Will informed consent become extinct???

Recently I attended a birth where the doctor told my client that studies have proven that women and babies have better outcomes when we "manage" labor. He cited "the Ireland Study" which at the time I had never heard of. There was a good reason for that. It was done before I was born. I am 38. That's been a while. I can't think of many studies that were done that many years ago that still hold water today.

Here is what we do know. Our cesarean rate as a nation is at an all time high - curently 31.8% as of 2007. This was a 48% rise from 1996. In 1970, the national cesarean rate was 6%. See date from fellow blogger:


With stats like that, how dare a doctor reference an outdated study to try to convince my client that she needs pitocin so that she will have her baby faster. Those statistics are a frightening look at what managing labor can do.

Most women never question what their doctor suggests. Many women go their entire lives thinking that they would have never gone into labor if they hadn't been induced because they were induced with all of their children at 41 weeks. One thing that statistically we do know....no one stays pregnant forever. Many women believe that it's a good thing that they had that cesarean for failure to progress because when the baby was born, he/she had a cord wrapped around their neck (maybe even twice). Cords are gently unwrapped from around baby's necks(during homebirths)the majority of the time, I would say. It is not an uncommon occurence.

Women are believing a lie that they are powerless in their birth process. They are being taught by providers that listening to their instincts is reckless and instead, they should completely trust the information from their doctor. Little do they know that it is the insurance companies that have more control over a doctors decisions and protocols. Dr's are threatened on a daily basis with unseen increase in their malpractice insurance if they don't follow the game plan. As long as no harm is done right?? Well, no visible harm. Sometimes, the harm of a interventive labor is to the woman's psychological well being. But hey, most lawsuits for that aren't successful, so it's as good of a risk as any. The doctor's malpractice insurance remains affordable.....and women everwhere don't understand why they feel they lost control of their whole experience? Informing and empowering????? I think not.

Enlightenment continues......

My current reading for my midwifery study unit is Easing Labor Pain by Adrienne Leiberman. I must say, the first few chapters were dry as a bone. Granted, I do have an older edition and some of the information is dated, but still dry nonetheless. However, as you get past the 4th or 5th chapter, I found the book to be very informative. Here are some excerpts I found important:

In Chapter 6, titled "You are what you eat", I found wonderful nutritional advice. For instance, Adelle Davis, a respected nutritionist, recommends calcium supplementation at the beginning of labor. The premise is that calcium eases muscle cramps....thereby making uterine contractions less painful, but not less effective. This is not studied and documented, but I find it to be logical. And besides, what can it hurt to take a little extra calcium when your contractions get going. So have a tall glass of whole milk and take a nice cal-mag supplement at the get go and see what happens!

In chapter 17, "Hospital Routines: Is the pain worth the gain?", Lieberman writes,
"Each form of intervention carries with it certain risks, which are worth accepting in high risk situations where the benefits may outweigh the drawbacks. However, in low-risk situations, advantages of intervention frequently do not exist. Then these interventions only add risk and discomfort wihtout providing any compensatory benefits."

I wish I could help every woman embrace this concept. All of the things that you are subjected to at the hospital - for the good of you and your baby - have not been proven to make your outcome better. Unless your risk level during pregnancy warrants constant monitoring, routine IV fluids or other things, they really aren't necessary. And my next point explains why this is.

Quote from the same chapter: "By 1985, indeed two thirds of this country's obstetricians had been sued for malpractice at least once. This medicolegal climate makes an obstetrician much more likely to intervene in the birth process. As one obstetrician said, 'I've never heard of a doctor being sued for doing a cesarean, but lots of doctors have been sued for not doing one.'"

This is the crux of the matter. Many of the things that women believe are just part of a safe and healthy pregnancy are simply tools to put on paper to thwart a lawsuit. We don't want to believe that. Birth is beautiful....babies are cute....doctors who deliver them are pro woman and baby, right? Doctors must practice defensively in a country that allows them to be put out of a career over one lawsuit. How do they know that you aren't the one who will end their career? It's better to strap you with the fetal monitor and make you uncomfortable enough to scream for the epidural rather than not have it on and take that 2% chance that something will happen to your baby unknowingly.

Women must educate themselves on the true facts and figures regarding all of these interventions. Know what really makes you safe. The safest thing for you and your baby during labor(as long as you have no major medical complications) is to be up and walking around - moving. Do this at home. The longer you are at the hospital, the more likely you are to become uncomfortable enough to need the epidural. As soon as you get that first intervention and become immobile, then the baby runs the risk of struggling to adapt. If that happens, you will find yourself in the operating room.

