Wednesday, July 25, 2007
Ricki Lake's birth documentary
Several people have asked about "The Business of Being Born," Ricki Lake's documentary about birth in the hospital and birth at home. The most recent update I have is that the film could have a limited theatrical release in the fall and perhaps an airing on Showtime before the DVD is released by the end of the year. It is an eye-opening film.
Monday, July 09, 2007
Gateway drug
From the LA Times....
http://www.latimes.com/news/nationworld/nation/la-sci-premature30jun30,0,7239244.story?coll=la-home-nation
Birth drug leaves some moms feeling worse
A drug commonly used for preterm labor has more serious side effects than alternatives and may even harm newborns, researchers say.
By Thomas H. Maugh II
Times Staff Writer
June 30, 2007
The drug most commonly used to delay preterm labor in women has more — and more serious — side effects than alternatives, without being any more effective, Stanford researchers reported Friday. The drug may even harm infants, they concluded.
Although labor generally cannot be stopped completely, physicians try to delay it for at least 48 hours to allow transfer of the mother to a specialized hospital and to maximize the effectiveness of steroids used to help the fetus' lungs mature.
The drug most commonly used is magnesium sulfate, but nifedipine and others are occasionally used.
"There is no free lunch with any of these drugs," collectively called tocolytic agents, said Dr. Deirdre Lyell of Stanford University's Lucille Packard Children's Hospital. "But magnesium sulfate has some particularly unpleasant side effects, including vomiting, lethargy and blurry vision. The alternative, nifedipine, often leaves women feeling better."
Despite obstetric advances, preterm delivery — births before 37 weeks' gestation — remains a major problem. In the U.S., 12.3% of births are preterm, for reasons largely unknown. Prematurity is the cause of 30% of infant deaths and of a variety of developmental problems.
Lyell, Dr. Yasser El-Sayed of Stanford and their colleagues studied 192 women in preterm labor at Packard Children's and Santa Clara Valley Medical Center. Half were randomly assigned to receive infusions of magnesium sulfate, and half oral nifedipine.
In the journal Obstetrics & Gynecology, the team reported that though magnesium sulfate quieted contractions more effectively than nifedipine, there were no differences in how long delivery was delayed, in the gestational age of the newborn or in the birth weight of the infants.
Meanwhile, two-thirds of the women who received magnesium sulfate experienced mild to severe side effects during treatment, including shortness of breath and fluid buildup in the lungs. Only a third of the women receiving nifedipine experienced side effects, such as headaches.
Infants born to the mothers who received magnesium sulfate, moreover, were more likely to be admitted to the neonatal intensive care unit and to stay there longer — a median of 8.8 days, compared with 4.2 days for the babies whose mothers received nifedipine.
Dr. Victoria Camerini, a neonatologist at Childrens Hospital Los Angeles who was not involved in the study, pointed out that magnesium can cause respiratory depression and bowel dysfunction in infants and that the mother's body has a mechanism to transport the drug across the placenta.
"If an obstetrician asked me which drug I would prefer," she said, "I would say nifedipine."
The researchers emphasized that magnesium sulfate was still an appropriate treatment for preterm labor. Many physicians continue to use it at the two hospitals where the study was conducted.
But perhaps it is time for physicians to give more weight to side effects when considering what to try first, Lyell said. "It has been my experience that women who have had magnesium sulfate remember it," she said. "They don't like it."
The findings are "probably a strong call to come up with more effective … agents with fewer side effects," said Dr. Michael C. Lu of UCLA's David Geffen School of Medicine, who was not involved in the research. "We also need to rethink our strategy in terms of preventing preterm births. Giving tocolytic therapy may be too little, too late."
--------------------------------------------------------------------------------
thomas.maugh@latimes.com
http://www.latimes.com/news/nationworld/nation/la-sci-premature30jun30,0,7239244.story?coll=la-home-nation
Birth drug leaves some moms feeling worse
A drug commonly used for preterm labor has more serious side effects than alternatives and may even harm newborns, researchers say.
By Thomas H. Maugh II
Times Staff Writer
June 30, 2007
The drug most commonly used to delay preterm labor in women has more — and more serious — side effects than alternatives, without being any more effective, Stanford researchers reported Friday. The drug may even harm infants, they concluded.
Although labor generally cannot be stopped completely, physicians try to delay it for at least 48 hours to allow transfer of the mother to a specialized hospital and to maximize the effectiveness of steroids used to help the fetus' lungs mature.
The drug most commonly used is magnesium sulfate, but nifedipine and others are occasionally used.
"There is no free lunch with any of these drugs," collectively called tocolytic agents, said Dr. Deirdre Lyell of Stanford University's Lucille Packard Children's Hospital. "But magnesium sulfate has some particularly unpleasant side effects, including vomiting, lethargy and blurry vision. The alternative, nifedipine, often leaves women feeling better."
Despite obstetric advances, preterm delivery — births before 37 weeks' gestation — remains a major problem. In the U.S., 12.3% of births are preterm, for reasons largely unknown. Prematurity is the cause of 30% of infant deaths and of a variety of developmental problems.
Lyell, Dr. Yasser El-Sayed of Stanford and their colleagues studied 192 women in preterm labor at Packard Children's and Santa Clara Valley Medical Center. Half were randomly assigned to receive infusions of magnesium sulfate, and half oral nifedipine.
In the journal Obstetrics & Gynecology, the team reported that though magnesium sulfate quieted contractions more effectively than nifedipine, there were no differences in how long delivery was delayed, in the gestational age of the newborn or in the birth weight of the infants.
Meanwhile, two-thirds of the women who received magnesium sulfate experienced mild to severe side effects during treatment, including shortness of breath and fluid buildup in the lungs. Only a third of the women receiving nifedipine experienced side effects, such as headaches.
Infants born to the mothers who received magnesium sulfate, moreover, were more likely to be admitted to the neonatal intensive care unit and to stay there longer — a median of 8.8 days, compared with 4.2 days for the babies whose mothers received nifedipine.
Dr. Victoria Camerini, a neonatologist at Childrens Hospital Los Angeles who was not involved in the study, pointed out that magnesium can cause respiratory depression and bowel dysfunction in infants and that the mother's body has a mechanism to transport the drug across the placenta.
"If an obstetrician asked me which drug I would prefer," she said, "I would say nifedipine."
The researchers emphasized that magnesium sulfate was still an appropriate treatment for preterm labor. Many physicians continue to use it at the two hospitals where the study was conducted.
But perhaps it is time for physicians to give more weight to side effects when considering what to try first, Lyell said. "It has been my experience that women who have had magnesium sulfate remember it," she said. "They don't like it."
The findings are "probably a strong call to come up with more effective … agents with fewer side effects," said Dr. Michael C. Lu of UCLA's David Geffen School of Medicine, who was not involved in the research. "We also need to rethink our strategy in terms of preventing preterm births. Giving tocolytic therapy may be too little, too late."
--------------------------------------------------------------------------------
thomas.maugh@latimes.com
Monday, July 02, 2007
New baby in the family
My brother's wife had a baby last Wednesday. Now, this would be a point of fascination for any aunt, but of course, Morgan's arrival was of particular interest to me. When I was finishing the manuscript for my book, Birth the Surprising History of How We Are Born, the final words I wrote were about my sister-in-law, Annmarie. She had just witnessed her own sister's delivery of a baby girl by cesarean (the baby was breech.) And Annmarie was transfixed by the idea of scheduling a date, waddling in to the OR, and having a newborn pulled from the zipper compartment. I wrote about her story in the context of the cesarean generation. (One out of every three babies in the US is born by c-section today, certainly not all out of necessity.)
Last fall, however, after Annmarie had read my book, she found out she was pregnant. Suddenly she seemed to have had a change of heart. She wanted a vaginal birth -- perhaps even with an element of surprise! So we were all excited when last week, she checked in to the hospital and contracted for several hours on her own. But her doctor thought her progress was slow compared with others on the maternity floor. Then came the Pitocin. Then the pain. Then the epidural. Then nothing...for three hours. No more dilation. So she had a c-section. The baby was in zero distress, by the way.
When the OB started cutting, Annmarie screamed. She could feel the scalpel scraping across her taut belly. They upped the juice and tried again. Again she screamed. They then put her under general anesthesia. When she woke up, she saw her gorgeous baby girl, with dark hair and big eyes, blinking at her.
Annmarie, like most new mothers I know, had little time or energy to question what had just happened. Fumbling with nursing, nursing a scar, she just valiantly got on with things, the many many things, involved with being a mother: loving her perfect baby, and being grateful for it. It's an anesthesia more powerful than the one they pumped into her in the OR.
Last fall, however, after Annmarie had read my book, she found out she was pregnant. Suddenly she seemed to have had a change of heart. She wanted a vaginal birth -- perhaps even with an element of surprise! So we were all excited when last week, she checked in to the hospital and contracted for several hours on her own. But her doctor thought her progress was slow compared with others on the maternity floor. Then came the Pitocin. Then the pain. Then the epidural. Then nothing...for three hours. No more dilation. So she had a c-section. The baby was in zero distress, by the way.
When the OB started cutting, Annmarie screamed. She could feel the scalpel scraping across her taut belly. They upped the juice and tried again. Again she screamed. They then put her under general anesthesia. When she woke up, she saw her gorgeous baby girl, with dark hair and big eyes, blinking at her.
Annmarie, like most new mothers I know, had little time or energy to question what had just happened. Fumbling with nursing, nursing a scar, she just valiantly got on with things, the many many things, involved with being a mother: loving her perfect baby, and being grateful for it. It's an anesthesia more powerful than the one they pumped into her in the OR.
Thursday, June 21, 2007
More from the VBAC vortex
A story from iParenting.com in which I was quoted about the controversy surrounding VBAC.
www.pregnancytoday.com/articles/4853.php
www.pregnancytoday.com/articles/4853.php
Tuesday, June 19, 2007
More Fundus
At a midwifery conference over the weekend I did a reading of my book and a talk about how midwives are portrayed by the mainstream media. (The short answer is not well.) For proof, see the below post in which I was quoted about the cost of giving birth. The first paragraph, however, is gratuitously disparaging to midwives, who attended most births in the early 20th century. Anyway, the midwives I spoke with at the conference still love their work and maintain their sense of humor, despite the crazy hours, occasionally unreasonable mothers and mediocre pay. A bumper sticker on one of their cars read: Midwives have more fundus. Indeed.
The cost of giving birth
This was an interesting story off a new report on the cost of giving birth in a hospital. The story does not, however, compare the bill with charges for home birth or those in a birth center (both much cheaper.)
The average cost of an American birth: $8,800
By Barbara Feder Ostrov
Mercury News
San Jose Mercury News
Article Launched:06/12/2007 06:30:00 AM PDT
At the turn of the 20th century, having a baby was dangerous, but not all that expensive: Women simply hired a midwife for a couple of dollars and prayed they wouldn't die on the kitchen table.
Today, the average cost of giving birth is about $8,800 higher, according to a new study released today by the March of Dimes.
Nationally, a vaginal delivery cost $7,737, with C-sections averaging about $11,000.
Giving birth costs the most in the Northeast, mostly because of the higher cost of living. Western states are the next most expensive; it's cheapest to give birth in the South.
Researchers examined insurance claims in 2004 for more than 43,000 deliveries, including prenatal care, delivery and newborn health care for three months after birth. The women studied had traditional employer-provided health insurance rather than HMO insurance and were not covered by government programs such as Medi-Cal.
It's important to study childbirth costs because pregnancy and childbirth account for nearly a quarter of all hospitalizations in the United States, the researchers say, with families, insurers and government sharing the costs.
The researchers found that insurers covered most of the cost of childbirth, with the women paying an average of $463 out-of-pocket for vaginal deliveries and slightly more for C-sections. Many consumers, however, report that their out-of-pocket costs are higher, depending on the care they receive and type of insurance they have.
When Colette Niazmand, a 30-year-old marketing manager from San Jose, planned for her child's birth, she estimated that she would pay about $5,000 to $10,000 out-of-pocket if she used the preferred provider plan offered by her employer. Instead, she chose to be covered under her schoolteacher husband's generous HMO, which essentially covered all prenatal care and childbirth costs.
"We were very lucky," said Niazmand, whose daughter is now 3-months-old. "We were prepared to have to pay some portion of it."
The study's findings point to the need for affordable health insurance for families contemplating having a child, said Dr. Jennifer Howse, president of the March of Dimes.
"Having a baby is the most costly health event families are likely to experience during their childbearing years," she said. "An uninsured healthy pregnancy can be a financial strain on young families, and a catastrophe in the case of a high-risk birth."
The costs can spiral even further if a baby is born prematurely: In another study conducted using data from 2001, the researchers found that a year's worth of health care for a premature baby averages $41,610, compared with $2,830 for a healthy, full-term infant.
In a related study conducted by the Kaiser Family Foundation and also released today, researchers found that women with so-called consumer-driven health plans faced much higher out-of-pocket costs than women with more traditional forms of health insurance. Consumer-driven health plans typically offer lower monthly premiums but higher deductibles, and some of these plans offer skimpy maternity coverage.
