Medications Used in Child Birth, www.lotusbirth.com/doc/FEB2003Lotusbirth-499.htm

Medications used in child birth and Active Management are harmful birth styles in comparison to Natural Birth Education and Practice. The Report below, by Doris Haire, in red, was a warning to The Birth Without Borders Conference, Sponsored by UNICEF in Chiange Mai, Thailand, March 1, 1997, for developing nations not to follow Western Societies Active Management Style of birth process and education to the medical students. It would be most helpful to see if they heeded that recommendation, of if the babies are being harvested in those nations as they are in Canada and the United States. These are the Concerns of Donna Young, Mother and Grandmother. (Please see link to Petition at end of this article, thank you).

Doris Haire, President of the American Foundation for Maternal and Child Health, New York, began her speech by stating,

"It is painful for me to report that nowhere in the world has the normal physiology of childbirth been more distorted than it has in the United States. There is growing concern in the U.S. that obstetric related drugs, which you refer to as medications, contribute significantly to our embarrassingly high rate of learning disabled children. American children, in general, continue to lag behind most industrialized countries in academic achievement, especially in those aspects of education, such as math and science, that require comprehension and deduction. Despite hundreds of millions of dollars spent each year on prenatal care and high tech maternity care U.S. schools continue to be flooded with children who cannot learn without special education instruction by teachers trained to work with learning impaired children. Special education has become a growth industry in the United States. And while we would be more comfortable blaming the problem on our high rate of prematurity, the fact is, that 75% of all handicapped children in the U.S. were born within the normal range of gestational age and weight, with no predisposing familial condition. Before your obstetric serves are tempted to adopt the westernized approach to maternity care help your colleagues to realize that the interventions that have become so much a part of westernized maternity care have the potential for permanently harming both the mother and her baby and eventually the fabric of society."

Comments: In Ontario, Canada, after the 1980's and two private cord stem cell blood banks were operating those provinces, over 65 percent of students recently tested could not pass an education achievement tests. I would contribute that to brain injury caused by the blood oxygen debt deprived the students by early cord clamping. The babies look beautiful and apparently normal on the outside, but they likely have lesions of the brain, as was warned about in the book, The Magical Child, written by the educator, Joseph Chilton Pearce regarding knowledge of endangering to children by drugs and early umbilical cord clamping, known harmful, since 1801, and then at that time the 1960's, the book printed in the 1970's. When will we have an application to the United Nations to deal with the Nations violating the duty of protection to the mother and child. NO form of discrimination of any kind to women, and that means factual and truthful information on reproduction, conception to the birth of her baby. Truthful information is not in the biology textbooks, one of the first source of misleading the future parents, stating most doctors clamp the cord immediately for human babies. Right there, they know the difference of not clamping the cord immediately on any other mammals.

The motive, then, on human babies is that policies were developed to harvest the babies, secretly, in most medical hospitals, the women forced and believed having to birth with specifically trained medical persons taught to show disrespect to natural birth education and practice, and instead, use policies that directed and/or allow the harvesting of the trapped blood in the placenta. The placenta then drained, sold, and the blood taken used without informed consent, in transplants, stem cells research and in cosmetic, or separated into the various components of the human blood. These being: white cells needed to fight infection; red cells to carry blood, stem cells (immature red cells) for their DNA; platelets to clot the blood; hormones, enzymes, amino acids...all important along with proteins in the plasma. Vitamins and minerals essential to the child and oxygenated blood into the expanding lungs. Most babies would be blue ribbon babies, if the mother and the father planned a healthy conception in drug free bodies, and not polluted or damaged by our environment. Doing that, by lack of proper education on the facts of what is a healthy natural birth, they are being deceived in what is known as "active management. Here the mother, as Doris Haire, so competently states, the mother is drugged, and other interventions are knowingly imposed on her. The mother not truly aware of her options. The babies appear, physically well, but weeks, months, years, trauma of the birth caused by interventions reveals learning and behavior problems. This is avoidable in natural birth education and practice.

