A Feminist Perspective on Breastfeeding

“Breastfeeding and Work; Let’s Make It Work.” What comes to your mind when you hear the 2015 World Breastfeeding Week’s slogan? Most Americans think of women working outside the home who juggle nourishing their babies at their breasts with the demands of a boss. This calls to mind breast pumps, bags of frozen breastmilk, and bottles left for daycare providers; mothers striving to provide the very best both financially and nutritionally for their families. If you are a politically progressive American, “breastfeeding and work” may evoke images of paid maternity leave, perhaps even as long as some European countries, which provide 1 to 3 years! If you are a woman working in an office job perhaps this slogan sets you dreaming about pretty, private, lactation rooms with cozy chairs, baby photos, relaxing music, a clean sink to wash your pump parts, a refrigerator for storing pumped milk, clean counter space and electrical outlets to plug in your double, hospital-grade, hands-free, electric pump. Or you may be one of the many women yearning for a long-enough break from running a cash register, working the sales floor, making motel beds, tending the sick, picking vegetables, or flipping burgers to drain your full breasts often enough during the day to keep your body producing enough of a milk supply to match your hungry baby’s growing needs.

These are all valid dreams and desires, but as a community lactavist and modern feminist I have a broader vision; a vision better for all of humanity.

Who decided what IS work and what ISN’T work? Men did. Our modern chauvinistic culture decided work was what men did away from home. Therefore, women weren’t working when they stayed home and raised children. Anyone who has raised children knows this is ludicrous. Raising babies into well-functioning, happy, healthy adult human beings is incredibly demanding work. The hours are ridiculously long. Your job description changes every few months. Your day is filled with multitasking, negotiating, and strategic planning. Safeguarding the next generation, assuring the continuation of the species, is arguably the MOST important human endeavor. Regardless, men deemed raising children as less important than making money; therefore, what women did was NOT work.

Sadly when the women of the women’s liberation movement fought for the right to work outside the home they adopted the male paradigm for themselves. Imagine all those career-minded women in their pant suits. Secretaries might wear skirts but any woman who hoped to climb the corporate ladder donned the female equivalent of the coat and tie. Even Hillary Clinton perpetuated this stereotype through much of her last campaign. The 1960’s feminist reasoning went like this. We want to compete in the professional world. The professional world was designed by men for men, therefore we will pretend we are men. We will pretend we don’t grow babies, we don’t birth babies, and we don’t make milk to continue to grow babies. Many of the feminists of the time, such as Gloria Steinem, DIDN’T have babies. Others, like Betty Friedan had children who were older by the time they spearheaded a cultural revolution.

The “Mommy Wars” are a direct outgrowth of this acceptance of the male construct of what is and isn’t work. The media plays into big corporations’ hands when they keep the conversation about women judging each other; “working” mothers versus stay-at-home mothers. Giant formula makers are happy the conversation stays away from the damage we are doing to the long-term physical and mental health of human beings by feeding milk proteins designed for baby cows instead of baby humans.

Purely from a science perspective the verdict is in. Breakthroughs in epigenetics, the human microbiome, gut health, and evolutionary biology all point to the same conclusion; formula feeding is a major health risk in our society, but no one is talking about it except people directly involved with lactation education. We desperately need to make a cultural shift if we want to truly deal with the obesity epidemic. Or tackle lowering our rates of heart disease, autoimmune disease, breast and cervical cancer in our country and much, much more. Studies link all of these health issues to artificial human-milk feeding.

That shift starts by valuing women’s abilities to nurture and sustain life. Acknowledge that women have brains, and uteri, and breasts that lactate. We are the crucial link between the generations. This most important ability needs to be supported by every level of society if we want the human race to thrive. We need to support not only the women who are pumping behind closed office doors, but also the women who need to pump during a break from picking strawberries, and the women who are working at home to raise kids, and the women who are nursing their children while they take calls for their in-home business, and the women who are taking their babies to work. We need to tell all mothers through our laws, through our media representation, through changes in our language, through our politics, and through our economics that all women who are providing breastmilk for their children are doing important work for all our futures. I want us to move beyond the Mommy Wars, to move beyond normalizing breastfeeding, into a culture that values and supports the significant contribution every lactating woman is making for our country, our world and our species.   

Jennifer Stover is the education chair of the Central Coast Breastfeeding Coalition, based in San Luis Obispo, CA. She has been a La Leche League leader for 5 years and a certified birth and postpartum doula for over 20 years, and founder of the Birth & Baby Resource Network.

What a VBAC Calculator Shows

This morning I noticed this intriguing post in our local ICAN group's Facebook page:

I know this isn't an active group, but this is the only one of my groups where it seems appropriate to post this. Does anyone know where I can find info about the VBAC rates for home births and hospital births? I found this cool VBAC calculator, but it doesn't account for birth setting.https://mfmu.bsc.gwu.edu/PublicBSC/MFMU/VGBirthCalc/vagbirth.html

A Vaginal Birth After Cesarean calculator? Really? So I decided to try it.

It is always important to know who you are playing with so I investigated who created this calculator. OK it says it is based on data collected from an article "Development of a nomogram for prediction of vaginal birth after cesarean". A nomogram? Huh? That is just a geometric way of looking at multiple variables. The data set came from the Maternal-Fetal Medicine Unit Network. Here is their mission statement: "The MFMU Network conducts clinical studies to improve maternal, fetal and neonatal health emphasizing randomized-controlled trials. The aims of the Network are to reduce maternal, fetal and infant morbidity related to preterm birth, fetal growth abnormalities and maternal complications and to provide the rationale for evidence-based, cost-effective, obstetric practice." They are a network of university based hospitals. These teaching hospitals are where the births happened that form the statistics to base this calculator upon.

First the questions they ask to help them calculate are telling. They want your age and body mass index. Don't know your BMI? Don't worry they'll calculate it for you. They want to know if you have a "proven pelvis". What's that? It is a woman who has either had a vaginal birth before or after a cesarean. In other words at some point a baby "fit" through. They want to know if your cesarean was for lack of progress dilating, lack of progress moving the baby through your pelvis or some other reason. Other reasons could be twins, breech, high blood pressure, fetal distress, maternal fever, etc. They just lump all the other reasons into one category. Most distressing to me are their questions about race. They break it down by African-American, Hispanic and all others lumped together. What the hell? What on earth should race have to do with it?

So here is what I found when I did some calculations.  I kept all other factors the same except the one I was looking at. Trying to compare apples to apples. Let's look at age first.

Age 
They obviously feel age matters. I changed the age from 18 to 30 to 35. 
I had between 7% to 10% less chance of successfully VBACing at 30 than at 18 years old. The low end reflects women who progressed on their predetermined schedule. The top end reflects women who fell off the time chart plus were heavier. At 35 it drops again. Now I have 10% to 15% less chance depending on the other factors. Ugh! Obviously age is NOT something you can do something about or can you? How many 35 year-olds do you know? I have worked with many and some have the physical health of a 40 year old while others could pass for being in their twenties.

Weight
By adding 70 pounds to a white woman with no previous vaginal births and allowable progress during labor/pushing she has lowered her chances of VBAC success by 12%. If she had a "failed" labor the numbers move down to 16% because of the additional pounds alone. This may make some sense because weight can cause confounding health issues, such as high blood pressure.So if you want to VBAC stack the decks in your favor by starting at a healthy weight. Oh wait! If you want to avoid that first section be a healthy weight before you get pregnant and then work with someone who knows about pregnancy nutrition to stay on track.

