Thursday, July 29, 2010

Guest Post: Summer Reading on Maternal Care

The following is a guest post by Christine H. Morton, PhD, Research Sociologist and List owner of You can reach her at

Summer Reading on Maternal Care:
Mis-Steps and Steps Forward….

As a medical sociologist interested in childbirth practices, I’ve got a library of fiction and nonfiction that has grown exponentially over the years. I’ve read all the usual suspects but recently have come across some compelling gems that somehow I missed over the past few years.

Now that I’m working with the California Maternal Quality Care Collaborative on the issue of maternal mortality and morbidity, I’ve been drawn into the world of quality improvement, patient safety and that bogyman of defensive obstetrics, ‘liability and malpractice.’ So imagine my delight when I discovered What do I say?: Communicating Intended or Unanticipated Outcomes in Obstetrics by James R Woods and Fay A Rozovsky — an obstetrician and a lawyer, respectively.  Their book (Jossey-Bass 2003) is designed to help obstetricians improve communication about bad outcomes while avoiding liability. It’s an interesting, if ultimately unsatisfying, book because it is very narrowly construed along those lines. While it fulfills its own goals admirably, for me it doesn’t take the issues further by examining the lack of communications and teamwork skills in medical school curricula or the real patient safety issues that emerge with some standard obstetric practices that are not evidence based. The case examples are very interesting though. How does an obstetrician who fought with a nurse about the appropriate course of action in the hearing of the laboring woman, discuss the adverse outcome with the new mother afterwards? I think I snagged the last used copy at a reasonable price off Amazon but perhaps your local library can get you a copy; it’s worth a read.

The next book I read followed as a perfect complement: the story of an obstetrician and her journey through self-discovery and healing after she is sued in the course of her work. Delivering Doctor Amelia The Story of a Gifted Young Obstetrician's Error and the Psychologist Who Helped Her (Vintage 2004, and many cheap used copies online). Dr. Amelia Sorvino is a well liked obstetrician who has been in practice a few years when, in order to respect her patient’s desires for a vaginal birth, delays a cesarean section. Subsequently, her patient’s baby is diagnosed with cerebral palsy; she loses her nerve, stops practicing and faces a lawsuit. The narrative structure centers around the therapy sessions with the author Dan Shapiro and Dr. Amelia, and the story is told through the psychologists’ lens. So many issues emerge that struck me as very illuminating in terms of how current medical training gets in the way of self-knowledge and personal growth of these young, hard working men/women. It fails to help them see the larger structures of politics/law/medicine, etc., affect their work (ok, the sociology of it all...). It’s a gripping read. I feel like we are missing the sense that doctors, yes, even obstetricians, are people, not perfect clinicians all the time, and our health care (and liability) systems are not set up to allow authentic engagement on a number of levels.

There is also a good novel about a Seattle anesthesiologist who gets sued, and her experience: Oxygen, A Novel by Carol Cassella, if you can bear to expand your reading beyond birth topics!.

The issue of ‘trauma’ among obstetric clinicians regarding their experience and fear of lawsuits is an interesting counterpoint to the ‘trauma’ experienced by birthing women — see this nice piece by an Australian journalist, Hard Labour, which really captured some of these issues.

I’m starting now to read Safe Patients, Smart Hospitals: How One Doctor's Checklist Can Help Us Change Health Care from the Inside Out (Hudson Street Press, 2010) by Peter Pronovost and Eric Vohr, a book about patient safety initiatives that were started at Johns Hopkins after poor communication, inflexible hierarchy, lack of appreciation for team perspectives and medical egos resulted in the preventable death of 18 month old Josie King. Not about maternal quality care or obstetric patient safety per se, but I see plenty of parallels in terms of the practices engaged in maternity care systems that put everyone at risk. Probably the only reason more pregnant women aren’t harmed by some of these practices is that they, unlike most hospital patients, are relatively healthy to begin with. The big insight for Pronovost is that hospitals, and the units within them, have their own culture, and this affects how patients are cared for. This isn’t news to medical sociologists and anthropologists (or doulas), but physicians are discovering it for themselves. It’s also a clear ‘news’ item in the quality improvement literature.... interesting.

