Do Birth Workers Know What Women are Reading?

Rixa at Stand and Deliver blogged recently about how obstetricians come to their beliefs about homebirth which reminded me of a question I asked myself a few months back.

Do obstetricians and L&D nurses know what women are reading about birth?

And, if they did, how would that change their practice?

Beyond the texts recommended by obstetricians and What to Expect When You're Expecting, it appears to me that many women planning hospital births are reading information on natural childbirth with books like:

Ina May's Guide to Childbirth
The Birth Partner
Hypnobirthing
A Thinking Woman's Guide to a Better Birth
Gentle Birth, Gentle Mothering
My Best Birth
The Birth Book
Birthing From Within
Spiritual Midwifery

A common thread of these books is arguments against using obstetric intervention through replacing interventions with simple strategies employed by the mother and her support people. Most of these strategies require advance preparation and knowledge regarding them though gaining this knowledge really doesn't take much time. Simply reading about it in a book, or even a website makes one qualified to change positions or to breathe deeply or soften one's jaw. It even qualifies someone present to suggest it to a laboring woman.

Now this is where I think this plays into Rixa's discussion. I'm going to theorize that one reason hospital birth workers are not supportive of homebirth (in addition the other reasons suggested by Rixa and her readers) is that homebirth is the epitome of natural birth where it becomes clear how very little knowledge and expertise is needed (except for when it is). This idea would feel like a threat to their livelihood, their career choice and might breed just a little bit of resentment towards other professionals who have not slaved through the initiation rite of medical school and residency to end up doing very similar work.

Doctors might shy away from asking themselves the question: "If birth were simple and reading a few books qualified a person to attend births, then what was the point of all that education? It can't possibly be as easy as these books say it is."

And then, as I continue on this pretend inner-monologue, perhaps hospital workers then would get frustrated with their female patients: "How could they possibly think they know enough and think that reading some silly books are going to qualify them?"

But, now I'm dreaming, what would happen if hospital birth workers read these books with an open mind? Would they be compelled to try some of these strategies or to suggest them during a woman's labor?

Are these books written compellingly enough to convince an obstetrician that maybe hands and knees for pushing is worth the try?


Or--now I'm really dreaming--what if these books became required reading for OB residents and L&D nursing students? Just so they knew what "fluff" pregnant women are filling their minds with as they prepare for birth. Perhaps, the assignment could be given with the intent to debunk the misinformation and to encourage doctors to reflect and prepare for how they will respond when women present these ideas in prenatal appointment.


And, if the less academic, popular press reading is too unpalatable for our esteemed birth workers, perhaps the expose of childbirth in America written by journalist Jennifer Block "Pushed: The Painful Truth About Childbirth and Modern Maternity Care" could be recommended first as it provides thoughtful insights into each side of the topic.

In any degree, from a pregnant woman's perspective, this would be more beneficial from dismissing them all together or pretending like they don't exist. Not recognizing their influence creates a vacuum of information, a empty divide where patient and doctor are trying to yell across but the message keeps getting lost.

However, I would hazard to guess that, if hospital birth workers could open their minds a little bit, many of them could recognize the value of the information and see how the paradigm fits together to make the idea of homebirth and non-interventive, unmedicated birth plausible and attainable in relation to relative risk and safety.

Or at least perhaps, we could stop talking past each and be on the same page.

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.

Where is this all coming from?

Many of my recent posts were prompted by a thought process that Rixa started me on when she posted a blog about doulas making a difference in the birth outcomes of women. She expressed her reservations that doulas may unintentionally support the status quo in our maternity care system.

This is my response to her post, and what started me on thinking about what an "organized effort" to promote change in the maternity care system would look like.

On August 20, at 9:58 pm I wrote:

In the last few months, I've been having a crisis of faith in doulas which has kept me away from going through the certification process.

From a first time mom who then came into the birth community, I learned that doulas tend to represent themselves as advocates and spokespeople for laboring women. But then the same doulas turn around and change the definition of advocate into something that doesn't mean what is being heard when a pregnant couple hears "advocate."

