Tuesday, March 31, 2009

A needed paradigm shift

Ok, so that is really old verbage. But the concept is still necessary. Or perhaps it is a cultural shift. Labor is what it is. For some women it is short and quick and wonderful, and sometimes it is long and tiring and wonderful too. So here is what needs to shift:

Fear ~ the fear of normal birth on the part of both expectant women as well as physicians. Women today are petrified of the pain associated with labor, with the process of labor and with the entire concept of childbirth. Physicians may fear litigation and for some, ok....for many, litigation drives a physician's practice bus.

Education ~ the educational process WORLD WIDE needs to improve for all people about pain in childbirth and how that differs from the pain we normally feel: labor pain tells us things and not necessarily that something is wrong. Women need to be better educated about birth, comfort measures and the side effects of interventions - including the long term side effects such as the emotional trauma. And finally, physicians need to be educated in normal birth and allowed to practice freely - with the knowledge and compassion that they want to practice with.

Mindset ~ our society's mental attitude toward birth needs to change. Labor is not a crisis waiting to happen and having a baby is not just an everyday occurance. Women remember and continue to process their births years....and decades....after the birth date. Pain in labor is not a curse by God ~ rather it is a blessing that tells us where we are in labor and what we should do as far as physical movement or comfort measures such as laboring in water. Finally, litigation should not be the end-all-be-all for a less than perfect outcome. Unrealistic expectations will be quelled with education.

Monday, March 30, 2009

Elective Cesarean ~ info has a price

I stumbled upon www.electivecesarean.com this afternoon.

Had to chuckle - it is run by a journalist - but that wasn't the part that was funny.

You have to register with the site for $5 to get any of the information.

Is Ignorance Really Bliss...or ?

I have been unscientifically studying the attitudes of expectant parents for some time, in regards to attendance at childbirth class. While we health care professionals have dialed down the number of classes in the series from seven (1980s) to four (2000s), the number of expectant parents attending our convenient drive through classes has dropped well below 33% of all parents giving birth.

Emma Dalton-Brown writes in the Jamaica Gleaner News, she basically doesn't WANT to know about birth, not from a class or even from a video.

The Listening to Mothers Survey II reports that, although most women who attended childbirth classes stated they were more confident in their ability to give birth, a majority of the mothers also reported they had more trust in their hospitals (60%), were less afraid of medical interventions (58%), and had greater trust in their caregivers (54%) after attending classes (Declercq E. R, Sakala C, Corry M. P, Applebaum S. Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences. 2006 New York: Childbirth Connection.). Eighty-eight percent of the mothers reported a better understanding of their maternity care options (Declercq E. R, Sakala C, Corry M. P, Applebaum S. Listening to mothers II: Report of the second national U.S. survey of women's childbearing experiences. 2006 New York: Childbirth Connection.). The Listening to Mothers II report did not examine whether there were differences in knowledge and decision-making actions between women who attended classes and those who did not.

There is still merit in Childbirth Education classes ~ we just have to take the time to attend. Just as new parents will have to take time to parent their baby, love their baby, feed their baby, stimulate their baby, educate their baby, play with their baby. Be certain a full and happy life is full of the right things....

Wednesday, March 25, 2009


The US birth rate rose to unexpected highs.

The US cesarean birth rate is 31.8%. Nearly 1 in 3 mothers are likely to be candidates for the surgical procedure therefore 1 in 3 babies may be candidates for complications of the birth by surgery. This rate is higher than most countries in the world, double the recommended rate by the World Health Organization and a 50% increase over the last 13 years.

CIMS, the Coalition for Improving Maternity Services, has released a press release calling for more transparency in maternity care. Read the Press Release here.

What do you think? Share your thoughts...........

Tuesday, March 24, 2009

BMJ says eat during labor

A study released today in the prestigious British Medical Journal may help to put to rest (finally), the controversy surrounding whether or not laboring women should be allowed to eat in labor!

The previous study done in 1976 was the standard siting Mendelson's Syndrome as a reason for not allowing snacks during labor.

While not a large study (only 2426 participants), the outcomes showed no significant outcomes as far as risks for eating or not eating during labor.

This is a truly significant study for all nurses, midwives, physicians, doulas and childbirth educators to embrace!

The Case Against BF ~ Part 2

Official outrage is mounting in regards to the article titled "The Case Against Breastfeeding". The United States Breastfeeding Committee has krafted a letter that will be sent to the editor of the Atlantic Magazine.

Here is their well written press release and how to write your own letter to the editor of the Atlantic.

Speak out now....your voice needs to be heard!

See the interview with Dr. Nancy Snyderman and Hanna Rosin on NBC's Today. Listen carefully!

Visit msnbc.com for Breaking News, World News, and News about the Economy

Sunday, March 15, 2009

The Case Against Breastfeeding: the case of misinformation, misconceptions and self-orientation

Like most advocates of breastfeeding, I wasn’t taken back by Hanna Rosin’s article in the upcoming issue of The Atlantic Magazine. While I honor her right to express her opinion as set aside by the Constitution, along with being a journalist comes responsibility of accuracy in the media – Rosin is an Atlantic contributing editor. Rosin shirks responsible journalism.

Rosin seems extraordinarily bitter about her role as a breastfeeding mother. How do I come to this conclusion? She talks of breastfeeding as being slave-like, a duty and about being “stuck” at home and unreasonably furious. She belittles the studies that show the definite benefits of breastmilk and breastfeeding. She speaks of being impatient while nursing ~ “often I’m tapping my foot impatiently, waiting for him to finish. Even part time nursing is “a strain”. She portrays breastfeeding advocates and formula makers as “Crips” and “Bloods”.

