Breastfeeding Advocate in Trouble

Apparently the got milk campaign people are after a mom who made ten hand lettered onesies with the words “got breastmilk?” In their statement they said that people milk confuse the two milk products… REALLY? Anyway, the call has been put out by the Lactivist for people to contact them:

Go ahead and get in touch with the California Milk Processor Board.

Jeff Manning is the Executive Director. The board’s phone number is (949)481-6620. Their fax number is (949)481-6680.

Manning’s email address is manning@gotmilk.com.

As with the last time, here’s my request. Spread the word. Pass it on. Let’s let the California Milk Processor Board know that we’re all fully aware of the difference between jugs containing breast milk and jugs containing cow’s milk.

Special Time

I was chatting with a friend today about how special the time right before birth is. Everyone around you seems to be tuned in to your every move as they anxiously await the arrival of your little one. One of the things that we were talking about is how fun it can be to think “is this it?” to every little twinge or possible early labor sign. I can’t help but think it would be sad to miss out on that with a scheduled induction or cesarean. I’ve been trying to think up inventive ways to tell my husband when I’m in labor, since I didn’t do anything really cool to tell him that the test was positive (in fact, the words “I told you so!” came out of my mouth.)

Birth Track, a New Way to Monitor Labor

I recently was directed to this new device marketed for women in labor called Birth Track. It is mentioned in Jennifer Block’s book Pushed: The Painful Truth About Childbirth and Modern Maternity Care. It is a device that tracks the position of the baby via sensors placed on the abdomen, the baby’s heart rate via an internal fetal monitor that is screwed to the infant’s scalp, and cervical dilation via electrodes that are clipped to the cervix.

I read over the website but was left with several questions. At first glance, I thought this machine was a bad idea, however, the promise of no vaginal exams was intriguing and prompted further investigation. Though everything I read about the device in the natural birth community was very critical, there was something in the back of my mind that wondered if for some women this machine might be a useful tool.

I emailed the company with an entire page of questions asking about the product. A representative of the company emailed me back and asked to have a phone conversation about it, which we did this morning. I learned quite a bit about the product. I also saw first hand the medical communities vast ignorance and prejudice about natural childbirth.

It is important to note that this machine is only being marketed in Europe, and is not currently being marketed to the United States. In fact there are no plans to market it in the United States anytime in the future. The reason given for this is that the US is much more conservative, they have a much higher rate of cesareans, and the representative told me this was due to the financial gain that cesareans provide to them. A machine that may reduce the rates of cesareans and provide a printout of legal evidence that a labor was progressing and the baby was fine, is not something doctors in the US are very excited about. Europe is actually looking to avoid cesareans and therefore they welcome tools that allow them to do so. The US is not interested in a tool that would help them avoid cesareans.

I of course was very skeptical that this machine would help physicians avoid cesareans. However, it was pointed out to me that digital exams are inaccurate and don’t measure the nuances of dilation. This machine measures tiny nuances of dilation that a digital exam will not be able to decipher, and it also measures the babies head moving down. At any given time during labor, if the baby’s head is moving down, or if there is an increase in dilation, then labor is progressing no matter how slow. Most cesareans are due to failure to progress, and if a machine shows some progression, any progression, then a cesarean is not warranted.

I asked how the electrodes attached to the cervix. He explained that they hook and clip onto the cervix. I asked if this was painful, and he told me that there are no nerve endings on the cervix and that these clips, once in place, are not painful at all. I asked if there were reports of pain in the studies that were done, and he assured me there was no pain whatsoever in both the epidural group and the drug free group. He said that patients reported being extremely pleased with the machine and didn’t report any pain. He explained that a vaginal exam is painful because there are nerve endings on the vaginal wall, and therefore attaching the device may be uncomfortable, but once it is attached there should be no pain. I still have a hard time believing that and would have to see a lot more data on the studies they did, how many women were in the drug free group, and exactly what they said about their comfort in wearing this device.

I next inquired about the ability to move around. He explained that there are two phases of labor, the latent phase and the active phase, and that during the latent phase is when the doctor wants the woman to walk the hallways and move around, but once she is dilated to 3 – 4 centimeters she is going to be in a lot of pain and will want to stay in bed. He told me that contractions will be so bad at this point that women wont be able to stand up through them. I informed him that the majority of women are able to stand through contractions and that it actually decreases the pain if they are able to remain mobile. He then said that the latent phase can take a great deal of time, but that the active phase must go quickly or there can be damage to the mother and baby, and he then explained in detail the many ways a baby could die if the active phase isn’t moving along. I inquired as to how quickly the active phase must be before damage to the baby ensues, and he admitted that this was highly debatable.

