Huffington Post Article on Childbirth in the USA

http://www.huffingtonpost.com/tabby-biddle/women-speak-out-about-wha_b_781205.html

"Women die in childbirth as a result of systemic failures including: barriers to accessing care, inadequate, neglectful or discriminatory care, and overuse of risky interventions like inducing labor and delivering via cesarean section." -- Amnesty International

For many of us who haven't yet been through childbirth, there's an image we have of what it's like: A woman is rushed to the hospital in a taxi; she gets put in a wheelchair and is rolled down the hallway in dire emergency; then we see her screaming, and yelling in pain and then... there's the baby.

Sadly, this is the image that a lot of television shows have put into our minds, and have led many of us to believe: Birth is scary. Birth is dangerous. And it might be better if we just numb out through the whole experience.

Because so many women don't have an image of what a natural, empowered birth looks like, there is a lot of fear surrounding the act giving birth. Accordingly, the majority of women give their inner authority over to doctors in their birth process. They trust the doctors more than themselves. The problem with this is that many women aren't aware that the majority of her doctor's medical decisions are being made today for monetary and legal reasons, and not necessarily for the good of her and her baby.

Here is the reality: Hospitals are businesses. They want those beds filled and emptied. They aren't really interested in having women with long labors hanging around. And there is something else you should know: Having a baby in a hospital might not be as safe as you thought.

Did you know that the United States has the second worst newborn death rate in the developed world... and one of the highest maternal mortality rates among all industrialized countries?

You can go to any other developed country in the world, and you will find that they are losing fewer women and fewer babies around the time of birth. The important thing to know here is that in these countries, midwives are attending 70 to 80 percent of the births (doctors are there for the small percentage that have complications). In the United States, midwives attend less than 8 percent of births.

Why is this number so low?

"I've interviewed a lot of nurse midwives and I've noticed that as soon as their practice reaches over 30 percent of the women in a certain hospital, the doctor will start firing them because that's too much competition," said medical anthropologist Robbie Davis-Floyd, PhD, in an interview for the documentary The Business of Being Born.

Hmmmm... interesting.

The common way to have birth now is be Cesarean section. Today in the United States, the Cesarean section rate is at an all-time high. Since 1996 the C-section rate has risen 50 percent, according to the National Center for Health Statistics.

Today one out of every three babies comes into this world by C-section.

This seems like a crazy statistic. What is really going on here?

Marsden Wagner, M.D., former director of Women's and Children's Health at the World Health Organization, gave his opinion in an interview for The Business of Being Born: "A Cesarean is extremely doctor-friendly, because instead of having a woman in labor for an average of 12 hours, 7 days a week. It's 20 minutes, and I'll be home for dinner."

Many women come to the hospital with a plan for a natural birth, but all too often their birth plan changes very quickly based on a doctor's decision (that is not necessarily based on any real complication). For example, one friend of mine had written a birth plan with her doctor. She would be having a natural, vaginal birth at St. John's Health Center in in Santa Monica, California. On the day of my friend's birth, her doctor did not show up. So my friend was then under the charge of another doctor. This doctor decided that instead of the natural birth my friend had wanted, she should have a C-section. His reason: she was taking too long in labor.

But the doctor forbade my friend from squatting and getting on all fours (apparently against hospital policy), even though it felt so good for her and it opened up her pelvis. (FYI: When he left the room, she went ahead and squatted anyway.) My friend knew she could give birth naturally. She felt deep inside that she had the strength and power to do this. She trusted herself. But the doctor kept insisting on a C-section.

After fighting off some medical interventions that the doctor was insisting on (one of these was the "fetal probe"), and a lot of eye rolling and shaming from the hospital staff in the process, her baby was born. While my friend was happy as can be about her new baby girl, she explained to me: "The birth was something that should have been beautiful, but degenerated into something that wasn't."

As Nadine Goodman, Public Health Specialist, has put it: "What the medical profession has done over the past 40, 50 years is convince the vast majority of women that they don't know how to birth."

I have heard too many stories from friends and family members where the hospital told them that they were open to the natural birth they wanted, but then the reality was so different. First came the Pitocin to speed up the labor, then the epidural to dull the pain from the strong contractions caused by the Pitocin, and then the C-section "for the safety of the baby."

