Grassroots Network: Cesareans related to increase in preterm births

Dear Friends,

A study about to be published has found that that singleton preterm births have increased, and that 92% of them were delivered surgically (i.e. by cesarean section). Read about this in the March of Dimes press release.

C- Sections a Critical Factor in Preterm Birth Increase

Some C-Sections May Not Be Medically Necessary, March of Dimes Says

WHITE PLAINS, NY, MAY 28, 2008, Cesarean sections account for nearly all of the increase in U.S. singleton preterm births, according to an analysis of nine years of national birth data.

Between 1996 and 2004 there was an increase of nearly 60,000 singleton preterm births and 92 percent of those infants were delivered by a cesarean section, (c-section), according to research by investigators from the March of Dimes and the U.S. Centers for Disease Control and Prevention (CDC) that will be published in the June issue of Clinics in Perinatology. While singleton preterm births increased by about 10 percent during this time, the c-section rate for this group increased by 36 percent.

….

While the press release does not address the issue of the increasing rates of induction, many of which result in cesarean delivery, the March of Dimes does suggest that many cesareans are medically unnecessary: “The March of Dimes is concerned that some early deliveries may occur without good medical justification and may be done at the request of the mother or based on an inappropriate recommendation from the doctor.”

In discussing this issue, it is good to remember that the only study of any kind that has actually asked mothers if they wanted a cesarean is the Listening to Mothers II study by Childbirth Connection which found that extremely few mothers who had cesarean sections actually asked for them, and that most felt pressured to have the surgery.

Sincerely,
Susan Hodges “gatekeeper”

The Threshold of Life

I previously posted about the book Rediscovering Birth by Sheila Kitzinger. I recently finished reading the book in its entirety and enjoyed the following description of the work of the midwife:

"In all cultures the midwife's place is on the threshold of life, where intense human emotions--fear, hope, longing, triumph and incredible physical power--enable a new human being to emerge. Her vocation is unique. The art of the midwife is in understanding the relationship between psychological and physiological processes in childbirth. Rather than being the provider of a technical service to support a doctor, or someone who scuttles around getting ready for an obstetrician and clearing away after him, her skills lie at the point at which the emotional and biological touch and interact. She is not a manager of labour and delivery. Rather, she is the opener of doors, the one who releases, the nurturer. She is the strong anchor when there is fear and pain; the skilled friend who is in tune with the rhythms of birth, the mountain tops and chasms, the striving and the triumph."

The intersection of emotional and biological is exactly why I valued the prenatal care from my own midwife so much--she cared for ME as a person and woman with feelings, plans, thoughts, hopes, and ideas while at the same time that she also checked my BP and the baby's heart rate. Women are much more complicated than a set of biological symptoms or vital signs! This type of care is irreplaceable and is no less than ALL pregnant women deserve.

CfM at ICAN Conference in Cleveland

Nasima Pfaffl, CfM Vice President, spoke last weekend at the conference Birth: Engage the Wisdom presented by ICAN of Greater Cleveland and the Doula Network of Northeast Ohio. Other speakers at this event were sociologist Barbara Katz Rothman (author of The Tentative Pregnancy) and Jennifer Block (author of Pushed). The purpose of the conference was to:

* Learn the reality of the U.S. technological birthing system
* Discover how to make positive changes, now and for the future
* Be inspired to return birthing wisdom to women and babies

Nasima spoke about consumer activism. Nasima is also a lead researcher for the CIMS Transparency Project and will be speaking while wearing this "hat" at the Lamaze "Off and Running for Normal Birth" conference in Kentucky this fall.

After the presentations, attendees had the opportunity to view the new film, Orgasmic Birth!

Grassroots Network: Traumatic Birth Resource

Dear Friends,

You may already know about Solace for Mothers: Healing after traumatic childbirth, a resource for mothers started by Sharon Storton.

Now there is an online community associated with this very useful and thoughtful website. Please read the announcement below and feel free to forward to other lists and individuals!

Sincerely,
Susan Hodges “gatekeeper”

This message is to announce a new online discussion board called Solace For Mothers, An Online Community For Healing Birth Trauma. It is for women who have experienced trauma around the process of giving birth. For these women, giving birth has left them feeling deeply disappointed, traumatized, or even violated. We want these women to know that they are not alone, that birth trauma is very real, and that other women have had similar experiences and feelings. We have created an online community as a place for women to begin or continue their healing journey.

In the online community, there are different categories and forums, and the topics covered are issues that often come up for women dealing with birth trauma. It is our hope that women can virtually support each other on their healing journeys in this online community, and perhaps eventually connect with each other in the real world if they choose.

