Hubby and I watched Michael Moore's Sicko a few days ago. Wow. Now, I've not seen any other Michael Moore films, so I don't have anything to compare it to. This film was fantastic. He points out the biggest problems with our healthcare system using real examples of people who have dealt with the worse and the standard. He also goes to a number of countries with socialized medicine to debunk the popular arguments used against such systems. After watching a film like that, one cannot see our healthcare system as successful in the least.
I found it very interesting for the birth aspect. Moore goes to France and visits a maternity room at a hospital, where mothers receive excellent care (and have lower mortality/morbidity than in the U.S.). He also touches on the fact that new French families receive state-funded postpartum doulas. How fantastic is that?
The film made me angry about our healthcare system (as though I wasn't already angry about it). It pointed out many of the problems I already saw in the system and pointed out ones that are horrifying. I know that there are often ways of getting around many aspects of the high prices and poor care we receive, but it doesn't work so well if you have a long-term problem or if the insurance companies are very much against you or if your premiums and co-pays add up.
I think that all emergency services should be completely free of charge, that all children's healthcare should be completely free of charge, that all elderly healthcare should be free of charge, that prenatal and pregnancy-related care should be free of charge, and that all other services should be affordable for everyone. I think that higher taxes should be implemented to make this possible. I do not think that medical personell would experience a lowering in pay for such care.
21 November, 2007
Birth This Week
I went to another birth with Candace this week. It was fantastic. I was called in the morning and done in time for lunch with Candace! Hah! Not that long births aren't great too, it was just a treat. It was also au naturale and the mom was ecstatic to have done it without meds.
The nurse was totally awesome. She gave excellent recommendations and even let the mom start pushing at about 8 cm because she was already fully effaced and "floppy." It worked wonderfully, and she birthed her baby with ease. Baby was over 9 lbs and the mom barely had a scratch. She was a super-woman for certain.
That's all I have to say about that. It was great.
The nurse was totally awesome. She gave excellent recommendations and even let the mom start pushing at about 8 cm because she was already fully effaced and "floppy." It worked wonderfully, and she birthed her baby with ease. Baby was over 9 lbs and the mom barely had a scratch. She was a super-woman for certain.
That's all I have to say about that. It was great.
17 November, 2007
Brought to Bed - book reflections
Today I finished reading Brought to Bed by Judith Walzer Leavitt. I am very glad I read it. Although written in the 1980's, the fact that it is a historical view of childbirth in the United States means that the information in it has remained pertinent. I have no interest in giving a book report, but I will say that it is definitely worth the read. I do want to get out some of what the book has made me think about.
I find it amazing that early hospitals did not make childbirth safer, even though that was the only reason women were going to the hospitals in the first place. It wasn't until the 1930's that it became safer to birth in hospitals than in homes, on average, and that was because of the availability of bood transfusions for hemmorhage and antibiotics for infection, for the most part. This means that the major changing factors for safety in childbirth did not come from obstetrics, but from medicine outside of maternity wards and schools.
Forceps deliveries, while better for situations in which babies and/or mothers would have died previously, were overused to the point of increasing maternal morbidity for the whole of women. Of course, women will choose a life of debility over a dead child, but when the debility was unnecessary to begin with, it is obvious that the "improvement" was not all that great.
I was amazed to realize that I have more knowledge and experience than most doctors had when they left medical school in the late 1800's.
I also found it very interesting to make general comparisons between the U.S. and Norway. In the U.S., it is incredibly rare (1%?) to have a homebirth, but in Norway, I think upwards of 30% of births are at home. The clencher is that Norway has lower maternal morbidity and mortality rates and lower neonatal morbidity and mortality rates than the U.S. It makes sense when you consider that Norway continued to utilize traditional midwifery models of maternity care, while adding science and medicine where it could help and maintaining the sense of normalcy in birth. The U.S., on the other hand, clung to "progress" and "science" to a destructive and dangerous extent, outlawing midwives and turning normal births into technological, doctor-driven anomalies.
I keep thinking that it's not obstetricians who have made birth safer, it's medicine outside of obstetrics, it's access to clean water, it's access to prenatal care regardless of financial ability, it's lower disease rates for rickets and tuberculosis, etc.
