tag:blogger.com,1999:blog-236857402024-03-07T15:30:19.494-08:00The Birth Book BlogTina Cassidy is a journalist and author of Birth: The Surprising History of How We Are Born (Birth: A History, in the UK). Her latest book, Jackie After O, was published in 2012.Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.comBlogger207125tag:blogger.com,1999:blog-23685740.post-9841979844913645052016-05-22T06:07:00.001-07:002016-05-22T06:07:27.645-07:00An open letter to expectant mothers on the safety of homebirth<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="color: black; font-size: 12pt;">You may have read </span><span style="font-size: 12pt;"><a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?_r%3D1&source=gmail&ust=1464008583120000&usg=AFQjCNEchrPvvZXmcDqYqaAJ8L1-cnr1OQ" href="http://www.nytimes.com/2016/05/01/opinion/sunday/why-is-american-home-birth-so-dangerous.html?_r=1" style="color: #1155cc;" target="_blank">an opinion piece</a></span><span style="color: black; font-size: 12pt;"> in the New York Times by a non-practicing obstetrician who typically saves her rants for Twitter fights against homebirth, midwives, breastfeeding and even certain parenting practices. Perhaps you were as surprised as I was to read her views in a respected mainstream publication at a time when:</span><span style="font-size: 12pt;"></span></div>
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<li class="MsoNormal" style="color: black; margin: 0px 0px 0.0001pt 15px; vertical-align: baseline;"><span style="font-size: 12pt;">The governments of many developed countries (such as the UK) are doing more to promote homebirth as a safe option for low-risk women</span></li>
<li class="MsoNormal" style="color: black; margin: 0px 0px 0.0001pt 15px; vertical-align: baseline;"><span style="font-size: 12pt;">Harvard-trained practicing OBs are talking about <a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://theconversation.com/are-hospitals-the-safest-place-for-healthy-women-to-have-babies-an-obstetrician-thinks-twice-42654&source=gmail&ust=1464008583120000&usg=AFQjCNESgm726jrqftibVmOnncoJGtMdKw" href="http://theconversation.com/are-hospitals-the-safest-place-for-healthy-women-to-have-babies-an-obstetrician-thinks-twice-42654" style="color: #1155cc;" target="_blank">the faults and dangers in our current hospital maternity system</a></span></li>
<li class="MsoNormal" style="color: black; margin: 0px 0px 0.0001pt 15px; vertical-align: baseline;"><span style="font-size: 12pt;">And although they are still a small number, home births have doubled over the last decade.</span></li>
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<span style="color: black; font-size: 12pt;">The number of women giving birth at home is less than 2 percent of the 4 million or so annual births in the U.S. And yet, according to the </span><span style="font-size: 12pt;"><a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60696-6/fulltext&source=gmail&ust=1464008583120000&usg=AFQjCNGUnJCD-kSbWeuE797ooSNwXZpRww" href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60696-6/fulltext" style="color: #1155cc;" target="_blank">Lancet</a></span><span style="color: black; font-size: 12pt;">, America is only one of eight countries in the world where the maternal death rate is increasing, nearly </span><span style="font-size: 12pt;"><a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.cnn.com/2015/12/01/health/maternal-mortality-rate-u-s-increasing-why/&source=gmail&ust=1464008583120000&usg=AFQjCNEEljZ2-pTPz4767lWt1_Qx2trgIA" href="http://www.cnn.com/2015/12/01/health/maternal-mortality-rate-u-s-increasing-why/" style="color: #1155cc;" target="_blank">doubling</a></span><span style="color: black; font-size: 12pt;"> since 1987. These awful numbers are rising for a few reasons-- including that hospital births have become so medicalized that they often introduce complications into what is otherwise an unchanged ancient physiologic process -- not because home birth has taken off like a rocket.</span><span style="font-size: 12pt;"></span></div>
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<span style="color: black; font-size: 12pt;">All of the gains our healthcare system made throughout the 20th century to fight infection, perfect anesthesia and cesareans, and provide better prenatal care are being eroded because doctors are introducing complications that don’t need to exist. To be clear, I’m not here to bash doctors. They mean well and often practice in an environment of fear where the saying goes like this: <i>you get sued for the c-sections you don’t do, not the ones you do</i>. So the system is skewed toward intervention, which is now so common, it is one the key reasons why more American women are choosing to stay home! Oh, the irony. Another reason more moms are choosing to stay home is because the </span><span style="font-size: 12pt;"><a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/full&source=gmail&ust=1464008583120000&usg=AFQjCNHtFcIjwGPPdCZoqVfRKhYLJyJJww" href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/full" style="color: #1155cc;" target="_blank">data shows it is safe</a></span><span style="color: black; font-size: 12pt;">, especially for low-risk mothers, and </span><span style="font-size: 12pt;"><a data-saferedirecturl="https://www.google.com/url?hl=en&q=http://www.scienceandsensibility.org/p/bl/et/blogid%3D2%26blogaid%3D782&source=gmail&ust=1464008583120000&usg=AFQjCNFLD1bDthXD6MyEydCmjAoKAwz2NQ" href="http://www.scienceandsensibility.org/p/bl/et/blogid=2&blogaid=782" style="color: #1155cc;" target="_blank">even for those who have had a cesarean</a></span><span style="color: black; font-size: 12pt;">.</span><span style="font-size: 12pt;"></span></div>
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<span style="color: black; font-size: 12pt;">Instead of focusing on what hospitals and OBs could do to lower their complications in birth -- beginning with reducing the outrageous national cesarean rate in the double digits that is as high as 50 percent in some hospitals -- the author of this confusing out-of-the-blue-except-that-<wbr></wbr>she-is-promoting-a-book diatribe against homebirth instead chose to turn her sights on midwives who attend home births.</span><span style="font-size: 12pt;"></span></div>
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<span style="color: black; font-size: 12pt;">That angle makes me even more angry.</span><span style="font-size: 12pt;"></span></div>
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<span style="color: black; font-size: 12pt;">In the late 19th century, the all-male medical profession began launching campaigns to eradicate midwives. Massachusetts was at the forefront of this movement as we churned out doctors seeking to claim market share in childbirth. These campaigns portrayed midwives as illiterate, often because the women were immigrants who spoke languages other than English. And yet these midwives carried generations of wisdom and decades of hands-on practice that gave them the ability to gently ease breeches into the world or guide a mother into a position to minimize shoulder dystocia. As home birth midwives were pushed to the brink of professional extinction, this knowledge also faded. How has that helped women?</span></div>
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<span style="color: black; font-size: 12pt;">In the Netherlands and other countries that recognize the value of integrating home birth midwives into the maternal health care system, families have access to physician consult when needed, and smooth transfers from planned home births to the hospital during the small percentage (about 10 percent) of births where additional care is needed. In the U.S., this integration fluctuates widely. In some areas, physicians and midwives collaborate and transfers occur seamlessly, ensuring families receive the appropriate level of care when complications arise. In other communities, physicians refuse to consult with midwifery clients or families describe hostile treatment when they transfer to the hospital.</span></div>
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<span style="color: black; font-size: 12pt;">The bottom line is, the debate around home birth statistics as it has been portrayed in the mainstream media is only serving to confuse expectant parents trying to decide what is safest for their family. The headlines have focused on research highlighting the relative risk rather than the absolute risk, which is still quite small.</span><span style="font-size: 12pt;"></span></div>
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<span style="color: black; font-size: 12pt;">Continuing to blame midwives of any stripe for the lack of safety in the U.S. maternity care system is an utter farce. It is not the path to making birth safer. Women need more options, and more ways to integrate midwifery into mainstream care. Right now, midwifery lives in the realm of women who can pay for it like the luxury item that it is. That is also wrong. Expanding access to midwifery care -- whether at home or in the hospital -- benefits all of us.</span><span style="font-size: 12pt;"></span></div>
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Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com2tag:blogger.com,1999:blog-23685740.post-59032198356029003392014-09-25T05:17:00.001-07:002014-09-25T13:59:49.773-07:00 Changing the Climate around Birth: A Kickstarter campaign for 'Why Not Home?'<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="vertical-align: baseline; white-space: pre-wrap;">I'd like a share a guest post by Jessicca Moore,</span><span style="vertical-align: baseline; white-space: pre-wrap;"> a family nurse practitioner and filmmaker in Petaluma, CA, where she lives with her husband, two children, and two sheep. I met Jessicca in Boston recently, where she was screening a not-yet-finished feature-length documentary, “Why Not Home?” The film follows hospital birth providers who chose to give birth at home. You can watch a <a href="http://www.whynothome.com/">trailer</a> and get more information <a href="http://bit.ly/whynothome">here</a> to </span><span style="vertical-align: baseline; white-space: pre-wrap;">support the project on Kickstarter, as I did. </span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: 15px; line-height: 17.25px; text-align: left; white-space: pre-wrap;">(photo by Erin Wrightsman)</span></td></tr>
