Formula-Fed America
Posted by doularama | Filed under News, Recommendations
Oh my goodness! I haven’t been to the movies in years and this might just get me out there. Something tells me, however, that it won’t be a date night with my husband. Maybe he’ll meet me afterwards. I hope it’s not just being released on DVD- I need a good excuse to sit in a room full of adults for a couple of hours. Anyway, here’s the trailer. Please jump on the bandwagon. Too many of us don’t take a strong position on breastfeeding because we don’t want to make anyone feel bad. How much harm are we doing so that we don’t hurt their feelings? Share the facts and you’re bound to change some minds. See you in the movies…
Formula Fed America
Tags: Breastfeeding, Formula Fed America Movie, Formula Feeding
On Interventions
Posted by doularama | Filed under News, Recommendations
In case you haven’t had a chance to read all of the books I’ve recommended here, I’m providing you this article from Utne Reader which gives you an overview of a couple of them. I think it’s important reading! Enjoy.
Drugs, Knives, and Midwives
by Elizabeth Larsen
The woman, who is expecting her first child, is a week past her due date. Even though tests show that her baby is doing well, her obstetrician decides to induce labor with Cytotec. It’s a drug that has not been approved by the Food and Drug Administration (FDA) for pregnant women, and it can cause contractions that are strong enough to lacerate the anatomical barrier that keeps amniotic fluid separate from the mother’s blood vessels — a situation known as amniotic fluid embolism (AFE). AFE is almost always fatal.
The woman’s contractions speed up immediately, but the doctor continues to give her Cytotec until her contractions are coming so rapidly that the baby is having difficulty getting oxygen. The fetal monitor shows that the baby is in extreme distress, so the doctor sets to work to save it.
Shortly after the birth, the mother starts to hemorrhage and goes into shock. The baby dies 35 minutes after birth. The mother dies a few hours later from AFE.
This nightmarish scenario is one of many from Marsden Wagner’s book Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (University of California Press, 2006). A perinatologist and a scientist, Wagner is a former director of women’s and children’s health at the World Health Organization (WHO). He’s also an old-fashioned whistleblower. By his lights, the American birth industry is in a crisis because we have turned a natural event into a medical condition. As a result, we’ve allowed obstetricians — and not the midwives who safely deliver the majority of the world’s babies — to control maternity care. The ironic result is that in our efforts to make birth as safe as possible, we have saddled American women and babies with a system that, despite being the most expensive on earth, puts us in the bottom tier of care for wealthy countries.
Today, more than 15 years after Jessica Mitford detailed the potential hazards of obstetrical forceps, fetal monitoring, and diagnostic ultrasound in The American Way of Birth and more than a quarter century after Immaculate Deception, author Suzanne Arms’ expose of high-tech birth, sold more than 250,000 copies, the number of American women who die around the time of birth is on the rise. According to WHO, 28 countries — including Croatia, Ireland, Kuwait, and Portugal — have lower maternal mortality rates. Forty-one countries have lower infant mortality rates.
It’s not just the shocking mortality rates that trouble Wagner and other reformers. Childbirth Connection, a New York organization dedicated to improving maternity care, recently published Listening to Mothers II, a national survey of 1,573 women who gave birth in 2005. Its findings document numerous indignities and dangers, most of which easily could have been prevented. Of the 25 percent of women who were given episiotomies (a cut in the muscle between the vagina and the anus to widen the birth canal), a startling 73 percent were not consulted before having the procedure.
While an episiotomy is a minor — albeit painful and often unnecessary — procedure, a cesarean section is major surgery, and 32 percent of Listening to Mothers II respondents had one. That’s a higher rate than the 29 percent cited by Wagner, itself a steep increase from the 21 percent reported five years earlier. Given that WHO has calculated that the optimal rate of C-section for saving the most women and babies is between 10 and 15 percent, what’s driving this trend?
