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.

ACOGs Homebirth Study reviewed by Jennifer Block

Jennifer Block a reporter who wrote, "Pushed," published a review on her blog about ACOG's study on the safety of home birth. Read it here:

http://jenniferblock.com/wordpress/?p=122

ACOG changes its VBAC Statement: This is huge!

Yeah! Finally, the American College of Obstetricians and Gynecologists is changing their policy on VBACs and women might have to wade through less politics to have a vaginal birth after a previous cesarean. Of course ACOG's wording could be stronger and we need to keep fighting for a woman's right to choose how she births her babies but this is definitely a step in the right direction.

Even if a hospital does not offer trials of labor after Caesarean, the group says, “such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery.”

The new guidelines replace the obstetrician group’s earlier ones — which were exactly what led many hospitals to ban VBAC in the first place. But the group says it never intended to limit women’s access to vaginal birth, and it acknowledges that its policies may have helped fuel the trend toward too many Caesareans.

http://www.nytimes.com/2010/07/22/health/22birth.html?_r=2&th&emc=th

New Guidelines Seek to Reduce Repeat Caesareans

By DENISE GRADY

Most women who have had Caesarean sections can safely give birth the normal way later, studies have shown, but in recent years hospitals, doctors and insurers have been refusing to let them even try, insisting on repeat Caesareans instead.

The decisions have been based largely on fears of medical risks and lawsuits, medical and legal experts say.

The hospital rules have infuriated many women, added to the nation’s ever-increasing Caesarean rate and set off a bitter debate over who controls childbirth. Now, the American College of Obstetricians and Gynecologists is issuing a new set of medical guidelines meant to make it easier for women to find doctors and hospitals that will allow vaginal birth after Caesarean, or VBAC (pronounced vee-back).

Women’s health advocates praised the new guidelines because they expand the pool of women considered eligible for vaginal births, but they expressed doubts about whether the recommendations go far enough to change a decade of entrenched behavior by doctors, hospitals and insurers.

The new guidelines replace the obstetrician group’s earlier ones — which were exactly what led many hospitals to ban VBAC in the first place. But the group says it never intended to limit women’s access to vaginal birth, and it acknowledges that its policies may have helped fuel the trend toward too many Caesareans.

“It will be better for women in the long run if we can lower the C-section rate,” said Dr. Richard N. Waldman, president of the obstetricians’ group and chairman of obstetrics at St Joseph’s Hospital in Syracuse. The guidelines are being published on Thursday in the August issue of Obstetrics & Gynecology.

About 1.4 million women had Caesareans — or about 32 percent of all births — in 2007, the latest year with figures available, according to the National Center for Health Statistics. Like earlier guidelines, the new ones say that vaginal birth is safe for most women who have had a Caesarean, provided that the cut in the uterus was low and horizontal, the way nearly all Caesareans are performed today. Sixty to 80 percent of women who have what doctors call “a trial of labor” — an attempt to deliver vaginally — after a Caesarean succeed.

The new guidelines go beyond the earlier ones, however, stating that vaginal birth after Caesarean is also reasonable for most women carrying twins and those who had two prior Caesareans.

Even if a hospital does not offer trials of labor after Caesarean, the group says, “such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery.”

The main worry is the risk of uterine rupture during labor, which can severely harm both the mother and the child and requires emergency surgery. But the guidelines state that for women with one previous Caesarean, the risk of rupture during a trial of labor is quite low — from 0.7 percent to 0.9 percent. If the same woman has a repeat Caesarean instead, before labor starts, the risk of rupture is even lower — from 0.4 to 0.5 percent.

But a Caesarean increases the risk of placental problems in later pregnancies that can cause hemorrhage or lead to hysterectomy.

Compared with babies born after a repeat Caesarean, those born vaginally after Caesarean have increased risks of stillbirth (the overall risk is well below 1 percent), but decreased risks of breathing problems and jaundice.

Until the 1970s, the rule was “once a Caesarean, always a Caesarean,” largely because of worries about rupture. But medical opinion shifted, and an expert panel convened by the National Institutes of Health in 1980 found that vaginal birth after Caesarean was safe for many women.

