The website "My OB Said What?" offers a very raw look at just how bad the birthing industry can get. The site is filled with appalling quotes that obstetricians, midwives, nurses and other medical staff have said to their patients (along with the occasional good quote). It is by no means a fair representation of all maternity professionals, more like a classic example of how a few bad apples can tarnish the reputation of their profession for others. Below is a collection of those quotes, along with the reasons why the comments are considered so bad, and what should have been said and done instead.

"If a baby hasn't engaged by 37 weeks, we need to do a cesarean section." – OB to mother.

What's wrong with this comment…

Firstly, 37 weeks is far too early to consider a cesarean. "Full term" is when a fetus reaches the approximate gestational age of 40 weeks. If the fetus and mother are doing well at 37 weeks, there is no reason to interfere and the pregnancy should be left to unfold at its own pace.

While many medical staff technically consider 'full term' to be between 37 – 42 weeks, current research shows this is a dangerous assumption – infants born between 36 – 38 weeks triple their risk of mortality compared to infants born at 39 – 42 weeks.27 Infants born before 36 weeks face even greater risks. These risks decrease with each additional week of pregnancy.1 Post term pregnancies (beyond 42 weeks) can also be left to unfold at their own pace provided there are no complications, and regular checks for complications are performed.2

Risks to late preterm infants (36-38 weeks) include 27...

3 fold increased risk infant mortality
4.6 fold increased risk neonatal mortality
28 fold increased risk admission to intensive care unit 
5.5 fold increased risk intravenous fluids
4 fold increased risk mechanical ventilation
7 fold increased risk respiratory distress
3 fold increased risk of infection
10 fold increased risk temperature instability
42% increased risk jaundice
60 fold increased risk apnea
4.5 fold increased risk difficulties with feeding
3 fold increased risk hypoglycemia

As for the doctor wanting to do a cesarean…Cesareans carry substantial increased risks for both mother and baby, and should only ever be done when absolutely medically necessary.9 Because of the increased risks, some hospitals have banned elective cesareans.10 Cesarean risks include...

For the mother
5 fold increased risk cardiac arrest 28
4 fold increased risk maternal deep vein thrombosis 25
2 fold increased risk acute renal failure 28
2 fold increased risk anesthetic complications 28
2 fold increased risk hemorrhage requiring hysterectomy 28
3 fold increased risk hysterectomy 28
5 fold increased risk wound hematoma 28
2 fold increased risk in-hospital wound disruption 28
3 fold increased risk major puerperal infection 28
2 fold risk maternal rehospitalization for reasons such as uterine infection, gallbladder disease, surgical wound complications, cardiopulmonary conditions, thromboembolic conditions, and appendicitis 21
2 fold increased risk of failure to breastfeed 25
2 fold increased risk of major post partum pain 25
27 fold increased risk of uterine rupture in future cesarean 25
57 fold increased risk uterine rupture in future vaginal birth 25
4 fold increased risk placenta accrete in future pregnancy 25 (the placenta attaches itself too deeply into the wall of the uterus significantly, increasing risk of hemorrhage during its removal)
3 fold increased risk placenta previa in future pregnancy 25 (the placenta is attached to the uterine wall close to or covering the cervix, it is a leading cause of vaginal hemorrhage)

For the infant
2-3 fold increased risk neonatal death 24, 35
2 fold increased risk neonatal death in preterm infants 32-36 weeks 26
8 fold increased risk neonatal pneumothorax (collapsed lung) 19
3-7.4 fold increased risk neonatal persistent pulmonary hypertension (failure of blood to circulation through the lungs properly) 44, 45
2-5 fold increased risk of serious respiratory morbidity (the earlier gestation the higher the risk) 29
2 fold increased risk neonatal pulmonary disorders 23
87% increased risk neonatal transfer to neonatal intensive care unit 23
4.3 fold increased risk neonatal intracranial hemorrhage 23
30% increased risk later development of asthma 25

There are also many other risks, click here for more details.

If the doctor in question had indeed performed a cesarean on this mother at 37 weeks gestation, he/she would have been needlessly putting the mother and infant at significantly increased risks.

Regardless of the doctors intentions, every woman has the legal right to accept or refuse a cesarean, or any medical procedure, drug, treatment or test. And after a woman makes her decision, she has the right to change her mind.11

"I might have to cut you." – OB to a mother who had made it clear she preferred to tear, moments before making a second degree episiotomy.

What's wrong with this comment…

An episiotomy is a surgical cut in the perineum as the baby is born in order to increase the opening of the vagina. Routine episiotomy is proven to offer no benefit and is no longer advisable, it increases the need for stitching, causes pain, extended healing time, increased bowel incontinence, and increased pain during intercourse.3, 4, 36

Obviously the doctor in question was not aware of current research and recommendations to abandon the practice of episiotomies. Regardless, he/she should not have cut this mother, he should have honored her request to not be cut. Again, every woman has the legal right to refuse an episiotomy, or any procedure, drug, treatment or test.11

Steps the doctor could have taken to maintain the integrity of the mothers perineum include using a caster oil heat pack held on the perineum during pushing.14

"Let's break your water and get an IV going to speed things up." – OB to mother who had made great progress until asked to get out of the tub and flat on her back on the bed.

What's wrong with this comment…

Firstly, laboring in water can effectively reduce the need for obstetric intervention (amniotomy, oxytocin, epidural, or operative delivery).8 Had this mother not been forced to leave the water, the need for obstetric intervention may have never been 'needed'.