Easing Labor Pain is worth the read for the mom who wants to be informed. THe book is not anti-hospital or anti-doctor. It is not going to tell you that you should just have a homebirth(but I might...LOL). It is very conservative, yet factual. There is also some wonderful information on methods of relaxation and labor coping strategies.

Want an empowering hopspital birth? Know your stuff. Find a provider you can trust. Hire a doula. Trust in your body. Keep moving. Push in a position that feels natural. Make your wishes clear. Make sure anyone present at your birth is completely onboard with your philosophies. Don't run through the doors after your first contraction. And finally.....remember that your body and your baby know the drill. Just relax and respond.

Morning Sickness.....a new perspective.

I got this from a fellow midwife in training. I cannot attest to its effectiveness, but from what I remember about morning sickness, anything is worth a try.

Morning Sickness

You can beat this. The cause and cure for morning sickness has been shrouded in mystery for a long time. But it is really not that difficult to understand, neither is it that difficult to conquer. Most medical texts say the cause is either hormonal or unknown. The standard answer of eating several small meals per day, or coating the gastrointestinal tract with crackers or fruit, is usually not effective. Even worse is the recommendation to take vitamin B6. This usually exacerbates the morning sickness, not abates it. Also, I think most of you understand this already, but I think I should mention it anyway: you do not have feel nauseous only in the morning to have morning sickness. The nauseous feeling can come at anytime of the day or night.

A powerful ally with a sidekick
When a woman becomes pregnant certain hormones are produced in large amounts. One of these hormones is the hCG hormone (Human chorionic gonadotropin) . This hormone is primarily responsible for maintaining the pregnancy. The measurement of this hormone is the most common diagnostic tool to confirm conception. Non-pregnant women will not have significant levels of hCG, in fact oftentimes it cannot be detected at all. The hCG hormone will keep a woman from spontaneously aborting (miscarrying) the newly conceived child. However, these high levels of hCG precipitate a response from the liver. The liver is stimulated to produce larger amounts of a digestive enzyme called bile. The hCG hormone is our powerful ally, working to maintain the pregnancy. The bile, whose release is stimulated by the hCG hormone, is the sidekick that causes the morning sickness. The encouraging news is that the more nauseous you feel, the less likely you will miscarry.

Why bile makes us feel nauseous
Bile is a digestive enzyme designed to break down the fatty acids that we eat. When we have no fatty acids in our duodenum (the first part of the small intestine and what most people commonly call the stomach), there is nothing to digest but YOU! This causes us to feel nauseous. We will feel queasiness in the center of our upper abdomen, right under the sternum (the small bony extension where the front rib cage joins together) and above the belly button (umbilical cord site). But eating fats is not the answer Oh ho! You must be thinking now that if you put fatty acids into your digestive tract that this will solve the problem. It seems to make sense that if the bile is meant to digest fatty acids, all we need to do is give the bile the fatty acids it wants to digest. Then the bile will not bother our intestinal lining making us feel nauseous. But, when we eat foods with fats in them, it actually causes a further release of bile. Now we have the original bile making us feel queasy PLUS a new onslaught of this same nauseous-causing substance. Then there is more to the bile story. Bile is also the carrier of expended hormones. Because the liver is responsible for filtering fat soluble substances from the bloodstream, hormones (which are fat soluble) are collected by the liver. The liver has the job of expelling from the body these expended hormones. The only exit out of the body that the liver has available to it is the bile. Bile will leave the liver, travel to the gall bladder, continue its journey to the duodenum, thread its way through the rest of the small intestine and then the large intestine. Finally it will be expelled out of the body through a bowel movement.

Well, that is the design of our Creator, but when we eat the way of the Western world, this plan can be thwarted. Before I explain that, I need to impress upon you this fact: the more hormones that are filtered out of the bloodstream by the liver, the more bile the liver will release for the purpose of disposing these hormones. When more bile is released, the probability of nausea increases drastically. How the Western diet affects bile In the West, we generally eat very high fat diets. The more fat we eat, the more we stimulate the liver to release bile in order to break down these fats. However, bile itself is a fat, and not all of the bile fats will exit the body. In fact, a large amount of the bile will be reabsorbed and recycled to the liver. The problem with the bile recycling is that these bile fats carry much debris. This debris has been filtered out of the bloodstream and put in the bile fat carriers to be escorted out of the body. But if the bile recycles, so does the debris that is carried in the bile fat. This means that there is more debris to be discarded in the next release of bile. The repeated recycling of the same bile creates a very nasty debris-laden bile that will make us feel even more nauseated. Bile’s good buddy I mentioned above how the Western high fat diet contributes to an elevated bile roduction. But even more significant is the lack of soluble fiber in the Western diet. If we Westerners would eat soluble fiber in ample amounts, we could eat all the fat we wanted and never suffer adverse effects.

