My Daily Domestic Diigolet 02/26/2008

For the first time, ACOG has suddenly started supporting freestanding birth centers, a drastic shift from its long-standing opposition to out-of-hospital births. The research on birth centers has not changed—in fact, the outcomes from the National Birth Center Study are similar

I would argue that it is hardly fashionable or trendy in that sense. Women choosing home birth face significant social stigma. It is not an easy or socially acceptable path. Instead, it is a choice that some women will always make out of deeply held philosophical or religious beliefs. This statement also implies that women choose home birth for frivolous reasons without serious thought or carefully weighing the risks and benefits of various options.

On the other hand, one recent trend in childbirth—elective cesareans with no medical indication—is supported by ACOG as ethically justifiable “if the physician believes that cesarean delivery promotes the overall health and welfare of the woman and her fetus more than does vaginal birth.”

ACOG yet again pays lip service to “a woman’s right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider” while working to undermine women’s ability to make those very decisions.

Dr. Marsden Wagner has noted that ACOG “has no data to support it [the 1999 VBAC recommendations], no studies showing improvements in maternal mortality or perinatal mortality related to the characteristics of institutions or availability of physicians.”

This shows ACOG’s distrust in a woman’s ability to make her own decisions.

5) ACOG claims to be concerned about the rising cesarean rate and states that it “remains committed to reducing it.” However, several of ACOG’s actions actively promote higher cesarean rates, including its support of patient choice cesareans as ethically justifiable and its 1999 VBAC recommendation.

) When all else fails, blame the woman

Yet with no new research on birth centers in the past year and a half, ACOG has recently reversed its stance. ACOG also ignores the CPM 2000 study about midwife-attended home birth, a large, prospective study of all CPM-attended births in the year 2000.

In states where midwifery is illegal, many midwives are forced to abandon their clients if they transfer to a hospital out of fear of being arrested. Midwives in many states cannot openly refer clients or consult with backup physicians. Surely these situations do nothing to improve safety for the birthing woman.

The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.” This statement as insulting as it is misinformed, and it shows ACOG’s inability to recognize that women choosing home birth do it to safeguard their baby’s well-being. Accusing women of being “bad mothers” is both unprofessional and paternalistic.

Many other websites have covered this topic in exhaustive detail, so I’ll refer you to them in just a moment, but first a few comments of my own. As Rixa rightly pointed out on her blog The True Face of Birth, ACOG’s sudden acceptance of out-of-hospital birth facilities (i.e. freestanding birth centers) flies directly in the face of their earlier November, 2006 Statement on the subject, where they were adamant that the hospital “is the safest setting for labor, delivery, and the immediate postpartum period,” and that “ACOG strongly opposes out-of-hospital births.” I wonder what caused the sudden change of heart?

There has got to be so much back-room wheeling and dealing and politics involved in all of this that one can only wonder at the motives. But crucially, why must support of freestanding birth centers be at the expense of homebirth?

As Rixa conjectured, maybe all of this is indeed in response to Ricki Lake and Abby Epstein’s documentary The Business of Being Born, which has done a terrific job of raising awareness regarding homebirth. The real question we need to continue to ask ourselves is this: Why is it that America, with all of it’s insistence on hospital birth and safety, still has one of the highest rates of neonatal and maternal mortality among developed countries? That question lies at the heart of The Business of Being Born, and clearly, the American way of doing birth, for all its emphasis on hospitals and safety, has not adequately addressed this.

The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) support home birth for women with uncomplicated pregnancies. There is no reason why home birth should not be offered to women at low risk of complications and it may confer considerable benefits for them and their families. There is ample evidence showing that labouring at home increases a woman’s likelihood of a birth that is both satisfying and safe, with implications for her health and that of her baby.1–

And don’t forget the economics at work here.

what’s good for the mother is ALSO GOOD FOR THE BABY. The two are not diametrically opposed. When a woman feels safe, supported and relaxed, she’s able to sink into her labor and allow her birth to unfold in the manner that’s best for the baby, without all of the stress hormones and cortisol, without all of the fear….and more often than not, with stunningly good outcomes.

In any case, you should go read the rest of Rixa’s post on The True Face of Birth ASAP: 10 Responses to ACOG’s statement on homebirth, as well as the other responses cropping up around the blogosphere.

: the best experiences of our lives so far have been the home births of our two sons.

Labor for our second born was about two hours long, and to have our toddler son there with us to greet our new baby made it special in a way that I have difficulty describing. In a way, I feel that having our toddler son there to help welcome his little brother set the tone for their relationship forever.

f you are an expectant parent and want to familiarize yourself with the advantages of giving birth at home, I recommend that you view a recently released documentary called The Business of Being Born. This documentary is defely for home births and against hospital births. While the makers of this documentary have a strong bias against hospital births, they ask viewers to consider questions that every expectant parent ought to seek answers to before making a decision on where to give birth; some examples of such questions are:

Why does the U.S. have the second-worst newborn death rate in the developed world?
Why are more than 40% of the deliveries done in some New York hospitals Caesarean sections?
Why, according to a study, are the peak hours for Caesarean procedures at 4 in the afternoon and 10 at night?

yet has the second-worst newborn mortality rate and one of the highest rates of maternal death during childbirth.

in the five countries that have the lowest infant mortality rates (Japan and four countries in Europe), 70% of births are carried out by midwives.

Modern American obstetrical care prioritizes making labor as convenient as possible for doctors, sometimes to the detriment of mother and baby; here are two examples of this:

I think that this documentary does an excellent job of encouraging expectant parents to think about how they can have the healthiest and most meaningful birthing experience possible, rather than just submit to what’s expected of them by their health care provider, relatives, and friends.
Based on my wife’s and my experiences with giving birth at home, we feel that it’s well worth every expectant parent’s time to give serious consideration to having a home birth.
If you have a home or hospital birthing experience that might be helpful to share with expectant parents who aren’t sure about where to give birth, please consider sharing your experience via the comments section below. Thank you.

