The Art of Palpation ~ Wisdom from a Traditional Birth Companion

Nana playing with/palpating her granddaughter before she was born. ©Billie Harrigan Consulting

Palpation is the act of using one’s hands to figure out something on or in a body. In maternity services, the practitioner routinely palpates the pregnant belly to assess the position and size of the foetus.

After the male midwife, which later became the obstetrician, infiltrated birth services and paternalized it into a male-centric, provider-centric practice, they’ve been “discovering” all kinds of things that were just normally known and carried out by midwives for centuries. Among them is the standard way to palpate a pregnant belly.

German obstetrician-gynaecologist Christian Gerhard Leopold (1846-1911) is credited with the obstetrical manoeuvre used today to palpate pregnant bellies called ‘Leopold’s Manoeuvre’.

Leopold’s Manoeuvre is a series of 4 specific actions. These 4 actions, along with an assessment of the maternal pelvic shape will help the practitioner to determine if complications will occur during delivery and whether a caesarean should be recommended. They think of it much like a crystal ball that somehow predicts the future. In the provider-centric world of maternity services, it’s another way the practitioner replaces the pregnant mother as the expert on her body and her birth and minimises the power of the birth dance where the mother and baby work together through movement to bring the baby earthside.

Manoeuvre one: Fundal Grip

The practitioner walks their hands up the sides of the uterus to the top of the uterus, called the ‘fundus’. Palpating the upper abdomen will determine if the foetus is lying longitudinal (up/down), oblique (on an angle), or transverse (side-to-side). If the baby is longitudinal, palpating the upper abdomen should determine if it’s a bum or a head.

Manoeuvre two: Umbilical Grip

Next is to determine where the foetal back is lying. By placing hands on either side of the mid-abdomen, the practitioner applies deep pressure on alternating sides to determine where the back is and where the extremities are (arms and legs).

Leopold’s Manoeuvres - public domain

 Manoeuvre three: Pawlick’s Grip

This is also named after a male obstetrician-gynaecologist, Karel Pawlick (1849-1914). This step determines how much of the foetus is above the pelvic inlet. The practitioner uses their fingers and thumb to grasp the lower abdomen, just above the pubic bone (pubic symphysis) to feel how much of the foetus can be felt above the pubic bone.

Manoeuvre four: Pelvic Grip

The practitioner faces the patient’s feet and tries to locate the foetus’ brow by placing both hands on the lower abdomen and moving the fingers of both hands towards the pubis by sliding the hands over the sides of the patient’s uterus. On the side where there is the greatest resistance to the practitioner’s descending fingers is the baby’s brow. A well-flexed head, meaning the chin is tucked down towards the chest, will be on the opposite side of the foetal back. If the head is extended, that is, looking straight ahead or upwards, the back of the head is felt on the same side where the back was found. If the brow cannot be found, the head is descended into the pelvis.

With the routine overuse of ultrasound, many practitioners are losing the art of palpation. Routine multiple ultrasounds are now taking the place of non-invasive and non-risky palpation to assess foetal size (with varying degrees of accuracy), amniotic fluid volume (with varying degrees of accuracy), and position of the baby (with a great deal of accuracy). It could be that since ultrasound is very accurate at determining position, practitioners are losing confidence in their own skills.

As a Traditional Birth Attendant, I like palpating pregnant bellies. I especially like it as a grandmother (Nana). Nothing delights me more than playing with my own grandchildren inside their mother’s bellies. In fact, Nana has turned her own grandchild from breech to cephalic. It’s a simple skill that tends to make me a more useful grandmother.

In all the texts I scoured that discusses how to do Leopold’s Manoeuvre, not once was the foetus ever considered as a sentient member of the procedure. The mother’s comfort is often considered, but primarily, it’s about the practitioner doing something to the client to gather information.

I tend to see palpation through a different lens. I feel it’s more about building a relationship with the baby than anything else. After all, if I’m going to be invited to the birth, the baby should know who I am and whether I am someone they can trust to care for their mummy and therefore take care of them.

