Monday, April 30, 2007

The Business of Being Born

I just got home from New York and I would say I am exhausted from partying all night except that I am still feeling a natural high from the main purpose of the trip: The premier of a documentary called "The Business of Being Born," produced by Abby Epstein with Ricki Lake (yes, that Ricki Lake) as the executive producer. The film, just shy of 90 minutes, makes a truly compelling case for home birth (one of Lake's sons were born at her home, in the tub) among low-risk women, showing how birth can become more complicated and medicalized in the hospital.

I make several appearances in the film to provide some historical and cultural context, but the true stars were those parents who welcomed the camera into their home or birth center to chronicle their babies' arrivals. The film also features many of America's 'rock stars' of birth, including midwife Ina May Gaskin, author Robbie Davis-Floyd, and public health expert Eugene Declercq, all of whom traveled great distances to attend the premier.

There are also home birth midwives who shine in this movie despite how little the mainstream knows about them. And of course, kudos to obstetricians in the film, who freely admit that low-risk births are boring and are better suited to be attended by midwives -- not doctors.
At the end of the movie, through which I experience a full range of emotions and choked back tears a few times, there was a standing ovatation from the packed theater. The producers were busy field pitches from potential buyers immediately after the screening, so it looks hopefully that the film will be widely distributed soon. I certainly hope so.

Friday, April 27, 2007

A short, amazing story

State's shortest mom gives birth to baby girl

YouNewsTV™Story Published: Apr 26, 2007 at 7:35 PM PDT

Story Updated: Apr 26, 2007 at 7:35 PM PDT
By KOMO Staff
Christianne Ray, who stands 2'9'' tall, set a state record when she gave birth to a baby girl on Tuesday.

Ray gave birth to Kyrsten Elise by cesarean section at the University of Washington Medical Center.

Baby Kyrsten was born 14 inches long and weighed 4 pounds and 8 ounces. It took quite a team of surgeons, doctors and nurses to bring her into the world.

And little Kyrsten faces a tough road ahead. Her many health issues put her in the neo-natal intensive care unit, and it will be many weeks before she can go home.

It's already been a long journey for Christianne. Doctors didn't know whether she would be able to carry a baby at first.

"'Cause they thought the baby was going to press on her lungs and she wasn't going to be able to breathe and neither was the baby or something," said her fiance, Jeremy Bowden. "They didn't want that happening, so we've proved them wrong about a lot of the stuff."

Once she became pregnant, she had to make weekly trips from Puyallup to Seattle to see specialists.

Christianne, who weighed 80 pounds, gained 30 more with her pregnancy. She couldn't make it up the stairs anymore and needed Bowden, who happens to be 6'4'', to carry her up.

Cristianne and her family believe she will be the smallest woman in Washington state to give birth.

We did some research of our own and found several women in history that were listed as the smallest mothers in the world. One of those women, Dolletta Boykin, was 28 inches tall and gave birth to two children back in the late 1880s.

Find this article at:

Wednesday, April 25, 2007

The VBAC Ban

This article in San Francisco Weekly is similar to a piece I wrote last December for Boston Magazine on how Massachusetts women, denied by doctors and hospitals the opportunity to try for a vaginal birth after a cesarean, were frantically seeking other options, including staying at home during birth. Clearly, this trend is nationwide.

No Hail Caesarean
Expectant mothers are losing an option to birth babies naturally and activists are charging it is more about money than safety
Published: April 25, 2007
Kilty Vahle planned to deliver her first baby as Mother Nature intended. No painkiller. No cutting. But as labor stretched on while her cervix did not, she surrendered to first painkiller, then labor-speeding hormones and an epidural, and finally a Caesarean section while the baby's heartbeat was still strong. She walked out of the hospital with a healthy baby, but vowed kid No. 2 would be pushed out in a rush of endorphins, not cut out in the fog of anesthesia.

