Highlights of the Lamaze Conference

I am still up to my eyeballs in stuff to do, but I need to share some of the wonderfulness that was the Lamaze Conference.

So, here are some highlights:

First and foremost, getting to be roomies for a night with Amy from Lamaze’s Science and Sensibility blog. I hope she feels the same way. She seemed happy about it before we fell asleep and I told her that I usually stop snoring if someone knocks on the wall. I don’t know if she had to use the trick or not.

Secondly, hearing Amy speak! She gave a great presentation of the evidence (or lack thereof) behind determining labor progress (which she described as a “hot mess”. You’re so right, Amy!) And, my surfboard buick laptop came in handy when she dropped hers. She used my laptop, and in the session before, also on research, my power cord came in handy when the computer they were using died suddenly mid presentation. Glad I went and was helpful!

I got to hold Rixa’s beautiful, sweet son Dio. Smelling his warm little head was almost as wonderful as meeting Rixa, and being with her at a few seminars to listen to her excellent, thoughtful input into the discussion surrounding birth.

I hung out around Reality Round’s poster presentation about infant massage in the NICU like a groupie for a little while. Other than that, I ran by her a few times as I tried to be where I was supposed to be fifteen minutes before for most of the weekend. She was even cooler in person than I had hoped.

I met Debra Bingham, DrPH, RN, LCCE, who is a wonderful person with a very important job. She is interested in my KALI Questionnaire. Ulp! I hope this comes to fruition. That is one of the things I am supposed to be working on right now.

I got to meet Teri Schilling after her inspiring and very well received keynote address (standing O from a huge room! Congrats, Teri!) and she told me she reads this blog! Wow! I also met doula Sharon Muza, who is also a reader. Weird but fun. I tend to think no one reads me, but I guess I know some people must since I get hits and comments.

The lectures and presentations were great. Laboring Under An Illusion is a wonderful documentary that should be required viewing for high schools, childbirthing classes and medical schools! And, I was tickled to see a few clips from House of Babies in the film. I was on that show for a few brief moments. Not in the clips she chose (thank Maude!) but still, I felt like I had a special connection.

Speaking of a connection, when the computer died on Judith Lothian, PhD, RN, LCCE, I got to ask her about her wonderful qualitative research on home birth. While we were waiting to get the password to restart the presentation, I got to ask her about the finer points of qualitative research. I was quite pleased to have many of my points from a recent argument on the subject verified in stereo. Qualitative research, especially on pregnancy and birth, is very cool and quite important. And, it’s an easy target for people who don’t know what they are talking about, as I experienced and she confirmed.

I also got to hear Tiffany Field, Ph. D. director of the Touch Institute at nearby University of Miami present, and talked to her after her fantastic speech. She invited me to tour the NICU at Jackson Memorial!

Anyway, this is getting long for highlights. It was a blast. I have a new necklace to show for it, too. I couldn’t resist.

CIMS response to The Today Show

The Coalition for Improving Maternity Services has written a fantastic response (pdf) to the horrid hit job disguised as journalism that was the Today Show’s The Perils of Midwifery (link to video) . I am reposting it here:

Sept. 23, 2009

Dear Producers of The Today Show,

The Coalition for Improving Maternity Services (CIMS) and the undersigned organizations are disappointed with The Today Show’s misrepresentation of midwives and home birth that aired on Sept. 11, in a segment titled “The Perils of Midwifery,” later changed to “The Perils of Home Birth.” This biased and sensational segment inaccurately implied that hospitals are the safest place to give birth even for low-risk women and mischaracterized women who choose a home birth with a midwife as “hedonistic,” going so far as to suggest that these women are putting their birth experiences above the safety of their babies. Neither could be further from the truth.