In my relationship with pregnant families, the first part of palpating a pregnant belly is to ask the mother if she would like this. She doesn’t have to submit to this. This is her choice. I’ve had clients with a history of sexual assault where this was a very threatening idea that someone would be touching their belly and never wanted it. Instead, they just told us where the baby was and what their guess was on how big the baby was. As it turns out, maternal guessing is pretty accurate and often beats the guesses of ultrasounds or experienced practitioners (1). Another client liked palpation, but could only do it sitting up with one hand over her breasts and one protecting her groin.

If the mother agrees to palpation, then I always suggest she go relieve her bladder first. There’s nothing worse than someone playing with your belly and a full bladder. It’s a recipe for leaking out a wee drip or a pent-up fart.

I have a nice couch by a sunny window that clients are invited to lie down on with as many pillows behind them as feels comfortable. I tend to sit on the couch with them nestled beside their legs.

Now here comes the most important part of palpation:

I introduce myself to the baby.

I say hello to the baby. I tell them my name and that I’m a friend of their mummy and daddy. I let them know that Nana often has cold hands.

I start very gently and talk to the baby the whole time. There are no pre-determined set of manoeuvres as this is usually led by the baby. I may find their little bum and squeal with delight! I talk about how much they’re growing. I invite them to play with me. Sometimes their little foot will poke out to start a little game with me. I’ll ask them to show me what position they’re in and if they’d be ok with us listening to their heartbeat with a fetoscope. If my hands are going to go lower on the mother’s abdomen to where a head might be nestled, I always ask permission from the mother before touching her anywhere close to her pubic bone. Likewise, if the parents want a measurement of fundal height, it’s the mother that places the end of the measuring tape on the top of her pubic bone. There’s no need for someone else to be rooting around down there. Once mum picks her spot where the tape measure starts, then that also helps to eliminate measuring errors that can come with multiple people measuring her belly and placing the tape differently.

Some babies become quite playful. And some will lie quietly, listening to me, deciding if I am friend or foe. It becomes quite easy to sense the baby’s receptivity. A baby who has taken a journey along with their mother through previous obstetric mistreatment or disrespectful prenatal visits will often lie quietly, perhaps taking in their mother’s reactions. It may take another visit to warm up to me and become more playful. I tell them that by the time they arrive, I hope we’ll be good friends.

Through gentle palpation, the baby and I are getting to know each other. The parents and I are building trust. We’re having fun! And through gentle touch, we discover where the baby is positioned at that particular moment. It’s not predictive of much else. Even persistently breech babies have turned in labour when I’ve been present. Perhaps in the presence of calm and loving family and birth attendant, the babies felt it a simple matter to rotate and come out head first.

Through gentle palpation, we can also get a sense for how much amniotic fluid is in the womb. It’s a chance to talk about hydration and salt. Parents are invited to listen to their baby’s heartbeat with a fetoscope, and depending on the position of the placenta, they may be treated to the sounds of its ‘whooshing’ as blood flows through the maternal side.

A fetoscope is non-invasive and listens to the baby’s heartbeat and the placenta

Through gentle palpation, we can invite the baby to adjust their position to make it easier on mummy. Perhaps a poking foot is feeling like it’s about to break mummy’s rib. Or little one hasn’t started the descent down into the pelvis as it gets closer to term. Having a simple conversation with the little one and explaining how they can help has shown over and over that these precious babies are sentient and love their mothers and want to participate in a loving and safe arrival.

And to conclude the palpation, I thank the baby for allowing me to play with them.

This gentle approach has brought many mothers to tears. For many of them, it’s the first time their body and their baby have been treated with reverence. In fact, I too, have often been brought to tears by the enthusiastic response of these precious babies who quickly understand that I care deeply about them.

Modern maternity services are decidedly centred around the practitioner. The manoeuvres designed to gather information help the practitioner to determine a course of action that lessens the potential for an obstetrically-determined negative outcome. However, truly client-centred and family-centred maternity care includes the baby as a fully sentient member of the family who deserves as much care, caution, respect, and dignity as every other member of the family. And that’s where we see some of the best outcomes!

Much love,

Mother Billie

©Billie Harrigan Consulting

Endnote

1.     Ashrafganjooei, T., Naderi, T., Eshrati, B., & Babapoor, N. (2010). Accuracy of ultrasound, clinical and maternal estimates of birth weight in term women. EMHJ-Eastern Mediterranean Health Journal, 16 (3), 313-317, 2010.

