Category: Medical Model of Birth

Pain is Acceptable

December 22, 2009 | Filed under: Medical Model of Birth, Midwifery Model of Care, Pain Management | Tagged | Comments (0)

Why are we not allowed to accept pain in our lives? Hurt from another person, a headache, the pain of childbirth – if you want to accept grief from a broken relationship, try natural cures to your headache and especially if you want to work through labor pains on your own, you’re often considered by some to be a bit odd.

We need other words for pain. Pain is used to describe a hang nail and a broken neck, yet those are two totally different types of pain. Where are our 50 words for pain? There is certainly enough of it to warrant a richer language.

In a previous post about the differences between the midwifery model of care and the medical model: (http://fullmoonsdaughter.com/blog/2009/03/the-differences-between-technocratic-and-holistic-models-of-care) Robbie Davis-Floyd mentioned that in midwifery care pain is acceptable. Pain is not acceptable in the medical model.

It’s okay to be in pain. We learn a lot from our darkest hours. And birth is a time when a woman becomes a mother and learns that she could do anything. She learns to get out of her own way, speak her truth, open up and surrender to her own power. She feels her strength and is in awe of her will.

Labor is hard work and most women interpret the sensations of labor as pain. It is a joining force between women around the world to connect together and hold the power of creation and the Universe in their bodies.

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Epiduals and Lower Lumbar Tattoos

November 15, 2009 | Filed under: In the News, Medical Model of Birth | Tagged | Comments (4)

I found this topic quite interesting and wanted to share. It’s not something I have ever though of before. The complete article is posted below form The Unnecearean:

Robin Elise Weiss posted an article on About.com: Pregnancy & Childbirth about some anesthesiologists’ fears of administering epidural anesthesia to women with lumbar tattoos.

Some anesthesiologists have speculated that placing an epidural during labor through this tattoo may be dangerous. The theory is that if you place the epidural needle through the ink, the dye in the skin may enter the epidural space and cause infection or damage. Other doctors offer the advice that if the tattoo is healed and the ink is dry there is no cause for concern.

The truth is we really don’t know, as very few women have been studied. One recent study involved three women. You may still opt for epidural anesthesia if you are pregnant, you can even request that they avoid placing the needle through your tattoo. If you are at the planning stages for a tattoo, consider a different location if you feel this decision is one you’d prefer to avoid.

Mayo Clinic obstetrician Roger W. Harms wrote in his July 2008 Q&A article that “the exception would be if the tattoo covers a large area and is still “fresh” — meaning the involved skin is still healing” and added that “very few studies have looked at the risks of epidurals in women with lower back tattoos.”

Snopes.com lists the claim that women with lower back tattoos should not receive epidural anesthesia as “undetermined” in a February 6, 2006, post entitled Suffer to be Beautiful. Post author Barbara Mikkelson offered her theory on why medical professionals are playing God when it comes to women with lumbar tats.

Whatever the medical world ultimately determines as the truth about potential risk regarding the combination of sacral tattoos and epidurals, I can’t help but be struck by the parallels between the modern rumor about inked vixens having to give birth unbuffered by pain medications and the penalty visited upon Eve for leading Adam astray. Eve, the original bad woman, the vamp, was punished for her part in the “Have an apple, sweetheart” fiasco by being cursed by God on high with the pain of childbirth, with the whammy laid upon her passed down to all her descendents (that is, all womanhood). Lumbar region tattoos on women are seen as communicating hinted-at promises of sexual favors. The consequence visited upon both classes of temptress is the same: they shall each know the physical pain of birthing children.

On Our Bodies, Our Blog, Rachel noted that the widespread coverage of the topic of lumbar tattoos and epidurals following an article in the Wall Street Times in September 2007 “distract[ed] from ongoing conversations about the state of birth today, and how women can best receive safe, effective, and satisfying maternity care” and noted that the odds of ever getting any decent research on lumbar tattoos and epidurals is slim.

Ultimately, there is not enough information to suggest that women should not get lower back tattoos if they plan to eventually give birth with administration of an epidural, nor is there enough to suggest that women who have such tattoos cannot receive epidural injections. There is likely very little incentive to study the issue, given that there are few reports of complications and no obvious money-making drug or procedure to be developed, short of the already available tattoo removal

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Thinking Woman’s Guide to a Better Birth

June 10, 2009 | Filed under: Childbirth and Labor, Labor Doula in Portland, Medical Model of Birth, Midwifery Model of Care | Tagged , , | Comments (0)

Henci Goer is a medical author and activist who is able to deliver clear birth statistics and information that anyone can understand. Admittadely biased towards natural birth, this book provides mothers with information they could use to better understand the hospital systems they are working through during pregnancy and labor. Though the stats are a bit outdated, the philosophies behind them still hold truth.

