Reducing Infant Mortality

"We intervene every step of the way--pregnancy, birth, bonding, breastfeeding--we step in and intervene and there are long-term consequences to that."
Monica Matos, Birth Educator
(on video-4:04)

"The interventions are not just benign. They do damage. Most maternity practices that are commonly used in the hospital were never designed to be used at the frequency we're seeing them be used now and none of the evidence supports this. A vast body of literature does not support the use of labor induction, epidural anesthesia, for instance or caesarean section at the rates we see it currently being used."
(on video-4:17)

"We've become a little bit cavalier in how long to carry the pregnancy. People are a little less likely to say, 'Well, let's just wait until its the right time.' Now it's for convenience and for us, not for just the baby's sake."
Bryan Oshiro, MD
(on video-5:10)

"If you do an elective caesarean you try to do it near the end of the pregnancy, what we call 'term.' You try to estimate how far along the pregnancy is. They are thinking that a lot of these babies are done when they're not done and they do the elective caesarean and they end up with a baby who is several weeks premature."
Marsdsen Wagner (Former Director of Women and Children's Health, WHO)
(on video-5:54)

"It is estimated for every week that a baby is born before term that they double their risk of having problems such as having respiratory problems, feeding problems, temperature instability, sugar instability, learning disabilities, and behavioral problems."
Raylene Phillips, MD, MA, IBCLC (Neonatal Fellow, LLU Children's Hospital)
(on video-6:20)

"We're playing roulette and most of the time we find an empty chamber when we pull the trigger at 36 or 37 weeks but sometimes we don't and we end up with a baby who doesn't do as well and gets into problems. What could have proceeded naturally, in order to get my vacation in on time or back to work now becomes something that threatens the life of my baby or at least his health."
Bruce Smith, MD, MPH (San Bernadino Department of Public Health)
(on video-6:35)



"When you're having a baby, there's nothing really wrong with you. You're not ill. In all the experiences you have in your lifetime, having a child is one the most miraculous and amazing times and I am so saddened by the amount of fear and trepidation and concern and worry that surrounds that event."

-Jennie Joseph, LM, CPM
(on video- 13:29)

"Care that's impersonal and mechanized and focused solely on a risk-based model really tells a woman that the process is faulty, that she's just a number in the process and doesn't promote her participation in her own healthcare. I think that's where midwifery can really be a positive benefit." d

-Anita Trudell, CNM, MSN (Midwifery, UCLA Medical Center)
(on video-13:48)

"We've gone so far off course in our prenatal care and in our public policy messages that most women don't think they can deliver a baby without technology-driven interventions and we know certainly that is just not true."
Geeta Maker-Clark, MD

(on video-14:10)
 
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If you would like to read an excelent book on this topic I recommend,
Impact of Birthing Practices on Breastfeeing by Linda J. Smith
(To be truthful the book is about how interventions in our birth affect the next stage of reproduction - but then that is my area of knowlegde!)
Best wishes,
SARAH
 
I have had two pregnancies, two births and two healthy children, both births involving intervention and I am thankful every day for these.

During my pregnancy with my son, I suffered a lot of issues includng major bleeding at 11 weeks, severe vomitng which led to hosptalisation four times, water inections which eventually led to my waters breaking at 26 weeks +5 days. The doctors at the hospital intervened and managed to stop the labour, which gave my son an extra week in the womb and this extra time was priceless at that gestation. When my son was born at 27 weeks + 5 days they intervened again, putting him on a ventilator, giving him blood transfusions when his body was weak and frail. they saved his life on many accasions during the 8 weeks he was in the NICU and I am so grateful for this intervention as I have a six year old healthy son at the end who does not have any long term health issues as a result of his prematurity.

Wth the birth of my daughter I was induced at 41 weeks. The induction failed, the chord was wrapped around her neck a couple of times and every contraction I was havng was distressing her so the doctors intervened in the end and performed an emergency c-section, which I agreed to as it was in the best interest of my daughter at the time.

