Forceps, as we know them in the west, were invented by men, specifically the Chamberlen family in England in the 16th century. For hundreds of years, only members of the all-male barber-surgeon trade could use the the tools, so midwives would have to call a barber to a birth gone awry. This post below, by a female OB -- and most OBs under 35 today in America are women -- caught my attention because its sentiment is so unexpected.
Midwife with a Knife: Forceps Are Your Friends
Friday, August 31, 2007
Tuesday, August 28, 2007
Maternal mortality
I know many people find America's maternal mortality statistics shocking -- particularly the fact that nearly two dozen countries have lower death rates attributable to pregnancy and birth than the US does -- but this report ratchets up the alarm.
Experts: U.S. Childbirth Deaths on Rise
By MIKE STOBBE
The Associated Press
Friday, August 24, 2007; 4:43 PM
ATLANTA -- U.S. women are dying from childbirth at the highest rate in decades, new government figures show. Though the risk of death is very small, experts believe increasing maternal obesity and a jump in Caesarean sections are partly to blame.
Some numbers crunchers note that a change in how such deaths are reported also may be a factor.
"Those of us who look at this a lot say it's probably a little bit of both," said Dr. Jeffrey King, an obstetrician who led a recent New York state review of maternal deaths.
The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to statistics released this week by the National Center for Health Statistics.
The rate was 12 per 100,000 live births in 2003 _ the first time the maternal death rate rose above 10 since 1977.
National Center for Health Statistics 2004 deaths report:
To read the full AP story go to:http://www.washingtonpost.com/wp-dyn/content/article/2007/08/24/AR2007082401321.html
To read the government report, see page 12 at:
http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf
Experts: U.S. Childbirth Deaths on Rise
By MIKE STOBBE
The Associated Press
Friday, August 24, 2007; 4:43 PM
ATLANTA -- U.S. women are dying from childbirth at the highest rate in decades, new government figures show. Though the risk of death is very small, experts believe increasing maternal obesity and a jump in Caesarean sections are partly to blame.
Some numbers crunchers note that a change in how such deaths are reported also may be a factor.
"Those of us who look at this a lot say it's probably a little bit of both," said Dr. Jeffrey King, an obstetrician who led a recent New York state review of maternal deaths.
The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births in 2004, according to statistics released this week by the National Center for Health Statistics.
The rate was 12 per 100,000 live births in 2003 _ the first time the maternal death rate rose above 10 since 1977.
National Center for Health Statistics 2004 deaths report:
To read the full AP story go to:http://www.washingtonpost.com/wp-dyn/content/article/2007/08/24/AR2007082401321.html
To read the government report, see page 12 at:
http://www.cdc.gov/nchs/data/nvsr/nvsr55/nvsr55_19.pdf
Saturday, August 18, 2007
Summer reading
I have just finished reading two books. First was the thoroughly researched and thoroughly readable Pushed: The Painful Truth about Childbirth and Modern Maternity Care, by Jennifer Block, a former editor at Ms. Magazine and Our Bodies, Ourselves. The second was Animal, Vegetable, Miracle: A Year of Food Life, by Barbara Kingsolver, about her radical 12-month undertaking of eating only that which she grew herself or that grew nearby. What struck me about both of these books -- besides how well each was done -- is how much these seemingly disparate topics, how babies are born and how food gets to our table, overlap in modern life. In Pushed, Block writes how "there was a direct tie between the rise of the assembly line -- of mass production -- and the rise of standardized, mechanize birth." Pitocin, the labor inducing and augmenting drug that half of all American women receive in the hospital today during labor and delivery, "owed its commercial availability to the centralization of the meatpacking industry. One pound of dried extract became the profitable by-product of pituitary glands from twelve thousand young cattle."
Kingsolver, for her part, talks about how agribusiness has brought us the unlikely phenomenon of cheap bananas all year round in places where they don't grow, and farm subsidues that actually help companies like Monsanto put small-town farmers out of business. In the end, we are left with grocery stores full of foods that are less healthful and more damaging to the environment, given the fertilizers and pesticides involved, as well as the fuels used to transport the food.
