Reply turned post, conscience clauses can be OK style

I am starting to grow weary of being the contrary voice. I duck out of many confrontations, believe it or not. But, sometimes I still speak up.

More than once, a liberal, pro-choice site has taken a stance against conscience clauses in general. Although I am a pretty vocal pro-choice commenter in the interwebs, I find myself defending conscience clauses in these conversations.

This time, I replied on a Feminists for Choice post asking if conscience clauses were ethical:

I am a medical student and a member of Medical Students for Choice.

I strongly believe in conscience clauses and plan on refusing to perform certain procedures and to dispense certain medications when I am a physician. I think every physician follows her conscience, and am afraid anti-choice activists are using this important part of medical ethics to refuse to provide services that are in the best interest of the patient.

I plan on refusing to perform unnecessary procedures that are requested all the time as an ob/gyn. I will not perform any genital mutilation, male or female. This includes any routine newborn male circumcision, or elective vaginoplasties. This of course does not extend to any medically indicated procedures, which would be in the patient’s best interest.

I will refuse to do labor inductions because a mother is sick of being pregnant or because I am going on vacation. I will refuse to do non medically indicated cesarean section because a mother is afraid of the birth process or wants to have her baby on a certain date, or because I want to get home in time to have dinner with my family on a day I am being paid to be on call.

I think practitioners that are truly ethical do not use conscience clauses as an excuse to deny medical treatments to their patients or clients because of some idea that premarital sex is immoral. It is easy to find work in an area that does not involve refusing to provide necessary medical care. Most of these people who are refusing reproductive health care want to make an issue out of their refusal to control women’s sexual autonomy, not to support their own ethics, and it’s a shame.

There are two students in my medical school class who have stated they will refuse to prescribe birth control. Both identify as Catholic. One was more than happy to take handfuls of condoms our club was passing out for when he has sex with strippers (I wish I was kidding). He said he is using them for disease prevention, not birth control, so he is not a hypocrite.

I hope he goes into radiology, or urology.

The other is a Jesuit priest. He is planning on going into psychiatry, so most likely won’t be in a position to be a birth control prescriber often. He is also honest and out in regards to his homosexuality, and is an activist to change the Catholic position on homosexuality. So, he thinks some rules are meant to be changed.

The point of these two stories is to say, ethics mean different things to different people. Physicians and other health care practitioners are too diverse a group to force into one group of practices. However, we can encourage responsible application of conscience clauses and try to make sure essential health care does not get refused in the process.

Moving during labor

Amy at Lamaze’s Science and Sensibility is hosting the second Healthy Birth Blog Carnival. This one is about Lamaze’s Second Healthy Birth Practice: Walk, move around, and change positions throughout labor.

Amy did a great job explaining how natural birth advocates are constantly asked to prove that what is physiologically normal, like being free to move during labor, is better than an intervention, when it should be the other way around. Here’s a great quote from her anticipatory pre-carnival post:

Somehow, things have gotten turned around, and the normal condition is now the “experiment” and the intervention is the “control”. In addition to being irrational, this is a set-up to perpetuate conventional obstetric care, which imposes unhealthy and unfounded restrictions on women in labor. This is because in “intervention versus control” research, you have to show that the intervention performs significantly better, otherwise the control condition remains standard practice. While many of us believe that encouraging a laboring woman to move when and how she wants to is healthier and safer than making her stay in bed, waiting for evidence that it produces better health outcomes is putting a burden of proof on normal birth that has never been applied to routine intervention. Besides, lack of evidence of harm, less pain, and maternal satisfaction are valid and important outcomes in and of themselves, and provide the justification we need to reject routine policies and practices that restrict maternal movement.

I had a similar argument with a commenter on this post. Many elective cesarean advocates seem to want to present vaginal birth and cesarean birth as two equal options, not a physiologically normal event and an intervention.

So, since Amy already handled this angle well, I am going to talk about my own experience, and give a little advice at the end.

When I had my first child, I thought I was well informed. Hell, I had read every page in What to Expect When You’re Expecting. I read Mothering and Parenting magazines (both sides!), hired a midwife, took a childbirthing class, and thought I would have a “natural birth” as long as there wasn’t any unexpected emergencies.

