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My father-in-law sent me a magazine with an article on a new study offering "proof" that breast-fed babies are smarter. The study involved more then 3,000 children in England and New Zealand and breast-fed babies had higher IQs than bottle-fed babies. Read about it here.
Here is a great piece on rising U.S. national cesarean rates from Childbirth Connection.
A report on a very sad study appeared in my in-box from www.orgyn.com the other day. Here is a link to the abstract: http://www.greenjournal.org/cgi/content/abstract/110/6/1256. In the study, "cesarean delivery was associated with a significantly reduced probability of a second birth." That is sad, very very sad. I for one can say that I had decided that if I had a cesarean for my second, I was absolutely not going to have a third. Thankfully I had a VBAC (vaginal birth after cesarean) and we are now happily pregnant with number three. My heart aches for those moms whose first birth experiences put an end to their childbearing.
The mom who inspired my post about induction was not induced. At 41 weeks and three days, baby arrived! And what a powerful birth. So many times today I marveled at how gently and effortlessly midwives handle birth. It was my first birth center birth (I had previously attended only home and hospital) and I am now a confirmed supporter of birth centers. I was impressed with how similar the birth was to a home birth. As at a home birth, the midwives didn't have to follow those hospital protocols that are rough on mom and baby (and put grey hairs on my head!). Now if only they could handle VBACs!
One of the midwives told me about an amazing hospital, the North Central Bronx Hospital, where midwives manage the majority of the patients and the cesarean rate is by far the lowest in the city. There is hope! If New York can do it, why can't other cities?
And attending a birth at 19 weeks pregnant wasn't bad at all. I am doubly tired and I did get sick once during the birth (luckily I scurried quickly down the hall to the family bathroom!) but over all it really wasn't an issue. I am a bit sad that I might not attend another birth for a while (I decided not to take on any more doula clients during my pregnancy but rather focus strictly on apprenticing). Oh there is nothing like the miracle of birth, the strength of birthing women... the power of it all can knock you over. I can't believe I get paid to do this stuff!
So many new VBAC blogs and birth blogs have started up in the past year, it is exciting. Here are three more blogs, Your Birth Matters, The Better Birth Blog and Refuse to be a Womb Pod that are fairly new on the scene. Thanks so much for linking up with me! When birth news is discouraging, it is a comfort to know that there are so many birth activists out there slowly working for change. Let's stand together!
So I posted yesterday's blog post on my neighborhood news group and it warranted a strong attack from a fellow mom. Perhaps I should have added the below blurb at the top of my post. This blurb is from a post on a pregnancy/birth blog about big babies**.
(this is not meant as medical advice, this is to remind moms everywhere that you have rights.... choose to use them! Trust your body! Choose care givers who trust your body! Make educated decisions. Care providers give you information... you have to decipher it and choose how to use it, ask questions, get answers you are satisfied with, if you aren't satisfied remember it is never to late to change to a new care provider or you can choose to just say NO!.) (http://www.pregnancybirthandbabies.com/Big_baby.htm)
I thought the above information was self-evident but I guess it isn't. Why do moms feel so threatened when I provide them with information? Why is a public attack necessary? I know there are many more attacks around the corner given the line of work that I have chosen but I do not relish the thought. What is wrong with helping women trust their bodies? If women would rather not read my posts, they can delete them in their in box or choose not to visit my site. My post was prompted by the sad reality that more and more women have been reaching out to me in my neighborhood informing me that their doctors bring up induction and the big baby worry. In my mind, that is a threat. When an "expert" declares you need to induce because you are going to have a big baby he/she is making a threat, not a suggestion. The threat is, if you don't induce, your baby will "be too big" and you may "tear", "baby may get stuck," etc. (this is what the doctors say to their clients, in reality induction will not reduce complications associated with a big baby). Moms are going to believe the doctor/expert. You may have nagging doubts but in the end most moms seem to choose induction because "if the doctor is telling me I should be induced, I probably need to be induced." My goal is to provide more information so that moms are encouraged to question their care rather than blindly accept the opinion of an expert.
