Wednesday, January 23, 2008

Miscarriage... Is There an Answer?

I think so, and I want to write a book about it!

Several years ago, I was contacted by several women who were having repeated miscarriages. They desperately wanted to have a baby. These women found their hopes soaring several times a year when they would find themselves pregnant, only to be harshly crushed a couple of months later when they began spotting... bleeding... cramping.... staying in bed, calling their doctor or midwife.... and then miscarrying.

Some of them would call me sobbing, saying, "All I want is a live baby! Why can't anyone tell me what's wrong with me? Why doesn't my doctor know what to do? I've done every test that modern medicine has invented and they still don't know why this keeps happening!"

I didn't know any more than their doctors did.
All I could say was, "I'm sure there's an answer somewhere. Obviously, something's wrong, and usually when there is something wrong, there is almost always a way to fix it..."

Their agony of miscarriage after miscarriage compelled me to try to find answers. I read books.
I spent days and months online, researching. I waded through big, fat textbooks, and boring Swedish studies on reproductive health. I read fertility books. I talked to mothers and their doctors and midwives.

I began to find bits and pieces here and there... things that sounded reasonable and helpful. I began forwarding articles and information on to my friends who were struggling with miscarriage.

Before long I began receiving calls - I'm four months pregnant and I'm doing fine!"
Mothers would beam, "This baby is our miracle baby!" and then they'd tell me about taking vitamins, drugs, herbs, hormone supplements, additional testing - all kinds of things that I had found info on.

One of those success stories!

I began to see things that were working for some of these women. They were solving their own problems with lots of information in front of them. They started passing my number on to their friends. Soon I found myself besieged with calls from desperate women from across the country who would call me at all hours, apologizing for their call, but explaining that they were spotting or cramping and thought maybe I could help them because their friend had told them about me.

I really couldn't "prescribe" anything to them. I couldn't tell them what to do. I wasn't a medical professional, and I wasn't their caregiver. But I had several big folders, packed with studies, articles, recommendations from both the medical field and alternative healthcare practitioners.
And now, I had personal stories from women who had live, healthy babies, and credited it to what they had done with both modern medicine and things as simple as herbal teas and healthy foods.

I decided to find the best book to recommend to these women... And I began searching for a "miscarriage bible" - an all encompassing book, explaining miscarriage and it's many causes and a whole range of possible solutions. When I realized it didn't exist, I began looking for a book from the medical model, focused on miscarriage and how to prevent it and a book from the holistic perspective as well. I bought most of the books I could find, but none of them seemed to be what these mothers needed.

So, I decided that I would write the book, since no one else has. I have a lot of information. I need to find a lot more. I need to know more of the most puzzling questions about miscarriage and what women want to know about it. My work on this project has been on hold for nearly two years now, as I have had other things to focus on. But, I want to get back to work on it shortly, because I know that every day there are women looking for answers, and I want them to find them somewhere...

If you have any suggestions, or questions about miscarriage that you would like to see answered, or if you have ideas for studies that you wish somebody was doing, or... whatever you think would be most helpful in the arena of miscarriage, I'm looking for more material and questions.

If you know of anyone who is currently researching miscarriage, or who has a special "remedy" or unique information in their practice, I'm anxiously waiting to hear more!

I'm interested in anything and everything that can be done to prevent a miscarriage - drugs, herbs, surgery, vitamin and mineral supplements, hormones, nutrition, family relationships, essential fatty acids....

I'd like to know what testing is most helpful and practical, and what has not be helpful in determining the causes of miscarriage.

I'd also love to include stories of women who have struggled with miscarriage, and of course, some success stories!

Email me at: betterbirth4you {at} gmail {dot} com.

Monday, January 14, 2008

The Struggle to Be Skinny Enough

It was a few weeks ago. I found myself sitting in a little restaurant, the walls covered with retro advertisements and old Coca Cola signs from the 50’s.

