It seems that there are few things out there as polarizing as labor.  I know, I know, labor shouldn’t be a polarizing issue because it is a natural process and we should just leave well enough alone.  I agree there are many times health care providers add things to the labor process that are not always necessary, but the oft public opinion is that we are doing so because we as providers are too much into the technology and not the natural process of labor.   I know many obstetricians that are fans of the natural childbirth.  I am more of a proponent of woman’s choice and one of the choices that many women make during labor is what to do for pain control.  If you were to ask most women that have never been in labor what they want to do for pain control, most of them would probably say that they would prefer no pain medication.  By the time active labor sets in and the reality of the pain takes hold, many of these laboring women have changed their minds because the pain is too intense.  Are we coddling these women by asking them if they would like an epidural?  Aren’t epidurals bad things that prolong labor and increase the rates of cesarean section?  Don’t epidurals interfere with the bonding between mothers and their babies?  What do you think?  I wanted to address some of the myths out there and some of the realities out there that patients have about epidurals and in the long run, remember, that it is your decision and only you know what it feels like to be in labor

1). Is it true that epidurals increase the cesarean section rate?  Well, there are many things that increase the rates of cesarean section and the epidural may be a small part of that but it is not a causal relationship.  The majority of women that have an epidural do not then go on to have a cesarean section.  The problem with the argument that it increases he cesarean section rate is the question ,”Would these women have had a cesarean section if they would not have had the epidural?” and this question is almost impossible to answer.  The reason that a epidurals potentially increase the risk of cesarean is because they do have a propensity to slow the labor process.  The reason for this process is not directly know, but it has been documented and this can be cause for the starting of pitocin  and other forms of active management of labor.  Many advocates of the natural birthing process claim that once you receive an epidural you are opening a Pandora’s Box and potentially sliding down that slippery slope towards a cesarean section

2). Epidurals will decrease my blood pressure.  This is true n some cases.  Because the epidural decrease sympathetic tone it can cause the blood vessels to relax just like the muscles, this could result in a drop in blood pressure and a subsequent change in the fetal heart rate.  If this happens the anesthesiologist will administer IV fluid or medications to increase the blood pressure.

3). I will not be able to move if I get an epidural.  Some patients have a very difficult time moving when they undergo an epidural, but in many cases you will be able to move your legs.  When you go to the dentist and have your lip numbed you can still talk, albeit not as well, but you can usually still speak and this is because you recruit the surrounding muscles to help.  This is also the case with movement of the legs.

4). I wont bond with my baby if I don’t feel the pain.  My wife had two cesarean sections and she has one of the strongest bonds with our children that I have seen.  I would challenge this statement until my last breath.  The bonding experience has much more multifactorial than just the evidence of pain during labor.

These are just a few of the myths surrounding epidurals and we go into much more detail in our book “Hands Off My Belly!: The Pregnant Woman’s Survival Guide to Myths, Mothers, and Moods” published by Prometheus Books and available at Amazon, Barnes and Noble, and Borders booksellers

MEDIA ALERT

Some people are fearful of the H1N1 vaccine, and being pregnant may add to a woman’s concern.  Myths about the vaccine are spreading, and these myths only increase fears.  

Drs. Shawn Tassone and Kathryn Landherr–a husband-and-wife OB-GYN team and co-authors of the new book Hands Off My Belly!: The Pregnant Woman’s Survival Guide to Myths, Mothers, and Moods–are available to speak on this topic:

What are some common myths about this vaccine and pregnancy?

• Vaccines don’t work in pregnant patients

• There are many serious side effects or it can cause birth defects
• It is untested and not safe in pregnancy
• I will become ill with H1N1
• If I get the vaccine it will weaken my immune system and pregnancy already has weakened me
• The vaccine contains thimerosal
• Pregnant women are contraindicated for the vaccine
• I may have had H1N1 so I am immune and don’t need the vaccine

What is true about this vaccine?

• H1N1 vaccine is made just like seasonal flu vaccine
• It is expected to be as safe as seasonal flu vaccine
• The single dose injections do not contain thimerosal (mercury)
• This H1N1 vaccine will not prevent seasonal flu
• You can get both seasonal flu and H1N1 vaccines when pregnant
• It is an inactivated virus and will not cause the flu
• All pregnant women are recommended to get the vaccine
• Pregnant women are one of the highest risk groups for this virus
• Pregnant women are being admitted to hospitals with severe flu infections

Contact Prometheus Books publicity at 800-853-7545 or publicity@prometheusbooks.com to request author contact information, a review copy or press materials.

