10 facts about the stimulation of childbirth, which every woman should know
Article by Sarah Wickham (Sara Wickham), translation of Ekaterina Zhitomirskaya. Printed in the AIMS (AIMS; Alliance for the Improvement of Maternity Services, UK Public Organization, Union for Improving the Service of Obstetrics;) AIMS JOURNAL Vol: 26 No: 2 2014 6-8
In modern Western culture, most women are aware of the stimulation of labor before they become pregnant.
They know that stimulation is offered if it is considered that it will be safer for the child to be born than to remain in the womb of the mother. I also suspect that many women know that one of the main reasons for the appointment of stimulation; this is the period of pregnancy, after which the child is considered; Also, many women know of some other women who were stimulated by birth, so they know other stated reasons for stimulation. These causes may be the age of the woman, if it is higher, normal, and premature discharge of water, and / or health problems, as well as complications of pregnancy, in which the stimulation of labor may be necessary
But that’s not all. The decision, whether to agree or not to stimulate delivery, there are many other aspects that also have a meaning to take into account. I spent the past few months studying this topic. The result was a recent edition (revised and enlarged) of my book; Stimulation of childbirth: to make an informed decision; (Wickham S (2014) Inducing Labor: making informed decisions.) AIMS, London). In May, for the presentation of this book in Bristol, I prepared a speech entitled, 10 facts on the stimulation of childbirth, which every woman should know. I did not intend to dwell on well-known things (see above), instead I wanted to draw your attention to some facts, circumstances and assumptions that are less well known and which may be worth taking into account when we make a decision about stimulation. In fact, of course, it is worth knowing much more, so my list of ten facts; just a starting point for discussion, and not exhaustive information on the issue.
1. It’s not like ordinary birth
Someone knows this, but I know from experience that not everyone. Stimulated births are very different from births, which began spontaneously. Of course, each woman has her own personal experience, but there are differences that are almost universal. First, to stimulate childbirth, a woman is injected with a synthetic hormone that causes more pain than in spontaneous births. And this pain comes faster. Synthetic hormones, in contrast to our own hormones, do not cause the release of anesthetic substances into the blood, which are produced by the female organism during normal delivery. In addition, stimulation can have its side effects, which means that it will be more closely watched by such a woman. Such closer observation can lead to a restriction of the mobility of a woman, which increases tension and, accordingly, pain, which in turn can cause a woman to feel that the situation is getting out of control.
I have already begun to talk about this in paragraph 1, but there are also other sources of pain, which I think women should know before deciding. For example, contractions caused by a prostaglandin gel or balloon, which are often used in the first stage of labor delivery, can quickly become painful in the absence of any visible effect. This gives a negative experience of birth, in addition, in this situation it is easy to get tired and / or lose the presence of the spirit much earlier than in the early stage of spontaneous childbirth. Contractions caused by oxytocin, too, can be very strong, and often time to adjust to them, the woman is less than in the spontaneous birth. More frequent vaginal examinations and other manipulations (for example, using a balloon) can cause additional painful sensations.
I wrote a lot about it on my website (www.sarawickham.com), so I will not particularly repeat myself. But the fact that I continue to be asked whether physiological management of the third period (birth of the placenta) is possible, as well as the refusal of CTG and / or vaginal examination in the event that the delivery has been stimulated, makes us think that this is not a well-known fact. Not that someone wants to stop a woman from making the right decision. But the drugs that are used to stimulate delivery are powerful enough. They block the release of their own hormones, and this can cause problems for the woman and the child. And the influence of these preparations stimulating delivery should be assessed, monitored and, if necessary, compensated. If a woman believes that such side effects of stimulation; it’s not what she needs, it’s probably better to ask yourself if this stimulation is necessary at all.
Nowadays, where it is customary at some period of pregnancy to offer women, to exfoliate; or; separate manually; fetal membranes in the hope that this will reduce the number of women who need medication stimulation. Even if we ignore the assumption that all women who are offered stimulation will agree to it, we must understand that the separation of the shell can cause discomfort, blood discharge and irregular contractions, while according to some studies this procedure speeds up the onset of labor for only 24 hours . The authors of the review published at Cochrane conclude: It does not seem that the routine use of manual separation of the shells from the 38 weeks has given significant clinical advantages. Carrying out this manipulation for the stimulation of labor should be considered in conjunction with the discomfort of the woman and other side effects of the procedure; (Boulvain M, Stan CM, Irion O (2005) Membrane sweeping for induction of labor, Coherane Database of Systematic Reviews 2005, Issue I. Art No .: CD00451 DOI: 10.1002 / 14651858.CD000451.pub2).
