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Are Hospital Birth Procedures Dangerous?

on May 11 | in Birth | by | with 25 Comments

For the record, I don’t hate doctors. In fact, if I had a high-risk pregnancy I would insist on having a doctor at my birth. Why? Because doctors are trained for high-risk situations. The problem is that their “worst case scenario” training often prevents them from seeing birth as it usually is: low-risk, uncomplicated and completely normal. What do we end up with: Reverse alchemy which turns beautiful low-risk pregnancies into high-intervention situations.

America spends a larger percentage of its gross domestic product on health care than any other industrialized nation, yet its citizens aren’t healthier for it. This is especially true when it comes to childbirth. Having a baby is the No. 1 reason for hospitalizations in the U.S., and a Cesarean section is the most common operation. In 2006, $86 billion was spent on maternal and newborn hospital charges, but despite this spending, our infant mortality rate ranks 29th among industrialized nations and our maternal mortality rate is a dismal 36th. (Emphasis mine for all quotes)

Fit Pregnancy: Better Births, Lower Costs

Before this gets glossed over as just another statistic let me say it differently. We spend more money to bring our children into the world than just about any other country and yet more babies die here than in 29 other developed nations. We lose more mothers than 36 other nations.

What Are We Doing Wrong?

Too often a pregnant woman goes to a hospital in early labor and ends up feeling micro-managed and undermined. She may have preferences that are completely legitimate but against hospital policy so her wishes are ignored.

For example, many hospitals do not allow women to eat or drink during labor so that if anesthesia is administered they won’t vomit and choke on the contents of their stomach. However, in “three large U.S. studies totaling 78,000 women in their Birthing Time that ate and drank freely, there was not once case of aspiration!”¹

On the flip side, there is a real danger of women becoming dehydrated and losing strength if not allowed to eat or drink. “Fasting causes the mother more discomfort as she cannot focus when her blood sugar is low, and further, fasting can cause ketosis, a weakening of the muscle cells, causing the uterus to work less efficiently.”² As someone who could not keep anything down for 12 hours during labor I can personally attest to the horrible effects of dehydration while trying to birth a baby.

Fit Pregnancy recently published an excellent article on evidence-based maternity care, and it got me thinking: What’s the rationale behind some of our most common obstetric procedures? Are they evidence-based or are their benefits naively taken for granted?

Below are my thoughts (and some actual research) on common L&D procedures, which together are sometimes referred to as the “Cascade of Interventions.’ (By “solving” one problem, these procedures often cause another unintended problem that requires another intervention and so on.)

Step One: Monitor, Monitor, Monitor

If you head to the hospital in early labor your medical team is likely to put a fetal monitor on you even though this restricts your freedom of movement. They will do this even though they know that the ability to walk and move freely helps labor to progress.

*There is NO proven benefit to continuous EFM [external fetal monitoring] over periodic checks of Fetal Heart Tones – birth outcomes have been shown to be the same whether EFM is used, a hand-held Doppler or a non-electronic fetoscope . . . This method does use ultrasound which has never proven safe . . . and may switch attention from the mother to the machine.

Hypnobabies Childbirth Class Manual, p. 87

When labor does not progress as quickly as your doctor would like move to Step Two.

Step Two: Produce or Induce!

Did you know that your baby’s health becomes more precarious right before your doctor’s big vacation in Maui? Okay, maybe not, but far too often doctors pressure mothers into inductions because they want to schedule births around their leisure time. Don’t believe me? That’s fine, but I’ve heard this straight from L&D nurses who really know what’s going on. Of course, such selfish reasons are not likely to fly with you, so they need to make it sound legit. How about “your baby is getting too big to deliver vaginally? If you don’t induce you’ll end up having a c-section.”

I’m not saying doctors outright lie. But either consciously or unconsciously they are more likely to focus on factors that justify an intervention when it suits their schedule.

Here’s the catch: If your body isn’t ready to give birth it won’t respond properly to pitocin. Choosing to induce to avoid a “big baby” could very easily take you down the “cascade of interventions” road, resulting in the cesarean you were trying to avoid. In addition, size estimates are wildly inaccurate. Below are some stories from real moms:

I have a friend who’s OB told her that she had to ‘get her baby out’ due to his ‘large’ size. It was her first baby, he was brought into the world via c/s. She had NO labor at all. Not even a twinge. He was born approx. 9 days early. He was 8 pounds 2 ounces, a completely average sized baby. Boy, was she angry that she had to have major surgery for nothing!

