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May 11, 2012 8:30 AM   Subscribe

Consumer Reports May 2012: What to reject when you're expecting (10 procedures to think twice about during your pregnancy; 10 things you should do during your pregnancy; 5 things you should do before you become pregnant). Mentioned in particular is the conclusion found in a federal study: Babies Take Longer To Come Out Than They Did In Grandma's Day."One big implication: Today's obstetricians may be rushing to do cesarean sections too soon because they're using an out-of-date yardstick for how long a 'normal; labor should take... The definition of a 'normal' labor — the range of times when a woman in labor reaches certain milestones — was laid down in the 1950s. Contemporary obstetricians still use that 'labor curve.'"
posted by flex (66 comments total) 21 users marked this as a favorite

 
The infant mortality rate in Canada is 25 percent lower than it is in the U.S.; the Japanese rate, more than 60 percent lower. [...]But another key reason appears to be a health-care system that has developed into a highly profitable labor-and-delivery machine, operating according to its own timetable rather than the less predictable schedule of mothers and babies.

Infant mortality in the US is largely due to poverty and racism, not the "labor-and-delivery machine".
posted by the young rope-rider at 8:40 AM on May 11, 2012 [16 favorites]


The Bradley Method was very useful for us in terms of being able to make informed decisions. There is a clear tendency in many hospitals to unnecessarily induce and speed up labor in a way that benefits the hospital, not the patient or the baby. It's always possible that induction will be medically necessary, but that necessity should be confirmed by the patient before they give consent.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:41 AM on May 11, 2012 [3 favorites]


There's poverty and racism in Canada as well. I find it telling that health care is something that Consumer Reports is covering - since in the US, you are much more a consumer than you are in Canada.
posted by flex at 8:42 AM on May 11, 2012 [3 favorites]


I was pleased to see that they actually advocated consulting a midwife.
posted by Burhanistan at 8:43 AM on May 11, 2012 [3 favorites]


This is from the second link:

Another big change is that many more women have induced labors these days. That is, they're not permitted to go into labor spontaneously. One in three women had spontaneous labor, among women giving birth between 2002 and 2008.

Women today are 19 percent more likely to get a drug called oxytocin, which increases the strength of uterine contractions. But this should shorten labors, so the study authors note that "if women were allowed to progress in natural labor without oxytocin, the stages of labor could be even longer with the same odds of achieving vaginal delivery."

posted by flex at 8:43 AM on May 11, 2012


Get a doula if you can get a doula. They are an experienced advocate for the patient and can also provide superb emotional support when it's most needed.
posted by East Manitoba Regional Junior Kabaddi Champion '94 at 8:48 AM on May 11, 2012 [4 favorites]


There's poverty and racism in Canada as well.

...and health care.
posted by the young rope-rider at 8:49 AM on May 11, 2012 [3 favorites]


I'd like to know how they determined that labors are/should be longer than 50 years ago.
posted by DU at 8:49 AM on May 11, 2012


Hospital practices here are different than in the US, because the profit motive is not the same. Is it so hard to believe - in a health care system with a profit motive - that a "a highly profitable labor-and-delivery machine" is not a consideration?
posted by flex at 8:52 AM on May 11, 2012 [4 favorites]


I'm not sure I'd take advice on such a subject from CR. They're flat-out incompetent on their other reviews.
posted by narcoleptic at 8:52 AM on May 11, 2012 [7 favorites]


Something that gets me is that women from all stripes are sometimes not aware of the options that they do have, re: setting, method, pain management, etc. A friend of mine - a well-educated woman who takes a proactive approach to her health - didn't know until halfway through her pregnancy that she wasn't required to go to the hospital. She assumed that any (American) births outside a hospital were the result of a mistake, that the family was caught by surprise.

I feel like there's a story of pregnancy that women hold themselves to, and it's dangerous on many levels. We've made amazing advancements in labor and delivery, and yes, women should avail themselves of those advancements, but the drawbacks and alternatives are glossed over. We need to educate people better so that they can make these choices for themselves.
posted by punchtothehead at 8:55 AM on May 11, 2012 [1 favorite]


They're flat-out incompetent on their other reviews.

This is a bullshit.

(Sorry, we're not allowed to say [Citation Needed] anymore)
posted by absalom at 8:57 AM on May 11, 2012 [8 favorites]


My father was a doctor, but he callously told us he wasn't interested in OB/GYN because after delivering a few dozen babies it was "like parking cars."

I think our doctor must have felt the same way. We didn't even know the dude (it was in the middle of the night, and he was on call, I guess). We had specifically requested NO EPSISIOTOMY but he wasn't aware of that and just whipped out his scalpel and did it, despite the fact that the baby was almost three weeks early and just over six pounds. Didn't ask if I wanted to cut the cord either (not a big deal, but still, some of us only have one child and it was kind of a special thing for us). But it was like parking cars for this old doctor.
posted by kozad at 8:58 AM on May 11, 2012 [2 favorites]


I know I've said this before in threads on metafilter, but the absolute best thing we did, which was a nice compromise for me (crunchy granola approach to childbirth) and my husband (pathologist, who in medical school had some really... interesting times on his OB-GYN rotation) was to have a midwife who delivered in a hospital. She herself was low-intervention (she told me she'd done one episiotomy in the previous 3 years, for example) but the surgery was just down the hallway if something did go wrong. Worked out beautifully.

