Japan: the best place to give birth?

Japan is one of my most favourite places to travel. After this morning, I feel a little more in love with the country upon reading an article about the increase in pregnancies among 'older' women. When I first started reading, I expected that the article would turn into a rant about why 'older' women are 'high risk' and need to be managed medically more so than other women. But then I read something that caught my eye: Japan has one of the lowest maternal mortality rates in the world: 6 per 100,000 births (lower than the US, Britain, Finland and Canada).

Why is it so low?

Well, the picture is complicated. Much like other developed countries Japan has a technologised/medicalised approach to pregnancy and birth. Women who are 35 years + are seen as 'older' mothers. Birth choices for women are still circumscribed by the limitations placed upon them by health professionals in hospitals, however, not to the same extent as in other countries like the US.

Surprisingly, use of epidurals is much lower in Japanese hospitals. This is in part due to the more practical reality that there is a shortage of anesthetists. As you might know, the use of epidurals has been linked with an increased risk for caesarean section.

While most Japanese women give birth in hospitals, there is a small proportion of women who give birth in birth centres, called josan-in. These centres are set up like a traditional Japanese home and offer women care by a team of midwives. Centres offer maternity yoga, cooking classes for post-birth diet and nutrition counselling as well as a pool for water births.

What I found most interesting, however, was that this article, whilst couched in the language of 'women over 35 are high risk' blah blah blah, in fact, the piece ended up being about the importance of women over 35 being IN CONTROL of their pregnancies. As one obstetrician notes, the worst thing women can do is let a doctor be in control of their decision making. This is vastly different from what I perceive to be the perception of health professionals in other parts of the developed world. Women ('older' or not) are so often viewed as incapable of making decisions when it comes to birth that in a conservative environment like Japan, it is refreshing to see that obstetricians do not shove tests on women and whilst operating in a medicalised system, see the importance of women doing pregnancy and birth on their own terms.

Grin and bear it, ladies: pain is supposed to be positive

Apparently, women today aren't as stoic as their ancestors when it comes to pain in childbirth.

Dr Denis Walsh, a senior midwife and associate professor in midwifery at Nottingham University, said: "A large number of women want to avoid pain. Some just don't fancy the pain [of childbirth]. More women should be prepared to withstand pain."

"Over recent decades there has been a loss of 'rites of passage' meaning to childbirth, so that pain and stress are viewed negatively," he added, arguing that patients should be told labour pain is a timeless component of the "rites of passage" transition to motherhood.

Now, while I think that in certain contexts epidurals are sometimes overused, why on earth should women suffer through pain if they don't have to? Does it make you a better mother?

Thoughts?

Epidurals on the way out in the UK

In Australia, it is no secret that medicalised birth is increasingly becoming the norm. With a greater push for less intervention and more one-to-one care, maternity reform is a red hot issue on the national agenda. Nevertheless, while the prospect of having wholly funded home births and more accessible birth centres throughout the country is exciting, should less intervention mean no intervention?

In the UK, doctors and patients are struggling over new regulations surrounding the use of epidurals during birth. As new guidelines have characterised the use of epidurals and caesareans as 'unnatural' in a bid to reduce interventions by up to 40%. The goal of the new guidelines is to ensure that more women are having 'normal' or 'traditional' birth. Obstetricians, however, have problems with this.

Kim Hinshaw, a consultant obstetrician at Sunderland Royal Hospital, said: ‘I have major concerns with this. I don’t think we will ever reach a figure of 60% normal delivery using this definition. For example, in Sunderland we have an epidural rate in first labours of 60%.

‘This definition implies that if you ask for an epidural for pain relief, but go on and deliver normally after a six-hour labour, your birth was not ‘normal’. That is a disgrace.’

And Professor James Walker, a consultant obstetrician at Leeds Teaching Hospitals NHS Trust added: ‘This is a very rigid definition of what normal birth should be. Epidurals should not be done without reason; they should be kept to a minimum. There are some women, however, who require an epidural because they cannot cope with the pain in any other way.’

I have to agree. While I am fully in favour of supporting national guidelines that seek to minimise the unnecessary interventions, at the same time, I bristle at the thought of women giving birth in pain and not being allowed to have relief if they ask for it.

Would you be happy with this model of care in your own country?

