The 1% Doctrine

I'm sure you've heard of Dick Cheney and his quote:
"if there is a 1% chance of a terrorist act occurring, we must treat that threat as if it were a certainty"
Ron Suskind wrote his book The 1% Doctrine about this and I just watched a great video that tied the 1% doctrine to the maternity system in the US today.

Eugene R Declercq,PhD, Professor of Maternal and Child Health at Boston University School of Public Health says in his video Birth by the Numbers of the 1% doctrine:
"this is the perfect description of the philosophy of contemporary maternity care. When you set up a system that focuses on the 1% of problems that might occur, you undermine the care of the 99% of the mothers who don't need those services."

I could not think of a better way to put it. You should watch the video, he breaks down the statistics in to easy to understand and plain terms. I find at times it is hard to take solid information away from personal stories. The stats get lost in the fluffiness or gore of the story.
It is all to easy to sit back after reading a birth story or watching a movie about birth and think "that madness will not happen at the birth of my child" or "well, at home may have been great for them, but what if..." Then you go about your day and do no research, no more critical thinking about system of maternity care in this country or of the birth options you may have (or why you don't have options).
This video was easy to follow, not to long and left me thinking about what I can do to help facilitate change. I have already changed the way I think about birthing and prenatal care, but what can I do to help families make their own informed choices? What can I do to help bring these choices to families covered by medicaid, like me? How can I help change the system so that Medicaid covers out of hospital births and gives these families actual choices?

Going back to Birth by the Numbers, the stats he speaks of are for birth rates, maternal and perinatal death, cesarean section rates but left me thinking of prenatal testing as well.

I never once asked why, when presented with a prenatal test when pregnant with Nico nor were the tests presented as a choice. I don't think that my situation with the Nurse Midwifery group is/was unique.
Let's take the first ultrasound (u/s) I had.
I think it was at our first prenatal visit at about 7 weeks....medical history given, family situation discussed, the CNM busts out the "wheel" The wheel is a guide to finding an estimated due date based on a 28 day menstrual cycle. Find the first day of the last period and the wheel gives you the estimated 40 weeks later ie: estimated due date. What if your cycles are 25 days apart (as mine are) then the provider should be able (through experience) finesse the date to accommodate your individual cycle.
At the end of our visit the CNM said we should schedule an u/s to better calculate the due date, so we did. No questions, no reading, no thinking. Nico's due date was then set at August 4, it would change 2 or 3 more times before he was born, spontaneously on August 13.

More concerning to me is the second u/s to "check and see how things are" I should have asked, "what things?" Knowing what I know now, I would have asked "what could you find out that would change the course of my pregnancy?"
This is how I feel about prenatal testing: What could this test tell me that will change the pregnancy?
Will I abort the pregnancy if there are markers for Downs Syndrome?
Is there some operation that I or the baby will need within the first 5 minutes of birth to save a life?
Even if some potential abnormality is found is there anything that can/will be done?
Will the abnormality be "watched" with more u/s, cause me tremendous amounts of undue stress and resolve itself as the fetus grows? This happens alot and to people I love.

I have to think the providers must order all these "watch to see" u/s to cover them in case there is a congenital abnormality in the child, the parents get sad/pissed and sue the provider for not "monitoring the pregnancy" and warning the parents. In turn causing the malpractice insurance rate to increase dramatically and the providers to treat 99% of pregnancies as though the 1% of problems will occur.

I also would like to discuss screening for Strep B late in pregnancy. As I understand it, Strep B is form of bacteria that can naturally "colonize" (live in) the genital tract of women without causing symptoms or being harmful. These colonizations can fluctuate, at 36 weeks pregnant you could test positive and at 40 weeks negative. The bacteria can be passed to the newborn during birth or not.
So, why not screen during pregnancy?
If you are a Strep b carrier you will receive antibiotics via IV and your newborn will be given antibiotics and treated as a sick child, even if no symptoms are present.
Well, if it can stop a possible infection, why not?
So as to not give unnecessary antibiotics to a new born.

True, strep B can cause a fever in laboring women. So can an epidural. Either cause gets you and your newborn antibiotics.