Next on my list, where it’s been for some time, is medical anthropologist Elisa J Sobo’s excellent foray into this literature, Culture and Meaning in Health Services Research (Left Coast Press, 2009). All this to gear me up for thinking about the book in my brain after years of research on maternity care advocates – the doulas, childbirth educators, midwives, and now at CMQCC, obstetric and neonatal clinicians who want to make birth better for women and their babies.
Read more ...

Monday, July 26, 2010

15 months old!

I'm still adjusting to the fact that I have two children. It seems like Dio's birth just happened. But then I see this little boy running around. He's losing his baby fat and his face and limbs are getting longer and leaner.

After spending a few weeks with his cousins, he's started to interact more with other children. He wants to be in the middle of the action at all times.
Like me, Dio's default look is serious and a bit somber. But as I tell people, "If he's not crying, he's happy. Even if he doesn't look like it."
We still get big smiles out of him sometimes.
Dio has 7 teeth and 3 more halfway in. He can walk and climb and throw balls and say or sign lots of words. I'm so glad that we do sign language--nothing hardcore, just a few Signing Time videos--because his words are fairly indistinguishable. But he usually signs at the same time he's speaking, so we usually know exactly what he's trying to say. We've been working on signing "please" because his usual way of asking for something is with a deafening shriek. Now he shrieks, then signs "milk, please" or "nurse, please." I'd like to keep track of all the words he knows or says, but it's getting to the point that I probably couldn't get caught up. Every day it seems there's a new word or phrase that he understands. Like the other day, I told Zari to sit down, and he plopped down right away and looked at me expectantly.

EC: He's doing pretty well going pee in the toilet or on the grass, if we're outside. He usually stands on the toilet seat, facing the bowl. Poops have been more elusive, since he gives very little advanced warning. And he poops all the time, at least twice a day and sometimes 5-6 times! He is really fascinated with pee and poop and loves to watch it be flushed away.

Sleep: Dio naps once in the early afternoon. He sleeps from 8pm-6:45am and rarely wakes up at night. If he does, he fusses for a minute or two and then goes back to sleep. He nurses before he goes to sleep, although he usually isn't totally out when I lay him down. He loves snuggling with his sock monkey. I'm glad I introduced it to him as a sleep aid. He hugs and cuddles it whenever he sees it during the day, and I imagine in the future it will help him bridge going to sleep without me (for example, when we have another baby and I can't always be the one putting him down for naps or bedtime). Now if I could just get Zari to sleep that well...she's been on a long streak of waking up 1-2 times a night and needing us to come into her room and help her back to sleep.

Siblings: Dio and Zari have good times together. Like blowing on each others' stomachs. He also likes to nuzzle his head between my breasts and blow bubbles. (Or farts? What are they called anyway?)

Don't get me wrong--life isn't always giggles and smiles. More often than not Zari is tormenting Dio and he is shrieking to be let go. She likes to tackle him and pin him to the ground. She will walk up to him out of the blue and push him over, and then watch him cry. She takes things away from him just because. And I get the feeling that she's doing these things on purpose to get a reaction from Dio--and from me. It drives me a bit crazy, because Dio is miserable and I feel like a broken record explaining that we don't hit people and Dio doesn't like that-- it makes him sad and please be nice to your brother. Sometimes I just have to remover her from the situation. We call it "taking a break." It entails sitting in a separate room--usually a nearby bedroom--until a) a few minutes have elapsed or b) she can show me that she's ready to get out and play nicely. I'm not sure of a better way to deal with deliberately mean behavior towards a sibling. She's 3, after all, and so I don't want to be making a huge issue out of normal 3-year-old behavior. In any case, I'm open to suggestions...

Vive le Canadian swim diaper. 
Read more ...

Sunday, July 25, 2010


Just because--some pictures of Zari this month.

Today we were in the garden and she adorned herself as a "forest fairy" with maple tree seedlings and basil.
Ice cream face. 
Jumping on the trampoline at grandma's house.
Cooling off at grandma's.
Read more ...

Friday, July 23, 2010

Bryce Dallas Howard of "Twilight" on postpartum depression

Actress Bryce Dallas Howard recently shared her experience of postpartum depression in Gwyneth Paltrow's Goop newsletter. It's haunting and vivid and so well-written. Here are a few excerpts.
I recently saw an interview I did on TV while promoting a film. In it, I was asked about my experience with post-partum depression and as I watched, I cringed. I said things like “It was a nightmare,” or “I felt like I was in a black hole.” But I couldn’t even begin to express my true feelings. On screen, I had seemed so together, so okay, as if I had everything under control. As I watched, it dawned on me. If I had been able to truthfully convey my ordeal with post-partum depression under the glare of those lights, I most likely would have said no words at all. I simply would have stared at the interviewer with an expression of deep, deep loss....

