The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
The gentlebirth.org website is provided courtesy of
Ronnie Falcao, LM MS,
a homebirth midwife in Mountain View, CA
|
The AMA wants to make birth centers illegal, along with homebirths,
even though
Read more about the ACOG 2008 Press Release from The Big Push for Midwives and Childbirth Connections You can also educate yourself week-by-week in your pregnancy with theLamaze Weekly Pregnancy Newsletter for Parents |
The Language of Birth
Remember that in a normal birth, mothers give birth and babies work to get themselves born by pushing off with their feet against the top of the uterus and by maneuvering their head to fit optimally through the pelvis. In a physiological birth, the birth attendant simply "attends" the birth, ideally supporting the mother-led birth process and intervening only when it is truly necessary.
Doctors truly deliver babies only by cesarean, forceps extraction, vacuum extraction or a variety of other invasive and often harmful interventions.
In the way that we're all trying to work towards giving babies their
birth right of a physiological birth, I think it would be helpful to use
the language of physiological birth.
Another Improvement - A Rating System for Doctors
DrScore - Give your doctor feedback.
Doctors can't get better if they don't know how they're doing.
RateMDs.com is changing
the way the world looks at medicine by providing patients with the unique
opportunity to rate and read about their doctors.
Request A Copy of Your Medical Records after the Birth!
An Idea Whose Time Has Come
This idea came from a researcher in the field of prenatal and perinatal psychology who observed that the people who have control of the information have control of the research. If you want to be able to participate in long-term research studies about your child's health as a side effect of the procedures performed during pregnancy, labor and birth, and in the newborn nursery, then you will need to have a copy of your records.
"As a prenatal/perinatal therapist, such records can be invaluable in explaining a problem or validating a hunch about what happened to a baby/child presenting symptoms of birth trauma. . . .[I]f it becomes routine for mothers to request their medical records, it's possible that hospitals will become a bit less defensive about releasing them (fearing they'll be used to support litigation) and that the idea that this information is rightfully that of the parents (and the baby, really) might become more accepted. This would serve to support more and more research I see taking place down the pike as my fellow students in our field explore different aspects of pregnancy and birth and empower families to learn more about how birth relates to how their children think, feel and act in life. . . . So . . . let's think in terms of working towards having medical records of births easily and frequently released to mothers who request them, and having mothers empowered to believe they are entitled to this data and that it can ultimately benefit their understanding of their birth, and their child's well-being."
The researcher suggests asking for the full medical records (including
nurses' notes) of their birth (and/or child's nursery stay).
WARNING!!! If you have Aetna health insurance, you may want to change at the next opportunity, when your employer has their annual "open enrollment". Aetna doesn't cover homebirth, citing a single study based in rural Australia which shows that high-risk births far away from a hospital are high risk. They further cite the policies of the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, both business competitors to homebirth providers. Their policy statement ignores a mountain of evidence that homebirth is as safe as or safer than hospital birth for normal, healthy pregnancies.. If their policymakers have any integrity, this logic will soon lead to cessation of coverage for planned VBAC's . . . there's no dearth of studies and AAP and ACOG policies proclaiming the danger of VBAC's . . . and then they'll stop coverage for any woman who declines standard ACOG/AAP recommendations regarding routine ultrasound, routine induction, routine IV's, routine use of continuous electronic fetal monitoring, routine administration of antibiotics for all GBS positive women (up to 40% of birthing women), and prompt cesareans for any woman who fails to progress in a timely fashion during labor and pushing. They may also stop coverage for children who are not vaccinated according to the full schedule of vaccinations recommended by the AAP, even though many intelligent parents decline the newborn hepatitis B vaccine and practice selective vaccination according to their child's own needs.
If this is troubling to you, as it should be, let them know. You
can easily send
e-mail to Aetna's National Media Relations Contacts and simply tell
them that they should not be in the business of denying coverage for reasonable
healthcare choices, such as homebirth, waterbirth and VBAC. They
will especially want to know if you are choosing another healthcare provider
because of this unreasonable policy. You might also suggest that
they expand their research beyond ACOG and AAP recommendations. They
could start at: http:
If I can boycott Nestle, so can you!
If you need more motivation to boycott Nestle, then read breastfeeding.com's
Stuff
That Will Make You Mad
"Mr Ian Smith of York, gave his account of the company's ethics: "As
one the members of Synod from York, where we have a significant Nestlé
presence, I was invited, before the last debate on this subject in 1994,
to meet some of their directors to discuss the issue. At that time they
freely admitted that they were the market leaders of a trade that was being
mishandled in some parts of the world. I observed that this resulted
in many thousands of infant deaths. The response was that if they didn't
sell the product someone else would. We've heard that line with regard
to landmines recently: In other words, it's better that they're killed
by our products rather than someone else's. Nestlé admitted that
the business has its unethical side, but they still push it hard. They
say they will stop - if others do too."
See also: Podcasts
You Tube Videos can be the easiest way to bring yourself up to date
with some important birthing issues. This list is courtesy of Kelly
Harrison.
EPIDURAL -
The MD explains the steps he's performing. Note that the video is edited
so that the time for the entire procedure is shortened.
C-SECTION (w/ "Mobius
Extractor") - I find the pleasing music an odd contrast to the up-close
cutting, prodding, tearing, etc. This leaves no details left to the imagination.
The "extractor" is a new device. This video is supposed to illustrate the
ease and benefit of using it. Shows stapling of incision. I can't help
but feel sorry for the women behind the curtain.
C-SECTION (Hartford
Hospital) - This is an hour-long "documentary" showing off the hospital
facilities, but it also gives us a c-section up close, uncut, so you can
get an idea of the time involved. The intro says there are over one million
cesareans each year making it the "most common procedure." I love this
doctor quote from the start, saying c-sec is "one of the most rewarding
[procedures] for the obstetrician to perform." The baby is breech and the
MD says delivery by c-sec is "safer" for the baby than vaginal birth. Also
note lots of lavage and O2 for baby who is very floppy.
HOMEBIRTH -
6-min homebirth with use of dopler and amniohook to break bag of waters.
Older sibling at birth.
HOMEBIRTH in the
UK - delivered on all fours on Christmas morning. Only "technology"
was dopler.
EDUCATION
Animation
of the normal process of dilation and delivery.
Animation
explaining "stations" relative to pelvic bone.
Animation
of shoulder dystocia
HUMOR - This is the
Monty Python Birth Skit, which is BRILLIANT. I love the part about
the totally irrational depression the mother will experience, so "it's
happy pills for you!"
Bill Cosby's old birth skit, in two parts, Part
A and Part B.
NEW!!! for 2008!
Lamaze offers a new personalized weekly e-mail newsletter for expectant
parents, Lamaze...
Building Confidence Week by Week. Free weekly e-mails from Lamaze feature
trustworthy information, practical tips and inspirational stories to help
guide women and families through pregnancy, birth and beyond.
If you want to see a glaring example of how obstetricians don't GET
the normal physiology of birth, you can go read their statement on Lay
Midwives. Their first problem is that they don't understand the
difference between a lay midwife and a Licensed Midwife or a Certified
Professional Midwife. Here's a primer for them and for you!
A lay midwife has no formal midwifery education or training,
so typically wouldn't carry anti-hemorrhagic drugs or resuscitation equipment.
A Licensed Midwife is a midwife who has satisfied the educational
and experience requirements of her state to earn a license.
Here's information about a California
Licensed Midwife (LM), which is considered the most rigorous set of
requirements. Here are photos of some of the
equipment she might bring to a birth.
A Certified Professional Midwife
(CPM) is a midwife who has satisfied the educational and experience
requirements of the North American
Registry of Midwives (NARM). CPMs typically train and practice
in an out-of-hospital environment.
A Certified Nurse-Midwife is a midwife who has satisfied the educational
and experience requirements of the American
College of Nurse-Midwives (ACNM).
(Notice that the last three are not mutually exclusive. In fact,
a single person could be an LM, CPM, CNM, CM, MD, RN, PhD if she wanted.
In fact, there is a great deal of overlap among the formal certifications,
but here's an easy way to think of it: The C is for "Certified", and this
means that someone received a Certificate from a Certifying body.
A license is from the state, and it gives someone the legal right to practice.)
One of the really funny things about ACOG's statement is that they seem
to think it's very important for midwives to be trained as nurses first
in order to attend births, but not for physicians. Have you ever
heard of a nurse-OB? No, I didn't think so. In most countries,
such as the UK, midwives are independent practitioners working in collaboration
with physicians, and they specialize in midwifery directly, without detouring
through nursing school. ACOG's repeated opposition to efforts by
all kinds of midwives to reinstate their relationship as collaborative
rather than supervisory emphasizes their desire to control women, birth
and midwives. It is no wonder that they oppose midwives who train
outside the hierarchical environment of the hospital, where the physicians
are the ultimate authorities.
You can read more about the Different
Types of Midwives.
Their second problem is their emphasis on hospital training, which is
typical for nurse-midwives. Homebirth midwives are specialists in
normal birth, with specialized training for handling birth emergencies
in an out-of-hospital environment with the portable equipment and supplies
typically used in a home environment. So it's obvious that they should
be trained in the environment in which they expect to practice.
You can read the Bridge Club's
Letter to ACOG re: Improper Term "Lay Midwife" [March, 2006].
(The Bridge Club is a committee composed of midwives from the two main
midwifery organizations in the United States.)
