For them I could

Sometimes I feel like it's inevitable. I'll probably end up a midwife, in the end. But most of the time I don't really look forward to it. It terrifies me to imagine holding the lives of women and babies in my fallible human hands. I don't really want to be a midwife. But I've been thinking lately of some facts and figures that just might be enough to propel me forward on the path toward midwifery.

First, my cousin-in-law, Liz, wrote a blogpost discussing the book Half the Sky. She shared a couple of excerpts that have been reverberating through my skull ever since:

In much of the world, women die because they aren't thought to matter. There's a strong correlation between countries where women are marginalized and countries with high maternal mortality. Indeed, in the United States, maternal mortality remained very high throughout the nineteenth century and beginning of the twentieth century, even as incomes rose and access to doctors increased. During World War I, more American women died in childbirth than American men died in war.... 'Women are not dying because of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.' (p. 115-116)

"More women die in childbirth in a few days than terrorism kills people in a year." (Jane Roberts, letter to San Bernadino Sun, qtd. on p. 146)

Then, last night, my brother-in-law watched a PBS segment on maternity care in rural Peru. He thought I'd be interested, so he passed along the link to me. Last year, CNN reported that Peru's pregnant women were "dying at scandalous rates"(source). Yesterday, PBS shared some of the solutions that are being implemented to reduce the mortality rates in Peru's remote areas. The segment starts with this intro:

High in the Andean Mountains of Peru, far from the modern conveniences of a city, generations of indigenous women have given birth at home, their only help from family or a village midwife.

The longstanding tradition of childbirth at home wasn't a problem for most women. But, in that small percentage of cases where complications developed at the end of a pregnancy, in a remote rural area, you could be days away from the nearest medical facility on foot, even multiple-hours' drive.

(Screenshot from the PBS segment)

I've been studying childbirth for the past seven years, but most of my reading and research has revolved around maternity care in the U.S. Although we still have a long way to go here in the U.S., our risk of dying in childbirth is far lower than the risk most women of the world face. I think I could feel content remaining a doula/birth activist if the rest of the world didn't exist. But it does exist.

The World Health Organization puts things into persective:

Every minute, at least one woman dies from complications related to pregnancy or childbirth – that means 529 000 women a year. In addition, for every woman who dies in childbirth, around 20 more suffer injury, infection or disease – approximately 10 million women each year.(Source)

Far too many women die simply because they lack "skilled care during pregnancy, childbirth and the first month after delivery," according to WHO.

While I don't feel compelled to become a midwife for my fellow American sisters, I do think I'd be willing to shoulder the risks inherent in midwifery in order to help save the lives of women in places where maternal deaths are excessively common. For them I could do it.

Unfortunately, those who are able to help these women often lack the ability to communicate in indigenous languages. I have a deep love for languages and have always wanted to learn to speak more of them. I've also always wanted to travel to Africa, South America, and other far-off places. I couldn't think of a better reason to fulfill those dreams. Someday down the road... I hope.

"Pit bull with a smile"

This lady is my new hero. :-)

(Thanks for the link, Sweetpea!)

More evidence on home birth safety

A friend shared a link to a news article reporting a new study out of Canada. The headline: "Home Birth With Midwife As Safe As Hospital Birth: Study." Here's an excerpt with a summary of the study's findings:

The authors of the new study compared three different groups of planned births in British Columbia from the beginning of 2000 to the end of 2004: home births attended by registered midwives (midwives are registered in Canada), hospital births attended by the same group of registered midwives, and hospital births attended by physicians. In all, the study included almost 13,000 births.

The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.

Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.

The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth. (Source)

The study doesn't appear to distinguish between low-risk and high-risk births--something most doctors would raise a red flag about. Doctors attend more high-risk births, so it's not surprising to see a higher mortality rate under their care. It's a tricky thing trying to compare different types of births because so many factors are involved in birth outcomes. But I still find this news encouraging.

As for the "self-selection" factor, I can definitely attest that I took a far more proactive role in my health during my home birth pregnancy than I ever had before. I exercised, I ate much more healthy food, and was more educated than ever about how to make my pregnancy and birth smooth and healthy. I wanted to do everything I possibly could to increase my odds of a healthy outcome for me and my baby. Whether home birth inspires women to be healthier or healthier women choose home birth, I say it's a win-win either way.