We then discussed the epidural and how it causes cesareans. He said that his machine would help in this way, because as long as there is any dilation or movement of the baby down the birth canal, then it is okay, there wont be any damage to the baby. They just don’t want to see a baby’s movement or the cervix stop progressing during the active phase of labor. He told me that the epidural causes cesareans because, since there is no pain, then oxytocin is not released, which stops progression of labor. I pointed out that another issue with an epidural is that the woman is laying on her back in bed, and not moving around to facilitate the baby being able to move through the pelvis, and her pelvis can’t move to allow for the baby to come through it. He then finally saw what I was getting at and assured me that women could move with the device on. He said they could roll in bed, squat by the bed, or use other positions, by the bed. They can not walk around unless they disconnect the machine, which he indicated would be no problem at all and that women can do this easily to use the bathroom.

He admitted that this device was not going to be for every labor. He suggested that it would mainly be for that first time mother who was planning to use an epidural. He told me that most women are required to be on a fetal monitor during the active phase and that you can’t move around while you are on a monitor anyway. I told him that I was on a fetal monitor for my sons birth, but it was not routine, it was indicated. He then asked if I was a nurse. I said no. He said, “well then how do you know what is routine and what is not at the hospital?” I was a bit shocked, but collected my thoughts enough to say, “because, when I was planning the birth I checked into the hospital to see what their routine procedures were. It was important to me to be able to move around.”

At this point in the conversation I was beginning to see his point of view; that most women get epidurals, and most women do not move about in the active phase of labor, and that most women are not going to be bothered in the least by a device that may limit mobility. He pointed out to me that doctors in the US may digitally check for dilation and find no progress, and tell a woman “I don’t think your progressing, we’re going to have to take the baby out.” He told me this is simply guess work, and that this device would take away the guess work. With this machine, instead of guessing, they would know, and they could make a decision based on knowledge and not an educated hunch. He reminded me that this device can measure what the contractions are doing on the inside by measuring the cervix dilation and the movement of the baby. Any progression will take away the justification for a physician to perform a cesarean, which is likely why many US physicians would not want this product available.

I asked what would happen if the baby was born before the cervical clips could be removed. He told me they would simply move aside and out of the way. They wont tear or damage the cervix, or harm the baby. This did happen in a few of the births in the studies and the clips functioned properly and did no damage. He said it only takes a second to take the clips off. I asked if they recommended breaking the water early in order to hook up the machine, as the internal fetal monitor part of the machine would need to be inserted into the baby’s scalp after the water was broken. He told me no, that they do not advocate breaking the water simply to attach the monitor. He told me that the machine will still measure the baby’s position and cervical dilation, and the monitor is only to be used if the baby is being monitored anyway. He told me that the machine is not intended to monitor a distressed baby, it is intended to track progression. The internal heart rate monitor is optional.

I asked what the studies that were done on the machine showed. Did they show that the machine worked, or that the machine caused better outcomes for mothers and babies? He assured me that there were several types of studies done and that they showed both. The machine functions properly, and there were better outcomes for mothers and babies, and parents were extremely satisfied with the use of the machine. He said that they were surprised to find that the rate of cesareans decreased with the use of the machine. They didn’t think the machine would change behavior, and performing cesareans is more of a behavior, but they did indeed decrease the rates of cesareans. He reasserted that this is why the machines are doing so well in Europe, because they want to decrease the rate of cesareans. He also said that the machine increased the speed of labors. I inquired as to how, and he told me that if the labor is not making any progress, drugs to speed it up are given quicker which results in faster overall labors. I also wondered if part of the reason is that women are not being given exams throughout their entire labors, not even that one to see if it is okay to push. I would have to see the actual studies, but I think this would be a logical presumption. We know that the less we tamper with women, the faster they labor. Perhaps a fortunate side affect of the machine is that women are left alone far more often then they normally would be.

We discussed the parent’s satisfaction with the machine. He said that mothers and fathers both were thrilled to be able to watch the machine track the baby’s progress. He said there is even a picture generated based on the data the machine collects that shows the station of the baby’s head as it moves down the birth canal. Though I have reservations about parents watching a screen instead of actively participating in the birth process, I asked if he thought that this gave parents a greater confidence in the process and empowered them to deny a cesarean when they could see for themselves that things were progressing. He said that he can’t speak to what parents thought in that regard, but that parents reported having a greater appreciation for what was going on when they had the visual information in front of them. Though this is not the way I would choose to empower women, perhaps in our technological culture, this is what it is going to take?

