Gloria Lemay Responds to ABC Segment on Unassisted Birth

“The baby could be born in a breach [sic] position, or with the umbilical cord
wrapped around its neck. The mother could suffer from significant tearing or
from a maternal hemorrhage and bleed to death in as little as five
minutes.”

Dear Women,

The above quote is by a physician who was interviewed by Good Morning America for a program about Unassisted Birth on Jan 8, 2008.

I think it’s very important to address the statement that a woman can hemorrhage and bleed to death in as little as five minutes. This is a very horrifying comment for a doctor to make and, for anyone who doesn’t really know birth, it could be enough to send them running for the hospital.

First of all, yes, it’s possible to hemorrhage and bleed to death quickly in birth IF YOU HAVE A SURGICAL WOUNDING.  Women die from bleeding in cesareans and with episiotomies. The closest to death that I have ever seen a woman in childbirth was in a hospital birth where the ob/gyn cut an episiotomy, pulled the baby out quickly with forceps and then left the family doctor to repair the poor woman. We were skating in the blood on the floor and desperately trying to get enough I.V. fluids into her to save her life while the family doctor tried to suture the episiotomy wound as fast as he could.  I have never seen anything like that in a home birth setting or a hospital birth that didn’t involve cutting.

Think about it – would any midwife ever go to a homebirth if it was possible for the mother to die from bleeding in five minutes?  I know I wouldn’t go if that could happen. We had a visit here in Vancouver BC from an ob/gyn from Holland back in the 1980’s. Dr. Kloosterman was the head of Dutch maternity services for many years and he was a real friend to homebirth and midwifery. He told us that you have AN HOUR after a natural birth before the woman will be in trouble from bleeding. Does this mean that you wait for an hour to take action with a bleeding woman? No, of course not. If there’s more blood than is normal, you need to call 911 and transport to the hospital within the hour, but you’re not going to have a maternal death before an hour is up. I have had 10 transports for hemorrhage in the many homebirths that I have attended (over 1000). Two women have required transfusions. The other 8 recovered with I. V. fluids, rest and iron supplements. Of course, no one wants to see blood transfusions in this day and age. We also don’t like to see a woman anemic after having a baby because it makes the postpartum time very difficult. The most important action after having a baby is to keep the mother and baby skin to skin continuously for at least the first 4 hours.

What doctors won’t tell you is that the most severe cases of postpartum anemia are in women who have had cesareans. Major abdominal surgery results in anemia. I have a friend who is a pharmacist in a hospital. He spends most of his days trying to figure out individual plans to help cesarean moms get their hemoglobin counts up. He finds these cases of severe anemia in post operative mothers very distressing.

I hope this information is helpful to you.

As far as the other nonsense this person is trying to frighten you with:

1. Significant tearing—if you look with a mirror at your vulva after birth and there seems to be skin that “flaps” away from the rest of the vulva structures, you can always go into the emergency ward and have someone suture the wound. Tears do not bleed like cuts do. This should not dissuade anyone from staying away from the place where the scalpels reside.

2. Breech position—you’ll know if your baby is breech. When the membranes release, you will see black meconium coming out the consistency of toothpaste. With a head first baby, the meconium colours the water green or brown but with a breech, the meconium is being squeezed directly out without mixing with water. The other way that you should suspect a breech presentation is if you have a feeling from about 34 weeks of pregnancy on that you have “a hard ball stuck in your ribs”. Breech presentations are about 3 percent of births.

3. Cord wrapped around the neck—the smart babies put their cords around their necks to keep them out of trouble. If you have a baby with the cord around the neck, it can be unwrapped very easily either during or right after the birth. The most important thing is to keep the cord intact.

Gloria Lemay, Vancouver BC Canada
Advisory Board Member, ICAN
Contributing Ed. Midwifery Today Magazine
Teaching midwifery on the internet at www.consciouswoman.org
Speaking at the Trust Birth Conference, Redondo Beach, CA in March 2008
www.trustbirthconference.com

I have to give a shout out to Bellies and Babies for her most recent post, some of which is excerpted below.  I encourage you to go read the entire post.  My commentary continues below the excerpt. 

