Link party! CBACs, Fulbrights, and bras

I am on the road! Excited to be traveling to a favorite city to help with and attend the wedding of a great friend. I have several posts in the "What every doula should know about breastfeeding" series in progress, but I don't know how much work I'll get done on them in the next week. So in the meantime, a few links!

A planned, empowered, and enjoyable CBAC story (by a mother who had already had one c-section and a VBAC). "I will never forget these moments. Ever. They were beyond perfect. At last a very beautiful, calm and positive birth experience. I felt fully supported, I felt my son and I were in good hands. My husband and I were respected, and the birth truly was a celebration."

A step-by-step guide for applying for a Fulbright. I am so proud of my sister who has a Fulbright next year to study sustainable agriculture in west Africa! Have you ever thought about wanting to research issues related to reproductive health or other related issues in another country? A Fulbright can fund you for a year, on huge range of research topics!

I've been getting into some different bra blogs lately! They are written by women who have "unusual" sizes (in quotes because it's not unusual for women to BE these sizes, it's just unusual for them to KNOW they are these sizes). This is a great post on how many women are fitted poorly into bras and how the many different shapes and sizes that we come in are not respected:"The War on Plus Four": "...for some women, the fact that they might need a 30 or even 28 band and a significantly larger cup might seem like an alien concept as we generally have it drummed into us that a 32 is the smallest band available, and anything below this should be considered a ‘specialist’ size. Or an ‘awkward’/'odd’ size (I’ve heard it described as such and everything in-between). Even the idea that going down a band size (or even multiple sizes) makes people shudder. "

That's all for now!

Breastfeeding & Feminism: Day 1

I really need to take more notes at these things! So here are a few notes pulled out of my very scattered information overloaded brain:

- Eugene Declercq gave a great keynote on statistical trends in C-sections, VBAC, and other birth-related stuff. One of the most interesting sections was on homebirth. Still very tiny numbers, so hard to identify a definite overall upward trend, but it seems to be on the rise. He then broke the trends out by race, and that was fascinating: homebirth rates were the same or dropping for all races except for white women, who are clearly seeing an uptick. He reports that in the latest stats, 1% of all births to white women happened at home. That seemed high to me, but apparently that's what the statistics are telling us. I am not at all surprised, however, by the disparity.

- Bettina Lauf Forbes and Danielle Rigg of Best for Babes spoke about reframing breastfeeding, including how much they dislike the phrase "protect, promote, and support breastfeeding" - they want to replace it with "inspire, prepare, and empower moms". They really have a marketing mindset of helping introduce moms to breastfeeding via common consumer culture avenues like celebrity profiles, then help educate them on avoiding the "booby traps". As they pointed out, we have very high BF intention rates - we need to help moms achieve their personal goals!

- Keren Epstein-Gilboa, who came all the way from Canada, gave a really dynamic talk on breastfeeding and envy. She first had us imagine something that we really, really wanted - a job, a person, a house, whatever - and say how it made us felt. (Great!) Then we had to think about how we couldn't have it - and how that made us feel. (Well, pretty crappy.) Now how did we feel about that thing, and the person who had that thing instead of us? We often tell ourselves we didn't want it anyway, or that it really isn't that great, or we try to break it into parts. She used that introduction to discuss her research on the relationship of fathers to breastfeeding, and how different societies treat mothers and by extension how they treat breastfeeding, and also what it means for women who try to breastfeeding and aren't able to. I only wish she'd had more than 15 minutes!

That's all for now - I've got to start recharging my brain for tomorrow...

Defensive medicine and the c-section assembly line

Apologies for the long posting silence. I have so many drafts in progress. In the meantime, I want to direct people to the excellent and thought-provoking posts and comments at the Unnecesarean's series Defending Ourselves Against Defensive Medicine.

I thought I would tell a little story to go with it. My last CenteringPregnancy group had their reunion today. The midwife organizes it so that the reunion takes place at the meeting of a group who is about to have their babies. Then the new moms can share their experiences of birth, breastfeeding, and baby care with the moms-to-be.

One of the reunion moms had quite the story. She had 3 days of labor and was finally at the hospital making very slow progress with a posterior baby. The midwife who facilitated the group was working with her and the doctor came in to tell the midwife that the woman should have a c-section.

