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
Tuesday, June 30, 2009
The HUG Your Baby program is coming to Denver!
Join us for one or more events with Jan Tedder, FNP, the HUG's creator. Two days and four events to choose from!
Events at Nourish Family Center (Register at www.nourishfamilycenter.com under Classes or Workshops)
- HUG Your Baby training (Parts 1 & 2) - 9 am to 4 pm on Tuesday, July 7 (5 contact hours) $100
- HUG Your Baby FREE Meet & Greet with Jan Tedder - July 7 @ 6 pm with food, fun and information. FREE
- HUG Your Baby (Part 1) - 10 am to 12 pm on Wednesday, July 8 (1.5 contact hours). $10
Event through The Lactation Program's Journal Club:
- HUG Your Baby @ Journal Club (Part 1) - The Auditorium at Rose Medical Center (2 contact hours) - July 8 from 2:30-5 pm. $25 ($30 for CERPs for IBCLCs)
www.nourishfamilycenter.com
Events at Nourish Family Center (Register at www.nourishfamilycenter.com under Classes or Workshops)
- HUG Your Baby training (Parts 1 & 2) - 9 am to 4 pm on Tuesday, July 7 (5 contact hours) $100
- HUG Your Baby FREE Meet & Greet with Jan Tedder - July 7 @ 6 pm with food, fun and information. FREE
- HUG Your Baby (Part 1) - 10 am to 12 pm on Wednesday, July 8 (1.5 contact hours). $10
Event through The Lactation Program's Journal Club:
- HUG Your Baby @ Journal Club (Part 1) - The Auditorium at Rose Medical Center (2 contact hours) - July 8 from 2:30-5 pm. $25 ($30 for CERPs for IBCLCs)
www.nourishfamilycenter.com
C-section Births Cause Genetic Changes That May Increase Odds For Developing Diseases In Later Life
ScienceDaily (June 29, 2009) — Swedish researchers have discovered that babies born by Caesarean section experience changes to the DNA pool in their white blood cells, which could be connected to altered stress levels during this method of delivery, according to the July issue of Acta Paediatrica.
It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.
Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells - a vital part of the immune system.
This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.
“Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.
“That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells.”
The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed.
“Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress.
“We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery. When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb.”
The authors point out that the surgical procedure itself may play a role in DNA-methylation and that factors other than the delivery method need to be explored in more detail.
“In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels - proteins that provide a key marker for inflammation” says Professor Norman. “However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues.”
Professor Norman states that the Karolinska study clearly shows that gene-environment interaction through DNA-methylation is more dynamic around birth than previously known.
“The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications” he says.
“C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early ‘epigenetic’ programming of the immune system may have a role to play.”
The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.
“Although we do not know yet how specific gene expression is affected after C-section deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research” concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet.
--------------------------------------------------------------------------------
Journal reference:
1.Schlinzig et al. Epigenetic modulation at birth - altered DNA-methylation in white blood cells after Caesarean section. Acta Paediatrica, 2009; 98 (7): 1096 DOI: 10.1111/j.1651-2227.2009.01371.x
Adapted from materials provided by Wiley - Blackwell, via AlphaGalileo.
It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.
Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells - a vital part of the immune system.
This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.
“Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life.
“That is why we were keen to look at DNA-methylation, which is an important biological mechanism in which the DNA is chemically modified to activate or shut down genes in response to changes in the external environment. As the diseases that tend to be more common in people delivered by C-section are connected with the immune system, we decided to focus our research on early DNA changes to the white blood cells.”
The authors point out that the reason why DNA-methylation is higher after C-section deliveries is still unclear and further research is needed.
“Animal studies have shown that negative stress around birth affects methylation of the genes and therefore it is reasonable to believe that the differences in DNA-methylation that we found in human infants are linked to differences in birth stress.
“We know that the stress of being born is fundamentally different after planned C-section compared to normal vaginal delivery. When babies are delivered by C-section, they are unprepared for the birth and can become more stressed after delivery than before. This is different to a normal vaginal delivery, where the stress gradually builds up before the actual birth, helping the baby to start breathing and quickly adapt to the new environment outside the womb.”
The authors point out that the surgical procedure itself may play a role in DNA-methylation and that factors other than the delivery method need to be explored in more detail.
“In our study, neonatal DNA-methylation did not correlate to the age of the mother, length of labour, birth weight and neonatal CPR levels - proteins that provide a key marker for inflammation” says Professor Norman. “However, although there was no relation between DNA-methylation and these factors, larger studies are needed to clarify these issues.”
Professor Norman states that the Karolinska study clearly shows that gene-environment interaction through DNA-methylation is more dynamic around birth than previously known.
“The full significance of higher DNA-methylation levels after C-section is not yet understood, but it may have important clinical implications” he says.
“C-section delivery is rapidly increasing worldwide and is currently the most common surgical procedure among women of child-bearing age. Until recently, the long-term consequences of this mode of delivery had not been studied. However, reports that link C-section deliveries with increased risk for different diseases in later life are now emerging. Our results provide the first pieces of evidence that early ‘epigenetic’ programming of the immune system may have a role to play.”
The authors feel that their discovery could make a significant contribution to the ongoing debate about the health issues around C-section deliveries.
“Although we do not know yet how specific gene expression is affected after C-section deliveries, or to what extent these genetic differences related to the mode of delivery are long-lasting, we believe that our findings open up a new area of important clinical research” concludes lead author Titus Schlinzig, a research fellow at the Karolinska Institutet.
--------------------------------------------------------------------------------
Journal reference:
1.Schlinzig et al. Epigenetic modulation at birth - altered DNA-methylation in white blood cells after Caesarean section. Acta Paediatrica, 2009; 98 (7): 1096 DOI: 10.1111/j.1651-2227.2009.01371.x
Adapted from materials provided by Wiley - Blackwell, via AlphaGalileo.
Monday, June 29, 2009
Fetal Monitoring
(MS-Taken from CfM. http://cfmidwifery.blogspot.com/)
Saturday, June 27, 2009
Fetal Monitoring
I started to write about this in my previous post and then realized it actually belonged in its own post!