It is strange for me to recall what I was like at that time. I seemed to be suffering emotional amnesia. I couldn’t genuinely cry, or laugh, or be moved by anything. For the sake of those around me, including my son, I pretended, but when I began showering again in the second week, I let loose in the privacy of the bathroom, water flowing over me as I heaved uncontrollable sobs....

Post-partum depression is hard to describe—the way the body and mind and spirit fracture and crumble in the wake of what most believe should be a celebratory time. I cringed when I watched my interview on television because of my inability to share authentically what I was going through, what so many women go through. I fear more often than not, for this reason alone, we choose silence. And the danger of being silent means only that others will suffer in silence and may never be able to feel whole because of it.

Read the rest of her story here. Be sure to read the entire newsletter, which has other stories and articles about PPD.
Read more ...

Wednesday, July 21, 2010

ACOG issues less restrictive VBAC guidelines

We just got back from a 10-hour road trip and all I want to do is go to sleep...but then I saw that ACOG just issued more liberal VBAC guidelines! This likely occurred in response to the NIH Consensus Conference on VBAC this year. Please visit the following links for more information.

First, read ACOG's press release about the new VBAC guidelines.

Then, read about the significance of the new guidelines at VBAC Facts.
Read more ...

Tuesday, July 20, 2010

DIY Medicine: From Blogger to YouTube

A few years ago, I mentioned an article from the Ottawa Citizen called Barbarians in Blogistan, which discussed the new do-it-yourself movement spreading via blogs. Today, the newest repository of self-help medical knowledge--to be shunned if you have any common sense, the article implies--is YouTube. In DIY Medicine, Dakshana Bascaramurty of the Globe and Mail argues that the new frontier is no longer online medical diagnosis--it's YouTube.
Before, doctors worried about patients who self-diagnosed after doing Internet research on questionable medical websites. But the social Web has given birth to a new beast: users who document their DIY medical procedures on camera and share the videos on YouTube.
Among the procedures mentioned in the article are toenail removals, cyst excisions, boil lancing, cast removal, suture or staple removals, abscess drainage and tattoo removals. And, of course, unassisted birth. Most of the article's examples contain some grisly language describing people pulling out their own toenails, or removing surgical staples in the backyard after a couple of beers. But unassisted birth has, by far, the strongest cautionary tale. The author mentions a 14-year-old girl who gave birth unassisted to a baby who died shortly after birth and threw the baby in a dumpster. Here's an excerpt:
Particularly troubling to Richard Musto, a public health physician with Alberta Health Services in Calgary, are the videos that depict unassisted home births, some of which have garnered millions of hits and several comments from expectant mothers eager to learn about the procedure.

Last month, a 14-year-old girl in Texas was charged in relation to the death of her newborn boy, whom she left in a dumpster. The baby died minutes after he was born and investigators suggest it may have been because the afterbirth blocked his airway. The girl and her younger sister learned how to deliver the baby at home after watching videos on YouTube.

“You can understand it’s a natural thing, but things go wrong in childbirth and that’s why you need to have someone that’s properly trained to manage that,” Dr. Musto says.
I get tired of childbirth being lumped together with medical procedures--from brain surgery to cyst removal to dental surgery. I also find the example of the teenager who throws her baby in a dumpster incredibly insulting to the vast majority of women who prepare extensively for an unassisted birth. Sure, I do worry about someone giving birth unassisted after watching a few videos and reading a some online articles. But that is not reflective of most UCers' level of preparation.

For example, before I gave birth the first time, I became certified in neonatal resuscitation and had first-hand experience resuscitating a newborn. (Short version of the story: precipitous birth, terrible Midwest blizzard, midwife driving as fast as she could. Baby came out limp and unresponsive to stimulation. Midwife was on the phone, advised mouth-to-mouth. The baby perked up after a few minutes of M2M. Midwife arrived a few minutes after the birth, by which time baby was stable and crying. I had vernix all over my face and glasses and clothes. It was quite the sight.)

