Archive for October, 2007

Let Your Water Break On Its Own, Say Researchers

Intentionally breaking the bag of waters (called Artificial Rupture of the Membranes, or AROM, as pictured left) has been a feature of standard maternity care for decades. It is often the first intervention recommended to women once they arrive at the hospital in labor, partly because it was always thought to help speed things along. Not so, say researchers at Cochrane, who conduct what are called “systematic reviews” of the available literature on a subject. As the New York Times reports today, Cochrane surveyed 14 trials involving about 5,000 women and “found little evidence for any benefits.” Dr. Rebecca Smyth, lead author of the study, told the Times: “We advise women whose labors are progressing normally to request their waters be left intact.”

Let’s Just Call It a “Due Month,” OK?

The Baby Isn't Late!Here’s a “due date” calculator worth endorsing. It gives you what it calls a “safe range” for the baby to be born, and explains why thinking in terms of a due date isn’t very helpful — or healthy:

A due date does not mean there is only one safe day for your baby to be born. It is meant to establish a range of time that your baby is mature and safe to be born. Because modern obstetrics narrows this to a specific day, unnecessary interventions, like inducing labor, come into practice.

Indeed, a baby is considered “term” (or fully cooked) between 38 and 42 weeks gestation. The due date is simply the estimate of 40 weeks (the midpoint in that 4 week stretch). So if we think of being “due” as a period of time rather than a specific date, then a woman is not “overdue” once the due date has passed — she has just simply reached the halfway mark in her due month!

The calculator is courtesy of the new web site Mothers Naturally (mothersnaturally.org), which was launched by the Midwives Alliance of North America. If you’re looking to give birth with minimal intervention and maximum support, you’ll find great information and resources at this site.

A Moment for the Uterus

it's all connected

Your uterus: it’s not just for reproducing. In fact, the organ is an integral part of your pelvic anatomy, your sexual function, indeed your whole-body health, throughout your lifetime, according to this vivid tutorial created by the HERS Foundation (Hysterectomy Educational Resources and Services). Women who are weighing the risks and benefits of VBAC v. repeat cesarean (and even women considering a primary cesarean) should especially take a look, as hysterectomy — surgical removal of the uterus — becomes more of a risk with repeat surgical deliveries. Hysterectomy remains the second most common major surgery in the United States.

What Pregnant Women Aren’t Told…

Childbirth is a political issue, and the left-leaning news portal Alternet.org is highlighting the lack of choices U.S. women have in how, where, and with whom they give birth. In a sweeping article published yesterday, authors Manda Aufochs Gillespie and Mariya Strauss give a great overview of U.S. maternity care (and link up to Pushedbirth.com, among other online resources). The two also have some sharp insights into why there hasn’t been more of a consumer demand for different care. The “But it won’t happen to me” myth pervades, they argue, and gives women a false sense of security in their provider. But we also can’t underestimate how the health care system mediates our perception of what’s safe, of what’s normal, say the authors.

Since medical insurers often won’t cover midwives and birth outside the hospital, many women never consider either as valid options, and therefore accept high levels of medical intervention as necessary. “For most women, the fact that hospitals have virtually cornered the market on childbirth and maternity care means that birth itself can assume the form of a medical problem rather than a normal human process. And, since most mothers are giving birth in a hospital room surrounded by highly trained doctors and sophisticated medical instruments, a low-risk, unmedicated labor can rapidly convert into a complex surgical case.” Read the article.

U.S. Hospital Infections Kill More Than HIV

superbug, super riskScientific American offers a great overview of antibiotic resistant staph infections, also known as “superbugs,” which add risk to any invasive hospital procedure. Consequently, the article leads with a story of a woman who contracted such an infection following a cesarean section, and chronicles her months of painful — and expensive — recovery. The offending bacterium causes 94,000 serious infections in the U.S. each year, resulting in roughly19,000 deaths — more than those caused by HIV, according to a study also published this week in The Journal of the American Medical Association. Read the full article.