Easy self education
about childbirth - audio file BIRTH - A one-hour public radio and audio
documentary about the practices and perceptions of birth in America.
What's the Best Way to Spend 80 minutes of your pregnancy?
Listen to Your
Body, Your Birth - Secrets for a Satisfying and Successful Birth -
a great audio book from Lynn
Griesemer. "80 minutes of warmth, common sense, humor, integrity
and love that inspires, encourages and reveals secrets for a most rewarding
birth experience - one you will cherish the rest of your life."
"This is the best audio resource about childbirth I've encountered.
It's got lots of wonderful tips and really does capture the secrets in
a way that's easy for women to understand. I highly recommend it!"
- [Ronnie Falcao, editor, The Midwife Archives]
Seeds of Compassion
- from a conference Apr. 11-15, 2008, with the participation of the Dalai
Lama. When we look across secular and religious wisdom traditions, and
across human history and cultures, compassion may well be the virtue that
is valued most highly and most broadly. The resources below seek to expand
our conversation about what compassion looks like in action and how best
to nurture it in future generations.
Check to see if the hospital you're considering is on the list of Baby-Friendly
Hospitals and Birth Centers. A Sept., 2005 study showed that
these hospitals had higher rates of breastfeeding, regardless of demographic
factors that are traditionally linked with low breastfeeding rates.
The
Mommy Uprising By Tina Cassidy - They're fed up with the unwanted C-sections,
the endless tests, the dubious interventions, and the scary advice from
overworked, malpractice-spooked doctors. And Boston women are shunning
the area's world-class hospitals to go to surprising lengths--and sometimes
take big risks--to give birth on their own terms.
For
expectant women, it's not too much to ask by Tina Cassidy. This
great article will help you to understand why "less is more" when it comes
to midwifery or medical support for a physiological process such as birth.
(Tina Cassidy is also the author of Birth: The
Surprising History of How We Are Born.)
Tina Cassidy's article is based on the Listening
to Mothers surveys.
Why
do women go along with this stuff? [Full text of Part
2]
PREFACE: Normal childbirth has become jeopardized by inexorably rising
interventions around the world. In many countries and settings, cesarean
surgery, labor induction, and epidural analgesia continue to increase beyond
all precedent, and without convincing evidence that these actions result
in improved outcomes (1,2). Use of electronic fetal monitoring is endemic,
despite evidence of its ineffectiveness and consequences for most parturients
(1,3); ultrasound examinations are too often done unnecessarily, redundantly,
or for frivolous rather than indicated reasons (4); episiotomies are still
routine in many settings despite clear evidence that this surgery results
in more harm than good (5); and medical procedures, unphysiological positions,
pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and
early mother-infant separation are used unnecessarily (1). Clinicians write
and talk about the ideal of evidence-based obstetrics, but do not practice
it consistently, if at all. Why do women go along with this stuff? In this
Roundtable Discussion, Part 2, we asked some maternity care professionals
and advocates to discuss this question.
One of the simplest and best things you can do for your baby is to work
with your birth attendant to prevent premature cutting of the umbilical
cord. Take a copy of Clamp
the Umbilical Cord Early and Risk Injuring Your Child's Brain by G.
M. Morley, MB, ChB (Ed.), FACOG, and discuss the issue with them.
[More info about premature cord clamping/cutting.]
While you're at it, you can talk to your birth attendant about using a
cord clamping system that is breastfeeding friendly.
Study Shows Homebirth Superior to Hospital
Birth - A summary of the 2005 BMJ Homebirth Safety Study.
Early
skin-to-skin contact for mothers and their healthy newborn infants
(Cochrane Review) - The Cochrane Collaboration is a committee of MDs who
review all known research in their fields to produce summaries. This
is a landmark abstract.
Make sure your birth attendant and hospital staff are familiar with
this study!
"Background: Early skin-to-skin contact involves placing the naked baby
prone on the mother's bare chest at birth or soon afterwards (< 24 hour).
This could represent a 'sensitive period' for priming mothers and infants
to develop a synchronous, reciprocal, interaction pattern, provided they
are together and in intimate contact. Routine separation shortly after
hospital birth is a uniquely Western cultural phenomenon that may be associated
with harmful effects including discouragement of successful breastfeeding."
From Birthing the Future
- they offer information, ideas, conferences and inspiring books &
videos. 970-884-4090
Birth in a Sanctuary - Imagine . . . a place where everyone:
The National Childbirth
Trust - From the UK, this site offers support in pregnancy, childbirth
and early parenthood. They have a separate portal for
professionals.
You can also educate yourself week-by-week in your pregnancy with theLamaze
Weekly Pregnancy Newsletter for Parents
Birth Blogs - Giving
Birth With Confidence - The authors of the Official Lamaze Guide muse
about birth, babies, and a whole lot more…
Empowering
Birth Blog - A homebirth after cesarean healed my scars and renewed
my trust in birth. Trying to spread the message that birth should be EMPOWERING.
The Birth Ecology Project
advocates for midwifery, doula care, natural birth, conscious parenting,
and sustainable living. The Birth Ecology Journal publishes articles and
essays of quality on topics of interest to parents, birth professionals,
and birth advocates on the website. Workshops for parents and professionals
are also in the works.
Homebirth
at the Hospital By Doula Giuditta Tornetta
Home Birth Talk provides information
about the home birth option and midwives, the facilitators of home births.
My first baby was born at home. The second (for lack of caregiver) was
born in the hospital (within an hour of our arrival) into my husband’s
hands while I squatted on the floor. The doctor who was called in by the
nurse was too shocked to do much more than watch and the only words we
heard from him were “oh my God!”. My husband reassured the OB (later
featured in the local newspaper for having 4,000 births to his credit)
with the words…”it’s okay we’ve done this before.” LOL
We left a few hours later. As “homelike” as that experience was
there is no question that I was not in my home and that the offers of “help”
(are you sure you don’t need a shot of oxytocin, wouldn’t you like to move
to the bed for the birthing of the placenta, do you think it is wise for
your 2 ½ year old to be in the bed with you, wouldn’t you like us
to bathe your baby before leaving) wouldn’t have been uttered by the midwife
who attended my first birth.
Some aspects weren’t even negotiable; I was required to leave in a wheelchair
rather than walk to the front door and my baby needed a name before leaving
if we wished to avoid extra administrative costs.
Although I had the complete support of my pediatrician (after interviewing
a mere half dozen) even he made a mistake and suggested we test the baby
for metabolic disorders before leaving. This of course proved to
be too soon and the results came back with a diagnosis of cretinism!
Flowered sheets or not…they weren’t my sheets and didn’t smell like
my laundry, the view out the window wasn’t my garden,
the people who knocked on my door weren’t my family members or guests,
and the attitude of those talking about us outside the door weren’t the
sounds of my household.
Was it a triumphant experience? You betcha! Did I use it
to motivate the dozens of couples taking my childbirth classes to create
their ideal (albeit hospital births)---but of course!! Would I ever
tell them it would be the same as having a homebirth? NO.
National Advocates
for Pregnant Women (NAPW) - NAPW has a vision of a world where women
enjoy full personhood and where neither pregnancy nor drug use serve as
an excuse to dehumanize and punish select groups of people
Dr Pregnancy is an educational
resource from the UK that seeks to celebrate the wonderful world of pregnancy
and childbirth.
The Biology of Belief reveals the
leading edge science of how parenting programs a child's genes and behavior.
If you have a child, are planning to have a child, or have ever been a
child, this book is for you.
Let your
monkey do it! by Skylar Browning - a fun article written by a dad about
how the primal part of the brain controls birth.
Ten Moons Rising -
Holistic Family Education & Resource Center. "It is painfully
obvious that our society is in need of change, and it is parents who will
play a critical role in realizing that change. For not only do we
bring new life into the world but, through the consciousness we bring to
our children's earliest experiences, we have the power to shift our current
path from one of fear and violence to one of transformation and healing."
They have an excellent links
list.
The Landscape
of Caring for Women: A Narrative Study of Midwifery Practice [Medscape
registration is free.]
"Midwifery care has been demonstrated over and over to be excellent
and associated with positive maternal-infant outcomes. . . . The midwives
in this study were negotiators, not dictators. They believed that power
rested with the women and not necessarily in themselves. This does not
mean to imply that they were weak or compliant; in fact, they were often
the opposite. . . . In addition, emphasis on presence and relationship,
rather than routine use of technology, may be misaligned with an institutional
and consumer fascination with machines as the solution to achieve optimal
birth outcomes. In this study, the midwife represented the "instrument"
of care. It was the midwife's ability to communicate, engaged presence,
and clinical judgment that presided, not the technology that was used."
In an age when women are choosing cesarean under the mistaken impression
that abdominal surgery is less painful and causes less damage, it's important
to remember that alternative birth positions can prevent most perineal
birth trauma; instead of choosing cesarean to prevent perineal trauma,
it seems important to remember that there are other important choices one
can make, such as your choice of birth attendant. In
this study, 73% of women attended by midwives birthed babies over intact
perineums.
Web-only resources written for parents
fish
can't see water - Why medicalised birth is bad for you. This
is a fabulous collection of information, including Marsden Wagner's writings.
Aletha Solter's new book, Raising
Drug-Free Kids: 100 Tips for Parents, begins at conception and includes
a discussion of how the drugs used in
labor and birth predispose children towards drug abuse.
