Strollerderby : midwives

They Say: Episiotomy Rate ... Cut!

Madeline Holler — Mon, 11 May 2009 12:29:00 GMT

Good news for stretched perineum in the greater Boston area! The rate of episiotomy at Brigham and Women's Hospital has fallen dramatically over the last 10 years. Wanna know why?

Well, for one thing, women refused them! (Go childbirth ed., birth plans and big mouths!) Also, certified nurse midwives were influential.

Another reason?

Peer pressure. Younger docs stopped doing them routinely and wouldn't let the older ones either. An article in the 2005 Journal of the American Medical Association, know as the Hartmann study, was particularly influential, as it found no reason for routine snips to the muscular skin that stretches as the baby's head emerges.

The drop in episiotomy had already begun in 1997, the first year of the study. Then, episiotomy was performed on nearly 30 percent of all births at that hospital. The decline continued slowly. But after the JAMA article came out in 2005, the rate dropped a staggering 50 percent. By the end of the 10-year study, which included 61,268 women (singleton births, head-down position, at least 36 weeks gestation), the BWH rate was 6 percent. The national rate was 9.

From Medscape:

The study concluded that local peer pressure and response to significant research, in particular the Hartmann study [the 2005 JAMA paper], contributed to the substantial reduction in rates of episiotomy across patient and provider groups over the 10-year period.

It recognized several other contributing factors, including long-standing CNM service in hospital-based practice, and the addition of CNMs to Harvard Vanguard Medical Associates in 1990. Institution of the Balanced Scorecard was a factor, as was the gradual retirement of older obstetricians trained in routine episiotomy. Younger residents avoid episiotomy, she observed. Dr. Johnson also recognized the obstetric chiefs' making episiotomy a priority in 2002 and noted that labor and delivery nurses were educated about the procedure.

She pointed out that women giving birth also increasingly refused episiotomy.

Midwives performed the fewest episiotomies, followed by female physicians (the study noted that select female physicians performed more than 60 percent of all episiotomies performed by female docs). Older male physicians performed the most episiotomies.

Anybody give birth at BWH? Did you have an episiotomy? Midwife? Select female doc? Old dude?

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Placentas Washing Up in Illinois Sewer

Madeline Holler — Fri, 27 Feb 2009 23:27:00 GMT

A public health administrator in Champaign, Ill., is asking that whoever is dumping fresh born plancentas into the local sewage system to, you know, stop it.

For the third time, workers at the local water treatment plant found afterbirth caught in a filter designed to keep large foreign objects (including human organs!) out of the treatment facility.

The placentas are consider potentially infectious medical waste and regulations forbid disposal in the sewer system.

The department apparently believes the flushed placentas were from homebirths. From a letter released by the public health office:

The individual or individuals in the community that have been engaging in this practice must stop immediately and begin disposing of the medical waste associated with home births in an approved manner. ...

Local health authorities strongly encourage community members to alert the proper agencies if they have any information regarding the unauthorized disposal of medical waste.

Authorities are investigating.

I think there's probably more to this story. Illinois is another of many states were midwifery is basically, if not outright, illegal. But homebirths attended by illegal midwives happen frequently and have been documented. So I think there's probably something more to this case -- that it's not some illegal but skilled and trained midwife flushing placentas down the toilet. Then again, I watch too much Law & Order.

Be like me and throw the things in the trash.

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South Dakotans Don't Support Home Birth. Or Do They?

Miriam Axel-Lute — Wed, 11 Feb 2009 22:00:00 GMT

As the economy continues into the toilet, there seems to be a growing push to consider increasing the use of midwives (both hospital and home birth, nurse-midwives and certified professional midwives) as a way to cut down health care costs.

Of course, it's being met with a predictable backlash from doctors screaming about how dangerous home birth is.

In South Dakota, this time around, the doctors won and the house rejected a bill to allow certified professional midwives (the only credential that requires experience in out-of-hospital births) to attend home births. In South Dakota, as in many other states, certified nurse midwives can attend home births if they work with a doctor who approves it—but no doctor will approve it, effectively making the option nonexistant.

But no matter. No one really wants the option anyway. From the AP story: "South Dakota had more than 12,000 live births in 2007, and only 26 of those babies were born at home, said Doneen Hollingsworth, state Health Department secretary. Only 19 of those were intended to be home births, which indicates home births are not supported by most South Dakotans, she said."

Or, um, that you've made it illegal for the people who want to attend home births to attend them? If people who wanted a home birth were willing to do it alone they wouldn't feel the need for this bill would they? (And they do.)

