Monthly Archives: May 2008

Continuous care in labor

I love the journal Birth. I just got a fresh copy of their table of contents in my email inbox, and I found this gem on continuous labor support in there. I have only read the abstract – I have a tab open in the EBSCO database as we speak for the full text. But wow wow WOW the results look great. Too bad they are from over a decade ago! Women’s bodies and doula practices have not changed a lot since then, but hospital practices and intervention rates have.

“Results: The doula group had a significantly lower cesarean delivery rate than the control group (13.4% vs 25.0%, p = 0.002), and fewer women in the doula group received epidural analgesia (64.7% vs 76.0%, p = 0.008). Among women with induced labor, those supported by a doula had a lower rate of cesarean delivery than those in the control group (12.5% vs 58.8%, p = 0.007). On questionnaires the day after delivery, 100 percent of couples with doula support rated their experience with the doula positively.”

I am going to find out how many women were in that induction group. I am sure induction rates have climbed significantly since 1992, like most other labor interventions. But a reduction of failed induction of 58.8% to 12.5%?? I don’t think every cesarean birth is a failed birth by any means, but a cesarean after labor induction, in general, is a failed induction. One does not induce labor with the intent of doing a cesarean, even though it is often the consequences of such an action, when issues like an unencouraging Bishop’s score are taken into account.

By the way, when searching the term “Bishop’s score” to provide a link, I found a do-it-yourself Bishop’s score page on one of my favorite websites, Childbirth.org. Women would have to have access to a computer in the triage room or clinic to use it for the most part, I would think, but hey, it’s interesting! I would think it would make more sense to ask the health care practitioner measuring effacement, dilation, etc. what Bishop score those would add up to, and what that means in the progress of your care.

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Pro-choice means having babies, too

I was so happy when speakers at our Medical Students for Choice meeting discussed far more than just abortion. Not only did they also discuss birth control access, sex education and teen pregnancy, but they also talked about choices in obstetrical delivery methods, practices and practitioners, and access of poor women and women of color to infertility care. Reproductive rights are full spectrum, baby.

I have had friends and acquaintances with varying degrees of fertility issues, from hyperfertility (like me!), problems conceiving, secondary infertility to a complete lack of fertility. Fertility is an unfair crapshoot at best. With numbers thrown around that 10% of couples suffer from infertility and more than 50% of pregnancies in the U.S. are unplanned, there is a whole bunch of unfairness spread around.

I thought this article at RHReality Check is a wonderful discussion about the cost of infertility treatments, and the attitude of some of our society that poor women somehow do not deserve to be parents. It only touches one aspect of a very complicated issue, but I think it is a great post.

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Music Monday – Julia Nunes!

I had such a hard time holding on to this until Music Monday!

I stumbled upon this YouTube ukulele sensation, (Yes, there is a such thing! Andy Warhol would be so proud.) Julia Nunes. Yes, she is playing the guitar in the video that pops up on her YouTube channel right now, but she mostly does covers with her ukulele. I think I like her talking voice almost as much as her singing voice! She does a wide variety of covers, from Spoon to Weezer to the Beatles to the Weathergirls (I’m Raining Men). My current favorite is Gone by Ben Folds. (I fixed the link – please click!) She does her own harmony via fancy (to me) editing.

I am so enchanted! She is the most adorablest.

This song is very appropriate to me right now.

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Combining passions

uterus-pancake.jpgI tried combining my passions of art (well, that one has been mostly dormant for a while), cooking and women’s health this morning. I made a uterus, ovaries and fallopian tube pancake. It may look a little sloppy, but I assure you it was delicious. I almost did an ooectomy when I was transporting it to the table, but I managed to save the ovary.

They turned out looking more like a character from Maus than any woman’s organs.

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Five stages of drinking

I totally thought of this hysterical comedy bit by Larry Miller when I woke up this morning with a killer hangover.

I made the pledge, say it with me: “I am never drinking again for as long as I live. And this time, I MEAN IT!”

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I have a theme song

Thanks, Stacie, for letting me know that I have a theme song. Oh, and it is sung by otters.

*I fixed the link! Thanks again, Stacie!*

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The justice system is on crack, baby

This is not the first time I started answering a post on Women’s Health News and decided that my reply was WAY too long and needed its own post on here. Rachel posted about a Mississippi case in which a woman was sentenced to 20 years in prison for having a stillborn baby test positive for cocaine. (Oops! Correction, the case was in South Carolina, thanks Rachel! And the other cases I was thinking about were in Alabama, not Mississippi. Whoops whoops.)