The "Trust Birth Initiative"
is an old/new concept in the birth field.
The Circumfort Kit
contains sufficient quantities of materials to effectively manage up to
five potentially painful procedures that are routine in the hospital.
This is a kit for parents to take with them to the hospital to make sure
that their baby receives adequate pain relief.
A Field Guide to Birthing: A Conversation
With Michael Witte, M.D., and Heidi Bednar, R.N. - A great discussion
of birth options from Medical Self Care, edited by Tom Ferguson,
M.D., 1978.
The goal of Prenatal
Parenting is a psychologically and physically prepared mother who will
birth a happy and healthy baby with full support from loved ones. A family
that follows the techniques described in Prenatal
Parenting: The Complete Psychological and Spiritual Guide to Loving Your
Unborn Child will birth a happy and peaceful newborn infant and
help reduce the unacceptably high infant mortality rate in the United States.
Bonding
With Baby Before Birth (from WebMD) - Making a connection with your
unborn child can strengthen the bond you share, make you feel closer, and
enrich you and your baby's lives. Talk to the baby. Say goodnight
before you go to bed, good morning when you wake up, and talk to it throughout
the day. . . .
See also: Bonding and Prenatal
Communication
Boycott Nestle
OK . . . if I can boycott Nestle, so can you. It happens that I love
chocolate, and it further happens that the chocolate I love best is made
by Nestle. My favorite candy bars are Nestle's Crunch, $100,000 Bar
and KitKat. I LOVE their hot chocolate mix, and, of course, Nestle's
Tollhouse Morsels. Oh, did I mention those great new Treasures morsels
with coconut?!? Unfortunately, Nestle is actively killing thousands
of babies around the world through their unethical business practices in
pushing formula to families that cannot afford to use it properly.
I can no longer come home from births where we struggle to help babies
breastfeed because it's so good for them, and then eat a Nestle's Crunch
to keep myself awake on the drive home and then make a nice cup of hot
chocolate while I do birth laundry.
You Tube Videos
Resources
Find A Midwife
Enter ZipCode
Enter Country
If Not US
Klein MC, Sakala C, Simkin P, Davis-Floyd R, Rooks JP, Pincus J.
Birth. 2006 Sep;33(3):245-50.
Honors the work you & your baby are doing
Values natural, normal birth!
Treats you as the amazing woman you are
Understands your baby is fully conscious and sensitive to everything.
Respects that both of you need only positive words & images
Don't settle for a typical birth, create an extraordinary one!
There are hundreds of Articles from "Preconception Advice" and "Pregnancy
Fitness" to "Breastfeeding in Public".
We have an online Discussion Forum with a community of mothers (and
fathers) with expert advice. Come and join in and share your thoughts on
the wonderful world of pregnancy! You might check out their page
on Advantages
of Natural Childbirth.
Women talking to women about birth.
Not another expert, not another class.
We facilitate discussion/support groups.
Meetings are usually in leader’s home, but may be in a library or church
nursery or community center.
The meetings are usually held one night a month.
Must Read - The Annual New Baby Issue 2004 of Attachment Parenting
This booklet is terrific - it is truly a treasure! : The
Annual New Baby Issue 2004 of Attachment Parenting: The Journal of Attachment
Parenting
It includes some wonderful articles:
Bonding with Your Newborn by William Sears, MD - This is the best, most accessible summary of attachment and bonding that I've seen.
The Chemistry of Attachment by Linda F. Palmer, DC (reprint)
A New Look at the Safety of Breastfeeding During Pregnancy by Hilary Dervin Flower, MA
Since the 1930s there was a steady reduction in the maternal death rate
each year until 1982. The
Safe Motherhood Quilt Project is a national effort developed to honor
those women who have died of pregnancy-related causes during the past twenty
years and to draw public attention to the unchanging maternal death rate.
Quilt
honors mothers who died giving birth - BY HOLLY TKACZYK - about The
Safe Motherhood Quilt Project
For a fun introduction to midwifery and natural childbirth, read BABY
CATCHER: Chronicles of a Modern Midwife by Peggy Vincent.
This is a really fun, engaging book and will help you to get a sense of
your own strengths when it comes to birthing. It presents both home
births and hospital births in a way meant to avoid alienating those on
either side of what too often degenerates into a heated argument about
place of birth.
Think baby's first hours or even days don't make a difference?
Read The first hour
following birth - 4th September 2002 - In this article, first published
in Midwifery Today, Vol 61, 2002, Michel Odent catalogues 12 perspectives
on the first hour following birth.
Bursting the bubble
on mobile myths By Peter Cochrane [8/13/04] - Beyond the critical issues
of the importance of birth choices and baby's first hour, there's the key
issue of not being able to use cell phones in hospitals. This article
points out that the cordless phones used in hospitals are more likely to
cause interference than cell phones, yet hospital staff seem to use them
freely.
Women of Spirit
- Ancient Women's Knowledge in a Modern Context - lots of wonderful articles
by Sarah J. Buckley, MD
Maternity Wise
helps women learn about options and make informed decisions.
MidwifeInfo.com - Resources for
Midwives and their Clients
Ecstatic Birth is a call
for a revolution, a revolution in the way we think about birth, and, as
a result, the way we give birth.
CHILD MIRTH: A conscious, empowering,
lovingly supported pregnancy, labor, birth, and postnatal experience that's
respectful of the mother's needs as well as the baby's; an ecstatic or
orgasmic birth; mindful parenting.
Planning a low-intervention birth? Wondering what your chances
are of achieving this? Read The
First National Survey of Women's Childbearing Experiences: In
short, all but a tiny percentage had highly interventive births although
about half felt that a non-interventive, natural birth was best. The ones
with non-interventive births were the home birthers. One-quarter had c/secs,
and about 40% were induced. Almost all felt they had enough information
and participated in decisions to the extent they desired, although most
didn't know there were drawbacks to epidurals or that they were entitled
to full info on interventions or that they could refuse them. Many had
experienced pp problems of various kinds, especially the c/sec moms. One-third
had clinical depression.
ROUNDTABLE
DISCUSSION: PART 1 - Why Do Women Go Along with This Stuff?
Sheila Kitzinger, MLitt1* Josephine M. Green, BA(Hons), PhD, AFBPsS,
CPsychol2* Beverley Chalmers, DSc(Med), PhD3* Marc J.N.C. Keirse, MD, DPhil4*
Kathleen Lindstrom5* , Elina Hemminki, MD, DrPH6*
PREFACE: Normal childbirth has become jeopardized by inexorably rising interventions around the world. In many countries and settings, cesarean surgery, labor induction, and epidural analgesia continue to increase beyond all precedent, and without convincing evidence that these actions result in improved outcomes (1,2). Use of electronic fetal monitoring is endemic, despite evidence of its ineffectiveness and consequences for most parturients (1,3); ultrasound examinations are too often done unnecessarily, redundantly, or for frivolous rather than indicated reasons (4); episiotomies are still routine in many settings despite clear evidence that this surgery results in more harm than good (5); and medical procedures, unphysiological positions, pubic shaving and enemas, intravenous lines, enforced fasting, drugs, and early motherinfant separation are used unnecessarily (1). Clinicians write and talk about the ideal of evidencebased obstetrics, but do not practice it consistently, if at all.
Why do women go along with this stuff? In this Roundtable Discussion,
Part 1, we asked some maternity care professionals and advocates to discuss
this question. (BIRTH 33:2 June 2006)
Doctors are not scientists [BMJ 2004;328 (19 June)]
Lack of Evidence-Based Medicine in
Obstetrics
Maternal and Newborn Health also now online!
The following book was recommended for evidence-based care of uncomplicated labor and birth. Supporting your practice with evidence-based care is helpful when seeking reimbursement from HMOs and when challenged by supporters of increased use of technology. This is an inexpensive paperback and is available from WHO Publications Center USA, 49 Sheridan Ave., Albany, NY 12210. tel. 518-436-9686 or fax 518-436-7433 The cost is $10 with $5 for shipping. ($1 shipping for each additional copy.)
http:
Excerpt of Summary of Research on Place
of Birth (or
the full section)
1997, iv + 54 pages
Establishes universal guidelines for the routine care of women during
uncomplicated labour and childbirth. Reflecting the consensus reached by
an international group of experts, the report responds to the recent
proliferation of practices designed to start, augment, accelerate, regulate
or monitor the physiological process of labour in industrialized and developing
countries alike. Recommendations for routine care are based on a critical
review of what considerable research has to say about the effectiveness
and safety of 59 common procedures and practices.
The report has six sections. The first establishes a definition of normal
birth, and then considers the reasons why, in the interest of improving
care, so many maternity services have uncritically introduced interventions
that have been shown, in well-designed studies, to be useless, inappropriate,
excessively costly, and frequently dangerous for mothers and babies. The
differences between normal birth in hospitals and in homes, in industrialized
and in developing countries are also considered together with the personnel,
training, and skills needed to attend a normal delivery.
The four sections which constitute the core of the report systematically
review the available evidence for and against the use of specific procedures
in general labour care and during each of the three stages of labour. Details
of this evaluation range from the advisability of withholding food and
drink during labour, through a review of evidence demonstrating that routine
use of episiotomy is harmful, to a description of several non-invasive,
non-pharmacological methods of proven efficacy in pain relief.