Reducing Infant Mortality

Great 17 minute film! Thanks for the heads-up, Jill.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

Monitoring

Emily passed along a link to a NY Times article: "Updating a Standard: Fetal Monitoring," by Jane E. Brody.

Electronic fetal monitoring (EFM), rolled-out in the 70's, hasn't done what doctors thought it would do--"reduce the risk of cerebral palsy and death resulting from inadequate oxygen to the fetal brain." In fact, EFM has had some negative consequences. The NY Times article reports:

¶Electronic monitoring has led to a significant increase in both Caesarean deliveries and forceps vaginal deliveries.

¶Monitoring results are widely used by lawyers to bolster malpractice cases of spurious merit, which has led to soaring costs for malpractice insurance and, in turn, prompted many obstetricians to stop delivering babies.

¶Electronic monitoring has not reduced the risk of either cerebral palsy or fetal deaths.(source)

I wish it were possible for hospital staff to implement intermittent monitoring by human beings. I've said it before, and I'll say it again... the best "monitor" for childbirth is a trained person, not a machine. Unfortunately, most nurses are too busy to spend the necessary time personally listening to fetal heart tones on multiple patients, and few doctors are present before pushing time. So EFM isn't likely to be replaced by person-al monitoring anytime soon (or ever).

So improving the use of this technology is definitely in order. I'm heartened by the efforts of the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Dr. George A. Macones who are encouraging obstetricians to refine and improve the way they interpret electronic fetal monitor tracings. Especially considering the somewhat frightening inconsistency of doctors' interpretations of EFM tracings, as the NY Times article reports:

In a study in which four obstetricians examined 50 fetal heart rate tracings, they agreed in 22 percent of the cases. Two months later, the same four doctors re-evaluated the same 50 tracings and changed their interpretations on nearly one of every five. . . .

And in more than 99 percent of cases, predictions based on the tracings that the baby would have cerebral palsy have proved wrong.(source)

These new EFM recommendations sound like a step in the right direction. I love that OBs are being encouraged try "giving the mother oxygen, changing her position, treating her low blood pressure and stopping stimulation of labor if that is being done" before jumping to a cesarean for abnormal fetal heart tones.

It's so easy to get caught up in villainizing OBs and the medical establishment. It's too bad a few "bad eggs" can taint our view of the profession. So I'm always grateful to be reminded that there are docs and medical researchers working hard to protect women and babies. I hope to see the day when MDs, midwives, researchers, nurses, doulas, and parents can come together for the betterment of maternity care. I really hope to see that.

Misleading headlines

I don't generally read the newspaper. We only subscribe on Sundays (for the coupons). But I do, on occasion, scan through the Google News headlines in my Google Reader to stay somewhat informed of what's happening out there in the world. Quite often I never click to read the full articles. I generally only click on the ones that are pertinent to my locale, my circumstances, or my interests. I assume I'm not the only one who often doesn't read beyond the headline. Which is why headlines like this are extremely frustrating to me...

"Police probe home birth; baby died"

If all you do is scan the headlines, what are you going to assume? You may assume the author is using the term "home birth" in the usual sense--a baby intentionally born at home. The average person would then continue their thought process with... "See! That's why we have hospitals, people! Babies aren't supposed to be born at home! What a horrible, preventable tragedy!" And those people may never know that this mother was completely unaware she was pregnant until she saw a baby in her toilet... which means zero prenatal care, zero preparation for birth. And besides that... we don't even know the cause of death. Was the baby preterm? How long was the baby in the toilet? So many unanswered questions.

I would like to think the article's authors were unaware that their use of the term "home birth" in connection with "baby died" was loaded and misleading. But, unfortunately, I think they knew exactly what they were doing.

On a happier note... my brother and sister-in-law welcomed their beautiful new baby girl yesterday afternoon. She was born at home with the assistance of midwives, surrounded by loved ones. They did experience some scary complications following the birth, but the midwives handled them, and everyone is doing well... trying to get some much-needed rest. Thank goodness for skilled birth attendants. I am eager to hear the birth story in detail!

Baby killers?

Every so often I like to plug "home birth" into a google news search and see what's out there. This morning I found something that has consumed my thoughts all day: "New study indicates hospital delivery safer for babies than home birth." What?! I hadn't heard anything about this study, so I checked it out.

