Motherguilt

My sister and I had a wonderful visit today when she came over with her two children. The combined menagerie, which included several neighbour children, had a blast outside in the heat under the sprinkler while we hid from the heat indoors with her four month old.

Our conversation turned to the huge guilt mother's face with every decision made... birth options, vaccination, breastfeeding, home vs work, daycare vs dayhome, school vs home school... the list is endless. The reason we discussed this was because of her daughter's language testing today which showed her to be mildly delayed in hard sounds and my sister was given several pages of information on how to support her with these sounds. From my experience of having a son with severe receptive and expressive language delays and the incessent testing the so-called experts continue to want him to do, I encouraged her to realize that her daughter's delay in this area was only a very small part of who she was and not to be discouraged by this so that she continues to seek other's opinions about her daughter. She knew what her daughter needed best!

You see, I learned the hard way that my instincts and knowledge about my son were completely accurate... his delays in one area of his life as well as his gifts and talents in other areas. When I sought outside support to supplement my skills in parenting my son, I had no idea the pain it would cause as expert after expert, in their own way, made me doubt my parenting skills by insisting that a structured school environment was what he neede most. Their whole focus was to integrate him into a classroom situation yet their recommendations strangely pointed in the opposite direction... individualized support, calm and structured enviroment, etc. It was in realizing that school was their only paradigm and they could not see outside of that box that I realized the truth, I was doing what was best with my own parenting skills and our decision to homeschool him along with his older brothers who have always been homeschooled. So while we can indeed access outside support, we also have to realize where that expert is coming from and base the accuracy of thier input on that... and to know that we are our children's parents and it is our right to make the best choices for them, despite outside opinions.

A funny thing happened...

on the way to the awards gala on Thursday. My daughter ate my makeup. Well not quite literally, but she did break it all over my bed and carpet in my room. What a sight that was to find as I went to get ready! She sure looked well made up :-) Ah well, I still had samples from my two minute Mary Kay career last fall so I broke into those. Minus mascara, I was ready to go in no time.

The YWCA Women of Distiontion Awards Gala was fantastic and we thoroughly enjoyed ourselves. My friends Claudia Villeneuve, Chapter Leader of ICAN of Edmonton/Edmonton VBAC Support Assn., Anita Ferrie, a co-nominee in the Advocacy category, and I had a blast. The food was excellent, the people were wonderful and the music was perfect. Neither Anita or I won, we lost to a wonderful woman we met that night, Diane Bergeron.

"Dedicated to her community, Diane Bergeron is a leader and a passionate advocate for people with disabilities. As the co-ordinator for the Premier's Council on the Status of Persons with Disabilities, and founder of the Edmonton Guide Dog Users Group, she is looked upon as one of the city's experts on disability challenges. Working alongside the Executive Director for the CNIB, Diane recently helped draft an updated version of the Blind Persons Rights Act. Despite her being totally blind, Diane's vision has no boundaries."

Congratulations to Diane and all of the award winners and nominees. I was honoured to have been nominated with such an amazing calibre of women. Thank you Claudia for nominating me and all the hard work you did to submit my nomination. You are awesome!

Breastfeeding Length in Canada

The Globe and Mail's talented reporter Andre Pickard wrote the excellent article Most Mother's Quite Breastfeeding Far Too Soon.

The single most effective way of giving a baby a healthy start in life is breastfeeding.

As a public-health measure, breastfeeding is unparalleled. It is cheap, easy to understand, has no negative side effects and the method is tried and true -- as old as motherhood itself.

Yet, Canada fails abysmally when it comes to providing babies with mother's milk.

Things look good at first: Eighty-five per cent of Canadian women breastfeed their newborn babies, according to Statistics Canada. However, in the weeks after birth, that rate falls off precipitously.

Every major health group, including the World Health Organization, the Canadian Paediatric Society and the Public Health Agency of Canada, recommends that babies be fed breast milk exclusively for the first six months of life, and that breastfeeding should continue as long as possible after the introduction of solid foods. The reasons for this are clear: Breast milk provides all the nutrients, growth factors and immunological factors a baby needs for optimal growth and development (physical and neurological).

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Cesareans in the News

New Jersey hospital Kimball honored for low rate of C-section births today:

LAKEWOOD — Sumayyah Simone stood in the back of the room, away from the podium, the speakers and the spotlight.

