Consumer Reports: high-tech births=poor outcomes

BlogHer Original Post

Consumer Reports isn't just for researching your next car purchase or washing machine anymore. That's right, that longtime resource for product reviews has broadened its scope to include health and wellness. In a recent article Consumer Reports tackles the topic of childbirth, concluding that "Too many doctors and hospitals are overusing high-tech procedures."

Consumer Reports cites a new report, Evidenced-based Maternity Care by the nonprofit Childbirth Connection, which found that "in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies." Some of those interventions include:

  • Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
  • Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
  • Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization's recommended national rate of 5 to 10 percent
  • Electronic fetal monitoring, unnecessarily adding to delivery costs
  • Rupturing membranes ("breaking the waters"), intending to hasten onset of labor
  • Episiotomy, which is often unnecessary

The study suggests that high-touch, low-cost, noninvasive measures are underused in today's maternity care for healthy low-risk women. These include:

  • Prenatal vitamins
  • Use of midwife or family physician
  • Continuous presence of a companion for the mother during labor
  • Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one's back
  • Vaginal birth (VBAC) for most women who have had a previous Caesarean section
  • Early mother-baby skin-to-skin contact

They've also included a quiz to test the consumer's knowledge about maternity care and debunk several misconceptions. Here are a few examples from the quiz.

An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.

False. Studies show that the 8 percent to 9 percent of U.S. women who use midwives and the 6 to 7 percent who choose family physicians generally experienced just-as-good results as those who go to obstetricians. Those who used midwives also ended up with fewer technological interventions. For example, women who received midwifery care were less likely to experience induced labor, have their water broken for them, episiotomies, pain medications, intravenous fluids, and electronic fetal monitoring, and were more likely to give birth vaginally with no vacuum extraction or forceps, than similar women receiving medical care. Note that an obstetric specialist is best for the small proportion of women with serious health concerns.

Once you’ve had a C-section, it’s best to do it again.

False. Studies show that, as the number of a woman’s previous C-sections increased, so did the likelihood of harmful conditions, including: trouble getting pregnant again, problems delivering the placenta (placenta accreta), longer hospital stays, intensive-care (ICU) admission, hysterectomy, and blood transfusion.

Labor itself can benefit a newborn’s immunity.

True. When babies do not experience labor (if the mother has a C-section before entering into labor, for example), they fail to benefit from changes that help to clear fluid from their lungs. That clearance can protect against serious breathing problems outside the womb. Passage through the vagina might also increase the likelihood that the newborn’s intestines will be colonized with “good” bacteria after the sterile womb environment.

The buzz in the blogosphere about this is mostly positive. Critics of the current state of birth in the United States are happy to see Consumer Reports raising awareness about the need for change and bringing this information to mainstream society.

The blogger at Rain Garden says, "I feel encouraged that a non-profit organization like Consumer Reports is picking this up on their radar - it is just one more spark that may ignite change."

Susan at Hug the Monkey agrees and says, "It's kind of amazing that a mainstream and respected organization like Consumer Reports has gotten behind natural childbirth. This must signal a shift in our society's ideas."

Shay at Augeries of Innocence says, "This just goes to prove pretty much everything that is in The Business of Being Born. If you haven’t seen the DVD, I highly suggest you watch it, rent it or buy it. Even if you’re not wanting to go completely natural for your birth, it has a lot of helpful information on it and really lets you see how wonderful the childbirth process can be."

Yogi Barrett, a prenatal class instructor who blogs at Five Points Yoga, says,

Though women and their partners shouldn’t have to become “experts” on maternal and fetal care when they’re pregnant, it’s very helpful to remember that you are a paying consumer. I recommend finding a doctor or midwife who will take the time to answer the questions you have, and who will talk to you about your choices, options and alternatives. Too often, women come to my class and say something like, “My doctor won’t let me go past my due date. She’ll induce me if I do.” We have to remember that we have a responsibility in all of this to ask questions, and know that it’s *our* decision whether we have that test or procedure. We cannot abdicate responsibility for our bodies and our babies, even if a doctor/midwife presents a procedure as non-optional. The time to set up this dynamic is before you’re in labor – it’s difficult to have rational conversation and decision-making in the midst of active labor!

If you’re pregnant, remember that you need to have confidence in your provider. It’s never too late to switch providers if you’re unhappy. I’ve had students switch providers mere days before giving birth! But also remember, the most important person to trust is yourself, and your baby.

I couldn't agree more. As a natural birth advocate myself, I think the fact that Consumer Reports posted this study is huge and another step in the right direction. Women want to be informed, they want to make conscious choices regarding their prenatal care and their birthing care for their sake and the sake of their babies. The more information women and their partners easily have access to, the more empowered they will be to make choices that are best for themselves and their babies.

Contributing editor Amy Gates blogs about green living, attachment parenting, activism and photography at Crunchy Domestic Goddess.

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