(and I can believe her episiotomy claim: I delivered a 8lb11oz kiddo with her arm over her giant off-the-chart head and had nary a tear, due to her work)
posted by gaspode at 8:59 AM on May 11, 2012 [3 favorites]


(first and final her = midwife. middle ones = baby) sigh.
posted by gaspode at 9:01 AM on May 11, 2012 [1 favorite]


They're flat-out incompetent on their other reviews.

This is a bullshit.


It really isn't. Find some reviews for a subject you know about and you'll see how shallow they are. They discuss price and a few other superficial things, but not nearly enough to make an actually good decision. For instance, their computer reviews (used to) often hinge on things like keyboards, monitor sizes, RAM, etc. Complete fluff. They might work to steer you away from complete garbage, but differentiating between "good" and "better" is beyond them.

I sure wouldn't look to CR for medical advice.
posted by DU at 9:08 AM on May 11, 2012 [2 favorites]


I would like to hear more about debunking and muckraking Consumer Reports. It's been awhile since I read it but I have always thought their journalism was roughly as good as Time magazine or the Los Angeles Times. Don't they do fact checking and corrections and whatnot?
posted by bukvich at 9:09 AM on May 11, 2012


Get a doula if you can get a doula. They are an experienced advocate for the patient and can also provide superb emotional support when it's most needed.

All the doulas I've encountered seem to have their own opinions about how a birth should go. Which is fine, opinions are like belly buttons, but I'm not gonna pay someone to push their agenda on me.
posted by ThePinkSuperhero at 9:12 AM on May 11, 2012 [6 favorites]


Hospital practices here are different than in the US, because the profit motive is not the same. Is it so hard to believe - in a health care system with a profit motive - that a "a highly profitable labor-and-delivery machine" is not a consideration?

The use of comparative statistics about infant mortality to judge the relative quality of childbirth care is highly flawed for a few reasons:

--It uses all deaths from birth to one year. Not all deaths before one year are related to the manner of birth.

--There are numerous other factors that lead to infant death (and maternal death), like inadequate prenatal care and poor maternal health (often due to a lifetime of inadequate medical care)

--Race is a huge factor in infant mortality and maternal health, even when you take out other confounding factors like income
posted by the young rope-rider at 9:13 AM on May 11, 2012 [1 favorite]


DU - Friedman's work was kinda skewed, among other things due to practices at the time that didn't actually let different stages of labor continue longer than a certain amount of time, so there's a certain artificiality (new word?) to things like the 95% percentile on the curve.
The fact that three different contemporary large, good studies have shown that the normal labor curve is significantly different is pretty compelling evidence. I have slides/review stuff on this somewhere in the binder sitting in front of me, but if you want to do some searching and/or have database access, the first researcher to look up is probably Leah Albers (CNM + DrPH).

I was actually really pleasantly surprised by this article; there were things a lot of people probably aren't aware of, like doing an external version for a breech baby, rather than heading straight to c-section (which is pretty common, as less people are willing to do or trained in breech vaginal births). Admittedly, I was also pretty stoked that there was a plug for nurse-midwives, and a link to the ACNM practitioner directly.
posted by circle_b at 9:14 AM on May 11, 2012 [1 favorite]


I wish all the articles saying "you should resist being induced unless it's medically necessary" would actually say something about what genuinely constitutes medical necessity. They always just list a few things that seem like acute problems (ok, induce) and then a whole bunch of chronic conditions that may or may not pose problems in any particular case.
posted by kestrel251 at 9:15 AM on May 11, 2012 [2 favorites]


The infant mortality rate in Canada is 25 percent lower than it is in the U.S.; the Japanese rate, more than 60 percent lower.

My understanding is that it's often highly misleading to make inter-country comparisons of infant mortality because each country sets its own definition of a live birth (as opposed to a late miscarriage or a stillbirth), and so they're counting infant mortality very differently. In the US, any baby who is fully expelled from its mother and then takes a breath, has a heartbeat, makes a voluntary movement, or displays any other signs of life, is counted as a live birth, regardless of gestational age, size, or how soon afterwards the baby may stop exhibiting signs of life. If the baby then dies, that's counted as an infant death. By contrast, many other countries have minimum size requirements (length or weight; in Canada, the baby must weigh more than 500 grams at birth), a minimum length of time the child must live (in Japan, for example, a baby who dies in the first 24 hours after birth is counted as a miscarriage, not an infant death), or a minimum gestational age (in most EU countries, a baby born before 26 weeks, even if born breathing, counts as a miscarriage if it doesn't survive). Those differences in measurement dramatically skew any attempts at comparison.

