cytotec


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!

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The more a midwife speaks to a mother and spends quality time with her, the more likely a mother is to open up and reveal more of her daily routines and habits that can affect her pregnancy and birth.  For example, the midwife will ask a mother the most basic yet critical questions like what is she eating and follow up with nutritional counseling, a topic in which the midwife owns expertise. She’ll ask her what is occurring in her life today, yesterday, expecting for tomorrow. A mother’s every day peace and stress contributes to her body’s sense of well-being and reaching the point where mother and her body believe it is time now to give birth safely and securely.

The psychology of labor is addressed during the med school L&D rotation by incorporating finding other resources for emotional and mental support.  Subsequently we have a number of practitioners in all fields lacking in bedside manner today, but in birth this aspect has an impact intangible to the practitioner but very real to the mother and her family.  The average obstetrical course of education includes fewer than three credit hours in understanding nutrition.  The focus on prenatal nutrition is only a small portion of the syllabus (do your homework choosing a careprovider!).  The home birth midwife also follows the mother into the immediate postpartum and continues home visits to see how mother and baby function as a unit.

It is the midwife who is better versed in delivering babies in various but normal birth situations.  A breech baby can be birthed safer in the hands of a midwife than a hospital attendant.  She has not let her skills fall behind because medico-legal liability has dictated a breech birth to be enough of a risk as to deem a cesarean to be the required course of action; therefore, she continues to hone both her observational and palpating skills.

The American College of Obstetricians and Gynecologists (ACOG), America’s leading organization promoting the benefits of clinical obstetrics in the sterile rooms of trained physicians, has found itself in a dilemma.  The technology and protocols ACOG promotes are the very ones that directly influence our birth statistics negatively.  The birth technology ACOG promotes to prevent or lower risks in birth for both mothers and their babies has not been proven to be beneficial, yet it is used profusely.  Birth in America rarely includes the intimacy of the act that culminated in procreation.  Images of an infant gently caught into its own mother’s arms are so rare that they cause the general public to question the safety of such an event. Debate for and against the licensing of midwifery – and the definition of midwifery itself – is gaining momentum, because statistics for hands off care of normal, natural childbirth are far better than those of managed birth.

In fact, Rebecca Watson of the New Mexico Department of Health has stated, “I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s.”

While home birth is stereotyped as dangerous because of the lack of medical supervision, it is the lack of that technology and medicine that actually makes birth at home safer than birth in a hospital under today’s protocols.

Studies have shown that once a technology is introduced and mandated, it is difficult to remove it from care practice despite being proven unsafe or unnecessary.  For instance, although the rates involving an episiotomy (cutting the perineum to create a larger opening for the baby to pass through) have dropped drastically since 1980, it is still a common practice.  Ironically, episiotomy rates today are justified as integral to the higher use of vacuum-assisted deliveries or unfounded fears that a baby is stuck because it is a large baby or presenting in a less than optimal position, (posteriors, for example, where a baby faces away from the mother’s back during labor).

America is one of the few nations where birth is managed more with technology than with the hands and eyes of the care provider, but other countries will soon catch up. In a country that boasts technology superior to other developed nations and is not known for undernourishing its citizens, our mothers and babies are faring no better at birth than underdeveloped nations such as Croatia. No improvements have been made in the maternal mortality rate in America since 1982, and  America’s infant mortality rate in the past two decades also has not improved. Our birth technology has increased and the number of routine prenatal screening tests have multiplied since the early 1960s, but our maternal and fetal outcomes have gone progressively backward.

“Despite a significant improvement in the U.S. maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that – essentially – no progress has been made in most U.S. states since 1982. Additionally, the U.S. Centers for Disease Control and Prevention has stated that most cases are probably preventable.” states C.T. Lang in a 2008 obstetrics and gynecology report.  Further, the Centers for Disease Control (CDC) reported in 1983 that the maternal mortality rate in the U.S. was 8.0 for every 100,000 live births (Monthly Vital Statistics Report).  In 1993, the rate was 12.0/100,000 live births (CDC).

Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure (World Health Organization) as well as those that are physician-caused including infection and hemorrhage.  Bacterium can be introduced first by the mother arriving in an environment where diseases are being treated as well as from infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. In addition, there are higher incidences of hemorrhage from forced delivery of the placenta as when a care provider intentionally pulls on an umbilical cord to tear the placenta away from the uterine wall of the mother’s womb. In all instances, normal birth evidence training of the professional birth attendant is critical.

Injuries and deaths related to the physician’s care range from the off-label use of medicine such as Cytotec (also known as Misoprostol) for the inducing of labor as well as the sanctified use of surgical delivery, which gives us embolism, one of the leading causes of maternal mortality and a risk directly associated with cesareans.  Cesarean rates for delivery rose by 46 percent from 1995 to 2006.

Women around the world, the time to look again at the image of women birthing with women versus a medical obstetrical group in normal birth is now. WE can improve global maternal and newborn birth outcomes and experiences. WE know birth. WE know women’s hopes and fears.  A new generation of birth wisdom and experiences is here!

Wishing you a truly happy Mother’s Day secure in the knowledge of your body’s innate wisdom!

Learn more about the wisdom of utilizing your best resource: an Independent Childbirth member led birth education class like Dorene Vaughn’s All Natural Baby!

Visit our comments section (this post) to find some of the most awesome birth wisdom posts our readers have found on the web and to add the ones you’ve found!

There are many variations on the only thesis available to opponents of home birth: What do the statistics say? Despite the enticement of a warm, peaceful and private birth that a home birth offers, the perceived importance of missing technology lingers like impending doom. In America, less than 1% of births takes place in homes. It is difficult for the other 99% of Americans to make the transition from technology as the benchmark for establishing worldwide leadership to the reality that the human body is designed to give birth and it has evolved to make many variations in labor and birth look so easy.

The Stockholm Birth Center Study followed one birth center’s outcomes over a ten-year period culminating in 2000 and comparing the outcomes to the associated hospital’s birth outcomes. The one strong observation in this study is the truism that many women will choose a birth center because of the perceived safety in having a hospital nearby. However, it is a mistake to conclude the birth center is free of institutional intervention. The study’s results are negated because of the influence of the obstetrical backup. Every woman who chose the birth center for her birth location was still subjected to the institutional care package. This is the most influential determinant in whether or not a woman is “risked out” of laboring and ultimately delivering in the birth center.

A birth center so closely associated with a hospital is not autonomous and must operate under strict supervision by institutional birth practitioners. The authors themselves state they did not study the effect of individual labor and delivery protocols, but rather the care documented in each case as a “package.” In addition, they have correctly remarked standards of maternity care do not exist, but they have again missed the mark on the importance of this statement. This is critical to interpreting the outcomes, because one solitary intervention can turn out to be the predictor of a birth outcome. For example, every care provider practices according to their comfort level; although every care provider will monitor a baby’s heart tones in labor, how the monitoring is done varies by care provider. Continuous electronic fetal monitoring (EFM) can range in definition from ten minutes hooked up to a monitor every hour on the hour to a handheld doppler check through a contraction every few hours to a telemetry unit (a girdlelike band outfitted to wirelessly transmit fetal monitoring data) that allows the mother walk more freely.

The ability to walk freely even under continuous monitoring allows the mother greater mobility for finding a position that increases her ability to cope with her contractions. Setting aside the U.S. Preventative Service’s Task Force’s findings and stance that continuous fetal monitoring provides no benefit at all – and the data showing that continuous EFM results in more cesareans – it can be argued that fetal monitoring that limits a mother’s mobility is therefore more likely to result in more intervention as the mother shows signs of distress and therefore the baby does as well.

The authors of the Stockholm Birth Center study argue that many other studies have reached conclusions similar to theirs. In the same publication we are offered a Cochrane Systematic Review of Home-Like versus Conventional Institutional Settings for Birth. Here the reviewers concluded births in home-like settings compared to purely hospital settings “provided only modest benefits including reduced medical interventions and increased maternal satisfaction.”

