Midwives Model of Care Reduces Cesarean Rate at New England Hospital

Got a link to this article in the Berkshire Eagle today: C-section births fall. "North Adams Regional Hospital performs significantly fewer c-sections than other hospitals around the state — an average of 18 percent of all births at the hospital compared to the state average of 34 percent..."

The reason? The Midwives Model of Care, of course! The article goes on to say:

"'I think what is being reflected in our numbers is that we are taking a more 'midwifery' approach with our practice then before,' Robin Rivinus, a certified nurse midwife with Northern Berkshire Obstetrics & Gynecology at the hospital, said last week. 'It means that we do fewer unnecessary interventions — inductions, Cesarean sections, episiotomies. We treat childbirth as the normal, natural thing that it is. We only step in when it's medically necessary, which is much better for both the mother and the baby.'"

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Molly

BMJ Study on Eating During Labor

A study from the British Medical Journal has confirmed (again) what midwives, doulas, and childbirth educators have known for a long time: eating during labor is fine. I have written about this topic before, so I don't have much more to add now, except that I find it very unsurprising to learn that women's bodies can handle light eating during labor. Giving birth uses a lot of physical resources, it is only logical that the body would need to be replenished periodically during labor! As I read on someone else's blog, sometimes the only answer I can find for "world breaking news" like this, is "well, duh!" ;-)

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Molly

Book Review: Mother Nature

Yesterday I finished reading a sweet little booklet titled Mother Nature by Mariahadessa Ekere Tallie. The subtitle is "thoughts on nourishing your body, mind, and spirit during pregnancy and beyond." The booklet is a nice, quick introduction to several attachment parenting concepts. It covers a lot of ground in its 32 pages and would make a nice gift for a pregnant woman who is interested in exploring ideas beyond What to Expect. The author was deeply influenced by her experience attending her friend's birth at the Elizabeth Seton Childbearing Center in Manhattan (now closed). When the time came to give birth to her own children, she chose midwife-attended home births.

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Molly

Idaho Midwifery

There have been some exciting developments in Idaho's legislative work this session. The legislature has approved a midwifery licensing bill and the bill is now awaiting the governor's signature. You can read more in this article from The Olympian and also at the Idaho Midwifery Council's website.

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Molly

Grassroots Network: Become a "Citizen" for Midwifery for only $10!

Count your voice among our membership and help us boost our maternity care reform efforts by joining Citizens for Midwifery now for only $10, our new "Citizen" rate.

If you already support CfM's work with an official paid membership, fantastic! Your support has enabled CfM to develop, grow, and network so that consumers have a voice in maternity care reform.

Many of you have shown interest in CfM through these Grassroots News messages but never officially joined the organization. Now we are inviting you to donate just $10 so you can be counted as a member. Increasing CfM's membership will give us an even more powerful voice for positive changes in maternity care, especially the Midwives Model of Care, for all women, in all settings!

It's easy: just donate $10 (you can pay online) to join CfM at the basic "Citizen" level and receive a colorful postcard (so attractive you'll want to display it!) acknowledging your membership as a "Citizen" for Midwifery. The postcard includes the Midwives Model of Care definition along with information about CfM and the website URL for handy reference to all of our online tools and resources. This level of membership does not include a subscription to the CfM News, but lets us count you as a member of CfM.

If you are a midwife, doula, childbirth educator, or other birth professional, and you would like to get your clients involved, we're glad to offer this inexpensive option. We have tools for talking to your clients (our Dear Client letters, which can be customized) and a rate you can afford on our Join CfM page.

And of course, you can upgrade your membership at any time to join at the suggested rate of $30 or more per year and receive copies of our advocacy newsletter, the CfM News. Our student rate of $20 per year includes the CfM News as well.

We hope you will show your support for Citizens for Midwifery by becoming a member and help CfM become an even stronger, more effective advocate for the Midwives Model of Care! Learn more on our website or join online here.

Orangutan Birth

Some time ago I wrote several posts about orangutan birth. Today, coincidentally, I got a link to a YouTube video of a lovely, undisturbed birth of a baby orangutan. It was interesting to see the parallels between this birth and human births without interference (I will "warn" you that the mama orangutan eats the membranes and other birth accompaniments, which, based on the comments box, some people may find unnerving). I did wish the mama had a little bit more straw with which to make a little "nest" for herself!

In totally unrelated media, I read an article today about the Baby Boomlet. As we have heard, more babies were born in 2007 than in any other year in U.S. history. The focus of media coverage of the recent birth stats seems to be heavily on this "baby boom" and also on the teen pregnancy rate, instead of on the ever-increasing cesarean rate.