I sat there, sipping my drink and waiting on my food, when the thighs of a bright and smiling girl with bouncy curls on a poster on the wall caught my eye. She wore a yellow pleated mini skirt, and was leaning back, holding her Coke. Her thighs were prominent in the picture and they were so … uh, normal sized. She wasn’t fat, or chubby, but her rosy cheeks glowed. She looked healthy and hearty. I couldn’t stop staring at her. It just seemed so weird to see a model about my size, not rail thin, on the wall.

I spent more time starting at the rosy cheeked girl with a huge smile on the Coca Cola poster than I did eating my food. How different from the models that are held up today as the perfection of beauty, I mourned to myself. The models from fifty years ago weighed far more than the stars of today. They weren't fat; they were healthy weights, with some curves, and actual flesh on their bones!

Angelina Jolie, thin limbs, gaunt and hollow face. Our culture has adjusted to thinking this is as good as beauty gets! Every magazine and billboard shouts out that sharp and stark cheek bones are more beautiful than gently rounded cheeks, legs are more beautiful with nothing but bone, and waists are most beautiful when they are impossibly small.

This is what our girls try to be. They starve themselves, live on diet sodas, protein shakes, low-calorie fillers… binge and purge because of the array of food set before them hourly. …Always feeling fat and ugly and hoping to catch a guy’s attention by getting as skinny as their friends. Size 4 jeans have almost become a status symbol.

Growing up in a culture that values an almost starved look (one that most people cannot obtain in a healthy way) carries over into motherhood.

A few months ago, I was visiting with a pregnant doula client and her husband. This beautiful woman who I’ll call Grace [details changed to protect her identity] is slender – 10-20 pounds underweight, and half-way through her pregnancy weighs less than she should as a non-pregnant person.

Grace was talking about her baby’s movement. I asked if I could touch her belly and feel the baby. She smiled and said, “Of course. He’s right here.” As I laid my hand on her nearly flat stomach (yes, she was half way through her second trimester!), she grimaced and said, “Sorry, there’s a huge blob of fat there. You’ll just have to ignore it.” Then she turned away and looked embarrassed.

Of course, I said something positive back to her about her body, but as I left I wondered how many other pregnant mothers feel the same way about their bodies, not because there is any truth to the way they feel, but because our culture makes them feel that way.

How many women feel like Grace? How many women are starving their babies for fear of “getting fat”?

I’m not advocating obesity or being overweight or gaining a huge amount while pregnant, or pigging out, or…

I’m advocating that women feel pressure to be healthy, not skinny!

Thursday, January 10, 2008

New York City Midwifery Care - 1931-1961

Maternity Center Association, New York City ~ 1931-1961

From 1931 the Lobenstine Midwifery Clinic of New York City, in affiliation with the Maternity Center Association (MCA), offered home birth services to help meet the needs of the most economically deprived and needy families of the upper Manhattan tenements. Between 1931 and 1961, 5,766 mothers registered with the clinic, of which 87% gave birth at home, attended by midwives. Their maternal mortalities were less than one third the national rates of the time. Their average neonatal death rates were only 16 per 1,000, while that of New York City as a whole ranged from 28.9 in 1931 to 18.4 in 1961. These results by the MCA midwives are even more remarkable in light of the fact that poor nutrition was prevalent among their clients. 36.4% of them suffered from secondary anemia, 6.3% tested positively for syphilis and 6% were in their tenth pregnancy. The MCA discontinued its home birth services years ago, but retains its legacy of superior outcomes.

~ From Law, M., Report on the Maternity Center Association Clink, NY, 1931-1951, American Journal of Obstetrics and Gynecology, 69:178-184, 195S.

~ Faison, J., The Maternity Center Association Clinic, NY, 1952-1958, American Journal of Obstetrics and Gynecology, 81:395-402, 1961.

