Thursday, April 26, 2007

ACOG and "obstetric tyranny"

Have I mentioned how much I love Marsden Wagner? I have to share this:

To understand the absolute monopoly ACOG [American College of Obstetricians and Gynecologists] has established in American maternity care, it is helpful to look more closely at this organization. The American College of Obstetricians and Gynecologists is not a "college" in the usual sense: it is not an institution of higher learning. Nor is it a scientific body. With few exceptions, its members and leaders are not scientists but medical practitioners, and there is nothing in ACOG's mission statement about science. The ultimate proof that ACOG is not a scientific body? Too many of its policies and recommendations are not based on real science. . . .

In truth, ACOG is a "professional organization," which amounts to a trade union. Like every trade union, ACOG has two goals--to promote the interests of its members and to promote a better product, in this case, the well-being of women. But if there is a conflict between these two goals, the interests of its members come first. . . .

American maternity care, then, is under the control of tribal obstetrics. A small group, most of them men, are controlling birth in such a way as to preserve their own power and wealth while robbing women and families of control over one of the most important events in their lives. . . .

Power without wisdom is tyranny. There are plenty of intelligent obstetricians who have lots of knowledge, but intelligence and knowledge do not guarantee wisdom. I have known wise individual American obstetricians, but I see no evidence of wisdom in organized obstetrics in the United States. The maternity care we have in what we like to believe is our free country is obstetric tyranny.

(From Marsden Wagner's, Born in the USA: How a Broken Maternity System must Be Fixed to Put Women and Children First, p. 33, 35-36.)

Recent attacks on midwives...

A bill was proposed earlier this year by members of the Utah state senate, Margaret Dayton in particular, which would have severely restricted the number of women who could choose a licensed midwife as a maternity care provider. They claimed they were simply trying to define what "normal birth" was and clarify a law that was passed in 2005 which gave midwives the ability to become legally licensed to practice in Utah, but their definition of "normal" somehow only included a very small percentage of women. Nearly all of the women involved with the Utah Friends of Midwives, many of whom have successfully given birth at home multiple times with excellent outcomes, would have been required to be referred to a physician under this bill.

The state division of professional lisencing and Utah's midwives had already spent two years clarifying their rules for licensure defining when they must refer their clients to physicians, etc. These things were already taken care of by the proper groups. This recent bill was simply trying to do what had already been done, but doing it in a much more restrictive way. And, it is interesting to note, that the bill was created by a woman who spent many years as a labor and delivery nurse, married to an obstetrician. It was also written by the Utah Medical Association whose membership includes many obstetricians. We can only assume this had a lot more to do with a "turf war" than concern for safety.

I wrote the following on a Utah State Senate comment website:

I am a mother of two--both hospital births. I am not a midwife nor do I have any relatives who are midwives. But I am a concerned person who finds it highly unsettling to see the rights of Utah's women so trampled upon. Whatever happened to the limited government and freedom the Founding Fathers fought so long and hard to ensure? . . .

I am concerned that Senator Dayton and those responsible for this bill have so little faith in mothers. I am concerned that they do not respect women enough to expect that they can make responsible decisions for themselves and their babies. Even if you disagree about the safety of homebirth, it is not your place to infringe upon mother's rights and require that they do what you may think is best. You say you are not restricting women's rights to choose, but the ramifications of this bill will do exactly that.

Thousands of unnecessary c-sections and other questionable medical interventions occur every day in hospitals in this country--putting mothers and babies at increased risk. So do not tell me that you are doing this out of concern for safety. If the medical community was really concerned about safety, hospitals would completely revamp their policies and most obstetricians would completely revamp their practices. We aren't so behind in the world's infant and maternal mortality rates because we've been making the safety of mothers and babies a priority. We certainly haven't made it a priority.

The issue here is not whether hospital or home is the safer place of birth. And I don't believe that is why the bill was initially created. The issue here is will we uphold freedom and have respect for the women and mothers of Utah, or will we trample upon their freedoms by essentially legislating their place of birth because we feel that they are incapable of acting responsibly?

Fortunately, this bill did not pass in the recent legislative sesssion, but supposedly Senator Dayton is "reworking" the bill for a comeback. Thank goodness for the outraged response of Utah's midwives, the Utah Friends of Midwives, and other concerned Utahns.

I'd like to quote Marsden Wagner's account, testifying in behalf of midwives in California who were trying to pass a midwifery bill:

I recently testified before a state legislative committee in California on pending midwifery legislation. Among other things I said in my statement that midwives are perfectly capable and that planned home birth is a healthy option for many women. I finished by suggesting that if anyone said otherwise to the committee, they should ask, "Where are your data?"

