Attention Virginia Birth Activists!

Please take action now to stop two bills introduced into the House of the Virginia General Assembly to limit the practice of Certified Professional Midwives. These bills have been introduced by Delegate Matthew Lohr - Harrisonburg.? Calls to the constituent hotline and members of the Health, Welfare and Insurance sub-committee opposing these bills are urgently needed!? For the latest Action Alerts, join our yahoogroup today!

http://groups.yahoo.com/group/VAMUM/

HB 2163, is a bill to amend ? 54.1-2957.9 (the CPM statute).

What is wrong with it:

• The proposed legislation would add an amendment requiring midwives to give informed disclosure to their clients about the risks associated with home deliveries and with some specific pregnancy conditions. This legislation is redundant to the existing statute that already requires that licensed midwives in Virginia hold the designation of Certified Professional Midwife (CPM) and practice according to the standards of the National Association of Certified Professional Midwives.

• CPMs are required by their certification to give a written informed disclosure regarding their experience, training, and the risks and benefits of home birth to every client at the beginning of care.

• The NARM Job Analysis (cited in the VA statute) specifies the principles of informed consent and the conditions that may require additional education and informed decision making. The conditions cited in HB 2163 are included in this list.

• The NACPM standards of practice (also cited in the VA statute) refer to informed consent and requirements for education and information of CPM clients.

• The Virginia Licensed Midwife regulations already require that informed consent be obtained before any invasive procedure is performed.

HB 2167 is a bill to require the Board of Medicine and the Department of Medical Assistance Services to review regulations and policies to ensure that no reimbursement is made to certified professional midwives providing services in high-risk situations, including high-risk home deliveries.

What is wrong with it:

• This legislation is discriminatory to low-income women. Any woman who qualifies for Medicaid is designated “high-risk” based on her socio-economic status. Midwifery care, by way of its hallmarks of increased education, support, and respect, has been proven to benefit women who are at risk for pregnancy complications. Evidenced-Based Care does not support restricting access to home birth to women based on perceived risk. This is a bill intended to discourage VBAC, thereby mandating surgical deliveries to women with prior c-sections in some Virginia communities.

Submitted by Birth Activist Pam Pilch

CNN Story on Facebook Protest

I was excited when my friend sent me a Facebook (ha!) that said that the nurse-in was covered on CNN’s online homepage today. However, when I watched the video, I was disappointed to see that they had blurred many of the breastfeeding pictures in the story. ?Does the next group have to be called “Hey CNN, Breastfeeding is Not Obscene!”?

Breastfeeding PSA

New Study On Scheduled Cesareans

There is a new comprehensive study about the safety of cesareans before 39 weeks gestation.? From the article, Early Repeat C-sections Increase Risks, Study Finds, published in the Washington Post, there is this quote about the study:

The study of more than 24,000 full-term infants found that those delivered at 37 weeks to mothers who had elective repeat C-sections were about twice as likely as newborns delivered at the recommended 39 weeks to experience breathing problems, bloodstream infections and other complications. Babies born at 38 weeks were 50 percent more likely to have problems; the risk was about 20 percent higher just a few days early.

The article states that the rate of cesareans is now over 30%, and that there is a great deal of debate as to why this is.? However, they then go on to say:

Although a pregnancy is considered full term after 37 weeks, the American College of Obstetricians and Gynecologists recommends that elective repeat C-sections occur no earlier than 39 weeks to make sure the baby has fully developed. But some women opt to deliver a little earlier for a variety of reasons, including being eager to see their baby, being tired of pregnancy or for convenience.

The article here suggests, with no data or studies to back it up, that the women themselves are convincing their OB’s to disregard their instructions from ACOG, go against evidence based care, and put the babies at risk in order to give in to the mothers whims.? I find it very curious that women hold so much power in this regard, when most other choices they make in childbirth in a typical hospital would be disregarded.? If doctors are so concerned for mothers choices, even when it means breaking their own rules and putting babies in harms way, then why aren’t the choices that women make for their labors and births that do not infringe on any rules or cause harm to their babies respected?? I doubt very much that doctors are truly allowing women to make an informed choice on this.? Perhaps women who are getting a repeat elective cesarean are showing an interest in an earlier delivery, but, are they then given the risks, benefits, or alternatives to delivering early?? Did they make a truly informed choice?? Or are they making a decision based on the belief that their baby is “full term” and is ready to be born?? In the absence of any cited study on the subject, it is my feeling that the article is making quite the presumption.

