Thursday, December 20, 2007
Christina Aguilera is following a long line of celebrities who think it's smarter to choose surgery and a painful recovery with good drugs than a few hours worth of work for their infant. Let's go through the rundown:
1. Cause baby to be born early.
2. Cause baby's body to be filled with drugs that are totally unnecessary.
3. Expose baby's lungs to normal air before being ready to be born.
4. Deny baby all of the benefits to going through the labor process, including clearing out the lungs and causing the reflexes of normal birth to kick into play, raising the baby's permanent risks for asthma, allergies, SIDS...
5. Cause all future children to be at risk for death due to stillbirth or miscarriage due to elective and unnecessary cesarean.
6. Raise risks for hysterectomy and/or pulmonary embolism to mother.
When oh when will these women realize that they should be learning the responsibilities of caring for children rather than ignoring the obvious risks to their behavior?
Saturday, November 24, 2007
Friday, November 23, 2007
There is no point in reposting something so well done, so feel free to read Kmom's article and the Caesarean myths article as well as watching the CPD video out from ICAN .
The problem with a CPD diagnosis for any woman is that it's based on a guess.
CPD means you look too small to have a baby.
CPD means we couldn't figure out why your baby wasn't descending.
After the Cesarean:
Well, baby didn't descend, therefore it couldn't have ever descended, right?
While the rare medical condition occurs regarding pelvis structure or size, even those conditions are not anathema to a normal birth, they are simply watchwords to keep an eye open if mother or baby are looking like they need intervention. Instead, we intervene without the obvious caution necessary simply because we can.
And I know Christmas is coming and with it all the insane inductions for reasons like tax deductions or family plans. I know how many women will wind up with major surgery between Turkey and New Years. To those women, may you find ICAN (www.ican-online.org) or other healing to go forward in your journey and may your healing be quick. May your holidays be spent being pregnant and enjoying it, aches pains and ickies all around, while waiting for your little one to come rather than forcing that day upon yourself too soon. May you not spend a night in the NICU because of an induction or cesarean that should never have happened. May all your VBAC's be successful. May...the peace of the season and the reason for it, a simple home birth of a small boy child, envelop you with the feeling of sacredness and respect for this process so old and so worth the journey, and may you see that one special moment that millions of women make without ever witnessing the miracle.
And for the perfect Black Friday moment: May you spend more time planning your birth and your care provider than you do buying a new toy or crib item for your layette. After all, you will remember your birth for the next 80 years. A dancing Elmo won't be remembered at all...
So, now I'm going to take time out to say "Happy Birthday" to someone I know who's mother helped make Thanksgiving dinner 28 years ago and then went and had a baby :) Nope, it's not my mom but the mother to a great woman who went on to have a cesarean and become a fellow activist in the field, helping women to overcome their hurts and go on to pursue healthy births. And it's now something to be celebrated when a labor is spent without bells, beeps and whistles and being told what time and when to have the baby, so I think her mom deserves some credit for the work of bringing her into the world. No schedules, no pressure. Amazing that women used to give birth on days where we were giving thanks and now, we strive to make sure there is nothing to be grateful for on that day. Kind of missing the point, aren't we?
Sunday, November 18, 2007
Should we be grateful that insurance companies can deny us coverage due to prior surgery?
Should we be grateful that our state government can override our rights and force us to have a cesarean for the "good" of our infant?
Should we be grateful that the way we garner strength is in having to fight during one of the most precious times of our lives?
How many times must we be "grateful" before the 1.7 million women being cut yearly are seen as an epidemic and not a safe solution to the "problem" of childbirth?
Thoughts to ponder: www.birthtruth.org/grateful.htm
May this week bring you many thing you give thanks for, in strength and happiness, in trial and pain. May your families be a comfort to you...
Monday, November 12, 2007
-"Some doctors would disagree. A vaginal birth after Caesarean carries about a 1 percent risk of uterine rupture, which can result in brain damage or death to the baby, as well as severe injury or death for the mother."And yet, EVERY cesarean is a "controlled uterine rupture," slicing open the abdomen and raising the risks for the exact same things for both mother and baby and for far longer into the future.
-For that reason, the American College of Obstetricians and Gynecologists recommended in 2004 that a doctor and an anesthesiologist be available during all VBACs.