Childbirth costs also are financed in part by taxpayers: Medicaid (called Medi-Cal in California) finances about 40 percent of deliveries in the United States, according to the study. At Santa Clara County's safety-net hospital, Valley Medical Center, about 95 percent of the nearly 6,000 babies born each year are covered by Medi-Cal, said hospital spokeswoman Joy Alexiou.
Costs for all kinds of health care, including childbirth, have skyrocketed in the past few decades, in part because of improved medical technology and medication.
Women in the early part of the 20th century typically delivered at home, with hospital births becoming routine only with the rise of health insurance after World War II, said Tina Cassidy, author of "Birth: The Surprising History of How We Are Born."
Today, childbirth often takes place in hospital birthing suites with sophisticated infant and mother biomonitoring, attended by obstetricians, nurses and anesthesiologists.
And if the cost of childbirth doesn't make you blanch, consider the current price tag for raising a little bundle of joy until age 17: $197,700 for food, shelter and other necessities, according to the U.S. Department of Agriculture.
IF YOU'RE INTERESTED
More information on both studies is available at www.kaisernetwork.org/healthcast/kff/12jun07. For government assistance with childbirth costs, low-income or uninsured Santa Clara County residents can call Valley Connection at (888) 334-1000.
The average cost of an American birth: $8,800
By Barbara Feder Ostrov
Mercury News
San Jose Mercury News
Article Launched:06/12/2007 06:30:00 AM PDT
At the turn of the 20th century, having a baby was dangerous, but not all that expensive: Women simply hired a midwife for a couple of dollars and prayed they wouldn't die on the kitchen table.
Today, the average cost of giving birth is about $8,800 higher, according to a new study released today by the March of Dimes.
Nationally, a vaginal delivery cost $7,737, with C-sections averaging about $11,000.
Giving birth costs the most in the Northeast, mostly because of the higher cost of living. Western states are the next most expensive; it's cheapest to give birth in the South.
Researchers examined insurance claims in 2004 for more than 43,000 deliveries, including prenatal care, delivery and newborn health care for three months after birth. The women studied had traditional employer-provided health insurance rather than HMO insurance and were not covered by government programs such as Medi-Cal.
It's important to study childbirth costs because pregnancy and childbirth account for nearly a quarter of all hospitalizations in the United States, the researchers say, with families, insurers and government sharing the costs.
The researchers found that insurers covered most of the cost of childbirth, with the women paying an average of $463 out-of-pocket for vaginal deliveries and slightly more for C-sections. Many consumers, however, report that their out-of-pocket costs are higher, depending on the care they receive and type of insurance they have.
When Colette Niazmand, a 30-year-old marketing manager from San Jose, planned for her child's birth, she estimated that she would pay about $5,000 to $10,000 out-of-pocket if she used the preferred provider plan offered by her employer. Instead, she chose to be covered under her schoolteacher husband's generous HMO, which essentially covered all prenatal care and childbirth costs.
"We were very lucky," said Niazmand, whose daughter is now 3-months-old. "We were prepared to have to pay some portion of it."
The study's findings point to the need for affordable health insurance for families contemplating having a child, said Dr. Jennifer Howse, president of the March of Dimes.
"Having a baby is the most costly health event families are likely to experience during their childbearing years," she said. "An uninsured healthy pregnancy can be a financial strain on young families, and a catastrophe in the case of a high-risk birth."
The costs can spiral even further if a baby is born prematurely: In another study conducted using data from 2001, the researchers found that a year's worth of health care for a premature baby averages $41,610, compared with $2,830 for a healthy, full-term infant.
In a related study conducted by the Kaiser Family Foundation and also released today, researchers found that women with so-called consumer-driven health plans faced much higher out-of-pocket costs than women with more traditional forms of health insurance. Consumer-driven health plans typically offer lower monthly premiums but higher deductibles, and some of these plans offer skimpy maternity coverage.
Childbirth costs also are financed in part by taxpayers: Medicaid (called Medi-Cal in California) finances about 40 percent of deliveries in the United States, according to the study. At Santa Clara County's safety-net hospital, Valley Medical Center, about 95 percent of the nearly 6,000 babies born each year are covered by Medi-Cal, said hospital spokeswoman Joy Alexiou.
Costs for all kinds of health care, including childbirth, have skyrocketed in the past few decades, in part because of improved medical technology and medication.
Women in the early part of the 20th century typically delivered at home, with hospital births becoming routine only with the rise of health insurance after World War II, said Tina Cassidy, author of "Birth: The Surprising History of How We Are Born."
Today, childbirth often takes place in hospital birthing suites with sophisticated infant and mother biomonitoring, attended by obstetricians, nurses and anesthesiologists.
And if the cost of childbirth doesn't make you blanch, consider the current price tag for raising a little bundle of joy until age 17: $197,700 for food, shelter and other necessities, according to the U.S. Department of Agriculture.
IF YOU'RE INTERESTED
More information on both studies is available at www.kaisernetwork.org/healthcast/kff/12jun07. For government assistance with childbirth costs, low-income or uninsured Santa Clara County residents can call Valley Connection at (888) 334-1000.
Monday, May 21, 2007
Dirty hospitals
This is a horrific story below and it reminds me of historical accounts about early maternity wards that I read for research on my book. Basically, as birth moved from the home to the hospital in the early 20th century, a woman's chance of dying in birth INCREASED, sometimes as much as 300 percent, especially in big cities. Why? One of the most common reasons was infection -- deadly germs spread from patient to patients, via doctors' dirty hands -- in the days before antibiotics. Although the below account is about a flesh-eating bacteria, there are many reports about harder-to-treat strains of infection that new mothers and other patients are catching simply from spending time in the hospital. Sounds like history repeating itself.
From Fox News:
Florida Woman Who Lost Arms, Legs During Birth Works for Answers
Sunday , May 20, 2007
SANFORD, Fla. — Claudia Mejia cannot give the hugs most mothers bestow on their children. Nor can she grab her 2-year-old son by the hand or place him on her lap. She cannot tuck her 9-year-old into bed or walk him to the school bus stop.
Motherhood for Mejia, 25, was redefined two years ago when a medical nightmare left her without arms and legs. She contracted a flesh-eating bacteria around the time she gave birth to her youngest son, Matthew, at South Seminole Hospital in Longwood forcing doctors to amputate her limbs to save her life.
The horror that began then still unfolds for the disfigured mother, who has pleaded with hospital officials for two years to turn her medical records over — something a judge just ordered.
She and her lawyers believe she either got the infection — "group A strep" — at the hospital or its doctors and nurses failed to quickly and properly treat it. They are suing the hospital and its parent company, Orlando Regional Healthcare System, seeking unspecified damages.
"I just want the truth," Mejia said.
Orlando Regional, however, maintains Mejia's infection was acquired elsewhere and that she was treated properly. In 187,000 births since 1988 at the nonprofit hospital system, comprised of seven medical facilities, Mejia is the only reported case of invasive group A strep, Jennings Hurt III, the hospital's attorney, said.
"Thank God it's rare," Hurt said. "The hospital and everybody associated with the hospital have great sympathy for what happened to her. It's truly tragic."
Invasive group A strep infects about three people in every 100,000 in the United States each year, said Dr. Dennis Stevens, chief of the Infectious Disease Section at the Veterans Affairs Medical Center in Boise, Idaho. Of those, about a third reach the flesh-eating stage, named necrotizing fasciitis, that often requires amputation, he said. The flesh-eating stage, which destroys muscles, fat, and skin tissue, is fatal in 30 to 70 percent of its victims, Stevens said.
The three days following the April 28, 2005, birth of her son are troubling, Mejia said. After she checked into the Longwood hospital and gave birth to a healthy baby boy at 7 a.m., a fever set in, medical records show.
A nursing document reveals her temperature was high throughout the day, reading 100.6 degrees at one point. Shaking and chills soon followed, and Mejia complained of severe pain in her stomach and a burning sensation when she urinated — all signs of a potential infection, her attorney, Ron Gilbert, said.
The nurses and midwives deny Mejia ever reported any severe pain, Hurt said.
"A 100.6 temperature is very, very, very low grade," Hurt said. "A person with group A strep with toxic shock syndrome has very high, spiking temperatures. Ms. Mejia's symptoms were inconsistent with that."
Diagnosing women with infection after childbirth can be a struggle, Stevens said.
"Doctors have to be able to read between the lines to know if this is the usual pain from just having had a baby or whether there is something else going on," he said. "One of the hallmarks of these nasty group A strep infections is severe pain."
As Mejia's body tried to fight off the deadly bacteria, nurses treated her with minor painkillers Tylenol and ibuprofen, medical officials confirmed.
The hospital's care was appropriate and reasonable, Hurt said.
The over-the-counter drugs, however, could not fight a disease commonly treated with an aggressive antibiotic regimen delivered intravenously.
The hospital began the process of discharging Mejia the following morning, but her then-boyfriend, Tim Edwards, complained.
"She's too sick to come home," he said. Mejia writhed in pain and began to vomit, still with nothing more than mild pain relievers and anti-inflammatory medications, Edwards said.
Doctors finally stepped in the next afternoon and ordered emergency surgery to remove her uterus, but the invasive bacteria had now entered her bloodstream. She went into toxic shock, her kidneys began to shut down and the blood flow to her arms and legs ceased, causing gangrene to set in, records show.
She was rushed to Orlando Regional Medical Center where doctors informed her that she would die if her limbs were not amputated immediately.
"I wanted to die," she said. "I really wanted to die. I couldn't go on living without arms and legs."
It was Edwards, 34, who spent an hour, racing against the clock, convincing her that she still had much to live for.
Edwards recounts his plea to his girlfriend of two years and the mother of his son: "Keep fighting. And when you're able, marry me."
Mejia said yes to life and marriage. Doctors amputated her legs above her knees, the left arm above the elbow and her right arm just below the elbow. Eight days later, Mejia and Edwards exchanged vows in the intensive care unit. She wears her wedding band on a chain around her neck.
Two years later, their love and family remain strong.
Edwards, a produce manager at Target in Sanford, begins each day at 4 a.m. He carries his wife, who without limbs weighs 84 pounds, and bathes her. Nine-year-old Jorge, a child from a previous relationship, cooks breakfast for the family — waffles "made with batter, not the kind you put in the toaster," his mother points out.
At an awards ceremony at Crystal Lake Elementary in Sanford on Tuesday, proud tears streamed down Edward's face as Jorge, a third grader there, received awards for good behavior and straight A's.
Family suppers aren't outdated either.
"We always eat dinner all together. It's never apart," Edwards said. "We're a family united."
Mejia has learned to brush her teeth, answer the telephone and surf the Internet. She eats by attaching a fork to a fabric band on her right arm above her elbow. She is motivated to walk again with the help of prosthetics.
Edwards asked her to remarry him last year on Christmas Eve.
"Next time she's going to walk down the aisle," he said.
From Fox News:
Florida Woman Who Lost Arms, Legs During Birth Works for Answers
Sunday , May 20, 2007
SANFORD, Fla. — Claudia Mejia cannot give the hugs most mothers bestow on their children. Nor can she grab her 2-year-old son by the hand or place him on her lap. She cannot tuck her 9-year-old into bed or walk him to the school bus stop.
Motherhood for Mejia, 25, was redefined two years ago when a medical nightmare left her without arms and legs. She contracted a flesh-eating bacteria around the time she gave birth to her youngest son, Matthew, at South Seminole Hospital in Longwood forcing doctors to amputate her limbs to save her life.
The horror that began then still unfolds for the disfigured mother, who has pleaded with hospital officials for two years to turn her medical records over — something a judge just ordered.
She and her lawyers believe she either got the infection — "group A strep" — at the hospital or its doctors and nurses failed to quickly and properly treat it. They are suing the hospital and its parent company, Orlando Regional Healthcare System, seeking unspecified damages.
"I just want the truth," Mejia said.
Orlando Regional, however, maintains Mejia's infection was acquired elsewhere and that she was treated properly. In 187,000 births since 1988 at the nonprofit hospital system, comprised of seven medical facilities, Mejia is the only reported case of invasive group A strep, Jennings Hurt III, the hospital's attorney, said.
"Thank God it's rare," Hurt said. "The hospital and everybody associated with the hospital have great sympathy for what happened to her. It's truly tragic."
Invasive group A strep infects about three people in every 100,000 in the United States each year, said Dr. Dennis Stevens, chief of the Infectious Disease Section at the Veterans Affairs Medical Center in Boise, Idaho. Of those, about a third reach the flesh-eating stage, named necrotizing fasciitis, that often requires amputation, he said. The flesh-eating stage, which destroys muscles, fat, and skin tissue, is fatal in 30 to 70 percent of its victims, Stevens said.
The three days following the April 28, 2005, birth of her son are troubling, Mejia said. After she checked into the Longwood hospital and gave birth to a healthy baby boy at 7 a.m., a fever set in, medical records show.
A nursing document reveals her temperature was high throughout the day, reading 100.6 degrees at one point. Shaking and chills soon followed, and Mejia complained of severe pain in her stomach and a burning sensation when she urinated — all signs of a potential infection, her attorney, Ron Gilbert, said.
The nurses and midwives deny Mejia ever reported any severe pain, Hurt said.