Soluble fiber is found in legumes (there are other sources but they are so minimally endowed with soluble fiber that it is not worth mentioning them for the cure of morning sickness). Legumes are pinto beans, kidney beans, garbanzo beans (also known as chick peas), black-eyed peas, lentils, black beans, red beans, navy beans, white beans, great northern beans, crowder peas (also known as field peas), yellow-eyed beans, and the list goes on. They are also termed soup beans. Most Westerners will admit that it is not often that we eat beans, if ever. These beans are dense with soluble fiber. Soluble fiber and bile (or any fatty acid) have a great affinity toward one another. In fact, they will bind so tightly together that they cannot be parted. As no fiber (soluble or insoluble) can cross the intestinal barrier, all the bile that has been bound together with the soluble fiber will exit
the body through a bowel movement. That means the bile will not recycle. That means the bile will not grow nasty with accumulating debris. That means you will feel less nauseous.

Less nauseous? Could I feel no nausea?
Yes, it is possible for you to feel no nausea from the blessing of increased hCG levels. I say blessing because the increased hCG means that you will most likely have a full term pregnancy. Eliminating the nausea does not decrease the production of the hCG hormone, but it just negates the hCG side effect of nausea.

The answer
I think you already know. The answer is to eat legumes. Now you must know to what extent you must eat legumes. If you are feeling nauseous, you must immediately consume your beans. You will need to eat at least 1/4 cup of cooked legumes. If you can eat more, it is even better. You will see relief in under 20 minutes. The nausea will go away. However, the nausea will be back in a period of time. That period of time is dependent upon the liver’s stimulation to produce more bile. If the hCG hormone is at high levels, it won’ be long (1-4 hours) before you are feeling that queasy feeling again. Then what? You eat your beans again. And so you go. You eat beans every time you have that nauseous feeling. If that means you are spending the majority of your time at the table with a bowl of beans in front of you, so be it! It will only be for a short period of time. As the bile is carried out of your body, the successive releases of bile become less potent with debris. After the consumption of legumes, each release of bile is less nauseating. Eventually (within a few days) you will not have to hang your head over a pile of beans all day. In fact, you will be able to consume beans just once or twice in the day to prevent the morning sickness from reoccurring.

Are there any side effects to eating legumes?
None, except the possibility of flatulence (commonly known as gas). However, if the gas is not causing you physical discomfort, continue on the legumes. The gas eventually will go away as the digestive system begins to produce the enzymes necessary to break down the beans. If you have gas to the extent that it causes you pain (not social pain, but physical pain), decrease your intake of beans at one setting. Instead of eating the 1/4 cup plus, eat a few teaspoons. Then gradually increase your intake until you can eat ample amount of the legumes. I would like to point out though that the majority of women who are experiencing morning sickness will not have much trouble with gas with the addition of legumes to their diet. There is so much bile present, the beans never really have a chance to become gas-producing.

Do not be fooled by simplicity
The answer to morning sickness, as you can see, is not that difficult. I urge you to try the solution. Do not fall into the trap of thinking that this is too simple of an answer. I am always amazed at how difficult we make things. Truly, we, as a medical community, have the tendency to turn mole-hills into mountains. Ladies, eat your beans! You will be surprised and grateful at how your pregnancy will become wonderful.

Pregnant woman = Doormat?????

Sometimes the birth climate in the US saddens me. You know, there was a day and time when doctors told women that reading was bad for their health. They said that all the sitting and strain on the eyes was taxing on their bodies. In reality, it was an effort to stop women from becoming informed.

But this is 2009 and we have come a long way, baby.....or have we? The sign above would suggest we have not. This is an actual sign that appears in the Aspen Women's center in Provo, Utah.

It has been shown in many studies that doulas improve outcomes for mothers, not harm them. Yes, I am aware that there are a few doulas out there who argue with doctors, contradict them in front of their patients and come across as arrogant in the birth room. There are heavy handed people in every profession. But the majority of doulas are there for the mother.

