Friday, May 29, 2009

Arizona Birth News: Further Details on Maternal/Child Death

The following was released in the Arizona Republic today, concerning state treasurer Dean Martin's wife and baby, who both died this week following the baby's birth:

"The Maricopa County Office of the Medical Examiner has released the cause of death of Kerry Martin, State Treasurer Dean Martin’s wife. They say she suffered a ruptured benign tumor in her liver known as an adenoma. According to the American Liver Foundation, adenomas of the liver are rare and asymptomatic."

I asked Nursing Birth why this would affect a term infant, and she postulated the following:

"The reason the ruptured ademoma would effect the term infant, is from blood loss. Maternal blood volume increases 45-50% in pregnancy, so a “benign” condition in a non-pregnant woman, can become a problem in a pregnant woman, if that condition is sensitive to blood volumes. The ruptured liver ademona could cause a catastrophic internal hemorrhage for the mom, thus causing hypovolemic shock in the infant. Very sad."

("Hypovolemic shock is a particular form of shock in which the heart is unable to supply enough blood to the body. It is caused by blood loss or inadequate blood volume.")

I'm guessing that this birth included a cesarean to save the baby, which was not successful (someone watching the news had mentioned that a cesarean was involved). Fascinating stuff - but still utterly tragic.

Thursday, May 28, 2009

26 weeks, 0 days: A Somber Sort of Week

This has indeed been a somber sort of week. There have just been so many deaths with people I am either connected with or interested in! I suppose that every week is that way for someone.

Anyhow, it started on Sunday morning when I woke up to the news that a baby whose mama's blog I had been following and praying for, baby Faith Hope, had died on Saturday. Her death was not completely unexpected, as she had a severe birth defect (anencephaly) that is 100% fatal. In fact, her survival to the age of 93 days was nothing short of a miracle - most anencephalic babies are either stillborn or die within minutes or hours. I don't know if she set any records, but she must have been close. However, she had been doing really well.

What made this story painful was really not the baby's birth defect or short life... It was the fact that the baby's mother received cruel hate-mail from internet sickos who thought she should have aborted her baby or not given her the care she needed to survive. Because anencephalic babies are born missing part of their brain, some people think that they are "not human" and therefore not worthy of either love, life or care. (How having a complete brain is a definition of humanity and a ticket to worthiness is beyond me.) She had to remove her email address from her site, shut down her Facebook account, and have her friends check her email to delete the hate mail from her inbox.

Never before would I have guessed that unconditional love was a qualifying characteristic for deserving the most despicable treatment possible. Hopefully these people have learned something from Faith's mama.

Anyhow, after that, on Monday we learned that an east valley midwife's client had lost a baby at 32 weeks. We are going to hold a bead ceremony for her tonight at birth circle, and we are organizing meals for their family. What a horrible grief. The odd thing is that I know that I know this girl by sight, as we attend the same birth circle chapter, but I don't know exactly who she is - I'll find out next week when I take them lunch. I keep running the list of pregnant mamas through my mind and wondering which one it is - a yucky feeling.

Then on Tuesday we learned that our Arizona Treasurer Dean Martin's wife had died unexpectedly in childbirth on Monday night and that the baby was not doing well. Today, after three days of prayers, we learned that the baby died last night. What an utter tragedy - to go from planning a family birth to planning the funerals for one's entire family.

And we can add to all of that the death of Mike Tyson's little girl in the news - something that makes all parents shiver with the possibility of in-home accidents for children.

So all in all, a somber week! I'll post about us later, and hopefully the rest of the week will be a bit more cheerful.

Arizona News: State Treasurer's Baby Dies Days After Mom

I was extremely saddened to see this news story just now reporting that our Arizona state treasurer Dean Martin's newborn son died last night, following the death of his wife earlier this week in childbirth. Please keep this poor man in your prayers and thoughts. To go from the joyful expectation of birth to mourning the loss of one's entire family is a grief known to few of us.

Treasurer Martin has stated that details of the deaths will be released in coming days, so I'll post more about that when it is released.

Tuesday, May 26, 2009

Arizona News: State Treasurer's Wife Dies in Childbirth

We were all saddened to hear this news story today which reported that Kerry Martin, 34-year-old wife of our Arizona State Treasurer Dean Martin, died last night in childbirth, and their newborn son is in grave condition.

Please keep this family in your prayers.

They're being very close-mouthed about the cause of death, and I don't know if they'll ever come out with anything definite in the news.

Not being a healthcare professional, I can't make many guesses on this one. But some things that come to mind are:

- Amniotic fluid embolism (more common with induced labors, especially those utilizing cytotec)
- Ruptured uterus (usually happens with cytotec-stimulated/induced labors)
- Cesarean birth gone awry

I can think of tens upon tens of labor/birth conditions that could produce an injured/dead mother OR an injured/dead baby, but a condition that would produce both is a little rarer. I'll be keeping my eyes on the news to see if anything is posted later.

Thoughts, anyone?

* Later note: Kathy added these thoughts, and they're good ones, so I wanted to add them on to this entry:

"For both mother and baby to be affected, the likelihood is something happening during labor or surgery; although it is possible that the baby may have had complications not related to the mother's problems -- for instance, some genetic or congenital defect -- and the mother's problems happened after birth. In addition to the possibilities you mentioned, there is DIC (disseminated intravascular coagulation); some sort of infection that rapidly advanced (a woman died a few years ago from this; her family claims she acquired the infection through the epidural, from the anes. not following sterile procedure); a nicked artery during C-section that was not noticed, then burst, leading to rapid internal blood loss (I've also read of this happening); or postpartum hemorrhage. The possibilities of problems are greater with C-section than with vaginal birth; but it may be that the baby's heartbeat took a nosedive, and she was rushed back for an emergency C-section (which has a higher rate of complications, particularly if it's a true emergency, rather than a leisurely intrapartum C-section due to failure to be patient). The timing of the birth (if she died 4 hours afterwards at nearly midnight means that the baby was born about 8 p.m.) suggests that this was not a planned C-section, since those are typically done earlier in the day, during typical working hours -- all scheduled C-sections I've heard of have been planned for "first thing in the morning" (by mid-morning at the latest)."

* An even later note: Nursing Birth wrote a post based on the question about the above that I sent her. It's awesome - check it out! Thanks to NursingBirth!

Active Phase Arrest: Have Some Patience!

This is an amazing and awesome video, posted by Jill at Unnecesarean. Check it out!!

"Active Phase Arrest" is when a mother dilates to some point in active labor (6 cm, 7 cm, etc.) and then doesn't dilate any further for two hours (a rather arbitrary definition, but there you have it). Current obstetrical practices generally funnel women who experience this into cesarean birth.

In this video, UCSF obstetrician Dr. Aaron Caughey discusses what happens when women in active phase arrest are given just two more hours of time to labor.... And voila! Vaginal birth for most of the women, with no decrease in infant condition and a great improvement in maternal outcomes. (What a surprise!) Of course, midwives have been practicing this way for a looonnnggg time, but hospital time schedules are hard things to alter. Maybe his research will start the process!

Elective Cesarean: The Side Untold

I first saw this on "Birth Faith" and later on other birth blogs, so I'm a bit behind the times...

We are often told the "risks of VBAC," but we are rarely told (besides the fact that repeat cesarean has more risks than VBAC) that cesareans can have life-threatening complications for both mom and baby. Here is one story, told by a mother pressured into a repeat cesarean (rather than the VBAC she wanted), in which the baby nearly died from complications directly related to cesarean birth (and unnecessary cesarean birth at that). Check it out!

The Story Leading Up to Sarah's 2nd Cesarean

Sarah's 2nd Cesarean Birth Story

Please remember this story when someone starts telling the wonders and "safety" of elective cesarean birth!

25 weeks, 3 days: Phoenix Summer Begins

I'm sitting at home right now while our toddler sleeps in (he's got a cold) and hubby is at church... what better time to update my blog?

We are all well, though the heat from the beginning of a loooonnnnggg Phoenix summer is somewhat depressing, and we're all getting ready to hibernate indoors for the next five months. (*Sigh*) Rather the reverse of most places, I suppose!

Yesterday we spent a pleasant afternoon wandering around our local plant nursery, and had a bunch of fun looking at plants we'd like to buy eventually. At the very end, however, we stopped innocently at the front desk to ask the price of an unlabeled edible fig tree.... and were immediately sucked into an inescapable sales vortex by an enthusiastic young salesman and were not permitted to escape before listening to a half-hour talk on all of their programs, packages, and services! We did our valiant best to nod intelligently and look as if we perhaps did have $2,000 to pay offhand for trees at any given moment. I don't know if we succeeded.

