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So, today I'm driving to the store and I see this woman struggling as she walks down the sidewalk with a baby in a carseat. I did not see her get out of a car and there was no car nearby, though she was heading toward the same store I was going to, and there was a parking lot. However, this struck me as incredibly funny. All I could think of was the horrible infomercials that start out, "Has this ever happened to you?" that proceed to make the easiest tasks seem impossible without the incredibly stupid featured product. I started cracking up thinking about the infomercial that would go something like this: Has this ever happened to you? Do you struggle with 15 extra pounds of plastic, just to keep your baby near you? Do you spend hours at the chiropractor or suffer with debilitating back pain? Does your kid have to wear a helmet 23 hours per day because his head is lumpy? (Positional Plagiocephaly and carseat overuse information here: http://publichealth.lacounty.gov/ivpp/pdf_reports/Infantile%20Positional%20Occipital%20Plagiocephaly%20from%20Child%20Safety%20Seats.pdfand here: http://www.oandp.org/jpo/library/2003_03_102.asp) Has your little one been in danger of falling to his death in unsafe situations like being precariously balanced on a shopping cart? Have you spent money you just don't have for ridiculous products that say they'll solve these problems, like straps, special covers, or handle padding or wheels? Well suffer no more! Who knew? Standard issue with every baby are... Yes, that's right! A MOTHER'S ARMS! Even better, your baby was already born portable at a very comfortable 6-10 lb. average weight! Why, babies are even bendy so they can fit into all sorts of comfortable configurations in Mom's arms, Dad's, even little sister's and grandma's! Mother's arms otherwise engaged and grandma no where to be found? NOT TO WORRY! There's a wrap for that! Since the beginning of time, mothers all over the world have needed to solve the problem of using their hands while not abandoning their babies. What do to? Ergonomically designed, weighing mere ounces, portable and doubling as a blanket, and meeting all of your baby's in-arm needs, this stylish option is even affordable! Never let this stupidity ruin your life again! <end infomercial> Seriously. Carseats are for cars. Carseats save lives when used properly in cars. Carseats can be a useful tool if you've just spent 2 hours driving a colic-y baby around to get him to sleep and are afraid that taking him out of the carseat will mean the shrieking will commence again. A carseat can even be helpful if you haven't been able to get the baby to sleep all day, it's now 7 pm, mom hasn't eaten a bite and holding a wriggling baby while attempting to eat would mean hot spaghetti on his head. Honestly, why does hauling a baby around in an awkward plastic bucket make sense to people? Why does it make more sense to invent things that will attempt to fix or mitigate the damage...instead of avoiding it in the first place? And ultimately, the saddest part is what we're teaching our littles. Dolls now come with carseats that toddlers are being conditioned to believe must be part and parcel. Please. I didn’t intend to comment on the Time magazine cover mainly because it was meant to be incendiary and I didn’t have any desire to give it energy. There are plenty of people with lots of letters after their names stepping up to explain why breastfeeding beyond infancy is natural and normal. They are doing a fine job. They are spending a great amount of time bringing the science of our mammalian biology to the masses in order to turn this into a teaching moment and initiate dialog.
However, last night I had to wonder if they are wasting their time. I have been astounded by the amount of vitriol directed toward this mother and mothers like her who follow their maternal mammalian instinct and nurse, as the World Heath Organization suggests, “...up to two years of age or beyond.” and per American Academy of Pediatrics guidelines recommending breastfeeding for “at least 12 months and for as long thereafter as mutually desired.” I am very much saddened by the harm this reaction does to mothers and babies. It is this that prompted me to share my observations. My work for almost a decade has been to examine why certain birthing and parenting practices persist, despite the evidence that they are ineffectual at the very least, and in some cases actually known to cause harm. I believed for a long time, like those who are sharing information regarding term breastfeeding (for as long as 'is mutually desired'), that providing evidence would result in a paradigm shift for those who just hadn’t based their opinions on solid facts. After metaphorically beating my head against the wall for years in just such an endeavor, I came to the conclusion that providing facts will not change beliefs. This was supported by a conversation I had last night on Facebook. The background is thus: A lesbian friend I know to otherwise be open-minded and compassionate commented that this cover was ‘disgusting’ and disrespectful of women. Another woman agreed and commented, “And gay marriage is wrong?! Pa...leaze!” I only know one of the three women who partook in this exchange, but I have no reason to believe the others aren’t just as reasonable and compassionate, so my response was, “Just because you aren’t used to seeing it doesn’t mean it’s wrong. The pose was meant to be provocative and controversial, but nursing a 3 year old is healthy and normal and backed by science.” Now, I thought that was a pretty benign response considering the disrespect being shown to women who are following a biological imperative...by other women no less. Not only that, but by women who have been disrespected by others who don’t understand them solely based on ignorance of biology. I kind of figured that was the end of it. However, yet another poster suggested that it would be fine if the milk were pumped and given in a glass. I found that interesting considering that belief is based on the cultural (and might I add quite patriarchal) sexualization of the female body and ignores the biological fact that breasts exists to feed our offspring. I pointed that mammals posses mammary glands, and are actually classified as mammals because of this. I asked if toddlers with bottles elicited the same ‘ick’ factor. She said “no.” In our culture, it is acceptable see toddler with a bottle or pacifier. If one stops for a moment to think about why that is, it is because we understand that mother’s milk provides sustenance to children beyond infancy, and sucking is a hardwired response to dealing with stress for babies and young children. Ok, now take the next step...why? Because before the advent of bottles and formula, the baby would be at the breast for those purposes. In many places around the world and for many people, that is still the case. Pacifiers and bottles are man-made devices meant to replace the breast...in effect to replace mothers. Anyone can do the job of feeding, nurturing and comforting once the woman’s special role is eliminated. My response was, “I'm just wondering at the logic. A bottle doesn't ick you out because it is a cultural norm...but NOT a biological one. The parallel was provided for gay marriage. This is abnormal CULTURALLY...not naturally. Same concept. I'm not saying it's not 'strange'...as in you don't see it in a bottle feeding culture. However, naturally, it is NORMAL.” Mind you, I was not the first to bring up gay marriage, but as I said earlier, I did find the comparison appropriate for the simple reason that those who object to gay marriage do so on the grounds that they believe it is wrong. That is their belief, which is not supported by fact. The objection to nursing beyond infancy is based on belief, not fact. In my mind it made perfect sense to point this out, because I felt that perhaps the vehement response of these women was a visceral one and that once they saw we had some common ground, we’d come to an understanding. A couple of comments that followed are what made me realize that wasn’t going to happen. One was: “My logic is at the age of 3-6 a child is old enough to begin to understand body parts/basic anatomy. The time to wean children from breast feeding should be well before this, in my opinion, before there could be any confusion.” Again, there is no confusion unless one has internalized that breasts are first and foremost sexual playthings. I use my hands for sex too, but that doesn’t mean I don’t use them for other purposed related to parenting my child. I haven’t heard anyone yet make the contention that hands are objectionable. Next was: “People can write anything they want, even people with credentials.” I’m sorry, but to me this reads as, ‘My mind is made up and I don’t want to be confused by facts from a legion of immunologist, anthropologists, neurobiologists, cellular biologists, neonatologists, perinatologists, psychologists or pediatricians.’ I brought up the WHO recommendations, which was met with, “You can throw every organization in the book at me and I still won't change my opinion. But do not sit here and draw a parallel between being gay (not a choice) and breast-feeding into toddler ages (a choice) because as far as I'm concerned you're comparing apples to oranges.” At which point I checked out of the conversation with, “Yeah, 'cause facts never do change beliefs. I get it.” And I did. I suddenly realized that evidence is pointless in a case where someone has based their opinion on nothing more than a belief devoid of facts. Of course I knew it. I’ve written about it extensively. What surprised me in this case was it was a woman I wrongly assumed would be above shaming other women for something that’s perfectly natural. The comparison was to people's opinions about gay marriage and people's opinions about duration of breastfeeding. So, for one, we are talking about culturally derived OPINIONS...definitely apples to apples. And both are a choice. Gay persons can and do certainly live in relationships not defined as marriage and always have. They can't always do so openly, and they are not afforded the same legal protections as couples who are 'married.' To be married and to fight for the right to be married is a choice. The same could be said for placing arbitrary limits on nursing a child that are based on nothing but beliefs about it that are not based on fact. As far as I’m concerned, the comparison is apples to oranges only when the facts about breastfeeding are not understood. Misinformation only persists and proliferates when people refuse to educate themselves. In this case, it harms women and children to allow this to continue, and the feminist in me just can’t let it go. Nursing into toddler years at this point in time is admittedly a choice because we have replaced (in our culture) that which is natural and normal. Thus, our children probably won’t die if we don’t breastfeed into toddlerhood. We have the ability to manufacture bottles, and glasses and mother’s milk replacements. We have exemplary sanitation and access to nutritious food (again, in the US and other developed nations, but not everywhere). Yet many women make the choice to bottle feed (or breastfeed for a limited time) because they feel pressured by culturally imposed ideas of what is ‘normal‘ and expected. The poster seemed to assume I am not a lesbian woman in her objection to the parallel drawn between gay marriage and extended nursing. At first, I found that interesting, until I realized I assumed she was. She was correct, however. I’m not a lesbian woman. I admittedly cannot possibly understand what it is like to live as a lesbian woman. I did live and work with 400 lesbian women for a month, and 25,000 women (about 60 percent of whom were lesbian) for a week. During that time, the assumption of many people I met was that I was a lesbian or bi-sexual woman, which gave me just a taste of how women are often treated when they don’t fit the cultural norm. It also afforded me the opportunity to have many meaningful discussions with lesbian women about discrimination, cultural assumptions, patriarchal power and more. While I experienced a good deal of disapproval for many of my unconventional parenting practices and life choices, I will admit nothing compared to what I experienced during that time, or what my friends live with daily. So when (someone I assumed to be) a lesbian woman pointed out how wrong it is for people to oppose same-sex marriage while at the same time using the same criteria to denigrate another woman for pushing societal boundaries, it made me wonder about a lot of things. For instance, how many gay and lesbian persons chose to get married to someone of the opposite sex not because it was what they knew was right for them, but because it was what was expected? Because they felt pressure to conform to some cultural idea of what was ‘normal’ that was not based in fact, but beliefs? Not their own beliefs, but those of the culture at large, no less. This is where I saw commonality. Historically (and still in underdeveloped nations or in our own where poverty is prevalent) not nursing a child beyond infancy meant a high infant/child mortality rate. In the absence of clean water and abundant food, if another human mother wasn’t available to nourish the child, the child died. Let’s face it, before we became an agrarian culture, it’s not likely we would have tried to capture a sabertooth tiger or mastodon for their milk. While suckling from a different species does happen throughout nature, it’s not all that common. And without buckets, cups and bottles, not really all that practical for human babies. Even with the advent of domestic animals we could constrain and containers to hold their milk, cow’s milk is made for baby cows who are born weighing 100 pounds and have 4 stomachs, not baby humans who are about 8 pounds at birth and have 1 stomach. Pediatricians warn against giving babies cow's milk because it is so bad for them. Yet guess what most formula is made of? Cow's milk! (Or soy, which is eminently worse.) And without proper understanding of the role of sanitation in wellness, many babies would still have died from such a substitution. Today, in places where food and clean water is scarce, extended breastfeeding still saves the lives of children, not to mention the lives of women. Breastfeeding reduces the risk of breast cancer, and the longer the woman nurses, the more protected she is. The longer a child nurses, the less likely they are to become obese, which is certainly a problem for our youth today. None of this even touches on the healthy emotional development for a child that comes from having all their needs needs met in their mother’s arms. Because here’s the thing...babies who are nursed from birth have no idea that YOU think of breasts as sexual. None. To them, it’s lunch and comfort...and always has been. Yes, today we have breast pumps and bottles and glasses. The fact remains that these things are cultural contrivances that replace Nature’s already perfect system of delivery of the perfect food. Breastmilk contains 400 substances that cannot be replicated in a laboratory, including white blood cells and other immunological factors that protect against disease in the child’s environment. (In fact, it is such a beneficial substance, it is sometimes prescribed for adult cancer patients.) Direct from the breast, it is sterile. No mother should nurse beyond what is comfortable for both she and her infant. Neither should a mother feel shamed into weaning before she and her child both feel ready. Likewise, no woman who wants to breastfeed should endure disapproving looks or hostile comments from people who objectify women based on the erroneous belief that breasts are primarily sexual. I find it very sad that women, especially a subset of women that are themselves misunderstood and maligned due to other peoples BELIEFS about them, devoid of facts, would be so unwilling to actually learn about why extended nursing is not only acceptable, but beneficial on so many levels. That these same women would impose the same cultural restrictions that others try to impose on them. I know mothers who have been harassed for nursing a toddler. Women have had their 2 or 3 year old child away from them because someone in power didn’t understand that it is normal and natural to breastfeed a toddler. Women are discriminated against and harassed every single day for nursing even tiny babies in public. Further, the reasoning behind why these people who disapprove feel that women should hide themselves away in bathrooms to feed their baby, put a blanket over their baby's head, should just stay at home if they 'have' to do that, or pump and bring mother's milk in a bottle when out in public come from the EXACT same objection; that breasts are sexual and therefore seeing them used to feed a baby, even if it is the most natural thing in the world and the best for baby, makes people uncomfortable. To this I would ask, if you are gay or lesbian, have you been offended when you have heard someone proclaim that gay or lesbian affection in public is 'disgusting?' Do you think that what you know to be natural and healthy should be hidden away because someone else who is ignorant of the facts, and chooses to remain that way, might be uncomfortable? Do you feel that the discomfort of others should dictate the parameters of your relationships? Many nursing mothers pretty much feel the same way. I actually agree that the cover is disrespectful of women, but because it pits women against each other, not because I consider nursing a toddler offensive. And as seen in the exchange that prompted my musings, it encourages women to judge other women in exactly the same manner as others have judged them. It infuriates me that women would do this to each other. It needs to stop. This is a feminist issue. Unless and until we, as women, support each other regarding natural and healthy choices, we invite vilification of women by others who would like to control what we do with these amazing bodies we are blessed with. This is important, so I had to speak up. by Kim Wildner
