The Other Side of the Glass
Wednesday, December 27, 2006
Stories like the one below raise a lot of questions. The death of a young woman in childbirth (most likely a hospital birth in a military hospital where all of our best skills for obstetrics originate) says as much about our society than it does this one, lone traumatized soldier on the worst days of his life. This family's story highlights the disparaging, pitifully inadequate and harmful lack of political and social will and compassion for providing support for families. Families birthing, families with loved-ones deployed, families with a traumatic experience and loss of a family member. Here we have the collision of all three -- a mother dies in childbirth while her husband is serving in the war, and he kills the baby.
Where is the collective, compassionate commitment for caring for women, babies and the family in our society?
Marine Arrested in Baby Son's Death
STATESIDE INCIDENT: 1 murder.
A 20-year old Marine who had been deployed to a training camp in Kuwait with the Ninth Communication Battalion from Camp Pendleton and who "was called back...to be with his ailing wife just before she died of childbirth complications was arrested on suspicion of murdering his newborn son."
He had previously told a local TV station that he "felt overwhelmed as a single parent of two and struggled to accept his son. `I didn't know how to feel about him. The same day he was born, my wife died,' he told KMPH in Fresno. `The feelings inside of me, I kind of wanted to push him away, but he's my son. My wife gave him to me.'"
His was jailed on charges of beating his 3-month old son. The death of his wife burdened him. He wrote on his personal web page, "For those of you who don't know, my beautiful wife ... died. Just because you see me smile and you see me laugh doesn't come close to the way I feel inside. I will never be as happy as I was until I'm with my wife again."
Where is the social regard for the importance of a woman birthing a baby and our families in the US having adequate resources during the child's infancy?
How can we not see the actions of medical birth are traumatizing to a woman, her baby, and her husband? How can we not see that our soldiers are asked to do what is beyond our comprehension while leaving their spouse and children home -- with substandard, if any support and care during and after their deployment? How can we not see that ANY grieving parent needs our compassion and truly adequate care and support. Once one leaves the hospital with a perfect, NICU, or deceased baby -- what is the responsibility of our society to support one another?? Can care and compassion be politicized or legislated as in George Bush senior's "Points of Light" that flickered and quickly sputtered or Billary's not-so-new or original concept of "It Takes a Village to Raise a Child." (published when I worked for the state of NY in 1999. We trained 100 such "villages" in the "Show Me" state - Missouri - in 1990 to address the drug problems in our communities, while the use of narcotics during the baby's birth has since increased to almost 80% of all births.)
When, oh, when, will we begin to examine the impact of medicalized birth on women and babies (boys, too) on increasing drug addiction, violence, depression, and apathy?
The natural, homebirth community tends to be more peer organized in local, grassroots groups that emotionally, physically, and spiritually support one another. Midwives, Doulas, LeLeche and Attachment Parenting type groups, Organic Foods, and other cooperatives seem to be providing ways for women and families to support others and to all receive support as equal community members.
We have a lot to learn from these communities that cannot be learned in "empirical studies" that steer social changes under the guise of fact in our psychological and medical caregiver's educations and programs. We have a lot to learn about reaching out to other human beings rather than donating money to a group or program to do so.
Reach out in love and compassion to a young birthing family, not with judgement, but with acts of kindness and generosity of time and support. One of the beautiful things of homebirth, midwifery, and doulaing is the nurturing of the mother whom one knows and values and the development of a true and caring relationship beyond those few hours of birth. Every doula and midwife I know would be there in a heart beat for any of her babies whose birth she participated. Has anyone had their OB come by with a meal and hold the baby or bathe your older child while you sleep? Do you invite you OB and L/D nurse to your baby's birthday party? How many more lives can be improved, and some actually saved by loving, caring compassionate, reciprocal, relational caring during the most critical time of a baby and family's lives and in times of need? I can't research it, and psychology and obstetrics won't do it, but I betcha the number is pretty high.
Tuesday, December 26, 2006
-- Rebecca West
The thing about the “home birth debate” that really, really bothers me is also a concern I have had for years throughout my professional career-life and adult life as a woman.Women hurt other women deeply. No where is this more evident and more damaging than in birth.
I know I have hurt other women in the process of just trying to live my own scrambled life of pursuing a career, raising children, divorce, remarriage, divorce. I have tried not to. I try to respect others’ differences and needs – and I see we are all women trying to make it in a world that is still controlled by archaic, patriarchal systems.
Men who dominate patriarchial systems are also controlled by the systemizing of birth and are at the mercy of brain imprinting from their own labor and birth when their mother was drugged and violated in their birth.Today, many women cringe at the word feminist. Certainly we women all like the benefits we women enjoy in America -- careers as airplane pilots, engineers, physicians, lawyers. Women can own property and can s tart a business, selling property even. A woman can conceive, give birth to and raise a child alone without that child being openly ostracized as a “bastard.”
The list goes on and on for what a woman is now able to do that women of age fifty years ago never dreamed of. Professionally, we are no longer nurses, secretaries, and teachers unless that is our calling. Our elders - our sisters, the feminists made that possible for us.
They fought and sacrificed for our rights, our equality, and our CHOICE. Nursing was one of the jobs that opened many doors for women. Women, as the subordinate group acquiesced to those in power in order to be there in the workplace and to advance the profession. There has been a large price to pay for woman being more like men in the world and having birth taken from the control of women. Women in medicine and women cared for in medicine are very wounded.
Women hurt each other in many ways because of their wounding. Women use words and emotions to fight – beginning very early in life. Women KNOW what will hurt the other person, and when they too are wounded, they will use it, knowing how deeply women feel their feelings. I wonder a lot about the lack of trust between women.
Our lives as mothers are so vulnerable. No other time in life are we as vulnerable as when we are bringing our new baby into this world. No other time in life are we in need of nurturing and support of other women, protection from men, and so vulnerable to harm, disregard, and control. As mothers, no matter how old our child is, no other aspect of our lives can bring us to our knees like the disrespect or disregard for our selves, our decisions, and our lives with our children.
You can call it New Age or whatever you wish, but it seems to me that in this human world everything works upon a concept of balance between the masculine and the feminine. This life is about balance and partnership, respecting the other within the self. Jesus was conceived by God, of the Heavens and born of a woman, an earthly woman, Mary. This makes Jesus and each of us a spiritual, human being. My Native American ancestors refer to Mother Earth and the Father Sky that we each embody. We are each of the earth and the heavens. Born of the male and the female. There is no doubt in my mind, as history shows this over and over, that when these are out of balance, terrible things happen. Historically, in our culture where the feminine is disregarded women have been treated brutally in birth, and they still are since the introduction of male dominated medicine.
Even though American women are treated better and have more rights than anywhere in the world, we still have astounding incidence of domestic violence, rape, and a pornographic industry based on violence (sexual) and exploitation of women. Apparently, when societies were more balanced or even matriarchal, those cultures were not as violent. Don’t get me wrong – I don’t think the majority of women today in the US who tend to devalue the feminine, are capable of running a non-violent matriarchal society. Women have taken on too much of the male persona and denied their own feminine. This is what allows them to betray other women emotionally, physically, and spiritually.
Far from being capable of creating supportive, nurturing and creative collectives, my experience of many women today is that they are very traumatizing to other women. Nowhere is the traumatizing of women by women worse than in the current medical care during birth and in the debates about birth -- everywhere it is being discussed.
The lack of compassion and regard for other women is astounding. Rather than explore and heal her own inner woundedness, women are trying to fight in this world for her place in masculine ways that harm other women. I see the profession of midwifery as an attempt to return the self and the world to balance. It is a necessary action of healing something that has been very wounded in order to return the world to balance. I do believe that what is necessary is for every woman to heal her feminine self.
I know many women who support and desire natural birth and homebirth, who seek diligently to stay out of hospital’s harm. It almost always leads a woman to healing her feminine self, embracing a more natural life in many ways, and becoming more aware of the planet some call Mother Earth – because the earth nourishes us and supports us.
"Peace on earth begins with birth"
Women in white (now green, blue, and purple) brutalize a baby in his or her first moments of life -- the neonatal nurse who laughed wickedly and loudly to my grandson (who had resisted even the gentle checking of the male neonatal doctor) as she stuck tubing down his throat, “You can ruuuuuun from the doctor, butcha can’t hide from the nurse.” – they are betrayers of the feminine.