Here's an excerpt describing the study's findings:

"The risk of neonatal death (dying during or shortly after birth) with a hospital delivery for a baby at term (between 37 and 42 weeks) was approximately 0.06%. The risk with a home delivery with a certified nurse midwife was almost double at 0.1% and with a non-certified midwife at home that number jumped to 0.18%. Low Apgar scores, a reflection of oxygen levels at birth, were also more common with home deliveries than in the hospital"(source).

Those are some disturbing numbers. Especially considering that they conflict with the growing body of evidence already published in peer-reviewed journals about the safety of home birth for low-risk women. Obviously I wanted to know more. So I poked around the internet off and on all day trying to find an original source for this study. All I could find were a few articles reporting about it. For example...

"Safety of midwife-attended home births questioned," from Canada.com
"Analysis Finds Risks With Midwife-Attended Home Births," from redOrbit.com

There were several other similar links. They all seem to be regurgitating the same words, but none of them directs me to more information. (It appears that this study has not yet been published in a peer-reviewed journal.) I want to know details!

Based on their findings, the researchers concluded that "the safest setting for the delivery of babies is in a hospital attended by a certified nurse midwife"(source). While the media grasped onto the home birth headline, they could just as easily have written: "New Study Shows Nurse-Midwives Safer Birth-attendants than Doctors." Except, while the press release willingly shared the neonatal death rates of the midwife-attended births, the only information we get about the doctor-attended neonatal death rate is: "Malloy hypothesized that in-hospital deliveries attended by certified nurse midwives had lower mortality risks in his study than in-hospital physician deliveries because the physicians were delivering babies at higher risk"(source). Wait a second... only a few paragraphs earlier, we're told that they limited the analysis to "low risk" births, which they define as full-term vaginal deliveries. If the only births included were "low risk," how could "high risk" babies explain why doctors were less safe?

Other questions I have about this study...

Were babies born with conditions or defects incompatible with life included?
Where did they find the records for these births?
What was the death rate for the babies delivered by doctors?
What about the birth center rate?
When was the "recent 5-year time period" they pulled data from?

I also have a hard time with their limiting the study to full-term vaginal deliveries. It seems sort of ridiculous to imagine including cesareans in such a comparison, but think about it... One of the reasons mothers choose home birth midwives is to avoid unnecessary interventions--for example, unnecessary cesareans. How many women began labor as "low risk," but ended up having their babies surgically removed because their labors were derailed by the bright lighting, immobility, strangers, or drug side effects? What about neonatal deaths preceded by cesareans that were brought about through iatrogenic complications? Excluding those neonatal deaths by removing cesareans from the study analysis removes one of the largest strikes against hospital birth in the minds of home birth proponents--the "cascade of interventions" leading to cesareans and increased risks for both mother and baby.

Clearly it's difficult to compare home birth and hospital birth. They're two completely different species. And there's no perfect way to structure a study's cohort to make home and hospital birth comparable.

But here's what we do know... at present, the published body of peer-reviewed research indicates that home birth is just as safe for low-risk women as hospital birth. We also know that home birth would be even safer than it is if hospitals and doctors would collaborate more fully with midwives in creating a better system for handling those rare emergency transfers (as we see in many European countries). Home birth would also be safer if practicing midwifery weren't illegal in some areas of the U.S.

Couldn't we focus on making all births safer instead of bickering about who's better? Couldn't we collaborate with each other in working to provide women and babies with the absolute best care possible? Couldn't we incorporate practices that facilitate healthy births in all settings? When will we demand that our care be evidence-based?

As for me, I knew giving birth to my son at home was the right choice for us regardless of the research. God trumps research... even studies of 12 million births.

If you have any more details about this recent home birth study, please let me know.

Where do they come up with this stuff?

After watching BoBB the other night, my friends and I were talking. One told us about a discussion she had had with an OB resident. She mentioned to him that she was looking into her options for her next child's birth and considering choosing a midwife (for a hospital birth). Apparently he tried to talk her out of it, saying midwives were much less safe. It almost made me wish I had been there... so I could have asked him, "Based on what? Show me your research." I don't know if I would have had the guts to actually say those words (being non-confrontational by nature). But I can't stop thinking about it. And it's got me on the defensive and all riled-up 'cause, clearly, I'm a huge fan of midwives. So I'll just refute him here . Since my friend is only considering midwives who can deliver at a hospital, I'm going to focus my proof on certified nurse-midwives (since they're the only kind of midwives who can deliver in hospitals).