Imagine if you will, a woman who has just discovered she’s pregnant. If she lives in the United States, one of her first thoughts will likely be that she has to make an appointment with her obstetrician. From that first appointment the woman usually acquiesces to test after prenatal test throughout the pregnancy. She will likely accept a plethora of interventions throughout her labor and birth that in many cases are, at the very least, uncomfortable or stressful (or both), and in some cases painful. She may be facing a fear of the unknown with courage henceforth unknown to her. She does so for the sake of her baby. She sacrifices privacy, and in some cases dignity, because she believes it will keep her child safe and herself healthy. What if the vast majority of women and babies are delivered safely because birth is a reasonably safe, healthy, physiological function of the mammalian body? In other words, what if the end result could be the same in a way that focused on the joy and wonder of the process of procreation…not on every possible thing that could, but is not likely to, go wrong? In the U.S. today, most people assume that medically managing birth makes it safer. It is widely accepted that the interventions in pregnancy and birth serve a purpose…in effect, that they are safe and effective. Does the evidence support these beliefs? To assess whether birth is safer medically managed as opposed to expectantly managed, I believe we must first examine how obstetricians became the primary caregiver for birthing women. As an experienced childbirth educator, I’ve discussed this with parents, and without exception, the belief has been that birth originally shifted from a midwife monitored event at home to a medically managed hospital occurrence due to safety reasons. That is an erroneous assumption. According to The Official Plan to Eliminate the Midwife: 1900-1930 (Gibson, n.d.), at the time that birth moved to the hospital, there was little doubt that midwifery was the safer option. Through early professional journals such as Transactions for the Study and Prevention of Infant Mortality (1910 – 1915), which Gibson obtained through Stanford University Medical Library, we have a unique glimpse into history. She quotes Dr. Ira Wile as saying in 1911, "In NYC, the reported cases of death from puerperal sepsis occur more frequently in the practice of physicians than from the work of the midwives’"(as cited in Gibson, 2006, Part I), and she attributes the following to a Dr. Levy in 1917, "Of the babies attended by midwives, 25.1 per 1000 ... died before the age of one month; of those attended by physicians, 38.2 per 1000 .... died before the age of one month; and of those delivered in hospitals, 57.3 per 1000 died before the age of one month. These figures certainly refute the charge of high mortality among the infants whose mothers are attended by midwives, and instead present the unexpected problem of explaining the fact that the maternal and infant mortality for the cases attended by midwives is lower than those attended by physicians and hospitals" (ibid.). This, despite the fact that 80 years prior, Dr. Ignaz Philipp Semmelweis had admonished physicians for not washing their hands before attending women after handling cadavers, which he suspected was one reason for their high rate of childbed fever, and subsequently higher mortality rate (CDC, 2001). He was ridiculed. Midwives would have had no idea their vocation was systematically being eliminated to provide “clinical material”…pregnant women…to obstetricians (as cited in Gibson, 2006, Part II). Even if they had known they couldn’t have done a thing about it. Women didn’t even have the right to vote. Since that time, there has never been a definitive study showing medically managed birth with obstetricians to be safer than expectantly managed birth with trained midwives, though there have been those that have tried (Pang, 2002). The conclusions and methodologies, however, have been called into question (MacCorkle, 2003; Vedham, 2003; Citizens for Midwifery, 2002; Gibson, 2006; Strong, 2000, pp. 222-223). In fact, Jock Doubleday (Doubleday, 2005) has been offering progressively larger amounts of money, with $50,000 being the last offered in December of 2005, for anyone who can provide such a study. The reward has stood unclaimed since he first offered it in 1998. Childbirth is safer than it was 100 years ago (Johanson, Newburn, & Macfarlane, 2002). Undoubtedly, it is safer to give birth in the U.S. than it is in many places throughout the world. However, to assume that if obstetricians now attend birth, then improved outcomes must be due to that development alone is a fallacy that does not take into account improved nutrition, sanitation, disease control, birth control or any number of other variables. There are many contributing factors to improved health and well-being in the childbearing year (Wagner, 1994). In fact, countries that enjoy the modern advancements mentioned above in addition to midwifery care have the best outcomes in the world (Strong, 2000), and “…there is never a doctor in the room” (Wagner, 1994, pp.124). Where exactly does modern obstetrical management place the U.S. in comparison to the rest of the world? There are 42 countries with lower infant mortality rates (Central Intelligence Agency, 2006) and 29 countries where fewer mothers die (World Health Organization, 2004, pp.23). While this may be surprising to some, certainly, it is not to suggest that the practice of obstetrics is unnecessary. We need surgeons and experts in pathology for a small number of cases that might be deemed high risk, such as mothers who have pre-existing medical conditions or mothers with addictions. The evidence suggests that number should be a very small percentage (Johnson & Daviss, 2005; Declercq, Skala, Corry, Applebaum, & Risher, 2002). In essence, the system under which the U.S. currently operates could be analogous to hiring a cardiologist as a personal trainer. Could heart attack deaths be reduced by having surgeons immediately available in the event that a normal, but strenuous, activity turned tragic? It’s very likely. However, would a game of tennis be imminently more difficult, if not impossible, if mobility were restricted by an assortment of electrodes and devices strapped to the player to assess every biological function and make the job of the cardiologist easier? If this seems like an absurd analogy, consider this: the image that most of us have of birth is of a woman in bed, usually on her back, pushing out her baby, possibly with her feet in stirrups, or her legs being pulled toward her ears by herself, her partner or a nurse. The path the baby follows is called the ‘curve of Caras’. Mothers are expected to push baby uphill in typical hospital birth. Why? Is there some physiological reason that mothers are expected to lay on their backs? No. The reason mothers are restrained to bed is so that the monitors can be hooked up and so that the doctor can sit comfortably at the end of the bed. Women are told throughout pregnancy to avoid laying on their backs because oxygenation to the uterus can be impeded by the weight of the baby resting on the vena cava. Does the position suddenly become safe in labor? No. This position is detrimental to babies, and it creates pain for the mother because the weight of the baby rests on her tailbone (Lamaze, 2005). The position also makes the pelvic outlet considerably smaller by resting the mother’s weight on the tailbone, this flexing it inward. It makes the final stage of labor much harder than it needs to be. It almost guarantees the perineum will tear(Walsworth & French, 1998). Therefore, episiotomies are done to prevent tears. This means healthy perineal tissue is cut to prevent tears that would be unlikely to occur if the mother were not in a position that creates conditions for tears. Does it work? Think about it. If you try to rip a piece of whole fabric, it remains strong. If you first cut the fabric a tiny bit, it rips easily. The same is true of the human flesh. Fourth degree lacerations (where the perineum rips through to the rectum) happen almost exclusively with episiotomies (Goer, 1995). All of this so the baby could be continuously monitored, and for the convenience of the provider, without any regard for how it impedes the process of birth, the danger it introduces into the process, or the comfort of the mother. It is not supported by evidence as safe, is not backed by common sense or evidence as effective for, well, anything. Yet