In the spirit of furthering the dialogue, I wanted to share the below email sent by a midwife who tried to comment on my site but for some reason was unable to do so.
I have attempted to subscribe to the Blogs and add my comments to you publication, no joy my computer will not link in. might be telling me something!
Any way, if you think this is relevant perhaps you could add it?
1. Induction of Labour: There has been, is and will be great controversies over this in the Uk. Many of us remember the days of 'non' IOL, and 'Unexplained Stillbirths' over 42 weeks. 20-15 years ago, a long time for some people, but not in the history of childbirth. we, the Health Proffesionals in the UK extended the length of pregnancy 42, 43, 44,+ weeks. Partly do to 'people power'. After increased fetal and maternal deaths, larger centres screened women over 41 weeks and found that in a majority of women over 42 weeks pregnant fetal compromise and maternal risk factors increased.
many UK facilities did not have the technology to enable them to offer indepth screening. (and still don't, we have referral centres, perhaps many miles away from home).
The general concensus was to offer IOL at 42 weeks, this recently has been altered by NICE (government body) to 41-42 week in un complicated pregnacies.
As some one who has seen different IOL practises over 40 years, I am aprehensive once the pregnancy reaches 42 weeks, for the health of mother and baby. There is always the exception but I have seen too many sad parents who 'did their own thing and waited'.
2. GBS, perhaps for a different aspect of Group B Strep visitors to the Blog/empowering................
would like to visit a UK parent lead web site........... www.gbss.co.uk or www.gbss.com It will tel you how parents whose babies have died of GBS or have become ill through GBS feel about 'testing'. You are fortunate in the USA at least if you know the mother is a carrier you have a choice whether to have antibiotics in labour and what to watch for in the baby up until 3 + months. gbss has motivated change and prevention in the UK. Without their energy and committment more babies would be at risk and families suffering.
3. being radical, I feel ALL pregnant women and their partner, if present, should be tested for any infection that could harm the baby.
Perhaps we sometimes overlook that the baby IS the innocence in 'Happy Families'!
Anni Plummer. midwife.
Re Anni's thoughts on GBS testing, my post on the subject suggests that the decision to test or not (in the absence of risk factors) is not as clear as it might seem. Certainly testing seems warranted when risk factors are present. When they are not, it is my opinion that whether or not to test should be the mom's decision. I worry about the long-term consequences of the over-use of antibiotics. Too often the solution can lead to a bigger problem.
In response to Anni's comments on induction, my biggest concern is with routine induction as well as how induction is often handled. For example, induction appointments in my area are regularly made at the 40 week visit and the date is often picked in favor of the hospital's/doctor's schedule. For example, the induction will be scheduled earlier to avoid a weekend or holiday induction. I certainly do not believe that all moms should be allowed to go past 42 weeks but that care providers should assess baby and mom, perhaps scheduling a biophysical profile if warranted, and if signs are good, then care provider and mom should sit back, relax, and await labor. Myles Textbook for midwives notes that perinatal mortality "is lowest at 40 weeks, and increases after 42 weeks, but that risk reduces with the use of modern methods of fetal monitoring. Where the perinatal mortality and morbidity in post-term pregnancy are increased, this may be a result of labour or birth rather than antenatal events."1
As I understand it, some moms have longer gestation periods and induction is not warranted, for other moms, baby really is post-date and would fare better outside the womb rather then in. And of course there is the problem of determining whether or not a baby really is post-date given that most moms don't know when they conceived and that Naegele's rule doesn't take into account the variations in calendar months etc. etc. etc.
1 Diane M. Fraser and Margaret A. Cooper, Myles Textbook for Midwives (London: Churchill Livingstone, 2003)532.