June 30, 2009

Doctors beginning to realize that induction is a big mistake

The wall is beginning to crack.  More and more evidence is piling up that all the inductions in the past 20 years for bogus reasons (like oligohydramnios, pregnancy of 41 weeks and gestational diabetes) have harmed women and babies.  Of course, the obstetricians would never apologize for this bloodbath.  Here’s the latest “study of the studies”–keep in mind that even the biggest, most carefully done studies are suspect in their methodology but, at least this one firmly denounces a number of the favourite reasons for inducing.  Gloria

_______________________________________________________________

Indications for induction of labour: 

a best-evidence review

 

E Mozurkewich,a J Chilimigras,a E Koepke,a K Keeton,a VJ Kingb 

a Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA 

b Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA 

Correspondence: Dr E Mozurkewich, F4835, PO Box 0264, Mott Hospital, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0264, USA. 

Email mozurk@umich.edu

 

Accepted 2 November 2008. Published Online 4 February 2009.

 

Background Rates of labour induction are increasing.

 

Objectives To review the evidence supporting indications for 

induction.

 

 Search strategy We listed indications for labour induction and 

then reviewed the evidence. We searched MEDLINE and the 

Cochrane Library between 1980 and April 2008 using several terms 

and combinations, including induction of labour, premature 

rupture of membranes, post-term pregnancy, preterm prelabour 

rupture of membranes (PROM), multiple gestation, suspected 

macrosomia, diabetes, gestational diabetes mellitus, cardiac disease, 

fetal anomalies, systemic lupus erythematosis, oligohydramnios, 

alloimmunization, rhesus disease, intrahepatic cholestasis of 

pregnancy (IHCP), and intrauterine growth restriction (IUGR). We 

performed a review of the literature supporting each indication. 

Selection criteria We identified 1387 abstracts and reviewed 418 

full text articles. We preferentially included high-quality systematic 

reviews or large randomised trials. Where no such studies existed, 

we included the best evidence available from smaller randomised 

trials and observational studies.

 

 Main results We included 34 full text articles. For each indication, 

we assigned levels of evidence and grades of recommendation 

based upon the GRADE system. Recommendations for induction 

of labour for post-term gestation, PROM at term, and premature 

rupture of membranes near term with pulmonary maturity are 

supported by the evidence. Induction for IUGR before term 

reduces intrauterine fetal death, but increases caesarean deliveries 

and neonatal deaths. Evidence is insufficient to support induction 

for women with insulin-requiring diabetes, twin gestation, fetal 

macrosomia, oligohydramnios, cholestasis of pregnancy, maternal 

cardiac disease and fetal gastroschisis. 

Authors’ conclusions Research is needed to determine risks and 

benefits of induction for many commonly advocated clinical 

indications.

 

 Keywords Best evidence, indications, induction. 

Please cite this paper as: Mozurkewich E, Chilimigras J, Koepke E, Keeton K, King V. Indications for induction of labour: a best-evidence review. BJOG 2009;116:626–636

June 30th 2009 Posted to Holistic midwifery & doula education, VBAC Very Beautiful & Courageous

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June 29, 2009

My people at the Chicago Pride Parade 2009

June 29th 2009 Posted to Intactivism, Inspiring people

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The Woman at the Helm of NOCIRC.org

Forest Knolls woman heads effort to stop circumcision

Richard Halstead  Posted: 06/27/2009 06:25:55 PM PDT 

Forest Knolls resident Marilyn Milos, who started the nonprofit National Organization of Circumcision Information Resource Centers, stands among research and case files gathered during her 30-year crusade against circumcision after she witnessed the procedure while working as a young nurse at Marin General Hospital.

Marilyn Milos, 69, of Forest Knolls was a nurse at Marin General Hospital in 1979 when she witnessed her first circumcision. The experience changed her life. After researching the procedure, she became convinced it was not only unnecessary but harmful. She says she was later fired from her job for sharing her opinions with patients and has spent the last 30 years crusading against circumcision as founder of the nonprofit National Organization of Circumcision Information Resource Centers.

Q: What do you remember about that first circumcision? 

A: As we walked into the nursery, the baby was strapped down to a plastic board. I called it “the rack” when I worked there. The baby was pulling against the restraints. Then the doctor started to cut and that baby let out a scream I’ve never heard come out of the mouth of a human, ever, and it became louder and louder. My bottom chin began to quiver and then tears poured over my eyes, and the doctor looked at my face and said, “There is no medical reason for doing this.”

Q: How did your supervisors at Marin General react when you started questioning circumcision? 