The Art of Palpation ~ Wisdom from a Traditional Birth Companion

Nana playing with/palpating her granddaughter before she was born. ©Billie Harrigan Consulting

Palpation is the act of using one’s hands to figure out something on or in a body. In maternity services, the practitioner routinely palpates the pregnant belly to assess the position and size of the foetus.

After the male midwife, which later became the obstetrician, infiltrated birth services and paternalized it into a male-centric, provider-centric practice, they’ve been “discovering” all kinds of things that were just normally known and carried out by midwives for centuries. Among them is the standard way to palpate a pregnant belly.

German obstetrician-gynaecologist Christian Gerhard Leopold (1846-1911) is credited with the obstetrical manoeuvre used today to palpate pregnant bellies called ‘Leopold’s Manoeuvre’.

Leopold’s Manoeuvre is a series of 4 specific actions. These 4 actions, along with an assessment of the maternal pelvic shape will help the practitioner to determine if complications will occur during delivery and whether a caesarean should be recommended. They think of it much like a crystal ball that somehow predicts the future. In the provider-centric world of maternity services, it’s another way the practitioner replaces the pregnant mother as the expert on her body and her birth and minimises the power of the birth dance where the mother and baby work together through movement to bring the baby earthside.

Manoeuvre one: Fundal Grip

The practitioner walks their hands up the sides of the uterus to the top of the uterus, called the ‘fundus’. Palpating the upper abdomen will determine if the foetus is lying longitudinal (up/down), oblique (on an angle), or transverse (side-to-side). If the baby is longitudinal, palpating the upper abdomen should determine if it’s a bum or a head.

Manoeuvre two: Umbilical Grip

Next is to determine where the foetal back is lying. By placing hands on either side of the mid-abdomen, the practitioner applies deep pressure on alternating sides to determine where the back is and where the extremities are (arms and legs).

Leopold’s Manoeuvres - public domain

 Manoeuvre three: Pawlick’s Grip

This is also named after a male obstetrician-gynaecologist, Karel Pawlick (1849-1914). This step determines how much of the foetus is above the pelvic inlet. The practitioner uses their fingers and thumb to grasp the lower abdomen, just above the pubic bone (pubic symphysis) to feel how much of the foetus can be felt above the pubic bone.

Manoeuvre four: Pelvic Grip

The practitioner faces the patient’s feet and tries to locate the foetus’ brow by placing both hands on the lower abdomen and moving the fingers of both hands towards the pubis by sliding the hands over the sides of the patient’s uterus. On the side where there is the greatest resistance to the practitioner’s descending fingers is the baby’s brow. A well-flexed head, meaning the chin is tucked down towards the chest, will be on the opposite side of the foetal back. If the head is extended, that is, looking straight ahead or upwards, the back of the head is felt on the same side where the back was found. If the brow cannot be found, the head is descended into the pelvis.

With the routine overuse of ultrasound, many practitioners are losing the art of palpation. Routine multiple ultrasounds are now taking the place of non-invasive and non-risky palpation to assess foetal size (with varying degrees of accuracy), amniotic fluid volume (with varying degrees of accuracy), and position of the baby (with a great deal of accuracy). It could be that since ultrasound is very accurate at determining position, practitioners are losing confidence in their own skills.

As a Traditional Birth Attendant, I like palpating pregnant bellies. I especially like it as a grandmother (Nana). Nothing delights me more than playing with my own grandchildren inside their mother’s bellies. In fact, Nana has turned her own grandchild from breech to cephalic. It’s a simple skill that tends to make me a more useful grandmother.

In all the texts I scoured that discusses how to do Leopold’s Manoeuvre, not once was the foetus ever considered as a sentient member of the procedure. The mother’s comfort is often considered, but primarily, it’s about the practitioner doing something to the client to gather information.

I tend to see palpation through a different lens. I feel it’s more about building a relationship with the baby than anything else. After all, if I’m going to be invited to the birth, the baby should know who I am and whether I am someone they can trust to care for their mummy and therefore take care of them.