Well, soon after I arrived at the hospital, I was told they didn’t have a birthing tub (I never thought to ask ahead of time, dangit) but I was told I could labor in the shower. After the shower, which was probably 20 minutes at the most, I was told I needed an IV with Pitocin. I had no idea what that was, but since my midwife recommended it, and everyone knows midwives always favor natural births over interventions, I didn’t even think of refusing. Well, I was told as soon as the Pitocin was started that I needed to be on continuous external fetal monitoring. Huh? Then, my midwife told me I had to stay in my bed(!!!), since the baby was showing signs of distress. I was not told before being administered the Pitocin that it would require being tethered to the machine, and I wasn’t told it may cause fetal distress, even after my fetus was apparently diagnosed with fetal distress. I wasn’t even told it may not be necessary, considering I had only been in active labor for about an hour when it was administered.

Fast forward several hours and I was flat on my back, pushing too soon, leading to a swollen cervix. No, no alternate positions were encouraged for my three hours of pushing, either.

So, my advice? Ask your practitioner(s), ahead of time, what their positions are on intermittent monitoring and movement in labor. Don’t just assume that what seems basic and normal will be encouraged or allowed.

More on fat bias and pregnancy

Jill at The Unnecessarean linked to this frustrating but great birth story at My Best Birth. “A Curvy Gal’s fight for a Natural Childbirth” is full of head exploding details, such as baseless threats from her midwife, recommendations for risky procedures with a lack of adequate informed consent, and suggestions of medical approaches that would actually increase the risk of adverse outcomes, not decrease them.

Here is a choice quote:

After some research, I called my midwife to say that I did not want a Miso induction, and that I wanted to wait and go into labor spontaneously. She said, “Well, in my experience, women with BMIs higher that 26 tend to have cervixes that won’t dilate without chemical induction.” Okay—first I was being pressured into induction because of the increased risks of a long gestation to m y baby and NOW she’s saying that because I am a curvier gal, my body is somehow clueless about giving birth (by the way, I had NO other risk factors in this pregnancy—no gestational diabetes, no elevated blood pressure, etc) I have since searched high and low for ANY medical study that supports her belief and have come up with nothing. I argued with her that I’d like to give my body the chance to go into labor on its own—at least through the weekend (agreeing to the postponed induction with the foly (sic) catheter instead). She was condescending and doubtful, but ultimately said it was up to me.

Rrrrrrgh.

The good news is that she did her research, refused the inductions, and ended up going into labor spontaneously and having a quick and easy birth.

Sick and leaning on the mute button

So, I am sick. Sick sick sick sick. I hurt everywhere. I have a fever and I am lightheaded. Runny nose, cough…the works. Blegh.

I am planted in front of the computer and the TV. I watched these Bill Nye videos about genetically modified foods. I just happened to get a link for them by being a fan of Slow Food USA on Facebook. It was interesting timing (not ironic, huh CableGirl?), since I just got in an annoying argument with commenters on on Dispatches from the Culture Wars. First of all, I am no fan of people who use snotty insults when they’re arguing on a site. Not necessary. Sarcasm is fine. But, if you’re going to go there, you better be right. I also don’t think blindly accepting technological advances is any more reasonable or educated than being blanketly afraid of all technology.

So, while I was tooling around on the internet, I had the Travel Channel on mute. Anthony Bourdain was visiting Ted Nugent. I could never listen to that much douchebaggy conversation, but I left it on in case there were any exciting gun accidents. Not that I wish that on anyone, but still, it’s exciting.

Now I am watching Birth Day. I wish I had the mute on here, too. I have heard “vertex position is NECESSARY” for a vaginal delivery. Also, I heard about a woman who had been in a long labor, and when her nurse introduced the next shift nurse, she said “And Amy has been with us forever.” Nice. She ended up with a fever after several hours of an epidural, and of course they discussed ZOMG infected baby!! but didn’t mention the link between epidurals an fever. The baby was born by “abdominal rescue” (wha??) and then was immediately taken to the well child nursery. Wait, I guess they don’t think there is a big risk this baby is infected. Then they talked about how it’s just great that she had a healthy baby.

I did get to see a successful external version (I cheered!) but I was surprised to see she got a neck down epidural for it, and then they induced labor immediately. I don’t know that much about external versions, however. The baby has distress now. They think it’s from the version. But, can it be from the Pit?

There is a woman who is one day past her due date (the horror) and was told her baby is “big” and she needs a cesarean. Oh, but she’s a hemophiliac. How does this sound safer? Her bleeding time test did not look good from my amateur eye. Why cut her without good indications?

