Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Must Read Blog: “It’s Your Birth Right!!” April 26, 2009

Stemming from a comment left on my blog, I was directed to check out a relatively new blog entitled It’s Your Birth Right!! and I have to report that this is quickly becoming one of my new favorite blogs J! 

 

Blog creator Nicole Deggins, CNM, MSN, MPH is an author, educator, childbirth enthusiast, and woman’s advocate.  She writes that the goal of her blog is “to help women and their families make INFORMED decisions about their birth experience based on HONEST/ UNBIASED information.”

 

I am most excited about two of Nicole’s posts entitled: Choose Wisely Part I & Part II.  These posts are great because they are better than any other article I have ever read about how and why families should be picky about choosing their best birth attendant.  In my opinion these posts not only give great, unbiased advice and reference variety of helpful resources, but they are also honest about the Top 4 TERRIBLE reasons for picking a birth attendant.

 

Nicole writes,

 

“I get questions, all the time from friends, friends of friends and even strangers.  They want my thoughts about pregnancy, labor and childbirth. I have spent HOURS talking with women providing answers and information they should be able to get from their prenatal provider/birth attendant.  I think to myself at the end of those conversations, “Why isn’t she able to get this information from her?  If  he doesn’t make her feel special, does not answer her questions, and doesn’t agree with her philosophy on childbirth and labor, why on earth is she allowing him to be her birth attendant?!”

 

When I pose this question to the women themselves, the answers unfortunately never include “Because I did my research and I found him to be the best match for me and my desired childbirth experience.”  Most of the answers I receive fall into the four categories below, none of which are good enough reasons alone to choose a prenatal care provider/birth attendant.”

 

The four categories that Nicole is referring to are:

 

1)     “She delivered my sister/girlfriend.”  

2)     “She is my gynecologist.” 

3)     “He is the best/most popular person in area.” 

4)     “Her office is so close and convenient to my office/house.”

 

I have to “second that” to every thing that Nicole writes about in her two posts.  I too am flabbergasted at how many women spend more time researching a new car, camera, computer, appliance, or handbag purchase than they do researching their care provider or birth options.  I am also floored by many of the women I take care of that seem to have NO IDEA how their doctor or midwife actually thinks, feel, and behaves in a labor & delivery setting.  One time, and I am not exaggerating, a woman I was assigned to care for looked up at me after a particularly upsetting encounter with her attending obstetrician (he was very rough with her vaginal exam, was down right pissed off that she refused an amniotomy and an epidural, and stormed out of the room) and said, “Wow, I didn’t realize he was so pushy!  He was really rude!  I don’t know if I want him to deliver my baby!”  I was thinking to myself, “HOW in God’s name are you just figuring out now that he is an asshole?!”  (Excuse my language but this particular doctor is a high intervention, low patience physician with the stats to prove it, on top of the fact that he treats nurses like his personal empty-headed gophers…ARG!)  Turns out the only research she did to find this doctor was that her cousin went to him and was happy with his services since he agreed to induce her early because she was “sick of being pregnant” (her words, not mine).

 

Of course there is also the lying phenomenon as well and this is one area where I feel the most sympathy for my patients.  That’s right ladies…people LIE and I hope that I am not the first person to tell you that doctors and midwives are people too!!  That’s why, as Nicole writes, interviewing potential birth attendants and ASKING FOR THEIR STATISTICS is so important.  Someone I know ended up switching her birth attendant at 36 weeks along because it had turned out that he flat out lied about his experience and philosophy regarding VBACs (vaginal birth after cesarean).  For example, if you have a question about a particular intervention, say episiotomy rate, and the birth attendant you are interviewing either skirts the question or says something vague like, “I only do them when I deem necessary,” I encourage you to ask him for his STATS.  You might be surprised at how often he “deems it necessary.”  It is also important to note that you cannot make sweeping generalizations about a care provider just by their credentials, that is, not all midwives follow a midwifery model of care and not all obstetricians follow a medical model of care (although by the very nature of their education many of them do).  So it is still important to research your birth attendant even if you are planning on choosing a midwife!

 

Also, I wonder if many women do not research their care providers/birth attendants because they come from generations of women who nodded their heads, smiled, and did exactly everything their doctor told them too regarding their reproductive health.  I mean, if a woman’s mother, aunts, and grandmothers didn’t question their doctors, what influence does she have to act any differently?  The good news however is that in today’s day in age, unlike our mothers and grandmothers, we have a most wonderful thing called THE INTERNET J.  So you have no excuse!

