Homebirth and midwives in NYT!

Lead story in today's NYT home section (with accompanying slideshow):

Baby, You’re Home

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

Here's the slideshow:
http://www.nytimes.com/slideshow/2008/11/13/garden/20081113-BIRTH_index.html

-dr-

Dr. Phil's a tool

Dr. Phil is soliciting women who've had bad homebirth experiences. I'm sure he'll be hard-pressed to find any. I encourage anyone who has a hospital horror story to submit it to his site:

http://www.drphil.com/plugger/respond/?plugID=12524

One of his questions asks:
Did you have your second child the traditional way in a hospital?

Traditional???!!!

ABC News: The Business of At-Home Births

ABC News: The Business of At-Home Births

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The Myth of the Elective C-Section | Reproductive Health | RHRealityCheck.org

The Myth of the Elective C-Section | Reproductive Health | RHRealityCheck.org

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Breaking News from Ricki Lake and BOBB

June18, 2008 Dear BOBB Friends and Supporters: We wanted to make sure you are all aware of the news story that has exploded over the last 24 hours regarding the recent AMA Resolution against homebirth and Ricki's response to being named in it. In February of this year, one month after the premiere of BOBB, the American College of Obstetricians and Gynecologists (ACOG) reiterated its long-standing opposition to home births. In an obtuse reference to The Business of Being Born, ACOG stated, "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre."  If that wasn't enough, ACOG, this past weekend, introduced a resolution to the American Medical Association (AMA) at their annual meeting. The resolution commits the AMA to "develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital...". The reasoning for this resolution begins, "Whereas, There has been much attention in the media by celebrities having home deliveries, with recent Today Show headings such as "Ricki Lake takes on baby birthing industry: Actress and former talk show host shares her at-home delivery in new film...". (Resolution 205, click here to read). Since when did Ricki become an evidence-based data point? What are they so afraid of? Just last week, Medical News Today reports that "about 8.2% of infants born in the US in 2005 had low birth weights, the highest percentage since 1968." US infant mortality rates continue to rank us below 30 other countries, 22% of pregnancies are induced, and most worrisome of all, in the last 4 years, the maternal mortality rate has risen above 10 per 100,000 for the first time since 1977. To us, these seem like the troubling trends, not home birth. News outlets including the AP quickly picked up this story yesterday as it hit TMZ, E! USA Today, Daily News, FOX. Ricki will be featured on Good Morning America this Saturday discussing the controversy. (If you Google "Ricki Lake, AMA" you will see the bloggers are all over this!) Filmmakers Abby Epstein and Ricki Lake teamed up with journalist and Pushed author Jennifer Block to pen the response (following at the end of this email) for the Huffington Post (click here to read). Late yesterday, the AMA changed the final wording on resolution 205 to omit the mention of Ricki. (Hmmm...) The AMA says that the American College of Obstetricians and Gynecologists (ACOG) drafted the initial statement so any issues should be taken up directly with them. Stay tuned for more news to come... The BOBB Team DOCS TO WOMEN: PAY NO ATTENTION TO RICKI LAKE'S HOME BIRTH Ladies, the physicians of America have issued their decree: they don't want you having your babies at home with midwives. We can't imagine why not. Study upon study have shown that planning a home birth with a trained midwife is a great choice if you want to avoid unnecessary medical intervention. Midwives are experts in supporting the physiological birth process: monitoring you and your baby during labor, helping you into positions that help labor progress, protecting your pelvic parts from damage while you push, and "catching" the baby from the position that's most effective and comfortable for you-hands and knees, squatting, even standing-not the position most comfortable for her. When healthy women are supported this way, 95% give birth vaginally, with hardly any intervention. And yet, the American Medical Association doesn't see the point. Yesterday it adopted a policy written by the American College of Obstetricians and Gynecologists against "home deliveries" and in support of legislation "that helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital" or accredited birth center. "There ought to be a law!" cry the doctors. The trouble is, they have no evidence to back up their safety claims. In fact, the largest and most rigorous study of home birth internationally to date found that among 5,000 healthy, "low-risk" women, babies were born just as safely at home under a midwife's care as in the hospital. And not only that, the study, like many before it, found that the women actually fared better at home, with far fewer interventions like labor induction, cesarean section, and episiotomy (taking scissors to the vagina, a practice that according to the research should be obsolete but is still performed on one-third of women who give birth vaginally). Which is why the American Public Health Association supports midwife-attended home birth. The British OB/GYNs have read the research, too, and have this to say: "There is no reason why home birth should not be offered to women at low risk of complications... it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman's likelihood of a birth that is both satisfying and safe" The other trouble with the American MDs is that they seem to have lost all respect for women's civil rights, indeed for the U.S. Constitution - the right to privacy, to bodily integrity, and the right of every adult to determine her own health care. The "father knows best" legislation they are promoting could indeed be used to criminally prosecute women who choose home birth, say, by equating it with child abuse. Research evidence be damned, the doctors want to mandate you to go to the hospital. They don't want you to have a choice. We think they're spooked. The cesarean rate is rising, celebrities are publicizing their home births (the initial wording of the AMA resolution actually took aim at Ricki for publicizing her home birth on the Today Show!), people are reading Pushed and watching The Business of Being Born, and there's a nationwide legislative "push" to license certified professional midwives in all states (The AMA is against that, too, by the way). The docs are on the defensive. After all, birth is big business-it's in fact the most common reason for a woman to be admitted to the hospital. And if more women start giving birth outside of it, who will get paid? Not doctors and not hospitals. "The AMA supports a woman's right to make an informed decision regarding her delivery and to choose her health care provider," the group said in a statement. But if it really supported women's birth choices it wouldn't adopt a policy condemning home birth and midwives. Because if U.S. women are to have real birth choices, everybody needs to be working together to provide them, not engaging in turf wars at their expense. By Ricki Lake, Abby Epstein and Jennifer Block for The Huffington Post
www.thebusinessofbeingborn.com