Of course, I need a disclaimer. Obstetrics has done some amazing things in the last hundred years. I do think that obstetricians are absolutely necessary under certain circumstances, and it is obstetrics which has helped determine what those circumstances are. Obstetricians are specialists, however, and it's unwise to see a specialist when you don't need one. If you don't want surgery, don't see a surgeon.
The book also made it clear that doctors really have always been pressed to take action, not to wait and allow things to happen naturally. Doctors were originally pressed by other arrangements and other women and families to care to, leaving them desiring to speed things along, to interfere, to make the women fit their schedules. This is still true, of course.
It also made it more apparent to me the position of nurses. So many people expect a nurse to be a support person during labor, but that's not their job. It has never been their job. When hospitals first began institutionalizing childbirth within their walls, most women were so drugged up that support for the woman wouldn't have been received. Not to mention that the environment was supposed to be "sterile" to the point that a nurse probably wouldn't have touched you unless necessary, let alone told you that you were doing a good job. Women were strapped down during normal deliveries through the 1950's. Who would think that a nurse would be supportive in such an environment? A nurse isn't support for the woman, a nurse is support for the doctor.
I feel like my blog entries are very anti-doctor/hospital/nurse and I keep feeling the need to back up and express the other end of the spectrum of my feelings. Perhaps I just need to clarify. I think that women should have homebirths or births at free-standing birth centers unless their health or the baby's health necessitates hospital birth. I think that women should be referred to midwives when they tell their gynecologists that they are pregnant and should only see an obstetrician if medically necessary. I think that the place held by each member of the birth support team should be explicit, with no false perceptions remaining at the birth. I think that women who want hospital births when they don't need them should be allowed to choose their birth environment, but should be given the risks involved, just like they would be for other choices in birth. I think the evidence and information should be freely given, regardless of who benefits from her choices.
I support women's choices. I just think that we all need to have a better idea of what meets our needs and expectations. I don't have all of the answers yet, of course. I hope, one day, to have enough information gathered that I can really wrap my head around a lot of this.
I find it amazing that early hospitals did not make childbirth safer, even though that was the only reason women were going to the hospitals in the first place. It wasn't until the 1930's that it became safer to birth in hospitals than in homes, on average, and that was because of the availability of bood transfusions for hemmorhage and antibiotics for infection, for the most part. This means that the major changing factors for safety in childbirth did not come from obstetrics, but from medicine outside of maternity wards and schools.
Forceps deliveries, while better for situations in which babies and/or mothers would have died previously, were overused to the point of increasing maternal morbidity for the whole of women. Of course, women will choose a life of debility over a dead child, but when the debility was unnecessary to begin with, it is obvious that the "improvement" was not all that great.
I was amazed to realize that I have more knowledge and experience than most doctors had when they left medical school in the late 1800's.
I also found it very interesting to make general comparisons between the U.S. and Norway. In the U.S., it is incredibly rare (1%?) to have a homebirth, but in Norway, I think upwards of 30% of births are at home. The clencher is that Norway has lower maternal morbidity and mortality rates and lower neonatal morbidity and mortality rates than the U.S. It makes sense when you consider that Norway continued to utilize traditional midwifery models of maternity care, while adding science and medicine where it could help and maintaining the sense of normalcy in birth. The U.S., on the other hand, clung to "progress" and "science" to a destructive and dangerous extent, outlawing midwives and turning normal births into technological, doctor-driven anomalies.
I keep thinking that it's not obstetricians who have made birth safer, it's medicine outside of obstetrics, it's access to clean water, it's access to prenatal care regardless of financial ability, it's lower disease rates for rickets and tuberculosis, etc.
Of course, I need a disclaimer. Obstetrics has done some amazing things in the last hundred years. I do think that obstetricians are absolutely necessary under certain circumstances, and it is obstetrics which has helped determine what those circumstances are. Obstetricians are specialists, however, and it's unwise to see a specialist when you don't need one. If you don't want surgery, don't see a surgeon.
The book also made it clear that doctors really have always been pressed to take action, not to wait and allow things to happen naturally. Doctors were originally pressed by other arrangements and other women and families to care to, leaving them desiring to speed things along, to interfere, to make the women fit their schedules. This is still true, of course.
It also made it more apparent to me the position of nurses. So many people expect a nurse to be a support person during labor, but that's not their job. It has never been their job. When hospitals first began institutionalizing childbirth within their walls, most women were so drugged up that support for the woman wouldn't have been received. Not to mention that the environment was supposed to be "sterile" to the point that a nurse probably wouldn't have touched you unless necessary, let alone told you that you were doing a good job. Women were strapped down during normal deliveries through the 1950's. Who would think that a nurse would be supportive in such an environment? A nurse isn't support for the woman, a nurse is support for the doctor.