The author of Bearing Meaning spends an entire chapter analyzing Williams Obstetrics and the language of birth contained therein. In Williams fetal monitoring is referred to as an "elegant means" of "demonstrating the effect of the forces of labor and delivery on the baby's heart rate." However, as the author of Bearing Meaning (Robbie Kahn) notes, "The tracings don't record labor in a generic sense. They record it under specific conditions--the hospital...Thus, monitor tracings hardly are elegant, if elegant means imparting information at high levels of sophistication. Indeed, the monitor may be simply recording responses characteristic of a woman laboring under the conditions imposed in the hospital rather than imparting sophisticated information about childbirth in general." (emphasis mine).
This observation reminded me of Henci Goer's recent post on the Science and Sensibility blog: The Labor Environment: “Many things that count cannot be counted." In this post, she looks at a recent study published in the June issue of Birth, "gauging the effects of modifying the labor room to encourage mobility, reduce stress and anxiety, and discourage routine medical intervention." The labor environment impacts women's birth experiences in a number of ways (some that cannot be quantified for research studies) and my observation is that fetal monitoring is one of the most significant elements of the labor environment. It creates conditions for laboring women that then alters their normal, physiological, spontaneous responses to labor and thus cannot be seen as accurately reflecting the influence of labor on the baby.
Speaking of fetal monitoring, ACOG just issued new guidelines refining the fetal heart rate monitoring guidelines. The guidelines briefly refer to manual auscultation. Quoted in the release is the following comment: "'Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002,' says George A. Macones, MD, who headed the development of the ACOG document. 'Although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.'"
--
Molly
CfM Blogger
Saturday, June 27, 2009
Fetal Monitoring
I started to write about this in my previous post and then realized it actually belonged in its own post!
The author of Bearing Meaning spends an entire chapter analyzing Williams Obstetrics and the language of birth contained therein. In Williams fetal monitoring is referred to as an "elegant means" of "demonstrating the effect of the forces of labor and delivery on the baby's heart rate." However, as the author of Bearing Meaning (Robbie Kahn) notes, "The tracings don't record labor in a generic sense. They record it under specific conditions--the hospital...Thus, monitor tracings hardly are elegant, if elegant means imparting information at high levels of sophistication. Indeed, the monitor may be simply recording responses characteristic of a woman laboring under the conditions imposed in the hospital rather than imparting sophisticated information about childbirth in general." (emphasis mine).
This observation reminded me of Henci Goer's recent post on the Science and Sensibility blog: The Labor Environment: “Many things that count cannot be counted." In this post, she looks at a recent study published in the June issue of Birth, "gauging the effects of modifying the labor room to encourage mobility, reduce stress and anxiety, and discourage routine medical intervention." The labor environment impacts women's birth experiences in a number of ways (some that cannot be quantified for research studies) and my observation is that fetal monitoring is one of the most significant elements of the labor environment. It creates conditions for laboring women that then alters their normal, physiological, spontaneous responses to labor and thus cannot be seen as accurately reflecting the influence of labor on the baby.
Speaking of fetal monitoring, ACOG just issued new guidelines refining the fetal heart rate monitoring guidelines. The guidelines briefly refer to manual auscultation. Quoted in the release is the following comment: "'Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002,' says George A. Macones, MD, who headed the development of the ACOG document. 'Although EFM is the most common obstetric procedure today, unfortunately it hasn't reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.'"
--
Molly
CfM Blogger
Thursday, June 25, 2009
Large Study Showing the Safety of Homebirths
Today at 3:33pm
Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births
Conclusions This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
A de Jonge a , BY van der Goes b , ACJ Ravelli c , MP Amelink-Verburg a,d , BW Mol b , JG Nijhuis e , J Bennebroek Gravenhorst a , SE Buitendijk a
a TNO Quality of Life, Leiden, the Netherlands b Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, the Netherlands c Department of Medical Informatics, Amsterdam Medical Centre, Amsterdam, the Netherlands d Health Care Inspectorate, Rijswijk, the Netherlands e Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
Correspondence to Dr A de Jonge, TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, the Netherlands. Email ankdejonge@hotmail.com
Copyright Journal compilation © 2009 RCOG
KEYWORDS
Midwifery • perinatal mortality • pregnancy outcome
Please cite this paper as: de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02175.x.
ABSTRACT
Objective To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.
Design A nationwide cohort study.
Setting The entire Netherlands.
Population A total of 529,688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.
Methods Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.
Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.
Results No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).
Conclusions This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
Accepted 26 February 2009. Published Online 15 April 2009.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1471-0528.2009.02175.x About DOI
Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births
Conclusions This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
A de Jonge a , BY van der Goes b , ACJ Ravelli c , MP Amelink-Verburg a,d , BW Mol b , JG Nijhuis e , J Bennebroek Gravenhorst a , SE Buitendijk a
a TNO Quality of Life, Leiden, the Netherlands b Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, the Netherlands c Department of Medical Informatics, Amsterdam Medical Centre, Amsterdam, the Netherlands d Health Care Inspectorate, Rijswijk, the Netherlands e Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
Correspondence to Dr A de Jonge, TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, the Netherlands. Email ankdejonge@hotmail.com
Copyright Journal compilation © 2009 RCOG
KEYWORDS
Midwifery • perinatal mortality • pregnancy outcome
Please cite this paper as: de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Bennebroek Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009; DOI: 10.1111/j.1471-0528.2009.02175.x.
ABSTRACT
Objective To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.
Design A nationwide cohort study.
Setting The entire Netherlands.
Population A total of 529,688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.
Methods Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.
Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.
Results No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).
Conclusions This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
Accepted 26 February 2009. Published Online 15 April 2009.
DIGITAL OBJECT IDENTIFIER (DOI)
10.1111/j.1471-0528.2009.02175.x About DOI
Tuesday, June 23, 2009
Breastfeeding Class Held Every Last Saturday of the Month
Peaceful Beginnings Doula Service Schedule of events:
Instructor for all classes is Amy Machado, CLD.
Peaceful Beginnings Doula Service will be holding a breastfeeding class on the last Saturday of every month at 10 am. This Saturday June 27, Saturday July 25, and Saturday August 29 are the next 3 classes.
