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When Tim Armstrong, CEO of AOL, cited the cost of “distressed babies” as the reason for cutting 401K benefits to AOL employees, he created a media storm by blaming sick babies for poor corporate governance.  Armstrong cited the million dollar costs of caring for two premature babies as the reason for needing to change employee benefits, essentially outing the private health information of a few of its workers (possibly against HIPPA regulations). He put the mother of one of those babies in a position of defending her daughter’s life and honor, and their family’s sizeable use of the benefits package they pay for through AOL’s employee insurance program.

It is much easier to blame babies and the women who bear them than it is to shine a light on selfish corporate leadership and our bloated, inefficient, for-profit medical system that often works on the rationale of doing procedures “because it can” instead of establishing criteria for action “because it should or should not.”  Extreme incidences such as this mask the underlying problems inherent in our “can do” medical system’s approach to caring for those who are ill, and hold a special lens for viewing maternity care.

I have not yet in the media coverage of this story seen a reference to the question of whether or not a “micro-preemie,” born barely at the age of viability, should undergo extensive lifesaving measures.  Some would call the procedures necessary to keep a five-month fetus alive outside of the womb “heroic measures,” but others could call those procedures “torture.”  Numerous needle sticks in veins that are so small they are barely visible to the eye, tubes in the nostrils and down the throat for months on end, electrodes and monitors attached all over the body, kept in a plastic box to maintain body temperature because the baby is unable to do that on its own, attached to a ventilator because it cannot breathe on its own, fed through a tube threaded through its nostril and down into its belly into an underdeveloped gastric system which is at high risk for painful and deadly infection, being so fragile that it cannot be held or touched for months are just some of the “heroic” measures that micro-preemies endure.

In addition to the efforts made to save the fetus, the mother often undergoes a cesarean section; a major abdominal surgery that puts her at risk for complications and infections and can jeopardize her health in future pregnancies.

Furthermore, the micro-preemies that survive into early childhood often suffer from ongoing health problems, learning disabilities, and behavioral problems.  Sometimes these problems are relatively minor and children grow to become healthy, productive adults.  Sometimes though, these children do not fare as well and demand constant, high-level care throughout their lives.  There is no crystal ball to tell the future and know which outcome will occur.

It is truly a miracle of modern science that a baby can be born so early and survive, but the doctors who make the decisions in the Neonatal Intensive Care Unit are not the same doctors who continue to treat the life-long illnesses and deficits from which micro-preemies often suffer, and they are not the doctors guiding the mothers through future pregnancies where they are denied Vaginal Births After Cesareans (VBACs) or suffer complications from the previous cesarean.  Previous cesarean has been linked to infertility, and by using surgical means to attempt to save a fetus with a 1 in 3 chance of survival, doctors put in jeopardy the very thing the parents may desperately want if their premature baby dies – a chance for another baby.  Pushing the envelope of viability is really a grand experiment on human subjects that sometimes seems to focus more on whether or not the doctors and medical teams can create miracles of life in the moment, but doesn’t take a long view of what those lives might look like in the days, months, or years ahead.

A surgeon’s tool is surgery, so it is the prescribed course of action for many who are confronted with illness and seek help through our current medical system.  There are numerous unnecessary and unhelpful surgeries performed every year to provide “healing” from heart disease and back problems, as well as other maladies.  Based on our doctors’ advice, we are optimistic to a fault, believing we can prolong life and cheat death without truly understanding the odds in each healthcare situation, believing we will be the one with the winning lottery ticket and consoling ourselves when failure occurs that “at least we did everything possible to save a life.”  What this system denies is the possibility of a more compassionate acceptance of fate, and tragic though it may be, there can be such a thing as a good death.

Maternity care is particularly vulnerable to over-action and heroic measures because birth, by its very nature, is the entryway into life.  Our modern system of obstetrics in the United States uses numerous interventions and takes every precaution to ensure a healthy baby which, ironically, leads to the highest death rates of mothers and babies of any country in the industrialized world.  Countries that treat birth as a normal, healthy process intervene less and get better outcomes.  Often, the families that are receiving this over-medicalized care are not even given enough information to make care decisions based on informed consent, nor are they given true choice in the medical setting.  Blaming the women, and without question, blaming the babies for costly care is the epitome of shit rolling downhill.