1) Mortality Rates
There are many levels of "safety" when it comes to birth. When doctors use the word, I think they're generally referring to the most basic level of safety--a mother and baby who are alive. So what does the research say about CNM vs doctor mortality rates? Here are a few excerpts...

"After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).

Regarding the above study: "Certified nurse midwives attended a greater proportion of women who are at higher risk for poor birth outcome: African Americans, American Indians, teenagers, unmarried women, and those with less than a high school education. Physicians attended a slightly higher proportion of births with medical complications. However, birth outcomes for certified nurse midwives were better even after sociodemographic and medical risk factors were controlled for statistical analyses" ("Infants Delivered by Certified Nurse Midwives have Lower Mortality Rates," National Center for Health Statistics Press Office, May 19, 1998).

"A nurse-midwifery program providing for the education of nurse midwives and integrating them into the existing health team helped reduce dramatically the infant mortality rate in a Mississippi delta county from 39.1 to 21.3/1000 live births in less than 3 years" (Meglen MC; Burst HV, Nurse-midwives make a difference. Nursing Outlook. 1974 June;22(6):386-389).

"[A] search of the scientific literature fails to uncover a single study demonstrating poorer outcomes with midwives than with physicians for low-risk women. An advantage to midwifery care is that evidence shows primary care by midwives to be as safe or safer than care by physicians" (Marsden Wagner, MD, MSPH, "Midwifery in the industrialized world").

2) Other Measures of Safety
Coming out of birth alive isn't the only thing that matters (a fact that many medical professionals seem to forget). How do certified nurse-midwives compare in other measures of safety? Let's take a look...

"Significant differences . . . between the obstetrician and nurse-midwife groups were found for seven clinically important outcomes: . . . infant remaining with mother for the entire hospital stay (15 versus 27%), third- or fourth-degree perineal laceration (23 versus 7%), number of complications (0.7 versus 0.4), satisfaction with care [higher with CNMs]" (Oakley D; Murray ME; Murtland T; Hayashi R; Andersen HF; Mayes F; Rooks J. (1996). Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives. Obstetrics & Gynecology, 88).

"The obstetric outcomes of a primary-care clinic for low-income women staffed by certified nurse-midwives is compared with the obstetric outcomes of a group of four obstetricians’ private practice patients. The birth outcomes were comparable with a significant reduction in cesarean sections (13.1% to 26.4%) for CNMs’ patients" (Source [Blanchette H. (1995). Comparison of obstetric outcome of a primary-care access clinic staffed by certified nurse-midwives and a private practice group of obstetricians in the same community. American Journal of Obstetrics & Gynecology, 172, 1864-1868]).

"The Medical University of South California Twin Clinic study demonstrated a lower rate of very early pre-term births, very low birthweight infants, Neonatal intensive care admissions, and perinatal mortality in a CNM directed Clinic where CNM care is given when compared to a MD directed team where MD care is given. This demonstrated that the contributions of CNMs to high-risk prenatal care can be considerable" (Source [Ellings & Janna, et al. (1993). Certified-nurse midwife directed twin clinic reduces very low birthweight delivery & perinatal mortality. Journal of Obstetrics and Gynecology ]).

"The risk of delivering a low birthweight infant was 31% lower. Mean birthweight was 37 grams heavier for CNM attended than for physician attended births. The authors, from the Centers for Disease Control and Prevention, National Center for Health Statistics, conclude that national data support findings of previous local studies that certified nurse midwives have excellent birth outcomes, and CNMs provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women" (MacDorman, M.F., Singh, G.K. (1998). Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiology & Community Health, 52).

I could keep cutting and pasting, but this post is getting rather long. Is there really anything unclear about the research?

So... where do they come up with this completely false notion that midwives are less safe?! When will medical schools, the media, and popular opinion reflect the actual truth about midwives?? When, oh when??

Birth Faith

This pregnancy has tested my faith in so many ways. But my deepest fear has definitely tested it most of all.