Unfortunately, The Today Show did not do its homework on the evidence regarding the safety of home birth and midwifery care. The segment featured an obstetrician who presented only the American College of Obstetricians and Gynecologists’ (ACOG) position in opposition to home birth, but it did not make any attempt to present the different viewpoints held by the many organizations that are committed to improving the quality of maternity care in the US. We are deeply saddened that the show did not take the opportunity to note that both CIMS and The National Perinatal Association respect the rights of women to choose home births and midwifery care, and that the respected Cochrane Collaboration recommends midwifery care because it results in excellent outcomes.
There is no evidence to support the ACOG position that hospital birth for low-risk women is safer than giving birth with midwives at home. What the research does show is that the routine use of medical interventions in childbirth without medical necessity can cause more harm than good, while also inflating the cost of childbirth. However, the current health system design offers little incentive for physicians and hospitals to improve access to maternity care practices that have been proven to maximize maternal and infant health.

“Birth is safest when midwives and doctors work together respectfully, communicate well, and when a transfer from home to hospital is needed, it is appropriately handled,” says Ruth Wilf, CNM, PhD, a member of the CIMS Leadership Team.

That is why the national health services of countries such as Britain, Ireland, Canada, and the Netherlands support home birth. In those countries, midwives are respected and integrated into the maternity care system. They work collaboratively with physicians in or out of the hospital, and they are not the target of modern day witch hunts. These countries have better outcomes for mothers and babies than the US.

Childbirth is the leading reason for admission to US hospitals, and hospitalization is the most costly health care component. Combined hospital charges for birthing women and newborns ($75,187,000,000 in 2004) far exceed charges for any other condition. In 2004, fully 27% of hospital charges to Medicaid and 16% of charges to private insurance were for birthing women and newborns, the most expensive conditions for both payers. The burden on public budgets, taxpayers and employers is considerable.

As US birth outcomes continue to worsen, it should come as no surprise to The Today Show that childbearing women are seeking alternatives to standard maternity care. After all, American women and babies are paying the highest price of all—their health—for these unnecessary interventions, which include increasing rates of elective inductions of labor and cesarean sections without medical indication.

To the detriment of childbearing families, the segment “The Perils of Midwifery” totally disregarded the evidence. Although the reporters acknowledged that research shows home birth for low-risk women is safe, that message was overshadowed by many negative messages, leaving viewers with a biased perception of midwifery care and home birth. CIMS makes these points not to promote the interests of any particular profession, but rather to raise a strong voice in support of maternity care practices that promote the health and well-being of mothers and babies.

One of the ten Institute of Medicine recommendations for improving health care is to provide consumers with evidence-based information in order to help them make informed decisions. The Institute recommends that decisions be made by consumers, not solely by health care providers. The Institute maintains that transparency and true choice are essential to improving health care. We remain hopeful that the medical community will soon recognize the rights of childbearing women when it comes to their choices in childbirth and will respect and support these choices in the interest of the best possible continuity and coordination of care for all.
We urge The Today Show to provide childbearing women with fair and accurate coverage of this important issue by giving equal time to midwives, public health professionals, researchers of evidence-based maternity care, and especially to parents who have made choices about different models of care and places of birth.

Sincerely,

Coalition for Improving Maternity Services

Academy of Certified Birth Educators
Alaska Birth Network
Alaska Family Health and Birth Center
American Association of Birth Centers
American College of Community Midwives
American College of Nurse-Midwives
Bay Area Birth Information
Birth Network of Santa Cruz County
Birth Works International
Birthing From Within, LLC
BirthNet
BirthNetwork National
BirthNetwork of Idaho Falls
BirthNetwork of NW Arkansas
Choices in Childbirth
Citizens for Midwifery
Doulas Association of Southern California
Evansville BirthNetwork
Harmony Birth & Family
Idaho Midwifery Council
Idahoans for Midwives
InJoy Birth and Parenting Education
International Childbirth Education Association
International MotherBaby Childbirth Organization
Island Families of Micronesia
Lamaze International
Madison Birth Center
Midwives Alliance of North America
Motherbaby International Film Festival
Nashville BirthNetwork
National Association of Certified Professional Midwives
North American Registry of Midwives
Ohana Island Care-Guam
Oklahoma BirthNetwork
Our Bodies Ourselves
Perinatal Education Associates, Inc.
Reading Birth & Women’s Center
Rochester Area Birth Network
Sage Femme
The Big Push for Midwives Campaign
The Tatia Oden French Memorial Foundation
Triangle Birth Network
Truckee Meadows BirthNetwork

