Much has been written this week about the American Medical Association, a trade association for doctors, drafting a resolution calling for the illegalization of home birth and blaming Ricki Lake for making it trendy with the film she and Abby Epstein made called "The Business of Being Born." (I highly recommend the film, which you can get on Netflix, and not just because I am interviewed in it. ;)
So I will try not to repeat what others, including Ricki, have said in response to the AMA, which boils down to a proverbial flip of the bird. Instead, I hope I can offer some context and history here.
1. The American Medical Association was a big part of the campaign to eradicate midwives nearly a century ago, a move that was largely successful, and this country is still grappling with the public health consequences of that -- with 99 percent of births taking place in a hospital; 1 out of every three births a c-section; and half the women in the hospital getting Pitocin. The campaign then was about money and power, as it is now.
2. I have NEVER heard a woman who has given birth at home say she made a mistake or that it was a horrible experience. If there are any such moms out there, I'd love to hear from you. By contrast, I hear more and more from women who have horrible hospital experiences with OBs who still think episiotomies are necessary and no woman should push for more than two hours.
3. Those who are against home birth will typically post on blogs with remarks that start like this: "My baby had shoulder dystocia...thank God I was in a hospital and that wonderful doctor saved me and my baby..." Well, guess what, that doctor probably performed the Gaskin maneuver, named after a MIDWIFE, who knows a thing or two about shoulder dystocia in home birth.
4. Throughout history, whenever women felt they did not have a choice in childbirth, they spoke out, voted with their feet, and forced change. Clearly, woman are beginning to feel pushed around, and many are choosing to stay home, in part, I hope, because they are being empowered by the FACTS, by scientific studies, by films, and by books such as mine and Jennifer Block's Pushed.
5. I had a home birth 6 months ago. It blew my mind. It was as birth should be and I am no radical. If home birth suddenly became illegal, and I suddenly became pregnant again, I would still find a way to give birth at home. Oops, guess I couldn't make it to the hospital in time. And you can bet that midwives would still come if called, regardless of the consequences. Tell me, how would illegalizing home birth do anything but force it underground and make it less safe?
Friday, June 20, 2008
Sunday, June 15, 2008
On Father's Day
I made an appearance in central Mass. the other night for a screening of the "Business of Being Born," an event organized by doula/Mothers & Co. owner Jeanette Mesite Frem. Jeanette was telling me that she is in a new film called "Being Dad," filmed by Australians and premiering in the US this summer. The film is meant to answer the question what should men expect when they're expecting?
To view the trailer, see: http://apac.vividas.com/5784_BeingDad/web/
I believe there are clips on YouTube, as well.
It's a great idea for a film. Whatever it takes to keep men connected and from saying things like, "Do you really want another piece of cake," when his wife is 9 mos. pregnant.
Meanwhile, today I got an email from Clay Nichols, who runs DadLabs, which is back from a five-day excursion to Stockholm to see first-hand the most dad-friendly place on earth. They were hosted by Baby Bjorn, who introduced the to politicians, daycare centers, and dads that have benefitted from Sweden’s progressive pro-family policies. DadLabs was most impressed with how connected to their children and happy with the paternity leave policy the dads of Stockholm were. The trip culminated with a meeting with the man behind the brand, Bjorn Jacobson.
www.dadlabs.com
To view the trailer, see: http://apac.vividas.com/5784_BeingDad/web/
I believe there are clips on YouTube, as well.
It's a great idea for a film. Whatever it takes to keep men connected and from saying things like, "Do you really want another piece of cake," when his wife is 9 mos. pregnant.
Meanwhile, today I got an email from Clay Nichols, who runs DadLabs, which is back from a five-day excursion to Stockholm to see first-hand the most dad-friendly place on earth. They were hosted by Baby Bjorn, who introduced the to politicians, daycare centers, and dads that have benefitted from Sweden’s progressive pro-family policies. DadLabs was most impressed with how connected to their children and happy with the paternity leave policy the dads of Stockholm were. The trip culminated with a meeting with the man behind the brand, Bjorn Jacobson.
www.dadlabs.com
Wednesday, June 04, 2008
Breakfast with Gloria Steinem
I had breakfast with Gloria Steinem this morning -- me and 1,000 other of her BFFs in Boston, at an event put on by The Commonwealth Institute, an organization that promotes women in business. She said a few things that really made me think. And a few things that really made me laugh, including: "I'd like to create a button that says 'The truth shall set you free, but first it will piss you off.'" Amen sistah.
She also talked alot about how family forms have a real connection to international and governmental relations. For example, the Native Americans had egalitarian family structures, where gender was never an issue. That lack of bias or set roles was reflected in their government, where female elders chose a chief and they could remove a chief. With three boys in the house, I will consider it a job well done if, when they grow up, they empty the dishwasher without their wives having to ask.
Later in the program a member of the audience asked her why younger women don't seem to appreciate all the hard-fought freedoms they have. This question posited -- without saying it -- why is this generation of women getting MBAs and then become stay-at-home moms? Gloria said she did not think young women don't appreciate their freedoms. It's just that women tend not to become activists about anything until they are older, and begin to feel their personal power slip away. Young women have all the power; they are fertile, pretty, etc., she said. As we age, all that changes.