it is a nearly universal intervention. At this point, it might be argued that by constantly monitoring the baby, we can avert a terrible tragedy by knowing moment by moment what the state of the baby is. Except that what the evidence says is that the routine use of continuous electronic fetal monitoring does nothing but increase the rate of surgical birth without any improvement in outcomes (Goer, 1995; Wagner, 1994). The act of giving birth becomes more difficult, and in some cases impossible, due to the assortment of wires and devices meant to assess every biological function. Each obstetrical intervention was created for a specific medical indication for which, when used appropriately for that indication, it is effective. Unfortunately, instead of being used selectively in exclusively pathological situations, many interventions are used routinely within a healthy population, in part due to the litigious environment in which physicians must operate (Carpenter, 2004). The following graph (Wildner, 2006) illustrates some of these. It shows the percentage of women who will experience the selected interventions under different caregivers, with no substantial difference in outcomes. (I created a chart to use as a visual comparison of the frequency of interventions used by obstetricians and midwives, but was unable to convert the format to insert on this blog. However, it showed a high rate of 6 different common interventions for doctors and nearly nonexistent rates of the same interventions by midwives.) If we can obtain virtually the same results without performing them (and we can), why are they being done? How many of these common procedures proven safe and are they effective? Two interventions deserve special consideration. These are procedures deemed ‘elective’, which is a bit misleading, because a woman may ‘elect’ to have them, but should she ‘elect’ to refuse them, they may be performed under court order (Irwin & Jordon, 1987). These two procedures, induction of labor and cesarean section, while they are extremely important life-saving measures when used for medical indication, are perfect examples of obstetrical technology gone awry when used for convenience. The World Health Organization suggests that induction is medically indicated no more than 10% of the time (as cited by The Coalition for Improving Maternity Services, 2003). Yet, according to the Listening to Mothers survey, (Declercq, et al, 2002) 55% of mothers were induced, even though there is acknowledgement that induction increases risk (Baxley, 2003; Rubin, 2006) and the chemical agents, such as Cytotec, used for elective induction are not approved by the FDA for such use (Haire, 2001; Physician’s Desk Reference, 2003). In fact, not only is Cytotec not approved for elective induction, it carries a serious warning not to use it for induction at all (U.S. Food and Drug Administration, 2005), which does not seem much of a deterrent to the American College of Obstetricians and Gynecologists (ACOG) or the American Academy of Family Physicians who “…supports the safety and effectiveness of vaginal misoprostol (Cytotec) for cervical ripening and labor induction” (Weaver, 2006) contrary to the scientific evidence. The Centers for Disease Control, (CDC, 1993) and the World Heath Organization, (as cited by The International Cesarean Awareness Network, 2004) recommend rates of surgical birth not to exceed 12-15%. The U.S. is currently at 29.1% (Dress, 2005), meaning at least half of these surgeries are medically unjustified. Obstetricians contend (Rubins, 2003) that the increase is due to ‘maternal request’ surgeries, to avoid such things as urinary incontinence later in life, or sometimes due to fear of pain, supposedly the case with Britney Spears. Yet, vaginal birth is not a factor in urinary incontinence (Albers, 2003; ACOG, 2005), despite what some doctors may suggest (Healy, 2006). If women are requesting surgery over natural birth, which some sources doubt (Lamaze International, 2006), then one would wonder if they are being apprised of the significant risks (Thornton, 2006). Risks that are perhaps worth taking if the life of mother or baby are compromised…but not worth introducing where none previously existed. People often say that in the end, all that really matters is that the mother and baby are okay. Is that really all that matters? What if the mother and baby could have been safe without adding insult to injury? While some authors merely tell women they should expect care with no basis in science (Murkoff, Eisenberg, & Hathaway, 2002) others defend over-treating in order “To be sure that not even one baby will be harmed during delivery” (Tuteur, 1994; Part III-Common Obstetrical Practices). Is that a realistic goal? Is it being realized? Not as evidence by the many people who have studied obstetrical management versus midwifery attended pregnancy and birth for the last 25 years or so (CIMS, 2003; Johnson & Daviss, 2005; Enkin, Marc, Keirse, Renfrew, & Neilson, 1995; Gibson, 2003; Goer, 1995, 2002; Wagner, 1994, 2003; Stewart, 1981; Keefe, 2001; Tillett, 2005). If success is measured by results, the U.S. obstetrical system could do better. In those 25 years, infant mortality has actually worsened, (Kristof, N., 2006) and maternal mortality has remained unchanged (CDC 1998; CDC, 2003). While this may seem an indictment of an entire system it truly isn’t. It is a call for reformation. Obstetrics have at their disposal the most advanced technology in the world. However, when you have a hammer, everything looks like a nail. By transferring care of healthy women and babies to midwives, only the actual ‘nails’ reach the ‘hammers’ through a referral from midwives, guardians of normalcy. Obstetricians are then able to use their considerable skills to benefit the women who really need their help. Under this new paradigm that views birth as a natural process, health care costs would be reduced, (Druley, 1998) maternal satisfaction would increase, (Villagran, L., 2006) outcomes would improve and obstetricians would get the recognition and respect they deserve for doing the job they were trained to do. Everyone wins. References Albers, L., Sedler., K, Bedrick, E., Teaf, D., Peralta, P., (2006, June). Factors related to genital tract trauma in normal spontaneous vaginal births. Birth, 33(2), 94. Retrieved January 28, 2007, from Ovid database. ACOG, (2005). Vaginal birth not associated with incontinence later in life. ACOG press Release. Retrieved February 13, 2007, from http://www.acog.org/from_home/publications/press_releases/nr11-30-05-1.cfm Baxley, E., (2003). Labor induction: A decade of change. American Family Physician, 67(10). Retrieved January 27, 2007, from http://www.aafp.org/afp/20030515/editorials.html Carpenter, D., (2004 November). Safe deliveries. H&HN: Hospitals & Health Networks, 78(11), 56-60. Retrieved February 13, 2007 from EBSCOhost database. Central Intelligence Agency, (2006, June 13). The World Fact Book: Rank order, infant Mortality rate. Retrieved January 24, 2007, from https://www.cia.gov/cia/publications/factbook/rankorder/2091rank.html Centers for Disease Control and Prevention, (2003, February). Pregnancy-related mortality surveillance: United States, 1991-1999. Morbidity and Mortality Weekly Report, 52. Retrieved January 25, 2007 from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5202a1.htm Centers for Disease Control and Prevention, (2001, March-April). Ignaz Philipp Semmelweis (1818-65) Emerging Infectious Diseases 7(2). Retrieved January 25, 2007, from http://www.cdc.gov/ncidod/eid/vol7no2/cover.htm Centers for Disease Control and Prevention, (1998, September 4). Maternal mortality: United States, 1982-1996. Morbidity and Mortality Weekly Report, 47(34). 