Attached at the Hip

The Effects of Fear

I recently posted a link on Facebook to an article I found about the disturbing effects of cesareans on women's fertility.  The issues discussed in the article include secondary infertility as a result of a primary cesarean, as well as the emotional and psychological scarring that leads many women to refuse to have more children.  These women simply can't face the possibility of having another cesarean, even if they know that a VBAC is also an option.

One of the most concerning things to me about an article like this is that the vast majority of women do not go into birth knowing the true risks of cesarean.  They are not told about the risks to future fertility (something like 13% had issues, as described in the article), to their future children, and to themselves.  Most women who have cesareans believe it is in the best interest of their child and themselves, but statistically we know that most cesareans are not necessary.

As they say near the end of the article, necessary cesareans account for approximately 5% (WHO says up to 10% is acceptable) of all births. In the US, it's 36% nationwide! We are, without question, at a point when we are causing more harm than good. It's statistics, and the evidence is abounding. Rather than saving lives, we're taking them. Rather than preventing harm, we're causing it. We're past the point of diminishing returns, and the blasé attitude in this country about cesareans is only making it worse.

It is true that many people escape cesareans "relatively unharmed." And there are, certainly, those 5-10% of cesareans that truly save lives. But 26-31% of women in America are undergoing major surgery; being introduced to the risk of infections (which can be major), damage to internal organs, and fertility issues; and having their babies health and breastfeeding relationships jeopardized for no reason. They are completely avoidable, mostly iatrogenic (caused by a hospital/doctor), superfluous cesareans that do more harm than good.

Fear is a huge enemy to birth. Unfortunately, our society and our medical professionals create an atmosphere of fear around every.single.birth. This fear that "something could go wrong" (and I am very familiar with what can, truly, go wrong in pregnancy and birth) makes women dependent on doctors and medical technology. Instead of relying on their bodies and the Omniscient Creator of their bodies and this awesome thing called birth, they rely on the god of Technology.

Unfortunately, study after study and uncountable real life situations have proven that these technologies are NOT creating better outcomes. In fact, in the US, where we use a laundry list of technological interventions because of our inordinate fear of birth (such as ultrasound, pitocin, continuous fetal monitoring, epidural, vacuum, forceps, and cesarean), our neonatal and maternal morbidity and mortality rates are climbing. We are one of the worst countries in the world for mother/baby health.  And, yet, these Technologies are touted as saving lives and preventing problems. Do they? Sure, in some situations. But they're overused and are responsible for so many of these problems.

And it's all because of fear. 

Women need to be informed, and by being informed, empowered. I have studied birth extensively, and I am firmly convinced that it is, as one midwife said, "as safe as life gets." There are risks everywhere, and birth is no different, when it is allowed to progress as designed.

It is, ultimately, a God-designed and God-ordained process that has very specific goals for both mother and child. When allowed to follow these processes, it is an amazing, enlightening, empowering, and wholly transforming experience. For every interference, some of that is lost, and the risks are increased.

I do highly recommend Pushed: The Painful Truth About Childbirth and Modern Maternity Care, by Jennifer Block, as a very thorough look at our modern birth care system. I feel that every woman (and her spouse) should read it, specifically, the first few chapters. Those interested in cesarean, VBAC, and birth advocacy should read the entire book (and likely won't be able to put it down).

(First) Adventures in Lobbying

Yesterday, my three boys and I were up before dawn to join a group from Texans for Midwifery at the Texas State Capitol in Austin.  There, we visited with lawmakers (or their aides/assistants), even taking the little ones into the offices for a rare chance to see democracy in action.  We capped off the day with plenty of play on the Capitol lawns, lunch, and a visit to a well-renowned coffee shop.

Texans for Midwifery organizes these visiting days every two years, and this year is especially important with midwifery legislation on the table.  House Bill 1107 proposes that Advanced Practice Nurses be allowed to write prescriptions under their own license.  Currently, Advanced Practice Nurses such as Certified Nurse Midwives must work with a physician to have prescriptions, even for routine items such as prenatal vitamins, written.  If approved, the new law would take an extra step and extra work (not to mention potential for error) out of the system, giving CNMs the ability to order needed items for their patients.

