Misoprostol on Law & Order SVU

January 26, 2011 3 Comments

Some of you may have seen the episode of Law & Order SVU that aired on 11-17-2010 entitled “Gray”.

The episode centered around accusations of rape against one male student at the fictional Hudson University.  The first half of the episode focused on the accusations made and how the lead detective’s daughter was indirectly involved.  Then, the drama really began.

In the course of the investigation, the detectives learn that the accused may have willingly caused his girlfriend to abort their 8 week old fetus without her knowledge.  Supposedly, he had applied a substance, he dubbed “love potion no. 9″, to himself prior to intercourse.  Supposedly, that substance was a mixture of petroleum jelly and misoprostol.

Here is where I went from purely being a viewer enjoying one of my favorite shows to a birth professional wondering how a drug that most women have never heard of had become a prominent feature of the second half of this episode. It is interesting to note that according to The American Congress of Obstetricians and Gynecologists (ACOG), in 2006 approximately 1 in 5 women had their labors induced , and misoprostol is a commonly used agent for this purpose.

What is misoprostol? Well, it is the generic name for an anti-ulcer medication otherwise known as Cytotec.  It is an oral tablet that is dispensed in either 100mcg or 200mcg per tablet and the recommended dosage is 1 tablet 4 times a day
with a meal.  According to the package insert under “Indications and Usage” it states: “Cytotec (misoprostol) is indicated for reducing the risk of NSAID (nonsteroidal anti-inflammatory drugs, including aspirin)-induced gastric ulcers in patients at high risk of complications from gastric ulcer, e.g., the elderly and patients with concomitant debilitating disease, as well as patients at high risk of developing gastric ulceration, such as patients with a history of ulcer.”  In the section labeled “Precautions”, it states the following: “Labor and delivery:  Cytotec can induce or augment uterine contractions.  Vaginal administration of Cytotec, outside of its approved indication (italics are mine), has been used as a cervical ripening agent, for the induction of labor and for treatment of serious postpartum hemorrhage in the presence of uterine atony.” and here is the point that all women who may be presented with the option of inducing labor using this very common method need to note: “A major adverse effect of the obstetrical use of Cytotec is the hyperstimulation of the uterus which may progress to uterine tetany with marked impairment of uteroplacental blood flow, uterine rupture (requiring surgical repair, hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism.  Pelvic pain, retained placenta, severe genital bleeding, shock, fetal bradycardia, and fetal and maternal death have been reported.”  The statement continues: ” There may be increased risk of uterine tachysystole, uterine rupture, meconium passage, meconium staining of amniotic fluid, and Cesarean delivery due to uterine hyperstimulation with the use of higher doses of Cytotec, including the manufactured 100mcg tablet.  The risk of uterine rupture increases with advancing gestational ages and with prior uterine surgery, including Cesarean delivery.”  Further down in that section, the insert states: “Nursing mothers: Misoprostol is rapidly metabolized in the mother to misoprostol acid, which is biologically active and is excreted in breast milk.  There are no published reports of adverse effects of misoprostol in breast-feeding infants of mothers taking misoprostol.  Caution should be exercised when misoprostol is administered to a nursing woman.”  Early in the insert, it is noted that the maximum concentration of misoprostol acid in breast milk was seen within 1 hour of the patient taking the dose.

So, let’s break this down into easy-to-understand language.  Basically, what this insert tells us is that the FDA has approved the use of misoprostol, or Cytotec, for the treatment of ulcers.  It tells us that, while it is commonly used for induction of labor, using it this way is “outside of its approved indication”.  This is commonly known as using a drug “off-label”.  This is not illegal, but it is also not regulated.  Therefore, it is imperative that consumers, and remember that a hospital patient, any hospital patient, is still also a consumer and has the right and the responsibility to become fully informed about any medical treatment, pharmaceutical or otherwise, that a physician may offer.  Some of the risks of misoprostol include contractions that are extremely prolonged and could be life-threatening to the baby, a marked decrease in the flow of blood between the uterus and placenta, uterine rupture, excessively frequent contractions, and release of the baby’s first bowel movement in utero which can be a sign of fetal distress.  It also tells us that infants who are breastfed within an hour of their mother’s taking an oral dose of misoprostol will be exposed to it through her milk.

Now that we have a basic understanding of what misoprostol is and what it is used for, let’s get back to the episode.

The episode continues with the unfortunate death of the accused’s girlfriend, which is apparently due to her succumbing to toxic shock syndrome, a bacterial infection, that was caused by “incomplete expulsion of the products of conception”.  According to the ME in the episode, her immune system had been compromised by the application of the misoprostol directly to her cervix.  One detective then cynically responds that misoprostol is “the gift that keeps on giving”.

What does this mean for you?