 

But really, I am preaching to the choir here aren’t I seeing as if you are reading this blog you obviously are seeking out more information J.  Rock on!  But to all the ladies out there who might be thinking about getting pregnant or are currently pregnant who haven’t yet started to do their research, I hope at some point someone tunes you in to all of the fantastic, helpful information that’s out there J!! In my dream world, no women ever feels the need to say “If I had only known…”

 

My (Aggravated) Response to “Ban the Breast Pump” April 3, 2009

Hanna Rosin’s done it again.  It was bad enough that she was even published never mind the fact that she was actually invited onto NBC’s Today show.  But now there are journalists out there seriously supporting her cockamamie ideas and poor research by writing about her in major news papers!  Oh give me a break!

 

Case in point: April 2nd’s edition of The New York Times.  Gracing the opinion page, an article entitled “Ban the Breast Pump” by Judith Warner, author of the 2005 book “Perfect Madness: Motherhood in the Age of Anxiety.”  Oh brother… this should be good. 

 

Warner begins the article by quoting Rosin in a recent four-part controversial podcast conversation she has filmed with three of her gal pals.  The main target, among a host of other things, is the breast pump.  Quoting Rosin, “That was my least favorite thing I ever did in my whole life.  Who could blame [your husband] for never wanting to sleep with you again?

 

Oh jeeze, and here Warner goes… This is what she had to say in regards to watching Rosin’s podcast and reading her Atlantic article, “Hallelujah, I all but shouted at the computer, desperate to join in the conversation with these newfound sure-to-be best friends.  Rosin’s article, based upon a review of the relevant medical literature and some physician interviews, makes the case that the health claims about breast milk have been greatly overstated.  Why have we made such a fetish of breast milk when there’s no evidence to prove whether, as Rosin puts it in the Atlantic video, ‘what’s key about breast feeding is the milk or the act of breast-feeding’?”

 

If all of this is not infuriating enough, Warner decides to end her article with the following “take that” to every nursing mother out there who for one reason or another, desires to, has to, and likes to use a breast pump:

 

“In fact, I hope that some day, not too long in the future, books on women’s history will feature photos of breast pumps to illustrate what it was like back in the day when mothers were consistently given the shaft. Future generations of female college students will gaze upon the pumps, aghast.  ‘Did you actually use one of those?’ they’ll ask their mothers, in horror.  And the moms, with a shudder, will proudly say no.”

 

Of course I am not so naïve to think that there aren’t some women out there that don’t particularly enjoy, maybe even hate, using a breast pump.  I can remember my best friend telling me stories about when she was pumping for her premature twin girls when they were in the NICU.  She told me that it was very important for her to provide the girls with her breast milk since they were so premature, the gift, she said, of added germ fighting power she knew only she could provide for them.  But a month was her limit and she has said to me how she does not miss “milking” herself and how hard it was to “warm up” to a breast pump when she was so sad her babies were not at home with her.  I can totally understand her feelings.

 

On the other hand, I remember my mom pumping breastmilk for my three brothers and sisters before working evenings as a waitress while I was growing up.  So I called her up today and asked her how pumping made her feel.  “It didn’t much bother me,” she said, “It actually was pretty quick when I used to do it and I was lucky enough that I only missed one feeding being at work.  But if I didn’t have that pump, boy, that would have made things more difficult.”

 

First of all, it really boggles my mind that Warner can write, “Why do we, as women, accept all the guilt and pressure about breast-feeding that comes our way instead of standing up for what we need in order, in the broadest possible sense, to nourish and sustain ourselves and our families?” and yet be SO BLIND to the reality that there are hundreds of thousands of mothers in this country and in the world that DO NOT believe that breastfeeding is a burden, plaguing their marriage and self esteem, and hurting their independence and career!  That she can be so PIG HEADED to oversee how, for many families, breastfeeding is the ONLY way they CAN or CHOOSE to nourish and sustain themselves?!  And NEWSFLASH!  The real truth is that there are many mothers out there that breastfeed, not because they feel guilt if they don’t or feel societal pressures to do it, but that it is the best choice for them and their families.  Rosin & Warner’s stance falsely gives their readers the impression that all of the breastfeeding moms out there are just waiting for someone to give them an “out.”  How ignorant!

