 The Thinking Woman’s Guide to a Better Birth
Table of Contents
Introduction: Obstetric Management: What’s Wrong with This Picture?
 Why the Gap?
Why This Book?
1. The Cesarean Epidemic: Obstetrics on the Cutting Edge
Myths and Realities Behind the Rise in Cesareans
What Determines Your Chance of Having a Cesarean
and What Should the Odds Be?
The Cesarean Procedure
The Bottom Line
Benefits and Risks of Cesarean Section
How to Avoid an Unnecessary Cesarean
Making a Cesarean a Positive Experience
2. The Full-Term Breech Baby: Cesarean Section is Not the Only Answer
What’s the Problem with Breech Birth?
Turning the Baby Head Down
The Home Version
The High-Tech Version
Alternative-Medicine Versions
The Bottom Line on ECV
Controversies and Trade-Offs of ECV
Strategies for Improving the Odds of Success of ECV
The Bottom Line on Breech Birth
Trade-Offs of Cesarean vs. Vaginal Breech Birth
Controversies of Vaginal Breech Birth
Safety Factors in Vaginal Breech Birth
Gleanings from the Medical Literature
External Cephalic Version
Vaginal Breech Birth
3. Induction of Labor: Mother Nature Knows Best
Why Not Wait?
Convenience Inductions
Suspected Large Baby
Prelabor Rupture of Membranes in Full-Term Pregnancy
“Overdue” Pregnancy
Tests of Fetal Well-Being
Cervical Ripening and Induction
The Bottom Line on Labor Induction Generally
Avoiding an Unnecessary Induction
Pros and Cons of Techniques for Ripening the Cervix
and/or Inducing Labor
General Advice on Induction
The Bottom Line on Labor with a Large Baby
Strategies to Avoid Unnecessary Intervention
The Bottom Line on Induction for
Prelabor Rupture of Membranes
General Advice
Compare and Contrast Three Approaches
to Prelabor Rupture of Membranes
The Bottom Line on Induction for Postdates Pregnancy
Compare and Contrast Three Postdates Options
Gleanings from the Medical Literature
4. IVs: “Water, Water, Everywhere, Nor Any Drop to Drink”
The Illogic of “Nothing by Mouth”
The Bottom Line
Pros and Cons of Forbidding Food and Drink in Labor
Pros and Cons of Routine IVs
What Should You Eat or Drink During Labor?
Ways to Minimize the Chance of Aspiration
Gleanings from the Medical Literature
5. Electronic Fetal Monitoring and Cesarean for Fetal Distress:
The Machine that Goes Ping!
How Did We Get into This Mess?
How EFM Is Done
External EFM
Internal EFM
The Bottom Line
Comparing External and Internal Monitoring
Situations When the Medical Literature
Supports the Use of Continuous EFM
Ways to Avoid the Drawbacks of EFM
Ways to Avoid Problems with the Baby
Gleanings from the Medical Literature
6. When Doctors Break the Membranes:
If It Ain’t Broke, Don’t Break It
The Amniotomy Procedure
The Bottom Line
Pros and Cons of Routine Amniotomy
Pros and Cons of Amniotomy for Indication
Avoiding Amniotomy
Gleanings from the Medical Literature
7.Slow Labor: Patience Is a Virtue
Active Management of Labor
Procedures
The Bottom Line
Benefits and Risks of Techniques for
Coping with Poor Progress
Strategies to Avoid the Need for IV Oxytocin,
Instrumental Delivery, or Cesarean Section
Gleanings from the Medical Literature
8. Epidurals and Narcotics: A Shot in the Dark
Why You Don’t Hear About the Downside of Epidurals
The Epidural Procedure
The Bottom Line
What an Epidural Does
The Trade-Offs of Epidurals
What an Injected Narcotic Does
The Trade-Offs of Injected Narcotics
The Trade-Offs of Natural Childbirth
Strategies to Avoid Pain Medication
Questions to Ask When Helping a Laboring Woman
Decide Whether to Have Pain Medication
Strategies to Minimize the Risks and Side Effects
of an Epidural or Spinal Epidural
Gleanings from the Medical Literature
9. Episiotomy: The Unkindest Cut
Why Are Doctors Still Doing Routine Episiotomies?
What Is an Episiotomy?
The Bottom Line
Pros and Cons of Routine Episiotomy
Traditional Indications for Episiotomy
Strategies to Protect the Perineum
Gleanings from the Medical Literature
10. Elective Repeat Cesarean Section: Just Say No
So Why Hasn’t VBAC Become Routine?
The Bottom Line
Pros and Cons of VBAC vs. Elective Repeat Cesarean
Factors that Exclude VBAC
Factors that Don’t Exclude VBAC
Factors that Promote Safe Vaginal Birth
Factors that Promote a Positive Birth Experience
Gleanings from the Medical Literature
11. Professional Labor Support: Mothering the Mother
Do You Really Need Professional Labor support?
What About the Father’s Role?
The Bottom Line
Pros and Cons of Professional Labor Support
Comparison Between Labor Support from
a Female Relative or Friend and a Doula
Comparison Between a Doula and a Monitrice
Choosing a Professional Labor Support Companion
Gleanings from the Medical Literature
12. Obstetricians, Midwives, and Family Practitioners:
Someone to Watch Over You
The Bottom Line
A Guide to the Qualifications of Birth Attendants
Pros and Cons of Various Classes of Birth Attendants
Interviewing a Caregiver
When Choice is Limited
Gleanings from the Medical Literature
13. The Place of Birth: Location, Location, Location
History Reexamined and a Few Current Facts
The Safety of Hospital Births
A (Relatively) New Out-of-Hospital Option
The Bottom Line
Comparing Birth Sites
Comparing Direct-Entry Midwives and Nurse-Midwives
Interview Questions
Advice If You Decide on an Out-of-Hospital Birth
Gleanings from the Medical Literature
Appendices
Literature Summaries
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Bibliography
The Mother-Friendly Childbirth Initiative
Resources
Index
© 1999 by Perigee Books
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