I also know that I am one of those mothers who found a doula as a no confidence vote in the hosptial. And while I avoided the cesarean, my plan backfired when I experienced PTSD after being forced repeatedly to find my voice in order to speak up for myself like Jen said. I did that and it was like trying to stave off a freight train that was trying to barrel down on me. And Jen is right, it is the responsibility of DOULAS (not mothers!) to correct the misconception that they aren't there to be advocates or spokespeople.

In addition to all of that, I do believe that doulas are contributing to the status quo of what is happening to women during birth. I see them spending more time trying to make women "more educated" when all that ends up happening is that those women go into the situation that is stacked against them. Doulas should be mounting organized efforts against hospitals and maternity care providers that change the face of birth in hospitals so in time it will become what we know is the true face of birth is supposed to be.

I see the efforts to make those changes being kept separate from the work of doula-ing. I've heard doulas say "when I'm older, I'll take on the system but now I'm going to focus on the individual family." While I understand where they are coming from, I strongly think that most doulas have the responsibility to do both: care for their individual familes and take on the system. As they do that work, women will join them.

This is also a time to say that when I do see doula efforts to take on the system, it is very disjointed and in little pockets. While that is the way grassroots changes come about, its important to connect those pockets and getting them to work together. It is that organized effort that is needed now.

To see the posts I've written aspects of what an organized effort would look like go to:
Birth "Think-Tank"
Legal Rights to Informed Consent in Birth
Framing Birth As Public Health, Reproductive Rights Social Issue
Speaking of Frames

Stay tune as my vision and ideas coalesce themselves, and how the organizations that I volunteer for (The Coalition for Improving Maternity Services and Solace for Mothers) fit into that vision.

Legal Rights to Informed Consent in Birth

This article from the Seattle PI "High rate of C-section births is health concern for women" was a breath of truth and reality of what women are facing with birth.

This is the first time, in a news media outlet, that I've seen hospital practices framed as coersive and trying to manipulate women's birthing choices. And the first time I've seen the abuses of the fields of obstretrics frames as a health issue, as well as a legal issue regarding reproductive rights and patient's rights.

One particularly persuasive quote from the article, says:

Such reasoning inappropriately views a pregnant woman's decision about her and her baby's needs as suspect, and it ignores her legal rights as a patient. All pregnant women, whether they view birth as a natural event only rarely needing medical intervention, or whether they willingly accept medical assistance with the birth process, have the legal right to informed consent and to direct the experience of bringing their children into the world.

The issue needs increased awareness. It goes beyond the talking point of VBACs and coerced Cesearans although those are grave concerns that need to be addressed. Please post comments to the PI article.

A Mother's Birth Rape

Last week I wrote about recognizing birth rape and how it is an accurate way of describing some of the treatment that women experience when birthing babies in hospitals and with professional birth attendants.

This week, I was sickened when I read an account of one of the worst (or best, depending how you look at it) examples of birth rape. Warning: some graphic detail that left me feel utterly repulsed by this doctors actions.

The mom will remain anonymous for her privacy. During the homebirth of her child, she realized that she needed some extra support when she reached the pushing stage of labor. She decided to transfer to the hospital to find that support. Upon transferring, she encountered an agressive OB. Her story continues as follows:

This doctor yells for me to stop pushing and get on the bed. I tell her no, and she yells for the EMT guys who are still in the hallway to help get me on the bed. I give in rather than be manhandled. Another contraction hits and I push, and of course, baby’s crowning. She (doc) yells at me to stop, grabs that nasty betadine stuff and starts scrubbing me, then literally throws a cup of mineral oil over my crotch. My husband and kids walk in then, just as L’s head pops out. One more good push, and there’s her body. I start to say, “give her to me,” doc yells, “THICK MEC,” and cuts the cord before I can even finish saying it. They had her off, and I demand for her not to be suctioned. Believe it or not, they listened. However, at this point, doc grabs the cord and starts yanking, and says that the placenta is having a hard time detaching, and I need to push. I give a tiny test push, and know it’s not coming, so I tell her NO! STOP PULLING! STOP! STOP! STOP! I’m screaming by this point, because she’s pulling with all of her might. I grab my belly where I can still feel it attached and beg her to stop, telling her it’s attached, STOP STOP STOP! My husband is saying the same thing…then it comes out. She tries to pull it away, but I scream at her again. She then says “Your placenta looks odd. You may have had a collapsed fibroid come out with it.” At this point, I’m getting tunnel vision, and a ringing in my ears, and say that I’m gonna pass out. You guessed it, this bitch has pulled out my entire uterus.

Aside from gross medical negligence, this is the essence of birth rape--a woman who is not consenting, in fact yelling NO, STOP, exactly like a rape victim, when a doctor continues to perform an procedure or action that is inflicting more pain, above and beyond the pain experience during a nonmedicated birth.

The mother almost died from losing over 3 liters of blood, and was lucky that the doctors who performed emergency surgery were able to reinsert the mother's uterus. Hopefully, she will be able to have another child and she will heal physically.

Knowing my own experience of PTSD after chilbirth, I would be very surprised if this mother does not experience extreme PTSD symptoms and will face an emotional recovery very similar to that of a rape victim. I pray that she is able to emotionally cope with her experience and gets the support and love from people that she needs.

A sickening this about this story, is that this is an extreme example, but similar things--performing procedures without the consent, in fact inspite of their refusal-- are being done to women EVERYDAY by doctors and midwives, who then turn around and act like they saved the mother's life (paraphrased from mother's birth story).

The mother states that she intends to not let the OB get away with that treatment and intends to pursue legal action and file formal complaints against the OB.

Updates report that, "It turns out there were two things that occurred simultaneously when the doc put traction on the cord. 1) the uterus was inverted, which was not in itself life-threatening, 2) the placenta was yanked out, which caused significant bleeding. They took her to OR because the doctor who pulled the uterus out high-tailed it out of the room, and they took her to OR for general anesthesia. She was not, however, cut open (thank God). They just pushed her uterus back in there. She later received two units of blood to cover what was lost in the placenta removal. She's in some pain, but is moving around well, and there doesn't seem to be any major future implications re her uterus."

Advocate Healthy Birth with Healthy People 2020

Healthy People provides science-based, 10-year national objectives for promoting health and preventing disease. Since 1979, Healthy People has set and monitored national health objectives to meet a broad range of health needs, encourage collaborations across sectors, guide individuals toward making informed health decisions, and measure the impact of our prevention activity. Currently, Healthy People 2010 is leading the way to achieve increased quality and years of healthy life and the elimination of health disparities.

The website is accepting public comments on various health issues important to the American people. They welcome "suggestions as part of a collaborative process."

Now is the time for birth advocates to post what they know about healthy birth. Suggestions for change include using hospital based obstetrics only for childbirthing emergencies, moving low-risk pregnant women and birth out of hospital under the supervision of midwives. Cite the research of Michel Odent, MD; Sarah J Buckley, MD; Marsden Wagner, MD, Ina May Gaskin, Henci Goer and the other big names in birth.

Now is the time to talk about the need of changing the current system which puts financial gain before the well being of women and babies.

Damages Granted in PTSD after Childbirth Case

I have wondered if there is a legal precedent of a case where a woman successfully sued a doctor or hospital for malpractice and medical negiligance that caused Post Traumatic Stress Disorder in the patient. I would like to take my case to court in an effort to bring awareness to birth attendants, health care providers and the public that doctors are abusing laboring women in their care. Women's personal dignity and privacy is being impinged upon, as well as their patient's right to informed consent is being violated. Women are then suffering mental anguish, sometimes on top of a physically debilitating recovery. This is not an issue about alive and healthy mothers and babies, but its a human rights issue where women are being subjected to forms of torture and rape at the hands of their "care" providers.

