Blog

http://www.webmd.com/heart/metabolic-syndrome/news/20091203/breastfeeding-may-reduce-diabetes-risk

We already knew that breastfeeding is great for the baby.  Emerging studies have shown how great it could be for the mother as well. In a study conducted by researchers with Kaiser Permanente, they discovered that breast feeding significantly lowers the women’s risk for developing metabolic syndrome. What is metabolic syndrome? Metabolic syndrome is a name for a group of symptoms that occur together and promote the development of coronary artery disease, stroke, and type 2 diabetes. So a little bit of statistics, this research is done well and is very comprehensive.  The researchers followed 704 women for a period of two decades (20 years!) starting before their first pregnancy. Because the women were enrolled in a larger heart disease risk study, the researchers had information on wide range of health and lifestyle factors. At the start of the study none of the women had metabolic syndrome, but 120 developed the condition during the follow-up. Additionally breastfeeding for a period of 9 months or longer is associated with a 56% decrease in risk of developing metabolic syndrome. In women who developed gestational diabetes during one or more pregnancies, the risk reduction was 86%. Gestational diabetes is a major predictor of type 2 diabetes. Women who develop diabetes during pregnancy have a fourfold greater risk for developing type 2 diabetes. Now looking at the study it seems very solid.  Again this another reason to breastfeed, on top of the many reasons that are already given.  

Link to Primary researcher’s home page: http://www.dor.kaiser.org/external/investigators_gunderson_e.aspx - Erica P. Gunderson, PhD

The Milk Study: Using Breast Milk to Screen for Breast Cancer and Assess Breast-Cancer Risk

For those of you who are interested in participating:

http://www.armyofwomen.org/current/view?grant_id=375

Study Summary The purpose of this study is to determine if breast cancer and breast cancer risk can be accurately assessed from a breast milk sample. Currently, there is no accurate way to give women information about their personal risk of developing breast cancer. We will use the cells naturally present in breast milk to examine changes in DNA that occur in association with benign and cancerous breast lesions. Learning about the genetic changes associated with both breast cancer and non-cancerous breast lesions will help us develop a way to provide women with information about their breast cancer risk. Using breast milk to screen for breast cancer will reduce unnecessary biopsies among nursing women.

Who Can Participate? You can join the Milk Study if you are:

• Currently NURSING/BREAST-FEEDING a baby

AND

• You are either GOING TO HAVE A BREAST BIOPSY in the near future or you HAVE HAD A BREAST BIOPSY in the past.

What Does Participation Involve? You will be shipped a milk collection container, informed consent form, and questionnaire. You will be asked to complete the consent form and questionnaire and to donate about 2.5 ounces of fresh breast milk from each breast. You will put the consent form, questionnaire, and breast milk in a box that will be picked up by Fed-Ex. You will be asked to provide a copy of the biopsy report. Approximately 1 year after sending your breast milk sample, the researcher will contact you to ask about any breast problems you have had in the last year.

Where? Anywhere in the United States

My two cents:

Now here’s an interesting concept. There are certain tissues in the breast that may help stratify women into different risk groups. The ideas is this, there are breast lobules in the breast that are the anatomic origins of breast cancer.  As women age, these lobules should shrink which usually results in reduced breast cancer risk.  However this does not happen in all women. So this information may help in being another tool for the physician to predict the patient’s risk.

More helpful links:

http://www.mayoclinic.org/news2009-rst/5445.html - very helpful article because it explains this idea a little bit more in layman’s terms.

http://www.ncbi.nlm.nih.gov/pubmed/19805686?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2

This is for those of us who like to read a scientific journal publications. This is the same journal paper that is mentioned in the article above. The study shows that acini (AS-ih-nye), the small milk-producing elements in breast lobules, can be counted in sample biopsies. The percentage of acini present per lobule at a given age indicates cancer risk.

http://cbs3.com/health/Breast.Cancer.Predicting.2.1084094.html - This articles mentions the HALO Breast Pap Test.

