The Home Birth Experience: Cesarean Prevention

While we don’t normally publish consecutive posts on the same topic we thought today’s post warranted release.  We are committed to increasing international awareness of the issues and controversies in birth care protocols, advances in birth policy legislation, best practices and alternative options available to mothers.  To that end I recently authored a paper for submission to the international database resource available for the summit on Respecting Childbirth.  The summit took place in France during our Mother’s Day week event, the week of May 11, 2009.  We are all pleased to announce the paper was accepted for their database and some light is being shed on the truth of the state of maternity care in the USA.  It is our desire to raise awareness internationally that although America spends a lot of money on technology it does not mean that all American technology is to be accepted on face value as being beneficial.  The link to the summit (above) will bring you to the link on the paper, Home Birth: The Gold Standard of Cesarean Prevention or you may click the title link to download the paper and distribute it in your community, to your legislators as you move forward protecting your birth options where you live.  The first link in this post will also provide you with a tri-fold brochure you may wish to distribute by email or hard copy to your state’s legislators as well.

 

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!

 

A Kangaroo Courts New England Redux

The appeal to the September 7, 2007 Cease & Desist decision (see our earlier post this blog) will be heard in New Britain Superior Court on Monday, September 17, 2008 at 2:00 p.m..

In this environment we are again denied public input.  That is why mothers, daughters, nieces, friends, we must continue to affect public opinion through the legislative sessions and, hopefully, a court who will base its decision on precedent and case law, not bias.  The nation was riveted to the case of a 16-year old boy fighting for the right to choose his own cancer care but considers a woman’s right to give birth in a setting proven safer than a setting where interventions are routine “controversial.”

Support your right to give birth where you feel you are physically, mentally and emotionally safe for our own health and for that of our soon to be born babies.  That right includes the option to give birth in a hospital.  Supporting the right for full access in order to make your own choice means allowing for both medically managed and whole health birth.

The proponents for hospital birth are pushing to restrict your federally protected right (as noted in the article referenced above) to choose your health care by persuading the public that homebirth is dangerous.  They are protecting their industry by striking your achilles heel: the safety of your baby.

Even if you don’t understand homebirth right now you can understand the right to educate yourself and make your own choice.  

Please tell the courts the Medical Examining Board is biased in their action and please help us remind them it has already been decided in the state of Connecticut that midwifery is not the practice of medicine.  Tell the MEB to stop their witch hunt.

Please support the right of birthing families to make educated choices about the births of their children.
*September 17, 2008 @ 2:00 PM*
* New Britain Superior Court*
* 20 Franklin Square*
* New Britain, CT 06501*

 

Time For A “Second Class” of Midwives?

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