Arrest of Labor
This is defined as absence of progress. So of course one must FIRST note that progress is a very subjective animal. The good news is this calculator says if you had a surgical birth for arrest or "failure" either during dilation or pushing your chances are only 9% to 12% less than the woman who didn't. As a doula I know it is critically important to look at WHY you stopped progressing or weren't progressing fast enough. Was the baby in a poor position? Was this a failed induction? Why were you induced? Too long past due date? How far was too long? Baby "suspected" of being too large? How large was he or she really? Induced for other health concerns, blood pressure, diabetes, etc.? Perhaps your water broke and labor didn't start quickly enough so you were given labor initiating drugs. Did you have an epidural? At what point in the labor? I can't stress how important it is to obtain ALL your records and to go over them with an experienced doula or midwife. Perhaps your "failure" to progress was actually THEIR failure. 

Race
Here is where they doubly fail women. Be prepared to get angry.
I went back and changed only race as a factor. So let's look back at the age issue WITH race added in. If I am a 30 year old woman of color I had a 10 to 16% less chance than an 18 year old. While a white 30 year old has a 7% to10% less chance.  And at 35 I as a white woman would have 10% to 15% worse odds but as a woman of color it plummets to a 21% less chance of success. Excuse me? What about race with weight? If I am a 30 year old white woman with healthy weight, no vaginal births and no "failure" the calculator predicts I have a 80% success rate in their hospitals. That same woman of color? 67.2%! That is a difference of about 13%. If  I am 70 pounds heavier I have a 16% worse chance of success than my white sister. 

So now I compared the best case scenario; 18 years old, healthy weight, no arrested labor c-section, vaginal birth before and after surgical birth, White to Black or Hispanic. Shockingly the numbers say a woman of color automatically gets 4% worse chance of birthing vaginally. That my friends is systemic racism in its most insidious form. It is in how they are treated from the moment they are in their doctor's offices until the moment they are discharged from the hospital. I have witnessed this unequal treatment. Every time it has angered me. Usually it appears to anger me more than the woman trapped in it. Perhaps because she has only her own experience to compare, whereas I can compare her to the white women I have supported. But here the numbers are; in black and white for all to see. A disgrace.

I did not intend for this to be a post about race. I started in thinking I was going to check out this calculator and compare hospital stats with homebirth stats. But the numbers took me a different direction. Here are two links for those of you who wish to compare homebirth and hospital birth numbers. They were posted by Terri Woods of SLO Doula Connection  in response to the ICAN query. She rightly warns that homebirth midwives automatically risk out a variety of complications and so it isn't exactly apples to apples. Still it is worth noting that out of 1,354 VBAC women 87% were successful. There is no way for me to do a straight comparison because I don't know anything about age, weight, reasons for prior sections or if they have had a vaginal birth either before or after their surgical birth. 

Science and Sensibility looks at the MANA homebirth study 

Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009

Planning to VBAC? Hire a doula. Plan a home birth. Hire a midwife. Get healthy and stay healthy. Finally question, question, question; especially if you are a Black or Hispanic woman. 

California Measles Outbreak; What's a Parent to Do?

Yesterday I caught the tail end of Dave Congalton on the radio talking with a local pediatrician who has written a new e-book about baby's first year. She was adamant about vaccinations and was sure that if parents were simply told the facts by their doctor they would automatically want to vaccinate. During the short time I was listening, 2 other docs called in to FULLY support vaccinations.                                 
She also said we were having a measles epidemic in California. At that point I called in. I asked her how many cases there actually were. She backed off and said she shouldn't have called it an epidemic but an outbreak. I told her I thought the cases were in vaccinated people. She said no they were unvaccinated. (Keep reading to see she and I were both right and wrong on that one.) She said this kind of bad information was the problem with the internet spreading false info. She accused parents of getting poor information off the internet and then being too frightened to do the right thing for their kids. So this morning I went to the internet to see what I could find out about measles in CA. Here is some info you should know.

Facts on California's measles outbreak
From the CDC web site:
"Measles causes fever, runny nose, cough and a rash all over the body. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die."                

Also from our government:                                                
"HEALTH ADVISORY – February 19, 2014

14 Measles Cases in the State of California in 2014

Fourteen cases of measles with onset in 2014 have been reported to California Department of Public Health. (In all of 2013, 189 people have been reported to have the disease. This represents the second largest number of cases in the U.S. since measles was eliminated in 2000.)
Among the 2014 California cases, four case-patients had traveled outside of North and South America, with three traveling to the Philippines. Nationally, an increase has been noted in the proportion of measles cases with travel to the Philippines. Measles cases from recent years have reported travel to Germany, France, England, India, and China, among other destinations.

Of the 2014 California case-patients without international travel, three had contact with known measles cases, two had contact with international travelers and five are under investigation to identify potential sources.

Of the 12 cases with known measles vaccination status, 8 were unvaccinated (7 were intentionally unvaccinated and 1 was too young to be vaccinated). That means 4 were vaccinated and 8 were not. So a third of the cases were in vaccinated people and 2/3 in unvaccinated. Why are vaccinated people getting sick? Had they only had the initial vaccine and not the booster or did they fave both shots and the life-long immunity they said we would have isn't turning out to be true? 

Please note they are NOT talking about deaths or even tell us how severe the cases were; simply that they had measles.

The last large outbreak of measles in the U.S. occurred during 1989-1991, with 17,000 cases of measles and 70 deaths in California.

Let's compare this to influenza. For the 2013-2014 flu season the California Department of Public Health says there were 332 deaths in California. 

Efforts to increase immunization rates in the 1990s were successful and endemic transmission of measles in the U.S. was eliminated in 2000.

Here is what eliminated actually means. In 2000 there were 86 cases in the US and 19 in California. 

 In 2013-2014, a large measles outbreak in the Philippines has resulted in over 1700 cases and 21 deaths. This outbreak has led to measles importations to Australia, Canada, the UK, and in many U.S. states. Additionally, measles is currently circulating in most regions of the world outside of North and South America."

In 2013 there were 189 cases of measles in the US and 15 cases in California. There were NO deaths. Now I want you to think about the numbers of people you know in California who had the flu this year. We probably each know at least 15 people. Of the California measles cases, 11% needed to be hospitalized, so 17 people were seriously ill. Pneumonia was the reason for hospitalization for 4 of the cases. It is important for pregnant mothers to note that 2 of these hospitalizations were for pregnant women and 1 miscarried. Let's look closer. Ninety-nine percent were import associated. In other words there was contact with someone who brought the virus into the US from abroad or was in contact with someone who was in contact with someone who had been abroad. Another interesting item is that 8% of the cases were in vaccinated people. 

How Does This Compare to the Flu?

Let's see what Web MD says about the flu:

Here's a rundown of some important flu statistics, based on the best available data.

Percentage of the U.S. population that will get the flu, on average, each year: between 5% and 20%.
That is with the current flu vaccination rate. So what percentage of the US population is 159 measles cases? The US Census Record says there are 316.99 million people in the US. So last year's outbreak was .00005% of people in the US.

Number of Americans hospitalized each year because of flu complications: 200,000, on average.
Remember there were 17 people hospitalized for measles complications last year. The last big outbreak of measles occurred from 1989-1991. Each year there were approximately 18,000 cases in the US with approximately 3,600 hospitalizations. 