Kendra

My last birthing was induced, and it turned out that my daughter was seriously premature due to the induction, and ended up in the NICU. She was 6 pounds, but my first two babies were born at 8 lb. 8oz and8 lb. 6oz. She was not ready to come out yet, and to this day it grieves my heart that I let the doctor talk me into an induction, and one so early! The reason for the induction . . . I was having some contractions, had ‘gestational diabetes’ and would probably have a ‘huge baby’! Instead, I had a baby who couldn’t breathe on her own, nearly died in transport to the children’s hospital, and was intubated for 3 days, with a 10 day stay. I’ll take an 11 pounder any day over that! It is still one of the most painful memories of my life.

Blessings, Lisa M

Excerpt from Hypnobabies Childbirth Class, p. 100 and 101

As if that weren’t enough, pitocin reduces the amount of natural oxytocin (the bonding hormone) that your body makes.

If you are given pitocen (which is the synthetic version of oxytocin) to induce your labor, or increase your contractions, this actually reduces the amount of the real oxytocin in your body.  You see a woman’s body will recognize the synthetic hormone as oxytocin and will not produce the real stuff (in regular amounts) since the imposter is already present.  The downside is that pitocen, since it’s man-made, can’t release the euphoric sense of love and ecstasy in your brain that oxytocin does (Yeah, bummer man). Ya follow? Which is why you really don’t want to be induced with pitocen if you don’t have too.  Also, did you know that having in induction increases your chance of c-section by 50%? YIKES. On top of that, an epidural increases your chance of c-section by 40%! Double YIKES!

Joy Kusek, Doula

An alternative way to start the cascade is for moms to request induction. The last few days/weeks are pregnancy can be extremely uncomfortable, so why not skip them? Not realizing that lung function is unlikely to be optimal until they naturally go into labor, moms mistakenly believe that induction is completely safe. Not so, says the Fit Pregnancy article:

Preterm births also contribute to expensive stays in the neonatal intensive care unit (NICU). Now there’s growing recognition that delivering even a few weeks early raises the risk of breathing and feeding problems and difficulty maintaining body temperature, says Sue Gullo, R.N., M.S., director of the Perinatal Community at the Institute for Healthcare Improvement (IHI) in Cambridge, Mass.

Step 3: Epidural Express

Since pitocin causes unnaturally strong (and painful) contractions, the next step in the cascade of interventions is to perform an epidural to relieve the pain. Epidurals can slow down labor and make pushing more difficult, meaning “additional interventions such as Pitocin, forceps, vacuum extraction or cesarean may become necessary,” says American Pregnancy. Hmmm, cascade of what?

Also, evidence links epidurals to early breastfeeding challenges. According to La Leche League International, “Infants whose mothers had no labor analgesia scored higher (x=11.1) on the breastfeeding scale than mothers who had epidurals (x=8.5) or intravenous narcotics (x=8.5).”

Step 4: C-Section Station

Boston University Professor Gene Declercq, who has researched home births for over 20 years, recently described a typical scenario leading to a c-section.

. . . because the contractions as a result of the induction become very strong, then they have to do an epidural to try to relieve the pain from those now stronger than natural contractions. That may slow labor a little bit further and then they have to keep adding intervention upon intervention to the point where at the end somebody says ‘We’re going to do a cesarean. Thank God we’re able to do this cesarean.’ Wherein if they hadn’t started that series of interventions in the first place, we may never have gotten to that point.

I’m not saying every intervention leads to a c-section. I know plenty of people who had vaginal births after receiving an epidural, including my mom. But, according to the Fit Pregnancy article, “Nearly one-third of the 4.3 million childbirths in 2006 were via C-section, compared with one-fifth in 1997.” And the numbers rise every year. There are situations for which I am very grateful cesareans are available. Circumstances in which they are necessary.

All this leads me to ask, if birth outcomes are so poor why do we keep using these procedures on a routine basis? For the record, I am totally support women choosing to give birth in a hospital if that is where they feel most comfortable. My point is that our infant and maternal mortality rates clearly indicate something needs to change.