(Not to mention that at least some of the other seven probably lied about whether their home births were planned to protect midwives working underground.)

Photo by dizznbonn.

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Move Over Angie's List: It's the Birth Survey

Miriam Axel-Lute — Fri, 09 Jan 2009 17:30:00 GMT

The Internet is a wonderful thing for making our opinions known: We can rate our professors, our Amazon purchases, our contractors, and our favorite blog posts (hint, cough). Why not our midwives and doctors and hospitals?

After a pilot in New York City, the Coalition for the Improvement of Maternity Services has launched The Birth Survey to collect detailed information about mothers' experiences with their pre-natal, labor and delivery, and post-partum care. If you've given birth in the last three years, I strongly urge you to go fill it out. The sooner they get a volume of responses, the sooner other parents can get meaningful information on the options in their area. (NYC parents can already view the pilot data here.)

The survey is anonymous, and takes about 20 minutes (longer probably if you're ranking more than one care giver, which you have the option to do). It gives you almost entirely questions that are relevant to you based on your previous answers, which makes it much more pleasant to fill out than many surveys, especially on something that can go as many different ways as birth.

The questions focus on issues that feed into CIMS's 10 Steps to Mother-Friendly Childbirth, especially things like how much support and information care providers gave and how well they listened and respected parents' wishes, as well as breastfeeding support provided and what sorts of procedures were done during labor and delivery and what rationales were given for them.

I also took the demo survey to see what kind of questions they asked about hospital births, and though it's clear they are concerned about high c-section rates, for example, I think they did a good job of being non-judgmental and focused on the mother's experience and assessment. And in case the survey brings up bad memories for anyone who had even half as miserable an experience as Catherine Skol (the Chicago mom suing her abusive OB), they also provide links to networks of counselors experienced in helping with birth trauma at the end of the survey.

If you've always wanted to officially record your displeasure with or your gratitude for (or ambivalence about) your birth attendants, now's the time!

Photo by peretzpup.

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U.S. Birth Centers in Danger of Closing

Miriam Axel-Lute — Thu, 18 Dec 2008 21:00:00 GMT

Everyone likes a best of both worlds solution, right? For many pregnant women, birth centers provide just that. For low-risk pregnancies, they are a comfortable, calm, non-hospital atmosphere in which to give birth. They often have pools, and kitchens for family members to cook in. They don't separate mother and baby after birth, but check vitals right there. And yet, for those uncomfortable with birthing at home, there are also a staffed and equipped medical facility, usually quite near a hospital and with established transfer protocols in place. They are often crucial in rural areas where hospitals are few and far between.

And yet, after 20 years, the federal Medicaid agency has all of a sudden begun to refuse to pay for them. (Why? Do they prefer to pay tons more for a hospital birth?) The agency claims there is nothing specifically in any legislation saying that it's a covered cost. (Ah, I see. Bureaucracy strikes again.)

This is not merely a case of the poor getting screwed either notes the American Association of Birth Centers. Other payers follow Medicaid's example, they say. Basically, if the law isn't changed, pronto, freestanding birth centers will be fighting for their financial lives. Many are already suffering from refused payments.

There is a chance to clarify the law when the SCHIP bill passes, but it has to be done before the Christmass recess, so AABC is asking everyone to call their congresspeople and let them know that this is in fact important—a no-brainer even (but perhaps you oughtn't to use that phrase).

Photo from Alma Midwifery.

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Midwives to Daschle: We're Cheaper and Better

Miriam Axel-Lute — Thu, 18 Dec 2008 16:30:00 GMT

The folks at The Big Push for Midwives are organizing to try to get upcoming HHS Secretary Sen. Daschle to make one of the community meetings on healthcare he attends one that they are holding in Missouri to discuss reforming maternity care.

There's good reason for this: Maternity care is one of the areas where the U.S. healthcare system exemplifies the lose-lose proposition of spending tons of money for piss-poor results in terms of maternal and infant mortality rates. There are better ways. As the Big Push folks report, "A recent Washington State study, using conservative cost estimates, estimates that the state's licensed midwives program, over two years, resulted in recoveries from Medicaid Fee for Service (FFS) alone at more than $473,000. Cost savings to the health care system (public and private insurance) is estimated at $2.7 million." That should catch any budget-minded appointee's attention.