"A 100.6 temperature is very, very, very low grade," Hurt said. "A person with group A strep with toxic shock syndrome has very high, spiking temperatures. Ms. Mejia's symptoms were inconsistent with that."
Diagnosing women with infection after childbirth can be a struggle, Stevens said.
"Doctors have to be able to read between the lines to know if this is the usual pain from just having had a baby or whether there is something else going on," he said. "One of the hallmarks of these nasty group A strep infections is severe pain."
As Mejia's body tried to fight off the deadly bacteria, nurses treated her with minor painkillers Tylenol and ibuprofen, medical officials confirmed.
The hospital's care was appropriate and reasonable, Hurt said.
The over-the-counter drugs, however, could not fight a disease commonly treated with an aggressive antibiotic regimen delivered intravenously.
The hospital began the process of discharging Mejia the following morning, but her then-boyfriend, Tim Edwards, complained.
"She's too sick to come home," he said. Mejia writhed in pain and began to vomit, still with nothing more than mild pain relievers and anti-inflammatory medications, Edwards said.
Doctors finally stepped in the next afternoon and ordered emergency surgery to remove her uterus, but the invasive bacteria had now entered her bloodstream. She went into toxic shock, her kidneys began to shut down and the blood flow to her arms and legs ceased, causing gangrene to set in, records show.
She was rushed to Orlando Regional Medical Center where doctors informed her that she would die if her limbs were not amputated immediately.
"I wanted to die," she said. "I really wanted to die. I couldn't go on living without arms and legs."
It was Edwards, 34, who spent an hour, racing against the clock, convincing her that she still had much to live for.
Edwards recounts his plea to his girlfriend of two years and the mother of his son: "Keep fighting. And when you're able, marry me."
Mejia said yes to life and marriage. Doctors amputated her legs above her knees, the left arm above the elbow and her right arm just below the elbow. Eight days later, Mejia and Edwards exchanged vows in the intensive care unit. She wears her wedding band on a chain around her neck.
Two years later, their love and family remain strong.
Edwards, a produce manager at Target in Sanford, begins each day at 4 a.m. He carries his wife, who without limbs weighs 84 pounds, and bathes her. Nine-year-old Jorge, a child from a previous relationship, cooks breakfast for the family — waffles "made with batter, not the kind you put in the toaster," his mother points out.
At an awards ceremony at Crystal Lake Elementary in Sanford on Tuesday, proud tears streamed down Edward's face as Jorge, a third grader there, received awards for good behavior and straight A's.
Family suppers aren't outdated either.
"We always eat dinner all together. It's never apart," Edwards said. "We're a family united."
Mejia has learned to brush her teeth, answer the telephone and surf the Internet. She eats by attaching a fork to a fabric band on her right arm above her elbow. She is motivated to walk again with the help of prosthetics.
Edwards asked her to remarry him last year on Christmas Eve.
"Next time she's going to walk down the aisle," he said.
Monday, April 30, 2007
The Business of Being Born
I just got home from New York and I would say I am exhausted from partying all night except that I am still feeling a natural high from the main purpose of the trip: The premier of a documentary called "The Business of Being Born," produced by Abby Epstein with Ricki Lake (yes, that Ricki Lake) as the executive producer. The film, just shy of 90 minutes, makes a truly compelling case for home birth (one of Lake's sons were born at her home, in the tub) among low-risk women, showing how birth can become more complicated and medicalized in the hospital.
I make several appearances in the film to provide some historical and cultural context, but the true stars were those parents who welcomed the camera into their home or birth center to chronicle their babies' arrivals. The film also features many of America's 'rock stars' of birth, including midwife Ina May Gaskin, author Robbie Davis-Floyd, and public health expert Eugene Declercq, all of whom traveled great distances to attend the premier.
There are also home birth midwives who shine in this movie despite how little the mainstream knows about them. And of course, kudos to obstetricians in the film, who freely admit that low-risk births are boring and are better suited to be attended by midwives -- not doctors.
At the end of the movie, through which I experience a full range of emotions and choked back tears a few times, there was a standing ovatation from the packed theater. The producers were busy field pitches from potential buyers immediately after the screening, so it looks hopefully that the film will be widely distributed soon. I certainly hope so.
Friday, April 27, 2007
A short, amazing story
State's shortest mom gives birth to baby girl
YouNewsTV™Story Published: Apr 26, 2007 at 7:35 PM PDT
Story Updated: Apr 26, 2007 at 7:35 PM PDT
By KOMO Staff
Christianne Ray, who stands 2'9'' tall, set a state record when she gave birth to a baby girl on Tuesday.
Ray gave birth to Kyrsten Elise by cesarean section at the University of Washington Medical Center.
Baby Kyrsten was born 14 inches long and weighed 4 pounds and 8 ounces. It took quite a team of surgeons, doctors and nurses to bring her into the world.
And little Kyrsten faces a tough road ahead. Her many health issues put her in the neo-natal intensive care unit, and it will be many weeks before she can go home.
It's already been a long journey for Christianne. Doctors didn't know whether she would be able to carry a baby at first.
"'Cause they thought the baby was going to press on her lungs and she wasn't going to be able to breathe and neither was the baby or something," said her fiance, Jeremy Bowden. "They didn't want that happening, so we've proved them wrong about a lot of the stuff."
Once she became pregnant, she had to make weekly trips from Puyallup to Seattle to see specialists.
Christianne, who weighed 80 pounds, gained 30 more with her pregnancy. She couldn't make it up the stairs anymore and needed Bowden, who happens to be 6'4'', to carry her up.
Cristianne and her family believe she will be the smallest woman in Washington state to give birth.
We did some research of our own and found several women in history that were listed as the smallest mothers in the world. One of those women, Dolletta Boykin, was 28 inches tall and gave birth to two children back in the late 1880s.
Find this article at:
http://www.komotv.com/news/7212536.html
YouNewsTV™Story Published: Apr 26, 2007 at 7:35 PM PDT
Story Updated: Apr 26, 2007 at 7:35 PM PDT
By KOMO Staff
Christianne Ray, who stands 2'9'' tall, set a state record when she gave birth to a baby girl on Tuesday.
Ray gave birth to Kyrsten Elise by cesarean section at the University of Washington Medical Center.
Baby Kyrsten was born 14 inches long and weighed 4 pounds and 8 ounces. It took quite a team of surgeons, doctors and nurses to bring her into the world.
And little Kyrsten faces a tough road ahead. Her many health issues put her in the neo-natal intensive care unit, and it will be many weeks before she can go home.
It's already been a long journey for Christianne. Doctors didn't know whether she would be able to carry a baby at first.
"'Cause they thought the baby was going to press on her lungs and she wasn't going to be able to breathe and neither was the baby or something," said her fiance, Jeremy Bowden. "They didn't want that happening, so we've proved them wrong about a lot of the stuff."
Once she became pregnant, she had to make weekly trips from Puyallup to Seattle to see specialists.
Christianne, who weighed 80 pounds, gained 30 more with her pregnancy. She couldn't make it up the stairs anymore and needed Bowden, who happens to be 6'4'', to carry her up.
Cristianne and her family believe she will be the smallest woman in Washington state to give birth.
We did some research of our own and found several women in history that were listed as the smallest mothers in the world. One of those women, Dolletta Boykin, was 28 inches tall and gave birth to two children back in the late 1880s.
Find this article at:
http://www.komotv.com/news/7212536.html
Wednesday, April 25, 2007
The VBAC Ban
This article in San Francisco Weekly is similar to a piece I wrote last December for Boston Magazine on how Massachusetts women, denied by doctors and hospitals the opportunity to try for a vaginal birth after a cesarean, were frantically seeking other options, including staying at home during birth. Clearly, this trend is nationwide.
No Hail Caesarean
Expectant mothers are losing an option to birth babies naturally and activists are charging it is more about money than safety
By LAUREN SMILEY
Published: April 25, 2007
Kilty Vahle planned to deliver her first baby as Mother Nature intended. No painkiller. No cutting. But as labor stretched on while her cervix did not, she surrendered to first painkiller, then labor-speeding hormones and an epidural, and finally a Caesarean section while the baby's heartbeat was still strong. She walked out of the hospital with a healthy baby, but vowed kid No. 2 would be pushed out in a rush of endorphins, not cut out in the fog of anesthesia.
Aaron FarmerSo, pregnant again last fall, Vahle scheduled her delivery at Homestyle Midwifery at St. Luke's Hospital in the Mission. There, a certified nurse midwife would guide her through labor with natural techniques, and the staff assured her she could push for a vaginal birth. But only as long as it was safe. That's because her prior C-section poses a small but horrible risk during labor: a .5 to 1 percent chance of tearing the uterine seam from the previous surgery, causing heavy hemorrhaging and requiring an emergency C-section to save the mother's uterus, her baby, and herself.
Vahle changed her insurance to a more expensive HMO that would cover the midwifery service.
But in mid-March and five months pregnant, she got an e-mail: St. Luke's, having merged with California Pacific Medical Center (CPMC) on Jan. 1, had stopped scheduling patients who wanted a vaginal birth after a C-section (known as a VBAC). She could schedule a C-section with St. Luke's or find somewhere else.
"When I finally had a moment to breathe, I burst into tears," the 39-year-old Lower Haight resident said. "I might not find the advocates I know I had at Homestyle" for a vaginal birth. "They may cut me off sooner and say we recommend a Caesarean now."
Joining a national trend, the CPMC-St. Luke's campus, known for its low-intervention midwifery approach to labor even outside the Homestyle Midwifery service, is now the first labor and delivery site in the city to stop scheduling vaginal births after C-sections.
Hospital officials say more expertise and staff are available to handle the higher-risk VBAC delivery at the main CPMC campus. It's the city's biggest labor and delivery floor with nearly 6,000 deliveries a year that practices a more medically managed method of delivery, with higher intervention rates and only four midwives practicing among the 50-some obstetricians who deliver babies.
But VBAC advocates argue the decision was more about money than safety, since St. Luke's has been successfully delivering post-Caesarean vaginal births for years. Advocates say the move limits a soon-to-be mother's control in one of the most important events of her life — forcing women to choose between a natural birth at home that lacks the safety net of an operating room steps away, or hospitals that may be more likely to urge women to have a repeat C-section, a surgery with more risk of complications and a longer recovery than a vaginal delivery.
"How can you take away the right to birth with whom you want and how you want?" asks Charity Pitcher-Cooper, a birth educator who is heading up a May protest march in support of VBACs. The march will end at St. Luke's door. "If you go to a place that does a lot of C-sections, you get nudged in that direction, just because they do a lot of them and see them as normal."
St. Luke's has now presented to some 20 pregnant women the options of transferring to the main CPMC campus or other area hospitals. Aside from a few who scheduled C-sections at St. Luke's, patients are now scrambling before the contractions begin to find a birthing option that fits their wishes and that their insurance will cover.
With the national C-section rate ballooning from 5 percent of births in 1970 to 29 percent in 2004 — San Francisco hovering at 24 percent — more and more women who have a second baby will have to make a similar choice: advocate a vaginal birth that carries a tiny risk of catastrophic consequences, or schedule one C-section after another with the risks of complications increasing each time.
For years, the saying was "once a Caesarean, always a Caesarean." But in the 1980s, with research showing the risk of uterine rupture was less than previously thought, VBACs came into vogue nationally. Government health officials advocated VBACs to curb the climbing C-section rate.
California Pacific Medical Center joined the trend, said Dr. Elliot Main, chairman of obstetrics and gynecology. Throughout the '90s, doctors suggested that all women with a prior C-section try to have a vaginal birth. They often induced labor or used synthetic hormones that make contractions harder and faster, both practices that later studies showed increase the risk of a rupture.
Consequently, the hospital had one to three ruptures a year, resulting in the "loss of uteruses, loss of babies," and the increase of malpractice cases, said Dr. Main. After four uterine ruptures in 1999 alone, CPMC changed its policy for VBAC patients. It stopped inducing labor, cut down on artificially speeding along labor, and screened candidates for those at low risk for a rupture.
Doctors became "gun-shy" in advocating that women with prior C-sections attempt labor.
"[Uterine ruptures] scar doctors as well as patients," Dr. Main said. "If the VBAC patient wants it, they'll be happy to do it, but they won't go out of their way to push a VBAC for patients. It's a shift of attitude that makes a significant difference in terms of the number of people who attempt a VBAC."
In fact, while nearly 80 percent of women with C-sections attempted a vaginal birth at the hospital during the '90s, now more than 80 percent automatically schedule another C-section surgery.
Many VBAC advocates and doctors say women are getting a biased view from many doctors about the potential risks of a VBAC vs. a repeat Caesarean.
"Women who do want VBAC are told they're being irresponsible and gambling with the lives of their babies," said Berna Diehl, spokeswoman for the International Caesarean Awareness Network (ICAN), a nonprofit that works to cut back unnecessary C-sections. "So they're shamed into a repeat Caesarean, which is too bad when you consider the overall safety [for a VBAC] is there. They're not always getting the full picture when they walk into a doctor's office to make a good, evidence-based decision."