If I go to my primary care provider's office with a runny nose, I do not automatically get an antibiotic nor do I want a provider that would give me one. Other causes are rooted out, allergies, common cold etc. and then the diagnosis is treated.

Why be so quick to give a newborn baby antibiotics?
If the newborn shows signs of infection, yes please treat with antibiotics.

This is our plan. If baby is showing signs of an infection, treat the infection. As our baby will be born at home, there is also no risk of this baby being infected by viral illnesses or bacteria that are prevalent in hospitals.
Don't think that since the birthing center is a separate wing that the support staff isn't all over the hospital before they are in your wing. There is no separate food staff, cleaning staff or lab techs for the birthing center at hospitals.

None of this was discussed by our CNM, it went something like this, "Do you want to screen for Step B this week?"
"What's that?" I ask.
"A bacteria that can live in or around your vagina and can cause and infection in your baby during birth. If you are negative, you won't need IV antibiotics during birth." says the CNM
"Okay" I say placing my feet in the stirrups, scooting my butt down to the edge of the paper covered table and opening my knees a little wider.

Please read, ask many questions and make informed choices, even if they aren't the same as my own. At least you will own those choices.

P.S. Our CPM's table doesn't have stirrups or paper.

ARRGH

I posted today. I started the post a long while ago and I cannot figure out how to change the publish date to today! So please scroll down for a prenatal visit post.
M

Weeks 8-14

Ahh, second trimester, how do I love you.
I have more energy. I am not so crabby. I still get nausea after supper, but not so bad. I can go a whole two hours now without eating, impressive I know.
I felt baby moving in the last week. At first it was hard to distinguish between the mad gas moving and fetus. Yesterday, no mistake, quickening. It is nice to have more than a tummy and nausea as physical proof of pregnancy. Even if it is only me who can feel it.

In other parts of our life.
Jesse was gone for two weeks on a gig. Two weeks is a long, long time for a three year old and his Mama. I am so very grateful to have family near. It wasn't as bad as I expected but I did yell more than I ever have in Nico's life. Disappointing, but a gal can only take so much.

Jesse got back last weekend and our town held Big Rig Day, a parking lot full of trucks, perfect.


Cherry Pickers, no problem. This is N's "serious worker face"

N's favorite breakfast treat, Ala Auntie, "Special Toast"
Toast, goat cheese (Goat Rising, delicious) with local Honey.

How much do I love that N asks for food like Goat Cheese and Kalamata Olives? Much to Jesse's dismay, he doesn't even like to smell olives.

Mmmm, special toast. I'm going to make some right now.

Out Rage.

I cannot wait to see this movie.

Prenatal visit

We had two prenatal visits with our midwife, she's a Certified Professional Midwife and just what we were looking for. She cares for the whole pregnant woman and her family. My emotional well being is asked about and discussed. Jesse and Nico's as well. She hugs. Our visits are about one hour. We are very comfortable and confident in her and her ability to support us through this process.
We have chosen to birth at home.
We did not come to this decision lightly, I don't believe the decision on where to birth should be a light one. We also don't feel that it was a tough choice.
I have read countless books and articles on birth, statistics, the medical model of prenatal care/birth and the midwifery model of prenatal care/birth.

I work within the medical community, I am fully aware of the life saving and quality of life increases that medical technology can provide.
I don't believe that in average, non complicated pregnancies the hospital with a surgeon* and inadequate nurse to patient ratio is the best option for most families.
I believe families/women have a right to an informed choice on were to birth & with whom.
I don't believe that pregnancy is a diagnosis or something to be remedied.
I believe that medical technology is amazing, if used appropriately.
I believe women have the right to informed consent in all areas of pregnancy and birth.
I believe that we are not all given informed consent in pregnancy/birth and are owed such.
I believe the system needs to change.
I believe in medical intervention only when necessary.
These are beliefs are mine and shared by others. What are your beliefs on birth?

