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Subject:10 birth myths
Time:08:20 am
Putting this up here for a couple of friends of mine who are pregnant for the first time.



10 Childbirth Myths
Tuesday, January 12, 2010 at 9:38am

Childbirth Myths via my doula friends

Myth: Episiotomy is better than tearing.
Actually, tears are usually less severe without episiotomy, and the procedure itself can cause further tearing. Episiotomy--the cutting of perineal tissues during delivery--is not something that most women give a second thought to, at least not until they've given birth for the first time. The perineum is the delicate area between the vagina and the anus. After an episiotomy, even sitting can be painful, and sex can be unbearable. Episiotomy is the most common surgical procedure performed in the US, and, according to Sheila Kitzinger, "It is the only surgery likely to be performed without her consent on the body of a healthy woman in Western society."1 During a typical hospital birth, it's the rare woman who is not cut either "above" (in a C-section) or "below" (an episiotomy). Currently, at least 80 percent of first-time mothers delivering vaginally in the US undergo this painful procedure.2 A research review by the World Health Organization, however, indicates that evidence only supports a 5 to 20 percent episiotomy rate.

Myth: Epidurals have no side effects.
The use of epidurals is so common today that many perinatal professionals are calling the 1990s the age of the epidural epidemic. Maternal Risks include : Hypotension (Drop in blood pressure), Urinary Retention and Postpartum Bladder Dysfunction, Uncontrollable Shivering, Itching of the face, neck and throat, Nausea and Vomiting, Postpartum Backache, Maternal Fever, Spinal Headache, Uneven, incomplete or nonexistent pain relief Feelings of Emotional detachment, Postpartum feelings of regret or loss of autonomy, Inability to move about freely on your own, Loss of perineal sensation and sexual function, Very Serious and rare risks include: Convulsions, Respiratory paralysis, Cardiac arrest, Allergic shock, Nerve injury, Epidural abscess, Maternal death. Labor Side Effects: Prolonged First Stage of Labor, Increase of malpresentation of baby's head, Increased need for Pitocin augmentation, Prolonged Second Stage of Labor, Decrease in the ability to push effectively, Increased likelihood of forceps or vacuum extraction delivery, Increased likelihood of needing an episiotomy, Increase in cesarean section. Baby Side Effects: Fetal distress; abnormal fetal heart rate, Drowsiness at birth; poor sucking reflex, Poor muscle strength and tone in the first hours.

Myth: Laying on your back is the best position for labor and birth.
The choice of labor and birth positions has a huge impact on a mother's comfort level during birth and how quickly and effectively her labour does or doesn't progress. The more options she has, the more prepared she is to handle her birthing experience. Effective positioning can speed labor and reduce discomfort by aligning the baby properly, by reducing area-specific pressure, and by reducing unnecessary muscular effort. The reasons for using these positions have nothing to do with comfort or effectiveness for labor. Rather, they are used solely because they are convenient for doctors. While they allow doctors easiest access, they are detrimental to birthing for many reasons. Foremost among these reasons is that the pelvic outlet is up to 30% smaller when a woman is in these positions. They also restrict a woman from freely moving and put greater pressure on the perineum, all of which can lead to other unnecessary interventions or complications like tearing, episiotomy, forceps delivery, or vacuum extraction. In addition, the risks to the baby increase as well. Poor birth positions can decrease fetal heart rate or cause other types of fetal distress, which may lead to continuous or internal fetal monitoring, increased risk of shoulder dystocia/problems with presentation, or a prolonged pushing phase.

Myth: Women become screaming lunatics yelling at everyone in the room.
Childbirth is not a psychosis where a woman suddenly takes on a new personality. Although in the earlier half of the 20th century women were given labor drugs that made them act very strange indeed, becoming crazy isn't a part of the natural childbirth process. What does happen is a woman uses all her energy to focus on the work she is doing and distraction makes this harder. Women in hard labor will use the least amount of energy to communicate—this may mean body language, grunts or one word commands. Some women use hypnobirthing techniques to stay calm and focused throughout the birthing process.

