Another recently-published study has found a link between exposure to common chemicals and the time it takes a woman to conceive as well as birth defects and growth restriction in fetuses. It's yet another example of how the expansion of technological options can have unintended side effects on our species.
The most disturbing fact is that the chemicals were known toxins in the process of being phased out. While it's encouraging that they are being removed from products, the reality is that the damage has been done; while they will no longer be present in newly-manufactured items, there presence will linger in landfills, water supplies, and our bodies for decades to come.
We must remember that our actions today force the outcomes of tomorrow. More due diligence is needed on the safety of such technologies before they are used to prevent this seemingly never-ending cycle of self-destruction through industrialization.
Monday, December 29, 2008
Another recently-published study has found a link between exposure to common chemicals and the time it takes a woman to conceive as well as birth defects and growth restriction in fetuses. It's yet another example of how the expansion of technological options can have unintended side effects on our species.
Monday, December 22, 2008
Understanding the Dangers of Cesarean Birth: Making Informed Decisions, a new book by Nicette Jukelevics, MA, ICCE of the wonderful resource on vaginal birth after cesarean section, VBAC.com has just been published.
You can learn more about the book and view the table of contents at: http://www.dangersofcesareanbirth.com
I haven't had a chance to read it yet, but I'm certain it will move onto my list of recommended resources.
Buy your copy from Amazon using GoodSearch and the vendor will donate to the Coalition for Improving Maternity Services (CIMS). Go to www.goodsearch.com/goodshop.aspx, choose CIMS as your charity, then choose Amazon and enter Dangers of Cesarean Birth in the Amazon search bar.
This is a timely book I'm sure will help empower and inform mothers to help stem the tide of ever-increasing c-sections without improved outcomes for mothers and babies.
Please pass this along to all the mothers in your life.
Wednesday, December 10, 2008
Researchers at the University of Bristol have conducted a new study which may help predict which mothers are at risk of later developing pre-eclampsia.
Friday, December 5, 2008
New study finds link between flaxseed oil consumption in pregnancy and pre-term birth
An interesting read....
Sunday, November 30, 2008
Yesterday, I ran across this article, which details the story of a UK mother with a history of precipitous labor (labor lasting less than 3 hours), who chose a homebirth (which nearly became an unassisted birth) with her last child to avoid giving birth en route to the hospital.
She and I share commonality in that both my labors were also precipitous. My first was born in 3 hours and my second in a mere 45 minutes.
As I read further, I was struck by a seemingly small detail, but one that truly crystallizes the differences between the US and UK maternity systems:
"After Charlotte was born doctors had recommended that Hazel have a home birth if she ever fell pregnant again..."
In the US, homebirth would never be suggested as the solution to precipitous labor. I can personally attest to the one-and-only US answer: "medically necessary" induction.
In my case, this would mean inducing between 36-37 weeks, as both my children were also born before 38 weeks.
So, despite the fact that precipitous labor at term is typically moving so quickly because it is completely uncomplicated, because everything is going right, I would be forced, not only to undergo a decidedly unnecessary induction with all the added risks it entails, but also at the additional risk of delivering a pre-term infant, and all in the name of "preventing complications".
This is a perfect example of how overmedicalized the US system is: instead of letting labor progress normally on its own, the desire for a false sense of control makes modern obstetricians believe they must save me from myself, that only by their aggressive intervention could I be saved from the risk of birthing in my own time, in my own home.
In all probability, my next birth will be unassisted, not as an active choice, but due to the lack of one.
My choices are:
1. Plan a hospital birth
- This means accepting an induction and all its ancillary interventions between 36-37 weeks. There are no birth centers in my state, so that is not an option, although even in a birth center, induction would be my only option. I have interviewed all the insurance-covered OBs in my area and this is the consensus, take it or leave it.
2. Plan a midwife-assisted homebirth
- Due to the lack of support for midwifery care from the medical maternity model, the nearest midwife to my home is still over an hour away. Were my next birth to go as quickly as my second, it's highly unlikely she would arrive before the baby did. Even if we called from the very first contraction, I doubt there would be enough time for her to get to our house.
So, what to do? Most likely, I will choose a midwife, paying four times as much for her care (since my insurance won't cover midwifery care), all the while knowing she probably won't be present for the birth.
While many would baulk at the thought of an unassisted birth, I accept that, whether I want it or not, this may well be the reality of birthing again. As such, I don't spend time worrying about this fact; rather, I can focus on preparing everything needed to birth as safely as possible at home.
If modern obstetrics truly cared about making birth as safe as possible, then their focus would be on practicing evidence-based medicine and recognizing when intervention was truly necessary. Thus, the midwifery model of care would be the standard, so that women such as I could birth safely with a skilled attendant present no matter what place of birth was chosen.
Friday, November 28, 2008
The Coalition for Improving Maternity Services' (CIMS) 2009 Mother-Friendly Childbirth Forum and Annual Meeting will be held March 5-7, in San Diego, California. The program includes 24 sessions that will cover a broad range of issues affecting childbearing women.
The 2009 CIMS Forum will cover topics ranging from "Racial and Ethnic Disparities in Birth Outcomes," to the findings of a new national report, "New Mothers Speak Out," on the physical and mental health challenges faced by new mothers, to "The Case Against Elective Repeat Cesarean Surgery," to "Why Transparency in Maternity Care Matters."
This is sure to be an eye-opening event and one that is truly crucial to affecting change through the modern maternity machine. The key to accomplishing true change in the system is through widespread public awareness, not only of the shortcomings of the current system, but of simple ways it could be changed for the benefit of mothers and babies.
The full press release is available here.
Sunday, November 16, 2008
A new study published in the November, 2008 issue of Obstetrics and Gynecology, conducted by researchers at the University of California, San Francisco, found that over 130,000 cesareans could be avoided each year by simply waiting an extra two hours for labor to progress normally.
The study focused on the all-too-common "failure to progress" c-section. The study was longitudinal over 1991-2001 and examined outcomes for 1,014 women having their first child at the UCSF.
Current ACOG guidelines state that physicians should wait two hours once an active labor arrest, or a period of time when dilation and effacement have ceased, before moving to a c-section. However, the article states that while this is the standard of care, many physicians currently ignore the guideline and move straight to an avoidable, unnecesarean.
Currently, 1/3 of all c-sections performed each year are for "failure to progress".
The study also highlights the dangers of a primary c-section, which are so often overlooked and were well outlined by the head author:
"Cesarean delivery is associated with significantly increased risk of maternal hemorrhage, requiring a blood transfusion, and postpartum infection," Caughey said. "After a cesarean, women also have a higher risk in future pregnancies of experiencing abnormal placental location, surgical complications, and uterine rupture."
Results of the study also found that women who had c-sections had increased rates of postpartum hemorrhage, chorioamnionitis infections and endomyometritis infections.
However, no significant difference in the health outcomes of the infants was found.
The most refreshing factor about this study is that ultimately, it highlights the dangers of primary and repeat c-sections as well as highlighting the role of physician non-compliance with the outlined standard of care.
Ultimately, the study shows that if physicians follow evidence-based guidelines in their practice, maternal outcomes are improved.
Despite the fact that this is a new study, this is not new information. The two hour wait time was already the standard of care when this study was undertaken. The real issue is getting physicians to respect the evidence and stop rushing to a c-section at the earliest convenience.
I have to wonder what will have to happen before physicians start using evidence-based practice in maternity care.
Despite study after study extolling the pitfalls of procedures such as episiotomy, lithotomy position, EFM, failure to progress c-section, restricted movement and arbitrary time limits on labor, these harmful practices are still standard across much of the US.
Perhaps a punitive approach would work: fine physicians for each non evidence-based procedure: $500 for an episiotomy, $1000 for EFM, $3000 for each unnecesarean.
That, I think, would be an effective approach at gaining adherence to evidence-based medicine and focus on maximizing reimbursement for quality care, not convenience.
Friday, November 14, 2008
Feel free to pass this along and support midwifery across the US. Donations are also tax-deductible.
Dear Friend of the Allied Midwifery Organizations,
MEAC needs our help!
