So many of us doulas, nurses, midwives and even doctors need to regularly do some continuing education courses to renew our certifications and or licenses. This is such an important part of what we do. Recently I went to the DONA conference and  I  came out with some great new insights, new info, and a renewed feeling that what I am doing is exactly what I want to do. You know how important your continuing education is for your clients. Many times I have heard parents come home from the hospital or from family gatherings with old fashion believes that some doctor, nurses, and even doulas and midwives, still have about breastfeeding, caring for a new born, or pregnancy and delivery. After many years in the business, we all gravitate to workshops on subjects we have not seen before, strange and unusual situations, diseases, complications etc. Yet, once in a while doing the tried and true breastfeeding workshop, or even hearing Dr. Karp’s lecture on the 5 Ss umpteen times has kept my practice up-to-date.

Here are some old fashion myths that are still perpetrated by many who have not bothered to know what is new up there:

“You must induce before 41 weeks, or your baby will be too big and it will get stuck and die – A breech baby must be delivered via cesarean due to the high mortality risk -Once a cesarean always a cesarean or you could lose mom and babe”

So many doctors induce as early at 39 weeks using all sort of reasoning, including fetal mortality. There are only a handful of doctors I know in Los Angeles that deliver a breech baby. For the most part a breech is an automatic cesarean, and don’t even get me started with the VBACs since now many hospital will not allow, even if you find a doctor who is willing. Here are the risk factors according to Andrew Kotaska MD, OBGYN, from his lecture Normalizing Birth in the 21st Century at the Dona Conference, 2008:

The risk of mortality is as follow:

• 1/1000 Stillbirths risk from 41 to 42 weeks of gestation
• 1/1000 Risk of perinetal death with cautious selective vaginal breech delivery
• 1/1000 Composite risk of perinatal death or hypoxic inschemic encephalopathy
• HIE – Reduced brain oxygen in the baby’s brain – with VBAC

Think this is too high consider the comparison:

• 1/200 risk of miscarriage from genetic amniocentesis
• 1/1000 yearly risk death in a 40 year-old non-smoking Canadian man (doc is from Canada)
• 1/1000 background stillbirth risk over ten days at term
• 1/1000 risk of trysomy 21 (down syndrome) infant in a 31 Y/O woman
• 1/1000 risk of MVA (moving vehicle accident) driving for 4 years

It would seem that the risks we are willing to take with a routine amniocentesis are way higher than a simple VBAC. Dr Kotaska goes on to say that “The increased neonatal and maternal morbidity and cost in the index and future pregnancy make it unreasonable to perform 1000 C/S to prevent one perinatal death. The obstetrician should recommend against cesarean section to prevent risks similar in magnitude to background risks.” In short, women should be informed of their choices and the pitfalls of cesarean sections, and/or pitocin induction. Those pitfalls should be discussed with as much emphasis as the supposed advantages. Women need to demand that there is a discussion of all reasonable alternatives for all these situations. It is called informed consent, no longer should the doctor just establish that “the baby is too big, we need to induce, section” etc. Autonomy demands that the ultimate decision regarding care rests with the woman.

Marshall Klauss MD, in his lecture “How Doulas Can Reduce Cesareans by Their Care” (Dona International Conference 2008) told us that “With a cesarean section vs. a vaginal delivery, there is a higher illness rate as well as a higher death rate in the mother. (c/sec – 5.85/100,000 vs. vaginal – 2.06/100,000.)

He further went on to dispel yet another myth:

“Honey, you’d want an epidural as soon as you get into the hospital. It will not hurt mommy or baby”

Dr. Klauss tells us, “An epidural in the a first time mother can delay the first stage labor by an additional 4 hours, and the second stage by an additional 1 ½ hour for a total of 5 ½ hours. With an epidural, the baby receives medicine almost immediately, and 15% of the time the mother and infant develop a fever of 38 degrees centigrade. On delivery after the baby is born, the staff takes the baby to the NICU for observation and a blood culture. The baby is separated from the mother and father but usually there is no infection. If the epidural is started before 4-5 cm of dilation of the cervix, there is a reasonable chance that the infant might not complete rotation, which leads to a posterior position that often leads to a c/section” Let’s add also that often the epidural leads to pitocin and failed induction is the number one cause for cesareans in the United States.