We never did find out the price of the fig tree.

Moving on.... We are slowly learning the ins and outs of home-ownership, though I think it will be a long journey. I can tell that I am starting to feel better because I have started having my usual manic-decluttering moments, though in-miniature, in between bouts of fatigue/nausea. As usual, the hardest part is getting DH involved, but I have found that if I put a small box of "to be decluttered" stuff in front of the television, I can get him to look at it before bedtime. I love going through his computer stuff! Stick it in a box for a few years, and voila! It's useless and outdated! So whenever he goes through his computer boxes, we throw about half of it out. I love throwing stuff out! It's one of my main de-stressors in life.

I am beginning to understand why "country folk" can sometimes have more hardened attitudes toward animals and wildlife than us "soft city dwellers." Even though we're still in the city, just having a larger property seems to have translated into semi-country living - and there are so many things, to put it vulgarly, that need killing! Roaches, gophers, crickets, ants, scorpions, tumbleweeds - just to name a few. DH, to put it frankly, doesn't mind at all - it's bringing out his "hunter-man" nature. Lately he's been perfecting his technique of killing flies by snapping them with bath towels. Even I have become somewhat hardened to killing scorpions, though I don't like it - we just have too many to relocate them, as I used to do in our apartment.

One thing I can't get accustomed to, however, is the killing of gophers... those things are just so darned cute! I love them. But they can destroy one's property, for sure.

Baby is doing well; she is very active!! I find the difference between her and our DS in-utero to be utterly fascinating - who would have known that one could tell differences in babies pre-birth? She remains hiccup-less, which makes me laugh when I remember my pregnancy with DS, who had hiccups several times daily from conception onward. Fun stuff!

I am doing my best to wean myself off of Zofran. It's not that I'm running out, but that I really would like to have a small stash left at the end of this pregnancy. It's not that I'm planning another baby... but there are such things as surprises, and I don't want to be left at the mercy of our insurance company should another surprise hit before I get up the guts to make the final decision to end our reproductive life permanently. I find that I can go without Zofran for a day, but the nausea just starts building and I have to go back on it after that.

Well, I'd better go get DS before he sleeps the whole day away! Love to all! Enjoy the holiday!

Sunday, May 24, 2009

With Love to Baby Faith

Some of you may remember me writing an entry about this sweet baby before:

Baby Faith Hope

She was born three months ago with anencephaly, a condition that is usually fatal within minutes, hours, or days. Against all odds, she lived three months and went to heaven yesterday.

Thank you, Myah (Faith's mama).... for having the courage to give your daughter life when you were encouraged not to let her live.... for sharing your journey with us on your blog.... for loving your daughter so intensely and being such a blessing to her, and to us in your example.

Go with God, little one.

Article: "Midwives Versus Doctors: The Gloves Are Still Off"

What an awesome article! Unfortunately I don't think this is a mainstream news source, but it's still great to see this type of article out there.

The original source:

"Midwives Versus Doctors: The Gloves are Still Off"

And the article text:

"The C-section is now the most common procedure performed in the United States. A third of American children are born through the belly instead of vaginally. Every year for the last decade, the States has set a new record for the number of C-sections.

"Now that I have your attention, there is an increasing gap between the traditional Western medical community and that of midwife-delivered, woman-based care. A couple of recent articles, in Time and in the LA Times, explore this gap.

"Here we are, discussing health care reform, and at the top of that discussion should be the way we bring babies into this world. One Oregonian midwife, Melissa Cheyney, has begun to examine the differences in care.

The U.S. has a limited idea of what it means to have a positive outcome at the end of a delivery. Basically it just means that everyone’s alive.

"You’ve heard it, and I know I’ve said it, “You got the prize in the end!” Sure, you have the baby, but did you receive the care that was appropriate to your circumstances?

But when you don’t have a lot of medical intervention, you also tend to have more breast-feeding and reduced rates of postpartum depression.

"Sounds great, right? Everyone’s happier, healthier, and the avoidance of interventions costs less: for insurance companies, Medicaid, and our own wallets. The LA Times reports:

As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation’s $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.

Pregnancy is the most expensive condition for both private insurers and Medicaid, according to a 2008 report by the Childbirth Connection, a New York think tank.
The financial toll of maternity care on private [insurers]/employers and Medicaid/taxpayers is especially large. Maternity care thus plays a considerable role in escalating healthcare costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets.

"No wonder the American Medical Association isn’t too keen on changing care.

"They should be, though. The U.S. isn’t the picture of health in many cases, and with childbirth, we’re lacking. According to the Time article:

About 99% of all births in the U.S. take place in hospitals, yet we rank 29th in the world in infant mortality — below Hungary and tied with Slovakia and Poland — with 6.71 deaths per 1,000 live births. That compares to a rate of about 3.5 deaths per 1,000 live births in Far Eastern and Scandinavian countries such as Singapore, Japan, Norway and Sweden.

"Or how about this recent study, from the Netherlands? It showed that for low-risk women, giving birth at home or in the hospital gave an even rate of infant mortality. Not too shabby.

"So what can we possibly do for these women and their families?

  • Treat low-risk women as just that. If a woman (such as myself) is young, healthy, and has no previous labor complications, she should be considered low-risk and empowered to labor in a peaceful setting without continual monitoring.
  • Pregnancy Education. I was lucky to have an awesome birth class for my first son, where the instructor not only gave women the low-down on what to expect during labor, she also walked us through the possible interventions and the side-effects of jumping on the drug bandwagon. This kind of education should be a part of every family’s pregnancy experience.
  • Pain Management. Give women reasonable alternatives to drugs to remedy the labor pains (when appropriate), such as massage, birthing pools, walks, and different positions. Those who have used epidurals for their labors may believe I’m crazy (I’ve heard as much), but contractions are the most intense pain you’ll ever forget…and quickly at that!
  • Bridge the Gap. I’m not entirely against doctor care, folks. I know there are many, many PhDs who believe that women can give birth naturally. As a community, midwives should work to show the public all the awesome outcomes of natural birthing. And they are. Now the AMA needs to listen!
  • Normalize Home Births. Many American women are low-risk, but the laws vary from state to state as to midwife care at home. I’m not asking for a federal law regarding home births, but I believe that if it were not regarded as an “out there” practice, we would be able to birth many babies in the peaceful environs of their own home.
  • Legacy. This is a big one to me. I was always told that “Pregnancy and childbirth are not medical problems.” Most women and their partners have been given a legacy of fear regarding birth. But anyone who has given birth naturally will tell you that it was a wonderful, empowering experience. After both of my sons’ births, I could have run marathons, if it weren’t for that pesky bleeding and the obligation to—you know—nurture and breastfeed the chil’ens. So Stop. Telling. Pregnant. Women. Your. Horrific. Birth. Stories. Period. They are not a receptacle for your baggage!

"This summer, Cheyney and a colleague will draft new guidelines to help midwives and doctors work together better. She hopes it will be “a model for collaborative care that will be the first of its kind in the United States.” That’s a great first step.

"The next step? Bringing down those high costs and the predilection to reach for the epidural at the first sign of pain.

"As a gender, we’ve been doing this birthing thing for a looong time. I’d say we should probably work on getting it right.

Saturday, May 23, 2009

Orange County Register Article: "How Do You Want to Deliver?"

A nice article, on the whole! It's nice that homebirth is beginning to be widely included in "lists of birth options" and is often supported rather than condemned. (Not that ACOG is listening....)

I find it disappointing that the birth center mentioned allows laboring in water but not waterbirth. This seems to be the case almost nationwide. Of the very few hospitals we have here in the valley that even have labor pools (or allow portable ones), I do not know of any that allow waterbirth (one's best hope is to find sympathetic nurses who will allow an "oops!" waterbirth). Despite waterbirth's phenomenal results and high safety levels, it simply has not gone mainstream in hospitals. Perhaps this is because the women demanding waterbirth generally turn to homebirth, so the hospitals have not yet felt the pressure to allow and/or encourage it.

Here is the original link:

"How Do You Want to Deliver?"

And here is the article text:

How do you want to deliver?

Women need to do their homework on birthing options available today.

For The Orange County Register

"So, you're pregnant. Congratulations! Now comes the interesting part: How do you want to deliver?

