pregnancy


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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Traditionally women have learned about birth through stories passed on from their mothers or other female relatives.  Sounds great but there are women for whom their mothers are uncomfortable telling their birth story or their mother is a Twilight Sleep mom or had some other birth experience that rendered her unable to recall many details of her birth experience.  Today, we have more and more women exploring all of their birth care options and birth stories range from birthing a baby under the moonlight because “I wasn’t sure I wanted to be at the hospital and fight the docs who didn’t agree with natural childbirth” to “the doc and I high-fived each other because this was his first time catching a baby with mom on her hands and knees” to “my midwife guided my hands into the water to catch my daughter.”

So, who’s your birth link?

The ICAN offer below is a genuine offer and has been posted through VBACtivism, an organized yahoo support group.  It is our understanding that you should contact the group below if you are seeking help protecting your access to VBAC health care because you have been denied the right to VBAC.  You will be asked to provide information pertinent to your situation and a determination will be made as to whether or not you have a case.  Please, if you’re thinking about contacting the email below, do it!  Just the fact that you are thinking about it is enough to warrant following through.  You and your baby deserve to exercise your rights to choose your health care for yourself.  Write a letter to your careprovider first but don’t wait for a response that may never come, learn more now!

I’m a lawyer with the Northwest Women’s Law Center in Seattle.  I’m investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states - Alaska, Idaho, Montana,Washington and Oregon.  If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and whether it is medically necessary, and are willing to consider working with a lawyer on this, we’d like to talk with you.  Please email us at vbacbanhelp@ican-online.org.  Our services will be provided free of charge.  


What does Dr. Helen Sandland have to do with our goal to help you be an educated health care consumer?  For the most part we all tend to be interested only in what affects us at the moment so for those women new to the birth scene and just reading our most recent posts we include here the story of a doctor who quit rather than be fired for refusing to adhere to her hospital’s medicolegal requirement to do more cesareans.  In continuing the struggle to give American women the best maternal care: the midwifery gold standard.:

Doctor Won’t Make The Cut:
Feeling pressure from hospital for more c-sections, she leaves

Wilmington Star Newspaper, 5 June 2005

Surrounded by a house full of cardboard boxes, Wilmington obstetrician Helen Sandland discussed how giving birth Mother Nature’s way is in jeopardy.

Dr. Sandland – known for the past decade as the doctor local women went to if they desired natural, vaginal deliveries – moved to Mississippi last week after being told by New Hanover Regional Medical Center administrators to do more c-sections.

She refused.

“I leave NHRMC with my morals and backbone absolutely uncorrupted,” Dr. Sandland wrote in her resignation letter dated May 15. “I am going to practice with a long-time friend, whose scruples I admire, and in a place where unnecessary surgery is not encouraged.”

During a time when national health officials have sounded the alarm that the cesarean section rate is at an all-time high and needs to be sliced, Dr. Sandland’s case raises questions about what factors are pushing the numbers higher.

Since history has been recorded, cesarean sections have always been a procedure used on mothers. The procedure was given its current name when, under Julius Caesar’s reign, Roman law decreed that all women dead or dying from childbirth were to be cut open to try to save the baby.

Until the 1800s, when formal anatomy education arose, the procedure rarely saved the mother’s life. It was used as a last resort until the 1940s, when antibiotics became available, and into the 1950s, when most women switched to giving birth in hospitals instead of at home.

Considered major abdominal surgery with complications that can lead to death, c-sections became used more commonly for abnormally positioned babies or when the mother or baby is in distress. During a c-section, mothers are given anesthesia, an incision is made through muscles of the abdomen, organs are moved aside and the baby is pulled from a cut in the uterus.

By 1970, 5.5 percent of babies were delivered through c-sections.

The rate doubled in five years and continued to increase until 1990, when it peaked at 22.7 percent. It held steady and slightly declined through the 1990s before picking up again in 1998. The rate now sits at 26.1 percent of 4,021,726 births nationally. North Carolina’s rate is 26.4 percent.

