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Making childbirth easier

Post by Ali on Sun Apr 28, 2013 7:41 pm

http://www.bbc.co.uk/news/health-22327882

Investigating how the womb works is the priority at a new research centre dedicated to understanding the problems experienced in childbirth and labour.

That knowledge, researchers say, will help them learn more about premature labour, miscarriage, stillborn babies and why emergency caesarean births have risen by almost 50% in the last 30 years.

Professor Susan Wray, director of the Centre for Better Births at Liverpool Women's Hospital, recognises that many women have gone through hell during childbirth.

"If we were talking about another organ [apart from the womb], we wouldn't put up with it," she says.

A team of 20 scientists, postgraduates and doctors are looking at how contractions of the womb are regulated and controlled.

Armed with this knowledge, medics could find new ways of helping women whose labour is not progressing as it should.

"We need to have predictors - when it will be a difficult birth, when a woman might go into early labour, for example," Prof Wray says.

"There are bio markers for some diseases, like breast cancer - we need to do the same thing for pregnancy."


Well I hope they succeed because this can only be a good thing, it might also have the advantage of lowering the excessive numbers of uneccessary C sections performed each year which in turn will end up not only preventing stress in women but costing the NHS less in the long run.
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Re: Making childbirth easier

Post by Tam on Thu May 02, 2013 7:17 am

I think the number one thing that needs to be done is to stop treating pregnancy like a disease. Medics are often the reason *why* labour does not progress as it should, as their very presence puts a labouring woman into flight mode. Also recognising that there is no 'due date' would be progress, as so many women end up being unnecessarily induced due to medics getting twitchy, and that can then end in emergency C section because induction itself increases the chance of complications.
This is one of the many reasons independent midwives (whose only concern is the woman and baby, not NHS protocol or targets) are so incredibly important, and why the profession being at risk due to government red tape is such a scary thing.

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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 7:27 am

Tam wrote:I think the number one thing that needs to be done is to stop treating pregnancy like a disease. Medics are often the reason *why* labour does not progress as it should, as their very presence puts a labouring woman into flight mode. Also recognising that there is no 'due date' would be progress, as so many women end up being unnecessarily induced due to medics getting twitchy, and that can then end in emergency C section because induction itself increases the chance of complications.
This is one of the many reasons independent midwives (whose only concern is the woman and baby, not NHS protocol or targets) are so incredibly important, and why the profession being at risk due to government red tape is such a scary thing.

I don't agree with the no due date Tam, there is a risk of the placenta failing if a pregnancy goes on for too long but I do agree that medical intervention increases the risks of childbirth.

I think independent midwives do a marvellous job, but even they rely on the services of the NHS when it's necessary to do so.
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Re: Making childbirth easier

Post by Tam on Thu May 02, 2013 7:45 am

Oh absolutely, but the window for normal birth is well between 38 and 42 weeks, whereas some doctors push for induction as soon as the exact 40 week mark has passed without any indication that the placenta is in any danger of failing.
Totally agree, my third baby was a preemie so even with my independent midwife I was cared for by two wonderful NHS midwives too. I also know though that with my first two babies my really bad experiences would have likely been much better with an independent midwife in the picture simply due to the misinformation I was given about what I 'had to' do, which was nothing specific to my baby or my situation, but solely their protocols.

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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 7:51 am

Tam wrote:Oh absolutely, but the window for normal birth is well between 38 and 42 weeks, whereas some doctors push for induction as soon as the exact 40 week mark has passed without any indication that the placenta is in any danger of failing.
Totally agree, my third baby was a preemie so even with my independent midwife I was cared for by two wonderful NHS midwives too. I also know though that with my first two babies my really bad experiences would have likely been much better with an independent midwife in the picture simply due to the misinformation I was given about what I 'had to' do, which was nothing specific to my baby or my situation, but solely their protocols.

A normal pregnancy is somewhere between 37 completed weeks and 42 completed weeks and doctors shouldn't be pushing for induction right on the 40th week. It doesn't really have to be by 42 weeks there is leeway but there is a need for regular check ups to keep track of the baby's health and I wouldn't like to think of women going much too long after that.