Drugs in Labor

This Report is to be an Exhibit in the Declaration of Dr. Sarah Buckley

MEDICATIONS USED IN LABOR:

Their Effects on Mother and Newborn

by DORIS HAIRE, President

American Foundation for Maternal and Child Health, New York Presented to the Birth Without Borders Conference

Sponsored by UNICEF in Chiang Mai, Thailand

March 1, 1997

I am very honored to be speaking to you today. As head of the International Childbirth Education Association and the National Women's Health Network and now the American Foundation for Maternal and Child Health I have had an opportunity to observe maternity care in 68 countries. It is painful for me to report that nowhere in the world has the normal physiology of childbirth been more distorted than it has in the United States.

There is growing concern in the U.S. that obstetric related drugs, which you may refer to as medications, contribute significantly to our embarrassingly high rate of learning disabled children. American children, in general, continue to lag behind most industrialized countries in academic achievement, especially in those aspects of education, such as math and science, that require comprehension and deduction. Despite hundreds of millions of dollars spent each year on prenatal care and high tech maternity care U.S. schools continue to be flooded with children who cannot learn without special education instruction by teachers trained to work with learning impaired children. Special education has become a growth industry in the United States. And while we would be more comfortable blaming the problem on our high rate of prematurity, the fact is, that 75% of all handicapped children in the U.S. were born within the normal range of gestational age and weight, with no predisposing familial condition. Before your obstetric services are tempted to adopt the westernized approach to maternity care help your colleagues to realize that the interventions that have become so much a part of westernized maternity care have the potential for permanently harming both the mother and her baby, and eventually the fabric of society.

Almost two decades ago the Director of the National Institute of Neurological and Communicative Disorders and Stroke, Dr. Donald Towers, cautioned in a speech before the National Committee for Research in Neurologic Disorders:

"It is the biochemical circuitry - the biochemical messengers and relevant nerve cells in the brain - that form the basis for mankind's behavior"

At no other time in an individual's life is his or her brain more vulnerable to alteration, trauma, and permanent injury than during the hours which surround that individual's birth. The nerve circuity of the brain and central nervous system of the fetus is rapidly developing as labor begins, making these complex structures vulnerable to permanent alteration or damage from the drugs and procedures administered to the mother during that time.

Even though they are well-intended drugs, including oxytocin, administered to the mother during labor and birth rapidly filter through the placental membrane and enter the blood and brain of the fetus in a matter of seconds or minutes. Once the infant is born and the cord is clamped, those drugs which are present in the newborn infant's blood and brain are essentially trapped in the infant's circulatory system. Because the newborn's metabolic and endocrine systems are immature the trapped drugs or their potent metabolites may continue to circulate in the newborn infant for several days or longer. While we would like to think that these drugs cause no long-term effect research my Rosenblatt and later by Sepkoski and colleagues has shown that the adverse effects of bupivacaine, used in epidurals, can still be detected six weeks after birth.

It should come as no surprise that the Swedish scientist Jacobson found an increased incidence of drug addiction among young adults who were exposed in utero to synthetic narcotics and other pain relieving drugs administered to the mother during labor. More recently research suggests that in utero exposure to oxytocin may increase the likelihood of autism in the exposed offspring.

The safety and effectiveness of many drugs and procedures that were once considered advances in maternity care are now being challenged by randomized controlled trials. In general, most of the common interventions in maternity care do not hold up under careful scientific scrutiny. Randomized controlled trials of various interventions in childbirth consistently underscore the improved outcomes resulting from cautious nonintervention in the physiology of human parturition. The midwife's ability to support the mother during labor and birth with little or no pain-relieving drugs or uterine stimulants continues to provide a standard of care against which to measure the advantages and disadvantages of obstetric interventions. Midwives can best defend the scientific soundness of their practice if they fully understand the known and potential risks inherent in the use of obstetric related drugs and intervention.

