Sunday, February 24, 2008

Safety and Risk

Like all matters of the heart,
As in all true passions of art,
Birth calls for the fullness of your madness.

Too reserved and cautious an approach will be met with equal fears and self protection.

To give ourselves fully is to be met fully,
For Spirit responds as is trusted;
As
being the key to finding yourself face to face with mystery

Light and color play between the scene and the painter and is lost to those who already view the picture they seek

.

Tuesday, February 19, 2008

That's why they call it labor and not epidural

Love and vision brought it all together, though it was tough at the end.
Such a birth helped the family go deep into where they were really at, and look at beliefs and see if the beliefs were assumptions and not really the fiber of their lives
in an era
when the hospital culture is permeating even them.

They had to ask, what is the culture of homebirth and the mystery and the walk? And am I there, or am I not? Is it really ok to be there or am I wrong?
and what is the box I long for anyway?
and its rules
and the schedule that trims your life and your passion for a safety that isn't even safe?

Will we trade one hard walk, when others look down on it, when we ourselves are lifted up by it?
Will we take on the safe road? The trauma there, though hidden, is absolute.
We have to surrender the praise of the passive
and find the birthing within

Thursday, February 7, 2008

ACOG's loose cog on homebirth and Gail's comments

I got an email from my friend Debra Pascali Bonaro today. She's always up to date. She sent along the following statement from American College of Obtetricians and Gynecologists.

Wow, see ACOG's news release below against Home Birth... ACOG must be feeling
threatened from all the discussion about Home birth...The Business of Being
Born
and more movies in the pike that are creating awareness and discussion.
I can't wait till we release Orgasmic Birth this spring. [Premiers in Minneapolis, September 25th, 2008]

As Christine Morton wrote: "interesting way they discount research showing
safety of home birth with trained midwives in attendance and end up
accounting for the rise in cesareans in terms of women¹s desires and
bodies. Hmmm."

I hope some of our groups will be responding to this... From a PR
perspective this is great... It shows they are threatened and this will
keep the dialogue going I hope.
Hugs
--
Debra Pascali-Bonaro
www.orgasmicbirth.com


Here's the statement:


ACOG NEWS RELEASE
For Release:
February 6, 2008
Contact:
ACOG Office of Communications
(202) 484-3321
communications@acog.org
ACOG Statement on Home Births

Paragraph 1.) Washington, DC -- The American College of Obstetricians and Gynecologists
(ACOG) reiterates its long-standing opposition to home births. While
childbirth is a normal physiologic process that most women experience
without problems, monitoring of both the woman and the fetus during labor
and delivery in a hospital or accredited birthing center is essential
because complications can arise with little or no warning even among women
with low-risk pregnancies.

2.) ACOG acknowledges a woman's right to make informed decisions regarding her
delivery and to have a choice in choosing her health care provider, but ACOG
does not support programs that advocate for, or individuals who provide,
home births. Nor does ACOG support the provision of care by midwives who are
not certified by the American College of Nurse-Midwives (ACNM) or the
American Midwifery Certification Board (AMCB).

3.) Childbirth decisions should not be dictated or influenced by what's
fashionable, trendy, or the latest cause célèbre. Despite the rosy picture
painted by home birth advocates, a seemingly normal labor and delivery can
quickly become life-threatening for both the mother and baby. Attempting a
vaginal birth after cesarean (VBAC) at home is especially dangerous because
if the uterus ruptures during labor, both the mother and baby face an
emergency situation with potentially catastrophic consequences, including
death. Unless a woman is in a hospital, an accredited freestanding birthing
center, or a birthing center within a hospital complex, with physicians
ready to intervene quickly if necessary, she puts herself and her baby's
health and life at unnecessary risk.

