The Lisa Epsteen Story: Is Medical Inaction a Crime?

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The Lisa Epsteen Story: Is Medical Inaction a Crime?

Lisa Epsteen’s baby boy was born healthy via cesarean section days after her doctor threatened to drag her to the hospital in handcuffs and put her four other children in child protective custody.

Ms. Epsteen knew the risks of delaying her cesarean and she made a choice to have her cesarean on a different day than what her doctor wanted. She weighed her doctor’s advice and also her own opinion. But Dr. Jerry Yankowitz, didn’t like her decision and tried to convince her otherwise in an email with threats of police and taking away her children.

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"Let nature take its course."

Thank God! “Let nature take its course.” Amen. Although this is HUGE for ACOG and I thank them for making this statement, two things bother me. 1) There’s something uncomfortable about having an older, white male who hasn’t had a baby or breastfed hold the most political power over women’s reproductive health. 2) I really didn’t like what he said about women requesting cesareans as part of the problem. There was a study about this rumor done recently and although we’ve all heard it, it’s like a super, super small number of women. So small it isn’t worth mentioning at all. Strange to see it in this high profile statement.

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Nonmedically Indicated Early-Term Deliveries

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Nonmedically Indicated Early-Term Deliveries

ACOG is on fire this month. Thank you. 

Me: The US is number #34 in the world below Cuba and South Korea in infant deaths, yet we spend way more money on hospitals and care. Could the over medicalization of birth in this country be contributing to the deaths our children?
 

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Trial of labor after C-section uncommon, but often successful : OBGYN News


"Overall, 13% (of pregnant women with a prior cesarean) had a trial of labor," reported Dr. Salmeen.


What's a trial of labor? In other words, your doctor allows you to try a normal birth rather than preemptively scheduling you for a repeat cesarean.

67% overall of those very few even allowed to try to give birth naturally were successful (doesn't include the successful vaginal births after a cesarean at home like mine).

Dr. Salmeen goes on to say "For hospitals that have policies against a trial of labor, or that are prohibitive in terms of a trial of labor, one category that can be viewed very differently is that of women with a history of previous vaginal birth."

In some select groups where vaginal births happened in the past the success rate for a vaginal birth after a cesarean was 90%!

Trial of labor after C-section uncommon, but often successful : OBGYN News

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ICAN's Speaker Series Event

Save the Date for this 

Online

 Event: 

May 14th at 5pm PST

.

Registration information to follow.

Sara

 Lamm, Director (with Mary Wigmore) and co-producer of Birth Story joins us online in conversation with Thais Derich (ICAN's Speaker Series Host).

Sara

 Lamm is a Los Angeles-based writer, director, and performer whose documentary film, 

DR. BRONNER’S MAGIC SOAPBOX

 was released theatrically in 2007 and had its television premiere on The Sundance Channel. Her work has also appeared at MASS-MOCA, The American Visionary Art Museum, on Public Radio, and in performance venues throughout New York City. In 2010, she was one of 25 emerging artists recognized by AOL’s 25 for 25 grant. For five years she produced and performed in Dog & Pony, a live NYC variety show featuring sketch comedy and multi-media performance. She has two children, birthed with the help of an extraordinary midwife.

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In Conversation with Ina May Gaskin


I’m giddy with excitement. I just spoke on the phone personally with Ina May Gaskin! Look for an interview on July 9, 2013 @ 5pm PST with Ina May through the ICAN Speaker Series! Free to ICAN members. Not a member? It’s easy to join online and you’ll be supporting a very important cause. The bigger the membership support, the louder the voice. Thank you!

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The Op-Ed Project

Spent my Saturday learning to write opinion pages. Did you know that op-ed pieces are 80% white male? And the kicker is that it isn't because the editors are bias, it's because women and minorities aren't submitting.

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Building the Writer’s Platform

My Amazing Writing Group @ the Book Writing World

(Originally Published @

The Book Writing World Blog

/)

There’s a lot of pressure on me to make money from my writing. Just doing art for the joy of doing it doesn’t mean scheduling time for it during the weekends. Art is something that’s acceptable to do only when all the real work is done. Well the “real” work is never done.