NEED FOR EVIDENCE BASED OBSTETRIC CARE

There is, in fact, no scientific support for the vast majority of interventions that have become common components of physician's practice patterns used in maternity care today. I hope that all of you will begin to familiarize yourselves with the work coming out of the Oxford based Cochrane Research Center. The Cochrane Library with its Pregnancy and Childbirth Database is a regularly updated electronic journal that provides essential information for those who wish to keep current with new research obtained from randomized controlled trials in perinatal care. It provides fast access to hundreds of systematic reviews of research, using disk and CD ROM for computers. I look forward to a time when learning to use the Cochrane Library database will be part of every midwife's education. The database repeatedly documents the added benefits of midwifery oriented care. It is clear that maternity care based merely on physician practice patterns is coming to an end.

Reviews of the literature by Campbell and Tew and more recently by Steer have found no scientific evidence that requiring an essentially healthy woman to give birth in the hospital is safer for the mother or her baby.

There is no scientific support for the majority of routine practices in maternity care, including

(a) having the perineum and administering an enema,

(b) electively inducing labor or stimulating contractions,

(d) placing an IV or saline lock,

(d) prohibiting a mother from eating and drinking fluids during labor,

(e) rupturing the amniotic membranes to stimulate labor,

(f) performing an episiotomy without first trying to avoid the need by helping the mother to a more physiologic position for birth,

(g) clamping the cord before it has stopped pulsating, etc.

Most of these interventions have the potential to precipitate the need for drugs to ameliorate the problems brought on by the procedure. The result, a cascade of adverse effects that all to often ends in a cesarean that could have been avoided.

Traditional obstetric practice patterns are difficult to change. Caldeyro-Barcia warned us thirty years ago that confining the woman to bed during labor decreases the effectiveness of contractions, increases the mother's perception of pain and increases the use of pain-relieving drugs and uterine stimulants, yet many practitioners still prohibit ambulation during labor.

EPIDURAL ANESTHESIA

Don't ever let an obstetric resident, registrar or consultant tell you that midwifery skills are no longer necessary. Consider the following information, which the U.S. Food and Drug Administration currently requires the manufacturer of bupivacaine hcl (Marcaine) to provide those care givers licensed to administers epidural anesthesia. The government approved labeling for bupivacaine hcl (Marcaine) reads:

"LABOR AND DELIVERY:

Local anesthetics rapidly cross the placenta, and when used for epidural, caudal or pudendal block anesthesia, can cause varying degrees of maternal, fetal and neonatal toxicity... Adverse reactions in the parturient, fetus and neonate involve alteration of the central nervous system, peripheral vascular tone and cardiac function..."

Under "ADVERSE REACTIONS. Neurologic" the official labeling continues:

"Neurologic effects following epidural or caudal anesthesia may include spinal block of varying magnitude (including high or total spinal block); hypotension secondary to spinal block; urinary retention; fecal and urinary incontinence; loss of perineal sensation and sexual function; persistent anesthesia; paresthesia, weakness, paralysis of the lower extremities and loss of sphincter control all of which may have slow, incomplete or no recovery; headache; backache; septic meningitis; meningismus; slowing of labor; increased incidence of forceps delivery; and cranial nerve palsies due to traction on nerves from loss of cerebrospinal fluid.....Neurologic effects following other procedures or routes of administration may include persistent anesthesia, paresthesia, weakness, paralysis, all of which may have slow, incomplete, or no recovery."

EPIDURAL ANESTHESIA AND CESAREAN SECTION

A randomized controlled prospective trial carried out by Thorp and colleagues has shown a ten fold increase in the rate of cesarean section among mothers who received a labor epidural. Separate investigations by Newton and others have shown that epidural analgesia can cause disruptions in normal uterine function that cannot be completely corrected by the use of oxytocin and can double the rate of stress incontinence.

