4 Years, 1 Month, and 17 days...

After 4 years, 1 month and 17 days of trying, I'm thrilled to announce that I'm expecting our third child in March. We are, of course, planning a midwife-assisted homebirth.

So, why did I wait so long to share the news?


Well, at first I didn't know I was pregnant. I'd had pneumonia the entire month of June, preceded by the flu, so the last thing I was expecting after all this time was a positive pregnancy test. I also have extremely irregular cycles, ranging from 25-62 days, so I literally can never count on when I'm officially "late" from month to month. And after many, many negative tests in the past, I avoid testing all all cost unless I truly think that I could indeed be pregnant.


I also wanted to be cautiously optimistic until I was certain that things were developing normally. I didn't want to share the news, only to have to un-share at a later date. We've always been late sharers - not until about 12-14 weeks with both of our other children.


This is also why we also didn't tell our children until about 8 weeks, when my morning sickness became too severe to write off as the flu.


For those who are interested, here's a short recap of the past 4 months:

Wake Up
~ An Hour Later ~
Vomit
~ An Hour Later ~
Vomit
~ An Hour Later ~
Vomit
~ An Hour Later ~
Vomit

...you get the picture.


The first 3 months were a nonstop blur of vomiting, broken capillaries in my face and constant nausea when I wasn't vomiting. It made me very thankful that my other children are older so that it didn't scare them and I was still able to care for them. My husband was the greatest help, taking over meals, handling most of the housework, etc so that I could take care of myself.


I've rarely been sick in all the years we've been married, so this was quite a new experience for us. I couldn't have gotten through it so smoothly without him.


Despite this rough start, I'm still thrilled to be expecting and it has been worth every moment with my head in a bucket to date. It just gets better from here on out and I'm continually excited for each new development that transpires.

Things that Are Different from My Previous Pregnancies

I thought it might be useful to compare and contrast my previous pregnancies, so here's a run-down of the most significant differences to date.

• Severe Morning Sickness
• I was not sick a day with my first and only had mild morning sickness with my second. This time around, I wasn't able to keep much of anything down for the first 12 weeks and even passed out on occasion (not a great experience). It started to ease off after about 13 weeks and now it's down to daily nausea, but no vomiting. I still have to be careful about what I eat, drink and smell, but it's completely manageable at this point.
• Fainting
• I never came close to passing out before, and was utterly shocked to wake up on the floor when it happened.
• Braxton-Hicks
• While I typically start to experience Braxton-Hicks around 16 weeks, this time they were noticeable starting at 14 weeks.
• Fetal Movement
• With my first, I felt fetal movement around 14 weeks and by 17 weeks, my husband could watch her moving inside my abdomen. With my second, I had an anterior placenta, so although I felt fetal movement around the same time, they didn't increase in strength until about 17 weeks, and weren't visible until around 18 weeks.
  
  This time, I first felt fetal movement around 13.5 weeks, but at this time it's still mainly little pokes and prods. I did start feeling more whole-body type movements just yesterday. This makes me suspect another anterior placenta.

Progress Toward Homebirth

The first challenge we faced was finding a midwife. We live in an extremely rural area where there are few options for OBs, let alone midwives. Due to my history of extremely rapid labors, distance was also a factor in selecting a midwife who actually has a chance of reaching us in time.


The first midwife I contacted was unable to accept due to a scheduled vacation right when I was due, with clients both before and after. I know how difficult it can be to get away and completely understand that you can't be everything to everyone all the time; sometimes, you have to say no.


Thus, I was down to a single option - if she couldn't take me, then I would have to search for an underground CPM (my state has a very hostile climate toward homebirth, with or without a CNM in attendance) within range who could attend me.


Luckily, she was willing to accept me. My next appointment is this evening, which I'm eagerly anticipating. At my last appointment, she had two clients who she thought might both have their babies that night, so I'm anxious to see what transpired.


I intend to make regular updates on our progress and preparation toward our homebirth, which will be filmed and shared on GivingBirthNaturally.com, so check back often for updates.


I'm not really showing much yet, but I'll post a picture of my belly-to-date soon.

ACOG Revises Position on Fluids During Labor

ACOG recently released new guidelines on fluid intake during labor, loosening the restriction on ice chips only to "modest amounts of clear liquids".