A hasty read of this data by institutional birth practitioners correctly supports their ingrained training that routine intervention is acceptable and “safe.” However, the paper actually clearly demonstrates that all births taking place in a hospital are going to meet up with interventions at some point during labor, and it is the overuse of technology that needs to be analyzed. Indeed that message is there somewhat cryptically as the authors instead hinder the possibility of improving on the scope of research by advising “caregivers and clients should be vigilant for signs of complications.” It is difficult for any woman who has given birth or who respects her body to hear such little value placed on the differences the studies do reveal, such as the “modest benefits” of “reduced medical interventions” and “increased maternal satisfaction.” Surely even one avoided episiotomy would be appreciated by the woman whose perineum would have been cut and would find several women healing from receiving an unnecessary episiotomy envious.

In 1998, a study of infant mortality in planned home births was conducted in Australia. Author Hilda Bastion reviewed these outcomes as neither hospital nor home births have defined what constitutes standard care. She reviewed both midwives and medical practitioners, registered and unregistered, minimal experience and heavy case load. Also included in the study were births that would be deemed risky by virtue of poor health in the mothers or other underlying health conditions. This is crucial to understanding the bias of many hospital birth proponents: It is not the intent of home birth advocates to claim home birth is best for everyone, but rather a viable option for low-risk and otherwise healthy women. The author goes so far as to note it is a disturbing trend that midwives may be encouraging and willing to take high-risk births because of the high number of low birth-weight infants counted in the statistics. In fact, it is quite possible that a woman who cannot afford good nutrition may also not be able to afford hospital birth care, and perhaps a midwife is her better choice than no care at all.

In general, birth care is divided into either purely institutional care or modified institutional care. No research exists on pure, spontaneous vaginal birth over an intact perineum without induction agents, drugs, surgery and instruments. What is available is mounds of research on what a mother or baby can “tolerate” in labor and what interventions have achieved an acceptable degree of risk. The acceptable degree of risk is not defined by an independent counsel but often influenced by the strongest or loudest lobbying effort, as witnessed by the American College of Obstetricians and Gynecologists’ (ACOG) August 2007 statement on the advance of midwifery options for consumers. ACOG’s bottom line is midwifery options must be controlled and home birth as an option must be eliminated. The average consumer misses the bias and conflict of interest: A rise in home births means a decrease in income for a field already plagued by the reality that there is no money to be made in natural childbirth.

In addition to a lack of studies of organic birth as defined above, there are no long-term, randomized longitudinal studies to confirm or deny the correlation of many interventions. For example, the impact of a mother’s drug use in labor on emotional bonding, breast-feeding, postpartum depression, later drug abuse (baby as a young adult), etc. In the 1970s, Doris Haire, the President of the American Foundation for Maternal and Child Health, said, “No drug has been proven safe and effective for use during pregnancy or childbirth.” Considering that 25% of drugs introduced in the market today are recalled or pulled off the market in 1 to 5 years, this statement has never been more true. Until such time that midwifery care can be studied with a critical but appreciative eye, we will find only the weakest of studies boxed in by outdated beliefs that American women cannot afford to birth outside of a medical institution. In fact, it is our country that cannot afford to NOT offer free standing birth centers as a birth care option for American women.

Works Cited
Bastian, Hilda, “Perinatal Death Associated with Planned Home Birth in Australia Population Based Study”: BMJ 1998; 317: 384-8

Hodnett, E.D and S. Downe and N. Edwards and D. Walsh, “Selected Cochrane Systematic Reviews: Home-like versus Conventional Institutional Settings for Birth”; BIRTH Issue 32:2; June 2005

Waldenstrom, Ulla and Charlotta Grunewald, “The Safety of Birth Centers Responses to a
Critique of the Stockholm Birth Center Study”; BIRTH Issue 32:2; June 2005

ACOG State Legislative Update Year In Review (August 2007)” begins by noting “troubling trends” in state legislation and sets the tone for the bias of this opinion from the American College of Obstetricians and Gynecologists (ACOG).  There are four trends ACOG finds troubling: right to home birth bills are on the rise, more midwives not recognized by medical associations are being licensed by states, midwives appear to have a public advantage and finally that ACOG considers itself on the defensive today.

