[from Monty Python’s The Meaning of Life. Transcript here.]
A couple of articles have been sitting in my Journalwatch pile for a goodly while now, so here they are.
“Effects of Pushing Techniques in Birth on Mother and Fetus: A Randomized Study”
Gulay Yildirim, PhD, Nezihe Kizilkaya Beji, MD
Birth, 35(1), pp 25-30, March 2008.
This Turkish study randomised a group of term low-risk first-time mothers into two pushing groups.
The first was coaching on conventional Valsalva-type pushing, which is routine in labour management in many countries. It was accepted as standard in Turkey before this study. If you’re unfamiliar with birth, this is the technique you see in the vast majority of American movies and sitcoms: “PUUSH! PUUUUUUUUSH! PUUUUUUUUUSH!!!!!!”. The woman is instructed to close her glottis and hold her breath while pushing. Typically this occurs when the woman’s cervix is determined to be “ten cm” dilated, sometimes without waiting for the spontaneous urge to push to become overwhelming.
The second group of women was supported in spontaneous open-glottis pushing.
* The duration of second stage was longer with Valsalva pushing.
* The babies did worse with Valsalva pushing, with lower 1- and 5-minute Apgar scores, lower umbilical cord pH, and lower oxygen levels.
* Women were less satisfied with coached Valsalva pushing.
So women don’t like coached Valsalva pushing, it lengthens labour, and it may put babies at risk. Why are we still doing it?
Women’s Autonomy and Scheduled Cesarean Sections in Brazil: A Cautionary Tale
Joseph E. Potter, Kristine Hopkins, Anibal Faúndes, Ignez Perpétuo
Birth 35(1), pp 33-40, March 2008
This study looked at birth in Brazil, which has a private-sector Caesarian section rate of 70%. The authors interviewed over a thousand women, one-third private sector and two-thirds public sector, twice during their pregnancy and once a month after the birth, about their birthing wishes and about what eventuated.
* Over 70% of women in each group expressed a preference for vaginal birth, with the rate slightly higher in the public-sector group. However, the cesarean section rate was 72% in the private group and 31% in the public group.
* 64% of the private C sections were scheduled, compared to 24% of the public C sections.
* The incidence of medical reasons for a scheduled C section among private sector patients who had no previous cesarean birth and who wanted a vaginal delivery was 13 percent (31/243).
We already have a massive difference in Caesarean section rate between our private and public hospitals here in Australia. In WA in 2005, the C section rate was 46% in the private sector, and 28% in the public sector. Is this where we’re headed?
And lastly, this joyful birth video. I could watch it over and over. The woman is on her back, but it is said in comments that she chose the position freely (a few women do.) The smile on her face as she meets her baby is just gorgeous.
Posssibly NSFW, if birth is NSFW where you are, but there’s nothing unexpected or unpleasant about it.