I think a lot of the experiences women have come down to where they choose to give birth, midwife led units are great although they are also bound by the same protocols as the consultant led units but the downside with independent midwives is they cannot get insurance and if something were to go wrong or a mistake was made, there is absolutely no come back at all.
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Re: Making childbirth easier

Post by Tam on Thu May 02, 2013 7:56 am

Yeah, I feel like that's one of the problems though, doctors trying to doctor even when no doctoring is needed Smile I wish rather than a due date, women were given dates for a due month, and there was open honest information about risks and the offer of checks of placental function when approaching that 42 week mark.

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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 8:01 am

Tam wrote:Yeah, I feel like that's one of the problems though, doctors trying to doctor even when no doctoring is needed Smile I wish rather than a due date, women were given dates for a due month, and there was open honest information about risks and the offer of checks of placental function when approaching that 42 week mark.

Problem with that though is assessing prematurity and the potential needs of the preemie if a woman goes into labour early.
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Re: Making childbirth easier

Post by Tam on Thu May 02, 2013 7:22 pm

True.

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Re: Making childbirth easier

Post by Tam on Thu May 02, 2013 7:32 pm

Although I guess no different from now? The number of weeks pregnant would still be the same, there'd be no change... just a change in the expectation, both from mothers and medics, that after 40 weeks you're somehow 'overdue'. If a baby isn't ready to be born until 41.5 weeks, then 41 weeks wasn't overdue Smile

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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 7:37 pm

41 weeks isn't really overdue as such given the definition of the length of a normal pregnancy. 37 weeks isn't premature either but people will say oh the baby was born 3 weeks early making it sound like it's a prem birth.

Babies come when they are ready but sometimes I just wonder if it isn't the mothers themselves who are so keen to have their baby (or fed up of being pregnant as the case may be) that their expectations are that at the end of 40 weeks at the latest, they will have had their baby.
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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 7:58 pm

Dimples wrote:A lot of the bad press around childbirth stems from the fact that women are often sent home again from hospitals after going in when they are in early labour. Understandably many women find that distressing and particularly when so the reason for doing so is because the labour ward or maternity unit as a whole is hopelessly understaffed and there is nobody to deal with her to enable her to stay in the hospital until she is closer to delivering.

However sometimes because there are insufficient numbers of staff, women are left, not even having been properly examined or adequately assessed. Often these women become distressed because they receive little reassurance and midwives don't have enough time to adequately assess progress and these frequently end up being the women who have problematic deliveries and emergency C sections

On the other hand, women going into hospital too early don't tend to labour as well as they would at home. It's almost like the hospital environment stilts the ability for the body to labour effectively, bit psychological really, sort of white coat syndrome.

It is that which frequently has the potential to lead to interventions, oh she isn't labouring effectively, lets accelerate by rupturing the membranes, that increases pain so an epidural is often called for, then synto etc, etc.
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Re: Making childbirth easier

Post by Tam on Thu May 02, 2013 8:02 pm

Ali wrote:41 weeks isn't really overdue as such given the definition of the length of a normal pregnancy.

Absolutely. I think we're saying the same thing. 41 weeks *isn't* overdue and yet some women (me being one of them) are told by doctors/midwives that the baby is so overdue at that point that they have to be induced. (I was naive in those days and trusted what they said). Cue unnecessary complications.

Ali wrote:Babies come when they are ready but sometimes I just wonder if it isn't the mothers themselves who are so keen to have their baby (or fed up of being pregnant as the case may be) that their expectations are that at the end of 40 weeks at the latest, they will have had their baby.

Yes I've known some mums like this too. I really do think that the magical 'due date' sets up this expectation though.

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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 8:04 pm

Dimples wrote:
Ali wrote:41 weeks isn't really overdue as such given the definition of the length of a normal pregnancy. 37 weeks isn't premature either but people will say oh the baby was born 3 weeks early making it sound like it's a prem birth.

Babies come when they are ready but sometimes I just wonder if it isn't the mothers themselves who are so keen to have their baby (or fed up of being pregnant as the case may be) that their expectations are that at the end of 40 weeks at the latest, they will have had their baby.

37 weeks isn't particularly premature but it is a point at which many babies lungs are still relatively underdeveloped for the term of the pregnancy. By that, I mean that babies acquire a considerable amount of their eventual birthweight during the last 3-4 weeks of gestation but their lungs may remain relatively immature due to having less surfactant and are at higher risk of respiratory distress at birth.