The facts ACOG provides are clear and succinct in their first two cases, but are opinion laden in the latter.  More home birth bills are being introduced and those that have been in debate for years now are finally passing.  For example, Virginia recently passed legislation protecting women’s rights to birth at home and in 2007 Missouri granted midwives licensure.  It is also true that states are granting Certified Practicing Midwife (CPM) licensure, hands-on training including non-medical skills.  This is not the same training model as the medical path for midwifery recognized by ACOG and the American College of Nurse Midwives.  ACOG does not debate the safety of home birth but rather goes into examining why midwifery and home birth are gaining groundswell support.

 ACOG tells us that midwives have learned how to “work” the legislative system and are now using the same tactics ACOG has used themselves: lobbying and propaganda.  Midwives have been so successful that they have garnered endorsement from the American Legislative Exchange Council (ALEC) for a model to license Certified Practicing Midwives.  ALEC’s endorsement is powerful because it is conservative in nature and therefore, an endorsement renders the CPM licensure model credibility.  ACOG’s illogical stand is, without medical training, midwives are an unsafe choice.

However, ACOG pointedly leaves out the basis for recognizing midwifery: it is not the practice of medicine.  This is critical to understanding the process by which midwifery is recognized and can be protected as a viable option for birth care.  Connecticut is undergoing the struggle to create a definitive line on the issue of whether or not midwifery is practicing medicine.  Almost ten years ago midwife Donna Vedam found herself on trial for practicing medicine.  The courts determined she was, in fact, practicing midwifery and midwifery is not medicine.  Then in 2006 the state’s Medical Examining Board (MEB) found another case to try, midwives who made the right decision, transferring a mother whose birth was not an emergency but should have the medical care her evolving situation might call for available.  The educated decision these midwives, Joan Mershon and Mary Ellen Albini, made in transferring the mother is argued by the MEB as practicing medicine.  There is an irony as midwives finding themselves hounded for providing midwifery care are also persecuted for transferring the mother into appropriate medical care.  The outcome of the birth was a fine healthy baby and mother.  Both mother and father refuse to testify against the midwives.

 ACOG states that midwives have the public advantage of winning support through the use of the buzz words “safety” and “choice.”  Their case – that this advantage is an unfair one – is not fact based.  They argue that home birth is safe in the Netherlands only because everyone lives near a hospital.  There is no evidence in that statement at all.  It only implies that home birth is safe only when it takes place near a hospital.  Their statement is not a case and it is clear they cannot even make the effort to understand what home birth care is.  It is evident that they fear what they do not understand, what is different.  

Further, ACOG also argues that comparisons of home birth and hospital birth cannot be compared because the studies are not scientifically rigorous.  This also ignores the basis for home birth care: birth occurs naturally and organic without active management.  Therefore as each mother-baby pair is unique, they cannot be controlled.

ACOG’s final cited troubling trends is, interestingly, presented last.  It should have been first as it clearly state’s the article’s bias: ACOG is on the defensive.  ACOG is clearly feeling not only outmaneuvered, but also recognizing that they placed themselves in this position.  For example, it is ACOG who made it difficult for hospitals to provide care for women who want birth vaginally after having had a surgical delivery (cesarean) also known as a VBAC (Wagner).  Yet, their position in this paper is that women are seeking out alternatives, home birth with midwives, since their care providers cannot provide VBAC as a birth care option.

ACOG closes the article stating that their position is that legislative support for midwives is not won on merit but rather a sympathetic public and press.  Additionally, ACOG says, it finds itself in a situation where showing up in large numbers when they can give testimony makes them appear to be engaging in a “turf battle” rather than a credible alliance.  This is the plea that they make to find or create alliances with other organizations.  Make no mistake, this is not a light objective to note as some pediatric and newborn service providers have jumped onto ACOG’s wagon.  

