Re-Blog: Are C-sections a Violation of Women?

This is such a great post by the Midwife at Birth Sense that I had to re-post here. I love the truths it reveals about cesarean sections and I love the message.
(Since she just posted it yesterday, please go over to her site to post comments, so I don't steal her glory.)

May you never feel violated from a c-section. All C-sections should be life-saving.

Are C-sections a violation of women?

The other day, one of my colleagues was discussing how she felt about c-sections.  “Every time I see a woman undergoing a c-section, I can’t get past the idea that it is a horrible violation of her body,” she stated.  “Even when I as assisting in the c-section, that gash in her body seems so wrong.

I wasn’t sure how I felt about her comment–I know that there are too many c-sections done; I know that some c-sections are unnecessary; but a violation of the body? 

Yesterday, I saw a woman in my office for her first OB visit.  this was her third pregnancy.  Her first and second pregnancies were both scheduled c-sections.  When I questioned her about the reason for the c-sections, she told me that her doctor said she must have a c-section because she had the HPV virus and was group B strep (GBS) positive.

I asked her if her HPV virus was manifested in genital warts.  On rare occasions, genital warts can be so large that they obstruct the birth canal.  In these cases, a c-section is necessary.  However, my patient assured me that she only had the virus, no genital warts.

I explained to her that neither HPV nor GBS were considered reasons to have a cesarean birth.  She looked at me blankly.  “That’s not what my doctor told me,” she replied.  I was shocked that a doctor would outright lie to a patient regarding the necessity of a c-section.  Yes, I believe this woman was violated.

Sometimes it is less clear whether a violation has taken place.  Another patient of mine was pregnant with her second baby.  Her first child had weighed only 5 lbs., but the delivery had been very difficult.  Her pelvis was smaller than usual, and even though the baby was small, his shoulders had gotten stuck during the birth.  With her second pregnancy, she was dismayed when I told her the baby was in a breech position about four weeks before her due date.  This baby also felt substantially larger than her first one–I estimated about 8 pounds.

A friendly OB with whom I consulted was willing to try to turn the baby in a process called ‘external version’, but the procedure was unsuccessful.  My patient now pleaded for a vaginal breech delivery, but the OB did not think it was safe, based on how difficult the first birth had been and the fact that this baby was about 3 pounds larger.  My patient became more and more angry as she tried to find someone who would help her have a vaginal breech birth, but every provider she spoke with felt it was too much risk to the baby.  She finally consented to a c-section, but when I saw her at her postpartum visit, she was very angry.  She felt she had been forced against her will into a c-section, and insisted that if she had another baby, she would go to a “third world country” where they would allow her to have her baby the way she wanted.  She felt violated.  This was a very sad situation for me, because I wanted to support her in her choices, but also did not feel personally safe trying to deliver her baby vaginally.  I envisioned how I would feel if her baby was partially born and I could not get the head and shoulders out.  How would I explain to her if her baby died because I could not deliver the baby?

It is my goal that none of my clients will ever feel violated by a c-section.  Note that I did not say “none of my clients will ever have a c-section”, but none will ever feel violated by a c-section.  A client of mine arrived at the hospital shortly after her water broke, and we noted a large amount of bleeding.  The baby’s heart rate was indicating severe distress, and a quick ultrasound showed that the placenta was partially separating from the wall of the uterus.  My client agreed to an emergency c-section, and in speaking with her afterward, I asked her how she felt about it.  she was a woman who was committed to natural birth, and had had four children without drugs or interventions.  “I’m so thankful my baby is alive,” she said.  “I don’t have any problem with the fact that I ended up with a c-section for this baby.”

I think this may be the key.  Too many times, unnecessary c-sections are excused by telling women to “just be happy you have a healthy baby,” and making her feel she is callous in wishing for a vaginal birth.  However, when a woman knows deep inside that the c-section was life saving (which is what all c-sections should be), I have found that she is able to accept it much more easily than when she questions the need for it.

So my goal is that none of my clients will ever feel violated by a c-section.  May you all have beautiful, normal births.  And on the rare occasions when fate intervenes and makes that impossible, may you be at peace and thankful for a surgery that, used wisely, can save lives.

Feminism and Birth

The term "feminism" gets a bad rap. For this post, I'm not going to go into a full analysis of who is a feminist and who isn't, the stereotypical feminists versus what an actual feminist probably looks like, what a feminist issue is and what isn't. For now, I'm just going to say that I think that feminism is about women's rights and freedom to choose what is right for them.


In the 1920's, the Feminist way to give birth was Twilight Sleep, with the use of scopalamine.

"Women were still being told that the pain of childbirth was the Curse of Eve and that it was because of Eve's sin in the Garden of Eden that women had to suffer during childbirth.
So you can imagine how the modern liberated feminist attitude during the time would be
I certainly don't have to suffer and that if there are drugs around that can keep me from having to suffer I'm going to go find those drugs because 'I'm a modern woman.'
Women thought that it took away pain during childbirth but it doesn't it actually just takes away your memory of the experience." - Robbie Davis-Floyd, The Business of Being Born

Today, most women would agree that Twilight Sleep was a terrible time in the history of childbirth. However, it would not be strange to find that many women think that any drug or medical procedure that can skip the suffering is the choice of a liberated woman. They want to skip the "messy" business of being labor, pick their delivery dates, have a cesarean section. Independent women have elective C-sections!

But is this really the feminist choice?


Gina, The Feminist Breeder puts it best:

"So many young women today think that drugged-up births and cesareans are the “feminist” choice, and that labor pains are oppressive or patriarchal in nature.  I understand… I really do.  I once was that girl.  I thought anything that could disconnect me from my biology meant freedom... I didn’t necessarily want a cesarean (I’m scared of surgery) but when I became pregnant, I had blind faith that the obstetrician I hired could easily and painlessly remove the parasite I was growing in my womb with a nice epidural cocktail and some forceps.  Simple, right?

Of course I had no education whatsoever about epidurals or forceps or cesareans, and how much damage they could do to a woman’s body.  I just assumed that if the technology existed, then they must have perfected it, and if it could keep me from feeling a contraction then by golly, I had to get me some of that."


This is a common attitude of women who have never given birth before. Most women know very little about pregnancy and birth before it happens to them. Most women, for the first pregnancies especially, think that their obstetrician will tell them everything they need to know and always have their best interests at heart. They think that, just as Gina says, "they must have perfect it" all by now, and women in movies are always getting epidurals, c-sections, etc, and the technology surrounding birth is the best way.

I try, in my own way, through this blog, my work as a doula, and conversations with friends, to spread the idea of what I think the REAL feminist way to give birth is: To Be Informed! It is liberating to be informed. Be knowledgeable of all your options before birth, during birth, during emergencies, and after birth. That way you understand the pros and cons, the benefits and risks, of every single care provider, procedure, piece of equipment, and treatment. That way you'll make an informed choice and you'll know whats really best for your body and your life.


Midwife Miriam writes on Birth Activist:


"“Why would you suffer? They have pain killers for that.” Or “you have the right to sign up for a c-section and get it over with, there is no need to suffer.” were the phrases I encountered the most. At that moment I realized that while the women’s movement did so much to further our rights in the workplace and controversial reproductive rights it had left behind an essential part of being a woman the reproductive right to birth as we saw fit. But wait… we can schedule our c-section, we are in control. Wrong sister! 

We as women have forgotten what we are. Beautiful powerful creatures who’s bodies were created with an ability that no man has, the ability to grow and birth a human being.

The male dominated medical field is selling us a bag of goods, and I am not buying it."


Both Miriam and Gina make impassioned pleas for feminists and young people of the women's movement to fight for choices in birth and women's rights. They especially ask that women stop and think about if a c-section is really what they want... Or if its even a choice rather than whats being pushed upon us all.

