Wednesday, February 18, 2009

Wednesday wrap-up

I might start doing a weekly wrap-up of miscellaneous news & articles that I find interesting. If I wait much longer than week, they start piling up rather quickly:

Speaking of upright/vertical birth...
Home birth
  • The "Authorities" Resolve Against Home Birth: a recent editorial by Nancy K. Lowe, editor of the Journal of Obstetric, Gynecologic, & Neonatal Nursing ( Volume 38, Issue 1, Pages 1-3). Click on the article title for the full text. An excerpt from her editorial: "The point is that we have no system of maternity care in the United States that provides a healthy woman the choice of giving birth at home and if she needs to transfer to a different type of care during labor, the transfer is easy. We do not have a system in which this woman is treated with respect and kindness, and her provider either maintains responsibility for her care or professionally and respectfully is able to transfer responsibility to another provider. Interestingly, while ACOG and AMA have declared that hospital grounds are the only safe place to give birth in the United States, the National Perinatal Association (NPA) adopted a position paper in July 2008 titled, 'Choice of Birth Setting.' The paper supports a woman's right to home birth services....Further, in Canada following the model of British Columbia, the province of Alberta has recently expanded its health care system to include women's access to midwifery services 'in a variety of locations including hospitals, community birthing centers, or in their homes.' "
  • Two Charleston Gazette articles: Midwife delivers babies in mothers' homes and Home delivery: After three hospital births, fourth-time mom was determined to deliver the old-fashioned way
  • A Herald Tribune (FL) article narrates how a home birth unfolds in Home Delivery
  • An article featuring Womancare Midwives of North Idaho
  • Tribute to Maude Callen, a nurse-midwife serving rural South Carolina for over 70 years. Make sure you click on the Life photo archive for lots of fantastic pictures!
  • Adventures in (Crunchy) Parenting wishes to move beyond binary views of safety
  • Future Search Conference on Home Birth currently being planned. From the description:
  • It will be a multi-disciplinary consensus conference of key stakeholders around the provision of home birth services in the United States, to be convened by the University of California San Francisco and various organizations, including the American College of Obstetrics and Gynecology the American Academy of Pediatrics, the Association of Certified Nurse Midwives, Mothers and Midwives Associated, Lamaze International, Association of Women Hospital Obstetric and Neonatal Nurses, and the International Center for Traditional Childbirth. Further, it is hoped that public health practitioners and students, insurers, government agencies, health economists, medical anthropologists, state and national legislators, and women who have given birth will be among the eventual participants. The purpose of the conference is to start to bridge the "divide" between the medical and midwife communities over out-of-hospital births in the United States. Safety of birth in any setting is of utmost priority. Rights to choice and self-determination and culturally appropriate healing are also core values in American discourse that influence this issue. The purpose of this multidisciplinary conference of key stakeholders will be to craft a consensus policy and strategy on provision of home birth services. The project may also inform regulatory discourse, alternative funding structures, and the required modifications of curricula to prepare physicians and midwives in urban, rural and remote settings to provide maternity services across birth settings.
Research studies & articles
  • Evidence-based labor and delivery management. Berghella V, Baxter JK, and Chauhan SP. Am J Obstet Gynecol. 2008 Nov;199(5):441-2. From the abstract: "Evidence-based good quality data favor hospital births, delayed admission, support by doula, training birth assistants in developing countries, and upright position in the second stage. Home-like births, enema, shaving, routine vaginal irrigation, early amniotomy, "hands-on" method, fundal pressure, and episiotomy can be associated with complications without sufficient benefits and should probably be avoided." (Email me for full text).
  • Born in the USA: Exceptionalism in Maternity Care Organisation Among High-Income Countries by Edwin van Teijlingen, Sirpa Wrede, Cecilia Benoit, Jane Sandall and Raymond DeVries. Sociological Research Online, Volume 14, Issue 1. From the abstract: "In lay terms, childbirth is regarded as a purely biological event: what is more natural than birth and death? On the other hand, social scientists have long understood that 'natural' events are socially structured. In the case of birth, sociologists have examined the social and cultural shaping of its timing, outcome, and the organization of care throughout the perinatal period. Continuing in this tradition, we examine the peculiar social design of birth in the United States of America, contrasting this design with the ways birth is organised in Europe."
  • Postnatal quality of life in women after normal vaginal delivery and caesarean section. Behnaz Torkan, Sousan Parsay, Minoor Lamyian, Anoshirvan Kazemnejad, and Ali Montazeri. BMC Pregnancy Childbirth 2009; 9: 4. From the conclusion: "Although the study did not show a clear cut benefit in favor of either methods of delivery that are normal vaginal delivery or caesarean section, the findings suggest that normal vaginal delivery might lead to a better quality of life especially resulting in a superior physical health. Indeed in the absence of medical indications normal vaginal delivery might be better to be considered as the first priority in term pregnancy." (full text available by clicking on article title).
  • Health Care Reform in the U.S. Organisation for Economic Co-operation and Development Working Paper #665, Feb. 6. 2009 by David Carey, Bradley Herring and Patrick Lenain. From the abstract: "In spite of improvements, on various measures of health outcomes the United States appears to rank relatively poorly among OECD countries. Health expenditures, in contrast, are significantly higher than in any other OECD country. While there are factors beyond the health-care system itself that contribute to this gap in performance, there is also likely to be scope to improve the health of Americans while reducing, or at least not increasing spending. This paper focuses on two factors that contribute to this discrepancy between health outcomes and health expenditures in the United States: inequitable access to medical services and subsidized private insurance policies; and inefficiencies in public health insurance." Full text PDF available by clicking on the article title.
VBAC & Cesarean Section
Birth Centers
For Expectant Moms, a Happy Medium Between Hospital and Home Births: profiles the struggles of one birth center to obtain permission to open

Pedialyte Alternative recipe (not necessary for breastfeeding babies, but great for older children & adults)

25 plants you should consider growing


  1. Interesting that one of your first links was about birth mirrors - I was just reading a very interesting post by a midwife about why she thinks mirrors are a bad idea...

  2. Rebekka,
    Fantastic article (and really in line with my personal approach to birth). Thanks for the link!

  3. May I say how much it irritates me that the AJOG abstract says evidence-based medicine = hospital birth, while the full text says (more accurately) that we don't have adequate data to determine whether home or hospital is associated with better outcomes? I'm not impressed by the authors' choice to use birth center data as a proxy for homebirth. It seems to me that a birth center presents some of the disadvantages of a hospital (i.e., having to get in the car and drive to a place that's not your home while you're in active labor; exposing your baby to other people's germs, etc.) without the corresponding advantages of a hospital (immediate proximity to high-tech intervention if warranted). It doesn't seem like rocket science: you can't evaluate homebirth if women aren't giving birth at home.

    End of rant. :-)

  4. OT, but a lady a LLL today asked me if I was TopHat and said she was a roommate of yours in college- Kristy? :)

  5. CJ--agreed. And if you look at the brief discussion of the "birth centers," the author mentioned a 50% transfer rate, which makes me suspect these were in-hospital "birth centers" rather than freestanding ones. All the data on FSBC that I've seen shows a much, much lower transfer rate.

    Tophat--yes, she was my roommate when I lived in Jerusalem! And a very good friend and either due any day or with a newborn. Say hi and give her a hug for me next time you see her!

  6. So much information, Rixa, thankyou X a million. Gonna be lazy and link to this post on my blog.

  7. I love the wrap-up idea! Thanks for sharing all your finds...


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