"Denise Spatafora, a life coach in New York, has written "Better Birth, The Ultimate Guide to Childbirth from Home Births to Hospitals" to help moms-to-be make the best choice for themselves.

"Local professionals also have advice to offer about the options women have.

"We spoke with Dr. David Lagrew, medical director of Women's Hospital at Saddleback Memorial Medical Center in Laguna Hills; Lorri Walker, a midwife at South Coast Midwifery and Women's Health Care in Irvine; and BJ Snell of the Community Alliance for Birth Options in Laguna Hills.

"All agree that for starters, women should thoroughly educate themselves about what pregnancy is and what kind of birth would give them the best possible emotional, mental, physical and spiritually rich experience – even if something out of the ordinary happens and they have to change delivery types at the last moment.

"'Too much of the time the unknown of the birth process creates fear for women," Spatafora said. "That was my main goal, to give women the tools to educate themselves and give them all they needed to make choices that would give them the ultimate birthing experience."

"She's had clients who intended to have a home birth with a midwife, but had to change their focus to a hospital-based delivery because something during their pregnancy made home delivery an unsafe option.

"'This doesn't mean that they can't have the same wonderfully memorable, fear-free experience," Spatafora said. "This just means that they have to become OK with the new and needed option, learn all they can about the procedure and realize that it will still be an intimate event."

"Spatafora gave birth to her two children at home in water, with a midwife.

"'That was my way and it worked out. For someone else, the best way might be in a hospital setting, or a birthing suite at a birthing center."

"Lagrew says the family birthing suites at Women's Hospital at Saddleback Memorial can offer the best of both possible worlds.

"'While many are encouraging home births, we feel that the center can give the mom and partner the same experience, but in a safe setting," he said. "Should the need arise, immediate intervention is available."

"The hospital encourages the use of a Jacuzzi, but not water births, he said.

"'We have education classes for the basics, for high-risk pregnancies, VBAC (vaginal birth after C-section), post-partum and daddy boot camp. We also have birthing beds, rocking chairs and music. Our policy is that if the request is safe and a comfort to the mom, we will provide it."

"Both Lorri Walker and BJ Snell said that options in Orange County – and at hospitals in particular – are limited. Most hospitals don't allow midwives access, they said. Walker and Snell both see a sharp rise in the county for out-of-hospital births.

"Giving birth, Walker said, is "a natural function that women need to gain control of by making it a more 'green' experience, educating themselves in a way that fits their lifestyle, gives them control and makes the event quite intimate."

"Birthing centers give women lots of freedom, Snell added: "They can have family and friends in if they wish. We don't use IV's – the moms are able to walk, eat, drink. We don't readily use episiotomies."

"Walker and Snell both agreed that birthing centers are not for all women. If a woman is having a high-risk pregnancy for any reason, she needs to use the traditional hospital setting, they said.

"Women do need someone to be their guide, and for most that means a doctor.

Contact the writer: Carine Nadel is a freelance writer in Laguna Hills. Send questions or comments on this article to

Friday, May 22, 2009

Chiropractic Care for Morning Sickness

I've finally found something that seems to work! For me, that is...

Here's my history:

When I was doing my research into naturopathic remedies for morning sickness, chiropractic care was one of the options that came up. However, I did not get a chiropractic adjustment during this pregnancy until two weeks ago. Why? Well, for the reason that I have a bartering arrangement with my chiropractor - she gives me an adjustment, and I cook her dinner. Need I say more, LOL? Cooking doesn't happen with morning sickness!

However, after hurting my back a month ago, my nausea skyrocketed - to the point of throwing up multiple times (this is at a time when I hadn't thrown up for several weeks). This is the first evidence I saw showing me concretely that spinal alignment affects nausea! I realized that I really needed to go to the chiropractor for my back, regardless of my nausea, and so I payed cash and went. Not only did my back feel better, but my nausea was greatly reduced. I was able to back off on the nausea meds considerably.

However, the nausea gradually crept up again - and then improved again with my next chiropractor appointment! So I have now seen three instances in which spinal alignment has affected my nausea levels (one negatively and two positively).

A couple of notes:

- An adjustment has not made my nausea disappear - just lessen.

- Also, the lessening was not permanent - repeat adjustments would be necessary to deal with nausea.

Would this work for everyone? Mmm... maybe, but I doubt it. Here are my thoughts:

- Remedies for morning sickness and/or hyperemesis (that is, severe morning sickness) seem to be highly individual. If you spend more than 30 seconds on the internet researching morning sickness remedies, you will find countless repetitions of, "I had terrible morning sickness until I tried [insert remedy here], and I haven't had any problems since!" Then one tries said remedy, and it has no effect. For example, ginger is lauded to the skies for morning sickness - for me, it just made things worse. So while chiropractic care might work for some people, I'm not going to say that it's a cure-all for everyone.

- As I said, this didn't cause my nausea to disappear - only lessen. When one is truly dealing with hyperemesis, a slight reduction in nausea just isn't going to cut it.

- And again, with this pregnancy I did not experience hyperemesis. What works for morning sickness (sea bands, ginger, protein snacks, etc.) is generally ineffectual or useless for hyperemesis. So it might be worth a try, but I'd use it in conjunction with anti-emetic drugs. Hyperemesis is not something that one wants to play around with and risk letting get out of control.

Anyhow, it's something to try! I'm going to try to commit to getting an adjustment every two weeks through this pregnancy, both for nausea and for breech/posterior prevention (and for an easier labor). So I'll post if I get any more insight into this matter! Please let me know if anyone else has used chiropractic care (or any other alternative care) for nausea successfully.

Thursday, May 21, 2009

News Story: "Risk to Baby Rises With Repeat C-sections"

What a neat story! Thanks to Rixa at Stand and Deliver for posting this news story from U.S. News.

Here's the link:

Risk to Baby Rises With Repeat C-sections

And here's the text! Bold-face is mine for emphasis:

Risk to Baby Rises With Repeat C-Sections

Procedure doubles odds for intensive care compared to vaginal birth newborns, researchers say

Posted May 21, 2009

By Kathleen Doheny
HealthDay Reporter

THURSDAY, May 21 (HealthDay News) -- Babies delivered by elective, repeat cesarean section delivery are nearly twice as likely to be admitted to the neonatal intensive care unit (NICU) than those born vaginally after the mother has previously had a c-section, a new study finds.

These c-section babies are also more likely to have breathing problems requiring supplemental oxygen, the researchers say.

"In addition, the cost of the birth for both mother and infant was more expensive in the elective repeat c-section group compared to the vaginal birth after c-section (VBAC) group," noted Dr. Beena Kamath, the study's lead author and a clinical instructor of pediatrics at the University of Colorado School of Medicine, Denver.

The study appears in the June issue of Obstetrics & Gynecology.

Nationwide, the c-section delivery rate keeps rising. According to the study authors, by 2006, 31.1 percent of deliveries in the United States were done this way.

Furthermore, women who have delivered once by c-section have a greater than 90 percent chance of undergoing another, the authors noted. But experts continue to debate whether these women should try labor and vaginal delivery, or automatically undergo another c-section, as there are risks are associated with each method.

To help clarify those risks, Kamath and her colleagues turned to records from the perinatal database at the University of Colorado Denver. Those records ran from late 2005 through mid-2008 and focused on babies born to 343 women who had planned a repeat, elective c-section and another 329 who planned to try vaginal birth after having previously had a baby via c-section.

The researchers looked at the differences between groups in newborn admissions to the neonatal ICU and the need for oxygen for breathing problems, as well as cost differences.

Kamath's team further divided the women into four groups. Of the 343 repeat c-sections, 104 went into labor before the c-section and 239 did not. Of the 329 women who attempted vaginal delivery, 85 failed (for various reasons) and went on to have a c-section.

Kamath's team found that 9.3 percent of the c-section babies were admitted to the NICU, but just 4.9 percent of the vaginally delivered babies were. And while 41.5 percent of the c-section babies required oxygen in the delivery room, 23.2 percent of the vaginally delivered babies did. After NICU admission, 5.8 percent of the c-section babies needed the oxygen compared to 2.4 percent of the vaginally delivered babies.

The median hospital stay was three days for babies who were delivered vaginally and four days for the other three groups. Total costs for the c-section group averaged $8,268; for the vaginal group, $6,647.

