Forums  •  Classifieds  •  Events  •  Directory

 
Page 5 of 8 FirstFirst ... 34567 ... LastLast

Reducing Infant Mortality

  1. #33
    laial is offline Registered User
    Join Date
    Nov 2010
    Location
    Hong Kong
    Posts
    41
    By the way, I just watched the video clip. Some interesting things I noted:
    1. There were mainly neonatologists, family physicians and midwives speaking; but no obstetricians?
    2. Yes the caesarean section rate is a lot higher than it is meant to be (WHO recommends 15%, the current rate is 30%)
    3. Litigation does play a significant part in the rise in intervention. Obstetricians get sued if they don't intervene and a bad outcome occurs, so more often than not, they tend to play on the 'safe' side and intervene to deliver the baby if they can.
    4. "Midwives and family physicians have the lowest infant mortality rate" - well that's probably cos they palm off all the high risk cases to the obstetricians!
    5. Most of the premature babies on the clip look like they are a lot less than 34 weeks gestation. We are saving more of these extremely premature babies these days, therefore it is only natural to have a corresponding increase in neonatal mortality as well.

  2. #34
    Shenzhennifer is offline Registered User
    Join Date
    Jul 2008
    Location
    Tsuen Wan
    Posts
    1,288
    I also find myself wondering what is classified as a heavy narcotic. All narcotics are opiate-based; the drug in spinal epidurals most certainly is not. I have read that a small amount of epidural drug passes through the placenta, and some babies have come out a big sluggish, but this can also be attributed to long and stressful vaginal labours. I just think that implying that epidurals, the most common form of pain control during labour, is a bit misrepresentative and misleading.

    I was one of the women who wanted a drug-free vaginal birth with no interventions. But hey, things changed, and I asked for an epidural after a couple hours on oxytocin. We all have different pain thresholds. I didn't feel it would adversely affect my baby. Furthermore, since I later had a c-section, I received more of the drug into my epidural, and then some more since it wasn't working well. My son came out kicking and screaming like a wild animal and got perfect responses in his apgar. He has not had a single serious health issue coming up on 2 years now.
    I can't say the same would have been true if he was born vaginally, who knows what might have transpired?

  3. #35
    thanka2 is offline Registered User
    Join Date
    May 2009
    Location
    HK
    Posts
    1,623
    Quote Originally Posted by laial View Post
    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 :-)
    One thing I'd like to just try to make clear again--I'm not saying that the doctors totally misjudge how long the baby has been in the womb because I do believe that the measurements used (ultrasound mostly) are a lot more accurate than they once were. So, I'm not saying that most womens' due dates are actually off. I am saying that every child is different so some may need 40 weeks and some may need more time to be fully ready to come out of the womb--before they are developed to the optimal point. Just because we say that the due date for babies is exactly 40 weeks doesn't mean all babies are completely ready to come out. In the same way, some babies may be fully developed and ready to be born at 38 weeks but I think it's better to leave it up to the baby to decide--healthier that way. Just a little sidenote, I believe much more in holistic medicine than I do in western medicine as with every health problem I've ever encountered, western methods did little if nothing (except drain my bank account) and I only found relief from more holistic treatments. Therefore, when it comes to childbirth, I just take everything the western doctors in the hospital say with a grain of salt. Like I said, I just come from a very different point of view than I think most of the women here do. That's not good or bad--it's just a difference and that's why it's very hard to not come off as if I'm from a different planet.

    Oh, and also, I didn't go overdue to 43 weeks. (My mom was overdue by three weeks with me, though). My due date was November 28 (my husband's birthday, actually) and at 1 am on November 28, just naturally, I went into labor. I had also been employing a lot of natural labor induction methods from 38 weeks on because I was just ready for that baby to come out but he decided at 40 weeks exactly it was time.

    I had steady, painful contractions at 5 minutes apart or less for the duration--the contractions never stopped or let up or got weaker. Labor progressed--slowly, painfully, slowly. My labor was really long--43 hours long. So, my son was born on the night of November 29 at 9:43 pm. I guess, the labor was then probably longer than 43 hours.

    I don't believe in luck. I had to endure a lot to get to the point of actually birthing my son and I had nothing but back labor from the get-go. Anyone who has had back labor knows that it sucks. Initially when the baby was descending his head was turned to the side so that increased the pain (he was looking over his shoulder as he was coming down the birth canal).

    As my labor was slower (I had already been in labor for over 24 hours at this point), one of the doctors came in at one point (a really young guy) and started trying to scare me into augmenting the labor with pitocin. These were his words and I quote, "You don't want to be like one of those women in sub-Saharan Africa that labor in the desert for days and then die in childbirth, do you?" We listened to his words and when he left, my husband and I almost burst into laughter (if I hadn't been in pain, I probably would have laughed). It was just ridiculous the scenario he was presenting and there was no stress or danger to the baby or me so there was no need to do anything except just go through labor. I'm glad I didn't choose to augment labor with pitocin and I'm glad I had a midwife who in her words "went to bat for me."