4.) Advocates cite the high US cesarean rate as one justification for promoting
home births. The cesarean delivery rate has concerned ACOG for the past
several decades and ACOG remains committed to reducing it, but there is no
scientific way to recommend an 'ideal' national cesarean rate as a target
goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean
Delivery to assist physicians and institutions in assessing and reducing, if
necessary, their cesarean delivery rates. Multiple factors are responsible
for the current cesarean rate, but emerging contributors include maternal
choice and the rising tide of high-risk pregnancies due to maternal age,
overweight, obesity and diabetes.

5.) The availability of an obstetrician-gynecologist to provide expertise and
intervention in an emergency during labor and/or delivery may be life-saving
for the mother or newborn and lower the likelihood of a bad outcome. ACOG
believes that the safest setting for labor, delivery, and the immediate
postpartum period is in the hospital, or a birthing center within a hospital
complex, that meets the standards jointly outlined by the American Academy
of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that
meets the standards of the Accreditation Association for Ambulatory Health
Care, The Joint Commission, or the American Association of Birth Centers.

6.) It should be emphasized that studies comparing the safety and outcome of
births in hospitals with those occurring in other settings in the US are
limited and have not been scientifically rigorous. Moreover, lay or other
midwives attending to home births are unable to perform live-saving
emergency cesarean deliveries and other surgical and medical procedures that
would best safeguard the mother and child.

7.) ACOG encourages all pregnant women to get prenatal care and to make a birth
plan. The main goal should be a healthy and safe outcome for both mother and
baby. Choosing to deliver a baby at home, however, is to place the process
of giving birth over the goal of having a healthy baby. 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.

# # #

The American College of Obstetricians and Gynecologists is the national
medical organization representing over 52,000 members who provide health
care for women.


Gail's Reactions

ACOG's statement includes misleading projections, emotionally-based opinions, fear, and just plain self serving PR. I'd be nice, but ACOG has been promoting its position with false and jilted accusations against non OB birth attendants for decades and it gets tiresome.

First of all, Mehl in the 70s and, currently, Daviss and Johnson in this decade have constructed excellent research on the safety of homebirth with non-nurse midwives. CPM2000 research outcomes have been available for plenty of time now for a fellow of ACOG to read it. Canada and Britain embrace the quality job done by Betty-Anne Daviss and Ken Johnson, though, like the doula studies, its rare that an American physician doesn't block, obscure and resist evidence-based innovations that would require them to share care in the birthing room.

Gail's rebutal:

1st paragraph
"No warning" --?! Trained homebirth Midwives handle birth emergencies very well. Ken Johnson shared that though homebirth midwives may experience higher numbers of shoulder dystocia [presumably due to higher average birth weights among homebirth families] there were no deaths and fewer adverse outcomes when compared to
shoulder dystocia in hospital birth statistics. I'm waiting for specifics on that finding from Ken. I mention it here as an example.

2nd paragraph and Gail's comments:
"ACOG acknowledges a woman's right to make informed decisions regarding her
delivery and to have a choice in choosing her health care provider, but ACOG
does not support programs that advocate for, or individuals who provide,
home births." So, ACOG acknowledges that women are choosing homebirth providers, but doesn't support homebirth programs or providers. Thats a relief. I wouldn't trust an ACOG based homebirth service. The transport rate would likely be 100%, eh?

3rd paragraph and rebuttal:
"Childbirth decisions should not be dictated or influenced by what's
fashionable, trendy, or the latest cause célèbre."
Will ACOG rebut the cesarean fashion raging in Hollywood?

"Despite the rosy picture
painted by home birth advocates, [Again, I'm loving living in the Light and Color as a homebirth midwife. Inside joke, and reference to Susan Sarback's School of Light and Color.] a seemingly normal labor and delivery can
quickly become life-threatening for both the mother and baby. "
We covered this in paragraph 1.


"Attempting a
vaginal birth after cesarean (VBAC) at home is especially dangerous because
if the uterus ruptures during labor, both the mother and baby face an
emergency situation with potentially catastrophic consequences, including
death. Unless a woman is in a hospital, an accredited freestanding birthing
center, or a birthing center within a hospital complex, with physicians
ready to intervene quickly if necessary, she puts herself and her baby's
health and life at unnecessary risk."