The bottom line in Pushed is that the natural way of giving birth should be the default, not the exception today. And that we still don't fully understand how we are messing with our complex biological systems when we override them with drugs and tools and schedules in a room full of strangers.
Likewise, Kingsolver argues that we all need to be reeducated about the local seasonality of food, why it is important not just to eat organic but to buy local. She writes: "The drift away from our agricultural roots is a natural consequence of migration from the land to the factory...But we got ourselves uprooted entirely by a drastic reconfiguration of US farming, beginning just after World War II. Our munitions plants, challenged to beat their swords into plowshares, retooled to make amonium nitrate surpluses into chemical fertilizers instead of explosives. The next explosions were yields on midwestern corn and soybean fields." Which is why we are glugging down products sweetened with corn syrup and getting fat in the process. To say nothing of our 30-plus percent cesarean rate.
Kingsolver, for her part, talks about how agribusiness has brought us the unlikely phenomenon of cheap bananas all year round in places where they don't grow, and farm subsidues that actually help companies like Monsanto put small-town farmers out of business. In the end, we are left with grocery stores full of foods that are less healthful and more damaging to the environment, given the fertilizers and pesticides involved, as well as the fuels used to transport the food.
The bottom line in Pushed is that the natural way of giving birth should be the default, not the exception today. And that we still don't fully understand how we are messing with our complex biological systems when we override them with drugs and tools and schedules in a room full of strangers.
Likewise, Kingsolver argues that we all need to be reeducated about the local seasonality of food, why it is important not just to eat organic but to buy local. She writes: "The drift away from our agricultural roots is a natural consequence of migration from the land to the factory...But we got ourselves uprooted entirely by a drastic reconfiguration of US farming, beginning just after World War II. Our munitions plants, challenged to beat their swords into plowshares, retooled to make amonium nitrate surpluses into chemical fertilizers instead of explosives. The next explosions were yields on midwestern corn and soybean fields." Which is why we are glugging down products sweetened with corn syrup and getting fat in the process. To say nothing of our 30-plus percent cesarean rate.
Monday, August 13, 2007
Simpson's house
I am here in Edinburgh, a gorgeous cobbled, hilly city with a castle, plucky people and an overwhelming amount of artist events to see at one of its various festivals (The Fringe, The International Festival, and The Edinburgh International Book Festival, for which I am here). But the most interesting sight for me to see this morning was the home of James Young Simpson, the first person to use chloroform to alleviate the pain of childbirth. In 1847, Simpson, two medical assistants, and some other guests passed around a tumbler (preserved in the red wall-papered dining room) that was filled with the "curious liquid." After inhaling the chloroform, they all flopped to the floor, with the exception of Simpson's woozy niece who looked down on them as she cried out "I'm an angel! Oh I'm an angel." With that, Simpson knew he had found a cure for pain and administered the drug to his first obstetric patient shortly thereafter. The woman gave her baby girl the middle name "Anaesthesia." One other interesting note: Simpson's house, the place where a drug was invented, is now used as a drug treatment center.
Said in Scotland
I gave a talk today at the Edinburgh International Book Festival about my book, published in the UK as Birth: A History. In the front row of the event sat Gillian Smith, head of Scotland's Royal College of Midwives. At one point, the audience and I were lamenting the lack of one-on-care women often receive during labor in the hospital, and how this was feeding the trend, in western countries, of women hiring doulas. Ms. Smith, however, quickly pointed out that in Scotland -- unlike England where there is a severe midwifery shortage -- women DO receive continuous care from a midwife during labor and birth. "How?" I asked. "Is it a function of the modest size of Scotland's population or the government's understanding of the value of such care and its support of having enough midwives to service the population. (Don't forget, they have nationalized medicine here.) She credited the government's evidence-based view that continuous care leads to better labors and easier births.
