This good news from The Rebecca Project:

“US Marshals agreed to end the routine use of restraints on incarcerated pregnant mothers during labor, delivery, and immediate post delivery.  The US Marshals have also reformed the type of restraints to be used on pregnant mothers during transports.  Any restraint that constricts the belly region of the pregnant offender will be prohibited.

In the US Senate Judiciary Committee report for the committee passage of the Juvenile Justice and Delinquency Prevention Act (JJDPA) reauthorization, language included the prohibition of restraints and shackles on pregnant girls in the juvenile detention centers.”

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Cesarean deliveries, even planned ones, can be traumatic for mother and baby: the woman is unable to feel or see the delivery, the baby doesn’t emerge slowly with time and uterine contractions to prime the lungs for breathing air; the cord is cut immediately and mother and baby separated, often for hours. British doctors and midwives are testing a “natural” cesarean technique that allows the mother and her partner to view part of the delivery and slows the birth process so that the baby emerges with the help of the uterine contractions, just as it would vaginally. “The baby’s shoulders are eased out ‘and the baby then frequently delivers his/her own arms in an expansive gesture,’” Nicholas M. Fisk , an Australian researcher, told Reuters. The baby is then placed on the mother’s chest while the surgery is completed.  Not exactly “natural,” but a step forward.

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On June 23, Amber Craig wrote a long, heartfelt, cogent letter to the president of the American College of Obstetricians and Gynecologists suggesting a reversal of the group’s restrictive policies on vaginal birth after cesarean (VBAC), which have lead hundreds of hospitals and legions of providers to “ban” women who’ve had previous cesareans from giving birth vaginally. ACOG wrote back with statistics and claims that are patently inaccurate. Craig wrote back again correcting the group’s claims with still more citations from the medical literature. If you’re following “VBACtivism” or ACOG’s recent attack on home birth, these letters are a must-read. They’re posted here.

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First, read Madeline Holler’s great Babble essay, “My Illegal Home Birth,” about going underground to give birth in Missouri, where midwives are felons.

Or, rather, were felons. If today’s Missouri Supreme Court decision holds, underground births like Holler’s — in Missouri at least — will be a thing of the past. The state’s highest court ruled 5-2 in favor of upholding a state law licensing certified professional midwives (read about the decision here; for some background on the saga, click here). The state medical society had sued over the legislation and a lower court found in their favor.

If you’re happy and you want to show it, consider a donation to the Friends of Missouri Midwives — they owe lots in legal fees.

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 http://www.ipetitions.com/petition/birthathome/index.html

382 2,451 4,899 signatures and counting..

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Below are two responses to the AMA/ACOG’s resolution to limit women’s autonomy in how, where, and with whom they give birth. The first is from Canadian physician and researcher Andrew Kotaska, the second is from the National Childbirth Trust in England, where the government is encouraging women to consider home birth! More bloglinks and repsonses to come. If you have one you’d like to see posted, send it here.

“ACOG should join the 21st century”

I would invite ACOG to join the rest of us in the 21st century.Modern ethics does not equivocate: maternal autonomy takes precedence over medical recommendations based on beneficience, whether such recommendations are founded on sound scientific evidence or the pre-historic musings of dinosaurs. In the modern age, the locus of control has, appropriately, shifted to the patient/client in all areas of medicine, it seems, except obstetrics. We do not force patients to have life-saving operations, to receive blood transfusions, or to undergo chemotherapy against their will, even to avoid potential risks a hundred fold higher than any associated with home birth. In obstetrics, however, we routinely coerce women into intervention against their will by not “offering” VBAC, vaginal breech birth, or homebirth. Informed choice is the gold standard in decision making, and it trumps even the largest, cleanest, RCT.(randomized controlled trials).

