Continuous Fetal Heart Rate Monitoring: Hospital Admissions

I've been posting a lot of research lately, but it is because research is just so great :) Really, can you think of a better way to grow and develop as a society? Research teaches us what has been, and maybe what should be. At its best, research results in positive change (there is also research at its worst, but that is a story for another day...)

I came across this recent systematic review from The Cochrane Library. [Side Note: If you don't know what The Cochrane Library is, and you are interested in health care (either personally or professionally), then you should be finding out! The Cochrane Library is an independent organization that conducts high-quality reviews, which provide evidence for health care decision making. Ever wonder why a doctor will prescribe a specific drug for your ailment? It's because of reviews that the doctor is able to read, in one paper, a summary of all existing evidence on a particular drug. If the evidence overwhelmingly shows in favour of the drug for treatment, then bingo! You get a prescription.]

The paper I linked to above is about cardiotocograph (CTG). When you go into labour and believe that it's time to head to the hospital, you will be assessed in triage. You're led to a little room, where the nurse will strap you to monitors which will record your baby's heart rate. This is normally done for about 20 minutes, during which time you will receive a cervical exam, and either be sent home or admitted to a room.

Granted, this is not done at all hospitals. Some will just listen to the fetal heart rate intermittently, quickly check you, and then determine whether it's time to be admitted. But generally, CTG is the way that things are done if you are under the care of a doctor or obstetrician (this blog post states that 76% of Canadian hospitals use CTG upon admission)

Why is this important? The Cochrane review that I linked to above found that c-section rates increase by 20% for women who undergo CTG compared to intermittent monitoring. Interesting, isn't it?

Science clearly shows that low-risk pregnant women should not be monitored continuously. In fact, this is an intervention that Lamaze International recommends you try and avoid, because continuous monitoring shows no benefits - only harm. Harm in the form of abdominal surgery, apparently.

In my experience, women that are strapped to monitors upon admission to hospital generally become agitated and no longer cope very well with their contractions. Not surprising, given that they are forced to lie in a bed, in a tiny clausterphobic room, and listen to the clippidy-clop of their baby's heart.

And yet, despite all the overwhelming evidence that shows that this type of monitoring can be harmful, we're still doing it! As I wrote in a previous post, it's all about the lag time between research findings and shift in practice.

But you know what does change policy? That's right - you dear readers! The women out there giving birth have the right to ask for good evidence-based care. When more women request a procedure (or decline a procedure), policies change over time to accommodate patients' wishes.

What has been your experience with hospital admission? What do you think of this 20% increased risk in c-section?

{Ottawa Doula} What to do when you're afraid of birth

After posting about the NHS's plans to offer c-sections for free in the UK, I have noticed an increase in traffic from people googling "scared of birth, should I have a c-section."

This has really touched me, and I wish there was some way I could reach out to these women and give them a hug. So here's my way - a blog post!

Preparing for birth can be a scary and overwhelming experience. I remember coming home from my first prenatal class, curling up into a ball and having a huge cry. The reality of what I was about to face hit me over the head like a ton of bricks, and I didn't know how to deal with the fear.

I studied for birth like it was a PhD comprehensive exam. When I would hear about other women's wonderful birth stories, I would suddenly become fearful - what if that doesn't happen to me? What if I can't do it? What if it all turns out "bad"?

The thing I've come to realize as a doula is that a woman who is well prepared, and well supported, can have a positive experience regardless of the outcome. Happy birth stories can happen in any hospital, with any care provider, as long as the woman feels like the director of her own experience.

Here are some information and tips for women out there who are scared of birth and considering a c-section instead:

1) What are your specific fears? There are most likely 2 or 3 things that you are dreading - for some women, it's the pain; for others, it's the possibility of a tear; others fear things like vomiting, being naked, or losing control (by making too much noise, fainting, or doing other "crazy" things)

2) Write out a plan of how you will deal with this fear if it does happen. Visualize it happening, and then visualize yourself dealing with the situation. Talk to someone about your fears, and have them work through them with you.

3) Hire a doula. Your husband can not be your "everything" and he will be scared as well. Most likely he has his own set of fears. If you can't afford a doula, ask for a friend or family member who has given birth (and who has a positive birth story to tell) to support you.

4) Make sure you have a good caregiver. You all know my thoughts on midwifery care. There is no one better equipped than a midwife to calm your fears.

5) Take a GOOD prenatal class. The classes offered at the hospital are usually biased and extremely boring. Look around for prenatal educators in your community who offer alternative classes. Here are a few great ones in Ottawa:

Ottawa Childbirth Education Association http://www.ottawacea.com/

Birthing From Within Classes http://primadoulas.ca/?page_id=22

Bradley Method http://www.healthy-beginnings.ca/

It's worth the money - another option is to hire a doula who is a childbirth educator, and ask her for some one-on-one classes in addition to your prenatal appointments.

Any other tips or thoughts out there for women who are afriad of birth?