"The failed VBAC babies required the most resuscitation and had the most expensive total birth experience," Kamath concluded. But, overall, the VBAC group did better than the c-section group in terms of hospital stay and other measures, she said.

Women who opt for a repeat c-section should first understand these risks and differences before they make their decision, Kamath said. [My note: But how many women ARE told both sides of the story?]

The study results suggest another important take-home point, according to Dr. Alan Fleischman, senior vice president and medical director for the March of Dimes, based in White Plains, N.Y. "The decision to have your first c-section is very important," he said. "There should be a clear medical indication [because] your first may dictate subsequent [delivery methods]."

Women also need to know that vaginal delivery is possible for many women who have already undergone a c-section, Fleischman said. Some hospitals do not allow vaginal delivery after a prior c-section, however, so he suggested that any woman who is planning on one find out early on what her hospital's policy is.

In the same issue of the journal, other researchers found that the chance of a pregnant woman having a hypertensive disorder -- such as high blood pressure that first occurs during the pregnancy -- has risen greatly in recent years, from about 67 per every 1,000 deliveries in 1998 to more than 81 per 1,000 deliveries in 2006.

This increase, in turn, is boosting the number of hospitalizations associated with health problems in the mother-to-be, such as kidney failure or breathing problems, according to researchers at the U.S. Centers for Disease Control and Prevention


25 weeks, 0 days: Checking In

Cross-posted from my morning sickness blog....

Wow, I didn't realize how long I'd neglected to update this blog! My other blog has been going through a flurry of activity lately, so I guess this one got shoved onto the back-burner.

Things are well! We saw our midwife (one of them, actually, as we have two) last Tuesday and had a ton of fun with her. This is the first time we've seen this midwife as a midwife - last time we saw her in-office (last pregnancy) she was still a student/apprentice midwife. Now she's licensed and out on her own! Pretty cool! And she does a great job. We're hoping that both midwives will be able to make it to our birth.

Speaking of birth, our birth team is finally shaping up! We have two doulas (tentatively, still working out details) who happen to be two of my very favorite people in the Phoenix birth community, and I am incredibly excited about that!! We also have a toddler-chaperone.... but only if the birth takes place on a night or weekend, LOL! So we'll hope for a due-date baby (which is a Saturday).

I have started doing my pregnancy exercises in earnest (tailor sitting, kegels, pelvic rocks, squatting) and am trying to get a walk in when possible (it's a lot harder with a toddler in tow!). I'm trying to practice the principles of optimal fetal positioning too, so I'm doing my best to sit on the floor or my birth ball and to lean forward while sitting. I do NOT want a posterior or breech baby birth!! I also dug out my Hypnobirthing CD and have started listening to it at bedtime. (This is on the principle of, "Since it didn't work last time, I guess I should do more of it!" LOL) Seriously, did relaxation really work for anyone out there during labor? I tried to practice relaxation during my last pregnancy, but it all went out the door with the first serious contraction. Well, maybe it will work better this time... I'll let you know. After all, I really do have a horribly hard time with meditation of any kind (my mind starts making grocery lists), so maybe it's just me.

I have been reading "Natural Childbirth the Bradley Way" and enjoying it. Oddly enough, I never got around to reading it last time. One interesting thing in it that has gotten me thinking is its emphasis on high protein intake. I've been contemplating the "protein vs. carbs" debate and thinking that quite possibly we Westerners have gotten it all wrong by focusing on a high-carb diet. If you look at it, most of our diets are extremely high-carb. I don't know how it got that way (possibly a combination of lobbying by the grain industry and the low-fat diet craze), but it seems to be true. However, I have noted the following:

- High protein seems to be much better for morning sickness. Even now, at 25 weeks, I get nauseated after eating a high-carb snack/meal (like waffles or fruit smoothies), but do not get nauseated after eating a high-protein snack/meal or a combination protein/carb meal.

- I feel better after eating a protein-heavy meal (eggs, cottage cheese) than a carb-heavy meal (cereal, waffles, toast, etc.). I have more energy and don't tend to crash and burn like I do with the other.

- My mom is using a low-carb-ish diet to control her high blood pressure.

- High protein intake is one of the key components of the Brewer Diet, which is used during pregnancy to prevent pre-eclampsia

Anyhow, this isn't a pitch for low-carb diets... After all, my DH made himself good and sick on a low-carb diet (apparently one's body can go through a really weird reaction if one eliminates carbs, which he did). And when I tried to do that diet with him, I lasted.... hmm, maybe 48 hours? I'm definitely not a no-carb or even super-low-carb person. It's just a thought that our incredibly and maybe overly-high-carb diets (focusing on processed grains to the exclusion of higher protein and/or fruit/vegetable intake) might not be the best idea after all. Thoughts, anyone?

Moving on from diet.... Other than that, I am doing well! My nausea improved once again after my chiropractor's appointment on Monday, so I am a believer in chiropractic treatment for nausea (I'll post about that soon). We are keeping busy with church and home improvement projects, as well as finishing our yard project. We are toying with the idea of throwing a "come see the house" party, which would be our first ever, and are also getting ready for a flock of family birthdays/anniversaries and more houseguests. June will be a busy month!

I hope that you are all doing well! I will do my best to check in more often. Have a great weekend, all!

VBAC Birth Story

Thanks to Jill at Unnecesarean for linking to this just-posted VBAC Birth Story. Check it out! A great read with lots of humor.

Wednesday, May 20, 2009

My Own List - Why I Prefer Homebirth

Here is my own list:

Why I Prefer Homebirth:

* Disclaimer: Homebirth is not for every woman, every couple, every baby, or every birth. Additional, there are some great OB's and not-so-great midwives out there. Therefore, this should not be taken as a condemnation of either hospital birth or obstetricians. Enough said!

(1) Current U.S. hospital Cesarean Rate: 31.8%; average homebirth midwife cesarean rate: ~3-5%. You pick.

(2) There are no such things as stirrups in homebirths.

(3) I can eat and drink at will, and indeed will be encouraged to do so.

(4) Birth is sacred - the most sacred moment of a woman's life. The sacred happens more successfully and meaningfully in an intimate setting.

(5) There are no limits on the number of people attending my birth. Many hospitals limit attendees to ~3 people; considering that my current birth team is around 8 people, that would be a problem!

(6) Doulas are encouraged, not grumbled over.

(7) I could never have had a natural birth (which I greatly desired) if medication had been easily available. Removing the temptation made focusing on the task a lot easier.

(8) One word: WATERBIRTH (which is not allowed at most U.S. hospitals)

(9) There are no time limits set on my labor.

(10) My midwife is always available by phone. Not her nurse, and not an answering system.

(11) My midwife will come over whenever I need her, day or night, stay for my entire labor and several hours afterwards. Most docs show up to catch and then take off.

(12) I know my entire birth team intimately - no nurses to get acquainted with and who change with every shift.

(13) Hour-long prenatals as opposed to 5-15 minute prenatals.

(14) A close, friendship relationship with my midwife as opposed to a clinical doctor-patient relationship with an OB

(15) Delayed cord clamping. Most OBs refuse to do this; most midwives don't do anything else.

(16) Respect for my decisions. If I choose to refuse vitamin K shot, antibiotic ointment, hep B vaccine, prenatal testing, etc., my midwife respects my decision rather than "requiring" it, lecturing me, or kicking me out of her practice for it.

(17) Immediate skin-to-skin bonding post-birth that is not interrupted.

(18) Most midwives do episiotomies only during true emergencies, meaning that they are almost never done.

(19) Midwives seem to practice more evidence-based medicine than most docs. Many hospital/obstetric practices are simply not supported by the evidence. For example, there is no proven benefit to routine IV insertion, constant electronic fetal monitoring, withholding of food during labor, early cord clamping, pitocin augmentation, routine induction of labor, prenatal ultrasound, vitamin K shot, etc. - and yet they are mandatory at many/most hospital births.

(20) I can birth in whatever position I choose! Hands and knees, squatting, hanging from a rope, in water, whatever!

(21) Microbiologically, homebirth is much safer - Babies and mothers are exposed to many more dangerous pathogenic bacteria in-hospital than in-home, and many more come home with hospital-borne infections.

(22) Safety: Homebirth for low-risk women has been proven again and again AND AGAIN to be as safe as hospital birth, and results in far fewer useless and/or harmful unnecessary interventions to mother and baby.

(23) Driving in active labor?? Ummm.... NO.

(24) Children can easily be present at the birth and be actively involved.

(25) My hubbie can catch the baby if he wants to.