MEAC is the Midwifery Education Accreditation Council. MEAC promotes excellence in midwifery education by supporting and accrediting midwifery schools around the country that prepare midwives for national certification as CPMs. MEAC is doing exciting, groundbreaking, and vital work for our midwifery movement. Just this month, the Milbank Memorial Fund, a non-partisan institute devoted to health policy analysis, issued a new report titled, “Evidence-Based Maternity Care: What It Is and What It Can Achieve”. The report cites data from the landmark study of CPMs published in 2005 and concludes:
The low CPM rates of intervention are benchmarks for what the majority of childbearing women and babies who are in good health might achieve.
MEAC currently accredits eight free-standing institutions and two programs that reside within universities, providing excellent midwifery education for more than 500 matriculating students.
Why does MEAC need our help now?
This year, the U. S. Secretary of Education deferred a decision to extend recognition of MEAC, requesting that MEAC provide evidence of a stronger financial and volunteer base. It is ESSENTIAL that MEAC satisfies the requirements to continue its recognition by the USED. This appeal to you hopes to accomplish two things:
1. Increase the capacity of MEAC’s Reserve Fund to cover one year’s operating budget ($120,000).
2. Demonstrate to the USED that MEAC has a strong base of support that can be called upon to respond swiftly and effectively in a time of need.
Please help us in this one-time capital campaign. We have come so far in the last decade. We can’t let it slip away. Your support is crucial and so much appreciated at this time! Please give generously. Large donations of $500-$1,000 will provide significant support. Smaller donations will help, step-by-step, to achieve this goal. We can do this together- it is an investment in our future!
The Leadership of the Allied Midwifery Organizations
*Donations to MEAC are tax deductible!
Make checks payable to MEAC, POB 984, LaConner, WA 98257,
Sunday, November 9, 2008
This will give you chills...
Disturbing to say the least.
In this same vein, the Primal Health Research Centre, led by Dr. Michel Odent, is exploring the correlations between the 'primal period' (fetal life, perinatal period and year following birth) and health and personality traits in later life.
On their site, PrimalHealthResearch.com they have compiled the Primal Health Research Databank, which includes studies that focus on the primal period of development. It's a wonderful resource for evidence-based information.
Hopefully, the efforts of such organizations as the Environmental Working Group and the Primal Health Research Centre will affect system-wide change for both our environment...and our babies.
Friday, October 24, 2008
The March of Dimes is sponsoring a Petition for Preemies as part of this October's Prematurity Awareness Month.
Prematurity is the leading cause of infant mortality in the US. The petition consists of 4 calls-to-action:
- Increasing federal government support of research and data collection on prematurity, to discover the causes of prematurity, to test prevention methods, to improve outcomes and treatment options for premature infants, and to better understand the factors in premature birth
- Expanding access to quality healthcare and devoting more resources to smoking cessation programs
- Urging hospitals and physicians to voluntarily assess c-sections and inductions before 39 weeks to examine adherence to professional guidelines
- Calling on businesses to support mother and infant health by respecting the March of Dimes' 14 recommendations.
To date, they have acquired 67961 signatures - what number is yours?
Thursday, October 23, 2008
New research shows that antibiotics given during apparent premature labor, without ruptured membranes or detectable infection, provide no benefit and may cause long-term harm to children
Cerebral palsy was present nearly twice as much in children at age 7 whose mothers received erythromycin during spontaneous preterm labor. An increase in risks was also seen with a combination of amoxicillin and clavulanate (co-amoxiclav), although it was lower. Among 1,611 children exposed in utero, 3.3% had cerebral palsy at age 7, compared with 1.7% of children in the control group or those exposed to co-amoxiclav alone.
In addition, the children were also at increased risk of functional impairment, which includes abnormalities such as difficulties with learning, walking, eyesight and other more extensive disabilities. 42.3% of children in the erythromycin group demonstrated some type of functional impairment.
For women with ruptured membranes but no signs of clinical infection, antibiotics neither improved nor increased risks.
The researchers calculated that one child would experience harm for every 64 mothers treated with erythromycin while 1 child would experience harm for every 79 mothers who received co-amoxiclav alone.
In the U.S., guidelines from ACOG recommend a combination of amoxicillin and erythromycin for women with preterm membrane rupture but neither the ACOG nor RCOG guidelines in England address the use of antibiotics for women in preterm labor whose membranes have not ruptured.
In response to the new study, Alison Bedford Russell, M.B.B.S., B.Sc., of Warwick Medical School, and P.J. Steer, M.D., of Imperial College London stated:
"The lessons to be learned seem clear: contrary to popular opinion ('might as well give them, they don't do any harm'), antibiotics are not risk free,".
The moral of the story: interventions should be used with discretion and follow the purpose to which research has shown them to be effective. More isn't always better.
Wednesday, October 22, 2008
A Historic Birth Summit will be held in Chicago on November 8, 2008 at the O'Hare Hilton, in the hometown of the American Medical Association.
This historical summit was called in response to the ACOG/AMA joint proclamation (resolution 205 A-08), which sought to draft model legislation to outlaw homebirth and purported that "the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers".
The summit will bring together birth activists, nurses, physicians, midwives, childbirth educators, doulas, and lactation consultants to will set the evidence-based record straight regarding midwifery care and childbirth in hospital settings in the US.
Despite their strong stand and numerous requests for the reasoning behind their proclamation, the ACOG/AMA could not cite research to support their opinion that hospitals are the safest setting for childbirth, because there is simply no research to support their stance.
At the conclusion of the summit, a joint evidence-based announcement will be made to refute the AMA/ACOG proclamation, highlight its inaccuracies, and the impact that enacting such legislation would have on an expectant mother’s right to choose her caregiver and place of birth.
All I can say is, give 'em hell....
Tuesday, October 21, 2008
A new study from the University of Aberdeen studied the impact that an initial miscarriage can have on a woman's next pregnancy.
Results revealed that a woman is 3.3 times as likely to have preeclampsia and 1.5 times as likely to have a premature baby. Women who previously had a miscarriage were 1.7 times as likely to experience bleeding or other signs of threatened miscarriage and 1.3 times as likely to experience bleeding later than 24 weeks gestation.
In a study of 33,000 women published in the British Journal of Obstetrics and Gynaecology, women who suffered a single miscarriage experienced nearly double the rate of inductions and 6 times as many instrumental deliveries with forceps or vacuum extraction.
Preterm birth after 34 weeks and birthweight less than 2500 grams was 1.6 times as likely.
Professor Philip Steer, BJOG editor-in-chief stated:
"The findings from this research are helpful to healthcare professionals caring for pregnant women.
"They provide us with an idea of the complications that may arise as a result of a previous miscarriage. This will help doctors in the management of the subsequent pregnancy."
One factor not assessed was the span of time between pregnancies, which does not decrease substantially until 1.5-2 years and increases with less than 6 months between pregnancies.
The moral of the story...don't let a care provider dismiss your concerns if you've suffered a past miscarriage. Most women go on to have successful pregnancies, but a past history of miscarriage can increase the risks with subsequent pregnancies.
Monday, October 20, 2008
A new study shows that up to 1/3 of women reported a traumatic childbirth experience, with up to 9% reportedly experiencing Post Traumatic Stress Disorder (PTSD), which can cause women to limit future reproduction, damage their ability to bond with their babies, and leave them permanently psychologically scarred.
Results showed that women who suffered a traumatic birth experience went down two paths regarding breastfeeding: they either embraced it as a way to "prove" themselves as a good mother after a difficult birth and steeling their resolve to breastfeed, or for others, it caused intrusive flashbacks, detachment, and physical pain that ultimately caused them to cease breastfeeding.
The authors concluded that:
...intensive one-on-one support for traumatized mothers may be necessary to help them establish breastfeeding. Sensitivity and awareness by medical professionals of the traumatized mother’s needs may also be helpful.
It was also suggested that healthcare providers be more aware to the signs of a traumatic birth, including temporary amnesia, remaining detached and poor eye contact/a dazed look.
The research study: “Impact of Birth Trauma on Breastfeeding – A Tale of Two Pathways,” appears in the July/August 2008 issue of Nursing Research and was co-authored by Cheryl Tatano Beck, Board of Trustees Distinguished Professor of Nursing and Sue Watson, chairperson of the Trauma and Birth Stress charitable trust.
