Category Archives: Medical guidelines

Heading Down the Road to C Section?

This article is written by an OB who has been practicing for 14 years.
I hope you enjoy.

Top Ten Signs Your Doctor Is Planning To Perform An Unnecessary Cesarean Section On You

I have been a practicing OB/GYN for fourteen years. I live in Frisco, Texas, one of the fastest growing cities in the United States, and I truly enjoy living and working here.  It is a great place for my family and, for the first time, my office is attached to the actual hospital I practice in.  This is the third and final place I will practice medicine.  I trained with some of the most respected academic OB/GYN’s in the country.  These physicians have contributed to books on Obstetrics, created practice guidelines for the American Congress of Obstetricians and Gynecologists (ACOG), and taught me to practice medicine based on scientific evidence.

I follow a few simple rules: do no harm, give your patients options, and provide information so they can make informed decisions.  So, last night I was sitting in my office looking at the fourth Cesarean Section (C/S) operative report of the day for yet another patient who wants to have a vaginal delivery following a previous C/S. I am frustrated and feel like I am fighting a losing battle.

When did Cesarean Sections (C/S) and elect Read the rest of this entry »


Postdates: Separating Fact from Fiction

So I am now 41 weeks pregnant, and the most common question I am getting is ‘so when are you being induced?’  On facebook, I answered that question ten times over a period of 3 days, so ended up making a new status message that consisted of this:
Thankyou for all your questions, thoughts and concerns regarding induction. I am comfortable, and bub is comfortable. I still have 1 more week before I am officially post-term. I will not be getting induced naturally or medically at any stage unless medically indicated. Now no more talk of induction! 😀
But I know that the people who were asking, were only asking and suggesting things because they care about me.  So I looked around and found this fantastic article that has some great research and simple facts that you can share with others.  This link was my status update this morning. This is how I introduced it:
Here’s some interesting research regarding ‘late babies’:
• A pregnancy is NOT “Postdates” until after 42 weeks.
• The risk of stillbirth is nearly a flat line between 38 weeks and 43.
• Amniotic fluid is dependent on maternal hydration, in the absence of congenital abnormalities.
• A baby’s weight virtually plateaus after 40 weeks.”
Good to know hey! 🙂 Read the rest of this entry »

Red Raspberry Leaf Tea – a blessing or a danger?

A lot of people say that red raspberry leaf tea is good for inducing labour, and other people say that you should take it the whole way through your pregnancy to have an easier labour.  People say that it can cause a miscarriage if you take it too early in your pregnancy  So what is the truth?  Is this tea a blessing or a danger?
The first two articles on RRLT has been gleaned from the research completed by the lovely ladies on the forums.

Susun Weed writes in Wise Woman Herbal for the Childbearing Year (Which is currently in it’s 24th printing!!):

The benefits of drinking a raspberry leaf brew before and throughout pregnancy include:

~ Increasing fertility in both men and women. Raspberry leaf is an excellent fertility herb when combined with Red Clover.

~ Preventing miscarriage and hemorrhage. Raspberry leaf tones the uterus and helps prevent miscarriage and postpartum hemorrhage from a relaxed or atonic uterus.

~ Easing of morning sickness. Many attest to raspberry leaves’ gentle relief of nausea and stomach distress throughout pregnancy.

~ Reducing pain during labor and after birth. By toning the muscles used during labor and delivery, Raspberry leaf eliminates many of the reasons for a painful delivery and prolonged recovery. It does not, however, counter the pain of pelvic dilation. Read the rest of this entry »


The Slow Labour: Patience is a Virtue

This is a chapter from a book by Henci Goer called The Thinking Woman’s Guide to a Better Birth.  This chapter is on slow labours and inductions.