Myth: A hospital is the only place to give birth.
There are many places to give birth. Home, birth center and hospital. In hospitals OBs and midwives attend births. Midwives also attend births in birth centers and homebirths. Birth centers and homebirths are equally safe as hospital births with a trained qualified midwife. In the Netherlands still today 1/3rd of births take place at home. Interestingly enough the Netherlands has the BEST birth outcomes out of 32 industrialized nations.

Myth: Babies should be born on or before their due date.
Allowing labor to begin naturally is the best way to assure that the baby is ready to be born. Only 5% of babies are actually born on their due date. Due dates are estimates at best. The average first time mom gestates till 41wks and 2 days. It is perfectly normal and safe to allow a pregnancy to gestate till 42wks and even beyond.

Myth: Drugs are the only way to relieve pain.
There are many ways to relieve pain during labor. The easiest one is to remain upright and mobile throughout labor. Laying down increases the pain and makes it more difficult to cope with. The use of water many women find soothing, either in a bath or shower. Massage with essential oils and using other massage “devices”. Using a birth ball is a very helpful aide. Long slow deep breaths to ensure you are getting plenty of oxygen. Many women today fear labor. It is a simple fact. And yet another simple fact is that fear in labor (or anything) will increase your pain. This is called the fear/tension/pain cycle. All this states is that when you are fearful, you tense, when you tense you cause more pain.

Myth: You can not push until you are 10cm.
Doctors, nurses, midwives, doulas and childbirth educators all warn that a swollen cervix will impede labor and increase the chances of tearing the cervix, thus causing hemorrhage. Non-medicated woman will never push so hard against her undilated cervix that it tears, because it will hurt. Pain is a natural deterrent to pushing too hard. However, when done in the correct manner, pushing to help rotate a baby and dilate oneself will actually eliminate a great deal of pain and cut hours off one’s labor and birth. So if you feel the urge to push, listen to your body – it can’t be wrong.

Myth: Once your water breaks you should go to the hospital ASAP!
About 15-20% of labors begin with rupture of membranes followed by contractions. If your water breaks and its brown or green in color and has an odor, you should go to the hospital. Or if you develop a fever after your water has broken without any color or odor you should go to the hospital. However this is rare. Ideally you want to stay home until you are in active labor. This isn't usually a problem since 70% of women with PROM will give birth within 24 hours. In fact, 90% of the women with PROM will have given birth within 48 hours. Only 2-5% will not have given birth after 72 hours. The “24hr rule” is hospital policy, sometimes it is even a mere 12hrs. Their thought is that you will develop a bacterial infection. Bacteria can’t migrate up the vagina unless physically pushed up there, for example by cervical checks. Hospitals are ramped with bacteria; MRSA, Staph and other bacteria. So when you are in a hospital your chance for an infection is much greater, especially if they are doing cervical checks every hour. Once in the hospital after your waters are broken you should limit or refuse vaginal exams.