On the other hand, I do have to quibble a little with the activists when they write: "The first step in maternity care reform centers on recognizing that our problems go beyond the secondary issue of insurance coverage and access to care." Yes, access to a broken system is a mixed bag and our problems go beyond insurance. But lack of health insurance isn't secondary. As much as I adore the midwife model of care, I'm willing to bet that lack of any prenatal care at all, health complications in mothers that went untreated because they didn't have insurance pre-pregnancy, and the stress of working extra jobs/hours to pay for unaffordable insurance total to a bigger problem for babies' health than even intervention-happy OBs. Besides, people without insurance won't get to see midwives either.

But nonetheless, Daschle should talk to the midwives at some point. Their message of better, cheaper, common-sense care is just the kind of thing the Obama administration might be able to see the value of.

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Taking the Midwifery Cause to . . . Postage Stamps

Miriam Axel-Lute — Thu, 06 Nov 2008 23:30:00 GMT

You've likely heard about the whole Stamps.com thing where you can order honest-to-god postage ("metered postage," the USPS hastens to add, not "real stamps." But they'll get your letter where it's going) with your own photos on it. Apparently they get touchy if you try to put anything "randy" or political (at least antiwar) on them though.

Happily for supporters of midwifery, however, the good folks at Stamps.com don't know just how political the choice of a birthing attendant can be, and they've got a lovely set of stamps available in partnership with the American College of Nurse Midwives that either say "Choose a Midwife" or give ACNM's website and have beautiful pictures of a pregnant belly and newborns (or ACNM's logo).

It's looks like ACNM has become a Stamps.com affiliate, which according to the site should be earning them "high commissions," which I'm glad to hear, since the cost for a sheet of their stamps comes out to well over twice the cost of the postage itself, even before shipping. If they sell, it sounds like a decent blend of fundraising and just getting the word out. I can hear the people in the mailroom now: "What was that on that envelope? . . . No, the stamp, not the crayon scribbles and apple juice spill."

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The Doctors Does Fair and Balanced

Miriam Axel-Lute — Wed, 17 Sep 2008 14:36:00 GMT

So perhaps you expected Dr. Phil to be fear mongering about home birth, but how about The Doctors? Their home birth show featured an undecided couple, an OB, and Dr. Sears, who supports home births. It was supposed to be an open dialogue. Guess who got to speak for 95 percent of the time? OB Dr. Lisa Masterson (pictured, who, apparently often provides sex advice on Dr. Phil. Oh well).

On the shows' forums, viewers are ripping into the show for not having a midwife participate. Wendy Gordon, a certified professional midwife from Portland, Oregon, also spells out all of their astounding inaccuracies, complete with footnotes, and suggests that the producers and the OB read the latest Listening to Mothers survey to find out what their experiences really are. Another midwife blogger suggests wryly, "Have Dr. Masterson call me. I'll tell her how to avoid a 10-15% shoulder dystocia rate."

This has got me wondering, though, is home birth getting so much negative publicity specifically because Ricci Lake and all the other folks questioning the U.S. medical model of birth actually have OBs scared? Are they worried about the competition? Is this the big backlash before a big breakthrough?

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What Does It Mean for Midwives, or Home Birth, to Be Illegal?

Miriam Axel-Lute — Thu, 11 Sep 2008 17:50:00 GMT

With the recent conviction of two Florida women for practicing "illegal midwifery" in a case where the mother died, I think it's worth sorting out exactly what is or isn't legal about home births and midwifery in this country.

First, it's not illegal to have a home birth, as Madeline Holler explained recently in her Babble story on her home birth. It's just often illegal to attend one acting as a medical professional (the question of whether the women convicted were acting as midwives was central to the case above).

In terms of the midwives, the first question that comes to most people's minds is that of licensing. There are two major midwifery credentials: the certified nurse midwife (CNM) and certified professional midwife (CPM). Both involve both written exams, proof of skills mastery, and clinical experience under supervision. CNMs also get a full nursing degree. CNMs are widely accepted throughout the country (though not nearly as widely as in other countries) and routinely see women for pre- and post-natal care and attend low-risk births in hospitals and birthing centers. CPMs are recognized and regulated in 24 states. Only CPMs are required to have experience in out-of-hospital birth settings, so they are more likely to be the ones attending home births. (As far as I can tell, the women convicted in the Florida case had no certification at all and it seems like their religious convictions may have kept them from seeking help as soon as they should have.)

Then there's the question about the legality of attending a birth at home even if you have the proper training. Many (if not all?) states require that a midwife wishing to offer home births be working in the practice of an OB that agrees to provide backup. Often this is what makes legal home births de facto unavailable—doctors are afraid for their malpractice premiums (or of the competition) and none in a given region will let home birth midwives join their practices. For a long time that was true up here in upstate New York.