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Molly
CfM Blogger

Grassroots Network: Useful press releases about new CDC stats

Dear Friends,

Several organizations have posted informative press releases with different points regarding the new CDC birth statistics, especially the issue of increasing cesarean rates:

From CIMS: “Need for Transparency Increases as Cesarean Section Rates Rise” (scroll down to see this press release listed near the bottom of the page). Points out the variations among hospitals and providers, and the need for information and transparency to enable pregnant women to make informed decisions about their care, and highlights the work of The Birth Survey projects.

From ICAN: “Cesarean Rate Jumps to Record High; 1 in 3 Pregnant Women Face Surgical Delivery More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery” Notes that a big contribution to the rise in the cesarean rate is the underuse of VBACs, including the facts that VBACs have been banned at more than 800 hospitals, and are not available at another 600 plus hospitals.

From Lamaze: “Evidence Increases for Risks in Cesarean Surgery as National Rate Continues to Rise” Emphasizes the accumulated evidence of risks associated with cesarean sections, for both mother and baby.

As Lamaze concludes (and Citizens for Midwifery agrees): “Two of the most important decisions a woman can make are where she gives birth and who she chooses as her care provider.” Regarding cesarean sections, a healthy pregnant woman can significantly decrease the chance that she will “end up” with a cesarean section by choosing midwifery care, especially in an out-of-hospital setting. (See “Out-of-Hospital Midwifery Care: Much Lower Rates of Cesarean Sections for Low-Risk Women”). In the face of these facts, it is incomprehensible and unreasonable that the American Medical Association and the American College of Obstetricians and Gynecologists continue to make policy statements in opposition to midwife-attended home birth, particularly when they have no evidence to back up their positions. (For more information about ACOG’s anti-home birth stance, see: “ACOG 2008 Press Release on Home Birth- CfM Rebuttal and Talking Points” and for more about AMA and ACOG organizations see “BACKGROUND INFORMATION ABOUT THE AMA AND ACOG”)

Do take a look at these press releases! It is likely that news media of various kinds will publish articles about the latest national statistics. We can all write letters to the editor and respond on blogs, making use of the information in these press releases and additional information in this message, and emphasizing the need for midwives, in and out of the hospital, to improve maternity care and birth outcomes in the US.

Sincerely,
Susan Hodges “gatekeeper”

Responses to Breastfeeding Article

As many people are already aware, a lot of attention has been given to a recent article in The Atlantic called The Case Against Breastfeeding. The article was then covered on The Today Show. The article's claim that there is a little evidence truly supporting breastfeeding is a disturbing one--and also quite incorrect. The Academy of Breastfeeding Medicine has issued a press release about the evidence basis and it is available here.

I was happy to see that the AAP also responded to the Atlantic article with the following:

AAP Responds to Breastfeeding Article in The Atlantic

You may have seen an interview on the Today show about breastfeeding based on an article that appears in the April issue of The Atlantic, entitled "The Case Against Breast-Feeding" by reporter Hanna Rosin. AAP President Dr. David Tayloe Jr. submitted the following letter to the editor of The Atlantic in response.

Letters to the editor
The Atlantic
Submitted via email
In the article, "The Case Against Breast-Feeding" by Hanna Rosin, the author skims the literature and has omitted many recent statements including the 2005 statement of the American Academy of Pediatrics which supports the value of breastfeeding for most infants. This policy references every statement with scientific evidence from over 200 articles which meet scientific standards for accuracy and rigor. The statement was meticulously reviewed by the Section on Breastfeeding, the Committee on Nutrition and numerous other committees and approved by the Board of Directors of the Academy. Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, a study released by the Agency for Healthcare Research and Quality (the AHRQ Report) strongly supports the evidence of benefits demonstrated in the breastfeeding research. The evidence for the value of breastfeeding is scientific, it is strong, and it is continually being reaffirmed by new research work.

The American Academy of Pediatrics encourages women to make an informed decision about feeding their infants based on scientifically established information from credible resources.

David T. Tayloe, Jr., MD, FAAP
President
American Academy of Pediatrics

Since the evidence actually is quite clearly on the side of breastfeeding, the article made me more sad about the feelings and attitude of the author. She references feeling a good deal of pressure to breastfeed and that this is the new "problem that has no name." I feel for her. Mothers today have a LOT on their plates and a lot of pressure from every direction about every subject. Whether or not the pressure she felt about breastfeeding is real, her feelings are and I grieve for her.