The midwife took him out into the hallway to discuss it. Turns out he had a morbidly obese patient who was also going to need a c-section, and would need the OR and a number of staff for a significant amount of time. The doctor's take was, "Let's get this one out of the way, then we'll do the more complicated surgery." The midwife went to bat and said "No. Mom is fine and baby is fine. I know my patient is stalled, but you do this longer surgery and THEN, if she's still not progressed, you can take her to the OR." They argued and (thankfully!) the midwife won. She went back in and put mom in a knee chest position (keep in mind this was a mom who had an epidural! these positions are possible under many circumstances!) The baby rotated to OA, and after that labor progressed and baby was born easily.

Thank goodness for guardian midwives in the face of not just defensive but assembly-line medicine.

I'm on a (posting) roll! Midwives posting their stats for the world to see

Apparently I'm on a posting roll tonight...

Did you know that CBS Midwifery in Manhattan posts all their stats for the previous year? An excerpt from 2009's:

Vaginal deliveries 80 = 88%

Normal spontaneous vaginal 76= 95%

Vacuum extraction 4 = 5%

Vaginal births after previous C/S 8 successful out of 9 attempts = 88%

Furthermore, they deliver babies at the in-hospital birth center at St. Luke's Roosevelt. A common complaint I have heard from doulas is that their clients expect to use the birth center, and are either risked out before labor ever begins, and sometimes during labor and then they are sent to L&D. Or they get there and are told the birth center is full. So I liked even more that the midwives make that piece transparent too:

Women who wanted Birth Center and were eligible at term = 68

43 - delivered Birth Center = 63%

24 - Transferred to Labor & Delivery in labor = 35%

1- Birth Center full- had to deliver on L&D = 2%


They also provide stats on degrees of perineal trauma, meds, reasons for c-sections...
Imagine if every practice did this! How amazing would it be to be able to compare this information when looking for a care provider?

What are practices out there that you know of that make some or most of their stats available to consumers?

Induction and perception

You all know how I feel about induction. Pinky has just posted about how tough inductions can be:

Like most L&D nurses, I hate to induce a primip with a long thick and closed cervix. Especially when she is not 42 weeks. Some babies go 42 weeks. We hate to see the 3 day induction. Which goes like this: 1st evening you get cervadil. Next morning we start pitocin even if you are still not ripe. Repeat cervadil in evening or maybe put in misoprostal next morning repeat pitocin. We might turn the pitocin off a few times if the floor gets busy during the day so you get set back a few times. By the 3rd day the woman and her partner are begging for a C-section. We hate to do this. Sometimes she pops into labor and delivers a baby no problem. But that is usually if she has a ripe cervix in the 1st place or by the end of 12 hours of cervadil. ...

Funny thing is no matter how much you tell folks about how the 3 day induction will suck, most will sign up for it. They must think, "Oh I won't be the 3 day induction and if I am I will get a c-section." I think most people down play the risk of c-section. Either they down play it or the catastrophize it. In my book a c-section is to be avoided if possible. It really is a big surgery but not a catastrophe. Most abdominal surgeries can be done by laproscopy. We have not figured out the laproscopic c-section.

It got me thinking about a blog I was following recently. Sometimes my google alerts kick up blogs of expecting moms and I end up scanning through them. This woman decided on an induction at 41+2 and wrote "I know I know, there are a lot of people out there that are against inducing, but [husband] and I are not." There are many ways the story could unspool, but the way it ended up was an induction beginning Sunday night, lasting through Monday night, and ending with a c-section on Tuesday morning due to exhaustion and slow progress. So, pretty consistent with Pinky's description.

This woman seemed OK with having ended up with a c-section, and I think it's great that she felt happy about her experience. But to me, it was illustrative of how choices with real consequences can start being treated as philosophic differences. I'm sure I would be placed into the class of one of the "lot of people out there" against inducing, but I am not "for" or "against" induction. Rather, I think that induction, particularly used electively and/or when the body is not ready (as measured by a Bishop's score), carries risks and that individuals should be aware of these risks.

Making the choice to use or not use an intervention involves a set of risks and benefits that every individual has to weigh for themselves. And one of the risks of induction is that it will be long, exhausting, slow, and result in a c-section which, as Pinky points out, carries real risk of its own. That's easy to ignore, though, when the discourse becomes whether people are "for" or "against" epidurals, inductions, c-sections, etc. That obscures the reality that these are not "chocolate or vanilla" choices of personal preference. It makes it easy to ignore the 3-day inductions and c-section complications, or at least to perceive them as common outcomes of labor (and so not consequences of the induction) vs. common outcomes of induced labor. It's hard because I think many people are trying to spread the word about the risks of induction. But if it's coming across as another "pick your flavor" choice, it's obviously not coming across correctly.