Then there are those trained midwives who prefer to stay under the radar even where there are doctors who would work with them because the limits on what they can do as midwives (no breech deliveries, no delivery past 41 weeks, etc.) are so restrictive.

The potential effects of all this on home birth midwives—and therefore the availability of home birth for most of us who wouldn't want to go unattended—is pretty scary.

Brett Singer asked in his post about the Florida convictions a couple days ago whether someone could be prosecuted for an illegal home birth even if nothing goes wrong. Sadly the answer is yes. There is a case in Connecticut like that right now. The midwives responsibly transported the mother to the hopsital when a need arose, and it all went fine, but the ticked off doctor who received her filed a complaint. (This is why many home birth midwives have underground back-up relationships with friendly doctors who just can't afford to work with them openly.) You can just imagine what happens in the courts in those rare cases when something unavoidable does go wrong in a home birth, despite proper precautions.

And cases like the one in Florida certainly don't help any. Sigh.

Photo by freckle'sphotos.

Australia Looks to Midwives to Handle Baby Boom

Miriam Axel-Lute — Thu, 11 Sep 2008 14:00:00 GMT

Apparently birth rates are booming down under, and to handle the demand, Australia's federal government is looking to expand midwifery care, giving licensed midwives more access to insurance, prescribing rights, and ability to get paid through public health subsidies even if they aren't working directly under a doctor's supervision. The goals of the review will also include "how to cut medical interventions such as caesarean sections and forceps deliveries. Alternative birth options will also be examined, including the possibility for more home births."

Australian OBs aren't thrilled, but it seems that in a country that has a "chief nurse and midwifery officer," who is leading the overhaul, that they don't have quite as much power as they do stateside.

Photo by salimfadhley.

Two women found guilty of illegal midwifery

Brett Singer — Sat, 06 Sep 2008 21:00:00 GMT

This is a serious issue, but I have to say that the term "illegal midwifery" sounds like something out of a bad Shakespeare parody.

Now that I've gotten that out of the way, here's the story:

"Tonya McGlade was found guilty of Attempting Midwifery Without a License. Linda McGlade was found guilty of Principal to Practice Midwifery Without a License.

"Prosecutors say the women helped Linda McGlade's other daughter-in-law deliver her baby boy. She died of internal bleeding two days after giving birth back in 2004."

In other words, they attempted to deliver a baby without having a license to do so. Sadly, the mother died; the baby survived. This site has a lot more detail if you're interested (fair warning: it's very sad).

What I'm wondering is, just how prevalent is this practice? If someone decides to give birth at home without a trained person present (midwife, doctor, nurse, whatever) and nothing goes wrong, would they be prosecuted as well? Judging by what I've seen on Babble, home births are far more common than I realized. If I had to guess, I would say that a large percentage of these births are against the law. And something else: isn't the problem that the patient died and received poor treatment, rather than the midwife's lack of license? I mean, you can get a midwife license online. (CORRECTION: according to a commenter, that web site only offers the coursework; to get licensed you have to complete your training under supervision.)

Image/source: mysuncoast.com

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Only 43% of British Moms Offered Home Birth! Outrage!

Miriam Axel-Lute — Fri, 05 Sep 2008 20:55:00 GMT

Here in the states, we know things are a little different across the pond. British nannies have a certain something, their weather lacks a certain something, and there's that whole royalty business.

But sometimes we forget just how deep the differences can go. Take maternity care. In fact, in order to avoid a rose-colored-glasses look, take what bugs Brits about their maternity care, as described in a government-sponsored survey, and reported under headlines like "Maternity Nightmares!"

The top concerns, according to one TV station that has done a recent follow up, are:

"43% of women were not offered a home birth
23% said they were underfed in hospital
36% were not offered antenatal classes
18% said toilets and bathrooms on wards were not clean"

Well now. Certainly dirty bathrooms and not feeding new mothers enough is unacceptable. Sounds like there's some serious funding and staffing issues at NHS.

But to American eyes that top item feels a little like hearing someone complaining about the freshness and flavor of their food while you're starving. Natural childbirth and midwifery advocates here would be doing a ~~little~~ major happy dance if anywhere near 57 percent of pregnant American women were offered a home birth. (Or, you know, even if fully trained home birth midwives were no longer treated as criminals.)

Even though the survey found only about 3 percent of British moms actually did give birth at home, even the mainstream British media clearly thinks having the choice presented to everyone is important. How strangely refreshing. Perhaps the AMA (which is trying to make home birth illegal) is overdue for a British invasion.

