Thursday, November 13, 2008

New York Times story

What's fascinating about this story to me is not the content. It's the publication, which marks a turning in point in terms of the cultural zeitgeist. Something is happening....FOr the better. Yes we can!

November 13, 2008
Baby, You’re Home
SQUATTING in an inflatable pool in the open kitchen of her apartment in Astoria, Queens, a very pregnant Alecia White Scharback, nude except for a bathing suit top, groaned in pain. It was 7:30 a.m. on Nov. 1, and Mrs. Scharback, 29, an actress, had been in labor for more than 36 hours. The contractions had been only mildly painful at first, but had grown increasingly fierce as a second night gave way to morning.

At the height of one contraction, Mrs. Scharback closed her eyes, bent forward and rocked her hips back and forth. “It hurts, it hurts, it hurts,” she moaned. Using a stainless steel refrigerator to steady herself, she vomited. Joshua Scharback, her husband, rushed to her side and gently stroked her head.

Mrs. Scharback was giving birth at home because she did not want any medical interventions in the process unless she needed them, she said. But after another four hours, she was beginning to doubt whether she could make it and was pleading with her midwife, Miriam Schwarzschild, for relief. “Oh, Miriam,” she whimpered, “I can’t.” Ms. Schwarzschild reassured her client: “You can. And whenever you’re ready, you can start to push.”

Home births have been around as long as humans, but since the 1950s, the overwhelming majority of American women have chosen to give birth in hospitals, which the American College of Obstetricians and Gynecologists identifies as one of the safest places for the unpredictable and sometimes dangerous process of childbirth. (The group has officially opposed home births since 1975, and this year the American Medical Association adopted a similar position.)

Recently, though, midwives and childbirth educators say, a growing number of women have been opting instead for the more intimate and familiar surroundings of home — even in New York City, where homes are typically cramped warrens of a few hundred square feet and neighbors often live close enough to hear every sneeze and footstep.

Births in New York’s hospitals, where pediatricians are able to check babies immediately for potentially dangerous conditions, it should be noted, still vastly outnumber those in its homes — in 2006 home births accounted for only one-half of 1 percent of the city’s 125,506 reported births.

But local midwives say they have been swamped with calls and requests in recent months, in some cases increasing their workload from two, three or four deliveries a month to as many as 10. (New York health department statistics for this year will not be available until 2010.) Several certified nurse midwives who have home-birth-only practices said they had gotten so many more requests in recent months that they have begun referring pregnant women to midwives in Rockland County, Long Island and New Jersey.

Erica Lyon, the founder of Realbirth, a five-year-old childbirth education center with three locations in the city, said 20 percent of the 160 couples who take her classes each month are planning home births, twice as many as six months ago., one of the biggest online purveyors of birthing pools — deep inflatable tubs with a specially designed built-in seat and handles — said its sales have doubled since last year, with more than 20 percent of its customers in New York City;, another outlet, said it has sold more than twice as many pools this year as last, 25 percent of them to New Yorkers and Long Islanders.

Home birth professionals in New York City have been struck, several said, by the fact that the increase is coming not so much from the dyed-in-the-wool back-to-nature types as from professionals like lawyers and bankers. “People who wouldn’t naturally self-select for home birth are coming in and getting very open-minded,” said Cara Muhlhahn, a certified nurse midwife who has had a home-birth practice for 17 years and is now fully booked six months in advance.

One reason for the change, it seems, is “The Business of Being Born,” a documentary produced by the actress and former talk show host Ricki Lake, which ran in only a few theaters during its theatrical release in January but has become an underground hit among expectant parents since coming out on DVD. (Rentrak, a company that monitors DVD rentals, said that instead of dropping off, as typically happens with new releases, the film is being rented at consistent rates.)

With scenes of several home births (including one in which Ms. Lake delivers her second child in the bathtub of her former West Village apartment), the film argues that women’s bodies are perfectly well equipped to give birth at home and that the occasion need not be a medical event.

Many women are wary of hospital births, both because of a patient’s limited control over the process and because of the growing frequency of Caesarean sections (use of the procedure increased by 50 percent nationwide from 1996 to 2006, to nearly one in three births, according to the National Center for Health Statistics).

“The Business of Being Born” seems to offer an alternative, and “is putting home births on the map in a way that makes women feel like it’s a really legitimate option,” said √Član V. McAllister, founder of Choices in Childbirth, a four-year-old nonprofit educational group that publishes “The New York Guide to a Healthy Birth.” “In your home you’re able to move around and be in the tub or in the shower. You’re able to eat and behave in a natural, more normal way. If you believe birth is not a medical emergency, it is the ideal place because it’s the place you can really let go and follow what your body wants you to do.”

