The Duggar Family

I would like to extend my well wishes and thoughts to the Duggar Family though this difficult period of their lives after welcoming their 19th baby, Josie Brooklyn Duggar yesterday, December 11th 2009 via emergency cesarean section for Pre-E after a hospital stay due to gallstones. Baby Josie was born at 25 weeks gestation at 1 pound 6 ounces.

Over the past 24 hours I have seen some of this most disgusting comments via the internet on news articles, and just message boards. Whether Michelle was on her 3rd or 30th child, Pre-E can happen to anyone at any age and during any pregnancy. This family may live differently than the vast majority of Americans, but seriously, if you want to say something negative, say it when mother and baby are far out of the woods, not when a micro preemie is fighting to live.

Some people never cease to amaze me.

Michelle has been such an amazing asset to the VBAC community in having 12 VBAC’s herself.
I can only hope in future years she will continue to work with and praise ICAN like she has in the past.

The Infamous Cascade Chart

As someone strongly involved in the birth community, this is probably one of my favorite pictures floating around the internet that I run across every once and a while.? One day when I find out the person who actually put these thoughts and cascade of interventions into a physical chart to view, I am going to kiss them!

I have always loved how it starts with induction, because lets face it, so many women today are starting their labors with some kind of artificial labor stimulant. Whether it be pitocin, or the oh so dangerous cytotec. I can personally say I have been the victim of the cascade myself with my first child. Had I seen this before my pregnancy with him, I would have never opted for the induction. Many do not realize that induction in many cases will fail, almost half of the time according to the most recent figures, and when I quote that, I am quoting Robbie Davis Floyd in a 2008 interview, I believe it was in Pregnant in America but my birth/pregnancy movies and interviews all start to blur together when you watch so many of them. These babies are not ready to be born in many cases, especially when we are seeing these inductions before the “due date” or the 40 week gestation mark. Although we know that “due dates” aren’t much to put stock into, many women and providers use them as some type of eviction date, which history has shown to be a pretty bad idea. No one is going to be pregnant forever and many women left alone will go into labor on their own. Now granted, there are cases that induction is medically necessary and for these special cases, I am completely thankful. Without induction these women would be subjected to cesarean sections instead of labor inductions which could in turn be even more hard on their body, and experience over all.
What we do not understand with the induction of labor is, we are creating unnaturally strong contractions in attempt to simulate something similar to natural labor. As someone who has experienced pitocin labor, and natural labor, I would take a million natural contractions over being on the receiving end of pitocin again. The comparison in my opinion is not even in the same ball park. Another issue with these contractions as most know, is the fact that they are more likely to cause fetal distress on the baby because they are not natural contractions or what normal contractions are supposed to be. So in turn we are putting our children under unnecessary stress. Especially if they are not ready to come and join us in “our world” yet. Again something I learned with my first.
Then we have the provider who comes in and looks at the fetal heart monitoring and says, “Oh No! Your baby is in danger!!” So off to the operating room we go for an “emergency” cesarean which in reality was caused by the pitocin to begin with. You would think by this point there would be a bit of common sense in the Obstetric community to say, ya know, I think we are causing these actions instead of blaming the increasing cesarean rate on “patient choice cesareans” which only make up 3% at most of the incredibly high cesarean rate in our country.

But a cesarean is only one path that this induction cascade can lead to. There are still women out there that will have a vaginal delivery when subjected to a labor induction, but in turn these women have greater risks for other procedures including episiotomies which have all in all been proven to really have little to no benefit to women in the long run. While episiotomy rates are starting to decrease, they are still over used in many communities. For example, here in my state of Connecticut, some hospitals have an over 25% episiotomy rate, when science tells us there really shouldn’t be over 10%. Trying to obtain these numbers are like pulling teeth too FYI!

We also have vaccum extraction. I had never really discussed this or spoken with someone who experienced this until I met my Chiropractor in the summer of 2008. He was discussing with me why Chiropractic care in infants is important, and then he described his own daughters birth, they had applied the vaccum to the top of her head, and while “assisting” her out, they pulled so hard the vaccum literally flew right off of her head. My Chiropractor described it so vividly… “I thought her HEAD popped RIGHT OFF! I was horrified to even look!”? My heart broke for him because no parent should have to go through that kind of fright during the birth of their child!

These all often lead to epidurals, which especially if you are going to have a cesarean section, you will either have this or a spinal block. All types of anesthesia that will have a direct impact on the baby. Although I have experienced women told there will be no effects on their baby at all.
I am sure most know about the “breast crawl” and I can say after watching a baby who’s mother did have an epidural, as opposed to a mom who had a natural birth, there is no comparing the instincts of the baby. While I had epidurals with both of my children, I didn’t have the opportunity to breastfeed then until they were a little over an hour old. My first was almost 2 hours. For more information on epidural effects on babies, click this link!

