judyslome's blog

There is no Evidence to Justify Cesarean or Vacuum for Prolonged Pushing

In the presence of a reassuring fetal heart, there is no reason to take any actions other than to keep pushing

Recipe to Annihilate VBAC Uterine Rupture

Uterine rupture at full term VBA1C labor rate is 1/500 in a population with average birth weight 3700 gm, in the absence of Prostaglandins, Misoprostol, and/or Pitocin

Episiotomy is Obsolete: All Perineal Damage At Vaginal Birth Is Preventable


Episiotomy is Obsolete: All Perineal damage at vaginal birth is preventable with motivated mother and practitioner

Episiotomy confers no benefits. The most effective way to prevent perineal damage is to avoid episiotomy. Episiotomy, albeit rarely, has resulted in the death of the woman from necrotizing fasciitis.

Episiotomy increases all the bad outcomes it was supposed to prevent. In a 1983 review of episiotomy during the years 1860-1980, this review found that episiotomy has no benefits and causes more 3rd and 4th degree tears, more short and long term fecal incontinence, more bleeding, more pain, and more short and long term sexual discomfort than not cutting an episiotomy. (1)

Should A Woman Having Twins Have A Home Birth Or Hospital Birth?


Should A Woman Having Twins Have A Home Birth Or Hospital Birth?

Why Homebirth is 1,000 Times Safer Than Hospital Birth for Low Risk US Women

Why Homebirth is 1,000 Times Safer Than Hospital Birth for Low Risk US Women

Why Homebirth is 1,000 Times Safer Than Hospital Birth for Low Risk US Women

Oft quoted research studies state 3X to 10X more babies die in the first week after low risk homebirth than hospital birth. In order for low risk homebirth to have higher perinatal mortality rates there would have to be a theory to explain this. There would have to be one or more complications of low risk homebirths that result in death in the first week that can be prevented by being in hospital, and death from these complications would have to occur more often than low risk deaths at planned hospital births.

Am Journal of ObGYN's Anti-Homebirth Campaign Sacrifices Lives of 100 US Women Per Year

Am Journal of ObGYN's Anti-Homebirth Campaign Sacrifices Lives of 100 US Women Per Year

Dr. Amos Grunebaum, ObGyn at Cornell Medical Center New York publishes an article in American Journal of Obstetrics and Gynecology which will indirectly kill 100 U.S. birthing mothers per year.

Re: Grunebaum A, McCullough LB, Sapra KJ, et al. Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol 2013;209:  

The Evidence For and Against Birth Induction

The Evidence For and Against Birth Induction
When is the fetus better off outside the mother's uterus, and if so, how should that be brought about?

Abstract: Smith (2003) found unexplained stillbirth occurs once in 2000 births (0.5/1000) after 34 weeks among low risk second pregnancies, following a first vaginal birth in the absence of induction for postdates.  If induction for postdates could prevent stillbirth by expediting the deliver, one would expect to save 0.5/1000.   Four systematic reviews performing meta-analysis of the data regarding the effect of induction for postdates draw three different conclusions.  Cochrane (2012) concludes that inducing at 41 weeks can prevent 1 stillbirth/perinatal death for every 410 inductions or 2.5/1000 perinatal deaths, a number exceeding the rate of unexplained stillbirth at term without induction. Hussain (2011) looking at inductions after 41 weeks concludes that performing  inductions at 41 weeks does not prevent stillbirth but does prevent 1 perinatal death in the first week of life for every 650 inductions (1.5/1000) performed. None of the studies look at mortality after 7 days. Therefore it is not known whether those 'saved' babies die after the one week mark.  Wennerholm (2009) and Sanchez-Ramos (2003) look at the same data for inductions after 41 weeks and found no evidence supporting induction for postdates, stating, that induction for postdates is not supportable from a scientific point of view.   There is limited and inconsistent data suggesting that induction might improve outcomes in the cases of: Postdates, Oligohydramnios, Suspected worsening of fetal anomaly at 34-39 weeks, Fetal Demise, Multiple gestation with fetal death, Poorly controlled diabetes, Hypertension at 38-39 weeks, Maternal Chronic Pulmonary disease, Maternal Chronic Renal disease, Intrahepatic cholestasis of pregnancy, Mild (after 37 weeks) or Severe (after 34 weeks) preeclampsia,  Isoimmunization, and Premature rupture of membranes-  after 34 week. There is a complete lack of research evidence suggesting that induction improves outcomes in the case of: History of unexplained stillbirth after 39 weeks, logistical such as distance from hospital or risk of precipitous labor, Antiphospholipid antibody, severe growth restriction or chorioamnionitis. Consistent reliable evidence is lacking for all justifications for induction.

What is Doppler Velocimetry?

What is Doppler Velocimetry?

   Although unexplained intrauterine growth retardation is related to smoking, drugs and alcohol, missing nutrients or micronutrients and/or stress, that is not where obstetrics looks to improve outcomes.  Instead of refusing care to heavy smokers or using frequent visits to enforce life style changes in nutrition and exercise, the protocol is to do Doppler velocimetry to measure the velocity of fetal blood flow for pregnancies at high risk of suspected intrauterine growth restriction (IUGR).

  In 1995 Alfirevic called Doppler velocimetry 'promising'.( Alfirevic 1995) But after it had been studied on 10,225 at risk pregnancies, the 2010 review by Alfirevic found the effectiveness of Doppler velocimetry questionable due to the poor quality of the studies and publication bias. (Alfirevic et al. 2010)  Only small retrospective studies of extremely low birth weigh babies reflect a possible benefit of Doppler studies. (Chalubinski 2012)   

  IUGR is said to be the result of an undefined term called: placental insufficiency. This appears to be an undefined catch all phrase for lacking an explanation for stillbirths.  Placentas might always be sufficient.

Why The Fuss Over Homebirth?

Why The Fuss Over Homebirth?

How to Eliminate Postpartum Hemorrhage

How To Eliminate Postpartum Hemorrhage

It's hard to compete with 20 billion years of evolutionary selection, but the current medical management of the birth of the fetus and the placenta attempts to do just that, albeit rather unsuccessfully. For eons, all animals including humans passed on genes and habits that ensured delivering a live healthy newborn without bleeding excessively or dying of postpartum hemorrhage at birth. Among mammals, bleeding to death would not result in successful reproduction, until recently, because a live mother was required to nurse the newborn. 

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