The Bradley Method of childbirth is simply a matter of choice. For some couples, Bradley classes have made them able to face labor without fear and anxiety. Bradley is getting picked on, in my opinion. THere aren't too many childbirth education "brands" in the US currently that would agree that our current state of obstetrical care is stellar.

This is about rights. On the side of the doc, kudos for at least being honest and posting publicly in your office that you have no intention of allowing women to choose the care options that they feel are best for them personally. No one can say they weren't warned. But in googling this office, for every woman who rallied against this policy, there was another who raved about their care at this office. I also found out that one doctor in the practice proudly uses forceps in all of his vaginal deliveries claiming it makes birth easier for the mother. I think even most of his fellow OB's would disagree with that. See this link for the facts: http://www.efn.org/~djz/birth/betterbirth/7bottom.html#fore

Regrettably, here in Charlotte, I have come across this attitude among individual doctors and entire practices. The difference is that they tell their patients something very different. They vow their support and encouragement to the mother who seeks a natural birth experience.....until she goes past 40 weeks, or her fluid levels are slightly low, or her measurements are 1-2cm beyond her dates or the most popular by far....the ultrasound shows a BIG baby. See information about true reasons for induction and intervention here: http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/LaborBeginsOnItsOwn/tabid/487/Default.aspx

If you are a woman seeking a natural birth experience, the responsibility has to be yours to educate yourself about your rights as well as the facts regarding medical protocols. I have seen too many women who had very strong resolve compromise when faced with scare tactics and inaccurate information. And steer clear of doctors who seem at all uncomfortable with your having a doula or tells you what childbirth education curriculum you should/should not use. This is an individual decision. And by all means....run from any doctor who refuses to accept a birth plan. YOU are the consumer. YOU pay the bill. The decision is YOURS.

So much for the textbook......

Labor is different for every woman, but occasionally, someone really breaks the mold. With permission, I share the story of my client, S.

S is a strong, energetic young woman having her first baby. She and her husband quickly became dear to my heart. Upon her labor beginning, like a good girl, she went for a beautiful walk in the park with her hubby, and called me when the contractions became a little closer. I told her that by listening to her, I did think she was in early labor and that she would be having her baby soon(meaning in the next couple of days). This went on all day. I went to an early morning birth, then had to take my toddler to the doctor, and decided to run over and check on her. She was frustrated. The contractions had been going on all day with no apparent change.

By the time I arrived, there were no clues that she was in active labor. Many times, contractions will slow down or even stop when I show up...then they pick up again. She would casually mention that she was having a contraction between our topics of conversation. With a loving smirk, I told her husband to call me when she stopped talking so much, that we would know then that it was time to get really serious. I also gave her some homeopathics just to see if it would help. After about an hour....I left thinking it would be a while.

I got home and took a much needed hot bath. The baby born that day had pulled me out of bed at 5am. I had also been at a birth the day before that...LOL. I was hoping for a few hours of sleep. But S's husband called me back before my hair was even dry. He said she had not stopped talking....rather...she had begun yelling and cursing and had droppped to her hands and knees on the floor. I told him to ask her what she felt like we needed to do....mamma instincts know. She said we should go to the hospital and out the door I went to meet them there.

Upon arriving, she was still chatty. She did stop talking for a contraction, but I did not see the seriousness and the concentration that I normally see in active labor. Usually, toward delivery, mom will stop talking even in between contractions....other than to say, "water" or "bathroom" or "hurts here." She and hubby didn't even bring the bags in out of the car because they had convinced themselves on the way to the hospital that this might not even be real labor. LOL Imagine all of our surprise when the nurse announced that she was 9cm.

There are always exceptions to the rule and she was one. But, it proves that mamma instincts will always tell you the right thing to do. It was time to go - even though she wasn't exhibiting the textbook signs. And by the way, she never did get quiet and contemplative. She never stopped cracking jokes and smiling. She made it look easy. And she made me stop looking so hard for absolutes.......

ACOG gets a big surprise.....

This is what happens when women speak up for their rights to the birth they want. I love it!


Issued: August 31, 2009

Viral Internet Campaign Exposes Bogus Research on the "Problem" of Increased Demand for Midwife Care

If you have difficulty viewing this message, please visit the PushNewsroom.

