Sunday, February 20, 2011

The Medicalization of A Normal Process

If a woman wants to enjoy a natural, no-interventions childbirth, she should "stay the hell out of a hospital..." These are the words of an MD in The Business of Being Born, a documentary on childbirth.  That's not to say that a woman cannot have a natural, intervention-free childbirth in a hospital, but rather, the odds are stacked against her. A hospital is a business, where they make more money with the more interventions performed (hep-lock, IV's, meds, c-sections, betadine, anaesthesiologist, catheters, episiotomies, circumcisions, antibiotic eye ointment, vitamin K injections, etc.). An OBGYN is a trained surgeon who is excellent in spotting (and often misspotting) problems; one who is usually very quick to hand out medication and perform unnecessary procedures. That isn't to say that a woman should stay out of a hospital, but rather she should understand her options and her rights. She should be treated normally and respectfully by her birth attendants.

America has one of the highest neonatal mortality rates in the entire world (some reports say it's the SECOND highest). All major health organizations say that a C-section rate for a country should be under 5-10%, but America's C-section rate was 32.3% in 2008 (and it's forecasted to be higher now. Look at some of the hospitals in California, for example. Hoag, a major hospital in Newport Beach, CA, was at 37% in 2008!). Why is this? We think of ourselves as "advanced," and yet have some pretty abysmal statistics.

It is the wish of many people that American doctors can lower their unnecessary C-section rates and birth interventions, and encourage women to embrace the wonderful, natural miracle they are performing.

The following article is from The Journal of Perinatal Education.

An excerpt of “Reality” Birth: Marketing Fear to Childbearing Women
Judith A. Lothian, RN, PhD, LCCE, FACCE and Ann Grauer, LCCE, CD(DONA), CIMI
Ann Grauer's Answer


As a childbirth educator and doula, I had hoped that television shows like The Learning Channel's (TLC's) “Birth Story” and Discovery Channel's “Birth Day” would help dispel some of the medical mystique that seems to surround birth in our culture. Rather than help women view birth as the normal life event that it is, to my horror, “reality” shows have made birth appear more medical than ever.

Rather than help women view birth as the normal life event that it is, to my horror, “reality” shows have made birth appear more medical than ever.

While “Birth Story” and “Birth Day” have managed to cause enough concern among expectant parents, they pale in comparison to the real terror offered in each episode of TLC's “Maternity Ward.” This show can single-handedly convince most women that their bodies are incapable of birthing without major medical intervention and that they would be crazy not to want all the technology they can get their hands on. After all, their babies' lives—and possibly their very own—depend on it.

Occasionally, I force myself to sit through an episode of “Maternity Ward.” What do I see? The cameras follow residents and attending obstetricians at high-risk medical centers around the US. The stories are told from the point of view of care providers who are overworked and frazzled. The show is not about women and families; rather, it's about the people providing medical care.

In “Maternity Ward,” no laboring women are depicted out of bed. Whether they are in early labor or pushing, they are flat on their backs. Machinery is everywhere. Blood pressure cuffs are on; electronic fetal monitors are strapped onto bellies. Legs are draped, and support people are off to the side. Heart-racing music plays whenever something “dramatic” happens. The mothers look terrified. I don't blame them. Within five minutes of watching the show, I am terrified for them.

As the doctors move from room to room, viewers meet mothers and hear a little of their medical stories (almost all are considered “high risk” by their health care providers). In the first room, for example, viewers meet a woman who has developed gestational diabetes. She's near her due date, so her doctor opts to induce labor, even though the mother's cervix is not ready. Will she make it through the labor? Will her baby be okay? Viewers will find out … after a commercial break. Almost four ads later, viewers witness the result: a 72-hour labor and a doctor who worries aloud whether or not the baby will be too tuckered and a cesarean section will be necessary. But, viewers won't know for now. It's time for another commercial break. When the show returns, the baby lucks out and only needs forceps due to his mother's exhaustion. That was a close one!

The cameras move on to the next room where a woman is in the midst of a precipitous birth.   As she pushes out her baby, the chaos around her is mind-boggling. The baby's head pops out (the woman's perineum is covered by a “fuzzy” lens) and, then, the shoulders don't come. And they still don't come. And the resident panics. This could be life threatening for the baby. And now, viewers must leave the scene for (you guessed it!) a commercial. A few minutes later, viewers are back with the mother again. With the use of superpubic pressure, the baby manages to come out and all is right with the world. Talk about your scary births! The doctor is proud that he delivered the 10 lb, 8 oz baby boy. The focus is on the doctor, not the mother.

In the show “Maternity Ward,” even women who are not high risk when they walk in the door are treated as if they are. A baby who has a fairly normal birth is whisked to the NICU because he isn't breathing as well as the medical staff would like him to be immediately after birth. They are certain he is septic. Four days later, this healthy newborn is released to go home after his tests indicate that he is perfectly fine. The resident who delivered the baby says, “I'm celebrating. Thank goodness we had a NICU here to make the right diagnosis.” Thank goodness, indeed.

Every episode in “Maternity Ward” dishes up things that make my skin crawl. Babies are always held up in the air for their mothers to admire (one even held upside down by his heels). Rarely do newborns make it to their mother's chest or arms. Partners are relegated to the corners of the room and don't seem to be able to offer the women much help. Babies are placed in warmers, even after being declared “healthy.” Moms look undone. The message is clear: This business of birthing is so dangerous that, even if you and your baby are healthy, it could change on a dime and you, too, would be in need of the most urgent medical care. Just to be safe, you'd better “deliver” where there are lots of doctors and machines and a NICU. You don't want to risk your baby's life or your own.