The full news release can be seen at http://www.acog.org/from_home/publications/press_releases/nr08-21-09-2.cfm


The new recommendations include:

According to ACOG, women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. Fluids with solid particles, such as soup, should be avoided, however. Women who have uncomplicated pregnancies and are scheduled for a cesarean delivery may also drink these clear liquids up to two hours before anesthesia is administered.

My favorite part of the release is this:

"Allowing laboring women more than a plastic cup of ice is going to be welcome news for many," Dr. Barth said. "As for the continued restriction on food, the reality is that eating is the last thing most women are going to want to do since nausea and vomiting during labor is quite common."

Tsk, tsk Dr. Barth. Leave it to a man to tell all pregnant, laboring women what they "will want", and to speak for all of us as if we're not worthy of individual consideration.


What he also fails to realize is that nausea and vomiting typically occur during transition, the shortest and latest part of labor.


Since labor can (and often does) last 12+ hours, his rationale is that because at some point 12+ hours down the road a woman may feel nauseous and possibly vomit, she shouldn't be allowed to eat at all during labor.


Instead he should consider that starving a laboring woman for 12+ hours could in fact cause the nausea and vomiting, independent of labor.


ACOG (and Dr. Barth) also fail to realize that digestion usually slows to a near-stop during labor as the hormones of birth build within the woman's body. While remaining largely undigested for hours, this food serves to provide critical energy to the birthing mother to help stabilize her and her baby's blood sugars. Robbing her of nutrients puts unnecessary risk of upsetting this delicate balance and increasing the risk of a "dysfunctional" labor pattern or fetal distress in the baby.


Although the relaxed guidelines are a small step in the right direction, they still shows the persistent lack of understanding that physicians have about labor and in considering individual differences. As long as they try to make modern obstetrics about a "one-size-fits-all" approach, we won't see the change women and babies deserve.


Perhaps the greater goals would be to train caregivers who could think independently, recognize normal birth, expect birth to progress normally, intervene only when necessary (and in the least intrusive, evidence-based ways first) and understand that a woman's body knows how to birth a baby, when it is allowed to do so.

Homebirth-Friendly OB Needs Your Help

An OB of a very rare breed, a homebirth, VBAC and vaginal breech supporter, Dr. Stuart Fischbein, who actively collaborates with midwives, needs your help.

He is currently being threatened with disciplinary action by his hospital for, in essence, doing his job to the very best of his ability: supporting informed consent and evidence-based medicine. His practice maintained a primary c-section rate of just 5% (as opposed to the hospital rate of 20%) and a total rate of 12% (compared to 29% for the hospital rate). Over the past few months, he has attended 3 vaginal breech birth and 3 VBACs which all ended positively. The hospital has already suspended the privileges of the two CNMs he works with, and he's next on their list.


To find out more about Dr. Fischbein's case and how you can support his cause, please visit his blog.


Here's more on how you can help:

1. Contribute to Dr. Fischbein's Legal Aid Fund. Make Paypal Payment to angelfischs@yahoo.com or mail a check payable to Alan J. Sedley, Attorney at Law to: 1234C Westlake Blvd., Westlake Village, CA 91361

2. Write a Letter to: Mr. Michael T. Murray, President, St. John's Regional Medical Center, 1600 Rose Avenue, Oxnard, CA, 93030 and copy to: angelfischs at yahoo.com.

3. File a complaint with the Joint Commission.

4. Network. Share his story with forums, blogs, newsletters, or start a letter-writing campaign. This issue is larger than him - it impacts birthing women everywhere.

5. Enroll in our Online Childbirth Classes. 10% of all tuition payments received in September will be donated to his Legal Aid Fund.


His hospital currently supports aggressive, non evidence-based policies which compromise patient rights, autonomy, bodily integrity and overall well-being in the interest of limiting professional liability.

For example, they ban VBAC patients, not from VBAC, but from receiving epidurals, which should always be a choice, whether or not a woman chooses to elect it.

They also have strict policies on homebirth transfers, limiting women in their choice of hospital, which could even be a violation of EMTALA, which states that no woman in active labor can be turned away from a hospital without treatment.

I strongly urge you to support Dr. Fischbein in any way you can - whether monetarily or otherwise. By supporting him, you are advocating for women's rights to quality, evidence-based care for themselves and their children. The consequences of inaction could be far reaching.

ACOG Steps Up the Anti-Homebirth Game

If ACOG were a dog breed, it would be a pit bull - tenacious and aggressive when threatened.