Forty years of indoctrinated training promoting the drugging of women in labor and birth, and our society is oblivious to the harm to the newborn baby. Look at the pressure on the cheeks of this baby to the right. Look how his arms are in a helpless posture, his abdomen sucked in. He is being traumatized. He is not breathing. He is in shock which will stay in his NERVOUS system as his body, brain, and soul is recording everything.
Is it possible we don’t trust each other as women because of the generations of violation to us women and our babies by WOMEN in medicine? Are they themselves not extremely wounded? On a really bad day (like watching the violation of my grandson or other babies) I liken them to Charles Manson’s girls, and some days more victimish themselves, like Patty Hearst. None of these young women started out to be killers or a bank robber with her kidnappers.
None of the woman who fell into bad situations with violent men, nor those in white, those angels of mercy, and wonderful women who were the first nurses planned or intended to harm other women. Quite the opposite. They intended to be caregivers. The treatment of women in the male dominated system (feelings denied, voices silenced) leads to the mistreatment BY WOMEN of OTHER WOMEN in the medical birth machine. It is a condition of the male dominated usurption of birth from the realm of women. Sadly, it is institutionalized into the medical and nursing training so that it is SO ACCEPTED as NORMAL-- for forty years going on one hundred -- that women numbly do it and never question authority -- even today in 2006. Where are the feminists? And, why are they denying the attachment research and focusing on women's workplace rights and child care for working women?
This is the legacy of American obstetrics -- control, shame, and covert violation of women's bodies and womens' souls. From the time men took over birth at the turn of the century there was a marked decrease in death due to many factors such as sanitation, antibiotics, and surgery.
We have to start with seeing that women are hurt, humiliated, manipulated, and shamed in the medical machine . We have to start with seeing what she feels is critical to how her labor and birth will progress or not. We have to see that babies are sentient beings that feel and remember what they and their mother felt, and they are fully engaged with their environment being imprinted in their brain.
From my perspective, BIRTH and making birth SAFE for WOMEN and BABIES is a feminist issue – because birth is that last place a woman should be made to feel like a doormat.
Birthing her baby is the absolute last place a woman should be dominated by a man, shamed, and violated, or drugged. Betrayal of women by other women in the male dominated system has profoundly harmed us women and our babies (sons - boys and men). What is being acted out in obstetrics?
Adventures in Motherhood
Welcome to the greatest adventure in a woman’s life.
Childbirth is a natural and wonderful. Your doctor has been especially trained to (so you are not as smart as him) guide you through this experience happily and help you deliver a healthy baby. (Don't trust yourself: you can't do it without his help.) Of course, he will need your cooperation in doing this (You must do only what he allows because it is for your own good) necessary that you follow his directions implicitly. (You must do only what he tells you is right and do so without without questioning and doubts.)
There is a good reason for everything he does or instructs you to do. (He knows better than you do what you need. He IS a man - even if it isn't necessarily about what is best for the woman, if it's good for him it will be best for you as well.) You will find that your doctor is not only your physician and medical advisor, but also a trusted friend who is sincerely interested in you and available whenever you need him. (You can only trust him; not other women who are not sincere or trustworthy.)
You may have many well-meaning relatives, friends, or neighbors who are eager to give advice. (No one else can take care of you as well he can, including yourself, your mother, your sister, your friends, and any other woman.) much of the time they are uninformed. (Women??!? do not know as much as men. About birth?! So, other women do not know enough to help you.) So if you have a problem, if you are worried, or you are troubled about anything, discuss it with your doctor; (You can only depend on him, the man.) he can help you best. (Only he knows what will be best for you and what you need.)
The following pictures tell the story of one girl’s adventure to motherhood. It could be you.
And, most likely it was you either being born or giving birth – or both. Most of us under seventy years of age in this country were born in the hospital after men and medicine took the reins driving birth down a very different path from the physiological, woman-led model of care. Women nurtured, supported, and protected other women in the midwifery model of care.
Most of us alive now were born in hospitals controlled by men, with our mothers “under the influence” of drugs, most likely a combination of drugs no longer used because of the bad effects that became known after years of use. (ether, morphine, scopalamine, “twilight”, Demerol, etc). Most of us were born with our own little baby brain “under the influence” of drugs. This means we were “impaired” and our mother was “out of it” and not present with or caring for us. She wasn’t able to talk to us, work with us, protect us, or be the first to touch and caress us or bring us to her breast. This is a huge wounding on the soul of humanity. Is it any wonder really that we have ever increasing rates of drug addiction and violence, not to mention, divorce, war, and life long mental and emotional issues in our society?
The introduction of medical caregivers at birth brought much needed interventions to help those women who for what ever reason were unable to birth naturally. Forceps, surgery, but mostly antibiotics saved many lives. The decreased maternal and infant mortality rates over the last hundred years are attributed to the introduction of antibiotics and the obstetric skills to save those women who would have died prior to the ability to do effective cesarean delivery. It reached it’s peak productivity at some point in time and then began to create another set of problems.
I hypothosize that during this period of post WWII affluence where women were rounded up and sent back home to be Betty Crocker emmulates that somehow the medical model was able to take over birth entirely rather than become an important partner in making birth safe. The result of this was the tapering off of decreasing infant mortality rates so that the infant mortality rate actually peaked out in 1956-8. Rather than look at the use of the drugs and interventions as NOW ALSO contributing to maternal and infant trauma and loss the effect to institutionalize birth, the medcal model was increased.
The little book quoted here was the propaganda of the early sixites that worked to institutional medical birth AND the violence of women. Odd, the field of domestic violence and addiction does not even address the drugging and violating of women in birth as a factor. Systemizing birth by the male-dominated disease-oriented model of medicine made women powerless in birth. I do not believe it was accidental. Worse, women were used to create this system. This has lead to a huge wounding of women – exacerbated by the professionization of the behaviors and interventions as “normal” and believed not to be traumatizing to mother or baby. Why? The same experience in any other setting for an adult woman or baby is readily seen as traumatizing and know to contribute to depression and other disorders, such as PTSD.
I call it the “Feminine Betrayal”. In my own healing, as a birthing woman, I was able to trace my first birth at age eighteen as the foundational experience for my life as a woman and how I related intimately with men and women. I was induced without consent, I was given an arsenol of drugs without consent (scopalamine, tranquilzers, gas). I was tied to the bed because of the hallucinations and resistance that scopalamine causes. My mother was not allowed in the labor room and could see me when nurses would come in and out. I was alone in the “delivery” room with strangers. I was tied down. Two nurses pushed on the top of uterus – I learned the next day because my ribs were hurting and bruised. I was in and out of consciousness throughout the birth. I have no recollection of labor from early Monday afternoon through my son’s birth at 10:30 am on Tuesay morning. Who touched me or did what to me, I do not remember. There is an ever-present shame that also is present for women who experienced cesarean surgery and the date-rape drug. I remember hearing, “Here’s your baby” and using every ounce of my consciousness to come out of the fog to see just a glimpse of him as he was wheeled by. That evening when my husband and mother were gone two nurses finally let me have him -- and aggressively tried to undermine his first breast-feeding.
My first experiences in craniosacral peds course was healing this moment of separation from my baby – twenty-five years later. I never knew how deeply traumatized and wounded my son and I were from that experience. I never knew the mulitude of maternal, relational, and intimacy struggles were from the profound wounding as a birthing woman. My son and I were always extremely close (he and his beautiful wife JUST left to go back to MN!) and I learned in the healing that we were “trauma bonded”, just as I was with my mother. Sometimes this manifests as very difficult mother-child relationships, sometimes in extreme over connection, and the many possibilities in between. It’s easy to say, in this society, most of us do not have healthy, easy, relationships with our mothers. Birth is the experience that will create and define our relationships. If a baby is the “bun bakin’ in the oven”, labor and birth then create the “frosting on the cake.”
While others fuss and fight elsewhere over one study related to 1% of the births in the United States, the blogger succeeds in distracting women from the real issue. The perpetration of violence against women and babies in hospital birth. I believe we ought to be looking at the historical picture of how we got to the point of 99% of the births in the hospital, with induction (so against physiology) and narcotics now considered “normal”, and a current surgical rate of 30%. We ought to be looking at the impact of the history of controlling women’s bodies, violating women’s bodies, drugging women and saying it doesn’t matter.