Science supports homebirth as a reasonably safe option. Even if it didn’t, it still would be a woman’s choice. ACOG and the AMA are, by nature, conservative organizations; and they are entitled to their opinion about the safety of birth at home. As scientific evidence supporting its safety mounts, however, (to which BC’s prospective data is a compelling addition) they will be forced to accede or get left behind. The concerning part of this proposed AMA resolution is the “model legislation. ”

If ACOG and the AMA are passive-aggressively trying to coerce women into having hospital births by trying to legally prevent the option of homebirth, then their actions are a frontal assault on women’s autonomy and patient-centered care. Hopefully the public and lawmakers realize the primacy of informed choice enough to justify Deborah Simone’s words: “We don’t need to be angry or even react to these overtly hostile actions from the medical community. We just need to keep doing what we do best; the proof is always in the pudding.”

It is sad to see the obstetrical community still trying to earn itself a wooden club as well as the wooden spoon; if the resolution passes, it is sad to see the politico-medical community helping them.

Andrew Kotaska
Yellowknife

NCT and the Independent Midwives’ Association (IMA) voice concern over actions of ACOG on home birth

NCT and the Independent Midwives’ Association (IMA) today voiced concern at the recent actions of the American College of Obstetricians and Gynaecologists (ACOG), that seek to undermine and threaten American women’s opportunities to give birth at home.

The NCT and IMA call on the ACOG to reconsider their position as a matter of urgency. Following the example of its international counterparts it should consider all available evidence on the benefits and risks of home birth. Women in America should have access to home birth rather than being limited simply to the medicalised model of birth available in US hospitals.

In February this year the ACOG reiterated its long-standing opposition to home births. More recently, the ACOG, introduced a resolution to the American Medical Association (AMA) at their annual meeting. The resolution commits the AMA to “develop model legislation in support of the concept that the safest setting for labor, delivery, and the immediate post-partum period is in the hospital…”.

NCT and IMA are members of the Maternity Care Working Party (MCWP), which advises members of the United Kingdom Parliament on maternity care and services.

Counted among the membership of the MCWP, are the Royal College of Obstetricians and Gynaecologists (RCOG), the UK equivalent of the ACOG, as well as the Royal College of Midwives. These two organisations issued a joint statement in April 2007 on home births which states:

“There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.” (Royal College of Obstetricians and Gynaecologists/Royal College of Midwives Joint statement No.2, April 2007)

NCT and IMA also believe that all women should have access to a home birth and up-to-date evidence-based information that addresses their questions, so they can make the right choice for them.

Home birth should be considered a mainstream option and offered as a regular choice for pregnant women using the health service, whichever country they reside in. For a healthy woman with a straightforward, low-risk pregnancy, home birth is a safe option. It is important that midwives provide care for women at home and that they have experience in home birth, receive active support and supervision, and that their training needs are met. Women’s individual needs must be assessed and the back up of a modern hospital system, with good communication and transport links, are important, should transfer be needed.

The views of the NCT and IMA are supported by UK Government policy which seeks to reduce unnecessary interventions in childbirth and increase the numbers of women who experience a normal birth.

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“Ladies, the physicians of America have issued their decree: they don’t want you having your babies at home with midwives. We can’t imagine why not…”


Click here to read the rest of this Huffington Post opinion co-authored by Jennifer Block, Ricki Lake & Abby Epstein

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Optimal childbirth leads to optimal conditions for breastfeeding (which provides optimal nutrition and immunity for newborns): babies who are born awake and alert, who didn’t have a suction tube put down their throat, who were not induced or scheduled and therefore are breathing with lungs that are fully mature, whose lungs reaped the physiological benefits of vaginal birth, who get immediate skin-to-skin contact with their mother, who are not routinely separated from their mother, and who are born to mothers in relatively good shape (i.e. not recovering from surgery) — these mother-baby pairs are more likely to breastfeed, and breastfeed exclusively. They’re also more likely to breastfeed if their hospital doesn’t give out pacifiers, supplement with formula, or send mom home with freebie formula samples.