16 Recommendations from the World Health Organization

These 16 recommendations are based on the principle that each woman has a fundamental right to receive proper prenatal care: that the woman has a central role in all aspects of this care, including participation in the planning, carrying out and evaluation of the care: and that social, emotional and psychological factors are decisive [emphasis mine] in the understanding and implementation of proper prenatal care.

1. The whole community should be informed about the various procedures in birth care, to enable each woman to choose the type of birth care she prefers.

2. The training of professional midwives or birth attendants should be promoted. Care during normal pregnancy and birth and following birth should be the duty of this profession.

15. Obstetric care services that have critical attitudes towards technology and that have adopted an attitude of respect for the emotional, psychological and social aspects of birth should be identified. Such services should be encouraged and the processes that have led them to their position must be studied so that they can be used as models to foster similar attitudes in other centers and to influence obstetrical views nationwide.

The WHO report, Care in Normal Birth, she draws from is dated 1997.  However, this does not negate the principles outlined in the post.  Perhaps the normal birth advocacy groups should appeal to the WHO to update this report, since some people might be inclined to discredit the information due to the time stamp.  Again, I stand by the information in the report that I have read thus far and that has been collated by Bellies and Babies.  Kudos to you, my friend!

I would like to draw special attention to point 15 regarding critical attitudes within the maternal care system.  I agree that it is imperative to identify care providers in our local communities who are critical of the over-use of technology, medication, and other interventions in normal (natural) birth.  Birth advocates must join with these individuals and work together to decrease the unnecessary complication of normal (natural) birth.  

There is a time to “fight” the system, but there is also a time to “join together”.  It doesn’t matter that I desire to have a homebirth in the future if 9 other women I know still prefer to go to the hospital.  It doesn’t matter that my neighbor might have a baby at the birth center even though I have been “risked” out of that possibility.  We need to work for mutual understanding and respect for all birth options and guide women and their careproviders to make evidence-based, ethical, and empowering decisions.

Cesarean Birth Plan

Scheduled cesarean birth has been one topic that has surfaced in many different ways on the ICAN list.  It is important to acknowledge and support our Sisters who will – for one reason or another – decide to schedule a repeat cesarean, so I decided to dig around on the internet.  I conducted a simple google search [cesarean “birth plan”] and immediately was directed to some interesting resources.

Cesareanbirth.com:

Most expectant mothers assume that having a Caesarean Section means that a birth plan isn´t necessary. However, creating a birth plan can ensure that the mother experiences the birth that she wants! Here are some things to consider for a planned Caesarean birth plan:

Would you like for your partner to cut the cord?

Would you like to have a free hand to touch the baby?

Would you like to watch the birth?

Who do you want present in the OR?

Would you like any sedatives or medications before the operation begins?

Would you prefer an Epidural or a Spinal?

How soon would you want to begin breastfeeding?

Do you want the hospital to bathe your baby immediately or would you rather do it later?

Furthermore, this site suggests that women who plan to schedule a cesarean should meet with the careproviders who will likely be involved – including an anesthesiologist.  I second that recommendation especially if you have strong feelings about how you would be medicated during the surgery.

ICAN White Papers:

The ICAN White Papers are continually being reviewed and revised so that they can present the most accurate and current information.  So know that the content and links are subject to change.  Here’s the link to the Family Centered Cesarean information.

Caesarean.org.uk:

This contains a good list of ideas for having a positive cesarean birth experience.  Included are many things I wouldn’t have otherwise thought of such as “[y]ou can ask for the lights to be dimmed for a couple of minutes at the moment of birth. Babies are born with their eyes open so if the lights are dimmed and there is silence, yours can be the first face that comes into view and yours the first voice your baby hears.”

A blogger’s cesarean birth plan:

You might look at this or other similar blog posts for ideas on how to frame your birth plan.

Other Resources

Updated: 10/23/08

Where to birth

I found this rather simple yet possibly effective intro mainstream news article about birthing “venues” on Cape Atlantic ICAN’s blog.  Check out this site, because Tiffany is posting really great stuff there.  Kudos to Montrose, CO and the care providers there who are doing their part to improve birthing outcomes in their community.  I’d like to discuss a few points made in the article:

*~*~*~

“I think our society, we control so much — we control (birth) too.”

