- Primary CareI have now attended more than a dozen home births and have noticed many differences from my 28 years of attending hospital births. But none is more striking than how the environment affects the traditions and attitudes of the practitioners. In a hospital based birth the primary care giver is almost always a nurse or possibly a CNM. They are bound by policies and procedures that limit individualization. No matter what the desire of the family dictates there is pressure on the staff to complete forms and data entry. They must document “progress” and even encourage intervention when it does not conform to some standardized norm. To not push the process along can bring the scorn of their supervisor. Nurses are encouraged to monitor all sorts of bodily functions and even the most caring have to deny food and interrupt the primordial place a woman should be for the sake of documentation.
- Family PracticeCreating loan repayment programs to increase the numbers of family practice physicians, nurse-midwives, and certified professional midwives, all of whom provide low-cost, high-satisfaction alternatives to traditional obstetrical care
- Emergency CareHospital birthing remains the right choice for many and certainly the best choice for some. But it must be realized from the moment a women leaves her home in labor until she puts the baby in the car seat to drive home everything that happens is counterintuitive with nature’s design. The hospital model is illness, not wellness. You leave your nest to arrive at an emergency room. You are placed in a hospital gown with monitors around your belly and a blood pressure cuff strapped to your arm. An IV is inserted. You need permission to go to the bathroom. You are not free to walk around and move and you are not allowed to eat. You are asked to sign consent forms and are constantly interrupted. And you are on the clock. All these policies lead to interventions that disturb the process of labor and contribute greatly to the rise in surgical birth.
- ImmunizationsAnd over 50% in the last generation with no measurable benefit. Did something suddenly happen to an American woman’s pelvis in one generation? While some modifications of policies are all too slowly reappearing we still have archaic, often ridiculous policies affecting laboring mothers negatively. Some are restrictive movement, restrictive oral intake, standardized charting requirements leading to interruption of natural labor, 90% epidural rates, mother-baby separation and over testing for questionable indications often resulting from economic gain and fear. This fear comes, not so much in the mother, but emanating from the practitioner who endures the realities of the professional climate rather than speak out. A great proportion of women do not have fond memories of their birth process and many women will suffer lifelong emotional and physical trauma from unnecessary inductions and cesarean sections. Babies, too, do not benefit from what is so often considered standard care. Early induction or surgical birth leads to increase risks of lifelong health issues. Ubiquitous standardized policies of immediate vaccination, eye care in culture negative moms and interruption of bonding are for what benefit again?
- GynecologyThe American Journal of Obsterics & Gynecology has recently published Dr. Chervenak's response to my letter to the editor which I wrote in response to his opinion piece against planned home birth. I have commented on this in a couple of blogs on this site (see November 2012). I even went so far as to put together a power point presentation breaking down his arguments and would be happy to debate him in an honest forum. My letter was published last April but the AJOG rules of LTE are very restrictive and I was limited to 400 words. In his rebuttal to me letter he continually sites that I did not prove what I said or that I lacked documentation or failed to provide supporting evidence. These tasks are pretty much impossible with 400 words. A fact I am sure Dr. Chervenak is aware since his rebuttal to me was allowed 641 words. This is the serious defect in our ability to communicate differing views to the powerful in academia and simply leads to childlike finger pointing and ego inflation without any real chance of clarity and honest dialogue. His reliance on studies, often ones in disrepute, skewing of data and denial of or failure to accept evidence and common sense contrary to his desired outcome of his opinion piece is a common thread in many of his thoughts and papers. I accept that he is a bright man with differing views than mine. My point is not to convince him of alternatives. My ideal is to present clarity over agreement so readers and my medical colleagues have the basis on which to make their own decision. Here is a link to his original article (which might be password protected), my 400 word limit letter to he editor followed by his 641 word response. Lastly, kudos to the American Journal for publishing a midwife's response, as well, which I have also posted.