My friends who work as hospital employees on Labor and Delivery tell me of mistakes that cost lives and ruptures. Mistakes such as attempting to flush the uterus of meconium or increase amniotic fluid by replacing the natural fluid with a saline solution-only not to notice that the solution is blocked by the baby's head and can't exit. The fluid builds up until the uterus ruptures. Then, there is the continued use of cytotec for induction and its causal increase in uterine rupture, and a subsequent rise in amniotic fluid embolism of over 200%. Amniotic fluid embolism is almost always fatal to the mother, and that is also true against the healthy mother, and she doesn't have to have had a uterine scar for a cytotec rupture.

Let's address the speed of surgery necessary for saving a baby after a catastrophic rupture. Another friend spoke of an induced VBAC mother on an epidural complaining of uterine and shoulder pain. She was told repeatedly that the epidural wasn't taking fully and that she was fine. That is, until the baby died. Then the doctors discovered that her uterus had been ruptured for some time- time enough to have done surgery hours before and save her baby.

Homebirth midwives tend to listen to mothers. Homebirth mothers do not have epidurals which can confuse symptoms. Other problems may occur with home VBAC, and rarely they will, but lets not confuse location of birth with the illusion that death happens in one place and not another. Facts, irrefutable data, exist to show the safety of homebirth.



4th paragraph and rebuttal:
ACOG is looking to see if a reduction in the cesarean rate is necessary? Would a plumber seriously tell the building commission one toilet per house is all that is really necessary? No offense to plumbers, please note, who do not, mind you, in any way imply that homeowners should install a toilet for every person in the house to protect them from the effects of incontinence. Nor do plumbers advocate studies to see how many feet of pipes American cities and towns could bear before the public noticed adverse effects, such as soil erosion, or problems with laying streets, and raise an alarm that would outweigh the monetary benefits to their profession. However, ACOG and many OBs talk of cesarean studies to see how many medically unnecessary cesareans could be done before the public complained of loss of mothers, injuries to too many mothers and children, etc. Right now, obstetrics supposes that the corresponding higher maternal death rate is acceptable at a 30+% cesarean rate.


Gail's comment on paragraph 5:
Women risk the increased injury of having an Obstetrician care for them rather then a Family Practice doctor or Midwife. Non medically trained midwives have been shown to have the lowest injury rates of trained birth attendants. (Mehl)Link


Paragraph 6:
References that refute ACOG's claim that homebirth hasn't been adequately studied is aptly addressed at the following links:
British Medical Journal, CPM2000 http://www.bmj.com/cgi/content/full/330/7505/1416
Midwives Alliance Homebirth References
Ronnie Falcoa's posting of Homebirth and Out-of-Hospital Birth, Is it safe?
Excerpts from Experts on homebirth safety at Heritage Homebirth
From Mothering Magazine and Pam England There's No Place Like Home.

Paragraph 7:
Thomas Strong, MD succinctly challenges the ACOG and medical prenatal care system in his book, Expecting Trouble. Women come to homebirth midwives sometimes just to get the superior prenatal care. We often spend 45 minutes to an hour with families. Nutritionally based prevention is limited in clinic settings. However, many homebirth midwives give extensive nutritional counseling to prevent anemia, preeclampsia, postpartum hemorrhage, to enhance the health of the baby and mother and postpartum recovery.

ACOG says, "Choosing to deliver a baby at home, however, is to place the process
of giving birth over the goal of having a healthy baby. "
Let me share an excerpt of an email I sent to a grandmother who works with infant loss in her occupation. She was worried about her daughter's upcoming homebirth:

"Remember the risks of birth are three, " Gail wrote,
  1. "Those we have no control over and will happen no matter home or hospital;
  2. Those that are due to interference or neglect by well meaning caregivers that misunderstand the physiology of birth (again, no matter where they are or got their training and in spite of intent);
  3. And last and least often, by delay in emergency help.

