Firstly, thank you for the emails wondering where I’ve been.  February a year ago I was diagnosed with multiple embolisms in both lungs.  By the time I was diagnosed the emergency room staff told me I was a walking miracle.  By all counts I should have been on a ventilator with only a miracle to save my life.

My family does not have a history of blood clots.  I had not recently had surgery.  I had not been on any long trips, air travel.

The only cause I could come up with is the Mirena IUD.  The doctors say there are no indications on file anywhere that the Mirena IUD causes blood clots or that a woman using it should watch for embolisms.

I would love to hear from others regarding their experience with the Mirena IUD.  On the web I have seen only a couple of stories of women experiencing same, but none of us can prove it is the Mirena IUD.

I would also like to hear from anyone who has used the Mirena IUD and had issues with pregnancies immediately after discontinuing its use.

All the best and thank you for your support, those of you who knew what I was going through.

Dale

Sheridan at the Enjoy Birth blog wrote a wonderful post, starting with:

Imagine the year is 2035.  People rarely cook at home anymore for a few different reasons.  They have gotten too busy and because of subsidies from the food industry eating at a restaurant is less expensive.  They actually pay more out of pocket to eat at home.  Many people look back and remember, “People actually prepared meals AT HOME!  It is amazing that they were willing to go through all that time and energy and that so many survived.”

It is an excellent analogy to the current “birth wars” that Jennifer Block wrote about here, discussing home birth versus hospital birth.

Both articles are must-reads!

Seriously?  When it comes to maternity care the emotional tie of a baby’s health can be used unscrupulously.  Of course a mother doesn’t want to do anything that would hurt her baby, but is the emotional blackmail of responses such as these really necessary?:

“Well, if you don’t care what happens to the baby…” “If you don’t do this your baby could die.” “You can choose that if you’re going to take all of the responsibility for the risks and sign this waiver.” ~ What Are They REALLY Saying?

Natural or ‘normal’ birth advocates and educators are sometimes labeled as rebellious, extreme, etc. with the opponents claiming in the same breath to also being focused on healthy birth outcomes.  Kathy Petersen, IC member, muses more about the same team issue.

There may not be an “I” in ‘team’, but there certainly is a “me.”  The only ‘team’ that exists is the one you put together and at its center is you.  You are the “me” in team.  You are an active participant in your birth and that actually benefits your practitioner because you get to give informed consent or informed refusal.   Are practitioners so afraid of the legal system that it’s easier to just have women go along with what makes a lawsuit least likely to arise?  The truth is most consumers don’t want to have to deal with a lawsuit either.  It may appear to be easier and simpler to just go along but it isn’t.  If Big Baby Bull doesn’t help you see ‘malpractice’ intertwined with emotional tugs perhaps a mother or a baby dying from the misuse of the drug Cytotec for an induction (for the suspected big baby??) will.

Informed refusal gets dicey because a practitioner must be able to prove that their client/patient was aware of the consequences of not following a specific protocol.  Yet when it comes to maternity care, a system so fraught with the overuse of technology that many in the field admit they’ve never seen a natural birth, can practitioners really convey to a mother what will happen if they refuse technology?  We can hear that conversation now: “Well, if we just sit here and wait you will have to have this baby completely on your own!”

A practitioner’s ability to understand normal birth is greatly undermined by their own failure to appreciate the litigious environment they created themselves.  ACOG recently admitted, for example, that the guidelines for external fetal monitoring are left open to interpretation.  What they are not making clear to the consumer though is that it is the obstetricians who have failed to understand and deploy external fetal monitoring prudently but it is the mothers who are shouldering the consequences, the fear of malpractice:

“Our goal with the ACOG guidelines was to define existing terminology and narrow definitions and categories so that everyone is on the same page,” says Dr. Macones. One of the problems with FHR tracings is the variability in how they’re interpreted by different people. The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings. ~ ACOG Refines Fetal Heart Rate Monitoring Guidelines, June 2009

Desirre Andrews, IC member and President of ICAN, shares Alexandra Orchard’s experiences spanning six years of trying to achieve a natural birth.   Again, as Alexandra and her family learned, it is not the VBAC itself that is to be feared but rather fear that the practitioner’s judgement, recommending surgical delivery in the first birth, will be called into question is what drives a practitioner’s loathe to attend a VBAC mother.