The difference is likely political. Any attempt in the US to say that a breathing human being outside its mother's body is not a living child would induce fits of rage from those who believe that a fetus or a zygote is a person, not to mention significant discomfort from the majority of Americans who are uncomfortable with late-term abortion. In countries where abortion is less of a hot button issue, counting a born 20 week old fetus as a miscarriage or a baby who takes one breath and then dies as a stillbirth doesn't lead to the same sort of political drama. But the fact remains that because of those differences, it's nearly impossible to make meaningful inter-country comparisons on infant mortality (which leads to big skews in comparisons of life expectancy at birth, as well). The US still, even accounting for these problems, has relatively high infant mortality among developed nations, but it's hard to say how much higher it is than in other places.
posted by decathecting at 9:27 AM on May 11, 2012 [34 favorites]


>I wish all the articles saying "you should resist being induced unless it's medically necessary" would actually say something about what genuinely constitutes medical necessity.

I suppose that responsible writers would leave it there since it would vary by case and would ultimately be between a patient and her doctor?
posted by Burhanistan at 9:29 AM on May 11, 2012 [1 favorite]


The doctor that delivered both of my children was also a customer, as I was in medical sales way back then. I remember being shocked to learn that he needed to deliver 14 babies a month just to break even financially. And he was a low overhead, single practice doctor. I guess it never occurred to me back then that baby delivery is a high volume business.
posted by COD at 10:02 AM on May 11, 2012


Consumer Reports? Are we at the point that pregnancy, that childbirth, is just another big purchase, like a house or a truck? Or are people eating babies now?
posted by TwelveTwo at 10:10 AM on May 11, 2012


All the doulas I've encountered seem to have their own opinions about how a birth should go. Which is fine, opinions are like belly buttons, but I'm not gonna pay someone to push their agenda on me.

For some reason, I can't read this any other way that "I would pay someone to push their belly button on me."
posted by Bulgaroktonos at 10:14 AM on May 11, 2012 [5 favorites]


I think this is a great article and I think it's fabulous that CR did this, because this information will likely reach a much wider audience now. Even as a well-educated person who likes to research the hell out of everything, I still somehow didn't know that choosing a midwife and a non-hospital birth did not mean you can't do tests like ultrasounds and amniocentesis.

Had I know this I would have probably been more likely to choose this route from the start, instead of firing my OBGYN and hiring a birth center midwife at 35 weeks. Which I'm so glad I did, since my baby ended up being 2 weeks overdue, and I ended up being in labor for 74 hours, with 11 hours of pushing -- in a hospital setting, that would have been labeled "failure to progress" and I would have been pressured into a c-section. Instead, I was able to give birth with no drugs and no injury -- not even a little tear! I think both my son and I had a better start thanks to the birth center and the midwives.
posted by rabbitrabbit at 10:19 AM on May 11, 2012 [2 favorites]


Babies Take Longer To Come Out Than They Did In Grandma's Day

Tell this to my friend who went from transition (active phase?) to birth in 30 minutes. The midwife didn't get to her house on time and her husband had to do the delivery. From her story, the kid (her third, three weeks overdue) basically slipped out.
posted by maryr at 10:23 AM on May 11, 2012


I was in labor for 50 hours total (some of that time spent running errands!) and pushed for 3 hours, but I did deliver in a hospital. I'm quite convinced that having a doula with us was one of the factors that allowed us to have a low-intervention/non-medicated birth. We pretty much avoided all the things CR says to avoid. The doc broke my water, but she claims it was unintentional during an exam.

so, doula doula doula! (yeah, she had a pro-natural birth agenda, that's why we hired her!)
posted by vespabelle at 10:32 AM on May 11, 2012


Find some reviews for a subject you know about and you'll see how shallow they are.

This is frustrating, because their testing regimin is extremely rigorous, thorough and exhaustive. Check out any video where they demonstrate some of their testing - I was bowled over by the lawnmower video. Add into that extensive phone surveys on current and previous owners on a number of factors, and this is one seriously serious product appraisal.

Then, their editors toss all of that aside when coming up with blurbs, and pick inconsequential points of comparison to highlight. Some of it, like in their car reviews, comes from the fact they have much different ideas what's actually important to car owners than the glossy mags and gonzo-journo blogs... and Consumer Reports' priorities of reliability, practicality, economy and comfort are absolutely the correct ones.

But a lot of it is that there seems to be a disconnect between the testing and editorial departments. The magazine doesn't appear to know what the hell its talking about half the time... but the ratings themselves usually meet up with reality, and are more dependable, in my experience, than the advertising-paid media.
posted by Slap*Happy at 10:49 AM on May 11, 2012 [4 favorites]


That is ... kind of thin. It ignores the basic reasons why induction is routine at 41 weeks (stillbirth rates rise; some data suggest a C-section is more likely without induction) and the dismissal of late ultrasounds is too pat (is the article suggesting women eschew nonstress tests? That seems like bad advice.)

I really recommend reading the Medscape summary about postterm pregnancy before decididing that everything about how we have babies in the US is bad. It's quite readable.

The WHO withdrew the 15 percent "optimal" C-section rate in 2010, according to Wikipedia.