Bonnie good!
Wednesday, August 08, 2007
It was only a matter of time...
When people talk about technology creeping into the delivery room, this is not usually what they have in mind. Check out this link to a piece on Salon.com.
http://machinist.salon.com/blog/2007/08/06/twitter_birth/index.html
http://machinist.salon.com/blog/2007/08/06/twitter_birth/index.html
Monday, August 06, 2007
An excellent op-ed
From today's Boston Globe:
The folly of 1 percent policy
By Eugene Declercq and Judy Norsigian | August 6, 2007
THE PHRASE that comes to mind when you hear Dick Cheney is probably not "reshaping American childbirth." Yet Vice President Cheney's "One Percent Doctrine" -- the title of Ron Suskind's 2006 book on post9/11 national security policy -- perfectly captures an approach to decision-making in American medicine that misallocates resources and undermines primary care. By focusing maximum resources on preventing an extremely rare but potentially disastrous outcome over necessary preventive care, this model has shaped healthcare decision-making in areas ranging from hysterectomies to coronary bypasses. One shift -- the rapidly rising caesarean rate -- exemplifies this problem.
Suskind reports that in debates over national security policy following 9/11, Cheney repeatedly invoked the principle that if there's even a 1 percent chance of a terrorist attack, we must prepare as if it were a certainty. This extreme position invariably gave Cheney the moral high ground in debates, where he could appear more willing to protect American interests than others with a broader focus. Of course, in winning the immediate argument, Cheney also ignored myriad longer-term complications involving problems not solved while the "emergency" is addressed.
In healthcare, caesarean sections represent the most recent example of this doctrine, as births are increasingly treated as potential emergencies requiring expensive, high-tech interventions. The caesarean rate in the United States has increased from 20 percent in 1996 to a record high of more than 30 percent in 2005, trailing only Italy (37 percent) and South Korea (35 percent) among industrialized countries. Obstetricians are more skilled at performing caesareans than ever before and caesareans are safer than ever. But they are not without negative consequences. When they are performed as elective surgery on mothers with little or no medical risk, these harms outweigh the benefits.
Yet caesareans are advocated as necessary to avert potential disasters that might occur. At a 2006 meeting sponsored by the National Institutes of Health, one doctor captured the 1 percent (or in this case 1/30th of 1 percent) doctrine when he described rare conditions and noted the benefits of a 100 percent caesarean rate (you read that right) in avoiding these outcomes in 3 in 10,000 cases.
Likewise, a 2006 position statement from the American College of Obstetricians and Gynecologists states that "Labor and delivery is a physiologic process that most women experience without complications," but then goes on to emphasize the 1 percent doctrine: ". . . serious intrapartum complications may arise with little or no warning, even in low risk pregnancies." The statement and the doctor's claim are true, of course -- anything can occur -- but does that mean that society benefits when every birth is handled as a disaster (or worse yet a lawsuit) waiting to happen?
No one wishes a health problem on any mother or child, but the "1 percent" advocates of higher caesarean section rates assert they care more about infant outcomes than those who oppose them. However, the consequences of universal caesarean sections on a largely healthy population are profound in both the short run (longer recovery, greater postpartum pain, higher maternal rehospitalization rates for surgical complications, higher costs) and long run (higher rates of subsequent stillbirths, greater risk of future uterine rupture, longer stays requiring more hospital space). The 1 percent doctrine cares little about such consequences since its focus is on winning the current argument.
Creating a crisis atmosphere is essential to the 1 percent doctrine and its ability to override all obstacles -- be they constitutional restrictions on national security measures or concerns about the United States ranking last among industrialized countries on infant mortality. Such an atmosphere encourages more centralized decision-making and stifles debate. The fact that most of these crises never occur and that countless resources are expended to prevent something that was unlikely to happen anyway is lost in the relief of the immediate positive outcome (a healthy baby or no terrorist attack). In the long run, however, we've wasted time and money, created new problems, and ignored systematically documented, if less emotional, evidence.