Feminists, reproductive rights, and VBAC

So Feministing also posted a link to the article on Joy Szabo's VBAC challenge, and the comments section has gotten - interesting. I don't want to say that every Feministing commenter is in fact a card-carrying feminist (what, you don't have a card? I keep mine in my wallet, it's laminated and everything!) but the reactions of some of the commenters really surprised me.

Despite my better judgment and a pile of other tasks I need to do today, I have gotten into the fray. It just raises my hackles when women who in many other contexts would aggressively question medical/legal authority and advocate for a woman's right to make choices about her own body go off on the "Well, if her DOCTOR says it why would she put HERSELF and everyone else at RISK" line. As if your reproductive autonomy ends when you choose to continue a pregnancy, and you must willingly hand your body over to the medicolegal system. As if VBAC access in no way equates to abortion access. As if it's OK for a hospital to threaten to get a court order for unnecessary surgery, because "She's the one who decided to get pregnant and decided to have a VBAC, so she's got to live with the consequences. The hospital has to protect themselves". I'm glad there are other commenters who see the irony here, but shocked that there are those who do not.

I have so much more to say about the relationship of feminists/the reproductive rights movement to birth, but that post would take longer than I have at the moment. Suffice it to say, I think reading the comments on that post is educational, if nothing else, and offers food for thought about how to appropriately illustrate to those in the movement that birth issues are not related to reproductive rights - they ARE part of reproductive rights and just as important as any other.

Arizona woman fights VBAC ban

Joy Szabo had a normal vaginal delivery for her first child, then an emergency c-section for her second, followed by a successful VBAC for her third. By the time she was pregnant with her fourth, the hospital in her town had banned VBACs. Yes, the same hospital where she had just had a successful VBAC two years earlier. So she decided to go out and make some noise about it.

Her local newspaper wrote an article about her situation. The Unnecesarean posted excerpts from her story and contact info for the hospital, prompting a Twitter response from the hospital's PR person (read all the way down the entry). Now the ICAN blog has Joy's story in her own words. Here's a bit from her second meeting with the hospital CEO:

...I asked why they are doing labor and delivery if they cannot offer a timely cesarean. She defended the hospital, saying that they can do emergency cesaereans, but did not want to accept the risk of VBAC. I asked what the hospital policy is if I show up and just refuse to consent to a cesarean. She said they would seek a court order. She repeated to me that Page Hospital does not have the facilities nessasary to handle an emergency.

(My translation: "Can Page Hospital handle an emergency c-section?" "Yes! No! Depends on who's asking! Go away or I'll get a court order!")

The newspaper article features a photo of the kick-ass message she's painted on her minivan, equating her hospital's threat to get a court order for a cesarean with rape. Because of the VBAC ban not only in her hometown, but on multiple hospitals closer to where she lives, as of now Joy Szabo has decided to try to find an OB/hospital in Phoenix - a 5 hour drive from her home - that will work with her VBAC.

The ICAN blog has links for "mom-sized" activism (or really, any busy-person-sized). Tell Page Hospital and the Banner hospital system that forcing a mom with 3 children to travel hundreds of miles just to give birth as her body intended, and threatening her with a court order for unwanted surgery...well, that's just Not Cool. And yes, that last part does sound a lot like rape.

Cesarean vs. VBAC

Via The Unnecesarean, who says "Alexandra Orchard is my personal hero":

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

While there are a lot of things I loved about this video (the honest portrayal of cesarean surgery, for one), the letter is what really blows me away. I would love it if more women who are disappointed with their care providers and hospitals openly expressed that disappointment. Nothing is going to change without better communication and who better to speak than someone speaking from immediate personal experience? It's hard for doulas to push that too much with individual clients, but it is inspiring when women and their families take the lead.

Update your links

On my short list of blogs you should be reading (besides mine) is Jill's The Unnecesarean. She recently had a sad case of domain-stealing, so update your links from Unnecesarean.com to TheUnnecesarean.com (or add it now if you haven't yet).

Just recently she has had in-depth information and discussion on how refusing an unnecessary c-section led to loss of custody, the outcome of charges against a doctor for being abusive towards a woman in labor, and noted the new Cochrane Review stating that use of antibiotics for GBS in labor is not supported by evidence. See? You don't want to miss this! And I can't link to all of it (just a lot).