Well, now that this drug has received some national attention, albeit in the fictional arena of a primetime drama, and despite some inaccuracies that are inherent to that arena, you will hopefully be more inclined to stop and ask questions about the method of induction your physician or midwife may recommend.  The tablets come in 2 different dosages, 100mcg or 200mcg, but the recommended dosage for induction according to World Health Organization is 20-25mcg orally every 2 hours or 25mcg vaginally every 4 hours.  The difficulty with this is that the tablets are manufactured to be taken whole, in their 100mcg or 200mcg amounts.  This means that the tablets must be cut; and anyone who has attempted to cut a pill in 2 pieces, let alone 4, knows how difficult it is to accurately do that, leaving the true dosage in each piece questionable at best.  This should be an important consideration for anyone who is offered this method of induction.

Having said all of that, I feel it important to admit that 13 years ago, I was given Cytotec orally to induce labor in my second pregnancy.  Admittedly, I was not the birth-savvy woman that I am today; and knowing what I do now, I would most likely handle my son’s birth differently.  Thankfully, my labor went beautifully and he and I came out of it healthy, happy, and whole.  But, I feel that it is my duty to help other women have access to the facts so that you all can make truly informed decisions, if and when, you are faced with them.

Ethan summer 2009

Bottom line is this.  Sometimes we can learn a lot from television.  Or at least we can begin a conversation that will lead us to become more knowledgeable about the world around us.  I have said it many times in my work.  I am not anti-intervention, I am pro-informed consent.  I hope that this post has helped you to become better informed about a very common intervention in birthing rooms around the country.

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2010-My Year in a Nutshell

January 3, 2011 Leave a Comment

So, here we are in the very beginning of January 2011.  Of course, everyone is looking back at 2010 and many blog posts will be devoted to “what have we learned”; and, admittedly, I did learn A LOT.  However, I feel that a quick listing of the highlights of my year will allow me the opportunity to sum everything up in a nutshell.  So, here goes…

Due to circumstances beyond my control, I needed to relocate my massage therapy office.  A blessing in disguise, I am now in a fabulous location right downtown in Farmington, having officially moved in October 13, 2010.  My clients and myself have enjoyed the proximity to so many wonderful shops, boutiques and restaurants, the weekly Farmer’s Market, and the local library.  We have also enjoyed the beautiful design of my new office that allows all of us to enter the space and experience immediate stress-reduction, as we are surrounded by peace, quiet, and soothing colors.

My massage therapy business thrived, despite the current Michigan economy.  Most of my clients have recognized the importance of regular massage therapy as part of their preventative care.  With stress levels so high, and the accompanying physical pain that is often a by-product of chronic stress, people are continuing to choose massage therapy as a low-cost, natural alternative to support their health.

I enjoyed the opportunity to mentor a newly graduated massage therapist, and although she has since moved on, it was a pleasure to watch her learn where her niche was in this amazing profession.  I wish Katie the best as she pursues her passion while working in a chiropractor’s office, bringing pain relief to his patients.

As with many things, though, when a door closes, a window opens.  I am thrilled to welcome Kristin Klein to my office.  She has moved here all the way from Alabama in an effort to join me in working with women and providing support during pregnancy, childbirth, and she is also offering postpartum doula services which will allow a new mom to have a second set of hands to assist her during her transition home in the first few weeks of having a new baby.

As a massage doula, I was blessed with the privilege of assisting 8 families during labor and childbirth to meet their babies for the first time!  5 girls and 3 boys took their first breaths this year, and 4 women became mothers for the first time!

On a personal note, my family suffered the loss of 2 wonderful women this year as well.  Within 2 weeks of each other, my husband’s 94-year old grandmother died peacefully in her sleep on July 31 and my sister-in-law’s husband lost his mother unexpectedly when she died in her sleep on August 11, 2010.  It was an incredibly difficult time for us, as anyone who has lost a family member can imagine.  Both women had been wonderful mothers and grandmothers, our Grammy was also a great-grandmother as well.  We will miss them both.  My own grandmother suffered a mild stroke and is thankfully recovering, if slowly.  My husband continues to care weekly for his father whose health is unfortunately deteriorating slowly.  As you can see, even massage therapists are not immune to experiencing times of great stress.  It is for this reason that I am extremely grateful to all of my clients who allowed me the honor of working with them during a very difficult year.  For me, giving massage  is as therapeutic as receiving it!

The year ended on a high note, as I attended the birth of my 8th doula baby of the year.  This was the 3rd baby for my client, all girls, and the first birth I have witnessed where the amniotic sac remained intact until the baby’s head was born.  That amazing birth will be a described in a separate post very soon.  Suffice it to say that in today’s highly-medicalized birthing environment, it is rare for a doula to see and I count myself very privileged to have the experience!

As of today, my own children have returned to school and I am returning to my office after a much needed break.  I am very excited to see what 2011 holds for me, my family, and my business.