A version of the 1 percent doctrine has been invoked for decades in steering the US healthcare system away from an emphasis on preventive care for the whole population to an obsession with treating rare events. As a debating strategy, the 1 percent doctrine is extremely persuasive. As a policy guideline, it makes no sense in either politics or healthcare.
Eugene Declercq is a professor of maternal and child health at the Boston University School of Public Health. Judy Norsigian is executive director of Our Bodies Ourselves.
The folly of 1 percent policy
By Eugene Declercq and Judy Norsigian | August 6, 2007
THE PHRASE that comes to mind when you hear Dick Cheney is probably not "reshaping American childbirth." Yet Vice President Cheney's "One Percent Doctrine" -- the title of Ron Suskind's 2006 book on post9/11 national security policy -- perfectly captures an approach to decision-making in American medicine that misallocates resources and undermines primary care. By focusing maximum resources on preventing an extremely rare but potentially disastrous outcome over necessary preventive care, this model has shaped healthcare decision-making in areas ranging from hysterectomies to coronary bypasses. One shift -- the rapidly rising caesarean rate -- exemplifies this problem.
Suskind reports that in debates over national security policy following 9/11, Cheney repeatedly invoked the principle that if there's even a 1 percent chance of a terrorist attack, we must prepare as if it were a certainty. This extreme position invariably gave Cheney the moral high ground in debates, where he could appear more willing to protect American interests than others with a broader focus. Of course, in winning the immediate argument, Cheney also ignored myriad longer-term complications involving problems not solved while the "emergency" is addressed.
In healthcare, caesarean sections represent the most recent example of this doctrine, as births are increasingly treated as potential emergencies requiring expensive, high-tech interventions. The caesarean rate in the United States has increased from 20 percent in 1996 to a record high of more than 30 percent in 2005, trailing only Italy (37 percent) and South Korea (35 percent) among industrialized countries. Obstetricians are more skilled at performing caesareans than ever before and caesareans are safer than ever. But they are not without negative consequences. When they are performed as elective surgery on mothers with little or no medical risk, these harms outweigh the benefits.
Yet caesareans are advocated as necessary to avert potential disasters that might occur. At a 2006 meeting sponsored by the National Institutes of Health, one doctor captured the 1 percent (or in this case 1/30th of 1 percent) doctrine when he described rare conditions and noted the benefits of a 100 percent caesarean rate (you read that right) in avoiding these outcomes in 3 in 10,000 cases.
Likewise, a 2006 position statement from the American College of Obstetricians and Gynecologists states that "Labor and delivery is a physiologic process that most women experience without complications," but then goes on to emphasize the 1 percent doctrine: ". . . serious intrapartum complications may arise with little or no warning, even in low risk pregnancies." The statement and the doctor's claim are true, of course -- anything can occur -- but does that mean that society benefits when every birth is handled as a disaster (or worse yet a lawsuit) waiting to happen?
No one wishes a health problem on any mother or child, but the "1 percent" advocates of higher caesarean section rates assert they care more about infant outcomes than those who oppose them. However, the consequences of universal caesarean sections on a largely healthy population are profound in both the short run (longer recovery, greater postpartum pain, higher maternal rehospitalization rates for surgical complications, higher costs) and long run (higher rates of subsequent stillbirths, greater risk of future uterine rupture, longer stays requiring more hospital space). The 1 percent doctrine cares little about such consequences since its focus is on winning the current argument.
Creating a crisis atmosphere is essential to the 1 percent doctrine and its ability to override all obstacles -- be they constitutional restrictions on national security measures or concerns about the United States ranking last among industrialized countries on infant mortality. Such an atmosphere encourages more centralized decision-making and stifles debate. The fact that most of these crises never occur and that countless resources are expended to prevent something that was unlikely to happen anyway is lost in the relief of the immediate positive outcome (a healthy baby or no terrorist attack). In the long run, however, we've wasted time and money, created new problems, and ignored systematically documented, if less emotional, evidence.