I feel like my blog entries are very anti-doctor/hospital/nurse and I keep feeling the need to back up and express the other end of the spectrum of my feelings. Perhaps I just need to clarify. I think that women should have homebirths or births at free-standing birth centers unless their health or the baby's health necessitates hospital birth. I think that women should be referred to midwives when they tell their gynecologists that they are pregnant and should only see an obstetrician if medically necessary. I think that the place held by each member of the birth support team should be explicit, with no false perceptions remaining at the birth. I think that women who want hospital births when they don't need them should be allowed to choose their birth environment, but should be given the risks involved, just like they would be for other choices in birth. I think the evidence and information should be freely given, regardless of who benefits from her choices.
I support women's choices. I just think that we all need to have a better idea of what meets our needs and expectations. I don't have all of the answers yet, of course. I hope, one day, to have enough information gathered that I can really wrap my head around a lot of this.
Cesareans (10/12/07)
The cesarean section rate in the U.S. is 30.1%. W.H.O. guidelines state they should never rise above 10% for developed countries. This means that 2/3 of all U.S. cesareans are unnecessary. W.H.O.'s guidelines are based on when the risks begin to outweigh the benefits of this major abdominal surgery. This means that babies and especially women are actually being unnecessarily harmed by this cultural practice.
Why no outcry? Why no laws being made against unnecessary cesareans? Why no required guidelines for hospitals and maternity healthcare providers to follow to reduce their cesarean rates?
I joined the ICAN (International Cesarean Awareness Network) Yahoo group and read experience after experience of women who felt robbed, raped, devastated, devalued, lied to, and more because they had a cesarean that they later found was unnecessary. I read stories of doctors and nurses presenting vulnerable, laboring women and their spouses with the "option" of cesarean, or worse yet, tossing the "dead baby" card on the table when there was no reason to believe the baby was in danger. After months of physical recovery and years of emotional anguish, postpartum depression, and cases of post-traumatic stress disorder, these women go over their medical reports, talk with other medical professionals, talk with other women, and learn that their cesareans weren't necessary. They learn, three children later, that the repeat cesareans they were "offered" during pregnancy were not also not necessary, but because their doctors presented it like the first option, they took it. Doctors say, "You can have another cesarean," and refer to a VBAC as a "trial of labor," instead of telling women, "There is good reason to have a VBAC, in your case." When a woman wants to have a "trial of labor," they're not only given the consent form, but they're also given the lecture of all the risks of the "trial," whereas mothers who choose to schedule a repeat cesarean are not usually told of the risks of thier second (or third or fourth) cesarean when they sign the consent form. It's not until they've had three or four cesareans that their doctors get a little worried and tell them that they shouldn't get pregnant again because another cesarean would be risky, and they won't attend a VBAC after a woman has had that many cesareans because it would be risky... so a woman is told not to have any more children. TOLD. Who is this person who plays God over you as a woman? Who thinks you should just get a hysterectomy with your next cesarean? What angers me the most this is that these women wouldn't be "at risk" with subsequent cesareans or VBACs if their doctors hadn't suggested they take the second cesarean, and better yet, if they hadn't had an unnecessary cesarean in the first place.
Yes, I'm getting carried away on a scenario where women have bad doctors or simply feel under-educated. Yes, cesarean sections are necessary and life-saving in some circumstances. It is utterly horrifying to me that the cesarean rate is what it is in the U.S. I cannot express the horror I feel at the idea that one in three live births delivered in the United States of America are removed from their mother's splayed abdomens while they lie behind sterile shields with their arms tied down and their spouses nowhere to be seen. It's the thing of horror novels to imagine women with their babies ripped from their bellies, and yet we do it. To me, it is equally horrifying when the surgery does not save lives and livelihoods. No, not all obstetricians are evil surgery-mongers who want to cut open every woman who comes through their practices. I've never been one to think it's okay being satisfied and passive because things are "okay" or because it's good more than it is bad.
The big questions are why are so many unnecessary cesareans being performed and how do we stop it?