Sunday, October 19, 2008
High Fat Maternal Diet Linked to Obesity in Babies
In an animal study from the University of Cincinnati and the Medical College of Georgia, researchers found that mice fed high-fat were more likely to have larger-than-average babies, which is a risk factor for being overweight or obese later in life.
They found that a high-fat causes the placenta to go into "overdrive" and sends too many nutrients to the baby developing in utero.
On a positive note, they also theorized that putting women on a high-fat diet may help to reduce the number of low birth weight babies.
In either case, this new research yet again highlights the importance of nutrition during pregnancy and the long-term effects it can have, for better or for worse, on your baby's life. Sadly, most obstetricians pay lip service to providing expectant women with detailed nutritional guidance during their pregnancies. Increased attention to nutrition could be the catalyst to preventing life-long complications for children and subsiding the obesity epidemic in many countries.
Saturday, October 18, 2008
Maternal Morbidity following a Trial of Labor after Cesarean Section vs Elective Repeat Cesarean Delivery: a Systematic Review with Meta-analysis
A new meta-analysis showed that while VBAC carries a greater, although still low risk (1.3%) of uterine rupture/dehiscence than repeat elective cesarean section, the risk is counterbalanced by lowered rates of maternal morbidity, uterine rupture/dehiscence and hysterectomy with successful VBACs.
The research also showed that the majority of women who attempted VBAC were successful (73%).
I have to wonder how much higher that number would be if women had true access to an evidence-based approach to childbirth without unnecessary interventions, and truely supportive providers.
Regardless, the evidence continues to overwhelm with support that VBAC should be a viable option in the majority of cases and that repeat elective cesarean section carries risks greater than or equal to VBAC.
It's time to lay the "once a c-section, always a c-section" myth to rest. Period.
Friday, October 17, 2008
Down Syndrome Screening Causes 2 Miscarriages for Every 3 Cases Detected
New research to be published in the Down's Syndrome Research and Practice Journal found that the miscarriage risk from amniocentesis and chorionic villus sampling (CVS) carried a 1-2% risk of miscarriage of typically developing infants.
The tests are usually only offered to women considered at risk; however due to the wide initial screening threshold, over 95% of women determined to be at risk will go on to have the tests and find that the results are negative.
The mindset behind the screenings is to "help women make informed decisions about their pregnancies". The research also called the skill and experience of those administering the procedures into question.
Before consenting to these or other procedures, ask yourself if knowing about the condition would change your plan of action for the pregnancy. If the answer is no, then consider refusing such screenings.
Many women choose the screenings to give themselves time to mentally and emotionally prepare to care for a child with special needs. However, due to false positives, some families are told their infants will have such conditions only to find that after months on end of worry, their fears were unfounded.
The moral of the story is to make informed decisions. If you know the risks of the screenings outweigh the benefits to your family, then don't hesitate to refuse them. You are your child's first advocate. Parenting begins with the decisions you make in pregnancy.
Choose well, choose wisely.
Saturday, October 11, 2008
I received the query below for an upcoming special on out-of-hospital birth. If you can help or know someone who would be interested in sharing their story, please spread the word:
My name is Zach Marion and I work at Video Arts Studios in Fargo, ND. We produced the series House of Babies for the Discovery Health Network. Under the guidance of master midwife, Sheri Daniels, at the Miami Maternity Center, the show follows couples during their pregnancy and ends with the delivery of their baby. It was very instrumental in raising awareness about non-clinical birthing practices on a national level.
Recently we have been approached to create a one-hour special on unique birthing practices worldwide. We are looking for families that would like to share their story on camera from pregnancy to delivery. Ideal candidates are expecting mothers due in and around early January that are planning to give birth outside of a clinic or birth center. This includes home births and beyond. The point of the show is to raise awareness about the alternative birthing options in the U.S. with the help of a midwife. Hopefully, the special creates a healthy dialogue among midwives, doctors, to-be parents, and the general public. Stories that are of particular interest are those that include interesting traditions during pregnancy and unique backdrops during delivery. For example, a Hindu family that wants to deliver outside or a family of hippies that are pursuing a home birth in a tent.
As you can imagine, access is usually the greatest struggle. Our presence at the birth goes nearly unnoticed. This unobtrusive nature was learned through experience gained while producing 26 episodes of House of Babies.
Do any clients spring to mind that might want to be a part of this project? Any and all contact leads are much appreciated. Feel free to contact me by phone with inquiries or information. I am available during weekdays between 8 and 5 CST. Thank you for your time.
Video Arts Studios
1440 4th Avenue North
Fargo, ND 58102
Saturday, October 4, 2008
Recently, I happened upon a heated discussion (or rant) by a physician [and I do use the term loosely] on the "unfortunate" occurrence of women having a say in their childbirth choices. His post and the comments of fellow physicians crystallize the flaws in our current system and its misogynistic treatment of women.
My response to their litany appears below:
Yes, there is plenty of clinical research going on....but what good is research if OBs don't follow the evidence in their practice.
All of the following procedures/routines have been shown to be at best, unnecessary, and at worst, harmful, to birthing women, yet they are still standard practice for much of the OB community:
- Pushing in Lithotomy position
- Cytotec for Induction or PPH
- Continuous Electronic Fetal Monitoring
- Routine Induction before 42 wks
- Manual Cord Traction
- Early Cord Clamping
- C-section for "Big Babies"
- Late Term Ultrasound for Fetal Weight Estimates
to name a very few. I have to wonder how the physicians above can claim to practice "science based medicine" when standard practice is rife with such non-evidence based procedures.
By even referencing the first example of the woman whose baby was "too big to fit" as a defense of their position that women should just shut-up-and-listen-to-everything-the-big-smart-doctor-says, these medical professionals have proven how fallible they truly are.
There is no evidence to support that suspected fetal macrosomia can reliably be diagnosed without a trial of labor [and one that does not have a woman flat down on her back tethered to an IV with an EFM belt strapped to her abdomen]. Furthermore, there is no evidence to support that weight is a predictor of which babies will fit, as the circumference of the head and shoulders is a more accurate indication than weight alone.
As posted above, the indication would have been shoulder dystocia, which most appropriately could have been resolved with use of the Gaskin maneuver (gasp! an evidence-based procedure from midwife Ina May Gaskin), which could have prevented the baby from being born floppy and requiring resuscitation.
But rather than employ evidence-based medicine, the physician in question had a tantrum about the patient delaying/refusing a [non-evidence based] c-section. He did not attempt to employ any other methods to prevent problems from occuring since he had already [inaccurately] determined a c-section to be the fast, easy and sole solution, the only one acceptable to him. Rather than acknowledging his own errors in judgment, he then blamed the patient for wanting a certain "experience" over a healthy baby.
The plain truth is that her motivations most likely did not arise from any desire for a certain experience, but in a desire to escape non evidence-based interventions.
With evidence-based care, she could have had both a positive experience and a healthy baby.
Contrary to expecting perfection, it is my realization that doctors and specifically to this discussion, OBs, are mere mortals - as human as the next person - which makes me question their recommendations, just as any good consumer would do.
They are just as prone to make decisions based on their own comfort and agenda as the rest of us. There is no higher standard to which they hold themselves, nor should we. They lie to get want they want and to force an outcome in their best interest, which is something all humans are guilty of at one point or another.
It is this realization, that OBs don't always provide care based on the best interests of the patient [because they are fallible humans by nature] nor that their advice is always based on the evidence, whether intentional or not, which makes me question their judgment and motives when providing maternity care.
Women cannot accept their doctor's advice at face value, which is something doctors should acknowledge and accept of them as consumers. In no other arena would people be expected to take what is said as the gospel truth, infallible and without question.
However, physicians are creating a double standard by arguing their humanity while condemning women for questioning their judgment. These two principles are mutually exclusive. One cannot claim infallibility while professing humanity.
To address the issue of litigiousness and liability, I can't help but think physicians have spawned this monster. By perpetuating the use of non evidence-based practices [some of which are proven to cause harm], they create complications that wouldn't have presented otherwise, including failure to progress, fetal distress by aggressive induction, PPH by manual cord traction, and the list goes on.
