Recent birth news

There has been a lot going on in news about birth in the last couple of weeks.

First there was the mom in Australia who had police show up at her door after she chose not to show up for the induction that her doctors scheduled her for. Her doctors decided to call the police to escort her in.

Later, the hospital issued her an apology. Ironically, they claimed that they were not trying to pressure her into an induction. Right..sending police isn't an intimidation tactic?

If The Birth Survey was available for mothers around the world to take, I'm sure Rochelle would be able to report that she did in fact feel pressure to induce from her providers.

Then there was the mom who is going to court over being court-ordered to remain on bedrest while confined in a hospital and undergo a mandatory C-section.

Both of these stories are disturbing to me because it shows the lengths that medical professionals will take to force women to act according to their recommendations.

I have been on the mothers end of disagreeing with the medical professionals I'm paying to advise me on my health. In the two cases described above I see enough evidence to know that the mothers were informed about the research and known risks of the proposed treatments and in good conscience chose what was actually more evidenced based and better for them personally. My experience fighting to prevent an induction leads me to empathize with these two women who experienced much stronger attempts to manipulate their choices and force them into things that they knew they had the right to refuse.

It may be unfair to expect, but I would not be surprised with either of these women were traumatized by these experiences where they had to fight for their bodily integrity and to make health choices for themselves; without fear of reprisal. I hope that if they are experiencing trauma, that they will find the support they need and know about Solace for Mothers as a resource for women who have been traumatized by experiences relating to childbirth.

To quote directly from an ACOG publication:

"Even if a woman's autonomous decision seems not to promote beneficence-based obligations (of the woman or the physician) to the fetus,...the obstetrician must respect the patient's autonomy, continue to care for the pregnant woman, and not intervene against the patient's wishes, regardless of the consquences."

Consumer Reports Health Condemns Common Obstetric Practices

Consumer Reports Health is a new public service from the well-known Consumer Reports. They are now providing reporting data on medical procedures and treatments in an effort to assist consumers of health care to be more informed. I am impressed, and pleasantly surprised, that they are present the research-based evidence regarding obstetric practice, instead of what the American College of Obstetrics and Gynoecologists is promoting. This is what Consumer Reports Health have to say about basic obstetric practice:

Despite growing evidence of harm, many obstetricians and maternity hospitals still overuse high-tech procedures that can mean poorer outcomes for baby and Mom. Test your knowledge with our quiz below.

T/F: An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.False. Studies show that the 8 percent to 9 percent of U.S. women who use midwives and the 6 to 7 percent who choose family physicians generally experienced just-as-good results as those who go to obstetricians. Those who used midwives also ended up with fewer technological interventions. For example, women who received midwifery care were less likely to experience induced labor, have their water broken for them, episiotomies, pain medications, intravenous fluids, and electronic fetal monitoring, and were more likely to give birth vaginally with no vacuum extraction or forceps, than similar women receiving medical care. Note that an obstetric specialist is best for the small proportion of women with serious health concerns.

Induced labor can halt fetal development.
True. The vital organs (including the brain and lungs) continue to develop beyond the 37th week of gestation. There is also a five-fold increase in the brain's white matter volume between 35 and 41 weeks after conception. Inducing labor (with synthetic oxytocin, for example) might stop this growth if the fetus is not fully developed. Between 1990 and 2005, the number of women whose labor was induced more than doubled.

Due-date estimates can be off by up to two weeks.
True. This inaccuracy can lead to a baby being delivered by induction or Caesarean section up to two weeks earlier than its estimated due-date, cutting off important weeks of fetal development.

"Breaking the waters" helps hasten labor.
False. There is no evidence to support the fact that this common practice (about 47% of women) shortens labor, increases maternal satisfaction, or improves outcomes for newborns.

Induced labor increases the likelihood of Caesarean section in first-time mothers.
True. The cervix may not be ready for labor. Other effects of induced labor include an increased likelihood of an epidural, an assisted delivery with vacuum extraction or forceps, and extreme bleeding postpartum.

Once you've had a C-section, it's best to do it again.
False. Studies show that, as the number of a woman's previous C-sections increased, so did the likelihood of harmful conditions, including: trouble getting pregnant again, problems delivering the placenta (placenta accreta), longer hospital stays, intensive-care (ICU) admission, hysterectomy, and blood transfusion.

Labor itself can benefit a newborn's immunity.
True. When babies do not experience labor (if the mother has a C-section before entering into labor, for example), they fail to benefit from changes that help to clear fluid from their lungs. That clearance can protect against serious breathing problems outside the womb. Passage through the vagina might also increase the likelihood that the newborn's intestines will be colonized with "good" bacteria after the sterile womb environment.

Epidural anesthesia is a low-risk way to make labor easier.
False. Many women welcome the pain relief, but might not be well-informed about the increased risk of its side-effects, including lack of mobility, sedation, fever, longer pushing, and serious perineal tears.

Epidural anesthesia presents risks to newborns.
True. Babies whose mothers received epidurals during labor are at risk for rapid heart rate, hyperbilirubinemia (the presence of an excess of bilirubin in the blood), need for antibiotics, and poorer performance on newborn assessment tests.

