Monthly Archives: June 2008

Whoops. Blog day for education, one day late

I don’t know why I didn’t remember that yesterday was the Blog Blast for Education. I had originally planned on posting about experiences I have had with my children, but I posted about a class I am in yesterday. And I am posting about it again, today. Yesterday was a hectic, hectic day in which I was quintuple booked. Sorry!

It should be no surprise to people who know me that I would love a class based on a message board. Well, here is my latest post, in response to the teacher discussing whether or not our culture promotes abortion. She told a personal story about growing up in Cuba, and how she thought abortion was promoted there by public policy.

Here is my post:

I totally agree, first of all, that government attitudes and health
policies do affect women’s choices. In Cuba, overt religion was not part
of the political picture, and neither was contraceptive access. Since
abortion was free and accessible, it was the predominant method of
controlling pregnancy and birth for women outside of herbal remedies.

In the United States, contraception is not readily available for
different reasons. Religion and cultural social conservatism are playing
a role in this, to a certain extent. There was already a great
discussion about this on Stephanie’s post about contraception use in the
Netherlands.

Recent legislation has slashed contraceptive funding and contraceptive
prices have skyrocketed, especially on college campuses. The doctor
appointed to oversee Title X funding for reproductive health and birth
control (Dr Susan Orr, the Assistant Deputy Secretary for Population
Affairs, who just stepped down after 3 years) has a public stance
against birth control, and used to work for the Family Research Council,
an organization lobbying to ban Title X funding. The largest “pro-life”
group, the American Life league, recently organized a national protest
day against the birth control pill, with the slogan “The Pill Kills”.
Even though 98% of women use contraception at some point in their lives,
our culture sends a very mixed message to women.

Recent changes in public health programs in the United States have had a
definite effect on teen birth rates, contraception use, and abortion.
Access to abortion in rural areas, which has plummeted due to political
resistance, and funding for abortions has dropped, and so has the
abortion rate, slightly, but to what end? More unplanned pregnancies
being carried to term by women who would terminate if they had the
funding and access to care?

I do not agree that the culture in the United States necessarily
encourages abortion. In the oxymoronic ideal we are given as women,
abortion is definitely not supported or encouraged. Yes, a certain level
of sexual appearance and behavior is expected of women, but once it gets
to the sexual level, we are supposed to say no, and not even think about
birth control, premarital sex, sex for recreation, women’s pleasure or
sexual appetite, or abortion. It is the virgin/whore dichotomy that is
the ideal. In a way, abortion is expected since contraception is not
promoted and our public health policy results in more unplanned
pregnancies. But, abortion is heavily stigmatized as a way to deal with
unplanned pregnancy.

The way that the public dialog has been framed when it comes to abortion
is in the extremes. No one talks about the reality that it is the most
common surgical procedure in the United States. I doubt many of us know
the 30-40% of women around us who have had them. It is not like the
public attitude towards plastic surgery, which is overwhelmingly
positive. The dialog either focuses on the 5% of abortions that are in
the second trimester, or tries to ignore the discussion all together.

The recent blockbuster movies about birth and reproduction are perfect
examples of this. In the movie “Knocked Up”, the characters can’t even
use the real word abortion when discussing it as an option in an
unplanned pregnancy. The supporting character says “shmamortion” or
something to that effect, since it is the procedure which cannot be
named, like the villain Voldemort in Harry Potter.

In “Juno”, the abortion clinic is staged as a place for purple haired,
insensitive freaks, and the teenage character is glorified for deciding
to become a “baby Santa” to an infertile couple. Incorrect medical
information about embryos having fingernails was given as a reason for
avoiding abortion. Without any counseling or remorse, she gives the baby
up for a closed adoption in which she cannot make contact, and skips
back to the father of her child who wouldn’t even admit paternity due to
the shame.

I have already talked about the complicated topic of adoption, which is
another huge issue. Statistics show that almost no women give up their
children for adoption in the UK, and it is thought to be due to the fact
that they have good social support for single mothers and universal
health care. What would Juno do if she had that waiting for her? Or,
would she have even gotten pregnant if she lived in the Netherlands?

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More on home birth, and my class!

(Note: Many of my older posts are transferred from my old blog, and all of the links are broken. I may, one day, have time to come back and re-link the posts. Maybe. This post would be high on the list if that ever happens. Sorry!)

I love my new online public health class. It is a class about culture and health, and the class is run as a discussion board. *Squeal!!!!*

This week’s topic is reproduction in different cultures. *Double squeal!!!*

Here is a copy of my post on the class board about homebirth in the US, UK, and the Netherlands:

There is a hubbub brewing right now, since the American Medical
Association (AMA) just passed a resolution encouraging state legislation
regulating childbirth, specifically to regulate that childbirth only
takes place in a hospital or a licensed freestanding birth center.

link

The American College of Obstetrics and Gynecologists (ACOG) adopted a
similar resolution, originally also discouraging birth in freestanding
birth centers. An outpouring of negative reaction, with evidence, led
them to revise their position to admit that free standing birth centers
have a strong safety record. However, the ACOG resolution was just a
position statement. This AMA resolution recommends drawing up model
legislation to enforce the position.