Certainly, in this age of rising malpractice insurance costs, obstetricians want to protect themselves from being sued. But Wagner also thinks that C-sections offer doctors a way to bring the most time-consuming part of their practice under their control. ‘It means they can split their time between seeing patients in the office, doing gynecological surgical procedures in the hospital, and attending births, on a timetable of their choosing, and reduces the chance that they will be required to attend births at inconvenient times,’ he writes. ‘For some, it is perhaps their only chance to have a decent personal life.’ Wagner also believes that our skyrocketing C-section rates are driven by the internal politics of the birth industry. By promoting cesareans, doctors are choosing a procedure that midwives cannot perform.
Even in an elective cesarean, a woman is almost three times more likely to die than in a vaginal birth. Beyond the immediate health risks, having a C-section decreases a woman’s chance to become pregnant again and doubles the risk of an unexplained stillbirth in later pregnancies. In 2 to 6 percent of cesareans, a doctor accidentally cuts into a baby. Babies born from an elective C-section are twice as likely as babies born vaginally to end up in neonatal intensive care.
The widespread use of labor-inducing and painkilling drugs is another by-product of what Wagner sees as the rampant medicalization of American births. According to Listening to Mothers II, four labors in ten were started artificially. The most common method used (80 percent) was synthetic oxytocin, more commonly known as Pitocin. There is no disputing that induced labors can be medically necessary. But they also are done at the request of anxious mothers who are so exhausted by their pregnancies that they just want to be done with them. In theory, there is nothing wrong with trying to jump-start labor; since human life began, women have been walking, squatting, rubbing their nipples, swallowing castor oil, snorting sneezing powders, and having sex to give their babies a nudge. But nearly 20 percent of the women in the study who were induced said that they felt pressured by their doctors.
The problem with using Pitocin is that it makes contractions more painful and creates a snowball effect that often leads to pain medications such as epidural blocks, which spur their own set of complications. According to Wagner, a quarter of women who receive an epidural experience side effects such as fevers, urinary incontinence after delivery, headaches, temporary and permanent paralysis, and even death. Because a woman who has had an epidural cannot feel or move her lower body, she has to give birth lying on her back, which is less efficient than upright positions such as squatting or standing.
When Wagner challenges doctors who use Cytotec, he’s told that if they were to wait for FDA approval, they would be stalling the medical progress of their field.
This arrogance, Wagner warns, is endemic in the practice of medicine. He urges his readers to push past unfounded fears about safety to realize that 80 percent of births don’t need medical interventions. But while Wagner blames the medical establishment, a roundtable discussion in the journal Birth (Sept. 2006) takes a wider view that implicates our panicky, instant-fix culture. ‘We are a terrified, risk-aversive society,’ writes Michael C. Klein, professor emeritus of family practice and pediatrics at the University of British Columbia, who believes that we want the easy solution in all aspects of our lives. ‘[We] pop a pill and carry on being fat and out of shape, while [we] expect to die suddenly at age 90 in the middle of sexual intercourse. We demand it of society, the medical profession, ourselves.’
In their indignation, critics of the current birth system tend to overlook the fact that despite its myriad shortcomings, there have also been considerable advances in the way we give birth, and that birth fads and trends are products of their time and culture. Tina Cassidy’s Birth: The Surprising History of How We Are Born (Atlantic Monthly Press, 2006) is a fascinating tour through the dark days of craniotomies (puncturing the fetal skull to remove babies who were stuck), cesareans without anesthesia, and ‘Twilight Sleep,’ a method developed in Germany in 1914 in which women were drugged into a semiconscious state, strapped to their beds, and then had their ears stuffed with cotton so they wouldn’t be awakened by their cries of pain. Indeed, a fair number of women giving birth today were born to mothers who were unconscious. Fathers were routinely banished from delivery rooms until the 1970s, and newborns slept down the hall in nurseries and were fed formula on rigid schedules.