Gina writes,

"Independent women need to be aware of the real price of trying to buy the “perfect, painless” birth experience from surgeons, and think about ways to change the system for the betterment of all women and babies. 

Last year I gave a 10-minute talk in an advanced public speaking course on this very topic.  When I finished, one young woman raised her hand and said,

“Wow, I never knew any of this.  I always figured I’d sign up for a c-section the minute I got pregnant, but you’ve really got me thinking.”

And that’s all I hope for.  I want more young feminists to ask “Are we taking control over our own bodies, or are we really just unwittingly giving all the control away and labeling that a choice?” and “When I enter my birth environment, am I sure I’ll be treated with respect, or are the residents joking that my desires for an autonomous birth just bought me a ticket to the OR?” If it’s the latter, then it’s time to demand better, and to keep demanding it, until our maternal and infant mortality rates reflect the amount of money women are paying into our maternity care system."


Miriam notes,

"If we have the right to choose a surgical date, then why is it illegal in 25 states to choose a certified midwife to have a homebirth? If I can choose my child’s birth date, why can it only be Monday though Thursday? Why? Because we are being led in a direction under the guise of it being our choice.

I look at some of the most powerful women’s rights groups in our country and shake my head and fist at them.  While the rally to defend our right to terminate a pregnancy they stay quiet on our right to not be forced into surgical birth.  Where is N.O.W. when in Miami-Dade county 51% of humans are being born via surgery.  Why is there no out cry for the illegal “ban on VBACs” that hospitals are claiming to have?  Why is choosing a vaginal birth after a cesarean (which is encouraged by ACOG) a crime that can be reported to the Department of Children and Families? Why are women having court ordered c-sections? Why? Why? WHY?

The women’s rights movement forgot all about birth.  To so many of us who CHOOSE to have children, it has been or will be a pivotal event in our lives. We have all kinds of choices to make about our bodies, I just hope that we tell our daughters that they have the right to make them, especially when it comes to birth."


The rights of a pregnant woman, the rights of a birthing woman, the rights of a breastfeeding woman are important feminist issues. A large percentage of women on this Earth are going to become pregnant and give birth at some point in their lives. Birth is absolutely a women's rights issue. I applaud the members of the women's movement who are fighting for our birth rights.

Breasts in Modern Day NYC and in Natural History

Whew! I this is the longest I've gone without posting on my blog. I guess I'll chalk it up to it being summer! There is a lot to do in New York City. I went to the Coney Island annual Mermaid Parade, which was full of colorful sea-themed costumes, including many women who simply painted seashells on their bare breasts. I also attended the NYC PrideFest Parade, where I saw even more bare-breasted women in costume.

Why am I focusing on this? Its not because I am judging the actions of any of these women. I'm pointing out how there are certain instances in which we accept that women will bear their breasts and society is accepts it. These women were not pulled aside by the numerous NYPD cops for indecent exposure. This is just whats done at these things, right? Standard. Expected. Typical. Customary.

So of course my thoughts go immediately to the issue of public breastfeeding.
Like so many other Lactivists (lactation activists), I've addressed this topic a few times already:

Public Perceptions of Breastfeeding

Cafe Manager Berates Breastfeeding Mom

Tampa, FL School Tells Mom Breastfeeding is Inappropriate

...and numerous other bloggers have written about women and mothers (among others) attacking breastfeeding mothers for breastfeeding in public, breastfeeding a toddler, breastfeeding without covering up, etc.

The argument is generally that it is gross, disgusting, offensive, indecent, sexual to see a woman feeding a baby from her breasts because either it will upset their meal in a restaurant or their children will be... what? become perverts later in life?

Providing important nourishment and nutrients to your child in public by breastfeeding is offensive and disgusting? Something to get thrown out of a restaurant, shopping mall, or school over? Even though it is Standard, Expected, Typical and Customary and has been the Natural and Normal way to feed a child the world over since the beginning of humanity?

I think its just a public embarrassment problem. People don't mind looking at their own breasts, the breasts of their loved ones, breasts on giant billboards or cable television, but if its a real human stranger's breast right next to them they don't know what to do. Especially if the woman is using her breast to do something they've never been exposed to: breastfeeding. This embarrassment causes them to not want to have to answer their childrens' questions. The American cultural norm is to see breasts in sexy ads, not feeding babies. If we can change the societal norm, we can change the societal mentality and be rid of the embarrassment problem.

Speaking of the beginning of humanity...

I spent a lovely afternoon in the American Museum of Natural History last week. It was full of parents and kids.

I visited one of my favorite areas of the museum - the Human Origins exhibit.  There was one particular diorama in this exhibit that showed a Neandertal man sharpening his spear, a woman holding an animal hide in her teeth while she used a stone tool to scrape the fat and blood vessels from the skin, and an older woman who sat and spoke with them. As you can see from the photos, none of them were wearing clothing. Genitalia was exposed, though partially hidden by thick pubic hair. Both womens' breasts were clearly exposed.

And yes, parents stopped, with their children, and looked at the exhibit with them. They didn't cover their childrens' eyes and run away at light speed. They didn't say "ugh! breasts in a public place, where my children are being exposed to indecency!" Why? Because this is an exception to that reaction? Well then why can't breastfeeding be an exception?

My favorite exhibits in the museum are, naturally, the cultural and archaeological exhibits - various Native Americans, Peoples of Asia, African People, and so forth. In one there was a diorama showing tribal life, and the people we wearing little more than loincloths. A group of kids and parents were gathered around it, and one child asked why they weren't wearing any clothing. One of the moms simply explained that they had to make all their own clothing out of what they could find. And that was that. Maybe it was awkward to have her child see half-naked men and women and have to explain that that is just how it is done, but she did it. And the children nodded, accepted the explanation, learned a little about history and culture, and moved on. This same concept can be applied when your child asks you why a woman is feeding her baby with her breast. They will learn that it is just how babies are normally fed, and they will absorb it as a societal more.

As PhD in Parenting puts it: "Breastfeeding is not creepy. Our society is creepy for thinking that breastfeeding is creepy."

Hypnosis for Childbirth

When I became a doula I began hearing a lot about hypnosis for childbirth. Generally, pregnant moms will take workshops or listen to CDs from either Hypnobabies or Hypnobirthing.

Hypnosis for childbirth is another childbirth education and preparation method. At first it sounds hokey, but from what I've seen and heard it is really similar to other coping methods and seems to really work for a lot of moms! It is also similar to what birthing mamas seem to already do: get into a zone inside themselves, listen to their breathing for calm, and so forth. I haven't had the pleasure of attending a hypnosis childbirth yet, but I am looking forward to it.

What Is It and How Does It Work?

by Kerry Tuschhoff, HCHI, CHt, CI 

Mention Labor and Delivery to an expectant mom in her last trimester, and chances are good that her heart will begin to race, her mind floods with concern and in some cases, panic. She knows that the day is coming when a force much bigger than herself will take over and her body will govern itself completely. For some women this is a very fearful event, but for a Hypnobabies mom, it is an eagerly anticipated challenge. 

These wise women use hypnosis to eliminate pain and fear from the birthing experience. In the past, the word "hypnosis" conjured up images of stage hypnotists re-creating Elvis, or mesmerizing others into embarrassing situations. Now it is common for hypnosis to be used therapeutically in many areas of medicine, dental and surgical anesthesia and personal therapy sessions. Even so, there are many misconceptions regarding hypnosis that can dissuade those contemplating this powerful tool. Here are a few FACTS:

* All hypnosis is self-hypnosis; the hypnotherapist is only the guide. A person chooses to enter into a hypnotic state, stay in and come out at will.

* Approximately 90-95% of the population can be hypnotized. Willingness, belief and motivation have great influence over hypnotizability.

* During hypnosis you are neither asleep nor unconscious, and will always "come out" whenever you wish. You are always in complete control.