"We need to make sure that we reduce the overuse of interventions that are not always necessary, like C-sections, and increase access to the care that we know is good for mothers and babies, like labor support." -- Maureen Corry, executive director of Childbirth Connection

As Dr. Eden Fromberg, OB/GYN, has admitted in an interview: "There was a doctor who used to train me who said, 'They can never fault you if you just section them. Just section them.'" In other words, the current thinking in the medical world is: avoid being sued at all costs.

"There's the prevailing sense among doctors that you don't get sued for the C-section you do, only the ones you don't," said Nan Strauss, a maternal health researcher for Amnesty International, quoted in The New York Times. Amnesty International published a report earlier this year declaring the country in the midst of a crisis in maternal health care.

The reality is that once the hospital starts with an intervention, it becomes a domino effect. They say: Thank God we were able to do all of these interventions to save your baby. But, as Eugene Declerqc, Ph.D., Professor of Maternal and Fetal Health at Boston University School of Public Health has said

.... the fact of the matter is if they didn't start the cascading of interventions, none of the rest would have been necessary.

[By the way, putting a woman flat on her back for giving birth literally makes her pelvis smaller and makes it much more difficult for her to use her stomach muscles to push. The result: It is much more likely that she will need an episiotomy and a vacuum or forceps will be used to deliver the baby.]

Negotiating their way through the hospital environment is a power struggle that many women aren't interested in, so they are choosing to have their babies at home.

"For most women who are having a normal, healthy pregnancy, it can be safer to have a home birth," said Cecily Miller, prenatal and perinatal specialist living in Los Angeles, in an interview with me.

When I asked Ms. Miller to tell me more about the benefits of a home birth for expectant moms, here is what she told me:

"Giving birth is a rite of passage. It is an initiation into motherhood. If we want an empowered initiation where women are honored in the female body, and we are ushering in new life to the society, then women need to feel safe in their birth process... Giving birth is the most intimate experience we can imagine. And how we make love is how we want to give birth."

Cecily explained to me that the qualities of making love and the qualities of the environment -- dim lights, private space, intimate space -- is the same conducive environment for birth. It should be a place where a woman feels she can be herself, which, as Cecily explained, is usually at home.

Sure makes sense to me.

When a woman is at home she can groan and make natural sounds (these sounds actually open up her pelvis); she can eat when we she needs to; rest when she needs to; have privacy when she needs to; kiss her partner, be held; walk around, look out at nature, and basically do what feels best for her. "The comforts of home afford a woman her ground, her roots... and then the body will naturally in most cases, open, and will give birth," explained Cecily.

A friend of mine who had both of her babies at home described just that: "The best thing about giving birth at home was that I never had to leave my home. I could be rooted there. My husband brought me smoothies. I could hop in the tub when I wanted to. I could get on all fours. Then after the birth, I was exhausted and all I wanted to do was curl up with my baby, and that is exactly what I did."

When I asked her about her confidence level for her home birth, she explained to me that through her birth classes and her yoga practice she felt prepared. "Deep breathing, steady focus, determination, and a desire to do it myself helped me bring my babies into the world." she said. My friend explained that when the time came, she allowed her body to take over and do the rest. "I really do believe we are all strong women. I think the whole hospital realm has brainwashed women to think: 'Oh you can't handle this, so we will give you drugs.' It's pretty sad." Agreed. She added: "While giving birth was the most challenging thing I've done in my life, having my children at home was comforting, inspiring and empowering."

While a home birth might not be for every woman, it's my hope that more women will consider it as an alternative to the institutionalized and currently over-medicalized environment of the hospital. As Cara Muhlhahn, a Certified Nurse Midwife in practice for more than 10 years, has said: A home birth gives the power back to the woman.

NY Governor Due to Veto Bill TODAY!

Governor Paterson of NY, we understand your counsel is advising you against the Midwifery Modernization Act, but we are asking you to please allow it to go through without signing it. This way he does not need to oppose his counsel or his constituents. CALL NOW! 518-474-8390. He is due to veto it today.

From NYT article on subject:

So to Ms. Paulin, New York’s requirement that midwives have a “written practice agreement” with a doctor or hospital seems like an unnecessary hurdle.

A week ago, a bill that would repeal that requirement breezed through Assembly and Senate committees, and its champions expected it to pass the full Legislature within days. Then it hit heavy opposition from the American Congress of Obstetricians and Gynecologists.

New York Times reports on Midwife Bill

Can ACOG Block Midwife Competition in NY?