Thousands of Activists Nationwide Force Physician Group to Scrub Its Website

FOR IMMEDIATE RELEASE

WASHINGTON, D.C. (August 31, 2009) – In under 18 hours, a viral internet campaign targeted at the American College of Obstetricians and Gynecologists (ACOG) forced the group to take down a public plea asking its members to submit anecdotal, anonymous data about patients who planned out-of-hospital deliveries. According to the request, which was originally linked from ACOG's home page, the professional trade association for OB/GYNs is "concerned" about the "problem" of growing numbers of women seeking out-of-hospital maternity care.

"Just follow the money," said Steff Hedenkamp of The Big Push for Midwives Campaign. "ACOG does not want to continue losing patients to Certified Professional Midwives and out-of-hospital birth, so they're telling members to send in more of the same old tall tales that far too many OBs love to scare women with. Well, we have news for ACOG8
0it's not working."

The campaign to expose the physician group's plans began on Facebook and Twitter and rapidly drew thousands of women to ACOG's website, where they submitted their own data about their healthy deliveries in private homes and in freestanding birth centers throughout the country. In response, ACOG moved quickly to scrub its website and placed its request for unsourced data from members behind a password-protected firewall.

"This was almost as fun as last year's campaign pressuring the American Medical Association to back off from its ridiculous claim that Ricki Lake is responsible for the increase in out-of-hospital deliveries," said Sabrina McIntyre, mother of two. "The AMA and ACOG seem to forget that women are capable of making rational, informed decisions about our maternity care providers and birth settings. We don't appreciate fear-mongering tactics meant to try and scare us away from using safe and cost-effective, community-based alternatives to our current maternity care system."

Analysts familiar with ACOG expect the group to use the anecdotal data collected from members to support its ongoing state and federal lobbying campaigns aimed at denying women access to out-of-hospital maternity care and Certified Professional Midwives, who are specially trained to provide it. "ACOG admits in its own documents that they've been forced to use 'hardball tactics' against women who are advocating for choices in maternity care," said Hedenkamp. "Frankly, this latest stunt of theirs to troll for 'fresh' folklore reek
s of desperation. "

The Big Push for Midwives Campaign represents thousands of grassroots advocates in the United States who support expanding access to Certified Professional Midwives and out-of-hospital maternity care. The mission of The Big Push includes educating national policymakers about the reduced costs and improved outcomes associated with out-of-hospital birth and advocating for including the services of Certified Professional Midwives in health care reform. Media inquiries: Katherine Prown (414) 550-8025, katie@thebigpushfor midwives. org

###

The Big Push for Midwives Campaign | 2300 M Street, N.W., Suite 800
Washington, D.C. 20037-1434 | TheBigPushforMidwiv es.org

The wonder of it all........

I believe birth really is more art than science. If you gather a group of 25 women and ask them what a contraction feels like, you will get 25 different explanations. If you ask them about their birth experience, you will get 25 very different impressions.

I think what is missing today in modern obstetrics is the recognition that women want a birth experience. Some women want an unmedicated birth and some want the epidural when they walk through the door, but they all want their experience to be miraculous and sacred. Sometimes a woman doesn't even realize how important this is to her until she has a birth that is less than satisfying.

A woman in labor is a masterpiece. Left to her own, she will usually find her "groove". I love the moment when a woman finds that. At a recent birth I attended, I walked in to hear mom singing a song about Greek letters and such. I later found out this was her sorority song. When the contractions were difficult, her "groove" was to sing that song and it worked to move her through the process. Another client quietly rocked and chanted, "Good things are happening down there" over and over again. It is beautiful. It is art. Mom is painting her birth experience. We need to respect her canvas.....her space. Let her create.

Labor calls a woman to reach deep within herself and be completely strong and completely vulnerable all at the same time. When a woman's labor stalls for a bit and technology is rushed to her side to "make things happen", then we diminish her work. We, in essence, tell her that what she is doing just isn't enough. Her masterpiece doesn't meet the expectations.

Pregnancy is not a disease and labor is not a condition to be managed. It is a process.....a journey. As long as we continue to "manage" birth instead of allowing a life to enter the world in the same miraculous way that it is created, then women will continue to feel dissatisfied with themselves and their birth. They may not be able to tell you exactly why they feel this "void", after all, they have a healthy baby and that's the goal....right? We must recognize that it is so much more than that. It is an image, a work of art, that will linger in a woman's mind for the rest of her life. She will look at it many times. She will attempt to interpret it. She will ask others to look at it and give their opinion. She will either see it as her most beautiful work, or she will consider it to be lacking.

