Sunday, October 28, 2007

Again, not nearly enough time to write like I'd like but...I came across this and I really like it. I seems SO obvious...why don't more women get this?

When you think about how much many women (at least educated women) WON'T put up with...the things that they find inexcusable...the things that they do allow (certainly educated women are even MORE likely to allow birth abuse) are mind-boggling.

So what does it take to open eyes?


Friday, October 19, 2007

My Video

Ok, I'm gonna try to do video is embedded at the bottom of my blog (when I put it as a sidebar, it got cut off) but I doubt most people will go look for it there....of course, when this disappears, they won't look for it here either -- not quite sure how to get around that :-)

Anyway, I made this video. And when I have a bit more time, I'll explain why I did (or didn't do) some of the things in it.


Friday, October 12, 2007

Fox in the Hen House hunting Witches

I recently learned about something very disturbing...the American Medical Association formed a group called the Scope of Practice Partnership (SOPP), whose mission is to launch investigations of unlicensed “midlevel providers” and to support initiatives to fight legislation expanding the current scope of practice for licensed “midlevel providers”. If you search "Scope of Practice Partnership" you'll find some interesting and really scary stuff -- unlicensed "midlevel providers" would include non-Certified Nurse Midwives ("lay" or "direct entry" midwives) in states where licensure isn't available, even if those midwives were CPMs and thus, license "ready". If you read between the lines (and on top of them too) you can see that "investigations" is a nice way of saying prosecution and of course, they also oppose legislation introducing licensure to these sorts of health care providers. Licensed "midlevel providers" include the following: chiropractors, advanced practice nurses (aka nurse practitioners), nurse anesthetists, optometrists, podiatrists, physical therapists and psychologists. This whole thing is being sold as an attempt to "ensure quality health care" but my answer to that would be deal with your own lousy health care before you started trying to "fix" someone else's. We all know how well most physicians do with individualized care...Log in the eye anyone?

Alternatively, I've seen it described as a "clearinghouse of information about non physician providers' educational preparation, licensure requirements, and state legislation and regulation regarding scope of practice." The big question is, what do they plan on doing with the information? Oh, well, whenever there is a "scope of practice question" (that would be some non-physician profession encroaching on the income source of the physicians in that state or states) this information can be used to "address the issue" or even better "develop model legislation that can help resolve that concern." A specific example would be nurse practitioners -- currently, the education level to be a nurse practicioner is at the Master's level. There is a move in the nurse practitioner community to move to a Doctor of Nursing Practice degree, rather than a Master's degree. Why is this a bad idea? Why, it would allow nurses to call themselves doctors! And heaven knows, we can't have that...gosh, are they going to come after me too? After all, I call myself doctor....I'm sorry, but physicians don't have a lock on the generic term "doctor".

I think it is most baldly put in this direct quote from AMA resolution 902 : “that state medical boards shall have full authority to regulate the practice of medicine by all persons within a state, notwithstanding claims to the contrary by boards of nursing, mid-level practitioners or other entities.” Needless to say, they define "practice of medicine" very very broadly. Resolution 902 also asserts that “patients may be put at risk for injury or death . . . receiving care from persons
who are not physicians (MD [medical doctor] or DO [doctor of osteopathic medicine])” It is important to realize that there is NO evidence to support this statement and the AMA has been unable to substantiate it. But then again, we all know that patients are never "put at risk for injury or death" by the actions of physicians....who practice only the most scrupulously careful, up-to-date, gold standard medicine, of course.

This is a bully stealing the lunch money from the smart kid, who also happens to be a really nice kid too.