Myth: You should be induced if your baby is too big.
Unless you've been wearing a corset since puberty...this is not going to happen. Period. The vast majority of the time, these weight estimates are based off of ultrasound very late in pregnancy. After the 1st and second trimesters, ultrasounds are off by up to TWO FULL POUNDS, either way. When ultrasound predicts a big baby, women may be just as likely to have a cesarean when the ultrasound is wrong than when it is right. In yet another study, roughly half the women predicted to have babies with birth weights in the top ten percent had cesareans regardless of whether their babies actually weighed in this range. It is very rare to grow a baby your body can’t birth. 50% of first-time moms that are induced will end up with a c-section. Women have been birthing “big babies” for centuries, women's bodies have not regressed in our birthing abilities.
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amenquohi
Link:(Link)
Time:2010-05-27 03:58 pm (UTC)
I agree with #1 - I ended up with an emergency c-section on the first one and a voluntary C-section on the second, so I skipped the whole episiotomy thing. Two other women in my neighborhood gave birth close to the same times as me, and they were in serious pain, sitting gingerly on their donut pillows, moaning and itching (as the incision healed) and just plain miserable while I was rolling on the floor with my baby, sitting, walking, whatever. My recovery was quick and easy for both, luckily.
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therealocelot
Link:(Link)
Time:2010-05-27 05:04 pm (UTC)
I think it just depends on the person. I had an episiotomy with my first, and while I think it was probably totally unnecessary, with negative effects long-term, and I really resent the doctor for doing it when I'd specifically requested to not have one, my recovery was pretty easy. I took an Advil the night after the birth because the nurses wouldn't accept that I really didn't need anything, and that was all I ever took. And I wouldn't consider my pain tolerance particularly high.
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jenn_unplugged
Link:(Link)
Time:2010-05-28 02:18 am (UTC)
Re: #10: My cousin was induced a week BEFORE her due date, and surprise, surprise, wasn't making progress. At some point they did an ultrasound and said that her baby was estimated to weigh well over 10 pounds, and they suggested a c-section. She was exhausted and freaked out, and she agreed. The baby? Weighed 7 lbs 10 oz. 0_o
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telemicus
Link:(Link)
Time:2010-05-28 04:12 am (UTC)
Yeah, so many stories like this, and the only answer is to educate expectant moms (and empower them with doulas!) because the arrogant, ignorant medicos don't seem to care. The thing is, I cannot seem to get through to my RL pregnant friends with this stuff at all, yet everyone I know online is totally wise and I'm preaching to the converted!
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jamesofengland
Link:(Link)
Time:2010-05-28 09:45 am (UTC)
Are you sure the episiotomy rates are that high? http://www.medscape.com/viewarticle/702541

The logic of the screaming lunatic bit only applies to women for whom a change of personality would be required for screaming lunacy when in pain. This is not a universal quality.

The Netherlands are top out of 32 industrialised countries if you pick the right countries, but the CIA World Factbook lists them as 27th best. That is not to say that the Dutch are bad, just that it must have been an awfully cherrypicked list.

"listen to your body – it can’t be wrong." ...

Where are you getting this from? I can't help but feel that if you wrote a post from scratch, with your own research, it'd be better than this (if a little more venemous towards doctors).
(Reply) (Thread)


therealocelot
Link:(Link)
Time:2010-05-28 04:54 pm (UTC)
Are you sure the episiotomy rates are that high? http://www.medscape.com/viewarticle/702541
I agree. The 60-80% figure is out of date, and makes me question what sources are being used. 60-80% *for first time moms* *delivering vaginally* seems to possibly be accurate for 10-20 years ago, and this corresponds with rates I've seen from other sources. I starred first-time moms and delivering vaginally because, for the 30% overall rate given for 10 years ago, this could well be accurate, given that first-time moms are the most likely to be given episiotomies, and an overall rate would also include in the range of 30% c-sections, who would obviously not be given an episiotomy. (The actual study took parity and presumably delivery method into account, but that data isn't mentioned in the abstract.)

I think the important message about episiotomy, which the myths article fails to address, is that the risk for episiotomy is modifiable. Choose a provider who believes in the current research that says that episiotomy causes more harm than it prevents and has a low episiotomy rate in practice, and your risk of having an episiotomy drops substantially.

The logic of the screaming lunatic bit only applies to women for whom a change of personality would be required for screaming lunacy when in pain. This is not a universal quality.
I imagine this is meant as a joke, but I have yet to see a woman turn into a screaming lunatic who yells at everyone in the room. I'm sure it happens, and there's an amount of selection bias in the births I've seen. But really, moaning and groaning is common, irritability and snappishness is common. Screaming can happen if women get panicky, but that's fear, not lashing out at others.

It makes perfect sense to me that the "screaming lunatic" idea stems from drug use, as well as historical practices such as using restraints on laboring women to prevent movement.

