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Show T lave You.r Baby, if Nine to rive M By KEVIN V. BROWN loon, causes no pain and requires no anesthetic. Then, Oxytocin infusion begins. The process is something like receiving a blood transfusion. Oytocin, in a water solution, flows from an overhung bottle, through a tube, into the mother's arm. The amount infused can be regulated according to indications on a graph. It can be sped up if contractions are too slow or slowed down if contractions become too intense or too 1 ou've heard of expectant mothers' midnight dashes to hospitals. Perhaps it has even happened to you. The middle of the night often seems to be a baby's favorite time to be born. The wife turns to her soundly i sleep- ing husband, wakes him, and whispers, "Dear, I think it's time." He jumps out of bed, dresses frantipally, runs, stumbles, fumbles, and generally carries on like a nervous nincompoop. It's a familiar story that becomes a family joke in later years. But that whole scene may pass into the nostalgic past because modern medicine has found a way for mothers to give birth at a predetermined time of day. It works like this. During her final two weeks of pregnancy, the mother and fetus are medically tested, then later the frequency, intensity, and duration of contractions are measured electronically. If they reach a certain level, the mother is ready, and the baby is delivered by a method called "oxytocin-in-duce- d labor." Oxytocin is a hormone that stimulates the contractions naturally in the mother's body. In oxytocin-induce- d labor, additional oxytocin is fed intravenously into the mother's body to speed up the natural process. If the mother were brought to the hospital between nine and 10 in the morning, her baby could be delivered about hours later, or between two and four that afternoon. This is about half the normal labor time. frequent The advantages of having your baby on your own schedule, not the baby's, are multiple. In an era of dwindling manpower, especially trained nurses, delivering babies on a predictable schedule reduces the number of personnel required. And it is surely preferable to the mother, who can now know precisely what day, and what time of day, her baby will be born, so she can make her preparations ahead of time, get a good night's rest, and appear at the hospital alert and ready. a- Experiments ''i five-and-one-h- alf The search for a method to assist, or speed up, the normal labor time goes back many years. It has only been in the last few years, however, that the problem has been solved sufficiently to use the method on a convenience basis, that is, to deliver the baby on a schedule most convenient for the patient and medical personnel. The key to the solution of the problem was to find what caused the uterus, or womb, which for nearly nine months nourished and protected the fetus, suddenly to eject it. Another hormone, progesterone, was found to be this key. The womb and its associated system would be capable of expelling the fetus at almost any time during pregnancy, except for the presence of progesterone. Like a sentinel, it guards the womb and prevents the billions of cells which make up the system from communicating with one another. Then, at about the 38th week, or two weeks before 4 Family Wezkly, November 8,1970 full term, it leaves its post, and the normal delivery process is allowed to begin. If it left its post at an earlier time, a premature birth could result. It is during these final two weeks, then, that oxytocin-induce- d labor is introduced. Both mother and baby are ready, The mother is ready when the cervix, or neck of the womb, is "ripe," or open; when the womb itself is receptive to oxytocin; when the pelvis is of normal size and configuration; and when there are no medical problems that would forbid using the system. m he baby is ready when it is fully grown and in a reasonably normal position for delivery. The initial judgment for timing the delivery, usually as close to full term as possible, is made by the patient's own physician. He is, in fact, present at the delivery, performing his normal functions. The hospital team performs the extra functions associated with oxytocin-induce- d labor. When the judgment is made, the mother is brought to the hospital, given a final physical examination, and, if fit, administered a small dose of oxytocin to test her reaction to it. If favorable, and in the majority of cases it is, the method can proceed. Two things are then done. A small balloon is placed on the end of a catheter, a flexible tube, and inserted the womb and the membranes holding the fetus. The contractions of the womb force fluids in the ballon through the tube to a pressure transducer, a device which translates the contractions into electrical signals. The signals are recorded on a graph, and their frequency, intensity, and duration can be read at a glance. Dr. Saul Gusberg, chief of obstetrics at Mount Sinai Hospital in New York, says, "Contractions every three or four minutes, and lasting about 60 seconds, indicate a good, healthy labor." There is no discomfort to the mother. Inserting the catheter, with the bal- bet-twe- en in induced labor have gone on all over the world, but in the United States, Barnes Hospital in St. Louis has certainly been in the vanguard. In the last three years, more than 700 babies half of all deliveries have come into the world by the induced method. And there have been no problems or complications after birth. In spite of its success at some hospitals and its great promise for the future, there are some obstetricians who feel it should not be done universally. Dr. Gusberg is one of the conservatives in this belief. "I don't think induced labor should be done as a matter of convenience, for either the doctor or the patient. In some cases it shouldn't be done at all: in first births when the mother's cervix is not ready almost until labor starts, when the fetus is in odd postures, or when there is any problem. that would forbid it. In some cases, excessive contractions can even injure the baby. "However, for medical reasons, it doesliave a place in obstetrics, in cases of slow, sluggish labor or prolonged labor when it can harm the mother." The promise is still there, however, and Barnes Hospital, for one, plans to have all babies deliered on the shift within two years. And if other hospitals follow, about all that will be lost will be the wild tales Dad tells when he's out with the boys, 'TU never forget the night Junior was born. I put my pants on backwards, then. . ." f nine-to-fi- ve |