Source: http://tinyurl.com/ccz8vh

Epidurals are now safe for birth

According to a report from New Scientist, epidurals are safer than once thought. Previously. it was thought that the risk of lasting harm from an epidural during birth was 1 in 25,000. New research shows the risk to be closer to between 1 in 320,000 and 1 in 80,000. Women giving birth with an epidural are actually now thought to be at the lowest risk of lasting harm. The highest risk patients are the elderly (risk of 1 in 6,000 to 1 in 12,000).

Tim Cook, a consultant anaesthetist at the Royal United Hospital, Bath, who led the project, said: “What the project has shown is that many complications of epidurals occur after major surgery in elderly unhealthy patients. The risks must also be balanced against the generally accepted benefits of epidurals.”


Sources:
http://www.timesonline.co.uk/tol/life_and_style/health/article5497517.ece
http://www.newscientist.com/article/mg20126913.600-epidurals-in-labour-safer-than-thought.html?DCMP=OTC-rss&nsref=online-news

Melissa Joan Hart: bring on the drugs

This is something you don't hear very often. Melissa Joan Hart says she regrets her decision to give birth 'naturally' to her second son, Braydon (now 6 months old).

"I kinda regret that one," she revealed.

"But the thing is, the healing was so much faster," the 32-year-old explained. "I didn't have to get the drugs out of my system and was moving around a lot more."

"I labored at home for 9 hours and then went to the hospital for an hour and a half - two pushes and he was out," she said.

Anyone else out there regret saying no to an epidural?

Source: http://www.usmagazine.com/news/melissa-joan-hart-i-regret-no-epidural

Epidurals don't always work!

And I thought having a caesarean was bad with pain medication...

A woman in the UK is planning to sue her hospital for failing to give her proper pain medication during an emergency caesarean. After an epidural, Sarah Carberry, 27 says she could still wiggle her toes and feel her legs but her doctors said that was 'normal'. When they started to cut into her womb, she was quite understandably in agony.

Note to self: wiggling body parts before major surgery = not good

Source: http://www.telegraph.co.uk/news/uknews/2660774/Mother-sues-hospital-over-caesarian-birth-without-pain-relief.html

Epidurals: get one even before pain starts

I know it was only recently that I wrote about epidurals and the post generated quite a large response...Nevertheless, epidurals are back in the news as a result of a new book Enjoy your labor: A new approach to pain relief for childbirth, by Dr Gilbert Grant, director of obstetric anaesthesia at New York University Medical Center. Grant argues that the old adage of 'natural' is best when it comes to birth is no longer applicable. In fact, Grant suggests that women should have an epidural even before they experience any pain associated with birth.

Whilst I agree, as Grant contends, that there is relentless pressure on women to give birth 'naturally' and that many women feel guilty when they choose to manage pain with epidural, the fact is that Grant suggests the opposition or at least the feminist critique of pain management methods in misogynist. He says:

"Childbirth instructors describe epidurals as unnecessary, or even harmful, interventions and make women feel that requesting one is a sign of weakness that may harm their baby. Labour is seen as an extreme sport - ‘no pain, no gain' - and yet this quasi-religious fervour is based on myth and misconception."

Hmm. While there are contingents of 'natural' birth advocates who argue that all pain medication in birth is 'unnatural' and 'bad', the majority of feminist critiques surrounding the use of epidurals is not that women are 'bad' mothers if they choose to use them. Feminists argue that it is the way in which epidural is presented as the default option for pain management in a highly medicalised environment that is problematic. Grants continues:

"It is barbaric that pain should still be viewed as an integral, even desirable, element of childbirth.”

In fact, I don't think the work of any feminist scholar of childbirth suggests that women 'should be in pain' in order to have a 'real' or 'authentic' experience of birth. Whilst this might be part of cultural narratives or even imperatives surrounding how women should 'do' birth correctly, this is a much different angle from scholarly work in this area.

Even more alarming is this suggestion:

"Technological advances mean that women are able to administer their own dosage and this makes them feel more in control. Furthermore, studies show that babies born to women who have had epidurals come out in better shape than those from ‘natural' childbirth."

What really bothers me about this statement is the association between control and technology. Women clearly can be empowered with medical advances in pain management as well as with other forms of reproductive technology. However, Grant fails to recognise that 'empowerment' rests on choice and in many American hospitals, for instance, the notion of 'choice' becomes blurry when women become part of a cascade of interventions which limit her ability to make decisions on her own. For instance, the reason so many women in America use epidurals is not just because they want them; with the induction rate close to 90% in some New York hospitals, for instance, epidurals become essential because contractions are so intense without a gradual build up. In these case, an epidural becomes routinised as a necessary medical intervention when perhaps many of those same women might not have chosen an epidural had they been able to allow labour to progress 'naturally'.