Their latest tactics include soliciting failed homebirth stories, with or without negative outcomes, via their website. It speaks volumes about their commitment to impartial, evidence-based policies backed in rigorous research evidence, doesn't it, that they aren't also asking for statistics on successful homebirths. It's a one-sided petition that suits their politics perfectly.


From the ACOG site:

Reporting of Unsuccessful Attempts at Home Delivery with or without Adverse Consequences

In 2006 there were 24,970 home deliveries reported in the United States[1]. Obstetrician-gynecologists and other members of the medical community may be faced with the presentation of an obstetrical patient who has attempted home delivery unsuccessfully. The need exists to quantitate the frequency and information of these events. The goal of this registry is to attempt to quantitate when home delivery is unsuccessful and what the outcomes are. To be HIPPA-compliant, no identifying information will be requested. Data points include the state of occurrence, as well as the month and year of delivery, maternal and gestation age, gravidity and parity and obstetric or neonatal complications. An attempt to identify the home attendant type if known will also be useful data.

ACOG appreciates your recognition of this issue and your utilization of this registry to assist us in data collection.

In a backlash they never saw coming, ACOG got data - just not the data they expected.


Their collection form was instead flooded with the positive homebirth stories of mothers nationwide who've had enough of their unfounded attacks on homebirth, midwifery and women's rights in general, and decided to fight back.


After this outpouring of positive homebirth support, ACOG put their submission form on a members-only, login page: http://www.acog.org/survey/hdComplications.cfm


Maybe they'll take the hint and put their self-interested policies locked far, far away from women, right where they belong.


If they do make the form public again, rest assured that the positive flood of homebirth stories will resume - they'll get the message one way or another, eventually.

Mayim Bialik "Blossoms" into My Kind of Woman

In the early 90s, Mayim Bialik was the teen icon of the show "Blossom", wherein she lived with her two brothers and spent time with her best friend, Six.


I must admit that although I've heard of the show, I never saw it, mostly in part to strict parents and a strong preference for books over television.


But it seems that Mayim, who took 15 years off after the show to earn a Doctorate and start her family, grew into my kind of woman - a homebirthing, breastfeeding, cosleeping, anti-vaxing, ec-ing, baby-wearing, homeschooling, more-than-just-a-little-crunchy mom.


You can check out a recent interview with her here: http://omg.yahoo.com/blogs/goddess/spotlight-to-nightlight-mayim-bialik-from-teen-icon-to-unconventional-mom/270?nc


I wish there had been more time for her to discuss her choices and why she and her husband made them. It really makes a powerful statement on the mainstream when public figures share their "unconventional view" about parenting and birth.


If only this would happen more often, eventually the tide could shift to make the current mainstream the unconventional ones.

Abby & Ricki Overdeliver Again: Webisode Series at MyBestBirth.com

Abby Epstein & Ricki Lake, who produced the ground-breaking documentary, The Business of Being Born, are again giving back to the birth world through their new site, MyBestBirth.com.

They're currently launching a series of celebrity webisodes covering the homebirths of different celebrities who've had homebirths. The full press release & details is posted below. Be sure to check it out!

RICKI LAKE LAUNCHES EXCLUSIVE CELEBRITY WEBISODE SERIES ON MYBESTBIRTH.COM
Cindy Crawford, Christy Turlington, Laila Ali, Melissa Joan Hart, Alyson Hannigan are among featured celebrities sharing personal birth stories as part of the series

Los Angeles, June 25, 2009--Ricki Lake and Abby Epstein, the documentarians behind the critically-acclaimed film The Business of Being Born and authors of Your Best Birth, will exclusively preview clips of their new film on MyBestBirth.com as a webisode series. This includes, never-before-seen interviews from celebrities Cindy Crawford, Christy Turlington, Melissa Joan Hart, Alyson Hannigan, Laila Ali, Kellie Martin, Sarah Wayne Callies, Kimberly Williams-Paisley, Joely Fisher and others, discussing their personal birth experiences.

Cindy Crawford’s birth story began the series on July 8th and it will culminate with an online chat with Crawford herself answering people’s questions from July 27 to 31 on MyBestBirth.com. The other celebrity stories will immediately follow.

Cindy Crawford’s birth story websiodes can be viewed at:
http://www.mybestbirth.com/page/cindy-crawford-part-1

The trailer for the webisode series can be viewed at MyBestBirth.com or http://www.youtube.com/mybestbirth.

