From: lisa@watson.ibm.com (Lisa Leutenegger)
Subject: Re: Use of drugs during labor - and electronic monitoring
Date: Tue, 28 Jul 1992 14:32:29 GMT
Disclaimer: This posting represents the poster's views, not necessarily those of IBM
Organization: IBM T.J. Watson Research Center

In article <1992Jul27.193823.13707@umiami.ir.miami.edu> ahelmers@umiami.ir.miami.edu writes:

>I'm not flaming you

Yeah right - you call your friends dumb.

>but you don't
>know what you will be wanting in labor, you simply haven't experienced it yet.

Of course not - but it does not make sense to me to not think about
what I will want in the event of a normal labor.  I don't think making only
spur of the moment decisions is a very responsible way to approach this
event.

>Lisa, I hope that your labor goes according to your plans but it sounds pretty
>dumb to me to declare NOW that you won't use a tool that could help you and
>your baby.

The point of researching this information is to be an informed consumer.
In most births medical intervention is unnecessary.  My birth plan is
what I would like if there are no complications - obviously if there are
complications medical intervention will be necessary and since I have
spent the time researching the pros and cons and the effectiveness of
the procedures used in modern labor my husband and I will be able to
make informed descisions if necessary.  

Everything I have read indicates that fetal distress can be determined through
periodic monitoring just as reliably as with EFM.  So I hardly consider
refusing 20 minutes of EFM upon arrival at the hospital to be refusing a 
tool that could help my baby and myself.  There is no proof that it can help 
and in fact there is plenty of evidence that it can lead to an unnecessary 
C-section.  EFM simply provides more data (not better) than does periodic
monitoring - but unfortunately most doctors and midwives don't know how to
interpret this data - so more is not necessarily better.

I am planning on a normal labor - to do anything else seems extremely
pessimistic and unnecessary.  In the event complications arise I am 
prepared and will deal with them as they come up.  I am not planning on
refusing any and all medical intervention - but my husband and I and 
our midwives firmly believe that informed consent is essential.  Having 
the midwives say "we're gonna hook you up to the monitor" and us saying 
"okay" is not informed consent unless we know why they want to use the 
monitor and what benefits and risks there are in using it and what other
options we have available.  We have discussed the benefits and risks of 
many of the procedures that may be used during labor with our midwives 
during our periodic exams and we will have further discussions during labor
if a problem arises as to how the procedure effects my specific case.

I have mitral valve prolapse so they want to inject antibiotics into 
me right before and after the delivery.  While I'm not convinced this 
procedure is necessary (they estimate that around 50% of the adult women 
in the US have MVP - and plenty of them have babies and go to the 
dentist without any problems).  I am not refusing this treatment because
the possible benefits (preventing bacteria from landing on my heart valve 
which could lead to infection) in my husband's, my own and our midwives'
informed opinion outway the risks.  To minimize the discomfort of this
procedure they will not put the heparin lock in place until just before
necessary and they will remove it immediately after the last injection.
Now obviously if for some reason I need IV the heparin lock may be unnecessary
but I hardly think I am wasting my time thinking about how I would like
them to administer the antibiotics in the case I have a normal labor.

>Doesn't this sound amazingly like  Jim Mumper a couple of years ago?  Some
>readers may recall him; he and his wife also went through a lot of researching,
>made some very firm decisions about what type of interventions they did NOT
>want during her labor, and had quite a bit of difficulty finding a facility
>that agreed to their terms.  
>
>As I recall, Barb M. ended up with a pregnancy that went several weeks past due
>date followed by an extremely long, arduous labor that ended in a ceserean
>section because the baby's cord was wrapped around its neck.

So?  Just because they spent time looking into what they wanted in the event
of a normal labor does not mean they were not also prepared for complications.
Obviously they did not refuse medical intervention when it was necessary.
In my opinion this is exactly why I have looked into these issues - so if
something like this happens I will know what to expect.


---lisa leutenegger
   lleut@watson.ibm.com