In my relationship with pregnant families, the first part of palpating a pregnant belly is to ask the mother if she would like this. She doesn’t have to submit to this. This is her choice. I’ve had clients with a history of sexual assault where this was a very threatening idea that someone would be touching their belly and never wanted it. Instead, they just told us where the baby was and what their guess was on how big the baby was. As it turns out, maternal guessing is pretty accurate and often beats the guesses of ultrasounds or experienced practitioners (1). Another client liked palpation, but could only do it sitting up with one hand over her breasts and one protecting her groin.

If the mother agrees to palpation, then I always suggest she go relieve her bladder first. There’s nothing worse than someone playing with your belly and a full bladder. It’s a recipe for leaking out a wee drip or a pent-up fart.

I have a nice couch by a sunny window that clients are invited to lie down on with as many pillows behind them as feels comfortable. I tend to sit on the couch with them nestled beside their legs.

Now here comes the most important part of palpation:

I introduce myself to the baby.

I say hello to the baby. I tell them my name and that I’m a friend of their mummy and daddy. I let them know that Nana often has cold hands.

I start very gently and talk to the baby the whole time. There are no pre-determined set of manoeuvres as this is usually led by the baby. I may find their little bum and squeal with delight! I talk about how much they’re growing. I invite them to play with me. Sometimes their little foot will poke out to start a little game with me. I’ll ask them to show me what position they’re in and if they’d be ok with us listening to their heartbeat with a fetoscope. If my hands are going to go lower on the mother’s abdomen to where a head might be nestled, I always ask permission from the mother before touching her anywhere close to her pubic bone. Likewise, if the parents want a measurement of fundal height, it’s the mother that places the end of the measuring tape on the top of her pubic bone. There’s no need for someone else to be rooting around down there. Once mum picks her spot where the tape measure starts, then that also helps to eliminate measuring errors that can come with multiple people measuring her belly and placing the tape differently.

Some babies become quite playful. And some will lie quietly, listening to me, deciding if I am friend or foe. It becomes quite easy to sense the baby’s receptivity. A baby who has taken a journey along with their mother through previous obstetric mistreatment or disrespectful prenatal visits will often lie quietly, perhaps taking in their mother’s reactions. It may take another visit to warm up to me and become more playful. I tell them that by the time they arrive, I hope we’ll be good friends.

Through gentle palpation, the baby and I are getting to know each other. The parents and I are building trust. We’re having fun! And through gentle touch, we discover where the baby is positioned at that particular moment. It’s not predictive of much else. Even persistently breech babies have turned in labour when I’ve been present. Perhaps in the presence of calm and loving family and birth attendant, the babies felt it a simple matter to rotate and come out head first.

Through gentle palpation, we can also get a sense for how much amniotic fluid is in the womb. It’s a chance to talk about hydration and salt. Parents are invited to listen to their baby’s heartbeat with a fetoscope, and depending on the position of the placenta, they may be treated to the sounds of its ‘whooshing’ as blood flows through the maternal side.

A fetoscope is non-invasive and listens to the baby’s heartbeat and the placenta

Through gentle palpation, we can invite the baby to adjust their position to make it easier on mummy. Perhaps a poking foot is feeling like it’s about to break mummy’s rib. Or little one hasn’t started the descent down into the pelvis as it gets closer to term. Having a simple conversation with the little one and explaining how they can help has shown over and over that these precious babies are sentient and love their mothers and want to participate in a loving and safe arrival.

And to conclude the palpation, I thank the baby for allowing me to play with them.

This gentle approach has brought many mothers to tears. For many of them, it’s the first time their body and their baby have been treated with reverence. In fact, I too, have often been brought to tears by the enthusiastic response of these precious babies who quickly understand that I care deeply about them.

Modern maternity services are decidedly centred around the practitioner. The manoeuvres designed to gather information help the practitioner to determine a course of action that lessens the potential for an obstetrically-determined negative outcome. However, truly client-centred and family-centred maternity care includes the baby as a fully sentient member of the family who deserves as much care, caution, respect, and dignity as every other member of the family. And that’s where we see some of the best outcomes!

Much love,

Mother Billie

©Billie Harrigan Consulting

Endnote

1.     Ashrafganjooei, T., Naderi, T., Eshrati, B., & Babapoor, N. (2010). Accuracy of ultrasound, clinical and maternal estimates of birth weight in term women. EMHJ-Eastern Mediterranean Health Journal, 16 (3), 313-317, 2010.