In an unofficial telephone survey, ICAN counted 300 hospitals nationwide that had stopped doing VBACs as of 2005, influenced by the influx of malpractice cases and a change in the formal recommendations of the American College of Obstetrics and Gynecology in 1999 that required a surgical team be "immediately" available to perform emergency surgery for a woman attempting a VBAC.
The percentage of women with a prior C-section having a vaginal birth sunk from a high of 28 percent nationally in 1996 to 9 percent in 2004, according to the National Center for Health Statistics.
San Francisco had remained a haven for VBAC births at its five labor and delivery floors. And St. Luke's was a little-known gem: 85 percent of women with C-sections who tried labor were able to give birth vaginally in 2006, the highest rate in the city. Cynthia Banks, a certified nurse midwife at St. Luke's until this month, attributes the success to the midwifery model of care at the hospital, where midwives outnumber doctors on the labor and delivery roster.
"Whenever there's a strong midwifery presence and philosophy of labor as a natural process, that's when things are safe as can be [for VBAC births]. It takes the women believing in their bodies and it also takes the providers being supportive of that."
But St. Luke's foresaw a possible scenario on nights and weekends when less staff was on hand: The main operating room team could be occupied, the ob-gyn team always called in for a VBAC labor attempt could be busy, and a VBAC mother, should she need an emergency C-section, could be left without a surgical team. "It's absolutely a possibility," said Dr. Laura Norrell, the hospital's chair of obstetrics. "We've been lucky it hasn't happened, frankly. So while [stopping VBACs] is a painful decision for us to make, I think it's the right one because it's all about guaranteeing a patient's safety."
Some women whose first delivery ended in a C-section have become disillusioned with hospital births, feeling they were "going with the flow" in a culture that sees labor as a medical condition to be induced, monitored, and sped up with the woman often numbed and confined to bed, instead of a usually healthy process that develops at a different rate for each woman and can be helped along by methods as simple as changing positions.
A number of these women check in for their second birth better educated and accompanied by a birth coach to resist what they see as unnecessary interventions. Studies show that inducing or speeding labor and even the routine use of a continuous electronic fetal heart rate monitor can lead to more C-sections.
But a few expectant mothers, to the alarm of many doctors, opt to avoid the headache of challenging doctors and birth their next child at home. Kim Weiss, the CEO of a software company in Sausalito, recalls telling a doctor during prenatal care at CPMC that she wanted to have a VBAC epidural-free, to which he responded, "Trust me, honey, I've birthed thousands of babies, and you're gonna want that epidural." She saw a slippery slope before her from an epidural to another operation.
Weiss says she trusted CPMC to handle any complication and is a repeat customer for ob-gyn care, but "natural birth at CPMC is an oxymoron. I thought if I ended up at CPMC, I would not have a VBAC, and it would not be natural. It would be a Caesarean."
The marathon runner read 15 home-birthing books, delivered in a birthing tub in her bedroom with her husband and certified nurse midwife by her side, and was up walking minutes later.
But Dr. Main says a home VBAC is "absolutely crazy."
"You're rolling the dice. The problem with a [uterine rupture] is that it's sudden and catastrophic, it doesn't gradually develop and give you a chance to get to the hospital."
Still, mulling her options, Kilty Vahle considers a home birth her best chance to deliver vaginally. She had thought of going to Homestyle Midwifery in active labor since a hospital can't refuse a woman that far along, nor perform a C-section without consent, but now even that option is in jeopardy. Last week, St. Luke's informed the midwifery service that it will be kicked out of the hospital's Women's Center on Aug. 1 since it is considered beyond basic obstetric care, although the midwives are considering opening a private practice within the hospital, said Yeshi Neumann, the service's founder. Vahle's due date is Aug. 2.
Of course, she considers all of those sub-optimal choices.
"I have an activist side to me, so I'd love the thing to be reversed and be the first VBAC [at St. Luke's] after the cancellation of the ban."
No Hail Caesarean
Expectant mothers are losing an option to birth babies naturally and activists are charging it is more about money than safety
By LAUREN SMILEY
Published: April 25, 2007
Kilty Vahle planned to deliver her first baby as Mother Nature intended. No painkiller. No cutting. But as labor stretched on while her cervix did not, she surrendered to first painkiller, then labor-speeding hormones and an epidural, and finally a Caesarean section while the baby's heartbeat was still strong. She walked out of the hospital with a healthy baby, but vowed kid No. 2 would be pushed out in a rush of endorphins, not cut out in the fog of anesthesia.
Aaron FarmerSo, pregnant again last fall, Vahle scheduled her delivery at Homestyle Midwifery at St. Luke's Hospital in the Mission. There, a certified nurse midwife would guide her through labor with natural techniques, and the staff assured her she could push for a vaginal birth. But only as long as it was safe. That's because her prior C-section poses a small but horrible risk during labor: a .5 to 1 percent chance of tearing the uterine seam from the previous surgery, causing heavy hemorrhaging and requiring an emergency C-section to save the mother's uterus, her baby, and herself.
Vahle changed her insurance to a more expensive HMO that would cover the midwifery service.
But in mid-March and five months pregnant, she got an e-mail: St. Luke's, having merged with California Pacific Medical Center (CPMC) on Jan. 1, had stopped scheduling patients who wanted a vaginal birth after a C-section (known as a VBAC). She could schedule a C-section with St. Luke's or find somewhere else.
"When I finally had a moment to breathe, I burst into tears," the 39-year-old Lower Haight resident said. "I might not find the advocates I know I had at Homestyle" for a vaginal birth. "They may cut me off sooner and say we recommend a Caesarean now."
Joining a national trend, the CPMC-St. Luke's campus, known for its low-intervention midwifery approach to labor even outside the Homestyle Midwifery service, is now the first labor and delivery site in the city to stop scheduling vaginal births after C-sections.
Hospital officials say more expertise and staff are available to handle the higher-risk VBAC delivery at the main CPMC campus. It's the city's biggest labor and delivery floor with nearly 6,000 deliveries a year that practices a more medically managed method of delivery, with higher intervention rates and only four midwives practicing among the 50-some obstetricians who deliver babies.
But VBAC advocates argue the decision was more about money than safety, since St. Luke's has been successfully delivering post-Caesarean vaginal births for years. Advocates say the move limits a soon-to-be mother's control in one of the most important events of her life — forcing women to choose between a natural birth at home that lacks the safety net of an operating room steps away, or hospitals that may be more likely to urge women to have a repeat C-section, a surgery with more risk of complications and a longer recovery than a vaginal delivery.
"How can you take away the right to birth with whom you want and how you want?" asks Charity Pitcher-Cooper, a birth educator who is heading up a May protest march in support of VBACs. The march will end at St. Luke's door. "If you go to a place that does a lot of C-sections, you get nudged in that direction, just because they do a lot of them and see them as normal."
St. Luke's has now presented to some 20 pregnant women the options of transferring to the main CPMC campus or other area hospitals. Aside from a few who scheduled C-sections at St. Luke's, patients are now scrambling before the contractions begin to find a birthing option that fits their wishes and that their insurance will cover.
With the national C-section rate ballooning from 5 percent of births in 1970 to 29 percent in 2004 — San Francisco hovering at 24 percent — more and more women who have a second baby will have to make a similar choice: advocate a vaginal birth that carries a tiny risk of catastrophic consequences, or schedule one C-section after another with the risks of complications increasing each time.
For years, the saying was "once a Caesarean, always a Caesarean." But in the 1980s, with research showing the risk of uterine rupture was less than previously thought, VBACs came into vogue nationally. Government health officials advocated VBACs to curb the climbing C-section rate.
California Pacific Medical Center joined the trend, said Dr. Elliot Main, chairman of obstetrics and gynecology. Throughout the '90s, doctors suggested that all women with a prior C-section try to have a vaginal birth. They often induced labor or used synthetic hormones that make contractions harder and faster, both practices that later studies showed increase the risk of a rupture.
Consequently, the hospital had one to three ruptures a year, resulting in the "loss of uteruses, loss of babies," and the increase of malpractice cases, said Dr. Main. After four uterine ruptures in 1999 alone, CPMC changed its policy for VBAC patients. It stopped inducing labor, cut down on artificially speeding along labor, and screened candidates for those at low risk for a rupture.
Doctors became "gun-shy" in advocating that women with prior C-sections attempt labor.
"[Uterine ruptures] scar doctors as well as patients," Dr. Main said. "If the VBAC patient wants it, they'll be happy to do it, but they won't go out of their way to push a VBAC for patients. It's a shift of attitude that makes a significant difference in terms of the number of people who attempt a VBAC."
In fact, while nearly 80 percent of women with C-sections attempted a vaginal birth at the hospital during the '90s, now more than 80 percent automatically schedule another C-section surgery.
Many VBAC advocates and doctors say women are getting a biased view from many doctors about the potential risks of a VBAC vs. a repeat Caesarean.
"Women who do want VBAC are told they're being irresponsible and gambling with the lives of their babies," said Berna Diehl, spokeswoman for the International Caesarean Awareness Network (ICAN), a nonprofit that works to cut back unnecessary C-sections. "So they're shamed into a repeat Caesarean, which is too bad when you consider the overall safety [for a VBAC] is there. They're not always getting the full picture when they walk into a doctor's office to make a good, evidence-based decision."
In an unofficial telephone survey, ICAN counted 300 hospitals nationwide that had stopped doing VBACs as of 2005, influenced by the influx of malpractice cases and a change in the formal recommendations of the American College of Obstetrics and Gynecology in 1999 that required a surgical team be "immediately" available to perform emergency surgery for a woman attempting a VBAC.
The percentage of women with a prior C-section having a vaginal birth sunk from a high of 28 percent nationally in 1996 to 9 percent in 2004, according to the National Center for Health Statistics.
San Francisco had remained a haven for VBAC births at its five labor and delivery floors. And St. Luke's was a little-known gem: 85 percent of women with C-sections who tried labor were able to give birth vaginally in 2006, the highest rate in the city. Cynthia Banks, a certified nurse midwife at St. Luke's until this month, attributes the success to the midwifery model of care at the hospital, where midwives outnumber doctors on the labor and delivery roster.
"Whenever there's a strong midwifery presence and philosophy of labor as a natural process, that's when things are safe as can be [for VBAC births]. It takes the women believing in their bodies and it also takes the providers being supportive of that."
But St. Luke's foresaw a possible scenario on nights and weekends when less staff was on hand: The main operating room team could be occupied, the ob-gyn team always called in for a VBAC labor attempt could be busy, and a VBAC mother, should she need an emergency C-section, could be left without a surgical team. "It's absolutely a possibility," said Dr. Laura Norrell, the hospital's chair of obstetrics. "We've been lucky it hasn't happened, frankly. So while [stopping VBACs] is a painful decision for us to make, I think it's the right one because it's all about guaranteeing a patient's safety."
Some women whose first delivery ended in a C-section have become disillusioned with hospital births, feeling they were "going with the flow" in a culture that sees labor as a medical condition to be induced, monitored, and sped up with the woman often numbed and confined to bed, instead of a usually healthy process that develops at a different rate for each woman and can be helped along by methods as simple as changing positions.
A number of these women check in for their second birth better educated and accompanied by a birth coach to resist what they see as unnecessary interventions. Studies show that inducing or speeding labor and even the routine use of a continuous electronic fetal heart rate monitor can lead to more C-sections.
But a few expectant mothers, to the alarm of many doctors, opt to avoid the headache of challenging doctors and birth their next child at home. Kim Weiss, the CEO of a software company in Sausalito, recalls telling a doctor during prenatal care at CPMC that she wanted to have a VBAC epidural-free, to which he responded, "Trust me, honey, I've birthed thousands of babies, and you're gonna want that epidural." She saw a slippery slope before her from an epidural to another operation.
Weiss says she trusted CPMC to handle any complication and is a repeat customer for ob-gyn care, but "natural birth at CPMC is an oxymoron. I thought if I ended up at CPMC, I would not have a VBAC, and it would not be natural. It would be a Caesarean."
The marathon runner read 15 home-birthing books, delivered in a birthing tub in her bedroom with her husband and certified nurse midwife by her side, and was up walking minutes later.
But Dr. Main says a home VBAC is "absolutely crazy."
"You're rolling the dice. The problem with a [uterine rupture] is that it's sudden and catastrophic, it doesn't gradually develop and give you a chance to get to the hospital."
Still, mulling her options, Kilty Vahle considers a home birth her best chance to deliver vaginally. She had thought of going to Homestyle Midwifery in active labor since a hospital can't refuse a woman that far along, nor perform a C-section without consent, but now even that option is in jeopardy. Last week, St. Luke's informed the midwifery service that it will be kicked out of the hospital's Women's Center on Aug. 1 since it is considered beyond basic obstetric care, although the midwives are considering opening a private practice within the hospital, said Yeshi Neumann, the service's founder. Vahle's due date is Aug. 2.
Of course, she considers all of those sub-optimal choices.
"I have an activist side to me, so I'd love the thing to be reversed and be the first VBAC [at St. Luke's] after the cancellation of the ban."
Monday, April 23, 2007
Birth in Japan
I thought the below news story was an interesting one, especially given the fact that Japan has among the lowest maternal and newborn death rates in the world.