Also, this section confuses correlation and causation: In addition, induced labor frequently leads to further interventions—including epidurals for pain relief, deliveries with the use of forceps or vacuums, and C-sections—that carry risks of their own. For example, a 2011 study found that women who had labor induced without a recognized indication were 67 percent more likely to have a C-section, and their babies were 64 percent more likely to wind up in a neonatal intensive care unit, compared with women allowed to go into labor on their own.

Induction is associated with those things, but it is also associated with things like a baby in a suboptimal position, a very large baby, a mother with a suboptimally shaped pelvis, etc. The above paragraph could just as easily be summarized as "Women who have spontaneous labor have births with less complications," but, duh, who wouldnt expect that? The "allowed to go into labor" language is inflammatory (who is doing the "allowing"? In any large study most U.S. women who go into labor spontaneously would be less than 41 weeks whereas induced would be 40+ weks, so these aren't equivalent groups anyway.) Obviously its better to go into spontaneous labor at 39 weeks (as the Medscape summary suggests) but what if you don't? Just waiting till everybody goes into spontaneous labor seems, according to available data, like it would result in a lot more stillbirths. And that would be terrible too.
posted by purpleclover at 10:53 AM on May 11, 2012 [3 favorites]


From the article:
“In this country, if your first birth is a C-section, there’s a 95 percent chance all subsequent births will be as well,”

and

About three quarters of such women [those with a low-transverse incision] who attempt a VBAC [vaginal birth after caesarean] are able to deliver vaginally.

Does this mean that just over 5% of women who had a first caesarian even try for a VBAC, or am I missing something? These "facts" don't seem to compute. I'm particularly interested in this as my planned natural delivery, (hospital, no meds, no induction, etc) with a doula six weeks ago turned into an emergency caesarean, and I'm not quite over it. I think that without my doula it would have been much more traumatizing yet, though. Obligatory pics of arcticbaby.
posted by arcticwoman at 10:57 AM on May 11, 2012 [8 favorites]


(In the pics above, I'm the mom with glasses and my wife is the mom with dreadlocks)
posted by arcticwoman at 10:58 AM on May 11, 2012


Tell this to my friend who went from transition (active phase?) to birth in 30 minutes.

Because one 3rd party anecdote trumps actual research?
posted by Bonzai at 11:04 AM on May 11, 2012 [4 favorites]


arcticbaby is a beaut, congrats arcticwoman and Mrs. arcticwoman!
posted by ThePinkSuperhero at 11:21 AM on May 11, 2012 [10 favorites]


arcticwoman - Upon seeing that picture with the "10 scoops of this came out of Iggy Pop" quote, my first thought was "Somehow I'm not shocked drugs will do that to you" then I realized it was a rabbit.

Also, cute baby!
posted by KirTakat at 11:28 AM on May 11, 2012 [2 favorites]


then I realized it was a rabbit
Ha ha, yeah, we name our animals after 70s/80s rock stars. Our other rabbit is Peter Gabriel (but we call her Gabe), and I'm determined to someday have a cat named Billy Idol.
posted by arcticwoman at 11:36 AM on May 11, 2012


Because one 3rd party anecdote trumps actual research?

Yes, it is anecdotal. I meant it to be anecdotal. I'm sorry if it came off as otherwise.
posted by maryr at 12:09 PM on May 11, 2012


Congratulations arcticwoman on your & your wife's beautiful baby!
posted by hurdy gurdy girl at 12:38 PM on May 11, 2012


The reasons for today's much longer labors aren't entirely clear. They may have something to do with differences in today's mothers compared with their grandmothers. For instance, first-time mothers are about four years older on average, they have higher body mass, and they're more racially diverse.

How can mothers be more racially diverse than they used to be? Or do they mean mothers who gave birth in hospitals? Racially mixed? Anyone know?
posted by small_ruminant at 1:19 PM on May 11, 2012


I am a CR subscriber, and I have read all of these suggestions before in other credible publications as well, but my own experience causes it to leave a bad taste in my mouth. A lot of it boils down to "Wait until you go into labor naturally and minimize interventions," and there is a rather heavy handed implication that C-sections and inductions are often done for convenience as opposed to "medical necessity."

I had a late ultrasound predicting a > 10lb birthweight for my daughter (which from CR's advice I shouldn't have had at all?), and my OB rather hesitantly suggested inducing labor rather than waiting for her to get even bigger, though I was only two days past my due date. I had in other respects a "low risk" pregnancy. But in fact my daughter was born with meconium in her lungs, had to be suctioned and artificially respirated before she could breathe, and was put on IV antibiotics for three days to treat the high fever she had and prevent infection from progressing. Had we waited any longer, these complications would certainly have been worse and the likelihood of their being fatal would have increased. The meconium was discovered when my membranes were artificially ruptured to speed labor, late in the process. Because of that, they were alerted to the risk to my daughter's lungs, and had a ressuscitation team standing by when she was delivered.

I think I violated their rules 3, 4, 5, 6, 8, and 9.