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<span style="vertical-align: baseline; white-space: pre-wrap;">By Jessicca Moore</span></div>
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<span style="vertical-align: baseline; white-space: pre-wrap;">Our current system of birth is unsustainable. A system that spends 111 billion dollars on maternity and newborn care annually is not sustainable. A 33% c-section rate, while sustainable in some sense, is not without significant consequence.</span></div>
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<span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">As a family nurse practitioner, I’ve done work in healthcare improvement over the past 10 years. “Every system is perfectly designed to get the results it gets,” is a common saying in improvement work. Keeping this in mind, it’s not surprising that we have ended up here. </span></div>
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<span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">I am not a conspiracy theorist. I don’t believe there is one player at fault. The factors at work in the system are complex. </span></div>
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<span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Instead of looking at hospitals, doctors, or insurers, I’m interested in how we as a culture have colluded with the system to sustain it and how we might change the cultural
conversation around birth. </span></div>
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<span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">Currently the message many women hear about birth is, “Birth is painful. You can’t do it. The experts know what to do, let them handle it.” What if instead women heard something like this, “Birth is an intense transition to motherhood. You are powerful and capable. You have everything you need within you to do this. If you need help, a trusted guide is here to help you.” </span></div>
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<span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">We live in a culture that values technology and progress, speed, efficiency, and expert advice. While these values have led to significant improvements in many areas of science and medicine, they don’t translate very well when it comes to birth. Our outcomes have made this evident. The judicious and appropriate use of technology is too often replaced with a one size fits all overuse of technology. Still, there is reason to hope. </span></div>
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<span style="font-family: Arial; font-size: 15px; vertical-align: baseline; white-space: pre-wrap;">There is a growing movement that questions these cultural assumptions and the way they are broadly applied. We have the power to change the climate around birth. We can choose to slow down and honor birth and it’s place in the family and community. We can do this at home and in the hospital while improving quality outcomes and the experience for women and families. </span></div>
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Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com1tag:blogger.com,1999:blog-23685740.post-74500619269541932092014-02-23T17:35:00.000-08:002014-02-23T17:52:11.353-08:00A Stack of Books<div dir="ltr" style="text-align: left;" trbidi="on">
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Just thought I would share a photo of the backstairs leading to my kitchen. They are painted to look like the covers of my two books -- Birth: The Surprising History of How We Are Born; and Jackie After O -- and the middle three that my husband Anthony Flint wrote. If you look closely, you'll see that there's room for one more. Taking bets as to which one of us will claim it. Regardless, we're grateful to Boston artist <a href="http://www.ohara-arts.com/">Jane O'Hara</a> for doing an amazing trompe l'oeil stack that makes our home even more special to us.</div>
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Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com1tag:blogger.com,1999:blog-23685740.post-75118411583725033442014-01-29T11:41:00.001-08:002014-01-29T11:41:42.582-08:00Why America Is at a Crossroads With Childbirth Education<div dir="ltr" style="text-align: left;" trbidi="on">
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Earlier this month, the closing of <a href="http://www.isisparenting.com/page/isisclosingrelease">Isis</a> shocked
families across all of its locations in Greater Boston, Dallas and Atlanta who
had come to depend on it as a place that supported their transition into
parenthood, from childbirth education, to lactation support and mommy-and-me
circle time. But despite a steady class
business, the company needed its retail sales to stay afloat, and online
encroachment from the likes of Diapers.com and Amazon spelled its doom.</div>
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<o:p></o:p></div>
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Meanwhile, on the West Coast, a chain called <a href="http://dayonecenter.com/">Day One Center</a> that also provided birth and
breastfeeding classes recently closed, too. It seems as though few companies
have figured out the right business model for birth-related support services in
the digital age.<o:p></o:p></div>
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Even single-store independents are not immune to the
struggle, from Crunchy Granola Baby in Salem, which closed in 2011, to Mothers
and Co. in West Boylston, which shuttered in 2012 and whose owner, Jeanette Mesite Frem, now
teaches in a cozy space above a pediatrician’s office.<o:p></o:p></div>
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While every business has its own nuances, do these failures
say something about what they are selling or our willingness to buy it or
perhaps both? What about the cultural shifts: more moms working who are too
busy to devote their time to classes, or the seismic technology changes
involving everything from online communities and YouTube pregnancy videos to
apps for timing contractions?<o:p></o:p></div>
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Historically, women never needed childbirth or lactation
classes because they would have been surrounded by other experienced women
throughout pregnancy, birth and the postpartum period, providing support
through each stage. In modern times, when birth moved from the home to the
hospital, women were cut off from that network’s information, leaving a void.<o:p></o:p></div>
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The first childbirth education class in the U.S. happened in
New York City, after American Marjorie Karmel gave birth in Paris attended by
Dr. Fernand Lamaze, who was famous for his principles of painless, natural
childbirth during a time when women were routinely heavily drugged during labor
in hospitals. Karmel came home to the U.S. and teamed up with Elisabeth Bing in
1960 to offer childbirth classes in an apartment on the Upper West Side. A
decade later, about 10 percent of hospitals sponsored prenatal classes. By 1975,
most did – as they do today. <o:p></o:p></div>
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“It was a consumer movement,” Bing told me in an interview
years ago in the very space where she taught thousands of parents how to handle
contractions. “The time was ripe. It was a time when the public doubted
everything their parents had done.”</div>
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<o:p></o:p></div>
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That is a very different mindset than today, where consumer
priorities seem to be less about questioning authority and more about having a
fancy stroller. In fact, only about one-third of all moms (59 percent of
first-timers) take birthing classes today, according to the Childbirth
Connection’s <a href="http://transform.childbirthconnection.org/wp-content/uploads/2013/06/LTM-III_Pregnancy-and-Birth.pdf">Listening
to Mothers III</a> report.<o:p></o:p></div>
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To have a big impact, about 75 percent of first time mothers
should have access to maternity classes, experts say. But even at a place like
Isis, where the classes were fed by a hospital referral pipeline, they could
not charge enough to keep the doors open. The lesson is that that either parents
don’t want to pay all that much for education, or they expect their health
insurance to cover it, like every other aspect of birth; and most insurance
will only pay a fraction of it. <o:p></o:p></div>
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“Right now, the way it’s covered through insurance, it’s not
highly valued either,” says Lamaze International executive director Linda
Harmon. “It doesn’t provide full fee for service.”<o:p></o:p></div>
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In addition to concerns about cost, expectant parents are
pressed for time. With many women giving birth later in life when they may be
more firmly established in their careers, making time for classes spread out
over several weeks may be too much. <o:p></o:p></div>
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And then there’s the internet. Blogs, websites, YouTube,
twitter, Facebook groups. It seems everyone is an expert or has experience to
share, which is great but can it really replace the personal touch that teaches
women about things they may not even know they should be Googling for?<o:p></o:p></div>
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Frem says no: “It’s hard to learn online for something so