The Thinking Woman’s Guide to a Better Birth

Practical Information for a Safe, Satisfying Childbirth

Chapter 7: The Slow Labor: Patience is a Virtue

  1. Problems with Typical Management
    1. Active Management of Labor
    2. Procedures
  2. The Bottom Line
    1. Benefits and Risks of Techniques for Coping With Poor Progress
    2. Strategies to Avoid the Need for IV Oxytocin, Instrumental Delivery or Cesarean Section
  3. Gleanings from the Medical Literature
  4. Bibliography

Problems with Typical Management

Obstetricians treat women laboring slowly the way Peter Pan treated the Lost Boys. He expected everyone to adapt to his ideas of the way things should be. If they didn’t, Peter saw to it that they did. For example, the boys entered the Neverland underground home through hollow trees. If a boy didn’t fit his tree, James Barrie writes, Peter “did something” to the boy. So too with obstetric management. Obstetricians have inflexible ideas of how labor ought to go. If your labor doesn’t conform to that pattern, typical doctors “do something” to you to make you fit. There are, as you may gather, a number of drawbacks to this myopic approach.

The first is that the standard for labor progress doesn’t give you nearly enough time before you are declared over the line. Doctors base their standard on studies from the 1950s and 60s supposedly of normal labors, but many women had interventions that could shorten labor such as oxytocin (trade name: Pitocin or “Pit”) or forceps delivery. A recent study evaluating healthy women who had no interventions that would affect labor length got very different results. For example, the standard says that starting from 4 centimeters cervical dilation, the average first-time mother will take 6 hours to achieve full dilation of 10 centimeters. Doctors set the cutoff defining “abnormal” progress in dilation at 12 hours for first-time mothers and 6 hours for women with previous births because, according to the standard-setting studies, only 5% of women will take longer than this. However, the new study found that average duration in first-time mothers was 7 1/2 hours, not 6, and the threshold for abnormal, fell at 19 1/2 hours, not 12, in first-time mothers and over 13 1/2 hours, not 6, in women with prior births. The standard also stipulates smooth, linear progress. More than a relatively brief halt is thought to require action. However, averaging many labors together evens out the variations. Individual labors often don’t work this way. Read the rest of this entry »


Official recommendations

Here’s a bit of research I have undertaken to find out what the official guidelines are on these potentially contentious issues. Long Pregnancies, PROM, Electronic Fetal Monitoring, Breech Birth and VBAC.  I wanted to find more official guidelines on different topics, but I couldn’t think of more topics to look up!  It’s always good to know what the professional organisations recommend, compared to what your doctor is recommending.

ACOG (American College of Obstetricians & Gynecologists) on
Long pregnancies

Most women give birth between 38 and 42 weeks of pregnancy. But very few babies are born on their due dates. It is normal to give birth as much as 3 weeks before or 2 weeks after your due date.

A postterm pregnancy is one that lasts 42 weeks or longer.

Problems occur in only a small portion of postterm pregnancies. Most women who give birth after the due date have healthy newborns. Read the rest of this entry »


Questions to ask your caregiver

Written on May 13, 2010 at 11:41 pm by Birth Sense


“I trusted my doctor, but when it came down to brass tacks, he ignored my birth plan”.

In the webpoll that I’ve been conducting over the couple weeks, I asked what readers think is the most important factor in avoiding a c-section.  47% of all readers said that the right provider is the most critical component in having a normal birth.

I agree with these readers.  Although there are multiple factors that enter into normal birth, the wrong provider can sabotage the best-laid plans.  For example, I frequently hear comments such as, “I trusted my doctor, but when it came down to brass tacks, he ignored my birth plan”, or “My midwife sounded as if she would support us in a normal birth, but she ended out being just as interventive as the physicians we’d interviewed”. Why do providers sometimes say one thing and do another? Read the rest of this entry »


Myth of Home Birth in the Hospital

This article really struck me.  It’s something I’ve been struggling with for a while – whether to go for a homebirth, or a natural hospital birth next time.  I must read this article a few more times I think. 