By asserting that women are not capable of fully understanding and making their own healthcare decisions, they are by extension saying that a doctor's judgment is paramount. Thus, any and all bad outcomes would be the doctor's responsibility, as they are claiming women don't have the ability to make these informed decisions.
In actuality, it is the doctor's responsibility to obtain true informed consent from his patients before any and all procedures by explaining the risks and benefits in a way she can understand. If a woman does not understand her options, it is because the doctor has not done his job.
In either case, the physician is responsible, for either taking the decision out of her hands, ingnoring her decision when it conflicts with his own, or denying true access to informed consent so that an informed decision can be made, even one that is contrary to the physican's determination of "doctor knows best".
Until the system is changed to give the locus of control back to birthing women, we will continue to see this downward spiral in the quality of our maternity care, of excessive infant mortality rates, increasing maternal mortality rates and skyrocketing rates of interventions as standard practice.
For a country that spends in excess of $50 billion per annum on maternity care, more than any other nation in the world, we have pathetic outcomes to show for it.
Thursday, September 4, 2008
Natural Birth May Aid in Infant Bonding
A new study conducted at Yale looked at the differences in maternal responsiveness to a baby's cry between mothers who gave birth naturally and those who chose an elective c-section and found that mothers who gave birth naturally were more responsive to their newborn's cries.
While the study is far too small to drawn any real conclusions, the results may peak more interest into research in the pitfalls of maternal-request cesarean section. Hopefully, some solid evidence will steer women away from making this decision lightly out of fear of labor or just plain old convenience.
While I don't personally agree with maternal request c-section, I still believe it is a valid choice that women should have, just as we should also have the right to homebirth with the provider of our choice.
What I don't believe is that insurance should have to pay for a maternal request c-section with no medical or emotional indications, since it is shown to increase the risks to both mothers and babies.
Unlike homebirth, which has been proven to be both a safe and cost-effective option, elective c-section can boast no such claims. This study is yet another piece of recent evidence that demonstrates the hidden risks of surgical birth.
Wednesday, August 27, 2008
960 Mothers and Babies Exposed to TB in San Francisco Hospital
This story represents yet another reason to consider homebirth.
Hospital-acquired infections kill more Americans each year than car accidents, breast cancer and AIDS combined. They are the 4th largest killer in the US, with 1 in 20 hospital patients, or 2 million people per year, acquiring a hospital infection. ( Source: Journal of Emerging Infectious Diseases, Committee to Reduce Infection Deaths, Centers for Disease Control and Prevention).
Perhaps the most horrifying truth about hospital-acquired infections is their primary cause: lack of handwashing.
It seems unthinkable that physicians wantonly allow the spread of infectious disease by not bothering to wash their hands between patients. Despite all their years of training, all their supposed knowledge on how disease is spread, they cannot be bothered to ensure the safety of their patients by faithfully washing their hands.
Even more concerning is the knowledge that they are not dealing with run-of-the-mill bacteria. Hospitals are breeding grounds for antibiotic-resistant strains and other "superbugs", including 25 strains with no known cure.
Hospital-acquired infection is one of the hidden dangers of hospital birth, as the family of Julie LeMoult tragically realized.
Hopefully, the mothers and babies exposed to TB in San Francisco will fare better, although each and every one of those mothers and babies will have to undergo the stress of bloodwork and potential exposure to antibiotics, as their families worry over their health and well-being.
I do hope the hospital has realized that all the friends, siblings, and families of these mothers and babies were also potentially exposed to active TB, which significantly raises the number of people placed at risk.
All in all, a costly mistake in so many ways.
Cesarean Section Linked to 20% Greater Risk of Type I Diabetes
A new meta-analysis that examined 20 studies with over 1 million infants born vaginally and over 10,000 delivered via c-section found a 20% increase in the incidence of Type I Diabetes in those babies delivered via c-section.
After eliminating confounding factors of gestational age, birth weight, maternal age, birth order, breast-feeding and maternal diabetes, the researchers found that the 20% increase in Type I Diabetes could not be explained by any of these factors.
They theorized that the c-section itself could be to blame:
It is possible that children born by Caesarean section differ from other children with respect to some unknown characteristic which consequently increases their risk of diabetes, but it is also possible that Caesarean section itself is responsible," said author Dr. Chris Cardwell.
The author also stated:
"It's important to stress the reason for this is not understood, although it is possible the Caesarean itself is responsible, perhaps because babies are exposed to bacteria originating from the hospital environment rather than to maternal bacteria."
He offers some sage advice in conclusion:
"Not all women have the choice of whether to have a Caesarean or not, but those who do may wish to take this risk into consideration before choosing to give birth this way."
I have to wonder how prevalent Type I Diabetes will become if the current c-section epidemic isn't remedied. We'll soon have a generation of insulin-dependent mothers who require more high-risk maternity care with increased risk of c-section, having babies with increased risk of developing Type I Diabetes, and so on and so forth.
A scary thought, indeed.
Thursday, July 31, 2008
More Dangers of Cytotec
More evidence is mounting that Cytotec should not be given during pregnancy. The above article references the dangers of administering Cytotec vaginally as part of a medical abortion.
A link was seen between this method of administration and the contraction of dangerous infections.
While the article doesn't reference the off-label use of Cytotec for labor induction, according to the findings reported, women who receive Cytotec vaginally to induce labor may also be at risk of contracting similar infections.
I sincerely hope someone chooses to investigate if such a link also exists in terms of vaginal administration of Cytotec for labor induction.
Despite the fact that both G.D. Searle, the drug's manufacturer, and the FDA issued statements discouraging the practice of using Cytotec off-label for labor induction, its practice is still performed by doctors who choose to make non evidence-based decisions with regard to their patient's care.
In fact, most women who received Cytotec at some point during childbirth (either for induction or to halt post-partum bleeding) have no idea unless they request their medical records.
It's major appeal lies in the fact that it's cheap and readily accessible - two reasons that wouldn't be enough for me to give consent for it.
Sunday, July 27, 2008
Women Benefit from Complementary Therapies During Childbirth
It's so refreshing to see natural methods for assisting childbirth being pursued, and in a hospital no less!
If you haven't checked out the article, two hospitals in Gloucestershire are providing natural therapies for labor support and comfort, including essentials oils, massage, and have actually provided trained staff to implement the program. In addition, these options are presented in pre-natal visits, so women are more aware of their options before labor arrives.
The most encouraging aspect in my mind is summed up nicely in this quote:
Some women say it's just like going to a spa rather than being in a clinical environment."
This statement represents a huge shift in the way most women think about childbirth. Just shifting a woman's perception about childbirth is a very powerful factor in how well her birth experience will progress. Women with negative perceptions about childbirth are already at a higher risk of complications due to the effect that mental and emotional stress can have on labor.
I'll be anxious to read their research once it's published. Hopefully this is a sign of good things to come....
Saturday, June 28, 2008
I'm coming late to the party, but I've definitely arrived. You may have heard about this already, but if not, a huge wave just rippled through the birthing world with the AMA's (American Medical Association) recent resolution to support ACOG and attempt to outlaw homebirth:
Whereas, Twenty-one states currently license midwives to attend home births, all using the certified professional midwife (CPM) credential (CPM or “lay” midwives), not the certified midwives (CM) credential which both the American College of Obstetricians and Gynecologists (ACOG) and American College of Nurse Midwives (ACNM) recognize ; and
Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as “Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film” ; and
Whereas, An apparently uncomplicated pregnancy or delivery can quickly become very complicated in the setting of maternal hemorrhage, shoulder dystocia, eclampsia or other obstetric emergencies, necessitating the need for rigorous standards, appropriate oversight of obstetric providers, and the availability of emergency care, for the health of both the mother and the baby during a delivery; therefore be it
RESOLVED, That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that “the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers” (New HOD Policy); and be it further
RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.” (Directive to Take Action)
Oh yes they did!
While this may seem a ludicrous and asinine attempt (which it indeed is), it was the best move they could have made (for us).