* Stronger-minded and stronger-willed people are easier to hypnotize; not the other way around as is usually assumed.

* You cannot be made to divulge information or do anything against your will while in hypnosis.

*Hypnosis is not Satanic or religion-oriented at all, just a way to direct your inner mind toward the positive for great personal benefit. 

*We are all in states of hypnosis many times a day already!

What about Childbirth Hypnosis Classes? 

When learning how to use hypnosis for childbirth, you are taught an understanding of how the uterine muscles will work efficiently together, as they were designed to do, when the body is completely relaxed. The depth of relaxation necessary can easily be achieved with hypnosis so you learn these skills in class, and practice them at home every day until your baby arrives. Important: Comfort in childbirth depends on much more than deep relaxation, so you are also taught the most in-depth hypnotic anesthesia techniques that exist. These make a huge difference in creating your truly comfortable birthing experience, and are easily learned and practiced.

Your Birth Partner can have a very integral role in the preparation process: listening to the CDs, reading the handouts and guiding the Hypno-mother into deep relaxation with hypnosis scripts. They are also an invaluable part of the labor and birth process as they help you to focus and concentrate, as well as supporting you physically. Please note: Mothers without partners can easily learn, practice and use Hypnobabies on their own. All aspects of Labor and Birth are covered in Hypnobabies classes, as well as information on Nutrition, Exercise, Avoiding Complications and Back Labor, Fear Clearing Sessions, Birth Plans, Consumer Issues and Postpartum as well as much more.

HypnoBirthing aka the Mongan Method

How does HypnoBirthing differ from other childbirth preparation methods?

Unlike other childbirth methods that teach you how to cope with and manage pain, HypnoBirthing is based on the premise that childbirth does not necessarily need to be painful if the mother is properly prepared and relaxed. When women understand that pain is caused by constrictor hormones, created by fear, they learn, instead, to release fear thus creating endorphins—the feel good hormones. They are then able to change their expectations of long, painful labor and are able to replace them with expectations of a more comfortable birthing.  Rather than exhausting, shallow breathing and the distraction techniques of typical “prepared childbirth” programs, HypnoBirthing parents learn deep abdominal breathing and total relaxation, enabling the laboring mother to work in harmony with her body and her baby. This allows her to achieve a shorter and more comfortable labor for herself and baby.

What HypnoBirthing looks and sounds like:

Christianity and Hypnosis

I have heard that many Christians are adverse to the suggestion of hypnosis because of the fear that it conflicts with their beliefs. I have heard of doulas being hung up on because they mentioned hypnosis visualizations as a possible coping technique. Here is what the hypnobabies website has to say:

It is important to remember that hypnosis is a state of mind that we are all already in many times a day, so it’s a very natural thing in our lives and is not an “altered state”. We are automatically in hypnosis when driving, swimming, doing other sports, sitting in church or a lecture, reading, watching television or movies or on the computer (a screen of any kind) and when waking up or going to sleep. In Hypnobabies we are simply guiding that process in a very positive way to create an easy, fear-free comfortable childbirth experience. Since our program is designed for women of every faith and belief system to use, it contains no “new-age” or other content that would offend anyone. Many of our Hypnobabies moms are Christian and have had wonderful success with Hypnobabies while incorporating their beliefs into our hypnosis scripts and practice as well as adding prayer into the actual hypnosis when giving birth. We have come to realize that that women know what they need and will find it in Hypnobabies, adapting it perfectly and serenely to their own religious or non-religious belief systems. They always do.

To read what a few Christian hypnobabies practitioners have to say, read here.

Can HypnoBirthing be beneficial to someone who has special circumstances or who must have a C-section?  

Yes! The HypnoBirthing website lists a great deal of ways that hypnosis training can help prepare you for a Cesarean section!

A Hospital Hypnobabies Birth 

FYI: in Hypnobabies they use different birth terminology than we normally do. Here are 3 terms that are used in the video:

• Contraction = Pressure Wave
• Labor = Birthing Time
• Transition = Transformation

 

Both Hypnobabies and HypnoBirthing offer doula companion training, to become a hypnobabies doula, for example. Specially trained to work with hypnosis birthing women. If this is something you'd be interested in, doulas, definitely check out their websites! 

Lotus Birth

As mentioned before, there are benefits to delayed clamping and severance of the umbilical cord for the baby. There have been few recent arguments that delayed clamping is dangerous. Here is another, more "extreme" practice related to the umbilical cord.

A Lotus Birth is one during which the umbilical is not cut.

Ever.

The placenta and baby are left attached until the umbilical cord naturally detaches.

Herbs, essential oils and salts are applied to assist in the drying process and keeps odor at bay. The umbilical cord usually comes off on its own 3 - 10 days postpartum. The placenta is kept in a little pouch and goes around with the newborn.

It is considered a gentler, non-violent form of birth.

I have found several articles online that claim that,

"Lotus birthed babes appear more calm and healthy than their counterparts whose cords are immediately cut. They receive quite a bit of extra blood, rich in nutrients and oxygen, that boosts their immune system. The placenta helps their liver by filtering toxins from the baby's blood as long as the pumping continues. Their navals heal faster, and they can have their first bath sooner. The experience is gentler on the child and very special for all involved."

Lotus Birth, aka Umbilical Nonseverance, is generally practiced only at home or birth center births. This seems pretty clear, I'd say, since hospital attendants generally clamp the cord immediately.

Wikipedia has this to say about the historical development of Lotus Birth:

In Tibetan and Zen Buddhism, the term "lotus birth" is used to describe spiritual teachers such as Gautama Buddha and Padmasambhava (Lien-hua Sen), emphasizing their entrance into the world as intact, holy children. References to lotus births are also found in Hinduism, for example in the story of the birth of Vishnu.
Although recently arisen as an alternative birth phenomenon in the West, delayed umbilical severance and umbilical nonseverance have been recorded in a number of cultures including that of the Balinese and of some aboriginal peoples such as the African !Kung.
Early American pioneers, in written diaries and letters, reported practicing nonseverance of the umbilicus as a preventative measure to protect the infant from an open wound infection.

Sarah J Buckley, a popular proponent for Lotus Birth, writes about her experiences with Lotus Birth. She says that Lotus Birth was named in 1974 when

Clair Lotus Day, pregnant and living in California, began to question the routine cutting of the cord. Her searching led her to an obstetrician who was sympathetic to her wishes and her son Trimurti was born in hospital and taken home with his cord uncut. Lotus birth was named by, and seeded through, Clair to Jeannine Parvati Baker in the US and Shivam Rachana in Australia, who have both been strong advocates for this gentle practice.

The practice then gained notoriety in the yoga community when Jeannine Parvati Baker wrote a book called Prenatal Yoga and Natural Childbirth. She saw it as the practical application of the yogic value of ahimsa.


Lotus Birth has also been observed in non-humans.

Primatologist Jane Goodall, who was the first person to conduct any long-term studies of chimpanzees in the wild, reported that they did not chew or cut their offspring’s cords, instead leaving the umbilicus intact. Because humans share 99% genetic material with chimpanzees, some lotus birth practitioners refer to chimpanzee practice as a natural practice for humans as well. (Since many cases of chimpanzee cord separation have also been documented, further studies are required.)

 

photo: http://naturalpregnancy.wordpress.com/

Formula Supplementation in the Hospital

Today I am re-posting a breastfeeding vs. supplementation story written in an excellent post by Public Health Doula about her first week doing night-time Lactation Consultant work in a hospital. She calls it Why Do Babies Get Supplemented in the Hospital? and it is a great story about what a huge difference breastfeeding support can make and discusses the harm to a woman of even one formula supplementation. Enjoy!