Hocus Pocus - The ARRIVE study says inductions reduce caesareans

In an epic sleight of hand, the US obstetrical industry has managed to produce a study that affirms the “benefits” of universal elective induction of labour at 39 weeks. Headlines have trumpeted this remarkable accomplishment! Inducing labour early “prevents” c-sections!

The conclusion of the much anticipated ARRIVE study (Grobman et al., 2018) are presented in their abstract:  

“IOL (induction of labour) in low-risk nulliparous women (first-time mothers) results in a lower frequency of CD (caesarean delivery) without a statistically significant change in the frequency of a composite of adverse perinatal outcomes.”

Obstetricians now have the much-desired go-ahead to routinely induce healthy first-time mothers prior to reaching 40 weeks under the guise that it will reduce c-sections with no additional negative outcomes to the mother or baby.

This is the same outrageous chicanery that brought us the ridiculously executed Term Breech Trial that changed obstetrical practices around the world (Hannah et al., 2000). It was the excuse the industry was looking for to do what they already wanted to do: surgery (Hunter, 2013).  

Obstetrics is a surgical speciality that also includes attending normal physiologic births. Years ago, the World Health Organisation sought to address disparities in health outcomes around the world in an effort to reduce maternal deaths in vulnerable places. They looked at countries with good outcomes and compared them to countries with poor outcomes. In wealthy nations where infrastructure was in place, food was easily accessible, and infection control measures were widely used, they tended to have a c-section rate around 5%. The WHO initially suggested that a c-section rate of 5-10% across the entire population could improve maternal-fetal outcomes. However, when the c-section rate rose above 15% across a population, the maternal death rate began to rise due to too much surgery.

There was naturally an outcry from the wealthy sector that was safely performing a lot of surgery and the WHO was roundly chastised for trying to prevent them from performing surgery on clients whom they believed would benefit from surgery. So the WHO said a c-section rate of 10-15% was “ideal” as it could potentially save lives, although they’ve subsequently stated that there is no benefit when the rate rises about 10% for a population (Betran, Torloni, et al, 2016).

Caesarean rates by country. (Betran, Ye, et al, 2016)

The problem wasn’t lack of surgery. The problem was that 99% of maternal deaths are in the developing world with half in sub-Sahara Africa and one-third in Southeast Asia where most fatal complications develop during pregnancy and are largely preventable or treatable. Half of these maternal deaths occur in fragile and humanitarian settings such as refugee displacement, natural disasters, and war (WHO, 2018). 

Since the WHO’s mistake in encouraging an increase in surgery in impoverished, fragile, and humanitarian settings, the rest of the world’s obstetrics industry has spiraled out of control. Canada’s national c-section rate has risen to 28.2% in 2016-17 (CIHI, 2018) along with an increase in most every other country.

Data from around the world shows an average annual rate of increase in caesarean surgery of 4.4% from 1990 to 2014 (Betran, Ye, et al, 2016). Globally, in 2015 21.1% of all births occur through caesarean surgery, representing just over one in five mothers around the world (Boerma et al., 2018). This rate has risen from 12.1% of all births in 2000, representing a relative increase of 74.38% in just 15 years.

Regionally, caesarean rates are:

• Latin America & Caribbean: 44.3% - an absolute increase of 19.4% and a relative increase of 77.91% (from 24.9% to 44.3%)

• North America: 32.3% - an absolute increase of 10% and a relative increase of 44.84% (from 22.3% - 32.3%)

• Oceania: 32.6% - an absolute increase of 14.1% and a relative increase of 76.22% (from 18.5% to 32.6%)

• Europe: 27.3% - an absolute increase of 16.1% and a relative increase of 143.75% (from 11.2% to 27.3%)

• Asia: 19.2% - an absolute increase of 15.1% and a relative increase of 343.18% (from 4.4% to 19.5%)

• Africa: 7.3% - an absolute increase of 4.5% and a relative increase of 155.17% (from 2.9% to 7.4%)

Global increase in caesarean surgery 1990-2014. (Betran, Ye, et al, 2016)

What’s to blame for these shocking numbers? While it’s common to say it’s due to older, heavier, or more unhealthy mothers, the truth is that caesarean surgery has risen for every clientele group including young, slim, and healthy mothers.