The Austin media covered the event.  The Statesman has a video filled with cute babies (too bad we had already gone out to play when they got there!), and KVUE did an interview with the woman the boys and I partnered with for our meetings.  Of course, the KVUE article makes it sound like midwives only provide care where there are no other options.  In reality, they're an excellent choice for all normal, healthy pregnancies, AND are a low-cost, oft-used option in low-income and rural areas.

My boys really enjoyed our day in Austin, and I was happy to have the opportunity to take them to such an important event.  I hope that the group of over 150 adults and 100 children made a positive impact on how our State government will support midwifery both in this session, and in the future.

The Birth Survey

If you've ever been pregnant, you've most likely searched for a care provider and birth place that would be just right for you.  But how do you find out what care providers and birth locales are really like?  It's nearly impossible to get specific answers to questions from providers, and especially from hospitals.  Without this data, we're left to choose from the proverbial phone book, or insurance company lists. Even personal referrals leave a lot of unanswered questions.  But what if these choices could make a huge difference in your pregnancy and birth?

The reality is that the choice of care provider and birth setting makes a tremendous difference, both on the progress of pregnancy and the outcome of the birth.  The Coalition for Improving Maternity Services (CIMS) has undertaken the task of making information about care providers and birth locations available to mothers, so we can make informed decisions about our births.

The foundation of their project is The Birth Survey, which is open to all women who have birthed in the U.S. in the last three years.  The survey gives you the chance to submit feedback for your prenatal as well as delivery care, through a detailed series of questions.  The information is being compiled into reports for the benefit of both mothers and care providers and hospitals, who can use the feedback to improve their services.

If you've given birth in the last three years, I highly encourage you to take The Birth Survey (take it once for each birth), so that other mothers will benefit from your experiences.

Evidence for Birth

It is startling to realize that many doctors in this country are using unstudied, unproven techniques and interventions on a routine basis, on unsuspecting patients - women in childbirth!  A recent study has outlined a number of issues with the common high-tech practices employed in American hospitals, pointing out that low-intervention births are far safer for mom and baby.  They are also, of course, much cheaper.

Consumer Reports has an excellent, concise article regarding the study and the difference between high-tech and high-touch births.  The Consumer Reports Maternity Care Quiz is also eye-opening.  Another report, from USA Today, following this study illustrates just why doctors and hospitals are so eager to intervene:  profit.

There are so many reasons to follow an evidence-based protocol for birth, and so few motivations for the high-tech, low-touch style of birth common in this country today.  I hope that the publicity of studies such as this will empower mothers to demand the type of care they deserve, and encourage caregivers to step up to the mark and give the best, high-touch care possible.

Trust

A job. A car. Food. Relationships. A spouse. Children. Rain.  Clear skies. Money. Peace. Friends. Prosperity. Answers. Performance. Grace. Safety. Every breath.

We trust God for many things; in fact, for some, we trust Him with nearly everything in our lives.  So, why, then, do we not trust God with birth?  What is it about our culture that has convinced us that God's design can't work?

There is a prevailing culture of fear surrounding birth, and, on a broader scale, the workings of a woman's body in general.  However, for those of us who believe our bodies are the creation of an all-powerful, all-knowing, and all-loving God, we have the freedom to embrace His creation and all of its intricacies.  We can replace fear of the unknown with knowledge of the design and rhythm of our bodies.

Knowing our bodies and how amazingly powerful they are is an important step to embracing birth and trusting God's plan for it.  Babies are not grown larger than a mama can birth (except in extraordinarily rare cases); their heads mold; our pelvises spread; we feel the urge to sway and move and change positions; our uterus squeezes in perfect rhythm; and ultimately, with no external influence, our bodies are capable of birthing a baby, peacefully and safely, into the world.

There is nothing more amazing in life than watching God's plan for life - conception, pregnancy, and birth - unfold.  Each minute detail is so perfectly planned, so that, when it follows its natural, God-given course, we are prepared for each successive step.  The entire process is about far more than the destination of holding a baby in one's arms. It is about physically, emotionally, and spiritually preparing to be a mother to a new child.  The atrocity that is "normal birth" in our culture results in many of these steps being skipped, and we lose out on the benefits God has planned for us.