My big victory was helping keep a hypoglycemic baby from being unnecessarily supplemented. The cut-off for hypoglycemia in the newborns here is 45. The nurse caught me in the nursery and said she had tested twice, baby was just below the cut-off and heading in the "wrong direction". To the nurse, formula seemed like a medical necessity at this point. She asked if maybe I could do it at the breast. When I came into the room, though, mom was crying - she didn't want to supplement. I offered to handle the situation from there and the nurse said that was fine - she left us to it. The mom told me the baby had been hungry and about to feed, right before the nurse had come in and taken him for the blood sugar testing. I said "Well, if he's hungry, he can nurse and if he nurses well, he won't need any formula."

So, we put the baby to breast - and this baby was, indeed, very hungry and nursing fairly well. Still, I was anxious - I did not want to screw this up, I was going to get all the colostrum into that baby that I could. The nurse had brought a couple of dental syringes for the formula. I took one and popped the stopper out, and asked mom if we could hand express into it from the other side and supplement the baby with expressed colostrum. Mom said OK very readily and wow, she had plenty! I was boggled to think this baby could have ended up with formula with so much colostrum available. The mom's sister was spending the night to help her out and happily assisted with hand expression (with mom's agreement, of course) - it was so nice to see such good family support! Who says other family members can't participate in breastfeeding?

Between nursing and supplementing, by the end of the nursing session I was having to take him off and wake him up repeatedly, and he would fall asleep as soon as he got back to the breast. This kid was full. (But I was not going to let him go to sleep without getting every last drop he could!) Finally, I put him skin-to-skin with mom (also good for blood sugar!) and called the nurse to tell her "went great, no formula needed!" And you know what? The nurse was totally fine with that. She gave the baby a full hour before rechecking his sugars and - yay! - baby was back above the cut-off - "heading in the right direction". The nurse was actually very gracious and helpful about all of this, and I realized after talking with one of the other LCs that it's not a "breastfeeding is bad" mentality at all on the nurses' part - this nurse just wanted to fix the blood sugar, and the formula could be the fix, or my help with breastfeeding could be the fix. Of course, since I'm not always there, it would be nice if this experience helps her have more confidence in the future with putting baby to breast as the first line of treatment. But one step at a time!

After all this drama about avoiding what probably would have been just several milliliters of formula, you may be wondering, what's wrong with just a little supplementation? Just to get the baby's blood sugar up - then they could go on breastfeeding, no problem. And I think it's a fair question. It doesn't seem like a single bottle would do that much harm. And yet we know that babies who are supplemented - even a single bottle - in the early days tend to have shorter durations of both exclusive and any breastfeeding. And is that so surprising? After all, we say to mom "You need to supplement with formula because your baby's blood sugar is low", what is the message we are sending? "Your milk has not been feeding your baby adequately, and it will not feed your baby adequately; we cannot trust that it is there in sufficient amounts and/or that your baby can get enough of it." Any wonder that these moms go on to mistrust their ability to nurse their babies? Additionally, even just a little formula affects baby's gut flora for weeks, changing the balance of beneficial flora that exclusive breastfeeding establishes (for more information on all of this, see this article by Marsha Walker, particularly the section "Some Cautionary Words About Supplementing with Formula").

Does all this mean we should not give formula when medically necessary? Of course not! But as you can see, medical necessity in this situation was somewhat blurry. With no breastfeeding support, it's possible that this baby would have needed to be supplemented with formula. But in the end, it turned out not to be necessary at all. Babies get those bottles of formula not necessarily through malice, but because of staffing issues, longstanding habit, and lack of education and lack of trust in breastfeeding. They get formula without the understanding of the risks of "just a little bit".

What can you do to avoid unnecessary supplementation in the hospital? A few things:

1) Prepare yourself for breastfeeding - read, take a class, attend La Leche League meetings - boost both your knowledge and your confidence.

2) Choose a certified baby-friendly birthplace - this won't eliminate the possibility of unnecessary supplements, but it will greatly decrease them!

3) Make sure breastfeeding is going well - let the staff know you are committed to breastfeeding, ask for a lactation consult, and solicit outside help from La Leche League or a lactation professional if you need to. Yes, those people can come visit you in the hospital!

4) Surround yourself with family and friend support. Maybe the sister-in-law who keeps asking whether the baby is "too hungry" is not the person to spend the night with you!

5) Be ready to advocate for yourself if needed, and have all that knowledge, preparation, and support ready. I saw another mom a few months ago who confronted the same night-time pressure to supplement for hypoglycemia. She insisted that she get a chance to breastfeed first and, lo and behold, that baby's sugar came up too. Self-advocacy is not always easy (and unfortunately not always successful), but it is very important!

Doulas are for Women Who...

Lately I've been doing a lot of posts that are just re-blogs of excellent articles or blog posts by others. I haven't had much time to sit down and blog something new on my own lately, but I'm still keeping up with the birth world. I hope that you all enjoy all the information I'm sharing, even though its not my original writing!

Kristen at Birthing Beautiful Ideas ran an International Doula Month giveaway contest where she asked doulas and lovers of doulas to enter by finishing the sentence "Doulas are for Women Who..." The responses she got were so fabulous they beg to be re-blogged (below). View her original post here.



Doulas are for women who want to have an empowering childbirth experience!
Whether through information, support, encouragement, processing, and so forth, a doula helps a woman realize that she has more strength than she ever knew!
*
Doulas are for women who miss their mothers.
*
Doulas are for women who give birth. Period.
Yes, there are some women who might find them to be “too much” and who do better on their own (maybe even birthing unassisted), but aside from this category, every birthing women should have this kind of support available to her if she wants it.
*
Doulas are for women who have birth partners.
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Doulas are for women who want to be supported and cheered as they bring their babies into the world.
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Doulas are for women who have no choice but to deliver in the hospital because there are no midwives or birth centers within a hundred miles or more. They should have the opportunity to have an empowering and positive birth experience.
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Doulas are for women who want a better birthing experience!
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Doulas are for women who want continuous support in their labor and birth. Nurse shift changes can change the dynamic of a room and affect the progress of labor and birth. Having a person constant that the mom and dad can look to for comfort knowing all is well is important.
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Doulas are for women all over the world from different cultures, homes, families, cities, for those women who dream that someone somewhere will listen to their fears, questions, wonders, stories, love, passion for the birth they want…..and for those who never want to birth on their own.
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Doulas are for women who want epidurals.
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Coulas are for women who want to ‘play it by ear’ rather than plan their way of birthing… Doulas are like instant access to so much information and tips/tricks. Have a question? Need a compass on your journey?  Thinking of a pitstop or a detour? A doula is right for you!

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Doulas are for birth partners (in my case husband) who wants to be supportive but doesn’t always know what to do!
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Doulas are for women whose friends are far away!
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Doulas are for women who are having cesareans. Doulas can help make a necessary cesarean a positive birthing experience. Doulas are for women who are having multiples. My doula stayed at my side while my husband accompanied our twins.
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Doulas are for women who have never done this before.
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Doulas are for women who want a drug-free birth. Or not.
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Doulas are for women who… Are strong enough and capable enough to give birth – but know they can use all the support they can get from anyone who likes healthy, happy, babies and mamas.
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Doulas are for women who are trained in the medical field, especially those that provide care for others during the time surrounding pregnancy and infancy. I am a newly certified CNM and although, and perhaps more so because, I consider myself very educated when it comes to pregnancy, labor, and birth, I really needed my doula at my own.
Knowing too much can be a detriment during labor. Sure, I’d seen many beautiful, normal births, but I’ve also seen ones that didn’t progress no matter what was tried, and devastating complications come out of nowhere in seemingly healthy moms/babies. I’ve seen the ugly side of hospital politics. I’ve seen birth plans and informed consent go out the window by rushed, overworked, pressured, or insensitive staff. I needed my doula there to help me turn off the mental noise of all of this knowledge. She was there to remind me of how well I well I was doing and of how strong my baby and body were. This allowed me to keep my anxiety at bay and to let my body overcome my mind the way it was designed to do. She was there to help advocate for my wishes, so I didn’t have to expend mental energy doing so, and to remind me of what I’d told her was important when I was too exhausted or distracted by contractions to do so. She gave me and my partner a safe and spiritual environment in which to bring our son into the world.
Also, my partner wasn’t really interested in learning about labor, because his view was that I already knew what to expect and what I wanted, so why did he need to. My doula helped him to help give me exactly what I needed from him during our birth. It was magical.
I could go on and on…
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Doulas are for women who have home births.
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Doulas are for women who birth babies. I believe that all women (and their partners!) can benefit from a doula. A doula is cheaper than an epidural and has no negative side effects!