All this care, optimism, and desire to cheat death – this attitude of “life at any cost” does cost us dearly.  Our inability to grapple with these issues ends up being very expensive, and truly does lead to “million dollar babies.”  I don’t have the answers for many of the questions these dilemmas raise.  What I might choose in a life or death situation would be very different from what you would choose, I am sure. There are no simple solutions.  It seems to me though, if doctors want to advance medical science through human experimentation the subjects should be fully informed and not have to pay for it, and if we truly believe as a society in “life at any cost,” that should extend to everyone and we shouldn’t gripe about it when it comes time to actually pay.

If AOL had planned for the rising costs associated with the rollout of the Affordable Care Act, which strives to provide everyone in our country with access to healthcare so they too might have a chance to cheat death, it would not have made the news.  If AOL leadership had respect for and appreciation of its employees to the point of reducing management’s salaries in favor of buffering these unusual and short-term costs of healthcare and retirement for its workers, it probably would not have made the news.  If it made an effort to improve the healthcare system in our country to one that is evidence-based, efficient and affordable, that probably would not have made the news either.  That bad behavior gets highlighted instead of examples of how to move equitable, affordable, high-quality healthcare forward for our country; that makes me “distressed.”

 

Michal Klau-Stevens is The Birth Lady.  She is a Lamaze Certified Childbirth Educator and expert on citizen childbirth issues.  Her website is TheBIrthLady.INFO.

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Do you remember the uproar that created the dolphin-safe tuna movement?  People discovered that fishermen, with nets trawling the ocean searching for tuna, captured and killed whole pods of dolphins.  Nets, as big as two kilometers long and two hundred feet deep, were used to encircle schools of tuna.  Once the tuna were surrounded in the net, the bottom was pulled tight, and the catch was hauled onto the boat.  The practice is still continued today, with about 60% of tuna being caught by this method.  It turns out many different species of marine life are caught in those giant nets.  It is called “bycatch.”  It is the unintended consequence of the business of industrial tuna fishing, and it kills hundreds of thousands of non-targeted sea animals, including endangered sea turtles, sharks, barracuda, and a number of other species.

Every time I read about the anti-abortion legislation being passed in states around our country I think about the dolphins and other majestic creatures that die in those giant nets as bycatch.  I think about them because to me they represent the collateral damage of a sweeping, indiscriminate practice that is wasteful and damaging, and that is how I see this legislation.

If the reproductive rights movement was viewed on a spectrum, one end would be those fighting for access to birth control and abortion, and at the other end would be those of us who are demanding access to optimal maternity care for women so they can have their babies in a safe and healthy way.  As an advocate for healthy birth, I am at the forefront of a movement that involves reproductive rights, and I fight for women who have made the decision to follow through with their pregnancies.

I have experienced the unintended consequences of anti-abortion legislation, including limited access to healthcare and polarized community.  The birth-related organization I work for decided to remove the tagline, “It’s your birth.  Know your options,”   that we used for marketing because I and several other chapter leaders reported being confronted at events on several occasions by angry people who thought the word “options” referred to abortion.  How many women did not approach our booths to get information about healthy birth and breastfeeding because they mistook our mission?  A woman I know who desperately wanted another child had to wait to miscarry a pregnancy that was not viable (no heartbeat was detected) because she was in a place that did not allow “abortions” and they would not do a D&C.

The whole idea of “personhood” seems to put the needs of fetus before the needs of the already living, breathing mother.  Both anti-abortion and personhood legislation seem to make it acceptable to view the mother as simply a vessel for growing life; an incubator that has no need for healthcare, human rights, personal autonomy, or bodily integrity.  Every woman who is denied a VBAC (vaginal birth after cesarean) because the risks to the baby may be slightly greater than a repeat cesarean, regardless of the fact that cesarean surgery exposes the mother to serious risk, is affected by this attitude.  Women who live in places where women are denied homebirth with a qualified birth attendant are victims of the same philosophy.  A friend of mine who moved to North Carolina had to go through the “underground railroad,” sending carefully coded emails and having furtive phone conversations to find a homebirth midwife who would attend her.  She felt a homebirth was a safer choice for her than a hospital birth because of all the unnecessary interventions to which she would be subjected in the name of ensuring a “healthy baby,” even at the sacrifice of her own health.  And heaven help the women who attempt a home birth but need to transfer to a hospital and are seen as criminals and undergo investigations by child protective services or are arrested for child endangerment.