In Meader vs. Stahler and Gheridian, $1.5 million was awarded to a family after a women suffered PTSD after an unneccessary C-section which she was coerced into by her doctors. Her lawyers argued that the doctors violated her right to informed consent and their negiligance in turn caused her months of agonizing physical and emotional recovery.

An article written about the case in Forensic Psychiatry and Medicine states:

Thus, it was not simply the physically disabling consequences of the surgery, but the loss of personal decision-making power concerning her body, her health, and the birth of her child, that caused Meador to suffer from Post-Traumatic Stress Disorder. Similarly, her husband's experience of loss of consortium was exacerbated by the physicians' failure to consult him to interpret his wife's wishes during labor. Instead of having participated in a true informed-consent process, he was left to feel powerless and helpless. In this way, forensic psychiatric testimony established a persuasive causal link between the lack of informed consent and the physical and emotional damages suffered by the patient and her family.

So there's my precedent! If a lawyer were to take on my case, he/she would be able to use Meaders case as evidence that others in our society and judicial system have viewed PTSD afterchild birth as a preventable condition and poor outcome caused by doctors who are not doing their jobs correctly. It was just that which lead to me experiencing PTSD after birthing in an abusive, manipulative hospital environment.

The above cited article goes on to discuss the relationship between informed consent and managed care (remember that labor care in hospitals is called aggressive management). It states that malpractice litigation based on violations of informed consent will become more frequent as medical care becomes more managed. The article mentions that "physicians may also be held liable for failing to inform patients about the conflict of interest they experience between their duties to patients and the dictates of managed care."

It was that conflict of interest that I encountered, where the manipulative and coercive treatment I received to convince me to either leave the hospital or consent to procedures against my wishes was done with the intent to clear the labor and delivery room faster so other patients (and their money) could come in, and in turn the hospital wouldn't be "wasting" money on me holding up their room.

A publication is currently being drafted by the American Medical Association that asserts that"physicians must serve their patients' best interests regardless of financial incentives." And if they do not, physicians can be held liable for damages.

The truth about epidurals?

This article was passed on to me by Carla Hartley, founder of the Trust Birth Initiative.

A new book says that women should routinely have epidurals in labour. Experts on both sides of the ‘pain is gain' divide give their views
Anyone who has had a baby knows that childbirth as a competitive sport puts the Olympics in the shade. I'll never forget the “post-match analysis” at my antenatal class, where intelligent, educated women offered grovelling apologies to our childbirth instructor for their “second rate” (i.e, anaesthetised) births. I couldn't help feeling that two thirds of the class had forked out £150 to be made to feel like bad mothers before their babies had taken their first breath.

So it was a relief to come across the book, Enjoy your labor: A new approach to pain relief for childbirth, by Dr Gilbert Grant, director of obstetric anaesthesia at New York University Medical Center. He says that the biblical edict to women to “bring forth children in sorrow” is simply no longer applicable.

So which theory is right? I decided to ask experts on both sides to share their views on the “best” way to give birth.

Dr Grant believes that women should get an epidural, even before pain starts. According to him, much of the information that women receive is incomplete or inaccurate, and that the lucrative “natural childbirth industry” creates fear and guilt about epidurals. He believes that opposition to anaesthesia during childbirth is the result of a deep-seated misogyny: “There is no other situation in medicine in which pain relief is routinely withheld. No man would be asked to undergo an appendectomy, which lasts about 24 minutes, without pain relief, yet the pain of labour, which can last for more than 24 hours, is viewed as something women have to endure.

“Natural childbirth has become a multimillion-dollar industry. The fear of epidurals is promoted by those who discourage their use - and who have a vested interest in doing so.