If you'd like to read some analyses of this, I've collected links here:

Coalition for Patients' Rights
Dynamic ChiropracticJune 6, 2006, Volume 24, Issue 12
Dynamic ChiropracticDecember 31, 2006, Volume 25, Issue 02
National Alliance of Professional Psychology Providers
Clinical Journal of Oncology Nursing • Volume 11, Number 2
American Dietetic Association
The Integrator Blog
Maryland Optometric Association
American Association of Nurse Anesthetists

Interestingly enough, I had a chance to discuss the quality empathetic and humane care pregnant women get from "doctors" the other night. For those who don't already know, I'm a Veterinarian and I work at a Veterinary ER Center -- I'm the person you see when your dog gets hit by a car or your cat blocks in the middle of the night (or on the weekend or the holiday, of course). I really love my work and the hours allow me to be other things besides a Veterinarian as well. When I'm working a weeknight overnight shift, I usually have 1 LVT (Licensed Veterinary Technician -- basically the Veterinary equivalent of a Registered Nurse -- they have 4 year degrees and have to pass a written and practical exam to be licensed). Anyway, we were discussing the recent birth events of another employee and I was expressing my disgust at how predictable things are most of the time -- this woman ended up with a cesarean she really didn't want at all and the way she got there was distressingly familiar to me. And my LVT, who is single, childless and in her 50's said all the right things...she was absolutely horrified that over 1 in 3 babies is born surgically. She was amazed that anyone could possibly think its a better way to have a baby. She was shocked that more women are dying in childbirth now than they were a year earlier...she was disgusted at the way OBs manipulate women at the end of their pregnancies when they are tired and exceedingly hormonal.

Too bad I'm not surprised any longer.


Monday, October 8, 2007

VBAC bans and other nonsense

Well, look at that, here I am again. I should probably be sewing Hallowe'en costumes...gonna be a busy couple of weeks I think. Anyway, I'm going to ramble this time about VBAC (that's vaginal birth after cesarean if you don't know, and if you are google searching blogs for that particular term ;-) and how much harder it is to have one now.

There's a lot of research on VBAC out there. For the most part it can be pretty easily summed up as follows:

The one complication that's relatively unique to VBAC is uterine rupture. Uterine rupture can be catastrophic, so it isn't something to ignore but catastrophic ruptures are also rare unless you do some stupid things. The rate of uterine rupture in labors that are spontaneous (that means no induction) and in the hospital is roughly 0.5% (1 in 200), but not all of those are catastrophic. Other than uterine rupture, there's no difference between a VBAC labor and any other labor. If you use things like pitocin or prostaglandins, you will increase the rupture rate. If you've had more than one cesarean, the rupture rate will be higher but its looking like it isn't really much higher (in one recent and very large study, it wasn't higher at all). If successful, VBAC is much better for the mother (obviously -- surgery really isn't "good" for anyone, it can be necessary but not good) and probably better for the baby too. It certainly isn't worse for the baby. The rupture rate is higher with incisions in the upper part of the uterus but we really don't know what the rates are -- all the numbers are quite old and women with these sorts of incisions are rarely "allowed" to have VBACs, so we don't know what the uterine rupture rates would be in this population. Things that do not increase the uterine rupture rate include being past your due date, having a "big" baby, having twins, being old, being young, being fat, being skinny or being short. Unless of course you are being induced because of any of those things.

Back in the 90's, the medical community "supported" VBAC. I'm too cynical to believe that this support was because of some noble desire to see women avoid the knife -- well, ok, maybe that was part of it....but really, it was about managed health care and cost cutting. And that's not a good reason...the good reason would be because its better care for mothers and babies to encourage VBAC (which it is) not because it makes the profit margin look better to the share holders. The reason I say this is because the OBs just couldn't keep their hands off ... birth of any sort goes better if you just leave it alone...and they couldn't. So they started doing stupid things like inducing women willy nilly and getting very casual about the whole thing...and so, because bad behavior begets bad behavior, there were some spectacular lawsuits. Though, I've been told that this has been somewhat overblown by the obstetrical community....I don't doubt it but I can't confirm it either. Anyway, ACOG (American College of Obstetrics and Gynecology, functionally the trade union for OBGYNs) came out with a practice bulletin that made "suggestions" about how to manage a VBAC and basically VBAC became an endangered species...ACOG claims that the practice bulletins are just "suggestions" but realistically, if an OB does something counter to the bulletin, they have little to stand on if they are sued. Which leads to VBAC bans.

