ICAN: Controversy?

Danielle Elwood of ICAN of Connecticut recently began an outreach to the birth community of our fair state.  It seems that she contacted Governor Jodi Rell to request support officially acknowledging April as a Cesarean Awareness Month:

“The reason I am writing you today is about Cesarean Awareness Month which took place in April. As the founder and leader of ICAN of Connecticut, I took it upon myself to contact Governor Rell with a request to recognize April as Cesarean Awareness Month but I was met with closed doors. After being denied I called and spoke with someone on Governor Rell’s legal team who explained to me that the Governor cannot support such a controversial cause.”

Is it any wonder that our state’s Medical Examining Board enjoys the power it wields over midwives?  Gov. Rell we encourage you to learn more about the process of normal, natural childbirth and the history of misused and abused obstetrics.  We encourage you to talk to your peers in states where midwifery is welcomed as a safe option for low risk women.  Midwives reduce the unnecessary c-section rate and that shouldn’t be controversial.

Danielle also included a short list of states that recognize April as Cesarean Awareness Month:

Governor Charlie Crist (R) Florida
Governor Kathleen Sebelius (D) Kansas
Governor Mike Beebe (D) Arkansas
Governor Chet Culver (D)  Iowa
Governor Ernie Fletcher (R)  Kentucky

If you would like to contact Governor Rell you may do so at:

Governor M. Jodi Rell
Executive Office of the Governor
State Capitol
210 Capitol Avenue
Hartford  CT 06106
Toll Free: 800-406-1527
Governor.Rell@ct.gov 

 

Cesarean Prevention: Tell Me If You’re Using Cytotec

 

You do so much to take care of yourself in pregnancy and you read about labor, try to take the most informative birth education series and choose the “right” careprovider and birth location for a healthy birth.  Most people don’t see this one coming.  We trust careproviders to first do no harm.  Harsh as it sounds, you can’t trust them all and even careproviders acknowledge some of their colleagues are doing things they would never do.

More importantly remember the best cesarean prevention is knowing your body is designed to give birth in its own time, in its own way.  If you are a first time mother it is especially important to know that birthing spontaneously and vaginally is the foundation for your next births.

 

“The two most power filled words - I can.”  - Anonymous

Every birth educator and doula needs to tell their clients this: Your careprovider must tell you if they plan to use Cytotec and must tell you about all of the risks involved before you consent to its use in your care.  You must remember that Cytotec also goes by “miso” or “misoprostol.”  Use all of these names in asking about this tiny little pill.

Throughout this blog you’ve read about the basis for informed consent as well as the disregard for informed consent when it comes to birth care.  You’ve also read about the dangers of Cytotec, how it’s used off label and it continues to be used in spite of the unpredictable rates of injury including death.  

While researching what progress we’ve made in raising awareness of the off label use of Cytotec I came across this lawsuit settlement from 2001 and now we are working to make others in the birth community aware of it as members of our Yahoo group spread the word:

“$2 million 

Failure To Obtain Consent For Off-Label Use Of Cytotec 
Case name withheld. 
Plaintiff’s Counsel: Joseph J. Wadland and James L. Ackerman, Wadland & Ackerman, Boston and Andover 
The plaintiffs were a 38-year-old woman and her husband who were expecting their first child. At about 41 weeks of gestation, the decision was made by her primary Ob/Gyn to induce her labor. A dose of 25 micrograms of Cytotec, a drug that the FDA has approved for the prevention of gastric ulcers, but not for the induction of labor or cervical ripening, reportedly was given vaginally. The care providers did not obtain the mother’s informed consent for the use of Cytotec that was being administered for an “off-label” indication in a high-risk situation. A series of complications arose, including the deceleration of the fetal heart rate and the baby was delivered via Caesarian section. The baby was lifeless and resuscitation efforts were unsuccessful. The mother also required a hysterectomy as a result of off-label use of Cytotec. When the claim settled on Aug. 7, 2001, it was the first reported settlement or verdict in Massachusetts involving the drug Cytotec. 
This settlement was first reported in the Nov. 5, 2001 issue.”