I'm not saying unassisted birth is perfectly safe, just think happy thoughts and nothing will ever go wrong, la la la. But condemning all unassisted birth--childbirth, after all, is a normal, inevitable physiological event, not a medical procedure--because of one tragic "dumpster baby" is way off the mark.

I'm not calling this one Code Mec yet. But it definitely merits an emphatic eye roll.
Read more ...

Monday, July 19, 2010

Lamaze/ICEA 50th Anniversary Mega Conference

I'll be speaking at the joint Lamaze/ICEA Future of Birth Conference this fall in Milwaukee. I had a blast attending last year's Lamaze Conference in Orlando. I expect that this one will be just as good, if not better!

I've been browsing through the conference program, trying to decide which sessions to attend. I'm especially intrigued by the presentation on More OB. I am excited for the keynote address about the ii\mpact of birthing practices on breastfeeding. And Wendy Budin's presentation on Historical, Sociocultural, Political and Biomedical Views of the Breast. And lots more!

Any of you coming?
Read more ...

Saturday, July 17, 2010

Controls needed for HG study

Last year, I participated as a friend control in a study on Hyperemesis Gravidarum. The researchers have recruited close to their goal of 1,000 participants (women who had HG) but need many more friend controls. One of the researchers explains (emphasis mine):
We currently have almost
 1,000 eligible participants for the HG study, but we have less than 500 friend controls. I'm writing to beg you to refer extra CONTROLS to
 participate in the study. A control is someone who has had at least 2
 pregnancies and has not had any weight loss or treatment for nausea in pregnancy. The controls cannot be blood relatives. Please have any willing friend controls email me at and reference your name or ID number.

We are getting there but I need your help!!!

Thank you for helping me find the cause and cure for HG!

Marlena S. Fejzo, PhD

If you participated in the HG study, please help by referring extra controls (ie, women who did NOT have weight loss or treatment for nausea during pregnancy).
Read more ...

Thursday, July 15, 2010


We're up in northern Wisconsin for our annual family gathering at my parent's cabin on Lac Court d'Oreilles. Somehow I managed not to take any pictures of us actually at the cabin. You can see some from 3 years ago here, when Zari was just 7 months old.

Two days ago, we took a day trip up to Madeline Island on Lake Superior. Lake Superior is usually ice cold, but a brisk wind was blowing the warmer surface water towards the shore, so the water was swimmable. Cool, but not at all cold. I played in the waves for about an hour. Eric snorkeled, but all he saw was sand.

Waiting for the ferry.
On the ferry.
Sand + sun + water = heaven for little kids
At the end of the afternoon, Dio took a nap under a giant pine tree.
Wisconsin is also the land of hokey oversized objects. It stormed all day yesterday, so we finally went to the Fishing Hall of Fame in Hayward to give the kids something to do. We have driven by it for 20 years but never went in until this year. It was about as chinzy as I expected.
Giant musky that you can walk inside.
Lots of oversized fish on the grounds.
There was even a little children's play area, all fish-themed: fish swings, fish climbing tunnel, fish teeter-totter.
Read more ...

Sunday, July 11, 2010

Conversation with my midwife

A few months ago, the midwife I used for Dio’s birth invited me to come to her office and meet a CNM she was thinking of adding to her practice. (Having a solo home birth practice is very demanding. Adding a second midwife would allow her to actually take vacations more than once every few years, to do more well-woman care, and to have more time for breastfeeding support as an IBCLC). Here are some recaps from our conversation.

My midwife Penny and the prospective midwife Holly talked about their backgrounds and how they came to both midwifery and home birth. Both worked as OB nurses for many years before they even thought of midwifery or home birth. Both eventually pursued a CNM degree with the intention of opening a home birth practice. Penny worked for several years in a large university hospital. It was the end-of-the-line for obstetrical cases, where you’d go if a high-risk situation arose in a smaller, less-equipped hospital; if you needed care for a 26-weeker; if you had an extremely complicated obstetrical history. Penny’s time working at Large University Hospital (LUH) taught her the limits of what medicine could do. Sometimes they could save lives and improve women’s and babies’ health. But other times—all too often—all they could do was offer compassion and support, unable to save every life or prevent all bad outcomes. And this was at the most tertiary of tertiary centers.

Penny said that working in such a high-tech, high-intervention setting gave her much more confidence to pursue a second career as a home birth midwife. She knew first-hand what the most advanced medical care could and could not do. There was no mystery or mystique about what a hospital could offer—something she sees as a great advantage, compared to many home birth midwives who have never worked intensely in a hospital environment.