Here is all the study really had to say about the matter:

Of 24,077 women who gave birth through a repeat C-section between 1999 and 2002, 13,258 were clearly elective — meaning the researchers could find no evidence that the baby or mother was in distress or any other medical reason the woman could not attempt to deliver through labor. Of those, nearly 36 percent of the deliveries occurred before 39 weeks.

It is unclear from the study why there were so many “elective” cesareans performed.? It is not clear to me whether the researchers considered a repeat cesarean to be elective or not.? If the researchers didn’t consider a previous cesarean as a medical reason as to why the mother should have another one, then that would explain the large number of scheduled “elective” cesareans.? It doesn’t seem that any data was provided as to whether the mothers or the doctors were selecting the time in which these cesareans would be scheduled.

The articles goes on to talk about the findings in the study about the true risks of a scheduled cesarean before 39 weeks:

More than 15 percent of the babies delivered at 37 weeks suffered a complication, such as problems breathing, low blood sugar, infections or conditions that required intensive care, compared with about 8 percent of those delivered at 39 weeks. About 11 percent of those delivered at 38 weeks experienced complications. Babies born at 37 weeks were four times as likely as those delivered at 39 weeks to have breathing problems.

It seems very clear cut, but then another angle is presented:

While other experts agreed that the study provides important information to help women and their doctors make decisions about timing C-sections, some said the risks of complications are relatively low and need to be weighed against the small but not insignificant chance that waiting a week or two would result in more stillbirths.

The article does end with a voice of reason though:

But Spong said the magnitude of the risk of stillbirth from waiting is unclear, and the new study shows the risks of complications from early delivery is significant.

“It’s hard to advocate doing a Caesarean at 37 weeks to try to prevent a stillbirth when we don’t really know the true risk,” she said.

Overall, I feel this is a very good study that has been done.? Many babies and new parents will be saved the possible traumatic experience of the NICU.? Many doctors, who already had some research and guidance from ACOG to tell them not to schedule repeat cesareans before 39 weeks, will now have this additional comprehensive study that clearly shows the impact of doing so.? This also may bring to women’s and doctor’s consciousness that cesareans themselves are not perfectly safe for all involved no mater what.? They need to be carefully planned and managed and only performed in cases of true emergency, or they could possibly do more harm then good.

Breastfeeding Mom Told to Cover Up

Apparently Allegiant airlines didn’t learn anything from other “breastfeeding on a plane” stories. Watch this video to hear about a mom who says she was told to cover up and when she covered up with a napkin, it wasn’t good enough. The flight attendant went and got a second flight attendant to tell the woman to “fully cover” her breast and her child. There is no way my baby would stand for that! Do you think there will be lactivism response to this? Nurse-ins, etc?

Creepy Obstetric and Childbirth Technology Patents

Childbirth technology often seeks to predict the unpredictable and control that which does not always need to be controlled or managed. Unfortunately, the primary motivation for inventing new birth technologies and applications isn?t always to make birth safer?it?s often intended to make birth faster and less expensive for hospitals.

Patent: Automatic apparatus for controlling the childbirth labor

The name of this 2006 patent says it all. It?s a device to control birth. The authors claim that the technology is known in obstetrics as a Pressure Labor Assister (PLA) with pressure sensors-controlled software, which ?utilizes the pressure increase inside an air chamber?formed within an abdominal band fixed around the patient?s body?and which occurs as a consequence of the natural uterine contractions, to provide an automatic extra force, as an aid to the parturient, for the expulsion of the future baby.?

Alternate ?automatic extra force? to expel ?the future baby?: Stand up. Change positions. Move.

Cost of alternative: $0

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Patent: System and Method for Analyzing Progress of Labor and Preterm Labor

This system of sensors applied to the pregnant abdomen measures and analyzes electrical uterine activity to provide ?early detection of failure to progress.? Now women will know if they need a c-section before wasting expensive bed space, nursing care and pharmaceuticals in the hospital. Ironically, the goal of the system is to reduce the number of c-sections. The authors of the patent also note that ?if given enough time, many very slow and even arrested labors will eventually proceed to vaginal delivery.?

Alternative to early detection of FTP: Time. Then more time.

Cost of more time: Varies depending on location of birth

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BirthTrack

Marketed to women as an alternative to multiple vaginal exams during labor, BirthTrack received FDA clearance in the United States. According to the BirthTrack Web site for mothers-to-be, ?you will have continuous information regarding the progress of labor and you will know the position of your baby every second. Your partner will be able to be an active participant in the labor process as he/she follows the progress of the partogram on the screen next to your bed.?