    Part of the lip of my cervix was holding his head back so the midwife went in and literally ran her fingers around the cervix to allow his head to descend further--that was extremely painful. It took several contractions to do this and I just remember pleading with her, "Please take your hand out" but she just replied in her Texas drawl, "Oh, honey, I'm going to have to stick it in there again in just a couple of minutes so I'm just going to leave it in there."

    I guess I just had the right type of midwife for me--at one point she literally looked at me and said, "Stop it. You're carrying on and you're wasting energy. You need all the energy you can save for later so you just calm yourself down and focus." I was kind of displeased at her at that moment but she knew what to say and do to help me get the job done. She knew what my commitment to myself and my baby was and she helped me stick to it even when I wanted to give up--she just firmly but gently reminded me of what I had said I wanted. She was the sweetest lady from Texas (I'm not from Texas, BTW) in all of my prenatal appointments but she was an absolute no-compromise coach when it came to the birth.

    Anyway, that's part of my experience.

    I also don't mean to come off as a b*tch--actually, I just come from a vastly different school of thought than most ladies here, I realize. It doesn't really do much good for me to share my opinion (in its full-strength) here because I've had a very different background, upbringing and experience altogether, I think. And, yes, I am opinionated and there are grounds to my opinion but it's really hard to explain here on this forum without really offending a lot of women.

    So, I realize I'm not going to change your mind and you're not going to change mine and that's cool.

  4. #36
    laial is offline Registered User
    Join Date
    Nov 2010
    Location
    Hong Kong
    Posts
    41
    Wow Thanka2 that sounds like quite an ordeal you went through with your labour ! I come from a western medical background, hence lots of scientific and evidence-based explanations (for example, if you have a prolonged active first stage or second stage of labour, the uterus tends to get tired from contracting and contracts less in the postpartum period, hence increasing the risk for a postpartum haemorrhage, which can be a life threatening emergency - probably one of the reasons why your doc said what he did, though he could have said it nicer :-). I respect that everyone has differing views, and I think that is part of what makes medicine, and in particular obstetrics, interesting. However, it also makes obstetric issues controversial, because there are no right or wrong answers - just whatever is right for the individual, which is not for anyone else to judge. I think ultimately it is up to each mum to make informed decisions (as much as possible) about her own pregnancy and labour, ask lots of questions, stay as sensible as possible and try not to be pressured into doing or not doing anything. At the end of the day, we're all aiming for the same goal - that is healthy mum and healthy bub! :-)

  5. #37
    thanka2 is offline Registered User
    Join Date
    May 2009
    Location
    HK
    Posts
    1,623
    Quote Originally Posted by laial View Post
    By the way, I just watched the video clip. Some interesting things I noted:
    1. There were mainly neonatologists, family physicians and midwives speaking; but no obstetricians?
    the high risk cases to the obstetricians!
    Did you also notice how the video brought out that there are basically two schools of thought when it comes to childbirth--there is the system that is more risk-based and then there is the midwifery approach. And I think that a lot of OBGYNs go by the former so this video spoke to the latter side.

    Also, they had:

    The former director (directed for 15 years) of the Women and Children's section of the WHO (also a perinatologist which is a subspecialist concerned with the care of the mother and fetus at higher-than-normal risk for complications)
    At least one other doctor who is also a perinatologist
    PhD with 25 years of experience now focusing on infant brain development
    Researcher who focuses on prenatal and perinatal psychology, prematurity, neuroscience, and psychotherapy
    The Medical Officer, County of San Bernadino Department of Public Health

    Along with scores of very highly qualified doctors and specialists who contributed to the film

