Technology In Perinatal Care

Birth Trauma Has Lasting Psycological Effects

Although alomst addressing trauma to the nervous system when looking at birth trauma, there is growing evidence that the traumas of birth have lasting psycological effects.

"Although controversy can still be generated, especially among persons who are not acquainted with contemporary findings, we should not proceed arrogantly with the routine traumatization of our infants at birth! Fortunately, an increasing number of therapists are being privately trained to recognize and work to resolve prenatal/perinatal trauma, but there could never be enough of them to do the work that is piling up. It would take an army of therapists to keep up with endless production line of trauma at birth! Their work could be--and should be--eliminated with the prevention of unnecessary traumas of contemporary obstetrics. But there is no end in sight at this time."

David B. Chamberlain, Ph.D.   Birth Trauma is Real!   Birth Psychology



The Due Date Dilemma

A recent report in the OB/Gyn Journal Dec. 2001 states that eliminating the concept of a due date, “may be helpful to all involved.”

The process of calculating due dates may be flawed as not all women ovulate 14 days from the onset of their menstruation. Additionally, other health factors of the mother play a role in delivery time. In reality, only 5% of all babies are born “on schedule”, anyway.

Because of the due date women feel pressured, become anxious and are led into inductions by their practitioners. Inductions usually lead to further interventions in birth. Interventions in birth frequently lead to trauma for both the mother and baby.

Dr. Vern Katz suggests that doctors expand the concept of a due date to a “due week.” In doing so, “it may allow biology to take its course a bit more.”

Katz VL, Farmer R, Tufariello J, Carpenter M   Why we should eliminate the due date: a truth in jest   Obstet Gynecol 2001 (Dec);   98 (6):   1127-1129

 

Incontinence Due to Forceps and Vacuum Extraction Births:

The relative risk of new mothers developing persistent urinary incontinence was 2.8 at one year following forceps delivery and 0.8 following vacuum delivery, compared with the risk of incontinence following spontaneous delivery, according to a study of 315 women. Of the group, 150 had spontaneous delivery, 90 had forceps assistance, and 75 had vacuum extraction. The rate of incontinence at two weeks postpartum was 13.3% in the vaginal delivery and vacuum extraction groups and 12.2% in the forceps group. The rate at three months postpartum was 6.8% and 6.7% in the vaginal and vacuum groups, respectively, and 12.5% in the forceps group. The trend continued for one year postpartum, with 3.7% in the spontaneous vaginal group and 2.8% in the vacuum group, compared with 9.8% in the forceps group.

— OB/GYN News, April 15, 2001

Is More Neonatal Intensive Care Always Better?

Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Low birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates.

The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately more providers per low birth weight infant, but offers less extensive preconception and prenatal services. This study questions the effectiveness of the current distribution of US reproductive care resources and its emphasis on neonatal intensive care

Thompson LA, Goodman DC, Little GA   Is More Neonatal Intensive Care Always Better? Insights From a Cross-National Comparison of Reproductive Care   Pediatrics 2002 (Jun);   109 (6):   1036-1043



High level of resources for neonatal intensive care does not give US better outcomes

The United States has more neonatologists and neonatal intensive care beds per person than the United Kingdom, Canada, or Australia but higher rates of low birth weight and death among neonates,

The study compared neonatal intensive care resources, preconception care and prenatal care, rates of low birth weight and neonatal deaths (deaths within the first month), and infant mortality (deaths within the first year).

Janice Hopkins Tanne   High level of resources for neonatal intensive care does not give US better outcomes   Brit Med Jou 2002 (Jun 8);   324 (7350):   1353



Should obstetricians see women with normal pregnancies?

A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives in Scotland compared with shared care led by obstetricians. The results concluded with these findings: Routine obstetric visits for women initially at low risk of pregnancy complications offer little or no clinical or consumer benefit.

Care by general practitioners and midwives improved continuity of care: there were fewer carers, non-attendances, and hospital admissions, and marginally fewer routine visits than with specialist led shared care; incidences of hypertension, proteinuria, pre-eclampsia, and induction of labour were also lower.

Should obstetricians see women with normal pregnancies? A multicentre randomised controlled trial of routine antenatal care by general practitioners and midwives compared with shared care led by obstetricians   Brit Med Jou 1996 (Mar 2);   312:   554-559