“Childbirth instructors describe epidurals as unnecessary, or even harmful, interventions and make women feel that requesting one is a sign of weakness that may harm their baby. Labour is seen as an extreme sport - ‘no pain, no gain' - and yet this quasi-religious fervour is based on myth and misconception. The founders of natural childbirth movements NCT and Lamaze, both men, incidentally, claimed that women in primitive cultures experienced no pain in labour. Pain in childbirth, they claimed, is a product of Western civilised society - a learned phenomenon. The implication was that if women breathed ‘properly' or assumed the ‘correct' positions, the labour would be pain-free. Women were made to feel they had failed if they asked for pain relief. There is evidence that in all cultures giving birth has been a painful experience,” says Grant.

“Opponents of the epidural also claim that it may impact negatively on breast-feeding, but there is little data to prove this. On the other hand, there is evidence that unrelieved pain is one of the risk factors for post-natal depression.

“Modern low-dose ‘walking epidurals' allow women to remain active while retaining the muscle strength to push out the baby. Technological advances mean that women are able to administer their own dosage and this makes them feel more in control. Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth.

“Women should be allowed to choose if they want pain relief, but should have access to accurate information. It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth.”

I'd love to hear some responses to these words. I'm not an expert when it comes to the birth research, although I do what I can to weed out the truth from the myths about treatment for pregnancy and birth.

I just find it fallacious that a doctor would compare the sensations of childbirth to an apendectomy which is an invasive surgery where flesh and muscles are being manually cut through. It takes me back to a previous argument: the female body is biologically manufactured for a baby to pass through it, but it is not a natural process for body parts to be cut out. If we wanted to compare apples to apples in this situation, we'd say of course, pain relief is neccessary for a Cesarean birth because its surgery where the baby is being artifically removed from the mothers body.

Also, I believe the author undermines his own argument by stating that the orginators of the natural childbirth techniques are men, as the author of the above article is also a man. If he's going to pull out the gender card, he can also recognize the fact that he himself would not understand or truly be able to appreciate what childbirth feels like from a woman's perspective.

And to address the above mentioned studies, I'd like to see where epidural and analgesia use in childbirth do not contribute to breastfeeding difficulties, or that epidural babies are in "better shape" than those babies who were not exposed to drugs in the mother's system.

Evidently, the obstetrician quoted in the above article is not familiar with the biomedical research done by Dr. Michel Odent and Dr. Sarah J. Buckley(see article the real risks of epidurals are discussed for both mom and babies) who eloquently describe the importance of an undisturbed, psyiological birth where drugs are not being used.

To conclude, I will also point out that, it may be true that "natural childbirth" is a multi-million dollar industry each year, but let's also remember that medicalized childbirth is a multi-billion dollare industry each year, where the belief that women's bodies were evolutionarily made to give birth is ignored and belittled with every procedure and intervention. And let's not forget, the revenue generated from epidurals: over $1000 for each one, and that's not including the incidentals to it: the electronic fetal monitoring, the cathedar, and the prerequisite IV. And this OB is saying that $150 for a childbirth education class is money gouging.

I'm sure that others could address the fallacies in logic and fact in this article better than I. I mentioned some of the points that I felt I could discuss with some intelligence. I'm open to hearing the thoughts and birth truth that others are knowledgeable of.

I saw it...and reserved TWO copies

Tonight I saw the Business of Being Born at the Seattle Film Festival. I had heard lots about it before finally seeing so I'd like to address some of the complaints I'd heard.

One: At one point in the movie, Michel Odent emphasizes the importance of low profile, fly on the wall type midwives. The next birth sequence shows a mother birthing her baby and the midwife reaching for the baby and bringing into the mother arms, grabbing a towel, placing it on the baby, performing a quick once over and saying "Don't mind me, just go about what your doing" (paraphrase).

The complaint I heard was that the midwife wasn't the shining example of the low profile silent midwife that Michel Odent had described. But when I watched the movie, I think I see why the film was editted in such a way. I think her statement was an effort to encourage the new mother to be absorbed in her new baby, and to allow those moments of introduction and bonding to be uninterrupted or rushed. However, I will say she wasn't completly hands off and could have been more low profile. Overall, though, I don't beleive she was a poor example of the point the movie and Odent was trying to make.