The number of people who die each year from flu-related causes in the U.S.: ranges from 3,000 to 49,000.
During the last big outbreak of measles in the US approximately 41 people died each year.

In the U.S., influenza and pneumonia were the eighth leading cause of death in males in 2009.

Number of flu vaccine doses available in the U.S. for the 2013-2014 flu season: Between 135 and 139 million.
That means that if all the doses get used they will have vaccinated 44% of the population for flu. The federal government wants a 90% vaccine rate for measles and they say are meeting or exceeding that goal! Less than 1% of young children are not vaccinated  and most of the unvaccinated kids are for economic reasons. So what percent of all the kids in the US are not vaccinated due to parental choice? I couldn't find that number. Obviously it is less than 1%. 

So where does all this fear come from? Most of it stems from one situation in New York where many people in one extended family became ill with measles. This family had chosen not to vaccinate due to philosophical reasons. They had family members who traveled to Europe and brought home an unwelcome souvenir. In total there were 65 cases of measles in New York. Here is the final word of why the the CDC is concerned:  "imported measles cases can result in large outbreaks, particularly if introduced into areas with pockets of unvaccinated persons."

From the National Vaccine Information Center:
(this is the organization which the medical establishment is talking about when they say crazy 
anti-vaccine people)  
"In 1960, three years before the first measles vaccine was licensed in the U.S., there were 380 deaths from measles recorded."            

Are vaccines safe or not?
Now let's explore the possible side effects from getting the MMR vaccine. Remember very little in life is 100% safe so with life there is risk. What are those risks?

From the CDC: 
"Moderate Problems
Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)

Severe Problems (Very Rare)
Serious allergic reaction (less than 1 out of a million doses)
Several other severe problems have been reported after a child gets MMR vaccine, including:
Deafness, long-term seizures, coma, or lowered consciousness, and permanent brain damage
These are so rare that it is hard to tell whether they are caused by the vaccine.
(Please note they give us NO numbers)

From the National Vaccine Information Center: 

"Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Reported serious adverse reactions following MMR vaccination include seizures, brain inflammation and encephalopathy; thrombocytopenia; joint, muscle and nerve pain; gastrointestinal disorders; measles like rash; conjunctivitis and other serious health problems.

As of March 1, 2012, there have been 898 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 56 deaths and 842 serious injuries. (Again we have no numbers of doses of vaccines to help us understand what percentage of doses; or true level of risk. I'm not even sure if these numbers include multiple years.)

Using the MedAlerts search engine, as of July 9, 2012 there have been 6,058 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with measles vaccine since 1990, with over half of those occurring in children 3 and under.

Evidence has been published in the medical literature that vaccinated persons can get measles because either they do not respond to the vaccine or the vaccine’s efficacy wanes over time and vaccinated mothers do not transfer long lasting maternal antibodies to their infants to protect them in the first few months of life."

There are other theories about vaccines long term risks beyond immediate reactions. None of these, as far as I know, have been proven. Conversely I don't know that there are any long-term studies on vaccine safety. Questions out there which I feel bear looking into are the potential vaccine/autoimmune disease link. Especially after seeing that the CDC says one of the moderate immediate reactions can be pain and stiffness in the joints in teens and women. Autoimmune diseases are definitely on the rise. Is this caused by vaccines? The anti-vaccine group would like you to think so. As far as I know we have no scientific studies to definitively make that connection yet. I want long term studies done. I want studies done on bundled vaccines, not individual vaccines. I don't believe the scientific community has done enough research into the possible synergistic effects of bundling vaccines. I think the fact that we now have potential humans to do matched studies on right here in America is fantastic. I don't want studies with unvaccinated people from third world countries compared to people in the developed world. I want us to follow long-term some of the now unvaccinated US kids and a matched group of vaccinated US kids. Let's really find out some concrete answers. Until then I'm not sure anyone knows. 
                                                                                               
What's a parent to do?
Parents need to make wise choices for their children. Are you planning to travel outside the US? Will you be having world travelers come into your home or be in contact with them in some other way, such as, airplanes, buses, trains, or hotel rooms? Perhaps you want to vaccinate. Perhaps 2 measles deaths in a 1000 cases is too high a risk for you to comfortably take as a parent. As doctors love to say (the doctor on the radio yesterday said it too) when it is your child 1 death is too many. Of course they NEVER factor in that, 1 death from a vaccine reaction is also 1 death too many for any parent. What is important to me is that you have solid information to make your own best choices. 

Then I want you to find a doctor who will listen to you as a parent, help educate you and then will allow you to make your choices without shaming you in any way; or worse yet fire you as a client. I want to take a moment to acknowledge one such local pediatrician, Dr. Renee Bravo. Here is what one of my "Whole"istic Mamas said about a recent visit. 

"Just wanted to share my positive experience yesterday. I've known Dr Bravo for probably 25 years & have been bringing my children to him since my 1st was born almost 11 years ago. I respect him & think he's a great person. Yesterday I brought baby #4 in for her 2 mos checkup. I was really nervous to tell him I didn't want vaccines for my baby since I'd unknowingly vaccinated my other 3 children & thought he might possibly hassle me like his associate did. When he asked about shots for this visit I declined & he said "no problem, whatever you want to do I'll support!" He said we could do delayed vaccines (he said he really likes Dr. Sears schedule), even more delayed, or none at all, just let him know. Then he said "you know you really only need most of these if you're traveling to a 3rd world country anyway." No hassle, no debate, just pure support. Yet another reason why I respect him!"

I know this was a lot to read but it is important that all of us base these kinds of parenting decisions on a real understanding of the facts. 

Next, since it is "going around", I wanted to give you info on how to tell if your child has measles and what your doctor can do. If you think you or your child has measles, or you have been exposed to measles, the sooner you go to your doctor the better if  you want to utilize their help. 

IMPORTANT: Do NOT go to your doctor without FIRST calling. Let them know you think your child has been exposed to or come down with measles. Ask IF they wish you to come in and HOW they plan to minimize risk to their other clients. Babies do not get vaccinated for measles until they are 12 months old. Therefore the kids most vulnerable to having difficulty fighting off the infection are not vaccinated.   

What do measles look like?
From the Mayo Clinic web site:

Description: a red, blotchy rash that usually appears first on the face and behind the ears, then spreads downward to the chest and back and finally to the feet.

Measles signs and symptoms appear seven to 14 days after exposure to the virus. Signs and symptoms of measles typically include:
Fever
Dry cough
Runny nose
Sore throat
Inflamed eyes (conjunctivitis)
Sensitivity to light
Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek, called Koplik's spots
A skin rash made up of large, flat blotches that often flow into one another
The infection occurs in sequential stages over a period of two to three weeks.

Infection and incubation. For the first seven to 14 days after you're infected, the measles virus incubates. You have no signs or symptoms of measles during this time.

Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.

Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first, particularly behind the ears and along the hairline. Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, fever rises sharply, often as high as 104 or 105 F (40 or 40.6 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.

Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.
When to see a doctor


What if I think my child has measles?

More from Mayo
Call your doctor if you think you or your child may have been exposed to measles, or if you or your child has a rash resembling measles.

No treatment can get rid of an established measles infection. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.

Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus, to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.
Immune serum globulin. Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Medications

Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles. Don't give aspirin to children because of the risk of Reye's syndrome — a rare but potentially fatal disease.

Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or your child has measles, your doctor may prescribe an antibiotic.

Vitamin A. People with low levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large dose of 200,000 international units (IU) for two days.

How do you tell if it is measles or chicken pox? 
Also from the Mayo Clinic site:

Chickenpox infection usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:

Fever
Loss of appetite
Headache
Tiredness and a general feeling of being unwell (malaise)Once the chickenpox rash appears, it goes through three phases:

Raised pink or red bumps (papules), which break out over several days
Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
Crusts and scabs, which cover the broken blisters and take several more days to heal
New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.


The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

What if my child has Chicken Pox?

Most children do not need to see a doctor other than to tell you they have chicken pox. When do you need to see a doctor?

From the CDC:
For people with chickenpox at risk of serious complications, call a health care provider if the person:
is older than 12 years of age
has a weakened immune system
is pregnant
develops any of the following:
fever that lasts longer than 4 days
fever that rises above 102°F (38.9°C)
any areas of the rash or any part of the body becomes very red, warm, or tender, or begins leaking pus (thick, discolored fluid), since these symptoms may indicate a bacterial infection
extreme illness
difficult waking up or confused demeanor
difficulty walking
stiff neck
frequent vomiting
difficulty breathing
severe cough

Good luck with your decision and good parenting!

Speaking for Midwives at SLO's Historic Celebration

This is Nora Lewis the certified nurse midwife who caught my son at Sierra Vista Hospital in 1990. That birth changed my life forever and set me on the path to becoming a doula. When it was over I had many hurt and angry feelings and a million questions. After being part of many women's births over the years I have grown in my understanding of what occurred during my own labor and have come to a new perspective and deep appreciation for my midwife. Working side by side with many different midwives has given me a great respect for the women who answer the midwifery call and dedicate their professional lives to helping women all around the world. I was honored to give a speech about midwifery at the Birth & Baby Resource Network's historic celebration for the International Day of the Midwife and I was very grateful to be able to publicly thank Nora Lewis for her courageous stand with me that long ago August day.
My Speech.

Midwifery; a David and Goliath Tale

The story of midwifery in America is a classic power struggle for women’s rights, respect and choice; a tale of the clash of women’s culture and values with the male dominated spheres of science, medicine and finance. It is an ugly story laced with racism and class war fare. This struggle continues to walk the halls of political power and sits in insurance industry board rooms today.
It began as the eighteenth century was drawing to a close and the science of medicine was on the rise. Men for the first time began to move deeply into the privacy of the birth room, a place that in most cultures around the world is traditionally populated almost exclusively by women. This slow and determined encroachment into what had previously always been a woman’s world began the battle.

Before men became involved American midwives had always held a place of respect within their communities. Their skill at helping women during the birth process was of vital importance to all in the community. Women were encouraged to stay mobile as long as possible during the birth, the pain of the process was recognized but not believed to be insurmountable, the passage of time was noted but there were no standardized graphs labors had to abide by, and women utilized up-right physiologically sound positions for pushing a baby out.


When male doctors took over this all changed. Pain relieving drugs were used as an inducement to have doctors attend women’s births. These medications changed the balance of power forever; stripping the woman’s innate abilities. She became an object to practice medicine upon; someone who needed her baby delivered to her like a pizza instead of using her own physical power to bring her baby forth. Soon untested scientific “theories” blended with necessities created by using pain medications and women were routinely being cut and babies were being pulled out with forceps.

As the prestige of the medical profession rose, so did their power. In the end it came down to dollars and cents. In order to corner the market doctors began a campaign to stamp out midwifery. First they created a belief that birth was a medical event which could only be safe if attended by a physician. Doctors traveled in the upper circles of society. They convinced bankers, lawyers and other prominent society men to avail themselves of the best that the science of modern medicine could offer for their wives by using a physician. Men controlled the medical schools and women were not allowed to attend so female care providers slowly began to die out. In the early twentieth century not satisfied yet, they convinced the government to begin a propaganda campaign slandering midwives as dirty, illiterate, and ignorant. Eventually only poor women or newly arrived immigrants were still turning to midwives for care.


Meanwhile another huge shift in health care in our country was taking place. Hospitals were on the rise, with their bureaucracies, standardizations, schedules and sanitization of birth. Women were told it was best when labor began to leave their homes, where they had some control, and travel to a hospital, where they had no control. Hospitals lead to the immediate separation of the newborn from its mother and scheduled feedings. These disruptions in the process along with the drugs created babies who could not suck effectively, needing to be force fed from bottles. Soon the women of America thought their bodies were so defective they couldn’t even breastfeed their own children. Meanwhile the practice of midwifery was outlawed in most states.


But it’s hard to hold good women down. It is hard to stop women from answering the call to serve women; especially women in need. In the 1920’s nurses began to step forward to get additional training in the skills required to help low income women, the rural and urban poor. These were women who couldn’t pay doctors and hospitals, therefore providing them care did not threaten the medical establishment’s monopoly. They eventually founded specialized nurse midwifery schools and associations. From this branch was born the certified nurse midwife. In the 1960’s couples living on communes had turned their backs on many forms of the “establishment”. These female rebels began to birth their babies at home with the help of other women in their communities. The daring women who answered this call eventually became highly trained homebirth midwives. It took courage to be a midwife, to practice midwifery without a license. Not only could you lose everything, your home and your practice, you could be thrown in jail. In our county one traditional midwife was brought up on charges and convicted in 1982. Over time this branch of midwifery also adopted standards for training, created associations and worked hard to become legal once again. In California the legal battle culminated in 1993 in the creation of a system to license out of hospital midwives but it took 4 more years for the first group of midwives to be licensed by the state medical board.


All midwives are still fighting for the right to work as autonomous, respected members of the birth provider community. Whether they are CNMs who have made the choice to work in a doctor’s practice under his supervision because even if they could find a company willing to cover them medical malpractice insurance is prohibitive, or the LMs who can’t get insurance company’s to reimburse their clients for basic care the struggle continues. The California Medical Board is currently reviewing whether to change the language in the regulations governing LMs to allow them to order the life saving medications and tools they need to attend birthing women. And so the struggle continues.


This year on May 5th, the International Day of the Midwife, the women and their families who have been cared for so well for so many years by our community’s midwives will gather in Mission Plaza to honor 41 courageous, tireless, and caring professional women. The Birth & Baby Resource Network along with the co-sponsors of this year’s Birth & Baby Fair wish to invite you to join us at 10:30 for this historic event in the annuls of San Luis Obispo women’s rights.


Participate in BBRN’s on-line Midwifery Project at: www.bbrn.org.
Learn More about the History of Midwifery:
A Midwife’s Tale; Martha Ballard her Diary by Laurel Thatcher Ulrich
Motherwit; an Alabama Midwife’s Story by Onnie Lee Logan
Listen to Me Good; the Life Story of an Alabama Midwife by Margaret Charles Smith
Birth Matters; a Midwife’s Manifesta by Ina May Gaskin
A Short History of Midwifery: from Midwife Info an independent internet resource 
I am a Midwife, a movie trailer by the Midwives Alliance of North America
Fiction with Midwifery themes:
The Midwife's Apprentice by Karen Cushman
The Red Tent by Anita Diamant
Midwives by Chris Bohjalian

A Midwife's Story by Penny Armstrong and Sheryl Feldman

Mothers' Day; Thinking Globally

As Mother's Day has come and gone for another year I am confronted with the cold reality that most mothers around the world don't have what we take for granted; good quality prenatal care, access to high quality nutrition, and well trained birth attendants. These simple things hold the key between life or death for women of the developing world. The gulf between the developed world and the emerging nations is wide and deep.