Also, as happens whenever I read articles about breastfeeding, I have to marvel that the "burden of proof" rests on breastfeeding--why do we need to continually prove a physiological, specific-specific fluid superior to an artificial product? The science is reversed--researchers should be asking whether formula has any support or evidence and also for evidence that this non-physiologic substitute product does no harm. As Dia Michels says, the marketing task for formula manufacturers is to get women to withhold from their infants that which they already have and could freely give. This seems like it would be remarkably difficult to achieve (I often use an analogy about blood--it would be difficult to convince most people to have their naturally occurring blood removed from their bodies and a blood-substitute piped in instead...). However, as we are all aware, the marketing actually works very well. When reading the article above, I see again that answer as to "why withhold" is often cultural and social--mothers in the U.S. often do not live in an environment/life structure that is conducive to happy breastfeeding. And, bringing this on-topic, most do not give birth in settings, or with practitioners, or with birth practices that support breastfeeding as the normal, healthy, biological next step after giving birth (instead, over 30% of mothers are potentially launched into trying to create a breastfeeding relationship as they also try to recover from major surgery. Even more women are trying to do so after other less-than-ideal birth experiences and medical practices).

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Molly
CfM Blogger

Grassroots Network: CDC releases birth stats for 2007

Dear Friends,

On Wednesday the CDC released the Preliminary Data for births in 2007. The birth rate is up, and so is the cesarean section rate, now nearly 32% of all births: "The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States."

The CDC's press release is included below. And you can find the entire report here.

Sincerely,
Susan Hodges "gatekeeper"


From: http://www.cdc.gov/media/pressrel/2009/r090318.htm
For Immediate Release: March 18, 2009
Contact: CDC National Center for Health Statistics
Office of Communication, (301) 458-4800


Teen Birth Rates Up Slightly in 2007 for Second Consecutive Year

The birth rate for U.S. teens aged 15 to 19 increased by about 1 percent in 2007, from 41.9 births per 1,000 in 2006 to 42.5 in 2007, according to a report Printable PDF released today by the Centers for Disease Control and Prevention. This is the second year in a row that teen births have gone up. They increased 3 percent in 2006 following a 14-year decline.

Birth rates also increased for women in their 20s, 30s and early 40s, but remained unchanged for younger teens and pre-teens aged 10-14. Only Hispanic teens noted a decline in the birth rate, which fell 2 percent in 2007 to 81.7 births per 1,000.

Unmarried childbearing increased to historic levels in 2007 for women aged 15-44. An estimated 1.7 million babies were born to unmarried women in 2007, accounting for 39.7 percent of all births in the United States an increase of 4 percent from 2006. Unmarried childbearing has increased 26 percent since 2002 when the recent steep increases began.

The report, "Births: Preliminary Data for 2007," Printable PDF from CDC's National Center for Health Statistics [ http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf ] is based on an analysis of nearly 99 percent of birth records reported by 50 states, the District of Columbia, and U.S. territories as part of the National Vital Statistics System.

Other findings:

* Total U.S. births rose in 2007 to over 4, 317,119, the highest number of births ever registered in the United States.
* The cesarean delivery rate rose 2 percent in 2007, to 31.8 percent, marking the 11th consecutive year of increase and another record high for the United States.
* The percentage of low birthweight babies declined slightly between 2006 and 2007, from 8.3 percent to 8.2 percent. This is the first decline in the percentage of low birthweight babies since 1984.
* The preterm birth rate (infants delivered at less than 37 weeks of pregnancy) decreased 1 percent in 2007 to 12.7 percent. The decline was seen mostly among infants born late preterm (between 34 and 36 weeks).

The full report and a separate report with state births data are available here.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Homebirth & Safety

A topic that often closely follows a mention of homebirth is that of safety. Women often say that they would like to have a homebirth, but decided on the hospital for "safety reasons." As we are well aware, ACOG also feels that all women should birth in the hospital for safety. And, as I've posted about several times previously, there is the insidious claim that to birth at home is to place the experience of giving birth over having a healthy baby. So, I was very interested to read a recent study about the reasons why women stay home to birth. Co-authored by a blogger that many people are familiar with, Rixa Freeze, the article was published in the Journal of Midwifery & Women's Health this month. One of the most common reasons given to birth at home was "safety" (the three other most common reasons were "intervention free," "negative previous hospital experience," and "control"). While obviously the study did not address physical outcomes, it backs up what I have always believed which is that women who choose homebirth are NOT choosing to do so because they value a "birth experience" over a "healthy baby."

Speaking of healthy mother, healthy baby, I shared a quote in another blog recently that I'd like to also share here. From the Winter 2008 issue of Midwifery Today:

"Although the popularly desired outcome is 'Healthy mother, healthy baby,' I think there is room in that equation for 'Happy, non-traumatized, empowered and elated mother and baby.'"

