1 / 17

Keeping the ‘Normal’ in Normal Birth

Keeping the ‘Normal’ in Normal Birth. Interdisciplinary Panel Discussion November 30 th , 2006. ‘Normal’ Birth: A Problematic Notion. Wide range of normal amongst labouring women Notion of normal has different meanings in different contexts WHO Definition

roza
Download Presentation

Keeping the ‘Normal’ in Normal Birth

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Keeping the ‘Normal’ in Normal Birth Interdisciplinary Panel Discussion November 30th, 2006

  2. ‘Normal’ Birth: A Problematic Notion • Wide range of normal amongst labouring women • Notion of normal has different meanings in different contexts • WHO Definition • Obstetric Normality in Active Management of Labour • Intervention has become the norm in contemporary culture

  3. WHO Definition of Normal Birth: • Spontaneous in its onset • low-risk at the start and throughout labour and delivery. • Baby is born spontaneously in the vertex position between 37 and 42 gestation • Following birth both mother and infant are in good condition.

  4. Normal Progression in Active Management of Labour • Strict diagnostic criteria for labour onset • Artificial Rupture of the Membranes (ARM) if dilatation not maintained at rate of l cm/ hr • Augmentation with synthetic oxytocin if dilatation not increasing at this same rate • Charting of labour progress– the partogram. • The provision of customized childbirth education & continuous 1 on 1 support*

  5. Intervention As Normal: Physiologic Birth:The spontaneous head-first delivery of a single baby without employment of narcotics, entinox or epidurals, synthetic hormones-induction or augmentation of labor, artificial rupture of the membranes or episiotomy. (Midwifery) Physiologic birthrate in Nova Scotia:4 • 1.75% for first time mothers • 5% for women having their second or subsequent baby

  6. Birth Intervention Menu • Continuous Electronic Fetal Monitoring • IV Drip • Catheterization • Epidurals, Narcotics, Entinox • Labour Induction • Artificial Rupture of Membranes • Labour Augmentation • Operative Assisted Delivery • Caesarean Sections

  7. Intervention Menu: The Gaps • 1 to 1 Continuous caregiver support (Midwife/ Douala/ Other trained birth attendant) • Consistent Information, Education and Support re Non-pharmacological Pain Relief Methods • Nourishment

  8. Interventions: The Cascade Effect • Cascade: A succession of things…each of which activates, effects, or determines the next • Understanding the Cascade of Interventions

  9. The Cascade of Intervention6 • Directional Relationships highlighted in this diagram have all been established in scientific literature. • To interpret the diagram begin with an intervention of interest and follow arrows from that point.

  10. Select Birth Indicators (2001)7

  11. NL Intervention Rates By Region(2005)8

  12. Why Should We Be Concerned?

  13. Caesarean Sections Infant Risks: • Breathing Problems • Low Apgar Scores • Fetal Injury • Increased Neonatal Deaths & NICU Admissions • Premature Birth • Lower Breastfeeding Initiation • Increased Asthma Incidence • Higher Stillbirth Rate amongst women with previous C/S Maternal Risks: • Operative & Post-Op complications: e.g. bleeding, clots, infections, transfusions • Increased pain, length of recovery, hospital stay and re-admission • Respiratory complications • Secondary infertility • Ectopic pregnancy • Placental abruption/ adherence problems • uterine rupture before and during labor • Need for further surgeries (e.g. Hysterectomy, bladder repairs)

  14. Caesarean Sections: The Financial Costs9 • Average Cost of Vaginal Delivery Without Complications in 2002/2003: $2700 • Average Cost of Caesarean Delivery Without Complications in 2002/2003: $4600

  15. Best Practice Guidelines • The World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent.10

  16. Explaining The Trend

  17. References 1. Kaufman KJ, Effective control or effective care, (roundtable debate: active management part 2) Birth, 1993; 20(3): 150-61 2. World Health Organisation (1996). Care in Normal Birth: A practical guide. www.who.int/reproductive-health/publications/MSM_96_24/MSM_96_24_Chapter1.en.html 3. Thornton, J.G (1996). Active management of labour. BMJ, 313: 378. http://www.bmj.com/cgi/content/full /313/7054/378 4. Source: The Reproductive Care Program of NS 5. The second national U.S. Listening to Mothers® survey (2006). http://www.marketwire.com/mw/release_html_b1?release_id=175714 6. Cascade of Intervention: http://www.acegraphics.com.au/parents/obstetric/diagram.html 7. Canadian Institute for Health Information (2004) Giving Birth In Canada: A Regional Profile. http://secure.cihi.ca/cihiweb/products/GBC2004_regional_e.pdf 8. Prepared By the NL Centre for health Information, November 8th, 2006 9. Canadian Institute For Health Information (2006) Giving Birth in Canada: The Costs. http://secure.cihi.ca/cihiweb/products/Costs_Report_06_Eng.pdf 10. WHO Guidelines for Caesarean Sections - http://www.childbirth.org/section/CSFact.html

More Related