A: They told me to keep my mouth shut because a couple of patients were upset that I’d told them what was going to happen to their babies. I said, “Well, the baby’s a patient. No one is more upset than he is.” It was my job as a nurse that when parents signed that consent form that they were truly informed.

Q: What is so important about the foreskin? 

A: It covers and protects the urinary meatus so the urinary tract maintains its sterility, and it’s the skin that accommodates the full erection. Circumcision is one of the reasons that men complain of tight erections, painful erections and curvature of the penis.

Q: Does circumcision reduce male sexual pleasure? 

A: Well, if you cut off 20,000 to 70,000 highly erogenous, specialized nerve endings, what would your guess be? All those nerve endings are the accelerator that allows a man to ride the wave to orgasm the way a woman does. Without them, the accelerator is replaced with an off/on switch; “Oops honey sorry, it’s because I’m so sensitive.” It’s not because you’re so sensitive. It’s because somebody did this to you. Somebody removed your accelerator. Men should be so pissed off about this.

Q: What is the long-term effect of the glans’ exposure? 

A: Initially, premature ejaculation occurs because there is no control. Later the denuded glans becomes dry, hardened and calloused. By their mid-40s, men are saying, “The head of my penis is numb. There is no sensation there.”

Richard Halstead can be reached at rhalstead@marinij.com 

 

June 29th 2009 Posted to Intactivism, Inspiring people

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June 26, 2009

Leave your son’s foreskin alone

WARNING TO PARENTS:
PREMATURE, FORCIBLE, FORESKIN RETRACTION OF INTACT BOYS — AN EPIDEMIC

by John V. Geisheker, J.D., LL.M.
Executive Director, General Counsel

In my capacity as the Executive Director of Doctors Opposing Circumcision, an international physicians’ non-profit, I field around three anguished complaints each week from parents of intact (not circumcised) boys whose foreskins were forcibly retracted by ignorant medical practitioners. Premature, forcible, foreskin retraction (PFFR) is a much more painful, serious, and potentially permanent injury than most parents imagine. It is also epidemic in English-language medicine (though apparently not elsewhere).  I speculate that only one in 1,000 cases in N. America comes to our attention. Indeed many parents have no idea their child was injured or why. That might mean as many as 150,000 cases in the USA each year, but no one knows for sure.
 

Here is a typical incoming email. (For reasons of HIPAA protection of our parents, this complaint is a composite, details changed, but it is very typical).
 

“Dear Mr. Geisheker,

I have read on a mothering website that you handle complaints about retracting the foreskin of little boys. We kept our boy, Ethan, now six months old, intact because we know circumcision is unnecessary, painful and risky. Last week during a routine doctor visit, and before I could stop him, our pediatrician, Dr. ‘Paul,’ peeled my son Ethan’s foreskin back all the way.  It happened so fast there was nothing I could do.
 

“Ethan screamed instantly, cried for hours, and has been restless and fussy ever since. There are now small circles, like cracks, around his foreskin, which ooze blood. His whole penis is red and swollen. Ethan is now unusually fussy as soon as his diaper is wet, and we think it must sting when he urinates. He screams when we change him or the diaper touches his penis.  It just breaks my heart to hear him. He had no problems at all before this doctor visit.”
 

“Dr. Paul told us that we must pull Ethan’s foreskin back this way every day or at least at every bath, to prevent what he called ‘adhesions’ and to clean out the smegma that builds up there. He said that if we don’t, our boy will need to be circumcised for sure.”
 

“Is all this necessary? I can’t believe you need to hurt a boy to keep him clean. It makes no sense to me and I am very angry at what happened to Ethan. He was a very happy baby before this.”
 

“Please help us.”
Signed,
Sad Mom of Beautiful Ethan
***********************

What happened to ‘Ethan’ in this composite anecdote (my three cases each week all have similar heart-breaking details) is an unmitigated, inexcusable disgrace, indefensible medical malpractice, and a clinically unnecessary (and illegal) injury to the child. ‘Mom of Ethan’ has exactly the right instincts, and with good reason.
 

Forced retraction is only rarely defensible. Inguinal hernia, undescended testicle, hydrocele, and varicocele can all be addressed without forcible retraction. The penis should be repositioned for any necessary intervention with sterile tape, not by inserted hemostat. Catheterization can be done by ‘feel,’ without retraction. Only in the instance of significant hypospadias or epispadias (congenital malposition of the urethral opening) might retraction be necessary and, even then, only if it is unavoidable collateral damage for which there should be specific follow-up care.
 