I think that not all intervention is a bad thing, mothers should be aware of complcations that can arise durng pregnancy and ask questions of doctors who are trying to intervene to ensure the right thing is beng done and for the right reasons but I am a firm belever that some interventions are necessary and because of these interventions I now have two beautiful children who I adore.
 
I dont think it's a question of being pro-intervention or anti-intervention.Both mother and infant mortality during child birth is very high in third world and developing countries. There is a lot of work being done to reduce this - and access to "intervention" can prevent many of these cases.

Some cultures have probably reached the other end of spectrum with too much intervention. Intervene-if-required would probably be a better option. That said I have found the idea of elective c-section for non medical reasons (work / holiday / good date) quite redicilous.
 
I do think that it's a trend these days that people want to schedule the baby into THEIR schedule and they have the baby induced or have a C section at about 38 weeks. But the problem is, even though 38 weeks is considered full term, a baby born at 38 weeks is often not as healthy as they could have been if they "cooked" for another 2-3 weeks. I personally know kids who were born early by induction or C-section who have respiratory problems and other health problems which COULD have been as a result of them being a little underdeveloped. (not necessarily definite, but there is a correlation for sure...)

I didn't watch the video, I did read the quotes though. And I do think it raises a good point about that issue. And while I don't think that all intervention is bad, I do think that CHOOSING for a baby to come two or three or even sometimes four weeks early COULD have long term consequences on their health. (it may be perfectly fine, but you never know. And why risk it?)
 
I think most of the elective c sections are scheduled to be performed at around week 38 because after that the probability of starting normal labor is much higher.
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38 weeks is actually not considered to be pre-term.

My waters started breaking at 38 weeks. I went to the hospital and immediately they had me lie down. Long story short, I was well aware of possible interventions that could happen during labour. I had all of them and saw my labour spiraling out of my control. It was rather dehumanizing. At one point I had 6 different wires/tubes coming from various areas. In the end, I had a c-section, as my boy just wasn't doing so well with the contractions, seemed to be stuck despite attempts to 'dislodge' him, and my cervix wasn't dilating well, even with oxytocin. My son was pulled out of me screaming and red, and scored perfect on his APGARs, and had no medical issue whatsoever. We did have a hard time breastfeeding for a long time, and to this day I blame it on him being taken away from me for 6 hours and then given formula without my permission.

Because of various reasons I have posted on different threads here, I may request an elective c-section in the public hospital, in which case I would accept it no earlier than 14 days before my due date. Ideally I would like to wait until I go into labour naturally, but I'm still not sure I can trust the public system enough for that.
 
I had my baby at 11am and didn't see him again until 10am the next day (I had an elective c section at week 40+3 when they found at week 40 that the baby hadn't had dropped), when I went to the nursery room to breastfeed him. He didn't have problem breastfeeding, and from what I saw, most of the babies at the nursery room were sucking without any problem (except for few ones).... So I don't really know about nipple confusion.
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I think if you watch the video they are not saying that interventions are a "bad thing" but that they are overused and in cases, such as yours, where you had complications, your interventions were medically feasible--there was a direct and important medical reason why they were being performed--they weren't performed for your convenience or because the doctor just thought the baby was "getting too big" or something like that. Actually, the doctors in this video all pointed to the huge medical benefits that technology has given us--such as ventilators and incubators that can keep our children alive and safe in an emergency. Not one person on this video said that there wasn't a real need for these things and most of the doctors praised the innovations in medical technology but brought up the issue that these interventions were never intended to be applied "willy nilly" (as one doctor put it). If you haven't taken time to watch the full video, I recommend it.
 
AmyH said:
I have had two pregnancies, two births and two healthy children, both births involving intervention and I am thankful every day for these.