(26) Birth is the most meaningful moment in a woman's life (for most women, I believe). It is more likely to be meaningful and empowering in a nonmedicated, intimate environment where the woman feels in control and respected.

(27) I'm more in control at home.

(28) I feel safer at home. Feeling safe = easier & less-complicated labor.

(29) I can have candles, music, low lights, etc. at home.

(30) I am more comfortable at home.

(31) I don't have to spend my labor fighting meaningless hospital protocols when I'm at home.

(32) If I end up with a cesarean, I will know that I really needed it (as opposed to the 15-20% of birthing women each year who end up with an unnecessary or iatrogenic cesarean).

(33) I have an intimate, friendship-based relationship with my midwife, meaning that I can totally trust her when she makes suggestions or says that an intervention is truly necessary.

(34) Home is where birth has happened for thousands of years.

(35) Birth is a natural process that needs to be respected and supervised, but not medicalised out of its very nature.

(36) Prenatal care given by midwives is completely comparable in quality to that given by obstetricians (and, I would add, usually much better due to the time that midwives take to answer questions and get to know their clients).

(37) At the hospital, I am a "patient." With my midwife, I am a "client." That makes all the difference.

(38) How many OB's do you know who ask their clients out for coffee and chat as part of their prenatal routine?

(39) It is easier to focus and relax at home.

(40) No one is going to wake me up at an ungodly hour to take my vitals.

(41) Hospital gowns are ugly, demeaning, and disempowering. Give me my own clothes, thanks!

(42) I can walk around completely naked, and no one minds or tries to get me into a gown.

(43) I can be as mobile as I want to, whenever I want to.

(44) I don't have to go through the torture of checking in, going through triage, and filling out paperwork while in active labor.

(45) Homebirth monitoring of labor is WAY superior! Instead of being on a monitor and being observed at the nurses' station, I have 2-4 caregivers who are with me every minute and are constantly observing, listening to baby's heartbeat, taking pulse/blood pressure when necessary, etc.

(46) I have the constant physical and moral support of my midwives.

(47) Midwives know a lot of great non-drug pain-relief options. Water, rebozos, counter pressure, massage, etc.

(48) Hospital gift bags/diaper bags just make me MAD - they are plastered with formula ads and filled with formula samples. What a great way to encourage breastfeeding.

(49) I won't be pressured to supplement with formula, which seems to have happened to just about every hospital-birthing friend of mine within memory.

(50) Midwives never use forceps or suction cups! (They're almost never needed in non-medicated births.)

(51) I will never be pressured to accept medication.

(52) Midwives don't have that annoying clinical detachment that almost every OB I've ever met unfortunately has. Don't know why, but it seems to be true.

(53) No IV. That's enough for me all by itself! (Needle-phobic people should not have hospital births, LOL!)

(54) Midwives specialize in birthing styles that produce intact perineums (i.e. no tearing). Yippee!!!

(55) Midwives don't use directed pushing (a.k.a. "purple pushing"). The mama pushes with her body's urges (unless she is confused and needs help, or there is a pressing reason to get baby out, such as dangerous decels or shoulder dystocia).

(56) Total strangers don't walk into the birth room unannounced! (Or worse yet, walk into the room and do a vaginal exam, LOL!)


I expect I'll add more later, but that's it for now!

Neat Birth Video!

Here is a recently posted birth video of a birth attended by two of our awesome local valley midwives, Shell Walker and Connie Canada. Great job to all involved!

Article: 35 Reasons to Choose Homebirth!

Thanks to Sally Stevens of ICAN for posting this on Facebook! A fun list. I think I'll write my own soon! (Maybe today!) Here is the link so that you can leave your own reasons:

35 Reasons to Choose Homebirth

And here's the text:

35 Reasons to Choose a Home Birth

posted by Veronica, selected from Green Options May 15, 2009 1:02 pm

Derek Markham, Eco Child’s Play

Why do I think a home birth is so much better than a hospital birth?

I’ve experienced a planned hospital birth, a planned home birth that ended with an induced hospital birth (and a month-early preemie) because of pre-eclampsia, and two home births. I am a big proponent of giving birth at home because of these experiences. The hospital births did not end up being horrible, and the nurses and doctors were (mostly) good people, yet after the home birth, I can’t imagine doing it any other way.

One major reason is that while a male OB/GYN may be technically proficient in his field, the fact that he hasn’t given birth, and can’t ever give birth, gives the midwife and doula a huge advantage in terms of actually relating to and understanding birth from a woman’s perspective.

35 Reasons to Give Birth at Home (in no particular order):

1. Home birth is safer - Your house is a lot less likely to be a source of antibiotic-resistant bacteria, and it’s not full of sick people.

2. Your chances are getting a C-section are reduced with a home birth.

3. It’s cheaper - A midwife’s fee is much less costly than a hospital stay.

4. You don’t have to go anywhere.

5. The food is way better at home. Organic food? Vegan? No problem.

6. You don’t have to have strangers at your birth (unless you want to).

7. Your home is always more comfortable than any hospital room.

8. Everything you need is there.

9. You can be as green as you want. Hospitals aren’t known for natural soaps, cleaners, or recycled-content anything.

10. You control the environment at home. If you want to dim all the lights or open a window, you just do it.

11. Birth is a sacred experience. What better setting could there be?

12. It’s so much quieter at home. There are no cabinets full of blinky lights, fans, and humming devices. Well, maybe some of you have that… But probably not in your bedroom. And you can power them down if you want.

13. Home birth is just more fun!

14. Your older kids can be a part of the birth.

15. Your pets can attend. Seriously. Pets are family, too.

16. Giving birth at home is an exceptionally empowering experience. We can take back birth from The Man.

17. No silly hospital gown is necessary at home. Wear whatever you want, or wear nothing.

18. You don’t need an ID bracelet for the mother or the baby when you birth at home.

19. You can choose the room for your birth, or change rooms in the middle. Not an option at the hospital.

20. Giving birth outside is an option with a home birth. Our first home birth was in our front yard, in a birthing tub, and our second in a tipi in our yard. It’s probably not an possibility for most city dwellers, but our second home birth was just on the other side of the fence from a public school (and recess ended just as active labor came on…)

21. No paperwork is necessary at your home birth.

22. You can cut the umbilical cord when you are good and ready. The speed at which they want to snip our newborn’s lifeline is unbelievable.

23. No gadgetry on the mother: A home birth midwife doesn’t require you to wear a monitor or get an IV started “just in case”.

24. You don’t have to sign out when you leave your house.

25. Your family doesn’t have to negotiate a giant parking lot and endless hallways to visit you.

26. A heating pad does not cost $50 to use.

27. You can have as much sage, incense, candles, whatever, as you like.

28. There is no pressure to circumcise, vaccinate, or apply for a Social Security number for your baby right after a home birth.

29. You don’t end up with a “gift bag” (marketing samples) from big corporate America, full of disposable diapers, formula, baby wipes, shampoo, soaps, and brand propaganda.

30. Your baby’s placenta does not become a biohazard. We left our placenta at the hospital, but we planned to bury it, so I drove back, all bleary-eyed, and asked for it. They weren’t going to give it to me, even though we had our name on it in the fridge (just like lunch…) We had to call the OB and have her sign off on the release, and then I had to sign about four different forms, and then they finally gave it to me in a bag with “Biohazard” all over it. Sheesh.

31. The dad has a bed at home. Sleeping on a foldout cot next to the hospital bed sucks.

32. Nobody comes in, wakes you up, and checks your vitals every half hour at home.

33. You can stream the live video of the birth to all your friends (Pay-per-view home births?) OK, I’m kidding.

34. Having a home birth is different. Different is cool.

35. The hospital is open 24 hours, so if you need it, it will be there.

I know that it isn’t for everyone, but if you feel at all drawn to home birth, I say, “Go for it - it’s not as mysterious as it sounds.” It’s the way women have always given birth. Only recently has birth become the domain of the doctor and hospital, the insurance company and the pharmacy.

I’ve listed 35 of the reasons that we choose home birth, but I’d love to be able to change the title to read “75 Reasons…” or “100 Reasons…”, so help me out here by leaving a comment.

Green Options Media is a network of environmentally-focused blogs providing users with the information needed to make sustainable choices. Written by experienced professionals, Green Options Media’s blogs engage visitors with authoritative content, compelling discussions, and actionable advice. We invite anyone with questions, or simply curiosity, to add their voices to the community, and share their approaches to achieving abundance.