Thirty minutes later, a representative from the California Medical Association stood before the same committee and said that midwives are less safe than doctors for low-risk pregnant women and that home birth is not safe. Lo and behold! One of the legislators on the committee immediately asked, "And does the California Medical Association have any data to support your statements?" Not surprisingly, it did not (there are none). Instead, the spokesperson retreated to the familiar position: Trust us, we're the California Medical Association. That legislator took note, and the midwifery legislation was eventually passed. Slowly but surely, times are changing
(see Marsden Wagner's Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First, p. 35).

Thank goodness for freedom and concrete scientific evidence.

Wednesday, April 25, 2007

Little known facts about Pitocin and induction

"Pitocin is the most abused drug in the world today." ~Roberto Caldreyo-Barcia, MD, former president of the International Federation of Obstetricians and Gynecologists

• Pitocin is not approved by the FDA for elective (patient or provider convenience) inductions or stimulation of labor (moving things along).

• Pitocin generally produces contractions that are much longer, more intense, and more painful than normal contractions....

Read the rest of this post over at my new website!

Tuesday, April 24, 2007

Why you really do want a doula...

When I gave birth for the first time, I didn’t know what a doula was, but I recently realized that the care and support of a “doula” is what actually carried me through that birth.

Her name was Eve. She was the labor and delivery nurse assigned to me when I entered the hospital for my oldest daughter’s birth. She was gentle, unassuming, and kind. When I told her that I was hoping to “go natural,” she mentioned that she could offer positions to try and techniques to cope with the pain of labor. She said she had given birth without drugs before, and knowing she was supportive and experienced gave me courage.

As labor progressed, Eve showed my husband how to provide counter-pressure to ease the discomfort of contractions. She pulled out the rarely-used, water-proof telemetry monitor so my husband could spray my back with hot water in the shower. When I got out of the shower, she brought in a birth ball and helped me to sit and rock on it. Later, she coached me to keep my vocalizing low, deep, and relaxed instead of high-pitched and tense. When I doubted myself and contemplated drugs as I struggled through the hardest contractions, she said, “Why don’t I check you first—you might be almost fully dilated.” Sure enough, I was only a couple of centimeters from the end. She told me that, in her experience, it felt good once you could push (and she was right). She rubbed my feet and sat by my side through those last intense contractions, encouraging me with her reassuring words. Although her shift ended before the pushing started, she chose to stay with me until after the birth. Ultimately, I did it! Giving birth for the first time without complications or drugs was one of the most empowering experiences of my life.

At the time I didn’t realize it was rare to find such a supportive, encouraging labor and delivery nurse. But, after my daughter was born, all I could do was mumble over and over to Eve, “Thank you, thank you, thank you.” I knew that if it hadn’t been for Eve’s patience and support I would not have had such a wonderful, satisfying birth.

Maybe you’re still thinking… what’s a doula? Doula is a Greek term—“a woman who serves another woman.” The tradition of women helping other women through childbirth is centuries old. The practice of hiring professionals to fill that role is fairly new. A modern birth doula is a hired labor support professional who provides comfort and advice but does no clinical tasks. According to the Doulas of North America (DONA) website, “The doula offers help and advice on comfort measures such as breathing, relaxation, movement, and positioning. . . . Perhaps the most crucial role of the doula is providing continuous emotional reassurance and comfort” (see DONA). Eve was a hospital nurse, not necessarily a trained “doula,” but she filled the doula role in my case. Based on my personal experience, I can attest that every laboring woman ought to have a doula’s aid.

Research supports my belief. Gathering and analyzing the results of 15 studies, a team of researchers found that, compared to women laboring without a doula, women who labored with a doula were:
• 26% less likely to have a cesarean section
• 41% less likely to have a vacuum extractor or forceps delivery
• 28% less likely to use pain medication or epidurals
• 33% less likely to rate their birth experience negatively
(Hodnett E, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003. Issue 3. See DONA).

Another study showed that women who were supported by doulas were more likely to have success with breastfeeding as reported in a questionanaire at six weeks postpartum—exclusively breastfeeding on a flexible schedule with few problems (see Hofmeyr, Nikodem, Wolman, Chalmers, and Kramer; 1991, South Africa. British Journal of Obstetrics and Gynaecology 98 (1991):756-764).

With such significant benefits, it’s no surprise that doulas are the most highly rated providers of labor support according to the “Listening to Mothers” survey published by Childbirth Connection (formerly the Maternity Center Association, see website). Despite such rave reviews, few women are even aware of doulas. Fortunately, now you are one of them.

So, how do you find a doula, and how much does it cost to hire one? It’s really quite simple to find a trained doula. You can search on the DONA website (and other doula association websites) for lists of doulas in your area. Once you have a list of names, it’s a good idea to interview each one to find the right “fit.” Cost varies depending on training and experience, but most doulas have packages ranging from $200-$800 which generally cover one or two pre-birth visits, labor support, and one or two postpartum visits. Doulas typically espouse the philosophy that cost should never be a roadblock, so most will work with clients to barter, create payment plans, or even volunteer their services. Ultimately, the cost is insignificant considering a doula’s ability to help reduce complications and costly medical interventions, not to mention improve your overall birth experience.