There are uncommon events that can make a lovely home birth turn sour or tragic. I acknowledge that.

But there are common and standard events that interrupt bonding, breastfeeding and a mother's perception of her ability to parent and succeed as a woman, mother, wife and community contributor that happen with every hospital birth. Yes, I mean to say every. Even those rare, good hospital births with wonderful, skilled and intuitive care providers like [your daughter's Family Physican used for her first child's birth].
These interruptions in the physiology of human birth come from birthing outside of a woman's own environment. These interruptions can not be made up, but they can be compensated for. We now have generations of human mothers compensating for poor birth environments and the subsequent adverse effect on mothering and self. We are the walking wounded.
[Your daughter], along with other home birth mothers, just doesn't think that accepting some harm, the certain harm of disrupting the physiology of childbirth, is worth accepting to avoid the very small risk of harm due to the location of a home birth. Most emergency cesareans take 20 minutes or longer to begin, did you know that? You may find the CPM study useful."



ACOG concedes:
"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."

CNMs offer a wonderful service to American women. And CNMs will remember when ACOG was against their profession. Birth Center advocates will remember when they were attacked by ACOG.
Let's not fall into the pattern of the recently oppressed once raised now turning on those below them in the hierarchy of (supposed) power. Midwives must stand together. Submission of midwives under physicians may have a similar dynamic of how a battered wife will submit and stand by her man as she and her children are lost or emotionally distorted beyond recognition.
Professor Shelley E. Taylor, PhD on Womens' Stress Response


We have to speak up for homebirth. Our future depends on safe and gentle, physiologically centered birth care. Not only from midwives, but doctors, nurses and family members, is physiological and kind care needed.


Here is an email sent to me about this entry:


"Great response as I too, was going to add, they should practice what
they preach. "Childbirth decisions should not be dictated or influenced
by what's fashionable, trendy, or the latest cause célèbre." I can't
tell you how often dr.s I have asked about the increase in C birth reply,
"My hands are tied as women come in asking for it at their first
prenatal visit." Sounds like the woman is blamed again rather than the
dr. giving reassurance a vaginal birth is safer and natural.

Since I am the 'grandmother' you speak of, it was great! I'll forward
this to [her] sister who is having a home birth in five weeks. Keep up
the good work!

Joann"

Wednesday, February 6, 2008

Minneapolis Birth ranks high

Alisa Blackwood, a local doula here, sent this around today:

Fit Pregnancy magazine has named Minneapolis the 2nd best city to have a baby in (behind Portland, Ore.). One of the reasons?
"Minneapolis has one doula for every 37 live births, the highest ratio in our survey. The national average is one doula per 649 live births."

Go doulas! Link to the Minneapolis "report card" and look up other cities here:
http://www.fitpregnancy.com/bestcities2008/106

Best,
Alisa

Alisa Blackwood
Freelance Writer & Birth Doula...and here is Alisa's signature quote:

"Peace: It does not mean to be in a place where there is no noise, trouble or hard work,
it means to be in the middle of those things and still be calm in your heart."

I wonder how we'd rank if we included our homebirths - hey, that's a question
Betty-Anne Daviss and Ken Johnson could answer if the stats collected on their

website, Understanding Birth Better, for the certified professional midwives (CPMs) were examined for such data. Just a thought.

Monday, February 4, 2008

Alternative to Induction

Wanna know the Spinning Babies way to help a baby settle down on the cervix?

First, Help the mother, according to her intuitions, choice, conscience, agreement and/or inclinations, to

Straighten (balance) the lower uterine segment with
  1. Sacral release 3-10 minutes
  2. Sifting 3 minutes,
  3. Inversion 30 seconds, then crawling forward to hands and knees to catch breath and stabilize before swinging upward to kneeling position
  4. End this segment by lying belly down on a partially inflated swim ring with pillows positioned at thighs, shoulders, and face, to relax 5 minutes or so.