 

The following is an incomplete list of reasons that a mother might NEED, CHOOSE, or WANT to express their breast milk with a breast pump:

1)     Their own milk supply is higher than their baby’s needs and not pumping causes their breasts to become uncomfortably full

2)     Their own milk supply is less than their baby’s needs and pumping is required to build up a bigger milk supply (the physiology is: the more a mother breastfeeds or pumps, the more milk she will make)

3)     Breastfeeding must be delayed after the birth of a premature baby or sick baby that does not yet have the ability to coordinate a suck and swallow motion and therefore must be fed via gavage feeding (tube in stomach) and not pumping would render the mother with out an adequate milk supply to start breastfeeding when the child is ready.  Not to mention the proven evidence of how beneficial breastmilk is for a premature baby.

4)     The mother must be away from the child at some point of the day/week (for example, when she returns to work), and wishes to provide the baby with breast milk via bottle feeding when she is unavailable.  Pumping also allows the woman to keep her milk supply adequate especially if she works full time or long shifts.

5)     The father desires to participate in feeding the baby and both parents desire that the feeding provided still be breastmilk

6)     The mother would like to build up a supply of milk that can be frozen and used during a night out or in any situation where the mother might have to be away from the infant.

7)     The mother is experiencing engorgement after delivery causing the mother’s nipples to become flat and the skin on her breasts to become taut, making it difficult for the baby to latch on properly.  The temporary expression of milk with the aid of a breast pump can soften the areola so that the baby can latch on properly and hence, remedy a situation that could potentially threaten the mother’s confidence in her breastfeeding ability.

 

So as far as banning the breast pump goes, I think that it is one of the most judgmental, unsupportive, ignorant, selfish, and detrimental suggestions to come out of this whole “The Case Against Breastfeeding” debacle.  And articles like Warner’s are only the beginning. 

(See: Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding)

 

Why The Today Show Hurts America (or, Battling The Case Against Breastfeeding) March 18, 2009

The Today Show hurts America.  That’s right.  And while I’m at it, so does Good Morning America, The Early Show, Fox & Friends, and every other American morning “news” and talk show that propagates careless, partial research and half-truths.  And Monday, it got personal. 

 

The American media has been finding itself in a heap of trouble lately.  First it was the political media that failed us by not accurately and truthfully reporting the state of events leading up to the war in Iraq.  Then it was the economic press, failing to appropriately and honestly alert us to the foreseeable consequences to greedy and dishonest deeds on Wall Street and in corporate America.  And now it’s the morning news/talk show circuit (and I use “news” lightly) that is flooding American homes with irresponsible, half-assed, and poorly researched segments that can have a profoundly negative impact on the breastfeeding culture as we know it.

 

Case in point, Monday’s segment titled Is breast-feeding really best?: The case against breastfeeding, hosted by The Today Show’s Natalie Morales, advertised with the tag line, “Some women are questioning whether the health benefits are worth it.”  When I saw this segment and read the “supporting” article on www.today.msnbc.com I honestly started to cry; my entire being was deeply saddened by the potential negative consequences this garbage could have on impressionable gestating and new mothers all over this country.

 

The segment starts by citing the American Academy of Pediatrics recommendation that mothers breastfeed their children exclusively for the first 6 months and continue to breastfeed while introducing solid foods for the first year.  After this, the segment goes downhill fast.   Dr. Nancy Snyderman, NBC’s chief medical editor, continues by apathetically listing an incomplete inventory of the health benefits of breastfeeding for both babies and mothers and then states (and this is a direct quote), “But some challenge the science is not so strong.”  [I will get to that outrageous untruth in just a moment.]

 

Next to speak is Hanna Rosin, a breastfeeding (that’s right) mother of three who recently wrote an article for the current issue of The Atlantic magazine entitled The case against breastfeeding.  Morales prompts Rosin with the statement, “You are not anti-breastfeeding but you do talk about the society pressures.  Explain,” to which Rosin responds, “New moms are really vulnerable.  You go into the doctor’s office, you read the magazines, and they make you feel like you are putting your child in grave danger if you don’t breastfeed them.  And then you read the scientific literature and frankly, there isn’t the solid evidence you would expect to support this.”

 

Let’s take these outrageous statements one at a time shall we! 