BirthChoice logo used with permission.

Is Home Birth a Civil Right?

Hannah Tennant-Moore — Sat, 09 Aug 2008 19:00:00 GMT

Most people agree that where and how to give birth is a personal choice. But what if your choice is one that many doctors feel is dangerous for you and your baby?

A resurgence in the home birthing movement has doctors and midwives grappling with this question, and Babble’s own Ada Calhoun has researched the heck out of the issue for Time.

Women who opt for home births argue that this method allows them more control over their birthing experience, making it unlikely that they will undergo interventions, such as C-sections or episiotomies, that they don’t feel are necessary. Midwives only assist at home births for low risk patients, and are trained not only to deal with emergencies themselves—often in the exact same way an obstetric nurse would—but they also know when it’s necessary to bring a patient to the hospital as quickly as possible.

But many doctors argue that the best medical care can only be accessed in the hospital—period. The American Medical Association is urging lawmakers to restrict the home birthing movement, in part by making it more difficult for direct-entry midwives (who don’t have nursing degrees) to get licensed.

Currently, only 1 percent of U.S. births occur in the home. So midwife Joan Bryson seems justified in defending home birth’s safety in these terms: “We [the U.S.] rank 42nd in the world in live births, and we spend more money than anyone else. You can’t blame it on home birth.”

My personal experience makes me naturally inclined to side with Bryson. Both my sister and I were born at home with a midwife, and my parents describe the experience in near ecstatic terms (honestly, their extreme enthusiasm when recounting my mother's 12-hour labor can be a bit disconcerting). Also, my older sister never exhibited the jealousy and sense of displacement that many older children feel after the birth of a sibling. I believe this was in part because she was present in the house while my mother was in labor, and was able to see my mother and me almost as soon as I was born. There was no sense that her mother had disappeared, and then returned carrying the reason for her disappearance.

It goes without saying that giving birth at home is not for everyone—but neither is giving birth at a hospital. Competent midwives should not be subject to prosecution for allowing women to opt out of a traditional hospital birthing experience.

Photo: Time

Health Minister: Giving Birth Standing Up Saves Lives

Madeline Holler — Wed, 16 Jul 2008 21:02:00 GMT

Just before I was ready to push out my second baby, I went to lay down on my back, which was how I gave birth the first time. My midwife, however, did that nice midwife-y talking and somehow convinced me to actually hoist myself onto my knees and lean against a chair. So I did.

A few minutes (hours? Who knows during labor ....) my second daughter slithered on out. Four words: huge baby, no tearing.

For that reason alone I'm a convert to birthing upright, what apparently is called in the biz "vertical birth."

Continuing our coverage of birth around the world, we bring you Reuters' 40-picture slideshow and multi-part feature on vertical birth in Peru, a practice health ministers are now encouraging in an effort to cut the country's abysmal maternal mortality rate. At least 185 women in every 100,000 births die in childbirth there each year (in the U.S., it's more like 20 in every 100,000).

From Reuters:

Peru's health ministry has said vertical birthing positions can be healthier for women by reducing pressure on the uterus and large blood vessels that can affect the amount of oxygen going to the baby. Standing or sitting during childbirth also tends to reduce labor and delivery time, according to the health ministry, and allows the mother to watch the birth better than if she were lying down.

Sitting and standing to give birth alone won't cut the numbers. However, officials hope that by respecting Andean traditions, such as upright birth and allowing women to stay dressed during birth, will encourage more to make the trip to the public clinics where complications and emergencies can be handled. Several hundred of these clinics have been set up around the country.

Interesting sidenote: the photographer writes a blog entry about her experiences at the clinic. A birth mother herself, she was nonetheless transformed by it all and fasicinated that the clinic overcame various obstacles like losing power and unsharpened scissors (yow!). But she returns time and again to feeling such sadness for the fact that these women don't have epidurals.

From her blog at Reuters:

These births are natural, without anesthesia. The pre-labor room, where the women endure the pains before actually giving birth, is really a chamber of terror in which the women scream out their pain, lying on the floor or pacing. They suffer, endure and survive in spite of not receiving anything for the pain.

"Chamber of terror"? For whom? The women? Look at their faces, they're in labor -- some are really in the zone. It's birth, of course they're in pain. But I'm thinking the terror may have mostly been the photographer's.

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Breakin' the Law with Birth

Adrienne Martini — Mon, 23 Jun 2008 16:30:00 GMT

Strollerderby's own Madeline Holler has done something that has amazed us all in the 'derby "office." No, it's not that she sorta broke the law when she birthed her second daughter. No, it's not how she handled said daughter's placenta. None of those things impressed us much.