If the baby is posterior,
precede the above with an abdominal release (diaphragmatic release). This can be done by a CST or myofascial worker, or anyone who knows how (yourself, for instance).


These activities can be down at any weeks gestation. They are to relax and balance the uterus. Other activities, such as chiropractic or soft tissue work by a professional body worker are also helpful. I'm just listing here, what a mother can do herself or with a clever friend.

If the mother is 39 to 42 or more weeks pregnant, repeat what releases are needed until the desired softening. But importantly, repeat the sifting and inversion even 2x a day until, either the baby is facing the right hip, or 2 days before an induction is threatened.

When you have given the posterior baby every chance to rotate to face the mother's right hip, her back, or between her right hip and her back (all these are good), then continue with this way to flex the head and help the baby drop.


Then sit upright, back extended properly, not leaning forward, on the firm birth ball (not soggy) and do hula hooping movements, like salsa rhythm or such. Feet, of course, flat and knees apart to make feet and ball a tripod. 20 minutes.

Then relaxing while sitting on the ball while someone stands behind her and does the "peak of the shoulder" pressure points for downward movement.

This is sometimes called the Shoulder Well (GB21) Find it about 4 finger-widths from your shoulder joint, which is like a bony knob, up towards your neck. There is a dip there, I guess that's the well. It's found where your shoulder muscle is highest. The point is likely to be the most tender spot along the shoulder. Zingy. Teach this point to your partner/friend. Your partner will use the pads of both thumbs with a firm downward pressure on both shoulder wells at the same time. The pregnant woman is sitting, either in a chair or on a firm ball. She can hold a steady piece fo furniture for stablizing herself.

The pressure can feel strong, so take a deep slow breath and then exhale slowly. Three breaths later the pressure will have let up considerably, but your partner won't have changed their pressure. That's the release, you see? Using it in labor may reduce labor pain and help descent. No need for this with a fast birth, eh?!


The mother may need to sit up in general so that her spine is lifted away from her pubic bone. But she is stable on the firm birthing ball. For some women, leaning forward while sitting, even in the birthing pool, can reduce baby's chances of engaging, descending or even later, allowing the shoulders to be born after the head is out.

Be sure to ask her caregivers if there is any medical reason not to do any of this stuff! Without making that connection to the caregiver first, the releases adn pressure points may be edgy on the doula Scope of Practice. To avoid a smudge mark on your Scope, ask the mother's caregivers about your plans first. There is nothing here that will cause a problem in the usual situations.
About the inversion as shown on my blog. If she has polyhydrominos, or her water broke with a gush because the head is high, or the head is so far above the brim to be not over the brim, then she may be cautious and skip the Inversion. The reasoning is to protect the umbilical cord. She can, instead ask a chiropractor to help with a pelvic adjustment of both the SI joints, the pubis symphysis, and include a neck adjustment (or the pelvis may not correct as far as desired).

This pattern of comfort measures, will help relax the ligaments around the uterus enough to let the baby flex the head, rotate, and settle lower into the pelvis. Remember that once a woman has had a baby, the baby may get into position over the pelvic brim without needing to fully engage before labor. Even a posterior baby is more likely to rotate in labor when a woman has had a vaginal birth before, and certainly with this daily exercise plan. Remember, this is a set of activities put together for descent. Don't try and get a baby to descend before 38 weeks unless the doctor insists on inducing (hopefully, ONLY because it is medically imperative).

If this set of activities doesn't help the posterior baby rotate, try other techniques listed at www.SpinningBabies.com Don't try to get the posterior baby to descend before a medical induction.

Once the head is on the cervix labor will begin, for a mom 41 weeks or later, in a couple days....Or in several hours in occasional cases.

Changing the Earth by supporting Birth

Mothers bring forth life; medical corporations do not. Birth can be simple, powerful and loving. Fetal positioning, natural birthing and practical help for normal birth.