NPR Report: Babies' First Bacteria Depend On Type Of Birth

http://www.npr.org/blogs/health/2010/06/21/127988586/babies-first-bacteria

Babies' First Bacteria Depend On Type Of Birth

11:54 am
June 22, 2010
by CHAO DENG

Babies start their lives with a clean slate. But it doesn't last long. All sorts of bacteria move right in at birth. And how a baby is delivered — vaginally or by Cesarean section — can make all the difference in what kinds of bugs start calling the newborn home. Researchers who tested 10 babies found those born vaginally tended to get colonized by bacteria such as Lactobacillus from the mother's vaginal canal. C-section babies, however, got more Staphylococcus, a type of microbe usually found on the skin and one that sometimes causes nasty infections. The results were published in the Proceedings of the National Academy of Sciences. Microbiologist Maria Dominquez-Bello tells Shots the bacteria on C-section babies may come from the first person to handle the baby. Without the exposure to vaginal bacteria from a natural birth, C-section babies may be more at risk of getting infections and even asthma. As the researchers note, the majority of antibiotic-resistant skin infections occur in infants born by C-section. Dominquez-Bello says that doctors might be able to reduce those bacterial risks by wrapping C-section babies in gauze that's been exposed to the mother's vaginal bacteria. It may be worth a look considering that C-section births are at a record high.

180 Degrees South

After watching the movie 180 degrees South last night, I came away with this thought:

When a climber gets to the top of a mountain, they stay for only a few moments looking at the view before heading back down. The top is the goal, but it is the journey to the top where the hiker is most likely to learn something about themselves.

Although having a baby at the end of pregnancy and labor is a lot different than the top of a mountain. The similarity is in the journey. If we focus solely on a healthy baby, healthy mama, and not on the journey to that place, then we miss out on all the possibilities for transformation and growth.

Home Birth: An Image

This picture from WikiMedia really moved me, and so I am sharing with you.

National Institute for Health Changes Its Statement on Vaginal Birth After Cesarean (VBAC)

The National Institutes of Health (NIH) finished the Conference on Vaginal Birth After Cesarean (VBAC) March 8th-10th, 2010, evaluating issues surrounding VBAC and seeking to quantify why VBAC rates have plummeted in the U.S. over the last decade.

http://consensus.nih.gov/2010/vbacstatement.htm

http://www.ican-online.org/

Clips that I picked from the International Cesarean Awareness Network Synopsis of the conference:

“The final statement from the NIH concludes that a VBAC is a reasonable option for most women. Over 75% of women who attempt VBAC will be successful.” says Desirre Andrews, ICAN President. “Currently less than 10% of women who have had previous cesareans deliver vaginally in subsequent pregnancies, leading to significant and preventable illness and death.”

“NIH took the American Congress of Obstetricians and Gynecologists (ACOG) and anesthesiologists to task, calling on them to change the language in their official recommendations on VBAC. ICAN has understood for years that this language plays a large role in the lack of access to VBAC in the U.S.” continues Ms. Andrews. “We hope ACOG rises to the challenge and also hope they will finally be willing to work with ICAN and other advocacy organizations to improve maternal and fetal safety.”

A survey conducted by ICAN in 2009 showed approximately 45% of hospitals in the United States formally ban VBACs either explicitly or through unsupportive policies and procedures. Many women are never counseled that they are good candidates for VBAC and thus undergo more risky and expensive repeat cesareans. The NIH report acknowledges that this represents a serious breach of medical ethics. ICAN supports every woman’s right to select the care provider, birth setting and birth plan of her choice.

Lacking in the NIH statement is support for a woman’s right to refuse a cesarean section as this was felt to be beyond the scope of the current mandate.

It was acknowledged, however, by many expert presenters that forcing a pregnant woman to undergo an unwanted surgery is medically indefensible, unethical and immoral. ACOG’s own statement on ethics states that a woman should neither be coerced nor punished for not following a recommendation.

CDC Reports: Home Births Increase in the US

To download the full CDC report, go to http://www.cdc. gov/nchs/ data/nvsr/ nvsr58/nvsr58_ 11.pdf.

From the Abstract of the Center for Disease Control's Report:

Objectives—This report examines trends and characteristics of
out-of-hospital and home births in the United States.

Methods—Descriptive tabulations of data are presented and inter­preted.