During my pregnancy with my son, I suffered a lot of issues includng major bleeding at 11 weeks, severe vomitng which led to hosptalisation four times, water inections which eventually led to my waters breaking at 26 weeks +5 days. The doctors at the hospital intervened and managed to stop the labour, which gave my son an extra week in the womb and this extra time was priceless at that gestation. When my son was born at 27 weeks + 5 days they intervened again, putting him on a ventilator, giving him blood transfusions when his body was weak and frail. they saved his life on many accasions during the 8 weeks he was in the NICU and I am so grateful for this intervention as I have a six year old healthy son at the end who does not have any long term health issues as a result of his prematurity.

Wth the birth of my daughter I was induced at 41 weeks. The induction failed, the chord was wrapped around her neck a couple of times and every contraction I was havng was distressing her so the doctors intervened in the end and performed an emergency c-section, which I agreed to as it was in the best interest of my daughter at the time.

I think that not all intervention is a bad thing, mothers should be aware of complcations that can arise durng pregnancy and ask questions of doctors who are trying to intervene to ensure the right thing is beng done and for the right reasons but I am a firm belever that some interventions are necessary and because of these interventions I now have two beautiful children who I adore.
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I replied above :)
 
Shenzhennifer said:
38 weeks is actually not considered to be pre-term.

My waters started breaking at 38 weeks. I went to the hospital and immediately they had me lie down. Long story short, I was well aware of possible interventions that could happen during labour. I had all of them and saw my labour spiraling out of my control. It was rather dehumanizing. At one point I had 6 different wires/tubes coming from various areas. In the end, I had a c-section, as my boy just wasn't doing so well with the contractions, seemed to be stuck despite attempts to 'dislodge' him, and my cervix wasn't dilating well, even with oxytocin. My son was pulled out of me screaming and red, and scored perfect on his APGARs, and had no medical issue whatsoever. We did have a hard time breastfeeding for a long time, and to this day I blame it on him being taken away from me for 6 hours and then given formula without my permission.

Because of various reasons I have posted on different threads here, I may request an elective c-section in the public hospital, in which case I would accept it no earlier than 14 days before my due date. Ideally I would like to wait until I go into labour naturally, but I'm still not sure I can trust the public system enough for that.
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In your case, your own body initiated labor--the doctor didn't go in and say, "Your baby is now done at 38 weeks so you need to be induced to get the baby out." I think that the problem is that many doctors are putting too much trust in numbers--actually, a baby is done when a baby is done--whether that's 38 weeks or 42 weeks or whenever. If a woman goes into labor before 36 weeks the baby will most definitely be treated as if he/she is premature but that's based on estimates as well--a baby born a 36 weeks (of the body's own accord--not induction) may very well, after investigation, be found to be "fully cooked."

Would you say that in your case you now feel that the interventions performed on you and your son were necessary at the time?
 
I know people that had elective c sections because they were afraid of going into labor... They just didn't want to endure long hours of pain.

I chose c section mainly because of convenience, due to my insurance coverage. I could have scheduled induction at week 41, and the baby might have engaged during labor. Probably would have required other kind of interventions, like forceps, or may have ended in emergency c section. I didn't know... I was more concerned about the hospital bill rather than the baby, as I thought I was in good hands. So I went to c section directly since we have different coverage for vaginal delivery and for c section. If I had been in a public hospital, I would have gone for the induction for sure.
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thanka2 said:
In your case, your own body initiated labor--the doctor didn't go in and say, "Your baby is now done at 38 weeks so you need to be induced to get the baby out." I think that the problem is that many doctors are putting too much trust in numbers--actually, a baby is done when a baby is done--whether that's 38 weeks or 42 weeks or whenever. If a woman goes into labor before 36 weeks the baby will most definitely be treated as if he/she is premature but that's based on estimates as well--a baby born a 36 weeks (of the body's own accord--not induction) may very well, after investigation, be found to be "fully cooked."

Would you say that in your case you now feel that the interventions performed on you and your son were necessary at the time?
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My water started to break, but my body didn't go into labour naturally - that was the problem.I know another woman who recently told me that her waters started to break like mine, and she didn't go into labour until about a week later. She was not told 'urgently' to go to the hospital, as I was.