I wrote about this in another place, and this article can be read on my website (Essentially MIDRIS 3 (9): 50-51), but it’s easy to state the main idea: either we we are waiting for the natural onset of labor, as it happens by natural laws, or we try to intervene and cause birth before they start themselves. Sometimes there are good reasons for causing childbirth, but if a woman takes castor oil or asks her midwife to manually separate the fetal membranes on a daily basis or choose some other folk; a method of stimulation, then she is going to call her birth with non-medicament means. Pay attention, I’m not trying to say that there is something wrong here, but I believe that since we live in a culture that devalues female bodily functions, it is important to clearly understand what our intentions are.
While I was writing the book, I was amazed to learn that the AIMS hotline received a call from a woman whose midwife said: We must stimulate you 24 hours after the departure of the waters. This is the law. ; This woman agreed to stimulate childbirth, which turned out to be very traumatic for her. I want all women to know that there are no laws that determine what a pregnant woman should or should not do. Both me and AIMS are very worried. Every doctor who claims such a thing should be reported to a higher-level organization. Any woman who is threatened in any way or simply declares something like this, we ask to contact AIMS for information and other support.
I am always worried when I hear in the words of midwives or doctors an underestimation of the recommended intervention. Especially I do not like expressions, droplets; or, a little help, used with respect to the intravenous drip of oxytocin. This is a powerful drug, and so to it and should be treated. It can cause fetal distress, and in some clinics it is generally accepted to increase the dose of oxytocin until the child reacts with distress (!), And only then stop increasing the dose; it is considered that the proper level of oxytocin is determined in this way. But even when the dose of oxytocin is no longer raised, once effective fighting is established, this drug should be treated with attention, and professionals should not be underestimated, no matter, intentionally or not, its effect.
The name speaks for itself. Stimulation does not always work, and the woman is not to blame for this. I would like to disenchant all women whose genera unsuccessfully stimulated, that with them and with their bodies everything is in order. This is another case, when some expressions used in the childblock are clearly worth reconsidering.
Risk of stillbirth of unclear etiology
for a period of 35 weeks 1: 500
for a period of 36 weeks 1: 556
for a period of 37 weeks 1: 645
for a period of 38 weeks 1: 730
for a period of 39 weeks 1: 840
for a period of 40 weeks 1: 926
at the time of 41 weeks 1: 826
for a period of 42 weeks 1: 769
for a period of 43 weeks 1: 633
Taken from Cotzias CS, Paterson-Brown S, Fisk NM (1999) Prospective risk of unexplained stillbirth in singleton pregnancies at term population based analysis. BMJ 1999; 319: 287. doi: dx.doi.org/10.1136/bmj.319.7205.287
The final paragraph refers to the assertion that as the age of a woman increases, the risks increase, and therefore their delivery needs to be stimulated. Indeed, some studies suggest a correlation between an increase in the mother's age and an increase in the number of certain complications, but there are several reasons to treat this data with caution. Women are more; senior; age are more often surveyed and are more often subjected to various interventions, and this in itself can cause complications. ; The elder; women are more likely to have health problems, and it is difficult to say what causes complications; the state of health of a woman or her age. Studies that deal with this problem do not always separate one from another, and in those studies where this was done, women who had given birth long ago and who can not be compared to today's women participated. Thus, there is a lot of material missing in this area, and modern research on this topic unfortunately leads only to the fact that more and more young women are also increasingly stimulated at earlier times, so that from the results of such studies women also do not have a special benefit.
In one day ; two after my report I asked some colleagues what facts they would put on the list, and they offered a lot of interesting points. It was not ten facts, but tens and almost hundreds of things that we would like to have women know. But, at least, this is the beginning. You can find more information about this (and much more) in the book: Stimulation of childbirth: take an informed decision, published by AIMS. Now our goal is; deliver this information to as many women as possible before they decide to stimulate.
Sarah Wickam; midwife, teacher, author and researcher, she had extensive and varied practice, and also engaged in obstetrical education, research, published articles and books.
Currently, Sarah organizes seminars; Recipes of normal delivery; for midwives and other professionals working in obstetrics, writes books for AIMS, speaks at various seminars and conferences, consults a lot and twice a week leads a column on his website www.sarawickham.com, where you can read many of her articles. Her latest book; Stimulation of childbirth: to make an informed decision.