Drug manufacturers would have you believe that the incidence and degree of toxicity of a drug depends only upon the procedure performed, the type and amount of drug used, and the technique of drug administration. What they fail to tell the provider is that gestational age, condition of the fetus, previous and concomitant exposure to other drugs, relative hypoxia and various pathological conditions can affect how a drug given to the mother will affect her fetus during labor, birth and the infant's development following birth. Hypoxemia and a resulting build up of lactic acid in the fetal blood during labor and birth can increase the uptake of a maternal drug by the fetal brain and heart.

EFFECT OF EPIDURAL ANESTHESIA ON NEWBORN

As mentioned earlier, Rosenblatt and her fellow investigators found that bupivacaine administered to the mother during labor can have prolonged adverse effects on the subsequent development of the exposed offspring. The investigators found that newborn infants with greater exposure to bupivacaine in utero were more likely to be cyanotic and unresponsive. They also found that visual skills and alertness decreased significantly with increases in the cord blood concentration of bupivacaine, particularly on the first day of life, but also throughout the next six weeks. Adverse effects of bupivacaine levels on the infant's motor organization, his ability to control his own state of consciousness and his physiological response to stress were also observed. In 1992 Sepkoski and colleagues carried out a similar investigation which supports the earlier findings of Rosenblatt et al.

MEPERIDINE/PETHIDINE

It's time to face the facts. There is no scientific evidence that any of the drugs administered to women during pregnancy, labor and birth are safe for the exposed offspring. The manufacturer of pethidine, called meperidine in the U.S., notes in the drug's information leaflet that the more serious hazards of meperidine for the mother are

(a) respiratory depression,

(b) respiratory arrest,

(d) shock,

(e) cardiac arrest

(f) coma and

(g) death

We have no way of knowing how frequently these adverse effects occur under normal clinical conditions because the law does not require physicians or midwives to report adverse drug reactions to the their drug regulating agency, even if the patient dies.

The FDA has allowed the manufacturers of meperidine/pethidine to provide only a minimum of information in the leaflet in regard to the drug's adverse effects on the fetus and newborn infant. The leaflet acknowledges that the drug does cross the placenta and can cause:

(a) an increase in cerebral spinal fluid pressure,

(b) depression of the respiratory and the psychophysiologic functions of the newborn infant, and

The implications of these effects, however, have not been investigated.

The package insert does not make clear that pethidine/ meperidine given to the mother during labor can slow the fetal heart rate and impede the normal transfer of oxygen from the mother's circulation to that of her fetus. Severe or prolonged oxygen depletion has been shown to cause the fetal brain to swell. This increase in cerebral spinal fluid pressure in the presence of fetal hypoxia, ruptured membranes and forceps extraction increases the likelihood of permanent brain damage.

There is some concern that the severely narcotized newborn infant may be more prone to aspirate its gastric fluids because the drug has blunted or paralyzed his protective gag reflex.

NUBAIN, STADOL, NISENTIL, DILAUDID, SUBLIMAZE, Other narcotic-like drugs approved by the FDA for use in labor are nalbuphine (Nubain), butorphanol (Stadol) and alphaprodine (Nisentil). Other drugs, namely hydromorphone (Dilaudid), fentanyl citrate (Sublimaze), and codeine, are also used in labor, but the FDA has not approved those drugs for such use. Like pethidine/meperidine, the delayed or long-term effects of drugs given during labor on the exposed fetus has not been adequately investigated. The little research that has been done on Nubain has shown the drug to concentrate more in the fetal circulation than in the mother's. Butorphanol is forty times more powerful than meperidine/pethidine and must be administered with extreme care to avoid an overdose. The manufacturer of Nisentil (alphaprodine) took it off the market, reinstated it, and has taken it off again.

HYDROXYZINE

Hydroxyzine (Vistaril) is an antianxiety, antinausea drug sometimes administered to women during labor. The potentiating action of hydroxyzine must be considered when the drug is used in conjunction with other drugs which depress the central nervous system.