physical and emotional.” While she has started a <a href="https://itunes.apple.com/ie/podcast/gutsy-mama/id756951901?mt=2">podcast</a>
and is considering video, she says her clients would rather meet wither in
person. <o:p></o:p></div>
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At the national policy level, there are pressures to improve
maternal and neonatal outcomes as well as lower costs by reducing cesarean
section rates and pre-term birth. Broader access to education would help achieve
all of those goals – but access to and interest in class-based education
appears to be waning. <o:p></o:p></div>
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Which begs the question: In the age of ‘massive open online
courses’ -- or MOOCs -- do we even need classes anymore?<o:p></o:p></div>
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Lamaze International, the nonprofit leader in childbirth
education that Elisabeth Bing co-founded, has been watching the cultural shift
and is now focused on “meeting women where they are,” Harmon said. That
includes their <a href="http://www.lamaze.org/PushForYourBaby">Push for Your
Baby</a> campaign; mobilizing social media to help mothers connect, which is
the channel through which many are asking for help; a blog that contains
evidence-based information; a 40-week education email; and even webinars. <o:p></o:p></div>
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“We’re pushing out information to reach them whether they
come to class or not,” Harmon said, adding that they are also committed to
teach sound business practices to independent teachers who leading classes in
converted barns, church basements and hospital meeting space.<o:p></o:p></div>
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Robin Elise Weiss, an author and heavily credentialed
childbirth educator, lactation consultant, doula and mother of 8, agrees that
embracing change is essential but says that there are benefits from
face-to-face sessions. <o:p></o:p></div>
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“It’s hard to teach relaxation through Facebook or twitter,”
she says, though she is an avid user of both and creates a Facebook group for
each class so they can teach each other. <o:p></o:p></div>
</div>
Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-43957546793133565502014-01-28T13:59:00.000-08:002014-01-28T13:59:07.974-08:0010 reasons why I am running the Boston Marathon<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM5uPF1oWOubc-H63PCLIABLwKAa-B8aDQMZBoWdAlowzdY2H03pcPKkg6BuY3-ObejDwwqeWRh_DejZWd34UakVozwKZOtTbwdPh4Ez6mGUNuaG3A7xJyIj_VV_G2GOyYBuiubA/s1600/marathon+pix.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiM5uPF1oWOubc-H63PCLIABLwKAa-B8aDQMZBoWdAlowzdY2H03pcPKkg6BuY3-ObejDwwqeWRh_DejZWd34UakVozwKZOtTbwdPh4Ez6mGUNuaG3A7xJyIj_VV_G2GOyYBuiubA/s1600/marathon+pix.jpg" height="640" width="358" /></a></div>
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<span style="text-indent: -0.25in;"> 1. Because I have two legs.</span></div>
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<span style="text-indent: -0.25in;"> 2. Because I am alive.</span></div>
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<span style="text-indent: -0.25in;"> 3. Because I don’t take #1 or #2 or so many other lesser things for granted.</span></div>
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<o:p></o:p></div>
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4. Because it’s for the <a href="http://www.teammr8.org/about/history">GREATEST possible cause</a>.<o:p></o:p></div>
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5. Because Boston is my home.</div>
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<span style="text-indent: -0.25in;"> 6. Because I’ve been a spectator for long enough.</span></div>
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<span style="text-indent: -0.25in;"> 7. Because if not now, when?</span></div>
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<span style="text-indent: -0.25in;"> 8. Because I’d like to experience a marathon as more than just a metaphor.</span></div>
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<o:p></o:p></div>
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9 9. Because I don’t want my sons’ most poignant marathon memory to involve a lock-down.</div>
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<span style="text-indent: -0.25in;"> 10. </span><span style="font-size: 7pt; text-indent: -0.25in;"> </span><span style="text-indent: -0.25in;">Because I need the exercise.</span></div>
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<o:p></o:p></div>
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Please consider donating any amount <a href="http://www.firstgiving.com/fundraiser/TinaCassidy/team-mr8-boston-marathon-2014">here</a> and join me in being an ambassador for peace.</div>
</div>
Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com1tag:blogger.com,1999:blog-23685740.post-6061733516469949632013-06-23T18:34:00.000-07:002013-06-23T18:34:51.959-07:00"Birth, Breath & Death:Meditations on Motherhood, Chaplaincy and Life as a Doula," a book by Amy Wright Glenn<div dir="ltr" style="text-align: left;" trbidi="on">
<img height="640" src="http://d188rgcu4zozwl.cloudfront.net/content/B00BUE242M/images/cover.jpg" width="449" /><br />
<br />
It's a slim memoir, about 100 pages long, but Amy Wright Glenn's memoir<a href="http://www.amazon.com/Birth-Breath-Death-Meditations-Motherhood/dp/1482079828/ref=sr_1_1?s=books&ie=UTF8&qid=1372037497&sr=1-1&keywords=birth+breath+and+death"> "Birth, Breath & Death,"</a> has stayed with me log after I finished it. The book is about how, as a young woman, she eschewed Mormonism to find her own spiritual path. She sought to understand all religions, and their commonality. She also put herself in challenging situations to learn about the two most important and spiritual aspects life -- the birth and death parts -- which many of us find too personal and difficult to face with others (or even ourselves.)<br />
<br />
Becoming a doula, even when she was unsure she wanted to be a mother herself, takes a wide-open mind and heart. Still, I can see why one might become a doula. To help a woman in labor is to be present at a miracle. But to help individuals and their family and friends meet the end is to surround yourself with sadness. That takes a kind of mettle that I cannot fathom, but am certainly grateful exists. Amy's willingness to confront death in many forms, with fortitude and grace, is mind-bending. The one exception to her willingness is when someone asks her to perform an exorcism. This scene becomes a form of comic relief in the book, though I don't think she wrote it to be funny.<br />
<br />
"We dance between form and formlessness," she writes. These words made me pause. Yes, so much exists before we are born and after we die. If we're not dancing in between we are wasting time.</div>
Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com1tag:blogger.com,1999:blog-23685740.post-69363130487093269862012-12-01T06:20:00.001-08:002012-12-01T06:20:05.627-08:00The Case for Midwives at Birth and Death<br />
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<a href="http://video.pbs.org/video/2291319164">Episode Four</a>
of Call the Midwife (see reviews of the other episodes below) was among the saddest yet, with a mother dying of <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001901/">eclampsia</a>, not
knowing her headaches were a classic sign of the affliction. Eclampsia remains
one of the most confounding mysteries in childbirth. No one really knows why it
occurs or how to prevent it. But the only way to end it is through delivering
the baby before the mother’s life is threatened. Unfortunately in this case, the baby was
delivered and the mom still died. The midwife who first met the mother – but never
had a chance to care for her – sat by her bedside as the woman lay dying, a
reminder that historically, midwives ushered in new life and ushered it out as
well. They typically cared for the ill and dying – not just pregnant women. There are “<a href="http://www.amazon.com/Art-Death-Midwifery-Introduction-Beginners/dp/1439229066">midwives
of death</a>” – hospice workers and others who help people pass peacefully at home. I
think we need more midwives at both ends of the spectrum of life.<o:p></o:p></div>
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<img src="http://www.rivershealingarts.com/images/Tunnel.jpg" /></div>
Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com4tag:blogger.com,1999:blog-23685740.post-6549808782987689452012-10-31T03:00:00.000-07:002012-10-31T19:00:04.589-07:00The Two Most Important Things in Episode Three of 'Call the Midwife'<br />
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<a href="http://video.pbs.org/video/2289885026/">Episode Three of PBS’ 'Call the Midwife</a>' was another great
show, with two interesting points relevant to the history of childbirth. (You can read my takes on <a href="http://tinacassidy.blogspot.com/2012/10/call-midwife-historical-guide-to.html">Episode One</a> and <a href="http://tinacassidy.blogspot.com/2012/10/breeches-and-rickets-lessons-from.html">Episode Two</a>, as well.)<o:p></o:p></div>
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First, an exuberant expectant husband who is craving
information about his wife’s pregnancy comes home with a book written by
Grantly Dick-Read (below), a British doctor who, like the midwives in the show, rode
around London’s poor neighborhoods on his bike in the fog to help deliver
babies. This was after World War I. Having grown up in the country surrounded by
farm animals, he watched many mammals give birth and approached a woman doing
the same without the fear that many other first-time mothers – and even
obstetricians – brought/bring to the process. He considered birth normal, not an
accident waiting to happen.</div>
<img height="267" src="http://www.bbc.co.uk/radio4/womanshour/02/media/Grantly-Dick-Read247.jpg" width="400" /><br />
His first book, Natural Childbirth, was published in 1933.