A version of the 1 percent doctrine has been invoked for decades in steering the US healthcare system away from an emphasis on preventive care for the whole population to an obsession with treating rare events. As a debating strategy, the 1 percent doctrine is extremely persuasive. As a policy guideline, it makes no sense in either politics or healthcare.
Eugene Declercq is a professor of maternal and child health at the Boston University School of Public Health. Judy Norsigian is executive director of Our Bodies Ourselves.
Wednesday, August 01, 2007
Food for thought
Hospital told to return placenta to mom
The Associated Press
News Fuze
Article Launched:07/19/2007 09:33:19 AM PDT
LAS VEGAS—A woman has won a court fight to keep the placenta after her daughter's birth. She had planned to grind it up and ingest it as a way to fight postpartum depression, but now plans to bury it.
Clark County District Court Judge Susan Johnson granted a preliminary injunction Tuesday, ordering Sunrise Hospital and Medical Center in southern Nevada to return the placenta to Anne Swanson. Hospital officials said they will comply.
The hospital had refused to give the uterine lining to Swanson following the April 12 Caesarean birth of her daughter, with officials calling it contaminated biohazardous waste. The judge ordered the hospital not to destroy the placenta, which was frozen, and ordered that it be turned over to Swanson within two weeks.
Swanson, who was 30 when she gave birth, originally wanted to give her placenta to a friend to be dried, ground into a powder and packed into capsules. She said she now plans to dry, store and eventually bury the organ instead of eating it.
"I hope this brings about a better awareness about the benefits of placenta," she said, citing a theory that placental hormones can help control postpartum blues.
Amy Stevens, system vice president for Sunrise Health, which operates Sunrise Hospital, described the ruling as specific to Swanson. She said the hospital must comply with strict regulations in handling human biohazardous waste.
There is no Nevada law prohibiting hospitals from returning placentas to mothers. But several Las Vegas area hospitals told the Las Vegas Review-Journal the organ is usually destroyed unless a physician designates it for medical tests or a patient seeks it for specific religious or cultural reasons.
The Associated Press
News Fuze
Article Launched:07/19/2007 09:33:19 AM PDT
LAS VEGAS—A woman has won a court fight to keep the placenta after her daughter's birth. She had planned to grind it up and ingest it as a way to fight postpartum depression, but now plans to bury it.
Clark County District Court Judge Susan Johnson granted a preliminary injunction Tuesday, ordering Sunrise Hospital and Medical Center in southern Nevada to return the placenta to Anne Swanson. Hospital officials said they will comply.
The hospital had refused to give the uterine lining to Swanson following the April 12 Caesarean birth of her daughter, with officials calling it contaminated biohazardous waste. The judge ordered the hospital not to destroy the placenta, which was frozen, and ordered that it be turned over to Swanson within two weeks.
Swanson, who was 30 when she gave birth, originally wanted to give her placenta to a friend to be dried, ground into a powder and packed into capsules. She said she now plans to dry, store and eventually bury the organ instead of eating it.
"I hope this brings about a better awareness about the benefits of placenta," she said, citing a theory that placental hormones can help control postpartum blues.
Amy Stevens, system vice president for Sunrise Health, which operates Sunrise Hospital, described the ruling as specific to Swanson. She said the hospital must comply with strict regulations in handling human biohazardous waste.
There is no Nevada law prohibiting hospitals from returning placentas to mothers. But several Las Vegas area hospitals told the Las Vegas Review-Journal the organ is usually destroyed unless a physician designates it for medical tests or a patient seeks it for specific religious or cultural reasons.
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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Copyright © 2007 IPS-Inter Press Service. All rights reserved.
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)
Contact Us | About Us | Subscription | Help us Improve | News in RSS | Mobile
Copyright © 2007 IPS-Inter Press Service. All rights reserved.
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.)
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