Newest, bestest KALI questionnaire, annotated

Here is the annotated survey, with an attempt at dividing the questions into domains and scaling them. So, the domains so far are K=Knowledge, A=Attitude, B= Barrier, P=Practice pattern, and Y=Autonomy of the patient. If a question says “Reversed” after it, then it is phrased in the reverse or negative compared to the evidence cited.

Sorry about the messed up formatting; I swear it looks OK in Word. I will try to edit it later today when I have more time.

The KALI Project Survey

Thank you for agreeing to participate in the Knowledge and Attitudes of Labor Interventions (KALI) survey. This survey is intended to gather information about obstetrical practice patterns. The survey is anonymous, and should take about fifteen minutes. By completing this survey, you are giving consent to be part of this study.

First, we would like to gather some information about you and your practice. Please answer these questions by either circling your answers or writing your answers in blanks provided. This information will be kept confidential.

1. You are:
[1] Male [2] Female

2. Age:
[1] 20 – 29 [5] 60 – 69
[2] 30 – 39 [6] 70 – 79
[3] 40 – 49 [7] 80 – 89
[4] 50 – 59 [8] 90 or older

3. Do you have children?
[1] Yes [2] No

4. Ethnicity:
[1] Hispanic or Latino
[2] Haitian
[3] Neither Hispanic nor Haitian

5. Race (choose as many as apply):
[1] White / Caucasian [4] Native Hawaiian / Pacific Islander
[2] African American / Black [5] Native American Indian /Alaskan
[3] Asian or Asian American [6] Other:_______________________

6. How would you describe the location of your ob/gyn residency?
[1] University
[2] University affiliated
[3] Community
[4] Other: ____________________________

7. Year of residency completion _____________

8. Which of the following most accurately describes your practice type?
[1] Public hospital
[2] Community health center
[3] University based practice
[4] Private practice
If private –
[a] Large partnership (four or more partners)
[b] Small partnership (two or three partners)
[c] Solo practice
[5] Military / government
[6] Other:____________________________________________

9. Do you currently practice obstetrics?
[1] Yes
If yes:
[a] Average clinical time spent with prenatal clients:______________(%)
[b] Average number of deliveries per year:________________
[2] No

10. Which of the following most accurately describes your personal practice scope?
[1] General obstetrics and gynecology
[2] General gynecology only
[3] Obstetrics only
[4] Laborist
[5] Maternal Fetal Medicine
[6] Reproductive Endocrinologist
[7] Gynecologic Oncology
[8] Urogynecology
[9] Other: ______________________________

11. Which of the following most accurately describes your current malpractice coverage?
[1] None / I “go bare”
[2] I pay for individual malpractice insurance
[3] My practice pays my malpractice premiums
[4] I am an employee of an institution that pays my malpractice premiums
[5] I am an employee of an organization or institution that provides legal defense but
not malpractice insurance
[6] Other: __________________________________________________

Please rate the following statements about obstetrics as accurately as possible. All questions will have this scale available for you. Please choose whether you:

[1] Strongly agree
[2] Agree
[3] Neither agree nor disagree
[4] Disagree
[5] Strongly disagree

1. _____Restricting maternal intake of all nutrition by mouth during labor prevents serious adverse maternal outcomes.(K)1 Reversed

2. _____Elective cesarean section should not be performed on a woman desiring several children.(K)2

3. _____Doulas (i.e. private labor coaches, or trained labor companions) improve maternal and newborn outcomes.(K)3, 4

4. _____Episiotomy should be avoided if at all possible. (K, A, P)1, 5

5. _____The use of continuous external fetal monitoring (EFM) increases the risk for cesarean delivery. (K)6

6. _____In the absence of maternal and fetal medical indications, vaginal deliveries confer more risk than cesarean deliveries. (K)7, 8 Reversed

7. _____Insurance should not reimburse use of doulas for labor and delivery.9 (A,B)Reversed

8. _____I employ episiotomy routinely, because it is easier to repair than lacerations that result when an episiotomy is not used. (K,P,B) 3, 10 Reversed

9. _____Fear of liability claims limit the options I present to my obstetrical patients.(B,Y,P)11, 12 Reversed

10. _____Liability insurance company policies forbid me from performing VBACs. (B,P) Reversed

11. _____Use of upright (non lithotomy) positions during the pushing and birth has no positive impact on perinatal outcomes. (K)1, 13 Reversed

12. _____The use of continuous EFM does not result in a reduction of cerebral palsy. (K)6

[1] Strongly agree [2] Agree [3] Neither agree nor disagree [4] Disagree [5] Strongly disagree