“I don’t see any end in sight right now,” said Dr. Bruce Flamm, regional chairman of The American College of Obstetricians and Gynecologists, saying there’s little concrete data on how many c-sections are unnecessary. “All of the current pressures seem to be going in the direction of more c-sections, not less.”

He and other national medical experts are concerned with the trend; a trend they believe is pushed by medical liability issues, convenience for both doctors and patients, and perhaps hospitals’ financial and staffing pressures.

“There are some doctors who say the only cesarean section I have ever been sued for is the one I didn’t do,” Dr. Flamm said. “It’s a sad but \true situation.” Not only is there a decreased chance of getting sued if a c-section is performed, but it’s less time consuming to perform c-sections instead of waiting out long and sometimes difficult labor.

“It’s a very vulnerable time,” said Deanne Williams, executive director of the American College of Nurse Midwives. “The increased demand is really a reflection of being told this is a quick fix, there’s no risk, why wouldn’t you? And that’s by the medical community.”

But, as many obstetricians will point out, pressure by doctors or hospitals is only part of the equation. Some women, they say, really are looking for a c-section because they fear the pains of labor or want to schedule it when grandparents are in town or around holidays.

“It’s called doctor shopping,” Dr. Flamm said, discussing how women will go from one doctor to another until they get what they want. “You have to be responsive, within reason, to the desires of the patient.”

Regardless of the reason, health officials across the country are concerned with the rates.

Leading medical groups such as the Centers for Disease Control and Prevention, National Institutes of Health and the World Health Organization have all spoken out against the increase, demanding the medical community investigate ways to lower the rate to 15 percent or below. C-section culture Dr. Sandland thought she was doing just that. 

In the decade she has delivered babies and cared for their mothers in New Hanover County, she has always had a rate below 10 percent.

“I’ve always maintained I’m a midwife with a MD behind my name,” she said from her two-story Pine Valley home last week while preparing to move. “It’s better for Mother Nature to decide when it’s time, not the doctor. My philosophy is you don’t interfere unless you really have to.” 

Her philosophy, admittedly different from the mainstream, attracted many patients who wanted the best chance of having a vaginal delivery.  Dr. Sandland became known as one of the few doctors in the area who would try to deliver breech babies naturally or pursue a vaginal birth with a woman who already had one child with a c-section. Her solo practice boomed.

If her lack of medical malpractice lawsuits and gratitude of patients are of any account, she was not only popular, but also successful.

Fellow Wilmington obstetrician Dr. Joshua Vogel said though she was considered too set in her ways or a renegade by some doctors, he admired her talents to deliver naturally in situations when other doctors would have automatically pushed for a c-section. “She was a valuable asset for patients,” he said.

Dr. Sandland said she became the target of the hospital’s professional review and credentials committees. Because it is confidential by law, she could not legally discuss the peer review process.

But the Star-News viewed two letters addressed to her from committee members. Written on New Hanover Regional letterhead dated July 6 and July 7, 2004, the letters discuss the conversation committee members had with her.

The first letter, written by Dr. Cobern Peterson, chairman of the Professional Review Committee, stated “concerns” regarding her practice. They include higher than average infant birth weights, much lower than average c-section rates and later than average gestational age of neonates at delivery.

The letter states “the main concern reiterated several times was an overall practice attitude rather than any individual case.”

The next letter, written by Dr. Janelle Rhyne, acting chairman of the Credentials Committee, states Dr. Sandland’s privileges at the hospital would be reappointed for a period of six months but monitoring would continue.

It reads, “Your c-section rate is to be within an acceptable range as determined by the NHRMC OB/GYN Department with a plus or minus deviation of two.”

No reason was given in the letters, other than adding the committee would be watching other outcomes like collarbone fractures – something experts say is a minor, common complication of vaginal deliveries.

New Hanover Regional spokeswoman Kendra Gerlach said two standard deviations equates to five or six percentage points above or below the average.