Was my induction "medically necessary"? I don't think it was, by their standards. I agreed at least in part because I was ready to not be pregnant anymore, but also because she explained to me that it was the path that erred on the side of caution. Maybe it was unecessary, but the downsides of doing it unecessarily were less scary than the downsides of not doing it if it turned out that it was necessary -- as, in my case, it was. Beforehand, though, there was no way to know that.

The same applies to a lot of C-sections. Pretend you are told a 20% chance that your baby will die if you don't have one. Since "dead baby" is probably at least 5x worse of an outcome than "unecessary surgery" by most standards, I think that game theory tells you to go ahead and have it. If everyone who has a 20% chance of losing their baby makes the same decision, then 80% of those C-sections are in some sense "unecessary." And yet, it is a very rational decision for each of those cases. I think this reasoning accounts for the high rate of C-sections, inductions, and other interventions in most hospitals. As for most of these being scheduled on a Tuesday "So that everyone can be home for the weekend" -- once you've decided that you're going to schedule it as a safety precaution, you might as well schedule it for Tuesday. I don't think that suggests anything about the motive for scheduling in the first place.

Sure, in an ideal world we would minimize interventions in "low risk" pregnancies. But what is "low risk"? I personally am willing to tolerate a lot less risk when it is my body and my baby on the line, and all pregnancies are at least somewhat risky. Many birth problems cannot be predicted in advance. Who gets to decide how much risk is tolerable? Surely the people who are already deciding to do these interventions: women and their doctors?

I'd like to see this discussed more as a matter of "caution" (and perhaps "over cautiousness") rather than "convenience," which seems like an insult to huge numbers of doctors and mothers, to me.
posted by OnceUponATime at 1:19 PM on May 11, 2012 [14 favorites]


For those of you in New Jersey, Morristown Hospital has birthing tubs and is very comfortable with midwives. You can ask them for a list of midwives that deliver at the hospital - we went with Hackettstown Midwives.

It's best of both worlds - a midwife who respects your birth plan for the delivery and a state of the art NICU if you need it (we did - our child was born 6 weeks early).
posted by exhilaration at 1:21 PM on May 11, 2012


While I appreciate what they're trying to do, something about the way this is presented bothers me. I had all the hallmark signs of pre-eclampsia, but with only a little protein spike, and baby Snickerdoodle was measuring small and hadn't grown in 3 weeks (which we found out via the post-24 week ultrasounds). I suppose we could of waited longer to see if my blood pressure would keep going up and the double vision would go away, but I trusted my doctors and everything turned out ok.

I wish that they'd done something along the lines of "Signs you should reconsider your OB/Midwife/etc." rather than focus on the medical procedures themselves. There's a lot of gray there, and most people would be better served knowing how to evaluate their medical provider rather than being told "don't do inductions."
posted by snickerdoodle at 1:26 PM on May 11, 2012 [8 favorites]


Consumer Reports--stay out of my vagina.

While I labored at a teaching hospital, where my friend swore up and down they were heavy on the c-sections because they were teaching---I didn't experience any of these "don't dos".

Epidural--sorry but that was my call. I felt 3 contractions that made me faint they were slo bad. Why should I be in 17 hours of excrutiating pain if I couldn't take it after 6 hours of labor? Sorry but I don't regret it.

C-section. Mine should have had a C since his heart was dropping, it was way past the 'natural labor point' for water breaking (infection coming my way), and when he popped out he was asphixiated. I believe that the risk of an APGAR 1 would have been averted if a c-section was done. Sure I was scared for a C but my mantra the moment I walked in was you do whatever you feel is necessary for my baby's health/survival. It may have saved me and my husband a traumatic birth experience that 3 years later still makes me whell up and put me in a panic attack. Now that he's going to be my only what, I can't imagine a 'what if' with him. He's my everything.

But c'est la vie. He's great now--sassy pants and all.
posted by stormpooper at 1:28 PM on May 11, 2012 [3 favorites]


I'm just a guy, but it felt to me like there was a whole lot of shaming going on in that CR piece of women who make certain birth choices that don't happen to be fashionable right now.
posted by The Bellman at 1:57 PM on May 11, 2012 [12 favorites]


Today's obstetricians may be rushing to do cesarean sections too soon because they're using an out-of-date yardstick for how long a 'normal; labor should take...

I think two things: first, that claim almost certainly false. But second, obstetricians also have a much better idea of the risks to children and mothers that can occur after prolonged labor, and that there's a very large element of risk management to this that's being glossed over here.
posted by mhoye at 2:19 PM on May 11, 2012 [1 favorite]


Some serious agenda-pushing here. "Women who used midwives were more likely...to have a spontaneous vaginal birth without the need for an epidural." What does that mean? They weren't in any pain? Or their provider decided that pain relief was not "needed"? I'm glad I read this before I looked to CR for advice on my next car. "Power steering may be popular right now, but research shows that drivers can make turns just as well without it...Automatic transmissions deny drivers the experience of bonding with their vehicles."
posted by Ralston McTodd at 2:27 PM on May 11, 2012 [2 favorites]


I found a couple things in the CR piece fascinating and new to me - the idea that doctors are using an outdated model of labor; and that you can take a form of progesterone to reduce the chances of an early delivery - as well as the statistic in the NPR piece that only one-third of women go into spontaneous labor (I had no idea the use of oxytocin was that widespread). And of course I liked that it pointed out the advantages of using midwives and the importance of a back-up plan should labor not go as you would like it to go - something I think a lot of "birth plan" checklists/instructions miss. I don't think many people know that VBACs are a viable option and I don't think most people know that elective early deliveries might not be a good idea. I appreciate decathecting's calm criticism over one specific point in the piece - that was very informative.