If you are in an online group that shares birth information share this one.  Please.

Then continue to read our posts on understanding informed consent and the stories of Cytotec’s unpredictability. 

Own your birth.  Demand full disclosure of all care practices.  Spread the truth about birth: You can.

 

The Hidden Truth - my *untold* Cytotec story

The only thing I was aware of for my first birth was that I didn’t want Misoprostol, per my reading. So, when I went in at 42 weeks and a few days for my induction (19, naive, unprepared) I told the doctor (not my normal one) that my doc and I had agreed to no misoprostol. He ‘reassured’ me that they hardly used that any more. In hindsight, I see he didn’t really give me a straight answer, so he also didn’t ‘really’ lie to me.

He administered the pill and left, saying my doctor was ‘on’ in 2 hours. When my doctor came in to see how I was doing and read my chart, he jumped through the ceiling, ANGRY.

He didn’t tell me what was up at that time.

Labor went seamlessly.

Birth went quite well.

AFTER birth, I had quite a hemorrhage immediately afterward. Then, 4 nights after birth, I passed a few huge clots. Early EARLY a.m. leading into the 5th day, I woke from a sound sleep to what I ‘thought’ was my babe crying (she slept in a bassinet a few feet from my bed). I got out of bed and walked the two steps to her bassinet only to see she was still sound asleep. What I DID notice is that, in those two steps, blood began pouring from my body. I was having a late-postpartum hemorrhage (pph) and the only person who could help me slept like a rock and was 1 room away.

WARNING, THE REST IS QUITE DETAILED AND NOT FOR THE SQUEAMISH:

I hobbled quickly to the bathroom and sat on the toilet. When I heard the bleeding was not slowing, but increasing, I tried getting ‘low’ to get my blood pressure balanced and reduce gravity’s assistance with my bleeding. Crawling to the tub, I began yelling for my mom (who I was living with at the time). Once I pulled myself into the tub and laid down, I began beating on the wall that separated her bedroom from the bathroom. It felt like an eternity… it was probably a few minutes, but she finally came into the bathroom and found her tile and walls, bathroom and tub, painted in my crimson blood. Hand prints dotted the walls and counter tops while a steady line trailed from my room to the bathroom.

She didn’t wait for an explanation but called the hospital, told them she would not be waiting for an ambulance, but to prep the police because she would NOT stop for their lights. She bundled me up in the car on a towel and told me to hold my baby. Her reasoning, she later said, is she thought I was going to die and reckoned that holding my child would help me hold onto this world a little longer.

Off we sped.

I passed out a few times on the way.

Once we got there, they could not find a pulse because it was so weak, nor could they get bp. They had a horrible time getting an IV line in too.

They were asking me questions but I couldn’t hear them. All I saw was their lips move and this rushing water sound. I was answering them as best I could - later my mom would tell me I was yelling and swearing like a sailor - something I never do. They took me away, yelling over their shoulders that she could sign while I was IN surgery.

That’s the last I remember. Next thing I know, I wake up a few hours later in recovery - catheterized, I.V.ed, my then-boyfriend was there, and my stomach felt empty….

I had had placental retention - which caused massive hemorrhage and clots. I was somewhat ‘toxic’ as well and spent some time on antibiotics. My doc said that if I would not have woken up, I would have bled to death in my sleep. A few minutes longer, and I would not have survived my trip to the hospital.

While there in the hospital, he told me he considered it the fault of the misoprostol, aka CYTOTEC. He never used it, because my case made 2 life-threatening Cytotec inductions on his watch. The first, he administered the Cytotec and the mom almost died on his table. The second, me, he had specific orders for no Cytotec and the other doctor blatantly disregarded it and misled me.

