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Reducing Infant Mortality

  1. #25
    laial is offline Registered User
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    Cool

    Quote Originally Posted by thanka2 View Post
    I just have a few questions regarding what you listed--

    - There was a high chance that the baby will not engage, even during labor.
    How do you know that the chance was high? Did the doctor tell you that? There are quite a few women for example who are facing a breach baby and the baby turns at the last second (or there are things that can be done safely and naturally to encourage the baby to engage) and the woman gives birth vaginally.
    - by themselves, many induced labors end up in emergency C sections.
    - emergency C sections are more risky than elective C sections.
    Why do you say so? If you have an experienced surgeon, there shouldn't be any more risk involved in doing the c-section at the last minute than pre-planning it--unless there is already something going wrong with the child or mother. In both cases there is a major abdominal surgery taking place.
    - Long labor is stressful for both the mother and the baby.
    Had you gone through a long labor before? What do you base this assumption on? Labor itself can be a stressful situation--whether it's long or short. Having gone through an extremely long labor naturally myself (43 hours) I can say it was difficult but I wouldn't say that it was any more stressful--I guess it depends on how you define "stress." Part of what makes labor, labor is that it is something one needs to submit to and allow oneself to go through--not fight against--when it's fought against that's when it becomes stressful in my opinion. As far as stress caused to the baby--long labors often are no more stressful to the baby than short ones. There are women who labor for weeks with a child and the child shows no signs of stress during or after labor. I think that the images we get from Hollywood give us a lot of misinformation about what labor is and can be.
    - I get fully covered by the insurance, and can stay in a private room, where my baby could room-in.
    Because you had a pre-planned c-section you got fully covered by insurance with all the benefits?...or if you had chosen a different route, would you have received the same coverage?
    - I totally trusted my doctor.

    Just really curious to know. Thanks.

    Just a couple of thing I would like to mention.

    If a baby doesn’t engage by 40 weeks, nature isn’t taking its course and one has to start considering possible reasons as to why the head isn't coming down. It is true that you may have an induction and end up have a beautiful vaginal delivery (and that’s what we all hope for!), but having a high head increases you risk of other complications (eg cord prolapse, obstructed labour with the cervix not dilating) and thus increases your chances of an emergency caesarean section (sorry I don’t know the exact numbers on this).

    Emergency caesarean sections are generally considered to carry more risk than a planned elective caesarean section. Though many emergency caesareans usually occur with no hiccups, there are many factors that come into play which increase their risk compared to elective. For example, having a caesarean in labour after your waters have broken increases the risk of infection (upward spread from the vagina). Also emergency caesareans can occur when staff may not be around or in optimum condition for the surgery (eg obstetricians / anaesthetists / paediatricians may not be at their optimum performance in the middle of the night, likewise with midwives and theatre staff; also if you run into complications there may be a need for support from other specialties, for instance like ICU – those doctors are around in closer vicinity in more numerous numbers during the day than at night time) and more often than not emergency caesarean sections are done in a more of a hurry relative to electives, hence theatre and medical preparation for the surgery may not be as optimal as an elective caesarean.

    Labour is a stressful event and babies do get tired. Every time the uterus contracts, there is temporary diminished blood flow to the baby, and if this happens constantly or over a long period of time, babies can get hypoxic and tired. It’s like the baby’s running a marathon in there. Most babies are quite resilient and cope remarkably well, however the longer the labour is, the more tired our bubs will be.

    That's all. Cheers! :-)

  2. #26
    laial is offline Registered User
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    Also one more thing, emergency caesareans usually occur when there is a problem with bub or mum ... hence an added risk is that bub or mum may not be in optimal condition in the first place (eg. you may have an emergency caesarean for fetal distress, where bub's distressed because he/she has had to endure labour - this may not have occurred if bub was not put through that hypoxic event of labour).

