Electronic Fetal Monitoring: "An appallingly poor test," says maternal-fetal medicine doctor

Read why in this excellent article from the Philadelphia Inquirer. I'm not only familiar with this research, but I've seen this exact scenario played out hundreds of times during my four years as a labor nurse. Just another reason we chose (and other families are increasingly choosing) homebirth.

NIH panel on VBAC, or: Give me liberty

Recently the National Institutes of Health convened a panel to examine the "issue" of vaginal birth after Cesarean (VBAC). Evidence was reviewed, testimonies heard, and a consensus statement released.

While cautiously optimistic that the issue was being reviewed at all, birth advocates had reasons to be concerned.

First, in 2006, a similar panel convened regarding the issue of Cesarean delivery on maternal request (CDMR). What they found was that there was "inadequate evidence to recommend for or against." Which is ridiculous, really, given that the risks of Cesarean to mother and baby are well documented, and they become even clearer particularly when there's not a potential medical indication and therefore benefit (such as resolving fetal distress, interrupting an obstructed labor, etc). So basically, they treated a natural process as having no greater weight than a surgical one and so came out stating that the scales were balanced. The ridiculous presumptiousness of assuming that they know everything there is to know about human labor and birth, that its impact on mother and baby and family and society at the time of birth and forever after is able to be scientifically measured and accounted for--and that even if it were, that the choice is theirs to make-- is outweighed only by the fact that in the case of debating VBAC, vaginal birth (which will happen, come hell or high water, as the natural end of a full-term pregnancy) is treated as the "intervention," something to be "done" as that which needs to be justified, while surgical delivery is treated as the control--the status quo, the "innocent until proven guilty." You can read more on the limitations of that panel's decision here.

Anyway. Henci Goer very cogently articulated the concerns going into the VBAC panel here. The Unnecessarean takes up the other end by articulating the concerns coming out of it. Both are very much worth reading, as are the comments; they contain a good deal of backstory on the lengths that doctors and courts are willing to go to in order to maintain control over birthing women's choices (some particularly sickening facts of court-ordered Cesarean cases, in paritcular), and one commenter shares the following quote from Sheila Kitzinger:

No one would deny that each infant and particularly every maternal death is tragedy to be prevented if at all possible, nor that modern obstetric care, which has developed in the hospital setting, has been at least partly responsible for the dramatic decrease in both maternal and peri-natal mortality over the past half century. But it is not necessarily perverse to question whether our present priority should be to reach minimum figures for peri-natal mortality at any price when this includes giving up things which free human beings have often felt to be more important than their own survival- such as freedom to live their own lives their own way and to make individual choices in line with their own sense of values.

Living out here as we do, in Virginia--home of liberty and rebellion in two major wars, the Revolutionary and the Civil War (not to wander too off-topic, but we recently watched Gettysburg and I was amazed to realize that far from what I learned in history, the Civil War was not about "OMG The South is racist," because the north was, too; it was about whether or not the states had the right to withdraw from a federal government making decisions they didn't feel were in their best interest. I'm inclined to believe that the founders intended that they SHOULD have this right, and so the whole outcome, viewed through that light, feels completely different to me) --I'm struck by the fact that this is exactly what "Give me liberty or give me death" MEANS. It doesn't have to mean death at the hands of the British army--it might mean facing down the (albeit very small) risk of a uterine rupture. Or the right to refuse chemotherapy. Or drink raw milk, or refuse vaccination. People have chosen the risks of freedom over the "safety" of relative captivity here for a long time ("ships are safe in harbor, but that's not what ships are for"), and parents have long been accepted as the proxy decisionmakers for their children, able to elect for one or the other on behalf of those too young to make the decision themselves, but this right is quickly being eroded, now beginning before birth.

So basically, while a small battle or two was somewhat won (recommending that ACOG drop its strict recommendation that only facilities with "immediately available" operating room personnel "perform" VBAC), the war (having any power to compel them to do so, plus the greater--central-- issue of a pregnant woman's right to what essentially amounts to constitutional personhood and self-determination--ie, informed refusal of surgery without regard to whether her physician "feels she is a good candidate") was not.

So. Henci Goer's signature line contains the quote below, which sums up the reaction to this latest news:

“You are not required to complete the work, nor are you free to cease from it.”
Pirke Avot 3:18

Let the work go forward.