The c-section rate at New Hanover Regional is 27.9 percent. At the time, Dr.. Sandland said, it was about 26 percent. That meant the committee was requiring her to reach at least a 20 percent c-section rate. To do so, she’d have to more than double her current rate.

“It’s just not something I could see happening,” she said. “You just don’t change your practices overnight. I certainly wasn’t going to change them to meet some arbitrary quota.”

Jack Barto, chief executive officer of New Hanover Regional, said he was not familiar with the letters but that it sounded to him more like a “guideline” than a “quota.”

“To me, a quota is, ‘You will be at X percent,’” he said. “I think it gives a range to allow physicians to have discretion.”

When asked if other doctors who deliver patients at the hospital are given the same guideline, he would not answer the question. He did not say why a guideline would be necessary.

But Dr. Sandland said that in a March conversation with Mr. Barto, part of the reason became clear.

“Barto said in a separate meeting that a c-section rate of 25 percent would reduce the likelihood of getting sued,” she recalled.

Mr. Barto confirms he had a meeting with Dr. Sandland but would not discuss the conversation.

“I had a private conversation with one of my physicians,” he said, asserting he did not recall discussing liability issues. “I talked with her about a variety of topics.”

Dr. Sandland also said the decree put a “seed of doubt” about other things going on during labor and delivery.

One time, she said a fellow physician called her to tell her she had a woman who was attempting to vaginally deliver a breech baby and, when Dr. Sandland explained the patient was aware of the risks and wanted to at least try, he said maybe he should go talk to the mother and try to “bully her” into a c-section.

Other times, especially when the unit was overrun with laboring moms, she said, there was pressure from department heads to speed up labor or consider a c-section.

“Quite a lot of c-sections are being done for so-called failure to progress,” Dr. Sandland said. “If you haven’t progressed in a couple of hours, a c-section’s waiting. There’s certainly a pressure to keep patients moving on through.”

Fellow obstetrician Dr. Vogel said he never felt pressured by New Hanover Regional administrators but he knows it goes on from time to time, mostly at for-profit hospitals for financial reasons.

The hospital’s chairman of the OB/GYN department, Dr. Bora Duruman, declined to comment on Dr. Sandland but said doctors are not pressured to do c-sections nor do they pressure patients toward c-sections unless the procedure is medically necessary.

“There’s no guideline at New Hanover Regional,” he said. “I take that back. There’s absolutely a guideline at New Hanover Regional. The guideline is healthy mother, healthy baby. The c-section rate then falls where it falls to achieve that.” Concerns for future Emily Lanier’s greatest fear when she went into labor Mother’s Day with her first child was of getting a c-section.

“My main thing was c-sections are not natural, and I wanted to experience natural delivery and I did not want to go through the recovery time,” the 29-year-old said.

But when her son’s head got stuck in her pelvis, her blood pressure shot up and his heart rate plummeted, she understood the necessity of the operation. 

Nearly a month later, she said she’s saddened New Hanover Regional has put a c-section “guideline” on at least one doctor.

“Something like that really doesn’t surprise me,” she said. “Kind of like at the end of the month, a cop has to give more tickets.

Everybody has quotas. I feel like if it happens at one hospital, it’s going to happen everywhere, so there’s really no escaping something like this.” 

Ms. Williams said members of her nurse midwives organization have long suspected hospital administrators may be driving the c-section rates behind the scenes, but she was shocked to hear a hospital actually put a quota in black and white.

“It’s likely happening,” she said. “If one person has the guts to come forward and say this has happened to me, it means it is happening a lot.”

Ms. Williams said hospital administrators would probably be happy to schedule all c-sections because it would control costs of staffing a labor and delivery unit around the clock.

“They want to put women on the conveyor belt,” she said. “They could save tremendous amounts of money.”

New Hanover Regional administrators said there’s no such movement at their hospital.

“For most people, this is the most amazing, wonderful moment of their lives,” Dr. Duruman said, also denying the hospital is out to make more money by doing c-sections. “What crosses your mind the whole time is healthy mom, healthy baby.”