What really stunned us all is that Holler delivered an almost 11 pound little girl without any drugs. Seriously. I need an Advil and a sitz bath just thinking about it.

Read Holler's excellent essay on midwives, natural births and kiddie pools. The betting pool on how long it takes the AMA to discredit our little Miss Holler will open later in the week.

Pregcellent: Are Breastfeeding Extremists Endangering Babies?

Kelly Mills — Wed, 28 May 2008 21:03:00 GMT

The Daily Mail has this typically hysterical and annoying headline for a recent story: "No, breast ISN'T always best for baby...whatever the extremists tell you". Ba ba buuuum. That's right, lactation consultants pose major threats to infant health and welfare! Talk about selling a story. But then the article goes on to cover the views of Clare Byam-Cook, a retired midwife who has helped loads of people (including Kate Winslet and Helena Bonham-Carter--celebrity nipple alert!) learn to breastfeed. And frankly, I think she has some good things to say.

Byam-Cook says some midwives are so dogmatic that they simply push breastfeeding, meaning moms with problems doing so end up with underfed and dehydrated. She also believes not all women can breastfeed or produce sufficient milk, and that in some cases a bottle of formula is not equal to giving your baby poison. And she notes that in addition to teaching women proper breastfeeding technique, we ought to give some instruction in how to bottle-feed and properly prepare formula, just in case.

I'm somewhat suspicious of the idea that there's a zealous conspiracy of midwives, and I don't particularly love many formula makers either. But as someone who spent twelve hours in the hospital with a wailing infant, waiting for my milk to come in, I was saved by a nurse who helped me rig a breastfeeding tube on my boobs to deliver, yes, formula. My kid went on to breastfeed for two years (which was one year longer than I wanted, honestly, but hey, we do what we do.) And while I think it's more the media than the midwives who paint breastfeeding as the only option for a mother who loves her baby, I'd love to see more respect for people's choices. Sure, breastfeeding should be encouraged and taught and we ought to be able to do it in public. But some people try and just can't do it, for any number of reasons. It isn't always feasible, and you shouldn't have to reap massive judgment from others for pulling out a bottle. Oh, and while we are at it, could we get some bottles that are free from plastic chemical freakiness?

Unassisted Birth -- Help Me Out

Madeline Holler — Wed, 09 Jan 2008 22:46:00 GMT

When I read stories about women who opt to give birth at home allllll by themselves -- no help from a midwife or a doctor or a staff of nurses -- I think to myself, "can you blame them?" I know, I know, a lot of you are thinking these people are just trying to be heroes or adhere to some kind of radical hippie code that shuns any relationship with established authority. Or you think they're narcissistic idiots who put their own childbirth dreams above the health and safety of an innocent child. Homebirth moms get that kind of talk too.

But I think all that's wrong. Quite wrong.

Pregnant women in the U.S. are in this totally weird position where our reproductive rights are, on both ends of the conception and pregnancy chronology, narrowing quickly. State judges, with the eventual help of the Supreme Court, are shrinking options on the early end of the spectrum. Doctors, hospital administrators, and insurance companies and legislatures (who make midwifery a crime) are taking away choices at the latter end.

Let's focus on the latter:

More than one third of all childbirth in the U.S. results in surgery -- a c-section. Some are, of course, necessary (but, like, 10 percent). A tiny percentage are the "too posh to push" variety and not indicated, but allowed (and hey, it's your choice, I won't stand in your way.). More are the "once-a-c-section-always-a-c-section," variety and then the rest, a significant number, could probably have been avoided all together.

It's the last two that, I think, push women to go the DIY route. In loads of hospitals all over the country, VBACs have been banned. Doctors and midwives are not allowed to do these vaginal births after ceseareans because of some studies that say there is an increased chance for uterine rupture in VBACs. Which may or may not be true, but that chance of which they speak is actually quite small. So what do you do? Avoid the hospital.

And avoidable c-sections? There a loads of ways to decrease one's risk of being pushed to have a c-section, but many can't be done in the hospital. Get in a tub, move around, stay off IV fluids, don't get hooked up to continuous fetal monitors, blah, blah, blah. They were in the birth plan! But the pressure! Look at what the quoted doctor has to say:

"What women need to appreciate is that the few hours of labor are the most dangerous time during the entire lifetime of the soon-to-be-born child," said Dr. Frank Chervenak, Chairman of Obstetrics and Gynecology at New York Presbyterian/Weill Cornell. "Because of this, I would argue ... all soon-to-be born children have a right to access immediate Caesarean delivery, and women who are denying this right are irresponsible."