In a key achievement, the final section classifies each of the 59 practices
considered into one of four categories: clearly useful, clearly harmful
or ineffective, inadequately supported by research findings and thus
to be used with caution, and frequently used inappropriately.
"... contains several important messages, messages that are perhaps
more crucial for the developed world than for the non-industrialised countries,
although they, too, will find much that is useful here..."
To order, send e-mail to QCORP@compuserve.com
WHO/FRH/MSM/96.24; order no. 1930104
Sw.fr. 10.-/US $9.00; in developing countries: Sw.fr. 7.-
- Midwifery Digest
This book is written for care providers but is also a valuable reference
for parents
Probably the single best source of research summaries regarding childbirth
is the book, Guide
to Effective Care in Pregnancy and Childbirth by Enkin et al.
[Now ONLINE !!!]
For those that don't know, this book is a guide to a huge two-volume book in which the studies done on most everything done in obstetrics have been evaluated and conclusions drawn. This work is also the basis for The Oxford Database of Perinatal Trials.
The smaller, very readable paperback Guide is available for $28.95. Amazon.com has a review, including the table of contents.
The most valuable part is the section in the back:
What's the evidence about Home versus
hospital birth (Cochrane Review)?
The Midwives Model of
Care is based on the fact that pregnancy and birth are normal life
events.
P e
a c e f u l B e g i n n i n g s - a collection of
several of the more popular and useful articles and information sheets
that I written or put together during the 1970’s and 80’s for use in childbirth
education classes, for the expectant and/or new parent clientele of health
care providers, and for educating the general public.
If you want to have a little fun while learning about pregnancy and
childbirth, check out the new game - "Who's
Having This Baby Anyway?"
Even if you're planning a medicated hospital birth, this is the closest
thing to informed consent you'll get, and you owe it to yourself and your
baby to learn some of the realities that the hospital glosses over when
they pretend "the drugs don't get to the baby".
Technology
in Birth: First Do No Harm by Marsden Wagner. M.D. - a great discussion
of the concept of appopriate technology and the folly of using technology
as if it carries no risks.
Cesareans:
Are they really a safe option? by Henci Goer - If you watched the recent
segment on Good Morning America [June, 2000] addressing the safety of cesareans
and the issue of a woman's right to choose this surgical procedure, you
probably ended up feeling quite confused.
BirthChoiceUK - This non-commercial website helps women in the UK choose where to give birth using information about maternity care, maternity statistics and research-based information about childbirth.
Has
the medicalisation of childbirth gone too far?
Richard Johanson, Mary Newburn, and Alison Macfarlane
BMJ 2002; 324: 892-895.
Getting
What You Want from Your Birth Experience an article by Doris Haire
4 minute speech to convince you to have natural
childbirth
Kim's Collection of Woman's Wisdom - great site for inspiration and self-education.
Mother's Intention: How Belief Shapes Birth by Kim Wildner
Reports on Birth Preference Options - This page contains reports, free for personal use, that explain the origins of the interventions often found on birth plans, their rationale & medical indications for use, and the scientific evidence either supporting, or not supporting, their routine use. From Women's Wisdom,
What is Fearless Birthing™?
- It is a program of self-discovery. It is nothing short of a map to the
place where mother's intuition awaits. It is a way to access the 'instruction
manual' that does come with each child!
My Words of Wisdom
- a collection of articles, poems and opinions from
Patti Blomme, author of the site Heads
Up! All About Breech Babies - Feed the Mother, Rest during
Labor, Birth's Most Dangerous Enemy, The Missing Link, A Rant on Choice,
The Chemical Symphony of Birth, She Could Have Died, Innocent Ignorance,
Can you Homebirth in a Hospital, I Can Do It, A Father's Affirmation, Ode
to An Epidural, Ode To A Home Birth, Little Wonder
Birthing the
Easy Way -Learning the Hard Way - a book about birthing by Sheila Stubbs
Tips for Labor - A Midwife's Suggestions after
Birthing Her First Baby by Joanna Baldwin, LM
A Father's
Anger and Birth Love by Bill McCracken - "the time is coming where
fathers will unite to stand up for their rights as the loving protectors
of childbirth." And Bill DID go on to have
the birth he envisioned.
Evaluated Childbirth
- a terrific site for women looking for support for natural childbirth
There’s
no Place Like Home - The advantages – and joys – of giving birth where
you live By Pam England, author of Birthing
From Within
This is a fabulous article from Mothering Magazine:
Revealing
the Real Risks: Obstetrical Interventions and Maternal Mortality
Issue 118, May/June 2003
By Marsden Wagner
I must applaud all of the women who try to find caregivers before they
become pregnant. They are more likely to find someone who "clicks"
with them, than when those pregnancy hormones are flying and they just
want to make a decision so they can feel that everything's calm.
At least, until they're eight months pregnant and push comes to shove about
testing or induction. Ask the hard questions early in care.
You can ask questions from The
Midwife Pro (Midge Jolly, LM, CPM) (formerly at Moms Online - oxygen.com)
The Compleat Mother - The Magazine
of Pregnancy, Childbirth and Breastfeeding - This quarterly magazine
is a wonderful source of affirming information and support for following
a path that is in your family's best interests, even if it's different
from the mainstream path. They also offer some absolutely wonderful
publications, "Birth Pleasure", "Birth Joy", and "Breastfeeding Anyway".Two
of these are described on the web pages, or you can order them in bulk
(10 for $20 + $3 shipping) from jody@minot.com
At BabyCenter.com they take weekly polls. Out of 5,717 respondents to the question: "Will you use drugs during childbirth?" 66% said yes, and 33% said no.
In a separate question, 15% of 2,888 women who planned an unmedicated birth actually had one.
If you're serious about wanting an unmedicated birth, make sure you're
setting yourself up for success - hire a supportive practitioner and a
doula and choose a birthplace where you know your choices will be honored.
Personally, I think homebirth is the easiest such situation to arrange,
but some women can make hospital birth work for them, too.
As you're making your birth choices, keep in mind both your own experience and your baby's experience. Here's a terrific picture of a baby that is halfway born looking absolutely ecstatic. Here's more information about the baby's experience of birth.
Your baby really does care about his or her birth experience!
TLC's A Baby Story sometimes has homebirth or birth center birth stories that can give prospective parents an idea of how they contrast with the standard high-intervention hospital birth.
Baby McGlynn - Twenty-five years after getting married and raising four children, Jack and Karen McGlynn are expecting again. At 43, Karen's desire for a natural home birth makes for a tricky delivery, but they know they can make it as long as they're together.
Baby Armstrong - Barry and Brenda prepare their two sons, Brendan and Brian, for the birth a third boy by painting a welcome home sign and attending a baby shower. The baby gets yet another B-name, as Blake is born in a water tub at a birthing center.
Baby Johnston - Both previously married, Julia and Ross are expecting their fifth child. This close-knit family home-schools and will all participate in the home birth with a midwife in attendance.
Baby Panec - Keri and Elliot commissioned an artist to create a unique nursery for their first child in their brand-new home. For the water birth, Elliot climbs in the tub with Keri to offer support during the labor and to watch with joy as their son, Eric, is born.
Baby Rachwal - Steve, an art director, and Karen, a professional storyteller, have arranged their careers for the tag-team parenting of their daughter Hyla and their new baby. They are planning a home delivery, complete with birthing tub, midwife and labor assistant.
Baby Herren - When Kathleen met Bill, they were stunned to discover they shared the same last name; but they also shared a commitment to traditional family values and their faith. This match made in heaven will give birth to their second child at home.
Baby Andrews - After deciding on a natural home childbirth, Robin and Ryan attend breastfeeding class and Robin checks out cloth versus plastic at Dydee Diaper Service. With 15 family members present for the painful natural birth, Ivy Rae is born at home.
Baby Bagnell - Chiropractors and parents Larry and Karen Bagnell believe in living life naturally with minimal medical intervention. They will apply those beliefs to the birthing process with a drug-free labor and delivery at home.
Baby Morgan - This unconventional couple prepares for their first child by hiring a body-cast sculptor to commemorate the birth. Then, they visit their pastor to plan the non-denominational christening before Sierra Rose is born by natural water birth.
Schedules
for A Baby Story for the next month
What Does Safe
Motherhood Mean? - Safe Motherhood in the USA means that no woman should
die or be harmed by pregnancy or birth. from Safe
Motherhood Initiatives-USA
Lists, lists and
more lists - a great list of lots of different support lists.
Why
Have Natural Childbirth? - an essay written by a mom who found her
birth experience wonderfully transforming.
Drugs in Labor - Why aren't We Screaming?
- How do drugs in labor affect your child's intelligence, motor development
and socialization?
Natural
childbirth options - even CNN is jumping on the midwifery bandwagon
Five Good Reasons to Delay Clamping the Cord - Hospital personnel have their agenda based on schedules and check-off lists, and it's unlikely to be in synch with your agenda to take advantage of those special birth hormones that give your baby a once-in-a-lifetime chance to bootstrap the way nature intended. Delaying clamping of the cord is your biggest ally in keeping the baby with mom ?smile>. I don't know if nature anticipated obstetricians, but the umbilical cord was certainly a clever way of giving them a hint that the baby is meant to stay with the mom after the birth. Too bad they've not gotten it quite yet.
Don't Cut The Cord! - a great summary article with tips for parents planning to give birth in the hospital.
Risks of Premature Cutting of the Umbilical
Cord, with some tips on encouraging the hospital staff to provide the
best care for your baby.