At our doula training two weekends ago, we did an introspective exercise. We were all given a piece of paper and a marker. Then we took the marker into our non-dominant hand and drew or wrote something to represent our deepest fear about our actual or hypothetical upcoming birth. For me it was very actual... very real. It was a limp and lifeless baby with his arms and legs hanging down below him. A dead baby.

I have never needed to face that fear before. I never worried that my daughters or I would die in childbirth. I worried about other things... logistics... would the staff pressure me to have interventions I didn't want? Would I be able to handle the contractions? Would I tear? I never asked, "Will my baby die?" This is the first time I've asked myself that question. And what a heavy question!

Of course my daughters could have died... even in the hospital. Babies sometimes die. I suppose the difference now is that I don't have the other logistical worries to occupy my mind. I know there will be no unnecessary interventions. I know I will be surrounded by support. I know I can handle the contractions. But I also know that, if something bad happens, those who have questioned our home birth will shake their heads and point their fingers at ME. No one would ever think to point their finger at a mother whose baby died in the hospital... even if it was her own ignorance of the risks of interventions or poor choice in doctor that led to the death. It would be absolutely unheard-of to blame the mother. Home birth mothers don't get that kind of courtesy... even when their babies' deaths have nothing to do with their birth location and would have died in the hospital anyway.

So I do think about it. And I know I wouldn't be able to handle facing that deepest fear in real life... without my faith. When that fear starts wrapping itself around my heart, it is my faith (and my husband's even stronger faith) that slowly eases the panic.

As we did the fear-facing exercise at our doula training, we went on to contain our fears with the internal and external forces/influences that would be at our disposal. I contained that frightening image with my husband, my midwives, preparation, and God. I suppose you could say, I contained that fear with my faith in them.

I had a really reassuring chat with my midwives this morning at my appointment. It was reassuring that they can't even remember the last time they had to transport a woman who'd given birth before (to the hospital). And their confidence that they could get to my house in 20 minutes put my "what if the baby comes too quickly?" fears to rest. They've never lost a mother or baby. They have seen it all when it comes to birth... over and over again (Mary, for 30 years!). And they're not afraid. So why am I?

My husband, who was always afraid of home birth in the past, has no doubt in his mind that everything is going to be fine. He isn't the least bit worried. At all. No matter how many times I ask him, in my weakness, "Our baby's not going to die, right?" He always responds with the same steadfast assurance and peace, "No. Everything is going to be fine." He has total faith in our path. So why can't I?

More importantly... God has never let me down. I have no reason not to trust Him. He guided us to this particular path and urged us not to fear. So why do I?

I suppose it wouldn't be called a "test of faith" if it wasn't hard. :-)

Sometimes I like to imagine that moment when my son emerges and I take his slippery little body into my arms... you know, that moment that always makes me cry in birth videos... I like to imagine hearing him take his first breath and use his lungs and vocal chords for the first time. And I imagine the overwhelming relief that will wash over me with each breath, each sound, each vigorous movement of his arms and legs... he is alive! That imaginary instant may be just in my mind, but it feels so real every time it presents itself. So real, in fact, that I think I just might have enough faith to believe I'll see that moment happen.

Meet my midwives

Today was my first check-up with my new midwives, Mary and Nedra. I'm just loving these ladies, and loving that I get to have two birth attendents for the price of one! Not only are they personable, fun, and great with my kids, but they are also excellent midwives. I think you'd be hard-pressed to find any doctor or midwife with stats as impressive as theirs.

Mary, the senior of the two, has been practicing as a midwife for over 28 years. She graduated from the Arizona School of Midwifery in 1980 and has attended over 2000 births. Nedra has been attending birthing women for about nine years as a doula and apprentice midwife and received her midwifery license in March. Now check these numbers out:

C-section rate 1-3%
Hospital transfer rate 2% (for women like me who've given birth before)
Perineal tears "almost never" (maybe once a year they have a woman who needs stitches, approx 1.5%)
Infant deaths None (excluding those with defects incompatible with life)
Maternal deaths None

Can you believe those numbers?! Pretty incredible. The only bad outcome these midwives have ever seen occurred not because of a mistake on their part but simply because the parents refused to transfer to the hospital until it was too late (as a result, their baby's health was compromised). Since that time, Mary and Nedra have adopted a policy to only accept clients who agree ahead of time in writing that they will transfer if it becomes necessary. And I happily signed that agreement!

