Belly Up

* bellies * birth * babies * breastfeeding *

Tuesday, March 1, 2011

It's All Greek To Me- Iatrogenic Issues

A Greek docor (Iatros) blood letting
In the ancient Greek language, the term "iatrogenesis" means "brought forth by a healer". At its most basic iatrogenic means that the care one receives is actually harmful. Since at least the time of Hippocrates and his Hippocratic oath to do no harm, people have recognized the potentially damaging effects of a healer's actions. A good example of iatrogenic harm is seen in the now abandoned custom of blood letting. Today it is hard to imagine that anyone ever thought using leeches (can I just add an ewwww here?) on sick people was a good plan, but I think the case can made that what happens to many women in labor makes about as much sense.

Many problems that occur in childbirth are iatrogenic in nature. Here are just a few...
* Concern of infection after a labor of 24 hours with ruptured membranes...that were artificially broken by a careprovider in early labor.
* Fetal distress...caused by the pitocin given to induce or augment her labor.
* Slow or ineffective pushing stage...hindered by mom being limited on the bed to a position that narrows her pelvic outlet, works against gravity and possibly aggravated by an epidural that mutes the urge to push.
* Hermorhage during third stage...careprovider pulled on the cord and caused partial/uneven placental separation.

Often iatrogenic consequences are expected, like chemotherapy causing hair loss. Harm is done, but the overall hope is that the good done by the treatment will outweigh the bad. This is a fair risk benefit analysis when done with informed consent. But would you choose chemo if the research showed that you would lose your hair and throw up, however the treatment would do nothing to stop your cancer and might even cause you to need a series of other invasive treatments?

A lot that occurs in a typical birth is fixing problems the routines and procedures create and the informed consent component is often skipped altogether. Think whack-a-mole, except less fun.  Let's look at one common rule of hospital childbirth, telling mom not to eat or drink during labor (see note). Obviously mom and baby both still need hydration so mom is given a routine IV to offset the denial of nourishment.  However, being tethered to an IV restricts movement which will certainly make coping with labor more difficult.  Thus the routine IV increases the chance that mom will request pain medication further restricting her movement and also increasing the potential need for labor augmentation and/or an assisted or even surgical delivery.  Another big bummer...IV fluids don't even make mom's tummy growl any less.

Of course hunger and discomfort would all be totally worth it if they made mom more likely to have a healthy labor and baby. Unfortunately just the opposite occurs in studies of low risk labors. Drinking and eating do not raise mom's risks, but *not* having them will almost guarantee that she will be more uncomfortable and in a longish labor it means she may not have the energy to labor effectively or push her baby out. This is an iatrogenic problem, to equate it with the chemotheropy example, this means mom has lost her hair, still has cancer and now needs radiation too.  .

I occasionally hear the phrase "a c-section saved my baby" or some variation of that comment.  To be sure, this is often true with no caveats attached as c-sections do save lives.  However, all too often this statement is only true in the context that as mom is being wheeled into the OR to save the baby's life, it may have been the very careprovider's management of labor that put it at risk in the first place.

*Requesting a hep-lock is a way to have both worlds...easy access to a vein in case of need and no loss of movement.  Most hospitals won't offer this option but will happily do it if mom asks.

1 comment:

  1. Oh, you are so right. The hep-lock is an awesome alternative at a hospital birth. I wish all first time birthers could read this article, but unfortunately it seems to me that it takes the horrible experience of the typical "American" birth to make momma mad and start researching a better method. (And then become appalled by the statistics and mortality rates of American births/babies)

    Recently a family member was "past due date" and was induced. I immediately told my husband, well, she'll have her C-section tomorrow. I was right. And that "past due date" baby was a mere 6 pounds. Then baby ran fever...imagine that after having drugs pumped into the system for 27 hours when she wasn't ready to come out, she ran a fever. So, the med. staff told her she definitely needed to supplement with formula bc of the fever. Seriously, unbelievable.

    Anyway, I'm going to recommend this site to anyone I know who is preggers...DFW or not!