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

Breast milk is spoken of as the natural food of young mammals. It consists of water, butter fat, milk sugar, some albumen, and salts. Undoubtedly it is the ideal food for the very young, even though the modern pediatrician, obstetrician, and mother have tried to outmode it. Dr. Holmes said that the young mother possesses two globes far better suited for the providing of nutriment for her young than the cerebrum of the wisest professor.
It is not a very heavy diet and it is undoubtedly wise to supplement it after a bit. I believe that many doctors nowadays start some solid food in the first few weeks of life. The milk of the cow has now entirely superseded mother’s milk for a goodly proportion of American babies. I doubt if anybody suggests that cow’s milk is better for the baby; rather they use the old familiar sales talk that it “is just as good.” The argument is all for the “modern mother” who for some occult reason cannot take the strain of nursing as women have done for millions of years. We were brought up on the teaching that nursing was part of the normal physiology of a woman who had just borne a baby. It is said to aid in bringing the uterus back to its original pre-pregnant condition. It delays the return of menstruation. It seems hard to believe that nursing is not worth while.
Not long ago I jotted down (from some source) the statement: “One of the effects of civilization is the fact that a large proportion of human infants have become parasites on the cow.” It is claimed that in northeastern United States only 23 per cent of infants are fully breast fed on discharge from maternity units. In England 80 per cent of hospital babies are discharged fully breast fed; ninety-five per cent of those born at home. An advertisement of a baby food states, “The most logical are on that regimen substitute is that which achieves the closest approximation to breast milk.” Another advertisement of a well-known baby food says, “This food closely approximates mother’s milk.” When even the manufacturers admit that their products are somewhat inferior, why do most American mothers and their physicians persist in using them? Both groups are a little shamefaced about the matter. Physicians report that the mothers refuse to nurse. The mothers say that they are discouraged by their doctors. We are told that mothers lack the desire to breast feed their babies because of the convenience of bottle feeding and a belief that their figures will be spoiled. Physicians now seem obsessed with their superman ability to handle modern products. I think the herd instinct has much to do with the whole matter. It would not be surprising to find at some future date a tremendous enthusiasm for breast feeding.
*8/276/5*
WOMEN’S HEALTH

A revolution in health care has caught Americans off guard. New research tells us that much of what our doctors and hospitals do for pregnancy and birth is wrong, expensive, and dangerous. That same research has found good, inexpensive, and safe methods for bringing babies into the world.
Although the United States may offer some of the finest medical technology on earth, millions of our citizens suffer inadequate health care. And the cost of medical care has zoomed to 810 billion dollars a year – a sum to stagger any treasury.
Add to this the fact that of the 4.17 million babies born in the United States each year, 39,000 die before their first birthdays of ills that are largely preventable. As for infant safety worldwide, statistics show that the United States has 9.7 deaths for every 1,000 births -ranking a lowly 22nd. Japan is first, with only 4.4 deaths per 1,000; Sweden is second, with 5.7.
But the new science of birth could improve that. A research team led by Dr. Murray Enkin has produced perhaps the world’s most careful and systematic study on childbirth. For 10 years, this team searched the world for solid scientific data on what’s wrong and what’s right in the handling of pregnancy by hospitals, doctors, midwives, nurses, and pregnant women themselves. Dr. Enkin is professor emeritus of obstetrics at Canada’s McMaster University in Hamilton, Ontario, and a principal researcher for the pregnancy project at Oxford University in England.
Much confusion surrounds pregnancy, Dr. Enkin says. “There are old wives’ tales, old doctors’ tales, medical textbook statements, doctors’ beliefs, scientific data, and communal myths.”
Although many caregivers do a great deal of good for mother and baby, Dr. Enkin’s team found that several do not. For example, he says, it is very important to provide a pregnant woman with social and psychological support. It reduces her anxieties about an easy and successful delivery, about the baby’s health and her own, and about the running of the family after the baby is born. However, Dr. Enkin adds, too many physicians fail to provide such support.
The Oxford team also discovered that hospitals and the staff members who oversee births -primarily doctors and nurses – routinely employ some methods of care that ultimately not only offer little benefit to mother or infant but actually can be dangerous to them. For example, some hospitals put healthy newborn babies in nurseries to prevent their mothers from passing on infections to them. However, evidence shows that generally it is much safer for the infants to room with their mothers, in whose bodies; after all, they were carried and nurtured, and very likely instilled with immunities. In the nursery, on the other hand, germs spread to the healthy infants from the sick ones.
Research shows that keeping mother and child apart for 4 hours or more can have dire effects, such as the failure on breast-feeding and the restriction of maternal affectionate behavior. How such separations affect maternal behavior has been the focus of much of this research. Urging that mother and newborn share a room, rather than be separated, the Oxford team cites a study suggesting that such routine hospital separation policy has led to an increased risk of child abuse and   neglect   among   socially   deprived, first-time mothers.
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WOMEN’S HEALTH

