In new study by Dr. Jason Wright and colleagues of Columbia University in New York, it is found that of 717 common OB-GYN practice recommendations from ACOG (American College of Obstetricians and Gynecologists), just 30% are based on top-notch research. Another 38% are based on observational studies, and another 32% are just expert opinion.

The study is a call for better evidence and, as it relates to you, the consumer, can be an alert to the fact that the jury is still out on many of the common practices that are perceived as ‘the only way’ childbirth operations can work in the US. Here is the link to the full article from it’s original publisher.

The c-section rate is still on the rise, up to 34%, and Dr. John Queenan predicts the rate will soon approach 50% in his article “How to Stop the Relentless Rise in Cesarean Deliveries,” published in August in Obstetrics and Gynecology. Queenan is deputy editor of said publication, and his editorial is a call to care providers to rein in the rate before stakeholders or governmental action take them by force. Queenan offers two solution to his complex question: 1)”make VBAC more accessible and more desirable” and 2)”prevent primary deliveries in the first place.”

His strategies include

• implementing hospital quality improvement programs,
• increasing utilization of midwives,
• addressing problems in the liability system, and
• improving shared decision making.

Woman, take note. The decision makers are hearing the alarms, too.

I post what I see. I saw this, and found it to be an intriguing alternative to our traditional cesareans performed routinely. I particularly am intrigued by their description and execution of “a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother’s chest for early skin-to-skin.”

Is it possible to have this experience here in the States? I don’t know. I don’t know if they are able to perform this kind of surgery on every cesarean candidate or only certain candidates that meet certain criteria. I am not a medical professional. I DO know that there are some striking differences between these care provider’s practices and many of our local ones. My initial reactions are 1) the OB is performing the surgery, but it is the midwife’s responsibility for the overall well-being of baby and mum; 2) delayed cord clamping is compatible with cesarean birth!; 3) I love the slow delivery from the uterus to help force the fluid out of baby’s lungs.

Under more scrutiny, this video is from the UK’s leading midwife, Jenny Smith. Here is her website: jentlechildbirth.org

This is old news. But some folks have been recently been interested in this. I had found their birth plan shortly after their letter about ‘no birth plans,’ but somehow failed to follow up with their plan for patients. So, in the interest of completion (better late than never), here is their birth plan:

Kingsdale Birth Plan

The physicians at Kingsdale Gynecologic Associates congratulate you on your pregnancy and hope that your journey through pregnancy, labor, delivery and beyond is exactly what you wish for.  Our primary goal is to provide you and your baby with the medical expertise, experience and support you need to have a healthy pregnancy, a safe delivery and a wonderful experience.

We recognize that this is a very busy time for you and your family and wish to help minimize the work ahead of you by providing our advice and philosophy in this “birth plan.”  By understanding how we practice and why, we feel that any other formal birth plans (often recommended by books and websites) are unnecessary.  If you have specific requests not discussed in this birth plan, please speak directly with your care provider about them.

IV’s: Patients often ask us if IV’s are necessary in labor.  The answer is “yes.”  Although we usually give IV fluids through the “hepwell” to keep you hydrated and nourished through the labor process, the most important part is the “hepwell” itself.  If we run into an emergency situation where your life (and the life of your baby) is in jeopardy, we do not want to lose time to intervene by not having IV access.  This is obviously a rare occurrence, but often an unexpected one.

Nourishment in labor: We usually limit women to ice chips and popsicles during labor.  This is not designed as an attempt to starve you.  Women often get nauseated, and sometimes vomit, during labor, which can be not only miserable but also dangerous.  In addition, if emergency surgery is required, an empty stomach will predispose you to much less risk.  Of course, we will give you nourishment and hydration through the IV as necessary.

Anesthesia: We respect a patient’s desire for pain control, or lack thereof, in labor.  The hospitals have multiple options for pain control including positioning techniques (birth balls, etc.), IV pain medication, and regional anesthesia.  Labor, unfortunately, is a painful process.  It is also an unpredictable process and we thus encourage you to have an open mind about your pain control needs.  Some labors are quite rapid and tolerable while others require a great deal of patience and intervention.

Labor without anesthesia: If your goal is to labor without an epidural, we do recommend that you attend an in-depth birthing class that teaches you about focal points and breathing techniques.  The labor and delivery nurses are also quite skillful at helping women with alternative positioning that will help both with the labor and the birthing processes.  Although you will always be supported in your decision to labor without pain control, you can always change your mind if necessary.

IV pain medication: IV pain medication if available for use during labor.  The medication can often make women a little sleepy and is said to “take the edge off.”  It will not completely alleviate the discomfort of labor.  We try not to use IV pain medication close to the time of the actual delivery as it depress the baby’s drive to breathe.