Two: I had heard the complain that the movie did not explain the director's (Abby Epstein's) preterm labor and baby's premature birth very well. Maybe since I had heard this complaint prior to seeing the movie, I was very viligant in tracking as many facts as possible. I believe it was all there--she was 4-5 weeks before her due date, Ricki Lake (not Epstien's doctor or midwife interestingly enough) noticed that her adodomen seemed unusually small for the gestational age, they transferred to the hospital because of preterm labor and because the baby is breech, and a C-section took place for that reason. I thought that sequence of events was explained pretty clearly.

Of course, I could only wish that breech delivery was a more socially acceptable method of birth than it currently is in the US, so her baby could have been born vaginally in the hospital as her baby, Matteo, still would have needed some special care due to his low birth weight (a little over 3 lbs).

Apart from addressing those complaints, I was pleased with the presentation, the history of birthing practice in the US, and the factual information given about the unnecessary interventions in use routinely today and their risks. Homebirth and midwifery practice were firmly explained as the ideal birth setting for the majority of births. I think this documentary and clips from it will be tremendous assets to the birth activists, so I am excited to receive my copies of the DVD.

I have two highlights of the show I would like to share. One was the plush pelvis and baby demonstration showing how the baby rotates into position and spirals out while navigating the pelvis during birth, at the same time showing how the pelvis expends to accomodate the baby. This was used as an illustration on helpful birthing positions and how the lithotomy position is the worst possible.

The other is being able to attend with a friend who is beginning to change her views on birthing practices. About three quarters of the way through the film, she rummaged through her purse, pulled out paper and pen and started writing a list of questions which she then grilled me about after the movie. That was a very gratifying experience for me because I saw the power of this film: it is getting women to question the maternity care system and to consider the alternatives to medicalized birth.

Hospital Practices Interfere with Breastfeeding

This kind of piggy backs on my earlier post about hospitals giving free formula samples to new mothers leaving the hospital postpartum.

Birth NETWORK has posted an article orginally published by the Center for Disease Control (CDC). It mentions the appropriate interventions that hospitals should employ to encourage breastfeeding for newborns born in hospitals. It also mentions obstetrical interventions during birth that interfere with breastfeeding. Those include the use of labor analgesics (pain medications like demoral, morphine, etc) epidural anesthesia, and cesarean birth.

The article also addresses the benefits of breastfeeding and why it should be encouraged, both for babies and mothers. It advocates extending breastfeeding through the first year as the benefits possibly include lower obesity rates in childhood and adolescence, and lower rates of childhood illness and infection.

These findings ought to make obsetricians and hospital staff to question the use of routine pain relief given to women in labor and prevent hospitals from lining their pocketbooks from formula companies intent to sell their product to women who ought to focussing their efforts on establishing a healthy and normal breastfeeding relationship. Trust me, women who need to formula feed their babies, know where to find it. It doesn't need to be sent home with them.

The Business of Being Born

The Business of Being Born, a documentary about birth in the US, is currently showing across the country. It is produced by Ricky Lake, who was disappointed to see how birth was treated in the hospital system. She resolved to have a completely different birth for her next child and planned a home birth with a midwife. The documentary shows the birth of her water baby as well as the stories of other families and the process of welcoming their children into the world. It also questions how birth is treated in the US, and that normal birthing is practically disappearing.

I am very excited to see this film. I have been waiting for it for MONTHS to come to a theater near me. And I was crushed when I missed a screening put on by the Seattle Midwifery School.

But finally, I have ample opportunity to see it! The Seattle Film Festival is doing 8 screenings of it between February 29 to March 6.

On a more personal note: My respect for Ricky Lake as a person has grown tremendously knowing that she's taken on this project. Our birth stories are pretty similar--non complicated vaginal hospital deliveries that left us feeling empty, that something was missing, or being treated wrongly in the birth process. We have both started on a path of advocating natural birth options for women who are low-risk. I intend that my next birth will be much like her second birth, out of hospital with minimal interventions, and to truly experience what normal birth is like.