[D.O.C. follows up all such complaints with a footnoted 10-page letter to the physician or nurse, detailing the correct medical protocol, and if the parents agree, a formal complaint to their state licensing authority we are only too happy to file.]

This post is the beginning of a much longer, more detailed article on the D. O. C. website by John Geisheker.    

  

 

 

 

 

June 26th 2009 Posted to Intactivism, Newborn care

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June 19, 2009

Media treatment of “baby in a hurry” stories

The British tabloids seem to love a good story about a baby that gets its little self born before the midwife arrives or on the way to the local hospital (usually in rush hour traffic).  I once saw a bit of film that was taken in a London (Eng) tobacconist’s shop; a birth caught on the store’s security camera.  The parents had been out shopping in downtown London when the woman realized the baby was on its way.  They went in the tobacco shop to use the phone and, while the father was in the back telephoning, the woman gave birth to the entire baby in her black stretch pants.  She was leaning over the counter and the whole thing was caught on tape. 

Recently on the Australian midwives email list, there was a story of a woman who gave birth in the front seat of her husband’s car on the way to the hospital in the morning rush hour.  Traffic was at a standstill so she held her newborn up to the window so the other travellers could have a look at a little one so new.

We seem to have one or two of these stories in our local paper every year, too, so it’s not a completely unusual occurrence.  I usually send these stories off to my pal, Laura Shanley, who is the guru of the unassisted birthers in the U.S.  She always points out to me, and it’s true, that the mother seems to have a bit part in these dramatic productions of the news media.  Full credit for heroism and quick thinking goes to the father, child, passerby, ambulance dispatcher—anyone BUT the woman.  She seems to have a bit part and, if anything, is just a naughty person for putting all those people through a lot of worry. 

What is missed is that birthing a speedy baby without any professionals around is actually a safe process.  I have read these stories for 30 years and have never seen a single one that involved a true complication.  In the one that I have linked above, there’s some talk about the baby being bluish but that’s normal and unmedicated babies are able to clear their own airways just fine if left alone for a minute.  A cord around the neck is not an emergency and can easily be unwound by the birthing woman.  Two important things that happen in these straightforward births is that 1. the cord is left to pulse until the baby is breathing well because there are no clamps handy and 2. the baby is held continuously by the mother which helps insure that she does not bleed heavily.

The one thing that I did love in the British story is the photo of the father with that “new Dad sheen” on his face.  I’m sure that the newspapers will continue to write these stories with all the drama laced throughout them but, remember, birth is a healthy, normal elimination process of the body that happens smoothly, easily and quickly for some women and their babies.  It’s an emergence, see?

June 19th 2009 Posted to Holistic midwifery & doula education, Homebirth

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Turnabout on Breech birth–talk is cheap

All day today I’ve received emails, telephone messages and Facebook notes letting me know that the Society of Obstetricians and Gynecologists of Canada have had a change of heart about vaginal breech birth.  The article in the Globe and Mail lets us know that the 30,000 Canadian women who undergo major abdominal surgery to have their breech babies have been given a raw deal. 

There is an obstetrician in Ontario, Mary Hannah, who has been the source of much of the wrong headed “research” that has led to the out of control rate of cesareans world wide.  Ms. Hannah was behind the study that said babies should be induced at 41 weeks gestational age.  That study was found to have major methodology flaws.  Now, we know that the breech study by the same woman is also bad science.  I would like to see the S.O.G.C. issue a press release that Ms. Hannah will not be allowed to publish in a scientific journal ever again.  She’s got a great deal of karmic debt load for causing so much unnecessary suffering in the world with her two multi centre controlled trials.

In obstetrics, the first rule has to be “Mother Nature is probably right”.  After all, Mother Nature has been doing birth for a very long time and doctors have only come into it relatively recently.  When these studies are so counter to what Mother Nature has been doing for millenia, they have to be suspected of being flawed in the methodology.  The fact that doctors and midwives march blindly along righteously cloaked in “evidence based practise” without questioning the wholesale surgical nightmare is hard to believe.

I cannot get excited about this latest epiphany of the medical profession.  The fact is that doctors feel good about being aggressive with birth.  They don’t like the unknown and they don’t like things wild.  The context of hospital treatment is to “control” the birth.  A controlled breech vaginal delivery is not a pretty thing to watch.  Through the 1980’s, I had a friendly obstetrician who would “allow” breech deliveries.  He would bring the woman in to be induced with a foley catheter placed into her cervix (a balloon at the end of the catheter would be inflated with saline solution to provide an irritant to the cervix).  The induction was done because he didn’t want the breech baby to get too big.  When the woman started to have sensations, he would get an I.V. into her arm so that he could get Pitocin running when she was pushing (didn’t want an arrest of contractions once the body was out).  Most of those breech births involved him cutting a “generous” episiotomy and introducing Piper’s forceps into the vagina  and onto the baby’s head to pull the head down.  Just recalling it all makes me sick to my stomach.  Those poor babies would usually come out with the placenta on top of their heads like a tam.  One little boy was resuscitated for over an hour and has severe cerebral palsy. The mother, too,  would have to recover from the episiotomy and that was brutal.