Time Article: "Doctors vs. Midwives: The Birth Wars Rage On"

Thanks to Mary Langlois for posting this on Facebook! An interesting article. Can't say I agree with everything in it, for example, the following:

"The key, of course, is the "low-risk" part — which means young, healthy mothers with routine pregnancies and no complicating variables like multiple fetuses or a history of delivery problems. These are the only kinds of cases midwives are supposed to handle."

Birth junkies will recognize the following, among other points: (1) Midwives ARE trained to handle multiples and other birth complications, such as VBAC and breech (which many OBs, sadly enough, are no longer trained to handle) and (2) maternal age is not necessarily a complicating factor.

However, I digress. It's definitely a good read. Here's the link:

"Doctors vs. Midwives: The Birth Wars Rage On"

And here's the article text:

Saturday, May. 16, 2009

Doctors Versus Midwives: The Birth Wars Rage On

"There's nothing more natural than being born. There's also nothing quite as fraught. A whole lot can go wrong during that long and tortuous journey from the womb to the world. Modern medicine can eliminate a lot of the risk, but in doing so, it can also turn what could be a joyous experience for the mother into the equivalent of an all-day appendectomy.

"It's this fact that has always been responsible for the fault line between obstetricians — who are trained to view birth as a medical procedure — and midwives, who see it as that but as something less clinical too. And if a new study conducted by two researchers at Oregon State University (OSU) is any indication, peace is not likely to be brokered between the two camps any time soon. (See TIME's photos: ER's Long Goodbye)

"For a society as technologically far along as the U.S., we do a surprisingly poor job of looking after our tiniest members. About 99% of all births in the U.S. take place in hospitals, yet we rank 29th in the world in infant mortality — below Hungary and tied with Slovakia and Poland — with 6.71 deaths per 1,000 live births. That compares to a rate of about 3.5 deaths per 1,000 live births in Far Eastern and Scandinavian countries such as Singapore, Japan, Norway and Sweden. (See TIME's photos of spiritual healing around the world)

"Part of the solution is improving hospital care, particularly for fragile preemies — and making sure all moms get equal access. Certainly, the American Medical Association sees things that way. The doctors who write AMA policy are also very clear that hospital care is the only prudent care. In 2008, the AMA passed its much-argued-over Resolution 205, which states flatly that, "the safest setting for labor, delivery and the immediate post-partum period is in a hospital or a birthing center within a hospital." To ensure your newborn's health, in other words, make sure the highest-tech medicine is close at hand.

"But midwives disagree. Home births attended by trained nurse-midwives are no less safe than hospital births, they argue, providing the midwives are affiliated with a nearby hospital to which the mothers can be brought in case of complications. "The most comprehensive study of this was published in the British Medical Journal in 2005," says Melissa Cheyney, an assistant professor of anthropology at OSU and a practicing midwife herself. "It showed that for low-risk [home] births in the U.S. and Canada, the infant mortality rate was roughly 1.7 per 1,000, or about the same as it is in hospitals." The key, of course, is the "low-risk" part — which means young, healthy mothers with routine pregnancies and no complicating variables like multiple fetuses or a history of delivery problems. These are the only kinds of cases midwives are supposed to handle.

"Cheyney decided to test the British journal's findings in her home state, where the rate of planned home births is at least twice the national average, due both to Oregon's culturally liberal leanings as well as its wide rural stretches, which can make hospitals hard to reach. (From 1998 to 2003, parts of the state also had higher than average rates of premature and low-birthweight babies, leading some critics to conclude that midwifery was partly to blame.) Cheyney and doctoral student Courtney Everson examined one county's birth records from the entirety of that period and found that in that area at least, there was not any increased mortality risk associated with low-risk home births. In interviewing doctors for her study, however, she also learned a few very important things about why they remain so fixedly opposed to the midwifery option.

"For one thing, even Cheyney admits that while the odds of mortality in the case of routine births may be no higher at home than they are in the hospital, they're no lower either. And even the lowest-risk birth can turn high-risk fast — with maternal hemorrhaging and fetal distress just two of the dangers — making immediate access to high-tech care imperative.

"Cheyney's conversations with physicians turned up other, more complicated issues. When hospital-based obstetricians see midwives and their clients it's usually because something has gone wrong and the laboring mother is rushed in for care. OBs don't see the uneventful births that proceed successfully at home. What's more, doctors in this position find themselves not just being forced to take on someone else's case, but someone else's problem. That's enough to sour them on the entire profession.

"'We've been getting a lot of insight into their world view," Cheyney says, "and it's been illuminating."

"One thing that might help soften that world view, she believes, is if the obstetricians try to see things from the midwives' perspective. "The U.S. has a limited idea of what it means to have a positive outcome at the end of a delivery," she says. "Basically it just means that everyone's alive. But when you don't have a lot of medical intervention, you also tend to have more breast-feeding and reduced rates of postpartum depression." Cheyney acknowledges that the kinds of mothers who choose midwifery might be the very kinds who would be less inclined to suffer postpartum depression or nursing problems in the first place, and her study addressed such so-called sampling bias.

"'We do think [sampling bias] is true for about half of them," she says. "We see women who are very well-educated and healthier to begin with and that helps them have better outcomes having home delivery. But the other big group is the uninsured or underinsured. They tend to have poor outcomes in the medical establishment but do better with home care or birthing center care." Again, though, those better results do not mean that the risk of infant mortality is lowered with home birth, but that the postpartum health of the mother and baby may be improved.

"Some of the debate may be resolved this summer, after Cheyney and a colleague draft new guidelines to help midwives and doctors work together more cooperatively. It will, she says, be "a model for collaborative care that will be the first of its kind in the United States." Even Cheyney's critics would have to agree that, if nothing else, she does walk the walk. She spoke with Time, but only briefly, grabbing a brief break while her infant daughter was taking a nap. Her one-week-old baby was born at home."

Sunday, May 17, 2009

Benefits of Delayed Cord Clamping

Nursing Birth has published an amazing and thorough post on the debate about delayed cord clamping and the benefits thereof. It's a must-read! Check it out here.

I didn't have to worry about anyone trying fast cord-clamping with our birth, as our midwives are so awesome about practicing hands-off, evidence-based medicine - which means no fast cord clamping! But I think that next time I'll ask to wait till the placenta is birthed before cord-cutting. I've also toyed with the idea of a lotus birth (waiting for the cord to fall off naturally), but am a bit intimidated with the amount of work required. We'll see!

Here's the awesome video that she also posted which examines the issue:

Friday, May 15, 2009

L.A. Times Article: "More C-sections, More Problems"

I am so excited to see all of these articles coming out lately which honestly examine the problems with our current cesarean epidemic! Who would have guessed? Not that our cesarean rates show any signs of dropping yet (or even stabilizing), but one has to start somewhere.

Here's the original site:

"More C-sections, More Problems"

I'm also going to reproduce the article below to have it in hard copy if it's ever removed, and the bold parts are my highlights of the important/surprising/fun parts:

More C-sections, more problems

"As the expensive surgery's popularity rises, so have premature births, maternal deaths and neonatal intensive care admissions. Serious medical intervention has diminishing returns, a doctor notes.

By Lisa Girion

2:47 PM PDT, May 15, 2009

"After an emergency cesarean with her first baby, Ruby Wales was holding out for a vaginal birth with her second one.

"With a toddler underfoot, the 33-year-old Mission Viejo woman wanted a faster recovery. But finding a physician to deliver her second child wasn't easy. Her first obstetrician turned her down flat. "She said, 'No -- no way,' " Wales recalled.

"Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.

"With that surge has come an explosion in medical bills, an increase in complications -- and a reconsideration of the cesarean as a sometimes unnecessary risk.

"It is a big reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good.

"We're going in the wrong direction," said Dr. Roger A. Rosenblatt, a University of Washington professor of family medicine who has written about what he calls the "perinatal paradox," in which more intervention, such as cesareans, is linked with declining outcomes, such as neonatal intensive care admissions. Maternity care, he said, "is a microcosm of the entire medical enterprise."

"As the No. 1 cause of hospital admissions, childbirth is a huge part of the nation's $2.4-trillion annual healthcare expenditure, accounting in hospital charges alone for more than $79 billion.

"Because the average uncomplicated cesarean runs about $4,500, nearly twice as much as a comparable vaginal birth, cesareans account for a disproportionate amount (45%) of delivery costs. Among privately insured patients, uncomplicated cesareans run about $13,000.

