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Wednesday, October 31, 2012

Episode 57 (Epilogue): How to Avoid Unwanted Intervention

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This week’s episode focused on medical intervention, and how expectant mothers can avoid them. Cheryl and Carmela begun the discussion by talking about the fact that 1/3 of U.S. mothers give birth surgically, while half of all labors in the United States are induced or augmented with medication.
Our first guest was Nicette Jukelevics, childbirth educator, researcher, and author of  Understanding the Dangers of Cesarean Birth: Making Informed Decisions. Nicette  talked with us about the different ways in which mothers can avoid medical intervention during labor, as well as what measures are important for expectant mothers to take in order to find supportive care providers. Nicette discussed the widespread usage of interventions, from IV’s, to epidurals, to episiotomies, to labor inducers, as well as how the usage of these interventions may increase risk for more serious interventions such as Cesarean sections. Nicette argued that this model of routinely used intervention is not the only way, and that research shows the reduced intervention combined with evidence based care is actually linked to the best birthing outcomes.
Nicette also provided our listeners with a variety of different aspects of birth and care for expectant mothers to consider. She noted that when thinking of what questions to ask one’s care provider, it is important to hone in on what you are expecting from a birth and what needs must be met by that type of a provider. For example, Nicette noted that in the case of a midwife assisted birth it was important to find out the midwife’s back up plans if a complication were to arise, while in the case of a hospital birth it was important to find out the content of the hospital’s admission and consent form in order to better understand their routine protocol.  Nicette also talked to us about the benefit of having a doula, specifically in a hospital setting. Nicette described a doula as a specially trained birth companion who provides continuous emotional and physical support during birth and immediately postpartum, and noted that women who have doulas often report having faster births with less intervention.
Our discussion with Nicette ended with a discussion of C-sections. Nicette pointed to many scheduled C-sections being related to third trimester ultrasounds, which have not been proven to improve health outcomes, but have led to more scheduled C-sections due to measurement of baby’s size which categorize them as being “too large” for vaginal delivery. Nicette also discussed breeched birth, and despite the fact that 65% of external versions are successful in getting a baby into the traditional birthing position,  many people do not know about this, and instead go along with a scheduled C-section without trying it. Nicette also talked about the need for more doctors who are trained in birth breeching in the US, and that breeched birthing attempt should attend to position of breech and health of mother and baby, and not necessarily jump to planned C-sections as a first option. We also discussed with Nicette the fact that anyone has the right to refused a C-section, and that preforming one on someone who does not consent is illegal. We ended our discussion with Nicette on the topic of VBACs, or vaginal births after Cesarean, and encouraged women who are attempting a VBAC to make sure that they have a care provider who is supportive of their wishes.
Our final guest was Mary Catherine Hamelin. Mary talked to us about her own success in obtaining the natural vaginal birth that she wanted in a hospital setting. She noted that the most important aspects to achieving this goal are to be informed, confident, and to have support. She also described the ways in which her own support in the hospital model inspired her to become  a doula who could in turn help other receive this same kind of care. 

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