More on ACOG

Some people think that when ACOG makes a declaration that the decision must have been based on evidence, and that such evidence has been found scientifically sound and agreed upon by the members of the organization. This letter shows that this is not the case.

From: Stuart Fischbein [mailto:angelfischs @ yahoo.com] Sent: Monday, June 23, 2008 5:35 PM To: ExBd@acog.org Douglas H. Kirkpatrick, MD The American College of Obstetricians and Gynecologists PO Box 96920 Washington, DC 20090-2188 Dear Sir: I am a practicing OB/ GYN in southern California and Fellow of ACOG and recently was informed by midwife colleagues of your recommendation and encouragement for the AMA to lobby Congress for a law banning out of hospital birth. Funny that I had to hear of this decision from outside sources and was never approached by my college to see how I or my local colleagues felt about it. I have grave concerns regarding my organization taking such a stand. I think we are all agreed that ACOG has a statement regarding patients' rights to informed consent and informed refusal. Yet, it seems with every decision our organization moves further away from that basic tenet. ACOG's little "guideline" paper on VBAC in 2004 where the word readily was changed to immediately has had the chilling effect of doing away with VBAC options at hundreds if not more hospitals. Not due to patient safety, or the ideal of giving true informed consent but really, let's be honest, to fear of litigation. I have seen how patients have become counseled by obstetricians at facilities where VBAC has been banned. They are clearly given a skewed view of the risks of VBAC but rarely told of the risks of multiple surgeries. If you think this is untrue you are, sadly, out of touch with real clinical medicine. As to out of hospital birthing, please give me the courtesy of an explanation as to the data you used and the process by which an organization which is supposed to represent me came to this conclusion. Any statement saying that it is as simple as patient safety and that one-size fits all hospital birth under the "obstetric model" of practice should be applied to all patients is, putting it nicely, not really in line with what best serves all our patients. In many instances, hospitals are not safe, certainly not nurturing and have a far worse track record for disasters than home birth. Even when emergency help is nearby this is true. The focus of all of us in medicine should be on reigning in trial lawyers and tort reform and lobbying Congress for that. The best interest of the college members and the patients we serve would be for my organization to spend its time and energy on something that has true benefit. Removing choices from well-informed patients and caring doctors and midwives is wholly un-American. So please send me detailed information on how ACOG decided outlawing home birth was a wise thing to do. You must have scientific data to take such a drastic stand. Please make it available to me so that I may share it with like-minded colleagues. I would also like to know the process by which this came to pass. Who first raised this issue and why? What committee reviewed all the data and did its due diligence in interviewing those of us with long-standing experience in backing midwives who perform out of hospital births. There must be a fine, non-confidential paper trail you can share with your members. Specific names of committee member who voted for this would be enlightening and I am requesting this information. I would like to know the background and expertise regarding out of hospital birth for each member who had a hand in the decision to go to the AMA. We live in an odd era where once something is said or recommended by a legitimate organization such as ACOG it has deep ramifications never intended such as becoming fodder for trial lawyers trying to squeeze the lifeblood and dignity out of your members. Or forcing women to travel hundreds of miles in labor to find a supportive facility. Or even worse, to have them arrive in a VBAC banned hospital and refuse surgery. Can this be the best we can do for our patients? Remember, your VBAC statement was meant to be only a recommendation but quickly became the rule by which hospital administrators, risk managers and anesthesia departments of smaller hospital banned this option for thousands of women. An option, that in proper hands, was the safe and accepted standard of care for 30 years. In fact, you still have an ACOG VBAC brochure that recommends this option! For those of us working at smaller hospitals where VBAC was banned due to lack of emergency help (anesthesia, OR crews, etc.) there is a big question that has perplexed us that no administrator seems to be willing or able to answer. That question is: "If a hospital cannot handle an emergency c/section for VBACs, and most emergency are for fetal bradycardia, hemorrhage (ie. abruption) or shoulder dystocia not for ruptured uteri, then how can they do obstetrics at all?" For they seem to still be able to have a maternity ward without in house anesthesia. Will someday ACOG, in their great wisdom but seeming disconnect from reality, make a "recommendation" that little hospitals stop providing obstetric services? Will this better serve women and their communities throughout America? I am frightened and angered by what you have done in my name. Now I ask you to defend your position in encouraging the AMA to lobby Congress for another restriction on the freedom of choice that belongs to women and their families. Those choices include midwifery and the right to have the most beautiful and life changing event occur wherever best fits their desire. Midwives are well trained and required to have obstetrical backup. They have very special relationships with their patients and want the very best outcomes for them. They do not need me or you to police them. We have a habit in our country over the past 40 years of thinking we can legislate out stupidity. All that has done is erode the individual freedoms that belong, by birthright, to each of us. I would hope you trust your Fellows to know their specialty, their colleagues, and what is best for the patient as an individual. These decisions do not belong to politicians or faceless committees. You should have more faith in your members to give balanced informed consent. Again, my recommendation to you is to put all your considerable energy into changing our legal malpractice system. Those of us actually practicing medicine and caring for patients know this to be the greatest threat to the mission and responsibility we have chosen to undertake. I look forward to your response and possibly the beginning of a meaningful dialogue. Sincerely, Stuart J. Fischbein, MD FACOG Medical Advisor, Birth Action Coalition

KZYX HypnoBirthing Interview

I often give presentations about natural birth. Sometimes I'm doing interviews, sometimes I'm preaching to the choir (speaking at midwifery conferences), sometimes I'm speaking to quite a varied audience (like nursing students).