POPULATION-JAPAN:
Obstetric Care Hits Crisis Levels
Suvendrini Kakuchi
TOKYO, Apr 12 (IPS) - Mayu Sasaki, 32, is expecting her second baby in May, but rather than making happy preparations the former economics researcher is filled with anxiety.
''We are so desperate that my husband and I have taken the decision to move to the neighbouring city of Kyoto where care is a little better than where we live now,'' she explained to IPS recently, citing the lack of hospitals that offer delivery services to women.
Sasaki lives in Takanohara, a small town in Nara prefecture, Japan's oldest capital located 322 km west of Tokyo. Nara is now battling a scandal over the death of a 32-year-old pregnant woman who died last November as a result of being denied emergency care.
Following complications during childbirth the woman died after she was rejected at 18 hospitals in Nara. During a police investigation, hospital authorities explained they had no choice but to refuse care because of a lack of obstetric personnel and beds for babies.
The case has shaken public confidence in Japan's highly sophisticated medical industry and raised the ugly prospect, say reproductive rights activists, that, indeed, obstetrics has become a low priority for the government.
They point to the recent heated debate over remarks made by health minister, Hakuo Yanagisawa, who called women "birth-giving machines," drawing wide criticism from women who accused him of ignoring their reproduction rights.
‘'There is a lot of pressure to improve national birth rates to boost the economy. But authorities refuse to give the necessary support for safe child delivery,'' said Dr Yoshiki Idou, an expert on the issue at Ohkatani Hospital in Nara.
Idou launched a health centre for children and mothers at his hospital in 2003 to help out against, what he describes as, a ‘crisis' facing that sector in Nara.
The centre offers counselling and care for new mothers and their babies and is well patronised against a backdrop where female reproduction services are losing ground due to low birth rates -- now 1.32 per woman.
He explained that as more women opt to have children in their later years, child birth has become riskier, making it all the more important to provide safer maternity and infant care facilities in Japan.
‘'There are no large hospitals providing gynaecological services in Nara, creating a dangerous situation for women living here,'' Idou told IPS. More than 1,000 new births were registered in Nara in 2005.
The Nara scandal has, say experts, finally spotlighted the dire situation in Japan. Statistics now reveal that the number of hospitals handling deliveries dropped to 914 from 1,009 in 2005 alone.
Other data also show that only 40 percent of university-related hospitals in Japan have one or two full-time obstetricians and a survey by the Japan Association of Obstetricians and Gynaecologists reported that Japan faces a shortfall of 6,700 midwives.
According to the health ministry, 62 mothers died in 2005 during deliveries, up from 32 in 2004 recorded in a study of 125,000 childbirths. Also, the risk factor among expectant mothers is much higher, say analysts.
''Having a baby in Nara is like being strapped to a time bomb,'' says Sasaki, who has been diagnosed as a high-risk expectant mother because she suffers from asthma. She added that it is ‘'hard to believe that Japan is an industrialised country.''
While authorities are focusing on the lack of medical personnel, doctors also point to the urgent need for government to establish better working conditions for gynaecologists and paediatricians in particular.
Surveys in hospitals show that more than 40 percent of female gynaecologists stop working when they start families because they cannot cope with the long hours of work and raising their own children.
Dr Yuriko Marumoto, who runs her own clinic for pregnant women, told IPS that ‘'adding to the high stress of their work, gynaecologists also face arrest and imprisonment if there is a problem. Thus, the job is shunned by new doctors creating a very difficult situation for pregnant women.''
Idou says the shortage of medical staff can be met by increasing funds for mechanisms that support such steps as paid holidays, hospital nurseries and a rotation and sharing system between hospitals.
Experts also point to the reluctance in Japan to open the door to foreign doctors, as is the case in other industrialised countries.
Against increasing pressure Prime Minister Shinzo Abe promised, last month in the Japanese Diet (parliament), to establish a ‘Women's Doctors Bank' as a means of offering support for female obstetricians and gynaecologists. (FIN/2007)
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POPULATION-JAPAN:
Obstetric Care Hits Crisis Levels
Suvendrini Kakuchi
TOKYO, Apr 12 (IPS) - Mayu Sasaki, 32, is expecting her second baby in May, but rather than making happy preparations the former economics researcher is filled with anxiety.
''We are so desperate that my husband and I have taken the decision to move to the neighbouring city of Kyoto where care is a little better than where we live now,'' she explained to IPS recently, citing the lack of hospitals that offer delivery services to women.
Sasaki lives in Takanohara, a small town in Nara prefecture, Japan's oldest capital located 322 km west of Tokyo. Nara is now battling a scandal over the death of a 32-year-old pregnant woman who died last November as a result of being denied emergency care.
Following complications during childbirth the woman died after she was rejected at 18 hospitals in Nara. During a police investigation, hospital authorities explained they had no choice but to refuse care because of a lack of obstetric personnel and beds for babies.
The case has shaken public confidence in Japan's highly sophisticated medical industry and raised the ugly prospect, say reproductive rights activists, that, indeed, obstetrics has become a low priority for the government.
They point to the recent heated debate over remarks made by health minister, Hakuo Yanagisawa, who called women "birth-giving machines," drawing wide criticism from women who accused him of ignoring their reproduction rights.
‘'There is a lot of pressure to improve national birth rates to boost the economy. But authorities refuse to give the necessary support for safe child delivery,'' said Dr Yoshiki Idou, an expert on the issue at Ohkatani Hospital in Nara.
Idou launched a health centre for children and mothers at his hospital in 2003 to help out against, what he describes as, a ‘crisis' facing that sector in Nara.
The centre offers counselling and care for new mothers and their babies and is well patronised against a backdrop where female reproduction services are losing ground due to low birth rates -- now 1.32 per woman.
He explained that as more women opt to have children in their later years, child birth has become riskier, making it all the more important to provide safer maternity and infant care facilities in Japan.
‘'There are no large hospitals providing gynaecological services in Nara, creating a dangerous situation for women living here,'' Idou told IPS. More than 1,000 new births were registered in Nara in 2005.
The Nara scandal has, say experts, finally spotlighted the dire situation in Japan. Statistics now reveal that the number of hospitals handling deliveries dropped to 914 from 1,009 in 2005 alone.
Other data also show that only 40 percent of university-related hospitals in Japan have one or two full-time obstetricians and a survey by the Japan Association of Obstetricians and Gynaecologists reported that Japan faces a shortfall of 6,700 midwives.
According to the health ministry, 62 mothers died in 2005 during deliveries, up from 32 in 2004 recorded in a study of 125,000 childbirths. Also, the risk factor among expectant mothers is much higher, say analysts.
''Having a baby in Nara is like being strapped to a time bomb,'' says Sasaki, who has been diagnosed as a high-risk expectant mother because she suffers from asthma. She added that it is ‘'hard to believe that Japan is an industrialised country.''
While authorities are focusing on the lack of medical personnel, doctors also point to the urgent need for government to establish better working conditions for gynaecologists and paediatricians in particular.
Surveys in hospitals show that more than 40 percent of female gynaecologists stop working when they start families because they cannot cope with the long hours of work and raising their own children.
Dr Yuriko Marumoto, who runs her own clinic for pregnant women, told IPS that ‘'adding to the high stress of their work, gynaecologists also face arrest and imprisonment if there is a problem. Thus, the job is shunned by new doctors creating a very difficult situation for pregnant women.''
Idou says the shortage of medical staff can be met by increasing funds for mechanisms that support such steps as paid holidays, hospital nurseries and a rotation and sharing system between hospitals.
Experts also point to the reluctance in Japan to open the door to foreign doctors, as is the case in other industrialised countries.
Against increasing pressure Prime Minister Shinzo Abe promised, last month in the Japanese Diet (parliament), to establish a ‘Women's Doctors Bank' as a means of offering support for female obstetricians and gynaecologists. (FIN/2007)
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Monday, April 09, 2007
Birth documentary in the Tribeca Film Festival
Ricki Lake has been working on a birth documentary that is premiering at
the Tribeca Film Festival(http://www.tribecafilmfestival.org). The film, called The Business of Being Born (http://tinyurl.com/24fm9w), was directed by Abby Epstein, a New Yorker who tried for a home birth but needed medical assistance when she went into premature labor.
Epstein and producer Ricki Lake (who had a home birth in her tub and says it changed her life) explore and question the way American women have babies. Shocking
facts (which you will see me and others talk about in the film)regarding the historical and current practices of the birthing industry interweave with stories of couples who decide to give birth on their own terms.
You can buy tickets online at http://www.tribecafilmfestival.org/tff-bo-ticket-info.html. Otherwise, you can buy single tickets starting April 13th.
The screening schedule is as follows:
Sunday, April 29, 7:00 pm Clearview Chelsea West (CCW)
333 W. 23rd Street (between 8 th and 9 th Avenues.)
Monday, April 30, 6:30 pm, AMC Kips Bay (AKB)
570 Second Avenue (at 32nd St.)
Thursday, May 3, 9:45 pm, AMC Kips Bay (AKB)
570 Second Avenue (at 32nd St.)
Friday, May 4, 5:00 pm, AMC Village VII (AV7)
66 Third Avenue (at 11th St.)
the Tribeca Film Festival(http://www.tribecafilmfestival.org). The film, called The Business of Being Born (http://tinyurl.com/24fm9w), was directed by Abby Epstein, a New Yorker who tried for a home birth but needed medical assistance when she went into premature labor.
Epstein and producer Ricki Lake (who had a home birth in her tub and says it changed her life) explore and question the way American women have babies. Shocking
facts (which you will see me and others talk about in the film)regarding the historical and current practices of the birthing industry interweave with stories of couples who decide to give birth on their own terms.
You can buy tickets online at http://www.tribecafilmfestival.org/tff-bo-ticket-info.html. Otherwise, you can buy single tickets starting April 13th.
The screening schedule is as follows:
Sunday, April 29, 7:00 pm Clearview Chelsea West (CCW)
333 W. 23rd Street (between 8 th and 9 th Avenues.)
Monday, April 30, 6:30 pm, AMC Kips Bay (AKB)
570 Second Avenue (at 32nd St.)
Thursday, May 3, 9:45 pm, AMC Kips Bay (AKB)
570 Second Avenue (at 32nd St.)
Friday, May 4, 5:00 pm, AMC Village VII (AV7)
66 Third Avenue (at 11th St.)
Tuesday, April 03, 2007
British battle royal
There is a fascinating debate raging in the UK right now. The National Health Service has decided that there should be one midwife per pregnant woman in the next few years. NHS is also on a kick encouraging home birth (which is why the call for more midwives.) At the moment, there is a serious shortage of midwives, who are still the primary attendant for laboring women, even in the hospital. Below is a column that ran in the Times of London. My comments are at the end of the column.
From The Times (London)
April 4, 2007
Natural birth! Hello? This is the 21st century
Let’s have fewer pious midwives, not more
Alice Miles
A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt. We know the NHS will never be able to provide every mother with her own named midwife to hold her hand throughout what James Naughtie hilariously referred to on the Today programme yesterday as her “confinement” (where do they find these male presenters born so many, many generations ago?).
We know it, because we know about NHS rotas and staff attitudes and the way the patients are made to fit around them. We know pregnant women are not all going to have their own midwife on call, unless that means call back after 9.30am and speak to the answerphone.
Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. You only need to read the introduction to see this. “It also emphasises the need for all women to be supported and encouraged to have as normal a pregnancy and birth as possible,” writes Ms Hewitt. Her junior “Minister for Care Services”, Ivan Lewis, adds: “I believe individualised care offered by a midwife, specialist support provided to those most at risk and normal birth without medical intervention will become a more realistic option for every parent.”
A “normal” birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. The more that modern medicine offers, in terms of pain relief and convenience, the more urgent the insistence of this weird sorority that a woman has to give birth “naturally”.
Again, why? We are no longer expected these days to die naturally, without the operation that would remove the cancer or the pain relief to help us on our way. We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept.
As a woman interviewed on the radio yesterday said, the worst part of her otherwise excellent treatment on the labour ward was the moment when the midwife gave her “quite a lot of grief” because she chose to have an epidural. She only had the strength to insist upon it because her father, sister and husband were all doctors and she trusted their advice. These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.
I remember when I told my very nice and until then helpful midwife that I was going to have a Caesarean (I, fortunately, had a choice). I might as well have said that after careful thought I had decided I would feed my baby heroin. When she had recovered sufficiently from the shock, Maureen, a large, broad-hipped woman and mother of about eight, suggested I might have been swayed by Posh Spice: “A lot of women want to follow their favourite celebrity.” Then she asked whether I was doing it at my husband’s request to keep myself perfect for him “down there”.
There was no way she was going to understand that for me a predictable, pain-free birth (yes, I wanted it in the diary; anything wrong with that?) with a surgeon I had met and trusted, accompanied by lots and lots of drugs, was my choice.
Too many women in their late thirties have too many horror stories of agonising labours followed by emergency Caesareans under general anaesthetic so that, after all that, they miss the actual birth. For the rest of their lives they must live with terrible scars from being slashed wildly across the stomach by the cack-handed doctor on call, and remember the first weeks of their child’s life in only a blur of exhausted depression and trauma. Does maternity not “matter” for them, too?
Ask a woman who has had a planned Caesarean: awake, calm, pain-free. And no risk of the “down there” issues that Maureen referred to, either.
