Midwifery Care

Assumption: Women need to be under the care of a medical doctor to receive the best are during pregnancy.

FALSE
Unless there are “substantial medical or obstetric complications,” women should be offered the choice of being cared for by a midwife.  In randomize trials, women under the care of midwives experienced no adverse affects and felt more in control of their birthing situations.

http://www2.cochrane.org/reviews/en/ab004667.html

My Views:
I love the midwife-led model of care, personally.  Midwives tend to be able to give their patients more individualized time at each appointment and in my experience this translates to women feeling more educated and more empowered about making choices regarding birth.  Many people do not realize that a midwifery model is available in some hospitals, so those who do not want to have their babies at home can still receive midwifery care.

Some recommendations for midwifery care in the San Antonio area:

Hospital birth:
Lone Star Midwives
http://www.lonestarmidwives.com/

Birth Center or Home Birth:
San Antonio Birth Center (Alisa Voss)
http://www.birthcentersa.com

Family Birth Center (New Braunfels)
http://www.birthcenternb.com/

Home Birth:
Jennifer Kelleher
http://www.birthexperiencemidwives.com

Robin Rabenschlag
http://www.multipleblessingschildbirth.com/

Salli Gonzalez
http://www.empowermentbirthing.com/

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Epidural Pain Relief

Assumption: Epidural analgesia relieves pain during childbirth with no adverse affects.

FALSE
According to studies, epidural analgesia does usually relieve pain during childbirth.  However, using an epidural often led to longer labor, stalled labor, and low blood pressure.  After the birth, women who used epidurals had more problems passing urine, moving comfortably, and were more likely to have a fever than women who did not use epidural analgesia.

http://www2.cochrane.org/reviews/en/ab000331.html

My Views:
Many women feel that the pain relief is worth these relatively minor effects.  Others do not want to experience the effects and decide instead to pursue other forms of pain relief.  The answer to the epidural/ no epidural question is as unique as each woman who answers it.  The only thing I recommend for ALL women is to know the possible effects before agreeing to the procedure.  Knowledge will empower you and help you make the decision that is right for you, your baby, and your family.

Repairing Tears

Assumption: Surgical repair is necessary after a first or second degree tear to the perineum.

FALSE (up to 8 weeks postpartum)
These studies indicate that between birth and 8 weeks postpartum, there was no difference in pain or complications between women with tears that were surgically repaired and those with tears that were allowed to heal spontaneously.

http://www2.cochrane.org/reviews/en/ab008534.html

My Views:
This is interesting because it would certainly be nice to allow tears to heal on their own.  Unfortunately, there are no long-term studies and one of the studies quoted here did find a difference in how the wound closed so I cannot recommend that tears not be repaired.  However, it is nice to know that it is not absolutely necessary.

Accupuncture in Labor

Assumption: Accupuncture and accupressure can help relieve pain during labor.

TRUE
In a study involving 1,986 women accupuncture and accupressure did relieve pain.  Pain was “less intense” and fewer pain relieving drugs were requested than with the placebo groups.

http://www2.cochrane.org/reviews/en/ab009232.html

My Views:
Although I have not known anyone personally who has used accupuncture in labor, I do know many who have used accupressure points and found them very helpful.  I believe that accupuncture and accupressure are valid ways of dimming pain.  However, even if you do not believe in the practices themselves, accupuncture and accupressure are relaxing and relaxation has been proven to relieve much of the pain associated with labor.

PROM: Home or Hospital

Assumption: Once membranes have ruptured, women are safer in the hospital than at home.

FALSE
Yet another topic in which there is not enough information to make a full conclusion.  These studies are interesting, but need more data!

The studies examined here measured outcomes when waters broke preterm. The studies covered 116 women, so the pool is too small to make definite conclusions, but of those women, people who STAYED AT HOME after the rupture were ultimately more satisfied with the experience and had no worse outcomes for mom or baby.  Women who went to the hospital were also more likely to have a cesarean birth.

http://www2.cochrane.org/reviews/en/ab008053.html

My Views:
My personal experience includes water breaking at 36 weeks and waiting 3 days for labor to begin.  I was not uncomfortable and was careful to protect against infection.  I was certainly much more comfortable at home with my family than I would have been in the hospital and am grateful that I was “allowed” to be at home during this time.  All worked out fine and Baby N got an extra 3 days of gestation. 🙂  But I’m just one case…