There is an introduction page (got to www.solaceformothers.org, scroll down and click on “online community”) and from this page you can register for the discussion board. Due to the very personal nature of this subject, we have made an effort to keep this community private, and women must register before being able to enter or view posts. If you do not fall into the category of a woman suffering from birth trauma, or if you would like to see a preview of the community before joining, you may visit this link to do so http://www.solaceformothers.org/preview.html This link is not the actual community and you will not be able to view members' posts from there, it will simply give you an overview of the topics covered.

We are sending this message out via email and posting it to online communities and to lists in order to reach these women. Please send this message to anyone who you feel may benefit from it.

Sincerely,

Jenne Alderks and Jennifer Zimmerman, creators and moderators of the discussion board

Supported by Sharon Storton and the Solace For Mothers team

Grassroots Network: More state legislative news

Illinois birth advocates have been working very hard on a CPM licensing bill and are making good progress, despite very complex politics in the state government. Several other states are in various stages of work on their bills, but their legislative sessions are finished for now, without any other bills being passed.

Overall, this is very encouraging progress!! Kudos to all who are working so hard to make legal access to direct entry midwives a reality!!

Sincerely,
Susan Hodges “gatekeeper”

UK Homebirth Statement

In February I posted about the joint statement on homebirth issued by the Royal College of Midwives and the Royal College of Obstetricians and Gynecologists. Citizens for Midwifery has officially joined with other midwifery organizations in endorsing this statement.

It still remains absolutely stunning to me to see the different attitude expressed by RCOG compared ACOG! In the conclusion of the RCOG statement it says, "[for midwife attended homebirth]...outcomes are likely to be optimal." This is in such stark contrast to the statement widely publicized earlier this year from the American College of Obstetricians and Gynecologists.

Mothering in the U.S.

In the news recently is the sobering reminder that mothers in the U.S. face a variety of challenges to their health and wellbeing. From the National Association of Mothers' Centers e-news:

"...the United States placed 27th in an international ranking of best and worst countries in which to be a mother.

That's right, 27th!

The US-based, independent global humanitarian organization Save the Children has published its 9th annual Mother's Index as part of its State of the World's Mothers 2008 report. The well-being of mothers is analyzed and compared in 146 countries.

Analysts looked at a number of factors, including the likelihood of death in childbirth, female life expectancy, expected years of female schooling, maternity leave benefits, participation of women in national government, and the ratio of female to male earned income.

The US has the highest risk of maternal mortality in the developed world. Women are only 17% of elected legislators in the US Congress. There is no nationally guaranteed paid maternity or paternity leave, and women only earn 66% of what men earn. The US fell one place in the ranking this year, having held the 26th spot in 2007.

The top ten countries in which to be a mother include: Sweden, Norway, New Zealand, Ireland, Germany, France, and Finland. Other countries ranking better than the US are: Italy, the Czech Republic, Slovenia, Greece, the United Kingdom, and Lithuania."

CIMS has a new site!

The Coalition for the Improvement of Maternity Care Services has launched a lovely new site! Check it out soon and explore their useful resources section, learn more about the Grassroots Advocacy Committee, and check for updates on The Birth Survey project.

Of Midwives and Laws

There has been news lately from advocates in both Maine and Missouri regarding the licensure bills that they were attempting to pass this legislative session. In Maine, the licensing bill was rejected, but approved a new law allowing CPMs to carry and use certain medications (such as pitocin). You can read more about this on the Midwifery World blog.

In Missouri, valiant attempts to pass a bill licensing CPMs was thwarted in the last hours of the legislative session. The bill managed to make it through the Senate (a first in years), but with only hours left in the session it was not heard in the House and thus did not make it to fruition. Hopes have turned to the Supreme Court case regarding the bill from 2007 and a decision is expected on June 10. You can read more in this St. Louis Post-Dispatch article. (The article uses the term "lay midwives", though the bill was actually about Certified Professional Midwives.) There is additional information on the Midwifery World blog as well.

Business of Birth article

Google Alerts alerted me to the following blog article at babygooroo that quotes CfM President Susan Hodges. The article is a really nice look at The Business of Being Born and about the author's personal experiences with maternity care and deciding to switch OB practices when her first doctor was dismissive of her needs.

Celebrate Doula Month!

May is International Doula Month!

Here are a few ideas of how to celebrate International Doula Month in your community:

• Have a community family picnic in the park with a big banner announcing that it is doula month! Invite all of the local doulas and birth professionals as well as lots of happy families :)
• Ask the public library if you can use a window display area for a doula information display.
• Send a letter to the editor about doulas or about your personal experience with a doula.
• Send a present or thank you card to your doula (if you had one).
• Send a donation to a doula or birth organization.
• Wear doula t-shirts or other birthy t-shirts and carry tote bags from doula organizations.
• Ask pregnant women if they have a doula and be prepared to share information about all of the benefits of a doula.
• Send out press releases to local papers.
• Be a "day sponsor" on your public radio station.
• If you are a doula, perhaps sponsor a "contest" of some sort with doula services as the prize.
• If there is a community health fair coming up, plan a booth with information about healthy birth, doulas, midwives, and so forth. Many communities have health fairs or women's health events in the spring.
  