She also talked alot about how family forms have a real connection to international and governmental relations. For example, the Native Americans had egalitarian family structures, where gender was never an issue. That lack of bias or set roles was reflected in their government, where female elders chose a chief and they could remove a chief. With three boys in the house, I will consider it a job well done if, when they grow up, they empty the dishwasher without their wives having to ask.
Later in the program a member of the audience asked her why younger women don't seem to appreciate all the hard-fought freedoms they have. This question posited -- without saying it -- why is this generation of women getting MBAs and then become stay-at-home moms? Gloria said she did not think young women don't appreciate their freedoms. It's just that women tend not to become activists about anything until they are older, and begin to feel their personal power slip away. Young women have all the power; they are fertile, pretty, etc., she said. As we age, all that changes.
Sunday, June 01, 2008
From today's New York Times, an absolutely outrageous tale of insurance companies denying coverage for women with previous cesareans. As always, it is money dictating the rules of health care. Of course, money (malpractice fears) is one of the reasons why the c-section rate in the US at 1 out of every 3 births. Honestly, it is surprising that it took insurance companies this long to wake up to the fact that they are paying either way -- for the c-sections that don't get done when they should, those that get done poorly (regardless of whether they were necessary) or when a woman is denied access to a vaginal birth after cesarean, which is happening more and more...
June 1, 2008
After Caesareans, Some See Higher Insurance Cost
By DENISE GRADY
When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified.
“It made no sense,” said Ms. Robertson, 39, who lives in Centennial, Colo. “I’m in perfect health.”
She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.
Ms. Robertson had been shopping around for individual health insurance, the kind that people buy on their own. She already had insurance but was looking for a better rate. After being rejected by Golden Rule, she kept her existing coverage.
With individual insurance, unlike the group coverage usually sponsored by employers, insurance companies in many states are free to pick and choose the people and conditions they cover, and base the price on a person’s medical history. Sometimes, a past Caesarean means higher premiums.
Although it is not known how many women are in Ms. Robertson’s situation, the number seems likely to increase, because the pool of people seeking individual health insurance, now about 18 million, has been growing steadily — and so has the Caesarean rate, which is at an all-time high of 31.1 percent. In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.
“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.
Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.
“You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other,” Ms. Udy said.
Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.
“Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.
“In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,” Ms. Pisano said.
Her group has reported that although most Americans with health insurance, 160 million, have group plans through employers, the number needing individual policies will probably keep rising, because more and more people are becoming self-employed or taking jobs without health benefits.
In a letter to Ms. Robertson, Golden Rule, which sells individual policies in 30 states, said it would insure a woman who had had a Caesarean only if it could exclude paying for another one for three years. But in Colorado, such exclusions are considered discriminatory and are forbidden, so Golden Rule simply rejects women who have had the surgery, unless they have been sterilized or meet the company’s age requirements.
“If you don’t work for someone who has insurance, and you have to get insurance on your own, this is terrifying,” Ms. Robertson said.
A spokeswoman for Golden Rule declined to explain how long it had been excluding Caesareans, how it had decided to do so or how many were affected, saying the information was proprietary. The company, based in Indianapolis, is owned by UnitedHealthcare, which collects more than $50 billion a year in premiums and has 26 million members, most with group coverage.
In Colorado, people denied individual health insurance can obtain it through a state program, Cover Colorado, which insures about 7,200 people. But the premiums are high, 140 percent of standard rates, a spokeswoman said, adding that some women had enrolled specifically because prior Caesareans had disqualified them from private insurance.
Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized.
“After five years, if there is not a complication of pregnancy, another C-section, or if they get their tubes tied and are no longer in that risk situation, that rate-up goes away,” said Randy M. Kammer, the vice president for regulatory affairs and public policy.
The higher rate is based on a Caesarean costing an average of $2,700 more than a vaginal birth (assuming no complications in either type of delivery). Ms. Kammer said Blue Cross Blue Shield could not provide a tally of how many members were paying the higher rates because of Caesareans.
“The aggravating thing is, there are a lot of elective Caesareans, and that adds to costs,” she said.
Elizabeth Bonet, who lives in Sunrise, Fla., learned about the higher rates this year when she applied to Blue Cross Blue Shield of Florida.
“I was very angry, outraged, shocked,” Ms. Bonet said. “It made me feel very helpless. These were not Caesareans I wanted. They were not elective Caesareans. I very much wanted natural births with both babies and was not able to have them, and to have to pay for that for years is outrageous, and I feel it’s discriminatory as well.”
Each state’s Blue Cross Blue Shield plan sets its own policies. In Texas, a spokeswoman said, a prior Caesarean will not affect a woman’s premiums or insurability, as long as she has recovered fully.
A spokeswoman for another major insurer, Wellpoint, said the company’s decisions about prior Caesareans varied case by case, but declined to explain further.
Aetna does not treat a Caesarean itself as a pre-existing condition, but does factor in chronic or recurring problems that might have led to the Caesarean, like diabetes or high blood pressure, a spokeswoman said.