Last, the public itself is brought into the drama with irresponsible headlines such as this one from the New York Times blog, Refusing a C-Section, Losing Custody of a Baby.

Contrast Alexandra’s letter to her obstetrician (watch the video to the end!) to this scenario ripped from the headlines today over the mother who supposedly lost custody of her daughter solely because she refused a repeat cesarean.

Independent Childbirth supports the natural birth community through the use of quality and self-earned birth knowledge about natural childbirth.  Mothers are the birth experts.  We share normal birth and because we do, more mothers today recognize medical interventions are sometimes needed but they do not justify today’s rate of surgical deliveries, birth injuries and denying mothers of patient rights.  Let calmer heads prevail, that of a thinking mother (who isn’t?) choosing normal birth experienced practitioners who value a mother’s instincts.

**For more on “informed refusal” visit The Risk Management Handbook for Healthcare Professionals.  For more information on the New Jersey case visit Knitted in the Womb and VBAC Facts.

This is probably best read if you have something calming to do at the same time, say, while  Nursing Johnny Depp.  The oxytocin released from breastfeeding may calm you more than you’ll be fired up in our comparison of ‘medical birth for all’ issues and out of hospital birth debates today to the Vietnam era.

Can we ever be on the same team?

“Domino theory” is the phrase coined during Eisenhower’s presidency in the 1950s to justify the hastening entry of the U.S. into foreign nations in order to stop the spread of communism.  Swap out the players of Eisenhower’s era with the ‘natural childbirth’ era you’ll have an idea of how ACOG fights the legal battle to erode the protection of normal birth ~ if not home birth ~ as a right for all women living in the USA.  If just one state votes to protect home birth then neighboring states will and so on and so on.  Home birth will spread like wildfire and healthy birth outcomes for healthy women will be the norm.  Incredible.

Basically, with a normal birth experienced care provider you can expect that:

Women and babies laboring normally don’t typically fall like a line of dominos towards a cesarean, episiotomy, forceps or vacuum delivery.  It’s the interventions that push them over.  Remember the pit to distress order?  Start your birth un-naturally or make it un-natural at some point with pitocin and/or an epidural, you’ll arrive at a greater risk ratio for mechanical or surgical delivery.   The domino theory espouses there is no time to wait, each intervention must be applied now because of the one applied previously, until eventually the penultimate goal, birth, must occur now.

Natural childbirth is currently your best insurance against un-necessary interventions and insurance for a normal and healthy birth.  If, laboring at home or in an independent birth center you are transferred it is not likely to be an emergency scenario but a scenario where the need for medical observation is warranted.

Certified Nurse Midwives are on the rise as a result of increasing numbers of women seeking midwifery care.  Hospitals and OB practices that have midwives in their group “look better” to consumers.  In order to employ midwives without risk to their own profit however they must show midwifery care as the practice of medicine, which midwifery is not.  To these practitioners only such a person with medical training, in these instances nursing, is recognized as a ‘midwife’ then.  Is it a coincidence then that midwives find themselves engaged in an internal battle themselves?

The domino theory today is alive and well, hobbling maternal and newborn outcomes. Dominos don’t always fall, but ‘medical birth for all’ advocates will always try new set-ups. Stand up for birth.  Choose the integrity of midwifery care.  Deliver with both feet on the ground!

We hear from practitioners about women whose goal it is to avoid a cesarean and have uninterrupted contact with her baby in the first hours of her baby’s emergence into our world.  It seems that these practitioners find it completely illogical for women to desire this goal because women are often out of it, exhausted, or undergoing surgery by the time second stage arrives.  In their experience, women are begging for epidurals, asking for c-sections, are completely unprepared for “the realities” of labor.  The practitioners are completely oblivious as to their role and influence in the outcome of the birth.  They are aware, though, that the public’s awareness of the need to question the application of protocols in general is on the rise.  Chaos ensues when the practitioner no longer takes on the responsibility of learning about normal birth, remaining current on research, does not hone his/her listening skills (read: bedside manner) and does not exercise patience, a critical element for a healthy birth outcome for both mother and her baby(ies).  How can we expect them to see they are the main contributing factor to what a laboring mother’s second and third stage will be?