Women in our culture hurt and betray one another in covert and overt ways. We women know it. It is time to look at the origin of betrayal of women that began with the burnings and hanging of midwives as witches.
Any woman involved in natural birth or in homebirth begins to see the difference in relationships between women, and how women and men are in intimacy. Homebirth doesn’t create perfect relationships but there is definitely a shift in how people treat one another. Healing my own birth and my experiences as a birthing woman of four children has lead me to experiencing and being a woman differently.
Monday, December 18, 2006
One of my "favorites" is when a woman who is 37 weeks has a spontaneous membrane rupture. She is immediately on a time frame imposed upon her by the medical establishment. I have noticed that this is one of the situations that will inevitably lead to the cesarean surgery "for failure to progress." What the midwives know is that it can be days before labor begins and that the risk of infection is very low outside of the hospital. The risk of infection is because it is the vaginal exams that increase chance of infection in the hospital environment. At any rate, it is required that she be on intravenous antibiotics (a direct entry to her blood and one of the conditions that makes her more suseptible to hospital-acquired illness.)
On the other hand, if a woman at say, 33 weeks has a spontaneous membrane rupture she will be put on medication to prevent the labor so the baby can stay in the womb and develop. She is often IN the hospital and subjet to vaginal exams.
Why is it safe for a baby before 37 weeks but not after? Why can't a woman with ruptured membranes at 37+ weeks stay at home until her labor starts? And, btw, what is ithe science that says it's ok to induce at 37 weeks so that now 40 weeks is considered late?
Another contradiction that baffles me is how the hospital is touted as the safest BECAUSE the doctor is there (in theory only.) I have seen one birth this year where the doctor was there at all before the mother was ready to push or they needed to get things going and finish it up -- "on the clock" of established time frames. My own grandson's doctor came in by 7:00 armed with Pit to "get that baby out." It's clear to most people that a physician can not be in three places at once -- labor and delivery, surgerical suites, and the office with 9-5 hours (home is number four). So, they run around and nurses manage the mother and baby anyway. Our baby was out by 8:30. Check that one off the list of "to do's" and off to the office.
If the doctor can be a half an hour away, why can't the mother labor or birth at home? I know, I know, it has to do with "management" and who has been managing. The transfer of a late stage laboring woman is something that hospitals and obstetetricians can work out a safe plan for with midwives.
What are your "favorite contradictions' of the obstetric practice?? When what they say is medically and scientifically sound and necessary is contradicted by the next doctor, nurse, or woman's situation?
Sunday, December 17, 2006
From Lee Passman:
Amy, you were replying to *my* post, and I did not mention neonatal mortality. I had a look at the butcherer's newspaper, ObgynNews. But even there one finds a ton of information how harmful c-sections are:
Elective C-section Revisited; Dr. Elaine Waetjen; August 1, 2002
C-Section Linked to Stillbirth in Next Pregnancy, 05/15/03
Maternal Morbidity Rises Sharply with Repeat Cesareans, 03/15/05
Prior C-Section Assoc. with Worse Outcomes – ICU Admit, postpartum infection, 03/01/05
Study Shows Elective Cesarean Riskier than Vaginal Delivery, 05/01/04
Asthma Associated with Planned Cesarean, 05/14/03
Cesarean Birth Associated with Adult Asthma, 06/15/01;
Steep Rise Seen in “No [Medical] Risk Primary C-Sections, 01/01/05
Offering C-Section ‘On Demand’ Can Be Ethical: ACOG, 12/01/03
Cesarean Rate Portends Rise in Placenta Accreta, 03/01/01
Placental Invasion on the Increase – hike in C-Section may be responsible, 01/15/03
Placenta Previa, C-Section History Up Accreta Risk, 09/15/01
A vaginal birth clears the baby's lungs and stimulates the hormones. C-sections are profitible. Premature births are HUGELY profitable.
Safe Baby Partners:
A human being has in "inherent blue print for health" (Osteopathy). That plan includes the biologically, neurologically programmed need to begin labor and to work in relationship with his mother throughout labor and birth. The baby is known in science to send the hormonal signal to the mother that begins labor.
Induction is a serious disruption of this process and has severe consequences -- it is showing up in the behaviors and health of our children. Narcotics further interfere with the mother and baby working together. Mother is DRUG IMPAIRED. The drug gets to baby, so baby is also impaired --- while doing the most important and defining, foundational process of his life and their relationship. BIRTHING from his mother's womb to becoming a physiologically separate being IS the FIRST and most defining action of the human's lifetime.
WHAT is goin' on in this society that this one, single act is so minimized and so interferred with? Why is the human baby so disregarded?
PHYSIOLOGICALLY speaking, ANATOMICALLY speaking, every single aspect of labor, birth, and baby coming to the breast is critical. The pressure on the head, the turning within the pelvis, the pressure on the lungs, the membrane sac in tact, the cord pulsing until placenta delivers, baby being covered in combination of his protective substance and mother's fluids (amniotic fluid, urine, vaginal, and even some feces) as immune protection, the first breastfeeding that re-connects mother and baby and provides a primer for the newborn's guts and intestines, etc. ALL of these are within in the moments that his heart and lungs are transferring from water to air breathing so all other systems can function optimally. Each one is part of a collective, systemic, and physiological purpose for the health and wellbeing of the human being.
Every day it takes compassion and understanding to not see obstetricians and nurses as some of the most ignorant and brutal humans on the planet, and to not see women as the most gullible (also ignorant) and fearful creatures. And, policy makers as the most self-centered and money-driven at the expense of people, especially the newborn. The survival rate in the hospital and in cesarean birth is a testament to the ability of the human being to survive, but at what cost to the physical and emotional health of the human being? DUH!??!??!
When they know what they know and they do it anyway --- that is incomprehensible. It is criminal. If one is not part of the solution, one is part of the problem. It is ignorant to fight so over the safety rate of 1% of the homebirths in this country when the data clearly shows there is not a significant difference between hospital and home. Research in MISSOURI in the late eighties showed that homebirth was safe with trained caregivers. The post is here. The debate is futile BECAUSE of the small numbers. Homebirth has not been shown to be more dangerous with 1% of the total births in this country happening under such conditions of poor quality of care between midwives and doctors/hospitals. The numbers are too small; the obstacles to homebirth too great, too disruptive, and too damaging. Medical rancor makes homebirth more stressful and dangerous.
A post today on homebirthdebate.blogspot.com titled, Dangers of homebirth says:
"Amber sent me a link to her blog Dangers of Homebirth. She wants other women to know how her homebirth went terribly wrong.
As she says:
"This type of story was not out on the internet when I chose to birth at home and is still not one of the first 10 popup ups on the net. My hope is that someone considering a home birth will read this and become as informed as possible to be the strongest advocate possible for themselves and their baby. I want to be clear that I support the ideas behind midwifery and natural childbirth and that I liked my midwife as a person. While I feel she made some critical errors in judgement, my goal is not persecute but to educate."
I read the blogger's one entry and found a heartbreaking story of a woman who had a terrible hospital birth and wanted something better for her second child. The heartbreak includes a HMO/health insurance nightmare (typical), distance from the hospital, and the always present conflict of anti-homebirth sentiments of the medical system. Informed choice and consent are empty phrases in the care of pregnant, laboring and birthing women and their baby.
The conditions under which midwives practice and women much live with in order to have a homebirth are created by the power-brokers, doctors and hospitals. Homebirth is not safe in the US because it is inherently unsafe, but because of the conditions and lack of access to respectful and quality care.
The blogger states towards the bottom of her article, "I still believe that birth should take place in a peaceful environment, with as little intervention as possible. But I think Midwives and doctors should work together and combine the best of both worlds, nature and science."
She so aptly echoes my charge and mission --- We need a reform of the malpractice laws and of the use of interventions and drugs in birth that keeping leading to the findings of the research published by ACOG itself, all while they systematically beat down midwifery and the women and babies they serve.
Dr. Amy has been quoting me without credit, using my phrase, "when people don't know what they don't know." Here we have more proof that obstetricians "know what they know (that is harmful) and continue to do it anyway" and as usual, "blame the woman." Obstetrics sure does support hospital coffers at the baby and mother's expense.
