“Will my wife’s vagina get all stretched-out from birthing?”

Mamarama uses the question, one many folks wonder about, to educate about episiotomy and unnecessary cesarean section surgery.

Viewers come away with a better understanding of the pelvic floor muscles’ function during pregnancy and birth as well as the importance of postpartum care regardless of how a baby is born. Watch for yourself.

Take away on episiotomy:

• Falling out of favor due to increased awareness of improved outcomes for patience and non-invasive support methods
• Painful during recovery, not during the procedure
• Typically requires 40 stitches
• Leaves scar tissue that can be debilitating
• Does NOT protect a woman from pelvic floor dysfunction

Skipping the episiotomy allows a woman’s body to tear only, if at all, in areas where there is stretching and stress. If stitches are required, they go only where they are needed. Healing is swifter and less debilitating. Childbirth Connection offers thorough information on episiotomy and why almost all women should avoid them.

If you are curious about home birth, the petition comments offer a great opportunity to learn about this often overlooked choice in childbirth. I particularly like the following comment submitted by my friend Minna. It was my good fortune and honor to attend her son’s arrival almost a year ago.

#557 Anna-Minna Pavulans, Ph D, Oregon

Dear NBC, I was deeply saddened at the angle with which you chose to present home birth in your recent segment on the topic. Last October, at the age of 38, I had a magic HBAC, i.e. home birth after cesarean. The whole experience was remarkable. Whereas giving birth in a hospital left me feeling broken and violated, home birth strengthened me as a mother. I researched my options and risks well in advance of even getting pregnant the second time and knew home birth was my best option for a safe, low intervention, physiological birth. Home birth is not a “celebrity fad” nor a “bad” or “unsafe” choice. For healthy, informed women, it is merely another choice in childbirth, a choice where your wishes to deliver your baby in a drug-free, caring environment are honored and guaranteed. To feed off the McKenzie family’s grief in order to promote ACOG’s agenda did not help the potential for dialogue between midwives and the mainstream birthing business. Childbirth is far too interventionist in the US, to the detriment of both babies and mothers. I was particularly irked by your use of statistics in the segment – making it sound like home birth is “taking over” the turf of hospital deliveries, when truly, only about 1% of babies are born at home in the US. Please address the inherent bias in your initial report on home birth and honor women’s right to informed choices in childbirth. A far more interesting (and informative) angle with which to report on home birth or birth with midwives in attendance, would be to approach it in light of overall health care reform.

Beyond postpartum vanity, we are encouraged to attend to the abdominal and pelvic muscle systems as a means for lifelong health and wellbeing. This modest form of preventive care prepares the way for birth as well as for life beyond. About these muscle systems we learn:

• How they facilitate and are affected by pregnancy, labor, birth, the postpartum period and life beyond the childbearing years

• The muscles’ unique structures, strengths and vulnerabilities

• Consequences of slack muscles including back pain, urinary incontinence, vaginal prolapse and reduced sexual enjoyment

In additional to physical wellbeing, Noble touches on relaxation techniques and the physiology of birth. She particularly likes hypnosis as a relaxation technique. The chapters dealing specifically with physical wellbeing are the strongest. Other books do a better job exploring mental preparation/relaxation techniques and the physiology of birth. That said it is the connection she makes between all three interior systems’ (muscle, mental health and physiological) interdependence that makes her book an important contribution for women’s health.

Unfortunately, Essential Exercises suffers from poor organization and more than its fair share of typos. It can be difficult to synthesize the information though the appendix helps. All of this could be easily addressed on the publishing side. Because mainstream literature skips over or pays no more than lip service to the role of abdominal and pelvic-floor muscle systems in our wellbeing, it remains as valuable a resource today as the first 1970s edition. Don’t take my word for it – check out the reader reviews on Amazon. There are several “wish I’d come across this earlier” sentiments posted.

In other words, CMS can legally withhold federal “matching” funds from state Medicaid plans. Interrupting 27 years of accepted practice, CMS recently directed all regional offices to stop payment to states requesting reimbursement. Without federal money, many states will probably refuse to reimburse birth centers for services rendered. South Carolina already has. Not surprisingly, some of the nation’s nearly 200 birth centers have closed.

The Medicaid Birth Center Reimbursement Act amends the Medicaid provision of the Social Security Act to specifically identify birth centers as accepted providers and authorize reimbursement to states for birth center facility fees. Passage will restore birth centers to their rightful place within the Medicaid reimbursement structure. Equally important, the American Association of Birth Center reports that the Congressional Budget Office’s legislative analysis indicates it will save at least $47 million over the next 10 years.

Medicaid reimbursement is imperative, if we are to have maternity-care choices and quality, cost-effective care for ALL women and children

• Birth centers provide cost effective, evidence based care. Accordingly, they reduce the gap in mother-baby outcomes among low income and minority women; they lower cesarean section rates for all women; and they dramatically reduce health care costs for everyone. They have a proven record for effectively reducing the main causes of neonatal death in the U.S: low birth weight and preterm birth. They also provide the non-medical approach to pregnancy, birth and breastfeeding that many well-informed women increasingly prefer.

• 50% of birth centers in the U.S. serve Medicaid clients.  Because private insurance companies follow Medicaid’s lead when developing reimbursement polices, all women, not just those covered by Medicaid, are at risk for losing access to birth centers. Even if private insurers continue to cover birth center services, women using a facility catastrophically impacted by lost Medicaid dollars stand to lose access, if it closes.