When asked if he thought that this machine had a place in natural birth (which we defined as non-epidural birth for the sake of the discussion) he began spewing off statistics to me, that 40 – 50% of labors are non-progressive and that when labor happened in the home many more infants and mothers died. I reminded him that there were several factors for that, and also that deaths increased when births moved into the hospital. He did not believe me and I told him I would email him information to back this up. I told him that the deaths increased due to poor hygiene and infections this caused. He said that if you have a homebirth with a midwife, and she has to check you every few hours, that can introduce bacteria and cause infections, so using the machine would be safer. I said, true, but homebirth midwives don’t tend to give women very many vaginal exams. He was very confused by this and acted as if he didn’t even understand how this would be possible. I explained that they look for other signs that labor is progressing, you know, they look at the woman herself. I cleared up misconceptions he had about midwives not using any technology, even to check heart tones. He continued to rant against homebirth, and I reminded him that this machine can only be used in a hospital and so homebirth was irrelevant to our discussion.

What about naturally birthing women in a hospital? He then reiterated that this machine was not for all women, and that they do not advocate it’s use in every single birth, though he stopped short at admitting that it was not a good idea for a naturally birthing woman. He told me that he had met with hospital midwives who were at first opposed to the machine, but then realized there would be use for it in their practice. This makes perfect sense to me though, since not every woman in a hospital midwife program is going to go drug free. He finally stated that if they are going to do vaginal exams (and he just could not wrap his mind around how they could get away without doing them) that the machine would be a good option for any woman, whether she had an epidural or was laboring naturally. I couldn’t disagree with him on this, as I pictured my own birth experience sans vaginal exams and I knew it would have been a much better experience. I had machines connected to me anyway, so that would not even have mattered. However, if a woman wants to have a natural birth, she rarely plans on being given an excessive amount of vaginal exams or in being hooked up to a monitor. He said, “if you want a natural birth, then don’t use it”. He said that some women don’t even want to be hooked up to a heart monitor and that if they want to take a risk like that then that is their choice. He told me how his two children were born with the cord around the neck and a lot of babies are, and that you can miss something like that if you are not monitored. I explained that 25% of babies had the cord around their necks and it was rarely a problem, and he explained that when the doctor saw the cords around the necks and yanked his children out with forceps, he believes it was because there was a problem. I understand how he could think this, and our discussion had gotten off topic. I got the information I wanted and so we ended our conversation.

He was a very friendly man and answered all of my questions to the best of his ability. I enjoyed talking to him. He was knowledgeable about his product and about what influence it has in the birth room. He was even more knowledgeable about the state of maternity care in the United States than I thought he would be. The only thing he was not knowledgeable about was natural childbirth, but in his line of work, I would imagine that topic rarely comes up unless it is in a negative way.

Before I contacted him I was intrigued by the machine, but I honestly thought it was likely a bad idea. Now I am not so sure. I do think it is a bad idea for a woman planning a natural birth, unless they would prefer to have one vaginal exam to attach the machine instead of two or more, and they would like to monitor their baby’s progress. I wonder though if it might be a good idea for women who plan to labor with epidurals. Once the machine is attached during active labor, there is the potential that the woman would be left alone to labor. Perhaps if there is some progress shown on the machine, any progress, it would make a cesarean legally difficult to justify. Women would then not be pressured to progress or threatened with a cesarean if they don’t. They would not be subjected to a multitude of vaginal exams when their labor slows, as long as it keeps moving along, everything is fine. If a woman used this machine, she could potentially avoid a cesarean simply by having legally documented proof that her labor was progressing. Also, by being left alone more frequently, she is more apt to labor quicker, which is what the hospital wants. Most of all it has the potential to reassure parents that everything is fine and normal, and that the woman’s body is doing what it is supposed to do in order to have a baby. I wonder if this could reinstall our cultures faith in a woman’s body to birth? This could also potentially empower the parents to advocate against an unwanted cesarean, since they are seeing with their own eyes that they are making progress. If each woman had the option of this machine if they choose an epidural, I can see how that would have the potential to help women avoid cesareans. Throwing a doula into that mix would increase her odds even more.

On the other hand though, we don’t know how this machine would be used by US physicians. Would they simply redefine “failure to progress” to reflect what the machine shows on average? Perhaps if there is often a lull in labor of an hour or two, that will be justification for a cesarean then? Perhaps they would ignore the advice of the manufacturer and simply break the woman’s water immediately. This could potentially increase the rate of cesareans and infections as well as other complications. They may even make this machine, along with it’s internal fetal heart monitor, mandatory for all women in active labor in order to reduce the amount of personnel on staff. Using a fetal monitor in normal labors when they are not indicated has been shown to have little benefit and only increase the rates of cesareans.