Aaron FarmerSo, pregnant again last fall, Vahle scheduled her delivery at Homestyle Midwifery at St. Luke's Hospital in the Mission. There, a certified nurse midwife would guide her through labor with natural techniques, and the staff assured her she could push for a vaginal birth. But only as long as it was safe. That's because her prior C-section poses a small but horrible risk during labor: a .5 to 1 percent chance of tearing the uterine seam from the previous surgery, causing heavy hemorrhaging and requiring an emergency C-section to save the mother's uterus, her baby, and herself.

Vahle changed her insurance to a more expensive HMO that would cover the midwifery service.

But in mid-March and five months pregnant, she got an e-mail: St. Luke's, having merged with California Pacific Medical Center (CPMC) on Jan. 1, had stopped scheduling patients who wanted a vaginal birth after a C-section (known as a VBAC). She could schedule a C-section with St. Luke's or find somewhere else.

"When I finally had a moment to breathe, I burst into tears," the 39-year-old Lower Haight resident said. "I might not find the advocates I know I had at Homestyle" for a vaginal birth. "They may cut me off sooner and say we recommend a Caesarean now."

Joining a national trend, the CPMC-St. Luke's campus, known for its low-intervention midwifery approach to labor even outside the Homestyle Midwifery service, is now the first labor and delivery site in the city to stop scheduling vaginal births after C-sections.

Hospital officials say more expertise and staff are available to handle the higher-risk VBAC delivery at the main CPMC campus. It's the city's biggest labor and delivery floor with nearly 6,000 deliveries a year that practices a more medically managed method of delivery, with higher intervention rates and only four midwives practicing among the 50-some obstetricians who deliver babies.

But VBAC advocates argue the decision was more about money than safety, since St. Luke's has been successfully delivering post-Caesarean vaginal births for years. Advocates say the move limits a soon-to-be mother's control in one of the most important events of her life — forcing women to choose between a natural birth at home that lacks the safety net of an operating room steps away, or hospitals that may be more likely to urge women to have a repeat C-section, a surgery with more risk of complications and a longer recovery than a vaginal delivery.

"How can you take away the right to birth with whom you want and how you want?" asks Charity Pitcher-Cooper, a birth educator who is heading up a May protest march in support of VBACs. The march will end at St. Luke's door. "If you go to a place that does a lot of C-sections, you get nudged in that direction, just because they do a lot of them and see them as normal."

St. Luke's has now presented to some 20 pregnant women the options of transferring to the main CPMC campus or other area hospitals. Aside from a few who scheduled C-sections at St. Luke's, patients are now scrambling before the contractions begin to find a birthing option that fits their wishes and that their insurance will cover.

With the national C-section rate ballooning from 5 percent of births in 1970 to 29 percent in 2004 — San Francisco hovering at 24 percent — more and more women who have a second baby will have to make a similar choice: advocate a vaginal birth that carries a tiny risk of catastrophic consequences, or schedule one C-section after another with the risks of complications increasing each time.

For years, the saying was "once a Caesarean, always a Caesarean." But in the 1980s, with research showing the risk of uterine rupture was less than previously thought, VBACs came into vogue nationally. Government health officials advocated VBACs to curb the climbing C-section rate.

California Pacific Medical Center joined the trend, said Dr. Elliot Main, chairman of obstetrics and gynecology. Throughout the '90s, doctors suggested that all women with a prior C-section try to have a vaginal birth. They often induced labor or used synthetic hormones that make contractions harder and faster, both practices that later studies showed increase the risk of a rupture.

Consequently, the hospital had one to three ruptures a year, resulting in the "loss of uteruses, loss of babies," and the increase of malpractice cases, said Dr. Main. After four uterine ruptures in 1999 alone, CPMC changed its policy for VBAC patients. It stopped inducing labor, cut down on artificially speeding along labor, and screened candidates for those at low risk for a rupture.

Doctors became "gun-shy" in advocating that women with prior C-sections attempt labor.