37 completed weeks of pregnancy is classed as full term Dimples. After 35 weeks steroids are no longer given to a mother in prem labour because they won't do any good, surfactant levels are at their peak by this point, the vast majority of babies won't require any kind of special care if they are born at this point either.

The main issue would be more likely to be a small baby with potential feeding problems leading to hypoglycaemia than one with breathing difficulties although that is not to say it couldn't happen. That can happen with a baby born at 40 weeks too.
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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 8:09 pm

Tam wrote:
Ali wrote:41 weeks isn't really overdue as such given the definition of the length of a normal pregnancy.

Absolutely. I think we're saying the same thing. 41 weeks *isn't* overdue and yet some women (me being one of them) are told by doctors/midwives that the baby is so overdue at that point that they have to be induced. (I was naive in those days and trusted what they said). Cue unnecessary complications.

Ali wrote:Babies come when they are ready but sometimes I just wonder if it isn't the mothers themselves who are so keen to have their baby (or fed up of being pregnant as the case may be) that their expectations are that at the end of 40 weeks at the latest, they will have had their baby.

Yes I've known some mums like this too. I really do think that the magical 'due date' sets up this expectation though.

I was induced at 41 weeks and 6 days with my youngest, unfortunately this labour (had I laboured any length of time) would have always led to complications, my daughter had her cord wrapped tightly round her neck 4 times. In fact, I am actually thankful I didn't go into labour at home and done all the usual waiting until the contractions became regular and strong etc, because had I done so the liklihood is I would have lost her.
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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 8:20 pm

Dimples wrote:
Ali wrote:
Dimples wrote:A lot of the bad press around childbirth stems from the fact that women are often sent home again from hospitals after going in when they are in early labour. Understandably many women find that distressing and particularly when so the reason for doing so is because the labour ward or maternity unit as a whole is hopelessly understaffed and there is nobody to deal with her to enable her to stay in the hospital until she is closer to delivering.

However sometimes because there are insufficient numbers of staff, women are left, not even having been properly examined or adequately assessed. Often these women become distressed because they receive little reassurance and midwives don't have enough time to adequately assess progress and these frequently end up being the women who have problematic deliveries and emergency C sections

On the other hand, women going into hospital too early don't tend to labour as well as they would at home. It's almost like the hospital environment stilts the ability for the body to labour effectively, bit psychological really, sort of white coat syndrome.

It is that which frequently has the potential to lead to interventions, oh she isn't labouring effectively, lets accelerate by rupturing the membranes, that increases pain so an epidural is often called for, then synto etc, etc.

For a while it looked as if hospitals were embracing the idea of making delivery suites more homely and less clinical in order to provide a more relaxing environment for the mother. That seems to have fallen by the wayside now and hospitals only seem to want women to present themselves at hospital when the baby's head is crowning. There is nothing wrong with arriving in hospital in early labour and ideally the mother should be allowed to walk around if she feels inclined to, have a bath, watch TV or do just as she would if she was still at home. She can still be assessed regularly and any changes can be identified promptly. For many women, the journey back home and then back to hospital again can be distressing, stressful and uncomfortable.... and likewise it can be stressful for fathers-to-be as well.

If everyone comes into the labour ward fully dilated, there is less time to conduct the labour in a calm and orderly way and if things are rushed, the mother will often panic and everything then can go pear-shaped. Being in hospital does not necessarily or inevitably equate to the need for a mechanised or medicalised delivery.

No, there isn't anything wrong with it, but there are only so many beds to be had and so many midwives to go round and tbh, what is the point of being in a hospital for hours and hours and hours with not much happening. If you assess a woman in early labour when she comes in and she's only 1cm dilated then do it again 4 hours later and she's still only 1cm dilated then she isn't really labouring as such and provided all is well with the fetal heart sounds and movements and her own health there isn't really any need for her to be in hospital anyway.

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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 8:41 pm

Dimples wrote:
Ali wrote:
Dimples wrote:
Ali wrote:41 weeks isn't really overdue as such given the definition of the length of a normal pregnancy. 37 weeks isn't premature either but people will say oh the baby was born 3 weeks early making it sound like it's a prem birth.

