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The variables of labor have been accounted for, with a number of procedures designed to protect the mother and the child throughout the pregnancy and birth in case of an unexpected complication. The procedures are numerous, too numerous to be thoroughly discussed in only a few pages. Therefore, only a few different procedures can be discussed here. These procedures will be the more common ones: Cesarean sections, forceps deliveries, fetal monitoring, and the use of epidurals. The necessity for each of these procedures will be explained as well as the unavoidable effects and the possible dangers and side effects. The research that is used to present these points will be in support of and critical of the procedures. After the research has been presented, I will enter my own conclusions and opinions concerning the procedures that are discussed, the validity of the risks involved, and whether or not such risks are worth the rewards. The use of a cesarean section to forcibly remove a child during labor is a practice that occurs often throughout the world. The procedure has been documented by the American Medical Association as a major abdominal surgery. This surgery, when necessary, is a life-saving technique for the child and the mother. According to the Public Health Citizen’s Research Group (1996), “there are three main medical causes for cesareans: non-progressive labor, breech presentation, and fetal distress.” The American Medical Association (1994) continues “Prolapsed cord (where the cord comes down before the baby), placenta abruptio (where the placenta separates before the birth), placenta previa (where the placenta partially or completely covers the cervix), or cephalopelvic disproportion (CPD, meaning that the head is too large to fit through the pelvis) can also produce the need for a cesarean section to be performed.” In all of these cases, if no cesarean is performed, a high probability exists that the child and/or the mother will die during the labor process. It is because of this possibility that cesareans are often over-diagnosed and that many women overlook the inherent risks of a cesarean. According to the Public Health Citizen’s Research Group (1996), 967,000 cesareans were performed in 1989 in the United States alone. The PHCRG goes on to state, “Cesarean rates quintupled in the United between 1969 and 1989 to 23.8%.” This is a frightening statistic considering the fact that the World Health Organization claims, “No region in the world is justified in having a cesarean rate greater than 10 to 15 percent.” Even more distressing is the findings of the PHCRG. They discovered (1996) “that over one-half of the cesareans performed in the United States are unnecessary.” Such information is disheartening when coupled with the statements of the American Medical Association. They state (1994), “Unnecessary cesarean sections yearly result in 25,00 serious infections, 1.1 million extra hospital days and a cost of over $1 billion, not to mention the death of about 500 women a year from bleeding, infections and other complications of cesarean sections.” The high probability of maternal or fetal death without the help of a cesarean is also responsible for mothers overlooking other risks and side effects. According to the American College of Obstetricians and Gynecologists (1997), “A cesarean section poses documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth. Furthermore, an elective cesarean section increases the risk to the infant of premature birth and respiratory distress syndrome, both of which are associated with multiple complications, intensive care and burdensome financial costs. Even with mature babies, the absence of labor increases the risk of breathing problems and other complications.” Despite the risks of having a cesarean section, all of the researchers concluded that cesareans are often needed, and must be performed in those cases. To avoid unnecessary cesareans, Childbirth.org suggests, “carefully studying the indications for a cesarean as well as understanding the causes, procedures, and risks involved.” Another common medical procedure used during labor is a forceps delivery. A forceps delivery is a delivery where the head is delivered using the forceps to pull the baby down on to the mother's perineum, and then withdrawn and the rest of the baby is delivered as normal. Forceps deliveries are sometimes necessary, according to the American College of Obstetricians and Gynecologists (1997) . “They are applied during four different situations. When the baby's head has engaged, (is lying in the mother's pelvis,) but fails to descend further, when the baby is in a posterior position or is a breech birth, when the mother becomes too tired to continue pushing, or the uterus fails to maintain contractions, or with premature babies so as to protect the delicate skull bones from being compressed in the birth canal.” The benefits of forceps deliveries are clear. If a forceps delivery is needed and does not occur, the child