Most new families today spend the night together in the same hospital room because activists in the 1960s and 1970s demanded that birth become a more human, family-centered experience. Now, a new breed of agitators are starting to take matters into their own hands. In a December 2006 Boston magazine article, Cassidy details the efforts of Boston-area women who are fed up with unwanted C-sections, false positive prenatal screening tests, scant breastfeeding support, and incorrect predictions from doctors about dangerously large babies. The members of this ‘mommy uprising’ are hiring hands-on midwives instead of obstetricians and are insisting that they be allowed to have a doula — a supportive labor coach — present at the birth. Some are passing on the hospitals altogether in order to give birth in the familiar comfort of their own homes. But while studies have shown that home births are as safe as hospital deliveries for low-risk pregnancies, most doctors oppose them. In some states, attending a home birth is illegal, and home birth midwives and their clients (not ‘patients’) have been driven underground.
Wagner argues that midwives are key to fixing our broken maternity system and that they should be given the primary responsibility for women with low-risk pregnancies. (Obstetricians can be responsible for women with serious medical complications.) He envisions a system in which most maternity services are located in neighborhoods and not hospitals. If the United States had a national health care system, American obstetricians would no longer be able to maintain their monopoly on the birth industry. He also calls for doctors and hospitals to be more transparent, providing information about not only their C-section rates, but also rates of maternal and infant mortality, uterine rupture, and adverse drug reactions.
Of course, there are thousands of obstetricians who provide expectant and laboring mothers with compassionate, ethical, and medically first-rate care. And there are plenty of midwives who in their fervent belief in the rightness of their approach display the kind of arrogance Wagner ascribes to his fellow doctors. To make its way into the mainstream, midwifery needs to move beyond its earth mother image and take a more tolerant view of American women’s fear of excruciating physical pain. In her book Misconceptions: Truth, Lies, and the Unexpected on the Journey to Motherhood (Doubleday, 2001), Naomi Wolf articulates this challenge. Describing the difference between the alternative birth center and the maternity ward at her Washington, D.C.-area hospital, she writes that ‘the contrast between the two delivery floors seemed to sum up a failure to give women decent choices in childbirth. I did not understand why the polarity was so stark: the beautiful floor with its rigid set of options regarding pain, or the slaughterhouse atmosphere of the regular birthing rooms where I could receive medication for the body if I needed it, but nothing for the soul. My heart longed for the alternative birth center, its beauty, the openness. But could I stand the pain? And would my labor go so smoothly that no complications would arise to get me sent to the warrens down below?’
As anyone who has read Misconceptions knows, Wolf was indeed shuttled out of the birth center when her labor failed to progress according to her nurse’s time line. After Pitocin and an epidural, Wolf was rushed into an operating room for an emergency C-section. It’s a scenario, she later found out, that is all too common among American women giving birth. To paraphrase Wolf’s critique of the popular pregnancy manual that in her view encourages women to passively accept overly medicalized births, she did not get what she expected when she was expecting.
The Business of Birthing
Posted by doularama | Filed under News, Recommendations
I just watched this short video and started to cry. Stop rolling your eyes, it’s about my passion, besides it could’ve just been the music. The video states my reasons for becoming a doula. The fact that the information presented in it is not common knowledge or openly discussed among women in their childbearing years is truly sad. So many of us just do what we know, whatever everyone else is doing without knowing that we have a choice. I am not saying that everyone should share my ideal for birth. I just want women to know that there are options so that they can feel empowered when they choose, and therefore decrease the likelihood of regret.
Tags: Childbirth in America, natural childbirth
Twilight Sleep
Posted by doularama | Filed under News
Twilight sleep is a state of finely balanced semi-consciousness. In 1902, doctors in Germany started injecting laboring women with morphine and scopolamine. When combined, these drugs induce a semi-narcotic state which allows women to have the experience of childbirth WITHOUT THE MEMORY OF PAIN. The goal was not anesthesia, but amnesia.
It wasn’t long before this was the popular birthing procedure in the U.S.. The method was said to dull the pain yet women were restrained and strapped to gurneys for their own protection as they thrashed around in bed, freed from their inhibitions by the drugs, but not entirely freed from the pain. Some had their legs clamped in stirrups for hours in order to be ready when the doctor arrived.
The women, while responding somewhat to pain, did not remember it after delivering their babies. They didn’t remember the pain or the actual deliveries.
At the time, the medical consensus was that scopolamin-morphin was without danger to the babies.