Babies come when they are ready but sometimes I just wonder if it isn't the mothers themselves who are so keen to have their baby (or fed up of being pregnant as the case may be) that their expectations are that at the end of 40 weeks at the latest, they will have had their baby.

37 weeks isn't particularly premature but it is a point at which many babies lungs are still relatively underdeveloped for the term of the pregnancy. By that, I mean that babies acquire a considerable amount of their eventual birthweight during the last 3-4 weeks of gestation but their lungs may remain relatively immature due to having less surfactant and are at higher risk of respiratory distress at birth.

37 completed weeks of pregnancy is classed as full term Dimples. After 35 weeks steroids are no longer given to a mother in prem labour because they won't do any good, surfactant levels are at their peak by this point, the vast majority of babies won't require any kind of special care if they are born at this point either.

The main issue would be more likely to be a small baby with potential feeding problems leading to hypoglycaemia than one with breathing difficulties although that is not to say it couldn't happen. That can happen with a baby born at 40 weeks too.

It's classed by many as full term but babies are known to still be developing and maturing during the final 2-3 weeks of gestation. By manipulating the definition of "full term" it may reassure many people to feel that their baby is not premature and as such, not considered to be in particular danger but that's as much to do with the fact that most women are in better health in the 21st century and accordingly might expect to have healthy babies. The fact remains that 37 week-old lungs are still not fully mature, even if the baby is classified as "full term". There is ongoing research which looks at long term heath and developmental effects of birth at 37 and 38 weeks gestation.

Also.... from the journal of the American Congress of Obststricians and Gynaecologists:

"After 37 weeks of pregnancy, there's still significant fetal development occurring until a woman's due date. The remaining weeks are the time when the lungs and brain mature and the fetus gains body fat," said Sindhu K. Srinivas, MD, a member of the Committee on Practice Bulletins-Obstetrics. Despite research demonstrating the developmental importance of these last few weeks, there has been an increase in deliveries scheduled before a woman's due date. "We know that healthy babies need 39 weeks to have the best start in life. Therefore, The College recommends against labor inductions or cesarean delivery for non-medically indicated deliveries at less than 39 weeks."

Personally, I'm a believer in leaving nature to take its course unless there is a powerfully over-riding reason to induce labour or perform a C-section. Being fed up doesn't really cut it as far as I'm concerned. Obviously some babies are waaaay to comfortable in there and need to be removed eventually but being in utero is generally the best place for a baby until they decide to put in an appearance.

Very few elective sections are scheduled before 39 weeks in the UK nowadays Dimples for that very reason but it has to be remembered that with C section the normal process of clearing any fluid from the fetal respiritory system doesn't take place as it does in a vaginal birth and that in itself increases the risks of respiritory distress in the baby, plus there is always the chance that the due date has been miscalculated too, even scans can't be 100% correct in assessing the date the baby will be due.

I do agree with you about letting nature take it's course but when there is a risk of a reduced placental function if the pregnancy goes on too long then at some point, and babies have died because of this, then at some point action needs to be taken to deliver.
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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 8:51 pm

Dimples wrote:
Ali wrote:
Dimples wrote:
Ali wrote:

On the other hand, women going into hospital too early don't tend to labour as well as they would at home. It's almost like the hospital environment stilts the ability for the body to labour effectively, bit psychological really, sort of white coat syndrome.

It is that which frequently has the potential to lead to interventions, oh she isn't labouring effectively, lets accelerate by rupturing the membranes, that increases pain so an epidural is often called for, then synto etc, etc.

For a while it looked as if hospitals were embracing the idea of making delivery suites more homely and less clinical in order to provide a more relaxing environment for the mother. That seems to have fallen by the wayside now and hospitals only seem to want women to present themselves at hospital when the baby's head is crowning. There is nothing wrong with arriving in hospital in early labour and ideally the mother should be allowed to walk around if she feels inclined to, have a bath, watch TV or do just as she would if she was still at home. She can still be assessed regularly and any changes can be identified promptly. For many women, the journey back home and then back to hospital again can be distressing, stressful and uncomfortable.... and likewise it can be stressful for fathers-to-be as well.

If everyone comes into the labour ward fully dilated, there is less time to conduct the labour in a calm and orderly way and if things are rushed, the mother will often panic and everything then can go pear-shaped. Being in hospital does not necessarily or inevitably equate to the need for a mechanised or medicalised delivery.