So they made me lie down, then after hours of nothing much happening, I finally agreed to the oxytocin. I pretty much knew that once I was forced to lie down, intervention after intervention would happen. They all did, like clockwork. Were they all necessary? Well, with my somewhat limited knowledge at that time, I also thought that the baby needs to come out within 24 hrs of your waters breaking. So after prolonging the oxytocin as much as I could, I pretty much let them do their work. I couldn't handle the contractions very well (3 at a time, 5 minutes long type thing, but not dilating me much), so I asked for the epidural, which then led to other interventions like a cathetor (Agh!!!!!!). At 22 hrs after my waters first breaking, and all the other stuff, and my baby not liking contractions with oxytocin, and my body not making them naturally, and a bunch of other stuff (and lots of pain!) I was quite fine when the doctor suggested the caesarian. So I think they did try everything they could before the end result, as my doctor knew I really wanted to avoid a c-section.

As far as interventions on my son, the bottle feeding was the only one. They proudly told me that he drank something like 60mls of milk, he was so hungry. After that, my colostrum wouldn't satisfy him and he would cry out for more and more. It's much easier to get milk from a bottle, than from a breast that hasn't made much milk yet. That's where the 'confusion' comes in, misnamed perhaps.

I would never plan a c-section for convenience, that I do know. My only reason to possibly plan this next one is out of the safety for me and my baby. Funny, since c-sections have a higher chance of complications, I know, but it's about how I feel about letting possible trainee doctors have me labour on unnecessarily and potentially dangerously, unbeknownst to them.
 
I know that 38 weeks isn't considered pre-term, but when you add in that often the due date could be a week (or sometimes even two weeks) wrong, depending on when it is calculated and by what method, sometimes a baby supposedly born at 38 weeks is not as "fully developed" as he should be, PARTICULARLY when the labour was started artificially by induction or by C section.
 
Gataloca said:
I know people that had elective c sections because they were afraid of going into labor... They just didn't want to endure long hours of pain.

I chose c section mainly because of convenience, due to my insurance coverage. I could have scheduled induction at week 41, and the baby might have engaged during labor. Probably would have required other kind of interventions, like forceps, or may have ended in emergency c section. I didn't know... I was more concerned about the hospital bill rather than the baby, as I thought I was in good hands. So I went to c section directly since we have different coverage for vaginal delivery and for c section. If I had been in a public hospital, I would have gone for the induction for sure.
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Do you now feel that the choices you made because of the insurance etc. were in the best interest of your child's health?
 
nicolejoy said:
I know that 38 weeks isn't considered pre-term, but when you add in that often the due date could be a week (or sometimes even two weeks) wrong, depending on when it is calculated and by what method, sometimes a baby supposedly born at 38 weeks is not as "fully developed" as he should be, PARTICULARLY when the labour was started artificially by induction or by C section.
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I think that is exactly the point that that all of the professionals who spoke on the video were really making. That our estimates of how old a baby is are not infallible. And even if the baby is technically 38 weeks or 40 weeks into gestation, every child is different as is every mother and a lot of the children who are already 'term' (38 weeks onward) are, for that particular child, not ready to come out. A lot of development of the brain and lungs happens in just the last few weeks before a baby is born and if we force a baby to come out when he/she is not ready we in essence cut that development period short and shock their systems as we introduce them to life outside the womb too soon. Just like when children leave the womb they develop at different paces so we can't assume a "one-size-fits-all" model of development I don't think we can say that "Well, this baby should be done at 38 weeks." It's just not that cut-and-dried and that's where we get into problems. I've heard several experiences from other women where they went over their due date--even by several weeks but it was the healthiest thing for the baby to leave him/her in even though many doctors would disagree. There was even one woman who labored for 2 weeks after her water broke and gave birth naturally with no complications to the baby or mother.
 
thanka2 said:
Do you now feel that the choices you made because of the insurance etc. were in the best interest of your child's health?
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Well... I shouldn't have said "mainly".. should be "partly"... If it were totally due to the insurance, I would have gone for the C section from the beginning.... Sometime it really amazes me! It was only 5 month ago, and I have already loss memory of my pregnancy!!!!