Effectively, ACOG and the AMA just took the issue of homebirth out of the medical realm and shoved it right into a civil rights issue. Namely, the question they've raised is:
Not according to the AMA. Their resolution clearly insinuates that women should not be able to have a choice when it comes to giving birth. Or, more correctly, only a choice pre-approved by the AMA.
This is actually such a positive move for homebirth - their misguided attempts have now thrust this issue in front of many women's rights groups which will now stand up and take notice of the issue. While homebirth may not have been on their agenda, a woman's right to choose anything and everything to do with her own health, safety and bodily integrity certainly is.
And the AMA's resolution is an attack of all those rights. Instead, they'd rather pat us on the head like unruly children and say "there, there, father knows best, he'll take care of you".
Now, homebirth is not for everyone. But the choice, the choice to homebirth, should be available to anyone. Period.
Where does the AMA and ACOG's reign stop if not here? What rights are you willing to relinquish next? The right to see the doctor of your choosing, or only one who belongs to the AMA? The right to decide where and when to see a doctor, or mandatory appointments and procedures, "for your own good"?
If you truly don't see the hidden message here and the slippery slope it is, please open your eyes to the truth. IF our best interest were truly at heart, then the AMA would be committed to supporting the research and banishing the non-evidenced based procedures which reign supreme in obstetric care, including episiotomy, lithotomy position, unchecked labor augmentation, contraindicated drugs for induction, to name a brief few.
The AMA and ACOG have inspired me to make my own resolution:
Whereas, The decree from the AMA and ACOG is an attempt by our patriarchal society to dictate women's actions, rather than acknowledging their capability to make their own healthcare decisions, especially with respect to bodily integrity; and
Whereas, This position is based on feelings, fear, and finances, not facts. There is no scientific evidence to support the AMA and ACOG's stance against homebirth and a wealth of evidence to support that a midwifery model of care is safer and more cost effective than the "active management" currently utilized by physicians in hospitals. Furthermore, all industrialized nations which support a midwifery model of care, including the UK, have better birth outcomes than the US, including lower rates of intervention, infant mortality and are more cost effective than our broken system. In fact, these nations are choosing to expand women's access to homebirth; and
Whereas, As the women who are giving birth, it is our body and our right to choose where to give birth, not to have that choice dictated to us "for our own good"; therefore be it
RESOLVED, That Catherine Beier supports the evidence-based concept that the safest setting for labor, delivery, and the immediate post-partum period is in the home for low-risk women with a skilled birth attendant present; and be it further
RESOLVED, That Catherine Beier is committed to upholding a woman's right and autonomy to make her own healthcare decisions, whatever they may be; and be it further
RESOLVED, That Catherine Beier, her daughters, and her daughter's daughters will give birth in the home so long as they be low-risk, be it legal or otherwise. (Directive to Take Action)
If you want to retain your right to make decisions about your own healthcare and bodily integrity, then show your support of women's rights by signing the Keep Homebirth Legal petition.
My signature is #291. What number is yours?
Monday, May 19, 2008
In order to support the wonderful work of doulas, I'd like to dedicate a portion of the site to meeting the professional challenges facing doulas today....a resource library of sorts to make every doula's professional life a little easier.
So, I'd like to start a dialogue on the greatest challenges facing doulas today. Is it a lack of professional respect? A misunderstanding of the profession? Do you find that many of your families lack basic childbirth education information and that your home visits must also include a crash course in Childbirth 101?
Are there any resources you need to help you build your practice, such as:
- Sample Contracts
- Sliding Scale Fee Schedules/Waiver Forms
- Family Handouts (& on what topics)
- Marketing Materials
- Introduction Packets for Physician's Offices, Hospitals, Etc
- Tools & Techniques Cheat Sheets
- Menu Planning Guides
- Website Templates
or does anything else come to mind?
I'd love to be able to meet some of these needs...but in order to do so, I must know what your needs are!
So, don't hesitate to comment or send me an email~ any and all feedback is most welcome. I'll do what I can to support each doula in her work and start tackling these wishes as they come in.
Friday, May 9, 2008
While I typically hold Dr. Michel Odent, called the father of waterbirth, in high esteem, this time he's fallen off the deep end of the birthing pool...
In an article featured here, Dr. Odent makes the case to remove all fathers from accompanying birthing women. He states that many fathers hinder their partner's birth experience, causing undue stress and labor dysfunction.
I do agree with him on this point, but this is where we part ways. His solution would be to ban all fathers from the birth a blanket "solution" that would treat a symptom, but not cure the actual disease.
Ultimately, he's missing the why factor.
And the answer is fear. Again, we return to a culture of fear and lack of education surrounding birth in general, not just natural childbirth. It is this lack of understanding of the birth process that prevents men from seeing childbirth for what it is. It's not that they aren't capable of supporting their women, they just don't know how.
A statement that truly offends me is:
"But having been involved in childbirth for 50 years, and having been in charge of 15,000 births, I have reached the stage where I feel it is time to state what I - and many midwives and fellow obstetricians - privately consider the obvious."
You, my dear Dr. Odent, should never consider yourself to have been "in charge" of these births. That power lies with the birthing mother and she alone.
I must say how disappointed I am to see such a patriarchal view of childbirth coming from him. I thought he would [should] know better. I also find it ironic that Dr. Odent recommends that women be present to support each other, naming an aunt, mother, etc. What he fails to realize is that the majority of these women will hold such fears about childbirth as well.
They too have been immersed in this culture of fear and have little idea of how to effectively support a laboring mother, despite the fact that many are mothers themselves.
Now, I do agree that it is obvious that many men hinder rather than help at the birth. They exude anxiety and have this stress etched in the lines on their faces. But my solutions would be to provide men with the needed tools and education to support their women, not ban them from the process.
I firmly believe that the person with the most power, for good or ill, during a woman's birth is a loved one, usually the baby's father.
I'll never forget the look on my own husband's face as he caught our second daughter. His only request for future births is that he be able to catch them all.
To think of denying him his place at our children's births is unbelievably callous. It would never happen in our family. My greatest fear at our oldest daughter's birth was that he wouldn't make it in time. That was the only thing that caused me any stress during her birth - how crushed he would be were he to miss it. He did make it - winded from running and gasping for breath - but he did make it.
I think the other warning that we can take from Dr. Odent's statements is the reminder that care providers often make decisions perceived to be in our best interest.
Truly, I believe that Dr. Odent is well-intentioned in his beliefs - he wants to promote calm, effective births for women.
In contract, my answer to this challenge would be to provide the necessary education and skills to empower both men and women to embrace the childbirth process. Now, this doesn't mean calling men "coaches" (a term I truly detest when it come to birth - men will never carry the expertise from experience needed to truly be a "coach")
His would be to further remove ownership of childbirth from families and deliver it into the hands of others.
But I have to wonder, isn't that what led childbirth to its current state?
A slippery slope indeed...
Tuesday, April 15, 2008
A recent hospital snafu chalks up two more reasons to promote homebirth and avoid routine infant circumcision.
In Marion, IL, two newborn boys were switched at birth. One was sent home with the wrong family, who received a call later that day to come turn in the errant child and claim their own son.
You would think that in this day and age of technological gadgets that go "ping" and the supposedly fool-proof safety measures in hospitals that this would be an impossibility.
However, the evidence shows otherwise.
The incident occurred after both boys were sent for circumcision. Their identification was removed for the surgery and then mistakenly replaced on the wrong child.
These errors make a strong case for homebirth: neither procedure, the mix up nor the circumcision, would have occurred were the children born at home.
Eventually the US will catch up and realize that homebirth is safe and routine circumcision is harmful, not the reverse.
The full article is available here.
Sunday, March 30, 2008
Kathryn Mora, a documentary filmmaker, recently contacted me regarding a project she is currently filming on natural childbirth. These are exciting times in the birthing world. The sudden influx of mainstream media coverage on natural childbirth and the benefits of evidence-based maternity care are increasing public awareness of the failings of our current system.
A synopsis of her project, as well as a request, is detailed below:
77 Brown Street Apt 1
Waltham, MA 02453
IMAGES AND FOOTAGE NEEDED FOR DOCUMENTARY FILM ABOUT CHILDBIRTH
I am journalist and a new filmmaker making a documentary film about how doctors, hospitals, drug and insurance companies have turned the natural event of childbirth into a hi-tech, money making BIG business for their own personal and financial gain with little regard for the well-being of women and their babies.