Well, those are the highlights of my year.  I would like to thank my family and friends who held me up when I felt myself crumbling beneath the pressures that naturally come with so much happening.  I would also like to thank my clients, without whom, I would not be able to enjoy so much professional success.

I hope that everyone can join me in looking at the new year as one full of hope, promise, and good things to come!!!

Grammy, you will be missed by us all!

2nd Massage Therapy Room

My new Massage Room

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Birth is All About the Support

July 6, 2010 Leave a Comment

I recently had the privilege of supporting another couple during their baby’s birth.  This was their first baby, it was my 20th birth as a Doula.  I am always amazed at how different every labor and birth is and even more amazed at what I learn with each one!

To start with, I met the couple in their home in the wee hours of the morning and we stayed there for a little while.  It was very quiet and calm.  Mom changed positions and walked around a bit.  She was managing very well using her breathing and inner peace.  Dad kept himself busy getting the last few items together for the hospital and giving physical support when it was necessary.  I was able to facilitate by offering suggestions and jumping in to provide physical support when warranted.

As labor progressed, it became apparent to both myself and mom that it was probably a good time to make the drive to the hospital.  The contractions were getting stronger and mom was beginning to have some shifts in how she was feeling.  I guessed that she was beginning to transition, but kept that to myself.  I’ve learned not to voice my guesses at how far along mom has progressed, although I do enjoy making a mental note and seeing if the first vaginal check at the birthing location verifies my guess!  Sure enough, the check done at admitting showed that she was in the middle of transition!

It had been a group decision, including her OB, for her to labor as long as possible at home.  This particular facility is a teaching hospital and is well known among birth advocates in the area as being one that has a high rate of interventions.  It was my client’s hope that her birth would involve as few interventions as possible.  Studies show that the earlier in labor a woman enters the hospital, the greater her chances of receiving “routine” interventions to “help move or speed up her labor”.  Taking all this into consideration, the decision was made for us to labor at home first.

Every hospital or birthing center is different and every nurse, midwife, and OB have their own philosophies.  As a Doula, I have worked with nurses who were extremely concerned with the technical aspects of managing a birth and I have worked with nurses who have advocated for my clients to have less obstetrical management during their labor and birth.  I have seen OBs who have “sneaked” an episiotomy in, and I’ve seen OBs who have surprised me by being more of a “baby-catcher” who just happens to have MD after their names!  I tell my clients that we never know what we may encounter byway of the medical staff, but that I will do the best I can to support their birth preferences and navigate the varying personalities and philosophies we may face.

I was pleasantly surprised with this one!  A previous birth that I was honored to be the Doula for at this hospital started with pitocin and ended with a c-section.  The staff had been kind and caring, but seemed very concerned with how they could manage the birth themselves.  My client was very happy with her birth and satisfied that she had done all she could to have a vaginal birth, but I was left wondering if there had been fewer students, residents, and other medical staff in the room suggesting options and sharing their opinions, if maybe she would have had a better chance at a vaginal birth.

I prepared myself and my client for birth in this facility.  I tried to reassure myself that maybe her birth would be less managed and helped her develop communication with her doctor so that she felt better supported in her decisions and hopes for her upcoming birth.  All along, though, I have to admit that I was a little scared that her birth would be filled with people coming and going and her ability to labor effectively decreased.  I did what I could to dispel her fears, while working to dispel my own.

What a wonderful surprise!  Because it was so very early (essentially still the middle of the night), the hospital was empty!  There were no nursing students and only one resident!  The nurse assigned to my client was so very supportive of the birth process and calmly went about her administrative responsibilities and care of my client.  Before long, it was apparent that birth was imminent.  The nurse had left momentarily, but I felt the need to take a quick look at what was going on.  My client was laying on her side and I gently lifted her top leg…What did I see?…A bit of the amniotic sac, about the size of a golf ball, full of fluid!  I quickly excused myself, leaving my client in the loving hands of her husband and found the nurse.  When I told her what I saw, she ran in, verified what I thought it was and called the OB on staff to let her know that birth was about to happen!  Since the OB was one not affiliated with my client’s practice, I quietly informed her that my client wished to tear rather than have an episiotomy and so she helped massage the tissue around the baby’s head as it emerged.  Everyone was verbally supportive, helping my client stay focused and calm as her baby was born.  Within minutes, a healthy, beautiful new life entered the world.

The OB was admittedly surprised with how quickly and successfully my client birthed her first baby.  She made the remark that most first-time moms come to the hospital and labor for hours and hours.  She also seemed surprised that my client did not suffer more than a minor tear during birth.

For the resident who was present, I hope that she remembers that unmedicated, minimally managed birth is possible and beautiful.

For the OB who attended this birth, I thank you for listening and supporting my client’s decision to not have an episiotomy and for speaking kindly and supportively to her.