Episiotomies reduce the risk of perineal tearing.
False. Evidence shows that routine use of episiotomy offers no benefits but rather increases women's risk of experiencing perineal injury, stitches, pain and tenderness, leaking stool or gas, and pain during sexual intercourse. Yet in 2005, 25 percent of women with vaginal births continued to experience this intervention. Episiotomy is one of several obstetric practices adopted into common usage before being adequately studied.

Source: "Evidence-Based Maternity Care: What It Is and What It Can Achieve," a detailed review of clinical evidence by Carol Sakala and Maureen P. Corry published by the Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund, October 2008.

That's Why?

It is known that anxiety interferes with the hormones of labour - and what perfect sense this makes. In nature if a woman is anxious it may not be safe for her to birth - safety is obviously paramount in birth and this feeling of withdrawing is natural to ensure a woman finds a safe place. We have indoctrinated women that hospital is the place of safety so no wonder this is where most women choose. Also it follows why many women go to hospital very early in labour - they wish to settle into their chosen place of birth.

Excerpt from Anna Berkely's home birth story on Birth International.

The above quote resonated with me because its a thought that I have been unable to put into words previously. When I was in labor with my son, I thought I was doing so well to not go to the hospital early in labor. The labor sensations started at 1 am in the morning, and by 11 am I was still having regularly spaced contractions. I had had an midwife appointment scheduled that day so I had waited for that visit before deciding to go the hospital. At that appointment, the midwife advised me to check into Labor and Delivery because I was already 3 cm dilated and contracting regularly. With that recommendation and the knowledge that labor had started some hours earlier, I figured I wouldn't be checking into the hospital during early labor and that I'd be able to hole up and find my space to birth my baby. I went to check in but L&D was full. They were full for another 5 hours. It was then that my labor seemed to go into a holding pattern, it didn't stop, it didn't slow down, but it also didn't progress or intensify as it should.

So no surprise that at 4 pm, when I was permitted to enter the birthing unit, there had been no further progress (in spite of walking to stimulate contractions and resting to conserve energy). I was very frustrated when after another 4 hours in the hospital filled with constant monitorring, interruptions and conflict with staff, I was told to leave because I was refusing interventions that would artifically stimulate the labor to progress.

I found that the hospital wasn't a safe place for me where I could feel comfortable to birth my baby. After the preceeding anxious hours before going into the hospital, I encountered even more anxiety when being pressured by the attending midwife to interfere with my baby's birth against my wishes. I strongly belief that standard procedures and "admission criteria" are a causative factor to my stress filled early labor which continued on in total for over 30 hours. From that point on, active labor and the birth went smoothly. An easy and straightforward 8 hours later, the sunshine in my life was born.

If I could go back and do it all over again, my birth plan would be much different. I would have chosen a home environment as the birth setting and a supportive, encouraging midwife. I know that I need a emotionally safe and nurturing environment to enable the process of birth to proceed from my body. And a hospital is not where I will find it.

Stop the Misuse of Cytotec to Induce Labor

Some would say this is old news, but the topic still hasn't gotten the attention from the US populace as it should so I'm writing about the dangers of Cytotec induction.

Cyotec is a drug developed for repair of stomach ulcers developed by the pharmaceutical company Searle. The company placed a warning on the label stating it is contraindicated for use in pregnant women as it can cause uterine contractions, leading to preterm labor. The obstetrical community put two and two together and thought, “Hey, we could use this to induce labor! Let’s try it.” So they did. No studies or trials to see the effects. They just started doing; often without the consent of their patients.

The active ingredient of Cytotec is the hormone misoprostol which when inserted into the vagina in capsule form softens the cervix and hastens dilation. Strong contractions are also brought on. Because the drug is being used against label it is hard to determine proper dosing. OBs are using the high tech method of cutting capsules into smaller pieces. Also, once inserted the capsule can not be removed so deleterious effects cannot be stopped or reversed once too high a dosage is given.

The FDA got wind of it and issued warnings to the American College of Obstetrics and Gynecology who in turn told OBs that Cytotec should not be used to induce labor, especially not in women who have previous had a C-section; instead recommending that every women who has had a prior C-section have another. But that’s another post all together. (For risks of C-sections see What They Don’t Tell You About C-sections) However, use of Cytotec for inductions is still commonplace in many hospitals across the county.

Off-label (or more appropriately against label) use of Cytotec in pregnant women can lead maternal or fetal death, uterine hyper-stimulation, rupture or perforation requiring uterine surgical repair, hysterectomy or salpingo-oophorectomy, amniotic fluid embolism, severe vaginal bleeding, retained placenta, shock, fetal bradycardia and pelvic pain. The risks of this happening spike dramatically if the woman has already had a prior C-section.

An example of a death caused by Cytotec induction is Tatia Oden French who was induced at the age of 33 with her first child. The Cytotec caused hyper-stimulation of her uterus that could not be reverses, leading to her uterus rupturing and ultimately her death as well as the death of her child during emergency surgery.

Her family started the Tatia Oden French Memorial Foundation to prevent this misuse of the drug from killing or harming other mothers and infants.

The foundation also started an online petition to the FDA to cut down on doctors known to be use the drug despite its warnings and contraindications.

Please sign the Petition