For some cool inspiration about promoting midwifery and homebirth in general at a public event or fair, check out this blog post from a midwife in South Australia!

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What is a doula? A doula is a non-medical labor support provider who offers her continuous emotional and physical support to women in labor, as well as information and support prenatally and postpartum. Doulas can make a huge difference in the quality of women's birth experiences, particularly in a hospital setting (research has demonstrated significantly lowered rates of interventions as well as increased satisfaction). You can read more basic information about doulas on the websites of the doula organizations DONA and CAPPA.

More about new CfM fact sheet

From Susan Hodges via the Grassroots Network:

Dear Friends,

CfM created a well-received poster for the Coalition for Improving Maternity Care (CIMS) conference in February titled What Does Good Maternity Care Look Like?, and we have made a hand-out version. The colorful flier (which also looks good in black and white) includes the Midwives Model of Care, CIMS Ten Steps of Mother Friendly Care, and Lamazes Six Care Practices that Support Normal Birth, side by side, with their urls, with the caption "Supporting evidence-based care, and promoting healthy mothers and babies!
We have now posted this flier here.

Please feel free to print it out and use it for classes, conferences, whatever. It gives a powerful message of "you don't have to take my word" for what constitutes good maternity care!

Sincerely,
Susan Hodges, "gatekeeper"

What Does Good Maternity Care Look Like?

Citizens for Midwifery has put together a nice new handout with three models of good maternity care presented side-by-side--The Midwives Model of Care, the Ten Steps of Mother-Friendly Care, and Six Care Practices that Support Normal Birth. It is great to have handout like this showing the compatibility between all of these evidence based models of healthy, effective maternity care and we are pleased to make it available!

Happy Mother's Day!

Some quotes from recent reads in honor of Mother's Day:

"We were all held, touched, interrelated, in an invisible net of incarnation. I would scarcely think of it ordinarily; yet for each creature I saw, someone, a mother, had given birth....Motherhood was the gate. It was something that had always been invisible to me before, or so unvalued as to be beneath noticing: the motheredness of the world."

--Naomi Wolf, Misconceptions

"I believe that these circles of women around us weave invisible nets of love that carry us when we're weak and sing with us when we're strong."

--SARK, Succulent Wild Woman

"The minute my child was born, I was reborn as a feminist. It's so incredible what women cam do...Birthing naturally, as most women do around the globe, is a superhuman act. You leave behind the comforts of being human and plunge back into being an animal. My friend's partner said, 'Birth is like going for a swim in the ocean. Will there be a riptide? A big storm? Or will it just be a beautiful, sunny little dip?' Its indeterminate length, the mystery of its process, is so much a part of the nature of birth. The regimentation of a hospital birth that wants to make it happen and use their gizmos to maximum effect is counter to birth in general."

--Ani DiFranco interviewed in Mothering magazine, May/June 2008

Happy Mother's Day!

Our Bodies, Ourselves: Pregnancy & Birth book news

I previously posted an excerpt of my review of the new Pregnancy & Birth book from Our Bodies, Ourselves. (My full review is available in the spring issue of CfM News.)

I just received an email from OBOS letting me know that the University of Michigan Health System is buying a huge quantity of the books to distribute to every prenatal client in their system. Isn't that great?! Wouldn't it be wonderful if other large institutions did this as well? The book is an affirming, empowering, woman centered book that is mainly based in a "climate of confidence." I would love to see that climate of confidence spread to become the norm in prenatal care and birth, instead of the "climate of doubt" in which many providers approach pregnant women, prenatal care, labor and birth.

Quantity discounts on the book are available for institutions wishing to follow the lead of the University of Michigan!

Maternal Mortality map

Jessica in MO sent me a link to the WHO graphic on maternal mortality rates (it is coded by color). You can view the image here. It is a dramatic visual, because I think most Americans would assume the US maternal mortality rate to be "blue" (which is the best-- less than 10 deaths per 100,000) along with Canada and Europe, but instead we are "green" along with Russia, Egypt, Latin America, and Turkey.

Breastfeeding & Birth Practices

I have a particular interest in the impact of birth practices on breastfeeding. Birth and breastfeeding are part of a continuum and it often seems forgotten or ignored that routine birth practices can have a significant impact on disrupting the breastfeeding relationship. Disturbed births lead to disturbed breastfeeding. An article I enjoy on this subject is one called "Winning at Birth" by Linda J. Smith, IBCLC (co-author of the book Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum ). In her article, Linda draws a parallel between preparing for an athletic event and preparing for birth (hence the use of the word "winning").