In my first birth, when the doctor asked me if I was ready to have a cesarean, she did so after several comments along the lines of "you aren't bringing the baby down," "you aren't going to be able to birth this baby vaginally" etc. I remember her placing her hand inside my vagina while I was pushing and her comments about the ineffectiveness of my pushing (those types of comments certainly don't help a mom push!!!). Of course I consented to the cesarean. Though the question was disguised as a choice, neither I nor my husband felt that we had been given a choice. A doctor told me I couldn't birth my baby vaginally, I didn't know enough about birth to question her statement, so I agreed to go ahead and have a cesarean. For at least a year after the birth I made a story up to myself about how I HAD to have a cesarean, that it was an emergency cesarean (it wasn't an emergency, I was given a "choice," after the doctor left the room the midwife offered that I could have the baby vaginally, though she couldn't "guarantee the condition of the baby" but after the strongly given opinion of the doctor, I couldn't really hear the midwife). If you had suggested that perhaps my cesarean was unnecessary during that first year, I probably would have felt threatened, I may not have been ready to "hear" what you were trying to say, but I would like to think that I would not have attacked the messenger.
* I wrote a follow-up/clarification of this post entitled Thoughts On Blogging.
**Please note, I am not trying to imply that complications are not associated with big babies, I am well aware that there are, but rather that the oft proposed solution, induction, is not the answer. I think it would be much more useful for care providers to tell their clients that their pelvises are ample and that most women will have no problem birthing a big baby.
Too many moms have approached me about their doctor threatening induction lately. I am currently supporting a mom who is past her "due date" and I have been struck at the difference in the management of her care (she is birthing at a birth center with midwives). Instead of making comments about a big baby, the midwives affirm that all is well with mom and baby (more on the midwives' protocols follows below). So here are more thoughts on the management of induction.
1. Best case scenario, induction shouldn't even be discussed unless there is a problem with health of baby/mom (in other words, if baby would fare better outside of the womb rather then in). I would love to see more doctors/midwives patiently wait for baby to come.
2. Since scenario number one isn't really an option in most areas of the U.S. unless you are having a home birth with a Certified Professional Midwife (and I am all for that!), here is a typical way induction is handled at a local birth center. I think it is a good balance between waiting for baby to come and acknowledging the reality that birth centers are backed up by hospitals that have strict induction protocols that must be followed if they are to continue having hospital back-up. I wonder why more OBs can't have a similar induction protocol....
The above scenario is NOT how many doctors I know (or the doctors moms tell me about) handle induction. At 40 weeks (instead of 41 weeks) they schedule your induction (which will usually happen by 41 weeks, 41 and a half if you are very lucky) and may use the threat of a big baby to silence the mom's questions. End of story. This is NOT the way to do things. You and your baby deserve better. Induction can increase your cesarean risk by 50%-250% (Henci Goer)! Please read this article on induction if you would like to know more: http://hencigoer.com/articles/elective_induction/. And on the big baby note, please read this: http://parenting.ivillage.com/pregnancy/plabor/0,,8nbq-p,00.html. Studies show that inducing big babies DOES NOT, repeat DOES NOT reduce cesarean, shoulder dystocia or birth injury (the complications associated with big babies, although many of these complications arise from birthing a big baby on your back with an epidural). If you are having a big baby and want to reduce your risk, make sure you don't get an epidural, stay mobile, and be certain that your care-provider is comfortable delivering babies when mom is in an all fours position.
Moms who are being threatened with induction, my heart goes out to you, this is the LAST thing you need when you are about to have a baby, but have faith, your body knows how to give birth, your baby will come, and your body CAN birth a big baby, much depends on staying mobile and finding a good position.
This looks interesting: http://www.atyourcervixmovie.com/. After I saw this clip I thought, I would be a gynecological teaching associate (what a fancy term, smile). Not now of course, I am pregnant, but I can appreciate the benefit of learning about women's bodies with a more personalized hands on approach. I am so grateful to the moms who patiently let me fumble around to determine how far dilated they are, after the midwife has already checked them, or take their blood pressure even though I sometimes leave the cuff tightened a bit too long. I wonder if there is a program like this in my area... Might be something to do on the side while the kids are younger and before I attend a lot of births. Someone needs to help medical students view patients as women rather than vaginas and breasts and the gynecological teaching associate program sounds like a great way to do that!
