World Breastfeeding Week

World Breastfeeding Week

August 1-7 is celebrating around the world as World Breastfeeding Week. This year the theme was breastfeeding in an emergency. The photo contest winners were so moving. I do hope that you will check them out.

Be sure to head over to the World Breastfeeding Week headquarters, download an action kit, look for topics and story ideas for your blogs or your community. Remember, celebrating World Breastfeeding Week doesn’t mean that you have to put on a huge production. You can do anything that you find appropriate. Consider blogging about breastfeeding and talking about how it has changed your life.

So, share with us a breastfeeding story, tell us about someone who made a difference in your breastfeeding experience, what is your favorite breastfeeding resource? Give some kudos to all the women and men who support breastfeeding in the comments section.

Does a Laboring Woman Have Any Rights?

I have been doing a lot of reading about the case of a woman who exercised her legal right to informed consent and refused a cesarean, and subsequently had her baby taken away because of it. This woman’s case hits very close to home for me. She labored in a way that was described as “combative,” “uncooperative,” “erratic,” “noncompliant,” “irrational” and “inappropriate.” I can imagine that the midwives who assisted in the delivery of my son would label the way I labored in much the same way. These terms are all very subjective, and I can imagine them being used for a patient that was vocal about refusing procedures they wanted her to comply with. The court records were vague on the next similarity, but it also seems that this woman was in an abusive environment. She even called the police from her hospital room. From everything I have read, it seems that they are using her accusations of abuse as proof that she was being irrational, and I have seen no description of what abuses occurred, as if the entire subject is too crazy a notion to spend any time on. I think if there was abuse, this is a pretty good explanation of her actions during labor. Another explanation is that she was previously treated for PTSD. A woman who has had PTSD in the past who enters a hostile environment, is in the vulnerable position that being in labor creates, is pressured and perhaps abused, will be triggered by all this and react - there is simply no way around that. When a person with PTSD is triggered, they go into panic mode which will insight the fight, flight or freeze mechanism. She obviously went to “fight”, since she could not flee or freeze at such a time. Instead of the people around her being understanding of her responses, a psych evaluation was done while she was in labor. Her past history of being treated for a mental illness was dug up, and a case was made that her and her husband (since he agreed with her), were not fit parents and the child was removed from their care.

There are several alarming factors in this case. It is legal for a woman in labor to refuse care. Every person has a legal right to informed consent and refusal. Informed consent means that the person will be given the risks, benefits and alternatives of a procedure. Informed consent includes the right to refuse care. But people always say, what if it is an emergency and the baby will die without treatment? The fetus is not legally a person, and therefore a pregnant woman has the legal right to make decisions for her own body, regardless of how those decisions affect the fetus. Furthermore, a parent of a living child has the right to choose or refuse medical treatments for their child. The only legal way that any person can be forced into medical care is if a court order is obtained that deems them incapable of making that decision. I am assuming that the psych evaluation during this woman’s labor was the first step in them trying to obtain a court order. This did not work however, because the first person to examine the woman deemed her mentally capable of refusing care. The second person to examine this woman was unable to complete his examination before her healthy baby was born.

I had no idea that it was legal to have a psych evaluation done while a woman is in labor. I am guessing that this is the only way to obtain a court order, but it seems that it should only be allowable for that purpose. It is unclear to me whether or not these evaluations had any bearing on the decision to remove her child. I find it very unsettling that a woman’s mental health can be evaluated for any purpose while in labor since women enter a different state of mind in order to accomplish the monumental task of giving birth. Is this natural alternate state of being understood by the evaluators? Do they realize that what they are seeing is not mental illness but just a woman in “labor land”? Are they able to decipher the natural affects of being in labor from true mental illness? It seems that any findings from a woman in labor would be in question, so the fact that this was even done with seemingly no understanding that they may not get accurate results is just extremely alarming.