Wow. You mean that the trade union for OB's has decided that all OB's actually must be at the births they are getting paid to attend! Or, even better yet, if they can't be at the births they are getting paid to attend, it's ok to refuse to do them!
-"When it happens, physicians have only minutes to perform an emergency C-section to save the baby and also tend to the mother, who could hemorrhage."
And yet, every cesarean is twice the blood loss to mom...not to mention quick cord cutting for baby, putting them at risk as well.
It just goes on and on...but the famous last words belong to this "intellectual"...
"Dr. Susan Hardwick-Smith, for example, who practices privately and delivers at Memorial Hermann-The Texas Medical Center, now refers patients who insist on having one to another physician. She would never take those risks with her own children, she said, so she doesn't take them with her patients' unborn babies."
Um..."Dr." ....you might want to note that every time you refuse to do a vaginal birth and yet, continue to do elective repeat cesareans...you are not only forcing risks on unborn babies...you are raising them for us all... and that mother and baby are being harmed by you. Congratulations...you are causing stillbirths, hysterectomies, infertility, possible slicing injuries to babies, greater risks of allergies and asthma, greater risks of dying due to respiratory issues for baby and mom could throw a PE. All in the name of "prevention"...
This kind of one-sided thinking endangers us all...
Cesareans are not safe simply because they are sometimes necessary. Turning all mothers into cesareans regardless of individual risk may not legally be malpractice (for those who can understand the difference between what is right and wrong vs what is a legal term) but it is damn sure unethical to do so in the name of protecting your practice. It makes one wonder when the humanity left the practice and only the fear was left. As one OB stated it several years ago: "After 38 weeks, the baby is my enemy"...
All in all, though, I can't help wondering how much revenue the newspaper gets from local hospital advertising. I'd like to think it was simply greed that kept them from publishing the truth, but I have the sneaking suspicion that they just simply don't understand how to give both sides of the story.
(Psst...saying repeatedly "advocates for..." doesn't make you unbiased or fair and balanced. It just means that it saved you from fact checking)
Tuesday, October 30, 2007
VBAMC. Virtually unheard of in a hospital environment, it's also prohibited in most "out of hospital" legislation. The following was emailed to me from a list earlier and it's given me cause for wonder and at the same time, alarm. Last evening, I spent 2 hours with two lovely women who will probably never have vaginal births without a fight. The idea of women having to fight to be able to make their own decisions in health care while pregnant, while gestating, while trying to be at peace simply offends me. Evidently, it doesn't offend the obstetricians who help force through the laws or the midwives who compromise simply to be able to offer care to anyone. Or maybe it does, I don't know. What I am having a hard time grasping right this moment is why we are fighting so hard for legislation that precludes MANY women from using it, due to a perception of risk which is not based in evidence. Those same OB's coerce women into agreeing to the second cesarean through unreasonable expectations (you have to have a 40 week baby under 8lbs? That's REASONABLE? I don't think so!) or through forcing them (I won't take you as a client unless you agree to a cesarean. Sorry, I don't do VBAC) and then have eliminated them through shared practice restraints from being able to do homebirths. So, for the sake of a 1% risk, these women are told they don't have the RIGHT or ability to choose a vaginal birth.
A woman in a hospital setting is not given a chance if she's a normal, low-risk woman having her first baby. I fail to see how mothers who have had more than one cesarean are going to receive fair or balanced treatment based on their needs and not blind protocols.
It's a conundrum. How to make midwifery accessible without making midwives be hunted.
How to make the "system" recognize that women deserve the right to birth where they choose, with whom they choose and with the responsibility of understanding the risks they choose through an informed consent process that matters. I don't see any of that in the legislation.
Oh, and by the way...if you can't have a VBAC unless you have had a VBAC...how in the hell do you get the first VBAC?
*RULE 4 – PRACTICE RESTRICTIONS *
The purpose of this rule is to define the practice restrictions applicable
to a direct-entry midwife.