My file says ‘iatrogenic complications due to the administration of Misoprostol for postdatism’ regarding my early pph. For my near-death hemorrhage, it states ‘late pph due to placental retention and subsequent septicemia’.

It affected my milk production. I dried up like the Mojave and had no idea (at that time) that I could reestablish milk production. So, at 5 days postpartum, my daughter went fully onto formula. I was devastated.

The saddest and most outrageous thing is that my file clearly ‘cuts out’ the TRUE cause for my placental retention and thus, my pph… the two are so clearly ‘divided’ that an untrained eye would never put the two and two together - thus, another example of the ills of Cytotec goes unreported.

My recovery took over 1 year. I had soreness and battled infection for 3 months postpartum. It took me another 4 months to be ‘ok’ having anything inserted into me (tampons, etc…) because of anxiety, and anemia was my ever present ‘friend’ while trying to regain my blood count and get my iron levels up. I have low bp anyways, so losing that much blood was no small stress on my body.

For more information on Cytotec, you can go to the Tatia Oden French Memorial Foundation website. Tatia Oden French was induced with Cytotec when she went past her due date. Both she and her baby died.

Women need to demand FULL and INFORMED consent/refusal. I was deliberately mislead and it almost cost me my life. It has cost many other women and their babies a higher price than I paid.

 

Are you pregnant with abuse in your past?

Imagine yourself in labor, and suddenly a very painful memory intrudes your mind and consumes your thoughts. Imagine how distracted you would become. Your contractions could slow down and stop. The physical intensity of labor might be overcome with the emotional pain of your past.

But it doesn’t have to happen this way. You can prepare yourself during pregnancy by reading When Survivors Give Birth by Penny Simkin and Phyllis Klaus and Survivor Moms by Mickey Sperlich and Julia Seng.

If you have been abused or even just suspect that abuse may have occurred, you are highly encouraged to discuss it with your entire birth team. This includes your doctor or midwife, birth partner, doula and childbirth educator.

Remember, all of your care providers have a responsibility to protect your privacy and rights. If they believe it to be in your best interest, they may also go out of their way to help you obtain appropriate services. Open communication is important and will certainly make a difference in your over-all pregnancy and birth experience.

If you are able to share specific details, those caring for you will be able to make better judgments and be more sensitive to your needs. There are some things that might trigger your memories of abuse. Some are obvious things such as being in bed during labor or breastfeeding after the birth. But other triggers, unique to your situation, might not be so easy to identify. This is where communication between you and your caregivers can prove extremely beneficial.

Having vaginal exams are common during labor and at the end of pregnancy. But having them might put you in an extremely vulnerable position. If you let your medical team know about your history of abuse, they will be exceptionally sensitive to your particular situation and comfort level. You have the right to opt out of this particular intervention, and your choice should be respected.

Fortunately, there are many resources available today that help shed light and understanding on the problem of sexual abuse. Care providers typically maintain a list of resources that include local therapists or counselors that specialize in abuse. They may also have books, recommend websites, and provide educational materials.

get help

There are several options you can pursue in order to promote health and wellbeing. What may work for one mother, may not be the best method for another. Sometimes, you may need to experiment with several techniques before discovering which is the most helpful. A care provider should always be consulted prior to trying any form of therapy

• counseling
• talk therapy
• Hypnosis
• Emotional Freedom Technique (EFT)
• Reiki
• Massage
• Art
• Meditation
• Naturopathy
• Homeopathy

This is the first in a multi-part series on pregnancy, birth and sexual abuse. This article is written for the pregnant woman with a history of abuse. Future articles will be written for those who work with pregnant women and will address ways to help a woman during pregnancy and birth.

About the author: Lasi Leavy has 15 years of working with at risk adolescents. She is an ALACE Birth Doula and Hypnobabies Childbirth Hypnosis Instructor.

 

A note for labor nurses

Have you ever considered looking at your patient? Seriously, there’s a real person, a laboring woman behind each strip on your computer screen.

