CNN article: Avoid episiotomies

Here's an excerpt from a recently published article on CNN.com, entitled 5 operations you don't want to get -- and what to do instead.

Episiotomy

It can sound so simple and efficient when an OB-GYN lays out all the reasons why she performs episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening along the perineum (between the vagina and anus) would reduce the risk of pelvic-tissue tears and ease childbirth. But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely -- and the numbers have dropped. Many doctors now reserve episiotomy for cases when the baby is in distress. But the rates (about 25 percent in the United States) are still much too high, experts say, and some worry that it's because women aren't aware that they can decline the surgery.

"We asked women who'd delivered vaginally with episiotomy in 2005 whether they had a choice," says Eugene Declercq, Ph.D., main author of the leading national survey of childbirth in America, "Listening to Mothers II," and professor of maternal and child health at the Boston University School of Public Health. "We found that only 18 percent said they had a choice, while 73 percent said they didn't." In other words, about three of four women in childbirth were not asked about the surgery they would soon face in an urgent situation. "Women often were told, 'I can get the baby out quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would you like an episiotomy?'"

What to do instead

Communicate. The time to prevent an unnecessary episiotomy is well before labor, experts agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And when you get pregnant, have your preference to avoid the surgery written on your chart.

Get ready with Kegels. Working with a nurse or midwife may reduce the chance of such surgery, experts say; she can teach Kegel exercises for stronger vaginal muscles, or perform perineal and pelvic-floor massage before and during labor. Health.com: Me and my Kegels

Statement from ICAN Regarding the Deaths of Two New Jersey Women

The women of the International Cesarean Awareness Network offer their deepest sympathies to the families of Melissa Farah and Valerie Scythes, two New Jersey women who died after undergoing cesarean surgery.* This tragedy affects not just these new families; it is a tremendous loss to the community.

While any birth poses small but measurable risks to mothers and babies, it is well-established that cesareans increase the risk of a mother dying by 3-4 times. Common causes of maternal death by cesarean include: hemorrhage, infection, post-operative blood clots, and adverse reactions to anesthesia.

The World Health Organization states that a cesarean rate of above 10-15% cannot be justified and rates higher than that pose a health risk to mothers and babies. In the United States, the cesarean rate is 30.2% and in New Jersey it is 37%, the highest in the country. These rates suggest gross overuse of the surgery. Medically valid reasons for a cesarean section include:

• Complete placenta previa at term
• Transverse lie at time of labor
• Prolapsed cord
• Abrupted placenta
• Eclampsia or severe preeclampsia with failed induction of labor
• Large uterine tumor which blocks the cervix
• True fetal distress confirmed with a fetal scalp sampling or biophysical profile
• True cephalopelvic disproportion
• Initial outbreak of active herpes at the onset of labor
• Uterine rupture
• Failed induction with fetal distress

Women who are advised cesarean sections because of the following reasons should explore all their options since medical opinions differ in these areas:

• Macrosomia (large baby)
• Maternal age
• Assisted reproductive technology
• Cephalopelvic disproportion (CPD)
• Dystocia • Failure to progress
• Breech
• Fetal distress
• Prolonged pushing stage

When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. When the surgery is overused without sound medical justification, however, it puts mothers and babies in harms way. Because of the increased risk associated with surgical delivery, ICAN works to reduce the number of cesareans that are medically unnecessary. Women can help reduce their risk of a cesarean section by following these tips:

• Choose a care provider with a low cesarean rate. Midwives can safely care for healthy low-risk women and have very low cesarean rates.

• Educate yourself on your birth options and your rights

• Hire a doula or labor assistant

• Avoid induction except for clear medical reasons

• Avoid common medical procedures which increase your chance of a cesarean

• Ask questions and explore all your options if you're told you need a cesarean because your baby is too big, you've gone "overdue," or your labor is moving slowly.

Ingesting placenta could mitigate Postpartum Depression

Pregnancy & Childbirth | USA Today Examines Practice of Ingesting Placenta To Mitigate Postpartum Depression
[Jul 20, 2007]

USA Today on Thursday examined the practice known as placentophagy, in which the placenta of a pregnant woman is saved, dried and emulsified, then placed in gelatin capsules and taken by the mother in the months after childbirth. Hospitals usually store placentas for a few days to allow for testing if there is a postpregnancy complication but then destroy them, according to USA Today. Some hospitals regard placentas as "hazardous medical waste" and are reluctant to let women keep them, while other hospitals allow women to keep the organ, USA Today reports.

According to USA Today, the practice of ingesting placenta "is far from widespread" and has been received with "great skepticism by more traditional medical experts." However, a "small but vocal contingent" of pregnant women and advocates "strongly" believe that the placenta is "rich in chemicals that can help mitigate fluctuations in hormones believed to cause postpartum depression," USA Today reports.

"I feel that it is what we as women are meant to do with the placenta," Jodi Selander -- who provides the encapsulation service at no cost to clients and is collecting testimonials of women who have ingested placenta for her Web site placentabenefits.info -- said, adding that other mammals eat their placentas. Mark Kristal -- a professor at State University of New York-Buffalo, who focused his 1971 doctoral dissertation on why animals eat their placentas -- said, "People can believe what they want, but there's no research to substantiate claims of human benefit." He added, "The cooking process will destroy all the protein and the hormones. ... Drying it out or freezing it would destroy other things."

Selander said she has sought FDA guidance but received no clear answers. FDA spokesperson Kris Mejia said the agency considers some statements on Selander's Web site to be unsubstantiated medical claims and will be reviewing the matter. "Human placental capsules that make treatment claims ... must be accompanied by well-designed and controlled clinical studies to support approval/licensure," Mejia wrote in an e-mail (Friess, USA Today, 7/19).

An article I wrote for an Indian website

I wrote this article about preparing for childbirth and the services I offer.

Some interesting parenting and birthing news

I recently came across two stories that might be of interest. The first is a study out of Wake Forest University that confirms the idea that toddlers learn language from people, not television. For more, click here.

The second is a firsthand account of the first hospital waterbirth in the Philippines. here it is:

Dear Everyone :)

Hello. This is my Waterbirthing Experience. I'm not a very good writer but I hope that I'm able to share my wonderful experience and I hope this will inspire other women to experience waterbirth - that there is another natural way of giving birth.

A lot of my friends and relatives have asked me why I opt to choose waterbirth. And I always answered them that "the water called on me." It's very difficult to explain this feeling. But ever since I got pregnant, I knew that I would be able to successfully give birth through the water. While some women chose waterbirth as pain relief or for gentle birthing. For me, there is this sense of inner of calling. I simply wanted to experience birthing without violence. That's why I prepared a lot for this birth during the whole duration of this pregnancy. I read books, I researched, I psyched myself, I exercised, I had acupuncture sessions… Psychological, physical, spiritual, emotional… etc.

While I gave birth to my daughter, 300,000 women all over the world are also experiencing the same thing. I might just be one of these women who chose to give birth through the use of water. Isn't this a great accomplishment?

Thank you for reading My Waterbirth Experience.

By the way, I saw the news and they said that this is the first ever recorded hospital waterbirth in the Philippines.

Cheers to all the mothers and the soon-to-be-mothers and of course the fathers!!!

Take care,
Velvet, Jonathan Adam, Jehielle and Voegelle Roxas