What was the alternative?  I had no experience with breech birth and I didn’t want my client to have a cesarean and have her childbearing future tainted forever.  Breech cesareans are not a pretty sight either.  The head can be trapped and forceps are needed to extract it from the abdominal incision.  Another boy has cerebral palsy after a cesarean done by a resident who had a terrible time getting the babe’s head out.  We didn’t have the internet back then, either, so I didn’t have access to all the great midwives who have published their ideas and photos of breech births. 

It’s different now.  I now have experience with breech birth and I’ve gathered really good information and tricks of the trade.  A home birth with a breech baby is a whole different kettle of fish than a hospital “breech delivery”.  Not every breech baby can be born safely by the vaginal route and, if a hospital is truly needed, a cesarean is a good option at those times.  The majority of healthy women with a breech presenting baby, however, will fare better staying away from hospital procedures.

If the S. O. G. C. is serious that it wants Canadian women giving birth vaginally to their breech babies, they’d be wise to hire an international team of midwives to show the doctors how it’s really done in the home setting.  Mary Cronk (England), Lisa Barrett (Australia), Ina May Gaskin (U.S.A.), Maggie Banks (New Zealand) and Patti Blomme (B.C., Canada) are the ones I’d like to see heading up that team.  When I see those women on the ground in Canada, I’ll get excited about the chances of Canadian women having vaginal breech births. 

Breech

�

June 19th 2009 Posted to Holistic midwifery & doula education, Homebirth

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June 9, 2009

Avoiding the cobra pose

Circumcision: Echoes in the Body
By Jeane Rhodes, Ph.D.

Recently, I completed a doctoral research project in which I investigated the possible link between the way children do selected yoga postures for the first time and their individual birth experiences. The body language of 22 children, five to nine years old, was carefully videotaped and analyzed. To learn about the children’s birth experiences I interviewed the parents. After analysis of the data, I was able to identify specific elements in the performance of the yoga postures that could be perceived as clues to the child’s prenatal and birth experience.
In the course of this research, I made an unexpected observation related to male circumcision. It can only be considered preliminary at this point, as the study was not designed to focus on this issue, and, had it not been so evident in this small sample, I probably would not have noticed it. Asking about circumcision had not been on my original list of questions for the interview with parents. Fortunately, the first father interviewed mentioned it, so I included a question about circumcision for all of the boys in the study.
What I observed was that the seven boys in the study who had been circumcised did not place their hips on the floor when doing an abdominal-lying-arch posture (the “cobra” pose for those of you familiar with yoga postures). In contrast, the two boys in the study who had not been circumcised did it easily.
When I mentioned this observation to a colleague who is a body-worker, she said she had noticed that her clients who had been circumcised were much more rigid in the pelvic area than those who had not been cir-cumcised. If this very preliminary observation is confirmed, it would be coherent with a recent finding on the long-term effect of circumcision on pain tolerance. A team at the Hospital for Sick Children in Toronto, Ontario (1995) studied the pain responses of children having routine vaccinations four to six months after birth. They discovered that boys circumcised as infants had higher behavioral pain scores and cried longer.

Cobra Pose

man doing cobra pose

June 09th 2009 Posted to Intactivism

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June 5, 2009

Thank you

This is my 100th blog post and I wanted to mark that accomplishment with a big thankyou to those of you who come by and read my posts.  According to the log, there are 80,000 of you in most months. 

I especially want to thank those of you who leave a comment.  You make me think and your feedback is much appreciated.  You also increase my blog rating in Google.  When I took Laureen Hudson’s course on blogging, she mentioned a hard core blogger who thought he was doing really well if he got 3 comments per post.  That’s what I am averaging so I’m very pleased with that. 

Thankyou to everyone who has linked to me and put me on your blog roll.  I appreciate it.

I especially thank Laureen Hudson (her blog is Elemental Mom over on the right on my blogroll) and Raquel Lazar Paley from  www.consciouswoman.org  who have been my mentors in how to have an online presence with the upcoming wave of digital natives.  It is so important that we meet young women where they are and communicate to them in the way they are most comfortable.  I’m committed to letting go of my entrenched ways of thinking and moving with the times so that I can make more of a difference in having birth work for everyone.