Results—In 2006, there were 38,568 out-of-hospital births in the
United States, including 24,970 home births and 10,781 births occurring
in a freestanding birthing center. After a gradual decline from 1990 to
2004, the percentage of out-of-hospital births increased by 3% from
0.87% in 2004 to 0.90% in 2005 and 2006. A similar pattern was found
for home births. After a gradual decline from 1990 to 2004, the
percentage of home births increased by 5% to 0.59% in 2005 and
remained steady in 2006. Compared with the U.S. average, home birth
rates were higher for non-Hispanic white women, married women,
women aged 25 and over, and women with several previous children.
Home births were less likely than hospital births to be preterm, low
birthweight, or multiple deliveries. The percentage of home births was
74% higher in rural counties of less than 100,000 population than in
counties with a population size of 100,000 or more. The percentage
of home births also varied widely by state; in Vermont and Montana
more than 2% of births in 2005–2006 were home births, compared with
less than 0.2% in Louisiana and Nebraska. About 61% of home births
were delivered by midwives. Among midwife-delivered home births,
one-fourth (27%) were delivered by certified nurse midwives, and
nearly three-fourths (73%) were delivered by other midwives.

Discussion—Women may choose home birth for a variety of
reasons, including a desire for a low-intervention birth in a familiar
environment surrounded by family and friends and cultural or religious
concerns. Lack of transportation in rural areas and cost factors may
also play a role.

In the last several decades, there have been considerable
changes in childbearing patterns in the United States. Historically, the
percentage of out-of-hospital births declined from 44% in 1940 to 1%
in 1969, and has remained about 1% for several decades (1–3).
Out-of-hospital births include those born in a residence (i.e., home
births), in a freestanding birthing center (i.e., one that is not part of a
hospital), clinic or doctor’s office, or other location. Some out-of­
hospital births are intentional, whereas others are unintentional due to
an emergency situation (i.e., precipitous labor or labor complications,
could not get to the hospital in time). This report examines trends and
characteristics of home and other out-of-hospital births in the United
States from 1990 to 2006.

Methods
Data shown in this report are based on birth certificates for the
approximately 4.3 million live births registered in the United States in
2006, and equivalent data from previous years. Descriptive tabula­
tions are presented and analyzed. Records where place of birth was
not stated were excluded before percentages were computed. This
report includes data on items that are collected on both the 1989
Revision of the U.S. Standard Certificate of Live Birth (unrevised) and
the 2003 Revision of the U.S. Standard Certificate of Live Birth
(revised); see ‘‘Technical Notes.’’ Data on place of delivery were
comparable between the two revisions, although the 2003 revision
added a new data item on whether a home birth was planned or
unplanned. Information from the new item is presented for the 19
states that had adopted the revised birth certificate by January 1,

VBAC Ariticle in the NYTImes today

Here's a great article in the NYTimes today about vaginal birth after cesarean at a hospital in Arizona.

http://www.nytimes.com/2010/03/07/health/07birth.html

How do they have a 13.5% cesarean rate when the rest of the country has a 32% likelihood of a cesarean?

And how is it that 32% of women who have had prior cesareans have successful vaginal births at this hospital, where it is less than 10% in the rest of the country.

Here are some answer to these question from the article:
- Midwives catch (deliver) all normal, low risk babies. The doctors are only there for high-risk interventions. In contrast, most other hospitals in the US, doctors deliver all births.
- Doctors are not given bonuses for cesareans, where in most hospitals this is the case.
- The hospital and doctors are federally insured against malpractice, in contrast to other hospitals, where private insurers have threatened to raise premiums or withdraw coverage if vaginal birth after Caesarean is allowed.

Mississippi House Bill 695 would OUTLAW Certified Professional Midwives

I used a Certified Profession Midwife (CPM) and had a glorious life-changing Vaginal Birth after Cesarean at home. Mississippi Senators are trying to make them illegal in their state. If you live in Mississippi call your Senators today and tell them that you want CPMs to remain legal.