Birthing from Within -This Book is Absolutely Terrific and All the Rage! |
 |
There is a great new book available called BIRTHING FROM WITHIN by Pam
England and Rob Horowitz that addresses birth as an emotional and spiritual
process. Pam was my childbirth educator and one of my midwifery mentors.
I can attest to her wisdom and to the transformative nature of her childbirth
prep classes. [They have a Web
site with information about courses for educators
and parents.]
Independent Midwifery in the
UK
Bornfree! The Unassisted
Childbirth Page - When I first heard about the unassisted childbirth
movement, I was dumbfounded. It sounded so terrifying, so risky,
almost irresponsible even to consider it! Then I read the book.
Wow! What a gift Laura Kaplan Shanley has given us. [More
about Unassisted Childbirth]
If you want to buy a video that you'll want to watch over and over again to see how calm and relaxed this mom is, check out the DVD, Psalm & Zoya - The Unassisted Homebirth of Our Twins.
Although this family arranged to have a midwife attend their birth, the babies came before the midwife could get there. Both parents (and the older sibling) are amazingly calm, even with the footling breech. If pregnant women watched this video every day of their pregnancy, they'd have a very different view of labor and birth!
I also think it's really important for all midwives to see footage of at least one unassisted birth, and this particular video has it all! Here's a blurb from the web page, but I'll add "Breastfeeding an older sibling during labor".
· A vertex birth
· A footling breech birth
· Use of a “birth ball” during labor
· Mother performing her own vaginal exams
· Mother catching her own babies
· A child present at birth
· A calm birth environment
· Birth sounds
· Smiles and laughter during labor
· Breastfeeding of twins
What an eye-opener. Well worth the purchase price!
Delivery Room Tragedy - Dangers of Vacuum Extractors
ABC's 20/20 did a piece on the dangers of vacuum extraction, which is preferable for many reasons to a cesarean in the case of a difficult birth. However, this piece and mainstream medicine completely ignore the superior alternatives:
"BIRTH CONTROL - When
did the movement to empower pregnant women to make informed choices turn
into a guilt-laden cult?" by Nina Shapiro. This controversial
article about epidurals and other drugs for labor generated a number of
responses that may help you to figure out what you really want your labor
to be about. This copy of the article is hosted at a very interesting
French site (with articles in English) called
Sorceresses Reborn.
OUT
OF THE WOMB, INTO THE FIRE - The Myth of the Safety of Hospital Childbirth
(A Response to Nina Shapiro’s article "Birth Control" in The Seattle
Weekly, November 26, 1998) by Jock Doubleday
Choosing An
Obstetrician or Midwife: What is the difference? by Suzanne S. Powell,
ICCE
Association of Texas
Midwives' Daily Gestational Age and EDD Calculator - This is easier
to read than "the wheel" for some people.
Giving Birth: Challenges
and Choices (1998, 35 min, color, stereo) A model for normal childbirth,
addressing popular misconceptions and hospital routines, focussing on issues
of pain, fear, midwifery, doulas, babies; featuring Dr. Christine Northrup,
OB. By Suzanne Arms
Yvonne L. Crynn's site The
Midwife and Home Birth, including Midwifery/Homebirth
Articles and information about the video, Home
Sweet Homebirth- This site is intended to help you educate yourself
and others about the choice of midwifery and homebirth. Families need to
be aware of birthing options. Midwifery is a model of care which
includes good nutrition, skillful midwifery, natural childbirth, homebirth
and breastfeeding. Also available in Spanish - LA
PARTERA Y PARTO DOMICILIARIO
The passion of mothering is not a New Age idea; it's a Stone Age absolute.Leilah's web site includes a fun, humorous article, What I Can Expect When I'm Expecting (which is always) - written while pregnant with her eighth child - just one of the many excellent articles from her Birth Love Columns in the Online Birth Center News. She also has a new book available - "Resexualizing Childbirth" - A collection of essays by Leilah McCrackenDeep within us is a fantastic pulse of ferocious love: it binds us to our babies, and makes us vigilant in their lifelong care. This pulse has been eroded by the institutionalization of many basic life events; most significantly, childbirth and learning.
Instead of ancient mothers selfishly guarding the individual loves and virtues of our children, we become modern custodians for the state - breeders and caregivers of an easily manipulated populace. Women must once again claim birth as a powerful, liberating life event- instead of a painfully medicalized one; and families must allow themselves to learn and stay together in the short time they have- and shun the bizarre lessons in life given by often hostile institutions whose main focus seem to be that of severing families and crushing true intelligence.
It is revolutionary to reject what society so stringently dictates, and revel in being Mother: not as a producer of marketable goods, but as the conduit of life itself.
One of Leilah's most recent pieces, Being
Born Blessed (born in the rain), is well worth the small membership
fee. Or . . . thanks to her generosity, it is also available
at gentlebirth.org
Welcome to the Labor of Love An Internet Community Built by Parents for Parents
Options for
Childbirth - Hospital, Birth Center, Home
A woman gives birth the easiest where she feels the most comfortable.
Gentle
Birth Alternatives - Childbirth Information
Gentle
Birth Alternatives - Links to Great Web Sites
Childbirth Information
excerpted from the book, Pregnancy
? Childbirth Tips, which is based on the belief that birth is a
normal, natural, empowering experience.
The Midwifery Link, a
resource guide for finding midwifery, doula, parenting, vaccination and
related issue information on the Internet.
Alternative Birth Resources - at Robin Elise Weiss' pages at The Mining Co.
Home Birth Resources - at Robin Elise Weiss' pages at The Mining Co.
Water Birth Resources - at Robin Elise Weiss' pages at The Mining Co.
The
advantages and disadvantages of homebirths, birth centers, and hospitals
Is Homebirth
For You? 6 Myths About Childbirth Exposed
Online version of a pamphlet created by the now-defunct Friends
of Homebirth in Texas.
Mother Friendly Childbirth
Initiative
Baby Friendly
Hospital Initiative
A Nurse Speaks Out About Hospital Care
- she shares her frustrations with assembly-line birth and the crazy economic
pressures that result in suboptimal maternity/newborn care.
What
price for a perfect delivery? - The importance of continuity
of care is highlighted in this article from the UK. I'm amazed that
it considers a three-midwife group to offer "continuity of care" though!
Our culture tends to be very undereducated about the importance of sensible postpartum recovery. Women bounce back much more quickly and easily when they are pampered for the first few weeks. And new babies are less likely to have colic.
Here's a good book to read BEFORE baby comes, because you'll be too busy afterwards:
The Keys to Postnatal Rejuvenation
How to Avoid Colic, Avoid Postpartum Depression, Experience Deep &
Profound Rejuvenation
"Many cultural traditions use the same principles after childbirth,
the ones which statistically don't have problems. The language is the same
- mothering the mothers with TLC, warmth, oiliness (internal and external),
massage, simplicity, moisture, favoring sweet, sour and salty tastes, specific
foods, freshly cooked (not raw) soupy foods, herbs, and of course rest
- these are keywords to favor. The details even of these considerations
are significantly more under guidance (and communication with/advice of
your primary care provider is essential with pre-existing medical conditions)."
The
Trials of the Midwife
by Katie Granju - From Minnesota Parent, October 1997
A must-read article for anyone trying to understand why the healthcare
system in the U.S. continues to snub the midwifery model, despite reduced
Cesareans, proven safety, and lower costs.
The State of California Access for Infants and Mothers (AIM) Program is a new program. It provides low cost health insurance to pregnant women and their infants who are not eligible for no-cost Medi-Cal or health insurance. The pregnant woman will choose a health plan that serves the area she lives in. The AIM Program is part of California's efforts to increase health care for mothers and their infants.
Access for Infants and Mothers Program (AIM)
c/o Healthcare Alternatives
P.O. Box 15248
Los Angeles, 90015
213-742-0487
800-433-2611
The AIM program provides health care to pregnant women with no
health insurance for their pregnancy and who are not receiving health
insurance through Medi-Cal.
The State of California, Managed Risk
Medical Insurance Board (MRMIB) office performs outreach for the Access
for Infants and Mothers (AIM) Program - low cost health insurance for
middle income pregnant women.
See also: Online and Offline sources
of information
The FP Revolution - The Family Practice
Newsletter - The new web-based source of contemporary information on
primary health care for professionals and consumers. Sponsors of the novel
health care e-zine, - Dr. Colin Kopes-Kerr continues "to scan, review,
analyze, and promulgate those sources of clinical information that I believe
to be most practical, most cost-effective . . . "
The Death of Evidence-Based Medicine? - June 12, 2002 - "The
New England Journal of Medicine will announce Thursday that it has given
up finding truly independent doctors to write and review articles and editorials
for it, as a result of the financial ties physicians have with so many
drug companies in the United States. The Journal says the drug companies'
reach is just too deep."
Evidence-Based
Medicine Simplifies Practice [Medscape registration is free.]
Evidence-Based
Medicine: Here to Stay or Gone Tomorrow? [01/04/2005 - Medscape
registration is free.]
There seems to be a new movement towards educating parents about the practice of "evidence-based medicine"; this means that practitioners make recommendations based on medical research, rather than on concerns about liability or "the way they've always done things".
There seem to be more and more books that focus on evidence-based medicine instead of simply telling you what your practitioner is likely to recommend. I think this trend is very beneficial for the well-being of mothers and babies and for consumer rights and advocacy.