705-7. Retrieved January 24, 2007, from http://www.cdc.gov/mmwr/preview/mmwrhtml/00054602.htm Centers for Disease Control and Prevention, (1993, April). Rates of cesarean delivery: United States 1991. Morbidity and Mortality Weekly Report, 42(15), 285-289. Retrieved January 25, 2007 from http://www.cdc.gov/mmwr/preview/mmwrhtml/00020285.htm Citizens for Midwifery, (2002, February 11). “Planned” home birth study misrepresented in the press. Retrieved January 24, 2007, from http://www.mana.org/WAHomeBirthStudy.pdf The Coalition for Improving Maternity Services, (2003). Problems and hazards of induction of labor: A fact sheet. Retrieved January 26, 2006, from http://www.motherfriendly.org/Downloads/induct-fact-sheet.pdf Declercq, E.R., Skala, C., Corry, M.P., Applebaum, S., Risher, P., (2002, October). Listening to mothers: Report of the first national U.S. survey of women’s childbearing experiences. Maternity Center Association, New York. Retrieved February 15, 2007 from http://www.childbirthconnection.org/article.asp?ck=10397 Doubleday, J. (2005). The unequivocal safety of home birth. Retrieved February 11, 2007, from http://www.spontaneouscreation.org/SC/NWNM2006/ TheUnequivocalSafetyOfHomeBirth.htm Dress, C., (2005). Record high cesarean rate in USA contradicts best practices for birth. Medical News Today. Retrieved January 25, 2007, from http://www.medicalnewstoday.com/medicalnews.php?newsid=34017 Druley, L., (June, 1998). The Childbirth Monopoly. Mother Jones. Retrieved January25, 2007, from http://www.motherjones.com/commentary/columns/1998/06/druley.html Enkin, M., Keirse, M., Renfrew, M., Neilson, J. (1995). A guide to effective care in pregnancy & childbirth (2nd ed.). Oxford. Oxford Medical Publications. Gibson, F., (n.d.). Comprehensive review & critique on the Pang-Benedetti study on home-based birth. American College of Community Midwives. Retrieved January 24, 2007, from http://collegeofmidwives.org/news01/ACOG%20%20Hm%20Brth%20Study%20Aug%2002.htm Gibson, F., (2003). Critique of broader issues in obstetrical care: The final frontier. Safe maternity practices for the 21st century. American College of Community Midwives. Retrieved January 24, 2007, from http://www.collegeofmidwives.org/ Citations%20or%20text%2002/Dr%20Brothers%208-page%20critique%2003.htm Gibson, F., (2006). The official plan to eliminate the midwife: 1900-1930. Part I. The story of the hundred year war against midwives. The American College of Community Midwives. Retrieved January 25, 2007 from http://www.collegeofmidwives.org/safety_issues01/rosenbl1.htm Gibson, F., (2006). The official plan to eliminate the midwife: 1900-1930. Part II. Motives of the medical establishment for the suppression of independent midwifery. The American College of Community Midwives. Retrieved January 25, 2007 from http://www.collegeofmidwives.org/safety_issues01/rosenbt2.htm Goer, H., (2002). The assault on normal birth: The OB disinformation campaign. Midwifery Today, Autumn,10. Retrieved January 26, 2007, from http://www.midwiferytoday.com/articles/disinformation.asp Goer, H., (1995). Obstetric myths versus research realities: A guide to the medical literature. Westport, Connecticut. Bergin & Garvey. Haire, D., (2001). FDA approved obstetrics drugs: Their effects on mother and baby. Alliance for the Improvement of Maternity Services. Retrieved February 2, 2007 from http://www.aimsusa.org/obstetricdrugs.htm Healy, B., (2006, June). Birthing by appointment. U.S. News and World Report. Retrieved January 24, 2007 from http://www.usnews.com/usnews/health/articles/060612/12healy.htm International Cesarean Awareness Network, (2004, March). ICEA Position statement and review: Cesareanbirth and VBAC. International Journal of Childbirth Education, 19(1), 31-40. Retrieved February 12, 2007 from EBSCOhost database. Irwin, S., Jordan, B., (1987, September). Knowledge, practice, and power: Court-ordered cesarean sections. Medical Anthropology Quarterly, Special Issue on Obstetrics in the United States 1(3) 319-334. Retrieved January 25, 2007 from http://www.lifescapes.org/Papers/COCS%20Hahn%201987.htm Johanson, R., Newburn, M., Macfarlane, A., (2002). Has the medicalisation (sic) of childbirth gone too far? British Medical Journal, 324(7342), 892–895. Retrieved January 28, 2007, from http://www.pubmedcentral.gov/articlerender.fcgi?artid=1122835 Johnson, K.C., Daviss, B., (2005, June 18). Outcomes for planned homebirths with certified professional midwives: Large prospective study in North America. British Medical Journal, 330(7505), 1416. Retrieved January 23, 2007 from http://bmj.bmjjournals.com/cgi/reprint/330/7505/1416.pdf Kristof, N., (2006 January). Health care? Ask Cuba. Op-ed piece, New York Times. Retrieved January 25, 2007 from http://www.nytimes.com/2005/01/12/opinion/ 12kris.html?ex=1263272400&en=c7ea472ff9651976&ei=5090 Keefe, C., (2001). Overview of maternity care in the U.S. Citizens for Midwifery. Retrieved February 2, 2007, from http://www.cfmidwifery.org/pdf/OverviewofMatCareApr2003.pdf Lamaze International, (2005). Non-Supine (e.g., upright or side-lying) positions for birth. Care Practice Papers. Retrieved February 12, 2007, from http://www.lamaze.org/MediaProfessionals/CarePracticePapers/tabid/90/Default.asp Lamaze International, (2006). The problem with ‘maternal request’ cesareans. Retrieved February 12, 2007, from http://www.lamaze.org/institute/advancing/docs/elective_cesarean_ethics.pdf MacCorkle, J., (2003). Homebirth under fire: What the headlines don't say. Mothering,117(March/April). Retrieved February 2, 2007 from http://www.mothering.com/articles/pregnancy_birth/homebirth/under-fire.html Murkoff, H., Eisenberg, A., Hathaway, S., (2002, April). What to expect when you’re expecting, (3rd ed.). New York, NY: Workman Publishing Company. Pang, J., Heffelfinger, J., Huang, G., Benedetti, T., Weiss, N., (2002). Outcomes of planned home births in Washington State: 1989–1996. Obstetrics & Gynecology, 100. 253-259 Physician’s Desk Reference, (2003 February). CYTOTEC® (Searle) misoprostol tablets. Retrieved February 2, 2007 from http://www.drugs.com/data/_pop3 .cfm?htm=76000319.htm&bn=MISOPROSTOL&pageid=0&&pop=1 Rubin, R., (2003). More moms opt to go c-section births, study finds. USA Today. July 21, p. 5d. Retrieved February 2, 2007 from http://www.usatoday.com/news/health/ 2003-07-20-cesarean_x.htm Rubin, R., (2006 March). ‘Increasing intervention' shifting births earlier: A few weeks has a big effect. Electronic version, USA Today. Retrieved February 15, 2007 from http://www.findarticles.com/p/articles/mi_kmusa/is_200603/ai_n16233838 Stewart, D., (1981). The five standards for safe childbearing. The case for homebirth. Marble Hill, MO: Napsac Reproductions. Strong, T., (2001). Expecting trouble: The myth of prenatal care in America. New York and London: New York University Press. Thornton, P., (2006, April 8). New study confirms cesarean risks. Medical News Today. Retrieved February 2, 2007 from http://www.medicalnewstoday.com/medicalnews.php?newsid=41247 Tillett, J., (2005, April-June). Obstetric rituals: Is practice supported by evidence? Journal of Perinatal & Neonatal Nursing, 19(2), 91-3. Retrieved February 2, 2007, from Ovid database. Tuteur, A., (1994). How your baby is born. Ziff-Davis Press, California. Retrieved electronic chapters February 7, 2007, from http://www.askdramy.com/ U.S. Food and Drug Administration, (2005, May). Misoprostol (marketed as Cytotec) information: FDA alert–Risks of use in labor and delivery. Retrieved February 2, 2007 from http://www.fda.gov/cder/drug/infopage/misoprostol/default.htm Vedham, S., (2003 March). Home birth versus hospital birth: Questioning the quality of the evidence on safety. Birth, 30(1). 57-63. Retrieved February 11, 2007 from EBSCOhost database. Villagran, L., (2006 June). A different path for childbirth: Growing number of women choose nurse-midwives to deliver their babies. ABC News. Retrieved February 2, 2007, from http://abcnews.go.com/Business/BusinessOfLife/story?id=2042314&page=1 Wagner, M., (1994). Pursuing the birth machine: The search for appropriate birth technology.Camperdown, NSW, Australia. ACE Graphics. Wagner, M., (2003). Revealing the real risks: Obstetrical interventions and maternal mortality. Mothering, May/June(118) 48. Retrieved February 2, 2007 http://www.mothering.com/articles/pregnancy_birth/birth_preparation/risks.html Walsworth, D., French, L., (1998 December). Minimizing trauma to the genital tract in childbirth. Journal of Family Practice, 47(6). 411-2. Retrieved February 8, 2007, from http://www.findarticles.com/p/articles/mi_m0689/is_6_47/ai_53509876 Weaver, S., (2006, February). FPIN's clinical inquiries: Vaginal misoprostol for cervical ripening in term pregnancy. American Family Physician, 73(3). Retrieved February 14, 2007 from http://www.aafp.org/afp/20060201/fpin.html World Health Organization, (2004). Maternal mortality in 2000: Estimates developed by WHO, UNICEF, and UNFPA. Retrieved February 8, 2007 from http://www.who.int/reproductive-health/ publications/maternal_mortality_2000/index.html by Kim Wildner