- ObstetricsThe sad truth is that for most Americans birth remains shrouded in mystique and fear. Hospitals and the medical model of obstetrics have gone too far. They have taken something beautiful and natural and convinced us it is an illness.
- Pregnancy
- Labor and DeliveryThe hospitals in Ventura County where I used to admit patients continue their de facto ban on vaginal birth after c/section. There is no appealing to the clinical evidence, ACOG and NIH recommendations or even their sense of fairness. Today I saw a patient whose story must be told.
- Kidney StonesFrom curvewire.com: Kim Kardashian Wants C-Section Posted by Johnny Robish on April 10, 2013 - 10:18pm..... “Kim Kardashian Wants C-Section: It’s being reported that pregnant Kim Kardashian wants to give birth by C-section as soon she’s 8-months pregnant because she wants her life back. And since Kanye is a musician, I would assume it’ll most likely be a “Middle-C” section.”..... I was at a dinner party last night in celebration of the recent homebirth of twins in Santa Barbara, CA. During a lovely evening we discussed a lot of topics and the subject of Ms. Kardashian’s choice came up. This blog is not about bashing her obvious narcissism but her choice did produce a dialogue about labor pain. I have given this subject a lot of thought during my metamorphosis from hospital based to home based practitioner. Since epidurals and narcotics are not available at home we rely on other methods to deal with pain. Movement, water, hypnosis, massage and strong support are beneficial and work well for many laboring women. The key is that these things help cope with the pain but don’t remove it. To understand why coping but not eliminating pain is important we need to ask ourselves why labor is painful in the first place. I mean, if we believe in evolution why wouldn’t the pain of labor evolve away since natural selection usually eliminates those things that are detrimental to the survival of the species. There is, of course, the biblical Garden of Eden explanation but let me put that aside for the moment. Just suppose labor pain is not detrimental but is beneficial. I give credit to my colleague, Aleks Evangelidi, LM, for her insight in this regard........ Anyone who has ever had a toothache or a kidney stone will argue there is no benefit to the pain other than to let us know something is wrong. Painkillers are a godsend in these circumstances. But labor is not a toothache and it is time to look at the pain of labor in a different light. All mammals have labor and all mammals have labor pains. The onset of labor contractions usually build slowly but eventually become quite painful lasting 40-60 seconds followed by 2-3 minutes of relief. The mammalian body responds to this pain by releasing its own narcotics and neurotransmitters that nature designed just for that purpose. Endorphins and enkephalins are the body’s natural opiates. Oxytocin release produces warmth and attachment responses and adrenaline helps the body cope with stress and possibly spaces out the next contraction allowing time for rest and recovery. And don't forget Cortisol, which orchestrates all sorts of needed stress responses including blood sugar modulation. It really is a beautiful cocktail that nature has designed just for this purpose............ When a laboring woman is not allowed to cope with pain as nature designed it is easily understood why hospital epidural rates approach 90%. Having to stay flat in bed so continuous fetal monitoring (CFM) can occur does n
- AutismThe to vaccinate or not to vaccinate controversy is far from ended despite a recent statement from the CDC based on an Institute of Medicine (IOM) review that concludes, "the evidence favors rejection of a causal relationship between thimerosal–containing vaccines and autism". I have seen this statement repeated in many recent news items including one in USA Today yesterday. (That just doesn't sound right....USA Today yesterday). I do not profess to have any expertise on this subject other than what I hear and read. Which means I am as confused as you are since the truth does not seem as black and white as the IOM would have us believe. I also, do not think there is any conspiratorial process going on between big Pharma and big Government.