This idea would eventually change as the negative side effects of twilight sleep came into the light.
Some of the complications noted were emotional. Removing the mother from the experience of childbirth, leaving her with no memory of the labor or delivery of the child is definitely a side effect.
However, more severely, the drugs had depressive effects on the central nervous systems of the newborns. This resulted in a drowsy baby with a compromised breathing capacity.
As if this wasn’t enough, let’s take another look at the following phrase: the experience of childbirth without the memory of pain. Is this not colossal disrespect!?! Ironically it was the suffragists who rallied for it to become standard procedure throughout the country.
By the mid 1970s, twilight sleep was no longer being used, but the labor and delivery staff of the previous generation had lots of stories to tell while the mothers had none. They just couldn’t remember.
Tags: childbirth, Twilight Sleep
New Videos!
Posted by doularama | Filed under News, Recommendations
Have you taken a look at the other pages on this blog? There are some great books and links listed in addition to interesting and fun videos. I’ve just added a couple of new videos including one depicting the birth of an elephant. For a long time I was hoping to find a good mammalian birth video to add and this one is perfect. Notice how the elephant moves in labor, swaying her hips and stomping her feet. She opens her mouth as her baby emerges. Many people think that opening the mouth correlates to the opening of the birth canal. How did the elephant know that? Enjoy!
Ina May’s Guide to Breastfeeding
Posted by doularama | Filed under News, Recommendations
Ina May Gaskin’s new book has just been released. I was at a seminar with her last year and saw a couple of the photos she wanted to use for the cover of this book. One was the photo of a mountain which she took herself. It looks just like a breast, with color variations and all. Below is the other set she wanted to use. My daughter delightedly exclaimed “leche” when she saw a nude statue in a museum once, and my son took another nude statue as a reminder to ask me for my own milk another time. In the end, her publishers got their way and the book has a very conventional cover.
Tags: Breastfeeding, Ina May Gaskin, Statue
Labor Pains for Men
Posted by doularama | Filed under News
Surely, some men will watch this and think that they would be able to do better, but there is much more involved than just the contracting of the uterus (the largest set of muscles in the body and men will never have them). There are other sensations, many would say pain, that come up in various parts of the body, and there is also a huge emotional factor that contributes. If you are frightened or anxious, dehydrated or have a full bladder, it all comes into play. There is so much involved, but this is still worth a look.
I say too bad men can not go through labor. Not because they deserve to suffer, but because it is really a privelege. Women can’t truly remember the physical component of how they felt during labor, but the emotional component never leaves us. That’s why, as a doula, I am working to help women create positive memories.
Tags: doula, Dr. Andrew Rochford, Men Experiencing Labor
Chewing Gum!?!
Posted by doularama | Filed under News
I have never understood the idea of chewing gum. What is the appeal? Chew, chew, chew and at the beginning you get a little flavor. Oooh, that’s exciting. Can I also chew it with my mouth open to annoy the people around me and make little crackling noises on the train so they won’t be able to read even though this is the only opportunity they’ll have? What fun. Even bubble gum, which provides some amusement as you practice a skill that you will never use elsewhere, seems pointless to me. I didn’t even need to finish that last sentence, did I?
Well, finally I see the reason gum was invented at all. Following are the results of a study that say that chewing gum after a cesarean surgery can help speed the rate of recovery. Now that’s something to chew on.
RODALE NEWS, EMMAUS, PA-Chewing gum after giving birth by C-section appears to help new mothers recover faster, stimulating bowel function sooner, which can translate to shorter hospital stays and lower healthcare costs, according to a study published in the journal BJOG: An International Journal of Obstetrics and Gynaecology.
THE DETAILS: Researchers looked at 200 pregnant women who delivered by elective cesarean section and put them into two groups; 93 who received one stick of sugarless gum for 15 minutes every two hours after surgery, and 107 who underwent traditional treatment-no clear liquids until a patient passes gas, and no regular diet until the first bowel movement.