About Us

The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. The CIMS Mother-Friendly Childbirth Initiative is an evidence-based mother-, baby-, and family-friendly model of care which focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

References:

1. The Perils of Home Births, http://www.msnbc.msn.com/id/21134540/vp/32795933#32795933
2. Birth Can Safely Take Place at Home and in Birthing Centers, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2409129&blobtype=pdf
3. Offers All Birthing Mothers Unrestricted Access to Birth Companions, Labor Support, Professional Midwifery Care, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2409134&blobtype=pdf
4. ACOG Place of Birth Policies Limit Women’s Choices Without Justification and Contrary to the Evidence, http://childbirthconnection.com/article.asp?ClickedLink=790&ck=10465&area=27
5. Ratifiers and Endorsers of The Mother-Friendly Childbirth Initiative, http://www.motherfriendly.org/ratifiers.php
6. Choice of Birth Setting, http://www.nationalperinatal.org/advocacy/pdf/Choice-of-Birth-Setting.pdf
7. Position Statement on Midwifery, http://www.nationalperinatal.org/advocacy/pdf/Midwifery.pdf
8. Midwife-led versus other models of care for childbearing women, http://cochrane.org/reviews/en/ab004667.html
9. Evidence-Based Maternity Care: What It Is And What It Can Achieve, http://childbirthconnection.com/pdfs/evidence-based-maternity-care.pdf
10. Lamaze Healthy Birth Practices, http://www.lamaze.org/ChildbirthProfessionals/ResourcesforProfessionals/CarePracticePapers/tabid/90/Default.aspx
11. Millennium Development Goals Indicators, United Nations, http://mdgs.un.org/unsd/mdg/Data.aspx
12. National Vital Statistics System, Birth Data, http://www.cdc.gov/nchs/births.htm
13. Induction By Request, http://www.marchofdimes.com/prematurity/21239_20203.asp
14. Cesarean Birth By Request, http://www.marchofdimes.com/prematurity/21239_19673.asp
15. Crossing the Quality Chasm: A New Health System for the 21st Century, http://www.iom.edu/CMS/8089/5432.aspx
16. The Mother-Friendly Childbirth Initiative, http://www.motherfriendly.org/mfci.php

Speaking of research

Check out Amy Romano’s latest post at Science and Sensibility about new, good research on homebirths.

Two things I found out yesterday

Rixa, the intrepid blogger at Stand and Deliver, won Lamaze International’s 2009 Media Award! If you haven’t read Rixa’s blog, (or Lamaze’s Science and Sensibility, for that matter), please check them out through the links above.

Her interview with Amy Romano is fantastic, chock full of analysis and information about modern maternity care. I was so tickled to see Rixa say she likes my blog! Like a cherry on the top of a sundae of a post. It is a wonderful, comprehensive look at both the quantitative, outcome based aspects of pregnancy and birth care, and the emotional, woman centered view of being pregnant and birthing.

I also found out that the Kali project shares a name with an escort service and live web cam of women sex workers in British Columbia. I was slightly amused and slightly dismayed. I consider myself to be “sex positive” and don’t mean to shame sex work. I am not a fan of exploitative sex work that exclusively involves women fulfilling what the mass media says is the male heteronormative ideal. Anyway, I hope they don’t mind sharing the name.

Reply turned post, birth power struggle style

This is a long reply to a post on Wandering Scientist’s blog called Thoughts on Labor, in which she tells her birth story:

I was fascinated by your birth story. You know, I have read so many of them online, but reading yours while I am learning about qualitative research through my fellowship gave me an idea.

You know, I have read so many of them online, but reading yours while I am learning about qualitative research through my fellowship gave me an idea.