Mrs. Scharback, for example, tried many different positions over the course of her labor: leaning on the windowsill of her newly decorated nursery, sitting on a birth stool, crouching on the bed, sitting on the toilet and, eventually, leaning back against her husband inside the warm birthing pool. Finally, having endured 40 hours of regular contractions with no painkillers — like most women who have home births, she refused them — she let out a guttural scream and pushed her new son, Noah, into the world.

Home birth also appeals to the desire of many new mothers to stay put, and in continual contact with their babies, after the grueling ordeal. Michelle Zassenhaus, 33, a Web designer and photographer who gave birth for the first time in March, said her apartment in Park Slope, Brooklyn, was an ideal environment for calm postpartum recovery with her husband, Silvio Galea, and their new daughter, Lucienne.

Shortly after the birth, “the doula and midwife got us all cleaned up, cleaned up the apartment, looked in our fridge, figured out what kind of food they could prepare for us, showed us some breastfeeding techniques, put us in bed, gave us some food, and left,” Ms. Zassenhaus said. “Those first couple of days when you’re usually suffering through postpartum, we were in this very quiet, intimate state of bliss.”

NEW YORK apartments would seem to present significant challenges to home birth. For starters, there are obvious concerns about the apartment itself: the prospect of an inevitably messy process in a tight space invites delicate questions, like, What happens to the rug?

Then, too, there is the matter of space: for a woman with children, for example, it’s hard to imagine where in the apartment to put them if you want them out of range of the big event. And because women giving birth at home sometimes want to surround themselves with a doula and a cadre of other supportive women — mother, sister, best friends — along with a husband or partner, a one-bedroom apartment, much of it given over to a giant inflatable tub, can quickly come to seem oppressively small.

But for some, the biggest concern is the neighbors: natural childbirth is not usually a silent affair, and sound baffling is notoriously lousy in many of the city’s buildings.

Ms. Zassenhaus, in Park Slope, waited until three weeks before her March 28 due date to tell residents of her town house about her plans, fearful that the ground floor resident, the owner, would try to persuade her to abandon them. “At first they were shocked and fearful,” Ms. Zassenhaus said. “But very quickly they embraced it, and they were all kind of excited to be part of the process.

“I kept them apprised, and when it was coming near to the date, I put a note on their doors that said, ‘Any day now, if you have a sleepless night because of my screaming, I apologize.’ ”

In the event, Ms. Zassenhaus made barely a yelp until the final moments of her three hours of labor. “For 15 minutes I grunted really, really loud,” she said. “My neighbors downstairs lit candles all over their apartment and prayed for us.”

Elizabeth Golluscio, a marketing consultant, and her husband, Elio Narciso, a founder of the wireless media company Zero9 USA, also debated whether to tell neighbors in their Upper East Side building about their plans, not wanting to “get them freaked out,” Ms. Golluscio said. “We only bought this place in May, so we were just getting to know them. The impression is, if people are having home births, they must be hippie freaks or religious fundamentalists.”

Ms. Golluscio was thrilled, she said, when the woman in the adjacent apartment moved out for renovations, but then she worried that the construction workers might overhear her making strange noises. On Nov. 3, when she found herself giving birth in her bathtub after five days of on-again-off-again contractions, and emitting “animalistic” moans, she was still worried. “He was born at 8:16,” she said of her son, Claudio, “so I was hoping the workers weren’t there yet.”

When the couple, both 35, first considered a home birth, in February, Ms. Golluscio also wondered about some of their favorite belongings, especially an expensive wood Mobileffe bed frame. “It’s probably the most expensive furniture we have in the house,” Ms. Golluscio said. “I was like, ‘I hope this thing isn’t going to get hurt.’ ”

Mr. Narciso, who watched his wife give birth to their first child, Matteo, at St. Luke’s-Roosevelt Hospital Center last year, was even more anxious, she added. “He was like: ‘What about the mess? What do we do with it?’ ”

Their midwife explained that they should gather old towels and sheets in advance, as well as a kit of disposable medical supplies, including the kind of pads used for house-training puppies. She also recommended buying or renting a birth pool, which can have a disposable liner and is drained into the toilet. “She was very, very ‘It’s not a big deal, it’s like one garbage bag,’ ” Ms. Golluscio said. “That’s what it was. We put everything in the garbage.”