"[Uterine ruptures] scar doctors as well as patients," Dr. Main said. "If the VBAC patient wants it, they'll be happy to do it, but they won't go out of their way to push a VBAC for patients. It's a shift of attitude that makes a significant difference in terms of the number of people who attempt a VBAC."

In fact, while nearly 80 percent of women with C-sections attempted a vaginal birth at the hospital during the '90s, now more than 80 percent automatically schedule another C-section surgery.

Many VBAC advocates and doctors say women are getting a biased view from many doctors about the potential risks of a VBAC vs. a repeat Caesarean.

"Women who do want VBAC are told they're being irresponsible and gambling with the lives of their babies," said Berna Diehl, spokeswoman for the International Caesarean Awareness Network (ICAN), a nonprofit that works to cut back unnecessary C-sections. "So they're shamed into a repeat Caesarean, which is too bad when you consider the overall safety [for a VBAC] is there. They're not always getting the full picture when they walk into a doctor's office to make a good, evidence-based decision."

In an unofficial telephone survey, ICAN counted 300 hospitals nationwide that had stopped doing VBACs as of 2005, influenced by the influx of malpractice cases and a change in the formal recommendations of the American College of Obstetrics and Gynecology in 1999 that required a surgical team be "immediately" available to perform emergency surgery for a woman attempting a VBAC.

The percentage of women with a prior C-section having a vaginal birth sunk from a high of 28 percent nationally in 1996 to 9 percent in 2004, according to the National Center for Health Statistics.

San Francisco had remained a haven for VBAC births at its five labor and delivery floors. And St. Luke's was a little-known gem: 85 percent of women with C-sections who tried labor were able to give birth vaginally in 2006, the highest rate in the city. Cynthia Banks, a certified nurse midwife at St. Luke's until this month, attributes the success to the midwifery model of care at the hospital, where midwives outnumber doctors on the labor and delivery roster.

"Whenever there's a strong midwifery presence and philosophy of labor as a natural process, that's when things are safe as can be [for VBAC births]. It takes the women believing in their bodies and it also takes the providers being supportive of that."

But St. Luke's foresaw a possible scenario on nights and weekends when less staff was on hand: The main operating room team could be occupied, the ob-gyn team always called in for a VBAC labor attempt could be busy, and a VBAC mother, should she need an emergency C-section, could be left without a surgical team. "It's absolutely a possibility," said Dr. Laura Norrell, the hospital's chair of obstetrics. "We've been lucky it hasn't happened, frankly. So while [stopping VBACs] is a painful decision for us to make, I think it's the right one because it's all about guaranteeing a patient's safety."

Some women whose first delivery ended in a C-section have become disillusioned with hospital births, feeling they were "going with the flow" in a culture that sees labor as a medical condition to be induced, monitored, and sped up with the woman often numbed and confined to bed, instead of a usually healthy process that develops at a different rate for each woman and can be helped along by methods as simple as changing positions.

A number of these women check in for their second birth better educated and accompanied by a birth coach to resist what they see as unnecessary interventions. Studies show that inducing or speeding labor and even the routine use of a continuous electronic fetal heart rate monitor can lead to more C-sections.

But a few expectant mothers, to the alarm of many doctors, opt to avoid the headache of challenging doctors and birth their next child at home. Kim Weiss, the CEO of a software company in Sausalito, recalls telling a doctor during prenatal care at CPMC that she wanted to have a VBAC epidural-free, to which he responded, "Trust me, honey, I've birthed thousands of babies, and you're gonna want that epidural." She saw a slippery slope before her from an epidural to another operation.

Weiss says she trusted CPMC to handle any complication and is a repeat customer for ob-gyn care, but "natural birth at CPMC is an oxymoron. I thought if I ended up at CPMC, I would not have a VBAC, and it would not be natural. It would be a Caesarean."

The marathon runner read 15 home-birthing books, delivered in a birthing tub in her bedroom with her husband and certified nurse midwife by her side, and was up walking minutes later.

But Dr. Main says a home VBAC is "absolutely crazy."