When Nico was a year old I started to reflect on his birth. I soon realized that I had some unresolved feelings about what was done to me at the hospital, prenatally and why I wasn't given all the information I needed to make informed choices. Jesse and I talked frequently about our memories of the pregnancy, birth & day after. My sister started asking me some very thought provoking questions and I started reading.

We used Certified Nurse Midwives in an Ob group during my pregnancy with Nico. I feel that my first mistake was how I (I say "I" because I alone made this decision) choose them and the hospital. We (I say we because I believe these are "we" decisions and can lead to wonderful conversations with in a partnered relationship) did no research, didn't realize that we should. We did not interview the midwives, didn't realize we should. I just knew that family members birthed with them and retold pleasant experiences. They were a popular group. They were close to our home and the hospital. They were midwives.

I became disappointed in myself and the medical community. I had not educated myself well enough about the possible outcomes of prenatal testing and birth. Oh, I read books while pregnant with Nico, just not the right ones. I had digested the standard What to Expect and others, we knew the phases of birth, went to "birthing classes" (in quotes because looking back I learned nothing helpful, just hospital policy) we planned a natural birth,had a birth plan and had the baby stuff at home. **

I did not, however, read about the medications that could be offered to me while in labor, the prenatal testing or the amazing results of hospital births with the support of a doula. None of this was brought up in conversation by the CNM's we visited prenatally either. I wish we had hired a doula for Nico's birth, it would have been nice to have a supportive, knowledgeable support person for Jesse and me. I believe that had we hired a doula, I would have breastfed Nico earlier and had better immediate postnatal care.

All of the choices Jesse and I make now are informed and discussed. We are supported by our CPM, physically and emotionally. This is what I wish for all women. There is too much fear wound around pregnancy and birth in this country.
Fear of causing your fetus harm.
Fear of pain.
Fear of our bodies.
Our bodies are built for pregnancy and birth, really they are.

I would like to invite you to have a conversation with me, each other and strangers about birth and pregnancy. I have been wanting to start conversations with those in my family and friends, but have not due to fear. Fear of hurting feelings. Fear of how I might be perceived.
I vow to start these conversations. When I do, please know, I do not what to "convert you" to some home birth hippie. I only want to discuss your feelings, believes and thoughts, as well as mine. I also hope that we can each learn something new about one another to think over. And I hope that you don't take my word for it and that you start reading.

Statistics that shock me:
C-section rate for live births in the USA according to the National Center for Health Statistics: 2006 is 31.1 % and rising.
***C-section rate at the hospital Nico was born in 2005: 25.4%
***Hospital with the highest rate in the state of MA 2005: 42.4%

Next posting: prenatal testing


* Obstetricians are surgeons, that is their designated medical specialty and how they are trained. Many do not see a live non-medicated, no intervention birth during their training!

**I am planning to post a book list, suggestions please.

**according to the birth report by State of MA choose 2005 page 39 (2006 and 2007 are also there and about 36-40 pages down, check out the stats!!!!!!)
More states are linked here

Etsy give-away.

Man, I love all the items here.
Take your chances and enter to win great handmade items.

8 Weeks and counting

This blog may slowly morph into a birth blog. Yes, birth blog. I am about 8 weeks pregnant, sleeping 10-12 hours each day and always with the damn nausea.

Nico is enjoying telling every one that "Mama has a baby in her uterus" but he says words like uterus so often that some folks have paid no mind until I say "yes, it's true".

I have precious few minutes until I need to eat again so here is the last month in photos.

Walking in Arcadia
Uncle Justin had his Doctoral Recital (Yippee, he's working so very hard! His brilliance is hard to deny) The Fine Arts Center at BU had this lovely goat head sculpture that Nico loved. (There was no placard with the artist name so I don't know who to credit)

Hanging out with the best (and cutest) cousin ever!



Sewing and knitting is at a stand still. Although I do have a blankie started and some diaper covers or soakers to go over cloth diapers, which I'd love to get from this kick ass diaper service.
Mother herb diaper service provides cloth diapers and wipes for the SAME price per diaper as disposables. Did you read that and the wipes part!!! They come once per week haul the stinkies away and leave fresh diapers, whoot.


See that, I'm already needing food!!