13. _____All women in early active labor should have an amniotomy (i.e. artificial rupture of membranes or AROM ) if they present with their membranes intact. (A,P,K)1, 14 Reversed
14. _____Few women would choose to have a vaginal birth after cesarean (VBAC) if they knew the consequences of uterine rupture.(Y,A,K)3 Reversed

15. _____I regularly employ episiotomy to shorten the second stage of labor and delivery. (B,P,A)15 Reversed

16. _____Low risk labor patients should be offered the option of intermittent fetal heart rate monitoring in labor.(K,A,Y)6

17. _____Elective cesarean section should only be performed after accurately determining 39 weeks of gestation.(K)2, 8

18. _____Mediolateral episiotomies result in less postpartum pain than median episiotomies. (K)16, 17 Reversed
19. _____Prior to an induction, patients should be counseled about the possible need for reinduction or cesarean delivery.(K,Y)18

20. _____The hospitals in which I attend births do not have sufficient staff to support intermittent fetal heart rate monitoring during labor.(B)6 Reversed

21. _____Most patients attempting vaginal delivery benefit from oxytocin (Pitocin) augmentation of their labor.(K,P)1, 19Reversed

22. _____I regularly employ episiotomy to prevent pelvic floor relaxation.(K,P) 3, 5, 16, 17Reversed
23. _____Hospital policies forbid me from performing VBACs.(B)20-22Reversed

24. _____If my partner or I were pregnant for the first time, I would recommend an elective cesarean delivery in the absence of any medical or obstetrical indication.(A)7, 23, 24 Reversed
25. ¬_____I have made changes to my practice because of the risk or fear of liability claims. (B)11, 12 Reversed
26. _____Childbirth is only normal in retrospect.(A)3Reversed

27. _____Clinical guidelines are useful tools for me in daily clinical practice.(A,P)25

28. _____I regularly employ episiotomy to prevent perineal trauma.(K,P)5, 15, 17Reversed

29. _____The use of continuous EFM reduces perinatal mortality.(K)6Reversed
[1] Strongly agree [2] Agree [3] Neither agree nor disagree [4] Disagree [5] Strongly disagree

30. _____ Labor induction for non-medical indications (psychosocial or logistical) should only be attempted after establishing a gestational age of 39 weeks. (K,P)18

31. _____I encourage my patients to try alternative or upright positions during the pushing stage.(A,B,P)1, 13, 26, 27

32. _____Physicians should initiate discussion of elective cesarean delivery as part of routine prenatal care. (A,P)28 Reversed

33. _____I refer patients who want to attempt a trial of labor after a prior cesarean delivery to another practitioner.(B,P,K)29, 30 Reversed

34. _____Women should have the right to refuse an episiotomy.(Y)12, 29, 31, 32

35. _____I recommend that most patients use a doula for their labor and delivery.(A,P,K)1, 9

36. _____I feel that it is a woman’s right to elect to have a caesarean section even if there are no clear maternal or fetal indications.(A)3, 28 Reversed

37. _____There is high interobserver and intraobserver variability in interpretation of fetal heart rate tracing.(K)6

38. _____Hospital standards of care or policies sometimes get in the way of optimal management of individual patients.(B)33 Reversed

39. _____I discuss the risks and benefits of episiotomies with my patients prior to delivery.(Y)31, 32

40. _____Routine artificial rupture of membranes (AROM) increases the risk of cesarean delivery. (K)1, 14

41. _____If a patient asks if she could use a doula for her delivery, I would encourage her.(Y,A)1, 4
42. _____ Time and scheduling pressures affect the way I manage labor and delivery.(B) Reversed
43. _____Most women with one previous cesarean delivery with a low-transverse incision should be counseled about VBAC and offered a trial of labor.(K)34

44. _____Episiotomies increase the risk of third and fourth degree tears.(K)5, 16, 17

45. _____Clinical guidelines are overly rigid and difficult to adapt to individual patients.(B)25 Reversed

How often do you consult the following sources regarding obstetrical practice?

[1] Never
[2] Rarely
[3] Sometimes
[4] Often
[5] Always

1. _____ACOG Practice Bulletins
2. _____ACOG Committee Opinions
3. _____Obstetrics and Gynecology Journals (e.g. the Green Journal, the Grey Journal)
4. _____Cochrane Database
5. _____Electronic evidence-based services (e.g. Epocrates, UptoDate)
6. _____Books and/or textbooks
7. _____Professional conferences
8. _____Physicians in my practice
9. _____Physicians in my local community
10. _____Physicians I trained with in residency
11. _____Physicians I consider experts in the field
12. Other sources: ______________________________________________________

Have you ever been the subject of a professional liability claim or litigation?
[1] Yes
If yes – Did the liability claim involve an obstetrical claim?
[a] Yes
[b] No
[2] No

Thank you for your time and participation!

