Wednesday, May 30, 2012

No pre-natal care = disaster

I caught a few episodes of TLC's I Didn't Know I Was Pregnant today. I have always found this 'not knowing' fascinating since I was so involved in my pregnancies. I realize my situation was vastly different as in most cases of this show, these women believed they could not get pregnant either through some form of infertility or by use of birth control while I was actively trying to conceive in the 7 year span it took us to have our children. I am not disputing the inability of knowing one is pregnant, what I found perplexing while watching this program was the frequent OBGYN MD appearances in which they explained certain medical situations and the issues surrounding them. The most common thing they said was that a pregnancy that did not have pre-natal care would likely have disastrous consequences. I found this mind-boggling, the implication that going to a doctors visit every month for nine months guaranteed a healthy pregnancy and outcome. Do not misunderstand me, pre-natal care is important in terms of fetal monitoring, maternal monitoring and ensuring the health and safety of the mothers choice of delivery; however, depending on the level of treatment a mother allows from their provider- certain issues may never be discussed. Some mothers wish to forgo certain maternal tests for Group B Strep, Gestational Diabetes and even some ultrasounds. Other mothers choose to forgo fetal testing which include scanning for Downs Syndrome and other fetal abnormalities which may be the least invasive form of ultrasound to the more invasive amniocentesis. In these cases, where mothers make educated and informed choices to opt out of testing and scans, there is little that a care provider is doing for them. All pre-natal screening can do is tell you if something is wrong and how to fix it, it can not guarantee you a healthy baby with all ten fingers and all ten toes. These instances of complications with fetal development are unique to mothers environment, genetics and diet. I find it perplexing that this show allows for so much fear mongering in that women who deliver (often) at home are in great danger and if they had not had this magical pre-natal then they are doomed. What these opinions exclude is that a healthy woman with an uncomplicated delivery will usually produce a healthy baby during a healthy natural birth process. This is part of the problem with how Americans perceive birth in this country, the media leads us to believe that doctors are absolutely essential in providing happy outcomes with birth and that women are incapable of creating, nurturing and delivering healthy babies on their own. We have bought too blindly into this mass produced hospital birth model as what is best, without asking our own questions. What we need to unravel from this fear is that birth is not truly the mystery we believe it to be, it is the most natural human process and is absolutely essential to the survival of our species. It could never be so complicated we could not manage it or it would defeat the process of our own evolutions. OBGYN care is a speciality within a specialty, it should be isolated to women who are in need of more complex treatment and management of other conditions either pre-natal or strictly maternal. The average mother does not require this slew of medical management in order to deliver a baby. When watching these programs, I advise it is done so with a grain of salt, any salesmen will say what benefits him most, this is no different for one of the largest for-profit enterprises in medicine, the OBGYN MD.

Friday, May 25, 2012

A Timeline of Midwifery

Stone relief from Isola Dell’ Sacra, Ostia, 1st century CE

I love this website, though it doesn't go back as far as I had hoped, it does provide a solid history of midwifery since the 18th century. Midwifery is actually older than  modern medicine and is considered the second oldest profession in the world. It can be difficult to find straight historical midwifery information on the internet, when I found this resource I practically jumped up and down and read like a rabid animal. 

I am still looking for a complete resource that dates before the Common Era. This one is too long to post here but you should check it out! The history of midwifery is fascinating.

Home Birth on the Rise!

After falling for 14 years, the percentage of home births in the US from 2004 to 2009 rose by 29% to the highest level since data collection on this began in 1989. However, although this looks like a big surge, the overall proportion of American women giving birth at home is still low: in 2004 only 0.56% of births were at home, rising to 0.72% in 2009.

The latest statistics on American home births appears in the January 2012 National Center for Health Statistics Data Brief, from the US Centers for Disease Control and Prevention (CDC).

The increase is widespread across the country although there are large regional variations, perhaps due to differences in state laws on midwifery practice and births outside hospital.

Another reason could be because of the large differences in racial and ethnic composition among states, since the surge in home births is largely driven by a 36% increase for non-Hispanic white women. About 1 in 90 births to this group of women is now at home, which is about three to five times higher than for any other racial or ethnic group.

Women may choose to have their baby at home instead of the hospital because they want a low-intervention birth in a place they are familiar with and where they can have their family and friends with them. Cultural or religious concerns, lack of transportation in rural areas, and the higher cost of hospital births (a home birth costs about one third as much as a hospital birth) could be other reasons.

The report finds that home births are more common among women aged 35 and over, and among women with several previous children.

The report also says most American women choosing to give birth at home have a lower pregnancy risk profile than those giving birth in hospital. Compared to hospital births, there are fewer teenagers or unmarried women choosing home birth, and fewer preterm, low birthweight and multiple births occuring at home.

The authors suggest one reason could be that midwives and other birth attendants are getting better at deciding which women are less likely to have complications giving birth at home.

According to research, most home births are intentional or planned, whereas most non-home births are usually because there is an emergency, such as early labor, inability to reach the hospital in time, or because of labor complications. This appeared to be reflected in data from 26 states (covering 50% of US births), which showed 87% of home births were planned in 2009.

The American College of Obstetricians and Gynecologists (ACOG) does not support planned home births because they believe "hospitals and birthing centers are the safest setting for birth". However, in an opinion statement released in 2011, their Committee on Obstetric Practice said it "respects the right of a woman to make a medically informed decision about delivery", and women enquiring about planned births should be informed of the risks and benefits. Specifically this should tell them that although the risk is low, the most recent evidence shows "planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth".

Written by Catharine Paddock PhD
Copyright: Medical News Today

Ina May in the Media!

Elinor Carucci/Redux, for The New York Times  
This is a long whopper of an article, so I recommend reading it when you have a moment to concentrate, but some highlights especially worth noting on Ina's suggestion that breech doesn't automatically equal c-section. Breech deliveries can be performed safely, as it has been done with the laboring mother pictured above. The Farm midwives still perform breech deliveries on a daily basis, but most doctors and a lot of traditional midwives will not attempt it. A breech baby doesn't mean you need to give up on your goal of a natural birth. This is a great read.  
According to the article in the Archives of Disease in Childhood, researchers have linked an increase risk for obesity in c-section babies over vaginal birth babies. Researchers site that there may be different gastrointestinal processes occurring in the c-section babies that cause this increased rate of obesity. Though there is no dependant clause stating the specifics of the research performed, including and not limited to: baby's diet, feeding schedule and/or the genetic factors of parents and family members.

I question the validity of this study and wonder if the higher rates of obesity in c-section babies are linked to a more mainstream trend in parenting in which babies are formula fed with high frequency and parents often supplement with a cereal/formula bottle and begin solids early. I also wonder how many of these c-sections in question were elective, after failed vaginal births or were repeat cesareans.

As a mother of 3 very active children who were born via 1 emergency and 2 repeat cesareans, I can say that while they're taller than other children, they are no where near overweight and were not large babies, in fact one of my children was premature. Two of my children received breast milk during their first month, one of mine was exclusively formula fed. We never supplemented with cereal bottles and I avoided solids for as long as possible. There seems to be too many errors in this 'study' to make a conclusive statement that c-sections are causing obese babies.