I am incredibly grateful for hospitals, doctors and lifesaving procedures when they are needed. If a woman wants to be induced or receive an epidural she should, provided she is informed of the increased likelihood that she will need a cesarean. On the other hand, low-risk moms should be given freedom to move freely, eat, drink and refuse interventions without a fight. I know of some cases in which this occurred, but it seems like more of a shining exception than the norm.

There are many ways hospitals could improve L&D outcomes. Some already utilize the assistance of midwives alongside physicians with great results. The benefit of midwifery teams working in hospitals is that they are better equipped to guide low-risk laboring women through the natural laboring process. That’s what they’re trained to do. With their help labor often progresses smoothly, mothers feel safe and attended to, and unnecessary interventions are reduced.

In more complicated circumstances some physicians are stepping up. Some specialize in helping women attempt vaginal births after multiple cesareans even though they have to pay more in malpractice insurance. I know of a doctor that is able and willing to assist in vaginal breech births rather than insisting on a cesarean.

What do you think? Am I crazy? Love me anyway?

Read part 2 of this series: Are Home Births Safe?

Resources

Birthing Beautiful Ideas – The C-Section Blame Game

Childbirth Connection – Cascade of Intervention in Birth

¹ Hypnobabies Childbirth Class page 90
² Ibid
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25 Responses to Are Hospital Birth Procedures Dangerous?

  1. Mae says:

    I love you for posting this. thank you for being so diligent in your research. I hope people actually READ the article, not just the title.
    Well done, Heather

  2. very well said! i’m glad you put the disclaimer at the end so people won’t think you’re judging them for having their baby with interventions. the more i read about natural childbirth, the more it makes me wish i had given birth that way with mine. well, IF i have another, i for sure know which route i will take! my experience with augmenting labor and induction and epidurals has been pretty good as my pushing times were VERY short, and i’m thankful. BUT, i have seen firsthand in the OB practice i used to work for, that it was very common practice to induce at 39 weeks, and perform a c-section if the mother hadn’t given birth by 5:00 pm or so for “failure to progress”. Pretty sad. The “cascade of interventions” is right on.

    • Heather says:

      Thank you, Joanna. Personally, I choose homebirths partly because I think I would cave and ask for an epidural if it was readily available! It’s not what I want theoretically, but there were points during Katie’s birth that I sure did wish for one. Epidurals and other interventions are common in other countries that have better outcomes because they are more judiciously applied. That’s what I’m hoping these types of discussions will promote.

  3. Kathryn says:

    I respect all moms for how ever they choose to give birth. I think sometimes moms are pressured into procedures and drugs that they might not need. People want to be able to trust their doctors, but it seems like sometimes these procedures are to make the doc’s life easier.
    I have chosen to have all 6 of my babies in a hospital. 5 of 6 times I did have a midwife. 4 out of 6 I did it with little monitoring, no IV and no drugs. My midwives were always supportive of my choice to do it naturally….the nurses were another story. I think they were mostly freaked out, because they just aren’t used to birth being so “un-medical”. When I stood my ground I got my own way. :) The last 2 times I was given pitocin after birth to stop my bleeding and help my uterus to contract. Good article!

    • Heather says:

      Love your comment, Kathryn! You make a good point about birth being “un-medical,” and it’s so awesome that you stood your ground. I wonder how many women you paved the way for that would have had MORE trouble (not to say they didn’t have any) with the same nurses.

  4. Richard says:

    What pissed us off when Dawn had Beth, she didn’t want the epidural and waiting till I was gone before “forcing” her to have one. I say that because she was drugged up and was not in her right mind to make decisions.

    On the flip side, had she not had a C-Section, Beth might have died. Her cord was wrapped around her neck.

    • Heather says:

      Thanks for your comment, Richard. Sounds like you had the best and the worst of it. On the one hand an intervention may have saved Beth’s life, and on the other a medical professional tried to go around you and pressure Dawn when she was vulnerable. Based on your comments here I doubt she would have tried that if you were around!

      • Richard says:

        The C-Section wasn’t the issue. We already knew that if she got too big (she was already a high risk pregnancy). The issue was the epidural. They forced Beth early because she hadn’t moved or kicked in over an hour and her blood pressure was up.