Mrs. Gerlach said the hospital charges $4,700 on average for noncomplicated vaginal deliveries and $14,200 for noncomplicated c-sections. Those amounts do not include doctor fees.

Consumer watch dog group Public Citizen has estimated that half of cesarean sections are unnecessary and result in 25,000 serious infections, 1.1 million extra hospital days and cost more than $1 billion each year.

Meanwhile, the procedures don’t seem to be making a difference, noted Dr. Flamm, explaining that while the c-section rate continues to climb, the number of fetal deaths remains steady.

Legally it’s safer, he said, but not necessarily safer medically. He added that he and other physicians debate constantly and can’t come to a conclusion of what the correct c-section rate should be.

Ms. Williams is concerned that the more c-sections become the norm, the riskier giving birth will be. 

“We are going to see an increase in morbidity and mortality for the mothers,” she said, explaining how the first and even second c-sections are fairly risk-free but then scar tissue builds up and increases the surgery’s risk.

“Every subsequent cesarean section, the risk of a woman ending up with a severe hemorrhage, losing her uterus or ending up dying goes up,” she said. “By the time women figure that out, we’re going to be long
gone.”

If you’re thinking of having a baby soon, have a friend, daughter, sister planning to have a baby: please take the time to learn what gives in America.

      Researching the safety of natural childbirth yet again ~ here defined as spontaneous labor resulting in a vaginal birth over an intact perineum ~ I discovered an article regarding the use of technology in preventing low birth weight.  As I read it I was reminded of Dr. Marsden Wagner’s article, “Technology in Birth: First Do No Harm” (Midwifery Today, 2000).  In the opening of his article Wagner claims “The biggest killer of newborn babies  is a birth weight that is too low, but the number of too-small babies born has not decreased the past 20 years.”

     Considering “the advances in technology and the dependence that American trained obstetricians have on technology” (Ricciotti, Chen & Sachs) could the dismal statistics, no improvement in maternal or infant death in the past two to three decades, be true?  ACOG admits to being on the defensive right now and they don’t like it.  They should be feeling the heat to prove their recommended protocols are appropriate and safe.  Can we really prove their birth technology is inappropriately applied?  Every technology recommended to mothers is under the guise of keeping her baby alive, a goal to hand her a live baby.  We’ve written here before that America is a place where women have access to nutritious food, clean air, land to walk or otherwise exercise in and sanitary conditions under which to give birth.  Therefore, we surmise, the number of women who are not “healthy and low-risk” would be low and could not correlate with the high cesarean rate and high maternal and infant mortality rates. 

     We’ve never argued that technology is not appropriate for some risky births, but we do claim that midwives are the experts in normal birth.  It is the trained and experienced natural birth supportive midwife who is the most qualified to define what is a “risky birth.”  So, let’s tackle the issue of low birth weight, a birth health issue we all agree we must work together to improve.

     Ricciotti, Chen and Sachs write “While it is difficult to determine what proportion of preterm births might be prevented by obstetric technology, it is possible to evaluate these technologies to determine which of them might actually improve birth outcomes.”  They culled data and research on the following protocols related to the prevention of low birth weight:

  • Home Uterine Activity Monitoring: No large scale studies have been done but what is known is the cost of its use for women at risk for pre-term birth is about $7,000 per pregnancy.  Results: The favorable outcomes could be either the monitoring or the positive daily interaction between mothers and their nurses.
  • Tocoloytic Drugs:  These are drugs used to stop pre-term labor ~ betamimetics, inhibitors of prostaglandin synthesis, mag sulfate, calcium antagonists, combinations of the previous and/or oxytocin analogues.  Results: No evidence they are effective and use of these drugs associated with many potentially severe effects, moreover “scientific evidence of efficacy available for all of these drugs is surprisingly scarce given the frequency of their use.”
  • Steroid Use to Accelerate Fetal Lung Maturation: Evidence of a reduction in respiratory distress syndrome and subsequent neonatal mortality when given one to seven days prior to delivery; obstetricians are not appreciative of the effects as they occur after the birth at which point the baby is now under the care of another medical field.
  • Bed Rest for Twins:  Trials have excluded those that are at risk i.e. women with bleeding during pregnancy, PIH, polyhydramnios, previous cervical cerclage or previous cesarean.  For those that are actually healthy and low-risk there may be a decrease in the incidence of developing PIH (perhaps due to exposure to attention to good nutrition?) although no evidence was found that pregnancies were prolonged.  Twins account for 1% of pregnancies but 10% of all perinatal deaths therefore, it is surmised, bed rest is simply routinely advised w/o clear evidence of any benefits.
  • Cesarean Delivery: No evidence showing improved outcome for vertex presentations.  For breech delivery it cannot be determined if the results are “due to the intervention or the way the women were selected to undergo a cesarean or a vaginal delivery.”
  • Episiotomy:  No data demonstrating it improves neonatal outcomes.
  • Forceps:  No benefit; increases the incidence of brain hemorrhages.
  • Reduction in Multips:  There are complex ethical issues and studies favor increasing fertility technology to avoid this dilemma as there does appear to be a slight increase in outcomes for quadruplets reduction to two.
  • Cervical Cerclage:  There might be a benefit to a small number of women however who those women might be cannot be definitely selected in advance; further, its use is proven to increase the use of interventions as noted in the admissions records which show the use of tocolytics, induction, infection and cesarean delivery.

     “The reasons physicians use unproven technology or ignore proven ones is unclear.  At present there is no easy and effective way to modify physician behavior … it is difficult to remove familiar technologies before they are proven to be effective … in the current climate of cost consciousness, it is imperative that the widespread use of these unproven and ineffective technologies be abandoned and the use of proven technologies be encouraged.  In addition, we must be careful not to use technology in those situations where it does not improve outcomes.  Dissemination of technology into low-risk populations has the potential to do more harm than good.  Finally, physicians need to be educated to be wise consumers of medical technologies.” (Ricciotti, Chen & Sachs)

     Once again, we repeat, it is not so much that we are against the use of technology at birth nor is it correct that we do not believe medically trained obstetricians are not needed.  We are firm in our educated opinion that obstetricians today are not exposed enough to normal, natural childbirth and all of its variations including delivery positions other than supine let alone multiples, breech, posterior presentations.  ACOG is working hard to cloud the true issue: obstetrical training in America is a poor resource.

 

Ricciotti, Hope and Chen, Katherine and Sachs, Benjamin P., “The Role of Obstetrical Medical Technology in Preventing Low Birth Weight”, The Future of Children, Volume 5 Number 1

Wagner, Marsden, M.D. “Technology in Birth: First Do No Harm” Midwifery Today 2000

More women turn back to the idea of homebirth:  Our own Candace McCollett and a local midwife were interviewed for Monday morning’s (September 8, 2008) health episode on Fox21 News in Colorado.

A nicely done piece and we thank the journalists who support presenting a balanced view on women’s choices.

If you would like to consider homebirth and midwifery care, learn more about both from a balanced perspective please visit Midwifery Today for items such as The Heart and Science of Homebirth.  (see comments below for MT’s update on this publication).  The more you know ….

Two years ago I was teaching a Bradley Method natural childbirth class and posed the question, why the Bradley Method?  I like having some insight on what parents are thinking about when they choose a birth class as well as getting to know what are their expectations of a birth class.  One mother responded one of her relatives is a retired Connecticut OB-GYN and had told her, when she announced her pregnancy, that our state’s c-section rate is at 40%.  One year later a mother who was also, at that time, doing her surgical residency at Yale-New Haven stated the hospital is “aiming for” a 40% c-section rate.  The interesting fact to me is that the CDC’s 2006 preliminary reports cites a 34.1% rate for my state.  Yet, another mother in my class who works in a patient advocate office gave me a 2007 “unscrubbed” rate of 38%.  Unscrubbed?  Scrubbed?