For more information, please visit MyBestBirth.com or contact Amy Slotnick at Amy@mybestbirth.com

# # #

About Ricki Lake:
Actress, producer, filmmaker and author Ricki Lake has reinvented herself at every stage of her 20 year career. Lake has gone from starring in the 80s classic Hairspray to hosting the long-running Ricki Lake talk show for 11 years—while continuing to star in feature films and appear in television projects. Lake has again evolved her career—this time to include birth advocate, documentarian and author with the recent releases of the critically-acclaimed film The Business of Being Born and pregnancy guide, Your Best Birth. Proving that her entertainment influence will always be multi-hyphenated, she presently hosts and executive produces the Vh1 hit series, Charm School with Ricki Lake.

About Abby Epstein:
Director and Producer Abby Epstein helmed the acclaimed documentary The Business of Being Born, executive produced by Ricki Lake. The success of the film inspired Abby and Ricki’s recent book, Your Best Birth. Abby made her film directing debut at the 2004 Sundance Film Festival with the documentary feature, Until the Violence Stops. On Broadway, Abby spent four years as the resident director of the musical RENT, overseeing the London premiere and two National Tours. She directed RENT in Mexico City, Barcelona and Madrid. Off Broadway, Abby directed over 100 celebrity actresses in The Vagina Monologues along with the National tour and premieres in Toronto and Mexico City.

Vaginal Breech Birth & SOCG

The Society of Obstetricians & Gynecologists of Canada (SOGC) has made a shocking announcement this week: to not only offer vaginal breech birth but to also establish training programs nationwide so physicians can once again become skilled in this lost art. From this article

Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.


The new approach was prompted by a reassessment of earlier trials. It now appears that there is no difference in complication rates between vaginal and cesarean section deliveries in the case of breech births.

“The safest way to deliver has always been the natural way,” said Dr. Lalonde.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

The article goes on to cover the disadvantages of a c-section, which are so often ignored:

Cesarean sections, in which incisions are made through a mother's abdomen and uterus to deliver the baby, can lead to increased chance of bleeding and infections and can cause further complications for pregnancies later on.

“There's the idea out there in the public sometimes that having a C-section today with modern anesthesia and modern hospitals is as safe as having a normal childbirth, but we don't think so,” said Dr. Lalonde.

“It is the general principle in medicine to not make having a cesarean section trivial.”

And the true kicker that sets apart SOGC from ACOG:

The SOGC believes that if a woman is well-prepared during pregnancy, she has the innate ability to deliver vaginally.

I have to say I'm somewhat shocked at this turn of events. While eliminating universal c-sections for breech is a great strategy for reducing overall c-section rates, it's still a bit stunning to see such an organization reach the same conclusion, and then take the necessary steps to see it happen. No muss, no fuss. Simple, direct, evidence-based, effective.


I do think that last quote has quite a bit to do with it. At the heart of the matter, SOGC realizes that women can and will give birth with or without them, so it's advantangeous to them all to foster good relationships based upon respect and acknowleding their autonomy to make their own health care decisions, which means offering alternatives to automatic abdominal surgery when it's not needed.


This strikes at the heart of the differences between ACOG and SOGC - ACOG does not let evidence drive their decisions nor do they believe in womens' innate ability to deliver vaginally when well prepared. And it shows in our birth outcomes. Lucky us.

MIA

So sorry to have been MIA for so long. After 4 cases of pneumonia (1 child, 2 husband, 1 myself), 3 nasty flus (2 me, 1 child), 2 asthma attacks, and an extreme supra-chondryall fracture of the humerus requiring surgical repair (oldest child) 2 casts and 6 weeks of physical therapy, we've had more than our share of medical issues in the past 3 months.


Now, as I lay recovering from the last vestiges of my own case of pneumonia, I am trying to catch up on the dozens of posts that were started, but never posted. I do sincerely apologize for the absence and hope the summer brings better weather - and better health - for us all.

Stating the Obvious: Hospital Practices Strongly Impact Breastfeeding Rates

A new study analyzed data from Listening to Mothers II, a nationally representative survey of 1,573 mothers who had given birth in a hospital to a single infant in 2005. Mothers were asked retrospectively about their breastfeeding intentions, infant feeding practices at one week, and hospital practices.