In Monty Python's 1983 movie, The Meaning of Life, there is a segment titled “The Miracle of Birth.” This piece offers a satirical commentary on the status of birth in the developed world. Machines that go “Ping!” are everywhere. Babies are numbered and isolated. The mother in the film asks, “What should I do?” and receives the ultimate answer from her doctor, “Nothing, dear. You're not qualified.” When I watch “Maternity Ward” I realize that “The Miracle of Birth” comes dangerously close to reality.

I can be a tiny beacon of light for normal birth.

This is one childbirth educator who isn't giving in. I talk about evidence-based practice and teach women how to get the information they need to make informed choices. I show normal births on video, and I continue to insist that they know how to do this thing called birthing. While every other person in their lives relates how scary and dangerous labor and birth can be, I smile and say that birth is “doable.” I can't make people believe me, and I can't force them to stop watching “Maternity Ward,” but I can be a tiny beacon of light for normal birth. If I am the only person who ever tells them that they are capable of giving birth, then so be it! At least they will have heard it from one person. And the best part is that I know many more childbirth educators are out there and are just like me. We'll find each other if we just keep our beacons shining. And when we do, the light will be blinding!

Women need to hear the story of normal birth.

Judith Lothian's Commentary

When I first started teaching childbirth education, women's fears were of the unknown. Providing knowledge about the process of birth and how to deal with pain fairly successfully moved women beyond their fears. Today, as Ann describes, women's fears are firmly embedded in the “known.” Unfortunately, what women “know” is medical birth, not normal birth. And all they know of birth, until they meet Ann (and you) in childbirth class, is usually from “reality” birth television and from the plethora of inaccurate and fear-producing childbirth books and magazines that many women devour. The message—pregnancy and birth are high-risk events fraught with the possibility of things going terribly wrong, even for healthy, low-risk women—is tightly woven through every aspect of our current culture.

 
If we are to change the culture of fear, we need to face the issue of fear head on. Like Ann, we need to speak with a strong voice, totally confident, telling a very different story. Women need to hear the story of normal birth. They need to know that normal, not medical birth, is the safest way to give birth. They need to know that normal birth is healthier for mother and baby. And they need to know that normal birth is “doable.” We need to convince with evidence-based knowledge and with our passion. We need to find ways to replace fear with trust in birth and with confidence in women's ability to birth their babies.

I used to wonder why more women in the United States do not have faith in their ability to give birth. Now I've changed my stance—I wonder how it is that women in the US manage to give birth in spite of all the hurdles placed in front of them. I call it the Maternity Ward-ization of Birth.

Wednesday, February 9, 2011

New Heart Disease Research for American Heart Month

February is American Heart Month.  Here are a few new nutritional studies relating to heart disease.

Processed Foods

The EPIC (European Prospective Investigation into Cancer and Nutrition) study recently published in the Archives of Internal Medicine demonstrate that changes in diet could lower the risk of a heart attack by 81% through inflammation reduction and lowering blood pressure. There are four dietary factors the study highlights in causing heart disease:

1.  Refined carbohydrates, grains and sugar
2.  Excess Omega-6 vegetable oils
3.  Omega-3 fat deficiency
4.  Oxidative stress

Because eating processed foods packed with sugar, refined carbohydrates and hydrogenated fats lead to a continual state of inflammation throughout our body, eliminating (or drastically reducing) processed foods can have a positive impact on heart health.

Olive Oil and Leafy Greens

Dr. Domenico Palli from the Cancer Research and Prevention Institute in Florence and his colleagues discovered that women who eat at least one serving of leafy greens a day are 46 percent less likely to develop heart disease than women who eat less. And those who consume at least three tablespoons of olive oil a day earn roughly the same benefit.

Tomatoes
 

Of course, populations that consume diets high in fruits, vegetables, and whole grains are known to have a lower risk of heart disease. 

Research published in the journal Molecular Nutrition & Food Research explains the importance of including tomatoes to prevent heart disease. It explains that tomatos "enhance fatty acid oxidation while regulating the release of metabolized fats from the liver. By directly influencing blood lipids already in circulation as well as during hepatic development, 9-oxo-ODA from tomatoes can halt vascular disease in its tracks."


Diet Soda

Diet soda drinkers have an increased risk of having a heart attack and stroke than those who do not drink any soda, Agence France-Presse reported.

A study looking at 2,564 people in New York City found that those who drank diet soda every day had a 61 percent higher risk of “vascular events” than those who did not drink any soda at all.

Sleep

Getting too little or too much sleep can increase the risk of having a heart attack or stroke, according to research published in the European Heart Journal.

"Having too little sleep, typically defined as fewer than five-to-six hours sleep a night and sleep that is interrupted, was associated with a 48% increased risk of developing or dying from heart disease as well as a 15% increased risk of developing or dying from a stroke. On the other hand, sleeping too long – more than eight to nine hours per night – was associated with a 38% increased risk of developing heart disease, a 65% increased risk of having a stroke, and a 41% increased risk of developing diseased blood vessels."  (http://www.insidermedicine.ca/)

Veganism

A recent paper from Zhejiang University in Hangzhou, China looked at several factors in plant-based diets that affect heart disease. The paper stated that vegans have a “generally low risk of cardiovascular disease" as long as vitamin B12 and omega 3 fat intakes are adequate. 

Research shows that those who shun all animal products are likely to have lower blood cholesterol levels and less hypertension. Vegan diets are also higher in phytochemicals and nutrients that may reduce heart disease risk.