You might remember this post explaining the extremely painful tearing I sustained when my first daughter was born. When Mary told me how anal retentive they are about preventing tears and that they "almost never" have a client who needs stitches, I think I heard the heavenly choruses singing "Hallelujah!" I am determined that I will give birth to my baby boy without tearing, and it's such a relief to know that my midwives will be doing everything they can to facilitate that goal!

I also love how kid-friendly their office is. They have the coolest wooden toys and puzzles (some with babies inside mommys' tummies), and they have given both of my girls a balloon at each visit. Here they are at our visit today...I love that "midwife" is a regular word in my girls' vocabulary and that it is easy for me to include them in the pregnancy process because of the efforts my midwives make to welcome young children into their office. I love that they get to hear the baby's heartbeat regularly and are already comfortable with Mary and Nedra. So, when their little brother is born, there won't be any strangers coming into our home. Just two women they will already know and love.

I am so thrilled to have chosen Mary and Nedra as my midwives. I know my baby and I are in the hands of remarkable women.

Two Tidbits Courtesy of Midwifery Today

I subscribe to Midwifery Today's weekly E-News, and found a couple of things in today's email worth mentioning.

Induction and Meconium Aspiration Syndrome

Part of this issue of E-News contained an excerpt from a Midwifery Today article entitled, "The Problem Is Induction, Not Meconium," by Gail Hart. Meconium is the fetus's thick, dark-colored first bowel movement, and, when found in the amniotic fluid, it is a sign of fetal distress. Meconium itself is not generally a problem unless it gets into the fetus's lungs--meconium aspiration syndrome (MAS). It is generally accepted that meconium is more common the longer the pregnancy goes, but that may be simply because those pregnancies are most likely to be induced. Gail Hart shares the findings of a study indicating that the factor most strongly associated with MAS was induction, not being postdates. This makes sense when you remember that drug-induced contractions can be abnormally intense and long, restricting oxygen supply to the fetus. It follows that fetuses being born by induction would experience more distress. Just one more strike against pitocin/induction in my book, as if I needed any more. Check out the actual excerpt from Gail Hart's article here.

Infant Formula and DHA/ARA

The other tidbit I wanted to share was especially disturbing. I have for the past few years been a big proponent of everyone making sure they get their omega-3 fatty acids, especially DHA, but this issue of E-News shared the dark side of the omega-3 craze as it applies to infant formula.

Based on a report presented by the Cornucopia Institute (a corporate watch-dog group), the DHA/ARA added to many infant formulas is created from fermented algae and fungus and is structurally different than the DHA/ARA found in breast milk. The FDA isn't even convinced of the safety of these algal and fungal DHA/ARA additives! Apparently some infants fed DHA/ARA formula have even suffered from severe diarrhea, vomiting, dehydration, and seizures until being switched to a non-DHA/ARA-supplemented formula. Some infants even suffered death. Despite the FDA's reservations, these additives were somehow still approved for infant/human consumption.

Formulas supplemented with DHA/ARA are marketed as being "more like breastmilk," suggesting to consumers that they are somehow healthier than other formulas. In fact, scientific studies are inconclusive regarding the benefits of these DHA/ARA additives. Martek Biosciences Corporation, a manufacturer of these additives even acknowledges: "Even if [DHA/ARA] has no benefit, we think it would be widely incorporated into formulas, as a marketing tool and to allow companies to promote their formula as 'closest to human milk'"(source). Here's what the Cornucopia Institute concludes about the motives of infant formula manufacturers: "Given the safety concerns and doubts within the scientific community, it is clear that the infant formula manufacturers’ claims are marketing tools designed to sell more formula, and sell it at a higher price"(source). So what it really comes down to is money. Are we really surprised? Of course not. They're corporations and it's their job to make money. Adding DHA/ARA sells more formula, regardless of the fact that it's very different from the DHA/ARA in breastmilk and may actually be dangerous.

Unfortunately, parents are too busy or too trusting to ask any questions about it. I know for a fact that, if I had needed to feed my infants formula, I would have gone with the DHA/ARA version because I would have believed it was better. Get this... just yesterday I bought some Yoplait drinkable yogurt. Which kind did I pick? The one that said "with DHA" on it, of course! I looked at the label this morning, and, sure enough, it has "omega-3 DHA algal oil"--the very stuff implicated the Cornucopia Institute's report! Marketers certainly aren't stupid. They know omega-3 DHA is all the rage. I'm especially prone to buy into the notion that anything with DHA is better, regardless of where that DHA came from. Oops.