Here are some great points that Henci makes:

~ Obstetric belief tends to become a self-fulfilling prophecy. It has been said that a healthy person is someone who hasn’t undergone enough testing by specialists.

~ Cesarean is the most common major surgical procedure performed in the United States.

~ Baby’s head fits neatly against the cervix like an egg in an egg cup. This prevents the umbilical cord coming down ahead of the baby and getting pinched between baby and mom’s pelvis.

~ Inducing for exceeding your due date is a textbook case of how mainstream obstetric care keeps narrowing the definition of normal until practically no one fits, which tends to create the “need” for intervention.

~ The conventual 40-week pregnancy length is completely is completely arbitrary. It was established by a German obstetrician in the early 1800’s. He simply declared that a pregnancy should last 10 moon months, this is, 10 months of 4 weeks each.

~ The uterus is most sensitive to Oxytocin at night, which is why labor usually starts at night.

~ Electronic Fetal Monitoring (EFM) is said to lower the risk of cerebral palsy or mental retardation because of oxygen deprivation during labor, but this is less than 10% of cases. Continuos EFM has become nearly universal since the 80’s and it it worked it should have affected the cerebral palsy rate by now, but it remains unchanged.

~ During cervical exams, moms should find out about state of cervix, how far baby is down, and baby’s position. Mom may be making important progress even though she isn’t dilating. As a labor doula this is information I always find out for mom.

~ Natural labor offers an unparalleled opportunity to discover inner resources, capacities, and strengths you never knew you possessed. And there is great value in such an experience.

~ Labor will hurt, probably a lot, but whether this is a negative experience is another matter.

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Ultrasound – What Every Mom Needs to Know

June 6, 2009 | Filed under: Medical Model of Birth, Ultrasound | Tagged | Comments (0)

 

~ Conclusive scientific evidence that routine (and by routine I mean scanning to see baby’s position at every prenatal in the last weeks of pregnancy, or 3-D ultrasounds to “meet your baby” in the womb) use of ultrasounds are safe does not exist. Its use is very familiar to the use of X-rays. 50 years went by assuming that X-rays were safe for pregnant women before hard lessons were learned. A textbook on prenatal care published in 1937 has this to say about X-rays: ”It has been frequently asked whether there is any danger to the life of the child by the passage of X-rays through it; it can be said at once there is none if the examination is carried out by a competent radiologist or radiographer”.

 

In 1978 that same textbook, after seeing the dangers of X-raying babies, revised its stance: ”It is now known that the unrestricted use of X-rays through the fetus caused childhood cancer”.
This mimics the current textbook view on ultrasounds: ”One of the great virtues of diagnostic ultrasound has been its apparent safety. At present energy levels, diagnostic ultrasound appears to be without injurious effect … all the available evidence suggests that it is a very  safe modality”.

~ Lancet, A current British medical journal, has this to say about Ultrasounds: “There have been no randomized controlled trials of adequate size to assess whether there are adverse effects on growth and development of children exposed in utero to ultrasound. Indeed, the necessary studies to ascertain safety may never be done, because of lack of interest in such research”.

~ The output of ultrasound plays a huge part in the affects on baby, however there are no controls in place as to what is a safe amount even though low outputs have been shown to be just as effective as high outputs.

~The skill of the technician performing the ultrasounds matters tremendously, yet there is no licensing or certification process for operators of the machines.

~Training midwives and doctors in the skills of palpation – using their own hands to feel baby’s position is just as effective as a machine. Not only is this low-tech and inexpensive, it also helps care giver and mom physically connect.

As an aside: I had a friend tell me of someone she knows who has gone through 2 pregnancies and the first time a care giver ever even touched her belly was well into the 2 pregnancy! I haven’t heard anything sadder since then in awhile.

Ask Ask Ask your caregiver why they are requesting an ultrasound. Ask what are the risks of an ultrasound. Ask what research their answer is based on. And then ask what are the risks of not getting an ultrasound. You may be surprised at the answers.

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The Active Management of Labor

June 1, 2009 | Filed under: Medical Model of Birth, Midwifery Model of Care | Tagged | Comments (0)

http://www.birthinternational.com/articles/wagner01.html

 

 

The above link takes you to an excellent article written by Marsden Wagner. He started out as a neonatologist and is now a consultant for WHO. He fully supports natural birth, midwives and midwifery and you may have seen him in birth movies – he’s the over-educated elfin guy who is fun to listen to.

 

I’ve jotted some highlights from the article and added my own thoughts on it.

 

From my own personal experience, I agree that most health care providers no longer know what a non-medicalized birth is. Their training rarely covers natural hospital births and almost never brings the medical student into a free-standing birth center or home to observe birth.

As a result of lack of exposure to natural birth, hospital staff often believe that labor is something that happens to women rather than something women do that can be empowering and a rite of passage. Because labor is involuntary and unpredictable, many doctors and nurses interpret that as birth being out of control.