For the nurse who was assigned to my client, I am impressed and appreciative to you for your calmness and all the emotional encouragement you gave my client so that she could be in her rhythm and work with her baby for an amazing birth.

What I will take away from this experience is this:  while I will continue to help my clients find a supportive caregiver and a facility that fits their hopes and preferences for birth, I will also remember that even if a client chooses to birth at a facility where interventions are truly the routine procedure, whatever happens, birth is really all about the support.

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Great Things Can Happen!

June 22, 2010 Leave a Comment

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I can hardly believe how last week went!  One day I went into my office and found a packet from one of our local television stations that was letting me know my business Tranquil Touch Therapeutic Massage For Women had been nominated for their “Vote 4 The Best” contest!  Then, the very next day, I received an email letting me know that my blog (this little blog!) had been awarded as one of Online Nursing’s top 30 Doula blogs for 2010!  What an amazing week!

I have to thank all my readers, clients, friends, and my family for supporting me for the past 6 years.  I also recently hired a new therapist to work with me, thus extending the opportunity to receive great massage therapy to even more women in our community.

Massage therapy was once thought of as a luxury that only the rich could afford.  However, recent studies have shown that as the stress levels of average Americans increases, their awareness that regular massage therapy is actually going to support their health and well-being is also increasing.  Low-back pain, chronic pain, and frequent headaches are some of the most common reasons for people to visit their doctors.  However, with healthcare costs rising and more people losing their health insurance, massage therapy is actually a very affordable option for pain relief.  It also helps improve your sleep and lower stress hormones.

Likewise, having a Doula at your birth is becoming more recognized as an essential part of a woman’s preventative healthcare.  Studies have shown that Doula-attended births have lower frequencies of high-cost interventions such as episiotomies, epidurals, and cesarean sections.  Having a Doula at your birth can lower the overall cost and increase your sense of empowerment, satisfaction, and speed your recovery.

It is my honor to be recognized as an expert in both aspects of a profession that I love.  Being a busy woman, helping to support other busy women, is a privilege that I will always be grateful for.  Life is full of ups and downs, trials and joys, and through it all, I will try to remember this week and that “Great Things Can Happen”, and do!

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Gratitude Post

February 22, 2010 Leave a Comment

So, here I am, at home with my kids on a snow day.  The last snow day that we had, I was scheduled to work at my office with 4 massage clients.  My last appointment had contacted me the day before to cancel due to illness.  I chose to cancel my first client of the day, believing that the roads would be clear by the mid-morning when my next one was scheduled.  As it turned out, the roads were a mess until late that afternoon and the parking lot of my office complex was never plowed.  I almost turned around at one point, but couldn’t reach my client by phone, so I trudged on, slipping and sliding.  When I arrived at my office and noticed all the snow in the lot, I had to park in a lot across the street and walk.  My 2 remaining clients were able to get there and we had great sessions.  This caused me to pause and think about how grateful I should be to have clients who are so committed to their health and so loyal to me.

So, when I found out today was going to be a snow day, I decided to think about all the things I am grateful for, the first being that I didn’t have to drive in it today!

But I digress.  Here are the things I am grateful for today:

  • My family & I are healthy and happy.
  • I have 2 of the best sons anyone could have!
  • We are blessed to have what we need, despite having to simplify our lives due to the economy.
  • My husband has a job (actually 2 part-time ones) that pays most of our bills, he recently got his Associate’s Degree in Marketing and Applied Management & is hoping to break into that field soon. (hint,hint ;-) )
  • I have an amazing job that allows me to meet amazing women in my community who recognize the value of massage therapy.
  • I also have the awesome privilege of being chosen to be the Doula for women who are taking charge of their births and value educating themselves about all of their options & recognize the need for labor support.
  • My job(s) allow me to arrange my schedule to be present and active in my children’s lives.
  • I have allowed myself, and been supported by my family & friends, to grow both professionally and personally.
  • The wonderful birth professionals and bodyworkers that I have met through various social networks who have helped me become more knowledgeable and confident in my work and have encouraged me to explore my “writing voice”.
  • Everyone who has chosen to take some time out to read my blog.

Of course there are many, many other things that I am grateful for, but these are the things I felt like sharing today.  I hope that everyone who reads this can take a moment and think about what you are grateful for and even share those things with me in your comments.

With Gratitude,

Exie

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Pregnancy & Doula Books

February 4, 2010 Leave a Comment

So, I’ve meant to post this for a while, but as is so often the case, I got sidetracked by life and all the craziness it entails.  Now that I have a little time, I am ready to share with you some of the books that I’ve read during the course of becoming certified and recertifying as a Prenatal Massage Therapist and Doula.

First, I will give my brief reviews of each book and I will also try to add a new page just for recommended books.