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Ayn Rand and Suffering

I forgot to include the whole reason why I chose to post about McCain's incredible war story yesterday. I've been re-trying to read Ayn Rand's Atlas Shrugged, and I came to one of those places in the book yesterday morning that forced me to put the book down to devote more time to fully understand a thought. Here's the quote that set me a-thinking (retyped via BlackBerry to let it seep in more slowly...like taking in a landscape on foot vs. from a car):

"She survived it. She was able to survive it, because she did not believe in suffering."

That's where I had to stop, but the quote continues:

"She faced with astonished indignation the ugly fact of feeling pain, and refused to let it matter. Suffering was a senseless accident, it was not part of life as she saw it. She would not allow pain to become important. She had no name for the kind of resistance she offered, for the emotion from which the resistance came; but the words that stood as its equivalent in her mind were: It does not count -- it is not to be taken seriously. She knew these were the words, even in the moments when there was nothing left within her but screaming and she wished she could lose the faculty of consciousness so that it would not tell her that what could not be true was true. Not to be taken seriously -- an immovable certainty within her kept repeating -- pain and ugliness are never to be taken seriously.

She fought it. She recovered. Years helped her to reach the day when she could face her memories indifferently, then the day when she felt no necessity to face them. It was finished and of no concern to her any longer."

Now granted -- that section is about a powerful business executive and her EMOTIONAL reaction to the pain of love. But I believe Rand's thinking can have very broad applications.

For example, is that the line of thinking John McCain pursued, when abused and broken as a POW he refused to divulge any more than his rank and serial number? Is that how he dealt with the pain inflicted on his body? By refusing to believe in suffering thus overcome it?

Is that how
prisoners,
deportees,
guerrillas,
spies,
soldiers,
the terminally ill,
artists,
poets,
doctors,
activists
perceive pain and suffering?

Can one overcome things just by refusing to believe in them? Things like sin? Self-hate? Stupidity?

Is this an extremely empowering approach to life or ridiculously addle headed one void of a reality check? It would be extremely liberating to give suffering a big F-U, but aren't there degrees and shades to it?