If I felt this piece was shaming I would not have posted it since no one needs that - shaming of mothers is something pretty high on my radar. I personally have had three inductions (one b/c my water broke w/ meconium present and two for week-and-a-half past due date with no active labor) and for every single one of my labors I had an epidural.

I am sorry anyone reading it feels that way because that was absolutely not my intention in sharing it on MeFi, nor for anyone to take what I feel is its even-handed suggestions or presentations of data (which of course one might disagree with) as personal criticism of their own pregnancy, labor, and delivery. The piece states right off "Of course, the idea is not to reject all interventions. The course of childbirth is not something that anyone can completely control. In some situations, inducing labor or doing a C-section is the safest option. And complications are the exception, not the norm."
posted by flex at 2:38 PM on May 11, 2012


One of the issues with epidurals is that it ties the mother to a bed or iv pole. While every mother's body and each baby is different, laying down is generally the exact opposite of what needs to happen. When laying down on your back, your pelvis gets smaller making it harder for the baby to come out. Being up and walking, dancing, swaying helps the baby work it's way down.

Had I been forced to lay down in a bed for my labor I would have had to have pain relief. In trying out what positions worked, I tried to lay down 3 times. It was horrific, unbearable. Getting up and moving around, getting in the birth tub made all the difference. I was able to deliver without any medical intervention.

Additional, epidurals can slow labor, requiring pitocin. Pitocin can make contractions come on harder, faster and stronger, which encourages the use of epidural.

I had an OB for most of my pregnancy. It was alright. Then I switched to a midwife and it was amazing. They treated my pregnancy and pending labor and deliver as a natural process rather than a medical "issue". Pre natal and post partum care was CARE instead of "treatment". They encouraged me to be an active participant in my care.
posted by HMSSM at 3:56 PM on May 11, 2012 [1 favorite]


Oh, and comparing a hospital to birthcenter birth costwise, the birthcenter ended up being several thousand dollars cheaper.
posted by HMSSM at 4:06 PM on May 11, 2012


This is frustrating, because their testing regimin is extremely rigorous, thorough and exhaustive. Check out any video where they demonstrate some of their testing - I was bowled over by the lawnmower video. Add into that extensive phone surveys on current and previous owners on a number of factors, and this is one seriously serious product appraisal.

Then, their editors toss all of that aside when coming up with blurbs, and pick inconsequential points of comparison to highlight. Some of it, like in their car reviews, comes from the fact they have much different ideas what's actually important to car owners than the glossy mags and gonzo-journo blogs... and Consumer Reports' priorities of reliability, practicality, economy and comfort are absolutely the correct ones.

But a lot of it is that there seems to be a disconnect between the testing and editorial departments. The magazine doesn't appear to know what the hell its talking about half the time... but the ratings themselves usually meet up with reality, and are more dependable, in my experience, than the advertising-paid media.


They may be all those things, but they still don't end up with the right answer. When I was a subscriber, I surveyed the things they rated highly, and purchased many of them. And I wasn't happy with the results.

More proof can be found in their car ratings. Cars that were identical, like the Dodge or Plymouth versions of cars, or the various GM manifestations of the same platform, came out rated differently. They have the same mechanical components and come out of the same factories. How can they be rated differently? Only one possibility: there is bias creeping in somewhere. Maybe not on purpose, but it is there.

So, while I'm sure they try hard and mean well, they just aren't trustworthy.
posted by gjc at 5:11 PM on May 11, 2012


If you feel like a doula is pushing her own vision of what birth should be and it doesn't mesh with your vision, she's probably not the right doula for you. A good doula will help you understand your options and work toward the birth you want, whatever it looks like (you know, within reason).

"Women who used midwives were more likely...to have a spontaneous vaginal birth without the need for an epidural." What does that mean? They weren't in any pain? Or their provider decided that pain relief was not "needed"?

I think it means that women who use midwives are more likely to effectively use other coping mechanisms besides pain meds, and also that women who want/plan to avoid pain meds are also probably more likely to seek out a midwife as a provider. Hospital midwives who are keeping their jobs are not in the habit of denying pain meds to women who want them.
posted by thirteenkiller at 5:36 PM on May 11, 2012


> "I'm just a guy, but it felt to me like there was a whole lot of shaming going on in that CR piece of women who make certain birth choices that don't happen to be fashionable right now."