About half (49 percent) of first-time mothers who intended to exclusively breastfeed reported that their babies were given water or formula for supplementation, while 74 percent reported being given free formula samples or offers.

Boston University (2009, March 19). Hospital Practices Strongly Impact Breastfeeding Rates. ScienceDaily. Retrieved March 20, 2009, from http://www.sciencedaily.com­ /releases/2009/03/090319161505.htm

So, this study only confirms what we already know - poor breastfeeding rates are more often caused by external factors, such as supplementation and formula offers - rather than a true inability to breastfeed.

The key to remember if you're planning a hospital birth is to state - widely and loudly - that you intend to exclusively breastfeed, and to accept all the assistance you can get, whether it be a true lactation consultant or a supportive nurse. You must remember to tell all staff that you want NO supplementation of any kind at any time - including pacifiers or glucose water.

The most vulnerable times will occur if they want to take the baby for "observation" in the nursery. While many hospitals allow 24 hour rooming-in, some still promote this archaic practice of shuttling newborns off to the nursery, where you'll have no idea if your wishes are being respected. If you aren't able to avoid this separation, for whatever reason, you can make your preferences explicitly clear beforehand or send dad to be on watch until this time period is up.

Ultimately, you may have to advocate for yourselves and your child. The best plan is to know what you're up against. Don't wait until the birth to find out if the hospital is mother-baby friendly or breastfeeding supportive. These factors can be easily assessed with a simple pre-birth tour or call to the maternity floor during your pregnancy. Don't let lack of preparation undermine your commitment to breastfeed your child.

New Product to Help with C-Section Recovery

A new product, Vitagel, is being used to assist mothers recovering from c-sections.

While I completely support minimizing recovery time and maximizing patient comfort and safety, I can't help but wonder if this new product will be used to market c-sections by downplaying the fact that c-section remains a major abdominal surgery that should be a last resort.

Only time will tell, but I can see the great potential for an increase in c-sections due to a public perception of safety and greater convenience due to a shorter, easier recovery time.

The answer isn't to take a product like this off the market, because all mothers should have access to the safest, quickest, most comfortable recovery possible, but to promote the evidence-based practices that reduce the incidence of c-sections and thus, the need for such a product.

This will be on my radar for 2009 - I'll be interested to see where it leads.

CDC Stats are In: C-Sections are Again on the Rise

Today, the CDC released preliminary birth data for 2007. While some statistics were encouraging, namely that preterm birth, the leading cause of infant mortality in the US, decreased for the first time in over 20 years, other statistics were not so encouraging:

For the 11th straight year, c-section rates continued to climb, from 31.1% in 2006 to 31.8% in 2007.

Pre-terms births, defined as infants delivered at less than 37 weeks of pregnancy, fell 1% in 2007 to 12.7% of all births. Per the March of Dimes, the improvement is largely due to a reduction in deliveries taking place before 39 weeks.

I've posted in the past on the mounting research outlining the dangers of induction and c-section before 39 weeks and the large number of pre-term births that could be prevented by doing so, which is a position also supported by the March of Dimes.

The CDC stats confirm that the efforts of the March of Dimes and other such advocacy efforts are helping to delay c-sections and inductions until closer to 40 weeks, but have as yet been unsuccessful in reducing the number of c-sections needlessly performed each year.

I find it so ironic that the key to improving birth outcomes for babies is forcing doctors to adhere more strictly to evidence-based guidelines. The incidence of pre-terms births was reduced, not by some great technical advance in medicine, but by making doctors stop performing potentially harmful procedures too soon.

In short, when doctors follow the evidence, birth outcomes improve.

The real conundrum lies in why is it so difficult to make modern maternity care practices follow what the evidence proves is best for mothers and babies...

Proposed Research Study on Social Support in Childbirth

Hazel Williams of the University of Sussex recently contacted me about a study she is conducting on the effect of social support on childbirth experiences. Details are posted below:

---

This month and next, there is an MSc Health Psychology study being run
at the University of Sussex (UK). We are carrying out research looking
at the effects of social support on experiences of childbirth. The
findings from this study will help us understand how different types
of support during birth may affect women's feelings of control and
emotions during and after childbirth.

If you are interested in taking part, the Health Psychology online
study can be found at:

http://www.sussex.ac.uk/Units/socpsy/webq/hw1/index.php

All of the information you give in the questionnaire will be treated
as strictly confidential and will be used only for the purpose of this
study.