But Simone and pregnant women like her were the reason everyone gathered.

Simone, due to give birth to her second child next month, was the impetus last week for a group of doctors, nurses and midwives to pack themselves into a hallway in Kimball Medical Center's maternity ward and accept an award for good maternity practices.

All because women like Simone want a natural birth.

"There's a trust relationship which I think is really important with a caretaker," said Simone, a 37-year-old Plainfield woman who has a Lakewood doctor monitoring her pregnancy. "When you're in a hospital, you need to trust your doctor."

And when a natural birth is needed or wanted, Kimball Medical Center is among the hospitals of choice.

According to a review of recent state health statistics, the rate of Caesarean-section births at Kimball is the lowest in New Jersey.

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And in South Carolina:

Multiple reasons account for rise in C-sections
By Mike Foley

Back in 1979, when Dr. Kenneth Trofatter began delivering babies in Greenville, the number of women having Caesarean births was about 16 percent.

Last year at Greenville Memorial Hospital, where Trofatter is now the director of maternal-fetal medicine for the University Medical Group, the hospital had 34.6 percent of its births via C-section, a surgical birth method where the baby is removed through an incision in the uterus. Across the country, the Caesarean rate rose to 29.1 percent in 2004 according to the World Health Organization, the latest year for which figures are available.

The end result is higher medical costs, for both private insurers and Medicare, and no end to the debate about the rising numbers of surgeries that some say aren’t always medically necessary. Among his colleagues, Trofatter said, there are two distinct feelings on the issue.

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Today's higher Caesarean rate raises concerns
Expectant moms must weigh risks, benefits for themselves and baby
By Mike Foley

Among his colleagues in obstetrics, Dr. R.E. Lattimore is an anomaly.

“I probably have one of the lower C-section rates in town,” Lattimore said. “It’s probably 14-16 percent over the long haul.”

The long haul in this case is Lattimore’s career as an ob-gyn in Greenville, now in its 21st year. During those two-plus decades, he’s remained conservative in his approach about unnecessary surgeries, including elective Caesareans.

“I’d prefer not to be on the wrong end of a lawsuit because a woman had an elective C-section and something went wrong,” he said.

While Lattimore said he sees lots of reasons for the ever-increasing number of C-sections, he believes that “everyone would like to see lower C-section rates.” But that’s not happening locally, in South Carolina, in the United States, or around the world.

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Preterm Cesareans Double Uterine Rupture Risk

Interesting news in OB/GYN News today...

MIAMI BEACH — Women with a history of preterm cesarean delivery are twice as likely to experience uterine rupture during a subsequent vaginal delivery, compared with women who have a history of operative delivery at term, according to a large study.

However, the absolute increased risk of 1% may be acceptable to some women who are considering a trial of labor after a previous cesarean section, Dr. Anthony Sciscione said at the annual meeting of the Society for Maternal-Fetal Medicine.

"The 1% may be too high for some women but acceptable to others." Dr. Sciscione, chief of obstetrics at Crozer-Chester Medical Center in Upland, Pa., and his associates compared 5,839 women with a history of preterm cesarean delivery to 35,528 with a history of term cesarean delivery.

They found the preterm group twice as likely to experience uterine rupture on a subsequent vaginal delivery, compared with the term group (odds ratio 2.05).

The risk was still increased when the researchers controlled for emergency cesarean deliveries (OR 1.73).

"Rate of uterine rupture was highest among those who had a previous preterm delivery and subsequent full-term delivery," said Dr. Sciscione, who presented the findings on behalf of the Maternal-Fetal Medicine Units Network of the National Institute of Child Health and Human Development, Bethesda, Md.

A delivery between 20 weeks of gestation and 36 weeks, 6 days was considered preterm. The two groups were similar, but the prior preterm delivery group was younger (mean 28.6 years versus 29.2 years) and less likely to have private insurance.

Women with a previous preterm cesarean delivery were also more likely to experience earlier uterine rupture (mean 37.2 weeks) than were women with a previous term cesarean (mean 39.1 weeks).

A meeting attendee asked if the women who had uterine rupture earlier were also in labor earlier.

"That is a good question," Dr. Sciscione said. "We looked at that, but the data are not ready yet.

