Issues in Child Bearing

Issues in Child Bearing
All video clips are embedded and can be started and stopped at your discretion by scrolling to the bar below the video image. Videos that are available in their entirety include a hyperlink.
When synopsis of facts are given hyperlinks are included if available or references may be found in the bibliography. When ready, click blue arrow in bottom LH corner to advance to next slide.
Image retrieved from http://flickrhivemind.net/User/PoolingWetPaint/Recent
Educ 566 Issues Project Spring 2014 Dee Matchett
The Issue
https://www.youtube.com/watch?v=6VStSNCFeEk&list=PLnxyOb8QR1gVmeDWCpp vyvMEvKItY6qO_
https://www.youtube.com/watch?v=PXSXrQQaBJg
www.oneworldbirth.net
https://www.youtube.com/watch?v=gXwaH98WWX8
Looking at Choices
Medicated Hospital Birth

Birthing Centers Homebirth Services There are many variations within these choices, but this project will look at their most common aspects.
Hospital Birth
(full video)
Lisa Ross Birthing Center in Knoxville https://www.youtube.com/watch?v=28ThzbqGzAs
Homebirth Services
Kate Shantz, Certified Nurse Midwife
https://www.youtube.com/watch?v=XNUq5yMQ_X4 http://www.katiecnm.com/pages/
Viewpoints
American College of Obstetrics and Gynecology: Committee Opinion

American College of Nurse Midwives: Position Paper Midwives Alliance of North America: Position Paper
Note: The American Journal of Obstetrics and Gynecology printed a rebuttal to the analysis of data upon which the ACOG Committee Opinion of increased risk of neonatal death was based. (Wax, et al., 2010) The rebuttal clearly showed the analysis to be misleading since only 4 studies cited were in this decade, 7 involved too few participants to be viable and only 1 of the studies was based in the US. That study came from birth certificates that did not indicate whether the births were planned or attended by licensed midwives. Grave concern was expressed about the generalization of these faulty statistics being applied to the current status of planned home births attended by qualified midwives in America (Kirby, R.S. and Frost, J., 2011).
Gail Gyte, a trainer in research methodology also reviewed Waxs meta-analysis and found that this study has serious methodological limitations (Gyte, Dodwell, & Macfarlane, 2011).
http://www.scribd.com/doc/34065092/Critique-of-a-meta-analysis-byWax#download
This lengthy paper can be viewed in its entirety at http://www.mana.org/about-us/position-statements The position paper supports the parental choice of birth setting and includes extensive documentation on the following topics: Respect for the Nature of Birth A Womans Autonomy The Safety of Homebirth Mothers Relationship of Equality with Her Midwife Consultation and Collaborative Care Cost-Effectiveness Significance of Birthing Place Informed Decision Making Midwifery Knowledge, Evidence-Based Practice and Homebirth Care Homebirth, Midwifery and National Maternity Care
USA Statistics Infant Mortality Rate Maternal Mortality Rate Morbidity Rate
http://www.cdc.gov/nchs/ data/databriefs/db23.htm
The United States has the highest infant mortality rate among the developed nations of the world. Ranking 30th is a clear indication that the medical model is not meeting the needs of newborns. Those nations that lead the world in low infant mortality incorporate the midwifery model into maternity care.
On the next slide is a clip from the short documentary Reducing Infant Mortality. It explores midwifery as a part of the solution to improving birth outcomes and the health of babies. A link to the website where the full film is hosted is included.
WARNING: Breastfeeding and birthing scenes include nudity.
http://www.reducinginfantmortality.com/
Interventions such as labor induction and Pitocin augmentation can lead to hypertension and uterine rupture (NICE, 2009). Induction results in a 20% increase of Cesarean section (Ehrenthal, Jiang, & Strobino, 2010). Cesarean section increases the risk of hemorrhage, pulmonary embolism, stroke, and sepsis (Coalition for Improving Maternity Service, 2010).