While walking the hospital halls recently with a client of mine who was in active labor, I caught snippets of the conversation between the charge nurse and my client’s certified nurse midwife.I knew exactly who they were talking about. They were looking at the computer screen containing my client’s EFM strips. The nurse said, I can see that the baby is doing fine, but I need to know what is happening during this time. When is she having contractions? Is she even having contractions? How do I know that she’s in a good labor pattern?

Dear Miss Labor Nurse, Please turn your head away from the computer screen and actually look at this person who is in your care for the night. If you look at her and listen to her, you’ll see that she is in labor and experiencing strong contractions. A cervical check not too long ago showed 6 centimeters dilated. Upon admittance at the hospital, she spent 30 minutes on both the uterine monitor and the external electronic fetal monitor. Perfect strips.

The midwife explained to the nurse that she was sitting with her patient and that she was having good strong contractions and that the baby was handling those contractions fine. The nurse just didn’t get it. She wanted to see proof on her computer screen and on the paper printouts.

She wanted a record of the contractions. A continual record of the contractions.

Only minutes earlier, we had all been in the room, my client sitting on a birth ball leaning over the bed. Her husband was doing counter pressure on her lower back during contractions while the midwife sat beside her, holding the doppler up to her contracting baby belly both during contractions and in between them for some “continuous fetal monitoring.”

Beautiful heart tones. Strong. Reactive. Variable. No decels.

The midwife didn’t bother putting the contraction monitor on my client because she knew it bothered her and everything was going ok, so there was no reason to. The LDR nurse walked in the room and wondered if the monitor were working, only to discover it had not been placed on her patient.

My client didn’t want it on. She asked what information it would provide. The LDR nurse said they could monitor her contractions. The LDR nurse said so you are refusing? My client asked her if she needed it. The LDR nurse said that they were watching the baby’s heart rate but they didn’t know when or if she was having contractions.

Then I said, your midwife is sitting right here next to you and SHE is monitoring the baby’s heart rate plus SHE knows exactly when you are having contractions because she is right here with you and she is watching your baby during the contractions and so far your baby is doing fine.

With that, my client said that she refused the uterine monitor. A new nurse stormed in a couple minutes later; the charge nurse who I spoke of earlier in this account. The nurse demanded, “Where is she?”

I said, you mean A? (the midwife).

“No the patient.” The nurse hadn’t even bothered to find out her name.

I said, “P is in the bathroom.” The nurse did a quick 180 and stormed out.

This was the first time I’ve doula’d at this hospital, and perhaps my last. There are other doulas who absolutely refuse to go there. I loved my client; I had been to her previous births at a different hospital and I didn’t even consider not going to the birth just because of the place of birth.

Labor nurses: every once in awhile you’re going to get a woman coming into your labor hall who doesn’t need continuous monitoring because she’s not using pitocin. She’s not having an epidural. When a woman doesn’t get those drugs, the rules can be different. It’s fine for a midwife to watch a woman in labor, using her eyes and ears and hands to help her patient. Labor progresses. Birth happens. Mommies and babies thrive without machines and paper printouts.

 

Spring Birth Trivia: $25,000 Pyramid Redux for Birth

Watch the movie to the end. If you know the answer e-mail it to us at thepowerofbirth@independentchildbirth.com for a chance to win a free pair of BabyLegs (ship to USA only, sorry!)

 

Dear Dr. Amy

Hi Dr. Amy ~I’m curious as to what really is going on that has you so afraid of allowing women to have the birth of their choice. No matter what I, as a safe birth advocate and you as a safe birth advocate ~ yes, we both want birth to be safe ~ believe is actually the safest, the fact is that in America we were meant to have our rights to do what we choose to do with our bodies, ourselves, protected.

