Wednesday, January 23, 2008

The worst intervention in the birth room ...

My recent experience working as a midwife in the hospital system has fastened my belief that the worse intervention in the birth room is the clock. When working with women in the community - there is no clock, there is no pressure and there is no unnecessary intervention. The events of labour unfold as nature intended. This is in stark contrast with birth in hospital. Every aspect of labour is MANAGED according to the clock. For example a women's membranes break the clock starts ticking. Often times she may be offered an induction of labour straight away or alternatively allowed 12 to 24 hours to establish labour or then have the induction of labour (and all it's associated problems).

A women's progress in labour is managed by the clock - the expected dilatation is 1cm per hour or her labour is considered abnormal and her labour sped up with Syntocinon. There is no quality evidence that supports a woman must dilate at a certain rate and in fact speeding up a labour unnecessary is quite harmful. Syntocinon causes the uterus to contract more painfully than a natural labour - increasing the use of pain medications (and their inherent effects). Syntocinon often causes too frequent contractions - depriving the baby of oxygen causing unnecessary fetal distress. One of the most catastrophic problems syntocinon causes in an increase in postpartum haemorrhage and the associated morbidity and occasionally mortality that a haemorrhage can cause.

While Syntocinon, in a few causes, will assist a woman to achieve a vaginal birth where her labour is truly prolonged. In most cases it is used unnecessary, causing a cascade of intervention.

Get rid of the clock in the birth room and allow women to labour under their own steam.

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