Now that I’ve looked into it further, I am not sure what I think about this device and how it may help or harm woman in the birth room. I think I need to see more information. It would be nice to have access to the actual studies, and of course independent studies would need to be done as well. I tend to think there may be something to the claim that it would help decrease cesareans as they are not even able to market it to the US. I also wonder though if there is some other reason that the US is rejecting the device. The bottom line is, I will have to reserve judgments about the Birth Track until I have more information.

Another Look at Group B-Strep

Perhaps it’s just my perception, but it seems like out of my last few childbirth classes, more than half have tested positive for Group B-Strep (GBS) — weeks before the last month — and then went on to make a decision to take the antibiotics in labor.

The CDC, ACOG and the AAP recommend screening for all pregnant women around 35-37 weeks pregnant, later in pregnancy so as to tell if the bacteria is heavily colonized close to labor and delivery, the time when it could be passed to the baby.

Wonderful articles have been written to illuminate the subject, and even if you’ve read them before, I feel it is worth revisiting. Good reads can be found at Childbirth.org and Holistic Pediatric Association (HPA).

Years later, we are still giving women antibiotics when they may not be necessary, increasing resistance of the bacteria. “Ampicillin and amoxicillin have been rendered virtually useless for treating GBS by their prior overuse in laboring women in an effort to prevent GBS infection in newborns,” according to the HPA. Additionally, we are still putting mothers at risk of dealing with thrush from the beginning, endangering the success of breastfeeding.

The “Awareness” article at Childbirth.org states that for many physicians “the focus is on the high risk patients. If a woman is found to carry GBS and falls into one or more of the high risk situations during labor, her doctor can immediately start antibiotic treatment which will help protect the baby and the mother.”

Individualized care and treatment that can lead to true informed consent or refusal, now there’s an idea.

VBAC Coalition, Step 2

If you read my last blog entry, you know that I’m working with several other women in our community to form a VBAC Coalition that will work to pressure area hospitals to reverse their bans on VBAC.

Now that we have formed our core group, we have divided the work into several categories.

1. I’m in charge of developing a list of contacts for hospitals–names, addresses, phone numbers, etc. In addition to sending a letter to every physician telling them about what we are doing, we will be contacting the decision makers at the top and scheduling a meeting with them to present our case. Some of the people on our list include

• The CEO
• The Department Head of Obstetrics
• The Department Head of Anesthesia(because VBAC Bans often result from anesthesiologists who don’t want to be on site while a woman is VBACing.)
• The Nurse Manager over Obstetrics (or Director of Women’s and Children’s Health)
• The VP of Mission and Ethics (some other similar jobs might be a director of compliance or risk management)

2. Another woman is in charge of compiling the evidence, including relevant statistics, research studies, and such.

3. Another woman is in charge of circulating a petition (our goal is to obtain at least 300 signatures to present to the hospital to show them that this is important to many women in our community) and collecting letters from a recent letter-writing campaign.

4. Another woman is in charge of research–in other words, getting to the bottom of the issue. As we make phone calls trying to find out which issues and which people are really responsible for the ban, it seems as though everyone is pointing their fingers at someone else. The hospital points its finger at their malpractice insurance provider. The insurance provider claims they never put any such pressure on the hospital to quit providing VBACs. We have to truly understand the issue before we can give them a compelling reason to change.

5. Another woman is compiling a binder of all our work to present to hospital administration when we meet with them.

I really think this is going to work. Stay tuned for step 3!

Jennifer Block’s Article in the Los Angeles Times

Jennifer Block wrote this article, Big Medicine’s blowback on home births for The Los Angeles Times. The article is about the AMA’s recent statement on homebirth, and why this is not in women’s best interest.

Lamaze- Building Confidence Weekly

Three weeks ago I signed up for Lamaze’s new Building Confidence Week by Week e-mails. So far, I have found them to be fantastic! Each e-mail has a little something written on preparation for labor and birth, a specific stage of birth, etc. The best part is the tone that they are written in. A lot of what is available on the internet is written to scare pregnant women. Lamaze’s e-mails are written the way you would expect - that pregnancy and birth are normal, natural parts of life. The other thing I have found is that when reading the e-mails I feel so much more positive. I get EXCITED about my baby’s arrival instead of dreading it as some literature has made me feel. So, overall, I give them four stars. What about you? Have you enjoyed them? If you haven’t signed up - you can do so here Lamaze Building Confidence Week by Week