What the public doesn’t know about the reported C-Section rates: they are confusing because no one is taking on the cause of telling the stories behind the numbers in a way that is clear to the consumer.  Therefore, we who are in the field supporting laboring women will tell you the shameful truth behind the organizations that can’t get out of their own way and are hobbling themselves at every turn in providing women with quality maternity health care.

I began by asking the CDC to clarify their data received and how it is sorted.  Here is their response:

“From: CDC-INFO
To: allgroupmail@comcast.net
Subject: RE: RE: YBFW: Stats
Date: Mon, 7 Jul 2008 21:08:12 +0000
> Thank you for your inquiry to CDC-INFO. Please find below information in
> response to your request on why Cesarean sections are performed.
>
> The National Center for Health Statistics (NCHS) collects and publishes data.
> NCHS does not make policy comments or interpret data, nor does NCHS conduct
> research.
>
> NCHS can provide you with data on Cesarean sections. However, we cannot
> translate the data.
>
> For more information about birth data, please visit the CDC website:
> http://www.cdc.gov/nchs/data/ad/ad385.pdf
>
> Thank you for contacting CDC-INFO Contact Center. Please do not hesitate to
call 1-800-CDC-INFO, e-mail cdcinfo@cdc.gov or visit http://www.cdc.gov if you have
> any additional questions.
>
> CDC-INFO is a service of the Centers for Disease Control and Prevention (CDC)
> and the Agency for Toxic Substances and Disease Registry (ATSDR). This
service is provided by Vangent, Inc. under contract to CDC and ATSDR.”

They do NOT conduct research.  They only tell you what they are told they can tell: the numbers as given to them.

Here’s what Independent Childbirth does know: not all hospitals participate in programs for reporting their statistics to the state.  That’s right.  Not everyone is giving their information therefore the CDC’s report does not include ALL of the data that is out there; only what is given to them.

The data provided to the CDC is reviewed by hospital staff and administrators to determine what is reported how.  That is to say the data is “scrubbed.”  How does that affect the reporting of the numbers?  Let’s give you a clear cut example.  Independent Childbirth member Louise Delaney relays this story told at this year’s CAPPA conference in response to our online discussion the scrubbing of statistics: “At the CAPPA conference this weekend someone brought up that stats at her hospital were indeed scrubbed.  For instance, if a c/s was done due to placental abruption, it was listed as a PA, NOT a c/s.  So there are FAR more c/s being done than are reported. “

To which another member responded that Placental Abruption is not a mode of delivery so how could that c/s be listed under PA and not C/S.  Well, you see that is the point (and which she was underscoring with  incredulity).  Each person working in the hospital system has a worldview limited to their patient, their office at the point of time in which she is delivering.  That’s it.  Period.  They do not look at what others are doing therefore they lose the benefit of learning from dialogue.  That is not a surprise to Independent Childbirth.  We have been reading for years about new methods of training for medical personnel across all field to teach them communication skills!!  I’ve walked into one hospital to support a premature birth and had to explain to the doctor that another hospital in our state uses blood analysis to determine lung maturation versus just assuming the baby’s lungs are not mature and trying to persuade the mother to consent to mag sulfate, a drug with horrible effects and unproven benefits to the baby.  In fact the evidence points to more deaths from its use!  D. Bernucca: Helping Women Avoid Unnecessary Interventions; Midwifery Today, Number 85 Spring 2008

More importantly, while many would assume that placental abruption can only mean cesarean it’s simply not true.  Perhaps today that is the protocol  However, either it wasn’t so eleven years ago when my youngest was born vaginally 8-weeks premature (at 32+ weeks) or the lack of dialogue is proven right here: everyone is making their own assumptions regarding outcomes.  Incidentally, my son’s premature birth was the consequence of placental abruption due to a cesarean birth two births earlier.  That’s right.  I’ve birthed two babies vaginally after one cesarean!!  Again, the stats are confusing because numbers are open to the interpretation of the very small worldview of the individual practitioner.