I would greatly appreciate any still images and footage of the following:
1. a full-term pregnant woman
2, a mother and her baby breast feeding alone and with family
3. a labor and birth at home
4. a labor and birth at the hospital, with and without drugs.
77 Brown Street Apt 1
Waltham, MA 02453
A feature article entitled, "CESAREAN NATIONS", about VBACS written for Metroland newspaper in Albany, New York, June 6, 2002 at www.metroland.net (located under back issues). This article deals with how hospitals stopped allowing women to give birth vaginally after they had a cesarean.
If anyone can aid her with this project, please use her contact information above to reach her. Remember, every little ripple we create can lead to big waves in the tide of our maternity care system. You never know how much your contribution can help unless you make it.
Monday, March 24, 2008
One of the commonly documented reasons for cesarean section is for suspected macrosomia, or the "big baby" syndrome.
Yet another study has been published which highlights the chasm between research and practice in modern maternity care:
Sadeh-Mestechkin D, Walfisch A, Shachar R, Shoham-Vardi I, Vardi H, Hallak M. Suspected macrosomia? Better not tell. Arch Gynecol Obstet. 2008 Feb 26; [Epub ahead of print] PMID: 18299867
OBJECTIVE: To evaluate the management policy of delivery in a suspected macrosomic fetus and to describe the outcome of this policy.
STUDY DESIGN: For this prospective observational study we followed the management by reviewing the medical records of 145 women and their infants. The study population included women at term admitted to the obstetrics department with suspected macrosomic infants, as was diagnosed by an obstetrician and/or by fetal sonographic weight estimation of >/=4,000 g. The comparison group (n = 5,943) consisted of all women who gave birth during the data collection period.
RESULTS: Induction of labor and cesarean delivery rates in the macrosomic pregnancies (actual birth weight >4,000 g) of the study group were significantly higher when compared with the macrosomic pregnancies of the comparison group. When comparing the non-macrosomic to the macrosomic pregnancies (actual birth weight >4,000 g) of the study group no significant difference was demonstrated regarding maternal or infant complications. The sensitivity, specificity and positive predictive value of the methods used for detecting macrosomia were 21.6, 98.6 and 43.5%, respectively.
CONCLUSION: Our ability to predict macrosomia is poor. Our management policy of suspected macrosomic pregnancies raises induction of labor and cesarean delivery rates without improving maternal or fetal outcome.
Notice the conclusion: induction and/or cesarean section for suspected fetal macrosomia, or "big babies" does not improve outcomes. This is yet more evidence of a fact already established. Despite the research, late term ultrasounds to check fetal weight are becoming a routine part of modern prenatal care. However, this routine practice carries no benefit and definite drawbacks for both you and your baby.
This means that for the vast majority of mothers told they require an induction or c-section for suspected cephalopelvic disproportion (CPD), or even told that "some women just aren't made for childbirth".
So,the real question comes down to how to avoid falling down the slippery slope from "you're measuring larger than average" to "your baby is huge, you need an induction/c-section (and often both as induction increases the risk of c-section fourfold).
Choose your provider well. Ask the tough questions. Nail down the percentage of primary c-section, inductions, episiotomy, etc. Don't take vague estimates for answers.
Avoid late term ultrasounds. They can be off by as much as two pounds in either direction and provide little to no true information on whether your baby will actually fit. The only way to know is to labor first.
Avoid continuous fetal monitoring. This will limit your movement which is a contributing factor to failure to progress c-sections (another red herring) by restricting your ability to let the baby navigate down the pelvis and use gravity's help.
Refuse to have your membranes ruptured. This can contribute to fetal malpositioning that can inhibit the baby from properly navigating below the pelvic bone and presenting the smallest head circumference. This becomes especially important if the baby truly is on the larger side of average.
Give birth at home. None of the non evidence-based procedures and interventions are used in homebirths. Anxiety and stress levels are also lower in a place where you feel safe and secure. This is rarely a place swamped with ill strangers, smelling of antiseptic and surrounded by machines that go "ping".
Friday, March 21, 2008
California has had a rash of troubled times in the childbirth arena as of late. The California State Department of Public Health assessed the following hospitals administrative penalties for potentially life-threatening violations that occurred in 2007:
Cedars-Sinai Medical Center (Los Angeles): $25,000
Enloe Medical Center (Chico): $25,000
Kern Medical center (Bakersfield): $25,000
Kindred Hospital Modesto (Modesto): $75,000 (3 violations)
Natividad Medical Center (Salinas): $25,000
Scripps Memorial Hospital (La Jolla, San Diego County): $25,000
Sierra Vista Hospital (Sacramento): $25,000
Universal Health Services of Rancho Springs (Murietta, Riverside County): $25,000
UC San Francisco Medical Center (San Francisco): $25,000
ValleyCare Medical Center (Pleasanton): $25,000
Washington Hospital (Fremont): $25,000
This is the second time California has fined hospitals as part of a law that went into effect Jan. 1, 2007. The law allows the state to assess penalties against hospitals in cases of "immediate jeopardy," or for violations likely to cause death or serious injury.
Besides all being located in California, another thread links these hospital fines together: in each case, the hospitals were cited for medication errors. In several cases, the patients in question died.
This is yet another reason to consider a homebirth. Tired, overworked staff put you at risk of medical mistakes. When you choose the hospital ticket, you get the hospital ride, including the increased risk of interventions and medical errors.
Do errors happen in homebirths? Yes, of course. To insinuate otherwise would be ridiculous.
However, no IV or epidural access at a homebirth protects you from these types of risks which are rampant in hospitals.
It is possible to limit your risks of medication errors in a hospital by refusing an IV. Be warned, though, that most care providers are not supportive of this. The majority will push for a heplock or saline lock at minimum, for no other reason than liability. In this age of CYA medicine due to an increasingly litigious society, I can almost sympathize with them.
But only almost. When you consider that the lack of evidence-based care is the precipitating factor to the majority of childbirth complications, they've truly made their own bed.
Unfortunately, they expect pregnant women to lie in it - flat on their backs, of course.
It is refreshing to see that ACOG can make some improvements in judgment, albeit small ones. While they still won't take a stance for or against it, their revised opinion on the scam that is private cord blood banking is a small nudge in the right direction.
I especially like the statement, "ACOG also advises physicians who recruit patients for for-profit cord blood banking to disclose their financial interests or other potential conflicts of interest to pregnant women and their families."
It's nice to see that ACOG has some interest in letting families know when they're being solicited for personal physician profit. The majority of mothers accept their OB's advice as research-based fact (in their defense, they should be able to depend on the information they receive as accurate and unbiased - sadly, this isn't the case). When their OB recommends cord blood banking to them as the responsible decision, they shell out thousands of dollars firmly believing their actions are in the best interest of their child. They have no idea that the doctor's recommendation may be colored with personal incentive to make a profit.
What is most upsetting to me is that the chances of the cord blood being usable to treat an illness is so unlikely. Again, their statement reveals, "there is no reliable estimate of a child's likelihood of actually using his or her own saved cord blood later. Some experts estimate this likelihood at 1 in 2,700, while others argue the rate is even lower. Physicians should also disclose to their patients that it is unknown how long cord blood can successfully be stored."
The chances are very slim that the child could benefit from their cord blood or that it would even be viable when needed.
The true kicker is that, "Pregnant women should be aware that stem cells from cord blood cannot currently be used to treat inborn errors of metabolism or other genetic diseases in the same individual from which they were collected because the cord blood would have the same genetic mutation."
One of the most-cited arguments I hear from mothers for private cord blood banking is that, "if my child got leukemia, the stem cells could cure him/her." This is a straw man argument. It's based on a fundamental lack of information that gives families of children with life-threatening diseases false hope.
That, in my opinion, is morally reprehensible. The odds are better that a donor's cord blood stem cells could treat the disease. However, the idea of donating my cord blood to a public bank, where it could be used for purposes to which I am ethically and morally opposed, is enough to stop me from considering it. Again, the other caveats of usability and viability are also present.