Check out these articles!

http://news.medill.northwestern.edu/chicago/news.aspx?id=150699

http://www.timesleader.com/features/Profession_delivers_12-01-2009.html

When thinking about your birth, finding the right providers matter. After all you want the best for both you and your baby. And no one knows your body better than yourself, so giving birth should be an empowering process that allows you to feel great about yourself.

Consider the Midwife.  They are not backwoods women who deliver babies under a shack. It can be quite the opposite, Ruerup is a certified nurse midwife.  She can prescribe medicine, deliver babies and administer gynecological care. She believes in choice, information and female empowerment and promotes her profession as a way to achieve all three. Clients love the personal care that midwives provide. Obstetricians were trained to treat, whereas midwives are trained to support. The midwifery model is about a partnership, rather than a hierarchy, it is about empowering the clients through information and talking about many options. They are “high touch and low tech” which means practicing the art of knowing, meaning knowing when to do something and when to allow it to take its natural course. A midwife can provide care and understanding that is very supportive and empowering for the mother.  What types of people seek a midwife?  Well, some people desire a partnership.  Some people believe in the holistic and organic care. And still some women want more control over their pregnancy.  Every preganacy is unique, and there is no right way to give birth.  

To find out more about potential providers check out the provider guide on the website!

Use imagery and meditation to help alleviate pain. According to several studies, it is very possible to use positive mental images to ease pain.

Current study #1, “Cerebral and spinal modulation of pain by emotions,” published in Proceedings of National Academy of Sciences (PNAS) was authored by Mathieu Roy, Mathieu Piché, Jen Chen, Isabelle Peretz and Pierre Rainville of the Université de Montréal. "Emotions -- or mood -- can alter how we react to pain since they're interlinked," the lead author of the study, Mathieu Roy, said in a news release. "Non-pharmaceutical interventions -- mood enhancers such as photography or music -- could be used in healthcare to help alleviate pain. These interventions would be inexpensive and adaptable to several fields."  Essentially, pain could be amplified if combined with negative imagery; conversely, pain could be diminished if combined with positive imagery.

Current study #2, “The Effects of Brief Mindfulness Meditation Training on Experimentally Induced Pain” is an article by UNC Charlotte psychologists Fadel Zeidan, Nakia S. Gordon, Junaid Merchant and Paula Goolkasian, in the current issue of The Journal of Pain. What does the article say?  Even with shorter sessions of meditations (about 20 minutes each) and over a short number of days (3 days) it is possible to achieve a significant result of diminished pain sensitivity.

So what do the above studies have to do with mother-friendly childbirth?  For many years mothers-to-be have used the idea of meditation and imagery to help prepare the body and mind for childbirth. Meditation helps the body relax.  Relaxation is one of the best technique to pain relief.  Being able to concentrate on positive imagery will not only help with pain management but also help with the labor. For a laboring mother, to understand and know what her body is doing will help speed up the labor. Meditation could be sitting in a quite room with peaceful thoughts, listening to soothing music, doing yoga, or practicing Pranayama breathing (the art of breathing control).  So really, pain control through the use of medical interventions should not be overused.  Rather, there are many healthier, natural methods to deal with pain during labor.

Below are the links to the scientific papers:

Cerebral and spinal modulation of pain by emotions

The Effects of Brief Mindfulness Meditation Training on Experimentally Induced Pain

Mother-friendly AND Baby-friendly practices are often times forgotten in current healthcare settings.  In one of my Women’s Studies classes, I learned about ‘Medicalization of Pregnancy and Childbirth’. What exactly am I talking about? It means taking normal natural occurrence of pregnancy and childbirth, then turning it into a disease of needing hospital attention.  From recent years, babies are born to mothers under the careful watch of doctors, attached to monitors, given drugs, and given episiotomies.