A. The direct-entry midwife shall not provide care to any client whose
medical history exhibits the following signs or symptoms:
11. Vaginal Birth After Cesarean Section (VBAC) unless compliant with Rule
*RULE 12 – STANDARDS FOR VAGINAL BIRTH AFTER CESAREAN SECTION (VBAC) *
The purpose of this rule is to establish parameters for VBAC patients
seeking midwifery care during pregnancy in order to safeguard the client's
A. A direct-entry midwife shall not assume primary responsibility for
prenatal care and birth attendance for women who have had a previous
cesarean section unless all of the following conditions are met:
1. All prospective VBAC women shall sign an informed consent statement,
which shall be retained in the client's records and include the following:
14 (a) VBAC educational information including history of VBAC and client's
own personal information;
(b) Associated risks and benefits of VBAC at home;
(c) A workable hospital transport plan;
(d) Alternatives to VBAC at home; and
(e) Other information as required by the Director.
2. A workable hospital transport plan must be established for home VBAC. The
plan shall be in writing and include:
(a) Place of birth within 30 minutes of transport to the nearest hospital or
emergency medical center able to perform an emergency cesarean;
(b) Readily available emergency numbers for the nearest hospital or
emergency medical center; and
(c) Provision for phone contact with nearest hospital or emergency medical
center prior to any transport notifying the destination that transport is in
3. There has been at least 18 months from the client's cesarean delivery to
the due date of the current pregnancy.
4. The client with 2 or more cesarean deliveries has also had a prior
B. Direct-entry midwife shall obtain prior patient cesarean records, in
writing, and shall analyze the indication for the previous cesarean, and
retain the records along with a written assessment of the physical and
emotional considerations in client's files. If the direct-entry midwife is
unable to obtain the written records, the direct-entry midwife shall not
retain the woman as a client.
C. Records that show a previous classical uterine/vertical incision or any
previous uterine surgery which required an incision into the uterine fundus
are a contraindication to VBAC at home and shall require immediate transfer
of care of the patient.
D. Direct-entry midwife shall not induce or augment labor by the use of
chemicals or herbal supplements or nipple stimulation.
E. A direct-entry midwife shall be present and manage the VBAC delivery from
the onset of active labor throughout the immediate postpartum period.
Monday, October 22, 2007
Obstetricians do know how it feels to be a VBAC mother. They live every day, wondering when someone will give them a gut wrench and hand them a court summons to appear. Knowing that someone else controls their livelihood in the blink of a moment, that gut check controls their existence.
VBAC moms live in daily fear of that gut check. It controls their ability to birth in a safe environment with a care provider they trust. Knowing that at any moment, their "care" could become defensive and controlling, knowing that at any moment, they could be left out to dry and forced to have an unnecessary surgery because of that OB's fear.
The difference is simply meted out in dregs..it's all fear and misery.
The only real difference in the outcome is this:
An OB could lose their practice, their livelihood, their home or their car.
VBAC mothers could lose their life or their baby's life on that table.
Defensive medicine cannot excuse away the unconscionable actions being taken that endanger our women and babies. Maintaining a license is NOT equivalent to maintaining a life.
Wednesday, September 26, 2007
From ICAN of Orlando:
If you only make one call in the next 24 hours, MAKE THIS CALL!
LOCH HAVEN OB/GYN: 407-303-1444
235 E Princeton St - Ste 200
Orlando, FL 32804
We have it on good authority that the doctors at Loch Haven OB/GYN will be having a meeting on Friday to discuss whether they will go back to doing VBACs now that Florida Hospital has lifted their ban. Loch Haven is a major obstetrical group at Florida Hospital. If they start doing VBACs, other OB's might follow.
Please, please, please! Call, write letters, or send emails to them, (or do all 3!). EVEN IF YOU DIDN'T HAVE A C/S, PLEASE HELP OUT! Please let them know that you will support them in their decision to protect a woman's right to choose how to birth. Encourage them, in whatever way moves you, to give women the option of VBAC. It is our hope that if they see that there is a market for VBACs, they will be more likely to go back to supporting them. (If they ask why you care if you didn't have a c/s, just say "Any pregnancy in the future may cause me to have to go under the knife. I want to know this option is available to me." Or something like that.)
**If you were a Loch Haven client in the past, or are now, it would be especially helpful for you to call.** If you avoided them because they wouldn't do a VBAC, please tell them so.