**Sigh** With more technology comes more responsibility for the ethical and moral implications. Some days, it's exhausting to contemplate....
Sunday, February 17, 2008
I feel it's time for a little inspiration in the world of childbirth. It can be so easy to get discouraged as we must fight to bring the evidence to light against the noise of modern maternity care and the not-so-helpful advice of friends and family when we tell them we're planning a natural birth.
So, here's a dose of inspiration to let you know you are not alone. There are others, many others, who have gone before you and embrace natural birth for the calm, peaceful, empowering event that it is.
"Attending births is like growing roses. You have to marvel at the ones that just open up and bloom at the first kiss of the sun but you wouldn't dream of pulling open the petals of the tightly closed buds and forcing them to blossom to your time line." Gloria Lemay
"Midwives see birth as a miracle and only mess with it if there's a problem; doctors see birth as a problem and if they don't mess with it, it's a miracle!" Barbara Harper in Gentle Birth Choices
"Every [hospital] intervention is a lesson in who really owns your body and your baby's body." Jock Doubleday
"There is power that comes to women when they give birth. They don't ask for it, it simply invades them. Accumulates like clouds on the horizon and passes through, carrying the child with it." Sheryl Feldman
"Many Western doctors hold the belief that we can improve everything, even natural childbirth in a healthy woman. This philosophy is the philosophy of people who think it deplorable that they were not consulted at the creation of Eve, because they would have done a better job." Kloosterman 1994
"Treating normal labors as though they were complicated can become a self-fulfilling prophecy." Rooks
"Hope has two beautiful daughters. Their names are anger and courage; anger at the way things are, and courage to see that they do not remain the way they are." Augustine
"The truth for women living in a modern world is that they must take increasing responsibility for the skills they bring into birth if they want their birth to be natural. Making choices of where and with whom to birth is not the same as bringing knowledge and skills into your birth regardless of where and with whom you birth." Common Knowledge Trust
"You are constructing your own reality with the choices you make...or don't make. If you really want a healthy pregnancy and joyful birth, and you truly understand that you are the one in control, then you must examine what you have or haven't done so far to create the outcome you want." Kim Wildner-Mother's Intention: How Belief Shapes Birth
"If a doula were a drug, it would be unethical not to use it." John H. Kennell, MD
"Unfortunately, the role of obstetrics has never been to help women give birth. There is a big difference between the medical discipline we call "obstetrics' and something completely different, the art of midwifery. If we want to find safe alternatives to obstetrics, we must rediscover midwifery. To rediscover midwifery is the same as giving back childbirth to women. And imagine the future if surgical teams were at the service of the midwives and the women instead of controlling them." Michel Odent, MD
"The best way to avoid a cesarean is to stay out of the hospital." Brooke Sanders Purves
"There is no scientific evidence that doing over 10 percent of births with a cesarean improves the outcome for the woman or improves the outcome for the baby." Dr. Marsden Wagner
"Mothers need to know that their care and their choices won't be compromised by birth politics." Jennifer Rosenberg
"Only about 15% of medical interventions are supported by solid scientific evidence...This is partly because only 1% of the studies in medical journals are scientifically sound and partly because many treatments have not been assessed at all." Richard Smith, editor of the British Medical Journal
"Reluctant doctors like to believe that they haven't much influence over their patients, but that is clearly not the case. Several studies have found that when doctors genuinely encouraged women to have VBACs, most of them did, and when they said nothing or acted neutral, most women didn't. Finally, when obstetricians discouraged VBAC in women who wanted to try it, none of them did." Henci Goer, Thinking Woman's Guide to a Better Birth
"This whole situation [hospitals denying women the right to VBAC] is the result of the American College of OBGYN’s in 1999 changing their guidelines for VBAC in response to medical/legal concerns to require that a physician be immediately available during an entire VBAC labour. This has been interpreted by hospitals, especially those in the more rural areas, to require around the clock emergency cesarean capabilities. Now there are complications that can arise in any labour, even if there is no VBAC issue. So if a hospital isn’t safe enough for a mother to have a VBAC in, it’s not safe for her to have her baby in period. I understand that it is a risk/benefit analysis for the physicians in the hospitals and it’s all coming back to the bottom line, and that’s unconscionable." Tonya Jamois, president of ICAN, during an interview on Today, November 30, 2004
"Women's strongest feelings [in terms of their birthings], positive and negative, focus on the way they were treated by their caregivers." Annie Kennedy & Penny Simkin
"A study of interactions between women and obstetricians offers an explanation. It described three levels of increasing power imbalance: In the first, you fight and lose; in the second you don't fight because you know you can't win. However, in the highest level of power differential, your preferences are so manipulated that you act against your own interests, but you are content. Elective repeat cesarean exemplifies that highest level." Henci Goer, Thinking Woman's Guide to a Better Birth
"Having a highly trained obstetrical surgeon attend a normal birth is analogous to having a pediatric surgeon babysit a healthy 2-year-old." M. Wagner
"When you have come to the edge of all the light you know and are about to step off into the darkness of the unknown, faith is knowing that one of two things will happen: there will be something solid to stand on or you will be taught how to fly." Patrick Overter
Saturday, February 9, 2008
The birthing world is buzzing with the aftershocks of ACOG's reiterated statement opposing homebirth.
Some of the responses are detailed below:
ICAN's public condemnation of ACOG and AABC
The Big Push for Midwives doesn't mince words in their response
Jennifer Block, author of Pushed, responds to ACOG's celebrity cause assertions.
If you have any choice comments for ACOG, let them hear it!
Contact ACOG at:
ACOG Office of Communications
Cold. Palpable. Irrational.
It's the stuff that little girls are raised on when it comes to childbirth. All the media images, all the horror stories, all their first experiences lead to one end.
The first question it brings to my mind is, "Why? Why do we as a culture embrace that childbirth must be a scary, frightening event that we are lucky to survive?".
In my reality, this perception couldn't be further from the truth. Childbirth, even natural childbirth, can be a peaceful, gentle, safe and empowering event. I have experienced it twice myself and know countless other mothers who can attest to the same fact. Sadly, in this country, we are now in the minority. But was it always this way? Were women always conditioned to fear birth?
No. The change occurred as women lost their culture of birthing, as the tradition of women caring for women and supporting each other through birth began to diminish, so did their confidence and trust in birth. As birth moved into hospitals, the wisdom of women was lost. The culture of confidence and midwifery care was lost to fear and medical management of birth as a disease - one to be treated and feared rather than welcomed and trusted.
As the fear continues to spiral unchecked, for many women, this irrational phobia has now led to an increase in maternal request c-sections. Women once deemed "too posh to push" are actually "scared witless" - they have become so conditioned to fear birth that to escape it they select a major abdominal surgery, oblivious of the risks, six weeks of recovery, and ramifications on their future fertility, all hoping to evade their fear of childbirth.
The following is a recent study that examines the role of maternal fear in elective c-section requests:
I Wiklund, G Edman, E-L Ryding, E Andolf (2008) Expectation and experiences of childbirth in primiparae with caesarean section BJOG: An International Journal of Obstetrics and Gynaecology 115 (3), 324–331.
The aim of this study was to examine the expectations and experiences in women undergoing a caesarean section on maternal request and compare these with women undergoing caesarean section with breech presentation as the indication and women who intended to have vaginal delivery acting as a control group. A second aim was to study whether assisted delivery and emergency caesarean section in the control group affected the birth experience.
A prospective group-comparison cohort study.
Danderyd Hospital, Stockholm, Sweden.
First-time mothers (n = 496) were recruited to the study in week 37–39 of gestation and follow up was carried out 3 months after delivery. Comparisons were made between ‘caesarean section on maternal request’, ‘caesarean section due to breech presentation’ and ‘controls planning a vaginal delivery’.
The instrument used was the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ).
Main outcome measures
Expectations prior to delivery and experiences at 3 months after birth.
Mothers requesting a caesarean section had more negative expectations of a vaginal delivery (P < 0.001) and 43.4% in this group showed a clinically significant fear of delivery. Mothers in the two groups expecting a vaginal delivery, but having an emergency caesarean section or an assisted vaginal delivery had more negative experiences of childbirth (P < 0.001).