A spokeswoman for another company, Mega Life and Health Insurance, in North Richland Hills, Tex., said: “If the Caesarean section was considered by the physician to be medically necessary for the safety of the mother or child then coverage is issued without conditions. If the procedure was determined to be ‘elective,’ coverage would be offered with a temporary waiver or at a higher premium rate.”
Insurers often accuse women and obstetricians of scheduling unneeded Caesareans for their own convenience — to deliver the baby at a certain time, or to avoid labor. But it is not known how much of the overall increase in Caesareans is because of a rise in unnecessary operations, or how many Caesareans are done at the mother’s request, according to a 2006 report by the National Institutes of Health.
“I think it’s really a very small amount, but we need more data,” said Dr. Mary D’Alton, chief of obstetrics and gynecology at Columbia University Medical Center, and an author of the report.
She said she was amazed to hear that insurers would charge higher premiums or deny coverage because of a past Caesarean.
“I would think if it’s happening, the medical profession has to take a stand,” Dr. D’Alton said.
But to people familiar with the rough and tumble world of individual insurance, the companies’ practices are no surprise.
Individual insurance differs sharply from the group coverage with which most people are familiar. Group policies generally require that the insurer cover everybody in the group, and charge the same rates for all. But with individual coverage, insurers in many states can vary their prices based on medical history, exclude certain services or reject anyone they consider a bad risk. (Several states, however, including New York, New Jersey and Massachusetts, ban such practices.)
Insurers say they need these strategies to protect themselves, because some customers apply only after they get sick or pregnant, skewing the pool toward people with high expenses.
Ms. Robertson said that had she known a Caesarean was grounds for rejection, she would not have even applied to Golden Rule, because the denial may be held against her in the future. Insurers routinely ask applicants if they have ever been denied, and red-flag anyone who says yes.
“My understanding is that once you’re denied it’s hard to get other insurance,” Ms. Robertson said. “Man, is that a scary thing.”
June 1, 2008
After Caesareans, Some See Higher Insurance Cost
By DENISE GRADY
When the Golden Rule Insurance Company rejected her application for health coverage last year, Peggy Robertson was mystified.
“It made no sense,” said Ms. Robertson, 39, who lives in Centennial, Colo. “I’m in perfect health.”
She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.
Ms. Robertson had been shopping around for individual health insurance, the kind that people buy on their own. She already had insurance but was looking for a better rate. After being rejected by Golden Rule, she kept her existing coverage.
With individual insurance, unlike the group coverage usually sponsored by employers, insurance companies in many states are free to pick and choose the people and conditions they cover, and base the price on a person’s medical history. Sometimes, a past Caesarean means higher premiums.
Although it is not known how many women are in Ms. Robertson’s situation, the number seems likely to increase, because the pool of people seeking individual health insurance, now about 18 million, has been growing steadily — and so has the Caesarean rate, which is at an all-time high of 31.1 percent. In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.
“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.
Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.
“You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other,” Ms. Udy said.
Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.
“Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.
“In many respects it works a lot like other situations where someone has a condition that will foreshadow the potential for higher costs going forward,” Ms. Pisano said.
Her group has reported that although most Americans with health insurance, 160 million, have group plans through employers, the number needing individual policies will probably keep rising, because more and more people are becoming self-employed or taking jobs without health benefits.
In a letter to Ms. Robertson, Golden Rule, which sells individual policies in 30 states, said it would insure a woman who had had a Caesarean only if it could exclude paying for another one for three years. But in Colorado, such exclusions are considered discriminatory and are forbidden, so Golden Rule simply rejects women who have had the surgery, unless they have been sterilized or meet the company’s age requirements.
“If you don’t work for someone who has insurance, and you have to get insurance on your own, this is terrifying,” Ms. Robertson said.
A spokeswoman for Golden Rule declined to explain how long it had been excluding Caesareans, how it had decided to do so or how many were affected, saying the information was proprietary. The company, based in Indianapolis, is owned by UnitedHealthcare, which collects more than $50 billion a year in premiums and has 26 million members, most with group coverage.
In Colorado, people denied individual health insurance can obtain it through a state program, Cover Colorado, which insures about 7,200 people. But the premiums are high, 140 percent of standard rates, a spokeswoman said, adding that some women had enrolled specifically because prior Caesareans had disqualified them from private insurance.
Blue Cross Blue Shield of Florida, which has about 300,000 members with individual coverage, used to exclude repeat Caesareans, but recently began to cover them — for a 25 percent increase in premiums for five years. Like Golden Rule, the company exempts women if they have been sterilized.
“After five years, if there is not a complication of pregnancy, another C-section, or if they get their tubes tied and are no longer in that risk situation, that rate-up goes away,” said Randy M. Kammer, the vice president for regulatory affairs and public policy.
The higher rate is based on a Caesarean costing an average of $2,700 more than a vaginal birth (assuming no complications in either type of delivery). Ms. Kammer said Blue Cross Blue Shield could not provide a tally of how many members were paying the higher rates because of Caesareans.
“The aggravating thing is, there are a lot of elective Caesareans, and that adds to costs,” she said.