 

Bogus Claim #1 I believe Rosin is right when she says that new moms are vulnerable and because of this, I feel like we should be using our resources and energy in this country to increase support for pregnant and postpartum moms instead of going on television and touting why one shouldn’t breastfeed!  In fact, pregnancy is a time when most women find themselves really starting to form a healthy obsession with researching everything they can about pregnancy, birth, and child rearing.  And that is good! We have come a long way from the 1950s when women were given hormone injections to dry up their milk, left alone as their babies were taken from them for hours or days after birth, told that their breasts were either “too big” or “too small” to breastfeed, or worse, that breastfeeding was only for “poor” or “uneducated” women.  It is sad that Rosin does not see how wonderful it is that magazines and physicians are finally on board with reporting on the benefits of breastfeeding and how to be successful at it!  And if those articles make women feel “bad” about choosing not to breastfeed, that doesn’t mean that these articles are bad, it might just mean that these particular women might need more education and support during pregnancy and postpartum.

 

Bogus Claim #2 As far as there not being enough scientific literature supporting the benefits of breastfeeding, how about this: a meta analysis published by the U.S. Department of Health and Human Services (AHRQ) in 2007 entitled “Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries,” which reviewed over 9,000 abstracts, 43 preliminary studies, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies on breastfeeding concluded with the following:

“A history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis [for the child].  For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer…Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression.”

An article posted yesterday on Motherwear’s Breastfeeding Blog originally referenced this study and I highly recommend reading the post as it is both informative and extremely well put!  As far as Rosin’s article, she only cites 2, that’s right…two research articles to support her argument that there isn’t enough evidence that “Breast is Best.”

 

 

Bogus Claim #3 The segment continues with Rosin stating, “I feel like many people do feel like they’ve failed, if they can’t breastfeed or have trouble breastfeeding, or if they want to stop breastfeeding.  They just feel like ‘I’m giving my kid poison if I give them formula’, and it really isn’t like that.”  In Rosin’s article she also gaffs at the idea of a “lactation consultant” by writing “(note to the childless: yes, this is an actual profession, and it’s thriving).  

 

What Rosin fails to realize is that lactation consultants are a woman’s ally, not enemy.  Their training and purpose is not to make women feel bad about not being able to or having trouble with breastfeeding, but rather to assist them in anyway so that they can become successful at breastfeeding!  And if after their help a woman still cannot breastfeed (for whatever reason), then at least she can rest assured that gave it her best. Should other mothers now judge this mother?  Of course not!  But that doesn’t mean that the information and support about breastfeeding should not be provided to that mother first!  Rosin alludes to the fact that in this country, women do not have enough postpartum support and yet she degrades one profession that seeks to do just that!  And furthermore I’d like to shout, Hey NBC!!!  How about next time you put together a panel to speak about breastfeeding issues, you include someone who actually is an expert in breastfeeding or breastfeeding education, like a lactation counselor, La Leche League leader, pediatrician, nurse, midwife, or obstetrician, instead of an Otolaryngologist (a head and neck surgeron) who specializes in head and neck cancer.  (That’s right, Dr. Nancy Snyderman is an otolaryngologist).  To me, that’s downright irresponsible journalism. 

 

Bogus Claim #4  Both Snyderman and Rosin stress the inconveniences of breastfeeding throughout the segment as well as pointing out the societal pressures against it.  “If you want to clear a zone of inhibition around your lunch table [at work], breastfeed your baby in public,” squawks Snyderman. By this point in the show, I began to think to myself, what is this segment’s main argument?  Is it that some mothers know the benefits of breastfeeding, but question whether the benefits are worth it to them?  OR Is it that breastfeeding does not offer health advantages for both mother and baby over formula feeding?  I hate to break it to the Today Show, but the former statement, although very saddening, is probably true…but the later statement is just blatantly FALSE! 

 

Is it that mothers should support each other, even if situations beyond their control arise that prevent their ability or shorten the length of time they’re able to breastfeed? OR Is it that formula is just as good as breast milk and therefore breastfeeding isn’t worth the “bother and inconvenience?”  Because again the former statement is true…but the later statement is blatantly FALSE!  Sadly, the Today Show automatically promotes both of the later statements with its sensationalized hooks and trailers for the segment, which were repeated before every commercial break for 30 minutes before the piece aired.  Oh, and by the way Snyderman, formula might not be poison, but I certainly don’t think it is conscientious to go on national television and call it “wonderful” and as healthy of an alternative.”