Nevertheless, I think it is a very dangerous proposition to suggest that epidurals should be part and parcel of birth without the inclusion of their risks. Moreover, this whole 'epidural before pain' framework only entrenches the notion that birth is scary and painful. Again, of course for some women it is intensely painful and everyone should acknowledge that, but the idea that women should be pre-medicating in anticipation is just ridiculous. Why not encourage women to learn alternative ways to manage pain before resorting to chemicals?

Moreover, the idea that pain must be pre-managed also suggests that women can never have 'positive' experiences with intense pain. If the pain of birth was so horrible, women would never have babies. Many women tell me that whilst birth itself was one of the most challenging moments of their entire lives, they felt like they had accomplished something; not because they had endured alot of pain and survived. They felt accomplished because birth is an intensely visceral experience and for some women, feeling childbirth in every ounce of their being is something they would not want to give up with medical intervention.

In the Netherlands, women are not allowed to have epidurals unless the mother is in a high-risk category. Whilst, I do not necessarily agree with this more extreme measure, the truth is that the majority of Dutch women give birth at home with a midwife and the maternal and infant mortality rate is extremely low. Why is it that in rich, 'Western' countries maternal and infant mortality rates are still relatively high? The answer lies in the unnecessary invocation of medical interventions (and not only epidural).

What do you think?

Source: http://women.timesonline.co.uk/tol/life_and_style/women/families/article3625980.ece

Pain-free birth just a pipe dream?

A new study says that women are kidding themselves if they think they can get through birth without pain relief. British researchers from Newcastle University reviewed 32 studies on expectations of labour pain, finding that most women who didn't want to have pain relief ended up with it.

However, what about home birth? 99% of women in America give birth in hospitals. Definitely not places which are conducive to quelling women's anxieties. 90% of births in New York hospitals are induced and epidurals are often doled out without any measures in places to help women manage pain naturally before the drugs are in place.

A 1988 U.S. study found that mothers that underwent labor in a hospital rated their pain as significantly higher than did a home-birth group. In the spirit of Sheila Kitzinger, what about accounting for those mothers that report euphoric, even orgasmic, feelings during what is supposed to be the most painful event in their lives. This study was obviously not included in the current review. More recent studies suggest that knowledge, confidence, and lower anxiety are predictive of positive childbirth. Also where is the discussion of the value of midwives? Studies show that midwives can help birthing women to find their own ability to cope.

This new review basically shuts down any positive feelings pregnant women may have in anticipating birth. Sure, it hurts and there is nothing wrong with choosing to have pain relief. However, why suggest that women are setting themselves up for failure by even thinking that they could possibly give birth drug-free?!

Source: http://www.independent.co.uk/life-style/health-and-wellbeing/health-news/women-are-misled-into-thinking-that-childbirth-can-be-painfree-795721.html

Bring on the epidural.

"More and more women are planning on getting epidurals, and I don't blame them," said Dr. Jerry Konialian, a fertility specialist at Northridge Hospital Medical Center, who has delivered thousands of babies since 1985.

"They were not common 20 years ago, but now they are demanding it. You don't even have to suggest it. It's wonderful, and it's safe. I tell my patients who do question it, `You wouldn't have a tooth pulled with no local, so why would you want this huge baby pulled out of you with no anesthetic?"'

A discomfiting point of view at a time when having a baby is riskier than ever, despite women living in a time when technology and medical advances are at their peak. No one is disputing that birth hurts. Women should be able to choose an epidural if they want one. However, I find it really appalling that obstetricians might be encouraging women to have epidurals under the assumption that a woman's body is incapable of birthing a baby without intervention. Moreover, the assertion that women are just giving up on natural birth in favour of anesthesia is ridiculous. Birth is very complicated in a hospital and women's 'choices' are often circumscribed by the context; if a doctor says she needs to have an intervention, many women are reluctant to dispute an expert opinion. Moreover, a number of women are so scared to give birth (tokophobia) they decide during the pregnancy that they do not want to feel any pain.

As I discussed a few posts ago, epidurals can slow labour right down and are just a link in the chain of interventions that often lead women down the path to an unwanted caesar. Having an epidural is no joke. It is essentially a spinal block and there are a number of risks:

*forceps or vacuum extractor are required more often (20-75%)

*may slow labor, requiring Pitocin (synthetic oxytocin)

*increases the chances of a cesarean delivery by two or three times

I don't think any woman takes this decision very lightly.