It doesn’t strike practitioners as odd that they’ve come to believe and accept myths or oft-repeated misinformation as fact.  Peer research concludes the use of consensus in scientific matters is not infallible.  If the Michigan AMA Resolution 710 proposed above isn’t difficult enough for expectant mothers to fight their way through, there is also the medical birth community’s attempt at blaming mothers for dismal service results including the rising cesarean rate.   It seems mothers are darned if they do (they’re identified as hostile) and darned if they don’t (they’re asking to be cut open).

For example, back in the news again is a protocol that has not changed since last highlighted three years ago, but if it did revert back to its historically safe use has the power to change our country’s maternal and newborn statistics: pitocin.

Pit to distress” is the formal name of a protocol by which a mother is given pitocin to  either induce or speed up her labor at a rate that subsequently distresses the baby and leads to an automatic c-section.   Independent Childbirth member Jennifer Riedy explains the protocol on her blog and follows up in our post stating First…nurses (and doulas, and OB’s…and any type of care provider) need to realize that what happens in their area of practice is not the same as what happens in another area.  Even as a doula I see vastly different practices in two hospitals that are part of the same hospital system and located only 20 minutes drive from each other.  If a particular hospital has implemented guidelines to avoid “Pit to distress” that is great.  But don’t fall into the trap of believing that it isn’t happening (in another L&D room).

Just because it isn’t *called* “Pit to distress” does not mean that isn’t what is done.  If an order is given to put a woman on a certain dose of Pitocin, then up that dose every 15 minutes up to some maximum dose, then the unwritten part of the order is “or until the baby shows signs of distress.”

…Bottom line, the package insert says to start the Pit at 0.5-1 microunit per minute, and raise at 1-2 microunit per minute increments every 30 to 60 minutes.  More aggressive protocols raising the drip rate every 15 minutes –even if it is using those same doses–also put a mother and baby at the risk of being “Pit to distress” because it takes over 30 minutes for the Pitocin to equilibate, so while baby may tolerate well the dose that was set at noon, you will not really know that until after 12:30, and if the dose was raised at 12:15 and 12:30…you may have hit the “distress point” with the 12:15 dose.”

There are other mothers who will tell you they experienced pitocin at levels that they instinctively knew were not right for their bodies because their bodies were not only in pain their bodies were also signaling signs of fight or flight response.  They begged to have the pitocin turned off, only to have practitioners refuse to document their request and outright deny it as well.   A Rockville General (hospital) doctor in Connecticut was cited by one such mom when she birthed there in 2007.  She went on to share that the practitioner believed her mother was trying to influence her decision to ask for the pitocin to be turned off and attempted to remove her mother from the birth room (labelled hostile perhaps?).  Another doctor at UConn in Connecticut has stated that he is known for having the most aggressive pitocin protocol and achieving more vaginal births that way.  But, at what cost?  Certainly we were present for one such birth where a mother experienced an adverse pitocin reaction and rather than document it as such her files were noted that she refused pitocin.  Incidentally this same doctor is infamous for telling mothers who desire a natural birth that “80% of women ask for epidurals” (could that be because of the pitocin rate you employ???).  This is not an indictment of UConn, where we have also been present for healthy natural childbirth experiences with other doctors.  It is to exemplify the need for mothers to research their practitioner options and to confirm Jennifer’s observations that two vastly different scenarios can take place in the same hospital!

Jennifer Riedy’s well researched conclusions on the use and abuse of pitocin being common are backed up by the medical community as well.  Doctors Gary Ventolini and Ran Neiger state (Contemporary OBGyn; Sept 2004): “Oxytocin is also abused when one attempts to induce labor, especially in patients with unfavorable uterine cervix, and ‘induction failure’ is diagnosed shortly thereafter, before the onset of active labor.  We feel that as long as the fetal condition is reassuring cervical ripening should precede labor induction.  Once labor induction has begun, don’t abandon it in favor of a (cesarean) delivery before the cervix has started changing only because a set length of time has elapsed.”