Rosin continues “As an example, Wolf quotes What to Expect When You’re Expecting, from a section called the “Best-Odds Diet,” which I remember quite well: “Every bite counts. You’ve got only nine months of meals and snacks with which to give your baby the best possible start in life … Before you close your mouth on a forkful of food, consider, ‘Is this the best bite I can give my baby?’ If it will benefit your baby, chew away. If it’ll only benefit your sweet tooth or appease your appetite put your fork down.” To which any self-respecting pregnant woman should respond: “I am carrying 35 extra pounds and my ankles have swelled to the size of a life raft, and now I would like to eat some coconut-cream pie. So you know what you can do with this damned fork.””

Ms. Rosin should bottlefeed. There it is…right out there.

What child wants to nuzzle at a resentful, mean and angry mother’s breast?

Ms. Rosin fails to quote the current experts in breastfeeding or efficiently quote evidence based studies. She refused to do her homework, most certainly because she would feel more “pressure” to do what is right for her baby – a feeling she desperately wants to avoid.

Rosin’s article is an attempt by Atlantic Magazine to boost readership by trying to insight a media riot.
Sorry, Ms. Rosin, those of us who have been around birth, breastfeeding and parenting for a while are familiar with this type of ploy. We are aware of the websites (such as http://www.thebirthfacts.com/ and group referrals such as La Leche League, and books that present all of your missing information. Just be aware of the damage, though, that you are doing for mothers who may be trying to decide whether to breastfeed or not. By demonstrating that responsible journalism for you is an oxymoron and not presenting each side accurately, you do more harm than good.

I just feel sad for your child(ren), Ms. Rosin.

Tuesday, March 10, 2009

When You Can't Have It Your Way, Legislate!

A news story aired on TV recently about a woman who had a dispute with a fast food restaurant over chicken nuggets (I think). So infuriated, she called 911.

Now it appears that a few physicians feel like the walls are closing in on their practices as "allied professionals" offer similar services. Instead of calling 911, they are calling lawyers and law makers, siting practicing outside of their scope.

While I am not educated on all of the complaints, the few I do know about midwifery.

But this is not the first time midwifery has been a target. According to the "History of Midwifery" written by the University of Texas Southwest Medical Center in Dallas:

Obstetricians began to identify a difference not only in the practices of the two professionals, but also in the neonatal/maternal outcomes between births attended by physicians and those by midwives. Statistics regarding maternal deaths and neonatal deaths which were available, sometimes suggested that midwifery attended births had poorer statistical outcomes than physician attended deliveries. It must be noted that any discrepancy may have been influenced by other factors. For example, as physicians became the provider of choice for the affluent woman, midwives cared for an increasing number of poor women. These midwifery clients usually lived either in rural areas of the country, or in immigrant areas of large urban cities where poor nutrition and poor sanitation were the norm. (Even with that consideration, sometimes midwifery statistics were equal or better.)The discrepancy between care of the two groups of providers was not as apparent in Europe, for it was during the 19th century that formalization of midwifery education had occurred in that continent, and statistical outcomes of midwifery practices were comparable to that of physicians in the same countries. Regardless of etiology, the difference between statistical outcomes of midwives and physicians in the United States precipitated a perception characterized as the "midwifery problem".

Current research is showing a difference in outcomes between physician and midwifery care ~ and in some instances, midwifery statistics are better. In the March 16, 2009 issue of American Medical Association News, midwifery again becomes the target.

And I have recently learned that several states, including Ohio, are beginning to legislate what childbirth educators should include in their curriculum (Ohio Revised Code 3701.63). This section of the Ohio Revised Code has to do with the dissemination of materials to educate on Shaken Baby Syndrome and I DO NOT HAVE AN ISSUE WITH THE TOPIC. What I do have an issue with is legislation mandating what childbirth educators teach in their classes.

To me, this is a dangerous precedent to set.

When childbirth education classes were "moved" out of the community and into the hospital (co-optation in the 1980s), I warned the CBE community of the dilution of curriculums to what the hospitals and staff wanted covered ~ which may or may not always be the evidence-based research.

I guess once again I am sounding an alarm. Take a good hard look at what is happening today and how that will impact tomorrow.

Tuesday, March 03, 2009

Accustomization In Birth

Accustomization (noun): creating a feeling of normalcy when the research or evidence clearly points in a different direction. (accustomize ~ verb).

Ok, so you won't find this in Webster's or on Wikipedia. I just made it up.

Well sorta.

I just put a name to it.

Birth is a normal event. However, the pregnant community, and quite possibly the professional maternity community, is being accustomized to feel that birth (more often than not) is a crisis waiting to happen.

VBAC is as safe as it used to be. However, the pregnant community, and quite possibly the professional maternity community, is being accustomized to believe that VBAC is dangerous. A caveat to that might be when double stitching of the uterus is not done; only single stitching is done.

Epidural Anesthesia has significant side effects for mother, the labor, and the baby. However, the pregnant community, and quite possibly the professional maternity community, is being accustomized to believe that epidurals are safe.

Midwifery care is great prenatal care and great labor/birth care. However, the pregnant community, and quite possibly the professional maternity community, is being accustomized to believe that if one uses a midwife, all care is substandard.

Um, do you see a pattern here?

There is definitely a pattern of accustomization.

It is time that birth professionals recognize the efforts to accustomize and place evidence based principles over tradition and policy.

We not only need to be the beacon of light but a mirror of truth.

We need to speak the truth, teach the truth and stand firm on the research-based ground.