Included in the Cornucopia Institute's report is the following disturbing tidbit (evidence that infant formula marketers have done their job very well): "According to the National Alliance for Breastfeeding Advocacy, mothers have contacted health care providers asking the following: 'I want the breast milk formula,' or 'I want the formula with breast milk in it,' and asking questions such as 'whose breast milk is in the formula?'"(source). Oh my.

While I do find all of this disturbing, I also recognize and accept that infant formula is a life-saver for infants who are unable to breastfeed. And, given this fact, I do believe that formula manufacturers should do everything they can to create a product as close as possible to breastmilk. Unfortunately, in the end, it's just a sort of lost cause because breastmilk is something technology, no matter how advanced, cannot duplicate. While formula saves some lives, it will never be ideal. I'll end with this quotation from the International Baby Feeding Action Network:

"While researchers fiddle with the balance of fatty acids in infant formula, and deal with the additional uncertainties of the complex cascade of interactions that each adjustment provokes within the omega families, breast milk will always be the simple, perfectly balanced source of each essential nutrient."(source)

For more info, see...
Midwifery Today, Volume 10, Issue 11
"Replacing Mother — Imitating Human Breast Milk in the Laboratory"
"C-sections, breastfeeding, and bugs for your baby," by Jeff Leach

Love this!

I love this excellent parody/response to the ACOG anti-homebirth press release posted by Tienchinho on the MotheringDotCommune Forum. Here are my favorite excerpts:

"As a home birth after cesarean mom (HBACM), I reiterate my support of home births. While complications can arise with little or no warning even among women with low-risk pregnancies, childbirth is a normal physiologic process that most women experience without problems. Continuous monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center has not improved maternal or fetal outcomes."

"Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by hospital birth advocates, a highly medicalized labor and delivery can physically and emotionally scar both the mother and baby. . . . Unless a woman is in a supportive birth environment that allows the birth process to unfold on its own schedule, she puts herself and her baby's health and life at unnecessary risk."

"It should be emphasized that childbirth comes with inherent risks. Implying any guarantee otherwise is misleading and unjust to a birthing mother and her family. Although able to perform live-saving [sic] emergency cesarean deliveries and other surgical and medical procedures, board-certified obstetricians have been cornered into practice styles that perpetuate the need for these same measures. They have lost skills such as detecting and adjusting a baby in the occiput posterior position. Untreated, this condition can result in prolonged labors mislabeled as 'dystocia' and in cesarean sections. They minimize the profound impact of a woman’s birth experience on her future relationship with her children as well as her own view of herself. Since suicide and substance abuse are leading causes of maternal mortality, disregard for a mother’s emotional health can lead to tragic consequences for her and her baby."

Click here to check it out!

Obstetric trade union threatened by homebirth

[An opinion piece I recently sent to a local newspaper]

With Ricki Lake’s new film, “The Business of Being Born,” giving homebirth a high-profile legitimacy, the American College of Obstetricians and Gynecologists had to do something. As if their monopoly on maternity care in the U.S. wasn’t extensive enough, they felt a need to, once again, stake out their turf. On February 6, the ACOG issued a press release outlining their strong opposition to homebirth. They claim to be concerned for the well being of women and infants. Given the state of maternity care in this country, I find the ACOG’s supposed concern highly questionable.

The ACOG press release criticized mothers who choose homebirth for placing “the process of giving birth over the goal of having a healthy baby.” Women choosing homebirth are often accused in this way. How could they put their own comfort before the health of their baby? The problem with that accusation is that it should really be turned the other way. How can obstetricians put their comfort before the health of the baby?

Many prevalent hospital birth interventions including labor induction for non-medical reasons, elective cesarean section, continuous electronic fetal monitoring, routine use of IVs, early amniotomy (artificial breaking of water), episiotomy, and withholding of food and liquids have not been shown to improve outcomes and, in many cases, lead to other harmful complications for both infants and mothers (click here for more info). These interventions are warranted in rare cases, but they are being used excessively. When many of the most common birth interventions used by obstetricians in hospitals cause unnecessary harm, it is hard to believe that the ACOG’s concern for the well being of mothers and infants is at all genuine. Interestingly enough, most of these interventions reduce the amount of time doctors must spend attending a laboring mother and protect them from possible malpractice lawsuits. It is obstetricians that are putting babies and mothers at unnecessary risk for their own ease and comfort, not homebirth mothers.