The circumcision debate seems to me to be one of ethicality. In the United States, female circumcision, also often referred to as “female genital mutilation” or FGM, is vehemently denounced, while infant male circumcision is just as adamantly defended. I would suggest that it is only cultural perception that allows a person to view one a violation of human rights, the other a rite of passage or acceptable religious imperative. The two procedures are really not as dissimilar as one might think. Both remove a part of the reproductive anatomy of a child who is too young to give informed consent. In both cases, the parts removed reduce sexual sensation and to one extent or another impair normal physiological function. The parts remove existed for physiological purpose, but were removed due to ignorance of these functions, or due to aesthetics and/or collective cultural or religious beliefs. Both are painful. In neither case is anesthetic usually used. What makes it abhorrent in one case should argue against the practice in both cases. However, infant male circumcision is still one of the most common surgeries in the U.S. (Stang & Snellman, 1998). Where FGM is practiced, in Africa and the Middle and Far East, defenders insist that Westerners just don’t understand. Women will not be marriageable if they are not circumcised, as they will be unclean and no husband will want a wife that looks different from the cultural norm. They are indignant that arrogant Americans would try to stop something that is required of them in accordance with their understanding of their religious practices (World Health Organization, 2000). When routine infant male circumcision discussion occurs between parents in the States, the debate is often heated. Defenders of the practice, usually parents who have circumcised or plan to, accuse anyone who opposes circumcision to be unfairly biased. The same people who might consider FGM barbaric consider the same procedure on a baby boy a ‘parenting option.’ Yet the most common reasons for choosing circumcision for a baby boy are essentially the same: · I want my son to look like his father · I think uncircumcised penises are ugly · It’s cleaner · It doesn’t hurt; babies can’t feel pain. Even if they did feel pain they won’t remember a ‘little snip’ · Religious reasons (oddly enough, often by Christian, not Jewish, parents) Are not the first two simply variations on the argument for conformity with the cultural norm? The circumcised penis as ‘normal’ is so ingrained in our society that many anatomy textbooks don’t even show natural penises; they show circumcised ones as ‘normal.’ Even so, this is not justification for what amounts to baby’s first plastic surgery. We don’t reconstruct a baby’s nose if it doesn’t look like his father’s. If his father has an accident that results in amputation of a finger, we don’t remove the baby’s finger so they match. Surely, more people are likely to see his nose or hands than his penis. According to the American Academy of Pediatrics, routine circumcision has no medical justification, although at one time it was recommended as was female circumcision, and for the same reasons (Rathmann, 1959). A natural penis is no harder to clean than the female labia (Fleiss, 1997). To suggest that boys cannot be taught personal hygiene of the body they were born with is, in my opinion, insulting. The argument that amazes me the most though, is that babies cannot feel pain, or that if they do, they don’t remember it so it doesn’t matter. For those that insist it doesn’t hurt, I offer a video that is available on the internet (Intact, n.d.). Some say, “I don’t think I could stand to watch that.” It is too painful for them, as adults, to watch, but not too painful for their son to experience when he’s just hours old? If babies do feel pain but can’t remember, are other sources of unnecessary pain acceptable? I would argue that lit cigarette butts to the feet of a newborn certainly are painful. While the incident may not consciously be remembered it is still a repugnant and vile abuse. Cultural acceptance doesn’t make circumcision hurt any less, and it doesn’t restore the functionality of the organ. The inconsistency in attitudes is simply not justified. Either it’s an abuse of little girls and boys, or it’s a simple parenting option. Resources: Fleiss, P.(1997). The case against circumcision. Mothering, 85(Winter). Retrieved February 2, 2007, from http://www.mothering.com/articles/new_baby/circumcision/against-circumcision.html Intact. Circumcision Video. Retrieved February 2, 2007, from http://www.intact.ca/video.html Rathmann, W. (1959, September). Female circumcision: Indications and a new technique. GP(XX) 3, 115-120. Retrieved February 2, 2007, from http://www.noharmm.org/femcirctech.htm Stang, H., Snellman, L. (1998, June 6). Circumcision practice patterns in the United States. Pediatrics (101)6. Retrieved February 2, 2007 from http://pediatrics.aappublications.org/cgi/content/full/101/6/e5 World Health Organization, (2000, June). Fact sheet N°241. Female genital mutilation. Retrieved February 2, 2007, from http://www.who.int/mediacentre/factsheets/fs241/en/ by Kim Wildner
When Ricki Lake appeared on The View at the time of the release of The Business of Being Born, Barbara Walters that interested me. Lake is explaining how having a natural birth at home with midwives empowered her. Walters is confused by that. This started me thinking about how many women do (or don’t) take childbirth classes and why that might be. Of course, partially that is because at the time I had a poll on my blog asking people if they took classes and why or why not. At the time of this writing, 52% did not take a class, and most respondents who didn’t take class said it was because they didn’t need one. Of course, you know I’m going to ask ‘why’ next, right? Did they feel they didn’t need one because they figured they’d blindly trust whatever their OB told them? Did they not understand the purpose of a childbirth class? (Hint, it has nothing to do with ‘breathing’…you must know how to breathe already or you’d be dead and I hate to say it, but there is no magic breath that gets babies out.) Did they have a midwife as a caregiver, and had everything explained to them (and had actually helpful books recommended to them so they could educate themselves) so that a childbirth class was redundant? Did the non-hospital childbirth classes not market themselves well? It was this last question that was on my mind when Maslow’s Hierarchy of Needs came up in conversation. Now, this pyramid of needs has tickled the back of my brain on and off periodically. This time, I realized why it kept bothering me. First, a nice visual of Maslow’s theory can be found following this link. The basic idea is that when we make a decision about something, these are the factors that will motivate us. First, we are concerned with survival issues. If our basic needs are not being met, we don’t really care about the other stuff. Next, we need to know we are safe and secure. We need some order in our life, some predictability and to be part of a larger whole. This is also about survival to a certain extent. Being part of the larger group is an evolutionary desire. We are tribal by nature. Solitary humans don’t do well, not just because we need others to be most effective at hunting, gathering, farming, etc., but we need social stimulation for the sake of our brains. If we don’t interact, we go a little bit nutty. Think of the movie Cast-a-way with Tom Hanks. Beyond that even, we need to fit in with our family, peer and work groups. We have a need to feel appreciated and loved. We can survive if the only the first two needs on the pyramid are met, but without the third, we probably would be slightly maladjusted. Next, we have the need to feel special. We want to feel respected and to be able to feel pride in our accomplishments. Finally, we reach a state of enlightenment or our full realized potential. Some say not many of us get to that point. Ok, so how does this relate to birth, childbirth classes and Barbara Walter’s bewilderment? Here’s my theory: Most American women are still making decisions at the first two or three levels. They believe birth is a dangerous, excruciating medical event. They want to be able to predict exactly what will happen each step of the way, even if the security is an illusion. If they do what every body else does, not only can they have a plan, but its familiar because it’s what everyone they know has done. They are following a blueprint. Sadly, because they do what everyone else does, they get the experience everyone else got, which is likely the painful medical event. But that’s ok with them, because they all have the same war story to tell. They fit in. They also get admiration for ‘surviving’ such a harrowing event. Those of us who make the decision to birth at home, or who take a class that advertises gentle and empowering birth, are doing so because we are not operating from a place of fear. Make no mistake I am NOT saying we are ‘better’ or ‘higher’. I’m saying because we are confident that we are safe, and our babies are safe, we are not operating from survival need. Because we know what the research says BIRTH is safe, we are not operating at security need. Hence OUR confusion when someone says, “You birthed at home? Oh, you are so brave! I could never do that!” We, of course, are thinking, “Sure you could.” We don’t consider ourselves brave at all. We are just doing what makes sense, personally and per the evidence. We are working from the ‘esteem’ level, because we can. We feel a need for a sense of accomplishment like anyone else. We feel a need to be respected by our spouse or our home-birthing friends and to feel unique. Now, we all have these needs, but what I’m saying is that we can make our birthing decisions from this level because we don’t have to worry about the first three needs. To try to empower a woman