Sunday, February 17, 2008

Inspirational Birth Quotes

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

Responses to ACOG's Statement on Homebirth

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

Feeding the Fear....


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

Speaking of Cesarean Section Rates...

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). The risk of uterine dehiscence and complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.

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...

ACOG's Position Statement on Homebirth

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...

ACOG Statement on Home Births

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'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.

Welcome to's Blog!

I've decided to expand to include a dedicated blog. I intend to use this blog as a vehicle for reporting the latest news and research in the field of childbirth and maternity care.

There has been a rash of new developments lately as public awareness of the sad state of modern obstetrics has received more mainstream media coverage and more legislation is being proposed to support midwifery services.

Check back often for updates or subscribe to my feed for up-to-the-minute posts.

Happy Birthing!

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