Afterward, I sometimes feel I 'nailed it'. These days, I consider those my 'Obama' presentations. So far, thank heavens, I haven't had any I considered 'Bush' moments. Tonight however, I feel like I was off my mark; sort of a McCain awkwardness. That makes me sad, because Chris Skyhawk was wonderful, and I was very cognizant that I was representing HypnoBirthing(R) to a large audience.

Normally I have my references on the tip of my tongue and can recall the most relevant of facts. I can sound somewhat intelligent for the most part.

Tonight I was reaching. I didn't feel like I answered the very thoughtful questions Chris asked in the most eloquent of ways. I have no idea why. I wish I could predict when I'd be able to hit the mark and when I wouldn't.

In any case, at the end of the interview, suddenly I heard dead air. There was nothing on the other end and I thought I lost Chris. I'm not sure if I did or not, but when I next heard him, he explained that they were getting updates on fires that are raging there.

So, for all you in CA, I wish I could send you some of the copious amounts of water we've had here. My thoughts are with you as you battle the blazes.

HypnoBirthing Radio Interveiw

Just so you know, I will be speaking with Chris Skyhawk Thursday, June 26, 2008 at 9 pm Central.
The show does stream live I believe, so if you want to check it out, here is the promo from Chris:

Please join host Chris Skyhawk for Universal Perspectives Thursday night at 7PM (P.D.T.) on KZYX where he begins a new series entitled Birth and Living. His guest will be Kim Wildner. Kim is a practitioner of a birthing method called Hypnobirthing which allows the mother, along with the aid of the father and/or labor companion, to give birth using their natural instincts and the bodies natural responses and hormones. These birthing methods allow babies to be born in a natural, drug-free manner.

Chris Skyhawk

www.chrisskyhawk.com

Protect all safe birth options!

I just got this petition in my email. I will be passing it along to everyone I know, and I ask you do to the same.

Hi,

I wanted to draw your attention to this important petition that I recently
signed:

"Keep Home Birth Legal"

I really think this is an important cause, and I'd like to encourage you to
add your signature, too. It's free and takes less than a minute of your
time.

Thanks!

Even if you wouldn't want a home birth, please sign this petition to keep this safe option available to those that would.

Obviously Ricki Lake is making a difference in public awareness; there has been a huge PR backlash from ACOG and the AMA regarding scientifically safe birth options that do not require their services. Ricki Lake has been targeted personally, although her name was ultimately removed from the resolution against homebirth due to protests from women's groups and other women angry at the attack on their personal freedoms.

There is a great article from the Huffington Post with a wonderful debate following. This is a very important issue! In the past, it was easy to play on women's fear about birth and convince them it was dangerous because a privileged few had access to the actual facts. In the information age, women can look up the data for themselves and can see that the U.S. has some of the worst infant and maternal mortality stats for the industrialized world. They can see actual birth video of painless birth, empowering birth and orgasmic birth on YouTube. (Just surf around this blog for many of them!) We now have a global community and women are starting to wonder just why their sisters in England or Holland should be able to have a safe homebirth when they have to fight for it here.

Not only have women decided enough is enough, but many doctors have decided to speak up. They've seen the surgical birth rates rise with no improvement in outcomes (or worsening outcomes) and stood up for evidence-based care, which includes midwifery care. They took a vow to harm none, and they are choosing to stand up for that over profits, unlike others.

We've reached a tipping point and ACOG and the AMA obviously know that. They are taking a defensive stance to secure their livelihood. And it isn't just OBs; hospital maternity care in the U.S. is one of the largest marketing tools hospitals have. Not only is it a huge portion of their income, but if they can get women in to their hospital for their birth, they will come back when other family members need care.

They are powerful entities. They will fight hard with seemingly unlimited resources. Let's just hope women are mad as hell and not willing to take it anymore.

Police Woman PROMOTED for breastfeeding!

A policewoman who breastfed nine orphaned infants during China's earthquake has been promoted. She is being hailed as a hero, as well she should be! She undoubtedly saved the lives of those babies.

Many babies caught in natural disasters do not die from whatever calamity they find themselves in. They die afterwards due to dehydration, starvation, or disease either because they lost their mothers, like these poor little ones, or because no water (or clean water) was available to mix formula or there was no way to get pre-mixed formula right away.

