vaccines, homebirth safety, birth center legislation

to be edited and fluffed out shortly

i believe i've posted about this before but heres a reminder.

"The American Association of Birthing Centers (AABC) is seeking federal legislation that would add freestanding birth centers to the list of health professionals and providers eligible for payment under the federal-state Medicaid program. ... Next week, AABC’s bill will be introduced in the U.S. House of Representatives by Rep. Susan Davis (D., CA) (San Diego). It will then be assigned a bill number and an official name. ... AABC is asking all birth professionals, birth advocates, and supporters of improving maternity care to help us lobby for this bill. Grassroots support phone calls to Congress is the single most important element in whether a bill like this becomes law. " more info to be found here http://cfmidwifery.blogspot.com/2009/04/grassroots-network-action-alert-help.html the bill is being introduced THIS WEEK!!!


also several of my favorite blogs have been talking about vaccines lately. so i'm researching the issue further myself. this is where i'm starting. http://www.fourteenstudies.org/index.html because this is, well i'm not sure i'd use the words anti-vax, but at least somewhat antagonistic towards the status quo re vaccination, i'm including a link to the cdc's site also http://www.cdc.gov/vaccines/ . there is so much to learn on this topic i honestly just quit researching after a certain point. but i feel like its time to re-open the topic.


and pinkyrn has been wondering if more folks are choosing homebirth and wondering about the safety compared to hospital birth. see this post
http://pinkyrn.blogspot.com/2009/04/home-birth-are-more-folks-choosing-this.html to which i posted a comment " i agree that birthing alone is outside of evolutionary and cultural norms though i can't make up my mind as to the actual risk involved. i do think if a woman chooses an unassisted birth she has a responsibility to have a back up plan for emergencies. she needs to take the time to read some resources in addition to internet forums and message boards, have an idea as to what constitutes a reason to transfer, an idea how to accomplish a transfer if one is needed, etc. that said attended childbirth can be just as safe as hospital birth and thats based on research. essentially the same conditions should be in place as i would expect for uc...but the presence of a midwife who knows what to look for in identifying emergencies and ideally has some medical back up herself, can make that back-up plan much more likely to function safely. regardless of what kind of homebirth a woman chooses i think she should consider her own health, anything that would risk her out of a midwife attended homebirth in most instances is at least worth researching, yk. also to be considered: ease of transport, distance to hospital, traffic, what kind of reception will she recieve at the hospital, etc....i think i have so much to say on this topic i'm going to steal my comment and post it on my blog :)
April 28, 2009 7:52 PM " and this " i forgot to come back and link any research re safety though i guess thats been covered because i was primarily refering to the new dutch study which yes is a different climate than the us in many ways. what is different about the dutch system? mmmm.... midwifery model is more prevalent, much better more centralized, standardized transport system, i'm not sure what else....maybe socialized healthcare has something to do with it? problems may be caught earlier even in low income women? in the us i think low-income is something of a risk factor whereas it wouldn't be there. i'm just speculating on that though. re wether or not more people are doing it i don't have full text on this but " In 2006, there were 38,568 out-of-hospital births in the US: 24,970 were home births and 10,781 occurred in free standing birthing centers [5]. From 1989 to 2003 the rate of home births in the United States declined from 0.69 to 0.57 percent of births, or by an average of 0.01 percent annually. The 2006 figures represent a very slight increase in both absolute numbers and rate, reaching 0.59 percent of all births [5]. This rate is comparable to that in other industrialized countries with two exceptions: England has experienced a slight rise in its home birth rate from 1.0 percent in 1989 to 2.7 percent in 2006 [6], while the Netherlands has maintained rates of home birth of approximately 30 percent [7]." http://www.uptodate.com/patients/content/topic.do?topicKey=labordel/15656 in the same summary i found this interesting in regards to safety "Mothers who had a home birth were ... much more likely to report not having had prenatal care. Such women could include unplanned, emergency home births, as well as mothers who wished to avoid traditional prenatal care." which does go along with my speculation as to why it may not be as safe here. according to this article in the ny times midwives in ny are getting more calls for homebirths http://www.nytimes.com/2008/11/13/garden/13birth.html i think that just goes to show more news coverage of homebirth though...
May 3, 2009 11:08 AM"

and congrats to rixa at stand and deliver! http://rixarixa.blogspot.com/

ican conference friday

i had such a good experience friday. i learned so much.