The last thing I want to touch on is the separation of mother and baby after a cesarean section which is very common. It is pretty uncommon for an newborn to be allowed to stay in the OR with mom, although it does happen sometimes. I can really related to the lack of bonding, breastfeeding problems, and reduced bonding because of this because I deeply experienced this with the births of both of my children. While I bonded, it was not that “instant motherly love” I am sure most feel. It hurts me to this day to know that my bonding was an almost learned bonding because I knew as a mother it was something I needed to do in order to protect my babies.? While most women who have had cesarean sections are not quick to admit this, I think by discussing this and acknowledging that this is a true problem it will only help to improve it for others in the long run. I also noticed that mothers who do experience this may be ashamed or fearful to admit this because it make portray them in a less than perfect light, or maybe others may look down on them because of this, but they should not be ashamed. It happens and there is nothing we can do about it but help other women to not go through what we did!

Be empowered by your birth, no matter how you birth!
If it is a bad experience, help to educate others so they do not go through what you did, so they can avoid the pain or heartache you have dealt with!

CDC Releases New Report Comparing U.S. and European Infant Mortality Rates

The CDC National Center for Health Statistics (NCHS) released a new report this morning which compares infant mortality rates in the U.S. and Europe.

Authors of Behind International Rankings of Infant Mortality: How the United States Compares with Europe explored what they refer to as the recent stagnation in the U.S. infant mortality rate that has generated widespread concern among researchers, policy makers, health care providers and activists.

Using data from the United States? Linked Birth/Infant Death Data Set and the European Perinatal Health Report, authors Marian F. MacDorman, Ph.D., and T.J. Mathews, M.S. of the CDC National Center for Health Statistics found that the main cause of the United States high infant mortality rate when compared with Europe is the ?very high percentage of preterm births in the United States.?

According to the study, while infant mortality rates for preterm (less than 37 weeks of gestation) infants are lower in the United States than in most European countries, infant mortality rates for infants born at 37 weeks of gestation or more are higher in the United States than in most European countries.

Discussions of the U.S. infant mortality rate are often countered with criticism that the U.S. records data differently than other countries, reporting very premature babies as live births. While this is true for five of the 19 European countries whose data was analyzed, 14 of the 19 European countries require that all live births at any birth weight or gestational age be reported.

The United States remains near the bottom of the rankings.

The report states, ?Reporting differences have little effect on the percentage of preterm births because most preterm births occur well after 22 weeks of gestation. For example, the percentage of preterm births for the United States in 2004 was 12.5% when all births were included and 12.4% when births of less than 22 weeks of gestation were excluded.?

MacDorman and Mathews attribute much of the high infant mortality rate in the United States to the high percentage of preterm births. Using the direct standardization method to apply the U.S. gestational-age specific infant mortality rates to Sweden?s distribution of births by gestational age, the NCHS found evidence that lowering the percentage of preterm births could have a dramatic impact on infant mortality in the United States.

November is also Prematurity Awareness Month.? Considering the risks involved in preterm birth, you may be wondering what you can do as a birth activist or as a parent.? Here are some basic things to consider:

• Let labor begin on its own. Without a valid medical reason, let your baby pick his or her birthday for the safest, easiest birth.
• Choose a practitioner with a low induction rate. If you have a midwife or doctor who rarely sees anyone who goes past their due date, it should be a red flag.? Ask the receptionist for her opinion of how many women go past 40 weeks. The answer might surprise you.
• Know the signs of preterm labor. If you think you’re having any of the signs of preterm labor, call your midwife or doctor immediately.? The sooner you get help, the more likely that premature birth can be delayed or stopped completely.
• Be mindful of the risk factors. Face it, you have responsibility for some of the risk factors.? While there are certainly some risk factors for preterm labor that you don’t control, take charge of the ones you can, including prenatal care, good nutrition, not smoking, etc.

Reducing Infant Mortality

Please watch this video and then spread the word about how to reduce infant mortality. Click here to visit the website and get help with writing to your legislator, or sending them this video.

Reducing Infant Mortality from Debby Takikawas on Vimeo.

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.

March of Dimes Gives US a ‘D’ for Prematurity

This week the March of Dimes gave the US a report card on prematurity. As some would have suspected, we are not doing well. Overall the US got a ‘D’ but my state was given an ‘F’, as were the states around me. Below you will find a post where Dr. Laura Riley talks about some things to be done to decrease the number of premature births in the US. In fact, she talks about prematurity from inductions and cesareans that are on the rise. My question would be how much is caused by what the physician wants and how much is the patient’s impatience? With so much focus on one day, could we lower the prematurity rate by simply giving the 38-42 week span as the possible due date?

You can go here to sign the March of Dimes petition for premies.

March of Dimes Interview for Prematurity Awareness Month

Dr. Laura Riley answers some important questions on prematurity and birth interventions for the March of Dimes and Birth Activist.

C-Sections = More Preemies?

Not only has the rising caesarean rate been a concern to those devoted to mother-friendly maternity care, but now a correlation is more publicly being made between caesareans and premature births. An article on MSNBC, “C-sections May Be Behind Rise of Preemie Births” suggests that arbitrarily picking a date for delivery may indeed lead to the rising number in premature births.