At our breastfeeding class you will learn:
-Advantages of breastfeeding
-How the breast works
-Initiating breastfeeding
-Pumping
-Working
-Nutrition
-As well as many other important things.
*The cost for this class is $35.00
Please remember our other events:
July 11th at 10:00 AM: Birth Plan workshop, $25.00.
July 18th: Baby wearing and cloth diapering work shop, $15.00.
We also are happy to offer private sessions for any of our workshops or classes at any time. Please contact amy@peacefulbeginni ngsdoula. com for more information, or call Amy at 610.223.0011. You can also visit our website for more information at www.peacefulbeginni ngsdoula. com.
Instructor for all classes is Amy Machado, CLD.
Peaceful Beginnings Doula Service will be holding a breastfeeding class on the last Saturday of every month at 10 am. This Saturday June 27, Saturday July 25, and Saturday August 29 are the next 3 classes.
At our breastfeeding class you will learn:
-Advantages of breastfeeding
-How the breast works
-Initiating breastfeeding
-Pumping
-Working
-Nutrition
-As well as many other important things.
*The cost for this class is $35.00
Please remember our other events:
July 11th at 10:00 AM: Birth Plan workshop, $25.00.
July 18th: Baby wearing and cloth diapering work shop, $15.00.
We also are happy to offer private sessions for any of our workshops or classes at any time. Please contact amy@peacefulbeginni ngsdoula. com for more information, or call Amy at 610.223.0011. You can also visit our website for more information at www.peacefulbeginni ngsdoula. com.
Thursday, June 18, 2009
Birth Plan class, and Baby Carriers and Cloth Diapers class
July 11, 2009 at 10:00 AM
Come to our Birth Plan class!
You will use our Birth Plan Template to create your own Birth Plan.
Cost is $25.00.
Contact info:
www.peacefulbeginni ngsdoula. com
610.223.0011
AND:
July 18, 2009 at 10:00 AM
Come learn all about baby carriers and cloth diapers.
Learn how to use different carriers; try them on and see what may work for you. Check out different types of cloth diapers and get your questions answered.
Cost is $15.00
Contact info:
www.peacefulbeginni ngsdoula. com
610.223.0011
Come to our Birth Plan class!
You will use our Birth Plan Template to create your own Birth Plan.
Cost is $25.00.
Contact info:
www.peacefulbeginni ngsdoula. com
610.223.0011
AND:
July 18, 2009 at 10:00 AM
Come learn all about baby carriers and cloth diapers.
Learn how to use different carriers; try them on and see what may work for you. Check out different types of cloth diapers and get your questions answered.
Cost is $15.00
Contact info:
www.peacefulbeginni ngsdoula. com
610.223.0011
Sunday, June 14, 2009
Pampered Pregger and Beyond
Now available from www.pamperedpreggerandbeyond.com
Motherhood 101: Create a Non-Burnout Blueprint (Audio)
Learn how to get support and much needed breaks postpartum with Dr. Shosh...
Motherhood 101: Sleep-Formula for Success (Audio)
Achieve maximum sleep during your postpartum period to achieive maximum health!..
Motherhood 101: Beyond the Fantasies (Audio)
Dispel The Fantasies About Motherhood in Motherhood 101: Beyond the Fantasies..
Setting the Supermom Cape Aside: Caring For Yourself by Dr. Shoshana Bennett
"Ten Common Fantasies About Motherhood" by Dr. Shoshana Bennett
The 5 Most Important Natural Remedies for Cesarean Recovery by Dr. Lauri Grossman
Now available from the Pampered Pregger and Beyond.com website.
Sleep: Formula for Success
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Motherhood 101: Beyond the Fantasies
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Create a Non-Burnout BluePrint
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Motherhood 101: A New Mother's Survival Guide
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Annual Professional Listing
Motherhood 101: Create a Non-Burnout Blueprint (Audio)
Learn how to get support and much needed breaks postpartum with Dr. Shosh...
Motherhood 101: Sleep-Formula for Success (Audio)
Achieve maximum sleep during your postpartum period to achieive maximum health!..
Motherhood 101: Beyond the Fantasies (Audio)
Dispel The Fantasies About Motherhood in Motherhood 101: Beyond the Fantasies..
Setting the Supermom Cape Aside: Caring For Yourself by Dr. Shoshana Bennett
"Ten Common Fantasies About Motherhood" by Dr. Shoshana Bennett
The 5 Most Important Natural Remedies for Cesarean Recovery by Dr. Lauri Grossman
Now available from the Pampered Pregger and Beyond.com website.
Sleep: Formula for Success
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Motherhood 101: Beyond the Fantasies
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Create a Non-Burnout BluePrint
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Motherhood 101: A New Mother's Survival Guide
Perinatal support from the comfort of your home available through Dr. Shosh's Wellness Series!..
Annual Professional Listing
Saturday, June 13, 2009
AMA Resolution Would Seek to Label Patients “Ungrateful”
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. http://www.ican-online.org/resources/white_papers/index.html
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. www.ican-online.org
________________________________
[1] http://www.ama-assn.org/ama1/pub/upload/mm/475/refcomg.pdf Resolution 710 “Identifying Abusive, Hostile or Non-Compliant Patients”
[2] http://www.childbirthconnection.org/article.asp?ck=10575 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
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. http://www.ican-online.org/resources/white_papers/index.html
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. www.ican-online.org
________________________________
[1] http://www.ama-assn.org/ama1/pub/upload/mm/475/refcomg.pdf
[2] http://www.childbirthconnection.org/article.asp?ck=10575
[3] http://www.ican-online.org/ican-in-the-news/trouble-repeat-cesareans
Thursday, June 11, 2009
The 20 Cancer Symptoms Women Are Most Likely to Ignore
Don't rely on routine tests alone to protect you from cancer. It's just as important to listen to your body and notice anything that's different, odd, or unexplainable. Here are some signs that are commonly overlooked:
1. Wheezing or shortness of breath
One of the first signs many lung cancer patients remember noticing is the inability to catch their breath.
2. Chronic cough or chest pain
Several types of cancer, including leukemia and lung tumors, can cause symptoms that mimic a bad cough or bronchitis. Some lung cancer patients report chest pain that extends up into the shoulder or down the arm.