Elizabeth Bonet, who lives in Sunrise, Fla., learned about the higher rates this year when she applied to Blue Cross Blue Shield of Florida.
“I was very angry, outraged, shocked,” Ms. Bonet said. “It made me feel very helpless. These were not Caesareans I wanted. They were not elective Caesareans. I very much wanted natural births with both babies and was not able to have them, and to have to pay for that for years is outrageous, and I feel it’s discriminatory as well.”
Each state’s Blue Cross Blue Shield plan sets its own policies. In Texas, a spokeswoman said, a prior Caesarean will not affect a woman’s premiums or insurability, as long as she has recovered fully.
A spokeswoman for another major insurer, Wellpoint, said the company’s decisions about prior Caesareans varied case by case, but declined to explain further.
Aetna does not treat a Caesarean itself as a pre-existing condition, but does factor in chronic or recurring problems that might have led to the Caesarean, like diabetes or high blood pressure, a spokeswoman said.
A spokeswoman for another company, Mega Life and Health Insurance, in North Richland Hills, Tex., said: “If the Caesarean section was considered by the physician to be medically necessary for the safety of the mother or child then coverage is issued without conditions. If the procedure was determined to be ‘elective,’ coverage would be offered with a temporary waiver or at a higher premium rate.”
Insurers often accuse women and obstetricians of scheduling unneeded Caesareans for their own convenience — to deliver the baby at a certain time, or to avoid labor. But it is not known how much of the overall increase in Caesareans is because of a rise in unnecessary operations, or how many Caesareans are done at the mother’s request, according to a 2006 report by the National Institutes of Health.
“I think it’s really a very small amount, but we need more data,” said Dr. Mary D’Alton, chief of obstetrics and gynecology at Columbia University Medical Center, and an author of the report.
She said she was amazed to hear that insurers would charge higher premiums or deny coverage because of a past Caesarean.
“I would think if it’s happening, the medical profession has to take a stand,” Dr. D’Alton said.
But to people familiar with the rough and tumble world of individual insurance, the companies’ practices are no surprise.
Individual insurance differs sharply from the group coverage with which most people are familiar. Group policies generally require that the insurer cover everybody in the group, and charge the same rates for all. But with individual coverage, insurers in many states can vary their prices based on medical history, exclude certain services or reject anyone they consider a bad risk. (Several states, however, including New York, New Jersey and Massachusetts, ban such practices.)
Insurers say they need these strategies to protect themselves, because some customers apply only after they get sick or pregnant, skewing the pool toward people with high expenses.
Ms. Robertson said that had she known a Caesarean was grounds for rejection, she would not have even applied to Golden Rule, because the denial may be held against her in the future. Insurers routinely ask applicants if they have ever been denied, and red-flag anyone who says yes.
“My understanding is that once you’re denied it’s hard to get other insurance,” Ms. Robertson said. “Man, is that a scary thing.”
Wednesday, May 28, 2008
A new c-section product
I received an interesting email from Digital Influence Group, a social media agency that actively engages in online conversations on behalf of their clients -- in this case, Genzyme, the biotech firm. Here's what the email said: "Digital Influence has been "raising awareness about c-sections; particularly c-section related adhesions, for Seprafilm, an adhesion barrier manufactured by Genzyme which helps minimize the risk of forming adhesions following abdominal surgery. As a result of our research, we’ve found that few women are aware of this potential complication, and that even fewer know there are preventative measures that can be taken. We’ve put together a quick list of links on this topic at http://del.icio.us/adhesion_awarenesss to help spread awareness, and thought you might be interested in the content there as well."
Monday, May 26, 2008
The constant gardener
This is Harrison today, at 5 months, enjoying his first picnic in the park, after which we decided to go home and plant my placenta. I took it out of the freezer last night, as if it were a piece of steak, but somehow it just did not seem right sticking it in the ground frozen. This morning, I couldn't look at the plastic Ziploc bag anymore and made haste to buy a plant to go in the ground. I chose a climbing rose bush with fragrant peachy blooms. I dug a hole in the one spot in the garden where the rose bush would fit, hard by a tree stump. I couldn't dig quite so far because I kept hitting roots. So I eyeballed the depth and, with sweaty brow, unwrapped the placenta and its loooong cord, marveled at it, was thankful for it, and tried not to wretch. I put it in the ground, placed the bush on top and began back filling. Of course, the hole was not deep enough. The only other place to plant it was in a large whiskey barrel. I dug a hole there, yanked up the bush, and then kept digging looking for the placenta. Suddenly, I felt like I was living an episode of CSI. What was wrong with me? I glanced up to see if any neighbors were looking. I grabbed the earth-encrusted placenta, dangling from its cord, and placed it in the planter, dropped in the bush, and covered it all up quickly.
I can't wait to see -- and smell -- it bloom.