And then there is the perennial issue of space. Before the onset of her labor, Mrs. Scharback, who in recent years has worked as a doula, worried about whether there would be enough seating in her 800-square-foot apartment for all the people who would be there: a midwife, a doula, her mother, her sister and her husband, along with a reporter and a photographer. “We thought maybe we should get some floor cushions,” she said.

For several hours on the morning she delivered, the guests took turns sitting on the couch, the floor and a glider set up in the new nursery. The bed became less of an option when the doula and midwife stripped it of its green-and-white designer sheets and, using a shower curtain as a liner, remade it with old pink ones. Several minutes later Mrs. Scharback climbed on, enduring a contraction on all fours with her face buried in a pillow.

A shower curtain liner also came in handy when Kirsten Rickert, 32, a stay-at-home mother, decided before dawn on Oct. 29 that she wanted to go through labor standing up in her living room overlooking Prospect Park. Standing on top of a shower curtain layered with a sheet, she planted her arms on her white couch and bent forward.

Some people, concerned that a home birth might be traumatic for children to witness, send them to stay with a friend or relative for the duration. Ms. Rickert and her husband, Cameron Skene, on the other hand, saw it as an educational opportunity for their 2 ½-year-old daughter, Maya. “There’s nothing mysterious about birth unless you want there to be,” Ms. Rickert said. “For us it just introduced Maya to life, and how life comes about.”

Maya awoke around 4 a.m. and joined her parents in the living room. “She was munching away on her apple and talking about 2-year-old stuff when I was having contractions,” Ms. Rickert said.

When it was time for Ms. Rickert to push, Maya watched intently. Although she didn’t like the blood and water that followed the baby, her mother reported, she wasn’t surprised: for months Ms. Rickert had prepared the toddler with an explanation of what would happen.

Just after her new daughter, Elle, emerged, at 5:23 a.m., Ms. Rickert sat on the couch (the midwife having put down an absorbent pad), and Maya came over to admire her new sister’s thick black hair. “She kissed the baby and gave her lots of love, and everything was fine,” Ms. Rickert said. “Then she goes, ‘Can I watch “Dora” now?’ ”

DESPITE all the preparations, of course, home births do not always go as planned. Most home-birth specialists have a relationship with a hospital or a doctor and talk in advance with their clients about the possibility of a hospital transfer. The best study of North American home births available cites an average transfer rate of about 12 percent. “If someone is preeclampsic, they’re not going to give birth at home,” said Ms. Muhlhahn, the longtime nurse midwife, referring to a disorder that is among the leading causes of death and illness in mothers and babies. “It’s very rare something so dire would happen that we would have to call an ambulance. We don’t wait until it’s a real emergency.”

Ivonne Dersch, 28, a marketing executive at American Express, had to abandon her home birth in TriBeCa after a routine check of the baby’s heart rate showed it was decelerating. The attending midwife decided Mrs. Dersch, who had been in labor for 28 hours, should be transferred to St. Vincent’s Hospital, a 10-minute cab ride away.

“We took the elevator and my husband hailed a cab,” Mrs. Dersch said. “It was like out of a movie.”

Although he tried not to show it, her husband, William, 31, a stockbroker, became fearful — “terrified actually,” he said. “For the midwife to say you have to transfer to the hospital, it’s all those emotions running through you.”

Mrs. Dersch worried that she would be given a Caesarean upon arrival, but after examining her, the doctor told her to push. Fifteen excruciating minutes later, she delivered a son.

Other hospital transfers have less favorable outcomes. Several months ago, Dr. Erin Tracy, an obstetrician and a public health expert at Massachusetts General Hospital, received a phone call from a colleague at another hospital, distraught about a patient who had almost died after a home birth.

In the colleague’s opinion, the patient, who had a severe postpartum hemorrhage, was transferred far too late for her own safety. “She was in dire straits, she needed multiple blood transfusions, and she wound up needing a hysterectomy, which could have been averted if she had been given the appropriate medications,” Dr. Tracy said.

“Many low-risk pregnancies become high risk with no warning and can become urgent within minutes,” said Dr. Tracy, who, as a representative of the American College of Obstetricians and Gynecologists, successfully petitioned the American Medical Association this year to join the College in condemning home births.

“In a home, even with a quality provider, you don’t have access to surgeries or blood transfusions or lifesaving medications you would have in a hospital,” she added. “The literature does say the majority of normal deliveries can be done at home. But I think, and others think, the stakes are too high.”