My "duh" file is getting full: Cesareans increasing, more women dying

photo by aka Quique

An increase in the number of (unnecessary) Cesareans means more women are dying, unnecessarily. Like so many other facts of modern life (don't get me started), a lot of people would like to see this information suppressed or distorted. But there it is. A striking quote from the study of maternal deaths in California: the current trend represents “the most significant spike in pregnancy-related deaths since the 1930s…it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.” Don't think the problem is just California--they're just the first ones to be honest about it.

So much for the lifesaving benefits of modern medicine, so frequently touted when the safety of homebirth is questioned, as it often is in the media these days.

Kind of makes that live elective C-section on the Today show (the one the doctor characterized as "orderly, routine and scheduled for this timeframe, just the way these are supposed to go...as happens at countless hospitals all over the country,"--indeed) seem a little in poor taste. The doctor in this case notes that the Cesarean was scheduled--mind you, with no "trial of labor" first--"because in both of their families, babies run big and she was past her due date and those are two indications that a cesarean section is a lot safer than having a vaginal delivery."

I'm sorry, what?! With countless increased risks of morbidity and mortality to both mother and baby, there are VERY few situations in which a SCHEDULED ELECTIVE PRIMARY CESAREAN TO A HEALTHY WOMAN CARRYING A HEALTHY FETUS is "a lot safer than a vaginal delivery." As a matter of fact, her own professional organization notes that "the evidence does not support prophylactic [ie scheduled] Cesarean delivery for suspected macrosomia [large baby]," and studies have estimated that it would require over 1,000 such Cesareans to prevent one permanent birth injury (generally the concern over giving birth vaginally to a large baby). Even more sobering, if such a policy of rampant unnecessary Cesareans were enacted, for every 3.2 brachial plexus injuries (the most common birth injury, a kind of nerve damage to the arm) prevented, one maternal death would occur due to the complications of Cesarean. And I don't think there is a professional out there who could give you any kind of support for the statement that going past a woman's due date (or guess date, as it is sometimes known--because the 40-week mark is simply the midpoint in the normal "due month," which encompasses full-term deliveries anywhere from 38 to 42 weeks) is an indication for scheduled Cesarean.

Bad, bad medicine. And women are dying, literally, to bear it out. It makes me want to scream.

Meredith Viera (who gaily tells the woman that SHE had a Cesarean and so knows that she'll be "on her feet in no time") notes toward the end of the show, "They chose the right way to deliver, that’s sure… by c-section."

I'm sure glad I chose the WRONG way to deliver my 10-lb (2-oz) baby--one that isn't contributing to the rising toll of dying mothers.

Perinatal

On Wednesday, Eden and I had the good fortune to attend the Perinatal Symposium on contemporary birthing practices and birthing rights. It was organized by Jessica Clements, an acquaintance of mine who has recently become a friend. I volunteered to help pull some of it together; my brother even did the website design. (Thanks, L!) Some familiar names were there, like Henci Goer and Robbie Davis-Floyd, and Debra Pascali-Bonaro, along with some that were unfamiliar to me, but no less impressive--like Shafia Monroe and Aravinda Pillalamarri. I was blown away by the true multidisciplinariness of the event--midwives, doulas, nurses, lawyers, anthropologists, artists, and even belly dancers all came together out of concern for birthing women. Many of them spoke of the need to secure a safe birthing tradition for our daughters, something which had a new resonance for me as I've attended many birth conferences, but this was the first in which I had my own fuzzy-headed, chubby-cheeked little girl in my lap.

One of my other favorite things about the conference was that it was the first time I've been in a context where women were openly and proudly breastfeeding. From five-week-old twins to babies in arms to toddlers who ran up to their mothers to nurse, there was a whole lot of breastfeeding going on, and it was a wonderful thing to be a part of. Unfortunately, in our culture, breastfeeding is nearly always a solitary event, as opposed to more traditional cultures in which it is a normal, social part of everyday life. It made me realize what I'm missing out on the rest of the time. While so many babies and children meant that at times things were a little rambunctious and the speakers were hard to hear, it was also neat to have a constant undercurrent of squeaking, sighing, murmuring (and occasionally shrieking) baby noises as an appropriate accompaniment to the topic at hand, and as a reminder that to all of us there, it was of far more than just passing or theoretical significance.