The most recent study on home births in the United States shows them to
not only to be safe, but to have better outcomes than comparable low
risk deliveries in US hospitals:

link

Currently, 30% of babies are delivered at home in the Netherlands, and
they enjoy a much lower maternal mortality rate and infant mortality
rate than the US.

link

The Royal College of Obstetricians and Gynaecologists (RCOG) issued a
joint statement with The Royal College of Midwives (RCM) (they work
together in the UK! and in the Netherlands! Imagine…integrated care!)
supporting and even encouraging home birth. They also enjoy a much lower
rate of maternal and infant perinatal morbidity and mortality than the US.

link

I broke the format rules. Consider that all one paragraph! As for my
opinion, I think it is clear that I support home birth in the full
spectrum of reproductive choice and informed consent. I am afraid that
obstetrics, the field I love and plan to practice, is in a very confused
state in the United States. Interventionist practices are not based on
evidence of improved outcomes. I just spoke to an attending at the
closest Ob/Gyn residency who was appalled by the practices she saw when
she started at that well renowned research and teaching hospital. What
was the most appalling to her, and to me, is not simply that these are
medical interventions. We are all in support of life saving technology.
But, when these interventions have been shown in easily accessible peer
reviewed research to lead to negative perinatal outcomes, why have they
become standard of care in normal pregnancy instead of in the rare cases
that they are indicated?

Announcement of bias/conflict of interest: I trained as a midwife for
two years, and had both of my children with a midwife. One in a
hospital, one in a freestanding birth center. I have attended births in
hospitals, including cesareans, in birth centers and at homes. I am
training to be an Ob/Gyn, however, so you can take anything I say with
whatever flavor grain of salt you like.

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Rrrrg, stinking AMA

So, I already had a chip on my shoulder about the American Medical Association. The American Osteopathic Association allowed women to practice as physicians way before the AMA did, and the AMA has tried to stop osteopathic physicians from practicing at one point. All of that is water under the bridge, but they apparently passed a resolution to try to ban home births, presumably in response to the success of Ricki Lake’s “The Business of Being Born”. (Hat tip, RH Reality Check, which is where I read it first.)

I can’t see why midwives and doctors can’t work more cooperatively here. There is successful cooperation between physicians and midwives in other medically advanced nations, like the Netherlands and England. With a shortage of ob gyns wanting to deliver, and skyrocketing malpractice rates, I can’t see why more doctors don’t leave the uncomplicated births to midwives, at home, in a birth center, or in a hospital.

The best births I ever attended were home births. Even the complicated one that reminded me of my own complicated birth, which was attended by a midwife, but took place in a hospital. The worst births, the ones that made me the most scared, were almost all at a hospital.

I went to the hospital with a fellow midwife student who was fully dilated at 28 weeks. We waited for the doctor on call at the hospital. We called before we even showed up and made it very clear how urgent the situation was. We waited. And waited. I was there with a midwife from our center, and the labor nurse happened to be a nurse midwife that we knew because she had graduated with one of our midwives. She was working at the hospital as a labor nurse, however, and was not there to deliver babies, just assist.

We waited almost 45 minutes. It only took us five minutes to drive there. Most home births happen within 20 minutes of a hospital. We waited for the doctor, and the NICU team waited patiently for the very vulnerable baby to come out. We called the head midwife at the birth center, and she said “That baby has to come out. Tell her to push.” The labor nurse / midwife nodded her head, and told her to push. The baby was born and whisked away by the NICU unit. The doctor showed up another 45 minutes after that.

I could tell you more stories about bad hospital births, but I am not just knocking hospitals. The issue I have with most of these stories is that the doctor is not there. The patient may be in the hospital, this magic building with the magic rooms and the machines that go ping, but the doctors are spread so thin that they are not there to help these women, and these are the HIGH risk women who can’t have a home birth. Seems like there is enough to go around.

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I got my new favorite t shirt!!

shirtSqueal!! My new Medical Students for Choice special anniversary t shirt just showed up in the mail. I love it!

Click on the picture to see it. It is a uterus and fallopian tubes, surrounded by tiny rhinestones! Bedazzling!!

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I couldn’t resist

I am on vacation in the Keys, so I have also been taking a vacation from posting. But, I couldn’t resist. Here is a photo series of actual ovulation. Hat tip to Green Fertility. Amazing!

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Designing a school shirt

I am trying to design a shirt for our school chapter of AMWA, the American Medical Women’s Association.

It is going to say “Be the doctor your mother wanted you to marry” and have this graphic on it. The suitor will be mirror imaged on the other side, so there will be two suitors.
Photobucket
You like?

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