Natural childbirth
I keep a copy of the obstetric bill for my birth and mother’s four day stay in the hospital. It was $63.29. Of course it was 1947, but still. The average hospital birth these days with a discharge in twenty-four hours is $8,000 to $10,000. Childbirth is the biggest source of income for US hospitals, and the four-million or so births a year end up costing over fifty billion dollars a year. One third of mothers undergo C-section when the recommended level should be one-third to one-half that number. One third of women have an episiotomy incision to assist in delivery of the infant head, whereas probably only a third need it .Somewhere around half of women have induced labor. There is a strong constituency out there who propose an alternative approach to labor and childbirth, that is, natural childbirth. They are very vocal about the “medicalization” of what amounts to a natural process. They point to the fact that although American healthcare has the most technically advanced system in the world; it ranks about thirty-seventh among other worldwide healthcare systems in efficacy, and it ranks fourteenth in maternal morbidity at six months. On the other hand, we have the American College of Gynecologists (ACOG) who are strongly lobbying lawmakers to prohibit out of hospital birthing practices. Surely what’s best for the infant and mother lies between these strong variances of opinion.
One thing you have to give the natural childbirth proponents is their emphasis on education. Whether it is live lectures, internet blogs, or programmed courses, they teach, teach, and teach. They advise on morning sickness from the time of conception, what fetal movements feel like, what Braxton-Hicks contractions later in pregnancy feel like, and the continuing physiologic changes in the mother’s body as the pregnancy progresses. They teach about diet, exercise, birthing positions, how to distinguish true labor, and the progress of natural labor. I have to admit sometimes in the medical model the pregnant patient is given a bottle of prenatal vitamins and basically told, “We’ll take care of the rest.” The mother might be told in advance what day she is to come in and have her labor induced, and be reassured that she will have an epidural anesthetic when any true discomfort occurs. Maybe she gets put into a kind of twilight sleep and has little memory of her labor. Each intervention of this sort might interfere with the progress of normal labor.
Another thing you have to give the natural child birth promoters is their habit of including the father into the birthing process. Instead of his hanging out in the waiting room drinking cup after cup of coffee, he’s right there with the mother assisting her with breathing techniques, techniques that involve physical distraction and mild levels of hypnosis, and other natural ways such as massage to diminish discomfort. Perhaps he helps her assume the various birthing positions or helps in any other number of ways. The basic concept is that he has attended all the teaching programs, and he knows what is going on at any given time, and feels confident to step in as he is needed.
Anecdotally, I might interject my own experience with natural childbirth. I have a generation of nieces and nephews who all agreed among themselves to utilize one nurse midwife at a birthing center. There were a total of twelve children born. None of the mothers required C-section, episiotomy, or epidural anesthesia. All infants were born in hearty condition and were doing well at their first birthday. I was impressed.
The negative side of natural childbirth, especially if there is not a physician and an operating room readily available, is that things can go wrong very fast during the course of some labors. The infant can suddenly show distress, if the cord is around his/her neck or if the placenta starts to detach or malfunction, the placenta can come out first causing severe bleeding, or the mother may have toxemia with severe blood pressure elevation and seizures. The nurse midwife is not able to prepare for these and other eventualities. Theoretically an infant or a mother, or both, could be lost under these circumstances. This is why ACOG has taken its stance against home deliveries. Most of the time deliveries go well, and the outcomes are good, but there are those few cases that would haunt a medical professional for the rest of his or her life.
So that’s the dilemma. Do we treat every pregnancy like a potential disaster and err on the side of over-intervention, or do we relax a little bit and let nature take its course? Of course the answer is somewhere in between. Excellent prenatal care will identify many problem pregnancies which could be passed along early to physician specialists. Likewise a nurse midwife or primary care physician should have certain intuitive skills to identify and refer potentially complicated pregnancies. My hat is off to both of these groups of medical practitioners who skillfully manage pregnancy and delivery.
John Drew Laurusonis, M.D.
Doctors Medical Center

Author's Bio: 

Dr. Laurusonis was conferred his Doctor of Medicine degree in 1983 and has been actively taking care of patients since completing his Internal Medicine residency in 1987 in the Garden State of New Jersey. Dr. Laurusonis has been licensed in four states but ultimately chose to permanently relocate to Georgia with his family and begin a private practice. Through his extensive experience in Internal Medicine, as well as in Emergency Rooms throughout the United States, Dr. Laurusonis saw how traditional Emergency Rooms were often overwhelmed by patients suffering medical conditions that were urgent but may not need the traditional “Level I Trauma Center”. Patients often waited six to twelve hours to be seen by a physician, were riddled with thousands of dollars in medical bills, and were generally unhappy with the system.
Dr. Laurusonis decided to open an Urgent Care Center instead of a 9-5 doctor's office. Through the last fifteen years he has received accolades from the community and his patients. He has expanded his practice to include many cosmetic therapies that have previously been treated with painful and extensive plastic surgery. He has been invited to the White House numerous times, has been named Physician of the Year from GA, as seen in the Wall Street Journal, and has served as Honorary Co-Chairman on the Congressional Physicians Advisory Board
Dr. Laurusonis and his practice, Doctors Medical Center, is open 7 days a week from 7:30 am to 9:30 pm offering such services as lab, x-ray, EKGs, aesthetics (Botox, dermabrasion, sclerotheraby and veins etc.), cold/flu, sore throats, fractures, sprains, lacerations, GYN, Pediatrics, Phlebology Anxiety/Insomnia/Depression Treatment, skin tag/mole removal, veins, allergies, asthma, physicals--just to name a few. Dr. Laurusonis welcomes you to either make an appointment or just walk-in to see him. Dr. Laurusonis will take the time to speak with you about your concerns--no problem is too big or too small. If you need additional services we have specialist referrals available or we can refer you to the neighborhood hospital emergency room. Give Doctors Medical Center a call--Dr. Laurusonis will be happy to speak with you.

John Drew Laurusonis, MD
Doctors Medical Center
3455 Peachtree Industrial Blvd
Suite 110
Duluth, GA 30096