This is the equation that midwives and mothers who birth at home have figured out!

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Molly
CfM Blogger

Round Up

Lots of great articles and resources came to my attention this week.

Advocates in Australia are facing the possibility of the elimination of private midwifery (and with it homebirth). You can read lots more about this on the Midwife Mutiny in South Australia blog. There is also an incredible video available here: Save Private Midwifery. The video is a collection of still photos with some text interspersed. the best part of this video is that is has phenomenal singing. Incredibly beautiful.

Just today I received a link to another beautiful video. This one is a French birth video with a voiceover poem in several languages. The mother labors in a peaceful setting and vocalizes really beautifully and deeply.

Speaking of negative legislation, there was an excellent post here: When You Can't Have It Your Way, Legislate! In it, I learned that in Ohio legislation was passed to mandate that childbirth educators cover certain information in their classes (in this case, it was about shaken baby syndrome, but it sets up a scarily slippery slope. Can you imagine what could happen to independent birth education if legislation of this type becomes common?)

In Nebraska this week homebirth had media coverage in Families Risk Law to Give Birth at Home.

Lamaze issued another great press release: Making Tough Decisions Without All the Facts: How Inadequate Informed Consent Puts Childbearing Families at Risk

And, the Huffington Post addressed How Safe are Infant Formulas?

Finally, speaking of infant feeding, this week I also read an interesting French article called Is Breastfeeding feminist or not?

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Molly
CfM Blogger

Solace for Mothers

We are pleased to announce the Solace for Mothers Friends and Advocates Online Community which provides a forum for those who support mothers who have experienced birth trauma, have been impacted by witnessing birth trauma, or want to connect with others to advocate for gentler birth practices.

Solace for Mothers is committed to providing resources and support to professionals and loved ones supporting women through the difficult emotions following a disappointing, hurtful, or violating birth experience. Spouses, family, and friends of mothers who have experienced traumatic births are offered a space to find information, support, and resources through participation in the Friends and Advocates Forum. Birth attendants are also provided with the opportunity to process their own emotions in response to births they have attended. Birth professionals and birth advocates are provided a space to discuss the causes of birth trauma, how policies and programs can be enacted to prevent trauma from occurring to childbearing mothers, and methods of treatment when trauma has occurred.

The Solace for Mothers Friends and Advocates Online Community welcomes birth activists, mothers, families, and professionals, all of whom are stakeholders in providing healthy, safe, and empowering births that enable families to successfully transition to parenthood. Users of the online community are invited to contemplate and discuss the current state of birth and what evidence based practices best support childbearing women, their babies and families. Advocates who are interested in becoming involved in organized efforts to promote these practices are encouraged to participate and share their thoughts.

The Friends and Advocates Online Community can be entered from here. The forum is made public for browsing and registration is required to post and respond to topics. To view the online community, go here.

Mothers are welcome to participate in the Friends and Advocates role but they are invited to register and participate in the Online Community for Healing Birth Trauma, which provides peer support to women who have had traumatic childbearing experiences. Birth professionals, family members, and friends please respect the privacy of the Community for Healing Birth Trauma and register only for the Friends and Advocates Community.

If you have something to say regarding childbirth and want to be a part of a larger conversation, please join us. We are interested to read your stories, thoughts, hopes and goals for the future! Please also feel free to pass this invitation on to organizations and individuals who would be interested in the topics of birth trauma and improving maternity care.

Warmly,
Sharon Storton, Founder of Solace for Mothers, Inc.
Jenne Alderks, Creator and Moderator of Online Communities
Jennifer Zimmerman, Creator and Moderator of Online Communities

DVD Review: Pregnant in America

DVD Review
Pregnant in America
www.pregnantinamerica.com

Reviewed by Molly Remer

Filmed by a father-to-be, Pregnant in America follows a young couple as they prepare for the birth of their first child at home and are surprised by what they learn about “life’s greatest miracle in the hands of a nation’s powerful interests.” The film was created by a layperson and sometimes that shows, but overall the film’s format lends a contemporary edge. Interview clips with birth experts such as Marsden Wagner, Robbie Davis-Floyd, Ina May Gaskin, and Kerry Tuschhoff are interspersed with segments of the pregnant mother (Mandy) talking about her pregnancy and her hopes for the birth. There are also a number of clips of person-on-the-street soundbites that add interest to the film.