Here it is:
OBSTETRICAL AND GYNECOLOGICAL SURVEY
Volume 61, Number 12 2006
CME REVIEW ARTICLECHIEF EDITOR’S NOTE:
This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits can be earned in 2006.
Public Health Implications of Cesarean on DemandLauren A. Plante, MD, MPH Assistant Professor, Obstetrics & Gynecology and Anesthesiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
Cesarean rates have been rising in the United States. Recently, there has been an upsurge of interest in “cesarean on maternal request” in the absence of any medical indication, a phenomenon that will further increase the cesarean rate. This trend may not be benign on a population basis, and reliable data are lacking.
This article reviews reasons for the increasing cesarean rate, describes maternal and neonatal consequences likely to accrue with a policy of cesarean on demand, and explores larger implications for public health.
Target Audience: Obstetricians & Gynecologists, Family Physicians
Learning Objectives: After completion of this article, the reader should be able to state that there continues to be a rise in the cesarean delivery rate in the United States and summarize that cesarean delivery on maternal request (CDMR) is contributing to this rise without data to indicate a decrease in maternal and fetal mortality and morbidity, possibly with a large population cost.
Synopsis of conclusions of Cesarean-related mortality and morbidity associated with a 5% annual increase in patient requests for non-indicated [medically-unnecessary] Cesarean surgery in the US:
* A total of 14 to 32 more maternal deaths
* A total of 5000 to 24,0000 more surgical complications
* A total of 4000 to 6000 more postoperative infections
* A total of 2200 more postpartum readmissions to the hospital
* A total of 200 to 300 additional venous thromboses [potentially fatal blood clots]
* A total of 33,000 more neonatal intensive care unit admissions
* A total of 8000 more cases of neonatal respiratory complications
* A total of 930,000 more hospital days for women, infant length of stay not calculated
* Between $750 million and $1.7 billion in healthcare expenditures
* Higher rates of hospital occupancy* Longer waiting times for elective operations of all kinds
* The potential for an overall increase in medical error related to higher hospital occupancy rates.
Safe Birth Partners:
I wonder why insurance companies continue to pay out for "medically unnecessary" and "patient choice" cesareans?
Woah ...I agree with you, Grandma, and let's back the bus up here.
Everything in a couple's lives prior to conception, and conception itself, and gestation create the dynamics of the impending birth as the family barrels down road of life -- love, stress, etc -- towards birth. There is a whole theory of how the conception through gestation experiences CREATE the dynamics of birth in the prenatal and birth psychology field -- not for here. Doctors and midwives both have no control over anything that leads to the multitude of possible issues that do happen. However, they are responsible for the outcome.This story says more about the total lack of support for a woman's choices than it does about this woman and her baby.
Amber took responsibility for her second birth. She CHOSE and STUDIED the option of homebirth and did everything right to move towards that, BECAUSE of the previous hospital birth. Pitocin, epidural, membrane stripping, and episotomy - a "normal birth", by medical standards that a woman is expected to just accept. But Amber knew better and she clearly had loving support from her partner. The financial choice is no small matter. Most people will go do whatever their insurance covers even if it is non-effective or traumatizing. She doesn't say, but I'd bet that the first baby was medically induced.
The most important issue in this story, is the contribution of a broken obstetric system to the lack of support for women to have a natural, peaceful, intervention-free birth. Most women choose homebirth to avoid unnecessary medical interventions. THIS is the problem. Is it a collaborative effort between hospital and insurance companies?
Like most Americans in need of ANY kind of health care, the important decisions were dictated for Amber by her HMO, not her. Often, very important medical decisions are not even made by one's physician who went through fifteen years of training. They are made by a insurance company employee with maybe a bachelor's degree.
Left with minimal options for what HER needs were -- to protect her baby by not being in that hospital environment without choice and control -- Amber had to make THE BEST decision she could, and that is what this whole birth debate is about. WHERE to best give birth safely, peacefully, and respectfully when the OPTIONS SUCK -- big time.
Not one meets the needs of the laboring and birthing mother and baby.
1) She could go to the HMO approved hospital knowing what she knows, and wants to avoid. Having the PRIOR birth experience she did and responding (correctly) to it as she did also made her a PSYCHOLOGICAL high-risk wherever she went unless she did the emotional, psychological work around that first experience.
There is not a social value for a woman to process this "normal birth" experience of traumatizing interventions.
Society, including MIDWIVES, doesn't promote the healing of a previous birth either before conception of the second one or during pregnancy. Doctors ignoring the impact of what they do is part of this stupid debate that perpetuates the system.
2) Her second option is a forty-five minute drive to birth center -- which always scares a mother-to-be. Even one who has a three day labor will fear not getting there in time.
Working in a birth center I observed the only time this is not true is in the case of a woman, like Amber, who had a long, protracted, painful labor in the hospital. At home she doesn't realize she is in labor and progressing so easily, so she waits too long, waiting for the intensity she experienced before that is "normal" with medical birth, but not with natural birth.
3) Amber made a good choice in choosing homebirth with a professional birth caregiver, a CNM, a team, within safe driving distance to a hospital. Sounds like the best option to me. (btw, same as the doctor drives to arrive to catch baby managed by an RN or CNM -- what's the big difference really?).
THIS DEBATE needs to SOMEDAY address how it is that women can work equally with birth care providers, insurance providers, and expect evidence-based care where ever it is. Hospital birth is not evidence-based and the means (for doctor's schedules and litigation avoidance) do not justify the end. This particular CNM made a judgement call to not go earlier when she saw the malposition. Probably not a wise one. WHY didn't she? Why do midwives often wait too long? I have observed for awhile now that this is a complaint of the obstetricians and the nurses. And, I have a theory.
The conditions and attitudes of medical caregivers TOWARD midwives and the woman who chose homebirth and transports PLAYS A HUGE PART in the CO-CREATED problem and the lack of partnership between midwives and doctors. WOMEN and BABIES are the ones harmed by the fervent control of birth by medical profession and disregard for midwifery care. I have heard many, many times by obstetric residents the sentiment, "That's your choice to have homebirth, but don't expect us to clean up your mess."
The "messes" of homebirth are never greater than the ones in the hospital. Midwives, unless they have a good relationship with the doctor or hospital, can be very affected in their decision-making by what they know will happen at the hospital --how she and the mother will be treated.
Highland Midwife so eloquently says -- the location was not the problem. This same situation happens all the time in the hospital. So, sometimes the midwife delays in transporting. Why? Lots of reasons. Just like a physician will respond to a situation based on recent experience, perhaps she has just experienced a previous similar situation, she knows who is on call, etc. A thousand reasons.
I have known homebirthsAPGAR of zero, but it was at home. I have issue with these homebirth doctors and midwives who have then proceeded to use hospital lingo, "Baby was juuuuust fine." NO ONE -- midwife or doctor at home or in the hospital -- wants to admit that the means don't justify the end. No one wants to believe that they have profoundly affected that baby.
NO ONE wants to ask the baby who had a 3 day labor with every intervention exception extraction or surgery or the homebirth attempt that ended up "just fine" without interventions, or ended like sweet, baby, Jewel's. Like Amber, I support a blending of nature and medicine. I believe we need to participate in birth with awareness that everything we do profoundly impacts the baby. I agree with homebirth opponents that birth should not just be about the woman healing her body --after a surgerical or traumatic birth. It should be about the baby. It's the baby's birth.
There is so much good in Amber's story. It is great testament to the power of a woman to make choices, be responsible for her body and birth, and to labor without drugs and stay focused on her labor and her baby. Mother and baby undrugged, whatever they go through is the most ideal.
Finally, and this is a CONSEQUENCE of the HMO, the lack of GOOD options, and the need to satisfy the needs and timetables of others -- Amber began induction of the baby in order to satisfy others' time frames and needs. One can call it "encouragement" but it is still induction - for the needs of others besides the baby.
WHENEVER ones uses ANYTHING to induce the baby's labor, it is INDUCTION. Herbs, castor oil, acupuncture, and homeopathy are natural and do not have the total effects of pitocin (such as the central nervous system effect of creating false sense of trust in the caregivers), but it is still induction and a disruption of the baby's innate biological, physiological impulse to begin labor when he or she is ready. CLEARLY, the baby was not ready and not in the right position for birthing. I suspect the first baby was also induced.