Saturday, May 24, 2008
ACNM's Annual Meeting
I gave a little talk and signed some books at the American College of Nurse Midwives' Annual Meeting in Boston today. And after the book signing, there was a screening of the "Business of Being Born," a documentary that every woman should see. Anyway, what really struck me was how transformative the film can be for lay people. After the show, a young couple who had wandered in off the street to see the film came up to me, clearly moved by what they had seen. "Where do I even begin to look for a midwife?" she asked. "To think that an hour ago I was making fun of the word 'doula,'" he said. "What a cute couple," I thought. Another person made the comment that home birth midwives are suddenly very, very busy. Music to my ears.
Friday, May 23, 2008
Placental palliative
As we head into Memorial Day weekend, and I finally pull my placenta out of the freezer and plant it (your suggestions have been fantastic, thank you!) I came across this news story on Indian MSN and it made me think even harder about what an interesting organ the placenta is.
http://lifestyle.in.msn.com/health/article.aspx?cp-documentid=1413857
Birth waste to heal wounds faster
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al
Eighteen-months old Raju (name changed) screamed with pain when boiling dal fell on him. His tender skin - half his body - had suffered second-degree burns. Panic-stricken parents rushed him to Mumbai's known plastic surgeon Dr Kalpesh Gajiwala.
After cleaning the wound and removing the dead skin, Dr Gajiwala placed the transparent biological dressing ‘Amnion' directly on the wound. The transparent thin dressing stuck easily to the oozing surface and sealed it completely . It automatically peeled off after the wound had healed. The child was saved from the trauma of daily dressing.
In the words of Dr Kalpesh who uses amnion quite extensively either in preparing the burn wounds for a skin graft or to help heal the sites from which a skin graft has been taken says, "It helps in faster healing and causes much less scarring."
Perhaps there can't be a better recycling of "after birth waste."
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al. And it is available in ‘ready to use' packs at India's only ISO 9001:2000 certified Tissue Bank of Tata Memorial Hospital.
As of now the hospital recovers this precious after birth waste from the two maternity hospitals in its vicinity to be processed; freeze dried, sterilised by gamma radiation and packaged. As amnion dressings are stored at room temperature, packets are easily mailed anywhere in the country .
Unfortunately this amazing membrane is going waste in the rest of the city and country. The solution lies in setting up a national bank. As its production is directly linked to the childbirth, the raw material availability will never be a problem in a country that is battling to arrest the birth rate. Only the donors will have to come forward as their consent is required even though it is a discarded tissue.
"The donor has to know its specific use and also give consent for the testing of the do- nated blood sample for HIV Hepatitis , etc," says Dr Astrid Lobo Gajiwala, head of the Tissue Bank. As many as 5,00,000 patients are treated in United States every year with amnion.
The biological wound dressing can be used on any part of the body. The largest size available is 20X20cms and smallest is 4X4cms. It sticks like a stamp, seals off the wound and peels off as the wound heels. Its cheap, it's transparent, and is usually preferred as it mimics the skin. Analgesic use is also reduced, as there is almost immediate pain relief.
http://lifestyle.in.msn.com/health/article.aspx?cp-documentid=1413857
Birth waste to heal wounds faster
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al
Eighteen-months old Raju (name changed) screamed with pain when boiling dal fell on him. His tender skin - half his body - had suffered second-degree burns. Panic-stricken parents rushed him to Mumbai's known plastic surgeon Dr Kalpesh Gajiwala.
After cleaning the wound and removing the dead skin, Dr Gajiwala placed the transparent biological dressing ‘Amnion' directly on the wound. The transparent thin dressing stuck easily to the oozing surface and sealed it completely . It automatically peeled off after the wound had healed. The child was saved from the trauma of daily dressing.
In the words of Dr Kalpesh who uses amnion quite extensively either in preparing the burn wounds for a skin graft or to help heal the sites from which a skin graft has been taken says, "It helps in faster healing and causes much less scarring."
Perhaps there can't be a better recycling of "after birth waste."
The delicate and durable membrane that protects the baby in the mother's womb called amnion is normally discarded after the baby's birth. But now this membrane is being used here in eye surgery besides ulcers, burns, diabetic ulcers, bedsores et al. And it is available in ‘ready to use' packs at India's only ISO 9001:2000 certified Tissue Bank of Tata Memorial Hospital.
As of now the hospital recovers this precious after birth waste from the two maternity hospitals in its vicinity to be processed; freeze dried, sterilised by gamma radiation and packaged. As amnion dressings are stored at room temperature, packets are easily mailed anywhere in the country .
Unfortunately this amazing membrane is going waste in the rest of the city and country. The solution lies in setting up a national bank. As its production is directly linked to the childbirth, the raw material availability will never be a problem in a country that is battling to arrest the birth rate. Only the donors will have to come forward as their consent is required even though it is a discarded tissue.
"The donor has to know its specific use and also give consent for the testing of the do- nated blood sample for HIV Hepatitis , etc," says Dr Astrid Lobo Gajiwala, head of the Tissue Bank. As many as 5,00,000 patients are treated in United States every year with amnion.
The biological wound dressing can be used on any part of the body. The largest size available is 20X20cms and smallest is 4X4cms. It sticks like a stamp, seals off the wound and peels off as the wound heels. Its cheap, it's transparent, and is usually preferred as it mimics the skin. Analgesic use is also reduced, as there is almost immediate pain relief.