- Depression
- Mental HealthJust a quick thought on the recent time cover story about the significance of external factors during intrauterine life that may play a much more significant role in our health and wellbeing than previously thought. Traditional teaching about how we end up has always been nurture v. nature, heredity v. environment. Well, it appears that there is growing data to support the idea that exposure to many things in utero may play just as big a role in determining our physical and mental health later in life. This comes as an interesting "discovery" to those of us brought up in the medical/scientific world but is well known to my colleagues trained in the more natural world of midwifery and common sense. The midwifery model emplores women to be in a healthy state of mind and body before and during pregnancy and has known the benefit of this knowledge for centuries. It is nice to see the science catch up with the empirically obvious and kudos to Time for a nonpartisan story that is beneficial to all. Dr. F
- Anxiety
- Diabetes Care
- UltrasoundJanuary 1,2012. Well, its a new Year! It began with a home visit this afternoon on a new client referred by Mary Lou O'Brien. Alison's second pregnancy was persistent frank breech at 38 1/2 weeks. Her 1st delivery was a beautiful home birth with Mary Lou. As always required, Alison and Dave, her husband, had the right mental "stuff" and no physical problems. We discussed her option of external version after more natural methods had been unsuccessful. However, the cost of going to the hospital for this family was prohibitive so they accepted the very small risk and great benefit of trying to flip the baby at home in bed. Without medication but with warm olive oil, nurturing surroundings and a portable ultrasound available, not to mention a very cooperative baby, the version took less than 30 seconds. An easy forward roll put the baby's head down to the delight of mom, dad & little brother Ocean. We were all overjoyed for them and proud to be able to offer choice, informed consent and alternatives such as external version and breech delivery options. Thanks Mary Lou. Be sure to let us know what happens next. A peaceful 2012 to all.
- MRI“Hands off the bum” was the message at this year’s Heads Up International Breech Conference. It was quite a gathering in Chevy Chase, Maryland. I want to express my most sincere gratitude to Robin Guy and her whole team for putting together a marvelous weekend. I attended as a moderator and panelist and feel very fortunate to share the spotlight with luminaries in the field. We were honored to have doctors Anke Reiter from Frankfurt, Germany, Andrew Bisits from Sydney, Australia, Marek Glezerman from Israel, Martin Gimovsky from Newark Beth Israel Hospital in New Jersey, Michael Hall from Colorado and Dennis Hartung from Wisconsin. Midwives Ina May Gaskin, Ibu Robin Lim, Jane Evans and Betty Anne Daviss were amongst a host of experts and educators in the world of breech delivery. It was a marvelous weekend with so many nurturing people supporting the reasonable option of selected vaginal breech delivery. Research was presented from 3 major academic centers that support the safety of vaginal breech as a reasonable and evidenced based choice and putting to rest, hopefully forever, the Term Breech Trial as something to be relied on as a basis for denying the breech option. There seems to be no significant difference in neonatal morbidity between vaginal and cesarean section for breech. There is a greater risk for the mother in this and future pregnancies when c/section is performed. All agreed that a change is needed in education for young physicians and midwives. Reintroducing breech delivery will not be easy as the skill and willingness has waned. We all believe the leaders of our profession including ACOG in the U.S. need to take a more active role in encouraging this movement. Ideally, specialized breech training centers such as exists in Frankfurt, Germany will open up creating the volume needed for interested doctors and midwives to learn the skills. Dr. Reiter presented her and Dr. Frank Leuwen’s techniques of delivering breech babies meeting their selection criteria in the all-fours position. They use MRI to measure the pelvic conjugate as their main criteria for inclusion. Other presenters used more traditional inclusion criteria but all agreed that selected vaginal breech delivery in experienced hands is a reasonable choice with a 60-70% chance of success. As with VBAC, if this option is dismissed by hospitals and doctors then they are wrongly condemning that percentage of women to surgery and the greater risk that incurs. Choice belongs to the informed woman! We were treated to videos and testimonials and birth stories from professionals and from some brave women willing to share their personal histories. Never let it be said that a healthy baby is all that matters. Some of these women still shed tears when they recall their births and how they had to struggle against skewed informed consent and a system that had failed them. We as a profession can do better. A special thanks to my colleague Beth Cannon, LM for her support of my b
- Allergies