New breech guidelines from Canada

The Society of Obstetricians and Gynecologists of Canada has come out with new guidelines for breech birth, saying that the automatic c-section is not an evidence-based practice and that all breeches should be evaluated and offered vaginal delivery if appropriate. New guidelines are here. I was curious to read through the guidelines, but as I read them I thought “What doctor is going to be willing to go through this checklist when they could just schedule another c-section and be done with it?” That’s why I liked an article that accompanies the published guidelines, by Dr. Andrew Kotaska, called titled, “Breech Birth Can Be Safe, But Is It Worth the Effort?”: (all the emphasis is mine)

Whether term vaginal breech birth is safe is no longer a question. The PREMODA study has clearly shown that with careful selection and management by average maternity units, breech birth can be safe. …

In the PREMODA study, the overall vaginal birth rate was only 23%. Is it important to mount the significant effort required to offer women breech birth if only one quarter will thereby avoid Caesarean section? … In North America, over 100 000 women have pregnancies that remain breech at term annually. With a success rate similar to that of the PREMODA study, some 25 000 could safely avoid Caesarean section.

…[T]he current practice of “not offering” women a trial of labour while providing ready access to Caesarean section is coercive, especially given the equivalency of long-term neonatal outcome. Now, with a more comprehensive understanding of the components required to make short-term outcomes of vaginal breech birth equivalent as well, it would be unethical not to provide this information to women. Although it may be difficult in some settings to offer vaginal breech birth routinely, its availability elsewhere should be disclosed and assistance offered to obtain it if requested. To offer only Caesarean section is ethically and legally difficult to justify if a reasonable alternative is available.

This is really the crux of it, and the guidelines even state that women who refuse a c-section recommendation must still be given care (why does this even need to be said?) Why is it OK to providers to offer one option and not the other? What if no c-sections were offered and all women were required to deliver breech vaginally, regardless of the risks – would anyone be ethically down with that?

I think the next big step is to change the attitude that offering women one choice (to be accurate, no choice at all) is acceptable. After some new evidence came out about Term Breech Trial and other breech trials in 2006, ACOG did a weak “we guess maybe you could try vaginal breech if you REALLY REALLY want to” policy change, and I think everyone would agree it didn’t change much here. The Canadian guidelines, on the other hand, are actual guidelines with specific recommendations on how to safely offer and assist breech deliveries, along with a recommendation to train more providers in breech skills. But without strong advocacy the status quo seems likely to persist there as it does here. Will there be loud enough voices in Canada demanding that those guidelines be applied?

Maternal mortality in NY state under review

The Poughkeepsie Journal notes efforts in NY state to investigate rising maternal death rates and notes that they have risen along with cesarean rates.

A few thoughts about this: it's easy to say "more women have cesarean sections because more women are high risk" (this is essentially what one OB in the article says). Very true - sing it with me, "Correlation does not imply causation". (By far the most important thing you learn in epidemiology.) High-risk women are more likely to have c-sections, and also more likely to suffer serious complications. But research also shows that cesarean section rates have risen for ALL women in ALL risk categories. So yes - it's not just that there are more high risk women, it's that there are more c-sections done on them.

I also wish the article had been willing to make it clear - c-sections DO carry a higher risk of maternal mortality. Maternal mortality is very rare - that's why it's measured per 100,000 (vs. infant mortality, which is measured per 1,000), so an increase may not be quickly visible because the rise in absolute numbers is very small. But if we get to a 40% cesarean rate, or 70% cesarean rate, or 100% like in some places in Brazil - we may not be able to say for sure which deaths were caused by cesarean, and which would have happened anyway, but it will be statistically guaranteed that some women will die from unnecessary cesarean surgeries. It doesn't really seem debatable.

Finally, as a caveat to all this and the entire article - I was curious to know whether New York state maternal mortality reporting has changed in the decade in question. Many states have adopted new death certificates and new reporting rules that have really upped the number of pregnancy-related deaths reported. The changes in reporting have made it really challenging to say anything reliable about national trends, and I wonder if the same holds true for NY.

Article on hypnobirthing

I really like this reporter's tale of her birth assisted by hypnobirthing techniques, in part because she spends relatively little time on the birth itself. Instead she discusses her wish to avoid her region's 45%(!) cesarean rate and how she had to "break up" with two different OB practices (actually, one broke up with her) before finding a doctor she trusted. I wish more women were unafraid to leave their OBs when they realize it's not a match! I love how she notes that her doctor never told her to push - even the most calm and non-interventive care providers so often ramp things up at pushing time.