In previous times, from literally cavemen days, women have been giving birth without medical inventions for a very long time. Whatever happened to the dignified and empowered births? Women are not given control of their own bodies and health in the hospital settings. For example, standing or squatting uses gravity in the birthing process. However, the tradition birthing position has been the woman lying down with her feet in the air, and often times behind curtains.  All that is seen is the vagina, instead of the entire women.  When given the chance (according to many different studies and my mother, aunts, and grandmothers) women would rather move, walk, bend or bathe during the birthing process.

So what do I believe? I understand that medical interventions have saved the lives of both mothers and babies.  I am advocating for decreased reckless use of unnecessary medical interventions. Not every mother needs an episiotomy or an epidural (in fact there is much literature cautioning in the overuse of those two procedures).  The happy median must be discovered, childbirth should be an empowering experience for women. Yes, its difficult and often times painful.  But you, as a woman, can give birth.  And your body is designed for it.

Sept. 22, 2009

Dear Producers of The Today Show,

The Coalition for Improving Maternity Services (CIMS) and the undersigned organizations are disappointed with The Today Show’s misrepresentation of midwives and home birth that aired on Sept. 11, in a segment titled “The Perils of Midwifery,” later changed to “The Perils of Home Birth.” This biased and sensational segment inaccurately implied that hospitals are the safest place to give birth even for low-risk women and mischaracterized women who choose a home birth with a midwife as "hedonistic," going so far as to suggest that these women are putting their birth experiences above the safety of their babies. Neither could be further from the truth.

Unfortunately, The Today Show did not do its homework on the evidence regarding the safety of home birth and midwifery care. The segment featured an obstetrician who presented only the American College of Obstetricians and Gynecologists’ (ACOG) position in opposition to home birth, but it did not make any attempt to present the different viewpoints held by the many organizations that are committed to improving the quality of maternity care in the US. We are deeply saddened that the show did not take the opportunity to note that both CIMS and The National Perinatal Association respect the rights of women to choose home births and midwifery care, and that the respected Cochrane Collaboration recommends midwifery care because it results in excellent outcomes.

There is no evidence to support the ACOG position that hospital birth for low-risk women is safer than giving birth with midwives at home. What the research does show is that the routine use of medical interventions in childbirth without medical necessity can cause more harm than good, while also inflating the cost of childbirth. However, the current health system design offers little incentive for physicians and hospitals to improve access to maternity care practices that have been proven to maximize maternal and infant health.

“Birth is safest when midwives and doctors work together respectfully, communicate well, and when a transfer from home to hospital is needed, it is appropriately handled,” says Ruth Wilf, CNM, PhD, a member of the CIMS Leadership Team.

That is why the national health services of countries such as Britain, Ireland, Canada, and the Netherlands support home birth. In those countries, midwives are respected and integrated into the maternity care system. They work collaboratively with physicians in or out of the hospital, and they are not the target of modern day witch hunts. These countries have better outcomes for mothers and babies than the US.

Childbirth is the leading reason for admission to US hospitals, and hospitalization is the most costly health care component. Combined hospital charges for birthing women and newborns ($75,187,000,000 in 2004) far exceed charges for any other condition. In 2004, fully 27% of hospital charges to Medicaid and 16% of charges to private insurance were for birthing women and newborns, the most expensive conditions for both payers. The burden on public budgets, taxpayers and employers is considerable.

As US birth outcomes continue to worsen, it should come as no surprise to The Today Show that childbearing women are seeking alternatives to standard maternity care. After all, American women and babies are paying the highest price of all—their health—for these unnecessary interventions, which include increasing rates of elective inductions of labor and cesarean sections without medical indication.

To the detriment of childbearing families, the segment “The Perils of Midwifery” totally disregarded the evidence. Although the reporters acknowledged that research shows home birth for low-risk women is safe, that message was overshadowed by many negative messages, leaving viewers with a biased perception of midwifery care and home birth. CIMS makes these points not to promote the interests of any particular profession, but rather to raise a strong voice in support of maternity care practices that promote the health and well-being of mothers and babies.