(Full video)
While the rising infant and maternal mortality rate is cause for serious concern, the high rate of morbidity in the US affects a much larger number of women. Morbidity is characterized by near death experiences and labor and delivery complications resulting in chronic illness and serious physical, cognitive and psychological disability.
Source: Centers for Disease Control
Severe Obstetric Morbidity in the United States: 19982005

Elena V Kuklina, MD, PhDa, Susan F. Meikle, MD, MSPHb, Denise J. Jamieson, MD, MPHc,Maura K. Whitem
Abstract ObjectiveTo examine trends in the rates of severe obstetric complications and the potential contribution of changes in delivery mode and maternal characteristics to these trends. ResultsThe prevalence of delivery hospitalizations complicated by at least of one severe obstetric complications increased from 0.64% (n=48,645) in 199899 to 0.81% (n=68,433) in 200405. Rates of complications per 1,000 which increased significantly during the study period included renal failure by 21% (from 0.23 to 0.28), pulmonary embolism by 52% (0.12 to 0.18), adult respiratory distress syndrome by 26% (0.36 to 0.45), shock by 24% (0.15 to 0.19), blood transfusion by 92% (2.38 to 4.58), and ventilation by 21 % (0.47 to 0.57). In logistic regression models, adjustment for maternal age had no effect on the increased risk for these complications in 200405 relative to 199899. However, after adjustment for mode of delivery, the increased risks for these complications in 200405 relative to 199899 were no longer significant, with the exception of pulmonary embolism (OR=1.30) and blood transfusion (OR=1.72). Further adjustment for payer, multiple births, and select comorbidities had little effect. ConclusionsRates of severe obstetric complications increased from 199899 to 200405. For many of these complications, these increases were associated with the increasing rate of cesarean delivery.
Dr. Marsden Wagner, renowned neonatologist and former director of Maternal and Child Health for the World Health Organization. Author of Born in the USA, Creating Your Birth Plan, and Pursuing the Birth Machine.
WARNING: Some pictures may be disturbing.
(full video)
Examining the Decision Process
Statistical Distribution of Birthplace
Autonomy
Childbirth Rights Declaration Compatible Ideology
Statistical Distribution
National Vital Statistics Reports, Vol. 61, No. 1, August 28, 2012
This table provides some insight into the decision making process of selecting a birthplace. More than 98% of parents choose the hospital setting. Of the less than 2% that choose an out of hospital birth, more than 50% choose to birth in their home. This is not a reflection on the quality of care in birthing centers. They have an excellent record of safety and satisfaction from clients. http://www.birthcenters.org/research In 2012, birthing centers in the USA had a 0% maternal mortality rate and a .4% infant mortality rate (Stapleton, Osborne, & Illuzzi, 2013). Those statistics outshine hospital outcomes by far. So why do parents seeking an out of hospital birth still prefer homebirth? I think a desire for autonomy in the birthing process is a major influence on the decision to homebirth. The following study supports that viewpoint.
Autonomy In 2003, the Department of Obstetrics and Gynecology at UMC in Maastricht, Netherlands attempted to do a randomized control trial of hospital vs. homebirth outcomes. Low risk mothers were to be randomly assigned a physician attended hospital delivery or a midwife attended home birth. After 6 months of seeking participants, the study had 1 volunteer. Dr. M. Hendricks then decided to change his study to one that inquired why women do not accept randomization of birth setting. Conclusion: it became clear that pregnant women strongly value their autonomy of choice (Hendrix et al., 2009). This cuts both ways, women who desire pain medication do not want to be denied their choice of treatment and feel just as strongly about their autonomous right to make that choice as women who want to avoid a medically managed labor and delivery. Both should be honored. The medical profession may also wonder why the homebirth movement persists when they have made strides to accommodate women with home-like hospital birthing rooms and free standing birth centers. These women do not want to delegate the course of their labor and delivery. They do not feel a hospital setting, despite bedroom dcor, will give them the freedom to allow birth to take its natural course. Some dont feel they would have that freedom in a birthing center either. A mother who has the support of the father to exercise her autonomy at home is fortunate. Together they make a strong team in defense of autonomy.
Such couples have formed numerous homebirth support groups that embody an ongoing grassroots movement to support parents and midwives. Thirty years ago, I was a participant in that movement. Three of my four children were birthed at home and I have known many homebirth couples. These are strong willed, independent men and women who place high value on giving their infant what they have decided is the ideal welcome into family life. Its not that they arent aware of risks. They want quality prenatal care and quality labor assistance. However, their definition of acceptable risk and quality of care differs from the medical standard.