These data and additional studies which I will be posting and crediting to Dr. David Stewart's work have been excerpted from his book, The Five Standards for Safe Childbearing, by Dr. David Stewart, Ph.D. Dr. Stewart is a medical statistician with special education in obstetrics and is one of the leading world authorities in the area of midwifery and home birth statistics. He has been an invited lecturer at meetings of the American College of Obstetrics and Gynecologists (ACOG) and the National Perinatal Association (NPA) and numerous other childbirth-related functions throughout North America. He has served on committees of the American Public Health Association (APHA) and the American College of Nurse Midwives (ACNM). Dr. Stewart is the author or co-author of more than 200 publications, including 13 books. He serves as the Executive Director and co-founder of the International Association of Parents and Professionals for Safe Alternatives in Childbirth - NAPSAC International.

For more information, or to purchase The Five Standards for Safe Childbearing, contact:

NAPSAC International

Rt. 4, Box 646

Marble Hill, MO 63764

Phone/Fax: (573) 238-2010 or

(800) 758 - 8629

Monday, January 7, 2008

A Clearly Defined Risk of Cesarean Birth: Hysterectomy

The American College of Obstetricians and Gynecologists’ “Green Journal” contains some enlightening news in the January 2008 issue that every pregnant woman should know. It’s contained in a report about a very recent study titled, “Cesarean Delivery and Peripartum Hysterectomy” -- Obstetrics & Gynecology, Knight et al, 2008; 111:97-105-

Check it out here:

I hope you have a friend with access to the medical journal who can get you a copy of the complete study. It’s a great resource to keep on hand… and to give to anyone who has been told that “cesarean is about equally safe when compared to vaginal birth”!

The study was a population-based, matched case-control study that studied 318 women who underwent peripartum (around the time of birth) hysterectomy between February 2005 and February 2006 and 614 matched control women. The study was done in the United Kingdom, using the United Kingdom Obstetric Surveillance System.

The conclusion of the study was:

Peripartum hysterectomy is strongly associated with previous cesarean delivery, and the risk rises with increasing number of previous cesarean deliveries, maternal age over 35 years, and parity (number of pregnancies carried to over 28 weeks) greater than 3.

Here are a few of the most interesting and relevant findings of the study:

Women who were having their first cesarean delivery were approximately 7.13 times more likely to end up with a hysterectomy (as compared to an equal control group having a vaginal delivery instead) by the time it was all over.

By the time it was the woman’s second or more cesarean delivery, her risk of hysterectomy was over 18 times greater than the woman having a vaginal birth!

~Women undergoing their first vaginal delivery were found to have a
1 in 30,000 chance of having a peripartum hysterectomy

~Women undergoing their first cesarean delivery were found to have a
1,700 chance of having a peripartum hysterectomy.

~Women undergoing their second cesarean delivery were found to have a
1 in 1,300 chance of having a peripartum hysterectomy

~Women undergoing their third or more cesarean delivery were found to have a
1 in 220 chance of peripartum hysterectomy.

ACOG’s journal said it themselves:

“This study has confirmed the significant risk of peripartum hysterectomy associated with prior cesarean delivery. These data provide evidence that cesarean delivery leads to a greater than seven times increase in the odds of having a peripartum hysterectomy to control hemorrhage. A similar risks was noted in a recent U.S. study using the Nationwide Inpatient Sample. We have also been able to identify that the risk also then extends beyond the initial cesarean delivery into subsequent deliveries; women who have more than one previous cesarean delivery have more than double the risk of peripartum hysterectomy in the next pregnancy, and women who have had two or more previous cesarean deliveries have more than eighteen times the risk. This full quantification of these risks provides the evidence needed to comprehensively counsel women about the risks of primary cesarean delivery and to counsel against cesarean delivery without a specific medical indication.”

The article winds up with a statement:

“Although fortunately a rare condition, peripartum hysterectomy nevertheless represents a catastrophic (and sometimes fatal) end to a pregnancy for any woman, regardless of whether she considers her family to be complete.”

Kudos to your obstetrician if s/he brings up this info when informing you of the risk of Cesarean section birth!