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Doulas are for women who only feel uninhibited in the presence of strangers.
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Doulas are for women who need an advocate at their side, a voice when they cannot speak and a knowledgeable guide down an unfamiliar but beautiful path.
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Doulas are for women who need to be reminded of their own inner strength. This strength is natural. It is psychological. It is innate. It is the power of our Creator that flows through us. Sometimes we just need to be reminded and encouraged!
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Doulas are for women who have planned cesareans.
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Doulas are for women who have midwives…I am a midwife and love working with doulas! Often we are too caught up in charting, or managing the birth in our heads, to do a great job of hands on. Doulas are a great constant for the laboring mama.
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Doulas are for women who are trained in the medical field, especially those that provide care for others during the time surrounding pregnancy and infancy.  Sometimes knowing too much, especially about potential complications, can lead to a lot of anxiety.  A doula encourages the quieting of the mental noise through reassurance and empowerment, so relaxation and trusting in instinctual body urges can take over.

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Doulas are for women and their entire family!
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Doulas are for women who want continuous support during labor and birth.  Nurses shift changes can change the dynamic of a room so having a constant presence of a doula can bring comfort to mom and dad.
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Doulas are for women who know they can find the way, but who feel better knowing an experienced friend is at their side.
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Doulas are for women who don’t think they can afford one.
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Doulas are for women who don’t like to be touched.
Doulas have a great bunch of resources, tips, tricks, and tools to help get you through labor…touch/massage is only one of them!
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Doulas are for women who… want 100% unconditional love and support throughout their birth experience.

The Status of NYC Midwives

This summer I am living in NYC before I begin graduate school in the fall. I have been keeping an eye open to see if any area doulas with clients in July need back up, or any women with July EDDs want cheap doulas, but I haven't gotten a lot of feedback. So I may be on a summer hiatus from doula-ing :( 

Being in New York does make me even more intrigued by all the news that has been going on with the Midwives vs. Obstetricians battle. I was going to post an article or write up a synopsis, but then I found that Stand and Deliver had already done so! And so I am simply going to refer you to hers:

 

A few days ago, The New York Times published this article about the current status of NY midwives: Doctors’ Group Fights a Bill That Would Ease Restrictions on Midwives. Since the closure of St. Vincent's, half of NYC's home birth midwives have been unable to obtain practice agreements. All midwives, hospital or home-based, currently need a signed practice agreement with either a hospital or physician. So New York state's midwives sought a legal solution to this impasse. Here's what happened:

A week ago, a bill that would repeal that requirement breezed through Assembly and Senate committees, and its champions expected it to pass the full Legislature within days. Then it hit heavy opposition from the American Congress of Obstetricians and Gynecologists.

In a memorandum, backed by a press conference in Albany on Thursday, the congress challenged the safety of midwife-attended births and suggested that the bill was a ploy to allow midwives to expand their turf and directly compete with doctors. “While this legislation does not intend to extend a midwife’s scope of practice, it has the ability to pave the way for midwives to open their own independent birthing centers,” it said.

Heaven forbid that midwives compete directly with physicians.

But wait--it gets even better. ACOG's reason for requiring written practice agreements is that without a practice agreement, giving birth with a midwife, including hospital-based midwives, will become terribly unsafe. The only thing standing between the laboring woman and disaster is this piece of paper. Here's how:

The obstetricians’ group has argued that written agreements are needed to keep women safe. Suppose a woman is giving birth in a hospital, attended by a midwife without a practice agreement, and the woman starts to hemorrhage, Donna Montalto, executive director of the New York division of the congress of obstetricians, said Thursday.

“What obstetrician who has never seen the patient, doesn’t know the midwife, and happens to be at home at their son’s baseball game is going to say, ‘Sure, I’ll come in and take care of your patient,’ ” Ms. Montalto said.

Yes, in the absence of a signed agreement, physicians will be asked to come in from their children's sport games and attend to an unknown woman. Gasp. As if unknown women never go into labor when a physician is on call. As if attending physicians know all of the women they deliver personally--except for those pesky midwife patients.

Emergency Unassisted Labor and Delivery Guide

A great deal of women give birth unassisted by a trained healthcare provider. This includes women in developing countries who give birth on the side of the field and then go right back to plowing, women in developing countries who don't have money or access to a care provider or health facility, women all over the world who plan to birth unassisted at home, and women who find themselves having an unplanned unassisted birth before their care provider can be with them.

This post is about the last group of women: the women who hadn't planned on birthing without help, at home or in the car or wherever, but hopefully have access to emergency supplies. Its also a great crash-course for the women, or dad/partner, about the basics of labor and delivery, and mom and baby postpartum.


Amy Romano on Science and Sensibility wrote a great post on Birth during Times of Disaster: Keeping Women and Babies Safe

In it she included a link to an emergency childbirth guide from the American College of Nurse-Midwives that includes a lot of really great information for women and partners who must deal with an emergency birth in a location where there are no skilled birth attendants present. I include some bits of the text below:


FROM THE AMERICAN COLLEGE OF NURSE-MIDWIVES
Giving Birth “In Place”: A Guide to Emergency Preparedness for Childbirth
Deanne Williams, CNM, MSN

This is not a “do-it-yourself”guide for a planned home birth, nor is it all the information you need for every emergency. It is not meant to replace the knowledge and skills of a doctor or midwife. The information is a basic guide for parents-to-be who want to be ready in case they have to give birth before they can get to a hospital or birth center.

CALL FOR HELP
If you think you are in labor, try to get to a hospital, birth
center, or clinic. If you are alone or travel seems unwise,
call the emergency number in your community and ask for
help. After you have called for help, keep your front door
unlocked so that rescue workers can get in if you are unable
to come to the door. Call a neighbor to come and help the
family. If the phones are working, keep talking to emergency
services or your health care provider who can “talk
you through” a labor and birth.
If your labor is going fast and birth seems near, stay at
home and have your baby in a safe place rather than in the
back seat of the car. Fast labors are usually very normal,
and the mothers and babies can both do well. Slow labors
will give you time to get to a hospital or birth center, or for
a health care provider to get to you. Get out your supply kit
and put the supplies where you can easily reach them.
As the helper, your job is to
Keep mom comfortable. It is good for her to walk, take a
shower, get a massage, and move even if she is in bed.
Be sure she drinks lots of fluids. Water, tea, and juice are
the best.
Be sure she goes to the bathroom every hour.
Say and do things that create a calm feeling, even if you
are very nervous.
Wear gloves if you are going to be touching blood.
Wash your hands or gloves often.
Do not let pets into the labor and birth room.
Talk to mom about the sounds of childbirth. Making
groaning or crying noise during labor is ok and can help
the mom-to-be. It can scare the helpers. So mom has to
try to not scream and lose control, and the helpers have
to let mom make the noise that helps her cope.
Decide how to help other members of the family. Will
they be present for the birth? What do they need to
feel safe?


