk first births in most Western countries. Evaluation of Cesarean Delivery, published by the American College of Obstetricians and Gynecologists (ACOG) showed a lack of evidence of improved medical outcomes with the widespread use of cesareans for low-risk, full-term first births, therefore, they are medically "unnecessary". Eighteen causes for this common practice have been documented in published research. Since UnneCesareans have multiple causes, a reverse in current trends is unlikely.

When I tell people that I am a homebirth midwife, they often respond by asking, "Why do women choose to give birth at home?" It would be wonderful if the answer would be that hospital outcomes are comparable to attended homebirths and homebirth is just more comfortable. But since US hospitals delivered 32% of low-risk women by cesarean surgery since 2007 and 1 in every 3000 of those died from the surgery, the answer is simple: to avoid dying in childbirth or being scarred for life by unnecessary surgery.

Then, the second question the listener naturally asks is, "Why do doctors do unnecessary surgery?" Many doctors and midwives are also concerned with this question and have researched it extensively. The following is a review of the recent research, most of it published since 2006, regarding the causes of unneCesareans.

Breaking Water Balloons and Amniotic Sacs

Breaking Water Balloons and Amniotic Sacs

How often does Amniotomy cause Cord Prolapse after 36 weeks?

Judy Slome Cohain, CNM

Abstract

Of the 33 English-language studies evaluating risk factors for cord prolapse, close to 80% evaluate every possible factor other than artificial rupturing of the membranes (amniotomy).  Of the 7 studies which evaluate amniotomy, 2 observational studies concluded amniotomy can cause cord prolapse, while 5 case controlled studies conclude amniotomy does not cause cord prolapse on the basis that amniotomy does not always cause cord prolapse, which is invalid logic.  Not looking before you cross the street also does not always result in being run over.  Intercourse with a woman with AIDS does not always result in contracting AIDS, but to conclude that AIDS is not transmitted by sexual intercourse is incorrect.  A comparison of amniotomy rates to cord prolapse rates at full term births found cord prolapse to increase with increasing amniotomy rates near term. Cord prolapse did not occur among 6000 attended full term labors when no vaginal exams or amniotomy were performed.

Cord prolapse, a cause of permanent disability and death, can be caused by amniotomy at or near term. To achieve optimal neonatal outcomes, the amniotic sac should not be ruptured artificially to speed up labor or induce labor.

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