One of the ten Institute of Medicine recommendations for improving health care is to provide consumers with evidence-based information in order to help them make informed decisions. The Institute recommends that decisions be made by consumers, not solely by health care providers. The Institute maintains that transparency and true choice are essential to improving health care. We remain hopeful that the medical community will soon recognize the rights of childbearing women when it comes to their choices in childbirth and will respect and support these choices in the interest of the best possible continuity and coordination of care for all.

We urge The Today Show to provide childbearing women with fair and accurate coverage of this important issue by giving equal time to midwives, public health professionals, researchers of evidence- based maternity care, and especially to parents who have made choices about different models of care and places of birth.

Sincerely,
Coalition for Improving Maternity Services
Academy of Certified Birth Educators
Alaska Birth Network
Alaska Family Health and Birth Center
American Association of Birth Centers
American College of Community Midwives
American College of Nurse-Midwives
Bay Area Birth Information
Birth Network of Santa Cruz County
Birth Works International
Birthing From Within, LLC
BirthNet
BirthNetwork National
BirthNetwork of Idaho Falls
BirthNetwork of NW Arkansas
Choices in Childbirth
Citizens for Midwifery
DONA International
Doulas Association of Southern California
Evansville BirthNetwork
Harmony Birth & Family
Idaho Midwifery Council
Idahoans for Midwives
InJoy Birth and Parenting Education
International Childbirth Education Association
International MotherBaby Childbirth Organization
Lamaze International
Madison Birth Center
Midwives Alliance of North America
Motherbaby International Film Festival
Nashville BirthNetwork
National Association of Certified Professional Midwives
North American Registry of Midwives
Oklahoma BirthNetwork
Perinatal Education Associates, Inc.
Reading Birth & Women's Center
Rochester Area Birth Network
Sage Femme
The Big Push for Midwives Campaign
The Tatia Oden French Memorial Foundation
Triangle Birth Network
Truckee Meadows BirthNetwork

About Us
The Coalition for Improving Maternity Services (CIMS) is a coalition of individuals and national organizations with concern for the care and wellbeing of mothers, babies, and families. Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs. The CIMS Mother-Friendly Childbirth Initiative is an evidence-based mother-, baby-, and family- friendly model of care which focuses on prevention and wellness as the alternatives to high-cost screening, diagnosis, and treatment programs.

References:
1. The Perils of Home Births, http://www.msnbc.msn.com/id/21134540/vp/32795933#32795933
2. Birth Can Safely Take Place at Home and in Birthing Centers,
http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2409129&blobtype=pdf
3. Offers All Birthing Mothers Unrestricted Access to Birth Companions, Labor Support, Professional Midwifery Care, http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=2409134&blobtype=pdf
4. ACOG Place of Birth Policies Limit Women's Choices Without Justification and Contrary to the Evidence, http://childbirthconnection.com/article.aspClickedLink=790&ck=10465&area=27
5. Ratifiers and Endorsers of The Mother-Friendly Childbirth Initiative,
http://www.motherfriendly.org/ratifiers.php
6. Choice of Birth Setting, http://www.nationalperinatal.org/advocacy/pdf/Choice-of-Birth-Setting.pdf
7. Position Statement on Midwifery, http://www.nationalperinatal.org/advocacy/pdf/Midwifery.pdf
8. Midwife-led versus other models of care for childbearing women,
http://cochrane.org/reviews/en/ab004667.html
9. Evidence-Based Maternity Care: What It Is And What It Can Achieve,
http://childbirthconnection.com/pdfs/evidence-based-maternity-care.pdf
10. Lamaze Healthy Birth Practices,
http://www.lamaze.org/ChildbirthProfessionals/ResourcesforProfessionals/CarePracticePapers/tabid/90/Default.aspx
11. Millennium Development Goals Indicators, United Nations, http://mdgs.un.org/unsd/mdg/Data.aspx
12. National Vital Statistics System, Birth Data, http://www.cdc.gov/nchs/births.htm
13. Induction By Request, http://www.marchofdimes.com/prematurity/21239_20203.asp
14. Cesarean Birth By Request, http://www.marchofdimes.com/prematurity/21239_19673.asp
15. Crossing the Quality Chasm: A New Health System for the 21st Century,
http://www.iom.edu/CMS/8089/5432.aspx
16. The Mother-Friendly Childbirth Initiative, http://www.motherfriendly.org/mfci.php