3. Frequent fevers or infections
These can be signs of leukemia, a cancer of the blood cells that starts in the bone marrow. Leukemia causes the marrow to produce abnormal white blood cells, sapping your body's infection-fighting capabilities.
4. Difficulty swallowing
Trouble swallowing is most commonly associated with esophageal or throat cancer, and is sometimes one of the first signs of lung cancer, too.
5. Swollen lymph nodes or lumps on the neck, underarm, or groin
Enlarged lymph nodes indicate changes in the lymphatic system, which can be a sign of cancer.
6. Excessive bruising or bleeding that doesn't stop
This symptom usually suggests something abnormal happening with the platelets and red blood cells, which can be a sign of leukemia. Over time, leukemia cells crowd out red blood cells and platelets, impairing your blood's ability to carry oxygen and clot.
7. Weakness and fatigue
Generalized fatigue and weakness is a symptom of so many different kinds of cancer that you'll need to look at it in combination with other symptoms. But any time you feel exhausted without explanation and it doesn't respond to getting more sleep, talk to your doctor.
8. Bloating or abdominal weight gain
Women diagnosed with ovarian cancer overwhelmingly report unexplained abdominal bloating that came on fairly suddenly and continued on and off over a long period of time.
9. Feeling full and unable to eat
This is another tip-off to ovarian cancer; women say they have no appetite and can't eat, even when they haven't eaten for some time.
10. Pelvic or abdominal pain
Pain and cramping in the pelvis and abdomen can go hand in hand with the bloating that often signals ovarian cancer. Leukemia can also cause abdominal pain resulting from an enlarged spleen.
11. Rectal bleeding or blood in stool
This is a common result of diagnosing colorectal cancer. Blood in the toilet alone is reason to call your doctor and schedule a colonoscopy.
12. Unexplained weight loss
Weight loss is an early sign of colon and other digestive cancers; it's also a sign of cancer that's spread to the liver, affecting your appetite and the ability of your body to rid itself of wastes.
13. Upset stomach or stomachache
Stomach cramps or frequent upset stomachs may indicate colorectal cancer.
14. A red, sore, or swollen breast
These symptoms can indicate inflammatory breast cancer. Call your doctor about any unexplained changes to your breasts.
15. Nipple changes
One of the most common changes women remember noticing before being diagnosed with breast cancer is a nipple that began to appear flattened, inverted, or turned sideways.
16. Unusually heavy or painful periods or bleeding between periods
Many women report this as the tip-off to endometrial or uterine cancer. Ask for a transvaginal ultrasound if you suspect something more than routine heavy periods.
17. Swelling of facial features
Some patients with lung cancer report noticing puffiness, swelling, or redness in the face. Small cell lung tumors commonly block blood vessels in the chest, preventing blood from flowing freely from your head and face.
18. A sore or skin lump that doesn't heal, becomes crusty, or bleeds easilyFamiliarize yourself with the different types of skin cancer -- melanoma, basal cell carcinoma, and squamous cell carcinoma -- and be vigilant about checking skin all over your body for odd-looking growths or spots.
19. Changes in nails
Unexplained changes to the fingernails can be a sign of several types of cancer. A brown or black streak or dot under the nail can indicate skin cancer, while newly discovered "clubbing"-- enlargement of the ends of the fingers with nails that curve down over the tips -- can be a sign of lung cancer. Pale or white nails can sometimes be a sign of liver cancer.
20. Pain in the back or lower right side
Many cancer patients say this was the first sign of liver cancer. Breast cancer is also often diagnosed via back pain, which can occur when a breast tumor presses backward into the chest, or when the cancer spreads to the spine or ribs.
Sources:
MSN Health
Visit http://articles.mercola.com/sites/articles/archive/2009/06/11/The-20-Cancer-Symptoms-Women-Are-Most-Likely-to-Ignore.aspx for Dr. Mercola's comments.
1. Wheezing or shortness of breath
One of the first signs many lung cancer patients remember noticing is the inability to catch their breath.
2. Chronic cough or chest pain
Several types of cancer, including leukemia and lung tumors, can cause symptoms that mimic a bad cough or bronchitis. Some lung cancer patients report chest pain that extends up into the shoulder or down the arm.
3. Frequent fevers or infections
These can be signs of leukemia, a cancer of the blood cells that starts in the bone marrow. Leukemia causes the marrow to produce abnormal white blood cells, sapping your body's infection-fighting capabilities.
4. Difficulty swallowing
Trouble swallowing is most commonly associated with esophageal or throat cancer, and is sometimes one of the first signs of lung cancer, too.
5. Swollen lymph nodes or lumps on the neck, underarm, or groin
Enlarged lymph nodes indicate changes in the lymphatic system, which can be a sign of cancer.
6. Excessive bruising or bleeding that doesn't stop
This symptom usually suggests something abnormal happening with the platelets and red blood cells, which can be a sign of leukemia. Over time, leukemia cells crowd out red blood cells and platelets, impairing your blood's ability to carry oxygen and clot.
7. Weakness and fatigue
Generalized fatigue and weakness is a symptom of so many different kinds of cancer that you'll need to look at it in combination with other symptoms. But any time you feel exhausted without explanation and it doesn't respond to getting more sleep, talk to your doctor.
8. Bloating or abdominal weight gain
Women diagnosed with ovarian cancer overwhelmingly report unexplained abdominal bloating that came on fairly suddenly and continued on and off over a long period of time.
9. Feeling full and unable to eat
This is another tip-off to ovarian cancer; women say they have no appetite and can't eat, even when they haven't eaten for some time.
10. Pelvic or abdominal pain
Pain and cramping in the pelvis and abdomen can go hand in hand with the bloating that often signals ovarian cancer. Leukemia can also cause abdominal pain resulting from an enlarged spleen.
11. Rectal bleeding or blood in stool
This is a common result of diagnosing colorectal cancer. Blood in the toilet alone is reason to call your doctor and schedule a colonoscopy.
12. Unexplained weight loss
Weight loss is an early sign of colon and other digestive cancers; it's also a sign of cancer that's spread to the liver, affecting your appetite and the ability of your body to rid itself of wastes.