Would the baby have ever turned to the ideal, correct position? Who knows? Baby does. Baby knows why she was in that position as she prepared for birth. She may have physiologically needed up to two weeks (average gestation) and then would have had time to move. Many times in healing work there is a very good reason for baby to be in a certain position until labor sometimes -- comfortable position, cord could be compromised.
COMMUNICATION with the baby in utero is the best but least used form of supporting a baby to prepare for labor and birth -- by physicians for sure, and even midwives. When it is medically necessary to induce conscious, respectful interaction with the baby is very effective.
Any way I look at it, the bottom line is that baby Jewel's labor and birth was that Amber was "induced" and "disrupted" by the medical establishment before they even got to the intersection of labor and birth. Amber, Jewel, and daddy have every right to be feeling whatever feeling they are -- the whole darned spectrum from joy to anger.
I have a particular interest in the father's experience in the medical machine (that includes insurance dictates, hospital policy dictates, the anti-midwifery sentiment). I am touched by his obvious support of his wife to make the best decisions possible for his children, and the financial sacrifice he obviously made. I acknowledge the powerless a man feels in witnessing the first birth and how our society does not honor his internal God-given impulse to protect his partner and child. My regards to an amazing man and dad.
What an unfortunate addendum here about the trip to the hospital. I wonder if the good doctor would see this as NOT affecting this child, as she refuses to even consider that everything that happens at birth in the hospital is insignificant to the laboring and birthing baby.
The baby is unaffected by what happens at the hospital but is everywhere else, and yet prior to admission in the hospital drugs are bad, but they are good in the hospital. So confusing.
Thank God for the new understandings of the brain and healing, so that whatever happens in birth we can mediate and heal.
Blessings to Jewel and her family,
December 17, 2006 1:40:00 PM PST
Saturday, December 16, 2006
"Do you really still believe that stating that a birth was traumatic is nothing but sheer melodrama?"
Perhaps, NOT. "Life saving on a grand scale" is not what the current scientific research indicates. And, cesarean birth is often about the loss of a body part and/or a life. The mother's as well as the baby's.
"The estimated risk of a woman dying after a cesarean birth is less than one in 2,500 (the risk of death after a vaginal birth is less than one in 10,000)." A woman is four times more likely to die having surgical birth than giving birth vaginally. Induction and epidural use are shown to lead to unnecessary cesarean. (Obstetrics & Gynecology 2005; 105: 974-82).
Cited By Shankar Vedantam
Washington Post Staff Writer
Thursday, June 2, 2005; Page A03
Scientists have found the chemical equivalent of the perfect sales pitch: a hormone that makes us more trusting than we normally are. Volunteers in a study were told they were participating in a decision-making experiment. Those who inhaled the hormone, which occurs naturally in the brain, were more likely to entrust others with large sums of money than were volunteers who inhaled no hormone. The experiment has profound implications about the nature of human trust. Researchers said their finding might lead to cures for people with disorders that prompt them to hold others at arm's length, but they acknowledged that the chemical, which is widely used in medicine,could be misused.
The experiment, involving 128 participants, was conducted by scientists at the University of Zurich and other academic centers. Researchers had some volunteers inhale oxytocin and then examined how they and those who inhaled a placebo invested money in a mock transaction. The transaction involved taking a risk: handing over money to a "banker" who had the option of returning the investment with a profitor withholding principal and profit, leaving the investor with nothing.
The experiment was a measure of the trust that the investors had in the bankers. Volunteers who inhaled oxytocin were more likely to trust the banker with money and risk larger sums, the researchers said in an article published yesterday in the journal Nature. The scientists said they made sure the chemical was not merely enhancing risk-taking behavior by substituting bankers with computers. Without the interaction with a human, the hormone had no effect. Oxytocin did not alter the behavior of the bankers, which strengthened the researchers' belief that the hormone was influencing trust. Bankers did not need to trust investors, because they were taking no risk. A banker's decision to return money was more a question of fairness,which oxytocin did not affect.
Trust is central to virtually every positive social relationship, from intimate love and friendships to financial transactions and politics, but little had been learned about its biological correlates in the brain, researchers said. Oxytocin is known to be activated in a range of social relationships in many animals, but this is the first time scientists have shown that it can serve as a switch to enhance trust inhuman relationships.
Ernst Fehr, director of the Institute for Empirical Research in Economics at the University of Zurich and one of the scientists who conducted the experiment, said the peak effect of oxytocin was seen after about 50 minutes and it wore off after two hours.
"Some may worry about the prospect that political operators will generously spray the crowd with oxytocin at rallies of their candidates," said neurologist Antonio R. Damasio of the University of Iowa, who has long studied the neurobiology of human emotions and who wrote a commentary accompanying the study. At the same time, he added in an interview, politicians and marketers were probably already triggering the natural release of oxytocin in the brains of audiences through their campaigns. "I am more alarmed about the manipulations of marketing than the possibility of oxytocin sprays,"he said.
Ethicists and theologians said manipulating the brain at a neurochemical level was different from ordinary kinds of persuasion. David A. Hogue, a theologian and pastoral psychologist at Garrett-Evangelical Theological Seminary in Chicago, said that "anytime we are working directly on the central nervous system, it feels much more intrusive."
Brent Waters, an associate professor of Christian social ethics at the seminary, which is affiliated with Northwestern University, questioned whether trust could be so easily reduced to chemical constructs. "The experiment presupposes a highly diminished and reductionist understanding of what trust means," he said.
Damasio, the neurologist, said it was inevitable that science was going to learn more about the biological correlates of trust and other human emotions. He said he saw no reason such knowledge should affect notions of human dignity and agency. "The question is do you want to preclude yourself from understanding,do you want to deny yourself the entire compass of knowledge that can come from science?" he asked.
Fehr and the study's other authors acknowledged the potential form is use of oxytocin, but he argued that it was no different than any other prescription product. Regulation, he said, could limit abuse. Hogue, the theologian and pastoral psychologist, said the research held out the possibility of reconciliation between individuals and the potential of healing rifts between political groups, even nations:"
While spraying oxytocin on one's political or religious adversaries maybe strategically difficult, comprehending the biological correlates of trust could conceivably offer promising avenues for reassessing and reconciling conflict."
(c) 2004 The Washington Post Company
Friday, December 15, 2006
"Whether the *victim* of malpractice is said to be 'hysterical' or 'melodramatic', I still don't agree with blaming the victim, especially in ways that seem cold and insensitive. There is such a thing as righteous anger against an injustice. It is important for society in general that this angry be expressed -- spelling errors and all -- so that we can change a broken system. The current system in the USA has many flaws. Hospitals operate under financial constrants, and even good doctors can feel institutionally pressured to perform unnecessary surgery, though certainly not in so many words. The system is also unfair to doctors, that uninformed courts decide malpractice suits instead of medical experts. Yes, sometimes even doctors are the victims, and their indignation is also justified."
Check out the Sorry Works Campaign at www.sorryworks.net. It was started in late '04 by a man whose brother died from medical induced cause. The campaign has grown to a national phenomenon and approach to not only avoiding and resolving litigation, but to promoting more humane care of patients in the first place.
The coalition has three goals: 1) educate all stakeholders in the medical malpractice debate about the Sorry Works! approach to reducing liability costs from medical errors; 2) serve as an organizing force and a central clearinghouse for information, news, ideas, and research on Sorry Works! and related full-disclosure efforts; 3) promote and push for the development of Sorry Works! pilot programs in different states
Watch and see -- obstetrics will be last to join on.
Just to be clear on this, the numbers that you constantly refer to are neonatal deaths (hospital vs. homebirth), correct? The numbers you are using are:1/1000 (deaths/per birth) hospital2/1000 (deaths/ per birth) home. Is this correct, and the correct language? 12.15.06 - 6:55 pm #
From Amy Tuteur, MD:
"Is this correct, and the correct language?"
It depends on the study and it depends on the year. The results of the Johnson and Daviss study showed a neonatal death rate of 2/1000. I have been quoting a hospital death rate in 2000 of less than 1/1000; it's probably substantially lower than that. That's because Johnson and Daviss removed congenital anomalies from the homebirth group. Once you remove congenital anomalies from the hospital group, the rate is probably 0.5/1000 or even less.