The real increase in surgery comes from:

• The management style of the hospital, where proactive management of patient flow and nursing resources results in more surgery and more postpartum haemorrhages (Plough et al., 2017)

• Fear of litigation, particularly when malpractice premiums rise about $100,000 (Zwecker, Azoulay, & Abenhaim, 2011)

• Financial incentives. Private facilities tend to perform more surgery as their clients have private insurance to pay for it (Dahlen et al., 2012). Even in the Canadian system, where compensation comes from a single payer through universal coverage, when the compensation for surgery is double that of a vaginal delivery, then there is a corresponding 5.6% increase in surgery when all else is equal (Allin, Baker, Isabelle, & Stabile, 2015)

• Training, scheduling, and institutional culture drive the rates of surgery in individual institutions (Roth & Henley, 2012)

Both maternal request and maternal morbidity has been blamed for the dramatic increase in surgery, but neither has held up to scrutiny. The increase is physician induced (Roth & Henley, 2012).

Tomasz Kobosz freeimages.com

Now this same industry that has brought us shockingly high rates of surgery due to the nature of the industry says they have a “solution” for this epidemic: induce healthy mothers early.

The caesarean epidemic is due to the industry wanting to perform surgery. The unsupportable conclusions of the Term Breech Trial turned the industry upside-down in a heartbeat and most mothers with a breech-presenting baby are now faced with mandatory surgery. This industry is so invested in getting their way that some of their members have even resorted to using the courts to force clients into non-consenting procedures (Diaz-Tello, 2016).

The idea that inducing a mother early will reduce the incidence of caesarean surgery is akin to saying that if you give a child a pre-dinner snack then they are less likely to over-eat at dinner. Fulfilling the need to medically manage the client’s physiology satisfies the surgeon’s training, preferences, and institutional culture that guide the physician to perform surgery. This is nothing more than a physician placebo. And when this pre-dinner snack doesn’t satisfy any more, and the honeymoon phase of routine early induction wanes, then rates of surgery will rebound.

To begin, an induction is not benign. The risks associated with an induction depend on what is done to the patient. This could involve multiple vaginal exams (infection, sexual re-traumatisation), artificial rupture of membranes (cord prolapse, infection, foetal distress), continuous foetal monitoring (caesarean surgery), chemical cervical ripening (uterine hyperstimulation, uterine rupture, foetal distress, maternal death, foetal death, meconium), IV synthetic oxytocin (Pitocin/syntocinon) (uterine rupture, postpartum haemorrhage, breastfeeding failure, postpartum depression and anxiety, water intoxication leading to convulsions, coma or death, foetal distress, meconium, neonatal jaundice, neonatal brain damage, and neurological dysregulation in the child years later) (Gregory, Anthopolos, Osgood, Grotegut, & Miranda, 2013; Grotegut, Paglia, Johnson, Thames, & James, 2011; Gu et al., 2016; Kurth & Haussmann, 2011; Elkamil et al., 2011).

Inductions are generally more painful and first time mothers are more than 3x more likely to ask for an epidural during an induction (Selo-Ojeme et al., 2011). This leads to a longer labour and pushing stage, need for more synthetic oxytocin, problems passing urine, inability to move after the birth, fever, and more instrumental deliveries (Anim-Somuah, Smyth, Cyna, & Cuthbert, 2018).

Now let’s talk about the study itself.

A total of 3062 women were assigned to labour induction, and 3044 were assigned to expectant management (wait and see approach). Just like with the Term Breech Trial, there was quite a bit of crossover, meaning those who were assigned to the induction group had a spontaneous birth and those who were assigned to a wait-and-see approach were induced (about 5% from each group – 1 in 20 participants). However, the results were reported to the group they were assigned to.

The enrolment was designed to be too small to detect certain outcomes. Adverse outcomes such as maternal death, cardiac arrest, anaesthetic complications, thromboembolism, amniotic fluid embolism, major puerperal infection, or haemorrhage are fairly rare but are associated with both induction and surgery.

Without enough participants, it’s not possible to determine if there was an increase in adverse outcomes from inducing mothers.