PREPARE THE BED
To keep the mattress from getting wet, cover it and the
sheets with a shower curtain and then cover the shower
curtain with another clean sheet, plastic-backed under pads
and lots of pillows for comfort. The mother may want to
spend a lot of time in bed, or she may prefer to be on her
feet or in a chair. Whatever feels best is okay.

WHEN THE BABY’S HEAD IS COMING FIRST
If you know your baby has been head down during the last
weeks of pregnancy, chances are good that the baby will be
head first at birth. This is the most common position for a
baby. First labors can last for 12 hours or more, whereas the
next babies can come much faster.

The Urge to Push
The longest part of labor is the time it takes for the cervix
to open wide enough for the baby to pass into the birth
canal or vagina (first stage). You can tell the cervix has
feel with your fingers to find out if the cord is around the
baby’s neck. If you find a cord around the neck, this is not
an emergency! Gently lift the cord over the baby’s head, or
loosen it so there is room for the body to slip through the
loop of cord.
The baby’s head will turn to one side and with the next
contraction the mother should push to deliver the body. If
the body does not come out, push on the side of the baby’s
head to move the head toward the mother’s back. The
shoulder will be born. The rest of the body slips out easily
followed by a lot of blood-colored water.

If the Head Is Born but the Body Does Not Come Out After
Three Pushes
The mom must lie down on her back, put two pillows under
her bottom, bring her knees up to her chest, grab her knees,
and push hard with each contraction. After the baby is born,
place her or him on the mother’s chest and tummy, skin to
skin, and cover both with towels. If the baby is not crying,
rub her back firmly. If she still does not cry, lay her down
so that she is looking up at the ceiling, tilt her head back to
straighten her airway, and keep rubbing. Not every baby
has to cry, but this is the best way to be sure the baby is
getting the air she needs.

If the Baby Is Gagging on Fluids in Her Mouth and Turning
Blue
Use the baby blanket to wipe the fluids out of her mouth
and nose. If this does not help, use the bulb syringe to help
clear things out. Just squeeze the bulb, place the tip in the
nose or mouth, and release the squeeze. This will suck fluid
into the bulb. Move the bulb away from the baby and
squeeze again to empty the bulb. Repeat until the fluid is
removed.
If the baby is still not breathing, follow the CPR
directions.

THE UMBILICAL CORD
There is no rush to cut the cord. All you have to do is keep
the baby close to the mom so the cord is not pulled tight. If
you pick the cord up between your fingers, you can feel the
baby’s pulse. Within about 10 minutes the pulse will stop.
At that time you can tie and cut the cord. Remember the
cord is connected to the placenta (afterbirth) which is still
inside the mother.

THE BABY
At the time of birth, most babies are blue or dusky. Some
cry right away and others do not. Do not spank the baby,
but rub up and down her back until you know she is taking
deep breaths. Once the baby starts to cry, her color will be
more like her mom, but her hands and feet will still be blue.
Now is the time to keep the baby warm. Remove the wet
towel that is over the baby and put another dry towel and
blanket over the mother and baby. Put a hat on the baby.
The mother can help keep the baby warm with her body
heat.
Put the baby to breast. Even if you did not plan to
breastfeed, one of the safest things you can do for mom and
baby is put the baby to breast. A breastfeeding baby helps
keep the mother from bleeding too much and gets the food
it needs right away. If the cord is too short to allow the baby
to reach the breast, it is ok to wait until you cut the cord.

CUTTING THE CORD
There are no nerve endings in the cord so it does not hurt
either the baby or the mother when it is cut. It is very
slippery so take your time because there is no rush. Wash
your hands, put on gloves and then get the container with
the scissors and shoelace. Tie one of the laces around the
cord very tightly with a double knot about 3 inches from the
baby’s tummy. The baby will cry when she is uncovered
because she is cold, not because it hurts. Tie the other
shoelace around the cord about 2 inches from the first knot.
Pick up the scissors by the handle without touching the
blades. Cut between the knots you have tied. It is rubbery
and tough to cut especially if you have dull scissors. After
it is cut, place the end of the cord that is still connected to
the mother’s placenta into the mixing bowl. Cover the baby
again to keep her warm.

THE PLACENTA OR AFTERBIRTH (THIRD STAGE)
The placenta looks like a big piece of raw meat with a shiny
film on one side. On the other side it has membranes that
are attached to the placenta (the membranes look like skin
that has been peeled off). When the placenta is ready to
come, you will see a gush of blood from the vagina and the
cord will get a little longer. Put the bowl close to the
mother’s vagina and put more waterproof pads under her
bottom. Ask the mother to sit up and push out the placenta
into the bowl.
There will be a lot of blood and water coming after the
placenta. Firmly rub the mother’s stomach below her belly
button until most of the bleeding stops. This will hurt but
needs to be done. The heaviest bleeding should stop in a
minute and then the bleeding will be more like a heavy
period. If the bleeding increases again, very firmly rub the
mother’s lower belly until the bleeding slows. When it is
firm, you will be able to feel the uterus (womb), which is
the size of a large grapefruit, in the lower belly. A firm
uterus is a good thing because it will stop the mom from
bleeding too much.
Mom’s bottom and her uterus may be sore. You may see
places where the mother’s skin has torn around her vagina.
Most of these tears will heal without any problems. Mom
will feel better when you put an ice pack on her bottom
where the baby came out and then put the sanitary pad on
top of the ice pack. She may want to take a couple of pain
pills at this time.

Put the placenta in a medium-sized trash bag and wipe
off any blood on the outside of the bag. Put this bag into a
second trash bag. Take the placenta with you to the hospital
or birth center. If you cannot leave the house for more than
4 hours, put the bagged placenta in a container with a lid
and put it in the freezer.

CLEAN UP
After the mother has delivered the placenta and the bleeding
has slowed down, give her a drink of juice, soup, or
milk and something to eat like crackers and cheese or a
peanut butter and jelly sandwich. Put on gloves to clean up
the bed. Roll up the sheet and pads inside the shower
curtain and put in a large plastic bag. Have clean under pads
ready to cover the sheets and a sanitary pad for the mother.
The dirty sheets and towels can be washed in cold water
with bleach or ammonia added. Wear gloves when touching
items that are bloody. Put a diaper on the baby or you will
be sorry!

BREASTFEEDING
It is important for the mother to breastfeed the baby in the
first hour after birth and at least every 2 hours until her milk
comes in.
● Breastfeeding will keep the uterus firm and decrease
bleeding.
● Colostrum, the liquid that is in the breasts right after birth
until the milk comes in, will give the baby all of the food
she needs and it will help prevent infection.
● Even if the emergency situation continues for days,
weeks, or months, there will always be a ready supply of
safe and perfect food for the baby.

Getting Started With Breastfeeding
A newborn will nurse best in the first hour after birth when
she is awake and alert. The mother may be more comfortable
if she lies on her side with pillows under her head. The
mother and baby should be face-to-face and belly-to-belly.

The baby will also nurse better if they are skin-to-skin (see
Figure 2).
The mother should place her nipple and breast against the
baby’s lips. The baby will lick and try to nurse. The mother
needs to help out by placing her nipple into the baby’s open
mouth. It may take a few tries before the baby can start
sucking. If the baby is sleepy, rub her belly and back firmly
to wake her up. If the baby is too sleepy, try uncovering her
for a short time and rubbing the mother’s nipple against the
baby’s lips. If the mother gets tired, take short breaks and
start again. Once the baby nurses for the first time it gets
easier.
If the baby sucks a few times and then lets go and the
mom has large breasts, mom may need to help the baby
breathe by using her finger to hold some breast tissue away
from the baby’s nose.

What to Avoid
● Don’t use a pacifier or a bottle to start the baby sucking.
It confuses some babies because they do not suck the
same on the mother’s breast and a bottle or pacifier.
● Do not separate the mother and baby for very long. The
more they stay together, including when they sleep, the
sooner breastfeeding will be well established.