NALOXONE

Naloxone (Narcan) has been approved by the FDA for use in infants narcotized by drugs administered to the mother, but the FDA has not approved the use of naloxone during labor. In most cases the sluggish, drugged infant becomes alert after receiving naloxone. However, once the short-acting naloxone has worn off, those infants given naloxone show no improvement over those infants who did not receive the drug. The infant receiving naloxone must be carefully and continuously observed. If the naloxone wears off before the effects of the pethidine/meperidine have dissipated, the narcotized infant whose gag reflex has been blunted or paralyzed by drugs administered to the mother during labor could inspire fluid from his stomach and succumb to aspiration. Naloxone should not be administered to a depressed infant unless the infant is narcotized. If the newborn infant is hypoxic for reasons other than being narcotized, naloxone can actually deepen the hypoxic state of the infant.

PHENERGAN

Pethidine/Meperidine is often administered in conjunction with a drug called promethazine (Phenergan) or in a combination called Mepergan. Promethazine relieves the nausea and vomiting caused by the administration of pethidine/meperidine or other powerful pain relievers. Promethazine is thought to potentiate the effects of pethidine by allowing less of the latter drug to be used. The drug is not without risk, however. Research by Corby has shown that promethazine markedly impairs platelet aggregation in the fetus and newborn, a condition which can cause bleeding within the brain of the fetus and newborn without similar effect in the mother.

NORMAL PH DOESN'T MEAN OPTIMAL PH

A normal PH at birth does not mean that a newborn infant has come through unscathed. Animal research in New Zealand, carried out by Mallard and colleagues, investigated the neuronal effects of isolated and standardized brief periods of umbilical cord occlusion in utero. They found that brief periods of cord occlusion can cause neuronal damage in the offspring, mainly in the hippocampus region of the brain, with persistent functional changes in cortical activity, even though there was rapid recovery of other potential indicators of fetal asphyxia. Follow up of animals exposed to such brief periods of occlusion indicates that there is often a subsequent progressive decline in function.

FDA EVALUATION OF OBSTETRIC RELATED DRUGS

Do these findings have implications for lessening the incidence of learning disability in the U.S. and other countries that have followed in our unfortunate footsteps? We must look to those countries with national health programs for the answers. Our own Food and Drug Administration acknowledges that drugs trapped in the infant's brain at birth have the potential to affect adversely the rapidly developing nerve circuitry of the brain and central nervous system by altering:

a) the rate at which the nerve cells in the brain mature,

b) the process by which the brain cells develop individual characteristics and capacity to carry out specific functions,

c) the process by which the brain cells are guided into their proper place within the brain and central nervous system,

d) the interconnection of the branch-like nerve fibers as the circuitry of the brain is formed, and

e) the forming of the insulating sheath of myelin (fat-like substance) around the nerve fibers which helps to assure that the nerve impulses - the messages to and from the brain - will travel their normal routes at the normal rate of speed.

Two decades age, at a Washington conference examining the possible precursors of learning disability, neurobiologist Joseph Altman expressed concern that the development of the human brain appears to be programmed so that certain cells and nerve fibers must develop in synchrony, in order to make appropriate connections within the central nervous system. He cautioned that drug-induced alterations of the chemical components within the brain may interfere with the synchrony of cell and nerve fiber growth, causing subtle or gross misconnections within the developing brain circuitry. The work of Zheng, Heintz, and Hatten, reported in the May 13, 1996 issue of Science, has shown that the migration of neurons along the glia fibers within the brain can be altered by changing the normal chemistry of the rapidly developing brain.

OXYTOCIN

While many of us may have been taught that oxytocin does not cross the placenta, the fact is that it does. Few parturients realize the inherent risks of oxytocic drugs. The work of Hollander and colleagues suggests that the use of oxytocin to induce or stimulate labor may increase the likelihood of autism in vulnerable offspring.