No, there isn't anything wrong with it, but there are only so many beds to be had and so many midwives to go round and tbh, what is the point of being in a hospital for hours and hours and hours with not much happening. If you assess a woman in early labour when she comes in and she's only 1cm dilated then do it again 4 hours later and she's still only 1cm dilated then she isn't really labouring as such and provided all is well with the fetal heart sounds and movements and her own health there isn't really any need for her to be in hospital anyway.


That's exactly my point - there are insufficient resources and that is what's wrong! I've lost count of the number of women I've spoken to who did as they were told and went to the hospital when they were having regular contractions - one or two whose waters had already broken - and then were sent home because there was no space to admit them to the labour ward.

By the time they went back later, their pain was uncontrolled and they were acutely distressed and in one case, she was told that she was too late to have a spinal, which was part of her wishes at the outset.

Dimples, generally hospitals only have one delivery unit, some will have high risk units and low risk units in the same hospital others don't, but they cannot magic up space for hoardes of women in early labour who are having no medical problems. Those women who are actively labouring and are in the process of giving birth must come first.

There are multitudes of women out there who have stayed at home, waited until the contractions are strong and regular, gone in and had perfectly normal, uncomplicated deliveries, women in fact who could have just as easily given birth at home.
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Re: Making childbirth easier

Post by Ali on Thu May 02, 2013 9:46 pm

Dimples wrote:
Ali wrote:
Dimples wrote:
Ali wrote:

No, there isn't anything wrong with it, but there are only so many beds to be had and so many midwives to go round and tbh, what is the point of being in a hospital for hours and hours and hours with not much happening. If you assess a woman in early labour when she comes in and she's only 1cm dilated then do it again 4 hours later and she's still only 1cm dilated then she isn't really labouring as such and provided all is well with the fetal heart sounds and movements and her own health there isn't really any need for her to be in hospital anyway.


That's exactly my point - there are insufficient resources and that is what's wrong! I've lost count of the number of women I've spoken to who did as they were told and went to the hospital when they were having regular contractions - one or two whose waters had already broken - and then were sent home because there was no space to admit them to the labour ward.

By the time they went back later, their pain was uncontrolled and they were acutely distressed and in one case, she was told that she was too late to have a spinal, which was part of her wishes at the outset.

Dimples, generally hospitals only have one delivery unit, some will have high risk units and low risk units in the same hospital others don't, but they cannot magic up space for hoardes of women in early labour who are having no medical problems. Those women who are actively labouring and are in the process of giving birth must come first.

There are multitudes of women out there who have stayed at home, waited until the contractions are strong and regular, gone in and had perfectly normal, uncomplicated deliveries, women in fact who could have just as easily given birth at home.

Ali please stop lecturing me. I know every bit as much as you do about how hospitals work and I know very well that many are under-resourced and also that many hospitals have had their maternity services moved or withdrawn, leading to many women having to travel further to their "local" maternity unit. Many women in rural areas have to travel many miles. In Edinburgh alone, we have lost 4 maternity units since the 1980s.

I am talking about women who did as they were advised and went to hospital when they were in established labour - women who in the recent past would have been able to be admitted to the hospital and remain there without being sent away.

I accept that many women could deliver at home but if that is not their choice or is not an option for whatever reason, no woman in labour should ever be sent away from a maternity unit.

I'm not lecturing you any more than you are me Dimples.

I'm well aware that many maternity units have closed in the past couple of decades or so, too many have closed, some have become birthing units only like one that is local to me. Both of my 'local' consultant units are just a little over 20 miles away and have seen an increase in the numbers of women choosing to access them because some of the smaller units have shut. But these haven't been increased in size, they have no more beds now than they did in the 1980's and therein lies the problem.

I think there is also a problem with the definition of established labour, it isn't just when contractions are regular and strong, it is that combined with cervical dilatation of about 3cm's. Many of these women who come in complaining of strong, regular contractions aren't actually dilating, particularly those in their first labours when the cervix needs to be taken up before dilatation even starts to take place.

I know it's unfair if women want to be in hospital because they are distressed or in pain but if the staff are spending their time dealing with these women then they are not spending their time with women who really do need them. There is enough crap about midwives having to spread their time over more than one labouring woman as it is without adding even more and so reducing their time even further.
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