Surviving Motherhood
by Ban Ki-moon, UN Secretary General

Reprint from UNICEF Philippines
UNICEF Philippines celebrates Mother's Day with the rest of the nation with a message to nurture and protect all mothers. Mothers’ Day is upon us in many countries around the world. Children of all ages will give flowers, make breakfast, call home.This is as it should be. On my travels around the world, particularly to its poorest and most troubled places, I have learned that it is mothers who keep families together -- indeed, who keep entire societies intact. Mothers are society’s weavers. They make the world go round. Yet too often, the world is letting mothers down.In the rich world, when a mother dies giving birth, we assume that something went wrong. For women in the developing world, by contrast, dying in childbirth is simply a fact of life. In some countries, one woman in eight will die giving birth. Complications from pregnancy and childbirth are the leading cause of death among girls aged 15 to 19 worldwide.Becoming a mother -- the rite of passage that Mothers’ Day celebrates -- can carry a terrible burden of fear, anxiety and loss for many women and their families.We know how to save mothers’ lives. Simple blood tests, a doctor’s consultation and someone qualified to help with the birth can make a huge difference. Add some basic antibiotics, blood transfusions and a safe operating room, and the risk of death can almost be eliminated.Recent figures show that we are making progress in helping women throughout the world. Yet we still have very far to go. Every year, hundreds of thousands of women die in childbirth, 99 percent of them in developing countries. That is why, as secretary-general, I have spoken out for the needs of mothers and pregnant women at every opportunity. I am counting on people around the world to back us in ending this silent scandal. No woman should have to pay with her life for giving life. On Mothers’ Day, let us honor mothers around the world by pledging to do everything we can to make motherhood safer for all.

Feeling inspired to do something to help our world wide community of mothers but you don't know how? Some of the members of Birth & Baby Resource Network are doing just that. These doulas have been called to work not only with birthing women here at home but they have a global commitment as well. Heather Larson went to study midwifery in Senegal and was so impacted by her experience she came home and founded Tree of Light. This non-profit is working to build a Birth House in Senegal. Terri Woods is part of a family inspired to help women have access to quality maternity care. She lives in the North County but also spends time each year working with her sister and daughter building, managing and staffing birth centers in remote areas of the Philippines. On September 22, 2010, the United Nations launched "The Global Strategy for Women’s and Children’s Health". They understand that to lift women and children out of sickness, poverty and death creates a more peaceful world for all. We all need to invest in the world's future.

Thank you to Terri Woods of Mercy in Action who posted this to her face book page.http://www.mercyinaction.com/

The Pendulum Swings

Can you feel it? The pendulum is beginning to swing the other way again. Last February I witnessed a doctor emotionally manipulating a woman, who was courageously working on pushing her baby out, into agreeing to a cesarean. I didn't know then that in that hospital room we were standing at the apogee of the pendulum's arc.

Apogee (Merriam Webster) Definition: 1. Farthest point on an orbit 2. final climactic stage, standing at the culmination

I only knew that in the past few years it had become a greater and greater struggle to keep my hospital doula clients out of the operating room. I didn't know that this was the final climatic stage in a hailstorm of surgeries.

Here is a simple physics lesson:
When a pendulum reaches it's apogee it holds its maximum potential energy. This energy is released as it begins to swing back the other way.

Can you feel it? In the past few months there has been a huge release of energy on a national and international scale against cesarean sections. On Tuesday I opened our local paper and saw more evidence of this phenomena; an article reprinted from the Los Angeles Times titled Study Finds Patience May Lower C-section Rates. That's right patience, not patients.

Here is a simple vocabulary lesson:
**Patient as a noun.
(Merriam Webster) Definition: 1.an individual awaiting or under medical care and treatment 2. one that is acted upon
**Patient as an adjective
(Merriam Webster) Definition: Patient 1.manifesting forbearance under provocation or strain 2. not hasty or impetuous 3. steadfast despite opposition, difficulty or adversity
**Patience is a singular noun
(Merriam Webster) Definition: the fact of being patient

Here is what this latest study done by the Eunice Kennedy Shriver National Institute of Child Health and Human Development said:

If doctors and their patients (women under their medical care) would have patience (forbearance under the strain of waiting out those last difficult weeks of pregnancy) and not go with an induction they have a much greater chance of not having a surgical birth. Of course for the woman remaining patient (steadfast) to the idea of waiting for spontaneous labor in spite of her doctors threats of placental disintegration, baby too large or blood pressure rising (opposition) can be a daunting (a great strain). In my experience getting a mom through these last prenatal visits is very difficult but well worth the effort. My own doula statistics bear this out with a 1% section rate for my first time moms who wait for labor to begin on its own.

If doctors would be patient (not hasty or impetuous) about the progress of their patients (women who they are acting upon) labors there could be many fewer c-sections. The authors of the study say doctors aren't acknowledging that labor takes time and doesn't follow a predictable pattern, especially in first time mothers. A high proportion of the surgical births reviewed were done after the patient (one who is acted upon) had been in active labor for only 2 to 3 hours! OMG!!! These women are being labeled as suffering from "failure to progress" which leaves them feeling defective the rest of their lives which leaves them much more open to being manipulated into repeat elective cesareans for all future babies. Most of the women I attend at births are in active labor for waaaaaaayyyy longer than that. I guide them, support them and explain that this is normal, babies take time and they are doing just fine. My cesarean rate even for mom's who agreed to an induction; 1%. The study showed that a major reason for having a cesarean was having had a cesarean. But my total cesarean rate with spontaneous labor, inductions and v-bac attempts is only 7%. There is no great mystery here. I am no wonder woman. Doulas and midwives support women whom they do not see as patients but instaed as healthy people in the process of a healthy physiologic act; like breathing or sex. Doulas and midwives having an abundance of patience is the key to good, safe, healthy births.

One final thought: Years ago I met the women who were spearheading our local International Cesarean Awareness Network at the time. One of them said, "There is no such thing as a 'failure to progress' only a 'failure to wait'. I have been calling it that ever since and now we are beginning to have the studies to prove who failed and what that failure has meant to women in america.

Can you feel it?

National Institute of Health panel strongly urges that steps be taken to reverse repeat cesarean sections.

Study in Journal of Obstetrics and Gynecology says v-bac is a reasonable and safe choice because the outcomes for repeat elective surgery and v-bac were basically the same.

New Guidelines from American College of Obstetricians and Gynecologists on repeat sections.

Study Finds Patience May Lower C-section Rates.

More on Why Women Need to Question Authority

From Joe Stover
Sent June 30th

"Hey Mom you should check out this article. It's kind of hard to believe/disturbing."

My son sent me this message and a link to a blog site the day after my post claiming women were being lied to and manipulated by the medical/money machine. He was deeply concerned about pregnant women being given a drug to prevent girl babies from growing up to have typical "masculine" traits. These girls are being labled abnormal because they show a lack of interest in playing with dolls or fantasizing about having babies and they grow up to have little interest in getting married and taking on traditional wife and motherhood roles.