Women requesting caesarean section did not always suffer from clinically significant fear of childbirth. The finding that women subjected to complicated deliveries had a negative birth experience emphasises the importance of postnatal support.
43.4% of women requesting c-sections were fearful of birth. The conclusions also showed that a previous negative birth experience from overly medically-managed birth also contributed to their later fears.
We reap what we sow and fear's being sown in spades. It's everywhere, from the mother next door who tells you her birth horror experience to "A Birth Story" on television, to mainstream media coverage and even your friendly neigbourhood OB who tells you "the baby will die if you want a VBAC".
When, oh when, will we start supporting women in birth rather than feeding the fear?
Friday, February 8, 2008
As the US cesarean section rate in 2006 climbed to a dreadful 31.1%, more media attention is being drawn to this ever-increasing epidemic.
One cause for this number is the ban that many hospitals have on VBAC, touting it as an unsafe practice. In most cases, the "once a c-section, always a c-section" mantra becomes the only option a mother has.
However, a new research study again shows the safety of VBAC vs. repeat elective cesarean section. In fact, it shows that multiple VBACs carry less risk of complication than multiple cesarean sections.
Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Brian M. Mercer, Sharon Gilbert, Mark B. Landon, Catherine Y. Spong, Kenneth J. Leveno, Dwight J. Rouse, Michael W. Varner, Atef H. Moawad, Hyagriv N. Simhan, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan Peaceman, Mary J. O'Sullivan, Baha M. Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, for the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network
Obstet Gynecol 2008 111: 285-291.
OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.
METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery.
RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52%(P=.03)0.52%(P=.03)
CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.
In contrast, this study demonstrates the increased risks that accompany repeat cesarean sections:
Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries. Robert M. Silver, Mark B. Landon, Dwight J. Rouse, Kenneth J. Leveno, Catherine Y. Spong, Elizabeth A. Thom, Atef H. Moawad, Steve N. Caritis, Margaret Harper, Ronald J. Wapner, Yoram Sorokin, Menachem Miodovnik, Marshall Carpenter, Alan M. Peaceman, Mary J. O’Sullivan, Baha Sibai, Oded Langer, John M. Thorp, Susan M. Ramin, Brian M. Mercer, for the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network. Obstet Gynecol 2006 107: 1226-1232.
OBJECTIVE: To estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.
METHODS: Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002).
RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission,
hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay *significantly increased * with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more
cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.
CONCLUSION: Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.
One of the most telling statements is in the conclusion of the second study: repeat cesarean section affects your future reproduction. This means that if you are planning a large family, cesarean sections may make this impossible and limit the number of children you can carry.
I wonder what would happen to the primary c-section rate if true informed consent became the standard of care. I'm afraid we'll never know...
Apparently, the American College of Obstetrics and Gynecology (ACOG) has taken notice of the rise in consumer awareness of the shortcomings of maternity care in the US (and other countries). As more and more documentaries, such as The Business of Being Born, Pregnant in America, and What Babies Want are being released, hopefully the birth pendulum will swing toward evidence-based care.
Or at least, that's what ACOG is afraid will happen...hence the sudden release of their reiterated position statement on homebirths:
Below is the text of their statement which can be read here with my comments appearing in red.
((rolls up sleeves)) Ready? Here we go...
Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. [Of course they oppose it. If they supported homebirth, it would mean admitting their own shortcomings and handing over business to the competition. It would be a poor business decision. ACOG supporting homebirth would be akin to Walmart telling consumers that Target is better and to take their business there. In short, never going to happen.] While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies. [Women who choose homebirth with a midwife are monitored more closely than those in a hospital. Fetal monitoring is available and used with homebirths attended by midwives. In addition, in a homebirth, there is one midwife caring for 1 woman. The mother is not left to the "care" of 1 nurse assigned to multiple women who will "monitor" her via EFM strip from the nurse's station. The midwife will observe all physical and emotional markers for signs of complication. In a hospital setting, the OB will typically not arrive until close to pushing time. In terms of continuous fetal monitoring, there is no research to support that it improves outcomes. ACOG needs to remember their own statements from the 2005 ACOG practice bulletin: Intrapartum fetal heart rate monitoring. Obstetrics and Gynecology, 106(6), 1453-1460 where continuous fetal monitoring is not recommended as it does not improve outcomes. ]
ACOG acknowledges a woman's right to make informed decisions regarding her delivery [but do they stress physician accountability for providing evidence-based information on both sides of the issues?] and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).
Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. [So, you're saying the Amish are trendy? They homebirth exclusively - it isn't practical to go to the hospital in the horse and buggy - but that must be another trend, right?] Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. [Especially true when the mother is tied down by monitors, jacked full of pitocin, strapped to a bed, denied food or drink, fingers and tools shoved repeatedly into her vagina, pushing flat on her back, poked with needles, exposed to bacteria, pumped full of drugs with her anxiety level through the roof.] Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. [A midwife providing constant care is better able to detect the first signs of a uterine rupture than a harried nurse watching a monitor strip.] Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk. [And hospitals carry no risks, is that right? Funny, I hadn't noticed MRSA in my house or the other 25 strains of virus that are resistant to all known antibiotics. Where can they be found? In hospitals (where sick people go).]
Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it [and what actions are you taking to suppress it? encouraging hospitals to ban VBAC?], but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. [Check with the WHO (World Health Organization) on that one - their research supports a c-section rate of 10-15% as acceptable.] In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. [Fat lot of good that did - rates continue to climb.] Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes. [Why are maternal choice primary c-section rates increasing? Because of fear - irrational, irrefutable fear. You know what I'm talking about...it's the stuff you're so good at spreading...since you won't provide evidence-based care, then you'll scare women into thinking they can't birth without you. Unfortunately, it works.]
The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital [although 75 years of homebirth research don't support this statement], or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers. [So basically, only in the places where your power reigns supreme... what a surprise!]
It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. [See BMJ study 2005. When you don't like the evidence, you instead choose to ignore it. Nice.] Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child. [Hence, why a woman transfers to a hospital - if and only when complications arise.]
ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. [Which can be achieved in either setting, but is assured in neither. However, the research supports that 93-95% of births are uncomplicated and low-risk. ] Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. [((censored)) Citation, please? Again, show me the studies that hold hospital birth safer than homebirth.] For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center. [So you don't lose your power over birthing women because if they realized that OBs are not the only option, you'd be losing their business and their money...]
# # #
The American College of Obstetricians and Gynecologists is the national medical organization representing over 52,000 members who provide health care for women.
Hmmmm...let's talk about that. What is ACOG? To answer this question, let's turn to Dr. Marsden Wagner, a leader in the fight for evidence-based maternity care:
To understand the absolute monopoly ACOG has established in American maternity care, it is helpful to look more closely at this organization. The American College of Obstetricians and Gynecologists is not a "college" in the usual sense: it is not an institution of higher learning. Nor is it a scientific body. With few exceptions, its members and leaders are not scientists but medical practitioners, and there is nothing in ACOG's mission statement about science. The ultimate proof that ACOG is not a scientific body? Too many of its policies and recommendations are not based on real science. . . .
In truth, ACOG is a "professional organization," which amounts to a trade union. Like every trade union, ACOG has two goals--to promote the interests of its members and to promote a better product, in this case, the well-being of women. But if there is a conflict between these two goals, the interests of its members come first. . . .
American maternity care, then, is under the control of tribal obstetrics. A small group, most of them men, are controlling birth in such a way as to preserve their own power and wealth while robbing women and families of control over one of the most important events in their lives. . . .
Power without wisdom is tyranny. There are plenty of intelligent obstetricians who have lots of knowledge, but intelligence and knowledge do not guarantee wisdom. I have known wise individual American obstetricians, but I see no evidence of wisdom in organized obstetrics in the United States. The maternity care we have in what we like to believe is our free country is obstetric tyranny.
Excerpted from Born in the USA by Dr. Marsden Wagner.
In short, ACOG is a business, plain and simple. And why do businesses exist? To make money. Period. If quality of care and maternal and infant safety were truly their chief concerns, it would be reflected in their policy, practice and procedures. Until then, the only consumers they're serving are themselves.