So what do you do in your next pregnancy? That's right. Avoid the hospital and that attitude toward pregnancy and childbirth.

What about the child? Well there are risks to childbirth and those risks play out in different ways in each of the settings a woman might want to give birth in. Don't think women and babies don't die after childbirth in hospitals, which is NOT saying death in the hospital is certain and likely. Just like it's not certain and likely at home or unassisted.

What I'm trying to say is that women/patients/clients want what they want. Because there are so many possibilities. So many ways to do it right. So few ways that make it wrong (smoking crack comes to mind -- but who am I to judge?) Yet hospitals, midwives and doctors only allow for (without battles) a certain range of them. And that's fine for them and their jobs. But not fine for some women. So some women opt for birthing centers with midwives or doctors, or homebirth with midwives or (the few remaining homebirth) doctors. And some women opt to go it alone.

Unassisted birth is not for me, but like I said, who can blame them?

PS: Is it me or is that a fake belly on the woman in the picture? Just asking ...

Photo: ABC News

What Goes With Your Own Placenta, Red Wine or White?

Karen Murphy — Wed, 25 Jul 2007 14:02:00 GMT

After my youngest son was born, my midwife held up my placenta to me so I could see it and invited me to look closer. I looked. It was like a huge slab of...organ. Liver? She held it lovingly, as if it was as precious as what I was holding, the tiny breathing brand-new human who had just made his entrance into the world.

Look! Placenta! gestured my midwife. Look what was inside you!

But look what I have, I gestured back with silent indifference, slightly adjusting my hold on my son. I'm pretty sure what I have is better.

Want to take it home? she asked.

I had heard of this, of course. Women who bury their placentas under a full moon, or under a tree, maybe. A spiritual thing. While aspects of that were certainly appealing to me, there was the problem of the...meatishness of it all. Ew.

So! On Mothertalkers there's a discussion of a practice called placentophagy, where the placenta is dried and processed into capsules to be consumed by its original owner. To ward off postpartum depression. Those who have tried it swear by it. (After all, it's good enough for Tom Cruise!) I totally have an open mind to things like this, only I will tell you right now that it's not for me. So what if most mammals consume their own "afterbirth"? Aren't they just being, I don't know, tidy?

So what do you think? Have you done this? Know anyone who has?

Do Natural Birth Centers put Mothers at Risk?

Sarah, Goon Squad Sarah — Mon, 07 May 2007 22:01:00 GMT

In the health section of Scotsman.com yesterday there was an article called Natural birth units 'putting mothers at risk'. The article says: "Up to a third of expectant mothers are rushed at the last minute to doctor-led labour suites because midwife-run wards cannot deal with medical complications or provide sufficient pain relief." Now, this article is based on research in Scotland and says that a lot of the problems are with first time mothers.

Obviously, this is causing a huge controversy where doctors and midwives are on opposite sides.

I have several friends that have recently given birth in birthing centers instead of hospitals. I know a lot of people who have done home births. I understand that women have been having babies for millions (or however old man is) of years without anesthesia and I know that it can be better for the baby.

I also know this: when my children were born I needed a blood transfusion. I had an emergency caesarian. I also had a very complicated pregnancy and odds are that the only reason my children both lived is because through modern medicine the doctors were able to delay childbirth for six weeks. I went into labor when I was 28 weeks pregnant. (Think of it as seven months.) Naomi Wolf is probably going to hate me for saying this but I thank my doctors and medical staff for saving my life and the lives of my twins.

That being said, even if I had gone into labor on my due date I still would have wanted an epidural and medical staff nearby. For me it just isn't worth the risk. I feel fortunate to live in a time where we have all of these wonderful medical tools (including painkillers) available to us.

I don't mean to slam midwives, I'm sure they are wonderful people. I am sure that a home birth without complications is a beautiful thing. I just like to hedge my bets, especially when it comes to my kids.

Lay Midwives Win Right To Practice In Wisconsin

Patti — Thu, 03 May 2007 16:27:00 GMT

Wisconsin has just become the 25th state in the US to legalize the practice of lay midwives. The first license has already been issued by the state, and in addition, the new law allows midwives to practice without being involved in a formal health care practice.

Lay midwives are often as experienced as their degree-holding counterparts, but they have had to fight for recognition and the right to practice their vocation openly. Nurse midwives are praising the legislature's decision as a validation of the midwifery model of care for women's health. Approximately 1100 babies were born outside of hospitals in Wisconsin last year, and those numbers are expected to rise with the new regulations.