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

Advancing Normal Birth in Journal of Perinatal Education

The Journal of Perinatal Education of Winter 2007 contains a 99 page supplement to the isssue that presents evidence and research for the Mother Friendly Childbirth Initiative. I've included the 10 steps contained in that Initiative below. Thearticle in the Journal of Perinatal Education discusses each of the steps and why they are apart of the Initiative being sponsored by Lamaze International and the Coalition for Improving Maternity Services.

THE COALITION FOR IMPROVING MATERNITY SERVICES:
EVIDENCE BASIS FOR THE TEN STEPS OF MOTHER-FRIENDLY CARE

Step 1: Offers All Birthing Mothers Unrestricted Access to Birth Companions,
Labor Support, Professional Midwifery Care

Step 2: Provides Accurate, Descriptive, Statistical Information About Birth
Care Practices

Step 3: Provides Culturally Competent Care

Step 4: Provides the Birthing Woman With Freedom of Movement to Walk, Move,
Assume Positions of Her Choice

Step 5: Has Clearly Defined Policies, Procedures for Collaboration, Consultation,
Links to Community Resources

Step 6: Does Not Routinely Employ Practices, Procedures Unsupported by
Scientific Evidence

Step 7: Educates Staff in Nondrug Methods of Pain Relief and Does Not Promote
Use of Analgesic, Anesthetic Drugs

Step 8: Encourages All Mothers, Families to Touch, Hold, Breastfeed, Care for
Their Babies

Step 9: Discourages Nonreligious Circumcision of the Newborn

Step 10: Strives to Achieve the WHO/UNICEF Ten Steps of the Baby-Friendly
Hospital Initiative to Promote Successful Breastfeeding

Appendix: Birth Can Safely Take Place at Home and in Birthing Centers

The article is very comprehensive on many, if not all, aspects of birth and maternity care in hospital settings. I'm pleased to see the appendix discussing out of hospital choices. The evidence stands for itself, and states it much better than my humble efforts at a blog can, that midwifery care is as safe (if not safer) than care provided by OBs and family doctors. Care provided by midwives is also shown to have fewer interventions which means exposing women and babies to less risk. The care is often more appropriate for the normal process that birth is; with less morbidity (as defined in a previous post), with more satisfaction, less postpartum depression and mood disorders (i.e. PTSD), greater success rates with breastfeeding, etc.

I recommend this article to pregnant women, or those planning to have a child. Its provides a very good description of what appropriate maternity care is, and provides clues to women to RUN AWAY if they see their care providers not taking the steps described by the Initiative.

POOP on the ACOG!

The American College of Obstetrics and Gynecology just released a new statement regarding home birth. It basically full of contradictions, lies, half-truths and propaganda regarding a topic they are opposed to on the sole reason is that home birth provides competition to a service that currently serves 98-99% of American women. That's pretty dang close to a monopoly, and of course, they want to protect it and their paychecks.

In order to not restate completely, I will refer my readers to a blog from the House of Harris that eloquently and comprehensively covers the contractions within ACOG's statement.

Rixa from the True Face of Birth also shows how ACOG is changing its own party line, without making offical statements that they are changing it. Like changing its verbage about freestanding birth centers. They used to be opposed, but without coming out and saying that they now consider ABCs (alternative birth centers) safe alternatives, they are lumping it into a statement reinforcing previous claims that they do not support home birth. They're so transparent (sarcasm intended).

And to conclude I will share an analogy. (Please remember that analogies are not perfect but can be used to figuratively illustrate a point).

The ACOG states that "while childbirth is a normal physiologic process that most women experience without problems, monitoring...is essential because complications can arise with little or no warning."

Let's compare this logic to the act of eliminating, emptying the bowel, or what I like to call pooping.