Yet the whole thrust of government policy is towards making that — the best choice for many — less and less available. They are closing smaller consultant-led maternity units and encouraging women towards natural home births or midwife-led units (no Caesareans), while hoping to use the specialist consultant-led birth centres only for the few expecting complicated births; minimal medical intervention, maximum embrace of the “natural”. Ouch!
Perhaps the most insidious effect of these official attitudes is the guilt they can engender in the poor woman who tries and feels she has “failed” to have a “normal” birth as eulogised by NHS midwifery and the equally messianic National Childbirth Trust, progenitors of so many doomed “birth plans”.
One writer in The Times has been describing the feelings of disappointment and failure she felt after an emergency Caesarean: “Right from the start I felt I had let [the baby, Charlotte] down, not to mention me and my family.” So irritated were many “pull yourself together, girl” readers, that she felt compelled to respond, this time less traumatised, a year after the birth (you can see the whole debate on the Alphamummy blog): “In the months leading up to the birth of Charlotte, like any very excited first-time mum, I read lots of books and attended a ‘natural birthing yoga’ class on a weekly basis. In all my teachings I was told over and over again that the best way is the natural drug-free way. I was told that drugs slowed down the labour and could affect the baby. Nowhere was I told the benefits of drugs. I was brainwashed into thinking that natural is right and drugs were wrong.”
Quite. It is shocking that a feminist Secretary of State for Health in the 21st century should be colluding with the pious missionaries campaigning to keep women’s birth experiences in the 19th. We are modern now. And we are not in the Third World. We do not need to get behind a bush and squat. Let those who want to go natural, choose natural. But let those who don’t, choose drugs. Choose a Caesarean. Choose life — any way they want it.
---------
So that's the column. My issue is that she is perpetuating a horrible post-modern myth that c-sections are not painful. They HURT. They can lead to horrible and hard-to-treat infections. And they are not safer unless there is a true medical issue with mother or baby. Scheduling the operation just to "put it in the diary?" Squeeze out one more column in advance? This is the plague of women of my generation. We are control freaks.
Having looked at how cultures around the world have given birth throughout time, I can say with great authority that there is never an easy way out of giving birth. On the one hand, it may seem easy to say, well if this is what she wants, fine, no skin off my back. But unfortunately, as more women clammor for c-sections, they become increasingly standard procedure; they're easy for doctors; they can manage their time and their patient flow more effectively. But once the operation becomes so common (1 out of every 3 babies in the US is born by section) it effectively limits the options of other women. That would be a shame.
From The Times (London)
April 4, 2007
Natural birth! Hello? This is the 21st century
Let’s have fewer pious midwives, not more
Alice Miles
A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt. We know the NHS will never be able to provide every mother with her own named midwife to hold her hand throughout what James Naughtie hilariously referred to on the Today programme yesterday as her “confinement” (where do they find these male presenters born so many, many generations ago?).
We know it, because we know about NHS rotas and staff attitudes and the way the patients are made to fit around them. We know pregnant women are not all going to have their own midwife on call, unless that means call back after 9.30am and speak to the answerphone.
Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. You only need to read the introduction to see this. “It also emphasises the need for all women to be supported and encouraged to have as normal a pregnancy and birth as possible,” writes Ms Hewitt. Her junior “Minister for Care Services”, Ivan Lewis, adds: “I believe individualised care offered by a midwife, specialist support provided to those most at risk and normal birth without medical intervention will become a more realistic option for every parent.”
A “normal” birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. The more that modern medicine offers, in terms of pain relief and convenience, the more urgent the insistence of this weird sorority that a woman has to give birth “naturally”.
Again, why? We are no longer expected these days to die naturally, without the operation that would remove the cancer or the pain relief to help us on our way. We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept.
As a woman interviewed on the radio yesterday said, the worst part of her otherwise excellent treatment on the labour ward was the moment when the midwife gave her “quite a lot of grief” because she chose to have an epidural. She only had the strength to insist upon it because her father, sister and husband were all doctors and she trusted their advice. These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.
I remember when I told my very nice and until then helpful midwife that I was going to have a Caesarean (I, fortunately, had a choice). I might as well have said that after careful thought I had decided I would feed my baby heroin. When she had recovered sufficiently from the shock, Maureen, a large, broad-hipped woman and mother of about eight, suggested I might have been swayed by Posh Spice: “A lot of women want to follow their favourite celebrity.” Then she asked whether I was doing it at my husband’s request to keep myself perfect for him “down there”.
There was no way she was going to understand that for me a predictable, pain-free birth (yes, I wanted it in the diary; anything wrong with that?) with a surgeon I had met and trusted, accompanied by lots and lots of drugs, was my choice.
Too many women in their late thirties have too many horror stories of agonising labours followed by emergency Caesareans under general anaesthetic so that, after all that, they miss the actual birth. For the rest of their lives they must live with terrible scars from being slashed wildly across the stomach by the cack-handed doctor on call, and remember the first weeks of their child’s life in only a blur of exhausted depression and trauma. Does maternity not “matter” for them, too?
Ask a woman who has had a planned Caesarean: awake, calm, pain-free. And no risk of the “down there” issues that Maureen referred to, either.
Yet the whole thrust of government policy is towards making that — the best choice for many — less and less available. They are closing smaller consultant-led maternity units and encouraging women towards natural home births or midwife-led units (no Caesareans), while hoping to use the specialist consultant-led birth centres only for the few expecting complicated births; minimal medical intervention, maximum embrace of the “natural”. Ouch!
Perhaps the most insidious effect of these official attitudes is the guilt they can engender in the poor woman who tries and feels she has “failed” to have a “normal” birth as eulogised by NHS midwifery and the equally messianic National Childbirth Trust, progenitors of so many doomed “birth plans”.
One writer in The Times has been describing the feelings of disappointment and failure she felt after an emergency Caesarean: “Right from the start I felt I had let [the baby, Charlotte] down, not to mention me and my family.” So irritated were many “pull yourself together, girl” readers, that she felt compelled to respond, this time less traumatised, a year after the birth (you can see the whole debate on the Alphamummy blog): “In the months leading up to the birth of Charlotte, like any very excited first-time mum, I read lots of books and attended a ‘natural birthing yoga’ class on a weekly basis. In all my teachings I was told over and over again that the best way is the natural drug-free way. I was told that drugs slowed down the labour and could affect the baby. Nowhere was I told the benefits of drugs. I was brainwashed into thinking that natural is right and drugs were wrong.”
Quite. It is shocking that a feminist Secretary of State for Health in the 21st century should be colluding with the pious missionaries campaigning to keep women’s birth experiences in the 19th. We are modern now. And we are not in the Third World. We do not need to get behind a bush and squat. Let those who want to go natural, choose natural. But let those who don’t, choose drugs. Choose a Caesarean. Choose life — any way they want it.
---------
So that's the column. My issue is that she is perpetuating a horrible post-modern myth that c-sections are not painful. They HURT. They can lead to horrible and hard-to-treat infections. And they are not safer unless there is a true medical issue with mother or baby. Scheduling the operation just to "put it in the diary?" Squeeze out one more column in advance? This is the plague of women of my generation. We are control freaks.
Having looked at how cultures around the world have given birth throughout time, I can say with great authority that there is never an easy way out of giving birth. On the one hand, it may seem easy to say, well if this is what she wants, fine, no skin off my back. But unfortunately, as more women clammor for c-sections, they become increasingly standard procedure; they're easy for doctors; they can manage their time and their patient flow more effectively. But once the operation becomes so common (1 out of every 3 babies in the US is born by section) it effectively limits the options of other women. That would be a shame.
Saturday, March 24, 2007
Birth: A HIS-story
This email is posted with permission:
Dear Tina,
Greetings and Blessings!
I have been reading your profound and magnificent book and came across my son's name so decided to contact you. I am Patrick (Lighthouse) Houser. My son, Jeremy, was born in 1980, in water. He is now 26. Lighthouse was a "stage" name at the time and no longer used.
In these last months I have begun an initiative called Fathers-To-Be, see website.
What I thought was to be a series of workshops has become an initiative. My first book is being edited now, The Fathers-To-Be Handbook.
In 1998 I moved to England and began working with my new wife, Binnie Dansby(see ecstaticbirth.com), in birth related work here. We live in the Kent countryside. Have also read your blog. Binnie also had an orgasmic birth with her second child.
I have no real motive in contacting you except that I am sure our paths are meant to cross in various ways.
Please have a visit to my site and check out the YouTube presentation, technology and the internet is soooo wonderful.
many blessings on you and your work,
PATRICK
Please enjoy www.fatherstobe.org and www.ecstaticbirth.com
Dear Tina,
Greetings and Blessings!
I have been reading your profound and magnificent book and came across my son's name so decided to contact you. I am Patrick (Lighthouse) Houser. My son, Jeremy, was born in 1980, in water. He is now 26. Lighthouse was a "stage" name at the time and no longer used.
In these last months I have begun an initiative called Fathers-To-Be, see website.
What I thought was to be a series of workshops has become an initiative. My first book is being edited now, The Fathers-To-Be Handbook.
In 1998 I moved to England and began working with my new wife, Binnie Dansby(see ecstaticbirth.com), in birth related work here. We live in the Kent countryside. Have also read your blog. Binnie also had an orgasmic birth with her second child.
I have no real motive in contacting you except that I am sure our paths are meant to cross in various ways.
Please have a visit to my site and check out the YouTube presentation, technology and the internet is soooo wonderful.
many blessings on you and your work,
PATRICK
Please enjoy www.fatherstobe.org and www.ecstaticbirth.com
Tuesday, March 20, 2007
Check out the how-to tips at the end
This news flash from The Independent (UK)
Published: 20 March 2007
How to have a sensual, drug-free birth
Forget epidurals. Midwives say they can train women to have births that are not only drug-free, but pleasurable - and even orgasmic. Anastasia Stephens reports
For Katrina Caslake, giving birth was not the terrifying, painful ordeal most women experience. Far from it. The midwife, from Wallington, south London, says she found it blissful, even orgasmic. "I found giving birth very sensual," says Caslake, 44, who didn't take painkillers for the birth of either of her sons, Aaron and Tomas, now 18 and 17.
"All my erogenous zones were stimulated. I was making sounds very similar to a sexual climax. And it was a very definite climax. I was doing the most feminine thing a woman can do and it felt fantastic."
It's a sentiment with which Frederika Deera, a PR officer at John Lewis in London, would agree. She had a similar experience giving birth to her two-year-old daughter Delphine.
"Giving birth filled me with the most indescribable euphoria," says Deera, who gave birth at a midwife-led unit in Portsmouth. "Of course there was pain, but my overall sense was of peace and happiness. I was on a complete high, so much that even having a major suturing afterwards did not bother me at all."
It was her "pleasurable experience" that led Caslake to train as a midwife. "I knew I wasn't unique," says Caslake, who helps run Yours Maternally, an independent midwifery service. "By encouraging other women to trust and relax in their bodies, I felt I could help them experience less painful, more pleasurable births."
It's an approach that's also encouraged at the Birth Centre in south London where midwife Nathalie Mottershead actively encourages sensual birth.
"If couples are willing, nipple and clitoral massage can be used to bring on labour contractions, open the cervix and vagina and help with pain relief," she says.
More to the point, the approach is capable of transforming birth - perceived by most women to be terrifyingly painful - into a pleasurable, even, ecstatic experience. "We work closely with women so they can give birth at home, in intimate surroundings. If mothers-to-be are open to feeling sexy, labour can be pleasurable, not painful, and it sometimes builds up to a crescendo at birth."
It's not as if the techniques used at the Birth Centre are isolated or rare.
"If a woman is comfortable enough to do nipple or clitoral stimulation during birth, it's a useful trick for pain relief and inducing labour," says Andrya Prescott, spokesperson for the Independent Midwives Association.
A visit to the Unassisted Childbirth Organisation's US website confirms just how erotic childbirth can be. The site describes in graphic detail women's fantasies in which romantic and sexual union leads to "blissful waves of pleasure", and "cosmic orgasms" at the point of birth. More women, it seems, get turned on by birth than you'd think. When Ina May Gaskin, a US midwife, conducted a poll of 151 women, 32 reported experiencing at least one orgasmic birth. Admittedly, these were home births by women who were "open" to the experience. The plus points are pretty significant - a single orgasm is thought to be 22 times as relaxing as the average tranquilliser, while sexual arousal widens the vagina significantly.
"Women might think twice about having an epidural if they knew that, but nobody talk about these things," points out Gaskin, a natural childbirth pioneer who was the first midwife to openly acknowledge that women could climax at birth.
It almost sounds too good to be true: a touchy-feely labour followed by an earth-shattering orgasm at the moment of birth. Unfortunately, this is very far removed from most women's description of childbirth. A major hitch is that, as with any sexual activity, the amount of pleasure gained - for women at least - is closely related to the degree of relaxation, trust and safety she feels.
Most women anticipate with dread the "birth ordeal", a state of mind that will make muscles contract and adrenalin levels rise before it even begins. And then, most women can only feel sexy in intimate surroundings, with people they know well. Hospitals and doctors don't really do the trick.