Reference List

(1) Berghella V, Baxter JK, Chauhan SP. Evidence-based labor and delivery management. Am J Obstet Gynecol 2008 November;199(5):445-54.
(2) ACOG Committee Opinion No. 394, December 2007. Cesarean delivery on maternal request. Obstet Gynecol 2007 December;110(6):1501.
(3) Reime B, Klein MC, Kelly A et al. Do maternity care provider groups have different attitudes towards birth? BJOG 2004 December;111(12):1388-93.
(4) Hodnett ED, Gates S, Hofmeyr GJ, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev 2007;(3):CD003766.
(5) Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp J, Jr., Lohr KN. Outcomes of routine episiotomy: a systematic review. JAMA 2005 May 4;293(17):2141-8.
(6) ACOG Practice Bulletin. Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles. Obstet Gynecol 9 A.D. July.
(7) Gunnervik C, Sydsjo G, Sydsjo A, Selling KE, Josefsson A. Attitudes towards cesarean section in a nationwide sample of obstetricians and gynecologists. Acta Obstet Gynecol Scand 2008;87(4):438-44.
(8) NIH State-of-the-Science Conference Statement on cesarean delivery on maternal request. NIH Consens State Sci Statements 2006 March 27;23(1):1-29.
(9) Green J, Amis D, Hotelling BA. Care practice #3: continuous labor support. J Perinat Educ 2007;16(3):25-8.
(10) Klein MC, Kaczorowski J, Robbins JM, Gauthier RJ, Jorgensen SH, Joshi AK. Physicians’ beliefs and behaviour during a randomized controlled trial of episiotomy: consequences for women in their care. CMAJ 1995 September 15;153(6):769-79.
(11) Hyer R. ACOG 2009: Liability Fears May Be Linked to Rise in Cesarean Rates. MedScape Medical News 2009 May 9.
(12) Florida Liability Lowdown. American College of Obstetricians and Gynecologists; 2009 Aug.
(13) Gupta JK, Hofmeyr GJ. Position for women during second stage of labour. Cochrane Database Syst Rev 2004;(1):CD002006.
(14) Smyth RM, Alldred SK, Markham C. Amniotomy for shortening spontaneous labour. Cochrane Database Syst Rev 2007;(4):CD006167.
(15) Low LK, Seng JS, Murtland TL, Oakley D. Clinician-specific episiotomy rates: impact on perineal outcomes. J Midwifery Womens Health 2000 March;45(2):87-93.
(16) ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 71, April 2006. Obstet Gynecol 2006 April;107(4):957-62.
(17) Carroli G, Mignini L. Episiotomy for vaginal birth. Cochrane Database Syst Rev 2009;(1):CD000081.
(18) ACOG Practice Bulletin No. 107: Induction of Labor. Obstet Gynecol 2009 August;114(2 Pt 1):386-97.
(19) Wei SQ, Luo ZC, Xu H, Fraser WD. The effect of early oxytocin augmentation in labor: a meta-analysis. Obstet Gynecol 2009 September;114(3):641-9.
(20) Lyerly AD, Mitchell LM, Armstrong EM et al. Risks, values, and decision making surrounding pregnancy. Obstet Gynecol 2007 April;109(4):979-84.
(21) Roberts RG, Deutchman M, King VJ, Fryer GE, Miyoshi TJ. Changing policies on vaginal birth after cesarean: impact on access. Birth 2007 December;34(4):316-22.
(22) Coleman VH, Erickson K, Schulkin J, Zinberg S, Sachs BP. Vaginal birth after cesarean delivery: practice patterns of obstetrician-gynecologists. J Reprod Med 2005 April;50(4):261-6.
(23) Bettes BA, Coleman VH, Zinberg S et al. Cesarean delivery on maternal request: obstetrician-gynecologists’ knowledge, perception, and practice patterns. Obstet Gynecol 2007 January;109(1):57-66.
(24) Wu JM, Hundley AF, Visco AG. Elective primary cesarean delivery: attitudes of urogynecology and maternal-fetal medicine specialists. Obstet Gynecol 2005 February;105(2):301-6.
(25) Vinker S, Nakar S, Rosenberg E, Bero-Aloni T, Kitai E. Attitudes of Israeli family physicians toward clinical guidelines. Arch Fam Med 2000 September;9(9):835-40.
(26) Difranco JT, Romano AM, Keen R. Care Practice #5: Spontaneous Pushing in Upright or Gravity-Neutral Positions. J Perinat Educ 2007;16(3):35-8.
(27) Gilder K, Mayberry LJ, Gennaro S, Clemmens D. Maternal positioning in labor with epidural analgesia. Results from a multi-site survey. AWHONN Lifelines 2002 February;6(1):40-5.
(28) ACOG Committee Opinion No. 395. Surgery and patient choice. Obstet Gynecol 2008 January;111(1):243-7.
(29) Fenwick J, Gamble J, Hauck Y. Reframing birth: a consequence of cesarean section. J Adv Nurs 2006 October;56(2):121-30.
(30) Goodall KE, McVittie C, Magill M. Birth choice following primary Caesarean section: mothers’ perceptions of the influence of health professionals on decision-making. Journal of Reproductive and Infant Psychology 2009 February;27(1):4-14.
(31) Simpson KR, Thorman KE. Obstetric “conveniences”: elective induction of labor, cesarean birth on demand, and other potentially unnecessary interventions. J Perinat Neonatal Nurs 2005 April;19(2):134-44.
(32) Helewa ME. Episiotomy and severe perineal trauma. Of science and fiction. CMAJ 1997 March 15;156(6):811-3.
(33) Block J. Pushed: The Painful Truth About Childbirth and Modern Maternity Care. New York: Da Capo Press; 2007.
(34) ACOG Practice Bulletin #54: vaginal birth after previous cesarean. Obstet Gynecol 2004 July;104(1):203-12.