So I make time for my writing in the waiting room of my son’s speech therapy session. A half-hour. I’m always looking for those little time nuggets, when I pull out my purse, take out my notebook and get some work done. I’m not making any money yet but wouldn’t that be nice if I did? Maybe that’s the hope that keeps me going.

The real question is, “If I never make money off of my writing, would that stop me from writing?” Well, my real answer is “No.”

Here’s my compromise: maybe I can find paid work for writing that I like to do. In today’s writing world, I need to build a writer’s platform to help my writing get “out there:” picked up by editors, agents, and publishers. Part of a writer’s platform is Facebook, Twitter, blogs, websites, books, and articles.

Publishing articles is an interesting one and it might be possible to build a platform by getting paid for writing articles. When looking for writing gigs, I focus on the jobs that I might really want to write. If I’m not picked, well, I might just write about the subject on my own blog.

I’m a mommy blogger, and so I look on sites like 

Elance

MediaBistro

, and 

Craigslist

 for writing jobs that support my current writing trend: parenting.

Elance doesn’t seem like a promising site because it’s global. I can’t compete with the price bids from freelancers in India, but I do like the daily job listings sent to my inbox. I’m hopeful there’s someone out there who wants a writer living in the U.S.A.

Media Bistro has some great articles on how to pitch to some well-known publications. It also allows you to post your portfolio so editors can seek you out. For example, if an editor is looking for a mommy blogger, he or she might see my resume in his or her search.

And, Craigslist never fails to be an excellent resource. I had a few back-and-forth emails with an editor from a parenting site after I saw their ad on Craigslist.

Maybe the day that I get paid for what I love to do isn’t so far off after all. It just takes some patience, research and realization that I’d be writing either way.

How are you building your writing platform?

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Moving Beyond Embarrassment

Let’s face it, being a shy writer doesn’t work that well these days with the world of Twitter, Face Book, and blogs. I’m more exposed as a writer than any other job that I’ve had. Different versions of me (aging me) over the past six years are documented on my blog. My kids’ pictures are there. My husband might still be spared from a public appearance. When moms that I see every day at school pick-up and drop-off tell me that they read my 

About Me

 page, I turn bright red.

I’m putting myself out there, yet I’m embarrassed by it. I write about parts of my personal life that I would only tell a close friend, but I blurt it out to the world. And then, I’m surprised when someone who I haven’t “told” begins to talk to me about it. It’s like owning a business but my face, heart, and soul are the business and to succeed I have to promote myself. I write what matters to me and sometimes that leaves me feeling a little vulnerable. These days a writer has to have some guts. Having a blog or website to quickly point to in a submission email to an editor is important and required.

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The Art of Merging

Ice Cream Cake

As I write this technical blog post, I can’t help but think back to my days working as a technical writer. After some unfortunate childcare situations, which I write about in my upcoming book “First Do No Harm: A Memoir,” I decided to stay home and take care of the kids full-time. Now I’m still writing but it’s creative.

So when I merged all the edits from Elizabeth Stark’s workshop class into my original document, I couldn’t help but want to pass on the technique. I’ve known about merge documents for a long time. I’ve even used it before for work, but it had been a while and I was a little scared of messing up my document or getting bogged down in some buggy Word feature. I was elated by how easy it was, useful, and by how much time it has saved me!

Every week in workshop class, a writer submits their 5K piece and the rest of the group has a week to comment on it. There’s line edits, readers comments, questions, and a brief statement at the end. To make comments, each reader uses Word, clicks on the Review tab, Turns on Track Changes, and begins reading. Some people prefer to write all their comments in the text of the document with Track Changes On and some like to use Comments that appear in the right-hand column.

Here’s the tricky part, when I get three or four replicas of my piece back at the end of the week, it’s a lot of toggling between documents. And I get lost on what comments I’ve done and haven’t done. Not to mention how hard it is to open all four Word documents, get everything organized only to be distracted and have to start again reorienting myself. There’s too much start up time and I don’t have that kind of time. 

Merging all the documents into one solved all these problems

. Here’s how I did it:

Keep Reading

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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

2010-10-20-pregnant_momtobe.jpg

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?

2010-10-20-childbirth_Europe.jpg

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.]

2010-10-20-HomeBirth.JPG

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.

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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

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.”

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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?

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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.

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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.

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