1) Pushed – The Painful Truth About Childbirth and Modern Maternity Care by Jennifer Block

                    This is an amazing review of many of the trends that have come and gone throughout the history of maternity care.  It will cause you to examine the impact that those trends have had on your own personal views of childbirth.  There are many personal stories of women who have fought the system and the common perceptions of childbirth.  The history of midwifery in America is extensively discussed and Ms. Block even uncovers the alarming trend of the criminalization of homebirth midwives and the mothers they serve.  This is definitely a book that any self-proclaimed birth-junkie will want to read.

2) The Doula Guide to Birth – Secrets Every Pregnant woman Should Know by Ananda Lowe & Rachel Zimmerman

                         This is a book that is written for the expectant mother, but one that every doula will enjoy.  There are multiple references made to the evidence-based medicine published in the studies of the Cochrane Collaboration.  The information is both concise and understandable.  The authors do a fabulous job of discussing how doula care can help the expectant mother regardless of who or even if she has a partner in life.  They refer to the Doula Project of the Chicago Health Connection which provides doula support for young teenaged women.  The amazing thing about the Doula Project is that the doulas were once teenaged mothers themselves!  The authors also discuss how doula care can help women who are surrogates or planning on giving their babies to another family for adoption.  I found the information to be very balanced and beneficial.  It is an enjoyable read for both birth professionals and the mothers they serve.

3) Pregnancy, Childbirth, and the Newborn – The Complete Guide by Penny Simkin, Janet Whalley, Ann Keppler, Janelle Durham, and April Bolding

                         This gargantuan book definitely is full of information.  It begins with the basics of describing the reproductive process.  While this may seem very elementary, I suppose that some women who have the foresight to read a pregnancy book before conception may find it helpful.  I did find the topics of how to choose a caregiver, birthing location, and childbirth classes to be beneficial to a pre-pregnant or newly pregnant woman.  The book gives detailed examinations of nutrition, environment, herbal remedies, prescription drug use and street drug use and how each of these mayaffect the development of the fetus.  The section that discusses the history of maternity care is very brief, but segues nicely into an explanation of how the body perceives pain and how the expectant woman may be able to approach the handling of pain.  The stages of labor are detailed well and help to demystify the process for the expectant woman.  As a doula, I don’t think this book is a necessary read, but for expectant women, it is a great book to help prepare for pregnancy and childbirth.  It is comprehensive and will help women feel well-informed and empowered for birth.

4) Birthing From Within by Pam England and Rob Horowitz

                         There are many doulas who are certified through the Birthing From Within course and have read this book as part of that process.  For those of us who are certified through other organizations, I believe that this is a valuable book that can be extremely beneficial in our growth as doulas.  This book is written for pregnant women and their partners and is designed to help them understand what labor might be like and how women can accomplish birthing their babies.  The authors try to help the reader challenge and acknowledge the beauty of pregnancy and childbirth despite the influences of society.  Birth art is introduced as a way to help women and their partners face and cope with their fears, hopes and concerns.  Birthing rituals from throughout history and across cultures are discussed to assure the expectant woman that there is no “right” way to birth.  The medical side of birth is discussed without using heavy, difficult jargon; but in a way that affords the reader dignity of intelligence.  There is valuable information for fathers as it is acknowledged that birth also has a profound affect on them.  Pain management is discussed in a way that helps the expectant mother understand and appreciate the benefits of childbirth pain to both her and her baby.  There are wonderful appendices that are easy references and even contain cut-out cards for the parents to use.

5) Doula Programs by Paulina Perez and Deaun Thelen

                         This relatively short, concise book is a great read for anyone considering entering the Doula profession.  How being a doula affects your lifestyle, how to care for your family, how to market your services and create a business identity are all discussed in this book.  If you are a prospective Doula, this should probably be one of the first books you read.

6) Gentle Birth Choices by Barbara Harper, R.N.

                         This book is an absolute must-read  for all expectant women and the professionals who work with them.  It is superbly organized and written in a way that is engaging to both types of readers.  There is a large part of the book that is devoted to dispelling many of the most common medical myths that exist today.  There are beautiful black and white photos throughout the book and a wonderful, if dated, DVD that is included with the book.  The book recognizes that birth happens in many places and under a variety of circumstances.  This is an amazing examination of what “gentle birth” really is and how women can have that type of birth for themselves and their babies. 

7) Spiritual Midwifery by Ina May Gaskin

                         While this book is intended as a must-read for aspiring midwives, it is an excellent teaching tool for Doulas and is a book that will inspire any expectant mother.  A large portion of this book is dedicated to sharing personal stories and first-hand accounts of birth on The Farm.  There are births that have both happy and sad outcomes, but all help us to appreciate the amazing power of women.  No matter what the outcome of a birth, this book helps to show that when a woman is supported with love, compassion, and kindness, childbirth can be the most empowering experience she has.