Since I did my hypnodoula training I've been so interested in attending a birth that uses these techniques! I'll be in another city this summer for a (very) full-time practicum for my master's, but I hope when I get back in the fall I'll be able to offer my services to some parents in the area who are doing HypnoBabies classes. It just seems like such an empowering birth technique.

A short history of the cesarean rate

Why did c-section incidence - fewer than 10% of births in the 1970s - rise in the 80s, fall in the 90s, and then rise again to where 1 out of 3 women give birth by cesarean today? The more I learn about it, the more I realize it's a pretty interesting story that says a lot about what shapes maternity care (hint: it's not always the evidence). The Well-Rounded Mama has a great post about the recent history of c-sections in the U.S.. It's completely worth reading, especially if you've been reading my posts and wondering "What's the deal with VBAC?"

More on breech!

And now hot on the heels of my last breech post comes this fabulous editorial from an Australian newspaper by a woman who asks, among other things, two very important questions:

1) Why do people admire men who climb mountains, but scorn women who have unmedicated births?

2) Why is it so hard to find someone to deliver a breech baby?

I admire her for asking questions and seeking out providers who can give her a second opinion on breech delivery, and I hope she writes again to talk about how her baby's birth goes. I hope many women read this and start asking more questions.

Breech waterbirth

The topic of breech presentation has been coming up for me lately from a few different venues! Someone asked me today what I would do if I had to make the choices of whether to attempt an external cephalic version to turn the baby, whether to schedule a c-section. I know that I would avail myself of acupuncture, chiropractic techniques, somersaults in the pool...every gentle way I could think of to turn the baby! I would have to weigh the risks and benefits of a version, as I would of a c-section.

One of the challenges I would be weighing, though, is how hard it can be to search and fight for the right to vaginal delivery for breech. Even in New York City, where I used to live, doulas would trade around the precious names of the few doctors who did breech deliveries. That's in a city of millions! Upstate, I knew a woman whose midwife wouldn't deliver her breech at home, but helped her find a doctor who would. He was from an African country, and thought breech was perfectly normal. He was happy to deliver her breech baby as he had many other babies in his own country. But you have to be hardworking and lucky to find a practitioner who is experienced with, and willing to do, a breech birth.

And finding a practitioner, of course, depends on you knowing and feeling confident that a breech birth is even possible. I absolutely believe that many people - even those carrying breech babies - do not know that vaginal birth and breech are not mutually incompatible.

Thinking about all this, I started rummaging around on the internets for breech info. I came across this video, and was struck by how beautiful and simple the births were (and exemplify "hands off" breech!) You're able to see breech babies emerge very clearly because of the unique birth tub used, and then you can watch them swim around a little before they're brought up to the surface! The little box that pops up at the beginning says this is in Belgium. I wonder if vaginal breech is common in Belgium, or only at this hospital. I'd certainly feel more comfortable choosing a vaginal breech delivery, though, if I had a great place like that to deliver! And this is proof that vaginal breech can indeed happen, under the right circumstances.

Why to choose your place of birth carefully

The Unnecesarean discusses a new c-section report out of Massachusetts. She has some great commentary, including on the claim that the hospital network with the highest cesarean rates does c-sections mainly because of problems like a big baby or "the shape of the mother's pelvis". Ah! There's the problem! All the funny-shaped pelvis women must have signed up to give birth at those hospitals!

Take a look at the list, too, and scroll from top (highest c-section rates) to bottom (lowest). First, notice how long it takes to get to facilities that are even below 30%. Second, notice how big the difference is between top and bottom. Now think: what are your chances of having a vaginal birth at the ones at the top of the list and the ones at the bottom?

If it ever sounds like I'm driving these points into the ground, it's because I am always amazed myself: half of the women you meet who had a c-section didn't need one. But they were told, and still think, they did - and when you hear their stories after the fact, it's so hard to tell who really needed it and who would have had a vaginal birth if they were at a different hospital, with a different provider. But it's a virtual guarantee that if you scooped up a handful of the women from the highest-rate hospital and put them at the lowest - funny-shaped pelvises and all! - some of those women would have a vaginal birth who wouldn't have otherwise.

How can we make women's medical care so randomly and hugely dependent on where they give birth?

Questioning the elective c-section

I have a few concerns about what's presented as fact by a mother interviewed about her elective cesarean delivery. Chief among them is that she asserts that because her baby was breech she would have "ended up with an emergency C-section and that's the thing you want to avoid".