Safe Baby Partners:
I am wondering what is the point of this debate on NEONATAL death rate which by definition is within the first twenty-eight days of life. First, the whole debate is based on "The neonatal death rate is 1/1000" and second, she is not addressing the research data about the increased rate of NEONATAL death due to cesarean section.
Has anyone even seen the study or documentation of the hospital neonatal death rate of 1/1000 -- that Dr. now Amy says here is "PROBABLY 0.5/1000 or less" after removing congenital anomalies? PROBABLY!?! She's using, oh, um, PROBABILITY now to determine the neonatal death rate in the hospital after removing congenital anomalies? Without a control group? Without citing the literature. Lord o' Mercy. Let me pull one out of the air. I think, uhm, that she's probably, uhm, about 95% wrong.
What is this "fight" about and how will the winner know they have won? And, what is the prize? Fewer "dead babies," as so warmly referred to the debate. Not likely. What is so important to the debaters to repeat over and over the same arguements and emotional pleas that are more rudely criticized than the post before? As one poster quotes Dr. Phil, "whadder ya'll gettin' outta this?"
AND, from where does this 1/1000 stat come? Has anyone seen the source of the 1/1000 statistic? Sorry, it could have been repeated numerous times and it went right over my head, because I am more concerned about the affects of drugs and interventions on the live babies who must then live with it through out their lives. I am still waiting for one itty-bitty piece of research to show that narcotics were shown to be safe for the laboring and birthing baby. Then I'll pull out my own "one semester of college statistics" knowledge.
Meanwhile, curious about the 1/1000 hospital neonatal rate Dr. Amy is using to make some point, I was visiting the "How healthy is America?" The 29th report from the Health, United States series, by the Centers for Disease Control and Prevention (CDC). http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=healthus05.table.372 . I am a little more trusting of their stats than what the homebirthdebate blog reports. The report shows the NEONATAL DEATH RATE in the US in 2000-2002 was 4.6. One can only logically presume these are hospital births? The INFANT MORTALITY RATE in 2000-2002 was 7.0. Either way that is 11.6/1000 babies died in the US in 2002. It doesn't differentiate according to where babies were born, but with a 1% homebirth rate the number of deaths at homebirth are small, I presume. How many were born by cesarean? Anyone tracking that?
Where is the concern and the debate over the research this fall over the cesarean news?
"The neonatal death rate for Caesarean birth among low-risk women was 1.77 deaths per 1,000 live births. The comparable rate among vaginal births was 0.62. Babies are up to three times more likely to die soon after delivery if their mothers choose a Caesarean section rather than a normal birth, a big American study has shown."
The procedure is performed in the United States on nearly one of every four babies delivered -- more than 900,000 babies each year. http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?requestURI=/healthatoz/Atoz/ency/cesarean_section.jsp. Maybe someone more mathematical than I can figure out how may babies are likely to die in 900,000 cesarean births.
Folks, the numbers for SAFER birth in the hospital just ain't adding up. How can the cesarean birth rate be almost twice what Amy says the hospital rate is, while here it says vaginal births accounted for only 0.62.
I think the fox has the hens scratching and cackeling for a reason. DISTRACTION. Whadder ya'll gettin' out of it?"
During my years of working with women and children in various settings, I developed a lot of metaphors to explain otherwise complex human experiences. Each became a personal story and metaphor for that person. I share them in allegory form here to be helpful in the dialog about where birth is safest, home or hospital.
She said, she said. They're all perceptions.
If we were all gathered around a piano and had to describe what we see we would have a different view of the very same Piano.
If one sits in the front and describes the keyboards to those behind stating that this is what makes the music, “when I touch the keys”, those behind could argue to the end of time, “That is absolutely false.”
Those in the front could argue, most assuredly and adamantly, “It most certainly is, and I am doing it, I have done it. You cannot change my mind, because I SEE it and I FEEL it. I AM making the sound. I am doing it right now!”
Those in the back could absolutely totally deny it, “No, it’s not scientific, logical, I don’t see it, so it’s not there. THAT is not what is making the sound.”
Those in the back of the piano may be looking at a simple flat wall, or they could be viewing the internal workings of the piano. Then, they might be further arguing, “No, I see where the music is coming. I can see the parts moving. I am trained to know how this works. You can't know how it works. I am the trained piano tuner.”
The one in the front can be blue in the face, angry, or melodramatic some might say, “I DO know how it works. It is ME who is MOVING the keys here to make the music. I am the musician, and I play by ear, naturally.”
The one in the back, knowing that it takes the other touching the key board to make their own music, and knowing she can also make sounds from her side, says, “Nope, you are a liar, that’s impossible.” She continues, “In fact, I can make it stop, proving that you are wrong,” as that person reaches in to stop the music. A cacaphony of noise occurs. “See, THAT proves it. Furthermore, you can not prove that you can make music in tune without me here to make sure.”
Some others who are seated at the end of the piano, or who have aerial view can try to point out to the those in the back or front that both are right, but not perfectly. They also will likely not convince the other of their perception, that sure, the one who can get inside and tune the piano doesn’t have to do so for the other to play music. Gosh, in all parts of the world, people play the piano without the piano tuner right there with back all open.
“I may not understand how it works in there, I haven’t seen it or studied it, and I can’t fix it, but I do see that she is right, there are lots of black and white keys over here that she must move to make the music you hear. She is a musician. And, she doesn’t need you right there, with the back exposed to do so. What if you just tune it up before she plays and wait and see?”
The points of my metaphor are:
1- The only way to understand the perceptions of others is to be willing to acknowledge that you likely do not see the whole piano or every perspective. I call it acknowledging that one doesn’t know what one doesn’t know.
2- To move yourself so that you can try to see other’s perspectives of the very same thing – to learn what it is that you don’t know you don’t know.
You've been hit -- now what do you do?
This is a metaphor I used with young women who had been sexually abused and other Post-traumatic disorders.
You are driving down the road, maybe a very careful driver, maybe observing every traffic law. Maybe not. Maybe you are on the cell phone, car-dancing to your favorite tune, thinking about the fight you just had, rushing to pick up your child, or running for groceries to fix dinner. It doesn’t matter --- because suddenly from nowhere, someone runs a red light and crashes in to you.
From that moment on YOU have the responsibility for how you react to every aspect of the situation. You can get out of the car and begin screaming profanities. You can rush over (hopefully) to see if the others are ok. You can leave the scene, cry, take a nap.
Truthfully, one’s reaction will often be dependent upon our perceptions of the other driver and the judgements, assumptions, and course of personal action are often reactive depending on the other, the one who did the wrong. Was it a group of teenagers, a mother rushing her child to the ER, a little old lady who confused the gas and brake pedals, a drunk driver, or an obstetrician rushing to the hospital to deliver a baby, some we know with whom we already have a relationship (good, bad, or otherwise, like our minister, our neighbor with whom we have a conflict). Too often, we humans reaction according to the judgements we make about the other.
The bottom line is the damage is done. The one harmed has choices about how they perceive themselves, their role, the other who harmed them. YOU now have the responsibility of going through the legal aspects and the steps to fix the car. You have to contact your insurance agent, you have to get quotes to fix it, you have to take it get it fixed and do without it. Maybe you have to take time off from your schedule to do these things, or you can’t, or you don’t have transportation during the process. You choose every minute of how you decide to response. A problem is the psychophysioemotional aspects that keep coming up -- fueled by hormones, perceptions, and response of the other (PTSD).
You may have been injured – even severely and that is whole other level to what you have to DO and PROCESS as a result of someone coming along and bashing into you. Maybe your car was brand new, maybe it had been a gift, maybe the other is uninsured and you fight your insurance company. A million and one things are possible. And, it’s a pretty good chance that you were not totally observant and not being the ideal, law-biding driver. YOU could be the "other." Every day in every relationship we somehow harm or trigger another's button even if we are being totally aware, concerned, and compassionate about the other. In the commission of living our lives and woundings, we unknowingly, unwittingly can interfere with or harm the other's way of being. I call them intersections, or inner-sections -- where our woundings bump up against the woundings of others.
What is your contribution? Even if there was not a thing you could have done differently how DO you deal with the feelings of not being a good driver that COULD have contributed?