"listen to your body – it can’t be wrong." ...
I agree, badly worded. I probably would have said something more along the lines of "Listen to your body - it will tell you what to do", which doesn't include the absolute negative.

It is true that, in an unmedicated birth where a woman is allowed (and encouraged in) freedom of movement, she will tend to naturally assume the position that is needed at a given time to facilitate delivery. I certainly wouldn't go so far as to say that it's never wrong, or that lack of medication and freedom of movement will always make a birth go right, but it's helpful for women to know that if they have a strong desire to be standing, or swinging their hips around, or lying on a specific side, or any other position they happen to be feeling drawn towards, there's probably a valid physiological reason for that feeling and they should go with it.
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jamesofengland
Link:(Link)
Time:2010-05-28 07:19 pm (UTC)
My sense is that the message that some doctors are OK would weaken the desired theme.

You're absolutely right to pick me up on the inappopriate tone there. This was one of the more reasonable points in the OP, and I was overly broad in my response (although I have second hand knowledge of people being awful, my sense is that they were people who felt that the situation gave permission for awfulness rather than people who had awfulness thrust upon them). I agree that the drugs do seem likely to be a part of the basis for the belief, but suspect that more of it comes from generic misogyny; "Hysteria", as understood by primitives, surely applies more to childbirth than anywhere else.

Again, I'm justly chastised; it's useful information, merely conveyed in a (to my tastes) overly mock hippy manner.
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jamesofengland
Link:(Link)
Time:2010-05-28 11:19 am (UTC)
So the obvious BS of the Netherlands claim made me curious about the actually best countries for this stuff. I'd expected that the data would not support the claim, as they'd not bs if the truth was good for them, but I thought you might appreciate the extend of the depravity of your source. The seven highest rates of infant survival come from countries where home births are essentially non-existant. After that, I stopped searching, but I'd recommend that you keep going through the list if you're still unconvinced about the bogosity of the statistic.
eg. "In Sweden, home births are not an alternative within the official health-care system. Only about one woman in a thousand in Sweden achieves a home birth".
http://linkinghub.elsevier.com/retrieve/pii/S0266613806000180
http://www.thefreelibrary.com/Midwives+in+Iceland--'mothers+of+light'--look+back+at+their+history+...-a0207280431
http://www.expat.or.id/medical/birthsingapore.html
http://www.tokyowithkids.com/discussions/messages/35/830.html?1055986396
http://www.midwiferytoday.com/magazine/issue93.asp
http://hongkong.angloinfo.com/countries/china/hongkong/birth.asp
http://www.geobaby.com/forum/thread129417.html

I should note that this doesn't prove that home births are awful; I suspect that in most places they do better, since I'd imagine there is a huge selection bias. It's a strict ad hominem; the argument put forward is not one that an educated person would use in good faith. It appears that your source is educated and thus one is led to believe that they are bad people, driven to dishonest claims in support of their partisan agenda; I'm guessing a professional organisation that receives financial benefit from these things or a puppet organisation thereof.
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therealocelot
Link:(Link)
Time:2010-05-28 06:30 pm (UTC)
You're linking to the countries with the highest *infant* survival (survival rates during the first year), which is obviously includes, but not directly correlate with, birth outcomes. Nutritional factors, quality and availability pediatric medical care, child abuse rates, car seat laws and other safety issues, rates of abortion due to prenatal diagnosis of fetal problems, and other things like that are also going to be factors. They can also be of questionable usefulness, as the criteria for inclusion varies from country to country. The US appears disproportionately low, for instance, because survival rates of very preterm infants are included, and this is not necessarily the case in other countries.

As far as I can tell, the claim about birth outcomes is still very questionable, and the Netherlands is actually noted for having poor perinatal outcomes compared to other Western European nations.