CARE OF THE MOTHER
If you still cannot get to the hospital or birth center to be
checked, the mother should go to the bathroom within
an hour after the baby is born.
If the room is cold, you can use the hot water bottle to
help keep the baby warm. Just wrap the warm bottle
in a blanket and place it next to the baby’s back.

After birth in a hospital, women are usually offered
Tylenol or Advil for pain every 3 to 4 hours as
needed. This would be a good choice at home if the
mother does not have an allergy to this medication.
When a new mother gets out of bed for the first time, she
may feel dizzy. It is important to have her leave the
baby on the center of the bed and get up slowly:
● Sit up on the side of the bed to see how she feels.
● Have an adult take her to the bathroom and wait to be
sure that she is not feeling faint.
● If she says she is going to faint, believe her and have her
lie down on the floor. Do not attempt to walk her back to
bed. You have about 10 seconds to get her down on the
floor before she passes out and bangs her head on the way
down! Once she is down flat, she will wake up and feel
better. Just wait a few minutes and then carefully help her
back to bed.
In a couple of hours the mom may want to take a shower.
Be sure she has had something to eat and is not dizzy when
she gets up. It is good to have someone close by because
dizziness can return quickly.


To read more of this guide, including a list of emergency supplies to keep on hand, what to do if baby comes bottom first, and baby care in the first couple days, click here.

Sterile Water Injections

What are Sterile Water Infections?

Injections of sterile water in the lower back, used to decrease back pain in labor.

Sterile water injections (SWI) are an effective method for the relief of back pain in labour. The procedure involves a small amount of sterile water (0.1 ml to 0.2 ml) injected under the skin at four locations on the lower back (sacrum).

The injections cause a brief but intense stinging sensation, like a wasp sting, that lasts for about 30 seconds and then wears off completely. As the stinging sensation eases, relief from the back pain is felt. To distract from the stinging sensation the injections are done during a contraction by two midwives. Women benefit from support and encouragement as the injections are being given.

SWI provides effective pain relief for up to 85 percent of women with back pain in labor and can last for up to two hours.

What are the benefits of SWI?

• often immediate effect
• no effect on mother’s state of consciousness
• no effect on baby
• does not limit mobility
• does not adversely affect labor progress
• is a simple procedure that can administered by your midwife
• can be repeated as needed.

SWI are an excellent alternative for relief of back pain in labour. Though SWI will not provide pain relief from contraction pain, once the back pain is alleviated, you may cope better with labor pain. As the back and pelvic muscles relax following the relief of pain, this may assist with the progress of your labor.

Sterile water injected lateral to the lumbosacral spine in women with severe low back pain during labor substantially reduces pain and decreases the rate of Cesarean deliveries, according to a meta-analysis published in the August issue of BJOG: An International Journal of Obstetrics and Gynaecology.

To investigate the therapeutic effect of the injections, the research team conducted a literature search that turned up 8 randomized, controlled trials (n = 828) comparing outcomes associated with sterile water injections with placebo (injection of isotonic saline), acupuncture, or transcutaneous electric nerve stimulation.

In all eight studies combined, sterile water cut the Cesarean section rate by half: 4.6% in the sterile water group and 9.9% in the comparison group (relative risk = 0.51).

The reports documented significant reductions in visual analog pain “TAJE scores of sterile water compared with all other interventions. The weighted mean differences were -26 at 10-30 minutes, -36 at 45-60 minutes, and -28 at 90-120 minutes.

Dr. Hutton’s team theorizes that the pain reduction from water injections may increase parasympathetic tone; enhance relaxation, which promotes fetal rotation to a more favorable position for vaginal delivery, and “decreases the urgency for a cesarean section and allowed for a long enough time for labor to progress normally.”  

Sterile-water injection causes a burning sensation that is much more painful than saline injection and is thought to relieve labor pain by counterirritation. Four RCTs included in one review found a significant reduction in back pain for 45 to 90 minutes based on a visual analog scale. Three of the trials found that women who received injections of sterile water were more interested in receiving the injections in a subsequent labor than women who received saline injections. None of the trials showed a decrease in requests for pain medicines, perhaps because of the limited time of effectiveness or a lack of effectiveness for abdominal labor pain.


Read More on Sterile Water Injections at Science Based Medicine

MDG #5: Improve Maternal Health

United Nations Millennium Development Goal #5: Improve Maternal Health by 2015

Target 1:
Reduce by three quarters the maternal mortality ratio

Target 2:
Achieve universal access to reproductive health

QUICK FACTS

• Estimates for 2005 show that, every minute, a woman dies of complications related to pregnancy and childbirth. This adds up to more than 500,000 women annually and 10 million over a generation. Almost all of these women – 99 per cent – live and die in developing countries.

• Maternal mortality shows the greatest disparity among countries: in sub-Saharan Africa, a woman’s risk of dying from treatable or preventable complications of pregnancy and childbirth over the course of her lifetime is 1 in 22, compared to 1 in 7,300 in developed regions. The risk of a woman dying from pregnancy-related causes during her lifetime is about 1 in 7 in Niger compared to 1 in 17,400 in Sweden.

• Every year, more than 1 million children are left motherless and vulnerable because of maternal death. Children who have lost their mothers are up to 10 times more likely to die prematurely than those who have not.

WHAT HAS WORKED

1. In countries such as Jamaica, Malaysia, Sri Lanka, Thailand and Tunisia, significant declines in maternal mortality have occurred as more women have gained access to family planning and skilled birth attendance with backup emergency obstetric care. Many of these countries have halved their maternal deaths in the space of a decade. Severe shortages of trained health personnel and lack of access to reproductive health are holding back progress in many countries.

2. Finding trained health workers to deliver emergency obstetric care is often a challenge in the developing world’s rural areas. UNFPA, in partnership with the Tigray regional health bureau (Ethiopia) and Médecins du Monde, an international NGO, has piloted an innovative project to train mid-level health officers so that they can provide life-saving emergency surgery at rural hospitals, where doctors are scarce. A positive evaluation of the project has opened the way for national scale-up to train health officers in integrated obstetric and emergency surgery. By doing so, access to critical life-saving obstetric services will be substantially improved to rural women.

3. In response to the 2005 Pakistan earthquake, UNFPA-supported mobile service units came to the rescue, and women received more comprehensive care than before the emergency. Health workers in these mobile clinics had seen 843,467 patients as of March 2008 for antenatal care consultations, deliveries, post-miscarriage complications and referrals for Caesarean section. Results show that 43 per cent of pregnant women in the affected area benefited from skilled birth attendance during the post-earthquake period as compared to the 31 per cent national average in Pakistan.

4. Galvanizing support for maternal health is the goal of the UNFPA-led Campaign to End Fistula, which in 2006 worked in 40 countries in sub-Saharan Africa, South Asia and the Arab States. The aim is to prevent and treat a terrible childbirth injury called fistula – a rupture in the birth canal that occurs during prolonged, obstructed labour and leaves women incontinent, isolated and ashamed. Nine out of 10 fistulas can be successfully repaired. More than 25 countries have moved from assessment and planning to implementation. Eleven governments, as well as private-sector supporters such as Johnson & Johnson and Virgin Unite, have donated to the campaign.



WHAT NEEDS TO BE DONE?

• Provide sufficient financing to strengthen health systems, particularly for maternal, childcare and other reproductive health services, and ensure that procurement and distribution of contraception, drugs and equipment are functioning.

• Establish dedicated national programmes to reduce maternal mortality and ensure universal access to reproductive health care, including family planning services.

• Provide trained health workers during and after pregnancy and childbirth for delivery of quality antenatal care, timely emergency obstetric services and contraception.