The homebirth grass roots movements pioneered the ideas behind various childbirth rights declarations that have become a parental guideline for quality prenatal, labor, and delivery care in the natural birth community. It is the modern day human equivalent of a mother bear standing guard over her infant and father bear standing guard over them both. The medical community needs to understand that women feel the need to delineate these rights because they have personally experienced denial of them. My first child was born in a homey hospital birthing room with the promise of a natural childbirth. With the exception of not being given pain medication, there was nothing natural about the experience. My overwhelming desire was to pull the screw out of my babys head, take all the IVs out of my arms, strip my belly of electronic beeping belts and find a dark, quiet and peaceful place to give birth. Inside me was a knowing that without all those contraptions and the endless interruption of examinations , my body could work much more calmly and efficiently and that baby and I would be fine. Other women find security in technology and feel safer in hospital care. I did not.
Childbirth Rights Declaration Link to full version: https://www.childbirthconnection.org/article.asp?ck=10084
Some notable points from the declaration that show the desire for autonomy:
Every woman has the right to choose her birth setting . Every woman has the right to receive all or most of her maternity care from a single caregiver or a small group of caregivers, with whom she can establish a relationship. Every woman has the right to leave her maternity caregiver and select another if she becomes dissatisfied with her care. Every woman has the right to accept or refuse procedures, drugs, tests and treatments, and to have her choices honored. She has the right to change her mind. Every woman has the right to unrestricted access to all available records about her pregnancy, labor, birth, postpartum care and infant. Every woman has the right to have family members and friends of her choice present during all aspects of her maternity care Every woman has the right to freedom of movement during labor, unencumbered by tubes, wires or other apparatus. She also has the right to give birth in the position of her choice. Every woman has the right to virtually uninterrupted contact with her newborn from the moment of birth.
Compatible Ideology
Women who have formed an ideology about birth want to find a care provider whose ideology is compatible with their own. Just as a teachers theory of education affects their methodology and the atmosphere of the classroom, a health care providers ideology affects their attitude towards birth and therefore the climate of the birth setting. There is no consensus regarding whether or not planning a home birth carries a small increased risk of adverse outcomes, but it is clear that it is associated with less intervention than a planned hospital birth. The reasons for the reduced intervention rates are probably found both in the characteristics of the women and in the practice of midwives assisting home births (Blix, 2011).
The next two video clips express the differences in ideology and opinions parents have formed that cause them to seek compatibility in their care givers.
Birth Right
https://www.youtube.com/watch?v=6tLzjyuJdiQ
Insert video
https://www.youtube.com/watch?v=mEBzyq40LJ4
Conclusion Risk Acceptance
Legality
Changing the Culture of Birth Tennessee Midwifery Heritage
Risk Acceptance Women have given birth without medical intervention for centuries. As long as women become pregnant, at least some of them will choose out of hospital birth. That will not change. The real question is whether the medical community and we as a society are willing to support the parental decision to birth in the place parents determine will give them the best opportunity for a safe and satisfying labor and delivery. This will vary with individual preferences and health conditions. Conflict can arise when labor or birth becomes a medical emergency and transport is necessary. Parents may face opposition from medical professionals who disapprove of their choices. Parents who are already stressed by an emergency situation may be placed in further jeopardy by negative attitudes.
https://www.youtube.com/watch?v=Zl8kwi4cV4I
When a baby or mother dies in a hospital setting, no one judges or criticizes the parental decision to choose a hospital birth with an obstetrician in attendance. No one asks if the outcome would have been better at home. Death, although heartbreaking, is accepted as a risk of the birthing process when birth takes place in hospital. If a mother or baby dies in a free-standing birthing center attended by a midwife, parents will face inevitable criticism. Could the outcome have been different in hospital? For those who birth at home and encounter infant or maternal death, there is more than criticism to be faced. Parents and their caregivers often come under investigation and could face criminal charges. There are 22 states in which Certified Nurse midwives are only allowed to practice in hospital and all other forms of trained midwifery is outlawed. In effect, homebirth is made unavailable to those who want midwifery care unless they opt for a risky unattended birth or can find a caring midwife willing to put herself at risk for their sake. In these states midwives attending home birth have been charged with involuntary manslaughter or endangering the life of a minor. http://www.drmomma.org/2011/04/local-midwife-faces-30-years-in-prison.html (The midwife in this case, Karen Carr, was acquitted as is most often the case.) Are we willing to let parents choose the level of responsibility for birth they are willing to accept and not withdraw support when the outcome is not a positive one? Ideally, high standards for quality care from Certified Professional Midwives will be adopted in every state and our culture will be more accepting of the choices parents make concerning childbirth.
Legality Certified Professional Midwives (CPMs) (trained without nursing degree) Legal Status By State
Emerald: legal Lime: illegal /active legislation Yellow: illegal/planned legislation Brown: Illegal/gathering advocates
See Interactive Map
http://pushformidwives.org/cpms-by-state/
Changing the Culture of Birth
The Faces of People Changing the Culture of Birth