Best wishes and thanks for your time.

Hazel Williams

---

Please consider participating to further our knowledge in this area and to support birthing mothers worldwide.

Screening of New Documentary: Birth

Some time ago, I posted about filmmaker Kathryn Mora and her forthcoming documentary entitled "BIRTH".

Kathryn contacted me to announce that the film is complete and a screening has been scheduled. I encourage everyone to attend. Details are available below:

ANNOUNCEMENT
You are all invited to the premiere screening the documentary, BIRTH on Thursday, March 19, 2009 at 7 p.m.

BIRTH, explores the benefits of natural childbirth and the dangers mothers and babies face in today’s high-tech and drug-filled maternity care environment. The mothers in the film who gave birth with drugs and medical intervention and without, compare their experiences. In addition, childbirth experts give valuable information and enlightening insights about birth. When a woman considers childbirth, education will help replace her fears with confidence and empowerment. This documentary will interest everyone because childbirth affects us all in one way or another.

The screening will be held at:
Center For Digital Imaging Arts at Boston University
274 Moody Street Studio C
Waltham, MA 02453
781-209-1700

For questions, please contact filmmaker Kathryn Mora at 518-867-7100 or via email kathrynmora@gmail.com.

Directions
From Points North/South to the CDIA Waltham Campus (274 Moody Street, Waltham, MA.)
Take Route 128/I-95 to Exit 26 (Route 20). Follow Route 20 East for 2 miles. Turn right onto Moody Street. CDIA is located 1/4 mile down on the left.

From Points East/West
Take the Mass Pike to exit 14 (Route 128/I-95). Take Route 128/I-95 to Exit 26 (Route 20). Follow Route 20 East for 2 miles. Turn right onto Moody Street. CDIA is located 1/4 mile down on the left.

PUBLIC TRANSPORTATION
Train: Fitchburg (Fitchburg Line) commuter rail to Central Square Waltham - CDIA is located two blocks up on Moody Street.
Bus: Oak Park - Dudley via Central Sq bus #170 or Cedarwood bus #70/70A

PARKING
There are two public parking lots within a short walking distance of CDIA. The Embassy Parking Lot is located two blocks down Pine Street behind the Embassy Landmark movie theatre and is located one block away from CDIA. The Crescent Street Lot is another option, located on Crescent Street between Moody and Adams. In both cases look for the parking signs when you reach Moody street.

ACOG Issues New Guidelines on Managing Stillbirth

Yesterday, ACOG released new guidelines on managing stillbirth.

Overall, it's a generally solid, informative, although very clinically-driven, piece that gives a run-down of the known stats and evidence currently available.

What really struck me was the section on Management. Stillbirth is universally devastating for new mothers and families. They've spent at least 5 months (since stillbirth is deemed to occur after 20 weeks) pregnant feeling this child grow inside them and anticipating its birth, only to have their worst fears realized.

In token appreciation to this great loss, the ACOG guidelines state:

After a stillbirth, sensitivity to the family's emotional state is important. Parents should be given the opportunity to hold their baby and perform cultural or religious activities, such as baptism.

In response to this tragedy and its overwhelming impact on the mental and emotional health of their patients, clinicians are advised in a brief, single sentence to be sensitive to the family's emotional state.

The other 3.5 paragraphs are devoted on how to get a family to agree to an autopsy or get their consent for a number of additional tests if they can't be talked into a full autopsy, citing this reasoning:

"Parents want answers when they have a stillbirth, so clinicians should not be afraid to request an autopsy. Without a thorough evaluation it will be difficult to counsel women on their risk of having another stillbirth," said Dr. Fretts.

While I agree in principle, in practice, far too many families are so emotionally blindsided, they can't see the benefit of the autopsy or testing at the time. Perhaps its due to the lip service physicians are instructed to pay to the family's emotional state, wrapped up in a single sentence with a few token activities thrown in.

Perhaps the guidelines could read, "families should be allowed to hold their babies for as long as they like, call whatever family members they wish to come support them, dress the baby and take pictures, as needed. Families should be moved to a location off the maternity floor to avoid painful contact with other families experiencing the joy of their new babies if they so wish".

It would seem to me that by truly showing empathy to the emotional needs of the family, it would be easier to broach painful topics such as autopsy and post-mortem testing.

Expanded Midwifery Care in Ireland

Here's a positive article on the expanded use of midwives in Ireland.