You might have been injured enough and your life altered enough that you became restricted in your life (even never walked again), or depressed for a long time. Maybe you were pregnant and your baby was born prematurely or did not live. Whatever it was, it contributed to your future life, your feelings, perceptions, and maybe your depression, rooted in the event, lead to the inability to make appropriate decisions that lead to further unwanted complications. You might have lost your job, then your apartment, and had to move in with friends or family. Or, you got addicted to painkillers, neglected your child and lost custody of that child to the other parent. Left college and became a bum.
Who is to blame? How does one get out of the cycle of victimization and out of the spin of PTSD? What if the person who hit you has a long record of such accidents? What if it were totally preventable? What if that particular intersection is a block from the hospital where there is scientifically or statistically a high number of accidents due to obstetricians rushing to the hospital? And, the city won’t do anything about it, because of pressure and money from the hospital.
Birth as a Metaphor
Birth is so about being responsible for who one is when they conceive and about where they are going in any one second of life – how one is gestating that baby nutritionally, environmentally, relationally. One’s own fears, hopes, stresses, and needs are all driving one down the road to that intersection of birth, where 90% of the time one is going to intersect with a rushing obstetrician.
How did we get here? With all of these paved roads, four lanes, lights, traffic laws, rushing obstetricians?
TO BE CONTINUED …..
Thursday, December 14, 2006
My thirteen year-old daughter and I were watching a birth in a movie recently. After the baby was born a medical person said to the grandmother, "You're a grandmother!" My daughter turned me and said, with a disbelieving eye roll, "Jeesh, like she wasn't before the baby was born?" Out of the mouths of babes, as they say. Of course, the woman was a grandmother from the "moment of conception" if you are pro-life; or if you are pro-choice, from the moment the woman decided to keep her baby. For me, I was a grandmother before my grandsons were conceived, before I even knew it.
At birth a baby will already know the voices of his mother and father and others in their environment. It is odd that our society acts as if the life of the baby, and his or her relationships, only begin at that moment when we first SEE them. Some say the relationship between mother, father and baby began even before conception, but certainly from that moment on. A mother knows this as she can feel how her baby responds to her within her. Yet, during labor and birth talking to the baby can raise many eyebrows.
I connected with my grandson in utero even though we were fifteen hundred miles apart during his gestation and I physically spent only one week with them during that time. I did so most easily through talking with my daughter, supporting her, laughing with her almost daily, always talking to and acknowledging him. Miles away I would quiet myself and connect to him and talk to him. His mother desperately wanted me there for his birth, a VBAC. I am aware that babies know who they want there as well. I talked to him all of the time about if he didn't want me there, if that's not what he wants and needs, it's ok. Just like I do with a mother and baby I support during pregnancy, labor, birth, and post-partum.
I was there, with days to spare, and I talked to him throughout labor, telling him who was in the room and why, telling him how much I loved him and his mommy. I told him how it would feel when the epidural came on, but that mommy was right there. She'd be sleeping. I held her during the procedure that was botched and she had two entry wounds. I held her like a mother holds a baby. I was holding him as well. I was the first human to speak TO him after his birth as I shielded him, barely touching him, as long as I could from the neonatalogist and his nurse's brutal resuscitation. "Andrew, it's Granny. I am so happy you are here." Have you ever noticed how mothers, fathers, grandparents, etc. will just barely touch a newborn baby - as if, in a knowing of just how gentle the touch is that a baby needs?
How my daughter felt in response to me created hormones that created more emotions. That's how we humans work. This was part of programming her child, and in particular, how my grandson will feel about me in a core way has to do with how his mother felt about me DURING pregnancy, labor and birth. Every billion cells in his newborn brain knows I love him, saw him, protected him, supported him. It is possible, I believe, for his mother to hate me some day and HE will not, because of his early fetal programming. Sadly, for many, it could work the other way. The mother hates or is angry with her spouse, her mother, etc during pregnancy, labor and birth, and later in life they reconcile, but will the child's brain be able to make that shift as well? I wonder. I wonder about all of the fascinating possibilities. Will the baby of a pregnant woman fighting with Dr. Amy have a neural connection for the name Amy, for doctors, for homebirth? I wonder.
When my daughter spoke to me during gestation she had a different emotional experience than when she was at work with seventh graders all day long, or in rush hour city traffic, or towards her live-in mother-in-law. My daughter's hormonal, physiological responses created by her emotions and relationship with me are a part of my grandson's experience. So is every the pregnant woman I treat compassionately, respectfully, and kindly. I am very conscious of the baby of every pregnant women I meet -- even at the store. I treat her as if she is doing the most important thing a woman can do on this planet. I am aware and regardful of the baby of the woman who has posted here.
Whether it is the first or fifth pregnancy, or a vaginal, cesarean, or a VBAC, it is important for mother's to consciously begin to create the relationship she wants with her baby during pregnancy. A woman builds a baby that is structured to live in that particular environment. The only way a developing fetus and unborn knows the outside world is through the mother's physiology , thoughts, emotions, and voice. A baby experiences it whether mother communicates directly with him or her or not. She can learn to differentiate for her baby what SHE feels that she does not want her baby to feel or be stressed by. For example, "My sweet baby, I am feeling very sad and abandoned because your father has decided not to be a part of my life and your birth, but that is my feeling about him, NOT YOU. I want you and I love you. I will do my best to care for you." A woman who can develop the relationship with her unborn, regardless of their circumstances, will have a better awareness of her baby and his or her needs and plan for birth. She'll be able to stay connected with her baby during labor and birth.
We all know nutrition is needed to create a physically healthy baby. We all know that a happy and calm mother is important. Whatever a mom feels and thinks -- joys, fear, worries, and hopes -- are a part of the prenatal programming of her baby's physiology, emotions, perspectives of the self and world, and personality. How else can a person be but how they were built? Want a peaceful baby? Have a peaceful gestation, labor, and birth. What a baby who feels loved, nurtured, and safe on the planet? Start in the womb to nurture, love, and protect. Do so in labor and birth and first days of life.
Somehow we know the prenate takes in everything that is good and loving, and even when there is a tragedy in a woman's life during her pregnancy; but, rarely does one fully engage the logic and science of fetal programming for every baby and every experience in utero. The science and knowing doesn't yet translate into a social agreement that we must treat every pregnant mom and baby with the utmost care and respect, knowing what we do to her and for her, we do to and for the baby as well. The baby is flooded and programmed, during his or her development, with whatever hormones the mother's experience create in her body. A mother ought to protect her unborn from people and situations that create negative emotions, thoughts, and worries -- including those who would disrespect her feelings about the baby and her birth choices.
We humans like to think unborn babies will remember the good stuff and forget the bad stuff. Sometimes the pregnancy is unplanned and an unwanted surprise, or the father leaves the relationship, or work and finances are stressful. Worry with unresolved fears and anger from previous cesareans can affect mother and baby during pregnancy. A mother-to-be who gave birth by Cesarean, especially emergency or unwanted, will have many emotions and worries come up during pregnancy. All of these issues and worries can be mediated anytime during pregnancy or after, by the mother having loving support, being aware of her emotions, and by communication with the baby.
Dr. Frederick Wirth, a neonatalogist explains scientifically how the communication between mother and baby happens and how to create conscious, nurturing communication prenatally. Two other leaders in the field have also written excellent books for parents-to-be that are scientifically grounded and excellent resources.
Prenatal Parenting by Frederick Wirth, MD - www.PrenatalParenting.com
Prenatal Prescription by Peter Nathaniels, MD (OB), PhD (Vet) (for parents-to-be)(Also author of Life Before Birth: The Challenges of Fetal Development and Life in the Womb: The Origin of Health and Disease - MY ABSOLUTE FAVORITE BOOKS. As an obstetrician and animal researcher, Dr. Nathanielsz has compiled his own research findings as well as those from the field of fetal programming. The last two are very science oriented and are must reads for anyone who wants to know about the physiological processes of pregnancy, labor, and birth.
Secret Life of the Unborn Baby, Parenting Your Unborn Child, and Nurturing The Unborn Child (with Pamela Weintraub). All three by Thomas Verney, MD at http://www.trvernymd.com/. He is co-founder of the Association for Pre and Perinatal Psychology
I can't believe I forgot my dear colleague's site. Gerald Vind, PhD, neurobiology, developer of Prental ReImprinting at www.pnri.net. Amazing information for pregnant women on his site.