8 ) The Thinking Woman’s Guide to a Better Birth by Henci Goer

                         I consider this to be the pregnant woman’s bible.  The many possible interventions and options that women may have to face in childbirth are discussed in a balanced and non-judgmental fashion.  The history and method of each intervention or option is briefly detailed and then there is a list of the Pros and Cons of accepting that intervention or option.  Studies are listed in the back to help the reader make a proper informed choice based on the evidence.  I love, love, love this book and recommend it to all my clients, especially those who have chosen to birth in a hospital environment.

9) The Birth Partner by Penny Simkin

                         This book is one of the best books to help an expectant mother’s support team to better understand how to help her through the different phases of labor.  It well-describes what a mother may be experiencing during the different phases, both physically and psychologically, and gives wonderful tips to help her partner provide support that is both comforting and effective.  As a Doula, I found this book to be a vital asset to me during the first few births that I supported.  As time has gone on, I find that although I refer to it with less frequency, I still feel comfort in keeping it in my birth bag where I can grab it easily if more support suggestions are needed during a birth.

10) Ina May’s Guide to Childbirth by Ina May Gaskin

                         This book is the champion of the Natural Childbirth Movement.  Multiple stories of unmedicated, truly natural childbirth are shared along with a critical examination of the many medical procedures and interventions that have become a part of routine childbirth in hospitals across the country.  If you are an expectant mother who has fears about your ability to birth your baby either with or without pain management, or if you are interested in finding out if unmedicated, truly natural childbirth is for you, this is the book to read.  If you are wondering whether the many medical interventions that have become routine are actually necessary to successfully birth a baby, you need to read this book. 

So, there it is, my book list.  It does not include every book I’ve read about pregnancy, childbirth or maternity care.  There are many more amazing books out there and if you have some to recommend, please do so.  I am always open to recommendations!

I would also like to send out a HUGE CONGRATS! to Abby Epstein for her successful VBAC http://www.mybestbirth.com/forum/topics/abbys-baby-is-here

And another HUGE CONGRATS! to Gisele Bundchen for her successful Waterbirth/Homebirth http://bostonherald.com/blogs/entertainment/the_assistant/?p=594

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Are We Shooting Ourselves in The Foot?

January 9, 2010 5 Comments

Recently I had a prenatal massage therapy client come in for an appointment; we’ll call her “Client A”.  On my prenatal massage client form, I have a spot for the client to request information about my birth doula service.  If she requests that information, I take a few moments to discuss what her desires for birth are and explain how my support can help enhance her birth experience and help her have a positive memory of how her baby was born.  I did this with Client A.

Allow me a moment to briefly share my background:  I have 2 boys who were born vaginally, but with medical interventions.  I have personally experienced induction, episiotomies, use of vacuum extraction, narcotics in labor, epidural, spontaneous water breaking, and AROM.  I know how some of these interventions were beneficial to me or my baby and some were harmful.  Fortunately, my children are healthy, happy, and show no signs of birth trauma.  Knowing what I know now about these interventions, I am sure that I would have made some different choices if faced with the same circumstances today.  I have provided support to 16 sets of parents and 17 babies as they entered the world, some in hospital settings and others in our local birth center.  I am neither pro-intervention, nor am I against intervention.  I am, however, pro-knowledge.  I believe that if a woman is fully informed of both the risks and the benefits of an intervention, she can in good conscience make the best decision for her and her baby; this is her birth after all.  As her doula, I support her in any well-informed decision that she makes.  I carry with me The Thinking Woman’s Guide to a Better Birth by Henci Goer  along with OB/Peds Women’s Health Notes to help my clients if they are faced with an intervention decision during labor.  I show them the information, which includes the pros and cons, and allow them to make the decision with which they are most comfortable.  I feel that this is the best way I can serve the birthing women who have invited & honored me to join their birth team.

Now, back to Client A.  She has indicated to me on several occasions during prenatal massage appointments that she would like to have a doula-supported birth.  This is her first child and she is apprehensive about how labor will go.  She has indicated that she is not opposed to interventions, although she would prefer to be able to do things such as walk and be in a tub (which is not available at the hospital she toured).  She spoke with her OB who told her that the hospital is a teaching hospital and therefore, she would be subject to the presence of and examinations by various residents and other staff.  She also was told during her tour that the hospital protocol is that everyone is hooked up to a fetal monitor.  While her OB is not opposed to doula support, she made sure to tell my client that the doulas that she has worked with have stepped over the line and tried to tell her how to do her job as the doctor.  This caused my client to express a wish to not do anything that may cause any kind of drama or confrontation during her labor and birth. 

Here’s my question:  In our efforts as doulas to support women and advocate for gentle births, are we shooting ourselves in the foot? While being zealous about birth and wanting to help as many women as possible to become educated about their choices, are some of us going beyond our scope of practice and code of ethics and actually  REDUCING the choices to women because we are creating battle lines with their medical providers?

