Eytons' Earth: Natural & Alternative Medicine

[silver_lover]

Dear Friends,

Here is a bit of useful research to start off the new year, brought to
my attention by Lamaze International (their press release is pasted
below).

"A randomized trial of coached versus uncoached maternal pushing during
the second stage of labor" by Bloom et al has just been published
(American Journal of Obstetrics and Gynecology (2006) 194, 10-3). The
authors conclude that although "coached" (ie, directed, breath-holding)
maternal pushing was associated with a slightly shorter second stage
(just 13 minutes on average), directed pushing has no other advantages
and NOT coaching causes no harm.

So here is evidence that undermines a standard hospital OB practice that
was adopted without evidence of its safety or effectiveness, and that
supports the mother-empowering Midwives Model of Care and the notion
that birth and women's bodies actually do work just fine!

In the current study, the authors took care to eliminate effects of
epidurals and position, to some extent. Women who had epidurals or
complications, including use of pitocin, were not included in the study.
The women in the study were all having their first baby, the babies were
estimated to be normal size (ie, not over 4000 grams), the attending
midwives (!) were trained so they all coached the same way, the beds
were in the same position (30 degrees raised), with the women lying on
their backs or sides. Allocation to the coached vs. not coached
protocol was randomized and blinded, and assigned at the beginning of
second stage (full dilation).

By "coaching" the authors are clear they mean directed, breath-holding,
knees up pushing. For the "uncoached" group, the midwives did not give
any specific instructions - the mothers were merely told to "do what
comes naturally."

The article did not include any information about howthe uncoached mothers actually pushed, or whether or not any of them had any emotional or comfort support. Since directed pushing has become
such a strong expectation in our culture, I wonder if some of the
"uncoached" mothers also did breath-holding pushing? If so, that would
tend to decrease any differences between the two groups. Also, people
reading news coverage of this research may be confused by what is meant by "coaching," since at least some people have heard of "husband
coached childbirth", in which the meaning of "coaching" is quite
different, or equate "coaching" with support from family members or
friends. This study was specifically about medical staff directing the
mother when and how to push vs. nothing more than suggesting the mother does what "comes naturally."

The fact that there was no statistically significant difference in rates
of perineal laceration (ie, tears) may be due to the fact that all the
mothers were in bed; the article does not include information on how
many women were back-lying vs. side-lying (the two position options they
were given).

The authors mention that the origins of the practice of directed pushing
are not really known. Williams Obstetrics has no mention of this
practice until 1950 (10th edition), where it is mentioned as desirable
only in the very occasional instances when the mother's spontaneous
efforts are not adequate, ie not routinely. The authors do not provide
any explanation for how directed pushing (ie, "coached pushing") became
a universal practice.

The authors previously published research showing that coached pushing
was associated with "evidence of impaired pelvic floor function", but
they only measured one aspect of urinary capacity and only at three
months post partum. While the present study shows no harm (but no
advantage) to directed pushing, the authors note that these are
short-term findings, and that further research might indicate that
directed pushing may have deleterious long-term effects.

For those of you who have not kept up with changes at Lamaze, the
following sentences in their press release (below) might be of interest:

"Once a hallmark of Lamaze, the idea of a "coached birth" when someone
takes charge of the birth and calls the plays of breathing and pushing
during second-stage labor has been retired for more than a decade.
Instead, Lamaze classes emphasize the importance of continuous emotional and physical support during labor."


Do check out the Lamaze website <http://www.lamaze.org/> www.lamaze.org, especially the section "Lamaze Institute for Normal Birth."

Sincerely,

Susan Hodges, "gatekeeper"

From Lamaze International:

FOR IMMEDIATE RELEASE
Contact: Kara Dress, 202-367-2434, <mailto:marketing@lamaze.org>
marketing@lamaze.org

NEW STUDY AFFIRMS LAMAZE PHILOSOPHY THAT "COACHING" IS NOT NECESSARY
DURING LABOR

WASHINGTON (January 4, 2005) Results of a new study published in the
American Journal of Obstetrics and Gynecology indicate that routine
"coaching" during labor has no short-term maternal or infant benefits,
and in fact has been linked to pelvic floor dysfunction and long-term
reproductive problems.

The findings of this study coincide with Lamaze International's
Philosophy of Birth that women know how to give birth; therefore,
encouragement and support rather than coaching are required.

Once a hallmark of Lamaze, the idea of a "coached birth" when someone
takes charge of the birth and calls the plays of breathing and pushing
during second-stage labor has been retired for more than a decade.
Instead, Lamaze classes emphasize the importance of continuous emotional
and physical support during labor.

Lamaze Certified Childbirth Educators (LCCE) teach fathers and family
members how to provide gentle, encouraging support and the basic comfort
measures that help women in labor, including walking, rocking, position
changes, massage, hot/cold therapy, hydrotherapy, slow dancing and use
of birth balls. Lamaze childbirth education encourages women to seek
birth environments that provide a full range of options for birth.

"Lamaze is no longer a method for giving birth rather, it's a philosophy
that educates and instills confidence in women preparing to give birth
and become mothers," says Judy Lothian, RN, PhD, LCCE, FACCE, co-author
of The Official Lamaze Guide: Giving Birth With Confidence.

"Women are inherently equipped to give birth without being coached to do
so," says Lothian. The Official Lamaze Guide encourages women to have
confidence in their bodies' natural ability to give birth, and provides
parents with the tools they need to make informed choices that result in
happy and fulfilling birth experiences.

For more information on Lamaze childbirth education or to order The
Official Lamaze Guide, visit <http://www.lamaze.org/> www.lamaze.org



###

Lamaze International, based in Washington, DC, envisions a world of
confident women choosing normal birth. For more information about Lamaze
and the Institute for Normal Birth, visit <http://www.lamaze.org/>
www.lamaze.org.
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