"You're rolling the dice. The problem with a [uterine rupture] is that it's sudden and catastrophic, it doesn't gradually develop and give you a chance to get to the hospital."

Still, mulling her options, Kilty Vahle considers a home birth her best chance to deliver vaginally. She had thought of going to Homestyle Midwifery in active labor since a hospital can't refuse a woman that far along, nor perform a C-section without consent, but now even that option is in jeopardy. Last week, St. Luke's informed the midwifery service that it will be kicked out of the hospital's Women's Center on Aug. 1 since it is considered beyond basic obstetric care, although the midwives are considering opening a private practice within the hospital, said Yeshi Neumann, the service's founder. Vahle's due date is Aug. 2.

Of course, she considers all of those sub-optimal choices.

"I have an activist side to me, so I'd love the thing to be reversed and be the first VBAC [at St. Luke's] after the cancellation of the ban."

Monday, April 23, 2007

Birth in Japan

I thought the below news story was an interesting one, especially given the fact that Japan has among the lowest maternal and newborn death rates in the world.

Obstetric Care Hits Crisis Levels

Suvendrini Kakuchi

TOKYO, Apr 12 (IPS) - Mayu Sasaki, 32, is expecting her second baby in May, but rather than making happy preparations the former economics researcher is filled with anxiety.

''We are so desperate that my husband and I have taken the decision to move to the neighbouring city of Kyoto where care is a little better than where we live now,'' she explained to IPS recently, citing the lack of hospitals that offer delivery services to women.

Sasaki lives in Takanohara, a small town in Nara prefecture, Japan's oldest capital located 322 km west of Tokyo. Nara is now battling a scandal over the death of a 32-year-old pregnant woman who died last November as a result of being denied emergency care.

Following complications during childbirth the woman died after she was rejected at 18 hospitals in Nara. During a police investigation, hospital authorities explained they had no choice but to refuse care because of a lack of obstetric personnel and beds for babies.

The case has shaken public confidence in Japan's highly sophisticated medical industry and raised the ugly prospect, say reproductive rights activists, that, indeed, obstetrics has become a low priority for the government.

They point to the recent heated debate over remarks made by health minister, Hakuo Yanagisawa, who called women "birth-giving machines," drawing wide criticism from women who accused him of ignoring their reproduction rights.

‘'There is a lot of pressure to improve national birth rates to boost the economy. But authorities refuse to give the necessary support for safe child delivery,'' said Dr Yoshiki Idou, an expert on the issue at Ohkatani Hospital in Nara.

Idou launched a health centre for children and mothers at his hospital in 2003 to help out against, what he describes as, a ‘crisis' facing that sector in Nara.

The centre offers counselling and care for new mothers and their babies and is well patronised against a backdrop where female reproduction services are losing ground due to low birth rates -- now 1.32 per woman.

He explained that as more women opt to have children in their later years, child birth has become riskier, making it all the more important to provide safer maternity and infant care facilities in Japan.

‘'There are no large hospitals providing gynaecological services in Nara, creating a dangerous situation for women living here,'' Idou told IPS. More than 1,000 new births were registered in Nara in 2005.

The Nara scandal has, say experts, finally spotlighted the dire situation in Japan. Statistics now reveal that the number of hospitals handling deliveries dropped to 914 from 1,009 in 2005 alone.

Other data also show that only 40 percent of university-related hospitals in Japan have one or two full-time obstetricians and a survey by the Japan Association of Obstetricians and Gynaecologists reported that Japan faces a shortfall of 6,700 midwives.

According to the health ministry, 62 mothers died in 2005 during deliveries, up from 32 in 2004 recorded in a study of 125,000 childbirths. Also, the risk factor among expectant mothers is much higher, say analysts.

''Having a baby in Nara is like being strapped to a time bomb,'' says Sasaki, who has been diagnosed as a high-risk expectant mother because she suffers from asthma. She added that it is ‘'hard to believe that Japan is an industrialised country.''