        The Doc probably did save Beth’s life, but he did it using 6 different IVs, a busted water, and a rather disturbing comment “Let’s see how fast we can do this one.”

  5. Jen Winn says:

    My best friend just had her baby last Thursday. She was a high risk pregnancy due to high blood pressure, past miscarriages, and concerns of preeclampsia. Her pregnancy originally started out as twins and she ended up losing one of the babies at the end of her first trimester. The doctor decided it would be best to induce her 3 weeks early since she had been in observation for high blood pressure the last two times she was in his office.

    They softened her cervix over night and gave the final treatment at 5:30 AM. At 9 AM they started the pitocin. Once the pitocin started, the baby’s heart rate started dropping very low. They would have to stop the pitocin and try to position her to get a response out of the baby. This continued on until 5:00 PM, once the doctor had seen all of his patients for the day. She she was only dilated 1cm, the doctor decided it would be best do to a c-section. During the c-section, the doctor cut the babies head with the scalpel making the incision. The baby had been down in the canal for probably close to 12 hours and her head was completely cone shaped. She ended up having to have 3 stitches.

    All in all the day was a complete nightmare. The baby is perfectly healthy but I just feel like there were so many unnecessary things that occurred the entire day. Knowing that she was high risk and everything that was going on with the pregnancy, why didn’t the doctor make a decision sooner? How did he not know where the baby’s head was?

    • Heather says:

      Jen – Although I don’t know much about the medical implications of high blood pressure and its effect on your friends birth outcome, I understand your sadness over her experience. She is very blessed to have a friend like you that cares not just about the end result but also emotional impact of the process.

  6. Meaghan says:

    I don’t think you’re crazy I think all of that is pretty dead on. A few years before I had violet a good friend of mine was on medicaid so naturally the only choice was hospital. She was given a “husband’s knot” without her consent which to this day causes her pain. That’s one of those fun things that happens with episiodomys. Honestly I was much more scared of that than any labor pains I had. LOL.

    But yah you are so right, women are told this is safe and normal so why would they believe differently (though obviously it is neither safe nor normal). Donna up at the birth center was actually my mom’s midwife, and she found Christy for me when I was pregnant and let me tell you, that was such a blessing! My husband was skeptical at first but knew better than to argue with me (LOL) so he went along with it. Now he tells everyone that he’s a natural birth advocate and that Violet’s birth was the best experience of his life! He’s witnessed a medicated “normal” hospital birth with his daughter from a previous relationship and even he agrees that something was not right with it.

    Anyway I’m so long winded…but like I said…no you aren’t crazy! :)

  7. Des says:

    stop the press, you and I are actually going to TOTALLY agree! :-)
    Yes I had hospital birth with a doctor both times, yes I had an epidural both times, yes I had pitocin one time, but I am grateful to have never had additional complications other than lower heart rate due to the pitocin causing such long, hard contractions that the baby didn’t have enough time to fully recover (with Lyric). (which isn’t anything to brush off- but thankfully no lasting complications occurred as a result).
    I TOTALLY agree that doctors and nurses pressure most women to give birth on THEIR time table and not let the body do what it was created to do.
    The more babies I have, the more informed I get about these things. Had I not had an AMAZING doctor that was a friend of ours, attended our church and was a believer AND managed to have the same amazing L&D nurse both times who was VERY supportive of whatever and even suggested alternate things, then I could have easily been in the c-section percentage since I have a narrow pelvis and both of my children had a lot of trouble getting under it and most doctors would have sent me for a c-section or episotimied the crap out of me. But she respected me and what I wanted.
    Unfortunately, we moved and so I am looking into alternatives. ALL that said, I am going to try and have my next baby with a midwife at a birthing center here. They are really strict (socialized medicine) and may not take me because I’m considered high risk (b/c of going into labor so early with Shiloh) but am praying for the perfect midwife to believe in me. I’m like you, there is NO way I can do a natural birth in a hospital knowing that I COULD have an epidural to make the pain stop :-)
    So, great article and totally agree. The medically (un) necessary interventions are TOTALLY leading to a ridiculous csection rate and robbing SO many women of an amazing vaginal delivery. Obviously some are totally necessary, but I agree that the many are not.
    Why do I always ramble so long on your comments lol :-)
    PS. The Business of Being Born is a really great documentary about all of what you just wrote an article about. http://www.thebusinessofbeingborn.com/

    • Heather says:

      I knew it would happen someday, but I never thought it would be on THIS topic! I hope you get the home/birth center birth you want with #3 and blog about it like crazy so I can get your take on the contrast!