Epidurals: Both Riverside Methodist Hospital and The Ohio State University Medical Center have anesthesiologists assigned to the labor and delivery unit who are readily available for the placement of epidurals.  There are unfortunately occasional delays in placement secondary to demand, but the anesthesiologists will always respond as quickly as possible.  The epidural anesthesia is the most common form of anesthesia for labor and delivery because it provides good pain control with little or no effect on the baby.  The epidural will make you somewhat numb from the waist down, therefore you are generally not able to walk after placement.  The nurses will continue to help you with position changes that will facilitate the birthing process.

The choice to use anesthesia or not is ultimately your choice.  There may be situations where we will recommend certain pain management options for you in order to provide the healthiest and safest option for you and your baby.  Ultimately, we want the birthing process to be one you can enjoy and remember fondly.

Fetal monitoring: In order to provide the safest possibly delivery, we feel that fetal monitoring is important during labor in order to assure that your baby is tolerating the process well.  We often accomplish this with continuous external monitors that are placed against your abdomen with elastic belts.  We will occasionally allow intermittent monitoring during walking and the hospitals have protocols for these times.  If we are concerned about the adequacy of labor or fetal wellbeing, we occasionally use internal monitors, which are more precise.  The intrauterine pressure catheter (IUPC) is a device that goes next to the baby to monitor the strength and frequency of contractions.  The fetal scalp electrode is applied superficially to a baby’s scalp to get the most accurate fetal heart monitoring.  We will not use these internal devices unless we feel they are medically indicated.

Labor support: We do recommend that you have a good support person or two during labor.  We recommend this person to be a spouse, partner, family member or close friend that you feel comfortable sharing such an important event with.  We recommend that you choose someone who will give you comfort when needed, let you rest when needed and who will add to your experience, not take away from it.  The labor and delivery nurses and doctors together act as “doulas” in a sense that we will be your advocate to provide positioning options, pain control and pushing techniques to make the process as easy as possible.  Your support person should be there to do just that–give support.

Mode of delivery: Our goal is to provide you and your baby the safest delivery.  We do occasionally need to do c-sections for delivery when it is necessary for you or your baby.  We never do c-sections for our own convenience.  If it looks like this may be needed for delivery, we will of course discuss this with you and your support person in detail.  We occasionally need to use forceps and vacuum extraction devices to facilitate vaginal birth, but again, this is always for maternal or fetal indication and will be discussed with you and your support person at the time.

Episiotomies: During the pushing process, the labor and delivery nurse and/or physician will likely perform perineal massage in order to stretch the tissue to accommodate the baby’s head and reduce the risk of tearing.  Although we try to avoid cutting episiotomies, this safe procedure is sometimes required to facilitate birth and to avoid severe tearing.  We promise to use our medical expertise and experience to make the best and safest decision for you and your baby.  The physicians at Kingsdale do not cut episiotomies solely due to “routine” practice.

After delivery: The birth of your child is truly an amazing event.  We want you to be able to bond with your baby as quickly as possible.  If the baby does not require immediate resuscitation, we will usually place the baby on your abdomen or chest, stimulate the baby there, and allow your support person to cut the umbilical cord.  Unfortunately there are situations that necessitate quick response from the pediatric staff in order to care for your baby.  This usually occurs in your room at the infant warmer.  If you and your baby are doing well after delivery, we will try to keep the baby in your room with you as long as possible, often transporting both of you to the postpartum floor together.  If desired, you may attempt “skin-to-skin” care and breastfeeding at this time.  With c-sections it is often necessary to take the baby to the nursery prior to your own transport.  In these situations, we will try to get you to your room as quickly as possible to reunite you and your baby.

We hope that this clarifies many of the questions about the birthing process that you may have along the way.  Please feel free to ask questions and obtain clarification if needed from your individual provider.

“Birth is the sudden opening of a window, through which you look out upon a stupendous prospect.  For what has happened?  A miracle.  You have exchanged nothing for the possibility of everything.”   -William MacNeile Dixon

Thanks to the hard work of a few individuals and organizations, a State Bill, introduced by State Senator Mike Faulk, is set to eliminate the age restriction on the current breastfeeding bill (currently at 12 months). Here, an article by The Tennessean about the bill in general and a video clip about the benefits of breastfeeding.

What you can do: until the bill goes up before the health committee (probably later this February or March), contact your local state legislator and ask them to support SB0083. After the bill goes before the health committee members, we then need to contact those members directly. Stay tuned.