 

 

Bogus Claim #5  On www.today.msnbc.com, Mike Celizic recaps the segment by writing, “After decades of indoctrination delivered with evangelical fervor, American women have come to take it as an article of faith that if they don’t breast-feed their children, they’ll grow up to be underachievers plagued with health problems and lacking a bond with their mother.”  Oh the drama! (…Give me a break!!)

 

In reality, if an organization or health care provider details and promotes the benefits of breastfeeding it does NOT mean that they are telling women that not breastfeeding their child will result in harm and danger.  It’s about RISK REDUCTION.  The truth is, research supports the belief that breastfeeding might lower your child’s risk for a variety of illnesses and reduce a mother’s risk for things like postpartum hemorrhage and postpartum depression.  That doesn’t mean that every woman who bottle feeds will get postpartum depression and her baby is guaranteed to be plagued with frequent diarrhea and ear infections.  It just helps decrease their risk!

 

Furthermore, when I go to the dentist and the dentist looks at my teeth and says to me, “Have you been flossing twice a day?” and I say “No…” and then he goes over the benefits of flossing and the risks of not flossing, what is wrong about that interaction?  True, I might be a bit embarrassed and feel a bit guilty about not flossing, but that doesn’t mean that the dentist should NOT tell me about the benefits of flossing!  It would be irresponsible of him as a health care provider to not at least make sure I knew all the risks and benefits and then if I still decide that flossing isn’t something that’s “worth the time”, then I have the right to make that decision for myself as an adult.  But throughout her article, time and time again, Rosin writes negatively about providing women with counsel and educational information regarding breastfeeding, NOT just about the unfortunate judgment that some women might face from their peers if they make the decision not breastfeed.  When I ask a patient if she is going to breast or bottle feed during my admission interview as a labor & delivery nurse, and she tells me she is going to bottle feed, it is my responsibility as a health care provider to ask her about her reasons and provide her with educational breastfeeding materials so that I know in the end, if she decides breastfeeding is not for her, it is not because of misinformation, old wives tales, misguided pressures from family, or a lack of education, but because it is just her decision.   

 

Bogus Claim #6 As for the time commitment argument, on the show Rosin stated “…and we all know what a time commitment breastfeeding is… I mean it’s a pretty serious commitment to breastfeed.  It’s not like taking a prenatal vitamin.”  She elaborates on this position in her article by writing, “[Breast-feeding]is a serious time commitment that pretty much guarantees that you will not work in any meaningful way. This is why, when people say that breast-feeding is “free,” I want to hit them with a two-by-four. It’s only free if a woman’s time is worth nothing.” 

 

First I personally know women who work in offices, restaurants, schools, parks, and hospitals, in white collar jobs and blue collar jobs, as doctors, nurses, teachers, farmers, bus drivers, waitresses, and stay-at-home moms, who would like Rosin to know that they believe, as well as myself and many others, that their work IS meaningful.  And if you are a mom who feels differently, who feels “miserable, stressed out, or alienated by nursing, or who feels her marriage is under stress and breast-feeding is making things worse”, then perhaps you are right.  Perhaps you shouldn’t be breastfeeding and perhaps you should also honestly consider obtaining counseling or joining a support group for new mothers because breastfeeding probably isn’t the root of all of your problems.  But for goodness’ sake, for Rosin to go around writing and stating on national television that “the actual health benefits of breast-feeding are surprisingly thin” and that breastfeeding is just “instrument of misery that mostly just keeps women down” [both direct quotes] is untrue, misleading, and hurtful to gestating and new mothers everywhere, both planning and not planning to breastfeed.

 

Second, I would like Rosin to know that MANY healthy practices in life take a time commitment.  Our primary care physicians and cardiologists often tell us Americans about the health benefits of eating a well balanced diet low in saturated fat as well as the benefits of exercising regularly.  Everything we do in our lives to better our health takes time, but that doesn’t mean that our doctors and other health care providers shouldn’t continue to educate people on these healthy practices just because people might feel “guilty” if they don’t do them!  And it also doesn’t mean that if you don’t exercise three times a week and eat a balanced diet that you are guaranteed to die of a heart attack.  It just helps to reduce your risk!