Wednesday, August 11, 2010
Fast Food, Assembly Lines and the Myth of Home Birth in the Hospital

I was eating today in a fast food chain restaurant (to remain unnamed of course) and struggling to pick something out on the menu that I could eat. I have been restricting my diet lately to see if it would improve a little annoying health issue I have been having and so I have removed dairy, gluten, eggs and sugar from my diet.

First, I felt like a freak. When I asked the guy behind the counter if dressing XYZ had dairy in it he didn’t seem to know anything. I was obviously not your average customer. I was a little embarrassed too because I was holding up the line and people behind me were starting to get irritated about my neurotic ways.

Finally I decided on a salad with no croutons and a balsamic dressing on the side. It seemed like it should be be fine with my restrictions.

When I got the salad it of course had cheese all over it. I had not known that would be on it. I scraped off what I could but inevitably there was some left over on top. I ate it anyway and it filled me up even though it would have been easier just to make myself something at home.

And your point is… Read the rest of this entry »

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Posted by on April 9, 2011 in All, Medical guidelines


The Placenta: essential resuscitation equipment

I wish I had had access to this article and these resources when pregnant with Will!  When I wrote his birth plan, I specified that if baby needed resuscitation, I wished it to take place on / next to me, with his cord still attached.  The ‘natural’ midwives thought this was a stupid request, and that I was ludicrous for even suggesting such a thing!  They said they would have to check with the OBs, but doubted it would be possible, as all the machines were on the other side of the room.  The machines.  Hmmm. reminds me of that Monte Python skit about birth. Might have to link that one as my next ‘article’… 😛 

And please watch the videos, they are fantastic 🙂

The Placenta: essential resuscitation equipment

Resuscitation Equipment

Knowledge about the short-term and long-term benefits of ‘delayed cord clamping’ is finally making it into practice. Midwives and in some cases obstetricians are realising the importance of allowing the placenta to finish circulating blood before intervening. I personally don’t like the term ‘delayed cord clamping’ and prefer the term ‘premature clamping’ to describe the alternative practice. However, whatever you choose to call it, the good news is that babies are benefitting from the practice. Read the rest of this entry »


Can I eat soft cheeses? Please?

A study into Listeria & Salmonella & Pregnancy.  Yay! I can eat my Brie cheese (in moderation) without worrying!

Food-borne illnesses during pregnancy

Prevention and treatment


QUESTION After hearing about outbreaks of illness resulting from Listeria and Salmonella, many of my patients are wondering about the risks of food-borne illnesses during pregnancy and what they can do to reduce their chances of contracting them.

ANSWER Although heating or cooking food is the best way to inactivate food-borne pathogens, improved standards and surveillance have reduced the prevalence of contaminated foods at grocery stores. Therefore, it is no longer necessary for pregnant women to avoid foods like deli meats and soft cheeses (associated with Listeria); soft-cooked eggs (associated with Salmonella); or sushi and sashimi. Read the rest of this entry »

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Posted by on April 4, 2011 in All, Medical guidelines


The Pregnancy Rules

I soooooo agree with this one!  Pregnancy rules are stupid!  You kind of wonder how the human race survived, when women didn’t know all these rules! 😛 

Saturday, April 2, 2011
The Pregnancy Rules

Is it just me or does pregnancy seem so…..complicated?  It cannot have been this difficult for all of time.  There are so many things you are supposed to remember and do and eat and not eat.  Makes my head swim.

Do take prenatal vitamins.  Don’t eat soft cheese. For that matter don’t eat fish more than twice a week and never eat sushi.

Do exercise.  But, don’t bounce, sit in a hot tub, do leg lifts or lay on your back.  Not even while you are sleeping.  Also, don’t do anything that requires balance such as riding a bike, walking a balance beam or for me, walk up stairs.  While we’re at it, don’t wear high heals for the same reason.

Do keep having relations with your husband.  But, don’t do anything kinky.  Or during your last few weeks.  Or if you experience spotting.  And remember about the not lying on your back thing. Read the rest of this entry »

Posted by on April 4, 2011 in All, Medical guidelines

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