in America:
Yale trained physician, Dr. Aviva Romm Family practitioner specializing in obstetrics and mother of four, all of whom she birthed at home. She is also an award winning author of numerous books .
http://avivaromm.com /choosing-home-birth
Karen Brody Playwright and founder of BOLD
Birth On Labor Day

https://www.facebook.com/BOLD.Action
https://www.youtube.com/watch?v=tSxpIYfXBW4
Amy Swagman Amy is a doula and artist living in Denver, CO with her three beautiful daughters. Her art is inspired by the women she serves as a doula during childbirth and postpartum.
http://themandalajourney.com/about/why-mandalas//
The natural birth of my first baby was a transformative, ecstatic experience that helped me recognize my own womanly strength and primal birth wisdom. Dancing during my labor seemed like the most natural thing in the world to me and I assumed it was a common practice. But I realized from sharing my birth story with other new moms that my birth experience was unusual. I learned that in my community many women feared birth or thought of birth as something they could expect to endure at best, but certainly not to enjoy. I felt compelled to create Dancing For Birth classes to help women celebrate pregnancy, look forward to giving birth, and become mothers in a way that empowers them. Stephanie Larson
http://www.dancingforbirth.com/home.html
Tennessee Midwifery Heritage
Currently, Certified Nurse Midwives are governed by the TN Board of Nursing, while Certified Professional Midwives function under the council of the board of osteopathic examiners and must be certified by NARM, the North American Registry of Midwives.
http://health.state.tn.us/Boards/Midwifery/ http://narm.org/about-narm/ The state of Tennessee has a rich heritage in midwifery that began with The Frontier Nursing Service, which started in Kentucky, but spread into the hills of Tennessee and has now grown to include all 50 states. A brief history of the organization is seen in the next video clip.
(full video)
Lastly, a trailer from the award winning documentary film, Birth Story, about a remarkable woman who has carried on the midwifery tradition in Tennessee and had a profound influence on how women birth in America, not only at home and in birthing centers, but also in hospitals. She did this by giving women a voice to express their desire for family oriented births that would allow fathers to be present, encourage immediate skin to skin bonding, provide rooming in policies for mother and infant, and the list goes on. These are things we now accept as standard care in all settings. Without the 1970s revival of midwifery to pioneer these concepts, that would not be true. The author of four books and sought after international speaker, meet 74 year old Ina May Gaskin of Summertown, TN. Ive had the honor and pleasure of meeting her in person. It was a riveting experience.
Warning: Birth and Breastfeeding nudity
http://watch.birthstorymovie.com/
In 2013, Ina May Gaskin was inducted into the Womens Hall of Fame.
Ina May Gaskin (1940 - ) A certified professional midwife who has attended more than 1,200 births, Ina May Gaskin is known as the mother of authentic midwifery. In 1971, Gaskin founded the Farm Midwifery Center in rural Tennessee and effectively demonstrated that home birth midwives could be well prepared for their profession without first being educated as obstetric nurses. During a stay in Guatemala in 1976, Gaskin learned a technique for preventing and resolving shoulder dystocia during birth. After using the method with great success, Gaskin began to teach it and publish articles about the method. Now referred to as the Gaskin maneuver, it is the first obstetrical maneuver to be named after a midwife. Gaskin is the author of four books, including Spiritual Midwifery (1975), the first text written by a midwife published in the United States. http://www.greatwomen.org/