DONA wishes to provide “A Doula For Every Woman Who Wants One,” and I’m convinced that most women, if educated about their benefits, would want one. Few women are lucky enough to have a supportive and attentive labor and delivery nurse like Eve. Birth has been given a bad rap over the years largely because women haven’t had the support they need to navigate labor’s journey with confidence, and society has, for the most part, lost faith in women’s bodies and the beautifully orchestrated process of birth. Birth can be a beautiful, satisfying, empowering experience—it has been for me. It could be that way for all women, and doulas are taking huge strides toward making that happen.


“Spontaneous labour in a normal woman is an event marked by a number of processes so complicated and so perfectly attuned to each other that any interference will only detract from the optimal character. The only thing required from the bystanders is that they show respect for this awe-inspiring process by complying with the first rule of medicine--nil nocere [do no harm].” ~G. J. Kloosterman, Dutch Professor of Obstetrics

(Qtd in. Sarah J. Buckly, “Ecstatic Birth: The Hormonal Blueprint of Labor,” Mothering Magazine Issue 111, March/April 2002. Source: "Universal Aspects of Birth: Human Birth as a Socio-psychosomatic Paradigm," Journal of Psychosomatic Obstetrics and Gynecology 1, no. 1 (1982): 35-41.)

Findings from the "Listening to Mothers" Survey

Report of the First National U.S. Survey of Women’s Childbearing Experiences published in October 2002:

“About one-third of all of the mothers reported that they either had a limited understanding or none at all about their legal right to clear and full explanations of any procedure, drug or test offered them, and their right to refuse or accept any care offered them. . . . Caregivers, facilities, and childbirth educators should provide women with clear information about their right to fully informed consent, and caregivers and facilities should fully implement ethical and legal standards for informed consent.”

“Doulas and midwives were the most highly rated providers of labor support, yet were used for this purpose far less frequently than other types of providers (5% and 11% respectively).”

“Compared to first-time mothers, experienced mothers were less likely to . . . use pain medications and various other labor interventions, report negative feelings during labor, have a physician as a birth attendant, or give birth by cesarean.”

“Although immersion in a tub, showering, and use of ‘birth balls’ received high ratings for help with labor pain, these approaches were used by 8% or fewer women.”

(Maternity Center Association. Listening to Mothers: Report of the First National U.S. Survey of Women’s Childbearing Experiences Executive Summary and Recommendations Issued by the Maternity Center Association. New York: Maternity Center Association, October 2002. See website.)

To the women of the world

After two years of reviewing 15 years of medical literature, a team of national experts has come forward with this reality: Many of the routine medical interventions used in births in the United States do not improve outcomes for mothers and babies. Some even cause harm.

Their findings demonstrate increased risks and problems with many prevalent interventions including labor induction, cesarean section, continuous electronic fetal monitoring, routine use of IVs, amniotomy (artificial breaking of water) and withholding of food and liquids. Though these interventions have become commonplace and viewed as part of "advanced" and even "superior" medical care, this study indicates these practices are not improving outcomes in most cases. In fact, they often create more problems than they eliminate. These findings will appear in the winter 2007 supplement to "The Journal of Perinatal Education" in a summary report entitled "Evidence Basis for the Ten Steps to Mother-Friendly Care."

This is not the first time these facts have been brought to the nation's awareness. Time and again researchers, activists and organizations, such as the Coalition for Improving Maternity Services, have tried to create change by raising awareness about the problems with maternity care in the the United States. Generations of women have recounted their birth horror stories over and over to each other. Scores of women wear the physical and emotional scars of unnecessary medical interventions.

Who is listening?

Does anyone care?

Let me use the words of Thomas Paine from his fiery call to arms, "Common Sense," with just a few of my own insertions: "Every quiet method for [change] hath been ineffectual. Our [appeals] have been rejected with disdain; and only tended to convince us, that nothing flatters vanity, or confirms obstinacy in [an old, broken system] more than repeated petitioning." The methods we have used thus far have been passionate and have brought about small victories, but the changes most needed have yet to be recognized or addressed by the mainstream medical community. We need a new approach.

Buckminster Fuller said, "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete."

Women and mothers of the world, I call on you to "build a new model." The time for complaining, pleading and persuading is over. Those methods have been tried, and they have done little. It is time to say, "Enough!"

Let us no longer accept mediocrity and "go along blindly" with any procedure. Let us no longer tolerate practices that have been shown to cause us or our babies harm. Let us stop playing the victims and start creating the reality that we all deserve — the absolute best maternity care possible. Let us demand the best of the best for ourselves and our babies.

We cannot underestimate the power of women united in behalf of themselves and their children. "There is a woman at the beginning of all great things," said Alphonse de Lamartine. Imagine what we can accomplish if we unite our efforts. Imagine what we can create.

(Opinion piece I wrote for The Deseret News.)