Trust.  We can trust Him with birth, and witness the amazing unfolding of His designs.

What We're Made For

I just finished watching The Business of Being Born - and all of the extra footage.  When the movie ended, I still wanted more.  The "extras" are definitely worth watching, with many good and very valuable points made, as well as some closure that I felt was missing at the end of the film.

It was good.  It was very good.  I think every woman needs to watch this, ideally with her spouse, and ideally early in pregnancy or even before.  There is so much that women in this country don't know about how birth works, both from the physical perspective and from the medical perspective.  

Did you know that the U.S. ranks 2nd-to-last in the industrialized world in infant mortality?  And it is on the rise?  The only industrialized country with a worse record for infant mortality is Latvia.  We're tied with countries such as Poland and the Czech Republic.  If our medical system and medical advances are so great, why are so many babies dying?  And mothers are dying, too.  According to an OB/GYN on the film, we spend twice what countries like Japan and the Netherlands pay for each birth, yet have significantly lesser outcomes.  One big difference?  Those countries have a significantly higher proportion of midwife-attended births, and save obstetricians for when they're really needed - when there's a real problem.  When complication-free births are allowed to be intervention-free, you get fewer iatrogenic injuries and deaths.  There are also fewer pre-term babies when pregnancies are allowed to continue until the baby is ready to be born.  

I, personally, could've used a box of Kleenex (or, rather, Seventh Generation facial tissue) for the film.  There are so many highs and lows in the movie - the horror of unnecessary interventions leading downhill quickly; the rush of emotions and endorphins as a baby is born into the water at home.  I've seen both sides of birth, and so react very strongly both to the injustices and the triumphs.  

Birth is an absolutely amazing process, and one of the points that the movie makes very well is that it is a huge disservice to women that they are not being told that; that they don't know that birth is empowering, engaging, awe-inspiring, elating, overwhelming; that they don't have the chance to experience the hormonal bond between themselves and their newborn in the moments after birth; that they are not an active participant in the most incredible experience they'll ever have.  Women who birth at home don't do it because they're super-human.  They do it because they are human - and human women are designed for - and capable of - this most amazing thing we call birth.

British Support for Birth

The United States has one of the poorest maternal and infant mortality rates in the developed world.  Countries which support midwifery and home birth, with OBs used in the case of high-risk pregnancies, fare significantly better.  In fact, the UK National Childbirth Trust (NCT) and the Independent Midwives' Association (IMA) published a press release voicing their concerns over the ACOG/AMA resolution I posted about yesterday.

Among their breath-of-fresh-air statements is this one:

Home birth should be considered a mainstream option and offered as a regular choice for pregnant women using the health service, whichever country they reside in. For a healthy woman with a straightforward, low-risk pregnancy, home birth is a safe option. It is important that midwives provide care for women at home and that they have experience in home birth, receive active support and supervision, and that their training needs are met. Women's individual needs must be assessed and the back up of a modern hospital system, with good communication and transport links, are important, should transfer be needed.

Now, why did we run away from England?

AMA and ACOG try to Limit Women's Rights

Crazy.  Just insane!  The AMA (American Medical Association) and ACOG (American College of Obstetricians and Gynecologists) want to formally define a hospital as the safest place to birth.  They are specifically targeting home birth in the wake of Ricki Lake's film, "The Business of Being Born," even going so far as to name her in their resolution.  What would come of this resolution?  Legally defining hospitals as the safest place to birth could make it very difficult for women to choose where they want to birth.  Nevermind the studies showing that home birth is just as safe as hospital birth for low-risk pregnancies.

Ricki Lake, Abby Epstein (her producer), and Pushed author Jennifer Block penned a telling response, published in The Huffington Post.  It's definitely worth a read.  And be sure to explore the various links in the text of the article, including to the study on home birth published in the British Medical Journal.

(Extra points go to anyone who can find my own comments on the article.)