  6. #38
    thanka2 is offline Registered User
    Join Date
    May 2009
    Location
    HK
    Posts
    1,623
    Quote Originally Posted by laial View Post
    Wow Thanka2 that sounds like quite an ordeal you went through with your labour ! I come from a western medical background, hence lots of scientific and evidence-based explanations (for example, if you have a prolonged active first stage or second stage of labour, the uterus tends to get tired from contracting and contracts less in the postpartum period, hence increasing the risk for a postpartum haemorrhage, which can be a life threatening emergency - probably one of the reasons why your doc said what he did, though he could have said it nicer :-). I respect that everyone has differing views, and I think that is part of what makes medicine, and in particular obstetrics, interesting. However, it also makes obstetric issues controversial, because there are no right or wrong answers - just whatever is right for the individual, which is not for anyone else to judge. I think ultimately it is up to each mum to make informed decisions (as much as possible) about her own pregnancy and labour, ask lots of questions, stay as sensible as possible and try not to be pressured into doing or not doing anything. At the end of the day, we're all aiming for the same goal - that is healthy mum and healthy bub! :-)
    It was and I also hemorrhaged. But my skilled midwife who has been helping with births in homes, hospitals and birthing center for 30 years took one look at me when I had my first appointment with her at 29 weeks and said, "You have red hair and fair skin and in my experience women with your complexion tend to have bleeding problems." She also said there were no official studies on the matter but her observations told her otherwise. She added, "But don't worry, if that happens, I know what to do. You're in good hands." And I was in good hands. There is some history of bleeding problems on my mother's side of the family with the women as well. But, the thing I appreciated is that my midwife always communicated to me with a sense of frankness without pushing an attitude of fear. I get the absolute opposite vibe from most of the doctors I've met. It's like they see a "ghost around every corner" and every woman could be a potential high-risk case. I think the video pointed to this as well--there is the risk-based model of care and I believe that is the standard in Hong Kong as well.

    The know-it-all doctor had no basis for what he was talking about. It wasn't about him being nice--it was about him doing his job in a respectful way not trying to manipulate me while I was in labor. Even my midwife was actually very "unkind" (she really pissed me off during labor because she wasn't coddling me at certain points--but in retrospect that is what I needed--she was a tough coach!) --but she spoke to me as an equal and she spoke with authority--she didn't need to try to scare me to lay out my options. I think that some doctors really think that their patients are idiots (the ones I've met in HK mostly do) and so the best way to get them to do what the doctor wants is to scare them into it. It's not respectful and it's manipulative, in my opinion.

    First of all, I was not in sub-Saharan Africa, laboring in the desert without access to medical care, secondly, neither I nor the baby were showing any signs of physical distress (besides labor pain--but, hey, that's. labor)--basically, my labor wasn't moving fast enough for his time schedule. My midwife was not alarmed. My nurses were not alarmed--and truth be told in a hospital (at least where I come from) the midwives and nurses handle 85% of the workload--sometimes the doctors just rush in to play "superstar" as the baby comes sliding out. In my case, I chose not to have a doctor and avoided that cost altogether. My midwife saved my life and she was just as informed, experienced and good at dealing with my "high risk" case as any doctor would have been.

    So, even though I did hemorrhage which created personal complications for me--that was after my son was born and if I had it to do over again, I would still go through it the way I did because I believe firmly from my own observations that it was the best choice for my child. It took guts and what we call "intestinal fortitude" to do it and after I was done my midwife told me, "Now, there is nothing you can't do or make it through"--in some ways I believe she was totally right.

  7. #39
    thanka2 is offline Registered User
    Join Date
    May 2009
    Location
    HK
    Posts
    1,623
    Quote Originally Posted by Shenzhennifer View Post
    I also find myself wondering what is classified as a heavy narcotic. All narcotics are opiate-based; the drug in spinal epidurals most certainly is not. I have read that a small amount of epidural drug passes through the placenta, and some babies have come out a big sluggish, but this can also be attributed to long and stressful vaginal labours. I just think that implying that epidurals, the most common form of pain control during labour, is a bit misrepresentative and misleading.

    I was one of the women who wanted a drug-free vaginal birth with no interventions. But hey, things changed, and I asked for an epidural after a couple hours on oxytocin. We all have different pain thresholds. I didn't feel it would adversely affect my baby. Furthermore, since I later had a c-section, I received more of the drug into my epidural, and then some more since it wasn't working well. My son came out kicking and screaming like a wild animal and got perfect responses in his apgar. He has not had a single serious health issue coming up on 2 years now.
    I can't say the same would have been true if he was born vaginally, who knows what might have transpired?
    I was curious also about the exact contents of an epidural and this is a little of what I found:

    Epidural medications fall into a class of drugs called local anesthetics, such as bupivacaine, chloroprocaine, or lidocaine. They are often delivered in combination with opioids or narcotics, such as fentanyl and sufentanil, to decrease the required dose of local anesthetic. This way pain relief is achieved with minimal effects. These medications may be used in combination with epinephrine, fentanyl, morphine, or clonidine to prolong the epidural’s effect or stabilize the mother’s blood pressure.


