Friday, September 24, 2010

Do you have a PhD in the Study of Bus Chassis?

I am diverting away from my usual preaching about evidence-based maternity care.  I am treading on thin ice.  Today's "sermon" is about....being thrown under the bus.

What motivated me to write this today?  On Facebook, one of my birthy friends had this quote by Winston Churchill today as her status:

“You have enemies? Good. That means you've stood up for something, sometime in your life.”

Now, many of us know that the birth profession is the compassionate and deeply moving care of expectant and new parents, embarking on their journey into parenthood.  With the wisdom of our sage femme mentors and the best evidence-based maternity care (sorry, couldn't help myself there), we lovingly share this wisdom and give of ourselves.  In the quiet moments before birth, we witness that spiritual awe, that divine moment, as our hearts weep with nurturing, joy and wonderment.

And the next morning, we throw miscellaneous colleagues under the bus.

Why do some of us do this?  Is it our gender?

Is it more personal than that?

Do some of our colleagues "deserve" it?

Are our colleagues really our enemies?

Do you feel more empowered and righteous by doing it?

It is truly a conundrum to espouse compassion and caring and loving and nurturing, and then destroy someone's feelings of self-worth for a time, upset their families and break their hearts.  Contrary to Winston's supposition that the Study of Bus Chassis might only be caused by standing up for something correct, some studies occur for seemingly no apparent least to the throw-ee.

If we spent the same time and energy of throwing someone under the bus, and applied it to a joint effort to honest truth telling about pregnancy, birth and breastfeeding, our goals and mission would be in a much better place.  We would be more efficient in guiding women in their quest for their birth experience.

And maybe, just maybe, none of us would be eligible for a PhD in the Study of Bus Chassis due to being thrown under the bus.

(Author's note: I will probably be thrown under the bus for writing this blog entry! LOL!!)

Thursday, September 16, 2010

Physicians & Patients Less Committed to Vaginal Births ~ says NYT Article

Continuing in the national spotlight, our nation's rising cesarean rate recently got some press in the New York Times.  Reporter Denise Grady cited the AJOG study by Dr. Jun Zhang and Dr. S. Katherine Laughon that suggests the reasons for the rise in cesareans including "the increased use of drugs to induce labor, the tendency to give up on labor too soon and deliver babies surgically instead of waiting for nature to take its course, and the failure to allow women with previous Caesareans to try to give birth vaginally."

As few other journalist have, Grady goes on to point out the concerns surrounding cesareans and the risks that are involved in the abdominal surgical procedure.

Additionally, Grady states that "In the study, 44 percent of the women who were trying vaginal delivery had their labor induced. When Caesareans were done after induction, half were performed before the woman’s cervix had dilated to six centimeters, “suggesting that clinical impatience may play a role,” the authors wrote. Full dilation is 10 centimeters, and a Caesarean before six centimeters may be too soon, the researchers said.

“Physicians and patients may be less committed” to the vaginal births, the authors said.

Dr. Zhang said it appeared likely that the Caesarean rate in this country would keep increasing, though he said he hoped it would never match the rates in Brazil (70 percent) or China (60 percent). If there is any hope of reducing the rate in the United States, or at least slowing the increase, he and his colleagues said, the key is to lower the rate among first-time mothers and increase the rate of vaginal birth after Caesarean. "


Thanks Denise Grady.


Tuesday, September 14, 2010

Cesareans for Profit?

As some hospitals' cesarean rates meet or exceed the 50% mark, several media outlets have asked the question: "Are hospitals doing cesareans for reasons other than a medical reason?"

It is important to unravel the layers here. First, hospitals do not, themselves, do cesareans. Physicians do. Obstetricians are, after all, surgeons. So it is the obstetricians that have privileges in those hospitals that do the cesareans who contribute to the cumulative cesarean rate.
Secondly, all hospitals are for profit. That means they are businesses that care for a large group of individuals and they expect to make a profit off of the illness or condition for which the individual is admitted. Oftentimes, it is the oncology department, the anesthesia department or cardiac departments that bring in the most dollars toward this profit.

Even if their designation is nonprofit, they must still pay their employees, still pay for supplies and still renovate and build. But the question is, does this have to be on the backs of expectant mothers and babies? (One private Southern California hospital has a 47% cesarean rate while a nonprofit hospital in Northern California has a 38% rate – both are unexceptable).