LAY MIDWIFE

“The worst machine in the hospital is the clock,” [Bill] Dwelley [midwife] said, adding that he allows the natural process to continue for as long as needed if everything is moving along healthy.

He said 90 percent of children are born without complications. Of that 10 percent that do have complications, an experienced midwife or doctor can handle 7 percent; 3 percent require surgical care.

But because of increased inductions, which increases the risk of c-sections, surgical intervention is rising. MMH has a 17-percent c-section rate.

“It’s about keeping the right to choose,” Dwelley said. “We are doing it in the spirit of the woman gaining power.”

These are powerful and perceptive statements.  Indeed, a woman who labors in the hospital is put on a clock.  Labor that does not happen according to established norms will be “helped”.  A 17% cesarean rate is really not that bad – perhaps that is a reflection of a fairly healthy birth culture?  It is important to remember that only a small percentage of babies are born with complications, most of which can be resolved with time, confidence, and supportive care.  When these complications cannot be resolved, transfer to a hospital is prudent.

NURSE MIDWIFE

“I love that this is available to us,” Baskfield said. She added that she feels she can choose to have her baby naturally and that she is comforted with the idea that she can take as long as she needs “without feeling like it’s wrong.”

As far as inductions and c-sections, CNM DeEdda McLean said they don’t offer the option unless there is a medical reason.

The nurse-midwife experience is about encouraging empowerment and supporting the road the mother wants to take.

Consider that these births are taking place in the hospital and therefore more succeptible to the medical model of birth.  Keep in mind that CNMs are generally overseen by obstetricians.  This nursing group is managing more than a third of the hospital births in this area, and it is likely that their cesarean rates are lower than that of the obstetricians.  In my case (I must admit my bias), the CNM began suggesting intervention as soon as she arrived at the hospital.  I believed, as did Baskerfield (quoted above), that a CNM would not take me down the road of intervention, and in the heat of the moment we both caved.  In retrospect I am diappointed that her care in labor & delivery didn’t match the excellent care given prenatally.

HOSPITAL

In a larger hospital, there may be a nurse taking care of the mother before, another during and even more attending to the baby. In Montrose, she said, it’s usually one nurse and so a bond can be formed with the family.

But she said patients do choose a hospital and the hospital has rules. This means an IV tube must be set up for emergencies and intervention is possible.

“When they are coming here we have to be ready for a disaster. If they choose a hospital, they choose to have interventions available,” she said.

In a small town, mothers may receive more consistent care.  It is important to find out about the nurses’ schedules and how many would be attending you in labor and recovery.  I had excellent care from my nurses.  I also recommend knowing the hospital protocol ahead of time.  You can refuse things such as automatic IV, heplock, or continuous fetal monitoring.  Yes, you can refuse it.  Those are interventions that are unnecessary if you are a low-risk patient.  “If they choose a hospital, they choose to have interventions available.”  Keep that in mind – if the interventions are available to you they are also available to your staff.

Physician Jacqueline Garrard said the birthing world is “pretty liberal,” allowing mothers to choose when and how they want to deliver.

Liberal is not how I describe the birthing world.  Childbirth is still largely governed by men who treat the female body like personal property.  Besides, not all mothers are “allowed” to choose how they deliver.  Ask any number of women who are denied VBACs in this country every year.  We have a long way to go before someone like me will call the birthing world “liberal”. 

sometimes doctors ARE idiots

You find something new on the internet every day, if you want.  I was browsing my google alerts and came across this sadly funny satire called “Why Doctors are Idiots” by natural health author, Mike Adams.

His “expose” of sorts on medical disasters in the 2000s includes:

Too posh to push? Don’t worry, your obstetrician will schedule a C-section childbirth appointment and deliver the baby on YOUR schedule instead of Mother Nature’s. It’s more convenient for him, too, because then he can still make his golf game. Don’t worry about the baby: There’s no benefit to vaginal childbirth anyway, right? What better way to welcome your child to the world than with a scalpel! Result: Millions of women subject their children to non-natural child birthing that results in an increased risk of lung disease afflictions as well as psychological birthing trauma lasting a lifetime.