The other conclusions about the safety of homebirth appear to be valid. http://www.bjog.org/details/news/182410/New_figures_from_the_Netherlands_on_the_safety_of_home_births_.html is the study being referenced, which was a large scale (around 500,000 participants) study of differences in outcomes between planned hospital births and planned midwife-attended homebirths in low-risk populations. No significant difference was found. This does point to the relative safety of homebirth compared to hospital birth in low-risk populations, at least in circumstances similar to the Netherlands, where hospital transfer is a quick and uncomplicated process.
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jamesofengland
Link:(Link)
Time:2010-05-28 07:10 pm (UTC)
I get the impression that we're in agreement on the Netherlands as #1 being absurd/ excessively cherry picked. As I said, I'm on board with the idea of planned home births being safe. I was talking to an MEP who focuses on such things a couple of weeks ago and he suggested that this was particularly true in the UK if one was unable to reach a private hospital or foreign country (Belgium apparently gets a lot of childbirth tourism). This supports your point about the difference between infant mortality and perinatal outcomes; if they survive the hospital, British kids seem to have a high survival rate.
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therealocelot
Link:(Link)
Time:2010-05-28 06:48 pm (UTC)
It appears that your source is educated and thus one is led to believe that they are bad people, driven to dishonest claims in support of their partisan agenda; I'm guessing a professional organisation that receives financial benefit from these things or a puppet organisation thereof.
It sounds to me like it was probably written by a woman who may or may not receive financial benefit (if she is a professional doula), but is primarily motivated out of honest caring for women and the birth process, and, while intelligent, has probably had no particular training in interpreting research studies or recognizing appropriate sources.
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jamesofengland
Link:(Link)
Time:2010-05-28 07:23 pm (UTC)
It's been too long since I've been sent this kind of email forward, whereas I read all too many from trade associations. You're right, this is much more likely to be home made. I'm slightly inclined to be less charitable in that I detect a fair bit of anger in there as well; my perception of the hate/ love balance involved in the motivation to create this is probably a little more towards balance than yours is, but that may be a result of my unfair mental associations. The Netherlands as #1 strikes me as being likely to be a trade association sponsored study, though.
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therealocelot
Link:(Link)
Time:2010-05-28 08:29 pm (UTC)
The part I think you may be missing is that women are, on the whole, not treated particularly well during birthin the US, and that many of them have very valid reason to be angry about their experiences. Birth is generally treated from the standpoint of reducing liability and/or hospital/provider convenience rather than what is actually best for the woman and baby - for example, requiring continuous fetal monitoring rather than allowing free movement, or performing a c-section at the slightest indication.

In some parts of the country, birth options are very limited. Midwives may not legally be allowed to attend homebirths, or so restricted in their ability to practice that it may as well be iillegal. In many area, there may not be a reasonably progressive hospital for hundreds of miles around. Even in areas where midwives can legally attend homebirths, access to their care may be very limited because supply exceeds demand, and because most private and state insurances don't cover homebirth, which generally cost thousands of dollars.

Because so many areas don't have good birth resources, women are forced to become self-advocates, and many of them don't have the education to effectively sort through the available information. And that's where you get stuff like this, where the overall message is probably more helpful than not, though the actual data is questionable.

One thing that jumped out at me on the page you linked about Iceland... perhaps the homebirth rate is so low partially because the hospital where most of the births happen is a good place to have babies. The high breastfeeding rate upon discharge points in that direction - that tends to result from a lower intervention, highly supportive environment, in addition to positive attitudes towards breastfeeding in the society as a whole.
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jamesofengland
Link:(Link)
Time:2010-05-30 06:05 am (UTC)
I bear no grudge against the gal who wrote this; I hope it was of much therapeutic benefit to her, and I'm sure that it has helped others. I don't have hard feelings for our host, either, just a little disappointment that she's not above this stuff. She does have skills in research.
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jamesofengland
Link:(Link)
Time:2010-05-28 11:29 am (UTC)
I should note that I was assuming your "doula friends" is a quoted bit, that these aren't things that you actually learned first hand from actual doula friends, but that this is propaganda passed on to you, possibly by an actual doula who is an actual friend, but not written by them. If it's actually a friend, I apologise for failing to conceal my contempt.
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