Secondly, the 'supine' position (lying flat on back) is considered one of the most ineffective positions in which to give labor. When compared to an upright position, the supine position is associated with longer pushing time, more fetal distress, more pain, and more injury to the perineum (a 3 fold risk of perineal tears, and a 2 fold risk of severe tears).5, 6, 7

Every woman has the legal right to labor in any position she wishes. Every woman also has the legal right to freedom of movement during labor, unrestricted by wires, tubes or other apparatus. And again every woman has the legal right to refuse to get out the water, having her waters broken, having an IV, or any procedure, drug, treatment or test.11

"So what, do women who give birth naturally get a trophy or walk around with gold stars on their foreheads?" – L&D nurse to mother during transition.

What's wrong with this comment…

The cavalier and unsupportive attitude of the medical staff in question undermines the fact that epidurals carry a myriad of substantial risks to both mother and baby, these include...

For the mother
88% increased risk of being dissatisfied with birth 31
4 fold increased risk of malposition of baby 30, 41
5.6 fold increased risk of dystocia 38
3 fold increased risk of needing synthetic oxytocin 30 (see above for risks associated with induction)
2 fold increased risk of needing the maximal dose of synthetic oxytocin 40
31.6 fold increased risk of motor blockade 37
18 - 74 fold increased risk maternal hypotension 30, 37
5 fold increased risk of shivering 37
29 fold increase risk of itching 43
46% increased nausea 30
3.3 - 5.6 fold increased risk of maternal fever 30, 37  (see below for risks associated with maternal fever)
42% - 6 fold increased risk of needing a forceps / vacuum delivery  37, 39 (see below for risks associated with forceps / vacuum delivery)
2.4 - 3.7 fold increased risk of cesarean for failure to progress  30, 39 (see above for risks associated with cesarean delivery)
43% increased risk of ceasarean for fetal distress 37
2-5 fold increased risk of postpartum hemorrhage 30
3.2 fold increased risk of anal sphincter tear 42
85% increased risk of 3rd and 4th degree perineal lacerations 30
2 fold increased risk of not breastfeeding at 6 months postpartum 13

Risks of induction include...
3 fold increased risk fetal asphyxia 46
2 fold increased risk of cesarean 32
2 fold increased risk of hemorrhage 33

The following adverse reactions have been reported in the mother:
Anaphylactic reaction Premature ventricular contractions, Postpartum hemorrhage Pelvic hematoma, Cardiac arrhythmia Subarachnoid hemorrhage, Fatal afibrinogenemia Hypertensive episodes, Nausea Rupture of the uterus, Vomiting, Excessive dosage or hypersensitivity to the drug may result in uterine hypertonicity, spasm, tetanic contraction, or rupture of the uterus. The possibility of increased blood loss and afibrinogenemia should be kept in mind when administering the drug. Severe water intoxication with convulsions and coma has occurred, associated with a slow oxytocin infusion over a 24-hour period. Maternal death due to oxytocin-induced water intoxication has been reported.34

The following adverse reactions have been reported in the fetus or neonate:
Bradycardia Low Apgar scores at five minutes, Premature ventricular contractions and other arrhythmias Neonatal jaundice, Permanent CNS or brain damage Neonatal retinal hemorrhage, Fetal death. Neonatal seizures have been reported with the use of Pitocin.34

Instead of patronizing these laboring mothers, medical staff should have taken every measure possible to facilitate natural birth and avoid an epidural. My guess is the medical staff simply weren't sufficiently trained to facilitate a natural birth, nor were they aware of the risks associated with an epidural and the interventions that often follow. Otherwise, the medical staff did know, but they simply didn't care.

One of the most effective methods of managing labor pain is to have a doula (professional birth supporter) in attendance at the birth, the effects include 15…

50% reduction in the cesarean rate
25% shorter childbirth
60% reduction in epidural requests
40% reduction in oxytocin use
30% reduction in analgesia use
40% reduction in forceps delivery

Other techniques that help facilitate natural birth include having a safe, private room to birth, water birth, supportive companions, abdominal breathing, vocalization, visualization, affirmation, self-hypnosis, repetitive movement, standing up, experimenting with different positions, massage, perineal massage, acupressure and hot or cold packs.14 Click here for more details.

"If you hadn't declined vaginal exams we would have known the baby was breech." – OB to mother who had declined vaginal exams at her prenatal appointments.

What's wrong with this comment…

This doctor should have palpated (felt) the mothers abdomen at regular intervals throughout pregnancy to determine whether the baby was breech. This is the most common method of examination, and studies show that it is 70% effective. If there was any doubt of the baby's position, the doctor should have ordered an ultrasound. And this should have been done well before the onset of labor.16

Vaginal exams are not recommended to determine whether a baby is in the breech position, there is no need to perform a vaginal exam. I could find little evidence to show that a vaginal exam could possibly ever determine whether a baby was breech. All that can be felt by a vaginal exam is the condition of the cervix.17

Further, vaginal exams carry an increased risk of infection, a perfectly sterile vaginal exam is impossible – as soon as a sterile glove hits the air it's exposed to bacteria. Further, when a finger is inserted into the vagina, bacteria is pushed up towards the cervix, increasing the risk of infection. The more vaginal exams, the higher the risk of infection.18 Having a vaginal exam at the beginning of labor increases the risk of neonatal infection 2.5 fold. 17 Infants born with an infection face a 4 fold risk of mortality.

Other risks caused by vaginal exams include prematurely stimulating the cervix into labor, and premature rupture of membranes (PROM).17

The main reason maternity carers ask to perform a vaginal exam is to determine the condition of the cervix, for instance how many centimeters the cervix has dilated. However vaginal exams are not necessary, and it can be very discouraging for women in labor to hear a labor assistant announce 'you are not progressing fast enough'. Provided there are no complications, a labor should be left to unfold at its own pace.17

Again every woman has the legal right to refuse a vaginal exam, or any procedure, drug, treatment or test.11

These are just a couple of quotes from "My OB Said What", I'll be writing a commentary on more in the future.

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