His second book, commonly called Childbirth Without Fear, came out in 1942 –
right at the time of America’s great migration of birth moving from the home to
the hospital. Many women, however, were shocked by how they were treated in the
maternity ward, and they embraced Dick-Read’s second book like a bible for how
to have a natural birth.<br />
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<o:p></o:p></div>
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He arguably set the stage for the natural childbirth
movement in American in the 1960s and ‘70s, though doctors Bradley and Lamaze
are more often associated with that time. <o:p></o:p></div>
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The second point of interest for me in the show was the
midwife’s use of a <a href="http://pregnancy.about.com/od/prenatalcare/ss/listeningtobaby_2.htm">Pinard
horn</a> (below), a low-tech but effective instrument for listening to the baby’s
heartbeat. </div>
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<img height="400" src="https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcRzofm3KokEJkHYbm2l2HFRl4LaBiWeHbEKAHvzOjp3Gm7Wbh8rIw" width="299" /></div>
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Even today, midwives like to use these – or the fetoscope (below) – because they
don’t pester the baby with bothersome noise like that which ultrasounds make
in-utero.<o:p></o:p></div>
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<img height="266" src="http://4.bp.blogspot.com/_0EsDVOhlY9E/TA6-hs6BnII/AAAAAAAAAvo/XSsvdpuqb1Y/s400/fetoscope+listening.jpg" width="400" /></div>
<br />Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-38042003617327639282012-10-30T08:33:00.002-07:002012-10-30T08:33:40.034-07:00Breeches and rickets: Lessons from Episode Two of the PBS Series Call the Midwife<br />
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<a href="http://video.pbs.org/video/2287561473/">Episode Two
of PBS’ Call the Midwife</a> gave us two births that most contemporary pregnant
women don’t have to deal with. (You can read my post on <a href="http://www.blogger.com/blogger.g?blogID=23685740#editor/target=post;postID=2554346377713289298">Episode One</a> here.)</div>
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<o:p></o:p></div>
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The show included a woman with rickets, which is a vitamin D
deficiency that was common among poor women who did not have a proper diet. The
affliction can cause bones to bend – often noticeable in bowed legs, as in below – but can
cause the pelvis to be misshapen as well. Sometimes the deformity could be so
bad that there was no way for a baby to be born vaginally.</div>
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<a href="https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcRlk-G_lLkdUkb5tVFHYr5oPxMPpEkr-fJoboal-m-A_xzEonpb" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://encrypted-tbn2.gstatic.com/images?q=tbn:ANd9GcRlk-G_lLkdUkb5tVFHYr5oPxMPpEkr-fJoboal-m-A_xzEonpb" /></a></div>
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The mom in Episode
Two had had a fatal outcome with a previous pregnancy but was able to have as
c-section this time around thanks to the National Health Service covering the
costs. If there is ever a time for a c-section, that would be it.<o:p></o:p></div>
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The other interesting birth was a breech, shown coming out
“ass first,” as nurse Chummy (below) deadpans
during the delivery. </div>
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<img src="http://www.mirror.co.uk/incoming/article188792.ece/ALTERNATES/s615/Miranda+Hart+as+Chummy+Browne+on+Call+the+Midwife" /></div>
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The scene shows how breeches can be born safely if
patience, wisdom, experience and the right birth positions are applied. Today,
sadly, very few women with breech babies are allowed to give birth vaginally by
their doctors – mostly due to a lack of experience in knowing how to gently
guide the baby out. It’s an artful midwifery practice we are losing – and shouldn't. I’ll leave it to the sage midwife <a href="http://www.inamay.com/article/undervalued-art-vaginal-breech-birth-skill-every-birth-attendant-should-learn">Ina
May Gaskin to explain why</a>. <o:p></o:p></div>
Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com3tag:blogger.com,1999:blog-23685740.post-25543463777132892982012-10-29T07:30:00.001-07:002012-10-30T08:36:01.675-07:00Call the Midwife: A historical guide to outdated birth practices<br />
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<img height="273" src="https://encrypted-tbn3.gstatic.com/images?q=tbn:ANd9GcQo9wukg13sDqjlc68L9hS2qA7mQ-GYfSnGgEkgcFZezutdr9ai" width="400" /></div>
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<a href="http://www.pbs.org/programs/call-the-midwife/">Call the Midwife</a> on PBS is not only a well-written show based on a
real-life British midwife’s work in the years shortly after WWII in London’s
East End. It is also an excellent way to understand the true nature of
midwifery, how childbirth has changed, and how it has not. I’ll be posting
several pieces about the series as it unfolds.<o:p></o:p></div>
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One thing that is fascinating to me is seeing birth
anachronisms – methods and instruments that are no longer used (for good or
bad). And <a href="http://video.pbs.org/video/2284744812">Episode One</a> contains a wealth of examples. First, the midwives give
mothers enemas. This practice thankfully fell out of favor decades ago. The
rationale behind them was that by cleaning out the mom, the baby would have
more room to maneuver and help the labor progress more quickly (as well as prevent soiling during labor). The technique was
called “high, hot and a hell of lot,” referring to where to hold the container
of hot water and how much to use. But enemas can be painful during labor and they were found to be of <a href="http://summaries.cochrane.org/CD000330/enemas-during-labour">no benefit</a>.<o:p></o:p></div>
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Episode One also contains a scene with<a href="http://summaries.cochrane.org/CD001236/routinely-shaving-women-in-the-area-around-the-vagina-on-admission-to-hospital-in-labour"> pubic hair shaving</a>,
which midwives and doctors used to do in an effort to make the area more antiseptic.
However, many studies later revealed that small nicks from shaving actually introduced
germs into the mom’s bloodstream and could cause infection, so it is no longer
recommended, except sometimes in c-sections. Phew.<o:p></o:p></div>
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Finally, perhaps the most awful of all of the outdated
interventions seen in Episode One is the episiotomy – a scene that will make
anyone cringe! -- where a cut is made to make the birth opening larger. These
were once routine, but again, many scientific studies have debunked the method,
showing that introducing a cut could make a mother<a href="http://www.nlm.nih.gov/medlineplus/ency/article/002920.htm"> tear more deeply and have more pain later </a>when she
might not tear at all if left alone.<o:p></o:p></div>
Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com2tag:blogger.com,1999:blog-23685740.post-50920178439792492232012-08-22T06:55:00.000-07:002012-08-22T06:55:06.847-07:00Understanding Pelvic Organ Prolapse and Its Treatment Options<br />
<div class="MsoNormal">Below is a guest post about pelvic organ prolapse, which recalled for me some historical case studies where uneducated birth attendants would, after the baby was born, yank on an umbilical cord to remove the placenta more quickly, and cause the uterus to come out as well. At the Mutter Museum in Philly, devoted to medical oddities, there were even some gruesome examples of what women had to use as pessaries (including potatoes)!</div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Anyway, good information and sound advice below, especially as it relates to "mother directed pushing," which means, you push -- or don't push -- as your body feels most comfortable; not when someone else tells you to.</div><div class="MsoNormal"><b><br />
</b></div><div class="MsoNormal">GUEST POST:</div><div class="MsoNormal"><br />
</div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidayw0CIOXH0OQ5QfRi08_2HBfjF-wibXss-1ky03uzLWkpRcTxyVQNXxDfIcIjZACwmjtxtLtIlCv2bTr8iM4ikEVKj6qQMSp_0pjPU0EQ-EQBCVu6sskf17r9LV6DpUhiWQrow/s1600/prolapse.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidayw0CIOXH0OQ5QfRi08_2HBfjF-wibXss-1ky03uzLWkpRcTxyVQNXxDfIcIjZACwmjtxtLtIlCv2bTr8iM4ikEVKj6qQMSp_0pjPU0EQ-EQBCVu6sskf17r9LV6DpUhiWQrow/s320/prolapse.jpg" width="320" /></a></div><div class="MsoNormal">Pelvic Organ Prolapse (POP) is a common condition that affects women between the ages of 50 and 70. In fact, approximately 50 percent of women will be diagnosed with the condition during menopause, when decreasing estrogen levels cause pelvic tissues to become thinner and weaker. The symptoms of POP range from very mild to severe, as do the treatment options. It is important that women understand what POP is, how it can be prevented, and the variety of treatment options available. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Some treatments are significantly more risky than others, so women should become educated to understand the risks and benefits associated with each.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>Pelvic Organ Prolapse<o:p></o:p></b></div><div class="MsoNormal">Although decreasing estrogen levels during menopause can be the final trigger for POP, there are additional contributing factors. The primary causes of POP are pregnancy and childbirth, although smoking, obesity and a genetic predisposition can also lead to a diagnosis of POP. The condition occurs when weakened pelvic tissues begin to sag, or drop, in the pelvic cavity. In mild cases of POP, a woman will not experience any symptoms. Her doctor usually diagnoses it during a <a href="http://www.womentowomen.com/sexualityandfertility/routinepappelvicexam.aspx">routine pelvic exam</a>. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">In moderate to severe cases, connective tissues will begin to detach from the pelvic structure, causing pelvic organs to drop completely and begin to prolapse into the vaginal canal. The organs most commonly affected by POP include the bladder, uterus and rectum.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Some symptoms of POP include:<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> -- </span></span>an inability to insert a tampon<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> -- </span></span><!--[endif]-->a feeling of bulging, or sagging, in the pelvic cavity or vagina<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> -- </span></span><!--[endif]-->difficulty beginning to urinate and/or weakened urine stream<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> -- </span></span><!--[endif]-->unusual constipation<o:p></o:p></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> -- </span></span><!--[endif]-->pain or discomfort during intercourse<o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="mso-list: l1 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> -- </span></span><!--[endif]-->spotting or light bleeding<o:p></o:p></div><div class="MsoNormal"><b><br />