"Adrenalin inhibits sex drive and labour contractions," says midwife Andrya Prescott. "You become tense and are more prone to feeling pain. It's why women can have trouble with labour and birth at hospital. Surrounded by strangers, their adrenalin levels are high. They can't relax. Even if they were open to getting aroused, at a hospital, they may as well forget it."
Part of the problem, it seems, is the way sexuality around childbirth has been denied. In her book, Ina May's Guide To Childbirth, Gaskin points out that doctors had to downplay female sexuality for medical men to be admitted to the birth chambers of women in the 18th and 19th centuries. This " denial" was later institutionalised when hospital births became routine.
Even today, it's a pretty taboo subject. "Lots of women would worry they'd be seen as abnormal or deviant if they admitted to feeling sexual at birth," says Carolyn Cowan, a yoga teacher and doula based in south London, who herself had an ecstatic birth. "It's something lots of women feel ashamed to talk about," she adds. "I run erotic dance classes for pregnant women to try to get rid of these inhibitions. I should know a thing or two - it took giving birth to my son to discover my G-spot."
The tide is clearly turning. A growing number of obstetricians and midwives point out what seems pretty obvious, yet has been somehow forgotten - that since sex leads to pregnancy and birth, they're pretty closely linked.
"When you look at sex, birth and lactation, the same hormones are involved," says Michel Odent, the obstetrician who pioneered the use of birthing pools in the Seventies. "It seems obvious that childbirth is a part of a woman's sexuality."
Many parents-to-be, for example, find that making love and nipple stimulation are one of the best ways to get labour going. That's because sexual arousal releases oxytocin, a love and bonding hormone, which triggers orgasmic and labour contractions in the uterus. Conveniently, this hormone is an endorphin, meaning it has an opiate-like effect - inducing pleasure while acting as a highly effective painkiller.
Aside from the pleasure and pain relief, the advantage of a sensual birth is less physical damage. "Women who are relaxed and feel good, undergo easier, smoother births, so suffer less tearing and bruising," says Caslake. "Fear makes a woman more tense and this holds the baby back."
The baby gets a pleasure hit too - bathed in "feel-good" hormones, they're more likely to come out feeling relaxed and content.
www.michelodent.com (for more info on love hormones); www.unassistedchildbirth.com (for more info on sensual birth); www.birthcentre.com (020-7820 6661); www.independentmidwives.org.uk; for sensual prenatal exercises contact Carolyn Cowan (020-7701 3845; www.mooncycles.co.uk); Yours Maternally Independent Midwives, Wallington, south London ( www.yoursmaternally.co.uk; 020-8401 9501)
How to have a pleasurable birth
Why some women achieve a "birth climax" while others endure excruciating pain is likely to be due to differences in environment, genetics, expectations, and psychological factors. Trust and the level of emotional support you feel from your partner or midwife is critical in inducing a feeling of safety and relaxation needed to get the "pleasure hormones" going.
Women are generally more likely to have sensual birth experiences during home deliveries in an intimate environment. Midwives who have witnessed women who've been physically aroused during childbirth believe the following techniques could make the experience more likely:
* Before and during childbirth, become intimate with your body. Look at yourself naked in the mirror, noticing any areas that trigger uncomfortable emotions. Send loving thoughts to that area until the difficult feelings pass. Ask your partner to look at your body and compliment you.
* If you feel comfortable with it, aim for a home birth.
* Work closely with a doula or midwife to build up a sense of trust with her, in your body and in the birth process.
* Ask yourself if you can believe that your body will be doing the right thing, to the best of its ability, to give birth successfully. The more you can believe this, the more you'll be able to trust yourself and relax.
* Pick a special room or area where you want to give birth. Light candles to create atmosphere and evaporate lavender essential oil in an oil burner to induce relaxation.
* Learn a relaxation method such as abdominal breathing or self-hypnosis to use during childbirth to curb the release of stress hormones.
* Create the expectation that childbirth could be pleasurable, even if there is pain: while pregnant, spend time imagining how it could trigger warm tingling sensations in your body along with feelings of love.
* If you feel it is appropriate, ask your partner to kiss you, stroke you gently or even caress your nipples as labour contractions come on.
Published: 20 March 2007
How to have a sensual, drug-free birth
Forget epidurals. Midwives say they can train women to have births that are not only drug-free, but pleasurable - and even orgasmic. Anastasia Stephens reports
For Katrina Caslake, giving birth was not the terrifying, painful ordeal most women experience. Far from it. The midwife, from Wallington, south London, says she found it blissful, even orgasmic. "I found giving birth very sensual," says Caslake, 44, who didn't take painkillers for the birth of either of her sons, Aaron and Tomas, now 18 and 17.
"All my erogenous zones were stimulated. I was making sounds very similar to a sexual climax. And it was a very definite climax. I was doing the most feminine thing a woman can do and it felt fantastic."
It's a sentiment with which Frederika Deera, a PR officer at John Lewis in London, would agree. She had a similar experience giving birth to her two-year-old daughter Delphine.
"Giving birth filled me with the most indescribable euphoria," says Deera, who gave birth at a midwife-led unit in Portsmouth. "Of course there was pain, but my overall sense was of peace and happiness. I was on a complete high, so much that even having a major suturing afterwards did not bother me at all."
It was her "pleasurable experience" that led Caslake to train as a midwife. "I knew I wasn't unique," says Caslake, who helps run Yours Maternally, an independent midwifery service. "By encouraging other women to trust and relax in their bodies, I felt I could help them experience less painful, more pleasurable births."
It's an approach that's also encouraged at the Birth Centre in south London where midwife Nathalie Mottershead actively encourages sensual birth.
"If couples are willing, nipple and clitoral massage can be used to bring on labour contractions, open the cervix and vagina and help with pain relief," she says.
More to the point, the approach is capable of transforming birth - perceived by most women to be terrifyingly painful - into a pleasurable, even, ecstatic experience. "We work closely with women so they can give birth at home, in intimate surroundings. If mothers-to-be are open to feeling sexy, labour can be pleasurable, not painful, and it sometimes builds up to a crescendo at birth."
It's not as if the techniques used at the Birth Centre are isolated or rare.
"If a woman is comfortable enough to do nipple or clitoral stimulation during birth, it's a useful trick for pain relief and inducing labour," says Andrya Prescott, spokesperson for the Independent Midwives Association.
A visit to the Unassisted Childbirth Organisation's US website confirms just how erotic childbirth can be. The site describes in graphic detail women's fantasies in which romantic and sexual union leads to "blissful waves of pleasure", and "cosmic orgasms" at the point of birth. More women, it seems, get turned on by birth than you'd think. When Ina May Gaskin, a US midwife, conducted a poll of 151 women, 32 reported experiencing at least one orgasmic birth. Admittedly, these were home births by women who were "open" to the experience. The plus points are pretty significant - a single orgasm is thought to be 22 times as relaxing as the average tranquilliser, while sexual arousal widens the vagina significantly.
"Women might think twice about having an epidural if they knew that, but nobody talk about these things," points out Gaskin, a natural childbirth pioneer who was the first midwife to openly acknowledge that women could climax at birth.
It almost sounds too good to be true: a touchy-feely labour followed by an earth-shattering orgasm at the moment of birth. Unfortunately, this is very far removed from most women's description of childbirth. A major hitch is that, as with any sexual activity, the amount of pleasure gained - for women at least - is closely related to the degree of relaxation, trust and safety she feels.
Most women anticipate with dread the "birth ordeal", a state of mind that will make muscles contract and adrenalin levels rise before it even begins. And then, most women can only feel sexy in intimate surroundings, with people they know well. Hospitals and doctors don't really do the trick.
"Adrenalin inhibits sex drive and labour contractions," says midwife Andrya Prescott. "You become tense and are more prone to feeling pain. It's why women can have trouble with labour and birth at hospital. Surrounded by strangers, their adrenalin levels are high. They can't relax. Even if they were open to getting aroused, at a hospital, they may as well forget it."
Part of the problem, it seems, is the way sexuality around childbirth has been denied. In her book, Ina May's Guide To Childbirth, Gaskin points out that doctors had to downplay female sexuality for medical men to be admitted to the birth chambers of women in the 18th and 19th centuries. This " denial" was later institutionalised when hospital births became routine.
Even today, it's a pretty taboo subject. "Lots of women would worry they'd be seen as abnormal or deviant if they admitted to feeling sexual at birth," says Carolyn Cowan, a yoga teacher and doula based in south London, who herself had an ecstatic birth. "It's something lots of women feel ashamed to talk about," she adds. "I run erotic dance classes for pregnant women to try to get rid of these inhibitions. I should know a thing or two - it took giving birth to my son to discover my G-spot."
The tide is clearly turning. A growing number of obstetricians and midwives point out what seems pretty obvious, yet has been somehow forgotten - that since sex leads to pregnancy and birth, they're pretty closely linked.
"When you look at sex, birth and lactation, the same hormones are involved," says Michel Odent, the obstetrician who pioneered the use of birthing pools in the Seventies. "It seems obvious that childbirth is a part of a woman's sexuality."
Many parents-to-be, for example, find that making love and nipple stimulation are one of the best ways to get labour going. That's because sexual arousal releases oxytocin, a love and bonding hormone, which triggers orgasmic and labour contractions in the uterus. Conveniently, this hormone is an endorphin, meaning it has an opiate-like effect - inducing pleasure while acting as a highly effective painkiller.
Aside from the pleasure and pain relief, the advantage of a sensual birth is less physical damage. "Women who are relaxed and feel good, undergo easier, smoother births, so suffer less tearing and bruising," says Caslake. "Fear makes a woman more tense and this holds the baby back."
The baby gets a pleasure hit too - bathed in "feel-good" hormones, they're more likely to come out feeling relaxed and content.
www.michelodent.com (for more info on love hormones); www.unassistedchildbirth.com (for more info on sensual birth); www.birthcentre.com (020-7820 6661); www.independentmidwives.org.uk; for sensual prenatal exercises contact Carolyn Cowan (020-7701 3845; www.mooncycles.co.uk); Yours Maternally Independent Midwives, Wallington, south London ( www.yoursmaternally.co.uk; 020-8401 9501)
How to have a pleasurable birth
Why some women achieve a "birth climax" while others endure excruciating pain is likely to be due to differences in environment, genetics, expectations, and psychological factors. Trust and the level of emotional support you feel from your partner or midwife is critical in inducing a feeling of safety and relaxation needed to get the "pleasure hormones" going.
Women are generally more likely to have sensual birth experiences during home deliveries in an intimate environment. Midwives who have witnessed women who've been physically aroused during childbirth believe the following techniques could make the experience more likely:
* Before and during childbirth, become intimate with your body. Look at yourself naked in the mirror, noticing any areas that trigger uncomfortable emotions. Send loving thoughts to that area until the difficult feelings pass. Ask your partner to look at your body and compliment you.
* If you feel comfortable with it, aim for a home birth.
* Work closely with a doula or midwife to build up a sense of trust with her, in your body and in the birth process.
* Ask yourself if you can believe that your body will be doing the right thing, to the best of its ability, to give birth successfully. The more you can believe this, the more you'll be able to trust yourself and relax.
* Pick a special room or area where you want to give birth. Light candles to create atmosphere and evaporate lavender essential oil in an oil burner to induce relaxation.
* Learn a relaxation method such as abdominal breathing or self-hypnosis to use during childbirth to curb the release of stress hormones.
* Create the expectation that childbirth could be pleasurable, even if there is pain: while pregnant, spend time imagining how it could trigger warm tingling sensations in your body along with feelings of love.
* If you feel it is appropriate, ask your partner to kiss you, stroke you gently or even caress your nipples as labour contractions come on.
So much for the above post
Painful Sex Common After Giving Birth
March 20, 2007
--------------------------------------------------------------------------------
(WebMD) Painful sex may affect nearly a third of women in the first year after they give birth, a new study suggests.
The researchers included Rebecca Knibb, Ph.D., senior lecturer at England's University of Derby.
They mailed questionnaires to 2,100 women in England who had given birth within the past year. The questionnaires were returned by 482 women (23 percent of those contacted). The questionnaire covered various postnatal health problems, including
incontinence, painful sex (dyspareunia), and pelvic pain.
Of the 482 women who returned the completed survey, 30 percent reported painful sex during the previous month.
The study also shows that, overall, 87 percent of the 482 moms who returned the completed survey reported at least one postnatal health problem during the previous month.
The most commonly reported problem was "sexual morbidity," which included painful sex, lack of lubrication or sensation during intercourse, and incontinence during intercourse.
Women who had given birth with the help of forceps were the most likely to report the postnatal conditions covered in the survey. Those who had given birth by cesarean section were the least likely to report such problems.
The study was limited by the fact that more than three-quarters of the mothers whom the researchers tried to contact didn't complete and return the questionnaire.
The relatively few mothers who participated may not represent all new moms. In fact, mothers with postnatal problems may have been more likely to complete the questionnaire.
The low response rate also prevented the researchers from gauging whether postnatal problems are constant or rare.
On the questionnaire, the women were asked to note how frequently they experienced each postnatal problem, with possible responses ranging from "rarely" to "all of the time."
