Articles of Interest

The following articles related to pregnancy, labor, birth and your baby may be of interest to you in making decisions about your pregnancy and parenthood.

What Every Pregnant Woman Needs to Know About Cesarean Section.pdf

This booklet is the first of its kind to offer the pregnant woman and her partner complete and up to date information on a broad range of outcomes on cesarean compared to vaginal birth. It covers important information in more detail than you and your caregiver are likely to be able to cover in a single prenatal visit. It is a valuable resource to better prepare you to make informed decisions that are right for you and your baby.   

Childbirth Connection  offers many excellent articles and resources for subjects from pre-conception to postpartum. The information is fact based, and frequently includes the best available evidence so you can make the best decision for yourself and your baby. Below is a partial list of the subjects covered on the Childbirth Connection web site.

o Choosing a Caregiver
o Choosing a Birth Setting
o Labor Support
o Labor Pain
o Cesarean Section
o Preventing Pelvic Floor Dysfunction
o VBAC or Repeat C-Section
* Stages of Pregnancy
* Your Growing Body & Baby: Pictures
* Listening to Mothers
* The Rights of Childbearing Women
* Alerts & Responses
* A Guide to Effective Care in Pregnancy and Childbirth
* Recommended Resources

How will I cope with labor pain?

Penny Simkin is a doula and childbirth educator with an intense interest in natural childbirth and helping women find their strengths in labor and birth. She has written a new booklet "Comfort in Childbirth" which may be downloaded hereas a pdf, but along with other comprehensive resources, is also available from Childbirth Connection

Comfort in Labor by Penny Simkin .pdf

For many pregnant women, concerns about labor pain are second only to concerns about their baby's welfare. Decisions you make about pain relief measures can have a profound effect on:

• your experience and memories of labor;
• procedures, medications, or restrictions that may become necessary for you or your baby; and
• your and your baby's well-being after the birth.

Circumcision: Information for Parents

   Written for parents, this easy to read brochure details risks and benefits,  how to care for an uncircumcised penis,  pain relief if you decide to circumcise, and how to care for  a child who has been circumcised. there is also a link on the site leading to the references used to develop this paper.
     Available from the Canadian Pediatric Association

A new website with information about circumcision is The Boy's Health Advisory ®, is a nonprofit educational organization with the purpose of informing parents and professionals about good penile care. Our mission is to raise awareness about the natural penis, educate good intact-care for boys and promote better treatment of boys.

Our advisors include physicians and nurses from the fields of pediatrics, obstetrics, and psychology, and leaders in the men's rights movement.

Their website is www.babyboy.info and includes several pamphlets, brochures, and pdf documents about most topics, including religous reasons, involved in the circucision decision.

The Safety of Birth at Home or Birth Center

Outcomes of Planned Homebirths with Certified Professional Midwives: Large Prospective Study in North America
  Published in British Medical Journal June 18, 2005

Press release from the BMJ

  Planned home births for low risk women in the United States are associated with similar safety and less medical intervention as low risk hospital births, finds a study in this week's BMJ.
   Midwives involved with home births are often not well integrated into the healthcare system in the United States and evidence on the safety of such home births is limited.
    In the largest study of its kind internationally to date, researchers analysed over 5000 home births involving certified professional midwives across the United States and Canada in 2000. Outcome and medical interventions were compared with low risk hospital births.
rates of medical intervention, such as epidural, forceps, and caesarean section, were lower for planned home births than for low risk hospital births. Planned home births also had a low mortality rate during labor and delivery, similar to that in most studies of low risk hospital births in North America.
   A high degree of safety and maternal satisfaction were reported, and 87% of mothers and babies did not require transfer to hospital.
   "Our study of certified professional midwives suggests that they achieve good outcomes among low risk women without routine use of expensive hospital interventions," say the authors. "This evidence supports the American Public Health Association's recommendation to increase access to out of hospital maternity care services with direct entry midwives in the United States."