</b></div><div class="MsoNormal"><b>Preventing Pelvic Organ Prolapse<o:p></o:p></b></div><div class="MsoNormal">There is evidence that POP can be prevented — or the symptoms can be significantly reduced — by maintaining a healthy weight, eating well, exercising and quitting unhealthy habits such as smoking. Women who are pregnant should discuss "Mother-Directed Pushing," as well as their options for delivery positions during their labor. Research has shown that working with a woman's natural birth physiology can reduce conditions like POP and incontinence.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">Kegel exercises are also beneficial in promoting pelvic floor health. Women who do Kegel exercises on a daily basis during and after pregnancy have a lesser chance of developing incontinence and/or POP later on.<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal"><b>Treatment for Pelvic Organ Prolapse<o:p></o:p></b></div><div class="MsoNormal">Once POP has been diagnosed, women should discuss treatment options with their doctor. They should try non-invasive methods before opting for more risky surgical interventions. Non-invasive methods include:<o:p></o:p></div><div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> --</span></span>Physical therapy</div><div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><span style="text-indent: -0.25in;"> -Electrical stimulation of pelvic floor muscles</span></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><o:p></o:p></div><div class="MsoListParagraphCxSpLast" style="mso-list: l0 level1 lfo2; text-indent: -.25in;"><!--[if !supportLists]--><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;">·<span style="font-family: 'Times New Roman'; font-size: 7pt;"> --</span></span><!--[endif]-->Vaginal pessary<o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">More invasive methods should only be used for moderate to severe cases of POP in which symptoms are uncomfortable and/or debilitating. One surgical method used to correct POP uses a material called <a href="http://www.drugwatch.com/transvaginal-mesh/">transvaginal mesh</a>. It has been linked to thousands of cases of severe health complications. The mesh product can erode into vaginal tissues, causing pain, infections and even organ punctures (organ perforation). These complications can be impossible to reverse. <o:p></o:p></div><div class="MsoNormal"><br />
</div><div class="MsoNormal">There are alternatives to transvaginal mesh surgeries that can be successful in treating POP. Women should discuss their full range of surgical options before choosing the safest and most effective treatment for their symptoms. <o:p></o:p></div><div class="MsoNormal"><br />
<b><i>Author Bio:</i></b><i> </i><i>Elizabeth Carrollton writes about defective medical devices and medication safety for </i><a href="http://www.drugwatch.com/"><i>Drugwatch.com</i></a><i>.</i><o:p></o:p></div>Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com2tag:blogger.com,1999:blog-23685740.post-90157638860774721002012-04-29T15:06:00.002-07:002012-04-29T15:07:28.715-07:00Raw milk maniaThere is an <a href="http://www.newyorker.com/reporting/2012/04/30/120430fa_fact_goodyear">excellent article</a> in the current issue of the New Yorker on raw milk, chronicling how the feds are cracking down on the sale of the unpasteurized variety.The story, focused on a "milk trafficking gang known as the Rawesome Three" in California, posits that raw milk is the new 'pot.'<br />
<br />
As I wrote in my book -- and this piece points out -- pasteurization came about because of swill dairies in the mid-19th century; cows were fed the grain leftover from whiskey production. That milk was making children sick. Pasteurization was the cure. And the concept became embedded in our culture.<br />
<br />
After reading how federal agents were dumping out thousands of gallons of raw milk in their raids, it made me think: Aren't soda, Twinkies and cigarettes all more dangerous in the long term? Why aren't they illegal? (Actually, raw milk IS LEGAL in California)...So, instead of ranting, I will just say this:<br />
<br />
Here's my jug.<br />
<br />
<img src="http://sphotos.xx.fbcdn.net/hphotos-snc6/252174_10150395199584502_634264501_10338581_7894014_n.jpg" />
<br />
Come and get me.Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-89648414812619150822012-04-26T17:52:00.000-07:002012-04-26T18:33:55.171-07:00Why becoming a doula is important now<br />
<div class="Standard">
Today, I present a guest post from Gina Forbes, the Workshop Coordinator at<a href="http://www.tolabor.com/"> toLabor.</a><br />
<span style="color: #cc33cc; font-family: arial, sans-serif; font-size: x-small;"><b><br /></b></span></div>
<div class="Standard">
Becoming a doula is important now, more than ever. With the current political climate and the
recent attacks on women's health care and civil rights, it seems very clear
that this is a precarious time in American culture. Yet, I also feel that we are on the cusp of
something bigger and better. Every day,
I learn about more individuals making greener, healthier choices for themselves
and the planet. People are beginning to
rise up and live consciously. This gives
me hope.<o:p></o:p></div>
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<br /></div>
<div class="Standard">
As a birth advocate, doula, childbirth educator, and Workshop
Coordinator for toLabor, I have thought long and hard about the role of a doula
in this cultural and consciousness shift.
What is the greater significance of being a doula?<o:p></o:p></div>
<div class="Standard">
<br /></div>
<div class="Standard">
The answer is this:
that EVERY person deserves to have autonomy over their bodies, their babies,
their families, and their choices. It is
a human right, a civil right. Every
person who becomes pregnant, gives birth, and becomes a parent deserves to have
high-quality, loving and compassionate care around this incredible time in
their lives. Doulas are people who are
trained to respect that principle as the basis for all other work they do in
their role as birth professionals.
Doulas ideally embody the role of empowered human being, facilitating a
process of transformation and support for each and every client. No matter what the birth experience looks
like, doulas should be there to create the space for their clients to claim
their choices, their autonomy, and their unique voice. If done successfully, this paves the way for
those individuals to become empowered, healthy, confident parents, which will
have a direct impact on the quality of future generations' lives. Birth matters!<o:p></o:p></div>
<div class="Standard">
<br /></div>
<div class="Standard">
I am an advocate for toLabor, the Organization of Labor
Assistants for Birth Options and Resources, because toLabor exemplifies these
beliefs in their doula training and certification program. <span style="color: #222222; font-family: 'Trebuchet MS', sans-serif; font-size: 9.5pt;"> </span><span style="color: #222222;">toLabor
aims to return the focus of control to the laboring woman, to create the space
and support for her to have her own voice, to be included and central in her
birthing process. toLabor understands
the importance of empowering families, honoring birth, and changing lives. <br />
<br />
</span><o:p></o:p></div>
<div class="Standard">
<em><span style="color: #222222;">Join
the Community of Change</span></em><span style="color: #222222;">.</span><o:p></o:p></div>
<div class="Standard">
<br /></div>
<div class="Standard">
toLabor will be having a doula training workshop in Jamaica
Plain, MA on May 18-20. For more
information on that workshop, please contact local sponsor Catherine
McKeown-Lindsey at <a href="mailto:catstamatos@yahoo.com"><span style="color: windowtext; text-decoration: none;">catstamatos@yahoo.com</span></a>
or at 617-817-5397. For other workshop
listings and more information on toLabor, please visit the website at <a href="http://www.tolabor.com/"><span style="color: windowtext; text-decoration: none;">www.tolabor.com</span></a>.<o:p></o:p></div>
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<br /></div>
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<br /></div>Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com3tag:blogger.com,1999:blog-23685740.post-38520169405970466832012-02-23T18:25:00.000-08:002012-02-23T18:25:41.820-08:00My birth book recommendationsI have a bunch of friends who are expecting babies soon, inspiring me to write about some of my favorite books on the topic of childbirth. <br />
<br />
I read alot when I was pregnant. Mostly the fear mongering stuff, like What to Expect When You're Expecting. In the end, it didn't serve me as well as I would have liked. Which is why I wrote <a href="http://www.amazon.com/gp/product/0802143245/ref=s9_simh_gw_p14_d0_g14_i1?pf_rd_m=ATVPDKIKX0DER&pf_rd_s=center-2&pf_rd_r=1GTQWMGCWB5ZPV1EBT1Z&pf_rd_t=101&pf_rd_p=470938631&pf_rd_i=507846">Birth: The Surprising History of How We Are Born</a>, to put the whole process into historical and cultural context.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzw1a8c372vH8dEfuXM5O-PiiIrBgXURZg8uOLgaMA_KvAI2OUGuqoHENjgPsZ41crpcDFUJQ5WVgy2aV9MY7ue3SQFjVBLRyjTN_8n0N6SyJ2uy_aN5iBmQpxzhuj6QOaIU41Uw/s1600/birth+book.JPG" imageanchor="1" style="margin-left:1em; margin-right:1em"><img border="0" height="320" width="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzw1a8c372vH8dEfuXM5O-PiiIrBgXURZg8uOLgaMA_KvAI2OUGuqoHENjgPsZ41crpcDFUJQ5WVgy2aV9MY7ue3SQFjVBLRyjTN_8n0N6SyJ2uy_aN5iBmQpxzhuj6QOaIU41Uw/s320/birth+book.JPG" /></a></div><br />