The manufacturer of oxytocin warns the provider in the package insert:

"Maternal deaths due to hypertensive episodes, subarachnoid hemorrhage, rupture of the uterus, fetal deaths and permanent CNS or brain damage of the infant due to various causes have been reported to be associated with the use of parenteral oxytocic drugs for induction of labor or for augmentation in the first and second stages of labor."

In addition to the more benign effects of uterine stimulants, such as nausea and vomiting, the American manufacturer of Pitocin (oxytocin) points out in its official labeling (package insert) that oxytocin can cause:

(a) maternal hypertensive episodes

(b) subarachnoid hemorrhage

(d) postpartum hemorrhage

(e) cardiac arrhythmias

(f) fatal afibrinogenemia

(g) premature ventricular contraction

(h) pelvic hematoma

(i) uterine hypertonicity

(j) uterine spasm

(k) titanic contractions

(l) uterine rupture

(m) increased blood loss

(n) convulsions

(o) coma

(p) fatal oxytocin-induced water intoxication

The following adverse effects of maternally administered oxytocin have been reported in the fetus or infant:

(a) bradycardia

(b) premature ventricular contractions and other arrhythmias

(d) neonatal jaundice

(e) neonatal retinal hemorrhage

(f) permanent central nervous system or brain damage

(d) fetal death

Uterine stimulants which foreshorten the oxygen-replenishing intervals between contractions, by making the contractions too long, too strong, or too close together, increase the likelihood that fetal brain cells will die. The situation is somewhat analogous to holding an infant under the surface of the water, allowing the infant to come to the surface to gasp for air, but not to breathe.

All of these effects increase the possibility of neurologic insult to the fetus. No one really knows how often these adverse effects occur, because there is no law or regulation in any country which requires the doctor to report an adverse drug reaction to the country's drug regulating agency, even if the patient dies.

These findings underscore the importance of the midwife managing the woman's labor in a way that will avoid the need for pitocin and the pain relieving drugs that are often administered to help the women cope with the intensified contractions.

SYNTOCINON

The risks inherent in the use of the oxytocic Syntocinon are essentially the same as those for oxytocin.

METHERGINE

Methylergonovine maleate (Methergine) acts directly on the smooth muscle of the uterus and increases the tone, rate and amplitude of rhythmic contractions. It induces a rapid and sustained tetanic uterotonic effect which shortens the third stage of labor and reduces blood loss. The use of Methergine has diminished because of its vasoconstrictive actions. Sandoz, the manufacturer of Methergine, now acknowledges that the drug can result in acute myocardial infarctions.

PUDENDAL BLOCK

Not even a pudendal block is without risk to the mother and her baby. Although once considered to have no effect on the fetus, an anesthetic drug administered to the mother in the form of a pudendal block reaches the infant's circulation and brain within seconds or minutes of its administration. A pudendal block has the potential for having the same neurological effect on the fetus as an epidural injection of the same drug.

LACTATION SUPPRESSANTS

Bromocriptine mesylate (Parlodel) is a nonhormonal, nonestrogenic agent that inhibits the secretion of prolactin in humans. The use of Parlodel for the prevention of physiological lactation is no longer recommended by the drugs manufacturer. Post market experience in the U.S. reported seizures, status epilepticus, stroke, and myocardial infarction among postpartum patients. While other manufacturers of lactation suppressants ceased marketing their products for that use voluntarily, the U.S. FDA had to force the manufacturer of Parlodel to stop marketing that drug as a lactation inhibitor.

OBSTETRIC INTERVENTIONS AND THEIR SYNERGISTIC EFFECTS

ROUTINE SONOGRAMS AND ELECTRONIC FETAL MONITORING

A massive Federally funded study by Ewigman et al in the U.S. found no justification for the routine use of ultrasonic scanning during pregnancy. Nor has routine electronic fetal monitoring been shown to improve the outcome of pregnancy when auscultation is carried out by a midwife skilled in the proper use of a pinard or stethoscope and recording the findings. Ellisman reminds us that intrauterine exposure to ultrasound has the potential to disrupt the myelination of fetal nerve cells.