I'm just a pregnant woman (10 weeks to go, whee!), but from my perspective it felt like it was an article pointing out that there are better alternatives than the standard that the US health industry is pushing - which to my British expat eyes, seems high intervention with less regard for the long term welfare of the mother. This is my first child, I've only lived in the US for a few years and this is my first major experience with the health system here. And despite having an excellent OB, I've still felt bewildered and talked down to and less informed about what happens than I could be. So this article? This is exactly the kind of thing I'm looking for, even though it's fairly recycled information, because it empowers me (and my husband!) with the knowledge that we have choices.

Women need to be encouraged to trust themselves and their bodies rather than listening to the naysayer culture that says (pretty much as soon as we announce our pregnancies) that life will go to hell in a handbasket, that the pain will be terrible, that it will all go wrong. The first choice we all need to be given is that we can deliver our children by ourselves with minimal intervention. It might not work out that way at the end of those 40 weeks... but we already know that. No woman is ignorant of how delivering a child can go terribly wrong. But the opposite? Doesn't seem so from my experiences.
posted by saturnine at 6:20 PM on May 11, 2012 [6 favorites]


"How can mothers be more racially diverse than they used to be?"

I think they mean mothers in the U.S. are more racially diverse than they used to be, as the U.S. becomes a more racially diverse country.

On a different note, I had the cephalic external version (CEV) they talk about in the article to try to turn my stuck baby over, at 38 weeks, and it was literally the most painful thing I have ever experienced in my entire life. It was ten times worse than the part where they actually cut me in half to remove a baby, or the part where I had to poop for the first time thereafter. It was excruciating.

My baby was crazy stuck with his butt wedged into my pelvis, and he didn't respond badly to the CEV (some babies have a serious stress response that can necessitate immediate delivery, generally by C-section). In fact, the OB who was trying to flip him was looking at him on the ultrasound during the procedure and said, "He's acting like he thinks this is fun, I've never seen a fetus do that before." But it didn't work -- he wouldn't budge -- and I had to have the C-section anyway. (And then they had to really yank him out because he was super-stuck and he had adorable little bruises on his butt from being super-stuck in my pelvis.)

I'm not sorry I attempted the CEV; at the time, I really wanted to make sure I tried everything* to NOT have a C-section. But it'd have to be a matter of life and death to make me try it with any subsequent children, it was just that bad. When people ask me about it, I generally say I'm glad I tried it, but that it was "pretty painful." Anyway, I wouldn't blame anyone who decided NOT to try the CEV, because it hurt like a MOFO.

*Not quite everything: A doula told me what I needed to do to flip the baby over was stand on my staircase, and put my hands two steps farther down the stairs than my feet, so that my butt was waaaay elevated and the baby would turn over. She said, "It works, I was sobbing with fear that my baby wouldn't turn, and the mucus from the crying was running up my nose and even into my eyes, but the baby turned over!" I was like, Are you fucking crazy? I wouldn't do that on my stairs NOT pregnant, I'm certainly not going to do it pregnant and fall down ALL THE STAIRS. Also if you have a situation that involves an optional situation wherein mucus from your nose is running copiously into your eyes, I think you're doing something wrong. Other things people swore worked that I did not try: putting ice on my belly ("they flip over to get their heads away from it!), pointing a flashlight at my vagina ("they turn towards the light!"), playing music at my vagina, and moxabustion. I did try yoga positions (and various other non-yoga positions suggested by a midwife and a physical therapist, but same idea), a therapy pool, CEV, and shouting at my belly in frustration.
posted by Eyebrows McGee at 6:27 PM on May 11, 2012 [1 favorite]


(CEV isn't that painful for everyone, btw. It's no walk in the park, but it's not that bad for everyone.)
posted by Eyebrows McGee at 6:29 PM on May 11, 2012


A doula told me what I needed to do to flip the baby over was stand on my staircase, and put my hands two steps farther down the stairs than my feet, so that my butt was waaaay elevated and the baby would turn over. ... I was like, Are you fucking crazy? I wouldn't do that on my stairs NOT pregnant, I'm certainly not going to do it pregnant and fall down ALL THE STAIRS.

...Couldn't you have done it at the bottom of the staircase?
posted by maryr at 7:11 PM on May 11, 2012


I've heard you can do that off the edge of the couch!
posted by thirteenkiller at 7:23 PM on May 11, 2012


"Couldn't you have done it at the bottom of the staircase?"

One assumes, but it still seems fall-inducing. And I'm still not sure I could manage that NOT-pregnant! (And yeah, you can do it off the edge of a couch or a bed, although for me, the way I'm built and the way the baby was positioned, that position made everything feel more smushed up and crowded, when apparently you're after the opposite effect. So I didn't do it a lot.)

The best thing was the therapy pool, which is 94 degrees and you just float around so the warm water can relax your muscles and the floatiness can lift the baby off your spine and maybe with relaxed muscles and everything floating the baby will turn. It didn't work either, of course, but at least I felt great after that one!
posted by Eyebrows McGee at 7:37 PM on May 11, 2012


I think it would have been safer to do that on a flat floor with a spotter. The stairs alternative seems unnecessarily dangerous for little to no benefit.