    All in all, I'm very pro-vaginal delivery and it is beautiful to have a normal vaginal birth, however, sometimes (as with other things in life) things don't go to plan. I think the way interventions are used is a very controversial topic, which everyone will, and has a right to, have their own opinion on. :-)

  3. #27
    thanka2 is offline Registered User
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    I would argue that exposing your sensitive baby to the narcotics (which most definitely pass the placenta--I mean, c'mon people--if you're not allowed to take most pain medications during pregnancy because they could affect the fetus, why would a heavy dose of pain killers at the very end not have any effect?) found in the pain killers and medications administered after most interventions would prove way more stressful to the baby's neurological system than a "long" labor. (And to define "long" is probably pretty hard to do--for some women, more than a few hours--or even an hour-- would be considered "too long") For this reason, babies are monitored during labor to ensure that they aren't suffering any stress. Birth isn't an easy process and there is nothing that is going to be make it stress-free physically for babies or women (even taking every intervention possible to avoid pain and discomfort is going to have it's price in the end--usually in the health and development of your child) but it is a natural process that works. Babies who are exposed to heavy duty pain killers often have trouble maintaining their temperatures when they leave the womb and the neurological probably go undetected or are diagnosed as something else years later.

    To me, it doesn't make any sense to go for a c-section because you "might need one" in the end. "Might" is a pretty big word. Also, I think that if you assume that a child is fully developed just because on a chart somewhere it says "40 weeks" and you start pushing things because "the baby has not engaged" because you assume that that 40 week estimation is infallible then you're putting a lot of trust in a number that could very well be wrong. If I was in that position--sitting at "40 weeks" (according to a doctor's estimate) and the baby had not "dropped" then I would be doing everything imaginable (and natural) to get that child to drop--and there are things out there to do that. I have no problem waiting 2 or more weeks past my due date in order to give that baby time to fully develop and drop. Afterall, every child is different. Myself, I was nearly 3 weeks overdue and born completely naturally with no complications--I say I turned out okay. :)

  4. #28
    AmyH is offline Registered User
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    Quote Originally Posted by thanka2 View Post
    I mean, c'mon people--if you're not allowed to take most pain medications during pregnancy because they could affect the fetus, why would a heavy dose of pain killers at the very end not have any effect?)
    Thanka2, no offence meant here but your post sounds rather condescending and judgemental. can I ask where you obtained your medical degree? Pregnancy and labour can be a stressful enough time for a woman and I am sure that the majority of people go in with the intention of having a perfect, natural, drug free delvery, but this is not always possible and at the end of the day each woman will make a decision at the time that they feel is best for her and her child. Can you provide articles and video evidence to support your claim that pain medicaton during labour has a detrimental affect on the baby?

  5. #29
    thanka2 is offline Registered User
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    Quote Originally Posted by AmyH View Post
    Thanka2, no offence meant here but your post sounds rather condescending and judgemental. can I ask where you obtained your medical degree? Pregnancy and labour can be a stressful enough time for a woman and I am sure that the majority of people go in with the intention of having a perfect, natural, drug free delvery, but this is not always possible and at the end of the day each woman will make a decision at the time that they feel is best for her and her child. Can you provide articles and video evidence to support your claim that pain medicaton during labour has a detrimental affect on the baby?

    No offense taken and none meant. Of course I have no medical degree but I just don't understand why last week I went to a doctor in Hong Kong because I've been having severe back pain and was told at max the only thing I could take safely for my baby would be 2 panadol. But, many doctors will say that the pain medication given to women in childbirth (epidurals etc) has no effect on the baby--I feel like it's really a misrepresentation. As I said, it doesn't make any sense to me that women would feel comfortable accepting such strong drugs that probably do have some effect on their children. Yes, labor is painful--it can be horribly painful but I don't understand why women would choose to risk their children's health so easily for convenience and comfort. And I think that probably is at the heart of the video I posted. Doctors are doctors but they are also working for a customer--so I feel like many just bend to the "market demand" and in the turn the health of newly born children suffers. There is always a time for everything but I feel like the true risks and side effects of interventions are rarely presented for what they are so it makes it easier for women to choose interventions with a clear conscience.