What is a doula?

I get this question all the time. It's a funny word, really(prounouced doo-luh). This is quoted from the DONA website(www.dona.org):

The word "doula" comes from the ancient Greek meaning "a woman who serves" and is now used to refer to a trained and experienced professional who provides continuous physical, emotional and informational support to the mother before, during and just after birth; or who provides emotional and practical support during the postpartum period.

People ask me, "Do you deliver the baby?" I say, "No, I'm just along for the ride." It sounds trite, but really I am.

Mom is on a journey that she has been traveling for 9 months. She has read books, she has talked to countless friends who have explained their births in detail(for better or worse)and she has poured over her gift registry trying to decide which of the 300 stroller models is the safest, best and cutest. She is driving this ride!!!

Along comes labor. It starts slow and builds. Mom and dad call me. I come over and watch mom's demeanor. I give her a reassuring smile every time she looks at me so that she will know she is doing everything right. I chat with dad, assure him that he is going to do fine also. And we all let the process unfold. I step in with a suggestion or a back rub if needed. Sometimes I remind mom to breathe or to relax. I reassure mom and dad at each stage that what she is feeling is normal and that she can do this. I provide a constant presence so dad can update family, grab a bite to eat, or just go to the bathroom! I help parents navigate the decisions about interventions and procedures so that they feel they can make informed decisions. And, of course, I fetch ice and sprite and coffee for dad at 2am and all those "practical" things.

At the end of the day, my goal is not that my clients feel they couldn't have done it without me. Rather, I hope they feel like THEY did it, and I just made the ride a little easier.

Chirpractic Care During Pregnancy

This was an article posted by a chiropractor from Asheville, NC who was a speaker at my doula training. I know and trust a local chiropractor, www.beyondwellnesscc.com , for my clients and friends. Check it out!


Chiropractic Care in Pregnancy

One of the most exciting times in a woman’s life is when she finds out that she is expecting a baby. Chiropractic care during pregnancy can be a valuable addition to a Mom’s prenatal care. A properly functioning spine and nervous system is an important part of a wellness pregnancy. In addition to the noticeable changes your pregnancy will cause your body, pregnancy can cause subtle changes in the musculoskeletal system—changes your Chiropractor is able to detect and correct.

The position of your growing baby will cause your center of gravity to shift, and your spine will naturally alter itself to accommodate this change. As a result, you may experience low back and pelvic pain. The increase in hormones during pregnancy can also cause ligaments, cartilage, and even bones to soften and become more pliable. Pelvic bones may even become displaced or fixated. Since your hips will need to spread to accommodate the delivery of your baby, fixated pelvic bones can lead to complications during delivery.

A bone or vertebra that is slightly out-of-place can create nerve irritation, which can and will interfere with your body’s communication system. By using special or modified techniques during your pregnancy, your Family Wellness Chiropractor can restore the function of your nervous system, improve your overall wellness, and increase your comfort during your pregnancy and delivery.
In fact, research has shown that:

84% of pregnant women treated by Chiropractors received profound relief from low back pain

Women who received Chiropractic care had nearly a 25% reduction in the average labor time and a 33% reduction for women carrying multiples

Postpartum pain was relieved in 90 of 120 moms that had been under regular Chiropractic care

During your pregnancy, your Doctor of Chiropractic can do the following:

Correct vertebral misalignment and relieve nerve interference with gentle adjustments.
Help ensure that pelvic bones are properly aligned, contributing to a shorter and easier delivery.
Re-establish the natural position and mobility of the joints.
Provide freedom from interference of normal nerve energy.
Decrease the likelihood of your fetus being in the wrong position during the last trimester.

Many Mothers have come to understand the vital role that Chiropractic care plays in a healthy pregnancy. The benefits of a Chiropractic adjustment offer more than just low back pain relief. The spinal adjustments have also helped them feel healthier during the pregnancy, decreased morning sickness, facilitated in shorter labor and delivery times, and increased overall sense of well being. Dr. Alisha Davis is dedicated to providing you with the absolute best in family wellness care. So take a moment today to discuss any concerns you may have regarding a wellness pregnancy and delivery and learn about the many benefits of Chiropractic care for you and your baby.

Dr. Alisha Davis, DC, DACCP

Are you an ungrateful patient? Ask the AMA!

