Women's Health

The research team – about 40 doctors, mathematicians, and public health experts – rated the effectiveness or danger of 285 forms of care, including pregnant women’s diets, the birthing position, episiotomy (cutting the skin and underlying tissue at the bottom of the vagina to prevent ragged tearing during delivery), and keeping a newborn in the hospital nursery or in a crib near the mother’s bed. Here are some of the results:
•      100 of the 285 forms of care studied were rated successful and safe.
•      37 were rated possibly effective, needing more exploration.
•      88 had unknown effects, requiring more research.
•      60 were rated “should be abandoned -they do little good and produce danger.”
The study criticizes the birthing position common in most urban hospitals – women lie flat on their backs or put their feet in stirrups, with the pelvis slightly tilted. Research suggests lying on the back can adversely affect labor by interfering with the blood supply of mother and baby.
When the mother is allowed to select positions during labor, she is likely to choose standing or walking for the first stages. She will feel less pain and need less pain medication if the birth canal is open wide. If she needs to lie down, she will elect to lie on her side during delivery, or she may squat and deliver the baby with her own hands. Although many cultures use the squatting posture, little scientific evidence supports its use in preference to standing or lying on one side.
Try this quiz: Test your knowledge – your doctor’s too. To answer, circle T or F for true or false:
1.  T or F? A medical doctor must supervise the entire pregnancy and delivery in case something goes wrong.
2.  T or F? It is really much safer to have your baby in a hospital, using the latest equipment and know-how.
3.  T or F? Hospital nurseries protect newborns from germs.
4.  T or F? Episiotomy eases birth, and suturing (sewing) the cut afterward prevents pain and infection.
5.  T or F? Once you have a cesarean, or C-section surgery, all later births must be by C-section, too.
As you may have guessed, all the answers are false. But many obstetricians and other doctors still insist they are true. And that is sad, because all of these long-established procedures can cause harm. The researchers found that episiotomies, for instance, often do not help and actually injure the vagina.
Hospitals are dangerous for both mother and baby, says Dr. Keirse. “Having a doctor involved in all pregnancies can be a bad thing. You get more technology, more hospital infections, more unhappy mothers – and more cost.
“It comes down to whether you consider pregnancy and birth pathological [disease] or physiological [normal] events,” he says. “As soon as a doctor shows his face, everything turns toward disease. It’s hard to accept that having obstetricians at all deliveries is a bad thing. Yet, if you have well-trained mid-wives, very few deliveries need a specialist present. In the Netherlands, 30 percent of all women deliver safely at home.”
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WOMEN’S HEALTH