Women have been carried out of their homes in shackles while in labor and forced to undergo cesarean surgeries.  This video by the National Advocates for Pregnant Women describes incidents where pregnant women, some of whom are anti-abortion, were denied their rights in order to protect the rights of the fetuses they were carrying.  While this video focuses on personhood legislation, what we are seeing with much of the current anti-abortion legislation which is closing down clinics is that women will have less access to all kinds of healthcare, including well woman exams, cancer screenings, and STD and HIV screening.

The other type of anti-abortion legislation that has unintended consequences for women who want to be pregnant involves mandatory ultrasound.  I have already heard stories of women who have found out that their babies suffered from genetic defects that are incompatible with life or who died in utero who had to endure mandatory vaginal ultrasounds before undergoing medically necessary abortions.  How much more pain and grief must these women suffer?

These laws being enacted are just like those giant fishing nets, catching their target but also capturing women who are pregnant and have very different needs than those of the women the laws seek to thwart.  Yet, women’s reproductive health runs along the full spectrum, and all women need individualized care.  Each woman has a different story, different needs, different circumstances, and different health concerns.  Women need to make these healthcare decisions with their doctors and have access to the full package of reproductive healthcare in order to remain healthy.  Legislation is too broad and general to adequately answer women’s healthcare needs when it comes to pregnancy.  It is wasteful and damaging, and produces too much bycatch in the form of personal pain and suffering for individual women and societal damage because so many women are unintentionally caught up in the sweeping net.

One step that pregnant women can take towards making sure their care provider is familiar with the latest evidence-based maternity practices is to give their doctor or midwife a copy of the book “Optimal Care in Childbirth,” by Henci Goer and Amy Romano.  Every maternity care provider should read this book, and keep it handy as a reference.  Women might want to keep a copy for themselves too.  Giving this book to your doctor or midwife sends a strong message that you value and expect to receive evidence-based maternity care and that you are savvy enough and motivated enough to seek out the evidence basis of their practice.

This book is not an easy read, nor is it intended as a reference for expectant women.  Instead of “what to expect…” this book is full of detailed scientific evidence about the care birthing women should be given and uses the physiologic, or the normal natural physical process of birth as the basis of care.  Authored by a medical writer and acknowledged expert in evidence-based maternity care and a research expert/midwife, “Optimal Care in Childbirth” gives thorough analyses of current medical maternity practices and the evidence that supports or refutes their use.  It also provides strategies for optimal care and mini-reviews of the evidence, and leaves no stone unturned with respect to the scientific basis for cesarean surgery, induction of labor, augmentation of labor, positioning for labor and birth, care after birth, newborn practices, and more.

I have heard doctors and midwives complain that it is hard to keep up with the research because they are so busy delivering babies.  I have also seen that “silos” exist, where doctors only read journals in their specialty, and miss out on the research that is conducted in related fields, such as midwifery, nursing, and childbirth education.  This book captures research from many sources and packages it in a manner that is portable and easy to share with others.  The mini-reviews provide quick reference points for decision-making in non-emergency situations.

The book costs $50, and by giving it as a gift to your doctor or midwife the message it sends is priceless:  receiving evidence-based maternity care matters to you and you are willing to invest your time and your money in order to get it.

Do they already have a copy?  Suggest they re-gift it to another doctor or midwife in the practice, or to the nurse’s station on the labor and delivery floor of the hospital, or to a nurse, or a hospital administrator, or…

 

Goer, H. and Romano, A. (2012). Opimal Care In Childbirth:  The Case For a Physiologic Approach. Seattle, WA: Classic Day Publishing.