AMA Resolution Would Seek to Label “Ungrateful” Patients

Redondo Beach, CA, June 11, 2009 - At the American Medical Association’s (AMA) Annual Meeting next week, delegates will vote on a resolution which proposes to develop CPT (billing) codes to identify and label “non-compliant” patients (1)

The resolution complains:

“The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction.”

“This resolution is alarming in its arrogance and its failure to recognize, or even pay lip service to, patient autonomy,” said Desirre Andrews, the newly elected president of the International Cesarean Awareness Network (ICAN).

If approved, the resolution could hold implications for women receiving maternity care. For pregnant women seeking quality care and good outcomes, “non-compliance” is often their only alternative to accepting sub-standard care. Physicians routinely order interventions like induction, episiotomy, or cesarean section unnecessarily.

Liz Dutzy, a mother from Olathe, Kansas, delivered her first two babies by cesarean and was told by her obstetrician that she needed another surgical delivery. “My doctor told me that I needed to have a cesarean delivery at 39 weeks, or my uterus would rupture and my baby would die.” She sought out another care provider and had a healthy and safe intervention-free {home} birth at 41 weeks and 3 days gestation.

A recent report by Childbirth Connection and The Milbank Memorial Fund, called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (2) shows that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

The resolution proposed by the Michigan delegation of the AMA could threaten patient care and patient autonomy for several reasons:

• Billing codes that would categorize any disagreement and exercise of autonomy on the part of the patient as “non-compliance” “abuse” or “hostility” could create a pathway for insurance companies to deny coverage to patients

• Use of these labels fails to recognize patients as competent partners with physicians in their own care

• Tagging patients as “non-compliant” fails to recognize that there is not a “one size fits all” approach to care, that different opinions among physicians abound, and that patients are entitled to these very same differences of opinion

• Labeling patients as “non-compliant” may, in fact, be punitive, jeopardizing a patient’s ability to seek out other care providers

The resolution also fails to address how it would implicate patients navigating controversial issues in medical care, like vaginal birth after cesarean (VBAC). While a substantive body of medical research demonstrates that VBAC is reasonably safe, if not safer, than repeat cesareans, most physicians and hospitals refuse to support VBAC. (3) The language in the resolution suggests that patients who assert their right to opt for VBAC could be tagged as non-compliant, even though their choice would be consistent with the medical research.

“The reality is that the balance of power in the physician-patient relationship is decidedly tipped towards physicians. The least patients should have is the right to disagree with their doctors and not be labeled a ‘naughty’ patient,” said Andrews.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. ICAN has 110 chapters in North America and Europe, which hold educational and support meetings for people interested in cesarean prevention and recovery.

(1) Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients”
(2) Evidence-Based Maternity Care: What It Is and What It Can Achieve
(3) http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans


If you don't like the idea of being officially labeled "non-compliant" or "ungrateful" for questioning your physician, then go to http://www.ama-assn.org/ama/pub/about-ama/our-people/the-federation-medicine/state-medical-society-websites.shtml , click on the link for your state AMA and contact them. Let them know that this proposal is unacceptable. Voting is next week.

Are you really overdue?

It is becoming routine for doctors to induce patients at 41.5 weeks in this area. Inductions have not increased favorable outcomes for women in the US. Is is possibly because 41.5 weeks isn't really 41.5 weeks? Read this article before you accept that you are "overdue."

http://www.associatedcontent.com/article/1047180/the_lie_of_the_edd_why_your_due_date.html

Meliea's recommended reading.........

I am often asked what books I would recommend for expecting and/or new moms. I thought this would be a great place to put my reading list!

Ina May's Guide to Childbirth by Ina May Gaskin

*This book is filled with beautiful birth stories. I have gleaned many tips for helping with different issues in labor from this book. I also like the chapter on episiotomy.

The Complete Guide to Pregnancy and Childbirth by Sheila Kitzinger

* All of her books are incredible but this one has very factual and statistical information to make moms to be feel more confident when talking to their doctors about electronic fetal monitoring, induction of labor for a postdate pregnancy, ultrasound technology and many other common issues that come up at dr. visits. There are also WONDERFUL photographs of positions for labor and the developing pregnancy. I carry this book in my birth bag.

The Thinking Woman's Guide to a Better Birth by Henci Goer

* This book is exactly what the title implies. It empowers moms to be to think carefully about all options and make informed decisions.