Issued: February 24, 2010 Do You (or Does Anyone You Know) Live in MISSISSIPPI? URGENT ACTION IS NEEDED TODAY Mississippi House Bill 695, which would OUTLAW Certified Professional Midwives and deny women access to their care, needs to be stopped TODAY! If you live in or have midwifery or doula clients in Mississippi, start making calls and sending emails to your STATE SENATORS ONLY and forward this page to anyone you know who lives in the state (calls can be made to home and office numbers both). Mississippi residents can find out who their State Senator is here: http://www.capitolconnect.com/demoassoc1/legislatorsearch.aspx It is particularly important that members of the Senate Public Health committee (listed below) hear from their constituents, telling them to vote NO on HB 695 and that you do NOT support making Certified Professional Midwives, who are specially trained to deliver babies in out-of-hospital settings, illegal. The bill, which includes stiff penalties for ANY midwife practicing who is not a nurse-midwife and which repeals the current exemption that midwives have from Mississippi’s medical practice act, has already sailed through the Mississippi House, so urgent action is needed TODAY. http://billstatus.ls.state.ms.us/2010/pdf/history/HB/HB0695.xml Hob Bryan, Chair (It is especially urgent that Senator Bryan hear from his constituents—please spread the word to anyone you know who lives in District 7 to start making calls) District 7 - Itawamba, Lee, Monroe Contact Information: Capitol: Room: 212 D P. O. Box 1018 Jackson, MS 39215 (601)359-3234 Home: P. O. Box 75 Amory, MS 38821 (662)256-9989 (H) (662)256-9601 (W) Bob M. Dearing District 37 - Adams, Amite, Franklin, Pike Contact Information: Capitol: Room: 215 B P. O. Box 1018 Jackson, MS 39215 (601)359-3244 Home: 305 Melrose-Motebello Parkway Natchez, MS 39120 (601)442-0486 (H) (601)446-7651 (W) (601)446-7651 (F) Email: bdearing@senate.ms.gov Hillman Terome Frazier District 27 - Hinds Contact Information: Capitol: Room: 213 E P. O. Box 1018 Jackson, MS 39215 (601)359-3453 Home: 2066 Queensroad Avenue Jackson, MS 39213 (601)982-1871 (H) (601)359-5957 (F) Email: hfrazier@senate.ms.gov John Horhn District 26 - Hinds, Madison Contact Information: Capitol: Room: 212 B P. O. Box 1018 Jackson, MS 39215 (601)359-6217 Home: P.O. Box 2030 Jackson, MS 39225 (601)362-1045 (H) (601)362-4285 (W) Email: jhorhn@senate.ms.gov Cindy Hyde-Smith District 39 - Lawrence, Lincoln, Simpson Contact Information: Capitol: Room: 405 B P. O. Box 1018 Jackson, MS 39215 (601)359-3246 Home: 400 Cattle Trail, N. W. Brookhaven, MS 39601 (601)835-3322 (H) Email: chydesmith@senate.ms.gov Kenneth Wayne Jones District 21 - Attala, Holmes, Madison, Yazoo Contact Information: Capitol: P. O. Box 1018 Jackson, MS 39215 (601)359-3232 Home: 232 Boyd Street Canton, MS 39046 (601)859-3438 (H) (601)859-8844 (W) Email: kjones@senate.ms.gov Willie Simmons District 13 - Bolivar, Humphreys, Sunflower Contact Information: Capitol: Room: 213 A P. O. Box 1018 Jackson, MS 39215 (601)359-3288 Home: P. O. Box 297 Cleveland, MS 39732 (662)846-7433 (W) Email: wsimmons@senate.ms.gov Bennie L. Turner District 16 - Clay, Lowndes, Noxubee, Oktibbeha Contact Information: Capitol: Room: 404 C P. O. Box 1018 Jackson, MS 39215 (601)359-3210 Home: P. O. Drawer 1500 West Point, MS 39773 (662)494-5061 (H) (662)494-6611 (W) Email: bturner@senate.ms.gov

Mass Media Childbirth vs. The Real Thing

A documentary by childbirth anthropologist Vicki Elson. Please visit www.birth-media.com for more info, ordering, etc. ...
http://www.youtube.com/watch?v=V9Gd7pqeESE

Get Me Out: Making Babies Through The Ages : NPR

Terry Gross interviews investigative author who wrote a book on the history of childbirth (15 minutes).

'Get Me Out': Making Babies Through The Ages : NPR

Randi Hutter Epstein's book Get Me Out: A History of Childbirth From the Garden of Eden to the Sperm Bank is full of delightful — and sometimes disturbing — anecdotes like this one. The author explores the medical and cultural history of pregnancy and childbirth, from folk remedies and old wives' tales to ultrasound images and fertility drugs.

KQED Radio: Pregnancy-Related Deaths on the Rise?

KQED Radio: Pregnancy-Related Deaths on the Rise?