Ms. Golluscio’s delivery, too, deviated unnervingly from the plan, though not in a way that turned out to be life-threatening.

At the moment her baby was born last week, her husband was outside on the street passing Matteo off to his baby sitter, and her midwife, Ms. Schwarzschild, was stuck in traffic. Only her doula, who was not trained to deliver babies, was with her, and Ms. Golluscio herself ended up scooping her new son from the bathtub water.

But she considered the event a success. “I feel physically awesome right now,” Ms. Golluscio said three days after the birth, adding that natural childbirth at a hospital might have left her feeling good, too, but that she attributed a big part of her well-being to “being home and in the water.” She added, “Even with all the uncertainty of not having my midwife there, this was the best thing ever.”

Playing It Safe

The American College of Obstetricians and Gynecologists has had an official policy against home births since 1975, and this year it asked the American Medical Association to adopt a similar statement. The A.M.A. agreed, and in June also condemned home births.

“The A.M.A. supports a woman’s right to make an informed decision regarding her delivery and to choose a licensed health care provider” and “stresses that the safest setting for delivering a baby is in the hospital or a birthing center within a hospital complex,” Dr. Steven Stack, a board member, said in the statement. “Serious complications can arise with little or no warning even among women with low-risk pregnancies.”

In contrast, health authorities in Britain view home births as a safe option for women at low risk of complications. In April 2007 the United Kingdom Department of Health rolled out plans for a “national choice guarantee,” to be put in place by the end of 2009, ensuring that all women can choose among giving birth at home, or at a hospital or another facility, and still have access to midwifery care.

The Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives issued a joint statement in support, agreeing that for most women, home births “may confer considerable benefits for them and their families.”


Sunday, November 02, 2008

This news story brought back flash backs from two women in my family who were both put through the ringer over prenatal tests that raised alot of concern and anguish...only to result in healthy babies. I see parallels between these tests and microscopes from 100 years ago. You see things never before possible and it all looks very scary. But of course, we now know that not all bacteria is bad...

New prenatal tests raise concerns
October 27, 2008

WASHINGTON - Doctors have started using powerful new DNA tests to screen fetuses for a wider range of genetic abnormalities, spotting more problem pregnancies early but stirring fears that the results will increase abortions as well as confuse and needlessly alarm many couples.

The tests, which use "gene chips" to detect much subtler chromosomal variations than standard prenatal testing can, have also triggered complaints that they mark another step toward a society that seeks to weed out aberrations in the quest for the perfect child.

Proponents maintain that the technique, called comparative genomic hybridization, allows couples to target genetic-based illnesses, which can alleviate their worries in some cases and in others identify abnormalities soon enough to terminate the pregnancy or prepare to care for an afflicted baby.

But critics say the tests have not been thoroughly validated and threaten to produce a flood of murky, misleading results that will subject emotionally vulnerable couples to unnecessary anxiety, perhaps prompting some to abort healthy pregnancies.

Some worry that they could be used to hunt for the rapidly growing list of genetic markers that merely signal an increased risk for cancer, diabetes, mental illness, obesity, addiction, and other conditions later in life.


1 in 2,500 vs. 1 in 10,000

This tragic story in the Boston Globe serves to remind us all that there is no such thing as a "routine" cesarean...and why c-section rates in general should be lower. Deepest condolences to the family.

Patient dies during C-section at Beth Israel Deaconess
October 21, 2008 07:01 PM
By Carey Goldberg, Globe Staff

For the first time in more than 10 years, a Beth Israel Deaconess Medical Center patient has died while undergoing a Cesarean section, the hospital reported today.

The mother died on Friday, and the baby experienced complications but appears to be improving, Dr. Kenneth Sands, the hospital's senior vice president of health care quality, said in a brief statement.

"This sad and very rare event appears to relate to an unanticipated complication at the time the baby was delivered by Caesarian section," it read.

"We immediately launched an internal review and have reported to the Department of Public Health. This is obviously a very sad and distressing event for our staff at Beth Israel Deaconess Medical Center who have not experienced a loss like this for over 10 years. We continue to extend our deepest sympathy to the family."

The risk of death from a Cesarean section is estimated at less than 1 in 2,500, according to information on the Beth Israel Deaconess website. That is significantly more than the roughly 1-in-10,000 risk of a vaginal birth, but still low enough that the operations are performed more and more often in the United States, now comprising nearly one-third of births.