That's just not true. Leaving aside the option of vaginal breech birth (difficult to arrange in terms of finding a provider, but not some kind of anatomical impossibility and very common elsewhere in the world) a known breech is not going to end in an emergency c-section. One of two things will happen: 1) the mother has a scheduled c-section before going into labor or 2) the mother goes into labor before her scheduled surgery, goes to the hospital, and has a c-section. Neither of these scenarios involve an "emergency" c-section. (I was also puzzled by her reference to a doctor in an emergency c-section not always being able to do a low transverse ("bikini line") incision. Does anyone know about this? I've heard of doctors cutting a classical incision for other reasons, but not emergency-related.)

The reference to differentiating between risk in planned and emergency c-sections is also not really accurate. Even studies that control for whether or not the cesarean was indicated based on risk have found a difference between cesarean and vaginal births.

Finally, I was struck by comments like "You don't have these awful stitches 'down there'" (I guess "inside and outside your abdomen" is better?) as if women are guaranteed tearing and/or an episiotomy at a vaginal birth.

I'm happy that this woman had a positive outcome from her elective cesarean section, but that doesn't change that cesarean section is riskier than vaginal birth. At the end they ask if she would have another elective c-section for future children, and she says "Absolutely!" While you could argue that the absolute difference in risk between c-section and vaginal delivery at the first birth is small, it is undeniably true that the gap grows with every subsequent c-section. Women planning to have multiple children should in particular think hard about choosing a cesarean.

Time Magazine covers VBAC

Via The Unnecessarean, Time Magazine covers the disappearing VBAC. Even more amazingly, they do a pretty good job of it! My favorite quote is this: "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?"

Yeah, how can they? "It's so much safer to be in a hospital where they can do a crash c-section!" So why do hundreds and hundreds of hospitals deny women VBACs on the grounds that they couldn't do a c-section quickly enough in an emergency?

I do wish the article had discussed how avoiding common interventions like pitocin can decrease the (tiny) risk for uterine rupture even more.

How to overmonitor birth even more than we already do!

I wanted to highlight a little bit of ridiculousness I found out about via Birth Activist's great post on Creepy obstetric and childbirth technology patents. Introducing...the Birth Track!

Let's discuss a few things on the Birth Track website.

First, "Currently, cervical dilatation and head station are assessed by the physician/midwife manually during vaginal examination. In the usual procedure vaginal examinations are performed numerous times during normal labor."

As Birth Activist so succinctly puts it, the alternative would be to do fewer vaginal exams. Furthermore, what are the problems with numerous vaginal exams? 1) they're uncomfortable for the mother; 2) they increase the risk of infection; 3) they can make people nervous about "lack of progress". Given that the monitors in question are attached to the cervix I can't imagine how numbers 1 & 2 will be improved, and I think 3 would be made even worse.


"The cervical dilatation measurements are performed by a small Ultrasound unit, that is placed on your abdomen, similar to the fetal monitor belt. Also three sensors are attached: two to the cervix and another one which is incorporated into the fetal scalp electrode."

I love how they try to downplay the fact that the monitor is attached to your cervix. "It's monitored by an external monitor! Also 3 internal ones." Note how they assume your water is (has been artificially) broken so you can use a fetal scalp electrode. Oh, wait, note how they assume that you'll be using a fetal scalp electrode (it screws into the top of the baby's head).


"You will have continuous information regarding the progress of labor and you will know the position of your baby every second."

Fabulous! Because continuous information has been proven to improve outcomes. Oh wait - it hasn't? It's been proven to do nothing, except increase the number of unnecessary c-sections? Oh.


"Your partner will be able to be an active participant in the labor process as he/she follows the progress of the partogram on the screen next to your bed."

Being an active participant because you watch labor progress on screen is like being an actor because you watch TV. It's a sad comment on what we think "active participation" in labor is.

Early c-sections increase risk

This new study shows, I think, more of what happens when we decide that something about birth just can't be that important. Since babies can be considered "term" any time after 36 weeks, why not take them whenever you feel like? Ignoring the idea that maybe we don't know everything going on in the last weeks of pregnancy, and if the body doesn't go into labor spontaneously there might be a good reason.

If you've seen "The Business of Being Born", they point out that most interventions in obstetrics are adopted first and then studied after the fact - when damage is already done. What really caught my eye was the doctor who said of scheduling an early c-section, "I really hadn't thought much about it until now." Some standard practices in use today - like continuous fetal monitoring - were introduced, later studied and proven not to be helpful, and then were too entrenched to root out.