The medical profession is helping out more and more travelers who have not made a good start through what Dr. Clement Smith calls the Valley of the Shadow of Birth. A baby born much before the full nine months is in a hazardous situation, the hazard being the greater the earlier the arrival. In the past, premature births have been responsible for over a third of infant deaths. It is nice to be able to report that much has been done about this matter and that premature babies are getting a lot better chance.
You see, these babies had planned to spend considerable more time in a very warm, very wet, and infection-free place until they had developed all the parts of their bodies and got them working better. The physicians say that they have “undeveloped physiological responses.” They are not even ready to breathe well. Therefore, it is difficult for them to get just the right amount of oxygen, a very important material.
These are all incubator babies, for one thing that these tiny babies cannot do is to regulate their body heat and they have very little to lose. They have lots of water in their tissues and little fat, while a full-term baby has less water and usually a great deal more fat.   It is necessary to have the air in the incubators moist as well as warm. The temperature is kept in the eighties but the air is not so dry as in your own rooms.
The babies will stand very little handling and they have little ability to resist infection. For the most delicate cases, hospitals now use a glass box with small openings on the sides so that the nurses may scrub up as they do for operations and, by putting their arms through these holes, may handle the baby without moving him about. Often the babies are too weak to suck and are fed through a tube. They should have breast milk.
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WOMEN’S HEALTH

Prolonged labor is a good reason for a cesarean. Some obstetricians charge that epidural painkilling slows the birth process that the mother, feeling no pain, fails to push hard enough to squeeze her baby out. Many anesthesiologists argue that epidurals speed some deliveries by reducing pain’s stress. But Dr. Ezzat Abouleish, professor of anesthesiology and obstetrics and gynecology at the University of Texas Medical School in Houston, says data from England show epidurals don’t affect labor’s duration. Janet O’Driscoll, 36, of Cleveland, says she feels she had an unnecessary C-section. “I was given an epidural. I could not feel the contractions. I could not push. The baby was coming down, but the doctor decided that the baby was too big. So cesarean surgery was performed. The baby weighed 8 pounds, 5 ounces.”
Mrs. O’Driscoll had two more children easily, by vaginal birth -one weighing 7 pounds, 8 ounces, the other 10 pounds, 1/2 ounce. “I think my first baby could have come out with the proper encouragement,” she says.
Despite the campaign to lower the numbers of unnecessary C-sections, many conditions do make them necessary, says Dr. Flamm. For example:
•      Slowed labor -the baby isn’t seen to be progressing down the birth canal.
•      Small pelvic bones -the mother’s frame is too small for baby’s passage. (But normal births have succeeded in hundreds of cases.)
•      Breech birth -when the baby is not coming through headfirst. If the doctor cannot turn the infant from a buttocks-or legs-first position, a C-section may avoid damage to mother and child.
To avoid unnecessary and dangerous birth surgery, first ask the doctor about his or her rate of cesarean deliveries. If the rate exceeds 15 percent, you might do well to look for another physician. Otherwise, you risk having surgery performed at the first sign of even the slightest trouble.
Research shows that if you have a vaginal birth after cesarean surgery, 99 percent of the time your baby should be at least as healthy as if delivered by surgery. And you will be playing the key role in your child’s destiny.
However, if the doctor advises a C-section during your labor because you or the baby are not faring well, your best bet is to follow that advice.
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WOMEN’S HEALTH