Substories about a woman who travels to Canada for a chance at a VBAC, about Cytotec and the Tatia Oden French foundation, and about the birth practices in Holland add to the strong dose of activism to the film. There are also some interesting encounters when Steve (the father/filmmaker) tries to get answers from a hospital as to why a cesarean was recommended for his sister-in-law (she gives birth vaginally with a different doctor and then they discover her original doctor is scheduled for vacation time—her supposedly medically-indicated cesarean having been proposed for right before the vacation is to begin…).

The film comes to a fairly dramatic close when the Buonaugurio baby is born at home and then transferred to the NICU for an undiagnosed reason. Because of the stressful feelings generated by the hospital footage, I would hesitate to recommend this film to a pregnant couple without a “disclaimer” letting them know that the baby is hospitalized (the baby is later fine and is shown as a happy, walking one year old).

The main emphasis of Pregnant in America is advocacy and activism. It is not a “birth movie” per se in that it has no live birth footage (there is some labor footage and then snapshots of the birth). It definitely kept my attention and it has a powerful message to share with parents-to-be about maternity care as an industry.

Violence, Women, & Birth

Edited to say that I made a mistake with the posting dates on my posts this week and International Women's Day was Sunday, March 8th.

Today is International Women's Day. The United Nations theme this year is "Women and men united to end violence against women and girls." As I've referenced before, domestic violence was the first cause in which I became deeply invested. Though I do not work in shelters any more and my focus has shifted to birth work, I continue to pay special attention to matters concerning violence against women. So, this theme naturally made me think about violence against women in the birth place. In 2002, Susan Hodges wrote an article for CfM News called "Medical Model Maternity Care and 'Violence Against Women'" and I wanted to share some thoughts from that article today.

Susan wrote:

I recently read an article from The Lancet that put “what’s wrong” into language that made me sit up and take notice. In Violence against women in health-care institutions: an emerging problem by A. F.P.L. d’Oliveira, S.G. Diniz and L. B. Schraiber (The Lancet, Vol. 359. May 11, 2002) the women authors looked at documentation of violence against women in health institutions worldwide, focusing “on four types of violence: neglect; verbal violence, including rough treatment, threats, scolding, shouting, and intentional humiliation; physical violence, including denial of pain relief when technically indicated; and sexual violence.” In other words: emotional, physical and sexual abuse. The authors go on to specifically mention violence against women in reproductive health services: “These forms include excessive or inappropriate medical treatments in childbirth, such as doctors doing cesarean sections for reasons related to their social or work schedules or financial incentives; or adhering to obstetric practices that are known to be unpleasant, sometimes harmful, and not evidence based, including shaving pubic hair, giving enemas, routine episiotomy, routine induction of labour, and preventing women having companions in labour.”

In other words, our work is about stopping violence against women in the birthplace – we just haven’t been calling it that. I am not saying that everything that happens in hospitals is bad, or that even the abusive aspects of hospital maternity care is necessarily equivalent to being raped or beaten. However, abuse is abuse, from relatively mild to severe, and just because it is not extreme does not negate the fact of abuse or violence against women. In particular, we are talking about government-regulated health care being provided to women having babies – we should expect and demand that every aspect of that care is the opposite of abusive, that the care is respectful of us in every way.

Think about the stories you have heard, or seen on TV, or just read in the newspaper. Here we are, healthy women giving birth, but the doctor or hospital does or does not “allow” us to walk, eat, drink, have a doula, or whatever! Think of all the times women have been threatened “if you don’t progress to x-centimeters by such-and-such a time, you’ll have to have a c-section,” or told to shut up during labor, or coerced into interventions, or berated for complaining, or yelled at to PUSH. Think of all the times vaginal exams and other interventions have been conducted without asking the woman’s permission, and sometimes by strangers. Not to mention all the invasive interventions (drugs, IVs, episiotomies, etc.) that are commonly imposed without informed consent, or women who are persuaded to acquiesce by means of lies about their necessity and lack of information about risks. Etc. etc. etc. We have known these things are wrong and very disturbing, but most of us have not called them acts of “violence against women.” Under any other circumstances, many of the actions and behaviors visited upon women laboring in hospitals would be completely unacceptable as verbal abuse or, in many cases, could warrant legal action for assault and battery. They certainly include acts that are in violation of professional conduct and standards of care as delineated in state laws. Violence against women is about abuse of power, whether on the street or in the hospital. So let’s start calling the disrespect, violations of privacy, loss of freedom, unnecessary interventions, intimidation, etc. what they are: Violence Against Women.

Speaking of hospital care and women, there is another good article from CfM News available online called Effects of Hospital Economics on Maternity Care.

And, this post by Gloria Lemay has been making the rounds lately and I think it is also fitting for today: Are You a Good Candidate for Hospital Birth?

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Molly
CfM Blogger