 

In conclusion, the state of maternity care and postpartum support in this country is in a crisis, and if we don’t even have the media reporting good research and promoting healthy living for ourselves and our children, it is only going to continue to get worse.  Shame on NBC for being so irresponsible; it’s one thing for The Atlantic to publish an opinion piece (no matter how outrageous), but it is another thing to put this woman and her bogus research on national television and try to pass it off as news.  The unfortunate thing is that for some people, shows like Today are their only source of news!  As a society, we should be focusing our energy towards making things better for new mothers by using the power of the media for good, like airing segments on breastfeeding/new parent support groups and tools for breastfeeding success or helping to pass legislation that makes appropriate break time, a clean & quiet place to pump, and an adequate place to store milk something that is available to ALL working mothers!  But instead the Today show decided to throw their hands up and agree that things are never going to change by providing unchallenged air time to this sorely misled mother.  And if shows like Today continue to propagate and support such astounding untruths on national television, they are going to continue to hurt America. 

 

Pregnant In America: A (Brief) Review March 13, 2009

I recently was sent a link to a website that lets you watch the 2008 documentary entitled Pregnant in America: A Nation’s Miscarriage for free.  The catch is that it will only let you watch 72 minutes of the movie, and then it makes you wait an hour to watch the rest (unless you sign up for their program which costs money). So if you don’t mind watching half the movie before dinner and then the other half after dinner, it’s worth it to just wait watch it for free!

 

The synopsis posted on the documentary’s website reads:

 

“Pregnant in America is a motivational and inspirational documentary made by film maker Steve Buonagurio about the birth of his daughter Bella. Shocked by the greed of U.S. hospitals, insurance companies and medical organizations, Steve and his wife Mandy set out to create a natural home birth in a world where everything is anything but natural. The film is as much educational as it is entertaining and prepares excepting parent for their uncertain journey of being pregnant and having their baby.”

 

My overall impression of the movie was good, as it is very empowering to see “ordinary” people (that is, couples who are not already in the birth advocacy community) honestly researching all their options once they become pregnant as opposed to buying into the medicalized culture of fear that so many of us grew up to believe is the only way.  I have been meaning to watch the movie a second time so that I may give it a more thorough review but just haven’t found the time.  Check back soon for an update!

 

My only criticism of the movie is that it seems a bit scatterbrained and “all over the place” at times and when I finished watching the movie, part of me felt like there was no real cohesive message but instead, a bunch of scattered messages throughout.  Other than that I feel it is a documentary worth watching.  I am also interested in hearing all of your impressions too J!  What do you think?!

 

Nature Knows Best: The Problem with Unnecessary and Early Induction/Cesarean February 27, 2009

I recently stumbled upon an article on TIME.com published back in January 2009 (I know, I know, a bit late J) entitled The Risks of Early C-Sections by Alice Park.  If you haven’t seen it, it’s a short article and a quick read.  In the article, Park reports on a study conducted by researchers at University of Alabama at Birmingham (UAB) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) that was published in the New England Journal of Medicine which found out of a sample of 13,258 pregnant women who had had a prior cesarean section, 36% elected to schedule their next c-section delivery (with the support of their physicians) before 39 weeks of gestation, which is the safety cutoff recommended by the American College of Obstetrics and Gynecology (ACOG).  Park writes, “ACOG’s guideline is based on studies showing that prior to 39 weeks, babies’ lungs are often too undeveloped to function properly outside the womb, and babies at this age tend to have difficulty regulating their blood sugar.

 

Park quotes Dr. Alan Tita from the research team in saying, “The fact that one-third of elective cesareans were done before 39 weeks was surprising.”  After all, the research shows that babies delivered at 37 weeks by elective C-section were twice as likely as those born at 39 weeks to have complications, “ranging from respiratory problems, heart issues, sepsis and seizures — conditions that typically require resuscitation or ventilator support in a neonatal intensive care unit”.  Contrary to Dr. Tita’s reaction however, when I read about the findings of the study, my reaction was completely opposite; I wasn’t surprised at all.

  

What the article did not touch on is the scary fact that there is a growing trend among the obstetrical community of both scheduling cesareans AND elective labor inductions (that is, inductions with no maternal or fetal health indication) BEFORE the recommended guideline of 39 weeks.  So to the OBGYNS of this country I have a question for you: Let me get this straight… you mean to tell me that you are willing to aggressively defend and follow guidelines adopted by ACOG that are UNSUPPORTED by research (for example, that planned homebirths for low risk uncomplicated pregnancies, attended by a qualified and licensed midwife are more dangerous than hospital births) BUT when your organization actually adopts an appropriate guideline that is supported by research, you just ignore it? 