the most poignant thing was when they asked everyone in the room who had had a cesarean to stand up...it was just a very visual reminder of the epedemic we are facing in this country.

when sara buckley was talking about the hormones involved in birth it went along so well with what i learned in my lactation class.

of course i got home from work today and had a ton of books on my reserve list at the library...get a little aknowledge and i just gotta have more!

i've got to get better at glad-handing and networking though....i wish i had bid on the buisiness cards at the silent auction

vit d, response to the case against breastfeeding, call for public comments on breastfeeding

so now they're linking vitamin d deficiency with the increased rate of cesarean....

http://www.medscape.com/viewarticle/585864?src=mp&spon=16&uac=89759SZ

http://www.nytimes.com/2008/12/30/science/30baby.html heres a post from amy at birthing with confidence that gives some additional critique to the study.

http://www.givingbirthwithconfidence.org/?p=246 (i loved everything i read on this blog btw....it was a new one to me but now on my favorites list) i'm no expert at reading or critiquing scientific studies, but it seems to me that good nutrition during pregnancy is common sense. http://www.jhsph.edu/wchpc/publications/MCH-Summ.-6.pdf

are women more likely to be d deficient now? maybe since we're supposed to wear sunblock all the time.....i learned in my lactation class that 20 minutes in the sun was good for, well i don't remember the exact figure but quite a lot of vit d. and whats more it can be split up over the course of a day.

heres a reply to the case against breastfeeding that i really liked

http://www.chicagotribune.com/news/local/chi-bd-triage-breastfeeding-05-apr05,0,1912282.story obviously i'm pro breastfeeding. actually like i said to my dad (in reference to nursing in public ) " no body is really against breastfeeding are they?" and i think rosin really should have written a different article......maybe the case against promoting breastfeeding without also protecting and supporting it?

but i do agree that breastfeeding doesn't have to be an all or nothing thing....at least after a while. once you get a good supply established, good latch, all the basics....if it will really make that much difference to your own health and well being to use an alternate feeding method sometimes, well mama's health and happiness is directly realted to her babies health and hapiness. thats why its called the mother baby dyad.

speaking of breastfeeding health and human services has issued a call for public comments http://www.blsmeetings.net/owh_call_to_action_on_breastfeeding/

heres some unsurprising news related to women and health insurance

http://www.mercurynews.com/topstories/ci_12159324 i was just talking with a customer at work about basically this very subject. she paid $60 out of pocket for bcp....not coincidentally her company does not offer paid maternity leave either....

and heres a new study about birth control pills http://www.eurekalert.org/pub_releases/2009-04/aps-oci041509.php

it shows that bcps reduce muscle mass gain. interesting stuff considering how common use of oral contraceptives is. http://www.infoforhealth.org/pr/a9/a9chap2.shtml

chinese research, other news....

had to pass this on though you may have to create an account to read the full article http://www.washingtonpost.com/wp-dyn/content/article/2009/04/12/AR2009041200967.html?wpisrc%3Dnewsletter&sub=AR

heres a quote

"In a provocative set of experiments involving mice, Chinese researchers have shown for the first time that an adult mammal can harbor primitive cells in her ovaries that can become new eggs and produce healthy offspring, they reported yesterday.
While much more research is needed to confirm and explore the findings, the work raises the tantalizing possibility that it could someday lead to new ways to fight a woman's biological clock, perhaps by stockpiling her egg-producing cells or by stimulating them to make eggs again. "

and heres a story that made me mad!

http://ipost.com/rd/9z1zlbv7p4l88e01oi0abmaa158n16h17hkrvts4mdg

as you probably know last year marked the highest number of births in the us ever. now i'm a pretty big environmentalist....i recycle, buy used, cloth diaper, etc but the joy of children far outweighs any environmental consequence in my mind....

and heres another risk of c-section deliveries....asthma
http://thorax.bmj.com/cgi/content/abstract/64/2/107

and heres something that pops up from time to time in my inbox the "natural" cesarean http://www.timesonline.co.uk/tol/life_and_style/health/article6028478.ece

can't say how i fee labout this as i've never had a section and wouldn't plan one .... i'd imagine some of these changes would be difficult to enact in an emercency cesarean, on the other hand some necessary cesareans are planned and anything to bring the experience closer to birth and further from surgery would seem to be a good thing

so i guess thats it for cleaning out my inbox :lol for now anyway :lol

still stuck on maternity leave

well i'm still reading about maternity leave though i've realized that as primary breadwinner in my family a lot of what is out there doesn't apply to me....

