04-29-09 RODALE NEWS, EMMAUS, PA—Medically induced labor and other procedures used by hospitals to assist in the delivery of babies are the number one medical costs billed to private insurers and Medicaid providers, according to a report released last October. However, a study just published by the Cochrane Library, online journal that reviews research on the effectiveness and merit of medical treatments, finds that simply walking around during the early stages of labor can help cut down on a number of delivery-related expenses, including epidurals, fetal monitoring, and Cesarean sections.
THE DETAILS: Authors of the report analyzed 21 studies that compared women who stayed in upright positions (sitting, standing, kneeling, etc.) during the early stages of labor with women who remained lying on their backs. The studies included 3,706 women total. Their review found that, in general, the first stage of labor for women who were upright was about an hour shorter, and those women were 27 percent less likely to need epidural anesthesia than women who remained on their backs.
WHAT IT MEANS: Getting back to basics for childbirth isn’t just common sense, it saves money and it’s more comfortable, says Eileen Beard, CNM, FNP, NS, senior practice advisor at the American College of Nurse-Midwives (ACNM). “It’s pretty well documented that ambulation decreases pain in labor,” she adds, “and it makes sense that if you’re comfortable, you have less pain and there’s less need for an epidural and less need for intervention.” Those added interventions, she adds, could increase your need for a Cesarean section. The study’s authors also write that lying on one’s back puts pressure on abdominal blood vessels, weakening contractions and making them less effective at pushing out the baby. And after all, says Beard, when you’re standing up, you have gravity on your side.
Putting women on their backs during birth is a modern idea that isn’t practiced in less-industrialized countries, says Beard. This has to do, primarily, with U.S. hospital protocols requiring nurses and doctors to put women on continuous fetal monitors, which gives hospitals more control over the birth and protects them from lawsuits, but also add unnecessary costs to deliveries among healthy women. “For the low-risk woman, there are no better outcomes with continuous monitoring than without,” she says.
And it’s important for women to be able to have babies the way they want, adds Beard, whether that entails walking around during labor or lying down for the duration.
Here are a couple ways to keep hospital policies from interfering with your personal preferences.
• Find a nurse-midwife. “Hospitals can be intimidating places,” says Beard, and midwives are powerful advocates. Midwives also make it easier for overtaxed hospital staff, if you choose less-common birthing practices like walking around during labor. “It’s easy for nurses to monitor patients who are lying down in one place,” says Beard, “whereas if someone’s walking around, they may have to chase that person down.” A personal midwife can monitor you, freeing a nurse up to help other patients. You can search for a midwife on the ACNM’s Web site, acnm.com.
• Ask questions. Hospital policies regarding birthing practices vary widely, so find out what’s possible before you start making plans. Knowing the policies of your hospital beforehand allows you to make informed decisions during childbirth, says Beard.