That being said, what is being fed to the media regarding maternity care in our country needs examination also. Cesareans are done because the U.S. has more obese expectant mothers, more older expectant mothers, more mothers likely to engage in litigation and more mothers who want cesareans due to a myriad of reasons.

Really? It is all patient/expectant mother driven?

If this latter explanation is in fact accurate, where is the Hippocratic oath here? You know, the old “First do no harm”? Wouldn’t physicians find it desirable to provide information regarding nutrition, advanced maternal age, litigation and those myriad of reasons why women want major abdominal surgery?

The uncomfortable truth is that more and more physicians take less and less time with their maternity patients and discourage childbirth education classes – both opportunities of educational enlightenment.

We should also examine the current rate of 44% induction of labors in the US. Really? Are only 56% of US women capable of going into normal labor by themselves? Is 44% of the US women’s bodies broken and need to be induced? I think not, considering that research shows that induction with a questionable Bishop Score may, in fact, lead to a cesarean. This begs the question, “why are there so many inductions?”

As a professional birth researcher and educator, I do not think there is ONE answer to the rise in cesarean question. I believe it is a multifaceted question that needs to be attacked, YES ATTACKED, on a multifaceted level. From physician education (and reprimand for doing unnecessary cesareans) to more robust expectant parent education to giving the nurses the knowledge they need to assist in a NORMAL birth ~ we need to step up and begin an educational revolution.

And we need it now.


Wednesday, September 08, 2010

Green Parenting ~ Guest Blogger Donna Walls RN, IBCLC, CCE

Donna Walls
The connection between the environment and our health is clear.  The alarm has been sounded about the harmful effects of many toxic chemicals. Now parents need to take action.

How can we protect out families from these ever-present chemicals. The answer is clear- start at home. We can create a safer, “greener” home by following these steps:

  1. Switch to non-chemical, basic cleaning products. This is safe and less expensive. For most basic cleaning you can use white vinegar. Dilute in half with water for cleaning kitchen and bath. If scrubbing is needed- sprinkle baking soda on the surface, add water to make a paste for simple, effective scrub. Lemon juice is also a great disinfectant for kitchen counters and cutting boards.
  2. AVOID anti-bacterial products. These have not been shown to be anymore effective than plain soap and water and most contain triclosan, a dangerous chemical linked to hormone disruption. If you are looking for a safe “away from home” hand sanitizer, mix 20-30 drops of lavender essential oil in 1 oz water. Spritz on hands, no need to rinse.
  3. Personal care products are a hidden source of harmful chemicals. They often look and smell so good, it’s hard to believe that many of them can cause cancer,  hormone disruption affect our immune systems. Minimize the use of these products for babies and children. Read the labels of all products before you use them and use only products that do not contain any paraben, phthalate, dye, fragrance or preservatives like EDTA. A simple tip- for dry skin use olive oil instead of expensive lotions.
  4. Get rid of the plastics! This one is a big one. We are surrounded by plastics, but make every effort to switch to glass or ceramic cookware, storage containers and serving  dishes. Plastics have been shown to release harmful chemicals into our food, especially when the food is warm or hot. A good investment is in glass kitchenware, wherever possible.
  5. Don’t be fooled by those good-smelling air fresheners. Most contain formaldehyde and other dangerous chemicals that increase the risks of asthma, ear infections and headaches. If you want the house to smell good- bring in some organic flowers, place a few drops of an essential oil on a cotton ball an place on a table or desk or simmer some aromatic seeds or citrus rinds to a fresh, clean, non-toxic aroma. Remember, plants like philodendron and spider plants are also great natural air cleaners.
  6. Avoid all insecticides and herbicides for your lawn and especially in your home. Since the 1960’ we have know about the dangers of these products, but they remain a staple of our everyday life and most people feel they are safe. Research shows the use of these chemicals are linked to asthma, mood and behavior problems, cancer and now interfering with our bodies ability to use insulin correctly, contributing to the sky rocketing rates of diabetes. Switch to organic lawn care products and use only non-toxic products in the house. Trying to get rid of ants? A few drops of a citrus essential oil in vinegar will do the trick. Choose organic foods whenever possible to avoid these exposures through food sources.
  7. Organic sheets, towels and infant clothing are available in more stores than ever. It’s worth a bit more to keep your children from exposures to dyes, flame retardants or formaldehyde.
  8. For more information check out and  and start a healthier more “eco-friendly” life today!!