  8. Lucy says:

    I agree whole-heartedly with Meaghan…you’re not crazy, you’re right! Living in the UK, I had no idea US hospital births were carried out this way until about a month ago, and I after asking myself ‘why’ and ‘how’ over and over again I come to the conclusion that doctors and obstetricians are simply selfish. Either midwives keep themselves to themselves, or they’ve been misguided too.

    I think it’s unfair that women have to choose between hospital and home because they want to fight for a natural birth. My reasons for wanting a hospital birth are simply that if something were to go wrong, or I were to be traumatised by labour, I wouldn’t want m home to remind me of it. I’m lucky, though, and I know that giving birth in a British hospital won’t mean I’m encouraged to have an epidural. In fact, encouragement and epidural are not used in the same sentence in UK midwifery…a woman can ask for an epidural, but it’s only mentioned as an option, if at all by the midwife.

    Before I write an essay, thank you for his post, I really enjoyed it and I hope it reaches some first time Mums out there…giving birth for the first time must be scary and I know I’d do whatever my midwife/obstetrician advised in a blink of an eye. Let’s hope that advice becomes more about the woman and her baby in future, as opposed to staff schedules!

    • Heather says:

      Well said, Lucy! I am hoping it will reach first time moms as well. They are the most vulnerable to the “cascade of interventions” since first labors are typically longer and doctors get in a rush. It’s so sad because many are too afraid to attempt a VBAC with later children.

  9. vanessa says:

    both of mine were born in the hospital and i loved it. my advice is to research your doctors. my ob is very old fashioned and likes to do everything naturally. she is definitely my safety net. she does not recommend inductions or epidurals. she is always available when i have any questions or concerns and not once do i remember her taking a vacation or “leisure time”.
    i absolutely love hearing those little heartbeats at every visit and seeing that beautiful little profile on the sonogram. just seeing those little limbs flutter in the first months check-up, then seeing how much that wonderful baby has grown and now has actual body parts and no longer looks like an alien in the last months checkups. lol. what a joy.
    i would much rather have that reassurance during my labor of a doctor being right there in case of high risk. i would seriously kill myself if anything happened to my baby during labor.
    my daughter was a full term baby- 40 weeks- and weighed 7lbs 9oz and my son also went to 40 weeks and weighed 9lbs 6oz. no complications with either pregnancy or labor and both were natural births :)

    • Heather says:

      Vanessa – Your doctor sounds fantastic. Good point about researching. I know of a family that switched doctors during the third trimester when they learned about the high c-section rate their first provider had.

  10. Jerri says:

    That’s a great post, Heather. I totally agree with you. If you take away the possibility of an epidural, you are forced to reach way down inside and find the strength to make it through. I had all five of my kids with no medication. I tried getting an epidural with #2 and #3, but I am one of the 5% of women whose epidurals simply don’t work. The epidural was not effective at all. When I HAD to make it through, I did it. And I’m so glad I was forced to do that.

    Also, I have coached and helped approximately 50 women through childbirth, basically a doula. Some of the women gave birth at home. Some were at a birthing center, and some were in the hospital. I have seen the negative side of medical births, and the joy and peace of “un-medical” births. But on the other hand, I have seen negative home experiences (a very small percentage) and women who had to be transported to the hospital. The bottom line is you have to be at peace with the way you have decided to give birth. During the time I was having my babies, we had amazing health insurance. We only paid around $50 for each birth. The insurance wouldn’t pay for midwives. If they had covered home births, that’s what I would have done. But we had peace that I should be at the hospital. That was the right choice for us then, but I LOVE the home births more!

    I guess that was just a long way to say, “I agree with you on every point!”

    • Heather says:

      Jerri, you are amazing. For me, the point where I had to dig down deeper than I ever had during labor was my “moment of truth” in motherhood. In the sleepless days and months that followed I looked back on that moment to remind myself that there is something deeper and more mysterious than will-power. I wish I could put it into words, but I think you’ll know what I mean. When I feel like I’m failing as a parent I remind myself of that moment, pray, and dig deeper.