The “posh” argument is overplayed though the alliteration is effective for media sound bites.  Convenience of interventive birth is a problem as is the fact that schedules, politics, malpractice insurance, insurance companies, ACOG, and a lack of true informed consent have lead many women and babies into bad (or at the very least, less good) outcomes.

Part of his “quick note” below states:

Conventional medicine, for the most part, does not want to learn anything new that might challenge its existing status quo dominance over the lives of parents and children. “Innovation is the enemy of the status quo,” and genuine health enhancement (and disease prevention) is the enemy of the entrenched medical industrial complex. Most doctors are complete idiots because they follow a dogmatic, religious-like belief in blatantly outdated junk medical science, even when real world observations and evidence demands the embracing of ideas that overthrow previously protected beliefs and career egos.

Until doctors can abandon their egos and admit they don’t know everything, they will continue to be full of crap.

The purpose behind this satire piece is not to engage in silly name-calling exercises, but rather to play an important role in social commentary on the huge failures of modern medicine today. Satire and humor have important functions in any free society: They reveal what’s wrong in a hilarious light, simultaneously entertaining us while encouraging us to challenge our own ideas and, perhaps, come up with new, better solutions for future generations. Political cartoons, stand-up comedians and satire pieces like this one all play a role in getting people to think more carefully about the issues at hand.

This problem of maintaining the status quo is a symptom of a patriarchal institution refusing to recognize its role in health maintenance and improvement.  Doctors and insurance companies have no business infringing their priorities over our bodies.  Doctors are going to have to accept (like everyone else) that they are working in a consumerist society.  The patient (client, customer) is always right.  The patient has the right to question recommendations and ask for second opinions.  The same rules that apply to someone who is being counseled to undergo back surgery apply to a woman who is being told to have a cesarean delivery.

I could ramble on about this, but instead, why don’t you head over and read this article and browse the other pieces at NewsTarget.

“BOBB” and Ricki Lake on Ellen

I was browsing one of my Google alerts today, and look what I discovered:

She had an extremely popular daytime talk show for 11 seasons and has just produced the new documentary, “The Business Of Being Born.” Wednesday, RICKI LAKE will join me to talk about her incredible documentary that examines childbirth. I’ll ask her how it feels to have a film of her giving birth in a bathtub, in theaters across America, why she thinks a homebirth with a midwife might be safer than in a hospital and how her new single life is going.

Ricki Lake will be on the Ellen DeGeneres Show on Wednesday, December 19 if you’re interested in watching it!  Click here to find out when the show airs in your area.

Now if only we could get OPRAH interested in these sorts of topics . . .

ICAN Member Drafts Petition in Response to VBAC Ban

Women with previous cesarean scars may not be allowed to have a vaginal birth at hospitals in Montana.  Vaginal birth after cesarean (VBAC) has been shown to be safe, and in most cases it is appropriate for a women who desires a VBAC to undergo a trial of labor. [1]

St. Peter’s Hospital in Helena is one hospital in the state that has put a VBAC ban in place.  This of course violates patients’ rights and human rights, as no one can be forced into unnecessary medical procedures and surgeries.  West Houston Medical Center tried to put a VBAC ban in place, but due to a large response to this petition as well as timely media coverage, the ban was reversed.  Rather, it seems as though hospital administrators back-pedaled their way to “allowing” VBACs. 

One ICAN member in Helena has created a petition to garner support for reversing the VBAC ban in Helena.  I urge you to support this petition even if you don’t feel this affects you directly.  Support this petition because women’s rights are being violated.  Babies’ rights are being violated.  Support this petition because no one should be forced to undergo major surgery.  Support this petition because you support a person’s right to choose what’s best for him/herself and his/her family.  Support this petition to send a message to other hospitals in Montana that don’t allow VBACs, who are thinking about banning VBACs, or who by practice discourage VBAC.  Montana’s state VBAC rate is about 1%, which demonstrates how difficult it can be to have a successful VBAC in a hospital setting.

Click here to find the petition and add your name in support.

Thank you for your consideration!

[1] See Landon et al, “Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery,” NEJM (December 16, 2004).