In a hurry? Contact the doctors directly at 520-544-0906 or ladeaobgyn@yahoo.com to schedule. See their bio here: http://www.handsoffmybellyguide.com/bios.php.

By Shawn Tassone, MD and Kathryn Landherr, MD – Husband and Wife OBG Team, and Authors of ‘Hands Off My Belly! The Pregnant Woman’s Survival Guide to Myths, Mothers, and Moods’ – Prometheus Books, Amherst, NY.

Is there a way you can tell the gender of your unborn baby before it’s born?  So many myths surround gender prediction that it’s often difficult to discern the real from the surreal.  Of all the pregnancy myths, gender prediction myths are probably the most encountered. The most common of these rely on fetal heart rate to predict whether the baby will be a boy or a girl.

In our clinic we hear expectant mothers declare that a heart rate of 140 beats per minute indicates a girl; others swear that the cut-off is the 150 mark. The truth of the matter is that a normal fetal heart rate fluctuates between 120 to 160 beats per minutes. In fact, if measure the fetal heart rate at ten minute intervals during an hour, you might just get six different heart rates, some below 140 beats and others below 140.

This variation has more to do with the developing fetal brain than the genitalia (although some would argue that the male brain and genitalia are one in the same.) The fetus’ brain is controlled by the sympathetic nervous system (the flight or fight response) and the parasympathetic system (relaxation.) As the fetus develops, these two systems engage in a power struggle. The heart rate speeds up when stimulated by the sympathetic system, and slows down when controlled by the parasympathetic response. We usually listen to the fetal heart for about ten to thirty seconds at a time in the office. If the baby is moving, the rate may be higher than if it were sleeping.

This variation also applies to men and women, boys and girls, none of whom have different heart rates based on gender. If someone stood behind a curtain, for instance, and I told you that person’s heart rate, you would not be able to determine if that person were male or female.  The same holds true for an unborn baby.  Thus, science again rears its materialistic head and claims this myth is simply not true.  The wonderful thing to remember is that your baby does not easily fit into some descriptive box, and he or she is as individual as you are.

Six Common Pregnancy Myths

Excerpts from “Hands Off My Belly! The Pregnant Woman’s Guide to Surviving Myths, Mothers, and Moods” Prometheus Books (2009), Amherst, NY.

Shawn A. Tassone, M.D.

Kathryn M. Landherr, M.D.  

1).  I heard that if I eat more breakfast cereal I will have a boy

• Really, can you imagine?  Actually this is a shred of truth in this statement based on a study done in England regarding pre-pregnancy diets and their relation to fetal gender, scientists found more boys are born to women who ate a high-calorie diet.  More specifically, a higher percentage of boys were born to women who ate breakfast cereal each morning prior to becoming pregnant.

2).  You must drink whole milk when you’re pregnant  and especially if you are  going to breastfeed

• Got Milk?  The National Dairy Council would have you believe that drinking milk is necessary for strong bones and healthy teeth.  Realistically, we are the only species that drinks milk into adulthood, and bovine milk at that.  There are many other ways to get calcium and more importantly vitamin D into your diet.  If you like milk, go ahead and drink it, but please do not feel as though you must drink milk in order to have a healthy pregnancy.

3).  There are more babies born during a full moon.

• One study actually evaluated individual behaviors and their relationship to the lunar cycle.  The researchers discovered that, contrary to popular belief, he phases of the moon did not increase the rates of birth.

4).  I will automatically receive an episiotomy during delivery

• Episiotomy is probably one of the more common procedures that is performed on a pregnant woman, but that is not to say that the procedure itself is common.  It has been estimated that episiotomies are performed in less that 5% of all deliveries and the numbers are decreasing.  In most instances the baby’s head or shoulders will make its own room as it comes out.  Your physician should discuss the episiotomy before performing the procedure and you should have a say as to whether or not you agree to have the episiotomy performed.

5). Clean teeth mean lower chances of preterm birth.

• You have many reasons to smile when you’re pregnant.  Healthy teeth and gums will indeed reduce the risks of preterm birth.  The preterm birth rate for those women receiving regular dental care was 6.4%, while the birth rate for those not receiving dental care was 11 %.