It's a good read that highlights many of the benefits of midwifery care. Enjoy!

Good Article on VBAC

Here's a well-written article on the soon-to-be lost option of VBAC that does a great job of highlighting the erroneous reasons hospitals and doctors report on why they don't offer VBAC.

This is one of my favorite parts:

In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.

I wonder how much longer it will take before ACOG realizes that in their efforts to "make it safe", they'd caused more harm than help.

Unfortunately, I don't think it will be any time soon.

Campaign to Change Hospital Policy Against Midwifery Care

I received this email from an expectant father seeking help in changing a local hospital's policy on midwives attending births. If you live in the area (and even if you don't), please consider making a phone call or sending a letter/email to the hospital administrator to heighten awareness of the issue and hopefully change hospital policy for the benefit of mothers and babies:

My wife and I are expecting our first in September. We are eager and excited to work with a specific midwife/nurse practitioner who works in a woman's health office near our home. This office is connected with Holy Cross Hospital in Silver Spring, Maryland. For this reason, we can not work with our midwife during birth because Holy Cross does not allow midwives to help women deliver in their hospital. They are the only hospital in our region that does this horrible practice. I was hoping you could help get the word out and help me to begin a campaign with the hospital leadership.


The president of the hospital is:

CEO and President: Kevin Sexton

Holy Cross Hospital

1500 Forest Glen Rd.

Silver Spring, MD 20910

301-754-7010
E-mail Address: sextok [at] holycrosshealth.org

~~~~~~~~~~~~~~~

If you've never phoned, written or emailed such a letter, here are some sample scripts with talking points to include:

"My name is ____________________. I live in _______ near ________ hospital. I wanted to share with you how the lack of access to midwifery care at ________ hospital has affected me and other women and families in the vicinity. (List 1 or 2 examples from the list below or add your own).

• I chose to travel ____ miles rather than give birth in this hospital due to the lack of midwifery care providers


• I had to choose a provider I'm not comfortable with because of the lack of midwifery care at this hospital


• Parents have the right to choose how, where, and with whom their children will be born.


• Women deserve to have access to all the nationally certified maternity care providers that women in other states, like Wisconsin and Minnesota, can choose from -- including CPMs


• Midwives are known to do an excellent job working with under-served populations, including undocumented worker populations, who are more accustomed to midwifery care in their home countries


• With obstetricians leaving that profession, midwives can help fill the gap for normal births in a cost effective fashion


• With their unique out-of-hospital training, Certified Professional Midwives can be a vital part of emergency services in times of epidemics, natural disasters or terrorist attacks (when hospitals might be overwhelmed with actual medical emergencies), allowing obstetricians to oversee the cases that required their surgical expertise


• I want the option of midwifery care available for my children,
  when they start to have children of their own

(You should pick the talking points that make the most sense in your situation and/or best represent your point of view or comfort level.)

"I hope that in light of these factors, you will reconsider your policy and allow midwives to have privileges within this hospital to attend to birthing women and their families. Thank you for your consideration in this matter."


Please spread the word to help this and other families in the area gain full access to the care providers of their choice.

Time to Take a Page from the NHS Book...

The National Health Service (NHS) Institute for Innovation and Improvement recently released a new initiative and toolkit to "to assist maternity units in achieving low caesarean section rates while maintaining safe outcomes for mothers and babies."


According to this article, after only 18 months, c-section rates dropped from 24% in 2007 to a mere 16% in November 2008.


The idea of a 16% c-section rate is the US seems like a dream. That is half our current c-section rate and very close to the World Health Organization's (WHO) target rate of 10-15% or less.


The truly intriguing aspect of the toolkit is that it is one of introspection. The NHS created a tool to help providers and maternity care units self-evaluate their practices against evidence-based standards, to see how their actions impacted the number of cesarean births and how altering those practices could help or hinder birth outcomes.


The American College of Obstetricians & Gynecologist's (ACOG) has stated that they are "committed" to reducing the number of c-sections. However, their approach, in sharp contrast to the NHS, has been to simply blame the mother - we're too fat, too lazy, too old, too small, or even "that's what they wanted" and so on and so forth...ad nauseam...


If ACOG is truly committed to lowering c-section rates nationwide, it's time for them to take a page from the NHS's book: start implementing the necessary steps to create the change you want to see.


Namely, start practicing evidence-based medicine and the rest will follow...