Sonogram: The New Crystal Ball?

I am So frustrated at the amount of misinformation put out there as FACT soley for the convenience of the provider! Grrrr!!!!! Some OB’s do it, some GP’s do it, some midwives do it, heck as far my experience shows some DENTISTS do it.

There was recently a comment made on my Castor Oil post from a woman who was told she was too small and couldn’t go to 38 weeks or her “uterus would rip open”. Baby was just TOO TOO big. Even if the poster got some of the semantics wrong (probably is her pelvis they are talking about not her uterus) the arguments for induction just amaze me. Of course I did not offer he any advice as to induction.

My local hospital routinely does inductions at 37 weeks. 37 WEEKS! Yeah. Ludicrous.

The main reason given to women for inductions and even cesareans is the “big baby” argument. And we have these wonderful things called sonograms to “prove” they are too big to “fit” through your pelvis. Please. Do they think we are stupid? Ignorant perhaps, but we are not STUPID.

Here is a lovely blog post by the fantastic “Unnecessarian” on sonograms and estimated size and due dates. Sonograms can be off as much as a pound either way and 2 weeks +/- for due date predictions! So if the sonogram says you are ok for an induction at 37 weeks (by the sonogram) and you induce and it’s off by 2 weeks guess whatcha get? A baby at 35 weeks with respiratory issues, breastfeeding challenges, and a myriad of other psychological implications the likes of which we have NO CLUE about yet.

And the weight predictions are just fantastical. The stuff of Harry Potter and traveling circus acts. There is some science there – just enough to be dangerous. Sure. Gaze into the sonogram screen and see your future: induction + pitocin + epidural = surgical birth.

And let me tell ya from experience: a 2nd degree tear is alot easier to heal from than a 10″ wound on your belly complete with scar tissue and a spinal headache for dessert.

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Oh. My. Goodness.

Here is a fantastic doctor doing what so few do (or at least they don’t make headlines). He seems to be really genuine about advocating for women in the rough spot of wanting a normal birth after thay have had a surgical one. As a VBAC mom, this gets my goat everytime.

I want to send this guy flowers.

12PinkRoses

Canadian study supports safety of planned homebirth

This ia really exciting. The study found HERE compares not only planned homebirth vs. planned hospital birth but also throws in planned hospital birth with both physician AND midwife. I often hear, “Well, I had a midwife in the hospital. That’s about the same as a homebirth.” No, it isn’t and here is the support for that position.

Not only are the planned homebirth outcomes better ACROSS THE BOARD, but they are bett with a homebirth midwife vs. a hospital midwife. Really cool info to have when asking or arguing for the safety of planned homebirth. (This booklet from Molly also has some great talking points in it!)

🙂

This just made my day. The canadian system has it’s caveats, no doubt, but the overall theme is that planned homebirth is SAFE with a trained midwife. I could do without the “registered” midwife thrown in there because I think it undervalues the work and safety of trained midwives who refuse to register (and there are many many GOOD reasons to not register). Of course they could not participate in the study and I doubt they were asked to. Afterall, who are they and WHERE are they? That, of course, is a question for another day. 🙂

Domicilary Obstetrics

Here in the US, homebirth midwives normally seek to remove and distinguish themselves from the term “obstetrics”. It conjurs images of sterile green hospital walls, episiotomies, paternalistic care, and the dreaded bed and stirrups of 2nd stage.

I recently came across the term used in a most delightful way at the Homebirth Australia site.. It’s definition most creativily defining what homebirth midwives do:

However, domiciliary obstetrics is the ‘art of invisibility’ and without complications a woman gives birth herself, supported and aided by her midwife. -Jan Pilgrim

I would love to have turned that phrase. “The art of invisibility”. Yes! A watchful eye, careful watching, gentle hands. THIS is the art of the midwife.

Off-label drug use

I understand that the off-label use of pharmaceuticals is a normal occurrence in the medical world. I get that. What’s not cool is that this is done in maternity care as well with dire consequences.