"Pregnancy is the most expensive condition for both private insurers and Medicaid, which roughly split the tab for such care, according to a 2008 report by the Childbirth Connection, a New York think tank.

"'The financial toll of maternity care on private [insurers]/employers and Medicaid/taxpayers is especially large," the report said. "Maternity care thus plays a considerable role in escalating health care costs, which increasingly threaten the financial stability of families, employers, and federal and state budgets."

"The cesarean rate in the U.S. is higher than in most other developed nations. And in spite of a standing government goal of reducing such deliveries, the U.S. has set a new record every year for more than a decade.

"The problem, experts say, is that the cesarean -- delivery via uterine incision -- exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

"Inducing childbirth -- bringing on or hastening labor with the drug oxytocin -- also is on the rise and is another source of growing concern. Experts say miscalculations often result in the delivery of infants who are too young to breathe on their own. Induction, studies show, also raises the risk of complications that lead to cesareans.

"Despite all this intervention -- and, many believe, because of it -- childbirth in the U.S. doesn't measure up. The U.S. lags behind other developed nations on key performance indicators including infant mortality, birth weight and neonatal intensive care admissions.

"And in at least two areas, the U.S. has lost ground after decades of improvement: The maternal death rate began to rise in 2002, and the typical American newborn is delivered at 39 weeks, down from 40. Public health experts view the trends with alarm.

"At a recent conference held by Childbirth Connection, physicians, employers, insurers and hospital operators wrestled with the disappointing data and discussed thorny questions, such as whether insurers should stop paying more for cesareans than for vaginal births.

"'Cesarean birth ends up being a profit center in hospitals, so there's not a lot of incentive to reduce them," said Dr. Elliot Main, chief of obstetrics for Sutter Health, a Northern California hospital chain.

"But there is a lot hospitals can do to reduce them, as illustrated by the wide variation in cesarean rates. Among California hospitals, cesareans range from 16% to 62% of births.

"Such variation means a lot of women are getting unnecessary cesareans, Main said. "There's no justification for that kind of variation."

"The surge in cesareans may owe more to celebrity magazines than medical journals. After word got out that Victoria "Posh Spice" Beckham had three, physicians reported a surge in requests for such deliveries, dubbed the "too posh to push" bump.

"Physicians, too, have been blamed for failing to make women fully aware of the consequences of cesareans, and for promoting them for convenience.

"But change is underway. The Institute for Healthcare Improvement's Strategic Partners program trains hospitals to implement a set of guidelines, such as the careful use of oxytocin, and a ban on elective deliveries before 39 weeks. In four years, 60 hospitals have signed on.

"'It's a culture change," program director Frank Federico said. "We're at a tipping point. . . . It used to be that we spent more time defending the 39-week rule. Lately, there's no question about that. It's, 'How can we improve the process to support that?' "

"WellPoint Inc. and UnitedHealthcare Services Inc., the nation's largest health insurers, also are trying to curb cesareans. In an analysis of its claims, United found that 48% of newborns admitted to neonatal intensive care units were from scheduled deliveries, many of them before 39 weeks.

"United targeted a group of Texas obstetricians with particularly high rates of deliveries before 39 weeks. An analysis showed that the babies these doctors delivered were admitted to neonatal ICUs twice as often as the national average.

"After being notified of the correlation, the physicians changed their practices and reduced neonatal ICU admissions by 46% in three months.

"The rise in avoidable first-birth cesareans has had a multiplier effect. Most U.S. physicians discourage vaginal deliveries after a cesarean because of some widely publicized cases several years ago in which the uterus split disastrously along the prior incision.

"That's why Ruby Wales' first obstetrician refused.

"'She said it was because there is a 1% chance of a uterine rupture," Wales said. "And I thought that was weird because there's more chance of things going wrong with a cesarean section."

"But some obstetricians believe that new evidence supports allowing some women the option of trying for a vaginal birth.

"'If the old incision was a vertical, then a trial of labor is not a good idea," said Dr. David Lagrew, medical director for the Women's Hospital at Saddleback Memorial Medical Center in Laguna Hills. "But what happens now in the United States is the low, transverse, an incision in the bottom part of the uterus, from side to side. Those heal better. All the studies say, in those types of incisions, the risk is less than 1%, probably a half percent, that it will open during labor."

"Saddleback delivers about 3,000 babies a year. In March, it joined a few hospitals nationwide that are pioneering the "hospitalist" approach to maternity care, which adds a measure of safety to attempted vaginal births after cesareans.

"A staff of hospitalist obstetricians mans the maternity ward 24 hours a day, seven days a week. They are there to deliver babies when an attending obstetrician gets stuck in traffic, to monitor lengthy labors and to assist in emergencies.

"Saddleback supported Wales' desire for a vaginal birth. Nine days after her due date and after 30 hours of labor, she gave birth -- the way she wanted -- to an 8-pound, 11-ounce boy.

"'I was so glad nothing happened at the last minute to have an emergency C-section because I'd gone through all this work," said Wales, resting in her hospital bed with baby Carson in her arms. "I'm so relieved that I don't have to deal with a [cesarean] recovery because I have a 2 1/2-year-old at home who is very active."


Note: If you have a minute, drop Lisa a note and tell her you appreciate the honesty and forthrightness of her article! Honest journalism needs appreciation!

Thursday, May 14, 2009

Birth in Children's Literature/Media: "I Watched My Brother Being Born"

"I Watched My Brother Being Born"
Video: 21 minutes
Book: ~10 pages

I could tell you all about this book/video set (and I will!), but the best testimonial for this product set is our three-year-old son - he loves it! We have been using it to help prepare him for our upcoming birth, and it has been an instant hit. The book is one of his favorites, and he insists on watching the video at least once a day (and I don't even let him watch television normally). In fact, today when I was momentarily distracted, he put it on for himself! (First time of ever doing that... we're doomed.) He loves it! I have sat through it with him multiple times and pointed out everything that's going on (doppler, mummy making noise, baby coming out, umbilical cord, placenta, etc.) that he is beginning to tell me the same things back! So he is definitely learning.

I got this set from our midwife after having endured the trials of "The Bears' New Baby" and wanting something better. As I've said, it was a hit. The birth was a homebirth of the mother's third baby, with her seven-year-old daughter and five-year-old son in attendance (along with doula, midwife, husband, and others). The video is narrated by the seven-year-old girl, and she has also written the text to the book. The video is comprised of video segments of different portions of the birth (early labor, active labor, birth, postpartum), interspersed with still photos and accompanied by a musical soundtrack. The book uses photographs from the birth along with the text. The birth itself is not particularly clear, as it is a waterbirth in darkness (with flashlights), but you definitely get the idea.


(1) The photos and video are somewhat amateur - i.e. well done, but not professional quality. Not that our son seems to have minded.

(2) If I was to redo the book, I would not have a child write it. Bright as she is, kids still don't write the best books! Also, it is too wordy. When I'm reading this to our son, I paraphrase it.

(3) There are quite a few typos in the book, i.e. "fetus scope" instead of "fetascope," and "umbilicus cord" instead of "umbilical cord." I'm not sure if they just left in the girl's typos as typical and authentic in a child's writing, or if they were just missed (the mom has a strong accent and is obviously not a native English-speaker, so if this was home-produced, the typos might have been missed).

Regardless of the glitches, this has been our best teaching tool so far. We're going to tell family that he'd like a copy for his birthday so that we can give this set back to our poor, long-suffering midwife! I highly recommend this resource for families wanting to prepare kidlets for homebirth attendance.

Video: Twin VBAC Homebirth

Sorry for the rash of birth videos! There are just so many good ones out there. This is a great photo/video collage of a home VBAC after, I think, two cesareans. This woman had to fight like a trooper to get her VBAC and her homebirth - great job! An inspiration to all VBAC moms and to all of us who want to make homebirth VBAC both legal and common.

Tuesday, May 12, 2009

Video: Birthing Plain and Simple

Here is another great video entered in the "BirthMatters Virginia" contest! Check it out and don't forget to leave a comment and rating.

This video focuses on the birthing practices of the traditional Amish, who primarily have midwife-attended homebirths with incredibly low rates of both cesarean birth and interventions. Having been a life-long admirer of all things Amish, it doesn't surprise me that their good sense carries over into their birthing practices!

Birthing Plain and Simple

I'm providing the link rather than the video itself because when I tried to embed the video, it took up almost the entire screen... and I'm not enough of a blogging expert to remedy it!