So I looked into it and as justified and disturbing as his concerns were was a bigger issue for me. Once again women and their babies are being experimented upon by the medical establishment without their knowledge or consent. How can that happen you ask? It isn't like someone is sneaking in while the women sleep and are giving them a drug. Of course not; it is much more insidious than that. It involves something few women understand thoroughly called off label use. Don't believe me? Here are two women's stories excerpted from an article that just came out in Time magazine June 18th.
Jenny Westphal, 24, who took dexamethasone throughout her pregnancy at the recommendation of a doctor, says she feels misled. . . She was not asked to give informed consent. Her daughter, now 3, who has CAH (the disorder they were trying to prevent with the dexamethasone!) has had serious and mysterious health problems since birth, including feeding disorders, that are not commonly associated with her adrenal-gland disorder. . . In April, Westphal, who lives in Wisconsin, started doing research online and discovered there was some controversy over the treatment. "I was outraged, frustrated and confused. Confused, because no one had ever warned me about this. I wasn't given the chance to decide for myself, based on the risks and benefits, if I wanted the treatment or not," she says . . . Westphal may never know whether her daughter's problems were caused by dexamethasone, though she will likely always believe they were. That is why so many similar situations, in which experimental drugs are prescribed off-label without informed consent rather than in clinical trials, wind up becoming case studies — not in scientific journals, but exactly where Westphal and her husband are considering taking theirs: to court.
When Marisa Langford found out she was pregnant again, she called Dr. Maria New, a total stranger, before calling her own mother. New, a prominent pediatric endocrinologist and researcher at Mount Sinai Medical Center in New York City, is one of the world's foremost experts in congenital adrenal hyperplasia, or CAH . . . Langford and her husband learned they were silent carriers of the genetic variation that causes CAH when their son was diagnosed with the condition after birth. . . "Dr. New told me I had to start taking dexamethasone immediately," says Langford, 30, who lives in Tampa. "We felt very confident in someone of her stature and that what she was telling us was the right thing to do." . . . Langford says that neither New nor her prescribing physician mentioned that prenatal dexamethasone treatment is an off-label use of the drug (an application for which it was not specifically approved by the government) or that the medical community is sharply divided over whether dexamethasone should be used during pregnancy at all.

In animal studies, dexamethasone has been shown to cause birth defects, but proponents of the treatment note that no human birth defects have ever been associated with the treatment, and that it is uncertain whether findings in lab animals translate to humans. . . "We just don't know what we are doing to these kids," says Dr. Walter Miller, the chief of endocrinology at University of California, San Francisco. "It's not sufficient to say, The baby was born and had all fingers and toes, so it's fine."

Perhaps most controversially, prenatal dex must be given as soon as a woman learns she is pregnant, which is usually several weeks before genetic tests can determine if the fetus is in fact a female affected with CAH — the chance of which is 1 in 8 for parents who already have an affected child or know they are carriers of the genetic disorder. If the baby is healthy, treatment is stopped, but at that point, the fetus has been exposed to the steroid drug for weeks. There is no data on how many mothers receive prenatal dex, but according to the odds, 7 of 8 may be taking medication unnecessarily.
OMG!!! 7 out of 8 don't need it, no long term studies have been done on the safety of the drug for the baby when given prenatally, the women aren't being informed that this is the case? OMG! OMG! OMG! How can this be? What the hell is this off label use thing all about?

Basically it comes down to the fact that any doctor can prescribe medication for anything they want. It doesn't have to first be tested for effectiveness on what the doctor is choosing to use it to treat. It doesn't have to first be tested for safety when used for this purpose. It doesn't have to first be studied for proper dosaging when used for this purpose. In other words when you are given a drug off label they are using you to experiment upon.

So why do doctors do it? Let's head back to the Time article to find out.

It enables doctors to do human research without gaining proper approval. All participants in human medical research are, by law, entitled to the protective oversight of an institutional review board (IRB), a committee that safeguards the interests of research volunteers and ensures they have been fully informed about the potential risks and benefits of an experimental treatment. If doctors are simply treating a patient with an off-label drug, they are not required to obtain written informed consent from patients. But if doctors give treatment with the intent to gain knowledge, they are technically doing research, which must receive IRB approval. . . Ethicists say physicians may sometimes treat patients off-label, then decide later to launch a follow-up study; or, they do follow-up research on patients who have been treated by other doctors. In the process, they have converted these patients into unwitting research volunteers. Some doctors game the system this way, Caplan says, to avoid battles with IRBs.

And there are battles. In the case of prenatal use of dexamethasone there is currently a battle between a Dr. Maria New, a prominent pediatric endocrinologist and researcher at Mount Sinai Medical Center in New York and some members of the Bioethics Forum. They are doing what they can to shut her down with letters, articles and general publicity. And then of course there are the court battles. Remember Jenny Westphal and her 3 year old daughter with mysterious ailments? They are doing just that, taking the doctors to court.
So you think this doesn't effect you since you don't carry the gene for this rare disorder? Think again. Was you labor induced? Are you seeing a doctor that will induce you if you go past a certain calendar date? Are you worried about being induced? Concerned about ending up on the dreaded "pit drip"? What if your doctor whom you trust said, "don't worry. We're not going to use pitocin. We're going to use this little tiny pill instead. You won't even need to be hooked to an IV and it is perfectly safe for you and your baby." What would you think? What would you do? More on this wonder drug and off label use next time.

Time article
http://www.time.com/time/health/article/0,8599,1996453,00.html#ixzz0sNjIwE7D

Letter of concern sent to the CARES Foundation
(Congenital Adrenal Hyperplasia Research Education & Support)
http://www.fetaldex.org/letter_CARES.html

Bioethics Forum
Preventing Homosexuality (and Uppity Women) in the Womb?
Alice Dreger, Ellen K. Feder, Anne Tamar-Mattis, 06/29 http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=4754&blogid=140

Understanding U.S. Birth Trends & How They Might Effect You

Currently there is a lot of buzz about our high cesarean section rate and trying to lower it. Why? Because the statistics are starting to bear out what many of us have been saying for years, that doing more cesareans doesn't mean better care or better results. Furthermore that moms are getting a tremendous amount of pressure from their doctors to have C-sections and that c-sections put moms at more risk with no improvement in benefits for babies. This video is a good explaination of current trends in our birth culture and medical practices. It goes on to show how these trends are effecting our cesarean section rates, maternal out-comes and baby out-comes.

My thoughts on the statistics coming out about c-sections:

What an outrage has been perpetrated on women yet again! The rising birth surgery rate in the last 10 years is an appalling abuse of power. This is just one more time in a long list of times when our society's views on women and it's values of pursuing science and money have blended with the male dominated medical model to put women in harms way. Women, just as other minorities within our culture, have been used and abused at the alter of the medical machine once again.

Young mother's today haven't grown up with the mantra, "Question Authority!" or the understanding of the true balance of power between men and women built into our system. They have grown up in a Hillary Clinton world where women like Meg Whitman appear to be able to have a firm grasp on the levers of power in the financial and political world. They don't understand that these women are an aberration. They are an illusion. In the world I live in thousands of women everyday are being lied to or at the very least subltly manipulated into turning their bodies over for someone else's monetary gain. And the propoganda is so good most of them have no idea what just happened to them. They actually believe that their rapists are their saviors. How sick is that? They arrive home dazed and in pain with only one clear thought, how grateful they are to their doctor for saving them and their baby.