WHAT IT MEANS: Generally, after any abdominal surgery, including hysterectomies and C-sections, a portion of your intestines is temporarily paralyzed. Most doctors won’t allow you to eat or drink until your gut awakens because they don’t want food to become stuck in your GI tract and cause complications. This study adds to the evidence that chewing gum is a helpful way to wake up your gut after surgery, perhaps because the act of chewing signals that food is on the way.o Make the chew case to your doctor. If you’re scheduled to undergo any abdominal surgery, ask your doctor if chewing gum could be used to speed up your recovery. University of Texas Southwestern Medical Center researchers found that patients who had undergone colon surgery and chewed gum for 15 minutes four times a day saw a return of bowel function a half a day sooner than those who just sipped clear fluids.
Tags: abdominal surgery, ceasarean, chewing gum, recovery
In the Caul
Posted by doularama | Filed under Birth Stories, News
Caul is the term used for the amniotic sac when it is still intact around the baby at birth. Fewer than one in one thousand babies are reported to be born in the caul, and there are some old beliefs surrounding these births. Among them is the idea that a baby who is born in the caul will have good luck
I am not really superstitious- I happily believe some of the positive (things) and leave the rest behind. I’ll even go as far as saying that Friday the 13th brings me good luck because, if everyone has bad luck on that day, the good luck has to go somewhere. So, I’ll often see the positive portents in my life, and recognize nary an ominous omen.
I feel like I came into birth work in the caul. I have been very lucky. I’ve had great mentors and many opportunities for continuing education. I’m usually called to births after breakfast and get home before dinner. I get women to the hospital just before they need to push, leaving no time for interventions, and homebirths speed right along too.
The last two homebirths I assisted were attended by the same midwife. For the first one, she arrived just three minutes before the baby was born. Things were just going so smoothly and everyone was coping well, it was hard to tell that it would end so soon. For the second one, she arrived a little less than an hour before the little caul-enveloped girl emerged. The midwife told me that I am very calming and that’s why labors go so quickly for me. Well, “calm” is the one word everyone uses to describe this midwife. What a compliment it was to have her say that about me.
Now I’m on call for another client with the same midwife. Some might suspect that my luck should run out by now, I choose not to worry myself with those thoughts and just take the challenges as they come (if they come).
I don’t think there are any long- standing beliefs about the people who are present when a baby is born in the caul. Well, there is now and you better believe it’s a good one.
The midwife mentioned above had an aunt who was also a caulbearer. She died the day the little girl speedily came out in her own caul. That’s not superstition, it’s just fact, but I like to believe that those coincidences are significant too.
Check out some amazing photos and some more info HERE.
Tags: caul, childbirth, in the caul, midwife, Navelgazing Midwife
The Safety of Homebirth Reviewed
Posted by doularama | Filed under News, Recommendations
Following is an abstract of a study that demonstrates the safety of midwife-attended homebirths from The Canadian Medical Association Journal. This is extremely important! People quote and misquote the findings of a very flawed study to say that homebirth is not safe and they are just wrong. Dr. Marsden Wagner, in his book Born in the USA, does a wonderful job of educating his readers on this. Too bad we’re not all his readers!
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.
Patricia A. Janssen PhD, Lee Saxell MA, Lesley A. Page PhD, Michael C. Klein MD, Robert M. Liston MD, Shoo K. Lee MBBS PhD
ABSTRACT
Background: Studies of planned home births attended by registered midwives have been limited by incomplete data, nonrepresentative sampling, inadequate statistical power and the inability to exclude unplanned home births. We compared the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians.
Methods: We included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physician-attended planned hospital births (n = 5331). The primary outcome measure was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.
Results: The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00–1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.00–1.43) among women attended by a midwife and 0.64 (95% CI 0.00–1.56) among those attended by a physician. Wo men in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29–0.36; assisted vaginal delivery, RR 0.41, 95% 0.33–0.52) or adverse maternal outcomes (e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.28–0.59; postpartum hemorrhage, RR 0.62, 95% CI 0.49–0.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.14–0.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24–0.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.21–0.93) and more likely to Abstract be admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.09–1.85).
Interpretation: Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.
Tags: Born in the USA, Canadian Medical Association, Homebirth, Marsden Wagner