During her years as a nurse at LUH, Penny loved taking care of home birth transfers. She was able to offer excellent care for the specific medical issues that needed addressing, while otherwise supporting and facilitating the woman’s desire for a gentle, unmedicated birth. I remember her telling me the story of catching one woman’s baby in the bathroom and putting the baby immediately on the mother’s chest—something she thought entirely commonsense, but something she got a lot of flack for from her co-workers. It was these experiences that pushed her to become a midwife.

Penny highly values the knowledge and skills she acquired as an OB nurse in a high-risk setting. She is totally fluent in inserting IVs, administering medications, intubating, resuscitating, etc. Now, she hardly ever uses these skills as a home birth midwife, because they are rarely, if ever, needed. (In fact, one skill she says is becoming rustier than she’d like is suturing, because women in her practice hardly tear, and if they do it’s rare that the tears need stitches—something she attribute to her hands-off approach. Dads or moms usually catch their babies; she steps in only if they do not want to catch or if neither parent is in a good position to do so.) But if/when her medical skills are needed, she is really, really good at them.

While we were chatting with Holly, Penny said to me, “you know Rixa, because of your background with unassisted birth, you hired me for different reasons than many women typically hire a home birth midwife. You didn’t need me so much for labor support or guidance. You really hired me for that 5% chance of needing really skilled medical assistance, something that I can do really well.” I thought about that and realized that I agreed with her. I am really independent and pretty much labor and birth all on my own. I don’t rely on my husband or female companions for labor support or encouragement. In fact, I prefer to do things on my own for the most part. So I wanted a midwife not for the 95% of stuff that she does during labor—now, that 95% is quite valuable and many women love the support and guidance their midwife offers during labor—but for the small chance that I’d need some kind of additional intervention or emergency skills.

Which brings me to another point I want to make—the more exposure I have to midwives, the more I realize how credentials and background do NOT translate into a certain style of practice. I have a lot of experience interacting with “lay” midwives, direct-entry midwives (CPMs), and home birth nurse-midwives. A CNM degree does not mean that a midwife will have a more “medicalized” style of practice (although it is true that most nurse-midwifery programs are geared towards preparing midwives to practice in a hospital setting).

Now, I am sure some people reading this are thinking, “Oh, Penny is such a MEDwife!” But nothing could be farther from the truth. She is very professional and very highly skilled. Very respectful of women’s desires at birth. She had such a quiet presence at my birth that I hardly noticed she was there; she honored all of my requests and wishes that we had talked about prenatally. She was especially adamant about not disturbing the immediate postpartum period. She doesn’t care about liability and has deliberately chosen to forego malpractice insurance and go “bare.” She is willing to go beyond the “standard of care,” to borrow a phrase from Dr. Denise Punger. Her attitude is “you need to prove to me why you shouldn’t have a home birth.”
Read more ...

Saturday, July 10, 2010

Open thread, birth story style

I'm up in northern Wisconsin with my parents, siblings, nieces, and nephews. So today's post will be a group effort. Please share your favorite birth stories--your own or links to someone else's. Talk about the role birth stories played as you prepared to give birth. Anything and everything related to birth stories is fair game!

To get things started, here's the birth story I want to share: a breech home birth at Musings of a Redhead, complete with lovely pictures.
Read more ...

Wednesday, July 07, 2010

All that matters...

And all that matters is that you have a healthy and safe delivery... no matter how it's done.

All that matter is a healthy baby and healthy mommy.

Whatever happens, what matters most is a healthy baby girl and a happy mama and daddy.

In the end, all that matters is bringing a healthy baby into this world, by whatever means necessary.

These are all real statements I came across one day last week.
I find these statements both tyrannical and tautological. Tyrannical because it leads to a restriction of choices in the name of safety. Tautological because *of course* mothers want their babies to be born healthy and want themselves to come out of the process unharmed.

The "healthy mom/healthy baby" rhetoric, if followed to its logical end, leads down several ridiculous and contradictory paths.

