| Chapter 1: | Maternal Expectations in 21st-Century U.S. Birth Culture |
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unanticipated strategies is intravenous (IV) fluid administration: Doubling the most commonly administered IV fluid dosage may reduce first-stage labor by up to two hours1 (O’Sullivan & Scrutton, 2003). Amniotomy, or inserting a crochet hook–like instrument through the mother’s vagina and cervix to rupture the bag of waters surrounding the fetus, is practiced on the premise that it can kick-start or speed up labor (Vincent, 2005). In 1980, only about 3.2% of women reportedly underwent amniotomy (DeFrances et al., 2007); by 2006, the rate had shot up to 59% (Declercq et al., 2006). Intravenous infusion of the drug oxytocin, commonly known by the brand name Pitocin, induces and accelerates labor by increasing uterine contractions. Oxytocin administration saw a threefold jump from 17.4% of mothers in 1997 to 55% in 2006 (Declercq et al., 2006; Ventura, Martin, Curtin, & Mathews, 1999). Rates of other procedures, including episiotomy (surgical cutting of the vaginal opening to facilitate newborn exit) and forceps or vacuum assistance, have actually decreased, offset by increased cesarean delivery (Martin et al., 2010).
Two other obstetric procedures used with vaginally delivering mothers warrant mention because they have come to be used routinely and figure into hospital labor and delivery time lines. Epidural labor analgesia (discussed in more detail in chapters 4 and 5), involving an opiate drug injection into the spinal column during labor (and therefore sometimes labeled spinal labor analgesia), slows uterine contractions. Epidural rates have increased threefold since 1981 and are now used in 71–78% of all birthing mothers (Declercq et al., 2006; Deering, Zaret, McGaha, & Satin, 2007; Hawkins, Gibbs, Orleans, Martin-Salvaj, & Beaty, 1997). Intrapartum antibiotic prophylaxis (IAP) is an IV drug infusion administered in labor to prevent maternal-to-fetal transmission of a common adult infection, group B streptococcus(GBS). In 2002, the U.S. Centers for Disease Control and Prevention (CDC) called for testing all mothers for GBS in their final weeks of pregnancy in order to plan for IAP. Despite controversy surrounding IAP’s risks and its ineffectiveness in reducing GBS-related newborn deaths (Baltimore, 2007; Ohlsson & Shah, 2009; Stoll et al., 2002), up to 30% of contemporary U.S. mothers receive IAP (CDC, 2002).