American College of Nurse Midwives Position Paper on Home Birth

This postion paper includes an extensive bibliography of studies and meta analyses  related to the safety of home birth. It also includes a brief sypnosis and crtique of some of the lesser quality studies which are frequently quoted as showing that homebirth is less safe than hospital birth.

Care Supporting Normal Birth Is Best for Mothers and Babies

    Findings from a two-year review of the science behind maternity care indicate that the common and costly use of many routine birth interventions, such as continuous electronic fetal monitoring, labor induction for low-risk women, and cesarean surgery, fail to improve health outcomes for mothers and their babies and may cause harm.
    The Coalition for Improving Maternity Services (CIMS) Expert Work Group study entitled, Evidence Basis for the Ten Steps to Mother-Friendly Care, reviewed the evidence in support of each of the Ten Steps of the Mother-Friendly Childbirth Initiative for Mother-Friendly Hospitals, Birth Centers, and Home Birth Services. Research findings include:

    • Women whose labors are induced for non-medical reasons are more likely to suffer from intrapartum fever and more likely to end up needing forceps, vacuum extraction and a cesarean surgery.
    • Inductions add to the risk of poor outcomes for the health of the baby. Artificially induced labors increase the rate of fetal distress and a serious complication of labor called shoulder dystocia (when the babyís shoulders have difficulty passing through the motherís pelvic bones). Elective induction babies are also more likely to need phototherapy to treat jaundice after birth, and are at higher risk for breathing difficulties and admission to neonatal intensive care.
    • Use of electronic fetal monitors is over 85% on low-risk women. They fail to reduce the number of perinatal deaths, the incidence of cerebral palsy or the number of admissions to the neonatal intensive care unit. Continuous fetal monitoring puts women at increased risk for an instrumental delivery, cesarean section and infection. • Overall 1 in 3 US women give birth by cesarean surgery. The majority of the operations are repeat procedures with no medical indication. 2
    • When compared to women who have a vaginal birth, cesareans put women at risk for infections, hemorrhage requiring transfusion, surgical injuries, and complications from anesthesia, chronic pain, adhesions, hysterectomy, pulmonary embolism, placental problems with future pregnancies, and death. Babies born by cesarean are more likely to suffer from surgical lacerations, respiratory complications, and to require neonatal intensive care.
    • There are more than 4.1 million US births a year with a cesarean rate over 30%. The health and economic impact of high tech birth is significant. In 2004, hospital costs for deliveries totaled over $30 billion dollars. The record high cesarean rate contradicts the national goals of Healthy People 2010 to reduce cesareans for first time mothers to 15% and increase VBAC (Vaginal Birth After Cesarean) rates to 63%.

    The CIMS study found that harm is also caused by routine use of intravenous fluids (IVs), amniotomy (breaking the bag of waters), withholding food and water from women in labor, and episiotomy. CIMS recommends supporting normal birth for birthing women and limited use of many common and costly birth interventions.
    The CIMS Evidence Basis for the Ten Steps to Mother-Friendly Care has been published
as a supplement to the Winter Issue of The Journal of Perinatal Education.  The summary article (pdf) may be downloaded here  and the full supplement may be found Journal of Perinatal Eucation, Winter 2007 Supplement .

Ice Massage for the Reduction of Labor Pain

Bette L. Waters, CNM, RN, Jeanne Raisler, CNM, DrPH, FACNM

Journal of Midwifery Womens Health 48(5):317-321, 2003.

   Most of the women in this study had a definite decrease in their perception of labor pain. Over the years, the search for answers to controlling labor pain has focused on drugs that alter mental and sensory awareness of pain with noxious side effects of the partial paralysis of epidurals, the confusion of opiates, and the total absence of memory in the use of scopolamine. Midwife deliveries take place in homes, birthing centers, and in hospital settings where women may choose from multiple pain control methods.  Any technique that provides safe, effective pain reduction without serious side effects and that can be given by any health care professional is a definite advance. The results of this preliminary study suggest that ice massage of the LI4 (illustrations included) may be in this category and can safely be added to the many other tools used by midwives, nurses, and physicians.