Points to call out:

This was a breaking story that uncovers a study held at the state level which is not being released. The word cover-up was mentioned.

Maternal death rates have tripled in California over the last 10 years study finds.

Cesareans are one of the big reasons for this increase.

OBs not telling patients about the real risk of cesareans. For example, repeat cesareans are not as safe as vaginal birth but vaginal births after cesareans are being banned around the country.

CPMC seems to want to only increase technology to avoid hemorrhages, prevention of blood clots from prolong bed rest, cardiovascular problems but Elliot Main, chief of Obstetrics and Gynecology at the California Pacific Medical Center, doesn't mention pulling back on the cesareans performed or other interventions.

Death certificates now have a check box since 2003 to indicate if the deceaced was pregnant within a year or her death.

Better reporting may have contributed to a 30% increase that just wasn't reported before but that still leaves the other 70%.

African women across all economic levels are 4% more likely to die during childbirth. Why? No one knows.

Obesity is a new and added risk to pregnancy and labor.

Maternal Death Rate in California is the same as US.

CDC cautious to release numbers. Yeah! because it's a HUGE public health issue that no one is dealing with.

when you pass 15% cesarean rate things start going south.

Aaron Caughey, associate professor at UCSF and director of the Center for Clinical and Policy Perinatal Research within the Department of Obstetrics and Gynecology says that we need to improve care of women in labor. YEAH!!!

Young healthy women are dying, people around the death call it a death before its time, the only reason why these women are dying is because they had a cesarean.

There's a lot of people who get hurt that don't die...that's me.

Dr. Aaron Caughey says that women pregnant now should spend early labor at home! stay healthy during pregnancy, a lot about taking care yourself

Another study: Are we really safe giving birth in hospitals today?

The San Francisco Chronicle just reported on a new study that once again says that we are not keeping our women and children safe in hospitals. The study says that the last time they saw a spike this high was in the 1930s. Are all those machines, drugs, and cesareans really making us safer? Why is it safer to give birth in Kuwait or Bosnia than in California?

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/03/MNER1BRFT4.DTL&tsp=1

Take Action, educated yourself, ask questions, and demand better care for our pregnant mamas and their babies.

Premature Births Are Fueling Higher Rates of Infant Mortality in U.S., Report Says

http://www.nytimes.com/2009/11/04/health/04infant.html?_r=2&hpw

----------------

Another factor in the United States, she said, is the increasing use of Caesarean sections and labor-inducing drugs to deliver babies early. The American College of Obstetricians and Gynecologists has guidelines stating that babies should not be delivered before 39 weeks without a medical reason, but doctors may be declaring a medical need more quickly than they did in the past.

----------------

High rates of premature birth are the main reason the United States has higher infant mortality than do many other rich countries, government researchers reported Tuesday in their first detailed analysis of a longstanding problem.

In Sweden, for instance, 6.3 percent of births were premature, compared with 12.4 percent in the United States in 2005, the latest year for which international rankings are available. Infant mortality also differed markedly: for every 1,000 births in the United States, 6.9 infants died before they turned 1, compared with 2.4 in Sweden. Twenty-nine other countries also had lower rates.

If the United States could match Sweden’s prematurity rate, the new report said, “nearly 8,000 infant deaths would be averted each year, and the U.S. infant mortality rate would be one-third lower.”

The first author of the report, Marian F. MacDorman, a statistician at the National Center for Health Statistics, said in an interview that the strong role prematurity played came as a surprise to her.

Dr. Alan R. Fleischman, medical director for the March of Dimes, said the new report was “an indictment of the U.S. health care system” and the poor job it had done in taking care of women and children. The report, Dr. Fleischman added, “puts together two very important issues, both of which we knew about but hadn’t linked tightly.”

Infant mortality is widely used as a way to gauge the health of a nation, and the relatively high rates in the United States have long dismayed health officials. Most European countries — as well as Australia, Canada, Hong Kong, Israel, Japan, New Zealand and Singapore — have lower rates of infant death than the United States.

Premature infants in the United States are more likely to survive than those elsewhere. Yet they are still more likely to die than full-term babies, and the sheer numbers born prematurely in the United States — more than 540,000 per year — drive up infant mortality.

The high levels of prematurity in the United States have various causes.