The Healthy People 2000 objective of reducing the cesarean rate to no more than 12% for primary cesareans, no more than 65% for women with previous cesareans, and no more than 15% overall not only failed, but failed miserably. The rate didn't go down, but went up and continues to do so. So, making objectives to make people healthier doesn't work.
The Coalition for Improving Maternity Services created the Mother-Friendly Childbirth Initiative, which states that mother-friendly maternity services will have a cesarean rate of less than 10% for low risk and 15% for high risk women (http://www.motherfriendly.org) was established in 1996 and hasn't worked in reducing the cesarean rate overall.
This is just the beginning of my thoughts.
Christina
Why no outcry? Why no laws being made against unnecessary cesareans? Why no required guidelines for hospitals and maternity healthcare providers to follow to reduce their cesarean rates?
I joined the ICAN (International Cesarean Awareness Network) Yahoo group and read experience after experience of women who felt robbed, raped, devastated, devalued, lied to, and more because they had a cesarean that they later found was unnecessary. I read stories of doctors and nurses presenting vulnerable, laboring women and their spouses with the "option" of cesarean, or worse yet, tossing the "dead baby" card on the table when there was no reason to believe the baby was in danger. After months of physical recovery and years of emotional anguish, postpartum depression, and cases of post-traumatic stress disorder, these women go over their medical reports, talk with other medical professionals, talk with other women, and learn that their cesareans weren't necessary. They learn, three children later, that the repeat cesareans they were "offered" during pregnancy were not also not necessary, but because their doctors presented it like the first option, they took it. Doctors say, "You can have another cesarean," and refer to a VBAC as a "trial of labor," instead of telling women, "There is good reason to have a VBAC, in your case." When a woman wants to have a "trial of labor," they're not only given the consent form, but they're also given the lecture of all the risks of the "trial," whereas mothers who choose to schedule a repeat cesarean are not usually told of the risks of thier second (or third or fourth) cesarean when they sign the consent form. It's not until they've had three or four cesareans that their doctors get a little worried and tell them that they shouldn't get pregnant again because another cesarean would be risky, and they won't attend a VBAC after a woman has had that many cesareans because it would be risky... so a woman is told not to have any more children. TOLD. Who is this person who plays God over you as a woman? Who thinks you should just get a hysterectomy with your next cesarean? What angers me the most this is that these women wouldn't be "at risk" with subsequent cesareans or VBACs if their doctors hadn't suggested they take the second cesarean, and better yet, if they hadn't had an unnecessary cesarean in the first place.
Yes, I'm getting carried away on a scenario where women have bad doctors or simply feel under-educated. Yes, cesarean sections are necessary and life-saving in some circumstances. It is utterly horrifying to me that the cesarean rate is what it is in the U.S. I cannot express the horror I feel at the idea that one in three live births delivered in the United States of America are removed from their mother's splayed abdomens while they lie behind sterile shields with their arms tied down and their spouses nowhere to be seen. It's the thing of horror novels to imagine women with their babies ripped from their bellies, and yet we do it. To me, it is equally horrifying when the surgery does not save lives and livelihoods. No, not all obstetricians are evil surgery-mongers who want to cut open every woman who comes through their practices. I've never been one to think it's okay being satisfied and passive because things are "okay" or because it's good more than it is bad.
The big questions are why are so many unnecessary cesareans being performed and how do we stop it?
The Healthy People 2000 objective of reducing the cesarean rate to no more than 12% for primary cesareans, no more than 65% for women with previous cesareans, and no more than 15% overall not only failed, but failed miserably. The rate didn't go down, but went up and continues to do so. So, making objectives to make people healthier doesn't work.
The Coalition for Improving Maternity Services created the Mother-Friendly Childbirth Initiative, which states that mother-friendly maternity services will have a cesarean rate of less than 10% for low risk and 15% for high risk women (http://www.motherfriendly.org) was established in 1996 and hasn't worked in reducing the cesarean rate overall.
This is just the beginning of my thoughts.
Christina
Welcome to Saffron Doula's Blog!
I have decided, after much inner-dialogue, that I should put my thoughts concerning pregnancy, childbirth, local and national birthing culture, statistics, cesareans, trends, and the like into writing. What better way than to create a blog and link to it from my web site and MySpace?
In case you are wondering, I am a doula. A doula is a non-medical childbirth assistant. For more on doulas or my business, visit my web site, http://www.saffrondoula.com/.