13. Upset stomach or stomachache
Stomach cramps or frequent upset stomachs may indicate colorectal cancer.
14. A red, sore, or swollen breast
These symptoms can indicate inflammatory breast cancer. Call your doctor about any unexplained changes to your breasts.
15. Nipple changes
One of the most common changes women remember noticing before being diagnosed with breast cancer is a nipple that began to appear flattened, inverted, or turned sideways.
16. Unusually heavy or painful periods or bleeding between periods
Many women report this as the tip-off to endometrial or uterine cancer. Ask for a transvaginal ultrasound if you suspect something more than routine heavy periods.
17. Swelling of facial features
Some patients with lung cancer report noticing puffiness, swelling, or redness in the face. Small cell lung tumors commonly block blood vessels in the chest, preventing blood from flowing freely from your head and face.
18. A sore or skin lump that doesn't heal, becomes crusty, or bleeds easilyFamiliarize yourself with the different types of skin cancer -- melanoma, basal cell carcinoma, and squamous cell carcinoma -- and be vigilant about checking skin all over your body for odd-looking growths or spots.
19. Changes in nails
Unexplained changes to the fingernails can be a sign of several types of cancer. A brown or black streak or dot under the nail can indicate skin cancer, while newly discovered "clubbing"-- enlargement of the ends of the fingers with nails that curve down over the tips -- can be a sign of lung cancer. Pale or white nails can sometimes be a sign of liver cancer.
20. Pain in the back or lower right side
Many cancer patients say this was the first sign of liver cancer. Breast cancer is also often diagnosed via back pain, which can occur when a breast tumor presses backward into the chest, or when the cancer spreads to the spine or ribs.
Sources:
MSN Health
Visit http://articles.mercola.com/sites/articles/archive/2009/06/11/The-20-Cancer-Symptoms-Women-Are-Most-Likely-to-Ignore.aspx for Dr. Mercola's comments.
Friday, June 05, 2009
Growing Your Birthing Business Workshop
Saturday July 11, 2009
9am to 3:30 pm
Babies In Bloom, Vista, CA (North San Diego County)
We will cover :
5 MISTAKES that are making you invisible to your clients.
Discover with my 7-Holes-Strategy where your business has LEAKS.
How to Draw in/REEL in prospects once they are interested.(WITHOUT Selling!)
The one thing you can do to increase your referrals dramatically!
The 9-Step Menelli Method for getting referrals (Lots of referrals!).
Magnetic marketing material that will get your potential clients calling you.
How to get people so interested in your business that you'll never see the glazed eyes expression ever again.
A NEW kind of business card that clients will beg to get from you. (We're not exaggerating, Kim Wildner is proof that this works!)
Create a customer evangalists who can act like an unpaid salesforce.
And much more!
For more information go to http://birthingbusiness.com/workshops.htm or call 760-522-2829.
9am to 3:30 pm
Babies In Bloom, Vista, CA (North San Diego County)
We will cover :
5 MISTAKES that are making you invisible to your clients.
Discover with my 7-Holes-Strategy where your business has LEAKS.
How to Draw in/REEL in prospects once they are interested.(WITHOUT Selling!)
The one thing you can do to increase your referrals dramatically!
The 9-Step Menelli Method for getting referrals (Lots of referrals!).
Magnetic marketing material that will get your potential clients calling you.
How to get people so interested in your business that you'll never see the glazed eyes expression ever again.
A NEW kind of business card that clients will beg to get from you. (We're not exaggerating, Kim Wildner is proof that this works!)
Create a customer evangalists who can act like an unpaid salesforce.
And much more!
For more information go to http://birthingbusiness.com/workshops.htm or call 760-522-2829.
Growing Your Birthing Business Workshop
Saturday July 11, 2009
9am to 3:30 pm
Babies In Bloom, Vista, CA (North San Diego County)
Sheri Menelli
Business and Marketing Coach
Director of The Birthing Business Institute
We will cover:
•5 MISTAKES that are making you invisible to your clients.
•Discover with my 7-Holes-Strategy where your business has LEAKS.
•How to Draw in/REEL in prospects once they are interested.(WITHOUT Selling!)
•The one thing you can do to increase your referrals dramatically!
•The 9-Step Menelli Method for getting referrals (Lots of referrals!).
•Magnetic marketing material that will get your potential clients calling you.
•How to get people so interested in your business that you'll never see the glazed eyes expression ever again.
•A NEW kind of business card that clients will beg to get from you. (We're not exaggerating, Kim Wildner is proof that this works!)
•Create a customer evangalists who can act like an unpaid salesforce.
•And much more!
http://birthingbusiness.com/workshops.htm
9am to 3:30 pm
Babies In Bloom, Vista, CA (North San Diego County)
Sheri Menelli
Business and Marketing Coach
Director of The Birthing Business Institute
We will cover:
•5 MISTAKES that are making you invisible to your clients.
•Discover with my 7-Holes-Strategy where your business has LEAKS.
•How to Draw in/REEL in prospects once they are interested.(WITHOUT Selling!)
•The one thing you can do to increase your referrals dramatically!
•The 9-Step Menelli Method for getting referrals (Lots of referrals!).
•Magnetic marketing material that will get your potential clients calling you.
•How to get people so interested in your business that you'll never see the glazed eyes expression ever again.
•A NEW kind of business card that clients will beg to get from you. (We're not exaggerating, Kim Wildner is proof that this works!)
•Create a customer evangalists who can act like an unpaid salesforce.
•And much more!
http://birthingbusiness.com/workshops.htm
Thursday, June 04, 2009
M.A.M.A. Campaign Seeks Campaign Manager
The Midwives and Mothers in Action (M.A.M.A.) Campaign is seeking applications for the position of Campaign Manager.
The M.A.M.A. Campaign is a coalition of provider and advocacy member organizations (National Association of Certified Professional Midwives, Midwives Alliance of North America, North American Registry of Midwives, Midwifery Education Accreditation Council, Citizens for Midwifery, and International Center for Traditional Childbearing) with the goal of achieving federal recognition for Certified Professional Midwives in the current national health care reform effort. The M.A.M.A. campaign seeks to work in cooperation with others in this initiative.