How would I interpret this in daily life? How would you? Can you honestly say that's how we deal with pain? Physical and emotional? I wonder how a welfare abuser would read that excerpt.

I don't think society helps us with putting suffering in context. It could be because fear is so commonly encouraged by all the information we consume. Suffering becomes a constant when we have instantaneous news of terrorist bombings, tens of thousands of deaths from natural disasters, hit-and-runs, robberies, lying politicians.

It's a wonder anyone goes outside any more.

As much as I deplored Fareed Zakaria's "post-America is here" article, I think he had a great point in understanding why most people wouldn't think we're living in a time of unprecedented peace and prosperity. While global organized death it down, every little act is reported in the information age. That hasn't been the case throughout history when we've sometimes had to wait decades to confirm through the opening of secret archives that millions had been slaughtered. We've had trouble putting every death and deplorable act in context as a result.

Another place I think this culture of fear has been extremely detrimental has been in the process of birth. Our non-stop thirst for information and acceptance of fear have produced a dangerous cycle. OBs and "Baby Doctors" who typically have no formal training for normal birth, manipulate fear of suffering (not to mention fear of self-realization, fear of lawsuits, fear of responsibility, and fear of the routine) to escalate normal situations to the crisis kinds for which they're trained.

Working backwards, this has produced a fear of pain. People believe strongly in suffering and they fear it. Since pain is the cause of suffering, you avoid pain at all costs, even when it is beneficial.

To bring this back to the Rand excerpt, how can we apply her "suffering does not exist" mentality to birth? To be sure, the process is often painful, but how a woman interprets that is very important to the process in my opinion. By embracing a sufferer's mentality, the pain becomes a horrible burden to be avoided at all costs, even to the point of demanding to have a child cut out of your womb.

By denying suffering a seat at the table the pain of childbirth could be seen as limitlessly empowering.

(Full disclosure: I will never have to give birth)

So, is suffering real? Should it be denied? Is that empowering or ludicrous?

-dr-

ACOD Statement on Hospital Births

The American College of Darius (ACOD) reiterates its long-standing opposition to hospital births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital full of God-complexed doctors is detrimental because complications can arise as a result of aggressive intervention even among women with low-risk pregnancies.

ACOD acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, and as a result, ACOD does not support programs or individuals that advocate for hospitalized births. Nor does ACOD support the provision of care by obstetricians who have not even witnessed live births during their "extensive" "certification" by the American College of Obstetricians and Gynecologists (ACOG).

Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by celebrity c-section decisions, a seemingly normal cesarean can quickly become life-threatening for both the mother and baby. Attempting an elective cesarean is especially dangerous because if the uterus is nicked during the operation, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is at home or at a birthing center, with midwives ready to transfer quickly to the shower if necessary, she puts herself and her baby's health and life at unnecessary risk.

Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOD for the past several decades and ACOD remains committed to reducing it, and there is a scientific way to recommend an 'ideal' national cesarean rate as a target goal! In 2008, ACOD read a WHO report that determined that cesarean rates should not exceed 10 percent to 15 percent. Multiple factors are responsible for the current cesarean rate, but long-standing contributors include our litigious society, impatient doctors, and uncaring professional organizations.

The availability of an obstetrician-gynecologist to intervene and manufacture an emergency during labor and/or delivery may be life-taking for the mother or newborn and lower the likelihood of mother-child bonding after birth. ACOD believes that the safest setting for labor, delivery, and the immediate postpartum period is at home, or a birthing center that meets the results jointly discovered by Rooks and Weatherby, or in a birthing center that meets the standards of the American College of Nurse Midwives, The World Health Organization, or the American Association of Birth Centers.

It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are evidence-based and extensive. If anything, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child because the American College of Obstetricians and Gynecologists (ACOG) does not support them.

ACOD encourages all pregnant women to get prenatal care and to make a birth plan. The main goals should be a good birth experience for both mother and baby. Choosing to deliver a baby at a hospital, however, is to place procedure and protocol over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose ACNM-certified, AMCB-certified, or NARM-certified midwives and that ACOG look at some evidence and support them.

