Henci Goer

Table of Contents

1. Introduction: Obstetric Management: What's Wrong with This Picture?

   1. Why the Gap?
   2. Why This Book?

2. 1. The Cesarean Epidemic: Obstetrics on the Cutting Edge

   1. Myths and Realities Behind the Rise in Cesareans
   2. What Determines Your Chance of Having a Cesarean and What Should the Odds Be?
   3. The Cesarean Procedure
   4. The Bottom Line
   1. Benefits and Risks of Cesarean Section
   2. How to Avoid an Unnecessary Cesarean
   3. Making a Cesarean a Positive Experience

3. 2. The Full-Term Breech Baby: Cesarean Section is Not the Only Answer

   1. What's the Problem with Breech Birth?
   2. Turning the Baby Head Down
   1. The Home Version
   2. The High-Tech Version
   3. Alternative-Medicine Versions
   3. The Bottom Line on ECV
   1. Controversies and Trade-Offs of ECV
   2. Strategies for Improving the Odds of Success of ECV
   4. The Bottom Line on Breech Birth
   1. Trade-Offs of Cesarean vs. Vaginal Breech Birth
   2. Controversies of Vaginal Breech Birth
   3. Safety Factors in Vaginal Breech Birth
   5. Gleanings from the Medical Literature
   1. External Cephalic Version
   2. Vaginal Breech Birth

4. 3. Induction of Labor: Mother Nature Knows Best

   1. Why Not Wait?
   1. Convenience Inductions
   2. Suspected Large Baby
   3. Prelabor Rupture of Membranes in Full-Term Pregnancy
   4. "Overdue" Pregnancy
   2. Tests of Fetal Well-Being
   3. Cervical Ripening and Induction
   4. The Bottom Line on Labor Induction Generally
   1. Avoiding an Unnecessary Induction
   2. Pros and Cons of Techniques for Ripening the Cervix and/or Inducing Labor
   3. General Advice on Induction
   5. The Bottom Line on Labor with a Large Baby
   1. Strategies to Avoid Unnecessary Intervention
   6. The Bottom Line on Induction for
   1. Prelabor Rupture of Membranes
   2. General Advice
   3. Compare and Contrast Three Approaches to Prelabor Rupture of Membranes
   7. The Bottom Line on Induction for Postdates Pregnancy
   1. Compare and Contrast Three Postdates Options
   8. Gleanings from the Medical Literature

5. 4. IVs: "Water, Water, Everywhere, Nor Any Drop to Drink"

   1. The Illogic of "Nothing by Mouth"
   2. The Bottom Line
   1. Pros and Cons of Forbidding Food and Drink in Labor
   2. Pros and Cons of Routine IVs
   3. What Should You Eat or Drink During Labor?
   4. Ways to Minimize the Chance of Aspiration
   3. Gleanings from the Medical Literature

6. 5. Electronic Fetal Monitoring and Cesarean for Fetal Distress: The Machine that Goes Ping!

   1. How Did We Get into This Mess?
   2. How EFM Is Done
   1. External EFM
   2. Internal EFM
   3. The Bottom Line
   1. Comparing External and Internal Monitoring
   2. Situations When the Medical Literature Supports the Use of Continuous EFM
   4. Ways to Avoid the Drawbacks of EFM
   5. Ways to Avoid Problems with the Baby
   6. Gleanings from the Medical Literature

7. 6. When Doctors Break the Membranes: If It Ain't Broke, Don't Break It

   1. The Amniotomy Procedure
   2. The Bottom Line
   1. Pros and Cons of Routine Amniotomy
   2. Pros and Cons of Amniotomy for Indication
   3. Avoiding Amniotomy
   3. Gleanings from the Medical Literature

8. 7. Slow Labor: Patience Is a Virtue

   1. Active Management of Labor
   2. Procedures
   3. The Bottom Line
   1. Benefits and Risks of Techniques for Coping with Poor Progress
   2. Strategies to Avoid the Need for IV Oxytocin, Instrumental Delivery, or Cesarean Section
   4. Gleanings from the Medical Literature

9. 8. Epidurals and Narcotics: A Shot in the Dark

   1. Why You Don't Hear About the Downside of Epidurals
   2. The Epidural Procedure
   3. The Bottom Line
   1. What an Epidural Does
   2. The Trade-Offs of Epidurals
   3. What an Injected Narcotic Does
   4. The Trade-Offs of Injected Narcotics
   5. The Trade-Offs of Natural Childbirth
   6. Strategies to Avoid Pain Medication
   7. Questions to Ask When Helping a Laboring Woman Decide Whether to Have Pain Medication
   8. Strategies to Minimize the Risks and Side Effects of an Epidural or Spinal Epidural
   4. Gleanings from the Medical Literature

10. 9. Episiotomy: The Unkindest Cut

    1. Why Are Doctors Still Doing Routine Episiotomies?
    2. What Is an Episiotomy?
    3. The Bottom Line
    1. Pros and Cons of Routine Episiotomy
    2. Traditional Indications for Episiotomy
    3. Strategies to Protect the Perineum
    4. Gleanings from the Medical Literature

11. 10. Elective Repeat Cesarean Section: Just Say No

    1. So Why Hasn't VBAC Become Routine?
    2. The Bottom Line
    1. Pros and Cons of VBAC vs. Elective Repeat Cesarean
    2. Factors that Exclude VBAC
    3. Factors that Don't Exclude VBAC
    4. Factors that Promote Safe Vaginal Birth
    5. Factors that Promote a Positive Birth Experience
    3. Gleanings from the Medical Literature

12. 11. Professional Labor Support: Mothering the Mother

    1. Do You Really Need Professional Labor support?
    2. What About the Father's Role?
    3. The Bottom Line
    1. Pros and Cons of Professional Labor Support
    2. Comparison Between Labor Support from a Female Relative or Friend and a Doula
    3. Comparison Between a Doula and a Monitrice
    4. Choosing a Professional Labor Support Companion
    4. Gleanings from the Medical Literature

13. 12. Obstetricians, Midwives, and Family Practitioners: Someone to Watch Over You

    1. The Bottom Line
    1. A Guide to the Qualifications of Birth Attendants
    2. Pros and Cons of Various Classes of Birth Attendants
    3. Interviewing a Caregiver
    4. When Choice is Limited
    2. Gleanings from the Medical Literature

14. 13. The Place of Birth: Location, Location, Location

    1. History Reexamined and a Few Current Facts
    2. The Safety of Hospital Births
    3. A (Relatively) New Out-of-Hospital Option
    4. The Bottom Line
    1. Comparing Birth Sites
    2. Comparing Direct-Entry Midwives and Nurse-Midwives
    3. Interview Questions
    4. Advice If You Decide on an Out-of-Hospital Birth
    5. Gleanings from the Medical Literature

15. Appendices

    1. Literature Summaries
    1. Chapter 2
    2. Chapter 3
    3. Chapter 4
    4. Chapter 5
    5. Chapter 6
    6. Chapter 7
    7. Chapter 8
    8. Chapter 9
    9. Chapter 10
    10. Chapter 11
    11. Chapter 12
    12. Chapter 13
    2. Bibliography
    3. The Mother-Friendly Childbirth Initiative

16. Resources

17. Index