Here are some good books about Evidence-Based Medicine:
Obstetric Myths Versus Research Realities: A Guide to the Medical Literature - This is the book that seems to have started this whole movement. It's very technical and perhaps best suited to healthcare practitioners or childbirth professionals. [Based on this work, we can no longer say that a great deal of American obstetric practice goes forth without adequate research. It is now more accurate to say that many interventions are used routinely or frequently in spite of research that has clearly shown that the procedure is being used inappropriately in this country." - Judith P. Rooks, CNM, MPH - Midwifery & Childbirth in America (1997)]
When Research is Flawed: Critiques of Influential Research Studies by Henci Goer
Pregnancy, Birth and the Early Months by Richard I. Feinbloom M.D. - This is a very common-sense book that manages to avoid a lot of the emotion about different birthing philosophies.
Care Practices That Promote Normal Birth from the Lamaze Institute for Normal Birth
DRUGS
NOT FDA APPROVED FOR OBSTETRICS - There have been no adequate and
well-controlled studies to determine the delayed, long-term effects of
the drugs listed below on pregnant women or on the neurologic, as well
as general, development of children exposed to the drugs in utero or during
lactation. Such use is defined by the FDA as "off-label" use. This
list includes fentanyl, morphine, terbutaline, Cytotec (misoprostol), Duramorph,
Narcan (naloxone), Prostin E2 (dinoprostone), Vistaril and Xylocaine (lidocaine
hcl).
Munchausen
Obstetrics - The American Way of Birth: Trauma and Brain Damage (excerpt
from a letter to a legislator) by Rich Winkel
What You Should
Know About Filing Your Health Benefits Claim - If you are an employee
or family member of an employee who receives health benefits from a health
plan provided through employment in the private sector, a Federal law,
the Employee Retirement Income Security Act (ERISA), protects you. Among
the protections, ERISA sets standards for administering these plans. Those
standards require plans to give you important information about the plan
and to have a fair process for handling benefit claims.
Weighing
Your Health Plan Choices - Consumer Reports, Sept., 2005 - the Overview
is available for all to read. [You must pay to subscribe to Consumer
Reports Online.] This article has a later section - How
to appeal denials of care
The
Secrets of Medical Decision Making: How to Avoid Becoming a Victim of the
Health Care Machine by Oleg I. Reznik
This book will help you understand all the forces at work behind the
recommendations you get from your healthcare providers. A must read!
Health Choices from Consumer
Reports - Use our Health Plan Report Card and Recognized Physician Search
Tool to ensure that you and your family are receiving the highest-quality
health care available in your area.
A Consumer Guide
to Handling Disputes with Your Private or Employer Health Plan - Kaiser
and Consumers Union have a great set of web pages about Consumer Rights
and Health Insurance.
Consumer
Reports Medical Guide - Compare disease and drug treatment options
RealAge.com - Information about avoiding
disease, the effects of aging, and medical errors.
WebMD.com - Recommended by Consumer
Reports for health-related tools.
The Pricing of U.S. Hospital Services: Chaos Behind A Veil of Secrecy [Medscape 01/12/2006
How
Childbirth Went Industrial: A Deconstruction by Henci Goer
Among the many good reasons for seeking an out-of-hospital birth, one reason is to avoid infection. It turns out that hospital infections are a growing, but hidden problem. In fact, in most states you cannot even find out how your local hospital stands regarding infections.
The organization Consumer Union is working to do something about this
problem. You can read about their Stop Hospital Infections campaign
at:
She Births: A Modern
Women's Guidebook to an Ancient Rite of Passage
WHAT
YOU DON’T KNOW CAN HURT YOU: KNOWLEDGE IS POWER IN A DOCTOR/PATIENT
RELATIONSHIP - on the www.obgyn.net site.
The Cato Institute's Policy Analysis #246: "The
Medical Monopoly: Protecting Consumers or Limiting Competition?" by
Sue A. Blevins.
YOUR
RIGHTS AS A HOSPITAL PATIENT IN NEW YORK STATE - Maternity Section
Raising your child in a toxin-free world - Four
Steps To Organic Motherhood - . . . Katie and Mic LeBel knew they wanted
to raise their children in an environment as free of toxins as possible.
I have Kaiser in southern California and while I was only pregnant for
13 weeks before my miscarriage, I have no complaints about my prenatal
care whatsoever. I also felt that except for the one OB who tried
vehemently to persuade me to miscarry naturally (instead of having a D?C),
the midwives, OB's and OB Nurses were all wonderful.
This has been my experience as a labor coach. If you're high risk
and need to be in a hospital, Redwood City Kaiser is my all-time favorite,
now that they've got "almost" full-time midwife coverage again.
Statistically, the safest births are those with the least intervention,
so they're also going to be the cheapest. This puts the HMO and the
consumer/client/patient on the same side in terms of wanting to avoid interventions.
This is so different from the non-HMO hospitals, where they make more money
by doing more procedures and by extending the hospital stay.
I've labor coached three births at Kaiser-RC and had great experiences
all three times. In fact, two of those births are the all-time best
hospital births I've witnessed. The staff was very respectful of
the parents' wishes for a calm, quiet, gentle birth, and they came through
beautifully.
They were even supportive of the parents' desire to delay the newborn
screen (aka PKU/heelstick) until the sixth day, when it's more accurate.
When you're shopping around, make sure to ask lots of questions about
the things that are important to you. If you're looking at Kaiser,
ask your local Kaiser hospital how many midwives they have on staff, and
whether there are gaps in the coverage. If you're considering other
insurance plans, ask whether they cover doulas or other professional labor
support. If you want to make sure you have as many options as possible,
also make sure they cover homebirth.
And, be sure to get it in writing. ?smile>
WASHINGTON, Nov. 18 (UPI) -- Getting hospitals to wake up and improve
their services may be as simple as publishing a consumers' report.
Missouri researchers released a study today showing that overall, hospitals
offered more options with better outcomes just a year after the release
of a comparison of care for pregnant women.
Daniel Longo (``LONG-goh'') told a meeting sponsored by the American
Medical Association today that a shoppers' guide put out by the state health
department lowered the rates of cesarean sections. Longo and colleagues
found that within a year C-sections had dropped 6 percent in places the
consumers' guide noted as high-rate hospitals.
Longo, from the School of Medicine at University of Missouri in Columbia,
says many of the more limited hospitals beefed up services to match the
competition. Half of the places the report identified as lacking follow-up
programs filled that gap within a year. A third of the more limited hospitals
added a nurse educator to coach breast feeding. And 43 percent of the hospitals
without car seat programs offered one by the time Longo surveyed.
The researchers also found that zestier competition cut health costs.
Longo found that improvements in ultrasound use and C-section births, first-time
and repeats, saved some $2 million in just one year.
A 1992 Missouri law required the health department to start publishing
these hospital consumer reports. Longo points out that a new consumers'
report, on emergency rooms, is scheduled for release Friday and that the
researchers plan to track its effects.
However, the obstetrical analysis, published in the Journal of the American
Medical Association, has already made Longo a believer in the reports'
power. He says, ``My advice to people in other states is, if you don't
have one, talk to your politicians.''
Not to say this always happens, but the trend is, you go to have your
baby, it's supposed to be a painful but happy occasion, but once you get
in the hospital you quickly learn that You personally have no rights. The
reality, at least the way I heard it from the doctor at the meeting I went
to, is that the hospital staff and doctors can do to you whatever they
feel like doing, and say it was medically justified, and they don't feel
they have to answer to anyone. And then you go home and get the bill for
this baloney.
I seem to be reading more and more about how hospitals are trying to
attract more birthing women by offering deluxe accommodations and food.
I actually find this a disturbing piece of evidence that birthing is big
business and susceptible to all the weird forces associated with money
and power.
Henci Goer's Letter to the San Jose Mercury News, 6/24/05
To the Editor:
Choosing where to have a baby based on whether it offers afternoon tea
(Moms Feted Like Royalty, Mercury News, June 21, 2005) is like choosing
a car because you like the cup holders instead of on crashworthiness. The
savvy woman has more substantive issues. She wants to know:
What is the cesarean section rate? A cesarean is major surgery with
all that implies in terms of pain, recovery time, and hazard, especially
hazards for future pregnancies. Research shows that cesarean rates should
be less than 15%.
How often is labor induced? Research does not support the principle
rationales for inducing labor. Among other risks, induction doubles the
likelihood of cesarean surgery in first-time mothers.
What percentage of women have epidurals; what comfort measures are available?
Where most women have epidurals, other options tend to disappear. A host
of potential complications follow in the wake of having an epidural and
the other interventions that an epidural makes necessary. The same is not
true of comfort measures such as tubs, showers, birth balls, and rocking
chairs.
What are the usual practices for laboring women? Research shows that
continuous electronic fetal monitoring, routine I.V.s, denying oral intake,
breaking the bag of waters, confinement to bed, pushing and giving birth
while lying on the back, and episiotomy—cutting the vagina to enlarge it
for birth— offer no benefits but have harms. The episiotomy rate should
be 10% or less.
How do you promote successful breastfeeding? Among other measures, hospitals
supportive of breastfeeding keep mothers and babies together day and night,
do not give babies water or formula, do not give babies pacifiers, and
do not give out formula samples.
How do you ensure my right to informed consent and informed refusal?