Dr. Fleischman said the smallest, earliest and most fragile babies were often born to poor and minority women who lacked health care and social support. The highest rates of infant mortality occur in non-Hispanic black, American Indian, Alaska Native and Puerto Rican women. But other minorities have some of the lowest infant mortality rates in the United States: Asian and Pacific Islanders, Central and South Americans, Mexicans and Cubans.

When it comes to prematurity, infertility treatments — drugs that stimulate ovulation and procedures that implant more than one embryo in the uterus — also play a role by raising the odds of twins or higher multiples, which have an increased risk of being born too soon.

Professional groups for fertility doctors recommend limiting the number of embryos transferred to avoid multiple births, but ultimately doctors and patients make their own decisions. Dr. MacDorman said that because most insurance in the United States did not cover infertility treatments, some patients chose to transfer multiple eggs in hopes that doing so would increase the odds of pregnancy and reduce expensive procedures.

“In Europe, they may have been more successful in limiting the number of embryos transferred,” Dr. MacDorman said, “because there is more national health insurance and people don’t have to pay out of pocket.”

Another factor in the United States, she said, is the increasing use of Caesarean sections and labor-inducing drugs to deliver babies early. The American College of Obstetricians and Gynecologists has guidelines stating that babies should not be delivered before 39 weeks without a medical reason, but doctors may be declaring a medical need more quickly than they did in the past.

“I don’t think there are doctors doing preterm Caesarean sections or inductions without some indications,” Dr. MacDorman said, “but there sort of has been this shift in the culture. Fifteen or 20 years ago, if a woman had high blood pressure or diabetes, she would be put in the hospital, and they would try to wait it out. It was called expectant management.

“Now I think there’s more of a tendency to take the baby out early if there’s any question at all.”

These births — called “late preterm,” which occur after 34 to 37 weeks of pregnancy, instead of the normal 38 to 42 weeks — are the fastest-growing subgroup of premature births. A late preterm baby’s risk of dying is about three times that of a full-term infant. But late preterm babies are still far more likely to survive than very premature ones, and the very early babies account for much of the death rate, Dr. Fleischman said.

Taking care of women’s illnesses and problems like drinking, drug use and smoking before and during pregnancy can help prevent prematurity, he said, adding that a state program in Kentucky to provide home visits by nurses to poor women during pregnancy had decreased preterm births.

Dr. MacDorman said prematurity was not the only factor behind infant mortality in the United States. She said full-term babies in this country also had higher death rates than those in Europe from sudden infant death syndrome, accidents, assaults and homicides.

Home Birth after Cesarean Video

Wow! I sobbed through this whole video. All that I can say is I feel the exact same way. Thanks Lydia for sharing this on your blog.

My Journey to a VBAC from Lindsey Meehleis on Vimeo.

Writing a Book

Well, I am writing a book. Yes, I can actually see the light at the end of the tunnel. I am going to pull this off while being a stay-at-home mom with a 3-month old and a 3-year old. I don't even have a babysitter. Although I am looking if you know anyone. It's me and boys all day every day. I love it! I picked the hardest time of my life to accomplish a goal that I've had since I was 10-years old. I love food and cooking, but it turns out that my book is about neither. It's about birth. It's about my polar opposite experiences giving birth to two children. One was a planned hospital natural birth (aka. no drugs) that went wrong and ended in a lot of drugs and the icing on the cake, a cesarean. And, the other one was a planned home birth that changed my life forever.

All this to say that I am not doing a lot of creative cooking right now because I am sooooo busy with the kids and my book at night. I did make a pumpkin pie last night which turned out great. I'll post that soon.

Birth by the Numbers: Video

In Birth by the Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today.

I think that you have to wait for it to download, but it is sure worth the wait. I love the stats on how mothers requesting cesarean sections aren't the reason why cesarean rates have sky rocketed. In reality, that number is so so small. Yeah! Mothers aren't blame.

American College of Obstetricians and Gynecologists (ACOG) up to Dirty Tricks

http://www.huffingtonpost.com/louise-marie-roth/acog-up-to-dirty-tricks_b_274372.html

A Short Film: Reducing Infant Mortlity

Our infant mortality ranking is 42nd on the world stage which means 41 countries have better statistics. This places us right in the middle of the following countries: Guam, Cuba, Croatia and Belarus, with over double the infant deaths compared to the top 10 countries of the world. (CIA World Factbook).

Here is a short video on reducing infant mortality and improving the health of babies in the United States. One of the producers is Shelley Campbell from San Rafael: http://www.reducinginfantmortality.com/. Learn more about the film here.