Tricky Research

The AJOG printed a 'study' that, in their minds, validates the ACOG's continued stance against home birth as a safe option for healthy, low-risk women. Their conclusions were that less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.

Before we swallow this hook, line, and sinker, though, lets break it down, shall we?

Tralee Pearce of The Globe wrote a response article to this 'study' on Thursday entitled U.S. Analysis on Home Birth Risks Seen As Deeply Flawed.

Patricia Janssen, an associate professor at the University of British Columbia’s school of population and public health, says that conclusion is “sensationalist” and based on data that are in some cases decades old, on very small samples and in some cases incomplete.

In many cases, she says, women included in the studies may not have planned to give birth at home. They may not have been attended by a properly trained midwife. And much of the data used were retrospectively, gathered using birth records, which may not include enough information...

... Michael Klein, emeritus professor of family practice and pediatrics at the University of British Columbia, says the analysis and its conclusion has to do with the climate in the United States around midwifery. It is less accepted by the medical profession there than it is in Canada, he said.

“We’re dealing with a politically motivated study,” said Dr. Klein, who was a co-author with Dr. Janssen on the B.C. study.

NHS writes their own follow-up on this study in Safety of Home Births Questioned:

Applying sensitivity analyses that excluded poorer quality studies had little effect on the findings. However, when the researchers excluded studies of home births attended by people other than certified midwives, there was no significant difference between the newborn mortality rates associated with the two locations of birth...

... There are other key points to consider when interpreting this research:

• Although home birth was associated with greater neonatal death (within 28 days), neonatal death is still very rare, and the absolute size of the risk is low (0.2% among planned home births and 0.09% among planned hospital births). The researchers calculated that only 0.3% of neonatal deaths could be attributable to birth occurring in the home rather than the hospital.
• It is also important to note that there was no increased risk of neonatal death with home birth compared to hospital birth once the analyses excluded those studies of home births attended by people other than certified midwives, i.e. when the home birth was assisted by a certified midwife there was no increase in mortality compared to a hospital birth.

Carolyn Ryan of the CBC reports that

The authors found that when babies were born at home there were fewer medical interventions like epidurals and episiotomies, and women in home deliveries tended to have fewer tears or lacerations, fewer cases of postpartum hemorrhage and fewer infections.

The team also came to the conclusion that there was a tripling of neonatal deaths for home births once babies with congenital abnormalities were left out. The tripling of fatalities represents a very small number — from four in 10,000 to 15 in 10,000, acknowledged Dr. Jay Iams, the journal's associate editor.

But Iams said the findings provide an appropriate caution to women that giving birth in a hospital can be safer.

"The study results are consistent with what common sense would tell you," Iams said.

But Dr. Michael Klein, an emeritus professor of family practice and pediatrics at the University of British Columbia, said the U.S. conclusions are "crap" that don't consider the facts.

"It's a politically motivated study that was motivated by the American College of Obstetrics and Gynecology who is unalterably opposed to home birth, and they probably were quite happy to publish this article because it fits with their political position," Klein said.

UBC epidemiologist Patricia Janssen, who collaborated with Klein, said the American study mixes their work with research dating back to the 1970s, and surveys with as few as five recorded births.

"The data and the methods taints the quality of the study," Janssen said, noting the review includes studies where the qualifications of the caregiver were not known.

In conclusion, their methodology of information gleaning doesn't support a well documented, well researched study that warrants any type of support. It doesn't lend any validity to the hospital birth debate, either.

It's not clear who attended all of the women, under what situations they were birthing at home, if it was planned or not, what types (health, age, 'riskiness', etc..) of women were birthing these babies, what training their attendees had, and what life saving equipment their attendees (if any) were carrying.

Other, more appropriate studies of planned home births with trained attendees in other countries have so far shown that there are improved outcomes for mothers and no significant increase in risk for baby.

Chalk it up to just one more case of the ACOG up to their dirty little tricks again.

** updated to add CIMS response and Science and Sensibility's response.

FGM, the AAP, and the Washington Post

I wrote about FGM in March and, in May the AAP considered making it legal in the U.S. through a 'ritualistic cut'.

As a result, Intact America published an open letter to the AAP in the Washington Post. Click on the picture below to see it larger.

And here is a link to the press release.

As a result of the public outcry the AAP has retracted its dangerous policy statement on female genital cutting.

YAY! Now we just need to get them on board with male circumcision.

Childbirth in the News

There have been some wonderful articles on recent studies that are very encouraging that I wanted to pass on to the women in my life (both IRL and blogsphere) that are expecting babies soon.

One discusses the issue of nuchal cords during labor and birth. A nuchal cord is, by definition, when the umbilical cord wraps around tte baby's neck while in the womb.