"Further study is needed to define those clinical characteristics which may accompany preterm cesarean delivery that may modify the risk for subsequent uterine rupture," Dr. Sciscione said.

Careforce Lifekeys

A friend of mine from Australia attends an excitingly dynamic church pastored by Dr. Allan Meyer and Helen Meyer, the founders of Careforce Lifekeys. She recently attended their 2006 Conference and came home supercharged. Her excitement has not only piqued my interest, I will be bringing their programs to our church counsel and the as-of-yet hired Pastoral Assistant who will be overseeing the Healthy Family Ministry program I created and currently coordinate.

Careforce Lifekeys is ground breaking. "Many of God's people struggle with issues that church life needs to effectively address. Lifekeys programs have a vital role to play in brining pastoral care and discipleship to God's people." Instead of avoiding or covering up problems, they instead tackle the very issues ordinary people struggle with every day and the root sources of marriage dysfunction, separation, divource, family breakdown, the destructive forces of shame and guilt, addictive cycles, co-dependence, insecurity, self rejection, grief, depression, chemical dependency, sexual abuse, sexual addiction, easting disorders and more. I am super excited about this and truly cannot wait to learn more about Lifekeys' programs.

VBAC vs ERCS Study

Kathleen Doheny from HealthDay News reported last week on the Annals of Family Medicine study (full text pdf), Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines. "The number of women who gave birth vaginally after a cesarean delivery has dropped in recent years, but without the expected reduction in infant and maternal death rates, a new study has found." Well, that is indeed a no-brainer for those of us who have a clue about VBAC and Caesarean risks and benefits.

As all good reporters do, she found someone to refute the evidence... there is always someone who has an expert "opinion." Dr. Richard Frieder, an obstetrician-gynecologist at Santa Monica-UCLA Medical Center and a clinical instructor of obstetrics and gynecology at the David Geffen School of Medicine at the University of California, Los Angeles, said the new study has a major flaw. "It doesn't address maternal or fetal complications," he said. He is correct in this regard and goes on to add, "The main complication of VBACs is not death but morbidity, such as blood transfusions, hysterectomy, infection, heart attack, stroke, kidney failure, the baby having low Apgar scores or brain hemorrhage. All they are talking about is how many people lived or died. But they didn't measure complications. If they had looked at complication rates, there would have been a huge difference favoring c-section." Sure there are risks to vaginal birth, but saying that there is a "huge difference"... yeah right, and pigs fly. Please show me the evidence Dr. Frieder.

I have done a lot of research into this very concern and the evidence is clear. Don’t miss Childbirth Connection’s (formerly Maternity Center Association) What Every Pregnant Woman Needs To Know About Cesarean Section booklet for solid, evidence-based facts on cesarean risks.

The study concludes with, "Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing ≥1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery." Well done doctors, now could we please lean on the idiots at ACOG to reverse their inane butt-protecting VBAC guidelines that have essentially eliminated vaginal birth as an option for most post-caesarean women in the US?

Hospital Birth = Death

How ironic that after posting this earlier this week, a young mother has died from a magnesium sulfate overdose in Florida. Her son survived and is in another hospital's NICU. How devastating for her family, my prayer are with them.

Announcing...

I am very proud to announce the opening of my newest endeavour, a new and innovative institution providing comprehensive certification for birth professionals in Canada. Developed from the training workshops provided through Mother Care, Rosenthal Perinatal College was formed out of a need for respected, thorough, and comprehensive certifications for birth and postpartum professionals within Canada, based on Canadian families’ specific needs unique to our country.

Founded on the principles of integrity and strong morals, Rosenthal provides comprehensive, evidence-based certification and continuing education for those seeking careers in the perinatal field. A premier training and certification college, Rosenthal equips students with the knowledge and confidence to support and educate families during the perinatal year. Rosenthal takes pride in their professional standards; their certification requirements are the highest of any certifying organization.

Alberta-based Rosenthal College, with the approval of Alberta Advanced Education’s Private Institutions Branch and in accordance with their regulations, provides quality certification and continuing education. For more information, go to our new website at www.rosenthalcollege.ca.

Hospital Birth = Risk

Sunday, NBC reported on A routine epidural turns deadly which asks, "did a hospital infection turn the happiest day of their lives into a nightmare?" A mother, amidst the bare minimum of care during her hospital stay, contracted meningitis and died within hours of birthing her son.