  11. Ashlie says:

    I had a hospital birth with my daughter and a home birth with my son. The home birth was done exactly they way I wanted it. In the hospital I was controlled told what to do, without any say. My daughter was given shots I never knowingly consented to. I would encourage women to seriously consider A midwife, they will let you plan and have full control over your body and the birth. I received excellent care from my midwife.

  12. Joy says:

    Something to keep in mind: Not only do many Birth Center take Medicaid (Midwives that are CNMs are approved by the government for coverage. Though CPMs are not), but birth centers are required by law to be within minutes from a hospital. They are required to be close enough to a hospital so that if mom must be transferred she will be in the operating room with 30 minutes. Which is exactly how long the hospital will tell you that it will take to have a mom laboring at the hospital already in her room to get prepped and in surgery.

    Most instances of birth center transfers to hospital are not truly life-threatening emergencies, transfers are often because mom is white-knuckling it through labor. There’s a vast difference between pain and suffering during labor. If a woman enters into a place of suffering (and it can’t be fixed through position changes, encouragement, etc.) and as a result of that suffering stops progressing in labor, sometimes an epidural is exactly what she needs. Midwives know to look for this and will at times be the one who suggest a transfer.

    Birth Centers keep statistics in the same way that hospitals do. If you’ve got a question, you can call and ask for their statistics. I know that the Birth Center here in Denton has a transfer rate of 8% and out of that 8% not all of those moms end up or needed C-sections. Considering that the state average in Texas for C-sections is around 32% – less than 8% is excellent.

    The world health organization (WHO) states clearly that when a nations c-section rate rises above 15% it is a signal that something is very wrong with healthcare.

  13. Shawna says:

    I recently attended the Tarrant County Birth network meeting that discussed infant mortality in our state. I too have been alarmed by these same statistics that you have mentioned (like our nation’s terrible ranking in birth outcomes) and have heard about the dangerous effects from the “cascade of interventions” , but I wanted to add that I learned at this meeting that maternal nutrition and stress levels, pre-pregnancy health, and good pre-natal care are the leading indicators of baby’s health outcomes- I am a natural and homebirth advocate, but I think it is unfair to suggest that hospital procedures are related to our poor infant mortality rankings without mentioning that in our country doctors are obligated to admit any woman in labor the hospital, but not obligated legally to provide pre-natal care for the un-insured who can’t afford it, and therefore often don’t have it. So many babies die because their mom’s have undiagnosed STD’s are don’t gain enough weight during pregnancy, or are too obese.

    Having said that- it is SO important that ALL mothers have the opportunity to access evidence based, mother-friendly care in labor and delivery and recieve the emotional support they need during labor to let their body do the work! It’s amazing how much pain relief can be felt from just standing up rather than laying down with an EFM and IV attatched to you…not to mention the bathtub! And these don’t carry the dangerous risks that epidural anesthesia does. I fully reserve the right to have an epidural in situations with extremely painful complications- but I do think that many doctors do not fully educate their patients properly about the risks that pain relieving drugs pose.

    I also resent the fact that the costs in $$$ to “rescue” babies from the cascade of interventions has made it nearly impossible for a self-employed person to afford health insurance that includes maternity coverage!!! Everyone should be insured- just in case the worst happens- but it sucks to have to pay $450/ month for basic catastrophic that would cover NICU etc. but still have to pay for 80% of the birth costs!!!

  14. Korina says:

    This is all very scary! I would love to have a homebirth and even my husband said he would totally support me on that, God bless him. The problem is the area I live in it is absolutely unheard of! There are no midwives to attend a homebirth and we live at least thirty minutes from the hospital. We do however have the option of choosing a doctor who has a CNM in his practice that attends births at a birth center just outside of the hospital. I think it would be great if you could do a post on how to give birth natually in the hospital for those of us that do not have the option of home birth. Which procedures to avoid along the way and how to make yourself more likely to avoid interventions. The doctor will claim everything he is doing throughout your pregnancy and labor are necessary for the health of your baby and no one wants to risk their babies health so they just go a long with it. Most women I know do not know for sure which procedures are truly necessary and which they can go without.

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