Jessica introducing the panel

Debra Pascali-Bonaro

Shafia Monroe

Lynn Griesemer

Thoughts on obstetrics vs family practice

photo by Orcoo

Rixa at Stand and Deliver has a really fascinating post about "Litigation and the obstetrics mindset." She states, "I am trying very hard to understand the obstetric mindset when it comes to risk, malpractice, and litigation in relation to choices such as VBAC or home birth." She presents a very thorough perspective on those issues, including quotes from discussions on obstetrical and midwifery message boards from those two specialties. The most intriguing part to me, however, comes about halfway through the post when she shares the perspective of a friend who is a family practice doctor. Here's what the FP doctor says. It's long, but it's all worth reading:

OB, as a surgical specialty, has a much different "flavor" than the FP [family practice] world I trained in. OBs are surgeons, and many have an "I can fix that!" kind of personality, where issues are seen as black and white, and they rely heavily on their judgment and skills and quick decision making. Surgical training is much more hierarchical than generalist training, and I think that builds in much more of the power issues that we see in medicine so much. OBs primarily view their clients as patients, and their decisions as scientific and don't concern themselves with the softer, social/emotional issues. Because of the power play issues and the idea that the OB is the knowledgeable important person in the relationship, I think this leads to a lot more worry on their part of the consequences of their decisions. The average OB is trained and socialized to be the decision maker and leader in the doctor-patient relationship, and to bear the responsibility for the outcome. They are also socialized to be very risk aversive - but only the risks that impact them the most. There is this overriding cultural expectation that OBs are expected to produce a perfect baby every time - but in reality, I think OBs propagate this much more than their clients do. I think so much could change if OBs (and many other kinds of doctors) could let go of the power differential and allow themselves to be seen as human.

As a family doc, even though I trained in a highly traditional medical setting, I was still trained by family docs, with a strong flavor of know-the-evidence, partner-with-your-patients type style. I think midwives, of course, lean even farther into the psychosocial part of their relationship with clients in their training. I think the more partnership or service style of practice leads to less fear that you will be held solely responsible for your decisions. Our generalist training, and in midwives' case, their woman-centered training, shifts more responsibility onto clients themselves, and I think leaves us feeling less worried about litigation, and more worried about quality care.

Of course these are big generalizations, and there are exceptions to everything, but in general the culture of the surgical specialty of OB is just so different than the culture of midwives, or even family docs.

I don't worry about getting sued very much. It rarely enters my mind as a factor in decision making. I worry a lot more about educating, and about encouraging my clients to make their own decisions. I worry about forming good relationships, providing room for disappointment to be expressed when things don't go the way we hoped, and making our decision making processes completely transparent and understandable to my clients. I worry about making sure my clients understand that there is a lot of uncertainty sometimes in what we do, that no outcome is guaranteed, and that I strive for excellence and hope for luck along the way, too. I hope that the relationships I form with my clients will mean that they can tell the difference between malpractice, and an honest human being doing their best.

Part of the lawsuit crazy fear really does seem incomprehensible to me, though. When I was pregnant with my fourth child, I went to a friend (or more acquaintance) who is an OB for prenatal care, and we had the weirdest argument over me being tested for gonorrhea and chlamydia in early pregnancy. I didn't want to be tested because I have zero risk, and it costs money. She kept saying that it was important to be tested, regardless of risk, because of "medical legal reasons." We went around and around until I finally said: "Look, 'medical legal reasons' only come into play if I sue you, and I can assure and guarantee you right now that I'm never going to sue you for not testing me for gonorrhea and chlamydia. I understand the risks and benefits of being tested, and I refuse. Period." She was terribly flustered that I'd brought up the word "sue" and terribly flustered that I said "refuse" and was clearly uncomfortable and it was so strange to me. In my practice, I matter-of-factly explain the benefits of being tested, and if clients choose not to be, I feel quite content that even if they are making the wrong decision, it's their decision and their consequences so I don't have to be personally invested in it - while she clearly couldn't let go of the idea that by not following the "standard of care" I could somehow accuse her of malpractice later. I still can't understand why so many OBs are so terrified of being held responsible for outcomes they can't control - why are they so frightened of allowing the decision making to rest with the folks who have to live with their decisions!?

This absolutely, 100% squares up with what I have observed from working with obstetricians on the one hand, and receiving my care from family practice doctors, midwives, and nurse practitioners on the other. In particular, we take Eden to a family practice group that I just absolutely love. I think Matt probably finds my swooning devotion a little bit odd, but when you've spent several years contending with just how excruciatingly difficult doctors can be, it feels so incredibly good to have your worries and low expectations blown out of the water by doctors and nurse practitioners who truly care and want to help you. Because that attitude is, I'm just going to say it out loud here, incredibly rare--I thought in medicine at all, but apparently mainly just in obstetrics.