<br />
<br />
Still, there are many more books that I wish I could have availed myself to. They include: <a href="http://www.amazon.com/Your-Best-Birth-Discover-Experience/dp/0446538132/ref=sr_1_1?s=books&ie=UTF8&qid=1330049653&sr=1-1">Your Best Birth</a>, By Ricki Lake and Abby Epstein, the names behind the excellent film The Business of Born; <a href="http://www.amazon.com/Baby-Catcher-Chronicles-Modern-Midwife/dp/B0009Q002I">Baby Catcher: Chronicles of a Modern Midwife</a>; <a href="http://www.amazon.com/Doula-Guide-Birth-Secrets-Pregnant/dp/0553385267/ref=sr_1_1?s=books&ie=UTF8&qid=1330049811&sr=1-1">The Doula Guide to Birth</a>, by my friend Rachel Zimmerman and her doula, Ananda Lowe; and <a href="http://www.amazon.com/Birth-House-Novel-P-S/dp/0061135879">The Birth House</a>, by Ami McKay (the only novel in the bunch.)Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-74848382735095539702012-01-09T20:26:00.000-08:002012-01-09T20:29:45.165-08:00A birth, a boy and a bookEight years ago today, on a sub-zero morning of a full moon, my son was born by unexpected c-section. He was fine. I was upset. My husband, then a journalist, shell-shocked from witnessing the cutting, cauterizing, puking, shaking and stitching, wondered if any of it had been necessary and defaulted to skeptical reporter mode, asking the obstetrician a question when I had finally been wheeled into recovery.<br />
<br />
"What," he asked her, "would you have done in this situation 500 years ago?"<br />
<br />
I was groggy but overheard the gruesome answer that she delivered to him at the foot of my bed.<br />
<br />
Her response generated more questions and my resolve to find out if what she said was true. I spent many therapeutic and enlightening hours in the rare books department at various libaries, pulled shifts in hospital maternity units, and devoted a great deal of time interviewing academics, midwives, doulas, nurses and parents, processing information for myself and what would become my book, <a href="http://www.amazon.com/Birth-Surprising-History-How-Born/dp/0871139383">Birth: The Surprising History of How We Are Born</a>.<br />
<br />
<br />
For these last eight years, Jan. 10 has been a day of reflection for me on becoming a mom and an author -- simultaneously. This year, I am noticing that my son is no longer a baby and the c-section scar, a thick keloid that looked like a frown when viewed from above, is almost imperceptible. <br />
<br />
Finally.Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com6tag:blogger.com,1999:blog-23685740.post-80117859449272793542011-12-08T03:43:00.000-08:002011-12-08T03:50:57.512-08:00A birthday thanksToday is Harrison's birthday. Four years ago, he was born in a pool of water (chronicled <a href="http://tinacassidy.blogspot.com/2008/03/our-new-baby-installment-30.html">here</a>) in his bedroom at our home in Boston, a VBAC attended by an amazing midwife, Deborah. As I do every year on this day, I say thank you to her for guiding me through one of the most amazing experiences of my life. This is a <a href="http://tinacassidy.blogspot.com/2009/01/little-poem.html">poem</a> I wrote about her.Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-83509467593003485072011-10-26T19:22:00.000-07:002011-10-26T19:26:09.166-07:00More Business of Being BornI wanted to pass along the brand new trailer for More Business of Being Born from Executive Producer Ricki Lake and Filmmaker Abby Epstein. This release follows their landmark documentary, The Business of Being Born, with a four part DVD series that continues their provocative and entertaining exploration of the modern maternity care system. More Business of Being Born, available November 8th, offers a practical look at birthing options as well as poignant celebrity birth stories from stars including Alanis Morissette, <a href="http://tinacassidy.blogspot.com/2010/02/gisele-and-home-birth.html">Gisele Bundchen</a>, Christy Turlington-Burns, Cindy Crawford, Molly Ringwald, Laila Ali, Kimberly Williams-Paisley and Melissa Joan Hart. Part 4: The VBAC Dilemma is currently available for rental on demand. You can watch a trailer <a href="http://www.youtube.com/watch?v=vJTN88Zv0_M">here</a>.<br />
<br />
As part of the cast of the first film, I was excited to <a href="/http://tinacassidy.blogspot.com/2007/04/business-of-being-born.html">go to its debut </a>at the Tribeca Film Festival, unexpectedly pregnant. The film confirmed my decision -- and my husband's decision -- to have a home birth. Here's what I wrote about some of the <a href="http://tinacassidy.blogspot.com/2008/01/business-of-being-born-reviews.html">reviews</a> of the original film.Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-5525799716690713992011-10-24T17:45:00.000-07:002011-10-24T17:45:19.348-07:00An amazing birth-artifactThis is an amazing image for two reasons: First, it was found by <a href="http://www.newscientist.com/blogs/shortsharpscience/2011/10/first-western-childbirth-image.html">a man who is legally blind</a>. Second, it shows a common position women gave birth -- standing up, supported by ropes or vines -- before doctors determined it was more convenient for women do to deliver on their backs. Which, it turns out, is the worst possible position because it is more difficult for both baby and mother. Thanks to Carey Goldberg at the CommonHealth Blog for pointing it out to me. <br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix7vfcq5vkz6lpZM4zubg3pEepYJpbCRzR-i-2S6lIkJFhfcLKfRAioWp4kkM-U0gXzq578hy9zz-x2_7iTTwFUDy-FDmw-VOvztrqNpTk-gn-mNgScdUFwlDqtBOSB0OC4jOV1A/s1600/Etruscan-pic-1.jpg" imageanchor="1" style="clear:left; float:left;margin-right:1em; margin-bottom:1em"><img border="0" height="213" width="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEix7vfcq5vkz6lpZM4zubg3pEepYJpbCRzR-i-2S6lIkJFhfcLKfRAioWp4kkM-U0gXzq578hy9zz-x2_7iTTwFUDy-FDmw-VOvztrqNpTk-gn-mNgScdUFwlDqtBOSB0OC4jOV1A/s320/Etruscan-pic-1.jpg" /></a></div>Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com1tag:blogger.com,1999:blog-23685740.post-77363879095409158252011-10-21T13:17:00.000-07:002011-10-21T13:37:31.499-07:00Carla Bruni-Sarkozy gives birth -- without the president thereCarla Bruni-Sarkozy <a href="http://www.dailymail.co.uk/news/article-2050948/Carla-Bruni-Nicolas-Sarkozy-celebrate-birth-baby-girl-Paris.html">gave birth </a>this week to a girl, but her husband wasn't there -- he was busy jetting off to Germany to meet Angela Merkel on important business. Fair enough. Or is it? I quickly received a couple calls from journalists asking what I thought.<br />
<br />
Throughout all of human history in almost every culture, until the last 30-50 years, men never witnessed the births of their babies. They didn't want to see it and the mothers didn't see the upside of having them there. Before birth moved from the home to the hospital in the early 20th Century, moms typically had a gaggle of other women and a midwife to support her through labor. Men were considered useless and it was not their place. This changed when birth moved to the hospital because suddenly women were often left to labor alone -- with the obstetrician stepping into the room at the last minute. This trend made women crave support -- and fathers, being family, were the only ones hospitals would allow, even if it took lawsuits to open the gates. (P.S. If the mother and father weren't married, hospitals initially refused to allow him to witness the birth. Lawsuits changed this practice, too.)<br />
<br />
Despite that history, men are now expected to attend the births of their babies. Which is great, if they want to be there and the mother wants them to be. <br />
<br />
But there are many dads who are squeamish, fight with staff, or freak out the mother. If the mother has other support -- and she always should -- and if she doesn't mind him not being there, fine. It may be best for everyone.<br />
<br />
As for Sarkozy, he's left with a public perception problem. Is Angele Merkel more important than your wife? Did this birth seem less important than those with your previous wives? At the very least, when he did show up at the clinic, he should have brought flowers.Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-35376331860515247922011-07-19T18:53:00.000-07:002011-07-19T19:00:44.988-07:00Regulating midwivesBelow is the written testimony I provided today during a hearing for a bill that would essentially sanction home birth midwives in Massachusetts -- some home birth midwives.<br />
<br />
Good morning. My name is Tina Cassidy. Some of you may recall that I spent many years here in this building as a member of the Boston Globe’s State House Bureau, covering many of these sorts of hearings. If I learned anything from that experience relevant to the task before me today – it’s do your research, keep it brief, and make your case clearly. So stop me if I fail on any of those points.<br />
<br />
First, I wholeheartedly support the concept of what you are trying to achieve with <a href="http://www.malegislature.gov/Bills/187/Senate/S01133">House Bill 2368</a>. Anything that promotes midwifery care – especially out of hospital midwifery care -- is good for women’s health, and the health care system, because better care can be provided for much less. Numerous rigorous studies prove this to be true.<br />
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I also support this bill’s mandate that out-of-hospital births be covered by insurance for the reasons stated above. In the UK, the government is actually encouraging more women to give birth at home as part of the National Health System because they, too, understand the benefits of home birth, not just for women but for all of society – and the public coffers.<br />
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However, I am dismayed that in an attempt to “allow” homebirths, this bill prevents women from choosing a lay midwife, a person who could have more experience and more knowledge than those who are regulated. That is something I viscerally oppose.<br />