I’m not talking about the random, “uh-oh”, I’m referring instead to the drug company themselves issuing statements saying “We do not endorse the use of this product for any use other than that described on the label.” Yeah, they’re probably just covering their b*tts but still. They said it. Yet it happens everyday in the labor and delivery department of nearly every hospital in the country. It has become so commonplace to induce labor that not only have we stopped wondering how/if this affects the baby or the mother we have now started grabbing whatever drugs we can find that give us “a better induction outcome”.

Hrrumph.

Bishop’s score be damned. God created women’s body to birth. With consideration made for the odd-one-out with pituitary damage or other disorders that truly make her body hold onto her baby long past safely, using drugs to begin labor before the body begins to open up on it’s own is risky risky risky.

Births are kindof like bowel movements. They happen on their own. Can’t plan ’em, can’t stop ’em, can’t hurry them along. Bowel movements happen (errr… I can’t help but think of a certain bumper sticker I’ve seen alot of right now).

Birth HAPPENS as well. Babies are born when it is TIME. If we have accepted that every other body system has knowledge to know when to open and release, then why can’t we accept the body’s wisdom in birthing when it is time?

You might have had a Cytotec induction. And so did your sister, your friend, aunt, daughter’s 2nd grade teacher… and all went well. On the surface perhaps. But what did it do to that baby’s emotional/psychological health to be so rudely pushed into the world before he/she was ready to come? And what about the women reading this who is a victim of a cytotec induction who is grieving the loss of her womb? Suddenly hurrying a baby out seems less important when faced with an emergency cesarean to save your baby’s life and a hysterectomy to save yours.

All from a couple of tidy white pills manufactured to treat ulcers. Who’da thunk?

Oh my goodness.

This has to be the single most ridiculous “invention” I’ve ever heard of in relation to women’s health. Good grief.

Ever heard of GOOD NUTRITION strengthening and giving elasticity to pelvic floor tissues?

Ever heard of emotional/psychological conditioning to learn to accept the labor waves instead of fighting them?

Ever heard of, oh I don’t know, BIRTHING WITH A MIDWIFE? 🙂

Goodness. I applaud the idea that episiotomies are ugly, nasty inventions of man (which, by the way, nearly every “invention” in relation to birth has been an unmitigated disaster). But seriously folks. A balloon in the vagina to stretch out vaginal floor tissues? Good grief Charlie Brown.

Who’da thunk it?

A WOW news release on MedLine this morning regarding the safety of planned homebirths. Get this:

All of the outcomes studied occurred with comparable frequency in the planned home and hospital birth groups. These included intrapartum death (0.03% vs. 0.04%), intrapartum and neonatal death within 24 hours of birth (0.05% vs. 0.05%), intrapartum and neonatal death within 7 days (0.06% vs. 0.07%), and neonatal admission to an intensive care unit (0.17% vs. 0.20%).

[My note: actually, the numbers show slightly better outcomes at home. 😉 ]
“As far as we know, this is the largest study into the safety of home births,” the authors note. The findings, they conclude, indicate that with proper services in place, home births are just as safe as hospital births for  low-risk women.  ~ BJOG 2009;116:1177-1184

NOw of course this is a “foreign” publication (British Journal of Gynecology) so I don’t know how much credibility it will get here in the trenches, but WOW. Very cool that the news is getting out there to US med students and physicians!

Only if…

“It’s a numbers thing,” says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. “You don’t get sued for doing a C-section. You get sued for not doing a C-section.”

I’ve seen this quote before, but it never quite made me as angry as it did this morning when I was reading it in the context of THIS TIME MAGAZINE ARTICLE. This California mom has to drive 100 miles to have the chance for a VBAC. Give me a break!

I understand liability, I truly do, and I understand that to continue offering care for the majority of patients, one must sometimes eliminate care for the minority. But hey. This is ridiculous. As a VBAC mom myself, I would have to drive at least 100 miles and then only have “permission” for a “trial of labor” within a very small window of opportunity. “Only if” my incision was of type A, “Only if “ my bag of waters hadn’t been broken more than 12 hours, “Only if” the baby was in a perfect position (by obstetrical definitions), “Only if” the labor didn’t last more than X number of hours, “Only” if it progresses well, “Only” if I would have continuous fetal monitoring, “Only if………”

By the time all of the restrictions had been placed on me I’d have a better chance of delivering my baby vaginally in a snow storm in the middle of April. Yeah, it happens, but rarely. Birth was not meant to be a 3-ring circus with planned events and bright lights.

