Risk Of Cerebral Palsy

Risks And Benefits Of Hospital Procedures
By Yvonne Lapp Cryns

In spite of all the advertising touting "home-like" birthing rooms in hospitals, for most women, a hospital birth will be nothing like a home birth. Interventions are routine in the hospitals in my state. Every laboring woman will be hooked up for some period of time to an electronic fetal monitor, given vaginal exams, and be told where and in what position she must give birth. If her membranes are ruptured, she will be required to deliver her baby within a certain time period. If her labor is moving too slowly, she will be given pitocin to augment it or have her water artificially ruptured. She will be told how many companions she may have with her. If she has other children she may or may not include them at the birth. How long she is kept in the hospital will vary depending on her physician and the particular hospital. How soon her baby will be released also will depend on the baby's pediatrician and hospital policy. Some of the more common interventions that take place during hospital births are discussed below.

AMNIOTOMY

Artificially breaking the amniotic sac is done routinely at many hospitals to speed labor up, get labor going, to test the fluid or to get it out of the way so that an internal monitor can be screwed into the baby's head. It was believed that breaking the water would speed up labor by 30 to 60 minutes but the only randomized control trial done disproved this. This procedure causes cord prolapse, a serious complication for the baby and increases the chances of an infection. With less amniotic fluid in the uterus during labor, the baby has a greater risk of cord compression problems leading to fetal distress and malpositions of the head. 1, 2

DRUGS & EPIDURALS

Nearly every woman giving birth in a hospital will receive a drug at some point during her stay. Pitocin is frequently used to induce or augment labor. Because it causes abnormally strong contractions, many women receive a pain-relieving drug such as a narcotic. Unfortunately, narcotics also are received by the baby and can affect the condition of the baby at birth and for years after. Some of these side effects are respiratory problems, impaired muscular, visual and neural development in the first week of life and in the following years, lower reading and spelling scores, difficulty in solving problems or performing tasks when they pose a challenge.

The new drug of choice at many hospitals is the epidural. It must be administered by an anesthesiologist and requires the mother to remain in bed afterward. She must be flushed with an IV fluid prior to getting it to keep her blood pressure up. A needle is inserted into the woman's back and small catheter is left in place where the medication is injected. It numbs the woman's body from the ribs to the toes. Many women ask for this drug because they do not want to deal with the pain of childbirth and believe it is safe for themselves and their babies because the physician who administered it, their obstetrician and the labor and delivery nurses all encourage the use of it and give no information regarding side effects.

The known complications are many ranging from requiring EFM, IV, immobility, urinary catheterization. An epidural also may allow no sensation of labor or the pushing urge, lower blood pressure, abnormally relax the pelvic muscles which may encourage the baby to adopt malpositions of the head, may decrease the production of oxytocin at critical times, and increase the need for forceps and cesarean section. Epidurals cause some serious complications such as heart attack, spinal damage, and spinal headache. After the birth, chronic backache is a common complaint as well as backache. The baby may be exposed to narcotic drugs given to enhance the effect of the epidural and which if given alone can compromise the baby's respiratory efforts as well as require the newborn to metabolize the drugs. We do not know the short or long term effects of the epidural or other drugs on the baby. Some claim that the baby is unaffected unless the mother becomes hypotensive. Some non-interventionist birth attendants recognize that occasionally epidurals may be useful for certain situations. Some examples when an epidural may permit a normal birth are for maternal exhaustion, severe back labor, certain malpresentations or psychological dystocia. Although the FDA approves drugs as safe or unsafe, they have no definition of safe and do not guarantee safety of drugs. Many who work with brain damaged children, wonder if the disability is due to obstetric drug use. They also question if women would make the drug choice if they were given complete information about side effects. The American Academy of Pediatricians discourages the routine use of obstetric drugs. 3, 4, 5, 6, 7