It stated “Our doctors will no longer perform VBAC.”

ince the doctors in that practice were males, it was difficult to imagine them performing a vaginal birth. Doctors do not perform vaginal births. Pregnant women do.

In fact, a study published in the February 13, 2007 issue of the Canadian Medical Association journal reported that women undergoing planned c-sections are three times more likely to die.

Is it any wonder maternal deaths are on the rise here in the US?

In November, the British Medical Journal published a study showing that the risk of neonatal death was 70% higher for surgically delivered babies than for normal deliveries.

The movie focuses on the profiteering that goes on in the birth industry at the expense of mothers and babies, and offers a look at how empowering and thrilling natural birth can be.

What the statement leaves unwritten is that every homebirth represents an economic loss of thousands of dollars for doctors and hospitals. After all, ACOG is essentially a trade union for the OBGYN industry. An anti-homebirth statement from ACOG is like an anti-tap water statement from Pierrer.

Calling homebirth “fashionable” or “trendy” is laughable. Hospital birth is the recent historical trend.

“Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby.” Translation: Homebirthers are selfish mothers who put their babies at risk.

Does ACOG at least support their contention with scientific data? Perhaps a study actually showing that hospital birth is safer? Not a chance. The studies, in fact, offer the opposite conclusion: Uncomplicated pregnancies end just as well at home.

In fact, US hospitals aren’t doing so well. Our country has the highest rate of cesarean sections, and the second worse newborn death rate in the developed world.

Translation: “The only reason we’re cutting 1/3 of American mothers is because they’re old, they’re fat, they’re lazy and they want to be cut.” These doctors refuse to take responsibility for America’s outlandish c-section rate, even though the rate varies widely between practices and is lower in natural (drug-fee) labors where women are allowed to eat, drink, and move around.

HealthInspections.com

“What can you ever really know of other people’s souls- of their temptations, their opportunities, their struggles? One soul in the whole of creation you do know: and it is the only one whose fate is placed in your hands. If there is a God, you are, in a sense, alone with Him

We all just want to pass along that a peice of us can relate to peice of you and that while we pray for you and your family, we try to understand by finding times in our own life where we’ve dealt with a difficult circumstance. It’s natural, especially if one is truly empathetic.

As Christians we are called to carry one anothers burdens. We are also told that we suffer sometimes so that we can comfort others with the same comfort Christ has given us. So, all I’m really saying is “you’re right” but the heart of people saying things sometimes is to try to comfort you and encourage you.

– I’ve learned that it can be much more hurtful than helpful to claim to understand what another person is going through.

As a woman of a preemie child with special needs and a woman with CF, I WANT to hear other people’s stories. If they have been down my path, it is comforting to me.

She arbitrarily shared with me that her son used to walk just like mine at age 3 and look at him now. My husband could give two hoots about her comment, but I was comforted, motivated, refocused, and more. From one mother to another——– there is hope.

I agree with what you said…our experiences can broaden our love for others, but I don’t think we can ever truly understand what they are going through even if we’ve gone through something pretty similar. We can certainly pray for and love each other though!

. I have found that a response along the lines of “that makes perfect sense”, applied to descriptions to how a person is feeling (rage, pain, whatever), does the trick better than “I understand”. As you said, no one can really understand. But, people can imagine themselves in a situation and say “how would I be feeling?” and come to the conclusion that whatever the speaker is saying sounds like a perfectly reasonable reaction.

These days, I’m more careful about how I try to offer solace to others, and I’m learning to love on them without necessarily using words that could accidentally sound stupid or be hurtful. Anyway, thanks for sharing these thoughts

But that doesn’t mean in any way that my challenging experiences mean I “understand” other people’s difficulties. What you said is so important for us to remember when we’re attempting to encourage, uplift, or comfort others.

Some times people need space in their grief, and all we can do is send our prayers to God to show them we are here and we still care.

Armed with highly sensitive and sophisticated monitoring gear, DiPietro and other researchers today are discovering that the real action starts weeks earlier. At 32 weeks of gestation – two months before a baby is considered fully prepared for the world, or “at term” – a fetus is behaving almost exactly as a newborn. And it continues to do so for the next 12 weeks.

Closer to birth, the fetus sleeps 85 or 90% of the time: the same as a newborn. Between its frequent naps, the fetus seems to have “something like an awake alert period,’ according to developmental psychologist William Filer, Ph.D., who with his Columbia University colleagues is monitoring these sleep and wakefulness cycles in order to identify patterns of normal and abnormal brain development, including potential predictors of sudden infant death syndrome. Says Filer, “We are, in effect, asking the fetus: ‘Are you paying attention? Is your nervous system behaving in the appropriate way?'”

By 13 to 15 weeks a fetus’ taste buds already look like a mature adult’s, and doctors know that the amniotic fluid that surrounds it can smell strongly of curry, cumin, garlic, onion and other essences from a mother’s diet. Whether fetuses can taste these flavors isn’t yet known, but scientists have found that a 33-week-old preemie will suck harder on a sweetened nipple than on a plain rubber one.

“Behavior doesn’t begin at birth,” declares DiPietro. “It begins before and develops in predictable ways.” One of the most important influences on development is the fetal environment. As Harvard’s Als observes, “The fetus gets an enormous amount of ‘hormonal bathing’ through the mother, so its chronobiological rhythms are influenced by the mother’s sleep/wake cycles, her eating patterns, her movements.”