I would find a new doula.
posted by purephase at 8:22 PM on May 11, 2012


I don't see anything at all "shaming" about this - quite the opposite. The skyrocketing levels of c-sections seem to be attributable to something other than actual improvement of outcomes. It's totally valid to inform mothers about how they might avoid uneccesary major abdominal surgery.
posted by yarly at 8:51 PM on May 11, 2012 [1 favorite]


Yeah, the use of the word "shaming" is quite out of place.
posted by Burhanistan at 9:19 PM on May 11, 2012


I checked out all the resources inthe links and was disheartened to find only 3 hospitals in my state follow guidelines for the best practices for breastfeeding (mine isn't one of them) and that the closest birth center is still about 80 miles away.

Looks like there's definitely room for improvement.
posted by misha at 9:38 PM on May 11, 2012


Bellman, under the disclaimers that 1) I'm also a dude and 2) one of my best friends is a CNM, I find your use of the word "fashionable" to be curious. In fact, the first two recommendations made in the article go directly against what are clear trends shown in the attached graphs (despite CR's failure to label their axes).

For better or worse, health care in the United States is a market in which the consumer has some choice (at least for people who buy the magazine.) The article is encouraging its readership to exercise this discretion against the attending tendencies of service providers to maximize profit by minimizing cost and insurance exposure while emphasizing value-added services. Cost can be minimized by shortening the periods both of gestation and labor, thereby maximizing revenue for given fixed costs of plant and labor. Insurance liability can be be minimized by externalizing health risks to outside the scope of coverage. Value-added services come in the form of various medically unwarranted procedures.

Regardless of any scientific or anecdotal evidence whatsoever, these market pressures will exist and are observed. None of them are beneficial to the recipient. There's a lot of specious evidence (both scientific and anecdotal) being thrown around, both in the article and this thread. The important thing is for people to be conscious of and discretionary with respect to the above-noted market pressures in choosing their care, to whatever extent they may be able to do so. "Fashion" has nothing to do with it.
posted by 7segment at 12:10 AM on May 12, 2012


I am very skeptical that "shortening the period of gestation" minimizes any costs. The only "carrying cost" for a healthy pregnancy is the regular checkups, which require maybe 10 minutes of a provider's time per week, at the end. As for "shortening the period of labor" (and recovery) -- the way to do that is to not use epidurals, not induce labor, not do a C-section. These "medically unwarranted procedures" you mention are the real opportunity for cost savings, if you're looking for them. Epidurals (which require an anesthesiologist) are expensive, surgery even more so, and induced labor requires a great deal more time in the hospital than natural labor (the early part of which is usually spent at home.)

Surely if cost savings were the driving factor in health care provider's decision making, then we would be seeing exactly what this article advocates: minimal intervention. High rates of natural childbirth. The cheapest obstetrical care is no obstetrical care, or just observation.

I don't think that "minimize intervention" advice is necessarily wrong. But let's please have an assumption of good faith. Everybody wants what is best for women and babies. We can discuss what that is, and whether we're achieving it in the US. But almost nobody is twirling their mustache and doing C-sections for profit, or convenience.
posted by OnceUponATime at 4:17 AM on May 12, 2012


Oh, purephase, she wasn't my doula; she was just one of those women who feels qualified to comment on everyone else's pregnancy all the time, which I think is why she BECAME a doula. She's kind-of a twit; I only mentioned she was a doula because I feel like "not falling down the stairs" ought to be a lesson in doula-school. Or a lesson in the School of Common Sense; I guess usually you don't have to TELL people not to encourage pregnant women to fall down the stairs.

(I did not actually use a doula; we talked about it, but my husband wasn't really comfortable with a non-medical outsider being with us during a private family event, and I didn't want a ton of people watching me labor anyway and after our labor-and-delivery class I felt reasonably confident about the process, and we're comfortable with our ob/gyn practice. But then I had a C-section anyway so it was moot.)
posted by Eyebrows McGee at 11:42 AM on May 12, 2012


Cars that were identical, like the Dodge or Plymouth versions of cars, or the various GM manifestations of the same platform, came out rated differently. They have the same mechanical components and come out of the same factories. How can they be rated differently?

Ah, I've seen this, though. With GM, it's Buick - if you needed to buy a GM product in the '80s or '90s, it better have been a Buick. Those things last, long after the almost identical Chevy, Olds and Pontiac models had rusted or rattled themselves into the boneyard.

It seems that even when sharing the same assembly line and parts bin, the cars were put together differently - they had different QC checks, and one batch of parts that might have passed a Chevy inspection would have been sent back to the supplier by Buick (and then likely sold to Oldsmobile). One of the reasons Buicks cost more (and why you wanted a Chrysler PT Cruiser instead of a Dodge Neon despite the shared engine and suspension - Chrysler was the "premier" brand, and pickier about finish and quality. Not much pickier, but still.)
posted by Slap*Happy at 7:50 PM on May 12, 2012


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