Maternity Care in England — It’s Shocking!

“I have little Anglo-envy: the rain is dreadful, the beer is flat, and the pound is whooping my dollar’s ass. But in the case of maternity care, I can understand my American friend Jo’s sentiment, ‘Thank God I’m not trying to do this in the States!’” Read more on the Huffington Post.

The Embattled Birth Center in New Jersey

Lonnie Morris is famous in Northern New Jersey — she’s one of a handful of alternatives for women who want to avoid a pushed birth in the state with the highest cesarean rate in the country. For many years she ran an independent birth center, The Childbirth Center, in Englewood, NJ. But in 2003, the amount due on her malpractice insurance bill suddenly had one too many zeros. It wasn’t a typo, and Morris had to close up shop. The kind maternity ward at Pascack Valley Hospital took her in, and over the past three years she and a team of nurse-midwives have attended about 750 women there, with great success. Women were encouraged to keep active in labor and give birth in upright positions, even in the water; they were not tied down in bed with monitors and induction drugs. The midwives also delivered VBACs and twins, and still their cesarean rate was 11% — the hospital’s overall rate was 36%.

But woman-centered, cost-effective care doesn’t much help a hospital’s bottom line, and Pascack (in financial trouble for years) is closing its doors come December. Morris and the birth center were supposed to get a luxe new labor ward with sparkling tubs; instead, they’re getting the boot. And the dozens of pregnant women who are due in the next two months are scrambling along with the midwives to find a labor ward that will have them. Low C-section rate, high patient satisfaction — you’d think there would be a bidding war for Lonnie and her clan, but on the contrary, they can’t find a new home. “We have no place to go,” Morris told The Bergen Record.

It’s Not That Women Are ‘Too Posh to Push,’ Says Study

It’s that they are misinformed. Australian researchers asked 78 women who requested medically unnecessary cesareans why they did so. For the vast majority, it wasn’t convenience or even fear of the pain that made them turn to surgery. For half of the women, it was fear that their babies would be harmed by a vaginal birth, and they believed (erroneously) that a cesarean would be a safer way out. Another quarter of the women feared incontinence and pelvic damage and believed (also erroneously) that a cesarean would be safer for them. Aussie officials believe that “cesarean on demand” is on the rise, and at least one state has banned elective cesarean prior to 39 weeks gestation. Read more about it in the Sydney Morning Herald.

Recalling Britney, The Statue…

idealism, not realism

Reading about Britney Spears losing custody of her two boys reminded me of how the “Oops” pop star was an unlikely muse for sculptor Daniel Edwards a couple years ago. Perhaps Edwards began casting the life-size nude (which looks nothing like Spears) before her scheduled C-section, because this piece refreshingly depicts a physiological birth position (and though it’s not pictured, you can see a baby’s head crowning from behind.) Maybe it also represents a sort of parallel universe in which Spears is the poster girl for good birthing rather than bad parenting…

How to Interpret the Uterine Rupture News

It has been reported that a very large study published in this month’s Obstetrics & Gynecology found that women who try to give birth vaginally after a previous cesarean are 50 times more likely to suffer a rupture of the uterus than women without a cesarean scar. Is this news? Not really.

Uterine rupture — when a scar on the uterus separates during labor — has been a known risk of vaginal birth after cesarean (VBAC) for decades. The literature has consistently showed a risk of about .5%, or 1 in 200, with what’s called a low transverse scar, the kind most all women get today. The new study found a similar rate, .7%.

The study is already being misreported, though. This local ABC affiliate in Chicago warns that, “women who have had previous caesarean sections and are now thinking about vaginal births might want to think again.” Reuters got it right, with the headline, “Uterus rupture rare after prior cesarean delivery.” But what most are missing or burying is the relationship between induced labor and uterine rupture: induction drugs doubled the risk of a rupture. (Which leads one to question the use of any synthetic oxytocin during a VBAC, even if it is only to “augment” contractions.)

If you were thinking about inducing a VBAC, you might want to think again…

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