Bibliography
Committee on Obstetrics Practice. (2013). Committee Opinion, (476), 14. Retrieved https://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Ob stetric_Practice/Planned_Home_Birth
Hendrix, M., Van Horck, M., Moreta, D., Nieman, F., Nieuwenhuijze, M., Severens, J., & Nijhuis, J. (2009). Why women do not accept randomisation for place of birth: feasibility of a RCT in The Netherlands. BJOG: An International Journal of Obstetrics and Gynaecology, 116(4), 537 42; discussion 5424. doi:10.1111/j.1471-0528.2008.02103.x
Johnson, K. C., & Daviss, B.-A. (2005). Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ (Clinical Research Ed.), 330(7505), 1416. Keirse, M. J. N. C. (2010). Home birth: gone away, gone astray, and here to stay. Birth (Berkeley, Calif.), 37(4), 341346. doi:10.1111/j.1523-536X.2010.00431.x Blix, E. (2011). Avoiding disturbance: midwifery practice in home birth settings in Norway. Midwifery, 27(5), 68792. doi:10.1016/j.midw.2009.09.008 Coalition for Improving Maternity Services. (2010). The Risks of Cesarean Section. Retrieved June 03, 2014, from http://www.motherfriendly.org/ Ehrenthal, D. B., Jiang, X., & Strobino, D. M. (2010). Labor induction and the risk of a cesarean delivery among nulliparous women at term. Obstetrics and Gynecology, 116(1), 3542. doi:10.1097/AOG.0b013e3181e10c5c
NICE, (2009). Induction of labour (p. 35). Manchester. Retrieved from http://www.nice.org.uk Gyte, G. M. L., Dodwell, M. J., & Macfarlane, A. J. (2011). Home birth metaanalysis: does it meet AJOGs reporting requirements? American Journal of Obstetrics and Gynecology, 204(4), e15; author reply e18 20, discussion e20. doi:10.1016/j.ajog.2011.01.035 Hendrix, M., Van Horck, M., Moreta, D., Nieman, F., Nieuwenhuijze, M., Severens, J., & Nijhuis, J. (2009). Why women do not accept randomisation for place of birth: feasibility of a RCT in The Netherlands. BJOG: An International Journal of Obstetrics and Gynaecology, 116(4), 53742; discussion 5424. doi:10.1111/j.1471-0528.2008.02103.x Kirby, R. S., & Frost, J. (2011). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics and Gynecology, 204(4), e16; author reply e1820, discussion e20. doi:10.1016/j.ajog.2011.01.031 Kuklina, E. V, Meikle, S. F., Jamieson, D. J., Whiteman, M. K., Barfield, W. D., Hillis, S. D., & Posner, S. F. (2009). Severe obstetric morbidity in the United States: 1998-2005. Obstetrics and Gynecology, 113(2 Pt 1), 293299.
MacDorman, M. F., & Mathews, T. J. (2010). Behind international rankings of infant mortality: how the United States compares with Europe. International Journal of Health Services: Planning, Administration, Evaluation, 40(4), 57788. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21058532
Michal, C. A., Janssen, P. A., Vedam, S., Hutton, E. K., & de Jonge, A. (2011). Planned home vs hospital birth: A meta-analysis gone wrong. Ob/Gyn & womens health. Medscape. Stapleton, S. R., Osborne, C., & Illuzzi, J. (2013). Outcomes of care in birth centers: demonstration of a durable model. Journal of Midwifery & Womens Health, 58(1), 314. doi:10.1111/jmwh.12003
Educ 566 Issues Project Spring 2014 Dee Matchett

Issues in Child Bearing

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Issues in Child Bearing

Enviado por

Direitos autorais:

Formatos disponíveis

Issues in Child Bearing