"Winning at birth - what an odd concept. Birth isn’t a contest. Or is it?...Birth is a very physical event, one in which our bodies have to exert themselves, perform. Birthing requires muscle control, determination, and grit. We even urge women to sign up for classes and practice. Women often grunt, groan, and make noise during birth just as athletes do. And because there is risk and a possibility for injury, the athlete is surrounded by skilled attendants."

As one of her tips for "winning at birth," she emphasizes choosing your birth attendant wisely (and I was happy to see she mentioned midwives as an ideal attendant to help you win at birth! Which then helps you "win" at breastfeeding.)

"Hire a skilled birth attendant as your coach. Your professional birth attendant’s attitudes and skill will play a major role in setting the stage for your baby’s birth. A professional midwife is an excellent choice, and many physicians actively support normal birth. Your professional attendant’s attitudes and beliefs about your ability to give birth normally and naturally will color all of her/his decisions and actions on your behalf. A good birth coach instills confidence, skill, and a winning attitude in her/his clients."

Speaking of midwives and breastfeeding, the most recent article from the International Breastfeeding Journal is titled "Assessing midwives' breastfeeding knowledge."

Cesarean Research

Last week I read a recent article connecting cesareans to a risk for strokes.

From the American Journal of Obstetrics & Gynecology 2008; 198: 391.e1-391.e7 (29 April 2008) via MedWire News Cesarean section (CS) delivery is an independent risk factor for stroke, a study of almost a million births has revealed. The researchers found that women who had cesareans had significantly higher stroke rates at 3 months postpartum, 6 months postpartum, and 12 months postpartum.

"Shiyng-Yu Lin and co-workers suggest CS delivery could alter hemodynamic and coagulation status, thereby predisposing to stroke.

'Based on the results of this study, a reduction in the CS delivery rate should prove to be beneficial for stroke prevention,' they conclude."

This week, another study reported that unexplained stillbirth is not linked to prior cesarean section. Source: BJOG: International Journal of Obstetrics and Gynecology 2008; 115: 726-31
(MedWire Posted: 6 May 2008).

International Midwives Day!

May 5th is International Midwives Day, which has been celebrated internationally since 1991. The theme for 2008 is Healthy Families: The key to the future.

Here are some ideas to mark this day in your community:

• Be a "day sponsor" on your local public radio station--either in honor of International Midwives Day or in honor of your own baby (but include in the day sponsor message that she/he was born at home with a midwife).
• Plan a simple community family picnic in the park (bring a banner that says what you're celebrating!)
• Send a press release to your local newspaper or radio stations.
• Wear pro-midwifery buttons or pins.
• Wear t-shirts or carry tote bags with pro-midwifery slogans on them.
  
• Ask every pregnant woman you see if she has a midwife!
• Make a donation to a midwifery or birth related organization (hmm...maybe CfM! ;-)
• Mark the day with a brief personal acknowledgment by lighting a candle for a bright future for midwifery everywhere.

You can read more about International Midwives Day on the Midwives Alliance of North America (MANA) website.

Robot Birth?

This article is from 2006, so it isn't new news, but was the first I had read about the kind of robot used to train people in obstetrics in managing birth.

From the article:

"The full-sized, blond, pale mannequin is in demand because medicine is rapidly abandoning centuries-old training methods that use patients as guinea pigs, turning instead to high-tech simulations. It's better to make a mistake on a $20,000 robot than a live patient.

The Institute of Medicine, an arm of the National Academy of Sciences, estimates that as many as 98,000 U.S. patients die annually from preventable medical errors. [emphasis mine]

"We're trying to engineer out some of the errors,'' said Dr. Paul Preston, an anesthesiologist at Kaiser Permanente and architect of the hospital chain's 4-year-old pregnancy-care training program, in which Noelle plays a starring role. "

The robot is very technologically advanced and can be programmed for all kinds of "disasters" as well as for more straightforward situations. She "gives birth" to a baby with vital signs and respiration (both mother and baby can also urinate and bleed!). While I am certainly glad this teaching tool reduces the amount in which birthing women are used as guinea pigs, there is something about this "tool" that, quite frankly, really bugs me. I guess because birthing women ARE often seen through mechanical terms and as a collection of parts rather than a real, feeling, caring woman. So using a mechanical tool to prepare for attending real women in birth seems to reinforce that view of women, labor, and birth.

Thanks to Debbie in Missouri for sharing the link to this article in the first place.

In addition, I am editing this post on 5/11 to note I just read a more current article (from April 2008) on the Knoxville News site.

"'These drills are usually held for situations that don't happen very often but are very serious when they do happen,' Fry said. 'The nurses need to be able to act automatically.'"

When I read this, I immediately thought of all the normal birth situations in which nurses also act "automatically" and pursue routines instead of individual needs and wishes :(