The highest form a civilization can reach is a seamless web of deserved trust. Not much procedure, just totally reliable people correctly trusting one another.

When you as expectant couples seek out a hospital or maternity center for pregnancy care and birth of your baby you must ensure that there is this “seamless web of deserved trust” at your care provider. While the doctor or primary care provider may be a “star” you must ensure that his or her support team and colleagues are equally committed, passionate and capable of delivering the highest standards of service.

Childbirth is a very personal and emotional process. Does your “superstar” doctor know your deepest fears well enough to calm you during your times of anxiety? Is your Birth Team clued in to your needs that they are able to support you at all times even when your primary care giver is not around? In many situations one person is the face of the hospital and the entire care continuum collapses when that person is not available. The support team, which invariably is not empowered or not capable is not able to rise up to the challenge, thereby impacting quality of service.

High quality teams and care providers build this “seamless web of deserved trust” among themselves so that level of care is kept at the highest levels. The team around the “star” is no less than a star itself. It is the team that sustains the star. An excellent birth team anticipates a mother’s needs, anticipates each team member’s needs, and works as a cohesive unit, with one goal in mind – highest level of physical and emotional well being for the mother.

So be wary of going to a “star” doctor or care giver, just because he or she is well known. Do your due diligence about the team that supports this star care giver. Seek out and talk to key members of this team. Check how your star care giver treats his or her support team. Is there respect for each other in their relationship? How does the team feel about the star caregiver? Chances are a team which is respected and not taken for granted by the star caregiver will go beyond their call of duty in caring for mother and her baby. The team and their star caregiver are bound in this “seamless web of deserved trust”.

Noted surgeon Dr. Atul Gawande mentions this interesting finding in his well know book “The Checklist Manifesto”:

“One of the things that struck me about the ‘Miracle on the Hudson,’ when ‘Sully’ Sullenberger brought the plane down that saved 155 people after it was hit by geese over Manhattan and landed it in the river,” Gawande says, was that “over and over again we wanted to say, ‘Look at this hero who piloted this plane down,’ and the striking thing was how much over and over again he said, ‘There was nothing that hard about the physical navigation of this plane.’ Instead he kept saying ‘it was teamwork and adherence to protocol.’ “

Gawande says he experiences a similar displacement of credit when he performs a surgery.

“I come out of my operations and then I go out and talk to the family and they say ‘Doctor, thank you for saving my husband!’ ” Gawande says. “You feel a little bit like a fraud because you know how much you were dependent on everybody getting this right. And when we acknowledge it, that’s when we come back to ideas like checklists.”

Education, researching your options, and conducting due diligence of your doctor / hospital / care provider team will go a long way in ensuring that you become an informed customer and that you are in the right hands.

In this study published in the online journal “Pediatrics” on Jan 30th, the authors find that over 90% of fever in labor is related to epidural analgesia and not infection! Further, their study shows that neonatal adverse outcomes such as hypotonia (low tone in the baby) increased form 10.8% to 25.2% as maternal temperature increased; and, percentage of infants requiring resuscitation tripled from 4.4% to 12.2% with increasing maternal temperatures! After adjusting for confounding factors, they found that there was a two to six-fold increase in neonatal adverse outcomes with increased maternal temperature. They conclude that “increased maternal temperature, regardless of etiology may have implications for the fetus”. Here is a link to this article. What is even more interesting to me is the sheer numbers – in this study, 3209 mother-baby pairs were evaluated, out of which 2784 mothers received epidurals – only 425 did not!! Out of these 2784 mothers receiving epidurals, 1781 women developed fevers (some below between 99.5 to 100, and others between 100-101)! I think it should give us all a moment of pause to think about how safe epidurals are for mother and baby!

I am not saying that epidurals should never be used; like everything else in labor and birth, it has its benefits in case of real need. It makes sense however, to explore all your options regarding alternative comfort measures, attend Lamaze classes to better prepare yourself physically and emotionally for your birth, plan to have continous labor support with a midwife/doula/loved one at all times in labor (research shows that this can decrease epidurals and c-section rates by as much as 40%), have a birth plan in place and have good open lines of communication with your care provider, so that you can minimize the use of epidurals during your labor and birth.

You can also link to an earlier blog that I wrote re: epidurals here

And, please feel free to send in your thoughts and queries ..

I am quoting below verbatim the summary of this review:

Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality, continuity of care and being cared for by a known and trusted midwife during labour.

There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called ’team’ midwifery. Another model is ’caseload midwifery’, where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. Allmodels of midwife-led care are provided in a multi-disciplinary network of consultation and referral with other care providers. By contrast, medical-ledmodels of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women.

Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman’s chance of being cared for in labour by a midwife she had got to know, and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding. However, there was no difference in caesarean birth rates.

Women who were randomised to receive midwife-led care were less likely to lose their baby before 24 weeks’ gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. In addition, babies of women who were randomised to receive midwife-led care were more likely to have a shorter length of hospital stay.

The review concluded that most women should be offered midwife-led models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.

At The Healthy Mother Natural Birth Center, not only do we give low-risk women the ability to have full trial of labor and to birth naturally, we also believe mothers who have higher risk such as previous c-section, gestational diabetes, hypertension, flexed breech babies and other so-called issues also go through labor for as long they and their baby are able to under the 24-hour watchful care of our midwives. We have all emergency infrastructure available at a moment’s notice inhouse and so there is no need for mother to be transported to another facility should  an emergency occur. Therefore in the Healthy Mother Model of Care, even so called “high risk” mothers are empowered to try for natural birth.

About Cochrane Review:

Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognized as the highest standard in evidence-based health care. (http://www.cochrane.org/cochrane-reviews)

At the Healthy Mother Natural Birthing Center, we see so many mothers who have switched from other doctors or hospitals complain that their doctors’ protocols do not allow for them to wait beyond 37 weeks. Mothers who have had previous cesarean sections tell us that despite their perfect normal pregnancies they were induced at 37 weeks or earlier, which lead to a cascade of further interventions, ultimately leading to a c-section – this is so not fair to mothers!! Mothers and their husbands need to educate themselves on evidence-based facts about the risks due to early induction. Talk to your doctor and insist that you be allowed to carry your baby for as long as you and baby are able to. Attend a certified Lamaze program to learn about the true facts and always seek out a second informed opinion about what your health care provider is telling you. You as the mother are the primary care giver to your baby and you owe it to your baby to do all the right things.