 

Does anyone else find this hypocrisy as OUTRAGEOUS as I do?  The scary truth is that this mind-set is (regrettably) just another common thread among the over-medicalized obstetrical model of care that sadly controls the maternity care system of our country.  Too many OBGYNs just do whatever they want, with complete disregard for maternal and fetal safety (even though they claim that it is their main concern) as well as complete disregard for evidenced-based research. 

  

I will digress for a moment to share with you a situation I found myself in as a labor and delivery nurse this past Christmas.  (As always, the names and any identifying information have been changed to protect confidentiality).  I arrived to work in the late morning as usual and was informed by the charge nurse that I would be admitting an induction into room 12.  Since it was Christmas I asked why she was being induced; After all, we do not schedule any inductions on holidays unless there is an urgent medical indication for delivery.  “I don’t know, because Dr. N is sick of listening to her I guess,” she frustratingly stated as she rolled her eyes.  Turns out the patient was triaged at our hospital the day before and was sent home for “false” labor since she remained only 2 centimeters dilated with an irregular contraction pattern after two hours of walking the halls.  Apparently after yet another sleepless night she had called Dr. N and stated “I am coming into the hospital today and if you don’t agree to induce me, I will refuse to leave!  I am too uncomfortable and am DONE with this pregnancy.”  When I questioned Dr. N about the situation, pointing out the fact that there was no medial indication for this induction and in fact, the patient was still only 2 centimeters and contracting irregularly every 8-15 minutes he said, “I have to give her what she wants.”  Excuse me…WHAT?  And furthermore when I pointed out the fact that the patient’s gestational age was only 38 weeks and 1 day he snidely remarked, “Don’t you worry, I’ll take the rap for it when it gets flagged and brought up in the peer review board.”  And do you know why he said this so nonchalantly?  Because that committee is made up of a bunch of other OBGYNs who don’t like anyone breathing down their backs and therefore, will only give him, at most, a slap on the wrist.  And that is EXACTLY what happened.  Talk about driving up healthcare costs; Not only were they were paying me double time and a half to be there on Christmas day but that baby boy ended up going to NICU for a “pitstop” for grunting and retracting (a sign of respiratory distress) within an hour of delivery!

 

 I would like to take a moment to share the fact that I have never been pregnant and therefore have never personally experienced the discomforts of pregnancy first hand.  Despite this I personally hold all pregnant mothers in high regard and have the utmost respect for the physical and emotional sacrifices that a pregnant mother has to make in the weeks that she is with child.  I feel that as a professional who works with pregnant mothers it is my responsibility to support and aid a mother through her journey in any way possible and if any woman complains or comments about her discomforts and pains, I make a conscious effort to provide compassionate and empathetic care and comfort to that mother.  In my opinion they certainly have good reason to grumble at times! 

  

That being said…I personally feel that the physical and emotional discomforts of pregnancy (although intense and very real) are all part of the deal and it is just one of the many sacrifices parents will have to make in their lifetime for their children.  Just ask any new mom…If you think it is hard to get a full nights sleep while pregnant, just wait until you have a newborn!  Basically what I am getting at is this: although I have the utmost respect and empathy for how uncomfortable pregnancy can be (heartburn, Braxton-Hicks, morning sickness, hemorrhoids, stretch marks, fatigue, backaches, leg cramps, varicose veins, swelling, shortness of breath, dizziness, the list goes on and on), these discomforts are NOT a good enough reason to end a pregnancy early when the risks for the baby are so high.  Likewise, for a physician to agree to an early induction or elective cesarean or even worse, to promote it (trust me, it happens!) is sooooooo wrong.  Although I agree with the article when Park writes, “Although most obstetricians are disinclined to schedule c-sections prior to 39 weeks, they still feel pressured by their patients to do so,” there are also many women who feel pressured by their physicians to undergo unnecessary labor inductions and elective cesareans, often under the guise of a bogus medical indication.  (My personal favorite is when physicians set up an induction for a woman for “preeclampsia” when every laboratory test we do on the patient shows that at most she might have “pregnancy induced hypertension” (which can be watched and controlled with simple medications and is NOT an indication for urgent delivery) and at least she might have had just one out-of-wack blood pressure in the office!  The list of these flagrant offenses goes on and on…) 

 

I have heard it with my own two ears; Doctors saying things similar to “Well you’ve got to give these women what they want or they will sue!”, or “The patients are calling the shots not me, it’s out of my hands!”  I mean COME ON!  Are they serious??!!!  That is so far from the truth it is LAUGHABLE.  First of all these types of excuses are LAME and UNACCEPTBABLE.  Doctors take the Hippocratic oath to “First Do No Harm” and agreeing to order, manage, and perform unnecessary early elective cesareans and labor inductions is negligent, irresponsible, and dangerous.  Tell me, if the fear of litigation is so strong in this country as to so powerfully influence a “defensive” and “litigation driven” approach to obstetrical care, why o why would any OBGYN agree to any unnecessary procedure that is shown, through research, to place the baby at high risk for complications?