As the years go on and the cesarean rates rise, I predict we will see more and more research unearthing the adverse affects of cesarean birth and the pendulum will swing back towards vaginal birth. At least that is my hope. Here is a good article from BBC news on some of the potential risks of elective cesarean. Please note that babies born by emergency cesarean had fewer lung problems then those born by elective cesarean. If you must have a cesarean for medical reasons, don't schedule it unless absolutely necessary for the health of mom/baby, wait until your body goes into labor naturally, then have the cesarean.
BBC NEWS
Caesareans 'may harm lung growth'
Babies born by elective Caesarean section are much more likely to
develop breathing problems, a Danish study examining 34,000 deliveries
suggests.
Researchers found they were up to four times more likely to have
respiratory problems than those born naturally, or by emergency
Caesarean section.
The babies may miss out on hormonal and physiological changes during
labour which help mature the lungs, they say.
The University of Aarhus study features in the British Medical Journal.
Major operation
Almost a quarter of UK births are now estimated to be Caesarean
sections - far above the 10% to 15% rate recommended by the World
Health Organization.
"A lot of woman are completely unaware of the fact that a planned
Caesarean section can negatively impact on their baby." Dr Maggie Blott
Consultant obstetrician
More than half of these were emergency Caesareans, but despite this
experts have been calling for measures to reduce numbers of elective
Caesareans, warning it is a major operation.
A recent Oxford University study found that women could be four times
more likely to die in childbirth if they opted for a Caesarean instead
of natural birth.
The Danish team examined data on over 34,000 deliveries, adjusting to
take account of factors such as the mother's age, weight, and whether
she smoked or drank alcohol during pregnancy
They found that babies born by elective Caesarean section had an
increased risk of general respiratory problems.
The risk was higher the earlier the Caesarean was performed.
A nearly fourfold increased risk was found at 37 weeks gestation, a
threefold increase in risk at 38 weeks gestation, and a doubling of
risk in infants delivered at 39 weeks gestation.
For example, at 37 weeks, one in 10 babies delivered by elective
Caesarean section developed respiratory problems, compared with 2.8%
of infants delivered naturally or by emergency Caesarean section.
At 38 weeks, the proportion was 1.7% compared with 5.1% and at 39
weeks, 1.1% compared with 2.1%.
The risks of serious respiratory problems showed the same pattern.
The researchers conclude that significantly fewer babies would develop
breathing problems if elective Caesareans were put off until 39 weeks
gestation.
They said: "It is plausible that hormonal and physiological changes
associated with labour are necessary for lung maturation in neonates
and that these changes may not occur in infants delivered by elective
Caesarean sections."
Lung fluid
Dr Maggie Blott, a consultant obstetrician at King's College Hospital,
London, said obstetricians in the UK were advised not to carry out
elective Caesareans before 39 weeks.
She said part of the problem might be that doctors had to switch
support lines to the baby very quickly during a Caesarean, and it was
possible that lung fluid is not drained away as well as it should be.
She said: "Some babies do develop transient breathing problems, they
usually recover from them, but occasionally a baby can be very sick
indeed.
"A lot of woman are completely unaware of the fact that a planned
Caesarean section can negatively impact on their baby.
"Any research which reinforces the fact that Caesareans are not
necessarily in the best interests of the baby is welcome."
Mervi Jokinen, of the Royal College of Midwives, said Caesarean
section rates were too high in the UK.
She said it was a major operation, which had health implications for
the mother, as well as the baby.
"The decision to opt for a Caesarean section should not be taken
lightly and should be based on good medical grounds," she said.
Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7137945.stm
Published: 2007/12/12 01:17:41 GMT
© BBC MMVII
The stats for VBAC (vaginal birth after cesarean) are out for Northern VA hospitals, thanks to ICAN of Northern VA and they are depressing. They range from a pathetic .08% to a high of 3.18%! Finally we have in black and white what doulas and midwives and moms seeking VBAC have sensed, it is next to impossible to have a VBAC in many hospitals. There is lots of work to be done. If you are a VBACing mom, PLEASE don't believe you will be part of that .08%! If your hospital has low VBAC rates, please find a new hospital or a care-provider with a strong VBAC record (and that means hard-core numbers, not the, "but of course I support VBACs" line that most doctors like to throw out without any real intention to back it up).
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