Available on Amazon.com

This is an unsolicited review and I receive no compensation for posting it.

Cut, Stapled, & Mended:  When One Woman Reclaimed Her Body and Gave Birth On Her Own Terms After Cesarean by Roanna Rosewood

©2013 by Roanna Rosewood.

Cut, Stapled, & Mended tells the story of Roanna Rosewood’s journey to motherhood and how the births of her three children changed her life.  Fiercely independent, emotionally detached from her painful childhood, and with rebelliousness against modern medical treatment instilled in her by her holistically minded divorced parents, she faces the birth of her first child with the self-assuredness of a proud warrior as yet untested in battle.  When her planned home birth goes awry because her water breaks but labor does not start, she finds herself in the midst of a hospital birth overseen by an unknown doctor who is not supportive of Roanna’s efforts for a natural birth and on the hospital’s timeclock to force her slow labor to speed up.  Exhausted and overwhelmed, Roanna consents to a cesarean delivery.  Roanna is tied down to a surgical table, and when her son is born and screaming at his entrance into the world, she is unable to go to him, to comfort him, or even caress him.  She begins her journey to motherhood feeling like a failure.  Her body feels broken and scarred, and visions of the surgery replay in her mind while she believes that the first experience her son has had in life is one of abandonment.

When Roanna is pregnant a second time, she pursues every alternative therapy she can find that might heal her body to help her have a vaginal birth.  When this pregnancy ends in a cesarean birth as well, the doctor informs her that she had dense scar tissue, called adhesions, growing throughout her abdomen and her uterus actually tore during the birth.  She refuses her midwife’s attempts to process through the birth experience, instead choosing numbness and a grim acceptance of her belief that she is not strong enough to bring life into the world.

During her third pregnancy, Roanna takes the opportunity to go on the trip of a lifetime to Hawaii.  While away from daily life, she is able to reimagine herself as different person and mentally process through many of her life experiences and her beliefs about herself, her relationships, and her needs.  She is able to connect with some core truths, and strip away some of the armor that has shielded her emotionally since she was a child.  Finally, she is able to have an unmedicated vaginal birth.  But, even that experience, which she has dreamed about and fought for tirelessly for years, leaves her with feelings that are completely unexpected.

Birth stories teach a number of important lessons to everyone who is involved in birth.  Women who will give birth need to hear them in order to learn more about what to expect.  Men who will be fathers need to hear them to better understand how birth transforms their partners into mothers.  Doctors, midwives, nurses, other caregivers, and hospital administrators need to hear the stories of the women they work with to hear firsthand the effects of the care they give on the women they care for.  While each birth story is as unique as the woman who is telling her story, there are themes and similarities that one can identify after hearing many of them.  Ms. Rosewood’s birth stories share similarities to many other birth stories which can act as guides to help improve birth in our country.

Ms. Rosewood eloquently speaks about the physical and emotional effects of cesarean surgery on women as they enter into motherhood.  She writes about the desire for a VBAC (vaginal birth after cesarean) which many women wish for but few achieve in this country.  She writes with refreshing honesty about the surprising nature of birth and how even a seemingly “perfect” birth demands to be processed emotionally and integrated into a women’s life.  In my opinion, the value and the beauty of this book are the depth of description and the honesty about the emotional components of Ms. Rosewood’s journeys through birth because few women give voice with such clarity to this side of the experience.  The emotional truths she describes are her own, and they are similar to the truths of thousands of other women.

Birth in this country is treated as a medical condition to be managed, not as the rite of passage which contains physical, psychological, and emotional components that all must be addressed.  The mind plays a vital role before, during, and after birth.  Cut, Stapled, & Mended thoughtfully explores the side of birth that is often ignored.  In doing so it highlights both the damage and the growth that can occur during any kind of birth, and that is something all people involved in birth should be paying attention to.

Thursday morning I was priviledged to attend the most integrated natural birth in a hospital that I have seen or heard of.  I know they happen, but I have not heard of one happening in a hospital in my community.  Thanks to Leah for letting me share her story!