I have one thing to say to young women today, "Wake up!! Stop drinking the kool-aid! Question Authority!" Just because Authority wears a white lab coat and has a degree behind the desk doesn't mean he or she has only your best interest at heart. Don't let yourself be a cog in the wheel of the great machine. Take a cue from your hippie sisters of the sixties and reclaim your right to your bodies and your births. You deserve it.

GET EDUCATED! WATCH THIS VIDEO: http://www.lamaze.org/OnlineCommunity/LamazeVideoLibrary/LamazeVideoPlayer/TabId/808/VideoId/4/Birth-By-The-Numbers.aspx

Health-care legislation increases birth options: Women covered by Medicaid are insured for delivery at birth centers as well as hospitals

Publised in the SLO New Times April 14, 2010
Picked up by the American Association of Birth Centers for their web site.

BY JENNIFER STOVER

A provision in the new legislation for health care gives women more latitude to decide where, how, and with what kind of professional they will give birth, and may lead to a birth center finally being established in San Luis Obispo.

Most Americans don’t know that 42 percent of all births in the United States are paid through Medicaid reimbursement. Thanks to the passage of the health-care bill, women so insured will have a choice of how they spend that money. Section 2301 includes full Medicaid reimbursement for free-standing birth centers, certified nurse midwives working in hospitals or birth centers, and certified professional midwives (CPMs) working in birth centers. Women can continue to choose a hospital birth with a doctor or midwife, but now they can choose to birth at a licensed out-of-hospital birth center attended by midwives instead.

The average cost of a birth-center birth is approximately one-fifth of a doctor-attended hospital delivery, a huge potential savings to Medicaid: Consider that the typical hospital birth costs approximately $20,000 and the cost can climb to $60,000 for a cesarean birth. Not all women will want to birth naturally without pain medication in birth centers. Not all women are appropriate candidates for birthing with midwives in birth centers. But if only 5 percent of the 4.3 million women in this country who give birth annually choose this option, it would mean millions of dollars saved each year.

For 28 years, local women have been asking now-retired Certified Nurse Midwife Linda Seeley why we don’t have this option. She explained, “A lot of women don’t want to have their babies at home, but also don’t want to be in a hospital. A birth center is usually located close to a hospital but not in a hospital.” After General Hospital closed, Seeley was part of San Luis Obispo General Hospital Foundation’s attempt to start up a birth center. She continued, “A center is more intimate, the women themselves are more in control of what happens. There is more satisfaction and lower stress. It is well known that the lower the stress, the better the outcomes.”

We have no out-of-hospital birth centers in the county. Atascadero midwife Edana Hall, CPM, who is licensed by the California Medical Board, said she is “cautiously optimistic this could lead to the opening of a birth center in San Luis.”

Tiffany Dietrich, a naturopathic doctor and midwife who recently moved to San Luis Obispo, explained that in the greater Seattle area where she recently practiced there are two birth centers. The fact that Medicaid in Washington State already paid for out-of-hospital birth-center births is part of what made that possible.

“When Medicaid pays for something, eventually the insurance companies also begin to pay,” Dietrich said. “It’s a good time to open a community birth center here. Our culture is changing. Out-of-hospital births are on the rise due to media exposure, such as The Business of Being Born, the documentary by Ricki Lake.
“What is happening in Washington State shows that birth centers are a successful model of care for women and babies—as well as financially—for the birth center and Medicaid,” she added.

Jessica Elliott relocated from Morro Bay to Oregon, where Medicaid and insurance companies already pay for out-of-hospital births. She echoed Dietrich: “There are currently three birth centers located in the Portland area where CPMs attend births.”
Elliott, a participant in an intensive clinical training for midwifery at the Andaluz Waterbirth Center, continued, “We do anywhere from 20 to 30 births a month, but demand is growing. The center recently had to hire two new midwives to keep up.”

Last June, a panel of local professionals who work with children and birthing women met with Congresswoman Lois Capps’ district representative, Betsy Umhofer, to present information about the merits of midwifery and out-of-hospital births. She listened to us carefully and relayed our information to Capps, who, as vice chairman of the Health Committee, was in Washington, D.C., working on the legislation that just passed.

After the signing ceremony, Congresswoman Capps issued this statement about this important section of the health-care bill: “I know that bringing a new life into the world can be the most profound moment of a woman’s life. And I am proud that this new legislation will afford women more choices regarding the setting in which this momentous occasion can occur. One of the many important provisions in the new health-care reform legislation is the increased access to care in a variety of settings, including for women who choose to obtain prenatal care and deliver their babies in freestanding birth centers. I was proud to support this provision that assures these centers Medicaid reimbursement for providing this important service in promoting women’s health.”

Jennifer Stover, the president of Birth and Baby Resource Network in San Luis Obispo, is a childbirth educator and doula.

Send comments via the editor at econnolly@newtimesslo.com.

The Day President Obama Signed the Health Care Bill

Published in the SLO Tribune on Friday March 26, 2010

Hidden in the thousands of pages of the Health Care Bill that President Obama signed into law were some items very few people were aware of that will effect women all across the country. They target issues concerning maternity care and they have the power to change our beliefs about where, how and with whom women should be giving birth in our country.

Did you know forty-two % of all births in the U.S. are paid for through Medicaid reimbursement? Now women will have a choice of how they use that money. They can continue to choose to birth in a hospital with a doctor but they can also choose to have a Certified Nurse Midwife attend them in a hospital, or they could attend them at an out of hospital birth center. Another option is to have a Certified Professional Midwife attend them at an out of hospital birth center. This doesn’t just represent more freedom for women to choose the birth the want it also represents a huge cost savings to the Medicaid budget. The average hospital birth with a doctor attending costs approximately $20,000. It skyrockets to $60,000 for a cesarean section birth. With our national cesarean section rate climbing every day this is a serious chunk of change. On the other hand the average cost for a birth center birth is approximately ¼ of that or $5000. Not all women should be birthing in birth centers with midwives but if just 5% of women choose this option it will mean millions of dollars a year saved.

Did you know until today they was no widespread standardized assessment of the maternity care being offered in this country? Statistics relating to the benefits and risks of current practices in use today, such as, induction of labor, medication to speed labor, or drugs for pain relief were not being kept in a national database. Over time this data base will yield important information for women and their care providers. Helping them base their care on informed choices.

Did you know women were being denied health care coverage because they had given birth by cesarean section? This was being labeled a pre-existing condition which ruled them out of further care. On top of that the current stance of the American College of Obstetricians and Gynecologists about vaginal birth after cesarean section makes it impossible for many women in the U.S. to do anything except have a repeat cesarean section for all future births. Until today women were faced with the choice of letting their insurance company limit the size of their family or pay about $60,000 per child.

Did you know until today your insurance company could deny you care simply because you were pregnant? Stopping this practice has the potential of effecting millions of women and babies. Guaranteeing access to quality maternity care impacts not just this generation but the next as well.

Thank you to Representative Capps for working to pass this important legislation for women and babies. When asked about this piece of the bill she said, "I know that bringing a new life into the world can be the most profound moment in a woman’s life. And I am proud that this new legislation will afford women more choices regarding the setting in which this momentous occasion can occur. One of the many important provisions in the new health reform legislation is the increased access to care in a variety of settings, including for women who choose to obtain prenatal care and deliver their babies in freestanding birth centers. I was proud to support this provision that assures these centers Medicaid reimbursement for providing this important service in promoting women’s health."