Coalition for Improving Maternity Services
1500 Sunday Drive, Suite 102
Raleigh, NC 27607

Tel: 919-863-9482
Fax: 919-787-4916

www.MotherFriendly.org

Making Mother-Friendly Care A Reality
CIMS is a not-for-profit organization recognized as tax-exempt under Internal Revenue Code section 501(c)(3). Our mission is to promote a wellness model of maternity care that will improve birth outcomes and substantially reduce costs.

The protesters made their way down Gregg Street to the hospital, holding signs up for passersby to see. "Our whole mission for being here today is just to try to raise some noise to increase the public awareness of it," said Sara Milford, a mother of four and co-leader for the Birth Network of Northwest Arkansas. "I'm trying to get the hospitals to open their eyes and understand that these bans are forcing women not only to do things they don't want to do but it's also creating a more unsafe situation," said Elizabeth Day, co-leader for the Birth Network of Northwest Arkansas. Washington Regional, Northwest Health System and Mercy Health System all do not offer VBACs.

In a joint statement, the hospitals said: "Each of our hospitals is committed to the provision of safe obstetrical care. It is our collective view that safe obstetrical care in our communities is furthered by not offering VBACs as a service in our hospitals...

http://nwahomepage.com/content/fulltext_news?cid=82852&shr=addthis

Though hospital births have become the norm since the 1950s, approximately 1.4 percent of Wisconsin babies are born at home, a percentage that is double the national average.

But why is the number still so low, compared for instance with Netherlanders, who opt to give birth at home 30 percent of the time? It isn’t because it is any less safe. In fact, Paula notes that a 2003 study by the New England Journal of Medicine found that, for low-risk women, homebirth with a qualified attendant is safe, or safer than, hospital birth.

Paula’s philosophy is that a woman will birth best where she feels most comfortable and safe. For some women, that place is home. “A woman will be “imprinted by … what she’s led to believe about her body and her innate capabilities,” Paula says. “Giving birth is the quintessential feminine act. It pays to find a midwife who will celebrate and respect that from start to finish.”

http://volumeone.org/magazine/articles/511/No_Place_Like_Home.html/page/1

Repeat C-sections Climb by More Than 40 Percent in 10 Years
By Agency for Healthcare Research and Quality
Apr 15, 2009

(HealthNewsDigest.com) - The percentage of pregnant women undergoing a repeat Cesarean section (C-section) delivery jumped from 65 percent to 90 percent between 1997 and 2006, according to the latest News and Numbers from the Agency for Healthcare Research and Quality.

http://www.healthnewsdigest.com/news/Research_270/Repeat_C-sections_Climb_by_More_than_40_Percent_in_10_Years.shtml

A decade ago, surgical delivery mainly was reserved for emergency situations, such as when mothers had high blood pressure or were failing to progress in labor or the baby showed signs of distress. Today, several factors are leading to the rapid rise in C-sections, even though having one carries with it a longer hospital stay, longer recovery time and the risk of complications from anesthesia. Those factors include changing attitudes toward childbirth, the convenience of a scheduled birth for busy women, and malpractice concerns by doctors and insurance companies.

Dr. Bruce L. Flamm, an obstetrician with Kaiser Permanente in Riverside, Calif., and a spokesman for the American College of Obstetricians and Gynecologists (ACOG), says the biggest reason for the rise is a change in thinking about repeat C-sections. A decade ago, mothers who had had a previous C-section were encouraged to try to deliver vaginally in subsequent pregnancies to avoid surgery and its accompanying high cost...

http://washingtontimes.com/news/2009/apr/15/birth-by-appointment/