The article states:

A new study backs up previous research showing that nuchal cord is not the
threat it's percieved to be.

The second article I would like to bring to your attention is entitled Eating During Labor Has No Ill Effects. According to the study cited in this article

Allowing a pregnant woman to eat during labor does not seem to have any impact
on the outcome of the infant or mother, and doesn't increase the risk of
vomiting, according to a new study.

This is exciting that they have documented what many of us already know! Combine that with the decrease in labor length (albiet small) in the group allowed to eat during labor, and our knowledge of the human body and it's need for fuel during strenuous activity, eating when hungry during labor and birth is a good thing.

This borderline hypoglycemic is so happy to see this archaic practice is getting the bad attention it deserves! Hopefully this means women no longer *have* to sneak their nourishment when opting for hospital births.

I am happy to say that I have also contacted local hospitals recently to see if they have updated their NPO ("non per oris" or nothing by mouth) policy and 3 out of 4 immediately said yes.

Finally, this article talks about the increase risk of cesarean section from inducing labor prematurely.

Again, this is not new news, but definitely exciting to see it get some good media coverage. My favorite part of the article is the last sentence (emphasis mine)

"Glantz advises that pregnant women and their doctors may be better off waiting
for spontaneous labor. "Try to reserve interventions for situations
where risk outweighs benefit". (and I assume he means risks of not intervening)

Now to see that in practice.... :-)

Reproductive News From the Week

Healthwatch: No place like home, or is there?
An OK article, I thought it talks itself around in circles a bit, but well outlined and gives adequate information for a mom to make an informed decision.

Good Catch! Toddler Helps In Delivery Of Baby Brother
This is a cute article on how normal birth is. VBAC mama has baby at home, 2 year old helps by getting a towel without any prompting and catches baby that mom pushes out on the couch. Ok, if a 2 year old can get it, maybe he can teach the OBs how he did it? :)

RU Safe and Simple?
Article on the risks of RU-486. This is surprising: you hardly ever hear the true facts of risks associated with abortion. This is good. I am pro-life, but even when a woman does choose abortion, it is a good thing for her to know when a procedure is unsafe or has higher risks. As we live in a pro-choice media society, it is surprising and heartening to see some good unbiased information on the safety (or lack thereof) of abortion methods.

New Advice: Skip Mammograms in Your 40s

The government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often is harmful, causing too many false alarms and unneeded biopsies without substantially improving women's odds of surviving the disease.

Interesting read.

Preeclampsia Linking to Thyroid Function
It's amazing what our bodies tell us... but now it serves to question: is the Pre-e a result of this increased risk later in life or is the increased risk later in life a result of life habits and the incidence of pre-e?

Breastmilk Contains Stem Cells
Formula is still 2nd best, but it still doesn't come close. :)

Pain in Labor - a Midwife's View Under Fire

I hadn't heard about Midwife Dr. Denis Walsh until I was looking up current childbirth news this morning (one of the sad byproducts of working M-F; I can only 'research' on the weekends).

And what I see is astounding and saddening.

He has submitted a work to Evidence Based Midwifery that discusses the topic of pain in labor and it's purpose. You can read an article on it here, another here, and another on it here.

I applaud him. He, as far as I can see, has not written anything malicious or inaccurate. He talks about the usefulness of feeling labor, the chemicals released as a result, establishing a good labor pattern, aids in stronger infant-maternal bonding, and generally has a natural purpose in the process.

Nothing that has not been mentioned already in other articles like this and this. He even states that sometimes epidurals are useful, but of course, one of the articles above states that his comments make women who fall short of a 'normal birth' feel stigmatized.

The rest of the articles are followed up with statements such as "I dare him to say that to a woman in labor", "When he pushes a baby out of HIS body, maybe we'll give a damn what he has to say!", and more, much more. Defensive, aren't we? Do a google search for his article and you will find him slammed from all angles (or see Rixa's post for additional links to more articles on him) - it's a free for all!

Think of it: he's a man (sets him up for attacks from prideful, defensive, or angry women), he's a midwife (which sets him up for attacks from the main-stream medical community), and he's a male midwife (which even sets him up for failure in many natural childbirth communities).

It amazed me to see that this poor man has been strung up like a pinata from both the Obstetrical community as well as feminists. Even some fellow midwives didn't spare the firing squad. And you know what, all of this hubbub and no one actually has his submission piece yet!

Which is why I was relieved to see this blog post.

Denis Walsh is not the slimy pig-man who’s out to demonize women who choose pain relief, as the Daily Mail (or the BBC, for that matter) would have us believe. He’s a midwife who wants midwives to act as advocates for women: to put the needs of the labouring woman on the map, rather than letting the midwive’s own needs as professionals or the the baby’s (purported) needs push all mention of the woman’s well-being out the window. I, for one, am very thankful I’ve read his work in preparation for the birth of my second child.