This is such a touchy subject. Of course no one recommends or condones prenatal cocaine use. Or cocaine use, in general. The toughest ethical decisions, in medicine and in law, involve unsympathetic subjects. But sentencing a poor addict who just suffered a stillbirth to twenty years in prison for homicide due to aggravated child abuse? I think this is a very nuanced conversation. I would love to spend a few days researching this and then write an annotated reaction, but I am going to write up my opinions on this so far, then continue to write on this whenever I come across a journal article or a new court case. Otherwise, I would never finish and finally address it.

First, drug use, treatment and punishment are a fiasco in this country. There is too much of a stigma for seeking treatment. Addiction is not treated as a disease, it is treated as a crime and a personal failing. We spend more government money preventing our children from using birth control than preventing them from using drugs.

There is a lack of adequate, effective, affordable or free treatment programs. I shadowed at the county rehab here. I have not been to their perinatal treatment center, but looking up the links has made me want to ask about shadowing over the summer. I know that the residential rehab I went to was full and had a waiting list. Their relapse rate was about 90%, and this is with the full spectrum of treatment drugs available. I am not sure how pregnancy limits detox protocol, but many of the drugs used, like benzodiazepenes (the valium and xanax family) for opiate withdrawal, are also addictive and not recommended for use during pregnancy, in general.

I live in one of the largest metropolitan areas in the country. Our beds are full and our numbers aren’t great. I am not sure what the situation is in rural Mississippi, where this particular court case played out, but I am fairly sure they don’t have local, top of the line facilities available with diverse programs. So, if a woman is an addict and is pregnant, before we blame, sentence, and punish her, we should examine what her options were for treatment.

Did she even have prenatal care? There is only one abortion provider (Guttmacher says 2 in 2004, but I found articles from 2006 saying they are down to one in Jackson) in the entire state of Mississippi, so reproductive planning wasn’t reasonably available. There is also a 24 hour waiting period, so even if she could get to the abortion provider and pay for the abortion, she would also have to pay for an overnight stay in the area. And, there is no public funding of abortion unless there is “life endangerment, rape, incest or fetal abnormality”. So, being a drug addict without funds for an abortion or rehab would not qualify you for anything except for, well, prison, it seems.

I have heard people in comments on threads on this subject say birth control is available, so why didn’t she use that? I am not sure how easily available free birth control is in Mississippi, but considering at least half of all pregnancies in the United States are unplanned, do we really expect a poor addict to be in more control of her fertility than at least half of the pregnant women in the entire country?

Now let’s talk about pregnancy, motherhood, and the unreasonable expectations placed upon mothers. Women are condemned and blamed for everything that goes wrong with their pregnancies and children, and are expected to abide by an unreasonably high standard of lifestyle. Someone told me a story at school about a woman who spilled a beer by accident on her baby at a restaurant. “What was she even doing drinking a beer?” my classmate said nastily, and the other students, all non parents, agreed.

What? A woman can’t drink a beer once she has a child? I am not promoting alcoholism. I think alcohol causes much more problems during and after pregnancy than cocaine, even. Unlike marijuana and many other illicit drugs, believe it or not, alcohol is linked to a definite set of debilitating birth defects. But seriously, a woman can have a beer with dinner at a restaurant, even if she is also a baby mother. Even if she is breastfeeding, I would argue, if it’s one beer. I have heard stories of women being harangued over diet cokes, coffee, sushi, you name it, by supposedly well meaning strangers or coworkers.

What happens if a woman eats brie or sushi, even knowing the risks, which include miscarriage and stillbirth? What is she engages in sex with a partner with visible herpes lesions? Drinks excessive coffee? Smokes cigarettes? None of these are illegal, but are linked to miscarriage and fetal demise. What if she does do something illegal, like smokes marijuana, but it is not linked to birth defects, miscarriage, or fetal demise? What is she is an alcoholic? It is not illegal to be an alcoholic, but is being pregnant for nine months equivalent to choosing to drive while intoxicated, which is illegal? I would assume that regularly purposefully blowing cigarette smoke in your child’s face would be considered a form of abuse, but only 20% of pregnant smokers quit smoking when they are pregnant. Are they all child abusers? What if they miscarry? Are they homicidal child abusers? What if their baby dies of SIDS, and their husbands are smokers? Are the husbands homicidal child abusers, subject to imprisonment?

How about the prison system? It is a mess for mothers. If I was pregnant and needed help, but was doing something illegal, there is no way I would risk being put into this system.

I think putting a woman in prison for 20 years in this situation is not the right answer. There is no pretty side to this, no happy option to support, but 20 years of prison is not the right answer. Being a drug addicted woman with a dead baby is bad enough. Adequate counseling, detox, social services, drug testing and birth control is what I would think would be a better way to spend tax dollars.

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