Wednesday, May 14, 2008
Placenta puzzle
OK, it's spring, and I am as behind on gardening as I have been on posting to this blog. I blame the mommy vortex for sucking up any free time. But anyway, I am realizing that I have a short window to take my placenta out of the freezer, bury it in the garden and perhaps plant something on top of it. Any recommendatins? We live in the city and have a very small backyard, already full with flowers and lilacs and forsythia. In other words, a maple tree won't work. Thoughts welcome!
Monday, April 21, 2008
Cast a vote
The headline in the paper today made my heart leap: "Push for Labor Support." Really? I thought. It's about time! Every woman deserves encouragement when giving birth. But then I realized the story was about Obama and Clinton and trade unions. Bummer. Clearly my head is in a different place.
Saturday, April 05, 2008
Our new baby, installment #36
... and second guest appearance by the home birth husband. Americans get entrenched in a set way of doing things; the years go by and all the protocols become automated, the accepted process is the path of least resistance, and it takes real effort to do anything differently. It's that way with sprawl, a subject I've written about, and this kind of self-reinforcing dynamic is very much at work in the business of being born. The hospitals take care of all the little details of bringing a new person into the world. Two specifics: the birth certificate and the social security number. In the days following Harrison's birth I called City Hall to see what I had to do to get a birth certificate, and wasn't given the full story. I came in armed with what I thought was sufficient documentation, only to be told I needed our marriage license; not immediately apparent why the city needed to know if we were married or not, but if we weren't, the mother needed to come apply. There was no answer at City Hall in Cambridge where we were married -- it was a Friday -- so I drove down to the state bureau of vital statistics to pull a copy (for about $20). Then I had to fill out a lengthy questionnaire with all kinds of personal questions that I had to ask Tina on the mobile phone in the busy municipal office. Needless to say this took the better part of a day. Next task: taking said birth certificate down to the Social Security administration to apply for Harrison's number. We need it for our tax return to prove the addition of a dependent, but the mutiple pages of instructions on the web seem to indicate it could take 12 weeks. And so we're forced to enter into another tried and true convention: the filing extension. Small price to pay, all of this, but just another indication of how the system makes us feel like we did something really unusual.
Monday, March 31, 2008
You call that a vacation?
So we're just back from Disney World...I have two things to say. First, we paid ten bucks for a balloon. One balloon. And second, the only billboard between the Magic Kingdom and the airport that was not for a theme park? It was for www.vasectomy.com.
Monday, March 24, 2008
Our new baby, installment #35
About 10 weeks after Harrison was born at home, my mother asked me to come down to Bellani Maternity, a boutique near her house, to watch a screening of "The Business of Being Born," Ricki Lake's new documentary, for which I was interviewed. What was special for me about this night was that my grandmother and my sister-in-law would be coming, too. Before we watched the film, my mother and I added up all the births among the surviving women on our one side of the family. My grandmother had three children. My mother two. My aunt 2; her daughter, 1; my sister-in-law, 1; and I had two. Out of those 11, 10 births were either horrendous, cesareans, or extremely painful. Only one birth was absolutely without complications and would be remembered for how simply wonderful it was -- the one that happened at home, with a midwife, my second child. Although my mother finally understands why hospitals can get in the way of childbirth, the results of our little mathematical exercise was still surprising. After the film, I mentioned the family statistics to my grandmother, who was unconscious during her births thanks to Twilight Sleep, and I think for the first time she, too, understood that birth could be better if we left it alone. It was a small triumph.
Monday, March 17, 2008
Our new baby, installment #34
Our midwife came to check on us three times after the baby was born, each time staying for more than a hour, weighing the baby, giving me a once-over, talking with the older boys. From a service perspective, it was downright luxurious, not having to dress a newborn and head out to a doctor's office in the freezing cold. This postpartum care was included in the fee we had to pay out-of-pocket for a home birth -- a cost that our premium insurance policy does not cover even though we are fully insured. Just because it happened at home. Knowing that insurers had spent $25,000 for my cesarean four years ago, and had just spent $11,000 for my cousin's vaginal birth in a hospital (she was later readmitted for infection but that was a separate bill), the thought that the insurance company could pay a fraction of those costs and have better outcomes and happier moms is nonsensical. It's a very dysfunctional system.