Letters must be in the mail by tomorrow AM to make it by Friday, but that may already be too late. I would recommend calls and emails just because we have so little time. Michelle is posting the letter she is sending, that would be a great starting point if you are not feeling very articulate about the topic at the moment. Make your calls/emails/letters personal, brief, and to the point. And, you could also point out that their own Dr. Hill was once a VBAC supporter, and you are excited for him to be again! Do it now, while you are thinking about it! :-) Call me if you need help!
Friday, September 14, 2007
*in the past, these meta analyses showed a 10% increase in Cxion (his word again..sigh) with epidurals. This one doesn't..hmm.
*Quoting him "It is not the fault of the RCT as a methodology!!! It is the fault of the inclusion in the meta-analysis of studies that ought not to be there - or the studies need to be grouped or stratified according to their settings or approaches so one can know if the results apply to one's own setting."
THIS IS IMPORTANT. Cochrane is trusted, so we don't realize that the data is being SPUN!
*There was an inclusion of one study with a LARGE population that gave their epidurals late in labor, only in active labor. Without Sharma, there is a 4.3 hour increase with epidurals, with Sharma, it's only 1 hour increase (1st stage of labor); cesareans were higher, perineal trauma was higher, infant consequences higher. The book for this is very blurry, so I am hoping that Dr. Klein will forward me his slides so I can actually use this information with real stats.
This session was a talk on Randomized Controlled Studies and how they are misused.
*In a matched cohort of healthy women, one hospital had a 8% cesarean rate, the other a 20% rate (early 1990's...don't we wish that was now!)
Cesarean rates with women having epidurals: 15.4% in the one low hospital and 67.2% in the other. The odds were 3.4x higher. In the low risk hospital, epidurals weren't given until later in labor, typically. The interesting thing is that with women having NO epidural in both hospitals, the cesarean rate was about the same and the women having an epidural in both hospitals, the risk of a cesarean was about the same. Dr Klein states that we don't know that it's causal, but it's a dang good coincidence, eh?
(Janssen P, Klein MC Differences in Institutional Cesarean Rates: The role of Pain Management. J Fam Pract 2001, 50(3) 217-223)
*His research survey also showed some correlation with epidurals and newborn outcomes. The higher the epidural rate, the lower the apgars in newborns and the more newborns in the NICU.
Interestingly, he notes that physicians who spent more time with their patients, even though their patients were in the hospital for a shorter period of time and used epidurals later..had better outcomes.
*universiality cannot be conferred by an RCT, even if done WELL. A small hospital with three doctors ad 1000 births per year is not going to have the same type of situation as a hospital with 30 physicians and 25K births per year. (my numbers, pulled out of my hat.)
More on the Next Blog Entry. :)
Thursday, September 13, 2007
But I have three daughters and they stand to lose so much. Their faith in themselves. Their health. Their future fertility. Their choices.
Giving birth in today's climate means that I have to pick one of them to have all of those risks thrown to the wind. And if things continue or they wind up with an obstetrician...their risks go to 1 in 2.
I'm the mommy and if you don't care enough to be doing something, I do. I'm the only one standing between my daughters and that future. Cesareans if necessary, fine, but otherwise, keep your non-evidence based defensive medicine away from my daughters or you will find yourself dealing with me. You may anyway.
Wednesday, September 12, 2007
Freedom to be able to move, make your own decisions.
How does autonomy play into the cesarean epidemic?
A homebirth midwife in many states is required to practice under a law which requires her to follow protocols established by the medical community standards, many times being excluded (Arizona) from seeing VBAC clients.
A CNM in a hospital setting is required to have her protocols reviewed by her "supervising" OB. In order to do so, she compromises on things that are expendable, many times excluding VBAC's from any care or making VBAC's do a variety of hoops such as continuous EFM (non-evidence based care), induction, refusal to allow a woman to continue past 40 or 41 weeks...the list goes on and on.
A Childbirth Educator has to watch what she says in order to keep her job because she might be encouraging women to ask questions, refuse interventions.
A doula is a private practitioner who can be removed from a hospital or banned from a particular practice's patients.
As Henci Goer reminded me this weekend, one particular individual at the NIH's meeting on Maternal Choice Cesarean stated that he was simply a good soldier doing his job, taking orders.
