February 2008

While it is not the expressed intent of Utah Senate Bill 93 essentially restricts the options of most low-risk, healthy women to choosing between a hospital birth they do not want or need or a homebirth with no birth careprovider.   Many of us find these “options” to be unacceptable. This bill is one exmaple of the many ways medical associations across the country are attempting to eradicate home birth as a legal option.Please do what you can to protect the rights of women to choose the health careprovider they prefer by contacting action groups in your area.  Start here to read about the battle in Utah. If you’re not sure how to locate such groups, you can try an internet search for “[your state] friends of midwives” or “[your state] midwives association.” You may also look at The Big Push for Midwives.If we sit by and do nothing while the medical associations do what they can to restrict our birthing options, we will be left with the only option of being “attended” by them.  There will be no room for “care.”Read about my battle in Utah for healthy, safe, respectful care for my upcoming birth.Laura Lund – Independent Childbirth member, Hypnobabies Childbirth Hypnosis Instructor, Founder – UCAN Birth Support Group


Recently the American College of Obstetricians released their plea to women to turn a deaf ear to the advocates of homebirth.

ACOG has lost credibility with the women of North America. When midwives, nurses and doulas realize that fact, they will stop caring what ACOG has to say. It would be of more interest to me what the Teamster’s Union thinks about homebirth. ~ Gloria Lemay, Vancouver BC, Midwife, Educator, Lecturer

The subject was the topic of alarm in some places but mostly served as an opening for the incredibly intelligent and thinking group of birth advocates to stick their tongues out at ACOG. Finally, ACOG has showed their hand to the women of North America and the birth community around the world.These are the same people after all who sold X-rays for pelvimetry (when the medical staff won’t stay in the room with you for an x-ray why would you believe x-rays are safe?) when women were pregnant, thalidomide, DES, Cytotec (also known as Misoprostol and Miso), and well, shall we continue? Yes, we at Independent Childbirth shall continue to talk about the other fears that ACOG bases their birth care policies but in the meantime you can keep having fun at their expense, literally.

Informed Consent is defined as the act of agreeing to a medical procedure, taking into account the benefits and risks of doing said procedure. It is up to you to KNOW, UNDERSTAND and DISCERN what is in your best interest. Informed consent is a patient’s right to be presented with sufficient information, by either the physician or their representative, to allow the patient to make an informed decision regarding whether or not to consent to a treatment or procedure. Patients generally are recognized as having the right to refuse medical care for any reason. Their reasons may include any personal grounds they choose, even if the physician considers their grounds to be frivolous or in poor judgment. In order to ensure that you are in a position to make an informed decision you should meet four requirements:
  1. your competence and reasonableness (you are not under undue influence)
  2. full disclosure has been given to you (risks, benefits, alternatives)
  3. you comprehended the information given to you (can you explain it in turn?)
  4. you are voluntarily giving consent based on all of the information you have been given
Informed refusal is defined as once a procedure has been explained with all the benefits and risks, consequences for NOT doing said procedure and you understand and accept these risks knowing that an adverse outcome is possible, if not likely, and choosing NOT to have the procedure.
Against medical advice is defined as a person checking themselves out of a hospital early or refusing admittance against the advice of their physician. Such persons are usually asked to sign a form that they are aware that they are leaving or refusing against their physician’s advice. The term AMA is usually noted on the hospital’s report and said person should be aware that their insurance may not cover any subsequent care or charges as a result of their decision. When the issue is about whether you choose to undergo a procedure against your judgement and therefore absolutely put yourself at risk for which the physician will not be held accountable for OR you are not in the economic position to refuse and bear the financial burden you are under duress and should not be engaging in this agreement!
Are these things important to you? They should be!
Understanding the roots of informed consent and recognizing the physician who is paternalistic in the interpreting of informed consent affects your ability to exercise your patient rights to the fullest extent protected by law. Learn about your health and patient rights in order to have dialogue with your careprovider that gives you REAL answers to your questions about birth care options and your ability to identify and bring to fruition those birth choices that are a priority to you.

Laborist noun; from Louis Weinstein, Thomas Jefferson University Hospital 1. (employment for Generation X and Y): depending on the hospital for one’s livelihood ~ income or resources 2. ( individual): doctors who work full time in the hospital, do only labor and delivery and work shifts of no more than 12 hours (from Arnold Cohen, Albert Einstein Medical Center): specialization, predictability

There’s a new doc in town. But mom probably won’t meet this obstetrician until her labor pains start.

This article poses Generation X and Y as the fall people for the economics of maternity care being in need of enhancement. If we are to believe this then we are to blame this same generation for assembly-line birth (start at induction and end your flow chart at episitiomy+forceps/vacuum or cesarean), obstetricians requiring a greater number of births in order to bill for and be able to pay for malpractice insurance (whether for poor use of interventions or mistakes made by lack of sleep) and office overhead costs and the dehumanization of birth.