    So, let's go through and see:

    -bupivacaine
    * Studies on animals show adverse effect and toxicity on fetus.
    * No adequate and well controlled studies done on pregnant women.
    * Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
    * Crosses placenta by diffusion.
    * Human studies revealed no birth defects.
    * Animal studies revealed increased incidence of fetal death and skeletal abnormalities when used in high doses.


    chloroprocaine
    * Studies on animals show adverse effect and toxicity on fetus.
    * No adequate and well controlled studies done on pregnant women.
    * Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
    * Crosses placenta by diffusion.
    * Human studies revealed no birth defects.
    * Animal studies revealed increased incidence of fetal death and skeletal abnormalities when used in high doses.


    lidocaine
    * Controlled studies done on animals in reproduction do not indicate risk to the fetus.
    * No adequate and well-controlled studies done on pregnant women.
    * Crosses placenta by diffusion.
    * Human studies revealed no birth defects.
    * Animal studies revealed no adverse fetal effects.


    fentanyl
    * Studies on animals show adverse effect and toxicity on fetus.
    * No adequate and well controlled studies done on pregnant women.
    * Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
    # can cause loss of fetal heart rate variability without hypoxia.
    # With epidural fentanyl, neonatal respiratory depression may occur.

  8. #40
    thanka2 is offline Registered User
    Join Date
    May 2009
    Location
    HK
    Posts
    1,623
    I submitted my last post without finishing the list.

    Here is the continuation:

    epinephrine
    * Studies on animals show adverse effect and toxicity on fetus.
    * No adequate and well controlled studies done on pregnant women.
    * Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
    # Teratogenic (capable of causing developmental abnormalities) in some animals.
    # No well controlled human data but suggested possible association with eye, ear, digital defects and club foot during first trimester exposure, and with musculoskeletal defects and umbilical hernia during exposure anytime during pregnancy.
    # It may cause uterine vessels spasm and potentiate the effects of oxytoxic drugs on the uterus resulting in fetal hypoxia and bradycardia.


    morphine
    * Studies on animals show adverse effect and toxicity on fetus.
    * No adequate and well controlled studies done on pregnant women.
    * Drugs should be given only if the potential benefit outweighs the potential risk to the fetus.
    * Crosses human placenta rapidly.
    * No adequate data in first trimester exposure but reported association with inguinal hernia after anytime use during pregnancy.
    * Chronic maternal use of the drug causes neonatal withdrawal and respiratory depression.


    So, the things that stick out about this information to me are:
    -in every case "no adequate and well controlled studies [have been] done on pregnant women"
    -almost every item has been found to have adverse effects and toxicity to the fetus in animals
    -the reason why the narcotics are given is to make the effects of the drug last longer, otherwise there would be little point in going through the trouble of putting the needle in if the drugs would not hold for the length of the labor or c-section
    -the drugs all pass the placenta and in the case of morphine it does so "rapidly" (as I had heard several people argue that "oh, these drugs only effect you--they don't ever get to the baby")
    -and something I may or may have not mentioned is that right now at 7 months pregnant I'm allowed to take up to two panadol "safely" for any pain I have (and I've had some really serious back pain this time--that renders me incapable of working some days) and the doctor will continue to tell me that this is the appropriate dosage of pain medicine. I asked if I might use a topical pain reliever called voltaren which is simply a cream that is applied to the skin that many people use for arthritis pain or cramps. I was told strictly that this could be harmful to the baby and I should not do it. This is a rather "weak" topical treatment compared with an epidural. Yet, if I go to the hospital and I'm in labor, the thing that was deemed "harmful to the baby" the day before all of a sudden is administered without any reference to the possible risks. To me, that seems very unbalanced. I wonder if you ask most pregnant women, "So, what exactly is in an epidural and what are the potential side-effects and risks to mother and baby? Did your doctor go over this with you?"--how many women could say, "Yes, I was informed about this by my doctor" unless the woman herself was very proactive and asked the doctor and then hounded him for specific information.

    In an unrelated thought--it is similar with birth control pills which carry an increased risk for blood clotting problems. I was never informed of this when I was prescribed the medication and not only that the doctor didn't even ask about my family history to see if I was at risk for this (which I am--my maternal grandmother had blood clotting problems and died of a blood clot and my mother has also had issues in the past). I wonder how many other women experience this sort of situation.

Page 5 of 8 FirstFirst ... 34567 ... LastLast

Similar Threads

  1. Baby reducing time on breast
    By mnight in forum Feeding Baby
    Replies: 7
    Last Post: 06-27-2009, 12:24 PM
  2. Reducing Pesticide Consumption
    By MLBW in forum Family Health
    Replies: 2
    Last Post: 03-24-2009, 09:51 PM
  3. mom with infant in pokfulam?
    By hiannaya in forum Playgroups
    Replies: 0
    Last Post: 03-18-2009, 10:54 AM
  4. Infant Swimsuit
    By jaetee in forum Everything Else
    Replies: 8
    Last Post: 06-15-2007, 04:43 PM
  5. DH needed to look after infant
    By angeilin in forum Helper Forums
    Replies: 1
    Last Post: 05-24-2007, 03:26 PM
Scroll to top