The Domino Theory: Feel Yourself Falling?

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:

• You will receive quality evidence based information not cheesy rationales.
• You will not be exposed to pitocin or dangerous medical inductions.
• You will not be exposed to internal fetal monitoring requiring the artificial rupturing of the bag of waters and penetrating your baby’s fetal scalp.
• You will not be falsely lead to believe all women need pain medications because labor is difficult.
• You will have a lower incidence of infections because there will be infrequent vaginal exams if any at all.
• You will not have limited mobility because you are not connected to monitors.
• You will not have limited mobility to deliver your baby because your practitioner isn’t planning to control your baby’s emerging from your with an episiotomy, through “super crowning” or otherwise ensuring you are on a bed in certain positions (usually some form of the “C” or semi-reclined position).

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!

 

You Can’t Get There From Here

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

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

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

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

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

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

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

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

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

Sir,

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

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

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

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

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

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

 

Celebrate Women’s Real Birth Wisdom!

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!

 

Never again

Preconceived notions are… interesting. I’m in the middle of watching the wonderful A&E version of Jane Austen’s Pride and Prejudice and the theme is, of course, Darcy’s and Elizabeth’s mistaken first impressions about each other, and working through the negative prejudice each had about the other, to get to the truth about themselves and each other. Sometimes first impressions can be very accurate; but sometimes they can be completely wrong.

When it comes to choosing a care provider, it is important not to blindly accept anyone’s recommendation, nor to follow merely a “first impression,” but to closely examine the person who is to be caring for you during pregnancy, labor, and birth. Just as Elizabeth learned that Wickham was not the kind, honest, and honorable person he appeared to be at first, so you may find that your midwife or obstetrician may not be exactly what she appears to be.

A friend recently mentioned that she was going to be trying a “natural” induction method (castor oil), and I didn’t say anything about the negative observations I had just recently heard about it; and I’m afraid it may have negatively affected the baby. At one point, it was “touch and go” for the baby. I said, “never again” — regardless of how much I think the mother may resist my input.

A fellow childbirth educator had an experience some years ago when a friend of hers mentioned that she hadn’t felt her baby move much lately. Not wanting to make her unnecessarily worried, she did not suggest that she go get checked out, although she herself had had a necessary preterm C-section for just the same thing. The friend’s baby was stillborn a few days later. “Never again.”

You read here about a birth educator who attended a vaginal twin birth as a doula, and both she and the pregnant woman were so glad to find a doctor willing to allow a vaginal birth, instead of insisting on a C-section, that neither one questioned whether the doctor had the experience necessary to attend a twin birth. As happens with some frequency, the second-born baby was breech, and the birth of the baby was quite traumatic, with the doctor showing his or her inexperience, and ultimately, fear. But the doctor told the mother afterwards — and perhaps the doctor believed it as well — that the trauma the baby endured was better than being brain damaged or dead; so the mother believed that the doctor ultimately saved the baby, and is content with what happened, although it was very unnecessary. “Never again.”

We do hear from time to time that we, as natural childbirth advocates, are extreme.  We’ve heard many a commentary that compares natural childbirth to a throwback to living like a pioneer.  We’ve all had the experience of having women who know we are natural childbirth and birth rights advocates walk away from us quickly or politely (sometimes not) shut us down.

We wonder sometimes if it’s worth risking having people try to paint us in that radical light to keep doing what we do: quelling preventable mother and/or newborn injury ~ physically, mentally and emotionally ~ including death.

Never again.

 

Orgasmic Birth: Our Review

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 Role of a Doula

Recently The New York Times wrote about doulas and the article left a negative impression about doulas, and tossed in a criticizing lactation consultant comment as an aside. To take the view that the New York Times article does–as an across-the-board view that doulas are problems–is an error. The paper presented a complaint rather than pursuing a couple of viable angles: the many expectations that mothers and partners have of labor support today, and the licensure of female support at birth such as midwives, birth educators in the role of birth support, monitrices (someone who has been trained to provide some clinical assessment in labor usually while mother is at home) and doulas.

There are now many birth support and whole birth health care options for women to learn about, choose from and advocate for change. Midwives, independent childbirth educators, doulas, birth centers, homebirth and breastfeeding are now more commonplace subjects to bring up when planning birth. Women today are realizing that they need to avoid interventions such as induction which carries a higher risk for cesarean or just arriving at the hospital too early; and there are options available to support their refusal to fall in line with industrialized birth. In response, hospitals are trying to offer more and more amenities but many parents recognize that in spite of measures by hospitals to draw them in by offering a luxury tub or more comfortable birth room furniture, hospital birth is still hospital birth. Seeing the smoke and mirrors, women who still choose to birth in a hospital may seek additional independent female support in birth which has been shown to be a positive influence on outcomes. However the benefits of the additional birth support is very clear in the birth community and we hope the media will take the time to do more in-depth articles on the anthropology of women in birth, culturally and traditionally.

It is confusing for the public to read contradictory articles posted by the same journalism venue such as this one from CNN that says doulas advocate for you and then CNN also posted this article stating “doulas are not supposed to offer a medical opinion….strictly to motivate the mother.” What remains the focus for women is that we still need to think independently, make our own choices and employ those who support our choices from birth care to birth itself. Women have many different reasons for hiring a doula besides strictly whether or not to ask them to advocate. Doulas can make fathers and siblings comfortable with birth and help them enjoy birth too! There are obstetricians, midwives and labor and delivery nurses who have witnessed doulas as an extra pair of caring hands so that all participating in the birth remain fresh and positive during a labor and birth–especially an intense birth. Doulas help military moms birthing without their partners. Doulas are sometimes even interpreters! This is a day that many never imagined: birth support, midwives, homebirth, unassisted birth, informed birth, etc. are all in the headlines!

In many states women’s choices are being restricted and the birth community continues to work together for the greater benefit of society at large ~ improving mother and baby outcomes ~ and for the mothers and babies where you live!