An example: shortly before Eden's 1-month checkup, I found out I'd need a doctor's note clearing me to go back to work since I'd technically been on medical leave. Since schlepping a newborn baby to an appointment for me, and paying to have somebody say "yes, you're fine" didn't sound that appealing, I figured I had nothing to lose by asking the nurse practitioner at Eden's visit if she'd mind jotting a note for me. We were there anyway, right? I was prepared for her to say no, and imagining a response like "Do you know what kind of liability it is for me to write a note saying you're healthy, I don't know whether you're really healthy, and even if you're healthy today, how do I know whether you'll still be healthy when you go back to work," etc etc. Because that is really the kind of logic I see employed on a daily basis. Kind of along the lines of the above--"Even though you know you don't have gonorrhea, and you aren't going to sue me, we need to test you for gonorrhea in case you sue me. For not testing you for gonorrhea. When you refused to have it done." HUH?!

Instead? "Oh, absolutely! I'd love to. That's no problem at all!" The same kind thing when there was some confusion with the front desk as to whether our visit could be billed as a well-baby exam when it was technically just a weight check (meaning a difference of whether our visit was covered at 100% or we had to pay a $20-30 copay)--while many providers play (or are) dumb to the workings of their own offices, let alone the insurance companies, the NP stepped out, talked to them herself, and came back and said "It's straightened out now. There's no reason you should have to pay extra when she's here, she's a month old, and she's had her well baby visit!" Granted, that was the nurse practitioner, but we have found our family practice doctor to be just as delightful. Documentation for Eden's birth certificate? Happy to help. Want to delay vaccination? That's certainly your choice.

I'd wondered about this discrepancy between disciplines and I think the above sums it up very well: OBs are taught to worry about themselves, and family practice doctors (along with midwives and nurse practitioners) are taught to worry about their patients. As pointed out above, there are exceptions on both sides of this, but overall, it leaves you feeling somewhat sorry for obstetricians--but even sorrier for their patients.

Funny article in TIME

You know it's not my favorite publication, but I was amused and pleasantly surprised to read this well-written article in TIME by a new dad whose wife decided she wanted to have her placenta encapsulated. One of my favorite lines: "For those of you who have never seen one, the placenta is to the baby what Stephen Baldwin is to Alec Baldwin."

Good post on the safety of homebirth

photo by Aldo Risolvo

Here.

Being privy to the high-intervention atmosphere that pervades the hospital, I feel better and better all the time about our decision to bring our baby into the world in a safe, gentle, loving atmosphere--at home. This post (and the study it's citing) gives some of the statistics supporting that choice.

First-trimester working conditions affect birthweight

From Nursing Birth (an incredible blog by an L&D nurse, and one which I highly recommend): apparently the American Journal of Public Health is publishing a study which indicates that high levels of job strain in the first trimester can contribute to lower-birthweight babies.

It makes me wonder how big this baby would be if I HADN't been running my butt off last fall!

But kidding aside, it makes me thankful to have a flexible enough job that I was able to take a day off here and there when I felt like I needed to. And as I'm sitting with my puffy feet up on my first Monday off of work at 37 weeks, that feels very right to me, too. And I feel very lucky.

Cesarean rates at Virginia hospitals

I've noticed a lot of traffic to the blog looking for the C-section rates at Virginia hospitals, Reston Hospital in particular. You can find that information for 2006 here.

Birth links

In honor of the people who have already started asking me OMG WHAT WILL YOU DO IF YOU GO OVERDUE SINCE YOU'RE PLANNING A HOMEBIRTH (even though I am only 35 weeks, already 1cm dilated, and having maddeningly regular Braxton-Hicks contractions--thank you, coworkers), I give you an excellent post by Adventures in (Crunchy) Parenthood called "Overdue is not an emergency." She does a nice job of synthesizing the evidence that exists surrounding post-dates pregnancies. Here's a shocker: the way obstetrics is currently practiced is WAY out of line with what the research suggests.

On a related note, Keyboard Revolutionary notes that what enables the maternity care system to be such a broken-down and dangerous yet multi-billion-dollar business is the same thing that drives the rest of our consumerist, commercialized society: making people feel like crap about themselves. I love her tone and her observations, since it echoes what I see everyday and what rings true to us about American society in general.