From the article: “Premature babies are at greater risk for a number of medical and developmental problems such as troubled breathing, bleeding in the brain, birth defects and death. Premature birth is defined as delivery before the 37th week of pregnancy, rather than the typical 40 weeks.”

Due dates are estimations based on generalized numbers and cycles. Unless a mother goes into labor naturally, there is really no one hundred percent accurate way to tell when a baby should be born. Exceptions would be for complications, of course, which according to the World Health Organization should be less than ten percent — more accurately around four percent.

“There was an increase of 60,000 (between 1996-2004) who were pre-term, and 92 percent of them were by Caesarean section,” cites Dr. Alan Fleischman, medical director and senior vice president of the March of Dimes infant health advocacy group. He is particularly concerned about the number of unnecessary cesareans.

Between mothers recovering from major abdominal surgery and infants in critical health condition, our health providers should be concerned as well.

Cuddling Cuts Preemie Pain

I found this article on WebMD today;

Cuddling Cuts Preemie Pain
Kangaroo Mother Care Helps Very Preterm Infants Get Over Pain Faster

Some quotes from the article;

“It works in premature infants of 32 to 36 weeks’ gestation, according to an earlier study by Celeste Johnston, DEd, RN, and colleagues at McGill University School of Nursing. But can it work in babies born as early as 28 weeks’ gestation? The answer is a qualified yes, Johnston and colleagues now find.”

“Kangaroo mother care was invented in 1978 by Colombian pediatrician Edgar Rey. Faced with a shortage of incubators, Rey found that mothers could use their own bodies to warm premature infants. Years of study show the technique to be at least as safe and effective as incubators, and it lessens mothers’ anxiety while promoting mother/infant bonding and breastfeeding.”

“The technique calls for the tiny child to be held upright between the mothers’ breasts and covered with a blanket. Because the child must be held upright against warm skin 24 hours a day, mothers can share kangaroo care with fathers and others.”

“More importantly, the very preterm babies recovered from the painful heelstick about a minute faster when held kangaroo-style than when left in the incubator. That’s a sign the babies’ bodies are beginning to self-regulate, a process known as homeostasis.”

“‘Mothers should be offered kangaroo mother care as neonatal intensive-care unit policy, not only to be close to their infant, but also to provide comfort,’ they add.”

If kangaroo care, or skin to skin contact, helps reduce preemie pain, wouldn’t it help reduce the pain or discomfort of full term infants as well? If it “lessens mothers’ anxiety while promoting mother/infant bonding and breastfeeding”, wouldn’t the same benefits be seen with full term infants? If kangaroo care becomes “neonatal intensive-care policy”, why shouldn’t it also become the policy in the regular labor and delivery unit?

Urge Action on PREEMIE Bill

From the March of Dimes:

There are only about 48 hours left before Congress adjourns for the year. House Energy and Commerce Committee Chairman Joe Barton (TX) is using the PREEMIE bill to negotiate over another bill in which he has an interest. The content of PREEMIE has been cleared by all, including Chairman Barton’s office. It has been pending in his Committee for over 2 years and was unanimously approved by the Senate on August 1. Please call your Representative today and request they ask Rep. Barton and Majority Leader Boehner to let the House vote on S. 707 before Congress adjourns.

Call the Capitol switchboard (202) 224-3121 or go to http://links.marchofdimes.com/ajtk/servlet/JJ?H=14itxb&R=680790184 to obtain your Representative’s phone number and tell him/her to ask Reps. Barton and Boehner to put the PREEMIE Act on the House floor for a vote today.
Below are points that you can make:

• You have been personally affected by preterm birth (briefly explain your story and the impact on your family)
• The PREEMIE Act has strong bipartisan support and 97 House co-sponsors.
• The PREEMIE Act is desperately needed to stem the growing crisis of preterm birth.
• The Centers for Disease Control and Prevention (CDC) reports that more than 500,000 babies are born too soon each year. Since 1981, that number has increased by over 30%.
• The National Academy of Sciences (Institute of Medicine) estimates the economic burden of preterm birth in the US was at least $26.2 billion in 2005, or $51,600 per infant born preterm. Approximately half of the cost of health care is borne by employers and families with the remainder billed to Medicaid, S-CHIP and other public programs.

Background

For more than 2 years, the March of Dimes has worked with Representatives and Senators from across the nation to enact “PREEMIE.” (S.707/H.R.2861). The bill calls for creation of a public-private agenda to accelerate the development of new strategies for preventing preterm birth and for treating babies who are born too soon.
The principal bill sponsors are Representatives Fred Upton (R-MI) and Anna Eshoo (D-CA) and Senators Lamar Alexander (R-TN) and Chris Dodd (D-CT). The Senate approved the bill by unanimous consent on August 1, 2006. Currently, PREEMIE must now be acted on by the House of Representatives before it can be sent to President Bush for his signature.
For more information, contact the March of Dimes Office of Government Affairs (202) 659-1800.

This e-mail is sponsored by the March of Dimes, a nonprofit organization. The mission of the March of Dimes is to improve the health of babies by preventing birth defects, premature birth, and infant mortality.
For more information about the March of Dimes, visit our Web site at http://www.marchofdimes.com/.