Pregnancy is simply one piece of healthcare and care involves nothing less than what is given to all others in all other health care fields regardless of gravity of the situation. I want to know why you feel a need to TELL women not to birth at home. I don’t TELL women not to birth in hospitals. I do what they ask of me: share what I know, point them to resources and let them choose for themselves.

Women who have been my birth clients have chosen from among hospital with OBs, hospital with MW/OB, free standing birth center with MW, homebirth with CPMs and Traditional Birth Attendants, homebirth with CNMs and unassisted childbirth. They made their own choices and collectively they represent a c/s rate right around 10% (the WHO guideline recommendations) and of the almost 90% vaginal birth rate a little over 80% of those were without drugs ~ pain medication ~ and only a few with augmentation.

The reasons for cesareans were breech and less than textbook labor patterns. I don’t believe everyone is either at your end of the “birth is not safe” spectrum or at my end of the “birth is safe” spectrum” rather I believe the greater majority is somewhere in the middle. Certainly statistics show that less than 10% of births take place at home. I wonder that such a small group with healthy birth outcomes would take up so much of your time.

I wish that you devoted the same amount of energy to asking careproviders to give all the facts about every procedure and protecting the right to make our own health care decisions. What exactly is it about homebirth that is so dangerous? I know I can pinpoint the abuse of oxytocin, the abuse of medical privileges in prescribing drugs off label and the untold risks of cesareans, such as putting your future children’s lives at risk, for specifics about medicalized birth that is dangerous.

I’m not alone in that aspect. There are doctors out there who agree these practices bear scrutiny and are unethical. They question America’s maternity health care system in whole. I really am very interested to know exactly what aspects of homebirth are dangerous in your opinion and why you feel a need to use fear to quell an individual’s right to explore and educate themselves, invade a person’s home, privacy, body and right to choose for themselves. I notice that most of what is posted between you and others on the internet is lost in rants.

I don’t need the stats. I can find stats myself and I fully understand anyone can interpret stats however they’d like. I’m interested in hearing what YOU KNOW about birth, your experience with birth.

As a matter of interest, in my case it wasn’t homebirth advocates who advised me to VBAC spontaneously, without medications and especially with my premature son.  My skilled homebirth midwives advised me to birth in a hospital with the underlying medical conditions I had.  It wasn’t the homebirth advocates that encouraged me to VBAC telling me I could do it and I would be fine.   It was two different obstetricians in two different hospitals.  It was obstetricians who weren’t just trained in VBAC and complications of birth, they were SKILLED.

 

A Kangaroo Courts New England

Winter is still here in Connecticut. I drove to Capitol Avenue to formally hear the opinion of the Connecticut Medical Examining Board regarding midwifery, specifically Direct Entry and Certified Practicing Midwives. It began with the lot of us being told the doors were being opened for us to to come in but we need to keep the noisemakers, meaning the children, out. Dennis O’Neill, MD, Chairman of the Board explained the acoustics were so poor in the Conference Room they could barely hear each other let alone the audience who might speak.

 

At this point in time we know only that the charges stemmed from a transport case, a transport that was timely and resulted in a positive outcome.

 

It has been reported by members in the midwifery community that the case was not the result of poor care, a complaint from the parents, nor was there a maternal or fetal death. Although I never caught the actual root of this case I did meet Donna Vedam who had been through this procedure before and realized her case was why we found ourselves here again. In her case, parents who were more than overjoyed with their birth experience wrote their insurance company asking them to consider covering homebirth in the future and wrote how homebirth saved money, reduced the use of interventions, and improved birth outcomes. Someone somewhere in the insurance company read the letter and thought this must be illegal! They forwarded the letter to the State to look into and Donna was accused of practicing medicine. That charge was dismissed as it was determined that she was practicing midwifery and midwifery is not medicine.

 

Since that precedence already exists, the Board has to step up the charge and go for practicing nurse midwifery without a license. It is a step toward regulating midwifery in Connecticut — and make no mistake about it — a step towards eliminating the “problem” of midwives enticing women away from OB income, and opening the window to the proven dangers of many routine interventions.