who is operating at a survival or security level will not work. She has other things to worry about. Not to mention, if she is in an unsafe environment, or doesn’t have access to nutritious food, or is in some way actually not healthy, she actually is at risk for complications, which means she’s operating at exactly the level at which she needs to be operating. This is why it is absurd when people say homebirth supporters are trying to ‘make people feel guilty’. Even the most strident homebirth advocates realize hospital birth is the only place to be for about 10-15% of women. Homebirth should be an option because it’s safe, not because it’s right for everyone. Think about it like this: You feel education is important. You improve the schools, and you make attendance mandatory. But one kid just doesn’t seem to care. He is often truant, and when he is there he doesn’t make much of an effort. You try to tutor him. You try special classes. You try rewards and punishments, but nothing works. He just doesn’t seem to value education. What if you found out the kid was homeless? What if he’s being beaten at home, or doesn’t get to eat every day? What if he was convinced he was worthless because he was told he was, every day? If you met the more basic needs, from the bottom up, he might be more interested, and able, to operate at a higher level on the needs hierarchy. Otherwise, he simply can’t. He has to meet his basic needs first. So, when we talk to women about the empowerment of natural birthing, they are confused. Sometimes they’re angry, but they may not be sure why. I believe it is because there is cognitive dissonance because on some level they know that the fear they feel is disproportionate to the actual risk. Because there is someone who doesn’t feel that same fear, it makes them question why they have it. Not consciously, of course, but if they become aware that some women can birth with dignity, comfortably, maybe painlessly, even ecstatically, and still be safe, but they believe that they must sacrifice all that for safety, it suggests that their suffering was for nothing. That’s not a comforting idea. It would make me angry too. This brings us to the question of how we can help them meet their needs so they can feel the ecstasy and empowerment we know is so transformative. Right now they don’t even care about that. You don’t know what you’re missing if you’ve never had it. You won’t even try for it if you don’t believe it’s really possible for you. Can you see how bubbling over with enthusiasm about your positively transformational birth experience comes across as lunacy to someone who is convinced they “would have died” if they’d done what you did? It doesn’t matter if it’s true or not, it’s what they believe. It doesn’t matter if they had an epidural that caused a sudden drop in blood pressure, that caused fetal distress that required a cesarean that saved their life. The only part of that equation that is important is the last part. It doesn’t matter that the medical management of their birth lead to the problem in the first place. What matters is the medical management saved their life…and it did. It doesn’t matter that they almost died of hemorrhage due to an elective cesarean, what matters is that modern medicine saved their life. Undoubtedly it did. It doesn’t matter that their baby almost died from a cord prolapse that coincidently happened just after artificially rupturing the membranes. What matters is that modern medicine saved their baby from certain death. It did. And because they are operating at that place of survival, it makes sense that is what they would focus on, it’s what’s important. They aren’t even going to question it unless they are operating from the 4th level. If they are, they are going to wonder how things got so askew. Many do. These are the women who have a couple of horrible experiences and then come to a HypnoBirthing class. Or, the women who hire CNM for VBACs after questionable cesareans. Or, the woman who has seen several of her friends suffer from birth-related PTSD who decides to explore the option of homebirth. No one is right or wrong; they are just making decisions based on their individual needs as they perceive them based on their own experience and beliefs. It's a theory anyway. The Factual Truth About Epidurals: Are they really harmless?
by Kim Wildner The January 11, 2012 Slate.com article The Truth About Epidurals: Are they really so bad? by Melinda Wenner Moyer concludes with this paragraph: "Women shouldn’t cave to pressure from either side." [Of the 'mommy wars' between natural birth advocates and pro-epidural advocates] "They should make informed decisions based on their goals and priorities. I aspired to have a comfortable birth even if it meant being surrounded by nurses and doctors and tubes and incessant beeps; other women may trade pain for a more intimate birthing experience. Each choice comes with its own benefits and unpleasantries. My unnatural childbirth left me with a memory that does not involve intolerable pain, and that’s exactly what I wanted." I’m concerned about this piece for a number of reasons, but the most significant are summed up in this paragraph, so I’d like to start here. I agree that women should make their own best and informed decisions. I object to the continued polarization of ‘us’ and ‘them.’ I also disagree with the characterization of the options as choices between benefits and ‘unpleasantries.’ This minimizes that in consideration of birthing options we must weigh benefits and risks. This includes risks to babies as well as ourselves. Thus, while the decisions very well may be based on ‘goals and priorities’ I would argue that the highest priority must be the health and well-being of the mother-baby dyad. Reducing the choice to that of comfort vs. an 'intimate' experience ignores that many women choose natural birth not because of the 'experience' but to minimize risk. Every intervention was introduced for a valid reason and when used appropriately, has the potential make a difficult birth better. That does not mean every intervention is appropriate for every situation. When used inappropriately, every intervention has the potential to also cause problems. This includes epidurals and other labor drugs. To suggest otherwise and is disingenuous...and a huge disservice to those trying to make an informed decision. I spent hours trying to look up the studies that the author mentioned but failed to cite. I did not find her references, but she was correct in her assertion that the evidence is ‘inconclusive.’ The vast majority of studies do say that rates of surgical deliveries increase due to a multitude of reasons involving epidurals. A handful suggested otherwise. So I went to The Cochrane Collaboration, the largest independent collection of available medical studies, encapsulated in A Guide to Effective Care in Pregnancy and Childbirth. This source states, “In women with epidural analgesia, both the first and second stages of labor are longer, and oxytocin use, malrotation and cesarean sections are more frequent.” (Enkin, et al p. 291) The Cochrane Collaboration last updated in 2011 states: "The review identified 38 randomised controlled studies involving 9658 women. All but five studies compared epidural analgesia with opiates. Epidurals relieved labour pain better than other types of pain medication but led to more use of instruments to assist with the birth. Caesarean delivery rates did not differ overall and nor were there effects of the epidural on the baby soon after birth; fewer babies needed a drug (naloxone) to counter opiate use by the mother for pain relief. The risk of caesarean section for fetal distress was increased. Women who used epidurals were more likely to have a longer delivery (second stage of labour), needed their labour contractions stimulated with oxytocin, experienced very low blood pressure, were unable to move for a period of time after the birth (motor blockage), had problems passing urine (fluid retention) and suffered fever. Long-term backache was no different. Further research on reducing the adverse outcomes with epidurals would be helpful." (Anim-Somuah, Smyth & Jones, 2011) Cesarean rates did not increase overall, but risk of cesarean section for fetal distress was increased? The experience of very low blood pressure often leads to fetal distress which leads to surgical birth. If a complication can be directly attributed to the epidural, and it leads to emergency surgery, is the surgery then considered due to a medical complication instead of the epidural, even though the complication would not have occurred in the absence of the epidural? If a study does not compare natural birth to medicalized birth, how can any conclusions be drawn about how the interventions impact a birth? And does it matter if the research is possibly tainted by special interests anyway? Dr. Marcia Angell, the Editor of the New England Journal of Medicine, said in 2009: "It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine." (Angell, 2009) When looking at the evidence in trying to make a decision as important as that regarding the long term health of our children, this should lead consumers to ask: Where is the funding for a coming from and who is performing it? Who loses revenue or might be out of a job if tools like epidurals are used sparingly? I hear a lot of disparaging remarks about natural birth advocates, but what do they have to gain by questioning the safety of labor drugs? Wenner Moyer suggests that we compare the objective evidence with “...the reassuring words of obstetricians and anesthesiologists who tout epidurals as being completely safe.” What makes her think that her doctor or anesthesiologist is making a recommendation on scientific evidence anyway? Reading the summary of ACOG recommendations for suspected fetal macrosomia (big baby) 2/3 of obstetrical recommendation not evidence-based! (Chatfield, 2001) A Guide to Effective Care in Pregnancy and Childbirth reveals this is hardly unusual. If we are only asking ‘Do epidurals effectively reduce or eliminate pain?’ and ‘Is there 100% consensus on safety?’ Wenner Moyer’s article addresses those questions. That is also providing that the only thing one is concerned about is whether the mother will end up with a surgery that has a 5 times greater mortality (death) rate than natural birth. But what about other consequences of epidurals? And what about just a little bit of plain old common sense. My best fell down a flight of stairs at 40 weeks, 4 days. At the hospital it was determined her baby was fine, but she had a broken tailbone. She asked for something for the pain and was told there was nothing they could give her that was safe for the baby. BUT if they would just let them induce her, she could pain relief. She asked them to just give her what they would give her in labor. If it would help then, why couldn’t it help now? They refused. She asked, ‘You can create pain with an induction and give me something for the pain you create, but you can’t give me the same drug for the pain I’m in? What kind of sense does that make?” They couldn’t answer that. She declined to be induced. If any mother were to test positive for a narcotic or cocaine, do you think there would be negative consequences? If a mother who had an epidural would have in her body a 'caine derivative, lidocaine, not approved by the FDA for use in pregnancy, labor, delivery or lactation, but used none-the-less. Or she might have narcotics like Stadol or Mepergan, also not approved for use in labor, but used often. Again, a drug is a drug is a drug and the effects are the same. It doesn’t change because it’s administered by a nurse or anesthesiologist. Stating the obvious does not mean that an epidural is never helpful or necessary. Stating the facts is not guilt inducing any more than stating that grass is green should make someone who is colorblind feel guilty because they see it as yellow or blue. The fact is grass is still green. This brings me to the notion that birth is always excruciating. If the debate is framed in such a way as to present the only choice as excruciating pain or completely safe numbness, it would seem crazy to opt for natural birth as opposed to risk-free drugs. Except that that isn’t being honest and those aren’t the only options. As a HypnoBirthing® instructor with more than 20 years experience in childbirth I expect a birth to fall somewhere on a continuum: A few ecstatic and/or orgasmic; about 30% painless without drugs; the vast majority mostly comfortable with either manageable discomfort or complete comfort throughout until the last hour or so; some that are painful, but empowering instead of insufferable; a few epidurals; a few cesareans. Some women will be upset with a 45 minute labor. Some will be perfectly happy with 3 days back labor ending in a cesarean. Interpretation of circumstance is what we make of it. Perception is reality. When women are confident that they are fully capable of making the best decisions for themselves no matter what situation is presented, because they made their decisions on the actual events specific to them and not an imagined potential reality, they do not feel a need to defend their decision. What I teach is evidenced-based and geared toward that end, but it still won’t be applicable to every child, mother or family. I advocate for natural birth and breastfeeding because of the benefits it conveys. It makes life easier, MOST OF THE TIME if we do not try to fight nature. But if it is not benefiting the mother and baby, or if the mother just does not want to avail herself to the benefits and prefers to create difficult situations, that is her prerogative. I don’t think it’s fair, to say of excruciating, dysfunctional labor, ‘this is what birth always is’ when so many difficulties are created, not encountered. Parenting comes with enough challenges without having to deal with ones that might have been avoided! One of the best ways to avoid the pitfalls is to take an independent childbirth class. Each year, 1 million out of 4 million birthing women will take a class at all. Of those that do, most will take a ‘prepared childbirth’ class offered by their hospital. I’ve taught those classes, and I can tell you they exist to make life easer for the hospital, not the parents. Think about it: If “60-80 percent of first-time pregnant American women’ get epidurals do, as Wenner Moyer suggests, then the classes are doing a pretty poor job of preparing anyone for anything other than when to get their epidural. I pass on evidence-based information for those that want it. In doing so I hope to make life easier for women, babies and families. But if the evidence-based isn’t easier, or possible, or simply not wanted, ignore it. Because ultimately, the key to ending the phenomenon we know as ‘The Mommy Wars’ is to make your own best decisions based on all the (independently verifiable) information available at the time, tempered with commonsense based on individual situations. No one else lives your life. No one else is responsible for the consequence of your actions. It doesn’t matter what you do, someone is going to think you are doing it wrong. The key to not letting that bug you is to be sure of your decisions, and know WHY you are making them. If it’s something someone else considers unsafe, like home birth in my case, make damn certain you know it IS safe, at least for your situation. That way if someone does accuse you of being a bad parent, you can actually use it as a teaching moment instead of getting your knickers in a twist. AIMS. (Alliance for the Improvement of Maternity Services): Drugs not FDA approved for obstetrics http://www.aimsusa.org/ObstetricDrugs-NotApproved.htm Angell,M., 2009. Drug Companies & Doctors: A Story of Corruption. The New York Review of Books. http://www.nybooks.com/articles/archives/2009/jan/15/drug-companies-doctorsa-story-of-corruption/ Anim-Somuah M, Smyth RMD, Jones L., 2011. Cochrane Supparies: Independent high-quality evidence for health care decision making. Epidurals for pain relief in labour. http://summaries.cochrane.org/CD000331/epidurals-for-pain-relief-in-labour Chatfield, J., ACOG Issues Guidelines on Fetal Macrosomia, Am Fam Physician. 2001 Jul 1;64(1):169-170. Retrieved from http://www.aafp.org/afp/2001/0701/p169.html Enkin, M., Keirse, M., Neilson, J., Crowther, C., Duley, L., Hodnett, E., Hofmeyr, J., A Guide to Effective Care in Pregnancy and Childbirth, 3rd edition, 2000. Oxford University Press, USA. Wenner Moyer, M., 2012. The Truth About Epidurals: Are they really so bad? Posted Jan. 11, 2012, at 3:28 PM http://www.slate.com/articles/health_and_science/medical_examiner/2012/01/the_truth_about_epidurals.html Kim Wildner is the author of Mother’s Intention: How Belief Shapes Birth and creator of Fearless Birthing™, workshops designed to assist birth-workers in facilitating evidence-based decision-making in their clients. She has been published in a number of birth related trade journals and spoken internationally with her latest speaking engagement at National University Hospital in Singapore. Wildner has more than 20 years experience in childbirth education and passed the North American Registry of Midwives (NARM) exam in 1993. She has been a HypnoBirthing® Certified Educator for over 10 years and holds a BA in Organizational Communications. A New Year, a new blog!
Well, sort of. This is a continuation of a blog I had for a long time, a long time ago. That blog had a ton of content that I'm too lazy to try to move, so you can find it here: Fearless Birthing Blog I'm not sure I'm all about the new interface though, so we'll see how it goes. |
AuthorMy name is Kim Wildner. I am the author of Mother's Intention: How Belief Shapes Birth. Categories
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