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Sheila Kitzinger on Ultrasound

Practice Variation in Cesarean Rates: Not Due to Maternal Complications
This brief but well-referenced post analyzes cesarean rates relative to differences in maternal diagnoses or pregnancy complexity. On average, the likelihood of cesarean delivery for an individual woman varied between 19 and 48 percent across hospitals.”

Birth attendants often claim that their high cesarean rate is due to their clientele - that they provide care for a lot of high-risk clients.  This analysis shows that:

    Among lower risk women, likelihood of cesarean delivery varied between 8 and 32 percent across hospitals.
    Among higher risk women, likelihood of cesarean delivery varied between 56 and 92 percent across hospitals.
    Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics.

This shows that practice variation in cesarean rates is real, substantive, and not just a reflection of the mother’s risk level.

Tips for Choosing a Care Provider - great overview! from Henci Goer

When we talked about the advisability and/or need for ultrasound last week I briefly touched on some of the aspects I  discuss with my gordas to put this new technology into context.  I was just reading "Rediscovering Birth" by Sheila Kitzinger and came across some passages which express my concerns far more eloquently.

"When women dream or fantasize about their babies they have confidence in direct communication with them, unmediated by the medical profession. They are in intimate contact with the life growing inside them and everybody else is secondary to that relationship. Once science and technology take over, that sense of living communication is affected by the various observations recorded by professionals. These can be used to reinforce the mother's awareness of her baby, but they often impose another order of reality that negates the mother's own intuitive knowledge."  p 16

"Researchers have been unable to show that ultrasound is dangerous. Yet, there is a different risk. It lies in the decisions that are made and actions taken as a consequence of ultrasound, rather than any inherent danger in scanning photography itself. Certainly having a scan affects the way parents "see" their baby.  It is the projection of an image that is monitored and interpreted by medicine. The focus is on the integrity of or possible damage to developing organs, and whether the fetus complies with a standard of normal growth."    p 28

"Claims have bee made that OB and others that seeing the image of their baby on a scan enhances mother love and helps reluctant fathers to bond. Papers are published in medical journals stating that OBs can facilitate bonding thru ultrasound and prevent failure to bond after birth, poor family relationships and child neglect and abuse. These OBs take pride in putting on a fetal performance and acting as showmen who present babies to a delighted audience. With no confidence in the spontaneous process of bonding  between mothers and babies, they have taken over the task of "promoting bonding." They justify the use of ultrasound in pregnancy not only on diagnostic ground, but so that parents can bond when they see the image on the screen.  IT is the medicalization of love."

"There is a world of difference between a mother's growing awareness of her baby's movement, like secret messages coming from the unborn child, and being shown an ultrasound scan. When a woman feels her baby kick she is literally in touch with her child. When she gazes at the scan, the baby is "out there", a creature separate and removed from her body, as if alone in space. The intimacy of the relationship has gone, and other people with specialist knowledge are able to interpret the image more accurately than she can. Anyone can watch the fetal movements and these can be verified in a way that a pregnant woman's own descriptions of movements cannot. This is based on the assumption that everything the other feels is subjective, while everything that can be produce by technology is objective, scientific and measurable.  Diagnosticians . . . control the information and the way in which the newborn is introduced to both parents."

Thank you Sheila for giving voice to so many of the concerns I have intuitively felt these many years! 



This Web page is referenced from another page containing related information about Prenatal Screening for Birth Defects/Ultrasound

 




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