Sunday, March 30, 2008

New Documentary On Natural Childbirth

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:

Kathryn Mora
77 Brown Street Apt 1
Waltham, MA 02453
518-867-7100 cell


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.

Kathryn Mora
77 Brown Street Apt 1
Waltham, MA 02453
518-867-7100 cell

A feature article entitled, "CESAREAN NATIONS", about VBACS written for Metroland newspaper in Albany, New York, June 6, 2002 at (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

Fetal Macrosomia and the "Big Baby" Cesarean Section

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).

Step 1

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.

Step 2

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.

Step 3

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.

Step 4

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.

Step 5

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

Troubled Birthing Times in California

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.

ACOG Revises Opinion on Cord Blood Banking

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....

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