I applaud his yet-to-be published piece and cannot wait to read it! From what I can see on the news now, he advocates alternative pain management options to better healthier, safer health care options for women in labor - evidence based health care. What shame is there in that? None. Shame on the nay-sayers instead!

*** Additional linkies here and here.

Watching Birth

The New York Times recently had an article on the inclination that many women of childbearing years have to seek out, and watch, births.

This inclination is a natural, almost instinctual, reaction. Women were made to give birth and women were made to understand birth, helping other women prepare for and give birth.

It is hard wired into our make-up, stitched into our primitive minds, that birth is natural, normal, and good.

Years and years ago, women used to help other women give birth. Birth was in the hands of other women and it was understood that it was women's work.

Then, something happened... and women forgot how to birth instinctively... That, I believe, is why now, when it is available, women gravitate toward good birth stories full of beauty, power, and our bodies abilities - that instinct is still there, lying dormant through all of the statistics and horror stories.

Just a small reminder to gear us up for The birth of Amerlyn Grace.

9/11

Oh the wonderful read that met my eyes this morning. Many of us still remember, still recall, still are affected by, the events of 9/11. I am one of those. When I rolled out of bed this morning the first thing that pressed in on my mind was where I was at when the events of 9/11 unfolded.

When I logged on this morning, I found doulamomma's post. I will repost the article she cites.

Childbirth Education and Doula Care During Times of Stress, Trauma, and Grieving
Debra Pascali-Bonaro, BEd, CD(DONA)

"Immediately after the events of September 11, 2001, I was privileged to play a unique role: coordinating a volunteer program to provide support and service to pregnant women in the greater New York/New Jersey area, where I live, who had been widowed by the terrorist attack. The result was an unprecedented collaborative effort supported by numerous related agencies and individual providers. Despite the group’s impressively amassed knowledge and resources, we identified many gaps in our understanding of how to address the needs of the widows of 9/11 and, in addition, how to generalize such understanding for the needs of other pregnant women in our area who were experiencing stress, trauma, and grief for any reason."

On this day, a day of remembrance, let us honor those whose lives were cut short too quickly, those they left behind, and the volunteers, like Operation Special Delivery (OSD), who continue to give hope and testament to all that is good and right with mankind in a time where there seems to be so much evil and wrong.

If you are an expectant mama, and your partner has been injured, lost their life, or will be deployed/active during your birthing time, you are eligible for the free-services of OSD.

And finally, since we are on the topic of stress, trauma, grief, volunteer support, and the like, let us not forget both the women who volunteer for The Birth Attendants, but also the women they support.

Home Made

This is a great story about the homebirth (and in this case, unassisted one) movement in Baltimore. I love the article, but more so, it is interesting to read the comments section to follow an ongoing debate with our favorite 'liberal feminist' who staunchly advocates for women's reproductive and safe maternal-fetal health care rights (hear the sarcasm). Read away. Just please, promise me you won't feed the ugly troll by visiting 'HER' site.

Hi, My Name Is Nicole and I am a Conspiracy Theorist

I have been called a conspiracy theorist for touting that women's options are actually disappearing the more liberal we get with our birth practices.

With recent articles like Choosy Mom's Choose Cesareans, and responses from myself and others, it sounds like we are just hot under the collar and making up dark images of a 'right to choose'.

But are we?

Emotionally and physically, women are hurt, and their options are forever limited or made to be seemingly insurmountable uphill battles. Cesareans are becoming so prevalent and rates are increasing because of 'choice', policies, and iatrogenic complications, that we made an awareness month about it to promote more public education regarding this major abdominal surgery.

ICAN has a great resource on hospitals and VBAC bans... check it out for yourself BEFORE you go into labor or choose a cesarean... you will have a better idea of if you will be 'allowed' a VBAC next time around. That is one battle that many of us were already aware of...

But the battle just got bigger.

Now, after a cesarean, women with abdominal scars could very possibly find themselves without insurance. Some insurance companies are beginning to refuse women coverage if they have had a previous cesarean or give them higher insurance costs.... Unless they are sterilized or infertile!

“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Cesarean Awareness Network, a group whose mission is to prevent unnecessary Cesareans.

Not only are women feeling pressure to have Cesareans that they do not want and may not need, but they may also be denied coverage for the surgery.

“You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other,” Ms. Udy said.

ugh! This is not how I, or any other professional in my field, wanted to be vindicated. I would rather be considered a conspiracy theorist than to see our healthcare and the lives of children and moms be affected in such a profound and inhumanitarian way.