ICAN is in the process of updating our list but as of a few years ago, there were over 300 hospitals in the U.S. that officially banned VBAC - in other words, you can't have one at that hospital, even if you've had one or more already. At least, that's what they'd like you to believe. Many more hospitals have de facto bans in place because there aren't any attending physicians who'll accept a patient who wants one or the restrictions on having one are so outlandish that it just never happens. I don't know about you but I find it really offensive that anyone, much less a hospital administrator or Board of Directors can tell a women how she's allowed to have her baby. Plus, I'm pretty sure its illegal. Why, you ask?

I'm still figuring this out but I think there are two different laws/regulations that actually make it illegal for a hospital to refuse to allow VBACs. The first is EMTALA (Emergency Medical Treatment and Active Labor Act) which says that if a woman shows up at a hospital in active labor, that hospital may not turn her away, no matter what. The hospital is required by law to admit her and stabilize her (defined as both the baby and the placenta out) OR if they are not able to provide care, transfer her to a facility that can (if they can transfer her before the baby and placenta are delivered. A physician friend explained to me that if the baby and placenta are delivered in transport, the hospital that shipped the woman gets in big trouble because obviously, they could have handled it). What EMTALA does is get the woman in the door. THEN there are the Medicare Conditions of Participation (CoP)- these are the rules any hospital that accepts Medicare dollars (most of them) must follow. The CoP has some very specific things to say about a patient's right to refuse treatment in the section on patient's rights:

"The patient or his or her representative (as allowed under State law) has the right to make informed decisions regarding his or her care. The patient's rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment. This right must not be construed as a mechanism to demand the provision of treatment or services deemed medically unnecessary or inappropriate."

Now...the one thing that I see a potential problem with is that last sentence -- "medically unnecessary or inappropriate." If someone did request a judgment on whether or not VBAC bans were illegal under this clause, I have to wonder if the argument would be made that VBAC is under some circumstances "medically unnecessary or inappropriate". The notion that VBAC is a "treatment" or "service" makes me crazy -- might as well say pooping is a treatment or service, it would make as much sense but that's not how it is framed much of the time -- I see VBAC referred to as a "procedure" rather frequently, even though the best way to have a VBAC is to not do anything at all (that's an odd sort of procedure). I wonder if the powers that be in the CoP world would look to ACOG for an "expert" opinion -- calling ACOG an expert in VBAC is like calling the oil companies experts in alternative fuel sources so needless to say, I have no faith that they'd give an unbiased opinion when asked. Its an interesting dilemma...should we push for a ruling on this? Or would it possibly backfire badly. To me it seems SO obvious that it is against everything we say is important in this country with regard to individual rights to bodily integrity, etc...but we are talking about pregnant women (who in some states are not allowed to draft advance directives or living wills because they are considered incompetent by virtue of being pregnant), particularly their uteri and we all know uteri aren't all that important (50% of all women will die without theirs -- hysterectomy is the second most common surgical procedure after cesarean. Can't help but wonder if things would be different if babies came out of prostates or something...) So here I sit wondering....should we push this? Where oh where is a lawyer familiar with Heath and Human Services law when you need one?

If you know of a hospital in your area that does outright ban VBAC, keep an eye out for the online survey that will be on the ICAN website soon. I'd love to have your information.


Sunday, October 7, 2007

I want Google to find me too!

So, though the chances that you're here reading this and don't already know me are probably pretty slim, just in case you don't, I'll tell you a little bit about me. And yes, I have ulterior motives, because I'm trying to "do my part" and get birth issues onto the radar screen of the mainstream (yeah, I know, set a reasonable goal there). On the advice of a friend, who also happens to be an ultra cool cyber-savvy person and the Publications Director for the International Cesarean Awareness Network (ICAN) I'm trying very hard. She told us to go out and blog blog blog. I get the Google alerts for various topics, including "International Cesarean Awareness Network" and I want my blog to show up one of these days!

Now, you ask, why is this something you care about? Surely with 3 of 4 kids in a charter school (that means LOTS of parent involvement and 120 miles of driving each school day), a preschooler still mostly at home, a full-time job (for the moment) and all that goes with that, having a blog and actually writing in it can't be such a good idea. And maybe you are right....I've yet to prove that I can keep up with this. But, since my job does include a lot of down time in the middle of the night, maybe I can pull this off (sleep? who needs sleep....I lost that biological imperative about 9 years ago. Ha!). But seriously, why do I care?