And the Citizens for Midwifery blog explores the difference between health care and medical care.

Article about maternity care in the LA Times

Christine Cotter / Los Angeles Times

Childbirth: Can the US improve? is a a step in the right direction, and I applaud its portrayal of a well-informed woman who sought and achieved a VBAC, but the tagline ("C-sections are expensive. Doctors ask if we are doing too many") strikes me as as incorrect--in fact, it's women, families, midwives, and other concerned parties, so much more than doctors, who are questioning the current C-section rate. (And they aren't doing so simply because it's expensive--their concerns center around around the known risks posed to mothers and babies.) Like so many media articles, however, this one is quick to blame the so-small-as-to-be-almost-neglible "too push to push" phenomena of patient-choice Cesareans for the rising rate, dedicating almost no time to the far more common "physician's choice" Cesareans, which may be cited as "necessary" for anything from a suspected large baby (not a valid indication) to going past a woman's due date to pretty much anything else under the sun. I was disappointed that the article didn't make a single mention of midwives, either--basically, it laid out the problems with US maternity care and ignored the fact that the solution to our problems (and the reason that the other countries discussed in the article are blowing us out of the water in terms of outcomes) is staring us in the face.

WATCH THIS

from A Doula Story

A Doula Story, despite its cable-television-sounding name, is a a wonderfully inspiring and beautifully produced 1-hour documentary about a woman in inner-city Chicago (a former teen mom herself) who devotes herself to educating and supporting pregnant teenagers. I wish all pregnant women had access to this kind of information and support--her girls are far more educated about their bodies and their choices than 99.9% of the middle-to-high-income women I see every day. It also reaffirmed for me how INCREDIBLY difficult it would be to be a single mother--especially a teen mother. My pregnancy was planned and wanted, I have the world's most supportive partner, and the baby and I have always been healthy-- and STILL there are times I've felt like I was falling apart or not going to make it. Pregnancy is taxing and hard and motherhood even more so; I can only imagine what these girls go through. This woman is there for them 24/7, even and especially once their babies arrive, teaching them how to be strong and loving mothers, and she deserves a medal for it. Well worth your time! You can watch it for free at the link above.

It's About TIME

Time Magazine has finally posted an intelligent and balanced article about birth! More specifically, about VBAC. You can find it here: The Trouble With Repeat Cesareans. Among other things, they do a nice job synthesizing the statistics about risk, as well as pointing out the irony of a laboring VBAC's having to drive 100 miles to another hospital rather than labor at a local hospital with on-call (rather than round-the-clock) anesthesia. Heaven forbid she labor at home instead--far from the risks of Pitocin induction or augmentation ordered by an impatient doctor, and with the continuous 1:1 presence of a trained, supportive midwife at her side--but it doesn't go quite that far.

In case you missed it, the New York Times ran an article last month about the dangers of scheduled Cesareans at 37 or 38 (versus the recommended 39) weeks of gestation. Among other things, more than a third of scheduled Cesareans are scheduled before the recommended 39 weeks, and a 37-weeker is twice as likely as a 39-weeker to experience problems such as respiratory distress. Not something that is being disclosed to women by doctors who are anxious to schedule Cesareans before the chance that a woman will go into labor first and--gasp!--call them in in the middle of the night.

Update: Midwifery Today has an article from 2006 (somewhat confusingly) titled "50 Ways to Protest a VBAC Denial." There are actually only 11, but they're very good ones.

Anti-midwifery legislation pending in Virginia

picture by Voxphoto

Virginia, which is actually pretty midwife-friendly (CPMs and homebirth are expressly legal, etc), has unfortunately had some very anti-midwifery legislation recently introduced into the Virginia House of Delegates. Essentially, they would deny Medicaid reimbursement for any Certified Professional Midwife performing services for at-risk women. Apparently "at-risk" initially included simply being low-income, but due to well-crafted protests from the constituency, that has since narrowed to just cover women seeking Vaginal Birth After Cesarean (VBAC). You can read the full story here, as well as other's (well-written) letters here and here. My own modest addition is below:

Dear Delegate Lohr:

I am writing to you as a Virginia citizen, registered nurse, and certified nurse-midwifery student, as well as a pregnant woman, to first applaud you for your commitment to withdrawing HB 2163. This displays a willingness to make decisions based on information and evidence as well as a sensitivity and responsiveness to the concerns of your constituency that is invaluable. I write secondly, however, to express opposition to bill HB 2167. The spirit and letter of this bills were it to become law, would have the chilling effect of denying safe, legal healthcare to recipients of Medicaid simply because they are low-income. This is unconscionable discrimination, especially since countless studies have demonstrated not only the safety but the superiority of midwifery care to women. (The most recent and rigorous of these is the Cochrane review found here: http://www.cochrane.org/reviews/en/ab004667.html, which ends with the conclusion that midwifery care has superior outcomes even to care that is shared between obstetricians and midwives; thus, it continues, midwifery care ought to be offered to all women. No qualifiers as to income, risk status, or previous uterine scar.)

On the contrary, obstetricians cannot cite hard facts, merely overblown scare tactics, in their efforts to deny women midwifery care and thus retain the bulk of the market share of births. While midwives have historically always worked to improve access to care and women's ability to educate themselves and make choices about their own healthcare, obstetricians have increasingly sought in recent years to restrict their options and suppress their access to quality care. As people of all political and economic backgrounds agree that the time has come for a new era of personal responsibility, a choice such as midwifery care (and homebirth, and VBAC versus mandatory repeat Cesarean) which promises to raise health outcomes, improve satisfaction, lower cost, and provide jobs for hardworking and caring women cannot be savagely attacked by such legislation as is proposed in Virginia. Please withdraw your support for HB 2167, which would only hurt women, midwives, and taxpayers.

Sincerely,

Katie Sullenbrand

Surprise, surprise: the delegate introducing the legislation didn't pluck it out of thin air, or craft it out of concern after evidence that midwifery care was unsafe (which doesn't exist): instead, it was proposed to him by a local obstetrician. Who I'm sure is up nights unable to sleep because of the idea that women are able to make an informed choice about the increased risk of uterine rupture posed by VBAC.

How conveeeeeenient: forcing poor women to undergo mandatory repeat Cesareans, and taxpayers to pick up the tab--while funneling 100% of the profits into the pockets of obstetricians.

They've always said doctors are smart.

If you live in Virginia, I'd encourage you to send an email as well. It only takes a minute!

The Storm is Gathering...

Coast to coast! To have homebirth-positive (and midwife-positive) full-length stories in two major newspapers within days of each other is incredibly, unbelievably exciting. I particularly like the way the SF Gate took the opportunity to point out the safety of homebirth as evidenced by major studies (on the whole, it's a stronger, more positive article than the NY Times one--but at the very least, check out the NY Times slideshow, which has some stunningly beautiful photographs). Oftentimes, the best we'll get is "Midwives claim homebirth is safe." Yes, we do, but where do we get that position? Data!

And, it's great to hear an ACOG member do what they do best: unabashedly lie to women. Here's a quote from the article, with my responses in brackets and italics:

"ACOG doesn't formally oppose home birthing but our position definitely implies that," says Dr. Erin Tracy, an ob-gyn at Massachusetts General Hospital and vice chair of ACOG Massachusetts. [Their position? "The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births." Uh, yeah, that's a pretty FORMAL OPPOSITION there...no "implication" about it."] "No one at ACOG is advocating for criminalizing home birthing." [Right, you're instead seeking it through the AMA: "RESOLVED, That our AMA develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex"] "We just personally think it's much safer to give birth in a hospital or at a birthing center."

"We just personally think"?! This is the professional organization for the almighty American OB-GYN, and their basis for denying women what could be their safest and most satisfying birth experience (not to mention a cost-effective one for the nation) is based not on science, not on medicine, not on personal freedom or autonomy even, but on...."We just personally think?!"

Here's what else they think: "For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center."

Hmmm...the only good midwife is midwife that delivers in the hospital, under the thumb of a doctor...even though the studies have shown that this isn't necessary for the safety of low-risk women. So... why do you think they "think" that?

I'll tell you why: because they the way they manage birth in the hospitals is all about convenience and money, and women are growing wise to that. And they're demanding better for themselves and their babies.

Why I'm....

proud to be from UIHC. And disgusted with the state of things in the rest of the state (and country). Because VBAC was so commonplace at UIHC, I had no idea that things were so different in the rest of Iowa...