Caveat: May result in an orgasmic birth for she-robots, lady cyborgs and the Noelle s550 Maternal Simulator.

Alternative to excessive vaginal exams: Don?t perform too many.

Cost of alternative: $0

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Patent: Cervicometer

How continuous monitoring of the cervix during labor was envisioned in 1960. The idea for BirthTrack has been around for 50 years.

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Patent: Obstetric Drape

Inventor Robert Shane proudly states in 1925 that his invention has to do with a drape or shield ?designed to cover the anterior part of the body of a woman in confinement.? The purpose of the invention is to provide a drape whereby the body may be ?properly covered.? Shane notes that it is a known fact that thousands of women die and thousands more ?are seriously crippled for life or for a long time as a result of infections occurring during childbirth.? What Shane didn?t realize in his efforts to provide sterile surfaces is that obstetricians were not washing their hands in between performing vaginal exams and performing autopsies.

Creepy Factor: Very High

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Patent: ?Hermetic Sealer of the Rectal Opening for Childbirth?

This 1928 invention is intended to hermetically and aseptically close the rectal opening during labor so as to prevent infection of the vagina from the intestinal contents. In addition, it claims that it will prevent overextension and lacerations of the perineum during labor, as well as hemorrhoids. To be clear, the inventor specifies that the invention is to be applied AFTER the skin surrounding the rectal opening has been depilated, cleansed and dried.

Again, a main source of infections in lying-in hospitals was later determined to be doctors? hands.

Creepy Factor: Moderate to High

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Patent: ?Labor Slippers with Straps for the Anesthetized Lady?

Designed by a gentleman in 1890, this obstetrical device is employed by ?plac[ing] the slippers on the lying-in patient after she has been put to bed.? The patent holder notes that ?The loop D is designed to receive the patient?s hand; but instead of furnishing a grip such loop is intended to embrace the wrist, as by such means there is no danger of the arms becoming lame, as has heretofore been caused by attendants pulling upon the patient?s hands.? He also advices padding the straps so as not to cut or injure the wrists.

Creepy Factor: Too sad to actually be creepy. Most American women choose to remain literally or figuratively tethered to a hospital bed in labor today without knowing they have options.

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Patent: ?The Midwife Eliminator?

This apparatus ?has been found to be of great utility. It gives confidence to the patient, aids her in assuming such position as will expedite delivery, makes it unnecessary to employ female assistants to support the back and by its support relieves the pains in the loin and at the sacral and lumbar articulations.?

Creepy Factor: Moderate

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Obstetric Stirrups

Filed exactly 100 years ago.

Why is she shrouded?!

Creepy Factor: The stuff from which nightmares are made

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Other Patents for Parents:
Did the media?s negative coverage of co-sleeping and bed-sharing make you afraid to snuggle your newborn? Consider visiting your local welder to commission a bed enclosure for a baby.

Night nursing would be a breeze through the bed enclosure with the use of this multipurpose nursing shield patented in 1877. Who hasn?t wanted one of these when stuck in traffic with a baby in the back seat?

Note: You can post pictures of yourself nursing on Facebook as long as you use this.

Have you come across any unusual patents or theories on how birth can be improved, augmented, controlled or rendered more efficient through technology? Comment with a description or link!

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Posted by Jill

Midwives Deliver

There was a recent article in the Los Angeles Times called Midwives Deliver written by Jennifer Block, author of “Pushed: The Painful Truth About Childbirth and Modern Maternity Care”.? She talks about what is currently wrong with maternity care in this country, and then puts forth her idea of how it should be fixed.? She proposes that midwives should take on the majority of care for low risk pregnant women and explains the benefits of doing so.? It is a very well written and well researched article.

Choices in Childbirth

There are lots of things that influence women’s decisions on where to give birth. A lot of it has to do with what happens during labor but recently I’ve been talking to a lot of women who made their choice based on what happens after the birth. Many hospitals aren’t doing Kangaroo Care, despite the research giving touting its benefits. Many women are afraid of what happens in the nursery when they aren’t around. I’ll admit, I’m one of them! Was your choice influenced by hospital or birth center policies about infant care?

Orgasmic Birth on 20/20

Last night 20/20 finally aired the segment on Orgasmic Birth. I was really fearful about how it would be protrayed since the topic was “Extreme Parenting.” I felt that they were even handed and neutral, even interested. Christiane Northrup, MD was speaking on the topic and had some great points, including my favorite: we have the pain we anticipate.? What does that mean to you?? How do you prepare for birth?