6).  If the fetal hear rate is below 140 beats per minute, it’s a boy; if it’s above 140, it’s a girl

• This is probably the most common of the fetal gender prediction myths we discuss in the book.  Studies, however, show no significant difference between a male and female heart rate, at least statistically speaking.  Fetal hear rates are normal anywhere between 120-160 beats per minute and if they are excited or relaxing will have a direct effect on their heart rate.

Over the past few weeks I have been noticing a significant amount of discussion on Twitter, and elsewhere, that seems to be centered around cesarean sections and the horros of a hospital birth.  Personally, I think that if a woman wants to deliver at home, or in a birthing center, then she should be able to do so, and I have often joked that you don’t need an obstetrician when a baby is delivering; you need us when they are not delivering.  The flip side of this observation is that women who wish to have a delivery in the hospital should be able to do so as well, and there are many myths utilized as scare tactics.  Some of the mythical items I see on these websites are listed below.

• The cesarean section rate is high because your physician simply wants to go home and have dinner. Ultimately, this saddens me to think that women would feel like this is something an ethical physician would do.  I am sure that this happens and that it has happened in the past.  Do we like to have dinner, sure who doesn’t? Unless of course we are having fish and then I am not really excited about dinner.  My concern is that there are things being stated about perceptions of certain physicians and that maybe this fear  is based on the few doctors out there that might do something like this, but what about the thousands of us out there that put the needs of the baby and the patient above our own on a daily basis.  The fearmongering is casting doubt on a situation that needs trust and reassurance.
• The cesarean section rate has increase by almost 50% in the last decade or so.  Depending on the numbers this may be true, but why?  First and foremost, there are many women out there that would choose to have a repeat cesarean rather than attempt a vaginal birth after cesarean (VBAC).  Now, you VBACers out there hold on, I understand that many women might have a repeat c-section because of the bias physicians impose in their counselling, but what else would you have us do?  There is a 1 in 200 chance of having a uterine rupture during VBAC.  That means there is a 199 in 200 chance that this will not happen.  If there was a 1 in 200 chance that you would get in a major car accident today if you went to the grocery store, would you go or would you stay home; I think most people would stay home; so why is does it cause so much ire in the minds of those who are pushing natural birth.  If this is truly a woman’s choice then so be it and let her choose.  There are a few cases out there where women are being refused the right to have a VBAC, but if we choose to let the woman have a choice then should we not offer the same choice to physicians.  If a physician does not want to perform an abortion then we don’t make them, and we shouldn’t make then offer VBAC if they are not comfortable doing so.  They should be able to refer that patient to a provider that does offer that procedure and they should not take care of the patient until it is too late to transfer.  My point is that we should offer the same rights to physicians that we offer to patients.  I truly understand that there are risks with a cesarean section, but I have persoanlly worked at 2 hospitals where VBACing patients had uterine ruptures and in both instances babies did nto survive, and this is totally avoidable.  I’m sure there will be comments on this but it is my opinion, biased as it might be.
• Recovery from a cesarean section is more difficult than a vaginal delivery.  This is true, but mom can still breastfeed and do the things she would have done with a vaginal delivery.
• You should ask your doctor their cesarean section rate.  I don’t have a problem with a patient asking me what my rate of cesarean section is and even why, but what are you going to do with the information?  First of all, the hospital usually runs these reports for a national database and if there are providers that are coming out ahead of the hospital average then there is uually an investigation into why this one provider is falling outside of the usual.  There are also so many factors that go into the decision for a cesarean section that the data points can be skewed.  Say for instance you physician is the only physician in town that will allow patients to request a primary cesarean section and because of this these women go to his/her practice.  This might make him/her look like they have a higher rate, but their patient poulation is skewed towards cesareans sections by market factors and patient choice.
• Once a c-section always a c-section.  This is not true, but truthfully it is getting harder trying to find a provider that will do VBAC deliveries.  The pendulum is swinging back towards this rule, but we are not there

Overall, this is a personal decision and should be made with info from both you and your physician.  This topic invokes fear, anger, and potentially misleading information.  Arm yourself with knowledge and try to stay objective in the information you process.  If you trust your provider and you trust yourself then you should feel good about the choice you have made.