 

In less than four minutes total the issue was brought up and voted on. Dr. O’Neill relayed that the case was dragged out over 21 months with only 8 actual days of hearing, after which there was no explanation as to why it took this long to finally bring the motion to a vote. Dr. O’Neill simply said “it eventually lay around held up in some office somewhere …(until now).” As for this writer, what the summation hints to me is that the testimony presented during those 8 days took a lot of time and energy for the medical community to understand.

 

A doctor raised his hand to move to uphold, another seconded, and then all of the Board Members unanimously declared to uphold the decision.

 

Neither the motion nor the decision were ever actually stated, but it was to cease and desist, don’t do it again — “it” being practicing medicine without a license. What this hints to me, the writer, is that formally stating the decision would require an explanation supporting the decision and no one was prepared to do so, either as a subversive tactic for the day (we were actually thrown out, prevented from taking a peaceful group photo in the lobby), or as an ongoing tactic of “because we can.”

 

What is important for all women to know is that the board isn’t made up of consumers or consumer advocates. If it were, it would have members such as homebirthers Jennifer Wisner, Tammy Gallo, Tara McElfresh, Lisa Breton, Aja McCarty, and Bruce and Randy Neely who were here with their homebirthing daughter, Kendra Smith. They might have included a gentle birth La Leche League leader like Rebecca Cronon.

 

I think the Board’s worst fear, though, is that a member of their own community, someone like Susan Parker, RN, CEN might have been on the Board. As a hospital-based nurse, Susan has seen “the worst of the worst including witnessing a maternal death just six months before” she herself gavebirth. The experience left her even more determined to birth at home.

 

Which hospital you ask? Avoiding that hospital in particular won’t keep you any safer in birth. Maternal deaths in hospitals are everywhere like Hawaii, California, and New Jersey, as well as many other states and the truth behind the stories aren’t being told. Consider this, embolism is one of the leading causes of maternal death. Risk of embolism increases with surgical procedures and the cesarean rate is climbing steadily!

 

We are not arguing that no one ever needs to birth in a hospital nor that everyone needs to birth at home. The point is that we have medics who do not know normal, natural childbirth, but they are making unfounded decisions about a non-medical event. This, while they are forgetting to investigate their own at the least, and turn a blind eye to their own at worst.

 

The midwives’ next step is an appeal or to argue for the right to argue the decision. 

 

I may not have been alive in 1692 but what transpired over the past few years and culminated in today’s five minutes in Hartford, Connecticut, could only have been done better were the Board Members in period costume.

 

On “Being” in Birth

There is a view that a baby is conceived and the mother is a maternal environment.  I suppose there must be a science to birth or else the medical model wouldn’t exist and be beneficial to the healthy mother who finds herself in the rare medical situation. No matter your comfort or fear of birth there is a truism: that our existence is meant to be, conscious birth.  We have an awareness that as our bodies decay our bones, those that carried our babies, may do so but very slowly.  These bones are solid with the memories of the blood, oxygen, nutrients that the frame supported.  These bones cradled life and remember the weight of a uterus heavy with child and light in love for the child; An appreciation that each of us is “here” and very much “present”.  That appreciation opens us to understanding the influence of those who share our child’s birth with us.   Every person who acknowledges our pregnancy can influence the birth, from birth fright to joyful birth. We spend time letting go of the negative when we run across someone angry who chooses to vent or release near us.  We know it’s not healthy.  It is unconscionable that our society does not promote this same attitude to mothers.  The longer we spend time on stress over birth the less likely we are to give ourselves permission to be radiant carrying life within us, smug in our selves as birthing bodies that have been wise with this knowledge for centuries.

 

50 Ways to Scare a Mother

If your Care Provider says something that Scares you… ASK Questions, DO Research and Make INFORMED Choices!