Leah’s husband Ben called me at 1:45 a.m. saying that Leah believed she was in labor and she wanted me to come over.  I got to her house around 2:45.  Leah was tired, but she was managing the contractions pretty well.  She moved around a lot, changing positions, trying to rest and still be comfortable during the contractions.  She was having a fair amount of back pain.  As the surges intensified Leah found a fabulous rhythm.  She rolled her neck from side to side, reached out with her hands and stretched and closed her fingers, and made a low groaning sound.  She looked like a bear to me.  It wasn’t long before the surges gained strength and lasted longer.  I sensed a change in Leah demeanor, and thought it was time to head to the hospital.

When we arrived and Leah was checked in the triage room, she was at 6 c.m.  The nurses seemed surprised that she was so far along.  We moved into the labor and delivery room, where the midwife and the nurse wanted to put Leah back on the electric fetal monitor to get a better reading on how the baby was doing.  The nurse was comfortable without opening a vein site, even with just a hep-lock, as long as the IV workings were in the room, so there was not even a needle stick.  Leah worked hard to get back in the rhythm that she had at home.  Her husband Ben brought his African drum, and set a great beat while I put some electric tealights out on the table.  Leah danced to the beat of the drum and found her rhythm again.  Once the nurse got the readings she was looking for on the monitor, she took it off of Leah.  The midwife mentioned breaking the bag of waters a couple of times, but made it clear that it was Leah’s choice.  Each time it was offered, Leah declined.  When Leah was dilated to 8 c.m. she felt her water break, but there was not a gush of fluid.  The contractions became more intense, and the back pain was nonstop.  Leah was on her hands and knees, and I got on the bed and applied counter pressure to her back.  As she moved into transition, she made it clear that she needed to be holding Ben’s hand during her contractions, and I told her to ride right over the top of the waves.  After five or six strong contractions, Leah was feeling a lot of pressure.  She wasn’t sure if she should push, or how to do it, but the nurse said to go ahead and try.  While on her knees and being upright holding a squatting bar, Leah worked at figuring out how to push.  The nurse gave her some guidance, but it was not “directed pushing,” and there was no counting or purple pushing.  The nurse then suggested that Leah move into the side-lying position.  The baby’s head crowned, and Leah gave a few good hard pushes.  The baby’s head arrived, still in the caul.  Two more strong pushes and the shoulders were out.  The midwife unwrapped the membranes from the baby’s face, and the rest of the body slipped out.

The beautiful baby boy was placed right on Leah’s belly.  Leah and Ben were overcome with emotion, and Leah kept telling baby K how much she loved him.  Kira, the midwife, just sat quietly on the edge of the bed and let Leah and Ben bond with their new son.  She let me feel the cord to feel how it was still pulsing.  It was several minutes before the cord stopped pulsing.  When it did, she asked Ben if he’d like to cut the cord, which he did.  The nurse prepared a syringe of pitocin, but Leah did not need it, as there was no extra bleeding and her uterus was clamping down nicely on its own.  Once the initial adrenaline rush of the birth had passed, Kira asked if Leah was ready to be checked for any tears.  The nurse took the baby over to the scale and weighed him while Kira checked Leah.  The baby weighed in at 9 lbs. 15.6 oz, and Leah had only a minor abrasion!  The baby was brought back to his mom, and he eagerly latched on and started nursing.

This birth was unique for several reasons.  First, it took place in a tertiary care facility, and really the only technology that was used was the electonic fetal monitor, and even that was put aside once reassuring heart tones were captured.  Leah’s choices were respected, and no one tried to push anything on her.  She was asked for her consent before every vaginal exam, and every time there was a choice to make, she was told the benefits and the risks.  The cord was not clamped immediately, and the baby was not whisked away to weighed, measured and bathed.  No erythromycin was put in his eyes, as the parents desired.

The baby was taken to the nursery for a while, which Leah and Ben would have liked to avoid.  Leah also would have preferred not to be asked during labor about having her bag of waters broken.  Overall though, it was a beautiful natural birth.  It was an excellent example of an “integrated” birth where technology is available if necessary, but not used indiscriminately.

If only they could all be that way…