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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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-

Business of Being Born

By now, you've read several of my postings on midwifery. Now there's a great documentary film in theaters about birth and midwifery that I thought some of you might be interested in seeing. Produced by Ricki Lake and set in Manhattan, The Business of Being Born is in theaters through the long weekend:
January 9 - 22, 2008
IFC FILM CENTER
323 6th Avenue, New York, NY

More show listings here, including Cali, Canada, Seattle, Minnesota, Bermuda, etc...

It's also on Netflix if that's more your speed.

You can watch the trailer on YouTube, and here's a short description:

Among 33 industrialized nations, the United States is tied with Hungary, Malta, Poland and Slovakia with a death rate of nearly 5 per 1,000 babies. This is the second worst newborn death rate in the developed world.

Why?

Compelled to find answers after a disappointing birth experience with her first child, actress Ricki Lake recruits filmmaker Abby Epstein to examine and question the way American women have babies. The film interlaces intimate birth stories with surprising historical, political and scientific insights and shocking statistics about the current maternity care system. When director Epstein discovers she is pregnant during the making of the film, the journey becomes even more personal. Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?

(from http://www.thebusinessofbeingborn.com/)

I've seen it a bunch of times now, and think it is a terrific, eye-opening piece of work. If you're interested in finding out more, please let me know!

-dr-

Manhattan Birthing Center

Nice:

Celebrities back midtown birthing center
A group of midwifery advocates obtained a lease for a 7,000 square ft. of former retail space at 30th Street and 7th Avenue to open a birthing center in 2010.
December 18. 2007 3:33PMBy: Gale Scott

A group of midwifery advocates backed by Ricki Lake, Rosie O’Donnell and Gloria Steinhem plans to open a $7 million birth center near Penn Station in 2010.

The group has obtained a donated lease for a 7,000 square ft. former retail building on 30th Street at Seventh Avenue and has hired an architect. Next year, it will make a certificate of need application to the state, says Rebecca Benghiat, executive director of Friends of the Birth Center.

Since the 2003 closing of the Elizabeth Seton Childbearing Center in Manhattan’s Chelsea neighborhood, pregnant women have had few alternatives to hospital birth in New York City. The Seton Center, part of the Saint Vincent Catholic Medical Centers system, closed in part due to the soaring cost of malpractice insurance for midwives. The new center will not provide that coverage but require practitioners to purchase their own, with midwives and doctors operating as independent contractors billing insurers directly.

Ms. Lake, Ms. O’Donnell and Ms. Steinhem are helping to raise money for the center. Fundraising kicks off Jan. 9 with a benefit screening of The Business of Being Born, a documentary featuring the home birth of Ms. Lake’s second son.

-dr-

Midwifery in the Globe

Great article in yesterday's Boston Globe from Tina Cassidy, author of Birth: The Surprising History of How We Are Born, talking about how midwifes have become a source of primary care for many women:

For some women, a midwife's care becomes primary
(Registration required)

Cassidy also has a blog over at: The Birth Book Blog, and has a cameo in The Business of Being Born (see below for trailer).






-dr-

Libertarian obstetrician

I bet you didn't know that one of the Republican 2008 candidates is a libertarian obstetrician from Texas! Ron Paul has been climbing in the polls, and has shown to be somewhat of an Internet sensation, raising over $10 million practically overnight. He has some unusual plans for spending it (flying a blimp all over the US), so think before you give.

His viability as a winner in Jan 8's New Hampshire primaries looks very slim, but you never know with these things.

Here's the intro to his Wikipedia page:

Ronald Ernest "Ron" Paul (b. August 20, 1935) is a Republican United States Congressman from Lake Jackson, Texas, a physician, and a 2008 U.S. presidential candidate. Originally from Green Tree, Pennsylvania, he has represented Texas districts in the U.S. House of Representatives (1976–1977, 1979–1985, and 1997–present). Paul placed a distant third in the 1988 presidential election, running as the Libertarian nominee while remaining a registered Republican. After his 1961 graduation from Duke University School of Medicine and a residency in obstetrics and gynecology, he became a U.S. Air Force flight surgeon, serving outside the Vietnam War zone.

Paul has been described as conservative, Constitutionalist, and libertarian. He advocates non-interventionist foreign policy, having voted against actions such as the Iraq War Resolution, but in favor of force against terrorists in Afghanistan. He favors withdrawal from NATO and the United Nations. Having pledged never to raise taxes, he has long advocated ending the federal income tax and reducing government spending by abolishing most federal agencies; he favors hard money and opposes the Federal Reserve. He also opposes the Patriot Act, the federal War on Drugs, and gun control. Paul is strongly pro-life, advocates overturning Roe v. Wade, and affirms states' rights to determine the legality of abortion.

During his 2008 presidential campaign, Paul has placed competitively in Republican straw polls, though he has substantially lower numbers in landline opinion polls. He has strong Internet support, leading in web searches and YouTube subscriptions, and had the largest one-day online fundraiser in U.S. political history. (more)

His all-over-the-map views might congeal support from some strange places other candidates can't reach (although Mike Hukabee has secured the Chuck Norris vote (what a weird video -- watch how uncomfortable Huckabee looks, like Chuck's about to roundhouse him)). Should be interesting to watch him as compared to the 2004 Howard Dean sensation. Byeah!

-dr-

Art's root: mother-infant interactions

As Ellen and I gear up for our second annual arT partY, I found Natalie Angier's NYT article The Dance of Evolution, or How Art Got Its Start particularly interesting. All the more so for the following excerpt:

Perhaps the most radical element of Ms. Dissanayake’s evolutionary framework is her idea about how art got its start. She suggests that many of the basic phonemes of art, the stylistic conventions and tonal patterns, the mental clay, staples and pauses with which even the loftiest creative works are constructed, can be traced back to the most primal of collusions — the intimate interplay between mother and child. (more)

The article goes on to link the simple interactions a mother and infant share -- facial expressions, tone of voice, body language -- to the heart of what art is: aesthetic operation. My understanding of the short article is that Ms. Dissanayake would claim that art is a response, particularly to an external stimulus. I don't know if I agree. Art I create certainly IS a response, but the art I am most proud of minimizes the amount to which it is a response to an external force and more often the source is unknown and internal. On the other hand is there anything someone can posses internally that is not in some way influenced by external forces?

What I would agree with is that mother-infant interactions are extremely influential. As famed French obstetrician Michel Odent explains in Ricky Lake's recent Business of Being Born, at the moment of birth, mothers release high levels of oxytocin, known as the "love hormone." At that moment, mothers are literally addicted to their babies and love (if they're not on an epidural). Sounds like a bad time to snatch a baby away to measure, weigh, slap, poke, and prod. Why is that our first moment of contact with the world is so commonly traumatic and disrupted?

-dr-

Midwifery news

Haven't had enough time to write full posts on each of these articles like I wanted to, so here's a quick collection of articles on birth and midwifery I've seen over the last couple months I'd like to share:

Forced Labor (Bostonia)

Brooklyn midwife's practice thrives as expectant moms seek natural deliveries (Daily News - Business section)

Footling Breech: A Midwife’s Own Birth Story (Midwifery Today)

Who Are the Statistics? (MT)

American College Of Nurse-Midwives Forms Presidental Task Force On Health Care Reform (Medical News Today)

Metro Midwives (September Issue pdf)


-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-

Miles for midwives

Student midwives from columbia university at the 5th annual Miles for midwives in brooklyn's prospect park. I made my 30min goal, a couple minutes behind ellen. Time to hit the gym more than twice a year.

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-