Frank Conversations on Cesareans

Most of the “risk” that we hear discussed for Cesarean section includes the possibility of

~post-operative infection,

~blood clots,

~anesthesia complications,

~damage to the bladder and bowels,

~potential problems with future pregnancies like infertility, miscarriage, placenta accreta

and placenta praevia

~and in some rare cases, even death.

Yet, few obstetricians really cover these potential complications in a way that will give a birthing mother a realistic view of what all her C-section could entail – a whole lot more than her idea of “I’ll be kind of sore for a few days or weeks.”

A friend of mine who recently had an elective cesarean developed blood clots afterwards and was shocked to hear that they could have been a result of how she chose to have her baby. Of course, she could have read up on the potential complications and figured that out herself ahead of time, but really, physicians should either thoroughly inform their patients themselves or see to it that they are reading books and doing research and getting informed during their pregnancies. And more than just reading, “What To Expect When You’re Expecting” or watching birth stories on TV.

Sure, of course, the anesthesiologist comes in and rattles off the usual, “you could die, be permanently paralyzed, etc.” stuff as the laboring mother is doing her best to hold herself together and prepare for the long ride down the hall to the OR, wondering if her baby will be okay. Of course, she nods and says she understands and scribbles her name on the paper in between contractions. But does she really understand what she’s signing up for?

That’s what I wonder. What kind of conversations do doctors have with their pregnant patients about the possibilities of a cesarean? …Not only that it could happen to them for various reasons (some good and some not so good), but that by simply having a cesarean, they are increasing their risk for many more complications.

Do they have frank conversations with their patients about weighing risks and benefits of a cesarean for a non-life threatening issue that comes up in labor (i.e. labor isn’t happening as fast as usual) if they are planning to have more children in the future? Or do they just imply that, “If you end up with a cesarean, trust me, it will be for a good reason to make sure you have a live, healthy baby. Vaginal births are great, but don’t get your hopes too high. You don’t want to be disappointed if it doesn’t work, because, really, your goal is a healthy baby, not how you have your baby.”

Saturday, January 5, 2008

What Are the Risks of Cesarean Section?

What are the risks of having a Cesarean section? …The risk of having two, even three C-sections? …For the mother, for the baby?

What are the risks of vaginal birth? …For the mother, for the baby?

If you are the typical American woman wondering about these questions, you’ll probably ask your doctor, perhaps check out a few resources online and see what the most popular pregnancy guide book, What to Expect When You’re Expecting has to say. You might even ask your childbirth educator about c-sections, and she would probably help you feel more prepared for it, by explaining when it is likely to happen and how you may feel about it if/when it happens to you.

Hearing women talk about cesareans has often made me wonder exactly what the average pregnant woman does and doesn’t know about having a c-section when she walks into the hospital to give birth. I’m on a mission to find out…

Is she adequately informed of the risks? Does she have a clear idea of the risks and benefits? Does she know as much about this procedure on her and her baby’s body as she does about purchasing her new car and comparing models?

I checked out What to Expect When You’re Expecting, and no where in its 437 pages could I find even one paragraph informing mothers of the potential risks for themselves when undergoing Cesarean delivery. The most I found for mothers was information on what a C-section would be like and how to be calm as you were wheeled back to the operating room for an emergency c-section, and then what recovery would entail – pain around the incision, possibly nausea and vomiting, possibly referred shoulder pain for a few hours and possible constipation, then it should be 4-6 weeks before you feel completely back to normal.

And this quote to put everyone’s fears to rest –

Question: “My doctor told me I will have to have a cesarean. But I’m afraid the surgery will be dangerous.”

Answer: “Today…cesareans are nearly as safe as vaginal deliveries for the mother, and in difficult deliveries or when there’s fetal distress, they are often the safest mode of delivery for the baby. Even though its technically called major surgery, a cesarean carries relatively minor risks – much closer to those of a tonsillectomy than of a gall bladder operation, for instance.”

Hmmmm…I’ve heard a few other things about cesareans recently. I’ll post them here as I get a chance…