Technology in Birth: First Do No Harm
By Marsden Wagner, MD
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Quotes:
“A woman in Iowa was recently referred to a university hospital during her labor because of possible complications. There, it was decided that a cesarean section should be done. After the surgery was completed and the woman was resting post-operatively in her hospital room, she went into shock and died.
An autopsy showed that during the cesarean section the surgeon had accidentally nicked the woman’s aorta, the biggest artery in the body, leading to internal hemorrhage, shock and death.”
“Has the recent increasing use of technology during pregnancy and birth resulted in fewer damaged or dead babies? In the United States there has been no decrease in the past 30 years in the number of babies with cerebral palsy. The biggest killer of newborn babies is a birth weight that is too low, but the number of too-small babies born has not decreased the past 20 years.
The number of babies who die while still in the womb has not decreased in more than a decade. While the past 10 years has seen a slight drop in the number of babies who die during their first week after birth, the scientific data suggest an increase in the number of babies who survive the first week but have permanent brain damage.
Is the increasing use of technology saving the lives of more pregnant and birthing women? In the United States the scientific data show no decrease during the past 10 years in the number of women who die around the time of birth (maternal mortality).
In fact, recent data suggest a frightening increase in the number of women dying during pregnancy and birth in the United States. So it may be that the increase in the use of birth technologies is not only not saving more women’s lives but it is also killing more women. This possibility has a reasonable scientific explanation: cesarean section and epidural anesthesia have both been used more and more in this country and we know that both cesarean section and epidural block can result in death.”
“Having a cesarean birth also affects the future reproductive possibilities of the woman, because having a cesarean section means she has a decreased chance of ever getting pregnant again. And if she does get pregnant again, she is at higher risk that her pregnancy will occur outside her womb, a condition that will never result in a live baby and is life threatening for the woman.
If in her subsequent pregnancies she succeeds in making it to the end of pregnancy and goes into labor, she is also at higher risk of two serious complications during the birth, both of which can threaten her own life and the life of the baby: a placenta that blocks the outlet for the baby or a placenta that detaches itself before the baby is born.”
“There has been an epidemic of unnecessary cesarean section births because doctors like a quick, surgical solution for birth. Now another birth technology—epidural block for labor pain— is seeing a rapid expansion of epidemic proportions because doctors are selling it to women as hard as they can.
(Epidural block for cesarean section is another matter, as it is the preferred anesthesia for this major surgery.) A new subspecialty of doctors—obstetric anesthesiologists—is built entirely on the economic foundation of epidural block for normal labor pain. They need lots of birthing women to choose this form of pain relief if these doctors are to make a grand living. (Their professional journal contains advertisements for purchasing private jets.)
These new specialists go to prenatal classes to sell epidural block and prowl the halls of hospital maternity wards, popping in on women in labor to sell their epidural block. Their hard sell includes telling women that epidural block is “safe.” How safe is it really?
Twenty-three percent, or nearly one in four women, given an epidural block will develop a complication. One undesirable complication is death—epidural block for relief of normal labor pain results in a three times higher mortality rate for the woman than labor without epidural block. One out of every 500 epidural blocks results in temporary neurological problems, such as paralysis in the woman; and in one out of every half-million epidural blocks, this neurological damage to the woman is permanent.”
“Thus, epidural block presents many serious risks for the woman. Are there risks for her baby? Since it is unlikely any woman would choose a form of pain relief that puts her baby at risk, women are not told that in 8 percent to 12 percent of labors in which the woman is given epidural block, severe fetal hypoxia (lack of oxygen to the unborn baby) is shown on the electronic fetal monitor.
The American College of Obstetricians and Gynecologists, after acknowledging the frequency at which birthing babies suffer hypoxia after the woman is given an epidural block, recommends that all women given epidural block have continuous electronic fetal monitoring so that fetal hypoxia can be identified.
Does this lack of oxygen have any permanent effect on the baby? Research has found that 1-month-old babies whose mothers were given epidural block during labor may have neurological test results that suggest possible minor brain damage. While this is a finding not yet completely confirmed scientifically, it is a possibility that is certainly worrisome and should be told to women offered epidural block. Epidural block carries another risk that is found in many of the interventions and technologies used during birth: the “cascade effect.”
This means that the use of one intervention leads to the use of another intervention, and the use of that intervention leads to the use of yet another intervention, and so on. If, for example, a woman is given a drug to start labor or to make labor proceed faster, this leads to more painful contractions. This in turn leads to the offer of pain relief, usually with epidural block, which, as we have seen, leads to an increased use of forceps or vacuum extraction, which leads to episiotomy or to cesarean section, which leads to fever in the mother, which leads to tests and treatments for the baby.”
“The present scientifically unjustified monopoly of maternity care by obstetricians in the United States is richly rewarding the obstetricians, and you can be sure they will fight to maintain the status quo, keeping out any competition such as midwives and out-of-hospital birth. This is why, as a consumer of maternity care, you must beware what you are told by doctors and hospitals and take full responsibility for ensuring you get the kind of pregnancy and birth experience best suited to your needs and no one else’s.”
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Jenny Hatch
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