• A Doula Too blogs about the horrible realization that our public is coming to: our cesarean rates are out of control, hurting our healthcare options, and hurting our babies.
  
• Karen The PA Doula is outraged and incensed - wanting to find a way to fix this mess.
  
• Navelgazing Midwife positively lights on the fact that this might make VBAC more possible and sought after and make cesarean a 'less achievable' OPTION for women when not medically necessary - will women start making more informed and mother-friendly, newborn-friendly healthcare choices?
• Pushed Birth reminds us that, with cesarean rates on the rise, it is a horribly unfair and hard place for families to be: coerced into unwanted cesareans either by default or by iatrogenic complications, and then refused basic care and health coverage - limiting their choices for care even more.
  
• Crunchy Domestic Goddess gives a great post on how others are responding to this article and have foreshadowed this day previous to it.
  

What next peeps? What do we have to do and be put through to get the information in between those plates of bones resting on top of your spine? Those of you in white lab coats - is it worth it to be home in time for dinner?Oi. I am going to the pool to cool off.

Epidurals Are For Tolerating the Hospital, Labor Is The Easy Part

This is a great article by a woman who explains SO WELL why many women who want unmedicated birth end up with medication. Take a gander and let me know your thought oh ye commentors.

Choosy Mom's Choose Cesareans?!?!

Oh, ACOG is pissed about the backlash by the homebirth advocacy groups now aren't they? It seems so very juvenile. Ricky makes the Business of Being Born and AS SOON as it is released, ACOG just 'happens' to put out a completely blind and ignorant, not to mention unsubstantiated, non-medically sound, and trite statement on their stance on home birth.

Since that time, numerous articles have surfaced in a VERY short time showing how 'wonderful' hospital birth is, and more than that, highly managed hospital births. Read on, then come on back here.

----

Some things that tick me off about this:

• Cesareans vs vaginal and breast vs. bottle are not NEARLY in the same realm. Yes, both have health benefits one way or the other, but one is MAJOR SURGERY.
• Misinformation - women are given SOME of the risks of Cs, but not all. They are not given the incidences of these risks either. I hear so often of women being scared into making Cesarean's elective procedures instead of emergent ones.
• Did you notice that the mom in this article said she felt "defensive" about choosing a cesarean? Did she ever stop to think about the REAL reason why she felt that way? Take responsibility for your own emotions and actions woman. She shouldn't be feeling defensive or ashamed about her birth unless there was a reason - and not a victim-reason either.
• "Something that people might not immediately think of is how this is going to cost the rest of us.....c-sections are very expensive, the more than women demand elective c-sections the more likely insurance companies will start to raise their rates for maternity coverage......this is simply unfair for the rest of us who believe in natural child birth to have to contribute financially to insurance premiums because some women are "too posh to push"... - Doula friend in Cali
• Articles like this give vaginal birth a bad rap. They fail to tell the REASONS for most vaginal birth risks. Most of the damage done in vaginal birth is due to pushing position, directed pushing, forceps, vacuum, episiotomy, etc....the way the birth is MANAGED... NOT vaginal birth in and of itself.

"There is an admiration of women who are able to do a vaginal birth without pain medications, then breast-feed, and do everything else perfectly," she says. "So I didn't go around advertising that I had chosen to have a C-section."

If she sees vaginal birth as part of the "perfect" way to birth, no wonder she didn't try for it... because trying and failing meant failing. No weight is given to the process, the attempt even... Fear. It permeates and mitigates reactions that and choices that are not wise. Because any choice made out of fear (fear of failure, fear of pain, fear of anything) is made for the WRONG reasons.

Grrr...

On the heels of that one, let's take a look at another Time's article. This time, I will let you be the one to comment on it before I add my $2.01

Delivered Safe and Sound

This is a great article written by a past L&D RN. She talks about the state of medical care in the U.S. right now, including information on I.V.'s, Epidurals, NPO, and other medical practices that fall into the 'conspiracy theory' mindset of those who have not done their research.

One of the most profound things that I read in her article was this:

" Is the hospital the safest place to have your baby? Most people would say of course it is. What I saw and experienced during those seven years taught me that safety is not inherent in a place, but in the philosophy of the care provider. Most only practiced the way they did to avoid lawsuits so frequently encountered in obstetrics. Often they did things the way they had always done them, without regard to new research or evidence-based medicine. What many think of as normal or necessary obstetrical practices, are more for the protection of the practitioner, than the safety of mom and baby."

And that sets the tone for the article. What are your thoughts? Does it surprise you that 'one of their own' acknowledges all that we, as CBEs, try to convey to the public? Give me your overall thoughts.

(don't forget to click on 'next' in the left hand column to advance to the next page of the article).