But according to a first-of-its-kind survey by the Centers for Disease Control and Prevention, the majority of U.S. hospitals are failing. Nearly 2,700 hospitals and birth centers were surveyed on labor & delivery care, postpartum care, and follow-up care. Hospitals received a mean score of 62 – that would be an ‘F’ in grade school — and birth centers came away with a solid ‘B,’ at 86.

“The findings indicate substantial prevalences of maternity practices that are not evidence-based and are known to interfere with breastfeeding,” says the CDC.

• Nearly one-quarter (24%) of birth facilities reported supplementing the majority of healthy, full-term, breastfed newborns with “something other than breast milk…a practice shown to be unnecessary and detrimental to breastfeeding.”
• 65% told mothers to limit the duration of suckling
• 45% gave pacifiers to the majority of infants
• 70% gave breastfeeding moms “gift bags” with formula samples.

The CDC concludes: “Facilities should consider discontinuing these practices to provide more positive influences on both breastfeeding initiation and duration.” Read the full report here. Want to know more about breastfeeding? Pop into the Breastfeeding Cafe.

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OK magazine and other tabloids are reporting that Angelina Jolie, very pregnant with twins, is awaiting labor with a midwife and two French nurses in Monaco — and hoping for a normal, vaginal birth. Jolie’s first baby was breech and she gave birth by C-section. “She prepared for a natural child birth for Shiloh and was very disappointed when her doctors told her she would have to undergo a Cesarean section,” a friend told OK!.

Women carrying twins in the U.S. have a hard enough time finding a provider willing to support a physiological labor and vaginal delivery. Many women are told they will have to labor in an operating room with a mandatory epidural, and that if either baby is breech they will move to surgery, because most providers now lack the know-how to deliver breech (like Jolie’s first OB).  Women wanting vaginal birth after cesarean (VBAC) are also facing major obstacles, like physicians and hospitals who simply refuse them.

Achieving a supported twin VBAC in the U.S. would be a long, bumpy, uphill battle — maybe even for a celebrity. Did Jolie, like so many C-section moms, try and fail to find a willing provider? Did she encounter hospitals with official VBAC bans? Physicians whose insurance policies prohibit them from delivering twins, or midwives whose licensing regulations prevent them from attending VBACs? Was she pushed to give birth in Europe? Maybe we’ll find out after the twins arrive.

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The New York Times is on a roll this week. One article reports on a study linking the rising cesarean rate to the rise in “late preterm” infants — those born at 34 to 37 weeks, when they are at a higher risk of breathing problems, breastfeeding difficulties, and spending their first days of life separated from their mothers in a Neonatal Intensive Care Unit. Another article blows the whistle on insurance companies denying individual plans to women who’ve previously given birth by cesarean. Treating the first cesarean as a pre-existing condition, the insurers argue such women are at a higher “risk” of having another surgery — which they are, because so many physicians and hospitals are discouraging, or refusing outright, women a vaginal birth after cesarean (VBAC). The Times reports that 500,000 U.S. women anually give birth after previous cesarean, and it has previously reported that at least 300 hospitals have official VBAC bans.

The medical insurers blame physicians and women for a glut of “elective” C-sections, which cost them more; physicians blame women and their own malpractice insurers. “I think there is pressure by patients on physicians to deliver early-ish when someone’s uncomfortable,” said Sarah J. Kilpatrick, head of ACOG’s obstetric practice committee, “and there is medico-legal pressure. Obstetricians are afraid of being sued,” so they may “proceed with a Caesarean to deliver the fetus when the fetus is probably fine.” What Kilpatrick doesn’t say is that the ACOG committee she heads is responsible for the de facto VBAC ban, which plays a huge part in the rising cesarean rate — and, as the study suggests, the rising rate of preterm babies.

The losers in all this, of course, are women and their families: going through unnecessary primary cesareans, then being discouraged or flat out denied normal, physiological birth for their next pregnancy, on top of that being denied health insurance because the repeat cesarean their providers are insisting upon would cost the insurer more money, and having babies at higher risk of being born too early, not to mention the risks of repeated major abdominal surgery for mom. And we call this maternity “care”?

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