Any advocate for normal birth who works with pregnant or laboring women
can recount story after story where women were given inadequate information,
no information, or misinformation or were pressured into consent. Denying
vaginal birth after cesarean, which forces women to agree to cesarean surgery
in order to obtain medical care, is the most salient example of this, but
it is only
Sincerely,
______________________________________________________________
MotheringDotCommune Forums
at Mothering Magazine
EmpoweredChildbirth
· Birthing in Love and Wisdom (A Yahoo Group)
20ishAPPregnancy
- Pregnancy list for young mothers interested in practicing attachment
parenting. Topics of discussion may include gentle and low internvention
methods of birthing, including midwife assisted and homebirthing, breastfeeding,
herbal and homeopathic medical treatments, non-circ'ing, non-vacc'ing,
vegetarian and vegan living, and other alternative, natural life styles
Homebirth Email List at
kjsl.com - This forum is for anyone who is interested in supporting and
learning about homebirth.
Yahoo!
Groups Birthdates - groups of women due or babies born in certain time
periods.
A Comment on Natural Childbirth, including
mention of the "Steiger curve" of penile performance.
A Thanksgiving Dinner to Remember
- some more humor about a medicalized family event
Mother Care, Whelping
Information & Beautiful Canine Birth Pictures! from Mari-May Kennels.
This is a great description of how to provide hands-off labor support for
dogs, and it's amazing how much of it applies to humans, too!
This brief essay, "Midwife Leaves Illinois After
Legal Harassment" helps illustrate what may happen to the good midwives
in your state, province or country if the birthing families and caring
citizens don't support them.
You can donate money to Citizens for Midwifery by just spending a few
minutes on-line. Check out: www.iGive.com
- CfM is listed with organization and receives money everytime one of us
visits the site. Just by signing up and designating CfM as your charity
of choice, CfM receives $2.00. Then CfM gets 10 cents everytime you
visit and make ten quick clicks after that. You don't have to spend
anything to make a donation to our cause.
http:
Selecting an Insurance Plan
I had Kaiser in the SF Bay area. I have heard it varies depending on where
you are, but I sure wouldn't recommend them around here.
From: C-upi@clari.net (UPI)
Subject: Consumers' report makes hospitals improve
Organization: Copyright 1997 by United Press International
Date: Tue, 18 Nov 1997 8:35:06 PST
UPI Science News
Bizarre Hospital Attitudes Towards Consumers
I think that the attitude toward women in the hospital is totally bizarre
considering what you would reasonably think you would get in an enlightened
democracy like America. You would think, being in a country where we are
all consumers and you can "have it your way at Burger King" and where everyone
believe their rights are important and we all talk about not being racist
and not being unkind....how is it that women can go to a hospital where
they ought to be honored and well cared for, and they get
etc.
Resort-style Maternity Care
the tip of the iceberg.
Henci Goer
Henci Goer's latest book is The Thinking Woman's Guide to a Better
Birth. You can find out more about her and her book at http:
Previously appearing on ParentsPlace.com as the "Birth Guru," she is now
a resident expert on Lamaze International's website, the Lamaze Institute
for Normal Birth, at http:
Support Groups
A Little Humor
How to Support Midwifery
See also: General Midwifery
Advocacy
Join a Midwifery Organization
The Midwives Alliance of North America (MANA)
is an organization of North American midwives and their advocates. MANA's
central mission is to promote midwifery as a quality health care option
for North American families. Print our their membership
form to join.
Citizens for Midwifery - print out the membership form at the bottom of their online brochure to join.
Coalition for Improving Maternity Services (CIMS) - help circulate the The Mother-Friendly Childbirth Initiative or volunteer to serve as a liaison for getting a local birth service designated as mother-friendly. [Mother-Friendly Childbirth - Highlights of the Evidence]
Contact your local midwifery organization
and ask how you can help.
You might also point out to them that homebirth saves the insurance
company (and ultimately your employer) lots of money, so they should consider
covering it at in-network rates even for out-of-network providers, or actively
lobbying homebirth midwives to join their network.
I *always* talk about my positive birth experiences, make sure women
know their opinions, answer any questions Im asked (normally after I've
asked them leading questions ;-) !!!) and stayed involved in my local
hb assoc so other women continue to have info / access to the same services
I did. Other little things I did were put home birth stickers
on my car bumper, added a "I was born at home" badge to my nappy bag and
also I've made up a carry bag that has my HB assoc logo and "Home Birth
Naturally" on it which I use for shopping etc.- this gets *lots*
of looks in the street and I can see them reading and then looking at normal
me! This has gone down so well that my HB assoc has decided
to take on the idea and we are next month making 100 of these for free
gifts to homebirthing mums in our area!
Midwifery Stamps - U.S. Postage - This doesn't really support midwifery financially, but it helps to recognize the work of two women who have left their mark on midwifery:
Mary Breckenridge adapted the British combination of nursing and midwifery to serve the rural poor of Appalachia through the Frontier Nursing Service, which she founded in 1925. These 77-cent stamps are postage for 3-ounce pieces, which is exactly what my intro. packets weigh. What better way to send them than with Mary Breckenridge?
Virginia Apgar, a doctor, developed the Apgar system for assessing a
baby's condition at birth. The scoring system is somewhat outdated,
but she was one of the first, possibly the first, whose name was used to
coin a birth-related term. It's such an irony that so many of these
birth-related terms have mens' names attached to them, totally ignoring
the thousands of midwives who preceded them.
Some Possible Examples:
The risk of neonatal mortality (an infant death occurring in the first 28 days of life) was 33 percent lower for midwife-attended births compared to physician-attended births with comparable risk factors. (Midwifery care, social and medical risk factors, and birth outcomes in the USA, J Epi ? Community Health, MacDorman M, Singh G, 1998;52:310-317)More facts available from the Citizens for Midwifery Fact SheetsIt is much more difficult for obstetricians to defend high-technology, high-intervention obstetrics when midwives and a few doctors are meanwhile showing that a much less expensive type of maternity care is equally safe. -- Marsden Wagner (World Health Organisation maternity specialist.) Editorial in The Lancet.
The World Health Organization (WHO) states that the preferred location for most births is outside the hospital, either at home or in a birthing center, and that out-of-hospital birth should be implemented and maintained as the basic standard for all midwifery education and training programs.
From the CDC bulletin: National Infection Control Week is October 18-24 (1998). Each year, approximately 2 million patients develop a hospital-associated infection, and an estimated 88,000 patients die as a direct or indirect result of such infections.
Dr. DeLee, who introduced forceps and episiotomy around the turn of the century, stated just before he died that if he had his whole life to live over he would do home births and nothing else, realizing that the majority of his work was probably going to do bad instead of good.
-Mayer Eisenstein, MD in Safe Alternatives in Childbirth
Send more suggestions
for this list.
A listing
of routine hospital procedures with links to pages that analyze each
procedure.
Association
of Nurse Advocates for Childbirth Solutions - WWW.ANACS.Org -
"We foresee a time... when all childbirth professionals will support women
in their childbirth choices and nurses will all practice evidence-based
maternity nursing and actively facilitate childbearing women to have the
most optimal birth with as few interventions as possible." Parents
can join this organization and further their own goals by supporting and
participating.
Tips for Labor from an OB Nurse
"Birth
as an American Rite of Passage" is a book by writer and medical anthropologist,
Robbie
Davis-Floyd. Dr. Davis-Floyd is renowned for her research in the field
of birth. This website decodes the messages conveyed by hospital
birth rituals otherwise known as "standard procedures for normal birth".
These ritual procedures, common in many American hospitals, make birth
appear to conform to the technocratic model and babies appear to have been
produced by society. Each procedure is explained in detail in the body
of the chapter.
Gracious
Births by Judy Edmunds - a midwife contrasts her experience of home
labor, hospital birth and homebirth.
I have delivered two babies in the past two years and both naturally
(no drugs or interventions). I see you are getting advice about having
a "birth plan" so I thought I would share with you that one of the best
things we ever did was NOT have a "birth plan" but rather a "Birth Preferences"
sheet. Honestly I know it sounds stupid but my doula suggested it and even
my OB commented on how that language is so much less off putting to hospital
staff.
One more step in the non-offending birth plan / preferences is to not show the staff what you've written down. We simply discussed what we wanted with our OB during regular visits, and my husband and I were clear with each other on what we wanted. I wrote down a sheet of my preferences (see Ina May's Guide to Childbirth... it helped me immensely), and made sure my husband had a copy. It was for him to be able to stick up for us, not to give the staff (which could potentially annoy them).
Other things I'd echo from what others have said: make sure someone sticks to your child like glue from the moment they're born. We asked for our child's hands to not be washed, but my husband noticed that the nurses kept trying to distract him or get him to leave while they gave dd her bath. And be very clear about all the ointments and shots... they will try to persuade you. Regularly and often. It gets really annoying.
Just remember that when you go into a hospital, the staff has habits
and routines which work for most of the people who come through.
So if you want something different, you really need to go in knowing that
you're challenging a system, even if it doesn't seem like that big of a
deal to you. Every time there's a shift change, there will be
someone new who will notice that you haven't done X, and they'll ask you
about it. It's all a part of their hospital routine. You just
need a plan for how you're going to remind them that you're different.
There's a list for women who have suffered birth trauma, i.e. birth experiences so traumatic that it continues to affect them very seriously - BirthTraumaSupport@egroups.com. This exchange may help women to appreciate the importance of the choices they make:
I am a childbirth educator and work very hard to get people to plan
their births and have dialogue with their care providers. I encounter families
that just walk in and lie down, and let the doctors do what they will.