That limited worldview has wave upon wave of reverberations to the public.  When you say you trust your careprovider you limit yourself to their worldview and interpretation.  While that sounds noble, you trust your careprovider, the fact is your careprovider may not have the time, the environment nor the skills for dialoging with others in their field in order to stay on top of the research.  Case in point, repeat C-section rates are also soaring, 88.7%, yet data “support(ing) the notion that VBAC is unsafe” is still lacking (Lynda DeArmond, MD Waco Family Practice Residency Program, Waco TX).  Further, “the most recent Cochrane Review … concluded that no trial existes to adequately help women and their caregivers make an informed decision between the two (VBAC or repeat c-section).”  Lastly, Dr. DeArmond points out the flaw of the risk rate of 2.7% quoted the most in VBAC articles, “it is based on one (1) prospective nonrandomized cohort trial and one (1) retrospective cohort study.” (VBAC Rockville MD, Agency for Healthcare Research and Quality, 2003 and McMahon, Luther, Bowes, Olshan; Comparison of a trial of labor with an elective second cesarean section, NEJM 1996, 335:689-965).

Unless the maternal health policy makers start talking to each other honestly, forthrightly and bluntly “women’s healthcare options” remains an oxymoron and we are literally bound (to the delivery tables) and gagged (with unnecessary narcotics).

On Sunday, August 31, 2008 I was awakened at 3:57am with a phone call from a father whose wife was in labor at that very moment with a nurse insisting mom lie on her back in the bed so the monitors would stay in place.  This mother presented at Hartford Hospital for IV antibiotics as she had consented to do for her GBS+ status.  However, mom had NOT signed up for “birth my way” via Nurse Ruth who stated she’d been an L&D nurse for 37 years, attended thousands of births and she knew this was best, had coerced mom into pitocin and was now prepping mom for an Internal Fetal Monitor and a c-section via her negative commentary on how labor was progressing.  A quick review of the facts of what mom was feeling with her contractions and her previous birth experience (I was their birth educator for that vaginal birth result) and I told dad roll mom over on her hands and knees with her butt up in the air … no one can force medical interventions on you and by the way if you’re still okay with pitocin make sure that pit isn’t being cranked up.  Call me again in two hours and I’ll be on my way to the hospital if you need me.

At 5:05am while I was in the shower the phone rang and recorded a joyfully tearful message from dad … a beautiful little boy (6lbs) vaginally.  I spoke to dad later in the day allowing the family to have their bonding time.  Dad relayed the following: “I requested the presence of the charge nurse and dispatched with Nurse Ruth.  L turned over to hands and knees in the hospital bed and the pitocin was turned off.  She had one huge contraction and with the next huge contraction she said she wanted to push  … I thought how could that be?  She was only 1cm when I called you.  The new nurse volunteered to check because L could very well be ready to push.  She did a vaginal exam and found L to be 10cm and the baby was born with just a couple of pushes after that.”  Oh, and I totally forgot to ask where the doctor was because honestly I figured if he/she was being told L is only 1cm then I’m pretty sure he/she was nowhere near the hospital on this Labor Day weekend.

From a Labor Day weekend cesarean to vaginal birth in less than one hour.  Dad advocated for mom’s patient rights and helped her roll over to her hands and knees!!  Is it any wonder the overall cesarean rate from 1995 to 2006 increased by 46%??  

I recently stated to my online group that the real cesarean rate for the USA is 35% probably higher and was questioned on the validity of that stat versus the 2006 national reported rate of 31%.  I may not be the Centers for Disease Control, the American College of Obstetrics and Gynecology, nor the American Medical Association.  I am however independent counsel for laboring women.  We are Independent Childbirth.  WE ARE the source.  WE ARE at the greatest variety of births in the greatest variety of settings.  We are literally supporting mothers.  We are members of a group who keeps REAL stats for REAL women for REAL options for their very REAL births.

Find an Independent Childbirth member for an independent childbirth class near you!!  Mom’s ability to exercise her patient rights once she is in labor is no small feat.  In fact, legally her every consent could be considered compromised.  Attempts to deny her independent birth care counsel and support via her partner, her family or a doula is a serious red flag!  Her birth support needs to understand labor, her birth care environment and how it impacts her choices.

