Sunday, November 30, 2008

How Different They Are...

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..."

Ummm, did I read that correctly?

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

Mother-Friendly Childbirth Forum to Gather in San Diego

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

The Pitfalls of Impatience

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

The MEAC Needs Your Help

Feel free to pass this along and support midwifery across the US. Donations are also tax-deductible.

October 2008

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!

Sincerely Yours,

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

Ten Americans

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, 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.

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