I feel passionate about women's choices before, during, and after childbirth. I feel passionate about VBAC (vaginal birth after cesarean) as a safe option for the vast majority of women who have had cesareans (I'll go into that in another entry). I also feel passionate about cesarean sections and the continued need to make change in the maternity field. These passions do not detract from my passion for women's ability to choose whatever is best for them personally.
I do not believe that there is any "right" way to give birth, nor that the things I want and need during childbirth are necessarily the same as things anyone else will want and need during childbirth. Birthing is an inherently personal, spiritual, life-changing event with unpredictable variables throughout its process. It is imperitive that women regain their status as the owners and doers of childbirth, refusing the trend of the last 70-odd years where medical professionals are considered the owners of birth and birthing women, the determiners of what will be done to a woman's body.
Medical professionals are necessary in some cases. Don't get me wrong there. Prenatal care and medical advances like antibiotics for infection, blood transfusions, and necessary cesarean sections do save lives. However, what should be an open dialogue between care providers and women and other support people is too often an unhealthy dichotomy where the medical professionals take the power and the women are left with the consequences of unfair control held over them. We have been taught in this culture to trust doctors to a flaw. We expect them to be perfect when they're only human. We place our lives and our bodies into their hands and feel angry, betrayed, violated when something goes wrong, when the inherent unpredictability of life, birth, and death rears its ugly head and thwarts us all. Or we later discover that we had options not revealed to us at a pivotal moment, that we didn't need the surgery after all, that our bodies aren't broken, that we could have said "no."
I think we need to make some changes to our medical system across the board, but certainly in maternity. We as women and mothers need to be smart consumers, demand what we want and need, refuse what we see as unnecessary, and get real, detailed, thorough answers along the way. That's why I'm a doula - because women need to know what their options are, because I need to know what is going on behind those "secure" and "sterile" doors. I am a doula because women need support in their most vulnerable hours, and not just physical and emotional, but informational as well. Women need to have someone there for them who will say, "here are your options," "here are the risks they're not telling you about," and "remember, you're in charge here." I want to make some changes, and I think this is a good way to start.
Christina
In case you are wondering, I am a doula. A doula is a non-medical childbirth assistant. For more on doulas or my business, visit my web site, http://www.saffrondoula.com/.
I feel passionate about women's choices before, during, and after childbirth. I feel passionate about VBAC (vaginal birth after cesarean) as a safe option for the vast majority of women who have had cesareans (I'll go into that in another entry). I also feel passionate about cesarean sections and the continued need to make change in the maternity field. These passions do not detract from my passion for women's ability to choose whatever is best for them personally.
I do not believe that there is any "right" way to give birth, nor that the things I want and need during childbirth are necessarily the same as things anyone else will want and need during childbirth. Birthing is an inherently personal, spiritual, life-changing event with unpredictable variables throughout its process. It is imperitive that women regain their status as the owners and doers of childbirth, refusing the trend of the last 70-odd years where medical professionals are considered the owners of birth and birthing women, the determiners of what will be done to a woman's body.
Medical professionals are necessary in some cases. Don't get me wrong there. Prenatal care and medical advances like antibiotics for infection, blood transfusions, and necessary cesarean sections do save lives. However, what should be an open dialogue between care providers and women and other support people is too often an unhealthy dichotomy where the medical professionals take the power and the women are left with the consequences of unfair control held over them. We have been taught in this culture to trust doctors to a flaw. We expect them to be perfect when they're only human. We place our lives and our bodies into their hands and feel angry, betrayed, violated when something goes wrong, when the inherent unpredictability of life, birth, and death rears its ugly head and thwarts us all. Or we later discover that we had options not revealed to us at a pivotal moment, that we didn't need the surgery after all, that our bodies aren't broken, that we could have said "no."
I think we need to make some changes to our medical system across the board, but certainly in maternity. We as women and mothers need to be smart consumers, demand what we want and need, refuse what we see as unnecessary, and get real, detailed, thorough answers along the way. That's why I'm a doula - because women need to know what their options are, because I need to know what is going on behind those "secure" and "sterile" doors. I am a doula because women need support in their most vulnerable hours, and not just physical and emotional, but informational as well. Women need to have someone there for them who will say, "here are your options," "here are the risks they're not telling you about," and "remember, you're in charge here." I want to make some changes, and I think this is a good way to start.
Christina
Subscribe to:
Posts (Atom)