We are all taking orders from the American College of Obstetrics and Gynecology in a trickle down of morbidity and mortality that will touch generations to come. None of us have our hands clean in this debacle. This is not fear of malpractice, though that makes a nice excuse for obstetricians to bring to the table. "We don't want to get sued." Well, I'm not sure who believes this any longer and if they did... let us ask ourselves:
Are we simply taking orders? Are we the bystanders saying "Oh My God. That woman just died due to an elective induction." (the wife of a local arena football player) or "Her boggy uterus wouldn't come back, so she lost her uterus due to an ERCS." (a mom in New Jersey) or "my baby spent 3 weeks in the NICU for an unnecessary cesarean"...are we simply recounting the tales?
Are we standing in horror, unable to move? Are we the resistance?
Or are we the Germans....crawling back into our homes to hide in case that they next come for us?
Tuesday, September 11, 2007
Thirty percent of all births in Florida done by CPM's were VBAC's.
And I just put all of them at risk by posting that. I was asked not to publicize or publish it because almost all of them are under review or investigation, either across the board or surreptiously. The climate of fear is palpable and protocols control birth at every level, even if you aren't an OB because the OB's set the standard for protocols with their trade union, ACOG. If you are a homebirth midwife, you will be hunted.
What is truly evil, however, is that other midwives, childbirth educators and moms will hunt you as well. If you do VBAC's, you "put the others at risk." At risk for what? For losing their licenses, for being investigated, for being lied about, for losing the right to attend "normal" women. In other words, they are forced to choose who to support and VBAC mothers are not who they choose, even when they still attend them. VBAC mothers are expected to step back for the "good of the many" and to walk a line of obeisance to all other women and care providers. When an OB states HIS policies, we are supposed to be grateful he even takes VBAC patients. When they state (without evidence) that we should be continually monitored, have epidural catheters placed, or birth in the OR "in case" we should be GRATEFUL. We should be quiet. We should thank our lucky stars that a surgeon is willing to waste his time to come watch by our bedside. Hell, some OB's charge $1000 up front, no insurance, for this priviledge. We aren't allowed in water to help ease the pains of labor and we should be grateful for them taking away this coping mechanism. And others will back them up, too. If we complain too loudly, they might stop doing VBAC's all together! Well, I disagree.
The right to choose a VBAC should have women lined up outside of hospitals protesting. Demanding. The media should be writing about the non-evidence based care and assault on these women, the stealing of their civil rights. Midwives, childbirth educators, doulas, mothers, and OB's should all be agreeing on this. And if they don't, it's simply fear at being caught out of the pack and being taken down. The fact that they are allowing women to BE isolated out of the pack and hunted says so much all ready.
Shut up? Sit down? I don't think so. I'm still writing letters and making calls. I may not change things, but I am tired of women being forced to give birth at home without any trained care or agreeing to care that is cruel and uncalled for in the name of appeasing those with the power or those who shudder in fear.
Lately, I've seen a variety of things that have disturbed me. I've come to call the phenomenon "Distortion of Normal".
For instance: The average size of a newborn infant.
We measure this by comparing all newborns. In fact, we should only be counting newborns who are unmedicated and uninduced, non-cesarean in order to get "real" numbers. But in this day and age, even that number would be distorted. We've come so far into an induction/augmentation culture that most babies are not allowed to reach their potential birth weight nor their potential birth dates. In a world of scheduled birth or scheduled surgery, how do you define the "day most babies are born" or the "average" gestation.
Monday, September 10, 2007
This is the CDC's Vital Stats page for cesareans. Do you know your county's risk?
My county had 21 VBAC's in 2004. Twenty-one healthy vaginal births after cesarean.
My county had 520 Repeat Cesareans.
If (being conservative) 70% of all trial of labor would result in a VBAC...that means that 364 women were potentially VBAC mothers and only TWENTY-ONE escaped being cut.
And my county has a 34.89% rate of cesarean and a 23.58% for all first time mothers having cesareans.
I'm going to scream now. I want you to hear this as a scream. I want you to hear it as the same visceral sound as if your mother caught you stealing and you are looking in her shocked face as she says "what the hell are you doing?"
WHAT ARE CARE PROVIDERS DOING TO NORMAL WOMEN IF ONE OUT OF FOUR NEW MOTHERS ARE BEING CUT AND MORE THAN ONE OUT OF THREE TOTAL MOTHERS ARE GOING HOME WITH MAJOR ABDOMINAL SURGERY AND LIFELONG COMPLICATIONS!