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At a minimum, this bill prevents many worthy and wise women from practicing an ancient tradition – a deeply respectable and important tradition as old as human history – a tradition that stopped about 100 years ago when medical colleges in the US began churning out “educated” doctors ready to deliver babies without having ever seen an actual birth. But those male doctors were regulated. The midwives, with millennia of hands-on practice, were not, and they were forced to the brink of extinction, with mothers paying the consequences when that continuum of knowledge passed on from generation to generation was all but lost. Want to know how to naturally deliver a breech baby? Ask a midwife.<br />
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I urge you today, please don’t have this bill be referendum on one lawsuit, or one midwife, or one story about a birth that went awry. Sadly, bad outcomes happen with even the best doctors with years of practice and all the technology money can buy. There are fantastic doctors in this room who have said, it’s not whether, it’s when. <br />
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When women choose a lay midwife, they often do it with far more research than a woman choosing an obstetrician. I say this from experience – as someone who was a first-time pregnant busy journalist who blindly chose the first OB with an opening for an appointment – and ended up a statistic in America’s unabiding cesarean epidemic, attended by a doctor whose definition of “normal birth” becomes more constricted every year, due to increasingly onerous guidelines and rising malpractice premiums.<br />
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For my second birth, I would have been blessed to have any of the certified professional midwives in this room attend the home birth. But the midwife I choose was a lay practitioner, someone I deeply trusted and connected with. She supported me emotionally and physically during an amazing and gentle experience, as well as in the weeks postpartum. It was blue chip care that I was willing to pay for out of my own not very deep pockets. <br />
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As she supported me, I am here to support her and others like her. In an effort to allow greater access to midwifery care, please don’t limit it.<br />
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Doing such will only drive underground those practitioners who are not CPMs and lead to the persecution of women who choose them. <br />
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Finally, please accept this additional written testimony – a chapter on the history of midwifery – from my book, Birth: The Surprising History of How We Are Born. It tells the story of the role that Massachusetts played in the near-final crusade against midwives. I believe if we don’t understand history we are doomed to repeat it.<br />
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Thank you so much for your hard work on this important issue.<br />
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Tina CassidyTina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com4tag:blogger.com,1999:blog-23685740.post-36207575645646992472011-02-16T08:57:00.000-08:002011-02-16T09:03:14.770-08:00Benefits of Continuous Support in LaborPress release RE:continuous labor support leads to lower c-section rates and better outcomes for moms and babes. http://tinyurl.com/4c5pojv<br /><br />FOR IMMEDIATE RELEASE - 11 am ET, February 16, 2011<br />Continuous Labor Support Reduces Risk of Cesarean Section and Other Adverse Outcomes in Women and Newborns<br />Type of Caregiver Can Make a Big Difference in Labor Experience <br /><br />New York NY — Women who labor with a dedicated support companion are less likely than women without such support to experience a series of risky birth procedures, according to a review published in the current issue of The Cochrane Library. The comprehensive study of experiences of 15,061 women who participated in 21 randomized controlled trials confirms previously known benefits for maternal health, identifies an additional benefit for newborns, and finds no downsides. The study was carried out through the prestigious Cochrane Collaboration, an independent international organization that prepares and keeps up to date rigorous systematic reviews of evidence from the best available studies.<br /><br />Overall, women who received supportive care from a companion throughout labor were less likely than women without such support to have a cesarean section, to use narcotics or any other pain medication, to use regional pain medication such as epidural analgesia, to give birth with vacuum extraction or forceps, and to rate their childbirth experience poorly. Having continuous support shortened labor and increased the likelihood of having a “spontaneous” birth with neither cesarean nor vacuum extraction nor forceps. These results confirm previous research. With the inclusion of six new randomized controlled trials, the present systematic review, identified another benefit of continuous labor support: reduced likelihood of a baby with a poor “Apgar score” rating of well being five minutes after birth. The authors conclude that all women should have continuous support while giving birth.<br />Ellen D. Hodnett, RN, PhD, Professor and Heather M. Reisman Chair of Perinatal Nursing Research, University of Toronto, and co-authors of “Continuous Support for Women During Childbirth” limited the study to randomized controlled trials. This type of research helps ensure that study groups are similar and that results are a true reflection of the effects of the care being studied — here, continuous labor support.<br /><br />“Cesarean section, vacuum extraction and forceps, and pain medications are interventions that increase the likelihood of adverse short- and longer-term effects in women and babies. Continuous labor support is an important way for women to avoid overuse and harms of these practices, and to have a positive experience at this special time,” said Carol Sakala, PhD, MSPH, Director of Programs at Childbirth Connection. Dr. Sakala is a co-author of the report.<br /><br />Supportive care during labor and birth does not involve clinical care, and may include:<br />• helping women with physical comfort<br />• providing emotional support<br />• offering information<br />• helping women communicate their wishes to caregivers<br />• engaging women’s husbands or partners, as desired by the couple.<br /><br />Impact Depends on Type of Caregiver<br />The study provides new knowledge about effects of continuous labor support under different conditions. A major finding is that the impact of this care appears to differ, according to the type of person providing the care. Effects were strongest when the caregiver was neither a member of the hospital staff nor a person in the woman’s social network, and was present solely to provide one-to-one supportive care, such as a doula. Compared with women who had no continuous support, women with companions who were neither on the hospital staff nor in the woman’s social network were:<br />• 28% less likely to have a cesarean section<br />• 31% less likely to use synthetic oxytocin to speed labor<br />• 9% less likely to use any pain medication<br />• 34% less like to rate their childbirth experience negatively.<br />When compared with no continuous support, continuous support by members of the hospital staff did not appear to reduce the likelihood of having a cesarean section or improve ratings of the childbirth experience and may have increased the likelihood of using synthetic oxytocin. These results may reflect the fact that hospital staff can experience divided loyalties, additional duties, and constraints of institutional policies when providing continuous support. Continuous support from a person in the mother’s social network (for example, her partner, husband, other relative, or friend) appeared to increase the mother’s satisfaction with her childbirth experience, but did not seem to impact her likelihood of undergoing a series of labor and birth interventions.<br /><br />Background<br />Historically, laboring women routinely received support from female companions. However, more recently in hospitals worldwide, continuous labor support has become the exception rather than the norm. “There is concern about widespread dehumanization of women’s birth experiences,” said Dr. Hodnett. “Concern about institutional routines, high rates of intervention in healthy women and newborns, limits on women’s autonomy and control, unfamiliar personnel, and lack of privacy is leading to calls for making continuous labor support widely available to childbearing women.”<br /><br />Leading options for continuous labor support in the United States include trained labor support companions known as doulas and — for satisfaction with the childbirth experience — the help of a friend or family member who is invited to be present when a woman gives birth. Childbirth Connection’s second national Listening to Mothers survey found that just 3% of women who gave birth in U.S. hospitals in 2005 experienced the most beneficial type of labor support, in the form of doula care. Although insurance coverage of doula services is limited, trained doulas are available in many communities throughout the United States. Typically, a woman (and her partner, if she has one) selects a doula during pregnancy, and they discuss the woman’s goals, preferences, and concerns. Some hospitals sponsor doula programs to increase access to continuous labor support. In addition to continuous presence during labor, birth doulas may provide some support in the days after birth.<br />“Hiring a doula was one of the best decisions my husband and I made during pregnancy,” said new mom Jenny McElroy. “Though we prepared by reading books, taking childbirth classes, and practicing comfort techniques, we were inexperienced with childbirth. Our doula knew exactly how to help my husband support me, help me cope with the pain, and help us stay calm and have the birth experience we wanted.”<br /><br />Effective Strategy for Improving Maternity Care Quality and Value<br />Medicaid programs and taxpayers cover about 42% of the nation’s births, and private insurers and employers cover about half. The review authors encourage policy makers to provide coverage and hospitals to provide programs for continuous labor support. “The benefits of continuous labor support for mothers and babies are numerous, well established, and compelling, and warrant economic analyses of the relative costs and benefits,” said Maureen Corry, MPH, Executive Director of Childbirth Connection. “Medicaid programs and others seeking ways to improve maternity care quality and value and women’s experiences of care should consider continuous labor support as a key component of a high-quality, high-value maternity care system.”<br /><br />Resources for Childbearing Women, Health Professionals and Policy Makers<br />Childbirth Connection’s website includes an in-depth evidence-based section to help childbearing women understand the benefits of continuous labor support, decide whether to have a continuous labor support companion, and arrange for such care (see www.childbirthconnection.org/laborsupport/). The professional area of the website includes a summary of results of the updated review and provides access to the full review, at www.childbirthconnection.org/laborsupportreview/.<br /># # #Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-80815823975122498172010-06-20T19:52:00.000-07:002013-01-23T03:22:37.162-08:00Random thoughts on Father's Day<div dir="ltr" style="text-align: left;" trbidi="on">