• Ensure access to timely emergency obstetric services and provide adequate communication, skilled personnel, facilities and transportation systems, especially in areas where poverty, conflict, great distances and overloaded health systems obstruct such efforts.

• Adopt and implement policies that protect poor families from the catastrophic consequences of unaffordable maternity care, including through access to health insurance or free services.

• Protect pregnant women from domestic violence; and involve men in maternal health and wider reproductive health.

• Increase access to contraception and sexual and reproductive health counseling for both men, women and adolescents.

• Increase efforts to prevent child marriage and ensure that young women postpone their first pregnancy.

Source: Committing to action: Achieving the MDGs, Background note by the Secretary-General for the High-level Event on the Millennium Development Goals, United Nations, New York, 25 September 2008; The Millennium Development Goals Report 2008, United Nations; UNFPA Webpage No Woman Should Die Giving Life: Facts and Figures, http://www.unfpa.org/safemotherhood 

A Woman C-sections Herself and Survives

Inés Ramírez Pérez (born 1960) is a Mexican woman from the state of Oaxaca who gained media attention after performing a successful Cesarean section on herself. Both she and her baby survived!

Ramírez was alone in her cabin in Rio Talea, Southern Mexico when her labor started. The nearest midwife was more than 50 miles away over rough terrain and rough roads. Her husband, who had assisted her through her previous labors, was drinking at a cantina. Rio Talea has 500 people and only one phone, but it was not nearby. Ramírez had given birth to eight children, seven living, at the time of the pregnancy in question. The last pregnancy, three years prior, had ended in fetal death during labor. Rather than experience the loss of another child in the same way, Ramírez decided to operate on herself.

At midnight, on 5 March 2000 — after 12 hours of continual pain and little advancement in labor, Ramírez sat down on a bench, drank from either a bottle of rubbing alcohol or "3 small glasses of hard liquor" (accounts vary), and assumed the traditional Zapotec birthing position, sitting up and leaning forward. She then used a large kitchen knife to cut open her abdomen in a total of three attempts. Ramírez cut through her skin in a 17 cm vertical line several centimeters to the right of her navel, starting near the bottom of the ribs and ending near the pubic area. (For comparison: a typical C-section incision is 10 cm long, horizontal and well below the navel, the so-called "bikini-line incision".) After operating on herself for an hour, she reached inside her uterus and pulled out her baby boy, who breathed and cried immediately. She then severed the umbilical cord with a pair of scissors and became unconscious. When she regained consciousness, she wrapped clothes around her bleeding abdomen and asked her 6-year-old son, Benito, to run for help.

Several hours later, the village health assistant found Ramírez alert and lying beside her live baby. He sewed her incision with an available needle and thread.

Ramírez was eventually taken to the local clinic, two and a half miles away, and then to the nearest hospital, eight hours away by car. Sixteen hours thereafter she underwent surgical repair of the incision site. On the seventh post-operative day, she underwent a second surgery to repair complications resulting from damage to her intestines incurred during her C-section. She was released from the hospital on the tenth day post-surgery, and went on to make a complete recovery.

Describing her experience, Ramírez said, “I couldn’t stand the pain anymore. If my baby was going to die, then I decided I would have to die, too. But if he was going to grow up, I was going to see him grow up, and I was going to be with my child. I thought that God would save both our lives.”

Ramírez is believed to be the only person known to have performed a successful Cesarean section on herself. Her case was written up in the March 2004 issue of the International Journal of Gynecology & Obstetrics.

She is also believed to have been profoundly lucky in several ways: to have put herself in the position she chose, which put her uterus — rather than her intestines — against the abdominal wall under the incision site; to have not succumbed to infection from the large open wound in a non-sterile environment; to have not passed out from the pain part-way through, or died from shock; and, if her drink of choice was indeed isopropyl alcohol to have drunk a sub-lethal amount of it. She did say, afterward, that she didn't advise other women to follow her example.

Parental Leave and Swedish Culture

In Sweden, the Men Can Have It All

By KATRIN BENNHOLD, New York Times

SPOLAND, SWEDEN — Mikael Karlsson owns a snowmobile, two hunting dogs and five guns. In his spare time, this soldier-turned-game warden shoots moose and trades potty-training tips with other fathers. Cradling 2-month-old Siri in his arms, he can’t imagine not taking baby leave. “Everyone does.”  

From trendy central Stockholm to this village in the rugged forest south of the Arctic Circle, 85 percent of Swedish fathers take parental leave. Those who don’t face questions from family, friends and colleagues. As other countries still tinker with maternity leave and women’s rights, Sweden may be a glimpse of the future. 

In this land of Viking lore, men are at the heart of the gender-equality debate. The ponytailed center-right finance minister calls himself a feminist, ads for cleaning products rarely feature women as homemakers, and preschools vet books for gender stereotypes in animal characters. For nearly four decades, governments of all political hues have legislated to give women equal rights at work — and men equal rights at home.

Swedish mothers still take more time off with children — almost four times as much. And some who thought they wanted their men to help raise baby now find themselves coveting more time at home.
But laws reserving at least two months of the generously paid, 13-month parental leave exclusively for fathers — a quota that could well double after the September election — have set off profound social change.

Companies have come to expect employees to take leave irrespective of gender, and not to penalize fathers at promotion time. Women’s paychecks are benefiting and the shift in fathers’ roles is perceived as playing a part in lower divorce rates and increasing joint custody of children.

In perhaps the most striking example of social engineering, a new definition of masculinity is emerging.

“Many men no longer want to be identified just by their jobs,” said Bengt Westerberg, who long opposed quotas but as deputy prime minister phased in a first month of paternity leave in 1995. “Many women now expect their husbands to take at least some time off with the children.”

Birgitta Ohlsson, European affairs minister, put it this way: “Machos with dinosaur values don’t make the top-10 lists of attractive men in women’s magazines anymore.” Ms. Ohlsson, who has lobbied European Union governments to pay more attention to fathers, is eight months pregnant, and her husband, a law professor, will take the leave when their child is born.

“Now men can have it all — a successful career and being a responsible daddy,” she added. “It’s a new kind of manly. It’s more wholesome.”

Back in Spoland, Sofia Karlsson, a police officer and the wife of Mikael Karlsson, said she found her husband most attractive “when he is in the forest with his rifle over his shoulder and the baby on his back.”

In this new world of the sexes, some women complain that Swedish men are too politically correct even to flirt in a bar. And some men admit to occasional pangs of insecurity. “I know my wife expects me to take parental leave,” said a prominent radio journalist who recently took six months off with his third child and who preferred to remain anonymous. “But if I was on a lonely island with her and Tarzan, I hope she would still pick me.”

In 1974, when Sweden became the first country to replace maternity leave with parental leave, the few men who took it were nicknamed “velvet dads.”

Despite government campaigns — one featuring a champion weightlifter with a baby perched on his bare biceps — the share of fathers on leave was stalled at 6 percent when Mr. Westerberg entered government in 1991.

Sweden had already gone further than many countries have now in relieving working mothers: Children had access to highly subsidized preschools from 12 months and grandparents were offered state-sponsored elderly care. The parent on leave got almost a full salary for a year before returning to a guaranteed job, and both could work six-hour days until children entered school. Female employment rates and birth rates had surged to be among the highest in the developed world.

“I always thought if we made it easier for women to work, families would eventually choose a more equal division of parental leave by themselves,” said Mr. Westerberg, 67. “But I gradually became convinced that there wasn’t all that much choice.”

Sweden, he said, faced a vicious circle. Women continued to take parental leave not just for tradition’s sake but because their pay was often lower, thus perpetuating pay differences. Companies, meanwhile, made clear to men that staying home with baby was not compatible with a career.

“Society is a mirror of the family,” Mr. Westerberg said. “The only way to achieve equality in society is to achieve equality in the home. Getting fathers to share the parental leave is an essential part of that.”

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