Federal recognition of Certified Professional Midwives will advance much needed reforms of the maternity care system in the U.S. It will increase women’s access to midwives by supporting reimbursement for CPM services. It will focus attention on equitable reimbursement, coverage for birth centers and expanded resources for educating more midwives. It will help achieve the goals of health care reform: reduce costs, guarantee choice, and ensure quality care for every American. Ample evidence exists that Certified Professional Midwives provide quality care that emphasizes prevention, reduces costs, and improves outcomes for mothers and babies across all populations and demographics, further meeting health care reform goals to increase preventive care and address disparities in outcomes.
The Campaign Manager position is part-time (3-4 days a week) and temporary for the duration of the 111th Congress. The Campaign Manager will work in collaboration with the Campaign Steering Committee, the Project Consultant and the campaign’s federal lobbyist; will manage the mechanics of the campaign; will be responsible for recruiting and mobilizing grassroots advocacy support; will develop campaign messages, materials and media opportunities.
Experience required: legislative or issue campaign management; recruitment and management of campaign volunteers; media and lobbying skills; excellent oral and written communication skills; ability to effectively manage a diverse team; word processing, spread sheet, data base and new communication technology skills.
To apply, please send a cover letter and resume by the end of the day Monday, June 8, to Ellie Daniels at ellie@greenstore. com.
We are looking forward to working with an energetic and motivated Campaign Manager.
Watch next week for the announcement for the M.A.M.A. Campaign website and how you can become involved in the M.A.M.A. campaign!
The M.A.M.A. Campaign is a coalition of provider and advocacy member organizations (National Association of Certified Professional Midwives, Midwives Alliance of North America, North American Registry of Midwives, Midwifery Education Accreditation Council, Citizens for Midwifery, and International Center for Traditional Childbearing) with the goal of achieving federal recognition for Certified Professional Midwives in the current national health care reform effort. The M.A.M.A. campaign seeks to work in cooperation with others in this initiative.
Federal recognition of Certified Professional Midwives will advance much needed reforms of the maternity care system in the U.S. It will increase women’s access to midwives by supporting reimbursement for CPM services. It will focus attention on equitable reimbursement, coverage for birth centers and expanded resources for educating more midwives. It will help achieve the goals of health care reform: reduce costs, guarantee choice, and ensure quality care for every American. Ample evidence exists that Certified Professional Midwives provide quality care that emphasizes prevention, reduces costs, and improves outcomes for mothers and babies across all populations and demographics, further meeting health care reform goals to increase preventive care and address disparities in outcomes.
The Campaign Manager position is part-time (3-4 days a week) and temporary for the duration of the 111th Congress. The Campaign Manager will work in collaboration with the Campaign Steering Committee, the Project Consultant and the campaign’s federal lobbyist; will manage the mechanics of the campaign; will be responsible for recruiting and mobilizing grassroots advocacy support; will develop campaign messages, materials and media opportunities.
Experience required: legislative or issue campaign management; recruitment and management of campaign volunteers; media and lobbying skills; excellent oral and written communication skills; ability to effectively manage a diverse team; word processing, spread sheet, data base and new communication technology skills.
To apply, please send a cover letter and resume by the end of the day Monday, June 8, to Ellie Daniels at ellie@greenstore. com.
We are looking forward to working with an energetic and motivated Campaign Manager.
Watch next week for the announcement for the M.A.M.A. Campaign website and how you can become involved in the M.A.M.A. campaign!
Why Are Nearly a Third of Childbirths Cesareans?
(originally published on www.mercola.com)
The cesarean birth -- delivery via uterine incision -- was once reserved for cases in which the life of the baby or mother was in danger. But now it is a routine practice. It is in fact the most common operation in the United States; performed in 31 percent of births, up from a mere 4.5 percent in 1965.
With that surge has come an explosion in medical bills and an increase in complications. Now, the use of cesareans is being reconsidered. It is a major reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results, and may actually be doing more harm than good.
Childbirth is the number one cause of hospital admissions, and is a huge part of the nation's $2.4-trillion annual healthcare expenditure. Spending on the average uncomplicated cesarean runs from $4,500 to $13,000, much more than a comparable vaginal birth. And the cesarean rate in the U.S. is higher than in most other developed nations despite a standing government goal of reducing such deliveries.
The cesarean also exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.
Sources:
Los Angeles Times May 17, 2009
Dr. Mercola's Comments:
(Please visit Dr. Mercola's website at www.mercola.com for video clip, photos, and more).
In the United States childbirth has been shifted to a conventional medical approach relying on drugs and surgeries as an alternative to the often superior traditional methods. According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent.
Well it's 2-300% higher with a whopping 31 percent of births in the U.S. performed via cesarean (C-section). This is a rate that even The American College of Obstetricians and Gynecologists admits is worrisome. This is actually the highest rate ever reported in the United States, and a rate higher than in most other developed countries.
In some cases, of course, a cesarean section can save lives, such as in the event of a prolapsed umbilical cord (the umbilical cord slips through the cervix before the baby and may endanger the baby’s oxygen supply) or placenta previa, which occurs when the placenta grows in such a way that it blocks the baby’s exit through the cervix.
Other situations, including when the baby is in a transverse (sideways) position or if the mother is having an outbreak of genital herpes, may also call for a cesarean section. But in many low-risk pregnancies, C-section is far from the best childbirth option.
Unfortunately, I suspect a large part of this growing C-section rate has to do not with medical necessity but with convenience and doctors’ fears of liability (of not performing a cesarean and giving nature a chance to run its course, especially if someone requests the surgery).
There has also been an unfortunate shift in attitudes about pregnancy and birth, taking it from a natural life phase and turning it into a medical condition that needs to be “treated.” Gradually, however, I believe women in the United States are opting for more natural childbirths and choosing to listen to their bodies and give birth the way nature intended, instead of the way an obstetrician dictates.
According to data from the National Center for Health Statistics for 2006, the most recent year for which data is available, 8 percent of pregnant women in the U.S. gave birth with a midwife compared with just 4 percent in 1990.