This mom, in the Time article, said her biggest fear was the drive and that she might not make it to the hospital.

If only… she gets that lucky. It might be her best chance at a natural birth.

Just about given up…

When quite unexpectedly I happen upon a blog by (of all things) a DOCTOR. 🙂 I love doctors really, truly. I’ve met and known some fabulous ones, wonderfully caring individuals who are stuck doing what they love in a minefeild of insurance risk-assessments and mandatory hospital protocols. My heart goes out to them. Truly. If I were 20 again I would most certainly go to medical school. It would the ultimate test of my belief system, and would surely try me to the core. I like that kind of thing.

Anyway… I digress…

This blog, it had the most beautiful birth story on it, written by a doctor. If all midwives could be SO lucky as to have a collaborating physician like this one. This is the stuff dreams are made of.

A Welcome Surprise

Enjoy.

Judgements

A recent story in a British newspaper left me feeling bewildered at this tragic loss and wondering what I can learn from it. A 20-something mother died 6 hours after giving birth to her baby at home.

I am not one to ignore or **hide** the less-than-optimal outcomes that occasionally occur at homebirths as some of our opposition would assert. Rather, I wish to dissect it (as much as possible form the information given in the article which is, I’m sure, far from all of it) and learn the lessons that are there for the taking.

The mom suffered a massive hemmorhage after an inverted uterus began bleeding profusely. It seems that a huge factor in this woman’s death revolves around lack of communication between the hospital and the attending midwife at the time of transport.

One of the gynecologists on staff said, “The staff were expecting a retained placenta. If they had been told it was a complete inversion of the uterus then she would almost certainly have gone straight to theatre and I would have been ready for her.”

One thing that seems to be missing from this article is the answer to this question, which of course, could only be answered by the attending midwife: “How/why did the inversion occur?” As a training midwife, this question is of utmost importance to me. All of the study I’ve come across says they are almost always caused by interference of some sort. Not always, but generally.

I am skeptical of it being anything but an induced inversion because she was not (apparently) forthright in telling the ER staff of the woman’s condition. Did she pull on the cord or placenta? Perhaps the woman was hemorrhaging and the midwife attempted manual removal in order to stop the bleeding? 

Or was there no communication because she is an independent midwife and was greeted with hostility when she arrived with her client at the ER with paramedics?

And rather than blame the midwife, we should probably wonder why paramedics weren’t trained to cannulate? When they, perceivably, attend more massive bleed situations than a midwife would? Her assumption was the same as mine might have been as she was quoted as saying, “Knowing the ambulance was only a few minutes away I thought it was better to leave it for the proper paramedics who have expertise in this on a daily basis.”  While cannulating (inserting an iv and fluids) may not have saved this woman’s life, it could have bought more time for the hospital staff to figure out what was going on and act accordingly.

There is quite a bit of talk about this on certain people’s blogs, saying this is exactly why DEM’s shouldn’t be practicing and why homebirths are “inherently dangerous”. Again, I would say, a DEM is such a broad term that I prefer not to use it. I prefer to use the term “midwife” and then find out on an individual midwife’s training is. Some CNM’s (from personal experience) have no business catching babies. They simply took the extra training for the pay raise. I had one tell me this straight out. She was an OB RN and had caught enough she thought she “ought to be getting paid for it”. “I wouldn’t say it’s my passion, but it’s a good gig.” CNM’s can also get their certification online. I mention this since it seems to be a point of contention and an excuse for the “CPM’s training isn’t good enough” crowd. All DEM’s are not created equal, just as all OB’s are not. Gasp – horror!!!!! Did I just endorse OB’s? No, I said I won’t cast judgement on them all for the actions of some.

This is all, of course, an overstepping of my bounds in regards to making a judgement on this midwife and this homebirth. There is no way for me to calculate, based on one newspaper article, what went wrong, who is to blame, etc. Nor is there enough in one article to use it as fodder for a position that says “ban on all homebirths”. It is a sadly uneducated and narrow-minded person who would do so.