not necessarily specifically re maternity leave but related things like sick leave....which i rarely use b/c if the kids are sick, well the hubster is home anyway so its not like i have to stay home

but before i get into all that, and even though io know everybody else in the birth community has already posted a link http://www.mama-is.com/the-birth-story-of-ean-campbell/ CONGRATS HATHOR!!!!

and a shout out to a new blog i just found that i really like http://breastandbellyblog.blogspot.com/



i found this " In an analysis of institutional factors that compel
employers to offer paid maternity and paid sick leave, sociologists Doug
Guthrie and Louise Marie Roth found that “pregnancy leave is tied to sick leave
policies within many U.S. organizations as a result of pregnancy legislation in
the 1970s and 1980s.”36 Based on a survey of more than 700 organizations, the
authors found that the percentage of women in an industry had no significant effect on paid maternity leave policies, but did have a significant effect on the probability that a firm offered paid sick leave.37 As a result, without paid sick leave, most low-income women are left with little or no paid time off after the birth of a child, and women tend to be concentrated in certain industries, like the service industry, that provides disproportionately few benefits.38"

thats from "women in the workplace: which women? which agenda?"

next on my reading list is a report from the commission on the fmla act of 1993
http://digitalcommons.ilr.cornell.edu/cgi/viewcontent.cgi?article=1002&context=key_workplace

eventually i'll move on from this topic and back to birthy business.....though really maternity leave is pretty relevant....i assume most of us don't want to go back to work within hours of having a baby

remeber the womens basketball coach who was hailed as some sort of hero when she was out coaching literally hours after a birth?
http://www.redorbit.com/news/oddities/868545/coach_at_game_hours_after_giving_birth/index.html

anyways real life is calling....

the continuing saga of maternity leave in the us

despite being distracted by some of my favorite blogs http://pinkyrn.blogspot.com/ and http://momstinfoilhat.wordpress.com/ i am plugging through the reports i linked to yesterday

so far i've learned that most women work well into the 3rd trimester.

i'm personally probably working through to the day i start labor even though i know recent studies suggest taking off at least 2 weeks prior to the due date decreases the chances of cesarean delivery and longer maternity leaves tend to increase the duration of breastfeeding

speaking of breastfeeding heres yet another reply to the case against breastfeeding (thank's mom's tinfoil hat ! ) http://mothering.com/guest_editors/quiet_place/quiet_place.html

and yet another linkie-poo to thank mom's tinfoil hat for:
http://www.birthcenters.org/legislative-alerts/index.php?id=16
this one is a letter supporting birthcenter legislation that i am so going to forward to all the docs in town

but now family calls and my reading and posting must wait....and i have to work the weekend so it may be a while...

maternity leave

so i'm followng up on the state of maternity leave, especially here in the us where i am though i plan to throw in some comparisons with other countries

first thing to catch my attention from my google search was this http://www.census.gov/prod/2008pubs/p70-113.pdf

how about that? a whole paper on the very topic i'm researching! and credible too since its from the census bureau :)

haven't read the whole thing yet but did just find this nugget

" The Family and Medical
Leave Act of 1993 (FMLA) mandates
up to 12 weeks of unpaid
leave for childbearing or family
care over a 12-month period for
eligible employees. Studies so far
have found little evidence that
such laws have increased the
amount of leave women take by
any considerable amount. 14"

wonder what the studies would show if the act mandated paid leave?

and i just found another paper i have to read entitled "Women in the Workplace: Which Women, Which Agenda?" written by Michael Selmi and Naomi Cahn

it appears to adress the fact that much of the policies, proposals and actual legislation serves the interests of professional women who can afford the income trade offs generally inherent in maternity leave policies

i pulled it up as a pdf and can't figure out how to link to it directly buts its the 5th link here http://www.google.com/ie?q=Wen-Jui+Hen+and+Jane+Waldfogel+Parental+Leave%3A+The+Impact+of+Recent+Legislation+on+parent%27s+leave+taking&hl=en&btnG=Search

i'll have to come back to this later tonite though....