ELECTIVE INDUCTION AND AUGMENTATION OF LABOR

Neither the elective induction nor the elective augmentation of labor is an FDA approved use of oxytocin or prostaglandins. As discussed earlier, oxytocin carries substantial risks for both the mother and her baby, and figures frequently in medical malpractic cases in the U.S.

ROUTINE IV

There is no scientific support for starting an IV in an essential health mother unless that mother is about to receive a pain relieving drug. Not only is an IV an irritant that can interfere with the mother's ability to walk or move about freely during labor, an IV has been shown to increase the risk of maternal infection and hemodilution.

ENFORCED FASTING

The practice of routinely withholding food and drink from women during labor is also without scientific merit. A careful review of the scientific literature on aspiration reveals that there is not a single documented case of aspiration occurring in a woman who was allowed to eat and drink fluids during labor, then subsequently administered proper anesthesia according to today's standard of anesthesia care. Aspiration is the result of improperly administered anesthesia, not eating during labor.

Research carried out by anesthetist Kieran Fitzpatrick and midwife Angela Flanagan in Jubilee Hospital, Belfast, Ireland, found that the group of women in their study who were allowed to take "light" food, such as toast, scrambled eggs, sandwiches, ice cream, yoghurt, jelly or fresh fruit, during labor had shorter labors, by one and a half hours, and required less drugs to relieve their pain and/or to stimulate contractions. In addition, babies born to mothers allowed to eat during labor tended to be more vigorous and score higher on the immediate postnatal APGAR scale. In one New York City high risk obstetric service, where midwives are the primary caregivers and women are allowed to eat if they are hungry and drink if they are thirsty, they have had only two cases of aspiration in almost 60,000 births. In both of those cases of aspiration the mother had had nothing by mouth from time of admission to the unit. As a result of the obstetric data in Belfast and New York routine enforced fasting is slowly but surely being abandoned in the U.S.

AMNIOTOMY

A meta-analysis by Brisson-Carroll et al in Canada provides no support for the hypothesis that routine early amniotomy reduces the risk of cesarean section. On the contrary, the investigators found in one large study an association between early amniotomy and cesarean delivery for fetal distress. In addition, the investigators found a tendency toward lower Apgar scores at 5 minutes. The investigators suggest that amniotomy should be reserved for those patients with abnormal labor progress. In light of the increased likelihood of cord prolapse or cord compression when the membranes are artificially ruptured amniotomy should be approached with caution.

EPISIOTOMY

Randomized controlled trials, reported by Klein and his Canadian colleagues have confirmed that routine episiotomy provide no health advantage to either the mother or the baby. There was no support for antiquated claims that routine episiotomy improves sexual and vaginal wall function. A 1996 review of the literature by Hueston found that episiotomy, especially midline episiotomy, increased the incidence of major perineal, sphincter and rectal tears. Lede and his colleagues found no reliable evidence that the routine use of episiotomy has any beneficial effect. On the contrary, they found clear evidence that episiotomy may cause harm, such as a greater need for surgical repair and a poorer future sexual capability. Fortunately the placement of the parturient's legs in stirrups for delivery is rapidly being abandoned as an acceptable practice pattern in the U.S. In a 1996 meeting on urogynecology sponsored by the American College of Obstetricians and Gynecologist specialists reported that one in every 10 women in America requires surgery for urinary incontinence or prolapse, and one out of five women who report urinary incontinence also suffers from fecal incontinence. The extensive review of the literature on episiotomy by Wooley should be required reading by health care students.

FORCEPS VS VACUUM EXTRACTION

American obstetricians, in general, have begun to abandon the use of forceps because the use of forceps has been associated with an increased incidence of brain injury. Now we are reminded by Hickey and McKenna that the vacuum extractor, even when used properly, can fracture the skull of the fetus.