• Birth centers serve women with limited or no access to a hospital. In many rural areas, more than 70% of women giving birth rely on Medicaid coverage. Some of Texas’ birth centers serve a Medicaid client population as high as 80 to 95%.

Tell Congress you support the Medicaid Birth Center Reimbursement Act

Sign-on to the American Association of Birth Center’s Consumer Letter to Congress

Join the Facebook cause: Support Consumer Access to Birth Centers and Midwifery Care

The story inaccurately and irresponsibly represents home birth and the women who choose it. Here are a few reasons why:

• The family’s recent and tragic loss functions more as a device for scaring women away from rather than informing them about maternity care practices and outcomes across the spectrum of provider and location options for the childbearing cycle spanning pregnancy, birth and breastfeeding.
• Stories like this one imply the only legitimate choice a “responsible” woman can make is birth under the supervision of a doctor inside a hospital. This logic fails to recognize that evidence-based practice supporting out-of-hospital, midwife-attended birth.
• The use of anti-midwife rhetoric and scare tactics (starting with the segment’s title) to describe home birth as hedonistic “extreme birth” and characterizing women who make this choice as celebrity- and trend-crazed gawkers belittles the subject and women in general.

Because most of us have little to no experience with birth before preparing for our own baby’s arrival, we are vulnerable to one-sided depictions of valid out-of-hospital models for mother-baby care. Instead of encouraging parents-to-be to learn about and make informed decisions, stories like this one foment misinformation.  A more responsible approach would:

• Have a practitioner and a policy expert speak about the midwifery model of care in an out-of-hospital setting as one supported by evidence-based research. Representatives from the American College of Nurse Midwives as well as someone from Childbirth Connection would be appropriate candidates among many others.
• Report and explore causes for the nation’s high intervention rates including a current cesarean section rate of nearly 32%. (The World Health Organization recommends a rate between 10 and 15%.)
• Present the choice by many women to avoid unnecessary intervention by selecting out-of-hospital birth as a serious (as opposed to immature or hedonistic) response to managed birth in a medical setting.

Fortunately, good information about maternity care is easily accessible. Anyone interested in home birth can start with Amy Romano’s recent post “A new era of home birth research” in which she focuses on a recent Canadian study. Of the study, she writes:

Consistent with many other studies comparing planned home with planned hospital birth, the results showed comparable perinatal mortality rates, less serious morbidity for both women and infants, and lower use of obstetric technology in planned home births.

This is a good place to learn about an overlooked and unjustly maligned birth option in our country.

In my own community, women and families have access to an extraordinary diversity of providers and settings. We have a solid homebirth community, an independent birth center, a hospital-affiliated birth center and two hospitals with labor and delivery units. In spite of this wealth of options, many women are and remain unaware of the midwifery and out-of-hospital options throughout childbearing. Because I live in a community largely characterized by a state research university and an impressive environmental / green movement, I am generally surprised by this lack of curiosity about mother-baby care. Community farming and local consumption enjoy tremendous support among many of the parents I know as they are deeply concerned by what their children eat and touch. Somehow maternity care practices often fail to make the list.

A woman who takes the time to read The Thinking Woman’s Guide to a Better Birth will begin each of her prenatal appointments whether at an OB’s office, a birth center or at home with a midwife prepared. Should her provider, for example, encourage a cesarean for breech presentation, she will know from reading Goer that the path is not so clear cut. She will know that cesarean for breech is not a simple, “no brainer” option. She will have the tools to begin a serious inquiry about what’s right for her. She will also have the necessary information about steps to take to turn a breech. Much of this information is not easily acquired within the medical model where most women receive care. That makes Goer’s book a good investment of time and money.

Because Canadian and US-educated doctors are trained to respond to breech presentation with surgery, they are poorly equipped to educate a woman about or support one preferring normal birth (breech babies come through the mother’s birth canal buttocks or feet first). Furthermore, most experienced doctors still willing to support vaginal breech birth are no longer permitted to support vaginal breech birth due to shifting professional norms. Given most women use a doctor for maternity care, they are consulting someone with a tremendous gap in information where breech babies are concerned. Most women then are uninformed about the many methods for attempting to turn a baby as well as ways to support normal vaginal birth for breech presentation.

SOBC’s commitment to improve outcomes and provide better options for women is a step in the right direction. As medical schools and current practice catches up, women curious about or preparing for a breech baby are well served to consult Henci Goer’s The Thinking Woman’s Guide to a Better Birth. Chapter 2 explores and identifies the many issues associated with and potential non-surgical responses to breech presentation.

• The US vital record system ineffectively collects infant and maternal mortality data. As a result, anecdotal data replaces scientific data. Leaving providers, medical and non-medical, to form inaccurate beliefs about one another.

• Evidence-based research comparing mother-baby outcomes for hospital and home settings does not include randomized-controlled trials. Randomly assigning women to birth at home or in the hospital is not feasible. Observational studies are the next best standard against which to measure outcomes. Evidence-based research shows home birth to be safe for healthy women.

• Risk is perceived and defined differently across care models and by those who work and receive care within them.

Understanding the role each of the above points plays in shaping what we know and believe about childbirth can, hopefully, lead us to a better caliber discussion. Women and babies deserve nothing less.