While authorities are focusing on the lack of medical personnel, doctors also point to the urgent need for government to establish better working conditions for gynaecologists and paediatricians in particular.

Surveys in hospitals show that more than 40 percent of female gynaecologists stop working when they start families because they cannot cope with the long hours of work and raising their own children.

Dr Yuriko Marumoto, who runs her own clinic for pregnant women, told IPS that ‘'adding to the high stress of their work, gynaecologists also face arrest and imprisonment if there is a problem. Thus, the job is shunned by new doctors creating a very difficult situation for pregnant women.''

Idou says the shortage of medical staff can be met by increasing funds for mechanisms that support such steps as paid holidays, hospital nurseries and a rotation and sharing system between hospitals.

Experts also point to the reluctance in Japan to open the door to foreign doctors, as is the case in other industrialised countries.

Against increasing pressure Prime Minister Shinzo Abe promised, last month in the Japanese Diet (parliament), to establish a ‘Women's Doctors Bank' as a means of offering support for female obstetricians and gynaecologists. (FIN/2007)

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Monday, April 09, 2007

Birth documentary in the Tribeca Film Festival

Ricki Lake has been working on a birth documentary that is premiering at
the Tribeca Film Festival( The film, called The Business of Being Born (, was directed by Abby Epstein, a New Yorker who tried for a home birth but needed medical assistance when she went into premature labor.

Epstein and producer Ricki Lake (who had a home birth in her tub and says it changed her life) explore and question the way American women have babies. Shocking
facts (which you will see me and others talk about in the film)regarding the historical and current practices of the birthing industry interweave with stories of couples who decide to give birth on their own terms.

You can buy tickets online at Otherwise, you can buy single tickets starting April 13th.

The screening schedule is as follows:

Sunday, April 29, 7:00 pm Clearview Chelsea West (CCW)
333 W. 23rd Street (between 8 th and 9 th Avenues.)

Monday, April 30, 6:30 pm, AMC Kips Bay (AKB)
570 Second Avenue (at 32nd St.)

Thursday, May 3, 9:45 pm, AMC Kips Bay (AKB)
570 Second Avenue (at 32nd St.)

Friday, May 4, 5:00 pm, AMC Village VII (AV7)
66 Third Avenue (at 11th St.)

Tuesday, April 03, 2007

British battle royal

There is a fascinating debate raging in the UK right now. The National Health Service has decided that there should be one midwife per pregnant woman in the next few years. NHS is also on a kick encouraging home birth (which is why the call for more midwives.) At the moment, there is a serious shortage of midwives, who are still the primary attendant for laboring women, even in the hospital. Below is a column that ran in the Times of London. My comments are at the end of the column.

From The Times (London)
April 4, 2007

Natural birth! Hello? This is the 21st century
Let’s have fewer pious midwives, not more

Alice Miles

A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt. We know the NHS will never be able to provide every mother with her own named midwife to hold her hand throughout what James Naughtie hilariously referred to on the Today programme yesterday as her “confinement” (where do they find these male presenters born so many, many generations ago?).

We know it, because we know about NHS rotas and staff attitudes and the way the patients are made to fit around them. We know pregnant women are not all going to have their own midwife on call, unless that means call back after 9.30am and speak to the answerphone.

Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. You only need to read the introduction to see this. “It also emphasises the need for all women to be supported and encouraged to have as normal a pregnancy and birth as possible,” writes Ms Hewitt. Her junior “Minister for Care Services”, Ivan Lewis, adds: “I believe individualised care offered by a midwife, specialist support provided to those most at risk and normal birth without medical intervention will become a more realistic option for every parent.”

A “normal” birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. The more that modern medicine offers, in terms of pain relief and convenience, the more urgent the insistence of this weird sorority that a woman has to give birth “naturally”.

Again, why? We are no longer expected these days to die naturally, without the operation that would remove the cancer or the pain relief to help us on our way. We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept.

