Friday, April 4, 2014

Perinatal Conference takeaway's

This is the third iteration of this blog post; the first and second iterations contained political undertones and I decided to remove them because I wanted this to be an education-only overview of my perinatal conference notes from today. For the sake of my conscience, however, I will say I think women (and women of minority groups in particular) fight an uphill battle in states which resist federal assistance of any sort. There is an obvious divide in the medical community between people who empathize with the plight of others and those who don't or seem so cynical toward government involvement that they would reject aid which would greatly benefit such groups. If you or someone you know is a woman of child-bearing age, especially if you are not a white middle/upperclass college-educated woman, you need a network of support my friend. I'm going to omit the political discussions from today because frankly I don't enjoy the banter; I am simply stating in an intentionally vague manner that women must advocate for themselves and each other. It is SCARY to see the opportunities missed, education not provided, and programs not implemented simply because political lines are seemingly more powerful than our community needs.

ANYWAY, I only stayed for the morning session despite wanting to attend the afternoon session on "The Type A woman and Her Birth Plan", but I noticed all the session Powerpoint slides were included in my conference binder, so I bounced after the delicious veggie-rich meal. Foodie note: if you've never eaten at Hotel Roanoke, you should go just for the bread pudding. OMG.

The notes I have come primarily from the second session called "Safety Pitfalls of Induction of Labor: The New Normal". This talk was presented by Dr. Richard Waldman, former chair of the ACOG and currently an OB-GYN at a practice in Syracuse, NY (blurb about him here:  Disclaimer (although if you know me you already know this...)- I am not a maternal/fetal expert by any means. While I am trying to absorb as much pertinent information as possible,  I know relatively nothing about inductions, c-sections, medications administered during labor, etc. So, this is why I hope others of you may find this information helpful as I certainly have and will plan to USE this knowledge to our benefit in the very near future as we prepare to meet our little man!

Some stats worth noting from this discussion:

  • Inductions are administered too frequently and too early (2.6x increase since 1990)
  • Overall induction rate: 44% (40% of those were "elective" meaning administered before recommended timeline)
  • Induction results in increased latent phase of labor (compared to spontaneous birth labor phase)
Here are the major takeaway points from the discussion:
  • 6cm is the new 4cm
  • At least 3 is the new 2
  • 41 is the new 39
If you are a L&D or OB-GYN healthcare person, you probably understand what this means. I can tell you when these slides were presented, all the midwives and doula's in the room cheered emphatically. This made me very happy. Research has overwhelmingly demonstrated the benefits of a midwife or doula for natural deliveries or avoidance of medical interventions during labor and delivery, so their approval of these numbers were reassuring. What's interesting is that these findings were recently published (March 2014) in Obstetrics and Gynecology (not sure if it's all or some of these findings) so unless ALL the midwives and doulas happened to read the same article from last month, which is entirely possible, it just means science now reinforces what they have known for some time :) 

So what the above means, in an overview:
  • 6cm is the new 4cm- basically, before you reach or surpass 6cm, you shouldn't mess with anything. Specifically, the "Consortium on Safe Labor data do not directly address an optional duration for the diagnosis of an active phase protraction or labor arrest, but do suggest that neither should be diagnosed before 6cm of dilation." 
  • At least 3 is the new 2- if this is your first baby, you should be encouraged to push for at least three hours or more (or four if you had an epidural administered) before making any other decisions about anything (c-section, etc). 
  • 41 is the new 39- I don't know what was specifically stated regarding 39 weeks, but in this context it was in reference to 41 weeks (and two days) being considered the new threshold at which induction is recommended to offset the risk of c-section. This is probably my favorite point from the whole day, not because it means I have to wait another almost two weeks to see if baby arrives naturally (which I want but still, more waiting), but this is VERBATIM what my doctor told me two weeks ago when we were discussing my tentative induction date. In layman's terms, he described April 16th as the point at which there was no greater likelihood of c-section vs. vaginal delivery if we went ahead and induced labor. Again, lots of applause from the midwives and doula's in the room on this one, so for all my fellow preggo's out there right now- patience is a virtue in more ways than one! 
Lots more info I could share, so if you want a copy of the slides I can scan a PDF version and email them to you next week provided we are still awaiting our son's arrival and I make it to the office :) In the meantime, I forgot to post this evidence from last week that at 39 weeks two days, I was able to walk/jog three miles with our neighbor/friend Chris at our local Pub Run. Thanks to Fleet Feet Roanoke for being a good sport about letting me participate. They were pretty fearful the baby would drop out along the Greenway mid-run so I made sure to sign their participant consent form and check back in after the "run" was finished :) 

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