Pooping is a normal physiologic process where solid waste is eliminated from the body that is commonly occuring, most of the time without complications. Except for those unfortunate who experience hemmoriods. Sometimes, pooping is really hard and prolonged which is a complication known as constipation. Maybe we should start calling it "failure to progress" or "defecation dystocia." Death can also occur when a unsafe rise in blood pressure caused by defecation can cause an anueryism or blood clot to burst. Fecal incontinence or a fecal fistula are also complications that can arise from defecation.

With that list of complications that arise from a "normal physiologic process" why isn't our every bowel movement carefully monitorred in case these complications arise?

From now on, I would like a medical attendant to carefully monitor me during every bowel movement as to not put my "health and life at unnecessary risk."

Bring Breech Birth Back

Giving birth vaginally to a breech baby almost never happens anymore. Especially not in hospitals. Its one of default reasons for a "necessary C-section." And since C-sections are the obstetrics bread and butter, the more the better. As result, its become archaic for OBs to know how to assist in the vaginal birth of a breech baby.

Some midwifes make it their business to know how to assist in breech births. Ina May Gaskin writes in her book about learning how to do it. However, many midwives will not attempt to assist in the process because of increased liability to their practice.

It is true that there is a small degree of increased risk in giving birth vaginally to a breech baby, but it can be done and it can be done safely with proper skill and training. Is it really necessary to cut a woman open if her baby is going out coming into the world a little differently than most? Have we really become a society where no one can be unique anymore?

As my friends will tell you, I am proud that I am unique and different. I strive to be an individual and do things differently as a matter of course. I am a person to dance to a beat of a different drummer. So is it any surprise, that I was a breech baby? Why wouldn't I start my descent into the world being a little different?

And how many OBs inform their patients with breech babies of techniques to turn a baby into proper position? The website spinningbabies.com provides techniques to move a baby into optimal positioning to birth. Meditation, talking to the baby and even patiently waiting a few days is often enough to turn a baby. There is also a chiropractic technique that uses spinal adjustments to get a baby to move. Most invasively (short of surgery) is a procedure called an external cephalic version where an OB or midwife uses external force to manually move the baby into proper position. This technique does not have a great success rate (65%) and can be painful for the mother, but it is an option to be considered.

And last but not least, there's the possibility of allowing a baby to choose her own way into the world. Amy of Crunchy Domestic Goddess fame shares the story of the surprise footling breech birth of her son. Sarah J. Buckley, author of Gentle Birth, Gentle Mothering, also shares the story of the breech birth of one of her children.

So it can be done! And I'm suggesting it should be done more often. I firmly advocate that women be given the information regarding breech birth without being pressured into a C-section that is also fraught with risks (see my blog What they don't tell you about C-sections). We might find more babies dancing feet first into this world!

The Complaint Process

After a traumatic hospital experience in January of 2007, I have been trying to heal myself and advocate for prevention of traumatic experiences for other women birthing in American hospitals.

First I asked the midwives at the hospital who I would send a complaint to. I was told the nurse manager. I took my complaint to her who said it would go to an internal review board with the midwifery practice at the hospital and their supervisory obstetrician. I wrote a letter to them detailing the outcomes of the care they provided me. It was 5 months from the initial phone call to the nurse manager to the response sent from the review board.

The response I got back ignored my case of PTSD and that it was caused by their treatment. Instead, I was told that I had "received a clinically appropriate standard of care."

I wrote back pointing out this discrepancy in handling my complaint. I was told that my case was being forwarded to the Grievance Committee conducted by the Risk Management department of the hospital. I was also given the contact information for the Joint Commission and the State Department of Health. Both have official complaint processes for patients and family members who believe that their care was not conducted well for whatever reason.

Currently, a year after the initial trauma, I have complaints lodged with the Joint Commission, my state department of health and the risk management department of the hospital. I'm waiting to hear what they will say. And who knows if my complaint with have an effect.

For others interest in making a writen complaint about care they have received go to:
Joint Commission Complaint Form

The Joint Commission is a non-profit accredidation and quality assurance organization for over 15,000 hospitals and medical care centers in the US. They have some clout in getting hospitals to change their policies.

I will update when further progress has been made.