As a woman interviewed on the radio yesterday said, the worst part of her otherwise excellent treatment on the labour ward was the moment when the midwife gave her “quite a lot of grief” because she chose to have an epidural. She only had the strength to insist upon it because her father, sister and husband were all doctors and she trusted their advice. These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.

I remember when I told my very nice and until then helpful midwife that I was going to have a Caesarean (I, fortunately, had a choice). I might as well have said that after careful thought I had decided I would feed my baby heroin. When she had recovered sufficiently from the shock, Maureen, a large, broad-hipped woman and mother of about eight, suggested I might have been swayed by Posh Spice: “A lot of women want to follow their favourite celebrity.” Then she asked whether I was doing it at my husband’s request to keep myself perfect for him “down there”.

There was no way she was going to understand that for me a predictable, pain-free birth (yes, I wanted it in the diary; anything wrong with that?) with a surgeon I had met and trusted, accompanied by lots and lots of drugs, was my choice.

Too many women in their late thirties have too many horror stories of agonising labours followed by emergency Caesareans under general anaesthetic so that, after all that, they miss the actual birth. For the rest of their lives they must live with terrible scars from being slashed wildly across the stomach by the cack-handed doctor on call, and remember the first weeks of their child’s life in only a blur of exhausted depression and trauma. Does maternity not “matter” for them, too?

Ask a woman who has had a planned Caesarean: awake, calm, pain-free. And no risk of the “down there” issues that Maureen referred to, either.

Yet the whole thrust of government policy is towards making that — the best choice for many — less and less available. They are closing smaller consultant-led maternity units and encouraging women towards natural home births or midwife-led units (no Caesareans), while hoping to use the specialist consultant-led birth centres only for the few expecting complicated births; minimal medical intervention, maximum embrace of the “natural”. Ouch!

Perhaps the most insidious effect of these official attitudes is the guilt they can engender in the poor woman who tries and feels she has “failed” to have a “normal” birth as eulogised by NHS midwifery and the equally messianic National Childbirth Trust, progenitors of so many doomed “birth plans”.

One writer in The Times has been describing the feelings of disappointment and failure she felt after an emergency Caesarean: “Right from the start I felt I had let [the baby, Charlotte] down, not to mention me and my family.” So irritated were many “pull yourself together, girl” readers, that she felt compelled to respond, this time less traumatised, a year after the birth (you can see the whole debate on the Alphamummy blog): “In the months leading up to the birth of Charlotte, like any very excited first-time mum, I read lots of books and attended a ‘natural birthing yoga’ class on a weekly basis. In all my teachings I was told over and over again that the best way is the natural drug-free way. I was told that drugs slowed down the labour and could affect the baby. Nowhere was I told the benefits of drugs. I was brainwashed into thinking that natural is right and drugs were wrong.”

Quite. It is shocking that a feminist Secretary of State for Health in the 21st century should be colluding with the pious missionaries campaigning to keep women’s birth experiences in the 19th. We are modern now. And we are not in the Third World. We do not need to get behind a bush and squat. Let those who want to go natural, choose natural. But let those who don’t, choose drugs. Choose a Caesarean. Choose life — any way they want it.


So that's the column. My issue is that she is perpetuating a horrible post-modern myth that c-sections are not painful. They HURT. They can lead to horrible and hard-to-treat infections. And they are not safer unless there is a true medical issue with mother or baby. Scheduling the operation just to "put it in the diary?" Squeeze out one more column in advance? This is the plague of women of my generation. We are control freaks.

Having looked at how cultures around the world have given birth throughout time, I can say with great authority that there is never an easy way out of giving birth. On the one hand, it may seem easy to say, well if this is what she wants, fine, no skin off my back. But unfortunately, as more women clammor for c-sections, they become increasingly standard procedure; they're easy for doctors; they can manage their time and their patient flow more effectively. But once the operation becomes so common (1 out of every 3 babies in the US is born by section) it effectively limits the options of other women. That would be a shame.