In 1985, 6.6 percent of women with prior Caesareans were giving birth normally. By 1996, the rate had risen to 28 percent. But some uterine ruptures were reported, with lawsuits and enormous payments, and the rate began to drop.

In 1999, the obstetricians’ group issued guidelines that had a chilling impact. By 2006, the percentage of women with Caesareans who later had vaginal births had plummeted, to 8.5 percent from 24 percent in 1999.

The chill came from two words in the 1999 guidelines: the college said hospitals offering a trial of labor after Caesarean should have a surgical and anesthesia team “immediately available” to perform an emergency Caesarean if needed. The previous policy had said “readily available,” which gave hospitals some leeway to call a team quickly.

The 1999 wording led many hospitals, particularly smaller ones, to ban vaginal deliveries after Caesarean, saying they could not afford to pay doctors to wait around during labor and could not risk being sued for malpractice if they flouted the guidelines and complications occurred.

In March, the National Institutes of Health convened a panel of experts to examine why so few women with prior Caesareans had normal births later. The panel reaffirmed that vaginal birth was safe for many women with past Caesareans, and urged the obstetricians’ group to reassess its guidelines.

The new guidelines mention the March conference. But the recommendations still say trials of labor should be offered in facilities with staff members “immediately available” to provide emergency care.

Those words are softened somewhat by the recommendation that if an immediate Caesarean is not available, it should be explained to the patient, and she should be “allowed to accept increased levels of risk” — or to plan a trial of labor elsewhere. Opinions vary as to whether the new recommendations will lead to a lift on bans on trial of labor.

Maureen Corry, executive director of Childbirth Connection, an advocacy group, said, “Overall, it’s dubious that these guidelines will in fact open up access for women.”

Debra Bingham, president-elect of Lamaze International, an advocacy group for natural birth, said the “immediately available” wording might still pose an obstacle.

Sandy Haryasz, the chief executive officer of Page Hospital, in Page, Ariz., which does not offer VBAC, said the hospital would review the guidelines, but she noted in an e-mail message that the guidelines still highlighted immediate Caesareans.

Dr. Sandra B. Reed, an obstetrician at Archbold Memorial Hospital in Thomasville, Ga., which does not offer trials of labor after Caesarean, said, “I do not think this bulletin is strong enough to change the current policy in our facility.”

Dr. Waldman said he still hoped the new guidelines would encourage more hospitals to allow trials of labor after Caesarean, but, he added, “the big issue is liability.”

“What I’m hoping is that everybody will get together and do the right thing,” he said. “That includes patients.If they take the risk, they have a certain responsibility not to sue the physician if there’s a bad outcome, knowing that they took the risk.”

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.

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.

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.

Take away the incentives for too many c-sections

"On average, Medicaid pays $5,000 more for a C-section than for a vaginal birth, and private insurance pays a far greater premium. You don’t have to be a cynic to wonder if that could have something to do with the rise in unnecessary C-sections."

Read this article about Obama's plan to change our nation's huge unnecessary c-section rate:

http://crosscut.com/2009/08/06/health-medicine/19144/

Time Magazine: The Trouble with Repeat Cesareans

http://www.time.com/time/magazine/article/0,9171,1880665,00.html

I copied and pasted page one of two below:

To avoid another C-section, Barton has to drive 100 miles to deliver in Los Angeles. For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car." Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that "once a cesarean, always a cesarean"--an axiom thought to be outmoded in the 1990s--is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them. (Read "The Year in Medicine 2008: From A to Z.")

Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.

After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean.

So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.

Continue reading here.

Excerpt from Artemis Speaks: VBAC Stories and Natural Childbirth Information

Oddly, in a book meant to reach out to me as a pregnant woman; the most memorable part for me was this small excerpt about what it means for me to be a mother. What a great way to explain what I did today: I loved.

The Eastern woman's mind is such that many are completely satisfied with being Mothers. It's as if in the West we forget to valorize "love." What did we do today? "We 'loved', nourished and directed our children." From inside you can see what an accomplishment that really is. To love is to be near what is "real" in our life experience. Western minds want to see a materialization of what has been done but if we watch from our heart we can see that loving has been done but gone unattached and returned to the source: the infinite. Om.

-Letter to Nan, (author) April 4, 1983 from Radha Malasquez, Varanasi, India