The first reason I care is because I had a cesarean over 9 years ago and I hated it. I knew I would (it was "scheduled" so I had lots of time to anticipate just how fun it wasn't going to be, given what I'd actually planned for) but I didn't anticipate how having it would completely shatter me. I mean, really, it shouldn't have, right? -- my husband and I had a lot of trouble conceiving and maintaining a pregnancy so we ended up in treatment (somehow I guess because I didn't just fall pregnant, I was supposed to really not care how the babies "got here"), the surgery was scheduled so I was able to request (demand) certain things to make it a better (less worse?) experience, my recovery was "good" (aka not medically complicated by anything)...and it shattered me. Pain that didn't just magically go away in 8 weeks (that's when they tell cesarean moms that they'll be back to normal), delightful depression that morphed into an impressive rage, a profound disconnect with my babies (fraternal twin boys), an even bigger disconnect with my husband (you can resume "relations" in 6 weeks. yeah, right. try 7 1/2 months and then not because you actually want to, you just feel that the likely damage done to your marriage is worth prostituting yourself to prevent), doubts and regrets that never ever stop and keep you awake night after night, the inability to take a shower without sobbing (because that's the only place you can do it and not be heard). The incessant fear that you are not a good mother that in fact you are a terrible mother because if you were a good mother, the overwhelming love you instantaneously feel for your babies (that I didn't feel at all) would make all the cesarean stuff just go away....yeah, I hated my cesarean.

When I found ICAN and joined the email support group, I found other women who had very similar experiences, very similar reactions, women who really didn't like their cesareans. And, they weren't afraid to talk about it! That was a sanity saver. THEN I started to realize how many women there were....that was many years ago, and the host for the list at that time was a program that was really difficult to use -- it was complicated and somewhat arcane to join, so I'm sure there were lots of women who never made it there (took me 3 tries and I'm pretty computer literate). Imagine how many there would be if it was easy and everyone had an Internet connection? As I started to move through my journey, I developed a passion for giving other women the help I'd gotten. Eventually, I took over ownership of the list, we moved to Yahoo and the number of women who joined each day was and still is staggering. Clearly, there is a problem with cesareans....and I can't turn my back on those women who are grasping at any hope that they aren't crazy and there was a way out of the place where they find themselves.

And things just get worse....the cesarean rate keeps going up and up (in 2005 it was 30.2% of all births, kinda -- turns out they don't even count things like multiples or breech or preterm in that number! Hey, I didn't really have a cesarean No seriously, the real rate in 2005 was probably more like 36% or so...) The infant mortality rate is going up....and guess what? The maternal mortality rate is going up too! And the interpretation of this bit of news didn't even have to be spun by ICAN -- the government stated quite clearly that the increase was most likely due to the increasing cesarean rate (and obesity, though that is likely not independent of the cesarean rate, since over-weight and obese women have cesareans at a much higher rate than other women, often for no apparent reason other than being heavy), along with better reporting. That last bit is interesting...we've suspected for a long time that childbirth related maternal mortality is woefully under-reported (as much as 4-16x by some estimates) so actually, things have been a lot worse than anyone could prove for a long time.

If you have any awareness at all that our health care system is way screwed up, you'll love this factoid: the U.S. spends more (total and per capita) on maternity care than any other country on this planet. And our measures of outcome, those good ole mortality rates, suck. We rank somewhere (depending on the list) between 21 and 25 in the list of developed nations. There are lots of developing nations that have better numbers than we do. We are throwing money away, while women and babies die. How come I never hear any of the presidential candidates talking about that? Oh, I forgot, the American Medical Association uses a lot of those health care dollars to pay really good lobbyists and to make contributions. Wait, wouldn't that be illegal? Uh huh, and nothing illegal EVER happens in health care OR politics. Your insurance premiums at work there. And you thought they were going to buy you good medical care, silly you.

Needless to say, I could go on and on and on. And I suppose that's the point of a blog...but...maybe we'll just save the rest for another time. If you are desperate to read more, you can go to my website. Start with You Should Be Grateful, the first thing I ever wrote and then go from there.