Source: http://www.dailynews.com/news/ci_8319895

http://www.childbirthsolutions.com/articles/birth/epidural/index.php

'Girlie Gowns' have landed

Argh. Just when I bagged J.Lo for having custom-made hospital gowns, some clever woman is now capitalising on the trend by producing 'Girlie' gowns for birth because, as she says, 'your delivery should be girly and not grungy'. These gowns have the exact same cut and embarassing open flaps at the back as the standard hospital gowns:

"The top half of the back is open (got to be accessible for that epidural, right?)"

Is an open flap for an epidural really a selling point? I'm not EVEN going to go there.

Nevertheless, they are charging $49(!) for a bloody piece of fabric that has polka dots and ribbon. Seriously!

If you were so concerned about wearing a hospital gown, wouldn't you choose to not wear one at all? Or to wear your own clothes? Why would you participate in such a ridiculous hospital ritual by having a friggin monogrammed gown?

Having a baby is one of the few times in a woman's life when she shouldn't have to worry about how she looks.

Birth is not an event in which women need another reason to buy a new outfit.

Source: www.girliegowns.com

A tour de force of birth

I finally saw On The Business of Being Born (OTBOBB). Ricki Lake and Abby Epstein have created a film that will make you experience what feels like a lifetime of emotions in the short span of 85 minutes. Navigating the streets of New York with a lone midwife on a mission to bring birth back into the home, OTBOBB draws on the experiences of pregnant women as they navigate the bureacracy of the American maternity system. In between providing a brief history of medicalised birth, the most profound and ultimately moving feature of this film is the up close and very personal view of birth---something which most women have never witnessed until their own. Babies are born throughout this film in some of the most humbling and beautiful footage I have seen on the subject to date.

Whilst the American and Australian maternity are relatively similar, the glaring lack of midwives in the American system is where the cracks in the foundation begin to show. The overwhelming use of 'pit' or pitocin in New York hospitals where an astounding 90% of births are induced is the trigger for the cascade of interventions to which American women are subject in contemporary maternity wards.

Thus, it is easy to see how the production of oxytocin, the naturally occurring hormone in women's bodies that triggers birth and is also described as a 'love' hormone to help with bonding when the baby is born, is stifled in this environment. The use of 'pit' or syntocinin (in Australia) is a synthetic form of oxytocin. However, when women are induced with this synthetic form of oxytocin, contractions are much stronger. When contractions are stronger, there is more pain and it is no wonder that the obstetric residents in certain NY hospitals were shoving epidurals in womens' spines as soon as the pain started to increase. However, epidurals slow labour right down. Ironic, eh? Women are induced to speed labour up in order to keep more beds open and the turn-over high in American hospitals. Yet, induction = pain = epidural. This slows labour down and puts baby at a higher risk for complications. The naturally occuring oxytocin? Replaced with adrenalin, the 'fight-or-flight' hormone which is produced when women are afraid or feel unsafe. No natural endorphins, no oxytocin. Just fear, shame and 'failure'. And you know what happens next? Caesarean. NY state hospitals have some of the highest caesar rates in America, hovering at 46%. Birth centres are closing faster every day due to the daily battles against insurance companies, rising costs and the inability to compete with hospitals. Homebirths? Only 1% of all births in America.

OTBOBB portrays modern birth as a battle being waged on women's bodies. There are no 'choices' when birth is left in the hands of 'experts' and midwives are nowhere to be found. Australian women are lucky in the respect that 'normal' birth is largely left up to midwives. However, the intervention rate is still extremely high in Australia and there is a growing lack of trained midwives available to all of the women that need them. Hospitals are increasingly reluctant to hire midwives because it is a competition for their obstetric business. Moreover, private midwifery care is rarely covered by insurance but this is most likely changing.

I had chills watching this movie. There were times when I felt so angry watching women in hospital being moved around like cattle, being told they had to be induced without any information provided to them as to the risks of the procedures being performed on their bodies. Informed consent is pretty much non-existent in the American system. America has one of the worst infant and maternal mortality rates in the world despite being one of the richest countries. Why? Birth has been taken out of the hands of women and their bodies are used to line the pockets of insurance companies, hospitals and obstetricians who don't care about the process but only about the product. As long as a baby comes out alive, it doesn't matter how it got there.

YOU MUST SEE THIS MOVIE.

NOW.

YOUR LIFE DEPENDS ON IT.