On the subject of routine induction at 41 weeks as another example, there are also practitioners who see the fallacy of consensus in the medical community, specifically from practitioners Leung and Lao of the Department of Obstetrics and Gynaecology, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (Routine induction of labour at 41 weeks of gestation: “nonsensus consensus”; BJOG Volume 109, Issue 12, Dec 2002):

Sir,

We read with great interest the commentary by Menticoglou and Hall published in May 2002 and want to echo the point of increasing caesarean section rate as a result of this nonsensus consensus. Our unit has adopted the practice of routine induction of labour at 41 weeks of gestation for several years on the basis of the findings of the Cochrane Review1, which suggested that this approach can reduce perinatal mortality. Women are admitted to the hospital at 41 weeks of gestation for cervical assessment with the Bishop’s score and induction of labour.  If the cervix is favourable, combined induction of labour with
artificial rupture of membranes and oxytocin infusion is performed on the following morning. If the cervix is unfavourable, a vaginal prostaglandin E2 3-mg tablet is used to prime the cervix. Combined induction is performed on the following morning if the cervix becomes favourable. If not, another dose of vaginal prostaglandin is given and induction is delayed for another day. In the case of labour occurring after cervical priming with vaginal prostaglandin, it is counted as induction of labour.

We have analysed the caesarean section rate for nulliparae undergoing induction of labour at 41 weeks of gestation from our hospital obstetric database. In the year 2000, 183 nulliparous women were induced under this consensus and 59 of them (32.2%) had caesarean sections. This caesarean section rate was significantly higher than that for term,
singleton, vertex presenting fetuses in nulliparous women in the same year (excluding those 183 women with induction at 41 weeks), which was 368/2271 or 16.2% ( 2 test, P < 0.0001). More alarming is that the caesarean section rate for nulliparous women undergoing induction of labour at 41 weeks of gestation increased even further to 35.0%
(63/180) in the year 2001 and 41.1% (23/56) in the current year (January to May).

We agree with the authors that it is now time to reconsider the consensus on routine induction of labour at 41 weeks of gestation, particularly in nulliparous women.

Reference
1. Crowley P. Interventions for preventing or improving the outcome
of delivery at or beyond term [Cochrane review]. The Cochrane Library,
1. Oxford: Update Software, 2002.

Simply put, you can’t get there (a normal second and third stage) from here (a medically managed first stage) without hitting a whole lot of long shots along the way.   We’ve read the book many times and the ending never changes.  Straightforwardly put, neither medical model practitioners nor mothers will ever know how different a birth experience might have been, and that has reverberations throughout a mother’s  lifetime and her baby’s lifetime.

The responsibility for knowing normal birth truly lies with mothers today as the majority of practitioners cannot get out of their own way in preventing injury to mothers and their babies.  You can, however, keep them out of your way.  Learn from the experts: other normal birth experienced support resources. The educated mother can choose her practitioner wisely and ‘get there.’

Keith Roberts is unfazed by the attention given him as the first man to be certified as a doula by DONA.  He has has spent over 30 years in the field of holistic care, specifically focusing on pregnancy massage therapy and birth support for the last fourteen.  The prenatal massage work he does was a segue to following one mother right into labor where he found expert massage therapy was extremely beneficial to her in labor.  She was the first of fifteen more mothers he supported in labor before he determined to pursue certification as a doula.

Keith is perhaps more determined than female doulas to not replace fathers at birth.  The female support presence is invaluable because she is female and yet that bond is one that many a father may meet with trepidation: a club that he can’t be a member of by virtue of his gender.  Keith recalls an image that influences his genuine welcome of the father, an old cover of International Doula.  The cover’s image showed a mother embraced by her doula and the father is in the background.  Many a father today may not care to be present for labor but just as many men know there was a battle fought by Dr. Robert Bradley and the Hathaways to protect a father’s right to be in the labor and delivery rooms.

Those men who do want to be present for their child’s birth are already engaged in a checklist of all that they are expected to be today: he is to know everything about birth because he will be the mother’s advocate allowing her to focus on her labor; this he must accomplish while also providing physical, mental and emotional comfort.  Then after the baby is born he must strike the perfect balance between staying with mother throughout third stage and going with his baby should there be a medical reason to separate mother and baby.  As many a partner has put it, he/she must be everywhere, have eyes in the back of their heads and know how to play football, delivery room football that is.