Wednesday, December 13, 2006
Some of these things you will decide you don't want, it doesn't work right, you want a different color. For whatever reason, you will attempt to put it back in the box to take it back to the store. We've all done this and never are we able to put the object back in it's orginal condition with all of it's specific packing support in the right place. EVEN when I take a lot of time to try to get it to look nice, the box bulges, the top won't close, the thing never looks nice and perfect through the plastic window.
After Christmas, or next time you have the opportunity try it, think about this. I want you to imagine the object is a uterus removed from the woman's body after the baby is removed. I do a trauma healing modality that includes CranioSacral Therapy and somatic/emotional release and healing. Not only with women who have experienced cesarean section, but I have worked with post-surgical patients with abdominal surgeries as well. One woman had a cyst on the anterior (inside) side of her kidney. This meant going through her abdomen to remove it. Her bowels were lifted out and moved to the other side to access the cyst.
When I work with these women to heal the physical aspects of their surgery (whatever it was) it is always about allowing the processing of the emotions around the surgery. Fear, grief, invasion, "my body is dysfunctional". The body tissues hold the memory whether one is sedated or not. Our body is now known to be the emotional part of our selves, where emotions are stored, in particular, in the organs. When a surgeon does anything to an organ (or any part) of another's body, that organ experiences, remembers, and feels it. A woman's uterus is a big part of her womanhood Self. Whether she has bore children or not, her uterus is strongly connected to her heart. Every day, but more so in birth and after, a woman creates and lives life through her feminine heart and uterus. Her connection with her baby during pregnancy is extraordinally powerfully with her heart and her uterus, and this never ends.
Who in the medical field is looking at the long term consequences to the physical and emotional lives of women who give birth by cesarean? Is there a higher rate of heart attacks? Bowel obstructions in later years due to scare tissue? Hormonal differences between women who give birth vaginally or by cesarean? Where is the damn research to show it is "safe" for her lifetime?
What ALWAYS happens when I am working with post-surgerical patient, csection or otherwise, is that the body feels like it never got put back the way it was, the way it was done perfectly when it was built. I know from my obstetric spouse the thrill of watching the best surgeon get the csection done in twelve minutes. I have watched surgeons since. There is no time to go slowly, because the need is for this woman's insides to not be exposed to air and germs. The organs, a woman's uterus or the other woman's bowels are quickly moved back into the body cavity. No care is taken to make sure it is as perfect as possible, like when I try to repack a box to take to returns. They are concerned about getting it in the box, not about whether it is in the very same untouched position. And, what I know, is that it is impossible.
What I know is that for the woman with kidney surgery whose bowels constantly felt terrible from then on, her entire organ system was affected in the following seven years. Many ailments began to happen after that. Heart, digestion, elimination -- all had a drug to cover the symptoms. It was not until she had the integrated body work and the opportunity to process the emotions before surgery, during surgery, and post-surgery (HELD IN THE BODY) and for the deep human touch that supported her bowels to reorganize,** that her body started to work normally. As normally as possible for a seventy-seven year old woman, seven years post-surgery.
** Physicians will gauf at this only because they don't know it, weren't taught it, and therefore fear it and consequently banish it.
The same compelling reason for the medical establishment to continue what they are doing to women in birth with surgery (it supports the future needs of the industry with patients) is the very reason to stop the unnecessary use of drugs and interventions known to lead to csection and to stop the planned, medically unnecessary cesarean births.
Yes, some interventions and surgeries are necessary. A surgeon can become more compassionate about this -- the total affect to the whole woman, including her psyche. She or he can be AWARE of the need of the body to come back to it's original, optimal condition. Surgery done consciously, knowing the total impact, can mediate a lot. PROTOCOLS can be established where every woman who has a cesarean birth is also afforded the appropriate after-care, such as the integrated body-mind work that I do. Unfortunately, at this time, medicine pooh-poohs us and denies the science to support the decades old antecdotal stories.
For women reading who have had cesearan surgery, I know this will activate you. The woundss -- buttons- -- are always right there. Please know this is meant to let you know the good news that there is hope and there are modalities out there to support your healing. Your disapointment, fear, shame, guilt, angry is all valid and recognized, and I leave you with the truth that there is hope for healing it.
Some people never do try to put the object back in the same condition, I know. The lid is hanging open, the cord sticking out, cardboard support is missing, the object just stuffed in the box. My ex, the obstetrician, was one of those. Who has time for that?
"Soft is the heart of a child. Do not harden it."
Finally, A Birth Film for Fathers
Through presentation of the current research and stories of fathers, the routine use of interventions are questioned. How we protect and support the physiological need of the human newborn attachment sequence is the foundation for creating safe birth wherever birth happens.
Based on knowing that babies are sentient beings and the experience of birth is remembered in the body, mind, and soul, fathers are asked to research for themselves what is best for their partner and baby and to prepare to protect their baby.
The film is designed for midwives, doulas, and couples, particularly fathers to work with their caregivers. Doctors and nurses in the medical environment are asked to "be kind" to the laboring, birthing baby, and newborn. They are called to be accountable for doing what science has been so clear about for decades. The mother-baby relationship is core for life. Doctors and nurses and hospital caregivers and administrators are asked to create protocols that protect the mother-baby relationship.
Men are asked to join together to address the vagaries of the medical system that harm their partner, baby and self in the process of the most defining moments of their lives. Men are asked to begin to challenge the system BEFORE they even conceive babies as there is no way to be assured of being able to protect his loved ones once they are in the medical machine, the war zone, on the conveyor belt -- some of the ways that men describe their journey into fatherhood in the medicine culture.
Donors can email email@example.com to get a digital copy.
The film focuses on the male baby, his journey from the womb to the world and reveals healing and integrating the mother, father, and baby's wounded birth experience. The film is about the restoring of our families, society, and world through birthing loved, protected, and nurtured males (and females, of course). It's about empowering males to support the females to birth humanity safely, lovingly, and consciously.
Finally, a birth film for fathers.
What People Are Saying About the FIlm
They are rightly calling what happens in every American maternity unit, every day, by its rightful name - abuse. Abuse of the newborn, abuse of the parents and their rights, abuse of the supposedly sacrosanct ethical principal of patient autonomy and the medico-legal doctrine of informed consent, which has been long ago discarded in all but name. I love it!
In the immortal words of the "shrub", "bring it on!" This film needs to be shown and if I can help facilitate or promote it, let me know.
Father in Asheville, NC
Thanks for sharing this. It was very touching to me. I thought of my brother-in-law standing on the other side of the glass when my sister had to have a C-section with her first child because the doctor was missing his golf date. I'll never forget his pacing back and forth and my realizing that he was already a father, even though he hadn't been allowed to be with his son yet.
Margaret, Columbia, MO
In case you don't find me here
I wish I'd kept a blog of my journey with this film this past 10 months. It's been amazing.
I have a new blog address for the film, and will keep a journal of simple reporting of the journey for the rest of the film.
I'll be heading east this week to meet with a group of men. I plan to post pictures and clips on the film blog.
I'll keep up here when I can -- when I learn something juicy, outrageous, or inspiring related to making birth safer for the birthing baby.
Review of the film
The full film will have the interviews of a wider spectrum of professionals and fathers, and will include a third birth, at home, where the caregivers do a necessary intervention, suctioning, while being conscious of the baby.
The final version will feature OBs, RNs, CNMs, LM, CPM, Doulas, childbirth educators, pre and perinatal psychologists and trauma healing therapists, physiologists, neurologists, speech therapists and lots and lots of fathers -- will hopefully be done in early 2009.
The final version will include the science needed to advocated for delayed cord clamping, and the science that shows when a baby needs to be suctioned and addresses other interventions. Experts in conscious parenting will teach how to be present with a sentient newborn in a conscious, gentle way -- especially when administering life-saving techniques.
The goal is to keep the baby in the mother's arms so that the baby gets all of his or her placental blood and to avoid unnecessary, violating, and abusive touch and interactions. When we do that, whether at home or hospital, with doctor or midwife, the birth is safe for the father. The "trick" for birthing men and women is how to make it happen in the hospital.