Wednesday, March 12, 2008
Our new baby, installment #33 (guest blogger/the husband)
I guess you can consider me the home-birth husband. When Tina first suggested it, I wondered if there was a middle ground -- a birth attended by a midwife in a birth center. No such thing, she reminded me, in Massachusetts. I then said a home birth is one thing, but a home birth VBAC sounded hard-core. Wrong again, as our wonderful midwife explained; no particular issues there. Then why don't hospitals do VBACs? A questionnable study, insurance, and lawsuits. Such was the process of my re-education. I learned I had to buy-in 100 percent and nothing less. No emphasis on the back-up plan, transport to the hospital if 'something goes wrong.' No dwelling on something going wrong. So when it was clear that Tina was in labor that Friday night, I felt disciplined, and was thinking positive, which helped me be less nervous. Although I did want the midwife to be there the minute after the first strong contraction. In retrospect I thought maybe I put my heart and mind in the hands of the midwife in the place of the doctors at the hospital -- the new expert to calm my fears -- but that wasn't really what happened. She came, I parked her car, she had a suitcase of stuff, and she went to my wife. The next two hours were between Tina and her. I fetched things and paced around the tub I had set up. After reading Tina's book, I was at peace with a man's minimal role. I caressed her forehead but it didn't seem like she was too aware of my doing so; she was busy, in the zone. It was an incredible athletic event, and I didn't feel like saying 'You're doing great' or any such thing, any more than it would be effective to say something encouraging to Derek Jeter ranging for a sharply hit ground ball. Maybe I was in a trance, but I even went along with the gag on the whole thing happening in the water. My surprise was that it was a boy. I was impressed by how attentive the midwife team was on checking Harrison out, and examining Tina -- checklists, all very thorough. I had no idea there was any kind of issue about the placenta and didn't worry at that stage, either. When it was delivered the midwife showed me what an ingenius contraption it was, sustaining Harrison for 39 weeks. It was a cold night, and I remember thinking, all they had to do was move one room over, mother and child. We were home.
Sunday, March 09, 2008
Our new baby, installment #32
Once labor and birth were finished, the reality of being at home really kicked in. The midwife weighed Harrison (7 pounds even) in a sling right by my side. She did her check up of him beside me on the bed. There were no heel pricks. No Hep B vaccines. No sugar water on the tongue. No discussion of circumcision. No incubator. No one saying they were taking him away for a bath.
My husband rummaged through the dark to find the baby something to wear -- no standard issue hospital garb. I jumped in the shower and gingerly got back in bed. My husband made me a sandwich and brought me a big pitcher of water to slake my thirst and we toasted the midwives and Harrison with some champagne and cake, which the midwives ate downstairs to give us time alone.
Harrison was born at 5 minutes past midnight. The midwives stayed to check on us all until close to 4 a.m., when they finally said goodbye, with assurances of a visit later in the day. We were too excited to fall asleep, and stayed in bed marveling at the baby. At 5:30, our 4-year-old came in and did a double take when he saw his new brother in the bed. It was like Christmas morning. He crawled in with us and we all stayed happily together until my parents, grandparents, aunt and cousin arrived with breakfast. It felt so great having them all there at the house, knowing they could stay as long as they wanted. My 85-year-old arthritic grandfather endured a long car ride, and even climbed a big flight of stairs to the bedroom, to see Harrison. He scooped up the baby and there we both cried. My grandfather was the one, throughout the entire decision to have a VBAC at home, to support it vocally. Having served on New Guinea during World War II, he saw many indigenous women give birth there. That exposure made him appreciate, respect and understand the process in ways that my grandmother and mother -- who had never known birth outside a hospital -- could not. I was grateful for his support. And loved that he could be there that morning.
My husband rummaged through the dark to find the baby something to wear -- no standard issue hospital garb. I jumped in the shower and gingerly got back in bed. My husband made me a sandwich and brought me a big pitcher of water to slake my thirst and we toasted the midwives and Harrison with some champagne and cake, which the midwives ate downstairs to give us time alone.
Harrison was born at 5 minutes past midnight. The midwives stayed to check on us all until close to 4 a.m., when they finally said goodbye, with assurances of a visit later in the day. We were too excited to fall asleep, and stayed in bed marveling at the baby. At 5:30, our 4-year-old came in and did a double take when he saw his new brother in the bed. It was like Christmas morning. He crawled in with us and we all stayed happily together until my parents, grandparents, aunt and cousin arrived with breakfast. It felt so great having them all there at the house, knowing they could stay as long as they wanted. My 85-year-old arthritic grandfather endured a long car ride, and even climbed a big flight of stairs to the bedroom, to see Harrison. He scooped up the baby and there we both cried. My grandfather was the one, throughout the entire decision to have a VBAC at home, to support it vocally. Having served on New Guinea during World War II, he saw many indigenous women give birth there. That exposure made him appreciate, respect and understand the process in ways that my grandmother and mother -- who had never known birth outside a hospital -- could not. I was grateful for his support. And loved that he could be there that morning.
Wednesday, March 05, 2008
Our new baby, installment #31
I still have a fair amount to say about my home VBAC. For starters, a faithful reader of this blog asked me if I was worried about having a placenta issue, since a prior cesarean can cause the placenta to adhere to the scar or even implant through the uterus -- both serious problems. The short answer is no. Despite having researched such problems while writing my book, a sort of haze effected my brain while I was pregnant and I thought nothing but positive thoughts, perhaps reinforced by my ever positive midwife. So, even when she seemed slightly concerned that the placenta was not coming out quickly, and told me to get on the bed and push, I was not worried. And sure enough, it all came out smoothly, in one piece. And when the weather turns nice, it will be taken from the freezer (it's wrapped in a towel in a Ziploc bag beneath some ice cream sandwiches the boys love) and buried in the backyard. Mom, are you rolling your eyes?