As Doulas, we are not supposed to perform clinical tasks, nor are we supposed to speak for our clients or make their decisions for them.

I have no illusions about the world, myself, or birth.  I know that we are in an uphill battle against insurance companies, OBs with “God-complexes”, and women who question their abilities or rights to decide how their babies are born.  I know that I am not the end-all, be-all of birth professionals.  I am, however, a mom who has had interventions because I didn’t know any better.  I am a doula who just wants my clients to feel empowered and informed enough to own the decisions that lead to how their births evolve.  And I am frustrated when a client decides to not have a doula because she is paying the price for another patient whose doula was a little over-zealous and put her OB on the defensive.

Filed under birth, childbirth, Doula, massage, pregnancy Tagged with , , , , , , , ,

Why do We Use Such Terrible Terminology?

January 7, 2010 3 Comments

So, I was reading one of the books on my list for Doula recertification and had quite a visceral reaction to one of the terms used in the section about Preterm Labor Treatments and that got me thinking that the terminology that we use everyday can cause us to develop fear, negativity and even lose confidence in ourselves.  This is not restricted to pregnancy and childbirth, but it seems to me that those circumstances call for even more care in the way that we phrase things.

I have had 2 children and have been a birth professional for several years.  Most of the terms used are very familiar to me, including the one that caused me to write this post.  What struck me is that although I knew the term and what it was, I’ve even known a handful of friends and acquaintances who have had the treatment; it never raised a red flag in my mind until now.  Chalk it up to a growing awareness of the power of words and my personal journey toward positive living.

By now you are probably wondering what it was that I read.  Okay, here it comes.  The Terrible Terminology: “Incompetent Cervix”  For those of you who are not familiar with the term, it refers to a cervix that shortens and begins to open prematurely and in the absence of preterm labor contractions.  This may occur in pregnant women who have experienced a weakening of the cervix due to conization (the removal of a cone-shaped wedge of cervical tissue during a cervical biopsy), surgery, or trauma.  If this is the case, the treatment is cervical cerclage (suturing the cervix closed until late pregnancy when the sutures are removed).   In these cases, most women can still labor normally and have safe vaginal births.

According to Mirriam-Webster, the term “incompetent”: means inadequate to or unsuitable for a particular purpose; or lacking the qualities needed for effective action, or unable to function properly.  Granted, when the cervix is unable to stay closed so that a pregnancy can continue to term, it does technically fit this definition.  However, this condition is usually caused by a previous event that has compromised its integrity and ability to stay long and closed until labor. 

I would prefer the term “weakened cervix” to be used when explaining to a woman that she needs to have the cervical cerclage.  Calling a woman’s cervix “incompetent” implies that her body is broken and perhaps inherently incapable of handling pregnancy and childbirth.  In my opinion, “Weakened” implies that her cervix started off strong and capable, but that strength has been reduced and so needs some extra support.  In my opinion, that gives a woman explanation of why the cerclage is necessary while not making her feel like part of her is broken.

This brings to mind another Terrible Terminology used all to often in childbirth: “Failure to Progress”.  This one seems pretty self-explanatory, but more often than not it is used to describe a labor that is just not moving quickly enough to fit into the doctor’s schedule or hospital protocol.  Usually women who are labeled this way end up with multiple interventions, possibly major abdominal surgery in the form of a cesarean section, and may describe their birth experiences in negative terms.  Most of us in the birthing community know that there are variations to labor and that as long as mom and baby seem to be coping well, a long labor is not a “failure” and eventually those babies are usually born just fine.

How many of us have not lived up to our potential, but would bristle at being called “incompetent” or a “failure”?  We’ve all heard about “the power of positive thinking” and most of us know that we feel better, even at the worst of times, if we can put a positive spin on our situation.  These are just a couple of examples of words that I feel have a negative impact and could be rephrased or not spoken at all.

So, I challenge you, just as I challenge myself, to think before speaking and consider the impact our words have on ourselves and others.

Filed under birth, childbirth, Doula, Misc. Interesting Stuff Tagged with , , , , , , ,

My opinion on ‘Miracle Mom’ from death to life story

December 31, 2009 Leave a Comment

Well, I’ve watched the GMA interview over and over again to see if my earlier questions would get answered.  Here’s my final take on it (quoted portions come from the interview on Good Morning America).

The story begins with a narration by ABC news anchorwoman, Elizabeth Vargas telling viewers that Tracey Hermanstorfer’s “water broke at dawn on December 24, seven weeks before her due date”.  After her husband quickly takes her to the hospital, the narration continues that “all was well until Tracey was overcome with exhaustion.  She closed her eyes and suddenly…She went into cardiac arrest.”  The narration continues to inform us that the staff tried to resuscitate her for the next 4 minutes under a code blue, but she was unresponsive.  Once the doctors determined that she was dead, they decided to attempt to save the baby boy she was carrying by performing an emergency c-section right in the delivery room.  The doctor performing the surgery is said to be Dr. Stephanie Martin, a maternal fetal medicine specialist at Memorial Central Hospital who had run in the room to assist in resuscitation when the code blue was called.