Lamaze blog carnival is up

The first Healthy Birth Blog Carnival is up: Let Labor Begin on Its Own. This is the first of six blog carnivals based on the Six Lamaze Healthy Birth Practices. I am hoping to submit an entry for each one.

I still have to read all of the entries for this one. This is a perfect first practice, since it happens at the beginning of labor. I have read up to 40% of labors are induced now.

The induction is the gateway to what is commonly referred to as the “cascade of interventions” that eventually lead to a cesarean section in many deliveries. When a woman is induced, she may be given Pitocin, and her water may be intentionally broken. The labor augmentation drug Pitocin, along with some induction drugs, like Cytotec (misoprostol) usually cause stronger contractions. That’s their point, but these contractions can be stronger and more painful than early labor would be, which makes pain relief measures like opiates or epidurals more likely.

Most hospitals include Pitocin augmentation and/or induction in their list of conditions that require continuous monitoring. Having ruptured membranes usually starts a clock ticking that limits how long this avenue of infection can be open. Depending on hospital protocols, this may be 12 hours or 24 hours, and then the woman is given a cesarean section for “failure to progress”.

Or, the Pitocin is turned up to make contractions that didn’t start on their own exist, and the fetus goes into distress, and the woman is rushed to have a cesarean section.

Or, if the woman does progress to the pushing stage, as the my link in the carnival suggests, Pitocin can contribute to shoulder dystocia.

Anyway, letting labor begin on its own means the fetus and the woman’s body are both ready for the birth process. Go check out the carnival.

Listen to Jill!

I finally got to listen to Jill at the Unnecessarean’s whole interview on Expectations radio.

I swear I has already listened to 20 minutes of it before someone told me she mentioned my blog! At about halfway through the fisrt hour of the interview, she says she is a fan (awww, *blush*) and mentions these posts about refusing to perform non medically indicated cesarean section.

I think it is a fantastic interview. This is definitely a nuanced topic (as I wrote in the second post of mine linked to above). Autonomy, right of refusal, provider conscience clauses and informed consent are complicated, multifaceted issues.

This all ties back to Participatory Medicine, which Amy Romano wrote about. (And Jill mentioned at the end of the first hour of the interview).

It’s National Midwifery Week

Hooray! It’s National Midwifery Week!

Hug a midwife before October 10th.

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.

Had a wonderful time at the Lamaze conference

I have a lot to report, but I am pressed for time today. I need to get everything done that I dropped in order to go to the Lamaze conference.

So, I will do a post soon. But, in the meantime, please know there is a vibrant community supporting healthy birth spread out all around the country, and the world.