At least, that's ACOD's long-standing opinion.

Here's what ACOG thinks:
http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm

Tell em what you think at:
ACOG Office of Communications
202.484.3321
communications@acog.org

-dr-

Marathons and Birth

Marathon action on Sunday was especially inspirational after my Friday and Saturday barhopping extravaganza. Especially this guy who ran it wearing a duck costume:



The NYC marathon hits all five boroughs, including our beloved Bronx, so Ellen and I watched from 138th and Grand Concourse -- somewhere between miles 20-21, where runners hit the infamous "wall," when the body runs out of glycogen to burn and switches to fat, causing dramatic fatigue.

My friend Julie (F3939) ran her first marathon this year, managing to beat out Katie Holmes (F127) and Sean John "P. Diddy" Combs (44778). You can check NYC marathon results here yourself. Julie is a great inspiration, and may have even inspired yours truly to try and do the same. Ahem --- MAY!

One person Julie did not beat, and who was also inspirational was women's winner Paula Radcliffe. The female marathon world record holder ran the NYC marathon (her first in 2 years) just nine months after giving birth. Her training regimen was halted for less than 2 weeks due to the birth, stopping the day before she gave birth and resuming just twelve days later.

It seems hard for me to imagine a woman running the day before giving birth. Then again, as the Sydney Morning Herald so gracefully put it: "Paula is having a baby, not having her legs cut off." I wonder if it really is so unimaginable to train for a marathon so late into a pregnancy or so soon after. No idea what the risks involved are. I would imagine them to be numerous. I would also imagine such a feat would be out of the question after a c-section.

I think this story does more to illustrate the single-minded approach marathoners need to be successful than any statement about birth, though. More people have probably been moved by her perseverance (insanity?) in running than by her choices in childbirth. Thoughts?

And now, a photo I took from mile 21 of the NYC marathon, illustrating the huge diversity of the runners, and the lack of toilets (look closely):

click for larger
-dr-

Apocalypto -- a movie about natural water birth

With a central focus on the unpredictable nature of birth, Mel Gibson's Apocalypto does a great service to shed light on the need for a naturalization of birth.



Ancient Mayan Jaguar Paw (below) is taken prisoner by angry brutes for a nearby urban center leaving his pregnant wife (above) and son stuck in a deep hole with no way out. The wife and son try their best to get out, despite rocks and panthers falling on them.

And then it starts pouring rain, and the water collects in the hole. Just as they're about to drown, the mom has an amazing water birth, and Jaguar Paw makes it back just in time after sprinting wounded for 2 days straight.


More than the decline of an ancient civilization, or an obloquy against Jews, Apocalypto is a movie about natural childbirth. I don't quite understand why some people find the scene funny, as I think it's a powerful testament to human ability and a somber reminder of how the medicalization of birth is leading to an increase in potentially harmful interventions.

Marsden Wagner, former head of Maternal and Child Health for the European Office of the World Health Organisation (WHO), discusses the "safety" of technological interventions in the birth process:

As with other technological interventions used at the time of birth, those using active management of labor seem bent on playing down or hiding any risks and reassuring everyone that it is "safe". For example they claim, "On balance, active management of labor is safe for the fetus, notwithstanding any associated dystocia. It is also safe for the mother" (O'Herlihy 1993). First, it must be said that such statements reveal a failure to understand "safety". Since every medical procedure or technology has side effects and risks, no technology is 100 percent "safe". In every case, it is necessary to balance the chance of a good result (efficacy) with the chance of a bad result (risk). With any intervention under consideration, the chance of a good result or bad result can be scientifically determined. Instead of telling the woman that the intervention is "safe", she should always be told all information on the efficacy and risk. But the decision as to whether the good chance outweighs the bad chance should not be made by the doctor, who is taking no chances, but can only be made by the person taking the chance --- the woman. Therefore the doctor can never say that any procedure is "safe" but only tell the woman the chances and let her decide (Wagner 1994).

Click here for more.

Not to mention, it's a great action flick pitting man vs. man vs. nature vs. sun gods, and vs. Spaniards (eventually).

-dr-