This written public statement is clearly an opinion piece reporting facts that are driving ACOG to explore options for defeating midwifery and home birth as a legally protected option for women.  It fails to cite any merits for this position and in fact the “uninformed public” they lament could also be the informed reader’s lament for the uninformed public may not understand that denying American women access to home birth is a clear violation of every American citizen’s right to privacy and right to choose what care or actions are taken upon their bodies.

What did 2008 bring us at Independent Childbirth?  Many, many, natural, spontaneous unmedicated labor and birth over an intact perineum taking places in homes, birth centers and a few hospitals under the expert care and guidance of independent midwives and enlightened midwifery/ob practices.

America is pretty unique in the type of childbirth prep our society recognizes.  Did you know in many countries, many cultures our way of birth prep is quite odd: all gather and sit in a hospital provided room or have a workbook and sit in a classroom style?  

Watch our birth link video again.  We are changing birth prep today!  We are centered on YOU.  You are the real woman, real options, real birth link!  Tell us about your birth link and take our survey!

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The cause of rising malpractice insurance for obstetricians is NOT that birth is risky. It’s that the medical model for birth care, also known as managed birth, is dangerous. We are not a nation of women and babies who need saving from labor. According to ACOG’s greatest supporter, Dr. Amy’s latest responses on who deserves to decide who is licensed to be a midwife in America, she considers anything less than a medical model midwife ~ highly managed by an obstetrician ~ a “second class” of midwife.

Let’s consider this: the average American believes primitive homes with dirt floors are unsanitary places to give birth, a clean source of water is vital for our health for consumption and bathing, a nation ought to have good farmland for producing healthy foods organic or otherwise, a nation ought to have cutting edge physician care options and everyone has the right to a free public education to the high school level.

If we are a nation of women for whom the majority live in clean homes with clean drinking water, are able to purchase nutritious foods and supplement with container gardening if not a full garden, are educated to a high school level minimum then why does America’s infant mortality rate rank only 0.19% better than Croatia? The American government is spending millions on health care and technology aimed at the minority and lower income population to close the disparity in maternal outcomes. American health insurance companies spend millions reimbursing for ultrasounds, screenings and diagnostic tests for genetic counseling and detecting babies with anomalies while they are in utero.

Setting aside some of the possible causes for the disparities in the IMR (i.e. nations that allow for abortion, nations which use a different cut-off date for considering a death to fall under the Infant Mortality category, etc.) we still have what it takes to rank higher as a nation of healthy mothers and infants. If our government truly wishes to rest on its laurels for providing what our citizens need for whole, physical health then, yes, our country is poised for what Dr. Amy considers a “second class of midwives.”

Our country should be strong and proud to say we are a nation of healthy, low risk mothers and we have earned the right to be the first to recognize that non-intervention trained women may serve these mothers, and these non-intervention trained women are intelligent and can recognize through simple measures how to recognize the mother who must be transferred over to a next level of clinical care. That level of care can be the CNM who is the expert in navigating the halls of medical protocol and hospital policies in addition to the CNM having the board certification to enact ‘medicine.’ The next level after that should be the medical specialist who also has surgical skills.

Our front line for our nation of healthy women preparing to give birth should be the midwife who is the expert in normal birth as well as the expert regarding her community and its affect on the mothers seeking her birth expertise. She can be the dialogue bridge between the medical experts who are willing and available to provide specialized services and the woman who truly needs them.

When choosing [representatives] for your committee, please include midwives who still do 70% of the births in the world and are experts not only at ‘normal’ birth but at keeping infants normal around the birthing process. ~ MacDorman and Singh, 1998

Were it not for the 1% of women in America who continue to choose homebirth with normal birth experts, the public would never have access to experiencing normal birth and using spontaneous, vaginal birth over an intact perineum as the gold standard for which to measure all birth policy.

I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s. ~ Rebecca Watson, New Mexico Department of Health

 

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.

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