CORD CLAMPING

Clamping the umbilical cord before it has stopped pulsing has been shown by randomized controlled trials to increase the incidence of anemia, especially among vulnerable populations. No properly controlled research has shown early clamping to benefit either the mother or her baby. At the 1996 Experimental Biology Meeting in Washington Raloff and Perez-Escamilla reported that early clamping has been shown to predispose infants to iron deficiency anemia, a condition that contributes to slower growth and learning. At two months of age, 88% of those infants whose cords had been clamped immediately at birth had signs of early onset iron deficiency anemia - almost twice as many as in the two groups of infants subjected to delayed clamping.

British neonatologist Peter Dunn has long stressed the importance of delayed clamping as a means of allowing the placental blood to help in the vascularization of the newborn's lung tissue, thereby facilitating the immediate inflation of the newborn's lungs.

MEDICAL MALPRACTICE LITIGATION: WHO'S AT FAULT?

American obstetricians would have you believe that the chaos in American obstetrics is the result of unfounded medical malpractice litigation, and that obstetricians are leaving the profession in great number. The fact is that we have a glut of obstetricians in the U.S. The American College of Obstetricians and Gynecologists now reports that there are so many medical graduates applying for obstetric residencies in the State of New York that there aren't enough places to accommodate them. Obstetricians in the U.S. also tend to blame the rising cost of health care on increased use of unnecessary tests and procedures in order to avoid being sued for medical malpractice. However, a one year follow-up by Baldwin et al found that those physicians who had been sued for medical malpractice did not increase their defensive medicine practices. In addition, a Harvard University review of thousands of medical records found that only one out of every 10 cases of medical malpractice was ever brought to the court's attention.

Our problem in the U.S. is that we have too many obstetricians and not enough midwives. The national rate of cesarean section in the United States today is approximately 24%. Yet, in those U.S. maternity services where midwives are the primary providers of maternity care the section rate is half that.

All of us would like to be able to provide the laboring woman with a magic remedy that would take away her pain, leave her with all her senses intact and would be free of harm to her and her baby. Such a drug is not yet at hand. For now, each mother (and father as well) must be given the facts and allowed to make their own decision as to what is right for them and their baby.

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MALPRACTICE STUDIES

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(Reference from Protect Babies http://www.123-baby-birth.com)

Comments to: donna@123babybirth.com

__________________________________________________________________

Note: PETITION www.thepetitionsite.com/takeaction/102580814

Please ask this site to have a Medical Alert Petition Site: petitions@earth.case2.com

We need support, Internationally, to help Canada correct or investigate present training of all medical persons who will or intend to be at a mother's birth.

We need support for informed choices, of both parents, that our babies are not being harvested by methods of Active Management.

Search this www.lotusbirth.com web site for : AAP policy, SOGC policy, ACOG policy; Placenta; Fetus to Neonate Circulation; 30-second clamping; World Health Organization and Dupont ; Circumcision ; Dr. Sarah Buckley's Declaration ; Canadian Criminal Codes and when a baby is a person; and any other subject you may be interested in child birth. Search Lotusbirth

(Reference from Protect Babies http://www.123-baby-birth.com) Search at Google this web site for the " No Policies " on equal protection to babies at from the various government officials who appointed representatives to protect the public on medical policies and practices; also the "No policies" of the various medical associations, societies, and colleges did not live up to no form of discrimination to women or the child of any kind. It is believed they had a duty to have a policy of equal protection and security of person, regardless of: age, mental or physical disadvantages ; race, color, social or marital status of the pregnant lady ; or belief or faith of the family, or genetic type of blood sought for by medical researchers, for stem cell matching, and use of white cells, mature red cells, platelets, enzymes, hormones, and plasma.

contact: Donna Young, Mother and Grandmother

Home: www.lotusbirth.com

References of research: www.lotusbirth.com/doc/FEB2003Lotusbirth-110.htm

A medical web site to visit:

www.cordclamping.com

Note: PETITION www.thepetitionsite.com/takeaction/102580814

Please ask this site to have a Medical Alert Petition Site: petitions@earth.case2.com