Birthing From Within

* This is a wonderful book for everyone, but especially for the mom who has had a traumatic physical event in her life(abuse, surgery, etc) or a previous traumatic or unsatisfying birth experience.

Gentle Birth Choices

* This book usually comes with a DVD with BEAUTIFUL births on it. Contains a lot of facts and figures as well as encouragement and comfort.

The Happiest Baby on the Block

* Read this BEFORE the baby comes and save yourself MUCH grief! This book helps parents understand their baby's behavior and learn to cope in positive ways. Also gives the famous 5 things to soothe your crying baby! This book helped me finally get my baby to nap.....two words....white noise!

The Vaccine Book by Dr. Sears(the son)

*Middle of the road, not to one extreme or the other facts and information about vaccines. Each vaccine is reviewed individually for it's purpose, side effects, efficacy, necessity and so forth. There is also a recommended alternative schedule for parent's who want to vaccinate, but not in keeping with the current guidlines.

The No Cry Sleep Solution by Elizabeth Pantley

*For mom's like me who couldn't have done the cry it out thing if you had paid me. Great information on all aspects of sleeping. This book saved my sanity....for real..... Again, recommended reading BEFORE the baby comes!

Feel the love, give the love....

February is love month. Many a October/November births will be made this month! :)

When I had my first 2 children in 1990 and in 1997, the process of caring for a newborn still included warnings about "spoiling" a baby. I have since done my research and realized that this is not possible. During the newborn phase, you are all that your baby knows. Transition to the world is not easy. If you've ever moved to a new city or state, or even a new neighborhood, remember how long it took to "get used" to your new environment. Your baby feels the same way.

Many a mom becomes overwhelmed when babies enter this transition phase. I hear many things like, "The baby will only sleep if he is being held." or "Unless I'm holding her or nursing her, she is crying." The babies on the commercials who sit in swings and bouncy seats cooing and watching their mom from afar are adopted alien babies! Your baby may do this when they are a little older, but not as a wee one.

Enter babywearing. Babywearing is strongly supported by the Attachment Parenting community. See a link from Dr. Sears: http://www.askdrsears.com/html/10/T130300.asp
Babywearing enables you to keep your baby close and secure while having 2 hands free! It produces a bond and a feeling of security for your baby. A more secure baby will usually equate to a less fussy baby. There are many different ways to wear your baby. Check out this site for an overview and parent reviews: http://www.thebabywearer.com/

My son is over a year old and I still wear him around the house. I don't know how I would get anything done if I didn't. I tell people my humorous story of having to take my older son to the doctor with baby in tow. I enjoyed tucking Jude into the sling(he was about 4 months old at the time) and keeping him unexposed to all the sick kids running around the waiting room. Upon leaving, I really needed to use the restroom. Thanks to my sling, I could use the restroom without having to worry about where to put the baby, or guiding a giant stroller into a small space. LOL It seems funny but at the moment, I couldn't have been more grateful for that sling!

For more information on babywearing and attachment parenting, see these websites:

http://www.kellymom.com/parenting/sling.html

http://babywearinginternational.org/

http://www.babycenter.com/2_baby-wearing-how-carriers-help-you-and-your-baby_1486841.bc

Let your baby be your most beautiful accessory!

A doula looks forward to a new year........

Being a doula means being in a constant state of learning. Every birth is different. Every woman is different. Just when you think you know something, you realize that there is so much more to learn.

This year, I plan to begin attending births as an apprentice with my midwife, in addition to continuing my doula practice. I am excited about this new chapter in my life. I want to serve the women in my community. This will mean more reading and studying.....which also means prioritizing my life.

Some wonder why I would choose such a path when Certified Professional Midwives are not legally recognized in NC. The answer is simple - someone has to do it. Right now, in the Charlotte area, the options for homebirth are limited to a few midwives who shoulder the load of this homebirth community. As the homebirth movement grows, so does the demand for qualified, competent midwives. Women deserve options. Women need options. I have a passion to give those options to them.

What does this mean for my doula practice? I don't intend to practice any differently. I will still continue to support women in the hospital setting. Standing for choice means I believe that a woman should be able to give birth in the place of her choosing, with the practitioner of her choosing.

I hope that somehow, in 2009, I can inspire women to embrace all of their choices. The only way the birth climate will ever change is if women refuse to allow it to remain as it is.......practitioner oriented. Women must demand that their needs be of the utmost importance, rather than the needs of the insurance company or a malpractice policy. I believe that this day is coming. I hope it is soon.