Dictionary.com's word of the day today was <a href="http://dictionary.reference.com/wordoftheday">couvade</a>, and quoted a sentence from my book to describe what it means. A fitting word for Father's Day.<br />
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I also heard from my friend Jeanette, who said she was watching the film "Being Dad," a good flick for fathers-to-be. I recommend it.<br />
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Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0tag:blogger.com,1999:blog-23685740.post-50737217825487938002010-02-04T08:08:00.000-08:002010-02-04T08:19:40.027-08:00Gisele and home birthI can finally say that Gisele and I used the same home birth midwife, a wonderful woman who believes in what she does, believes in women "owning" their birth and the empowerment it can provide. <br /><br />Choosing the same midwife is not all Gisele and I have in common. Our sons were born on the same date, Dec. 8 (two years apart), and... well, we both have handsome husbands. <br /><br />But seriously, I am so eager to see what effect, if any, a Brazilian supermodel's choice to give birth at home can have on women's perceptions about it and whether the publicity can help reduce the soaring c-section rate in the US and Brazil (where it is close to 90 percent in some places).<br /><br />One can hope.Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com7tag:blogger.com,1999:blog-23685740.post-62768782590659711132009-12-21T09:08:00.000-08:002009-12-21T09:17:03.826-08:00More on mammograms at 40Having recently turned 40, my CNM suggested a mammogram was in order, just in time for the national debate over whether and when to have one. For those like me, here's some historical context to help with the decision. I found the author's historical context very helpful in understanding the modern dialogue...But hey, that's why I love history. (I added the bolding for emphasis.)<br /><br />November 20, 2009<br />Op-Ed Contributor<br />Addicted to Mammograms <br />By ROBERT ARONOWITZ<br />Philadelphia<br /><br />THE United States Preventive Services Task Force’s recommendation this week that women begin regular breast cancer screening at age 50 rather than 40 is really nothing new. It’s almost identical to the position the group held in the 1990s.<br /><br />Nor is the controversy that has flared since the announcement something new. It’s the same debate that’s gone on in medicine since 1971, when the very first large-scale, randomized trial of screening mammography found that it saved the lives only of women aged 50 or older. Despite the evidence, doctors continued to screen women in their 40s.<br /><br />Again in 1977, after an official of the National Cancer Institute voiced concern that women in their 40s were getting too much radiation from unnecessary screening, the National Institutes of Health held a consensus conference on mammography, which concluded that most women should wait until they’re 50 to have regular screenings.<br /><br />Why do we keep coming around to the same advice — but never comfortably follow it? The answer is far older than mammography itself. It dates to the late 19th century, when society was becoming increasingly disappointed, pessimistic and fearful over the lack of medical progress against cancer. Doctors had come to understand the germ theory of infectious disease and had witnessed the decline of epidemic illnesses like cholera. But their efforts against cancer had gone nowhere. <br /><br />In the 1870s, a new view of the disease came to be developed. Cancer had been thought of as a constitutional disorder, present throughout the body. But some doctors now posited that it begins as a local growth and remains so for some time before spreading via the blood and lymph systems (what came to be understood as metastasis). <br /><br />Even though this new consensus was more asserted than definitively proved by experimental evidence or clinical observation, it soon became dogma, and helped change the way doctors treated cancer. Until this time, cancer surgery had been performed only rarely and reluctantly. After all, why remove a tumor, in a painful and dangerous operation, when the entire body is diseased? <br /><br />The new model gave doctors reason to take advantage of newly developing general anesthesia and antiseptic techniques to do more, and more extensive, cancer surgery. At the turn of the 20th century, William Halsted, a surgeon at Johns Hopkins, promoted a new approach against breast cancer: a technically complicated removal of the affected breast, the lymph nodes in the armpit and the muscles attached to the breast and chest wall. <br /><br />Doctors widely embraced Halsted’s strategy. But they seem to have paid little attention to his clinical observations, which indicated that while the operation prevented local recurrence of breast tumors, it did not save lives. As Halsted himself became aware, breast cancer patients die of metastatic, not local, disease. <br /><br />By 1913, the surgeons and gynecologists who started the American Society for the Control of Cancer (later the American Cancer Society) had begun an anti-cancer campaign that, among other things, advised women to see their doctors “without delay” if they had a breast lump. Their message promoted the idea that if cancer was detected early enough, surgery could cure it. <br /><br />This claim, like the cancer theory it was built on, was based on intuition and wishful thinking and the desire to do something for patients, not on detailed evidence that patients were more likely to survive if their cancer was caught early and cut out. But it did create a culture of fear around breast cancer, and led the public to believe that tumors needed to be discovered at the earliest possible moment.<br /><br />The “do not delay” campaign reached its heyday in the 1940s, when through lectures, newspaper articles, posters and public health films, doctors exhorted people to survey their bodies for cancer warning signs like breast lumps, irregular bleeding and persistent hoarseness. This campaign generated greater fear, which led to more demand for some means to gain a sense of control over cancer — typically satisfied by more surveillance and treatment. <br /><br />During the 1930s and ’40s, more and more cancer was being diagnosed. The rising numbers led to even greater pressure to define early stages of cancer and find more cases as early as possible. Meanwhile, the apparent improved cancer survival rates — a result of more people receiving diagnoses, many for cancers that were not lethal — seemed to prove the effectiveness of the “do not delay” campaign, as well as radical cancer surgery. <br /><br />By the 1950s, some skeptics were pointing out that despite all the apparent progress, mortality rates for breast cancer had hardly budged. And they continued not to budge; from 1950 to 1990, there were about 28 breast cancer deaths per 100,000 people. But calls for earlier diagnosis only increased, especially after screening mammography was introduced in the 1960s. <br /><br />When the 1971 evidence came along that mammograms were of very limited benefit to women under 50, it ran up against the logic of the early-detection model and the entrenched cycles of fear and control. Detecting cancer in women under 50 should work, according to the model; indeed, younger women are the ones most likely to have the localized cancers that have “not yet” metastasized. And many doctors and women understandably objected, as they do today, to giving up the one means they had to exercise some control over cancer. <br /><br />Critics of this week’s recommendations have poked holes in the Preventive Services Task Force’s data analysis, have warned against basing present practice guidelines on the older imaging technology used in the studies, and have called for still more studies to be done. They generally sidestep the question of whether the very small numbers of lives potentially saved by screening younger women outweigh the health, psychological and financial costs of overdiagnosis. <br /><br /><strong>You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail. This doesn’t make sense. We could do more research and hold more consensus conferences. I suspect it would confirm the data we already have. But history suggests it would never be enough to convince many people that we are screening too much. </strong><br /><br /><em>Robert Aronowitz, an internist and a professor of the history and sociology of science at the University of Pennsylvania, is the author of “Unnatural History: Breast Cancer and American Society.”</em>Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com6tag:blogger.com,1999:blog-23685740.post-1526406721679116082009-12-21T07:53:00.000-08:002009-12-21T07:59:08.704-08:00It's all Greek to meWhat is the proper plural form of doula? Doules or doulas? A reader of this story in the <a href="http://www.telegraph.co.uk/health/6797264/Doulas-meddlers-in-the-maternity-suite-or-a-mothers-best-friend.html">Telegraph UK </a>suggests that it should be doules. Regardless, US doules may be shocked to see that UK doules earn alot more per birth. (OK, the spelling felt awkward.)Tina Cassidyhttp://www.blogger.com/profile/14636705157835152712noreply@blogger.com0