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.

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.

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...

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.

Birth Summit To Be Held In Chicago

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....

Dr. Diabolic and the God Complex

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:

• Episiotomy


• 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.

960 Mothers and Babies Exposed to TB in San Francisco (AKA Another Reason to Avoid Hospital Birth)

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.

More Evidence of the Dangers of Cytotec

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.

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