Ecstatic About Orgasmic Birth

Despite the fact that traffic caused me to miss the first 20 minutes of the film screening, I was still so glad that I made the trip to Baltimore and paid the $10 to see this movie. I also dropped another $40 to buy the DVD (though apparently you can buy it through the website for $35, though I'm not sure if that includes shipping...).

It was, in a word, wonderful. I would have to say that it's probably my favorite all-around birth video to date (sorry, BOBB, I still love you, too). (Matt said it was his, too.) Birth As We Know It might win out for the sheer beauty of multiple waterbirths in the sea, but Orgasmic Birth included so much beautiful birth footage (in water and "on land"), so many wonderful interviews with couples, and also a great deal of factual information (the DVD also has a feature called "Birth by the Numbers" which walks you through the various statistics impacting maternity care in the United States today). All my favorite experts (Ina May Gaskin, Marsden Wagner, Christianne Northrup, Robbie Davis-Floyd, and Elizabeth Davis) were prominently featured and spoke articulately on the topics at hand.

I thought that probably the best and most touching segment was one on birth for survivors of sexual abuse. Featured is a fragile-looking but determined survivor who describes her history of abuse, then describes her birth, saying "I felt myself just leave, and this...this woman came in...who just knew how to birth a baby!" She looks shyly but proudly at the camera, nods slightly and says, "I felt transformed." It's an amazing thing to watch, especially given that the prevailing medical "wisdom" today is that women who are survivors of sexual abuse are best off with a very early, very dense epidural at the least--or, worse, a scheduled primary Cesarean. That doesn't give them a lot of credit, does it?

As I'd anticipated, the actual discussion about orgasms during birth (which do happen, but not that often) is brief and incidental, and the thrust (sorry) of the film has lots more to do with women's sensuality, and the intimacy and privacy and bliss of birth, and creating the same kind of loving and secluded environment for birth as you would for lovemaking than it does with the actual experience of orgasm. Obvious fact that there are lots of naked women in it notwithstanding, the movie is incredibly tastefully (and beautifully) done, dare I even say family-friendly (though I suppose it depends on your family), and I wouldn't be embarassed to watch it with anybody.

I could go on forever about this movie but I'll just say that if it doesn't make you wish you were nine months pregnant and in labor, well, I don't know what will. It did for me. The only possible icing on the cake was that at the end, out walked MARSDEN WAGNER, and I got to shake his hand and chat with him for a little while after the screening. AHHHH! Talk about goosebumps!!

Birth News

I think partly it's the economy; I think people are also just getting fed up. And unfortunately, as the link demonstrates, women are also dying. Any way you look at it, it seems like the storm is gathering for change (I hope)...

On a lighter note, as I've mentioned, I'm going to Baltimore today to see Orgasmic Birth. You can be sure a full report will follow!

Making Birth Your Own

Talk Birth has a couple of good posts up on the uniqueness and individuality that can shine through in birth. A couple of memorable quotes:

I tell men in my classes not to be “scared” of their wives in labor, but to walk through the waves (of discomfort, anxiety, whatever) and just hold and love her. I tell them that they do not need to be “trained” to be more “special” or different than they are. They don’t need to be doulas. What they need to do is love her the way they love her and reach out to her to show her that [emphasis mine]."

And from Giving Birth: How It Really Feels by Sheila Kitzinger:

“I believe that this is one of the important things about preparation for childbirth–that it should not simple superimpose a series of techniques, conditioned responses to stimuli, on the labouring woman, but that it can be a truly creative act in which she spontaneously expresses herself and the sort of person she is. Education for birth consists not, as some would have it, of ‘conditioning,’ but aims at giving a woman the means by which she can express her own personality creatively in childbirth.”

This is one of my major beefs with hospital birth--in order to facilitate efficiency, a woman and her family's individuality and intimacy get stripped away and sacrificed in the name of various routines. I've seen many times that this can be a very disempowering way to start a family.

Put Your Money Where Your Mail Is

The ACNM released some sweet-ass midwifery stamps in celebration of Midwifery Week last week! The stamps are limited-edition and, unfortunately, at almost a buck apiece ($18.99 per sheet of 20), they're kind of expensive, but the proceeds go to support the ACNM and its Education Fund. Ways to make it a little cheaper: if you order two or more sheets, they're $16.99 apiece; and if you enter the code "tenoff" before checking out, it should knock 10% off your order. For two sheets of stamps, this took me down to about $0.76 a stamp--still a little pricey, but worth it for the cause. Plus, they're beautiful stamps.