Please keep enjoying the blog and send your friends this way, too.  Keep the comments coming. Gloria

June 05th 2009 Posted to Holistic midwifery & doula education

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The goats have no midwives

The goats have no midwives. The sheep have no midwives.

When the goat is pregnant, she births safely.

When the sheep is pregnant, she births safely.

You, in this state of pregnancy, will birth safely.

Recited by the village midwife and several elders among the African Yoruba

goat & baby

June 05th 2009 Posted to Homebirth

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June 3, 2009

Rose’s birth

Dear Rose,  you’re a grownup young woman now but you’ve asked me to tell you your birth story so here goes.

Your mom phoned me a few weeks before her due date to see if I would help her give birth to you at Surrey Memorial Hospital.  She explained that your older brother had been born by cesarean and she had been planning to have you that way, too.  Her doctor had encouraged her to have a vaginal birth but she originally said “NO.”  I think your Dad was a big influence on that.  He never came around to thinking natural birth was a good idea.  As far as he was concerned everyone should have a cesarean–much neater and tidier in his view.  Of course, no one listened to him.

When your Mom made the request of me to be her birth assistant, she had begun to realize that giving birth vaginally might be better for her health and much easier as far as recovery.  My response to her request was “No, I won’t go to that hospital with you.”  She asked “why not? isn’t that what you do?”  I explained to her that I had never seen or heard of a nice birth at that hospital and that it would hurt me too much to watch her go through their treatment of her.  She asked “What would you suggest I do then?”

I said “Well, I’d like to sidle up to this more obliquely, but we don’t have any time. . . I’d like you to have a home birth.”  Your Mom was astounded.  She had only just started to bend her head around a vaginal birth, she had never known anyone who had a homebirth, and this idea came out of left field.  She said “You would NEVER talk me into that!”  I told her that I’d like to try and that I would give her 3 hours of sales pitch for free if she would let me give it a whirl.  She laughed and said okay and the rest is history.

We met, we talked, we laughed, we watched birth videos, I told her stories and, by the end of our time, she was enrolled in homebirth.

It was a long birth.  Your Mom dilated slowly but steadily.  Your Dad made himself scarce with his motorcycle buddies out back through most of it.  Your Mom was always strong and brave except when your Dad would come in the room so it’s probably good that he wasn’t into it at all.  We had to drag him in the bathroom when you were actually emerging and, even then, he pulled his shirt up over his face and just peeked his eyes out.  The minute he could see you were breathing, he rushed out again!

One of my students, Joanne, was with us through the whole birth.  It was the first birth that she ever attended.  I said to her “Joanne are you ready to catch your first baby?” and Joanne gamely nodded “yes”.  So, your lovely momma pushed you out very gently while in an all 4’s position on the bathroom floor.  Joanna received you in such a tender gentle way and you went right onto your Mom’s skin.  We helped her to turn over and sit leaning back on pillows against the bathtub for a while.  Your Mom held you close the whole time. The placenta was born and your cord was cut after it had completely stopped pulsing and the placenta was out.  You were a very sweet, pink little doll.  Your mom was completely captivated and I guess your Dad really liked you a lot because he kept giving us cash after that.  :)  

When it was time to tuck you and your Mom in bed, we noticed that your Mom was walking towards the bed completely hunched over.  We had to tell her “You haven’t had a cesarean, you can stand up straight to walk.”  She looked so surprised and, yes, she straightened up and stopped protecting her guts.  The next day, I came out and you were nursing like a champ.  I asked your Mom to do some situps and leg raises and she looked at me like I was insane.  Again, I had to say “You haven’t had major abdominal surgery this time, you can lift your legs.”  She was sceptical but did it just fine.  The day after that, when I came she was up, dressed and making spahetti sauce in the kitchen.  I thought “Whoops, we shouldn’t have told her how strong she is!”  The day after that, I came to do a blood test on your heel and your Mom had taken you and gone to the gym!  She felt so good and she never complained about anything because nothing feels bad after you’ve known what a cesarean feels like.

Your Mom joined my Midwifery Study Group and helped many people to have nice births.  She is such a fun person to work with and I’m so happy that I got to see her give birth powerfully.  Thanks for getting your little head down and cooperating so that I looked good at your birth, honey.

I love you, Gloria

June 03rd 2009 Posted to Homebirth, VBAC Very Beautiful & Courageous

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