Many people are quick to point out that the c-section refusal was not the final reason given for the removal of her child, but it was her mental illness and her and her husbands unwillingness to work with the system in having their child returned to them. As for her mental illness, she had been treated in the past for PTSD. She had completed her treatment. Many women have a history of being treated for a mental illness. If a woman has ever been to therapy, chances are there is a diagnosis of some kind in her records somewhere. Many women have been on medication at one time or another. Lots of women have been treated for postpartum mood disorders. Will these things now be held against us when we have children? Is it legal to remove a child from a home just because a woman has been treated for a mental illness in the past and they feel that she is therefore at greater risk of abusing or neglecting her child? The irony is that the very system who caused my PTSD can now remove any future children I have because of it? And this is all perfectly legal in this country? As for their unwillingness to work with the system, I can understand that. In those first weeks after being traumatized and devastated, and seeing things through this lens of overwhelming emotions, I am not too sure that they would be capable at that point of seeing the benefits of cooperating with the people who just did this to them.

So, does a laboring woman have any rights? Do the laws of informed consent and refusal apply to her? Why is it that a woman is stripped of all her legal and civil rights during the window of time that she is giving birth, yet she has personal and parental rights at any other time in her life? The laws of informed consent are on the books, but they can’t be upheld legally. If she is violated and damaged, she can not sue for compensation simply because no lawyers will take a case like that. I was just told last week by a lawyer that I had no legal right to refuse any unwanted physical contact or medical procedure during my labor since I had signed a blanket consent form upon arriving to the hospital. Apparently, according to him, a woman can scream “no” and “stop” all she wants to, but she has no legal rights do so, since once she signs that consent form she is allowing the hospital and it’s staff to do whatever they deem necessary from that point on. I disagreed with him, but he holds the beliefs and opinions of most of the lawyers and judges and health care providers in this country. In order for a woman to have any rights, it has to be able to be upheld legally in court. Otherwise, it is just a useless law written in a book somewhere and has no power or bearing on women’s lives. Therefore, I would say that no, women have no legal rights while in labor or giving birth. I think this is the singular problem with our maternity care system. If a woman has no legal rights to refusal in an emergency, then everything becomes an emergency, and she suddenly has no legal rights over anything that happens to her from vaginal exams, to IV’s, to fetal monitoring, to episiotomies and c-sections. In order to change the system, women must be granted their legal rights. Education can only go so far. We can all be highly educated victims, or we can change the system and insist that we have a right to informed consent and refusal in maternity care.

Cochrane Review Finds No Evidence for Treating Group B Strep with Antibiotics

The following is the summary of the recently published Cochrane review, Intrapartum antibiotics for known maternal Group B streptococcal colonization, which found that giving antibiotics is not supported by conclusive evidence:

Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms; bacteria are particularly found in the gastrointestinal tract, vagina and urethra. This is the situation in both developed and developing countries. About one in 2000 newborn babies have Group B streptococcus bacterial infections, usually evident as respiratory disease, general sepsis, or meningitis within the first week. The baby contracts the infection from the mother during labor. Giving the mother an antibiotic directly into a vein during labor causes bacterial counts to fall rapidly, which suggests possible benefits but pregnant women need to be screened. Many countries have guidelines on screening for GBS in pregnancy and treatment with antibiotics. Some risk factors for an affected baby are preterm and low birthweight; prolonged labor; prolonged rupture of the membranes (more than 12 hours); severe changes in fetal heart rate during the first stage of labor; and gestational diabetes. Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.

This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were around 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.

The Unnecesarean Blog

Just a public service announcement that The Unnecesarean Blog has a slightly different address, please change your links. You can continue to read her thought provoking and engaging posts at:

http://www.theunnecesarean.com

Dr. Drew Sucks at Breastfeeding

I had caught a few episodes of “16 and Pregnant” on MTV this season. Mostly, I was disappointed at how many inductions were shown but all of the episodes I caught had vaginal births (albeit intervention-ful.) Tonight I turned on the “16 and Pregnant Reunion- Life After Labor” and most of it didn’t surprise me. They didn’t sugar-coat motherhood and the moms complained like crazy about how horrible labor was. No one mentioned a childbirth class or a doula. ?Then an audience member asked why none of the mother’s breastfed. One mother mentioned that she had tried breastfeeding and it was horrible. Dr. Drew interrupted her and yelled “It HURTS!” I’m pretty sure Dr. Drew has no personal experience with breastfeeding and has obviously not read any breastfeeding texts, ever. Breastfeeding should not hurt! Dr. Drew Pinsky is best known for radio/TV show Love Line where he gave advice on sex, love and relationships to teens and twenty-somethings. Dr. Drew is a bit of an icon but if he is giving out bad advice should today’s youth look somewhere else? What about Mary Jo Podgurski? If you want to see some interviews with the moms from “16 and Pregnant” you can look here. You can also write to MTV and suggest that Dr. Drew get some breastfeeding education at this address:

Mtv.com

1515 Broadway

New York, NY 10036

Lamaze Discusses Cesareans with Medscape

Lamaze International’s President, Dr. Pam Spry, discussed cesarean section with Medscape recently. Here is a small excerpt:

Medscape: Are rates of surgical delivery being driven up by women or clinicians? Is this the age of Blackberry birth — scheduling everything ahead of time?[16]

Dr. Spry: Actually, there are 2 parts to this question. One is, what has driven up the rate of repeat cesareans, and that answer is easy: there has been a big decrease in the availability of choosing to labor and deliver vaginally (VBAC) after having 1 or 2 previous cesarean births, causing a huge increase in the rate of surgical delivery [for repeat cesareans]. Compared with the early 1990s when VBACs were encouraged and acceptable, many hospitals, insurance companies, and clinicians now refuse to allow women to try laboring after a previous c-section because of perceived medical and legal risks.

The second part of the question is whether women or clinicians are responsible for the increase in the primary c-section rate, and I think that’s more difficult to answer. In a study of more than 1500 women, we tried to determine just that. The research results indicated that only 1 woman in the study actually reported that she requested a cesarean, which leaves the decision for the vast majority of cesarean deliveries up to clinicians. So understanding when cesareans are medically necessary, as well as the risks involved, is important in achieving a safe and healthy birth.

There are definitely some interesting discussions. If you’ve been around the block, they aren’t new, but it’s nice to see them laid out so nicely for the average person. Read it and let us know if you agree with Dr. Spry’s conclusions about how and when change will occur.

ACOG Revises Induction Protocol

The American College of Obstetricians and Gynecologists (ACOG) has issues a press release saying that there is a revision to it’s labor induction guidelines. The basics from the press release do not look very different from what I had heard from ACOG before, so I’ll have to wait to have the paper in my hands. Here are some basics from the press release:

• Wait until 39 weeks or do fetal lung maturity testing
• Use cervical ripening before full blown labor induction
• Do not use Cytotek on someone with one prior cesarean
• Induction reasons may be for physical reasons with mom or baby or other reasons that are reasonable, like distance from hospital in a rural area
• There are risks to induction
• There are some reasons induction is not an option (placental, fetal position, etc.)

What are your thoughts on labor induction? One thing that jumped to my mind was that they said labor induction had doubled since 1990 and that now 1 in 5 women were induced. That number sounded really low to me.

My heart’s a twitter!

Okay, so I did twitter during labor last year when my daughter was born. That was considered a bit out there, now it’s not so out there. What are you doing on Twitter for Birth or any other activism?

You can find us on Twitter at:

http://twitter.com/birthactivist/

Husband of A Birth Activist

What does it mean to be the husband of a birth activist? I was considering this as my husband and I were driving down the road today. We were discussing a couple with whom we had just had lunch. They were pregnant and assuming they would have a c-section for LGA. Finally, my husband said “You can’t always change people’s minds. Sometimes they are going to make decisions that will hurt them.” Obviously, as the wife of a birth activist, he listens to my rants frequently. But what does that mean for him? Do partners of birth activists feel the same way about the importance of normal birth? What about your partner? My husband agrees with me but doesn’t think it’s his responsibility to educate people the way I do. I’m OK with that as long as he stands up for our decisions and gives good advice if people ask for it. How does your partner act?

Birth Videos from Mothers Advocate

These great videos are based on the Healthy Birth Practices from Lamaze and InJoy Video.