What bothers me most is the lack of adequate care this family received, from obstetrical decisions to staff follow through, though this is not unusual. The lack of evidence based or even adequate care is almost universal across North America to families who subject themselves to a hospital birth experience. In their defense though, most don't know what the alternatives (like traditional midwifery care) are, the excellent care and proven safety of those alternatives.

Seriously though, has "modern" (allopathic) medicine not set themselves up to "have the answers" so to speak and then be completely and utterly unable to provide them? Physicians are so confident that they can "deal with the side effects" of so many obstetrical interventions, such as inductions and epidurals, that they have not only become commonplace, many women are not even told of their risks even when being subjected to them.

We as a society have been blinded by the rhetoric and sales pitch so completely that we actually allow modern medicine to provide inadequate and often dangerous care and accept it as normal. No wonder malpractice insurance rates are through the roof. Just to compare the care the above mother received to midwifery support is laughable. Would a midwife "subject" her clients to the same care and even hope to be in business? No she would be in jail.

But obstetrics is only part of this big mess. May 29th, Businessweek article Medical Guesswork revealed, "from heart surgery to prostate care, the health industry knows little about which common treatments really work." Anne, a good friend of mine blogged about this here. I grow more leery every day when I see physicians trained to treat symptoms and be completely oblivious to the causes. I mean seriously, how else could anyone justify surgery as a solution for asthma? Evidence-based practice is a vital and very worthy goal, it's frustrating to see modern medicine miss this by such an incredibly wide margin.

VBAC in the journals: the good, the bad and the ugly

Over the past couple of days, some interesting press has me thinking. For instance, the lastest Annals of Family Medicine includes a study showing Reducing post-cesarean vaginal births has no effect on mortality:

Although attempted VBAC deliveries fell significantly after the guideline revision, from 24.0 percent beforehand to just 13.5 percent afterwards, neonatal mortality rates per 1000 live births were no different for attempted VBAC deliveries from those for repeat cesarean among neonates weighing at least 1500 g during either of the two study periods.

Neonatal mortality rates for attempted VBAC among neonates weighing less than 1500 g were higher than those for repeat cesarean deliveries. Their conclusion, "We recommend that a balanced presentation of risks and the encouraging outcomes found in this analysis be included in discussions with pregnant patients who have had a previous cesarean section." Excellent advice. Too bad fear of malpractice in the face of ACOG's VBAC guidelines will skew any "discussion" physicians have with expectant mothers so badly that the truth will rarely be seen.

Meanwhile, over at Obstetrics & Gynecology, their latest journal includes Dr. James Scott editorial, Cesarean Delivery on Request: Where Do We Go From Here? in which he concludes with the advice, "Go slow on this for now, be cautious, don’t get caught up in the rhetoric, and individualize until better evidence is available and the ultimate consequences are well known. To do otherwise just might come back to haunt us." (Obstet Gynecol 2006;107:1222-3) To be honest, ACOG has made a lot of decisions that should be haunting them based solely on bettering their members malpractice insurance rates and wallets with complete disregard for maternal-child health or evidence-based practice. But I digress...

O&G also has a brand new study, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries which is something anyone knows who works at all with caesarean/vbac mothers, I mean it's simple common sense. Their conclusion, "Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery." (Obstet Gynecol 2006;107:1226–32)

Last but not least, they have the National Institutes of Health State-of-the-Science Conference Statement: Cesarean Delivery on Maternal Request from March 27–29, 2006 outcomes. Their conclusion, "The magnitude of cesarean delivery on maternal request is difficult to quantify. There is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request compared with planned vaginal delivery. Any decision to perform a cesarean delivery on maternal request should be carefully individualized and consistent with ethical principles." (Obstet Gynecol 2006;107:1386–97)

Hmm. So ACOG's "decision" to essentially eliminate VBAC Trial of Labour as a viable choice for women in the US is coming back to haunt them. Despite the carefully worded conclusions above, it is becoming more and more obvious to even the ones who have turned a blind eye to the risks of major abdominal surgery for deliveries. The well-touted risk VBAC has of uterine rupture is pailing strongly in the blinding glare of surgical risks with many of them long-term risks in future pregnancies.