Consumer Reports: high-tech births=poor outcomes
by Amy Gates

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.

Comments

 

Our Births are Ridiculous!

I hope that getting this agencyinvolved will eventually lead to the change America so desperately needs regarding birthing.  It is a travesty that in such a medically rich environment, the death rates among mothers givign birth and babies being born are some of the highest in the world.  When, exactly did birthing become such a business and stop being about the natural process of bringing a human being into the world?

Having had 2 c-sections myself with a VBAC inbetween, I know the dangers.  Hospitals want patients in and out and if your birth is not progressing in what they deem to be a "timely" fashion, they will try to intervene.  It is all the interventions that cause more complications and problems resulting in higher c-section rates.  Do you realize how many Ob's have not been trained in normal, natural birthing?  They are trained to be surgeons, to get the baby out, not to support the mother in doing something that should come naturally. 

Sure, there are exceptions, but they are in the minority and that really needs to change.  Women need to be empowered and educated that they can do this!  Oh, it is so frustrating, thanks for this post!

Carrie at Stop Screaming I'm Driving!

 

I don't get it.  I really

I don't get it.  I really don't get it.  Why does anyone blindly trust a medical professional?  I grew up around a lot of medical professionals and would never blindly trust them...

MLO / Melissa

 

Your title is quite misleading.

The article states that doctors are overusing high tech procedures, which I agree with. But to state that High tech procedures=poor outcomes is very misleading, and notably incorrect.

 

Visit my blogs at ThreeSeven (all that's irrelevant and amusing) and
ecochick (all that's green, cool and Canadian).

 

I understand what you are

I understand what you are saying. I feel it is a fair title though. In the article they state, "Childbirth without technical intervention can succeed in leading to a good outcome for mother and child, according to a new report." So I feel that when unnecessary intervention is used, it can lead to a poor outcome. Of course, "poor" is subjective, but when a mom (who was healthy and low-risk, but was induced and then diagnosed as failure to progress and rec'd a c-section) has to spend weeks recovering from a c-section and can't easily breastfeed or pick up her baby or walk around, I think that could be considered by some as poor. Of course a healthy baby is always the goal, but I think maternity care and birth care in this country could be done differently to lower the c-section rate and lower the use of other often unnecessary procedures.

As is said in the article, "The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment."

It's definitely a controversial subject, but I'm highly in favor of getting information out there, thereby empowering women and allowing them to make informed choices.

Amy
Crunchy Domestic Goddess
BlogHers Act contributing editor

 

uh oh...

I totally agree with a previous commenter that you should NEVER just rely on doctors to manage your healthcare.  It's the same with your (and your kid's) education...you've got to be involved and question those with authority.

However, I had 5 of those 6 "high-tech" procedures done during both of my deliveries and I had a wonderful experience with childbirth...with no negative effects that I can tell.  So again, do what you think is right for you.

xoxo

tcb 

 

I learned my lesson

My OB had to reel my tiny 6 lbs. daughter out of me like a fish on a hook via vaccum extractor. Why? Because as a first-time mom, the epidural worked way too well. I had no idea how to push, couldn't feel the contractions. She came out looking like a cone head. :(  I believe I came very close to a c-section.

First I got mad, then I got educated. My next three babies: with a hospital midwife, no drugs. All mommy-power pushing. Very empowering, I might add. No more cone head babies for me. 

Monica

Paper Bridges: a blog about books, faith and life.

 

I had

an unecessary c-section with my son.  I hope, now that I am educated, that I can shoot for a VBAC with my next one.

 

The Title Is Just Fine, Not Misleading

I am sorry, but I have to disagree with the commentor that stated the title was miseading.  The c-section rates in America are through the roof!  Yes, healthy babies and moms are the ultimate goal (and a higher hospital bill due to major surgery which trickles down to the pocket books of everyone on the other end of the experience) but at what cost?

For each unnecessary intervention, like induction, there is a side effect (fetal distress, for example).  Then there is risk of needing another intervention, like major abdominal surgery, which carries a whole other slew of complications and risks. Do you see how the snowball effect happens?

The long term effects of c-sections are also problematic, as each time a patient has surgery, scar tissue is formed and that in itself can cause lifelong reproductive and gynecological issues.  Trust me.

I will always advocate for the education of child-bearing women when it comes to their care and the care of their pregnancies.  They need to be encouraged to stand up to medical beliefs and practices that may not be in their best interest, but in the best interest of the doctors time and the hospitals bottom line of doing business.  Did you know that there are more c-sections done late in the day so that doctors can make it home at a decent hour?  It's true.

I suggest watching "The Business of Being Born" for more information - it will open your eyes about the history of birth in American and where it stands now.

Carrie at Stop Screaming I'm Driving!

 

I hadn't seen this issue yet, thrilled,
though!

yay for shopping for childbirth methods and approach in the same logical comparison model as shopping for a car. 

I am glad this is getting out there - I've been a fan of Childbirth Connection's evidence-based information for years (including the portion that was MaternityWise.org, now merged as part of the same organization). I used it a lot for my own pregnancy and birth experiences, at least for the education part.

I ended up with three hospital births, but all for appropriate medical reasons, and no uniformity of procedure involved - pitocin without epidural, for example, and expectant management of a long labor rather than clock-limits on labor - even with an epidural that time. The evidence in evidence-based medicine can point toward intervention, or away from it, depending on the situation. It's when the high-tech is used because it is there, rather than because evidence supports its use in this patient's case, that the problems snowball.  

Hands Full of Rocks: http://hedra.typepad.com