Those are some heavy charges to lodge against these young people, and on behalf of the many young and older parents who have come through our birth classes we feel a need to set the record straight. Parents are searching for “care” providers. Knowledgeable, skilled and normal-birth experienced men and women who still hold a baby’s first seconds and moments in our world as being wondrous, joyful and sacred.

Parents are searching for men and women who refuse to work robotically, pushing crowds of women down a birth chute without names, identities or beliefs. Parents, who while appreciating the conveniences of technology for things such as researching information, have never stopped believing that healthcare should consist of nurturing the whole body and preserving whole health with invasive procedures as a final option. America may not rank up there with Cuba and other countries with better maternal and infant mortality outcomes but we do not believe that Americans or parents around the world prefer medical birth to normal, human birth.

The Midwives Model of Care™, defined by the Midwifery Task Force, is alive and well, although if journalistic pieces such as Division of Labor continue to make it through the editorial process it may be harder for the public to learn about it (and some might argue that the dehumanization of birth will continue to rise as a fault of the media’s integrity).

Under the Midwives Model of Care™, which is “based on the fact that pregnancy and birth are normal life processes”, quality birth care includes:

  • Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
  • Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  • Minimizing technological interventions
  • Identifying and referring women who require obstetrical attention “The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.”
Across all other fields of health care there is a return to patient-led care. So we ponder what is going on behind the scenes that the medical schools churning out obstetricians feel a need to keep women and babies in the operating rooms but to pay med school bills. Here are some more links for further information on this topic: Hospitalists Review Essay; and Laborists, nocturnalists, weekendists: Will the “ists” preserve the rewards of OB practice?

Eating during your birthing time is a topic that would be covered in an Independent Childbirth Class. It is important for expecting parents to educate themselves on this matter before their birth starts, so they know for themselves if it is safe to do so or not and so they can discuss with their care providers and birth location if this is supported or not.

The World Health Organization has some guidelines regarding this topic. Scroll down to page 13-14 to read the section regarding nutrition during birth. Here is the conclusion.

“In conclusion, nutrition is a subject of great importance and great variability at the same time. The correct approach seems to be not to interfere with the women’s wish for food and drink during labour and delivery, because in normal childbirth there should be a valid reason to interfere with the natural process. However, there are so many die-hard fears and routines all over the world that each needs to be dealt with in a different way.”

For most moms drinking and eating lightly IS safe during their birthing time. It can even help their birth to go more smoothly, because they will have the energy they need and be hydrated. For more links to other research check out Enjoy Birth’s Blog post on this topic.

There is a strange contrast that exists in the American College of Obstetricians and Gynecologists in which they support the right of women to choose an unnecessary Cesarean section–in the name of patients’ choice, patient autonomy, and informed consent; but are not allowed to have a vaginal birth after Cesarean (VBAC), or to give birth to their breech babies vaginally–despite what the patient wants, regardless of the same rules of patient autonomy, and in defiance of the practice and doctrine of informed consent. Here is a very interesting article from the Annals of Family Medicine, May 2006, entitled Patient Choice Vaginal Delivery?, which explores this dichotomy.

The introductory paragraph of the article is as follows:

Patient-choice cesarean delivery, a primary elective cesarean delivery performed without a medical indication, is increasing among pregnant women. The American College of Obstetricians and Gynecologists (ACOG) has released a formal opinion supporting obstetricians who perform elective primary cesarean delivery, citing the ethical premise of patient autonomy and informed consent. As physicians who advocate for women’s right to choose among a variety of medical options, we are pleased at the emphasis on preserving women’s medical choices. We are, however, perplexed at the narrowness of the choice. In recent years we have seen a decline in women’s choices for vaginal birth as vaginal birth after cesarean (VBAC) becomes less available and vaginal breech birth is rarely performed. The question of patient-choice cesarean delivery asks only whether a woman should have the right to choose a cesarean delivery in the absence of a medical indication. A woman’s right to choose a vaginal delivery is not addressed.

It is tempting to just quote the entire article, because there are so many good points it brings out, but I will refrain and just encourage you to read this article for yourself, and perhaps discuss it with your doctor. The authors cite many sources in the above paragraph and throughout the article, supporting their statements with published studies. They discuss the risks of C-section to the mother (both in the immediate post-partum, as well as its implications for future pregnancies), vaginal breech births and VBACs, their risks and benefits, what studies have said about them, what ACOG’s official recommendations are, and how these same births are handled in other countries.

click here or here!  And go out and rent the Northern Exposure episode of “Shelly’s” birth or there’s “Suki’s” homebirth on Gilmore Girls oh and…..how many have you seen?!