Later added video with Kathy's help... Thank you Kathy!!

Saturday, May 9, 2009

23 weeks, 2 days: Base Ingratitude, and Other Sins

I have come to the disgusting conclusion that the human heart is capable of the basest ingratitude possible, myself being the number one example.

Here's a good example:

Last pregnancy = out of control morning sickness (hyperemesis), complete misery/despair/etc. I swore to myself that I would never complain about anything else ever again should I be blessed with a non-hyperemetic pregnancy!

This pregnancy = I find myself grousing because (oh, tragedy!) I have put on more weight than I want to!

I mean, come on! Anyone who has dealt with hyperemesis knows that there is almost nothing out there (including death) that we would rather not deal with as opposed to undergoing hyperemesis again. And I'm complaining about a few added pounds?

So, my sermon to myself today is: "DEAL WITH IT, LADY!" And stop the grousing!!

I must confess myself surprised to find that it is so easy to gain weight in a non-hyperemetic pregnancy. With our last I lost weight rapidly and then didn't start putting any on until somewhere midway through the second trimester. So weight gain as a problem was never an issue for me.

However, I should have known (by the fact that I managed to gain a completely normal amount of weight last time, even with hyperemesis) that I might expect to gain more this time! And I definitely have. I've actually gained, at 23 weeks, as much (and some, if I want to be honest) as I gained the entire time last time. And we still have 17 weeks to go! Yikes!!

So the truth of the matter is that I am just going to have to resign myself to being a bit plumper than normal for the next year or so. Worse things have happened. After all, it is better to be plump sans hyperemesis than fashionably slim by means of puking one's guts out around the clock, LOL!

Sometimes we just need a bit of perspective pounded into our heads.

Other than that, all is well! Baby is doing well. She is more active than DS was, and also has far fewer hiccups. DS had hiccups multiple times daily from the time he was conceived, as far as we can tell, and this baby has had them only a couple of times that I can count. It's great that we can tell physical and personality differences even in-utero!

Have a wonderful weekend, everyone!

ICAN of Central Arizona: Check it out!

This past Thursday night I attended my first-ever ICAN meeting! So exciting! (ICAN = International Cesarean Awareness Network) I had a lovely time and want to recommend the group to all Phoenicians!

ICAN is, as the name says, international, but our Phoenix chapter is relatively new (1 to 1 1/2 years old). The leader is Sally Stevens, who also helps run our local (and booming!) produce co-op, Bountiful Baskets, and who is an on-fire birth advocate and all-around wonderful woman.

I learned a ton at ICAN - both about cesareans and about general birth information. The gathering was informal, at a local midwife's office, and consisted of conversation centering around the night's topic ("Laboring at Home") with plenty of side discussions about birth, birth politics, midwifery - all those yummy, yummy topics. There were expectant moms, VBAC-hopeful moms, and lots of birth professionals who all wanted to learn more about birth, cesarean prevention and VBAC promotion.

So..... If you have time, check it out! ICAN meets at different rotating locations all over the valley, and I'll be hooking up with them whenever they're reasonably close to us. They are an awesome group, a wonderful resource, and a ton of fun to visit! Check them out!

P.S. The ICAN website also has a TON of information on cesarean birth - make sure to browse it sometime!

Birth Center Alert: Action Needed!

The following letter was posted on the Phoenix Birth Network yahoo group:


American Association of Birth Centers
Legislative Alert

Judge Rules Against Birth Centers

The federal administrative judge ruled against birth centers in the Texas Medicaid case. The federal government (CMS) is not required to pay the state their federal match for birth center facility fees.

So far CMS has disallowed payments to Alaska, South Carolina, Texas and Washington state for birth center facility charges. The Texas appeal would have directed CMS to continue paying the 42 Texas birth centers their facility fees - as it had for over 20 years.

The nationwide implications of this ruling for birth centers could be catastrophic. This decision applies to all states. Without payment of the birth center facility fees, birth centers in all states will be pushed to the brink of closure. We have already seen centers close in the state of Washington.

We have been proactive in finding a permanent solution for centers nationwide, and are actively lobbying for legislation that would mandate the birth center facility fee payment to the states in Medicaid. Representative Susan Davis (D) from California and Representative Gus Bilirakis (R) from Florida are set to introduce the bill in the U.S. House of Representatives.


1) Spread the word and gather signatures for the Consumer Letter
Many of you are already spreading the word via email and putting the letter in your waiting rooms - that's great!

Download the letter to put in your waiting room or anyone else people gather.

Sign on the letter on the web.

Put a link to the letter on your website - Here's the html code:http://www.surveymo s.aspx?sm= XGO2ZxaqKojCOGBg _2fBVxWg_ 3d_3d">Click Here to sign the Consumer Letter

2) Call your U.S. Representatives and Senators
The House Bill has both a Democrat and Republican lead sponsor. Now, we need the same in the Senate. Ask for their support of this legislation. Download to "Pregnant Women's Access to Care Threatened" for some talking points. Our future depends on it!

3) Continue to collect signatures for the Physician Letter from our friends in the medical community.

Thank you for taking time out of your busy schedule to get our birth center legislation introduced and passed!

Jill Alliman, CNM, MSN
Legislative Chair American Association of Birth Centers
Because this is a copied-and-pasted letter, none of the above links will work. So follow this link to take action! We need our birth centers!

Thursday, May 7, 2009

Homebirth VBAC in the Media

Thanks to Sally for posting this on Facebook! This is a birth story of a homebirth VBAC (a HBAC) in California, published in the Orange County Register.

Homebirth VBAC in California

Wednesday, May 6, 2009

Pictures from International Midwives Day

Here are some pictures from our celebration of International Midwives Day here at Papago Park in Phoenix! Check them out! It looks like most of the pictures were taken after my friend and I left, so we're not in any of them, though I know a lot of people pictured, and our very own midwives are in several of the pics. If you missed it, plan to be there next year!

Pictures from Phoenix Midwives Day

Thanks to Cerin of Precious Moments Photography for the pics!

Baby Faith Hope

My blog-friend Kathy made me aware of this blog a few months ago, and I wanted to share it with everyone!

Baby Faith Hope

Baby Faith was born with a condition known as anencephaly, in which parts of the brain, scalp and skull are missing. It is a lethal abnormality, and babies are usually stillborn or die within hours or days. Faith's mother was encouraged to abort, but she bravely carried to term knowing that her daughter would not live, and baby Faith is now..... 10 weeks old! I don't know if she's broken records for anencephalic-baby lifespans, but she's got to be pretty close. I don't know what her prognosis is, but for now she is doing just fine.

I have been unable to email Myah, baby Faith's mother, as she had to remove her email from her blog due some extremely sick people emailing her hate-mail about her baby. So Myah, if you ever read this, know that you are in our prayers! Keep up the awesome work with your precious baby! This family could use all of our prayers and support.

Tuesday, May 5, 2009

International Midwives Day in Phoenix: A Success!

A friend and I attended the International Midwives' Day celebration today in Phoenix, and it was a big success! Lots of exhibits, loads of people attending - a hit!

This year (the first year of doing something bigger here in Phoenix), we had music, food, a raffle, ultrasounds, free pregnancy massage, and a number of booths with some of the following:

- Bradley method childbirth
- ICAN of Central Arizona
- Waterbirth
- Arizona Student Midwives
- Baby Wraps
- Pregnancy Photography
- Birth Statuary

AND..... Sign-ups for a soon-to-be-formed Arizona Birth Advocacy group! If you weren't there, contact Mary Langlois to find out more and to sign up! I can't wait. We've needed this for a long time.

The organizers did a terrific job of getting together a great event! Nice work, everyone! Looking forward to next year.

Chiropractic Care for Turning Posterior Babies

When I was at my chiropractor's office on Monday, she told me about a technique that she had recently learned for turning occiput posterior babies that was incredibly effective, and I wanted to share it with everyone!

An occiput posterior baby is a baby whose face is facing the mother's front, rather than her back as babies normally do (occiput anterior). Posterior babies are associated with long, difficult, and extra-painful labors - thus, a position to be avoided whenever possible!

The chiropractic technique used to turn posterior babies is called "diaphragmatic release" and is incredibly simple to give and receive (my chiropractor demonstrated on me, and it was amazingly easy!). So.... If you or a client end up with a pre-labor posterior baby, you might want to try it out! Read about it here.