Why a Midwife May be a Better Choice than an Obstetrician
Obstetricians are specially trained surgeons, taught from early on how to use surgical and other medical interventions to assist in childbirth. They certainly have their place in the medical field, as obstetricians excel at helping high-risk women deliver babies safely. But this is the minority of women.
More than 75 percent of women have normal pregnancies, meaning all of the surgical interventions obstetricians are trained to use are unnecessary. In these cases, a midwife, who is there to offer help, education and support during pregnancy, labor, delivery and after, is actually the safest, most qualified birth attendant.
Notice the word “attendant.” A midwife is there “attending” the birth, assisting in helping the woman’s body to do what it was designed to do naturally, give birth. A doula can also be immensely helpful for women during pregnancy and labor, as their role is to offer continuous emotional support, and assistance on topics such as breathing, relaxation and positioning.
This is the type of support that will help most women to deliver their babies in the safest and most comforting way. Unless there is a complication, medical interventions are typically unnecessary, and often do more harm than good.
Are Hospital Births Really Safer?
There is a misconception in the United States that having a hospital birth with an obstetrician is the safest way to give birth. There is not a single report in the scientific literature that shows obstetricians to be safer than midwives for low risk or normal pregnancy and birth.
Despite this, the American Medical Association recently passed a resolution saying "the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex…"
The reason for the resolution, according to AMA, was due to recent media attention given to homebirths. In other words, they were afraid more women would start to question whether a hospital really is the best option.
So let’s look at some facts.
Nearly all U.S. births (99 percent) occur in a hospital, yet the United States has one of the highest infant mortality rates of any developed country (6.3 deaths per 1,000 babies born). In the Netherlands, however, where one-third of deliveries occur in the home with the assistance of midwives, the infant death rate is lower (4.73 deaths per 1,000).
Cesarean rates are also typically lower among midwife-assisted births compared to obstetrician births, a benefit in and of itself.
One study in the British Medical Journal found that a woman’s risk of death during delivery is three to five times higher during cesarean than a natural delivery, her risk of hysterectomy four times higher, and her risk of being admitted to intensive care is two times higher.
Women who undergo cesareans are at an increased risk of many other complications compared with a natural birth as well. These include:
• Increased risk of mortality
• Infection to various organs including the uterus, bladder or kidneys
• Increased blood loss
• Increased risk of complications in future pregnancies
• Decreased bowel function
• Respiratory complications
• Longer hospital stay and recovery time
• Adverse reactions to anesthesia
• Risk of additional surgeries such as hysterectomy or bladder repair
Cesareans also have a psychological effect on women. As written in Having a Baby, Naturally, which is an excellent resource for all mothers-to-be, "Many women who have cesarean sections reported that the experience was traumatic." Women are also less able to care for the newborn immediately after childbirth and therefore may miss out on bonding opportunities.
There are other risks of hospital births to consider as well, such as drugs used to induce labor, which are also on the rise. If given too early, these drugs can result in the delivery of an infant who is too young to breathe on its own, and may also raise the risk of complications that lead to cesarean.
Early umbilical cord clamping, a practice that has been linked to difficulties breathing and brain damage in the newborn, is also common in hospitals but less so among midwife-attended births.
Excellent Resources for Natural Childbirth
The care you opt for during pregnancy and childbirth is highly personal, but if you are having a normal, healthy pregnancy I do suggest you explore all of your options, rather than simply defaulting to a typical hospital birth.
To start, if you are pregnant or planning to become pregnant I highly recommend watching the documentary The Business of Being Born. It explores the current U.S. maternity care system, including all of its faults, and interlaces the statistics with birth stories to give you a wide range of perspectives about childbirth. You can watch the trailer below right now.
Also, as I mentioned earlier the book Having a Baby, Naturally by Peggy O'Mara, the editor and publisher of Mothering magazine, is also highly recommended; it addresses common concerns and questions of pregnancy from conception through the first months of parenting.
Finally, my past article Natural Birth is Best has a variety of sources to help you make your pregnancy and childbirth as healthy and joyous as it possibly can be.
One of the MOST Important Duties for Pregnant Women
I am convinced that in the not too distant future it will be mandatory for women to receive regular vitamin D blood test levels.
It is absolutely imperative that pregnant women maintain a blood level of between 50 and 70 ng/ml of 25 hydroxy D as the newest evidence suggests that will radically reduce the risk of autism and virtually eliminate type 1 diabetes in the newborn.
There simply isn’t any excuse for not checking these levels and most women will require from 5,000 to 10,000 units of vitamin D per day to achieve these levels.
The cesarean birth -- delivery via uterine incision -- was once reserved for cases in which the life of the baby or mother was in danger. But now it is a routine practice. It is in fact the most common operation in the United States; performed in 31 percent of births, up from a mere 4.5 percent in 1965.
With that surge has come an explosion in medical bills and an increase in complications. Now, the use of cesareans is being reconsidered. It is a major reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results, and may actually be doing more harm than good.
Childbirth is the number one cause of hospital admissions, and is a huge part of the nation's $2.4-trillion annual healthcare expenditure. Spending on the average uncomplicated cesarean runs from $4,500 to $13,000, much more than a comparable vaginal birth. And the cesarean rate in the U.S. is higher than in most other developed nations despite a standing government goal of reducing such deliveries.
The cesarean also exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.
Sources:
Los Angeles Times May 17, 2009
Dr. Mercola's Comments:
(Please visit Dr. Mercola's website at www.mercola.com for video clip, photos, and more).
In the United States childbirth has been shifted to a conventional medical approach relying on drugs and surgeries as an alternative to the often superior traditional methods. According to the World Health Organization, no country is justified in having a cesarean rate greater than 10 percent to 15 percent.
Well it's 2-300% higher with a whopping 31 percent of births in the U.S. performed via cesarean (C-section). This is a rate that even The American College of Obstetricians and Gynecologists admits is worrisome. This is actually the highest rate ever reported in the United States, and a rate higher than in most other developed countries.
In some cases, of course, a cesarean section can save lives, such as in the event of a prolapsed umbilical cord (the umbilical cord slips through the cervix before the baby and may endanger the baby’s oxygen supply) or placenta previa, which occurs when the placenta grows in such a way that it blocks the baby’s exit through the cervix.