They are coming in pregnant and going out high risk. What is happening in the process?
The sad part is..this was three years ago. I guess the hospitals are damn lucky the rates aren't kept real-time, huh?
So what is your county doing to women and what are you doing to change it?
Sunday, September 9, 2007
So...Dr James McKenna, the uberdude of co-sleeping and normal infant sleeping behavior stands up at the Lamaze Conference after being given an award and comments on the ridiculousness of receiving an award for the simple acts of a baby simply sleeping with it's mother! I could have hugged him!
Then he does one better.
"The only authority over parents that these professionals have is what the parents choose to give to them."
If only parents believed that and worked with the intuition and assumption that babies deserve to be with their mothers and that parents should be willing to lay down their lives rather than allow the treatment that these so-called professionals of the world regularly and pervasively assault them and their babies with.
So back to the Legacy.
Dr. Klein shared that he was born by Cesarean section and I found that to be unique in and of itself. How many children will be leaving legacies born of a generation of surgical births? I'm probably going to update this post several times in the process, but here are some highlights I found from listening to him.
1. He's still a doctor. Medical model/statistical significance, those things matter to him so it's a bit like having a spy on the "inside".
2. His statement on the conflict of interest inherent in "informed consent":
"Counseling over the mode of birth should not be in the hands of those who benefit the most from it."
3. He was explaining some data and compared it to cesarean birth, then changed his wording and stated, "See, even I get caught in that trap. I shouldn't be saying cesarean birth. The term is cesarean section."
High points from the Research commentary:
*He stated that the epidemic of placenta accreta has parallelled the rise in cesarean section.
*He emphasized looking at the totality of the environment when assessing research. You can't transfer the results of an optimal environment with excellent care onto the vast audience of women getting substandard medical care in the United States, just as you can't take a midwifery driven program in Israel and transfer those results onto OB care populations in the US. You will not get results that apply to your life, your environment, your hospital.
*Nulliparas (first time moms) should never be compared to multiparas due to the differences that arise in how birth happens the first time vs subsequent pregnancies. Totally different animals. "You have to be a very bad doctor to screw up multiparas"
*Acknowledgement that nurses are not looking at the mother, but watching the machinery.
*He emphasized using both sides of your brain. You can not take only the left-sided thinking of 'this action equals this outcome' without taking into account the larger picture and impact on a variety of consequences. The global approach is necessary if you don't want to cause more problems than you are trying to prevent.
It's not simply renormalizing birth (walking in labor is NOT an intervention, it's the NORM biologically for our species) it's also learning how to turn conversations away from defending natural or normal birth and towards proving the assumptions of non-evidence based care.
How do you prove that vaginal birth is normal? How many studies does it take to explain that what happens after an non-interfered (oh isn't this a wishful thought!) with birth is species normal?
That's how I feel about ICAN (www.ican-online.org) and VBAC.
However, at a conference like Lamaze, the split was at least fifty/fifty on who knew about ICAN. The International Cesarean Awareness Network has existed for 25 years as a grassroots entity helping mothers prevent cesarean, recover from the surgery, plan for indicated surgeries and promoting VBAC as a healthy, safe way to birth. With 100 chapters in existence, how can so many mainstream educators not be aware of it? What resources are they giving their mothers to deal with the cesarean rate? To deal with the aftermath in a 1 in three society that is in reality 50% in so many places. How are these mothers being supported after a birth goes in that direction? These are questions to be asked because these are the women helping them prepare for birth.
"Oh, that area is numb, you can't feel it."
"Oh YES you can"
"I had a cesarean, I didn't feel any pain on my scar"
Wow. Just wow. How many mothers walk away from the hospital still feeling pain? My roommate at the conference still has pain in her scar THREE YEARS LATER. We can be experts in our own situation with a cesarean, but other mothers out there are feeling more or less than we are and we cannot even begin to express totalities. I resisted the urge to ask her how long ago her surgery was and if she wasn't extrapolating her current reality onto what happened in the first few postpartum weeks.
If it doesn't hurt, why are some cesarean moms hooked on oxycodone?
So what can we take back from the choir and sing to the masses?