E-Mail Correspondence with Congresswoman Capps

Here is the e-mail I sent to Betsy Umhofer, Representative Capps' local Liaison and Congresswoman Capps' reply.

Dear Ms. Umhofer,

I would like to thank you and Representative Capps for your work on the Health Care Bill, especially the part that includes Medicaid reimbursement for Certified Nurse Midwives & Certified Professional Midwives working in out of hospital birth centers. Your work will provide quality maternity care for many women in our community who seek out of hospital birth experiences. I have written a piece about the legislation on my blog: http://slolaboroflovedoula.blogspot.com/2010/03/historic-health-care-bill-for-women.html.

I am currently working on an opinion piece about it for either New Times or Women’s Press. Would Congresswoman Capps care to send a quote about why she supported this piece of the overall bill and what she hopes will come from it?

Here is Congresswoman Capps' reply

"I know that bringing a new life into the world can be the most profound moment in a woman’s life. And I am proud that this new legislation will afford women more choices regarding the setting in which this momentous occasion can occur. One of the many important provisions in the new health reform legislation is the increased access to care in a variety of settings, including for women who choose to obtain prenatal care and deliver their babies in freestanding birth centers. I was proud to support this provision that assures these centers Medicaid reimbursement for providing this important service in promoting women’s health."

Historic Health Care Bill for Women, Maternity Care and Midwives

I just watched President Obama sign into law the health care bill. People may disagree about this bill and what it means for our future. I'm not going to discuss the total bill. What is important to me is something few people are aware of. Buried in this bill is a very important piece of legislation that speaks directly to women & midwives. Because of the passage of this bill women on Medicaid can now seek midwifery care from both a Certified Nurse Midwife or a Certified Professional Midwife and birth their babies in out of hospital birth centers. This is a huge step forward for CPMs in their desire to be acknowledged as birth professionals providing safe care for healthy moms and babies during birth. It will make birth centers more financially viable due to Medicaid reimbursement and therefore will lead to more birth centers being opened and more out of hospital births occurring. This is greatly needed at this time in our country to balance the current medical birth climate and bring down the huge cost of maternity care.

I was very proud to watch our Representative, Congresswoman Lois Capps, at the signing ceremony. I would like to thank her for her dedication and work, for her caring about women's health issues and for her support of midwives & midwifery. I would like to thank the women who cared enough to take the time to sit down with me and Betsy Umhofer, Rep. Capps local liaison, and present to her why she should support this important piece of legislation: Jessica Elliott, past president of BBRN & current midwife in training, Edana Hall, Licensed Midwife, Miday Johnson, Certified Nurse Midwife, Megan Bochum, past local International Cesarean Awareness Network leader and student midwife, Janet Murphy, Cal Poly Child Development Specialist, and Stephanie Wilson, LMST and SLO-Child Abuse Prevention Council Postpartum Depression Specialist. It was women like this all around the country speaking up that made this moment in our history happen. Congratulations!

Rise in California Maternal Death Rate Linked to Cesarean Sections: Why Aren't They Telling Us?

My brother, Richard, alerted me to an article in the San Francisco Chronicle yesterday with the head line "Pregnancy Related Death Rate on the Rise". It turns out a task force headed up by a scientist in the California Department of Public Health started a study back in 2006. There were gasps from the audience and basic disbelief when they reported their findings at an American College of Obstetricians and Gynecologists' conference in 2007. The attending doctors seemed to think it was implausible that in this day and age with all our current technology we could possibly be getting worse outcomes for mothers. (A side note is that we are also getting worse outcomes for our babies. The rate of "premature" babies that end up in our neonatal intensive care units is growing too!) They don't seem to see or perhaps they don't want to see that there is actually a link between the increase in technological birth and the bad outcomes. In 2008 a second study confirmed the initial study's findings.

And here it is 2010 and the California Department of Public Health has still not released this study to the public. In other words the very people, who most need to know about this study, the women every day who are getting cut open to give birth in our country, are being kept in the dark. We continue to be sold the myth that a cesarean birth is completely safe, even in some ways preferable to a vaginal birth. Our culture continues to promote the idea of choosing dates and scheduling inductions or cesareans without even any labor at all. Women continue to think this is a safe way to escape the pain of labor. Do you think this would be happening if women were advised by their doctors that their chance of DYING while giving birth would more than DOUBLE if they are induced or schedule a cesarean?

Although the study's findings have still not been released, a California Task Force has begun pilot projects to bring down the death rate. What are they doing? Encouraging the reduction of the induction rate! Why? Because studies show that an induction DOUBLES your chances of "needing" to have your baby come by major abdominal surgery.

In 2002 the Medical Director at one Orange County hospital instituted new guidelines for elective inductions; no inductions before 41 weeks of pregnancy. That means no scheduling an induction because that’s when Grandma will be in town or because the next week your O.B. is going on vacation. It also means women don't get to their 39 week prenatal visit and have the doctor cheerily inform them that they will put them on the schedule to be induced if they haven't had their baby by week 40. From my own experience I can tell you how critical that last week is for moms' bodies to prepare for labor. Their body chemistry is slowly building toward a perfect hormonal balance to begin and support a labor that will progress until their baby is born.

And what has happened at the Orange County hospital? They have fewer babies who need to spend their first days in a neonatal intensive care unit separated from their parents instead of bonding and breastfeeding at home. They have fewer maternal hemorrhages which is the leading cause of death for mothers during the birth process. And they have fewer emergency hysterectomies which is what they have to do to save her life if a woman is bleeding to death. The hospital has also seen its profits go down. Full O.R.s and neonatal units, and longer hospital stays for recovering moms equal big bucks. Remember having a baby by cesarean surgery is at a minimum twice as expensive.

Here it is by the numbers ladies:
California Maternal Death Rate 1996: 5.6 mothers die per 100,000 live births.
2006: 16.9 mothers die per 100,000 live births.
California's rate is even worse than the national rate which is 13.3. My guess as to why we are higher is a deadly combination of cultural factors, fear of liability by doctors and Hollywood stars fueling a "too posh to push" mentality.

Here is a question I would like answered. Where does the fact that we have gone back to the “once a cesarean always a cesarean” policy fit into this picture? How can a woman be an informed consumer when choosing between the risks of having a repeat cesarean versus the risks of trying for a vaginal birth after a cesarean if they are keeping the facts about the risks from us?

So if someone is recommending to you to schedule an induction simply because you are at week 40, or you are thinking about just picking a day for your baby's birth by signing up for a trip to the Operating Room, don't make your decision lightly because your life may depend on the decision you make. Consider first do you have any other indications that your health or your baby's health needs you to take this risky step? Is your blood pressure too high? Is your baby no longer growing or showing other clear signs of being in distress? Women will often be frightened by stories of healthy placentas magically turning into degrading placentas the moment they are at 40 weeks plus 1 day. Yes, all placentas will begin to break down at some point. For some women it will start at week 38 and for others at week 43. The only way to know about your placenta is to monitor the health of your baby through nonstress tests and ultrasound. Remember there are times when the very best choice for you and your baby is an induction or cesarean surgery but only if there are clear indications of current risk.

Read "Bodie's Birth" to hear a couples' story of a necessary cesarean section and how our system should work.