Remember, this study took place in the US where they boast some of the worst maternal and neonatal outcomes in the developed world. How they practice obstetrics has much to do with this. Both the induction and the expectant management groups experienced high rates of interventions and the outcomes for the babies were consistent with that:

• 15% were not breathing at all or were breathing weakly 5 minutes after birth

• 12% were admitted to the NICU

• 5% had neonatal jaundice

• 1% needed breathing support for a day or more

• 0.7% experienced meconium aspiration syndrome

• 0.6% had hypoxic ischemic encephalopathy

• 0.3% suffered intracranial haemorrhage

• 0.3% had infections

• 0.2% had seizures

The results for the mothers were equally awful:

• 5% had severe postpartum haemorrhage of over 1500cc requiring a blood transfusion, blood products, or a hysterectomy

• 4% suffered a third or fourth degree perineal tear

• 2% had a postpartum infection

Benjamin Earwicker freeimages.com

With shockingly terrible results like this, the industry has the temerity to suggest that signing up for an elective induction to placate their nerves is a good idea because they’re less likely to perform surgery?

Frankly, it’s asinine nonsense from a group that needs a dramatic change in education and culture. We’ll see how long it takes for this insanity to move throughout the obstetrical world.

Make wise choices, my friends.

Much love,

Mother Billie

References

Allin, S., Baker, M., Isabelle, M., & Stabile, M. (2015). Physician Incentives and the Rise in C-sections: Evidence from Canada (No. w21022). National Bureau of Economic Research.

Anim-Somuah, M., Smyth, R. M., Cyna, A. M., & Cuthbert, A. (2018). Epidural versus non-epidural or no analgesia for pain management in labour. The Cochrane database of systematic reviews, 5, CD000331-CD000331. 

Betrán, A. P., Torloni, M. R., Zhang, J. J., Gülmezoglu, A. M., WHO Working Group on Caesarean Section, Aleem, H. A., ... & Deneux‐Tharaux, C. (2016). WHO Statement on caesarean section rates. BJOG: An International Journal of Obstetrics & Gynaecology, 123(5), 667-670.

Betrán, A. P., Ye, J., Moller, A. B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The increasing trend in caesarean section rates: global, regional and national estimates: 1990-2014. PloS one, 11(2), e0148343.

Boerma, T., Ronsmans, C., Melesse, D., Barros, A., Barros, F., Juan, L., Moller, A., Say, L., Hosseinpoor, A., Mu, Y., Neto., D., Temmerman, M. (2018). Global epidemiology and use of and disparities in caesarean section. The Lancet. Volume 392, Issue 10155, P1341-1348, October 12, 2018.

CIHI. Canadian Institute for Health Information. (2018). Hospital Morbidity Database, 2016–2017.

Dahlen, H. G., Tracy, S., Tracy, M., Bisits, A., Brown, C., & Thornton, C. (2012). Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ open, 2(5), e001723.

Diaz-Tello, F. (2016). Invisible wounds: obstetric violence in the United States. Reproductive Health Matters.

Elkamil, A. I., Andersen, G. L., Salvesen, K. Å., Skranes, J., Irgens, L. M., & Vik, T. (2011). Induction of labor and cerebral palsy: a population‐based study in Norway. Acta obstetricia et gynecologica Scandinavica, 90(1), 83-91.

Gommers, J. S., Diederen, M., Wilkinson, C., Turnbull, D., & Mol, B. W. (2017). Risk of maternal, fetal and neonatal complications associated with the use of the transcervical balloon catheter in induction of labour: A systematic review. European Journal of Obstetrics & Gynecology and Reproductive Biology, 218, 73-84.

Gregory, S. G., Anthopolos, R., Osgood, C. E., Grotegut, C. A., & Miranda, M. L. (2013). Association of autism with induced or augmented childbirth in North Carolina Birth Record (1990-1998) and Education Research (1997-2007) databases. JAMA pediatrics, 167(10), 959-966.

Grotegut, C. A., Paglia, M. J., Johnson, L. N., Thames, B., & James, A. H. (2011). Oxytocin exposure during labor among women with postpartum hemorrhage secondary to uterine atony. American journal of obstetrics and gynecology, 204(1), 56-e1.

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