The ACOG press release also erroneously claims that there are no scientifically rigorous studies demonstrating the safety of homebirth. There are, in fact, many reputable studies demonstrating that a midwife-attended homebirth is just as safe as a hospital birth for healthy women with normal pregnancies, and with much lower intervention and c-section rates. The most recent and largest of these studies was published in the British Medical Journal in 2005 (“Outcomes of planned home births with certified professional midwives: large prospective study in North America.” Kenneth C Johnson and Betty-Anne Daviss).

The United States is unique among developed nations in its obstetric-heavy maternity care system. The developed nations with the best birth outcomes, the lowest c-section rates, and the lowest rates of maternal and infant death have the majority of women attended by midwives and a significant portion of them giving birth at home. The United States trails behind 27 other developed countries in terms of maternal death and 35 other countries in terms of neonatal deaths.

Homebirth is not “trendy” as the ACOG would have you believe. Women have been giving birth in their homes for thousands of years. Being induced early or opting for an elective c-section are the truly dangerous trends. Women who choose homebirth do so after much research and soul-searching. They deserve our admiration and respect for their courageous choice to avoid the complications stemming from medical intervention and follow their birthing instincts. It is these informed women who will stem the tide of obstetric abuse. As Marsden Wagner, Director of Women’s and Children’s Health for the World Health Organization for 15 years, pointed out, “In every country where I have seen real progress in maternity care, it was women's groups working together with midwives that made the difference.”

Midwives and Emergency Preparedness

Deborah Smithey makes a great point in her article, "The need for certified midwives," when she argues that midwives are a great asset to any city's emergency preparedness plan. Pregnant women are at great risk during and following natural or man-made disasters. When hospitals may be over-flowing with sick and injured survivors and electricity may not be available, women who would otherwise have given birth at the hospital will have to seek alternatives. Smithey explains how midwives are prepared to handle just such circumstances:

"Certified Professional Midwives are trained to work in homes and other out-of-hospital settings. Many midwives serve the Amish and Mennonite communities, and are accustomed to working without electricity or other modern conveniences."

Having certified midwives accessible throughout each community ensures that all pregnant women have access to high quality care regardless of any disaster that may occur. Read her full article here.

And still rising...

Have you heard about the latest c-section data from the CDC? They just recently published the data from births in 2006. The c-section rate from last year is at a record high--31.1% of all births!

Eugene Declercq, Ph.D., Professor of Maternal and Child Health at Boston University School of Public Health highlights some concerns: “At a time when maternal and infant mortality rates are decreasing throughout the industrialized world, the United States is in the unique position of having both a rapidly increasing cesarean rate and no improvement in these basic measures of maternal and infant health.”

That's right. As cesarean section rates rise, so do maternal and infant deaths. Though it's no proof of a connection, it is a frightening snapshot of the state of maternity care in the U.S.

If you'd like more information about how to avoid a cesarean, how to have a vaginal birth after a cesarean, or need resources for recovering from a cesarean, check out the International Cesarean Awareness Network.

Hmmm... Interesting...

"After working as a practicing physician for several years, I became a perinatologist and perinatal scientist, as well as a full-time faculty member at the Schools of Medicine and Public Health at UCLA. Then I became a director of maternal and child health for the California State Health Department. In that capacity, I learned that in the rural town of Madera, California, doctors had decided that they no longer wanted to attend births at the Madera County hospital. They complained that it took too much of their time and didn't pay enough. So in 1968, two out-of-state midwives were recruited by the county to fill the gap. After two years of midwifery practice at the hospital, the rate of babies dying around the time of birth in the Madera County hospital was cut in half. Alarmed that their style of maternity care was being made to look bad, the doctors in the town agreed that they would once again attend births in the hospital if the two midwives were fired. The hospital fired the midwives, the doctors returned, and soon the rate of babies dying around birth rose to its earlier levels" (Marsden Wagner, Born in the USA, p.99, emphasis added).