and/or the mother will definitely die. However, there are still major risks involved with such a procedure. According to R.B. Johanson and V. J. Menon (1999), “forceps delivery often resulted in maternal trauma and required a large amount of regional and general anesthesia. This risk is a danger that mothers must be aware of. It would seem that if the situation presents itself in which a forceps delivery is necessary, the risks are immaterial in comparison to the alternative. However, there is another solution that is now available to women that has, according to certain studies (Johanson and Menon, 1999), “significantly less maternal trauma and with less general and regional anaesthesia.” This method is a vacuum delivery method. Unfortunately, there is a trade-in. Johanson and Menon (1999) go on to say that “the vacuum extractor was associated with an increase in neonatal cephalhaematomata and retinal haemorrhages.” Though this is also an unfortunate risk, it is much safer than a forceps delivery. Another procedure that is now becoming an extremely popular one is that of fetal monitoring during labor. The purpose of fetal monitoring is to have continuous observation of the vital signs of the mother and the fetus. It is designed to give doctors an advantage in diagnosing fetal distress and maternal trauma. To many this seems like a beneficial proposition, in theory. Unfortunately, studies show that this popular procedure is little more than wishful thinking. According to Kaiser (1991), “electronic fetal has consistently failed to demonstrate a statistically significant difference in either the perinatal mortality rate or the outcome of high risk pregnancies. In fact, some studies (Prentice and Lind, 1987) have indicated that electronic fetal monitoring increases the occurrence of cesarean sections and forceps deliveries. Such evidence indicates that the effectiveness of usefulness of electronic fetal monitoring is grossly overestimated. The findings of these various researchers are intriguing, but I have my own take on things. Much of the time, the researchers indicated that there were extreme risks involved in any of the procedures. However, I would disagree with them and instead say that there are even greater risks in not using the procedures when they are necessary. Being a child born of a cesarean section, I have not experienced any of the so-called “maternal disassociation.” Of course I may be an isolated incident, but I believe that it is immature and ignorant of the researchers to make such broad blanket statements about the effects of a procedure. Granted, there is a risk involved in these different procedures, just as there is risk involved in eating dinner. In fact, a woman would be more likely to choke on the hospital food after her pregnancy than to have her baby or her suffer any significant trauma. The research, though honest, is misleading. Though it must be conceded that on the topic of electronic fetal monitoring, the facts speak for themselves in saying that EFM is ineffective in all manners, when discussing cesarean sections and forceps deliveries, such statements cannot be made. In both cases, the alternative to the procedure is the death of the child and/or the mother. No procedure could have worse risks than that. More unfortunate that this realization is the fact that none of the researchers offered any reasonable alternatives nor stated that there were not any available. The closest one came was to mention an alternative to forceps deliveries, vacuum deliveries, which was just as dangerous to the child. If reasonable alternatives exist, then the researchers should at least mention them, if not discuss their effectiveness. If reasonable alternatives do not exist, the researchers should divulge this information as well. The only conclusions that can be drawn from the recent research are that medical procedures used during birth are dangerous, often ineffective, and, at this point, the best that medical science has to offer. Bibliography: Albers, Leah, and Krulewitch, C. J. (1993). Electronic fetal monitoring in the United States in the 1980s. Obstetrics & Gynecology 82, 8-10. American College of Obstetricians and Gynecologists. (1997). Pregnancy Complications. New York: Journal of American Medical Association. Johanson, R.B., and Menon, V. J. (1999). Vacuum extraction versus forceps for assisted vaginal delivery (Cochrane Review). The Cochrane Library, Issue 1. Kaiser, G. (1991). Do electronic fetal heart rate monitors improve delivery outcomes? Journal of Fla Med Assoc, 78, 303-7. Prentice, A., and Lind, T. (1987). Fetal heart rate monitoring during labour--too frequent intervention, too little benefit? Lancet, 8572, 1375-7. Public Health Citizen’s Research Group. (1996) Cesarean Fact Sheet. Cesarean Sections. [On-line]. Available:http://www.childbirth.org/section/CSFact.html (10 April 2000). Weiss, Dr. Robin E. (1994). Cesarean Sections: An Overview. New York: Journal of American Medical Association Word Count: 1508
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