First, it allows widespread abuse and manipulation of birthing women by negating anything that happened in the course of the birth, as long as the mom and baby survived. (Because in this context, "healthy" is a euphemism for made it out alive, not necessarily thriving and vibrant and injury-free.) It excuses any and all deviations from principles of evidence-based medicine and informed consent. And ironically, it often leads to greater net harm. Why? Because the "healthy mom/healthy baby" rhetoric is usually used to justify increased medical intervention. Pressured to have a c-section you didn't want or need? Encouraged to have an induction for dubious reasons? Given an episiotomy even though you clearly said you would rather tear? You should be grateful, because all that matters is that you have a healthy and safe delivery... no matter how it's done.

Second, it creates a false dichotomy between Good Moms who do the Right Things (like doing whatever their care provider says without asking questions) and Bad Moms who care more about The Experience than their own and their baby's wellbeing. You know, the hedonistic, selfish, narcissistic moms who'd rather listen to Enya and labor in an Aquadoula than have a living baby.

Third, it creates an artificial hierarchy of women's wants and needs, in which the mother's--and especially the baby's--health cannot coexist equally with other goals. Goals such as feeling respected and honored and joyful during the birth process, being able to make decisions about their care, and emerging from the birth feeling powerful and confident.

Fourth, the healthy mom/healthy baby idea opens the door for dictatorial top-down decisions. Because if the most important thing is a healthy mother and a healthy baby, then logically anything that adds additional risk to mother or baby should not be allowed. Let's follow this logic down its slippery slope to the final, authoritarian end:
  • No epidurals or pain medications except for surgical births, because they add medical risk with no medical benefit (no one has ever died from the sensations of labor, but there are a host of risks--from minor to deadly--from epidural anesthesia and IV narcotics).
  • No elective inductions.
  • No elective cesareans.
  • No home births (if you believe there is increased risk to the baby).
  • No hospital births for low-risk women (if you believe there is increased risk to the mother and/or baby from standard hospital and obstetrical practices).
  • No VBACs because they have a slightly increased risk to the baby.
  • But no repeat cesareans because they are riskier for the the mother and sometimes the baby as well...So if you have a cesarean, you are not allowed to have any more children, since both VBAC and ERCS carry risks, and risk to either mother or baby is not acceptable. After all, the most important thing is a healthy mom and healthy baby.
See how ridiculous this is becoming?

I'm not saying that I don't value a healthy mother and healthy baby. On the contrary. It's just that the "healthy mom/healthy baby" rhetoric serves as a smokescreen. I'm thinking back to a comment by a family physician whom I am honored to know. She attends births as part of her family practice and has four children of her own:
I know as a mother that I would do anything to have my children whole and healthy (and I'm so blessed that they are!). I would have 10 cesareans, I would take any intervention, I would walk on hot coals. But it doesn't mean that we should require everyone to have every intervention known - or even that that would be the safest for everyone. I would take any intervention to have a healthy baby if it was needed, but that doesn't mean I should have every intervention no matter what.
Read more ...

Blog updates

First I want to say a huge thank-you to everyone who commented on my existential blogging crisis. It means so much to me to hear from you, and I wish I had time to respond to everyone individually. And don't worry--I have no plans to stop blogging any time soon. I really love doing this blog and I can't imagine how isolated I would feel without it.

Now for some housekeeping: I finally was able to log onto Facebook and created a fan page. All my blog posts will automatically be updated there, making it easier for you to read & share my posts. I've also linked the page to my Twitter account, so you can receive updates about new posts via Twitter.
Read more ...

Tuesday, July 06, 2010

Delivery room wrestling match

In an article in the Omaha World-Herald about using alternative positions for labor and birth--aptly titled Stand and Deliver--one physician literally wrested an ambulating woman onto the delivery bed. Dr. Maureen Fleming is director of general obstetrics and gynecology at the Creighton University School of Medicine. Here's the story:
As for obstetricians preferring a more convenient position, Fleming said they, like midwives, are accustomed to strange positions and situations. She recalled a woman in so much pain that she angrily started to walk out of the hospital room. Fleming had to wrestle her back. “I almost fell on the bed with her because I had to throw her on the bed.”
The midwives interviewed for this article tended to be more supportive of alternate birth positions, including kneeling, standing, and squatting.
Alternative positions are by no means sweeping maternity units. The majority of births are done with epidural injections, which numb the lower body and make it virtually impossible for the woman to stand or squat. Nevertheless, some midwives and other delivery experts suggest that expectant mothers are more frequently considering delivering from some position other than the back. “I recommend women get out of bed all the time,” said Heather Ramsey, a certified nurse midwife at the Med Center.