Dr. Martin delivered the baby, but he was not breathing either.  It appears that just as the baby was delivered, Tracey’s pulse returned (one has to assume that she was still hooked up to the pulse monitor in the delivery room, which is normal protocol in most US hospitals).  She was quickly transferred to the OR and within moments her son, Coltyn, took his first breath of life.

Thankfully, both Tracey and her son looked happy and healthy in the interview.  I am thrilled for her and her family that their story had the best outcome anyone could have hoped for.

However, I wonder about her remarks that her son was 7lbs.4oz even at the reported gestational age of 33 weeks. (average weight at that time is somewhere between 4 and 5 lbs, this estimate comes from a table provided by Doublet PM, Benson CB, Nadel AS, et al: “Improved birth weight table for neonates developed from gestations dated by early ultrasonography.” Journal of Ultrasound Medicine. 16:241, 1997.)  Tracey even seemed confused by Elizabeth Vargas’ statement that Coltyn was 7 weeks premature.

The next point was that she said after she got pitocin, she “felt a little wierd” and “the pains were just a lot harder than I could remember so we just decided to go ahead and do the epidural for the very first time”.  Mike Hermanstorfer stated that Tracey was sitting up when she received the epidural, laid down after administration and then commented that “she was tired and that’s when the whole nightmare started”. He goes on to say that his wife did indicate that her legs went numb and she closed her eyes to take a nap because of the anticipated long day ahead of them, but then “she wasn’t waking up”.  He noticed that as he was holding her hand it started to turn cold and he looked and noticed her fingertips turning blue.  A nurse then noticed the color in her face had changed “she was grey as a ghost” her husband tells us.

Dr. Martin then takes her turn explaining what happened.  When she heard the code blue, she ran to Tracey’s bedside, where” the anesthesiologist had already started breathing for Tracey” and preparations were being made to resuscitate her if her heart stopped, which it did within a few seconds of Dr. Martin’s arrival.  She makes the comment that “unfortunately in most of these situations, despite the best efforts of the team, um, mom is often not able to be revived.  And so we anticipated that possibility.”  She indicates that the decision to perform the cesarean was only after they determined that the resuscitation efforts were ineffective and they wanted to deliver the baby to give him the best chance at survival.  Amazingly, Tracey did respond once delivery occurred and she was able to be fully revived.

Although Elizabeth Vargas erroneously repeats twice that the cesarean was done “without anesthesia”, it is obvious that Tracey must have still been numb from the epidural that had been previously administered.  This was a comforting thought to me because I just couldn’t imagine the pain she would have been feeling during the cesarean as she was beginning to come around.  She reportedly had been without a heartbeat for somewhere between 4-5 minutes and stopped breathing a minute or two earlier.

Dr Martin concludes the interview by saying that while she doesn’t have “a great explanation”, but offers the theory that “primarily that emptying the uterus relieves the body of a responsibility to try and feed that baby in that uterus.  And so perhaps that stress relief offered some, you know, um, ability for the heart to recover.  And it also unblocks the obstruction to the blood flow to and from the heart because that uterus at term, or near term is quite large and can block the blood flow when they’re lying flat like that.  But the reality is even that  in those situations, most of the time, the mom does not have such an incredible turnaround.  We may notice an improvement in their blood pressure, for example, or their response; but it’s very, very unusual to have this type of immediate recovery because as soon as she got her heart rate back, Tracey just continued to get better and better.  By the time she was in the ICU about an hour and half later, she decided she didn’t care  to be intubated anymore, removed her tubes…” she was able to talk after that and even made sure they knew the name she’d chosen for her newborn son.

Tracey Hermanstorfer has 2 older children and indicated that their births had been unmedicated.

Again, I congratulate the family and share their relief in Tracey and Coltyn’s healthiness, but I wonder if the outcome had been different, would it have been newsworthy?  How many of the 569 maternal deaths in 2006  or how many of the 18,989 infants under 28 days old who died also were deemed to “inconclusive” and how many of those were even reported on by the media? (stats from U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau)

Clearly, with the US having the “second worst newborn death rate in the modern world” according to an article on CNN at  http://www.cnn.com/2006/HEALTH/parenting/05/08/mothers.index/ and ranking an appalling 41st out of 171 countries for maternal mortality as reported by IPS at http://ipsnews.net/news.asp?idnews=39642 , something is terribly wrong with  the way we handle pregnancy and childbirth in this country.

Filed under birth, childbirth, Doula, Medical News, pregnancy Tagged with , , , , , , , , , ,

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