Kathryn Cranford, ND, NHCM, CPM AANP Conference 2013 Keystone, CO

102 Pages·2013·25.28 MB·English

by  Rebecca Takemoto

Kathryn
 Cranford,
 ND,
 NHCM,
 CPM

AANP
 Conference
 2013

Keystone,
 CO
As
 a
 Naturopathic
 Midwife
 I
 get
 to

hang
 out
 with
 a
 lot
 of
 cervixes…
Most
 :mes
 they
 behave
 beau:fully
Some:mes
 they
 don’t

We
 may
 end
 up
 in

hospital
 for

induction,
 pain

medication,
 or
 in

some
 cases,

cesarean
 delivery.
So,
 what
 makes
 the
 difference?
My
 Anecdotal
 Personal
 Prac:ce

Thought
 Triggering
 Birth
 Experience

  Manual
 dilation
 of
 cervical
 scarring
 after
 LEEP
 –
 48
 hour

labor,
 “excrutiating,
 never

 again”.

  Second
 labor
 (same
 mom)
 I
 almost
 missed
 the
 labor,

“I
 could
 do
 that
 a
 hundred
 times”.

  Had
 these
 births
 happened
 in
 hospital,
 the
 first
 would

more
 than
 likely
 have
 been
 a
 cesarean
 delivery
 and
 the

second,
 very
 likely
 a
 repeat
 cesarean
 delivery.
My
 Anecdotal
 Personal
 Prac:ce

Thought
 Triggering
 Pap
 Experiences

  Paps
 on
 women
 with
 os
 so
 small
 the
 cyto
 brush

won’t
 go
 in,
 even
 with
 a
 good
 deal
 of
 pressure

  Escharotic
 treatment
 on
 one
 of
 these
 women:

  Hx.
 of
 normal
 cycles,
 no
 cramping

  after
 dysplasia
 treated
 by
 a
 cone-­‐biopsy
 healed,
 monthly

severe
 cramping

  her
 pap
 only
 remained
 normal
 after
 the
 procedure
 for
 a
 short

time.

  After
 a
 course
 of
 escharotic
 treatment:

  much
 improved
 menstrual
 symptoms

  Reversion
 to
 a
 persistent
 normal
 pap
 result
Cervical
 Os

Non-­‐parous

Parous

Stenotic

That’s
 probably

not
 the
 cervix,
 try

higher
 or
 lower.
Hard
 Stop
 on
 Elec:ve
 Induc:ons

Earlier
 than
 39
 weeks
 gesta:on

  The
 majority
 [of
 hospitals],
 67%,
 have
 a
 formal
 policy

against
 non
 medically
 indicated
 labor
 induction,
 and

among
 those
 without
 a
 formal
 policy,
 just
 over
 half
 said
 it

was
 against
 their
 standard
 of
 care.

  Comparing
 9515
 before
 and
 2641
 after
 “hard
 stop”
 policy

outcomes:

  Significant
 decrease
 of
 5.9
 hours
 median
 time
 to
 delivery

(P=.002)

  C/S
 rate
 for
 elective
 inductions
 from
 15
 to
 7%
 (P=.05)

  NICU
 admissions
 down
 1/3
 from
 3%
 to
 2%
 (p=.02)

  No
 increase
 in
 the
 stillbirth
 rate.

American
 Congress
 of
 Obstetricians
 and
 Gynecologists
 (ACOG)
 61st
 Annual
 Clinical

Meeting:
 Abstracts
 42
 and
 50.
 Presented
 May
 6,
 2013,
 and
 Abstract
 44.
The
 “delighNul
 surprise”
 outcomes

of
 such
 a
 crazy
 policy…

  “Something
 we
 didn't
 even
 anticipate
 as
 a
 benefit
 of
 this
 policy,
 but

was
 a
 delightful
 surprise
 to
 see,
 was
 a
 decreased
 admission
 rate
 to
 the

neonatal
 intensive
 care
 unit,”
 Dr.
 Healy
 told
 Medscape
 Medical
 News

at
 the
 meeting.

 
 "You
 have
 less
 of
 the
 early
 term
 admissions
 for
 things
 that
 are
 not

life-­‐threatening,
 but
 still
 disruptive
 of
 the
 neonatal
 period
 that
 will

affect
 breast-­‐feeding
 and
 maternal-­‐neonatal
 bonding,"
 said
 Angela

Silber,
 MD,
 director
 of
 maternal-­‐fetal
 medicine
 at
 Summa
 Akron
 City

Hospital,
 OH

  His
 survey,
 presented
 here
 at
 the
 American
 Congress
 of
 Obstetricians

and
 Gynecologists
 (ACOG)
 61st
 Annual
 Clinical
 Meeting,
 found
 that

nearly
 two
 thirds
 of
 more
 than
 2600
 hospitals
 are
 on
 the
 bandwagon.

  “And
 we're
 even
 considering
 stopping
 elective
 inductions
 completely

—
 it's
 just
 a
 matter
 of
 time.”

American
 Congress
 of
 Obstetricians
 and
 Gynecologists
 (ACOG)
 61st
 Annual

Clinical
 Meeting:
 Abstracts
 42
 and
 50.
 Presented
 May
 6,
 2013,
 and
 Abstract
 44.