Benefits of inducing would seem to be avoiding postmature syndrome, attempting to deliver a baby that had grown too big for the mother and bypassing meconium staining. However, studies fail to confirm this line of thought. The actual amount of time needed for a baby to grow to term varies and figuring an exact due date for each baby has not yet been done. Ultrasounds have at best a 10 day window of error if done in the first trimester. The phenomenon of postdates, is poorly understood. Macrosomia occurs prior to postdates as does"postmature syndrome." (p. 181) The entity of postmature syndrome is based on a single physicians "subjective evaluation of 37 babies." Research seems to indicate that watchful waiting is the more prudent course of action for healthy women. 14

IV

At a great many U.S. institutions, one of the first items of care to be rendered to the obstetric patient will be her IV, "just in case." Just in case she needs drugs or surgery or her veins collapse making insertion of an IV impossible. Nancy Wainer Cohen and Lois Estner interviewed many labor and delivery nurses to find out how frequently a laboring woman's veins collapsed. They learned that this does not happen. This is not the way birth happens in other nations, where a laboring woman is permitted to eat and drink lightly. This cultural warping began in the 1940's when anesthesia was being given to nearly all birthing women by mask and vomiting and food aspiration were risks associated with this. Eliminating food and drink, they felt would eliminate this risk. Today, however, anesthesia methods have improved and this is no longer the problem it once way. Improved intubation techniques make this problem virtually a thing of the past. Doris Haire, a maternity care writer, in looking at 20 years of medical literature on aspiration during surgery found that the cause was not eating or drinking prior to the surgery, but caused by incompetence of the anesthesiologist.

General anesthesia is given to approximately 4% of those who undergo cesarean section. Approximately 0.3% cesarean surgeries will require intubation that will be difficult to do yet not all women who require intubation will aspirate. This translates into denying all laboring women food and drink because 1 cesarean sectioned woman out of 10,000 may aspirate.

Although IV's are supposed to keep the stomach empty, a glucose IV actually works to slow down the emptying of the stomach. It also may encourage tissues to swell so that it makes it more difficult to intubate, if that becomes necessary. IV fluid accumulates in the bladder and that may slow down labor. Some women may have sensitivities to the IV and have a reaction from one. It restricts the woman's mobility. The needle in the arm is painful and inhibits free movement. The baby also may suffer from the mother's IV, as studies are being done to determine if the excessive sugar administered through a glucose IV may harm the baby. 14, 15, 16

LITHOTOMY

This used to be the position of choice for physicians doing hospital births. The mother lies flat on her back with her knees in the air. It is a most unphysiologic position for mom and baby, but it does give the physician a good view of the mother's perineum. While in this position, the mother must push the baby out uphill. It is known to cause fetal distress due to the baby lying on the mother's arteries and veins. Most women will not choose this position if given alternatives.

Dr. Roberto Caldeyro-Barcia is considered an expert on this position for labor and delivery. He and his researchers found that this lithotomy or supine position is the worst one for laboring women because it adversely affects every facet of birth: makes labor more painful, reduces uterine activity, and can dangerously lower blood pressure. He says, "Except for being hanged by the feet, the supine position is the worst conceivable position for labor and delivery." 17, 18

MONITORING

Electronic fetal monitoring is required at nearly every hospital for at least a short time. When it was first available, it was used only for the most high risk situations. However, it is now used for everyone regardless of risk status. A large reason why EFM is used so extensively is that staff is in short supply and this technology allows for fewer care-givers.