Keith’s role is primarily for physical comfort.  It is easy for mom to choose between the two males present for her emotional and mental support….dad is her intimate partner.  “(Partners) are a reflection of mother’s state-of-mind; they tend to follow her lead and birth is just as much of an unknown to them as it is for mom.  They (dads) have as much a desire to meet birth at mother’s level of comfortability and she will want dad in front of her, to see him and be held by him.”  Further, for all of the reasons listed above, men appreciate having another male present in the primarily female energy until and unless a male obstetrician walks in for a few minutes of observation, medical speak and then exits.

When asked how he perceived the choice of a woman to invite doulas, let alone a male doula, to their births over their mothers even Keith’s keen observation of relationships is quick to surface.  In his experience few mothers want their own mothers present because they will feel a need to perform or meet parental expectations whether real or imagined.  Having their own mothers present is often an overwhelming thought no matter how comedic, true or polite the response is expressed!

Keith’s own intimate insight into birth as someone who could not experience birth for themselves but supports laboring women gives invaluable advice to partners.  These are his experienced Natural Birth Critical Factors:

  • Once you are in labor you cannot stop the flow of birth care you signed up for.  Choose wisely.
  • Read. Read. Read.  Take a natural childbirth class and read some more! A natural childbirth experienced and focused birth class leaves mothers and their partners with less “unkowns” and less fear of those unknowns.
  • Learn about fetal positioning.  The more you know about baby presentations and how to encourage optimal ones and work with less than optimal ones the more sense prudent changing of positions in labor makes.
  • Your choice of birth care practitioner directly relates to your odds of having a cesarean!
  • Keep the bag of waters intact!  Artificial rupturing of membranes (AROM) or artificially breaking the bag of waters is trivialized.  EVERY practitioner knows that within a short while of breaking the bag of waters labor intensifies in a ratcheted manner (versus a natural progression) and the majority of women will subsequently ask for an epidural.
  • Hire a doula for the purpose you want be it physiological support, birth knowledge, support for dad.  In all cases the doula can alleviate what stresses you most leaving you better able to meet labor’s demands with all of your own energy.
  • It is very hard to buck the system therefore, go back to Critical item number one.
  • Lastly, but more importantly, he reminds mothers that they have their own voice.  A doula will provide his/her opinion if asked but will never make a mother’s choice for her.  Mom must convey her choice directly to her careprovider and partners must be prepared to be be the first line of support echoing mother’s choice and minimize the number of minutes he/she might otherwise spend playing football by putting all that you’ve learned in a natural childbirth class into action.  Learn more about how your doula can best help you.

Through supporting women in labor hands on, so to speak, Keith has gained a whole new appreciation for the courage of women and for the hospital birth experience.  He concurs with Penny Simkin’s address at the DONA conference in Washington D.C. three years ago where stated the doula backlash is very real.  Keith advises new doulas to be mindful of their standards of practice and ethics.  Unless they have an established relationship with local practitioners then their voice, necessary for the support of laboring women, must be viewed as respectful of the practitioner and facility as well.  Birth is a hands on experience for the obstetricians and nurses themselves.  This is an opportunity for them to observe truly natural childbirth and learn.  If the doula is not respectful and professional in conveying her knowledge and experiences then the entire birth community suffers the backlash.

While we don’t normally publish consecutive posts on the same topic we thought today’s post warranted release.  We are committed to increasing international awareness of the issues and controversies in birth care protocols, advances in birth policy legislation, best practices and alternative options available to mothers.  To that end I recently authored a paper for submission to the international database resource available for the summit on Respecting Childbirth.  The summit took place in France during our Mother’s Day week event, the week of May 11, 2009.  We are all pleased to announce the paper was accepted for their database and some light is being shed on the truth of the state of maternity care in the USA.  It is our desire to raise awareness internationally that although America spends a lot of money on technology it does not mean that all American technology is to be accepted on face value as being beneficial.  The link to the summit (above) will bring you to the link on the paper, Home Birth: The Gold Standard of Cesarean Prevention or you may click the title link to download the paper and distribute it in your community, to your legislators as you move forward protecting your birth options where you live.  The first link in this post will also provide you with a tri-fold brochure you may wish to distribute by email or hard copy to your state’s legislators as well.

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