Don’t be just another number!  Talk!  Let your birth help tell the story behind the numbers!  Don’t let organizations that don’t speak to each other speak for you!

Share your positive birth experience and lessons learned!!

This movie, Orgasmic Birth, focuses on the women giving birth, and that’s something the public has been waiting for a long time!! Every woman you’ve ever shared birth with is in this film. There is the mother who believes you trust doctors for everything and she ends up with an induction, epidural and baby finally born after two vacuum attempts … and she believes the doc saved her. You see the mom who also believes the same, is induced, and has a cesarean. However, the movie starts and ends with the mothers who have believed in the birth process, their bodies and that how they birth matters to their babies. You hear from fathers who love that their babies were born surrounded by their home and loved ones…their natural environment to begin life in.

Instead of the black/white contrast of The Business of Being Born, you have a sophisticated segue in the sense that the commentator’s information is presented around the story told so the dots are connected fully because these women tell their own story and the commentator fills in the ‘real’ story. It’s not told fear based, it’s told from a know natural birth perspective. No rant. It just is.

We believe that it is also the intent to interview everyone in a home or home-like atmosphere, with the exception of hospital footage for those two moms with routine medicalized birth … and that’s a smooth, thinking contrast. Every person is speaking softly even when venting on medical birth. Love the moment that Dr. Northrup tells us with medical intervention we “screw it up” — “it” being normal birth.

It is also one of the first films presented to the public to show a wonderful birth class outside of the hospital. We don’t know if it is the producer’s intent but perhaps the film is trying to turn Lamaze around and portray Lamaze in the Institute for Normal Birth light. We say this because the producers limited themselves to Lamaze. They did also keep footage of someone mentioning a Lamaze in-hospital class that they didn’t like.

We wish more had been done to represent other independent birth ed options as independent childbirth educators are among the most deeply anchored normal birth supporters in America and have always known that hospital preferred birth classes are a disservice to women, hindering their access to unbiased information and, many argue, used only for props to keep women birthing in hospitals. Around the world, normal birth education may not be done in the traditional setting that we in America are accustomed to but it is still independent of medical fear and bias, with knowledge transfer occurring rather as a woman to woman knowledge share with midwives as the informational conduit.

We do wish the film included reflection on mothers who are second or even third generation homebirthers as well. These women kept normal birth in America from completely fading away. There really needs to be a film as a tribute to these women pioneers. In other words, it is important that nations, especially America, fully recognize that home birth, normal birth is not something new; that women have believed in and enjoyed their normal births before 2008.

The births shown are wonderful. One of the best births is the mom who talks about childbirth as a mother’s sacrifice. You might cringe because you start thinking here we go… “Birth is painful. Birth is a sacrifice. Birth is about a medal.” However, to our delight, this mother delivers within a pretty normal window for active labor, 26 hours, she’s birthing at home and the midwife says outright in a hospital she would have been given pitocin and c-sectioned by now. The great thing is the mom talking afterwards about enjoying that birth for its own challenge for her if not for any great spiritual or relaxing birth story.

This is a great contrast to the mom who I mentioned above with the vacuum baby who says not until closer to her due date and hiring a doula did she hear anyone talk about embracing contractions. Until then everyone talked about labor as a difficult thing. You really do get the full connection of the contrast between the two women’s births… some of the responsibility lies with women doing the work to face and/or overcome fears… some of the responsibility lies with careproviders’ attitudes about birth and their inability to provide humanized birth. It’s not only about medical vs. normal birth. It’s also about what women are told, have been told and how it’s still quite accidental for women to hear about birth as an enjoyable event in their lives.

The abuse survivor’s birth and another homebirth will make you cry. The very personalized births will leave you smiling and swaying with the moms. Very cool.

We can’t wait to share it with you and we hope to see you at our screenings!! Just check our “Birth Events Near You” page on this blog.

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

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