Tuesday, March 04, 2008
Our new baby, installment #30
This is Harrison. And me. If you look closely, you can see that the cord is still not cut. We waited until it stopped pulsing and it was tied off with a string. Still no sign of that placenta. So after what seemed like an eternity holding Harrison in the tub, the midwife told me I should get out, and let gravity help expel the afterbirth. I felt a little wobbly in the knees. I handed the baby to my husband, climbed out and walked to my bed, which I had made up like a layer cake of sheets and shower curtains.
Monday, March 03, 2008
Our new baby, installment #29
One more contraction, and our baby was out, a successful and stunningly uplifting home VBAC.
"It's a boy!" the midwife said, her first words in a long while, as his body popped up to the surface.
Although his head had emerged with the cord wrapped around his neck, the midwife had reached into the birth tub to check on him, felt the cord pulsing, and knew he was OK. All through the two hours I spent kneeling in the water, she never once told me to push. And I never did. My body did the work on its own and I let everything take its time. I think the reward was in not needing a single stitch.
I sat in the tub holding him, transfixed, looking in his dark eyes, his hair curled from the wetness. He was breathing just fine, very alert, not crying, checking out his new bedroom, moving his eyes across the room. His body, covered with creamy vernix, was incredibly soft and I held him close. He took to nursing like a champ. My husband finally decided it was OK to take a picture (maybe I will post one tomorrow)and we all rejoiced in the moment.
A couple minutes later, our second midwife, who had gotten caught in a construction tangle on the turnpike, arrived -- deflated she had missed the birth.
All seemed well. But where the heck was the placenta?
"It's a boy!" the midwife said, her first words in a long while, as his body popped up to the surface.
Although his head had emerged with the cord wrapped around his neck, the midwife had reached into the birth tub to check on him, felt the cord pulsing, and knew he was OK. All through the two hours I spent kneeling in the water, she never once told me to push. And I never did. My body did the work on its own and I let everything take its time. I think the reward was in not needing a single stitch.
I sat in the tub holding him, transfixed, looking in his dark eyes, his hair curled from the wetness. He was breathing just fine, very alert, not crying, checking out his new bedroom, moving his eyes across the room. His body, covered with creamy vernix, was incredibly soft and I held him close. He took to nursing like a champ. My husband finally decided it was OK to take a picture (maybe I will post one tomorrow)and we all rejoiced in the moment.
A couple minutes later, our second midwife, who had gotten caught in a construction tangle on the turnpike, arrived -- deflated she had missed the birth.
All seemed well. But where the heck was the placenta?
Friday, February 29, 2008
A book in the mail
I just have to share about a very sweet note tucked into a book that arrived on my stoop today. Both the letter and the book, Artemis Speaks: VBAC Stories and Natural Childbirth Information, were written by Nan Koehler. (The book in 1985, the letter two weeks ago.) Nan says she still has a 1,000 copies of her book "in the barn" but that used book dealers are selling them for $50 a copy. I haven't checked Amazon.
Anyway, in her book it says that Nan is (was?) a traditional birth attendant/botanist/herbalist living in California who was part of the home birth movement back in the day.
In her letter, she remarks that the hormone relaxin is very close to insulin. "One atom different," she writes. "So the solution for easy birth is walking - exercise...to circulation the relaxin in the pelvis."
She also said I should have mentioned that in some cultures there are dietary taboos "that ensure that babies remain smaller - then they are fattened up after birth..." Fair enough. I'd love to know more on this. I bet lots of New York women would buy that diet book.
And then she wrote that the real reason why labor begins at night for so many women is because their hormonal output is greatest at 3 a.m. (when most labors begin) and the low point is 3 p.m., when labor tends to stop. Makes sense.
She also highly recommends castor oil over pitocin. (My response: Anything is better than pitocin...)
She concludes the letter by responded to a section in my last chapter, on the postpartum period, where I discuss various methods traditional midwives have used to dress the cord stump, including cow dung and ashes.
"Cow dung is very sterile," she says. "Check that some more."
Indeed I will!!
Can't wait to read Artemis Speaks.
Anyway, in her book it says that Nan is (was?) a traditional birth attendant/botanist/herbalist living in California who was part of the home birth movement back in the day.
In her letter, she remarks that the hormone relaxin is very close to insulin. "One atom different," she writes. "So the solution for easy birth is walking - exercise...to circulation the relaxin in the pelvis."
She also said I should have mentioned that in some cultures there are dietary taboos "that ensure that babies remain smaller - then they are fattened up after birth..." Fair enough. I'd love to know more on this. I bet lots of New York women would buy that diet book.
And then she wrote that the real reason why labor begins at night for so many women is because their hormonal output is greatest at 3 a.m. (when most labors begin) and the low point is 3 p.m., when labor tends to stop. Makes sense.
She also highly recommends castor oil over pitocin. (My response: Anything is better than pitocin...)
She concludes the letter by responded to a section in my last chapter, on the postpartum period, where I discuss various methods traditional midwives have used to dress the cord stump, including cow dung and ashes.
"Cow dung is very sterile," she says. "Check that some more."
Indeed I will!!
Can't wait to read Artemis Speaks.
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