25 states down, 25 to go!

Midwife Video: "Like Heaven Into My Hands"

Karen Murphy — Wed, 18 Apr 2007 15:03:00 GMT

[sigh]

If you never had a midwife catch your babies, or a home birth for that matter, this video may give you a glimpse into a different way to have a baby. Plus it might make you wish, at least for a split-second, to have another one all over again, no matter the circumstance. At any rate, it's a wonderful reminder of the blessings of new life and the wonderment and joy that's within all of us at the time of a birth of a new baby. (I so wish this warm and glorious woman had been my midwife!) Via The Lactivist.

I think I'm gonna go hug me a baby right now.

The Sad State of the American Maternity System

Karen Murphy — Sat, 10 Mar 2007 17:49:00 GMT

Did you know that the good ol' U.S. of A. has the second-worst infant-mortality rate of developed nations? While at the same time the cost of health care surrounding birth in the U.S. is one of the highest? Do you see a problem with that? I was astounded when I read the transcript of this week's "Living on Earth", a radio program found on public radio. Speaking as someone who has experienced a variety of birth scenarios with my four children, I can completely agree when Dr. Marsden Wagner, the OB/GYN interviewed for this show, says that the American maternity system has turned into an essentially medical system, "turning birth into a surgical procedure". That's right, what should be in most cases a simple and uncomplicated, natural experience, has become a medical and potentially litigious nightmare for everyone concerned.

The midwives suffer because they've been needlessly pushed out of the profession. The OB/GYNs suffer because they've set impossibly high standards, promising perfect births and perfect babies to everyone, and the only way they can do so is by prostituting themselves by adding control to a scenario that doesn't like to be controlled. Whatever happened to letting the baby decide when to be born? Now babies are born after oxygen-starving drug-induced labors so the doctor can make his tee time, or worse yet are born by c-section, a real surgical procedure that according to Dr. Marsden is performed in this country about twice as often as is warranted medically.

The birthing mother suffers because she loses the ability and support to bring a baby into the world by using her own personal power, grounding herself with the inherent knowledge every laboring mother is capable of accessing. We've been taught that birth is a potentially scary, medical experience, so we allow ourselves to be hooked up to monitors telling us what our bodies already know (I thought that was the silliest thing, avidly watching the monitor to know when my contractions were, when I could of course FEEL the damn things myself!) And far and away the saddest loss of all is the baby's, now born in a world colored by needless drugs, bright lights, pain, and fear.

So what do we do? Sure, there are many who birth at home (which I was 2 weeks from trying myself, but chickened out at the last minute, some sixth sense telling me that my baby would have medical issues at birth, and sure enough he did). But what about everyone else? How do we escape this maddening world of fear that something might go wrong (which it admittedly does at times), and escape this ever-tightening circle of needless medical intervention while balancing the need to keep our babies and ourselves safe and healthy?

Elective C-Sections and Midwives: Saving Lives in Iraq

Rachael Brownell (Redsy) — Fri, 05 Jan 2007 14:00:00 GMT

In today's Washington Post, the story of mounting infant mortality rate in Iraq as the medical system -- at one time the pride of the Middle East -- unravels under the weight of the 1990s embargo and now the war. The Post's story focuses on the tragic death of a baby who became lodged in his mother's birth canal and died when unskilled nurses (no doctor could be found) used forceps to extract him and crushed his skull.

The combination of road closures, physician kidnapping, and the stress of war and poverty are taking a signifant toll on maternal-child health in Iraq and the problem is exacerbated by the mass exodus of Iraqi physicians (some estimates say up to 50% have fled since the U.S. invasion).

Understandably, women are frequently less willing to take the risk of traveling during curfew hours to hospitals that may or may not have doctors avalable to help them deliver their babies. More women are turning to midwives to avoid hospitals altogether. Still others are scheduling elective c-sections around curfew hours.

The infant mortality rate in Iraq now stands at 48.6 per 1,000 live births -- in other words, 5% of all babies delivered die or are dead on delivery. As a point of comparison, the U.S. rate is 6.9 per 1,000 live births -- one of the industrialized world's worst rates.

For those of us totally overwhelmed by the tragedy in Iraq, learning that women and children are suffering there isn't surprising or particularly new information. But stories such as these have a way of cutting to the chase. I simply cannot imagine the sorrow of delivering a baby who should have been healthy and living, but who died almost directly because of the war. And I can't help but think I'd be ready to take up arms against my oppressor -- whether American, Sunni, or Shi'ite.