Sunday, May 20, 2007
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).
Thursday, May 3, 2007
Sad, but true
"We do not see childbirth in many obstetric units now. What we see resembles childbirth as much as artificial insemination resembles sexual intercourse." ~Ronald Laing, psychiatrist
Wednesday, May 2, 2007
Think you're better off with an epidural? Think again...
• Epidurals cause women’s bodies to stop or slow the release of oxytocin—slowing labor and removing the feel-good effects of the hormone. The first stage of labor tends to be about 26 minutes longer and the pushing stage 15 minutes longer in women with epidurals. Epidurals also eliminate the natural peak of oxytocin intended to occur at the time of birth to facilitate the delivery and bonding processes.
• Women with epidurals are nearly three times more likely to have Pitocin—to speed up labor—than those without epidurals.
• When the pelvic floor muscles have been numbed by an epidural, a woman’s body cannot guide the baby’s head to the ideal birth position as effectively. Babies are four times more likely to be posterior (facing up—a more difficult position for birth) in the final moments of labor when their mothers have epidurals. As a result of these complications, some women with epidurals experience difficulty pushing their babies out—doubling their risk of forceps or vacuum extractor deliveries.
• Other epidural side effects for mothers include: drop in blood pressure, difficulty passing urine, itchiness, shivering, sedation, nausea and vomiting, fever, breathing difficulty, inadequate pain relief, slurred speech, drowsiness, convulsions, postpartum weakness and/or numbness, postpartum back pain, mild to severe postpartum headache (sometimes lasting six weeks), temporary or permanent paralysis, cardiac arrest, respiratory arrest, and death. A woman’s risk of dying from childbirth complications triples when she has an epidural. (For a recent news story on the rise in epidural-related maternal deaths, see here.)
• When mother develops an epidural-induced fever, her infant tends to have poorer condition at birth, has an increased risk of having signs of brain damage, and will likely undergo an invasive sepsis evaluation to check for infection.
• Epidurals can lead to worrisome fetal heart rate changes also. This is in part because women with epidurals tend to lie down in one position for extended periods of time which can restrict blood flow to the fetus. Change of position will often improve the fetal heart rate abnormalities. When an epidural is coupled with Pitocin, the signs of fetal distress can be more prolonged and severe.
• Some data also indicate that babies born to women who had epidurals show increased risk of poor brain function at one month of age.
• As many as 85% of women in some U.S. hospitals receive epidurals.
• Women with epidurals are nearly three times more likely to have Pitocin—to speed up labor—than those without epidurals.
• When the pelvic floor muscles have been numbed by an epidural, a woman’s body cannot guide the baby’s head to the ideal birth position as effectively. Babies are four times more likely to be posterior (facing up—a more difficult position for birth) in the final moments of labor when their mothers have epidurals. As a result of these complications, some women with epidurals experience difficulty pushing their babies out—doubling their risk of forceps or vacuum extractor deliveries.
• Other epidural side effects for mothers include: drop in blood pressure, difficulty passing urine, itchiness, shivering, sedation, nausea and vomiting, fever, breathing difficulty, inadequate pain relief, slurred speech, drowsiness, convulsions, postpartum weakness and/or numbness, postpartum back pain, mild to severe postpartum headache (sometimes lasting six weeks), temporary or permanent paralysis, cardiac arrest, respiratory arrest, and death. A woman’s risk of dying from childbirth complications triples when she has an epidural. (For a recent news story on the rise in epidural-related maternal deaths, see here.)
• When mother develops an epidural-induced fever, her infant tends to have poorer condition at birth, has an increased risk of having signs of brain damage, and will likely undergo an invasive sepsis evaluation to check for infection.
• Epidurals can lead to worrisome fetal heart rate changes also. This is in part because women with epidurals tend to lie down in one position for extended periods of time which can restrict blood flow to the fetus. Change of position will often improve the fetal heart rate abnormalities. When an epidural is coupled with Pitocin, the signs of fetal distress can be more prolonged and severe.
• Some data also indicate that babies born to women who had epidurals show increased risk of poor brain function at one month of age.
• As many as 85% of women in some U.S. hospitals receive epidurals.
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.)
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.
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.
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