Ramsey and other proponents of alternative positions say the benefits can include decreased pain, better blood circulation for the mother and baby and easier downward descent for the baby. Pain medications, they say, can make the mother and baby drowsy, which may impede the infant's ability to immediately breast-feed.
The two physicians interviewed for the article, on the other hand, viewed analgesics and epidural anesthesia as overwhelmingly positive:
Fleming and Pankratz, a board member with the Nebraska Medical Association, said pain medication and epidurals are fine. “We don't believe there's anything unnatural about alleviating pain in labor,” Fleming said. “My philosophy,” Pankratz said, “is technology is present to make our lives better.”
The article began with a woman who gave birth in a hospital standing up, one knee propped up on the bed. Rosalina Romero tried several different positions, finally finding one that alleviated the intensity:
Finally, she stood with her fists on the bed. The horrible pain dissipated and became more of a burning sensation, far more tolerable. “It's just what felt natural,” she said. She lifted one leg and her husband, Brent Vignery, held the leg up. The baby's head began to come out. She put a knee on the bed and kept one foot on the ground. Their baby, Dexter, emerged. “Gravity helped a lot,” she said.
In contrast, Dr. Fleming expressed her doubts that gravity helps the birth process:
Fleming said she doubted gravity played a role in delivery, as some proponents of standing or squatting believe. The opening of the cervix, or cervical os, holds the baby in, she said. “Babies don't just fall out,” she said.
My commentary:
Delivery room wrestling match = assault and battery
Does gravity cease to exist if you don't "believe" in it?
Read more ...

Friday, July 02, 2010

Existential blogging crisis

Sometimes I wonder why I blog and whether I should keep going. This boils down to a few questions:

Is my blog too birthy? Or is it too filled with the mundane and the everyday? I feel like I haven't posted much about family life because it seems so...quotidian. But then I start feeling boxed when the blog becomes more and more about birth and pregnancy and less about anything else. I've thought about starting another blog just for personal/family life stuff. I even have a great blog title and address called Two Frozen Doctors. However, I hardly have the time to do one blog, let alone two. So for now, I'm sticking to one.

I love the discussions we have here, but I do wonder: does any of this make a difference? As much as it's nice to talk with people whose views you already share, to feel a sense of commonality and community, I wonder if anyone else is even reading. Let alone examining their own viewpoints and experiences in light of what gets talked about here.

And then there's the whole "am I wasting my time when I could be doing *real* things in the *real* world?" question.

I'd love your feedback on these questions. I'd also like to hear about which kind of posts you want more of. Some of the things I do on this blog include: research updates and analysis, guest posts, my own meditations on birth and mothering, academic essays, critiques of North American obstetric practices, links to blogs and news articles, birth stories & videos, and book/film/product reviews, and updates and pictures of my family.
Read more ...

Thursday, July 01, 2010

New York State passes Midwifery Modernization Act

Read more about it here.
Read more ...

A physician speaks about doulas and birth plans

This comment just came in from Kingsdale Gynecologic Associates: Doula Ban and Birth Plan.
So I am actually a physician. Doula's may be beneficial in some situations, but you all must remember that the role of a physician is to provide good medical knowledge and advice based on evidence. Where Doula's may be thought of as positive most have zero training and often times may give inaccurate medical advice which is out of their scope of practice. If people want Doula's there should be a government agency licensing those individuals. As you wouldn't want just any person playing your doctor the same gaves for those helping. If they obstruct what we are trying to do they are not beneficial and can ultimately hurt you. Further, they do not have any medical liability. If you want a Doula they should accept medical liability for the 18 years that OB gyns do. In regards to birth plans. They are all nonsense. When it comes to the delivery room most if not all mean nothing. Your in pain you said I don't want drugs you change your mind you get drugs. Happens everywhere all the time. Look the most important thing is not extra personnel in the delivery room. The important thing is a safe and healthy delivery for both the infant and mother. Any mother or father for that matter that thinks anything else is more important should not have children till they get their priorities straight.
Let's discuss this comment from multiple angles--research evidence for/against doulas, personal experience as a doula/birthing woman/nurse/physician/midwife, role and usefulness of birth plans, desirability of licensing and malpractice insurance for doulas, etc.

Here are a few links to get the discussion started:
Have at it.
Read more ...
Related Posts Plugin for WordPress, Blogger...