Tests, Routine Labor Interventions & Restrictions

Meggan Wehmeyer:
I wasn't sure where to post this, but my hospital has a "mandatory" 1 hour "observation" period in the nursery 1 hour after birth. When I called and asked for their rationale, they said the baby was at high risk of complications during this time and needed to be monitored by a professional. Do you have suggestions for research that addresses this? Suggestions for how to effectively decline the observation period (other than changing hospitals)? Thank you!!

Henci Goer:
We have abundant research that the best place for a healthy baby to be in the hour after birth is skin-to-skin with its mother. Here are links to studies showing the benefits of this practice and therefore the harms of separating them. The first one is your money study because it is a Cochrane database systematic review:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17636727
http://www.ncbi.nlm.nih.gov/pubmed?term=Matthiesen+2001+oxytocin
http://www.ncbi.nlm.nih.gov/pubmed/12725547

Frankly, I would recommend changing hospitals or planning out-of-hospital birth with a qualified caregiver because if staff don't practice evidence-based care with regard to how they treat healthy newborns, then they almost certainly aren't practicing evidence-based care in other arenas as well. If changing venues isn't feasible, women need to know that not only do they have the right to informed refusal, but parents have the right to make refusals on behalf of their children. That being said, they will have to be prepared to withstand scare tactics or other coercive efforts as well as the fallout that can come from being labeled "difficult patients."

Elaine Homont:
My daughter recently gave birth in a hospital where it is their routine practice to take all babies to the nursery after a short bonding period for "routine procedures", my daughter had a birth plan that included her having skin to skin with baby immediately after birth and for as long as possible, and to have no mother baby seperation during her hospital stay. Even though the hospital did not practice rooming- in she was allowed to keep baby with her the entire time,thanks to her perseverance and strong willed personality. She was faced with having the title of "OH your the no seperation room" when staff came on for each new shift. It is very important that we as moms realize we are also consumers and can take our business elsewhere if we are not pleased with the service, and I think more hospitals are also realizing this.

Henci Goer:
Amen to that!

Henci Goer:
I admire you and all women who stand up for themselves and their babies, but deplore that any woman should have to. Many women don't know when they need to--Lamaze's website http://www.lamaze.org/default.aspx?tabid=53 can help there--but even when women have the knowledge, depending on circumstances, it may be more than they can manage in the throes of labor or the tumult of the early postpartum when medical staff tell them they know what is best. That's why I told Meggan it was better to, to reverse a commercial tag line most of you are too young to remember, "switch than fight."

Megan Beck:
I was insistent that my babies were not taken from me, though it was hospital "policy" to do so for an hour after birth and before release. I might have come across as a royal pain to the nurses, but I didn't care- this is my baby we're talking about. They had to find a pediatrician to come to my room, the hearing test wasn't administered until a week later, and the nurses rolled enough eyes, but Killian never left my side.

I did the same for my first daughter's birth but was a bit younger and not as well versed, so my compromise was that they wait until I could get out of bed and walk to the nursery with her. They did several procedures (weighing in the nursery at midnight and 5am) hearing tests, jaundice testing, ect and so on, and every single time they huffed and puffed as I waddled down the hall with them so that I could be with her. I was so worn out when I got home from the hospital, and learned to insist they come to ME for my son's testing. They can't force you to anything, as long as you are willing to sign a waiver...and most of the time if you tell them you'll sign the waiver, they give in and just do what you ask.

Carla Harless:
The hospital's rationale for this out-dated policy has no basis in fact or research...this blatantly shows the policies at this hospital are more concerned with liability issues rather than fostering the bonding period. Not only does this negatively impact bonding, but also breastfeeding. If you are steadfast in your beliefs, stick with them...hospitals have a waiver for just about everything.

Robyn Smith:
Henci, I have a question about the Glucose Tolerance Test. I've seen statements questioning it's effectiveness and others saying that it can be accomplished with jelly beans just as well as with the glucose drink. What's your research revealed?

Henci Goer:
@Robyn
I haven't updated my gestational diabetes research, but we have known for a decades that the OGTT is not reproducible, meaning if you repeat the test, you often get a different answer. For more detail, see this page of an article I wrote awhile back for another website: http://www.ivillage.com/gestational-diabetes-3/6-a-129187?p=3. And I'd have to go hunting through my files to find the study, but, yes, the test can be done with jelly beans.

Heather Paris:
I am curious if you could share your stance on the AFI guidelines. At what point (#) would it indicate the baby is in danger? I had one client who agreed to an induction with an AFI of 4. They tried to induce her with a prostaglandin, then pitocin and got nothing. She cleverly asked if they could measure the AFI again by u/s. It was up to 7 and she got to go home. But that was after more than 12 hours of being at the hospital.

Henci Goer:
Good for your client! Here's what the research has to say: First, measurements of amniotic fluid volume can be affected by transducer pressure on the abdomen, intruding loops of umbilical cord or limbs, inherent difficulties of estimating a volume from a two-dimensional image, maternal hydration, gestational age, interobserver variability in taking measurements, and doubtless the skill and experience of the operator matters too. In other words, amniotic fluid volume estimates are far from reliable or reproducible. Second, we have no studies showing that performing estimates routinely improves outcomes. On the contrary, the sole trial in which the test was done and results concealed from clinicians showed that while low volume was associated with abnormal fetal heart rate in labor, the association was too weak to make the test useful for discriminating which women should be induced. In addition, we have other studies showing that the test increased intervention rates, including cesarean delivery, without improving neonatal outcomes. Nonetheless, a 2009 survey of members of the U.S. Society for Maternal-Fetal Medicine found that in cases of oligohydramnios with no other complications, only 20% of respondents would let a pregnancy continue beyond 40 weeks regardless of cervical ripeness despite insufficient evidence supporting induction for low amniotic fluid volume in the absence of other adverse symptoms and despite only one-third of them believing induction would be beneficial. (In the interest of time, I'm not including the citations, but if you need them, write to me at my Forum under the subhead "tests & interventions.")