Anyway, even when my insurance coverage for normal delivery was low, I was hoping to have a natural one, without epidural if possible. Everything was fine, and my baby was head down already at around week 34. I have been having scans every 2 weeks to monitor the baby position, and at week 40 the doctor noticed that the baby hadn't dropped further since week 38. I got diagnosticated CPD and suggested C section, although still gave me the option of waiting till week 41, and go for an induction labor hadn't started yet by then. I weighted the pros and cons:

- There was a high chance that the baby will not engage, even during labor.
- by themselves, many induced labors end up in emergency C sections.
- emergency C sections are more risky than elective C sections.
- Long labor is stressful for both the mother and the baby.
- I get fully covered by the insurance, and can stay in a private room, where my baby could room-in.
- I totally trusted my doctor.

So yes, I do feel that the choice I made were in the best interest of my baby.
 
Gataloca said:
Well... I shouldn't have said "mainly".. should be "partly"... If it were totally due to the insurance, I would have gone for the C section from the beginning.... Sometime it really amazes me! It was only 5 month ago, and I have already loss memory of my pregnancy!!!!

Anyway, even when my insurance coverage for normal delivery was low, I was hoping to have a natural one, without epidural if possible. Everything was fine, and my baby was head down already at around week 34. I have been having scans every 2 weeks to monitor the baby position, and at week 40 the doctor noticed that the baby hadn't dropped further since week 38. I got diagnosticated CPD and suggested C section, although still gave me the option of waiting till week 41, and go for an induction labor hadn't started yet by then. I weighted the pros and cons:

- There was a high chance that the baby will not engage, even during labor.
- by themselves, many induced labors end up in emergency C sections.
- emergency C sections are more risky than elective C sections.
- Long labor is stressful for both the mother and the baby.
- I get fully covered by the insurance, and can stay in a private room, where my baby could room-in.
- I totally trusted my doctor.

So yes, I do feel that the choice I made were in the best interest of my baby.
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I just have a few questions regarding what you listed--

- There was a high chance that the baby will not engage, even during labor.
How do you know that the chance was high? Did the doctor tell you that? There are quite a few women for example who are facing a breach baby and the baby turns at the last second (or there are things that can be done safely and naturally to encourage the baby to engage) and the woman gives birth vaginally.
- by themselves, many induced labors end up in emergency C sections.
- emergency C sections are more risky than elective C sections.
Why do you say so? If you have an experienced surgeon, there shouldn't be any more risk involved in doing the c-section at the last minute than pre-planning it--unless there is already something going wrong with the child or mother. In both cases there is a major abdominal surgery taking place.
- Long labor is stressful for both the mother and the baby.
Had you gone through a long labor before? What do you base this assumption on? Labor itself can be a stressful situation--whether it's long or short. Having gone through an extremely long labor naturally myself (43 hours) I can say it was difficult but I wouldn't say that it was any more stressful--I guess it depends on how you define "stress." Part of what makes labor, labor is that it is something one needs to submit to and allow oneself to go through--not fight against--when it's fought against that's when it becomes stressful in my opinion. As far as stress caused to the baby--long labors often are no more stressful to the baby than short ones. There are women who labor for weeks with a child and the child shows no signs of stress during or after labor. I think that the images we get from Hollywood give us a lot of misinformation about what labor is and can be.
- I get fully covered by the insurance, and can stay in a private room, where my baby could room-in.
Because you had a pre-planned c-section you got fully covered by insurance with all the benefits?...or if you had chosen a different route, would you have received the same coverage?
- I totally trusted my doctor.

Just really curious to know. Thanks.
 
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we do know some weirdos who had their child delivered at 7 months because the date was a combination of the husband and wife's birthday and month was also the same as their anniversary. the Child was fine at birth but later has developed lot of issues. It might not be connected. i dont know but really how dumb can people be. There was no issue of money, holidays etc in the above delivery. The child at the age of 3 was treated with a heart issue
 
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