    I don't know how many studies have been done on the effect that meds have on the baby at birth but talk to some midwives about what babies look like when they come out after experiencing narcotics--there is a huge difference in color and response. I will try to find more specific things as I've read some things on this topic when preparing for the birth of my son.

  6. #30
    AmyH is offline Registered User
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    my previous post was quite harsh and abrupt so let me first apologise for that! I have no experience with natural childbirth but did go through 24 hours of active labour on my second (thought I could be one of those mums to have a sucessful VBAC but it was not to be!) This labour was drug free until I was advised that it was probably likely that I would need a C-section due to issues with the baby getting distressed so the doctor advised me to have an epidural which they could then top up to perform the surgery if it was necessary.
    The epidural was working for half an hour before I had to have the c-section but my daughter was born crying, and within an hour she was breast feeding, had her eyes open and was very alert so I can assume that the drugs in the spinal block had no real affect on her (but I have not had a drug free natural laboured chld to compare her to!)

    I defintely agree that it is worth while getting as prepared and educated as possible before labour but not all birth plans work out in the end and I dont think that women should feel guilty if they had some pain medication or if the birth ended in a c-secton, as long as both mother and baby come out it safely.

  7. #31
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    In my case, week 40 was really my 40th week, as my ovulation was induced using clomid, and the ovulation date determined be OPK. Also at my week 40 scan, the doctor noticed that my placenta was starting to age, so adviced me not to wait for too long.
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  8. #32
    laial is offline Registered User
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    Just for the record, epidurals are completely safe in labour - it is a local anaesthetic that goes into the spine that is used, and the amount that gets through to bub (if any) is so minimal that it is not considered significant. On the other hand, narcotics such as morphine and pethidine (which are given systemiclly) can go straight through from maternal bloodstream to bub, this is normally only an issue when it is given within a few hours prior to bub being born - this causes similar side effects as it does in an adult (ie. sleepiness and hence feeding difficulties, respiratory depresssion). However, prior to labour, opioids are generally considered safe and are commonly used in pregnancy ("generally" being Pregnancy category B or C). Of course, the safest thing is no drugs at all, but one has to weigh up the benefits and risks of pain relief (eg. there is no point refusing pain relief to a mum who is hysterical in pain, cos she's not going to be able to labour efficiently while she is so hysterical).

    Also I would hope that if someone has a due date set by an obstetrician, it is one that is within two weeks of being accurate. Generally if you have an early "dating" ultrasound (7-13 weeks) and know your period dates, and they roughly agree with each other (say within a week), you can be pretty sure that the accurate due date is within that week. However, if there was some mix up and, for instance, your accurate due date was actually 2 weeks earlier than you thought (so you thought you were 38 weeks but you are actually 36 weeks), sure you may end up with a premature baby which is not ideal and may end up with complications (as could any term baby) - but most babies born after 34 weeks these days usually do quite well and act as term babies anyway. However on the other hand, if your accurate due date was 2 weeks later than you thought (so you think you're 40 weeks but are actually 42 weeks), there is known to be a significant risk of placental insufficiency which rises exponentially after 42 weeks and this may end up in a stillbirth. This is why most inductions are planned at around 10 days overdue, to give you a couple of days to labour and have your baby before the risk starts increasing at 14 days overdue. Thanka2 you are very lucky that you did well at 43 weeks! If my only choice was to have bub premature (<37wks) or post dates (>42wks), I'd definitely go premmie! Sorry, probably diverting from the topic a little!

    As for the mode of delivery, it needs to be individualised for every mum and can be quite a grey area - and it's all about weighing up the risks and benefits of vaginal birth versus caesarean. Every mum is different so it's a bit difficult to make a general comment on this one.

    Sorry for writing so much! I'll stop now :-)

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