Other situations, including when the baby is in a transverse (sideways) position or if the mother is having an outbreak of genital herpes, may also call for a cesarean section. But in many low-risk pregnancies, C-section is far from the best childbirth option.
Unfortunately, I suspect a large part of this growing C-section rate has to do not with medical necessity but with convenience and doctors’ fears of liability (of not performing a cesarean and giving nature a chance to run its course, especially if someone requests the surgery).
There has also been an unfortunate shift in attitudes about pregnancy and birth, taking it from a natural life phase and turning it into a medical condition that needs to be “treated.” Gradually, however, I believe women in the United States are opting for more natural childbirths and choosing to listen to their bodies and give birth the way nature intended, instead of the way an obstetrician dictates.
According to data from the National Center for Health Statistics for 2006, the most recent year for which data is available, 8 percent of pregnant women in the U.S. gave birth with a midwife compared with just 4 percent in 1990.
Why a Midwife May be a Better Choice than an Obstetrician
Obstetricians are specially trained surgeons, taught from early on how to use surgical and other medical interventions to assist in childbirth. They certainly have their place in the medical field, as obstetricians excel at helping high-risk women deliver babies safely. But this is the minority of women.
More than 75 percent of women have normal pregnancies, meaning all of the surgical interventions obstetricians are trained to use are unnecessary. In these cases, a midwife, who is there to offer help, education and support during pregnancy, labor, delivery and after, is actually the safest, most qualified birth attendant.
Notice the word “attendant.” A midwife is there “attending” the birth, assisting in helping the woman’s body to do what it was designed to do naturally, give birth. A doula can also be immensely helpful for women during pregnancy and labor, as their role is to offer continuous emotional support, and assistance on topics such as breathing, relaxation and positioning.
This is the type of support that will help most women to deliver their babies in the safest and most comforting way. Unless there is a complication, medical interventions are typically unnecessary, and often do more harm than good.
Are Hospital Births Really Safer?
There is a misconception in the United States that having a hospital birth with an obstetrician is the safest way to give birth. There is not a single report in the scientific literature that shows obstetricians to be safer than midwives for low risk or normal pregnancy and birth.
Despite this, the American Medical Association recently passed a resolution saying "the safest setting for labor, delivery and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex…"
The reason for the resolution, according to AMA, was due to recent media attention given to homebirths. In other words, they were afraid more women would start to question whether a hospital really is the best option.
So let’s look at some facts.
Nearly all U.S. births (99 percent) occur in a hospital, yet the United States has one of the highest infant mortality rates of any developed country (6.3 deaths per 1,000 babies born). In the Netherlands, however, where one-third of deliveries occur in the home with the assistance of midwives, the infant death rate is lower (4.73 deaths per 1,000).
Cesarean rates are also typically lower among midwife-assisted births compared to obstetrician births, a benefit in and of itself.
One study in the British Medical Journal found that a woman’s risk of death during delivery is three to five times higher during cesarean than a natural delivery, her risk of hysterectomy four times higher, and her risk of being admitted to intensive care is two times higher.
Women who undergo cesareans are at an increased risk of many other complications compared with a natural birth as well. These include:
• Increased risk of mortality
• Infection to various organs including the uterus, bladder or kidneys
• Increased blood loss
• Increased risk of complications in future pregnancies
• Decreased bowel function
• Respiratory complications
• Longer hospital stay and recovery time
• Adverse reactions to anesthesia
• Risk of additional surgeries such as hysterectomy or bladder repair
Cesareans also have a psychological effect on women. As written in Having a Baby, Naturally, which is an excellent resource for all mothers-to-be, "Many women who have cesarean sections reported that the experience was traumatic." Women are also less able to care for the newborn immediately after childbirth and therefore may miss out on bonding opportunities.
There are other risks of hospital births to consider as well, such as drugs used to induce labor, which are also on the rise. If given too early, these drugs can result in the delivery of an infant who is too young to breathe on its own, and may also raise the risk of complications that lead to cesarean.
Early umbilical cord clamping, a practice that has been linked to difficulties breathing and brain damage in the newborn, is also common in hospitals but less so among midwife-attended births.
Excellent Resources for Natural Childbirth
The care you opt for during pregnancy and childbirth is highly personal, but if you are having a normal, healthy pregnancy I do suggest you explore all of your options, rather than simply defaulting to a typical hospital birth.
To start, if you are pregnant or planning to become pregnant I highly recommend watching the documentary The Business of Being Born. It explores the current U.S. maternity care system, including all of its faults, and interlaces the statistics with birth stories to give you a wide range of perspectives about childbirth. You can watch the trailer below right now.
Also, as I mentioned earlier the book Having a Baby, Naturally by Peggy O'Mara, the editor and publisher of Mothering magazine, is also highly recommended; it addresses common concerns and questions of pregnancy from conception through the first months of parenting.
Finally, my past article Natural Birth is Best has a variety of sources to help you make your pregnancy and childbirth as healthy and joyous as it possibly can be.
One of the MOST Important Duties for Pregnant Women
I am convinced that in the not too distant future it will be mandatory for women to receive regular vitamin D blood test levels.
It is absolutely imperative that pregnant women maintain a blood level of between 50 and 70 ng/ml of 25 hydroxy D as the newest evidence suggests that will radically reduce the risk of autism and virtually eliminate type 1 diabetes in the newborn.
There simply isn’t any excuse for not checking these levels and most women will require from 5,000 to 10,000 units of vitamin D per day to achieve these levels.
Tuesday, June 02, 2009
Operation Special Delivery featured on the Today show
http://today.msnbc.msn.com/id/26184891/vp/31061923#31061923
CAPPA's Operation Special Delivery was on the TODAY show this morning!
Operation Special Delivery, or OSD, is an organization that provides free childbirth assistants, also known as labor doulas, to wives of deployed military. For more information please view the clip linked up top. Or visit www.operationspecialdelivery.com.
CAPPA's Operation Special Delivery was on the TODAY show this morning!
Operation Special Delivery, or OSD, is an organization that provides free childbirth assistants, also known as labor doulas, to wives of deployed military. For more information please view the clip linked up top. Or visit www.operationspecialdelivery.com.
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