POST EDIT 2/9/2011: This bill needs positive support ASAP. Contact Senator Faulk’s office at (615) 741-2061 and tell him you support SBSB0083.

Visit this Finnish mom and copywriter’s blog to see more of her daughter Mila’s dreams! I don’t like to divert the blog too far from birth, but Adele’s blog is too precious for this creative to ignore.

Voice of America has a new article by Mike Osborne, featuring two of our local midwives: Mary Anne Richardson, a CPM (the article incorrectly states), and Mavis Schorn, a Nurse Midwife (the article states she is a doctor, she is not). The article, “Welcome Home, Baby“doesn’t completely explore the differences between nurse midwives and certified professional midwives, but does show that many women are choosing midwives, for hospital and out of hospital births. Both Schorn and Richardson are in the Middle Tennessee area, and both lovingly serve local women.

Ouch. It’s difficult to not take this letter personally. Patients of Kingsdale Gynecologic Associates (in Columbus Ohio) received a copy of this letter recently.

The team at Kingsdale Gynecologic Associates is so pleased that you are expecting.  We look forward to helping you enjoy your pregnancy and hope to provide a meaningful and safe birthing experience.

Because of concerns for increased risk to you or your baby, the doctors at KGA have made a thoughtful, unanimous decision not to allow doulas to participate in the birthing process.  It has been our experience that they may serve to create a state of confusion and tension in the delivery room, which may compromise our ability to provide the safest delivery situation possible for you and your baby.

Again, with safety in mind, we have created a Kingsdale Birth Plan (which can be viewed in the obstetric packet provided at your initial visit), outlining the philosophy of our doctors with regard to labor and delivery.  It is our opinion that other birth plans are unnecessary.  We feel that our many years of obstetric experience in a setting of modern day challenges (larger babies, more difficult deliveries) enable us to provide sound judgment with regard to each woman’s particular needs during her course of labor.

Thank you for your understanding in our hopes of facilitating a safe pregnancy and birth process.

___________________________

Patient’s signature

________________________

Date

Kudos to the docs over at KGA for their blatant honesty. They do not want doulas present when they are delivering their clients of their babies. So let’s have some honesty equaling their honesty. It does not benefit doctors for their patients to have knowledge of the research that doulas can provide to their clients about common interventions. My role as a DONA doula is not to create tension or confusion in a labor room. It is to provide well-researched evidence for couples that must make decisions about their child’s birth. My role is to provide emotional support as well as help my client with comfort measures. My role is not to speak on my clien’ts behalf to medical staff. So where does tension come from? Doctors who don’t practice evidence-based medicine vs. doulas who provide evidence and research. This is not to say that there may not have been a renegade doula who came into conflict with one doctor too many over at KGA. A renegade doula is a doula by name, but may not be under a certifying organization, or if she is she doesn’t stick to their scope of practice. Too bad.

It is too bad for KGA’s patients planning on having labor support at their births. Thankfully they can find supportive care (see Women’s Contemporary Health practice), and maintain their will to be informed and educated about their bodies and the birth process during the birth of their child. Thankfully KGA decided to show their true colors and can now be seen as what they are: doctors in control of labor instead of allowing their patients to be in control of their labors and bodies.

I live in Music City. I work as a doula. Our Nashville hospitals are within miles of famous, or infamous, Music Row. I have always been a musician, in his own right my husband is a musician. Our best friends are amazing musicians: Shirock. It is not something we do, it’s as integral to our lives as eating, sleeping, and breathing. Which is why, when I heard the following story, originally heard on npr’s all things considered, I had to give it space here.

Marco Benevento lives in New Jersey. He is a pianist and jazz musician. His most recent album is entitled “Between the Needles and Nightfall.” Without having heard his music, you guess he may play some intense music. Or have an intense drug issue.  After all, where do most folks imagine needles in association with musicians? Sorry guys, I’m afraid Lost’s Charlie has propagated the stereotype even further.

But find Benevento’s music, hear the beauty in the jazz, and now learn why needles. Benevento’s second daughter was born at home, and to induce labor his wife experienced acupuncture treatment. After the treatment their midwife commented that “Hopefully, you’ll have your baby between the needles and nightfall.” Their daughter, Ila Frost, was born just before dark.

Somewhere between Music Row and downtown Nashville, somewhere between your bed and your bath, somewhere between the east and the west, babies are born everywhere, all the time. Somewhere between inductions and c-sections, somewhere between acupuncture and moxibustion, somewhere between foley bulbs, prostaglandins and amniotomy. Way to go Benevento, you have won me as a fan for your educated decision to have a homebirth, and to chronicle it through your music. Another event in the circle of life, music, and death.