note to self for brain acronym

b = benefits
r = risks
a = alterntives
i = instincts
n = doing nothing

great tool for decision making during labor and birth

family planning

i'm starting with a link to a n article from the san francisco chronicle http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/03/24/MN9416HD33.DTL

and also this http://momstinfoilhat.wordpress.com/2009/01/27/692/ and this http://momstinfoilhat.wordpress.com/2009/04/06/reply-turned-post-ive-heard-this-song-before/
from moms tinfoil hat

i'm not sure why the big whigs think not covering maternity and family planning services will save money?

re family planning, how many unintended pregnancies are the result of a lack of access to affordable family planning?

according to the guttmacher institute's report Abortion in Women's Lives ( http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdf ) "Most U.S. couples want only two children. To achieve this goal, the typical woman spends roughly five years pregnant, postpartum or trying to become pregnant and three decades trying to avoid unintended pregnancy.1 "

thats 30 years of using some form of bc...and i only know of one methods thats free and charting your cycles and remaining abstinent during your fertile times is just not workable for all women all the time...

i just read thAT for every dollar spent on family planning we save 4$ on later use of social services....can't find anything to back that up just yet but it sounds good

as an aspiring midwife i don't always agree with acog but heres something they got right and this is from last year

http://www.acog.org/from_home/publications/press_releases/nr05-08-07-2.cfm

i think i'm going to have to expand and to tackle maternity coverage later as it is getting late....

birth plans

today i want to talk about birth plans. i know the idea of a birth plan is somewhat controversial in birthing circles.....pam england (birthing from within) is not a fan although other than this http://www.truebirth.com/2008/03/the-birth-plan-trap/ i can't find much via google that goes into the cons of writing a birth plan theres this http://community.livejournal.com/trustbirth (scroll down to the very last entry) which doesn't specifically adress birth planning but does discuss the ways in which some hcps might try to change your plans....

i think really the thing that would be bad would be relying on a birth plan that you haven't gone over with your care provider rather than actually communicatng with said hcp

i think a birth plan is a great tool for figuring out how you envision your birth going and lots of people have already written a lot on that subject

a birth plan is really just a jumping off point to start doing your own research....presumable after choosing a provider who is already aligned with your general birth philosophy, someone who practices evidence based medecine etc

alot of what i'm reading as i look into this are posts from moms who were dissapointed that they made a birth plan but didn't have the birth go according to plan. there seem to be 3 main reasons this happens

1. unanticipated medical issue (in some cases an emergency, in other cases not)
2. hcp who have had their fingers crossed when they signed off on the birth plan
3. hospital policy

not too much you can do about the first assuming a non-preventable situation like say a prolapsed cord or something

the other two though....

i personally suggest researching your hcp before you start writing up a birth plan. finding out section rates seems to be the preliminary question. i called around town and rates vary from %30 to %9 where i am. (of course the birth center an hour and a half away has about a %4 rate so guess where i'm going :> )

not only should you research your individual ob or midwife but also the place of delivery which may have its own set of protocols in place

you can look at the mother and baby friendly hospital initiatives for more info as to what numbers to be asking about in terms of place of birth

http://www.motherfriendly.org/pdf/Having_a_Baby-English-8_5x11.pdf

also i'd be sure to have the hcp sign off on anything that goes against the typical standard of care for your chosen birth place and have it on file with the birthplace as well as brinbging a copy witrh you

as to figuring out what your birth philosophy is i found this post got me thinking http://labortrials.wordpress.com/2008/01/29/trust-birth-or-dont/

hth somebody....

April is Cesarean Awareness Month

First off from my inbox today, courtesy nursingbirth at http://nursingbirth.wordpress.com/2009/04/03/top-8-ways-to-have-an-unnecessary-cesarean-section/ top 8 ways to have an unecessary cesarean. this is an addition to the top 7 ways to have an unecessay cesarean found here http://www.faintstarlite.com/2009/03/top-7-ways-to-have-an-unnecessary-c-section/

have to say i agree with every single point made

have to give the flipside though and let you know how to avoid an unecesarean....

1 labor at home as long as possible
2 eat and drink as needed during labor

did you know a recent study suggests that eating and drinking lightly during labor is ok?http://www.bmj.com/cgi/content/full/338/mar24_2/b784

3 labor in whatever position you want too
4 push when and how you feel like it
5 birth at home or in a freestanding birth center

see this study for homebirth cesarean rates http://www.bmj.com/cgi/content/full/bmj;330/7505/1416
and this from citizens for midwiferyhttp://www.cfmidwifery.org/pdf/cesarean2x.pdf

those are just off the top of my head

i'm sure there are more..... post your best tips on the comments