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Vacuum-assisted delivery.
The literature seems to allow certain general conclusions regarding the choice of instrument for
assisted vaginal delivery. Both forceps and vacuum extraction offer certain advantages and
drawbacks. Forceps are more difficult to apply, more prone to potentially significant facial
injuries, require generally better maternal analgesia, and are associated with increased
maternal soft tissue trauma. Vacuum extractors in general are easier to apply, are more likely
to result in scalp trauma, and may be associated with increased rates of intracranial trauma. It
seems likely that factors particular to each patient may play a significant role in the genesis of
delivery associated with maternal and neonatal morbidity. Because of the ease of application,
vacuum extractors may be used potentially in circumstances in which forceps assistance would
not be attempted, allowing an operator of average experience to perform rotational deliveries.
The use of vacuum extraction does appear to decrease the incidence of cesarean section in
delivery populations. Given the apparent association between difficult assisted deliveries and
increased neonatal morbidity, it is incumbent on the operator to attempt delivery only when
vaginal delivery seems to be a safe option. Furthermore, the operator in such circumstances
must be willing to reassess the attempt if initial attempts are not met with success. The minimal
rates of significant intracranial injury associated with vacuum extraction in randomized studies
of the method demonstrate the relative safety of the vacuum extraction when used judiciously.
The ultimate choice of the route of delivery and method of assisted delivery should reflect a
consideration of the fetal station, presentation, and maternal and fetal circumstances. It is
hoped that further investigations in this area may clarify some of the issues discussed in this
article.
Labor is induced in more than 13 percent of deliveries in the United States. Postdate pregnancy
is the most common indication. Oxytocin is the drug of choice for labor induction when the
cervical examination shows that the cervix is favorable. The use of this agent requires
experience and vigilant observation for uterine hyperstimulation, hypertonus or maternal fluid
overload. In a patient whose cervix is unfavorable, the use of prostaglandin analogs for cervical
ripening markedly enhances the success of inductions. Misoprostol, a prostaglandin E1 analog
marketed as a gastrointestinal mucosal protective agent, is safe, efficacious and inexpensive for
use in cervical ripening and labor induction. Further studies will better delineate its optimal use.
Family physicians need to be familiar with the various methods of cervical ripening and labor
induction.
Induction using oxytocin has side effects, but because the drug does not cross the placental
barrier, no direct fetal problems have been observed.
Birth Networks
These organized, regional groups of pregnant women and birthing professionals meet regularly
to educate, empower and support each other and advocate for the improvement of maternity
care in their communities. What started as a grassroots movement has exploded across the
county.
Evidence of a growing trend: Amy Romano of Lamaze International estimates that the number
of birth networks has doubled in the past year. Since 2004, the Lamaze Institute for Normal
Birth has awarded grants to form and expand birth networks.
Birth Stories
Expectant women are hungry for information on labor and birth, and the mainstream media is
responding with birth stories. These stories offer much more than entertainment; they provide
information on birth options, tools, classes and techniques. The impact of birth stories on
expectant parents is quickly coming to the attention of the birth professionals, and many are
actively discouraging patients from watching the highly-dramatized birth programs on cable
television. Because the level of fear in a laboring woman directly impacts the progression of her
labor, birthing professionals are directing patients to read only empowering, inspiring birth
stories.
Evidence of a growing trend: There are now 7 programs on cable television that highlight the
experience of labor and delivery. Most pregnancy magazines now feature birth stories on a
regular basis, and many birth networks and childbirth educators now sponsor birth-story nights.
Prenatal yoga
Prenatal yoga strengthens and stretches the muscles that are used in childbirth, and teaches
breathing and focusing techniques that help women through labor.
Evidence of a growing trend: In San Diego, California, prenatal yoga instructors are reporting an
increase in class attendance of approximately 50% over the last three years. Much of the
increase is attributed to growing support from doctors, midwives and childbirth educators who
send their clients to yoga classes to relieve back pain, reduce tension, and cope with high blood
pressure. A number of prenatal yoga videos are now available to women who prefer to practice
at home.
Water-assisted labor
Widely known as natures epidural, warm water can ease the discomfort of labor by helping a
woman relax. A birthing tub counters the effect of gravity on her contracting muscles, and
even a warm shower can provide soothing comfort to tired and tense women.
Evidence of a growing trend: In the last 10 years, water-assisted labor has grown exponentially.
In 1995 there were only three hospitals in the country that offered it. Now it is offered in more
than 260 hospitals 15% of all U.S. hospitals. In the last year alone there was a 4% increase,
and this number is expected to grow in the coming year.
Doulas
A doula is a professional who is trained to provide emotional and tactical support a family
through pregnancy, labor, delivery, and newborn care. Studies show that the presence of a
doula reduces the need for medication, as well as the possibility of a Cesarean-section birth.
Evidence of a growing trend: Every doula organization reports phenomenal growth in
membership, and in the number of students in doula training classes. Doulas of North America
(DONA), just one of several doula organizations reported a 10-fold increase in the number of
certified doulas in the last 7 years.
Pregnancy Massage
A specialized form of bodywork, pregnancy massage addresses the specialized needs of a
rapidly changing body. It enhances the function and alignment of muscles and joints, improves
circulation and muscle tone, and relieves mental and physical fatigue. These benefits translate
to lower levels of stress hormones, as reported in a study by Dr. Tiffany Field at the University
of Miami School of Medicine.
Evidence of a growing trend: Instructor Elien Alexander from The School of Healing Arts in San
Diego, California, reported a 10-fold increase in the number of students becoming certified in
pregnancy massage in the last 5 years.
NCM102
CURRENT TRENDS IN OBSTETRICS