Such a setup for misery. What can I tell people that will help them to
see that birth matters, that the choices that are made affect the outcome,
that technology has risks?
My opinion is to tell them that the #1 thing Dr's do when you just,
as you say, "come in and lie down", is they automatically give you the
birth THEY want. By that I mean they put your labor and delivery on THEIR
schedule. They will induce you so they don't miss their kid's birth day
party, they will break your water and strip your membranes, give you pitocin,
etc.... until your healthy and normal labor becomes something very rushed,
medical, unnatural and extremely controlled. There becomes NOTHING beautiful
and natural about it. And, if they are busy and impatient, (which they
always are), then instead of letting you pass your placenta naturally,
they will push on you, yank on your cord, and rip it out as if you could
never do it for yourself because somehow they render you helpless and insufficiently
equipped to do what women have been doing without all this "help" since
the beginning of time. That's what I would tell them. Knowing what you
want is only half the battle. Having someone to ENFORCE your wishes in
the midst of all the medical intimidation is the other half. So in two
words I will tell you what the key is..... TRUSTED DOULA
I disagree. To ask a doula to take on the responsibility of fighting your battles for you is unfair.
If you don't want to be induced, hire a midwife or doctor who doesn't induce labor. If you don't want electronic monitoring, don't go to a place where that is standard while you're in labor. If you don't want the placenta "delivered," hire someone who doesn't do that.
It's highly unlikely that you can, while giving birth, also manage to
convince some L & D nurse that everything she has been taught to do
is wrong. Much easier to just hire someone who agrees with you in the first
place. The likelihood of negotiating a homebirth in a hospital is pretty
slim.
Shame of it is many do hire people they think will respect their wishes,
but when push comes to shove they say, "It must be done for safety sake."
See also: Legal Issues - Informed Consent
Midwives
Code of Professional Ethics from Artemis House
ICEA Statement on Informed Consent
Getting a stubborn patient to say Yes
- an article written by and for OBs about how to coerce laboring women
to agree to routine treatment.
The Issue of Informed Consent:By Katherine A. Dettwyler, Ph.D., Associate Professor of Anthropology, Texas A?M University, Specialist in Infant Nutrition
The New Zealand College of Midwives statement on Informed Consent.
The Code of
Health and Disability Services Consumers' Rights from New Zealand.
Being able to pull this card from your wallet when confronted with urgent or major treatment/test decision manages your mind and keeps the questions consistent throughout test/treatment discussions. A very upset or shy person could just hand the practitioner the card and ask that all discussion occur within that format. As a practitioner myself, I use it to organize my thoughts and keep my discussions complete, informed and consistent.
Key Questions About Your Care
Answers to the following questions will help you participate in your care responsibly and help you know what to expect.
When a Test is Suggested:
Please order and disseminate the card freely....this is just another
way to make for educated, informed people who may then choose midwifery
care.
Clients cannot be expected to know what no one is teaching them.
I couldn't resist forwarding this post on to these lists as I am appalled
by its contents. I guess it is something many of us suspected, but to have
it stated at an ACOG meeting is terrible. Please read on as this may affect
the way some of us talk about birth plans and assertiveness and doctor/patient
relationships!
I have been a silent observer on the list for about a month. I haven't written because I am just an aspiring midwife/ student and I will be unsubscribing voluntarily next week. I respect that many midwives feel a need for a private space without us "wannabes," but I just couldn't resist responding on this topic before I go.
As far as parents' right to refuse eye drops for their babies- I have been doing my senior thesis on the legality issues of midwifery, (I must say I am not a law student though, I am studying women's health and development/ population) and my research in the law libraries led to the issue of mothers refusing medical treatment for their unborn babies. I would like to remind everyone that there has been a terrifying precedent set in many state courts which allows doctors to perform a variety of interventions on the pregnant woman and her fetus against her will. Examples include experimental operations in utero to prevent deformity- not even to save the life of the fetus! Of course, there have been many court-ordered C-secs, court-ordered hospital births (the pregnant woman in AL who had wanted to birth with a midwife was arrested and court ordered to have the baby in the hospital). The law has been very severe to "protect" babies inside mom, and it seems even worse with babies outside mom. Even the religious exemption has been overruled lately... very scary from my perspective.
I attended an ACOG course on obstetric emergencies, and one section,
"how to deal with the difficult patient who presents a birth plan" sparked
the comment from one of the teachers, "Tell her whatever she wants to hear
and when she is in labor you can do anything you- the dr.- want because
the courts have accepted the argument that the pain of labor is so intense
she is not in her right mind and can not make decisions that hold legal
weight...(a paraphrase from my memory) Of course, the official ACOG book
says to cooperate with the woman if possible first because courts have
been "very reluctant" to force women to have procedures...the courts are
becoming less and less "reluctant".
I have an article called "Abuse and Neglect of the Unborn" which has
a section on precedents set in parents refusing care for their children
(unborn and born), and a (pretty extensive) collection of articles from
legal journals on (lay) midwives' court cases around the US, and the debate
over regulation and enforcement. If anyone needs a place to start in creating
a legal defense or wants copies of any info for file just in case, please
email me at tammy.nakanishi@sit.edu Thanks for letting me listen, I learned
a lot.
Winkler, Rosenthal. Sexist practice in medical school- vaginal examinations on women without consent. Needle 1988 June:10-11.
Phillips A. When what you don't know can hurt you. Guardian 1991 Jan 22:34.
Bewley S. The Law, medical students and assault. BMJ 1992:1551-53.
Robinson J. Are we teaching students that patients don't matter? J.
Med Ethics 1985; 11:15-21.
It seems that a nursery nurse turned them into CPS (Child Protective
Services). This was after the dad asked her if someone else could try to
place an IV on the baby. She had been trying for 45 min. and when the dad
asked her to stop and let the baby rest while they got someone else she
claimed he was interfering with a needed medical procedure. The police
came 20 min. later.
My experience here was with child protective being brought in against
a family for trying to take their newborn out of the hospital AMA.
The family was accused of depriving the child of 'standard of care' treatment,
which was interpreted as child abuse. The crazy part was that this
was for prophylaxis -- not treatment of any diagnosed condition. Once the
court order was presented, this family buckled under the pressure and left
the kid for treatment, rather than risk having him taken. Crazy that
educated parents really have no choice sometimes!
I had a similar experience with transport.White,middle class married
couple,early twenties.Transport after 2 and 1/2 hours of pushing with no
descent,mom pretty tired,dad scared and frazzled etc.Vacuum extraction,apgars
8?9.OB announces that she saw pus on the baby's head,and that the baby
is grunting and retracting.She calls in Peds and they have mom sign a form
for treatment except that mom refuses to have a Lumbar Puncture done unless
bloodwork indicates a problem.They are then threatened with losing custody
of the child unless they cooperate.They agree,baby and mom were kept for
three days,baby in isolation,tests were all negative.The OB requested 3
months of followup for this "at risk" couple from social services!
|
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Voice of Experience: There is a lot of anxiety among pregnant
women these days - our country is at war, and the political environment
is very adversarial. This isn't a supportive environment for birthing
women. My personal recommendation would be for women birthing for
the first time to take two different birth classes - one Bradley class
to help educate you about the physical aspects of childbirth, and another
class that focuses more on the mental/emotional aspect of birthing: Hypnobirthing
or Birthing from Within. It's possible that BirthWorks
classes would satisfy both needs.
Do
They Deliver? - Comparing the Claims and Philosophies of Natural Birth
Methods Can Be Challenging, Learns a Mother-to-Be by Lindsay Moran [8/22/06]
Breck Hawk, RN, midwife, doula and author of Hey!
Who's Having This Baby Anyway? has created Childbirth Awareness
classes for newly pregnant women / couples. - These classes are called
iCARE (Improving Childbirth Awareness for a Richer Experience) and are
not designed to take the place of classes that already exist out there.
They are an added bonus to the education that pregnant women need to have
the safest and richest experience in their baby's birth. The classes
are designed to be taught before a woman chooses which direction she wants
to go with her labor.
Adele Szilardi's The
Bay Area Childbirth Education Locator
Western Canada Birth
Professionals Directory
What's the difference between BirthWorks and Bradley? How can I get more information about both?
Sorry for the newbie question - we just decided to have a home birth
(YAY) - and I would like to find a method that works. We used Lamaze
with our first child and it didn't work very well. It might have
also been the surroundings, the quick labor and the busy hospital
room but...I'd like to explore my options.
Birth Works is a childbirth education program that teaches women that
there is no one right way to give birth. Instead of focusing on breathing
patterns, Birth Works helps women to look at (and deal with) the beliefs
and attitudes that they have about birth, as well as dealing with grieving
and healing, using breathing and visualizations, affirmations, etc.
It really is a wonderful program, that I think could have saved me from
an unnecessary cesarean. But then again, if I hadn't had that cesarean,
I wouldn't be training to teach Birth
Works!
http:
888-TO-BIRTH (862-4784)
mailroom@birthworks.org
"BirthWorks is:
A childbirth education and teacher certification program with
an innovative and experiential design. Birth Works® embodies
a philosophy that develops a woman’s self confidence and trust in
her innate ability to give birth. The classes are experiential and
provide both a physical and emotional pre