Too few women provided that information, so the researchers couldn't analyze whether moms experienced postnatal problems consistently or occasionally in the year after giving birth.
The study appears in the Journal of Clinical Nursing.
Reviewed by Louise Chang, M.D.
©2007 WebMD, Inc. All rights reserved.
March 20, 2007
--------------------------------------------------------------------------------
(WebMD) Painful sex may affect nearly a third of women in the first year after they give birth, a new study suggests.
The researchers included Rebecca Knibb, Ph.D., senior lecturer at England's University of Derby.
They mailed questionnaires to 2,100 women in England who had given birth within the past year. The questionnaires were returned by 482 women (23 percent of those contacted). The questionnaire covered various postnatal health problems, including
incontinence, painful sex (dyspareunia), and pelvic pain.
Of the 482 women who returned the completed survey, 30 percent reported painful sex during the previous month.
The study also shows that, overall, 87 percent of the 482 moms who returned the completed survey reported at least one postnatal health problem during the previous month.
The most commonly reported problem was "sexual morbidity," which included painful sex, lack of lubrication or sensation during intercourse, and incontinence during intercourse.
Women who had given birth with the help of forceps were the most likely to report the postnatal conditions covered in the survey. Those who had given birth by cesarean section were the least likely to report such problems.
The study was limited by the fact that more than three-quarters of the mothers whom the researchers tried to contact didn't complete and return the questionnaire.
The relatively few mothers who participated may not represent all new moms. In fact, mothers with postnatal problems may have been more likely to complete the questionnaire.
The low response rate also prevented the researchers from gauging whether postnatal problems are constant or rare.
On the questionnaire, the women were asked to note how frequently they experienced each postnatal problem, with possible responses ranging from "rarely" to "all of the time."
Too few women provided that information, so the researchers couldn't analyze whether moms experienced postnatal problems consistently or occasionally in the year after giving birth.
The study appears in the Journal of Clinical Nursing.
Reviewed by Louise Chang, M.D.
©2007 WebMD, Inc. All rights reserved.
Monday, March 19, 2007
Laboring alone
This story, which ran in the London Observer on March 18, discusses how frequently women are left to labor alone in the hospital. While that may not seem like a big deal, many studies have shown -- and human history has suggested -- that birth is quicker and less complicated when a mother has continuous, encouraging support for labor and delivery. In that context, it is a shame that women -- many more in the US than in the UK -- are often left in their room alone to handle waves of contractions. (Is it any wonder so many of us jump at the chance of an epidural?)
Here's the piece:
A survey of women who have recently given birth in hospitals has found that a fifth do not have a midwife or doctor by their side throughout the delivery.
Health experts are alarmed because official guidelines state that women in labour should have continuous care.
The growing shortage of midwives is leaving some maternity units struggling to cope, particularly as parts of Britain are seeing a rising birth rate.
The survey of 5,000 mothers, funded by the Healthcare Commission and produced by the National Perinatal and Epidemiology Unit in Oxford, also shows high levels of dissatisfaction with post-natal care, with many women saying that they felt stressed by noisy, crowded conditions where there was too little support, particularly for first-time mothers.
The findings come as the government prepares to announce its own maternity implementation strategy. Ministers have realised that maternity care has received too little money and direction within the NHS, and are identifying 'hot spots' where care is very poor.
The new strategy will give women the right to choose whether to give birth at a local hospital, in a more informal midwife-led unit, or at home with midwife support. This right to choice over place of birth, however, will not be implemented for another two years, as many parts of the NHS cannot yet offer all three options.
Dr Gwyneth Lewis, the national clinical director for maternity services, told The Observer that offering individual care was extremely important. 'If just one woman feels that she was left alone during the birth, then that is one woman too many. It is totally unacceptable to leave any woman alone.'
Lewis said she was well aware of the pressure on%
Here's the piece:
A survey of women who have recently given birth in hospitals has found that a fifth do not have a midwife or doctor by their side throughout the delivery.
Health experts are alarmed because official guidelines state that women in labour should have continuous care.
The growing shortage of midwives is leaving some maternity units struggling to cope, particularly as parts of Britain are seeing a rising birth rate.
The survey of 5,000 mothers, funded by the Healthcare Commission and produced by the National Perinatal and Epidemiology Unit in Oxford, also shows high levels of dissatisfaction with post-natal care, with many women saying that they felt stressed by noisy, crowded conditions where there was too little support, particularly for first-time mothers.
The findings come as the government prepares to announce its own maternity implementation strategy. Ministers have realised that maternity care has received too little money and direction within the NHS, and are identifying 'hot spots' where care is very poor.
The new strategy will give women the right to choose whether to give birth at a local hospital, in a more informal midwife-led unit, or at home with midwife support. This right to choice over place of birth, however, will not be implemented for another two years, as many parts of the NHS cannot yet offer all three options.
Dr Gwyneth Lewis, the national clinical director for maternity services, told The Observer that offering individual care was extremely important. 'If just one woman feels that she was left alone during the birth, then that is one woman too many. It is totally unacceptable to leave any woman alone.'
Lewis said she was well aware of the pressure on%
Tuesday, March 06, 2007
London calling
I spent all of last week in London promoting my book, which has the new title in the UK of Birth: A History. After 10 BBC interviews it was clear that many issues around birth are universal: Women grappling with pain relief, political fights surrounding who controls birth, and economic issues that ultimately decide where, when, how and with whom women deliver. But there are some differences between birth in America and birth in the UK. First, their maternal and neonatal mortality rates are better than ours. Their midwifery rates are higher than ours, and their health czar recently came out publicly to promote home birth, saying she recognized that decades of studies have consistently found home birth to be at least as safe as hospital births for low-risk women. And it's cheaper for the National Health Service, their universal health care system. The trouble is, there aren't enough midwives to facilitate home birth. But women have already picked up on the government's pitch. They like the idea. They're going into labor with the plan of staying at home. Sometimes a midwife gets there in time. Sometimes she doesn't.
From a doctor in Hawaii
This post is an email (posted with permission) from a doctor on the big island of Hawaii.
hello tina,
i just finished listening to your interview with terri gross on "fresh air" and had a comment. first, the interview was great and you bring up some great points about the history of birthing and the current (abysmal) state of birth management.
my issue is the neglect of mentioning of the role of a family doctor in the birth process. as a practicing family physician, i have delivered well over 500 babies and helped to raise them. family docs deliver and manage labors mush more like midwives than other md-obstetricians. we are trained in an approach that is patient centered. not surgically oriented, so the options that you discussed a midwife might suggest are well within the practice of most family physicians practing ob as part of their training. but, family docs have more physician trained decision making capabilities than many midwives and broader surgical training that sometimes is of benefit. also, family doctors often have more insight into how the birth of this individual child into the family unit may be affecting labor, through the deeper and more extensive interaction with the rest of the nuclear and often with the extended family.
i urge you to consider mentioning, or learning more about the role of the family physician in the american and international birthing process. a good start is the american acedemy of family physician website at www.aafp.org.
i currently practice on the big island of hawaii. my current practice scope is limited, and does not include ob, partly because of "political" infighting among the ob-gyns in this town and their desire to limit access of family doctors to obstetrical patients. and also, because i have adopted 2 little girls from china in the past 2 years and am busy being a mom.
but, i loved my obstetrical practice and very strongly feel, and the data at aafp will back me up, that family docs are an underutilized resource in the field of obstetrics. we have really excellent track records for safe, non- operatively intervened and happy outcomes.
i'm happy to do whatever i can to educate the folks about our role.
thanks
hello tina,
i just finished listening to your interview with terri gross on "fresh air" and had a comment. first, the interview was great and you bring up some great points about the history of birthing and the current (abysmal) state of birth management.
my issue is the neglect of mentioning of the role of a family doctor in the birth process. as a practicing family physician, i have delivered well over 500 babies and helped to raise them. family docs deliver and manage labors mush more like midwives than other md-obstetricians. we are trained in an approach that is patient centered. not surgically oriented, so the options that you discussed a midwife might suggest are well within the practice of most family physicians practing ob as part of their training. but, family docs have more physician trained decision making capabilities than many midwives and broader surgical training that sometimes is of benefit. also, family doctors often have more insight into how the birth of this individual child into the family unit may be affecting labor, through the deeper and more extensive interaction with the rest of the nuclear and often with the extended family.
i urge you to consider mentioning, or learning more about the role of the family physician in the american and international birthing process. a good start is the american acedemy of family physician website at www.aafp.org.
i currently practice on the big island of hawaii. my current practice scope is limited, and does not include ob, partly because of "political" infighting among the ob-gyns in this town and their desire to limit access of family doctors to obstetrical patients. and also, because i have adopted 2 little girls from china in the past 2 years and am busy being a mom.
but, i loved my obstetrical practice and very strongly feel, and the data at aafp will back me up, that family docs are an underutilized resource in the field of obstetrics. we have really excellent track records for safe, non- operatively intervened and happy outcomes.
i'm happy to do whatever i can to educate the folks about our role.
thanks
Friday, February 16, 2007
Half of all Chinese women having cesareans
I laughed when I saw this story posted on the China Post website under the banner advertisement for "Business Opportunities."
China's caesarean section birth ratio dwarfs WHO standard
(Xinhua)
Updated: 2007-02-15 21:05
BEIJING -- The ratio of caesarean section births in China has soared to 50 percent, far exceeding the standard of 15 percent set by the World Health Organization, medical experts say.
The ratio of caesarean births in China remained at five percent from 1950s to 1970s, but now some urban hospitals have a C-section rate of more than 60 percent.
It is widely believed that one of the reasons for the sharp rise is that doctors recommend C-section delivery to pregnant women to boost their earning power.
"Caesarean sections earn doctors higher profits so doctors tend to persuade pregnant women to have a caesarean," said a doctor who did not wish to be named.
In Beijing's hospitals, the operation and hospital fees for a caesarean section are three to four times higher than that of a natural birth. At the Union Medical College Hospital, it costs 1600 yuan (US$205) for a natural labour, but 4000 yuan (US$480) for a caesarean section.
The C-section, commonly viewed as an emergency procedure, is also being seen as an alternative to the pain associated with natural birth. Many pregnant women see C-section delivery as a pain-free process without any knowledge of the potential consequences.
"C-sections can cause some bad aftereffects to both mothers and children. Doctors should make the risks known to pregnant women, but only a few choose to do so," the doctor added.
Pan Junfeng, a gynecologist in Beijing's Haidian District Hospital of Maternity and Child Care, said, "The chances of postoperative infection for caesarean sections is 10 to 20 times higher than that for natural labor and the death ratio of pregnant women for caesarean section is five times higher."
"The chance of subsequently suffering from depression is 6.28 times higher and there is also a greater chance of haemorrhage," Pan added.
Pan said "Expectant mothers in China often have the mistaken idea that it is safer and less painful to have a caesarean section, while it's quite the contrary."
Medical experts have urged doctors to explain to pregnant women and their family members the two methods of delivery, making it clear that caesarean section can have a negative effect on both babies and mothers.
They also advocate regular psychological consultation for pregnant mothers and recommend doctors to encourage natural birth.
http://www.chinadaily.com.cn/china/2007-02/15/content_810507.htm
China's caesarean section birth ratio dwarfs WHO standard
(Xinhua)
Updated: 2007-02-15 21:05
BEIJING -- The ratio of caesarean section births in China has soared to 50 percent, far exceeding the standard of 15 percent set by the World Health Organization, medical experts say.
The ratio of caesarean births in China remained at five percent from 1950s to 1970s, but now some urban hospitals have a C-section rate of more than 60 percent.
It is widely believed that one of the reasons for the sharp rise is that doctors recommend C-section delivery to pregnant women to boost their earning power.
"Caesarean sections earn doctors higher profits so doctors tend to persuade pregnant women to have a caesarean," said a doctor who did not wish to be named.
In Beijing's hospitals, the operation and hospital fees for a caesarean section are three to four times higher than that of a natural birth. At the Union Medical College Hospital, it costs 1600 yuan (US$205) for a natural labour, but 4000 yuan (US$480) for a caesarean section.
The C-section, commonly viewed as an emergency procedure, is also being seen as an alternative to the pain associated with natural birth. Many pregnant women see C-section delivery as a pain-free process without any knowledge of the potential consequences.
"C-sections can cause some bad aftereffects to both mothers and children. Doctors should make the risks known to pregnant women, but only a few choose to do so," the doctor added.
Pan Junfeng, a gynecologist in Beijing's Haidian District Hospital of Maternity and Child Care, said, "The chances of postoperative infection for caesarean sections is 10 to 20 times higher than that for natural labor and the death ratio of pregnant women for caesarean section is five times higher."
"The chance of subsequently suffering from depression is 6.28 times higher and there is also a greater chance of haemorrhage," Pan added.
Pan said "Expectant mothers in China often have the mistaken idea that it is safer and less painful to have a caesarean section, while it's quite the contrary."
Medical experts have urged doctors to explain to pregnant women and their family members the two methods of delivery, making it clear that caesarean section can have a negative effect on both babies and mothers.
They also advocate regular psychological consultation for pregnant mothers and recommend doctors to encourage natural birth.
http://www.chinadaily.com.cn/china/2007-02/15/content_810507.htm
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