I briefly blogged about this recently because of the floods the mid-west is now experiencing, but this is one aspect I never thought of. Kati Kim kept her own children alive when her family was stranded in a snow storm and her husband was lost looking for help, but I hadn't thought of how many other children could avoid suffering, even if their mothers were lost, if there were other women around who could provide instant, sterile, prewarmed nourishment.

Wow! Women are amazing!

Virtual Refrigerator

My daughter did this and I thought it was pretty.

State of Emergency

Yesterday around 4:30 pm the tornado sirens went off, so we headed to the basement. Over the next two hours or so, the sirens went off about a half dozen more times as funnel clouds were spotted. We finally had to come up to grab something to eat and use the facilities . We couldn't hear much of what was going on above ground, so we were stunned at what was going on while we were underground. The pictures above are just some of what we took. Crazy. People are getting around in boats.

And once again, I was struck by how tragic it is that women don't have a clue what they would do if they were stranded and had to birth on their own. Or that so many babies starve because parents can't get to the store to get formula or can't find clean water to mix it with if they have it, when if they were breastfed, sterile, ready-made food would be instantly available.

Of course, the women don't need to know anything special, because their bodies know. Babies come out and they don't care where they are or who may (or may not) help mom. However, women would be much less afraid if they know they could (and indeed do) birth their own babies just fine under all but the most unusual of circumstances.

Archived Entries with Birth Videos

Some of the great videos I posted went up months ago, and while I haven't exactly been prolific in my writing, they still got buried.

So, here are a couple of links to the pages that have birth videos (for those women needing a little inspiration):

http://fearlessbirthing.blogspot.com/2008_01_20_archive.html
http://fearlessbirthing.blogspot.com/2008_01_13_archive.html

Also, a collective thank you to those of you posting regarding the request for painless birth stories! I haven't responded to each personally mainly because there have been so many (How fabulous is THAT?), although I did made sure the comments got posted.

So, thanks again, and keep them coming! Stories (or offers to tell stories) can be sent to kim at kimwildner dot com or links to stories that are public domain can be added via comment from the post entry as others have done. Nothing will be used without direct contact and permission from you.

The High Cost of Health Care

The current issue of AARP: The Magazine has an excellent article titled Why Does Health Care Cost So Much by Shannon Brownlee, the author of Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. I'd love to get my hands on a copy of this to review here. I couldn't tell from the available editorial or customer reviews if maternity care is covered in the book, and there isn't a 'look inside the book' option.

In any case, the problem, as Brownlee explains so well in the article is over-treatment, with 50% of the interventions that not supported by evidence. In obstetrics, that number is higher. Citizens for Midwifery and Childbirth Connection reveal that:

Fully 85% of U.S. women enter labor at "low-risk" for problems (Healthy People 2010), but virtually 100% of U.S. women have at least one intervention. (Listening to Mothers Survey. Childbirth Connection 2002). Every intervention has the potential of doing harm as well as good. If a woman has an intervention she doesn't need, then she runs the risks with no counterbalancing benefit.
http://childbirthconnection.org/article.asp?ClickedLink=334&ck=10068&area=27

Why women aren't furious about this I can't imagine! In fact, what blows me away is that when movies like The Business of Being Born or books like Obstetric Myths versus Research Realities and Born in the U.S.A expose the problems within the system that make it dangerous, expensive and emotionally damaging, women don't get upset that the system is broken. Instead they get mad that anyone dare suggest the system even has issues, damned be the evidence! I keep finding little puzzle pieces as to why this may be so, but honestly, I feel the more I learn the less I know some days.

Naturally Born Twin Video

This is wicked cool!

Painless Birth

It's been ages since I actually posted content here, I know. I haven't been a slacker, honest! I'm actually writing a book on painless birth, so I've been researching and writing. Mother's Intention is also about to go out of print, so I'm re-writing as well, hoping to fix what I didn't like about it the first time and perhaps find a publishing house that will pick it up. I'd like to concentrate on writing and research, not billing, marketing, or order fulfillment. I also have two presentations for the HypnoBirthing(R) convention that require preparation. Oh, and I have a 'real job' now too.
In addition, the summer is getting crazy just because that's what summer does.

In any case, I'm putting out a call for birth stories for the new book. I need people to send me stories of their painless natural births (including mostly painless or almost painless), either created (through HypnoBirthing or other means NOT including drugs) or encountered (those fast, painless births that take mothers by surprise in the shower, on the toilet or in gas station bathrooms). If I choose to use your story, I will send the paperwork for official permission to use it. I'm only expecting to use three to five stories at the end of each chapter, so depending on how many submissions I get, there is no guarantee every story will make the cut. You will retain the copyright to your own story, and it will be edited only for spelling and grammar. I'm looking to keep each story under 1,000 words. If typed, we're looking at two or three pages double spaced, size 12 font, 1 inch margins. If you want to include photos, that would be awesome.

Please pass this request around to all of the lists you may be on and to anyone who may want to participate. I'd like a nice assortment of birth locations and birth attendants. Thanks!