 

Furthermore, if a physician refuses to perform an unnecessary early induction or cesarean for a mother who is demanding one, what can she really do?  It is very unlikely that she could change doctors since there are very few practices that will accept what is referred to as a “late transfer of care.”  Some doctors say they fear litigation.  Could you imagine that?  How absolutely unfounded and preposterous!  On what grounds could the mother actually win the suit?  I can see the opening statement now: “My client is suing this doctor for not performing an unsafe early labor induction/elective cesarean.  You see, your honor, her back hurt ‘really bad’ and she was ‘just sick of being pregnant.’  Clearly this doctor should be locked up for correctly following the evidenced based research that supports his decision!” Absurd!

  

In conclusion, I would like to say one thing to all the women and obstetricians out there desiring and performing unnecessary early elective cesareans and labor inductions: Nature Knows BEST!

 

Couldn’t Have Said It Better Myself… February 16, 2009

The current issue of the AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses) publication Journal of Obstetric, Gynecologic and Neo-Natal Nursing includes an amazing editorial about ACOG (American College of Obstetricians and Gynecologists) and the AMA’s (American Medical Association) 2008 official resolution against home birth and out of hospital birth centers as options for women and against home birth care-providers.  The author Nancy Lowe, an editor for the journal, carefully looks at the research on home birth and responds to the resolution in a powerful and thought provoking way.  The editorial is so well written that it is worth reading for yourself:

 

The “Authorities” Resolve Against Home Birth   by Nancy K. Lowe, Editor

 

Thank you, Ms. Lowe, for your inspiring and empowering words that ring so true to my ears as both a birth advocate and labor and delivery nurse!  I too feel caught up in the system.  I know in both my head and my heart that the current arrangement of maternity care in the U.S. is not serving our mothers and babies well!  But the good news is, we are not alone!  It’s not “hippy,” “earthy-crunchy,” “granola,” “weird,” “dangerous,” “selfish,” or “gross” to support homebirth, natural birth, breastfeeding, and birth choice.  It’s about the EVIDENCE!  It’s about EVIDENCED-BASED RESEARCH, which unfortunately is something many obstetricians (even ones I work with on a regular basis) refuse to acknowledge, adopt, and respect!  I wish I could scream it from the rooftops sometimes!

 

One thing I would like to add that I feel Lowe did not address in her editorial (although she alludes to it by way of scare-quoting the word Authorities in the editorial’s title), is that ACOG and the AMA are by no means governing bodies and do not hold any authority to rule over anything!  ACOG and the AMA are NOT agencies of the United States Department of Health and Human Services and have NO authority or responsibility for regulating and supervising maternity care in the United States.  The thought that they are “governing bodies” is a myth that is often perpetuated by OBGYNs themselves.  In reality ACOG is professional association of medical doctors specializing in obstetrics and gynecology while the AMA is the largest association of physicians and medical students in the United States. 

 

 You do not have to belong to these organizations in order to practice as a physician.  The main mission for both of these organizations: To advance the interests of physicians and to lobby for legislation favorable to physicians.  When you really break it down they are just clubs!  PLAIN AND SIMPLE!  Don’t get me wrong, I understand that it is their American right to lobby for their own interests but it is important for the public to realize that what is in their best interest isn’t necessarily what is in the best interest for mothers and babies.  (And in fact, history has proven this time and time again.  I highly recommend the book Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First by Marsden Wagner.  It will truly blow your mind!) 

 

There is a quote I stumbled upon recently by François-Marie Arouet (better known by the pen name Voltaire), a French Enlightenment writer, which I would like to leave with you… 

 

“It is dangerous to be right on subject on which the established authorities are wrong.”  ~Voltaire

 

Eerily relevant for an 18th century philosopher, isn’t it?!