It’s sad to read the example of a hospital considering birth normal even if it includes an amniotomy, induction, augmentation, epidural or episiotomy. I feel that the list can go on to include continuous fetal monitoring, IV, withholding of food, drink and privacy, numerous cervical checks and disregard to birth preferences. What is even sadder is that most women today have accepted those same standards and also believe that birth with serious intervention is normal.

I found it interesting to read how the clock has quickened. Marsden states that the definition of the normal upper limit to labor has been reduced from 36 hours in the 1950s to 24 hours in the 60s and now holds steady at 12 hours since 1972, when active management was introduced. He also mentions that these random times were based on clinical concerns and not scientific evidence. With this scenario on hand, women adjust to the hospital and not the other way around.

My head was shaking when Marsden compared active management to inventing cars that can be driven too fast and then when the speed causes accidents, rather than change the cars, we invent speed bumps and as a result of the speed bumps people hit their heads on the car ceiling and we give them pain medication.

I think a better comparison would be the creation of entire task forces whose job is to monitor speeders and catch them in the act so they can then ticket them and make money from their speeding. That feels similar to hospitals making money from highly medicalized births.

Marsden concludes that hospital staff can never tell a woman that a certain procedure is safe because that person is not taking chances. A safety determination can only be made by the one accepting the procedure and that is the woman taking the chance.

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The Differences Between Technocratic and Holistic Models of Care

March 26, 2009 | Filed under: Medical Model of Birth, Midwifery Model of Care | Tagged , , | Comments (0)

Robbie Davis-Floyd is a medical and cultural anthropologist who has written extensively on the differences between the hospital (technocratic) model vs. the holistic (midwifery) model of care for childbearing women.

Below is a table Robbie put together, that Anne Frye published in Volume 1 of Holistic Midwifery, that I’d like to share with you. It simply lays out the differences, as she sees them, between the technocratic (T) and holistic (H) models for women seeking care during their childbearing year.
I’m taking the time to post this because I have yet to find such an extensive, starkly honest and accurate listing. When I first read this I was both shocked and relieved to see it all on paper in one place. Of course, this list doesn’t fit every doctor or midwife, but it feels fairly accurate to me. I hope you enjoy.
T: Male-centered
H: Female-centered
T: Women = objects
H: Women = subjects
T: Male body = norm
H: Female body = norm
T: Female = defective male
H: Female is normal on her own terms
T: Classifying, separating approach
H: Holistic, integrating approach
T: Mind is above & separate form body
H: Mind & body are one
T: Body = machine
H: Body = organism
T: Female body = defective machine
H: Female body = healthy organism
T: Female reproductive process dysfunctional
H: Female reproductive process healthy
T: Pregnancy & birth inherently pathological
H: Pregnancy & birth inherently healthy
T: Doctor = technician
H: Midwife = nurturer
T: Hospital = factory
H: Home = nurturing environment
T: Baby = product
H: Mother/baby inseparable unit
T: Baby grows itself through mechanical process
H: Connection between growth of baby and state of mother
T: Fetus is separate from mother
H: Baby & mother are one
T: Safety of fetus pitted against emotional needs of mother
H: Safety of baby and emotional needs of mother are the same
T: Best interested of mother and fetus antagonistic
H: Good for mother = good for baby
T: Supremacy of technology
H: Sufficiency of nature
T: Importance of science, things
H: Importance of people
T: Institution = significant social unit
H: Family = essential social unit
T: Action based on facts, measurements
H: Action based on body knowledge, intuition
T: Only technical knowledge is valid
H: Experiential & emotional knowledge valued as highly as or more than technical knowledge
T: Best prenatal care is objective, scientific
H: Best prenatal care stress subjective empathy, caring
T: Health of baby during pregnancy ensured through drugs, tests, techniques
H: Health of baby ensured through physical & emotional health of mother & her attunement to the baby
T: Labor = a mechanical process
H: Labor = a flow of experience
T: Time is important, adherence to time charts during labor is essential for safety
H: Time is irrelevant, the flow of the woman’s experience is important
T: Birth must occur within 24 hours
H: Labors can be short or take several days
T: Once labor begins it should progress steadily; if it doesn’t pitocin necessary
H: Labor can stop and start, following it’s own rhythms
T: Some intervention is necessary in all births
H: Facilitation (proper food, effective positioning, support) is appropriate, interventions are usually inappropriate
T: Pain is unacceptable
H: Pain is acceptable
T: Analgesia & anesthesia for pain during labor
H: Mind/body integration, labor support for pain
T: Environment is not relevant
H: Environment is the key to safe birth
T: Uterus = involuntary muscle
H: Uterus = responsive part of whole woman
T: Woman is hooked up to machine with frequent exams by staff
H: Woman does what she feels is appropriate
T: Once a surgical birth always a surgical birth for most woman
H: VBAC is normal
T: VBAC = high risk
H: VBAC = low risk
T: Cesarean for breech presentation or twins
H: Squatting or hands and knees for breech, twins often born via the birth canal
T: Birth = a service medicine owns and supplies to society
H: Birth = an activity a woman does that brings new life
T: Obstetrician = supervisor, manager, skilled technician
H: Midwife = skillful guide
T: Doctor is in control
H: The midwife supports, assists
T: Responsibility belongs to the doctor and the system
H: Responsibility is the mother’s 