One of the reasons I am interested in these birthing issues is I want to examine the power relationships between health care practitioners and women. I am going to use a survey (quantitative) and some in depth interviews (qualitative) with obstetricians in my area. Maybe I could follow up with some qualitative and quantitative research with women regarding birth interventions. Listening to Women has already approached this, but I think it’s mostly quantitative. Maybe I could do some qualitative research on birth stories on the internet to examine women’s perspectives on their interactions (and those of their personal support system, such as your husband in your case) with health care practitioners during the birth process. You did some thoughtful processing of this in your post.

Should a woman need to be so educated on interventions and when they are appropriate that she or someone she brings or hires can run interference to protect her from her paid health care practitioners?
Your husband takes the frequent claim that cesarean is the malpractice preventing option and jumps to the conclusion that it is somehow a safer option and prevents catastrophic problems. However, research usually shows that outcomes are generally worse for the mother, the baby, and future pregnancies with cesarean delivery. There are so many aspects to this I can’t just cite one study. There will be an extensive bibliography on this in my final paper, and you can search my blog history or The Unnecesarean for references .
Or, just search the recent contents of the so called Gray Journal (follow the search link and enter this: “Am J Obstet Gynecol”[TA] AND “cesarean”[TIAB] ) and Green Journal (enter: “Obstet Gynecol” [TA] AND “cesarean”[TIAB]). These journals are the bully pulpits of mainstream professional American obstetrics.
Coming to the realization that physicians, nurses, midwives, and even patients with full informed consent and insurance and/or means may make decisions during birth that do not favor the health of the mother or the fetus / neonate is a difficult one for people realize and discuss. My theory is that the interventions chosen by health care practitioners favor the practitioner’s role and make it easier, and that certain risks to the birthing unit are acceptable if it favors the correct direction in the power relationship. Women respond to pregnancy, birth, and subsequent pregnancies and births in a wide variety of ways, and may choose anything from elective cesarean to unassisted homebirth, depending on a variety of factors. There is less of an expectation for women to follow evidence based practices, but I hope there is an expectation for health care practitioners to do so.
Malpractice is a commonly quoted boogeyman as a reason to intervene, but research also indicates that using evidence based algorithms for interventions can lower cesarean rates and malpractice rates simultaneously. Many studies show an association between high malpractice payouts and premiums and high cesarean rates, but the casuality is missing in that association. What if it is the other way around? Interventions chosen despite evidence against their usage in many situations may arguably cause more malpractice suits and higher premiums. Causality is hard to prove in complex situations like this, but it can easily be argued that this association may not only be influenced in one direction.

Good things a brewin

I haven’t had time to post recently. But, good things have been brewing, so I wanted to throw up some links.

First, a study finds homebirth as safe as hospital birth. Of course, this occurred in the Netherlands. I would love to practice there one day. An American DO needs to pave the way, since our licensing is ambiguous in that country. Note the complication rate was 7 per 1000. That includes NICU admission or any neonatal mortality.

Note that in the United States, our infant mortality rate alone is 7 in 1000.

Hillary Clinton gave a rousing defense of comprehensive international reproductive medicine. I still get misty when I hear our administration advocating for evidence based, women centered medicine that will save more lives of women and children.

Also good stuff, the FDA is going to be extending over the counter, non prescription status for plan B to 17 yr olds. It is safer than a pregnancy for all ages, children who can’t talk to their parents about it are high risk and should have more access. Unfortunately, proving your age requires ID. I think the requirement should be lifted because privacy outweighs the negligible risk. If a young woman is in a small town, she will be forced to show her license in order to get Plan B. We need mroe progress on this issue. Plan B needs to be available without a prescription, end of story.

The New England Journal of Medicine published a study on using PCR, a cheap DNA analysis is better than a pap smear when screening for cervical cancer. Very interesting. I may be doing some research on PCR testing for HPV during my research fellowship.

And, finally, Shakesville has been cracking me the hell up.

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.