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Is the Medical Model of Birth Really Better – Guest Writer Colleen Mahon-Haft

February 2, 2009 | Filed under: Medical Model of Birth | Tagged , | Comments (0)

 


Since the 1940s and 1950s, the maternity care system in the United States has overwhelmingly involved hospital births and an increasing number of surgical and drug-related interventions, making birth a highly medicalized event.  With this paradigm shift towards use of our advanced medical technologies and well-trained doctors, why does the United States not have better maternal and neonatal outcomes? 

 

The use of hospitals in the United States for childbearing started in the early 19th century for women who did not have suitable homes. In 1900, less than 5% of women gave birth in hospitals (Starr1984).  The proportion of births occurring in hospitals rose from 37% in 1935 to 97% in 1960, and reached 99% by the 1970’s (Rooks, 1997). By the 1940’s, the standard was set, and hospital births became the cultural ideal. The idea was that at the hospital the doctor had all the “tools of the trade” readily available. Unfortunately, this was and continues to be a major downfall of hospital birth. Included in those tools were medications, forceps, surgical instruments, confinement to bed, enemas, pubic shaving, arm and leg restraints, and hospital nurseries with rigid schedules. Birth came to be seen as an illness that required medical attention.

 

  • The modern medical way of birthing is not producing better results; it is interfering with the instinctual process of birth. The World Health Report (from the World Health Organization) indicates that the neonatal death rate (death in the first twenty-eight days of life) is greater in the United States than in thirty-five other developed countries (WHO 2005).
  • The maternal mortality rate in the U.S. is the highest it has been in decades, according to statistics released by the Center for Disease Control (Hamilton et al 2005). According to the figures, the U.S. maternal mortality rate was 13 deaths per 100,000 live births in 2004. In 2006 a shocking one in 4,800 U.S. women dies from complications of pregnancy or childbirth (United Nations 2006).
  • The U.S. ranks 41st out of 171 nations, behind even some nations without similar technology and resources, such as South Korea. Despite our enormous wealth and highly advanced technology, the United States lags far behind most other industrialized countries, and even some developing nations, in providing adequate health care to women during pregnancy and childbirth. 

In countries where laboring mothers are not subjected to the medical model, the maternal and neonatal death rates are significantly lower. In the five European countries with the lowest infant mortality rates, midwives (who practice holistic care) preside at more than 70% all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland’s maternal and infant mortality rates are far lower than in the United States (Otis 1990). The United States has more neonatologists and neonatal intensive care beds per person than Australia, Canada and the United Kingdom, but the newborn death rate in the U.S. is higher than in any of those nations (Lawn, et al 2005).  

The international standing of United States (in terms of infant mortality rates) did not begin to fall until the mid-1950s. This correlates perfectly with the founding of the American College of Obstetricians and Gynecologists (ACOG) in 1951. ACOG is a trade union representing the financial and professional interests of obstetricians who has sought to secure a monopoly in pregnancy and childbirth services. Prior to ACOG, the U.S. always ranked in 10th place or better. Since the mid-1950’s the U.S. has consistently ranked below 12th place and has not been above 16th place since 1975 (Stewart, 1993).


Today in the United States, not only do nearly all births take place in a hospital, but they often involve unnecessary medical procedures that can actually make the natural birth process more dangerous. Women are wheeled in to “labor suites” where they are hooked up to machines, strapped with monitors, given (usually) unnecessary intravenous fluids, and put “on the clock.” 

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Home and birth centers definitely have opponents, but the statistical evidence states that if you are a healthy low risk woman, having your baby in a hospital is riskier than home or birth center. One set of midwives in Tennessee had 2,028 planned homebirths from 1970 until 2000.  Ninety-eight percent of them delivered vaginally with a 1.3% emergency transport rate and a 1.4% Cesarean rate (Gaskin 2002).


There is not a hospital in this country with numbers as low as that. Why? Because the midwives let birth happen. They do not rush to induce, they do not perform unnecessary tests, they just let the mother birth her baby, and the majority of the time, it is uncomplicated and not a medical event. The paradigm shift towards medical birth is hurting this country, and unnecessarily killing and injuring many women and newborns each year.  






 

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