Peeing yourself as a mom - a rite of passage?

In her article, A Vaginal Birth Means Your Baby Isn't the Only One Who'll Need Diapers, author Mary Fischer does something a little different when reporting on recent birth research (showing less pelvic floor muscle strength in women who've had a vaginal birth compared with a cesarean)...

For example, she doesn't deny it's true, and she doesn't tell personal stories of sneezing then peeing herself in the context of eliciting sympathy from or extending empathy to other women. Instead, Fischer almost celebrates incontinence-related pelvic floor damage as something to be taken entirely in your stride - something "actually pretty hilarious".

RCOG reinstates controversial document

Anyone can make a mistake, and I believe that's what RCOG did in publishing this document. Yet despite the criticism that followed, and despite initially removing the document from its website, RCOG last week reinstated the document via this statement.

RCOG says media reports were "misleading", and so wants "to clarify" some of the controversy that arose - you can decide for yourself whether these statements, for example, clarify RCOG's guidance:

*"It is not meant to restrict services to women."

New guidelines underline low risk for planned CS babies

New guidelines published this week state that for low risk planned cesareans, "the need for vigorous resuscitation is no different from that which occurs in an uncomplicated vaginal birth", further supporting the case Dr. Murphy and I make in our book.

The New Zealand Newborn Services Clinical Guideline, 'Paediatric Attendance at Low Risk, Elective Caesarean Deliveries', reviewed by Malcolm Battin, states [my bold]:

BBC's Jenni Murray says 'Get real!' about birth pain

With the controversial headline, As plans to cut down on epidurals cause a furore, JENNI MURRAY says... Get real, girls! Pain is part of childbirth, Jenni's point of view will undoubtedly have its critics.

But there's a part of her story that might elicit sympathy too, which is something we talk about in our book, and that is the possible adverse effect on a child growing up with a mother who had a traumatic birth. Jenni writes of her own mother, "She never hesitated in regaling me with the horror story of my arrival and the damage it had done to her physically and emotionally."

What is a 'normal' birth? asks BBC Woman's Hour

This morning I was interviewed on BBC Radio 4's Woman's Hour alongside Cathy Warwick, General Secretary of the Royal College of Midwives, by presenter Jane Garvey. The topic, 'normal' birth, was chosen on the back of this guidance document for CCGs (still on the RCM's website but removed from RCOG's website last week following complaints) and the subsequent press release from organisations opposed to its contents. You can read the documents above and listen to the Woman's Hour interview here to make up your own mind about what the guidance says.

BBC London and WM radio interviews

On Friday morning (August 31), I was interviewed by Adrian Goldberg on BBC WM and Vanessa Phelps on BBC London. The interviews are only available for a few days on BBCiplayer (although the Vanessa show is not available yet).

Media response to news of guidance for CCGs

Aug 24, Pulse Today: GPs urged to discourage women from 'unnecessary' hospital births, caesareans and epidurals, Sofia Lind

Aug 25, The Skeptical OB: New document on British maternity services is fundamentally unethical, Dr. Amy Tuteur
Aug 28, BF without BS: If this is cost-cutting, just be honest, please

Aug 30, The Sun: Grin ‘n bear it, Plan to cut childbirth pain relief and caesareans, Emma Little and Martyn Halle

RCOG removes controversial guidance from website

Following vehement opposition from maternity organisations and doctors, the Royal College of Obstetricians and Gynaecologists has today removed its guidance for CCGs ('Making sense of commissioning Maternity Services in England', published August 14) from the RCOG website.

 

I don't know yet whether revised guidance will be published, and if so, whether RCOG will collaborate with organisations other than the RCM and the NCT, but in the opinion of many, this would be the appropriate action to take.

Meanwhile, in the Sun newspaper today, Emma Little and Martyn Halle report:

'Cathy Warwick, of the Royal College of Midwives, defended the proposals, insisting: “There are women who do not want to have caesareans or epidurals who are having them at the moment.”' 

Lowest scalp injury risk with planned cesarean

Scalp injury during birth is a risk commonly associated with all cesarean deliveries, and therefore good reason to discourage women from choosing surgery, when in fact the vast majority occur following a planned vaginal delivery.

I explained this in the comments section of today's Daily Mail article, Caesarean 'superknife' that could spare thousands of babies from injury when surgeons cut through the mother's womb:

Mumsnet users angry at maternity guidance

Women posting on Mumsnet have quite rightly got their knickers in a twist after reading Friday's press release on RCOG's (and the RM and NCT) guidance proposing increased rates of 'normal birth' and cesarean rates of 20%.

There are two threads - one in Childbirth and the other in Feminism/ Women's Rights - and here are just few examples of what's being said:

"...I'm utterly appalled by this. It seems to be in direct opposition to what NICE, NHSLA and others are saying. And the trouble with targets is they completely neglect individual care, and create a conflict of interests for doctors & midwifes - and ultimately put woman last."

PR response to RCOG's 20% cesarean rate guidance

"New RCOG guidance urges CCGs to increase births without epidurals and reduce caesarean rates to 20%"

Controversial guidance contained in a new document published by the Royal College of Obstetricians (RCOG) could result in worse health outcomes for mothers and babies, and greater costs for the NHS, say maternity campaigners (left) and doctors (below).

You can read the press release in full HERE.

Perception of risk is everything...

...and birth is no different. Most women perceive greater risks either with a trial of labor or surgery.

This struck me again today while at our local gym play session, and where a sign reads, 'one child at a time on the trampoline'.

It's no exaggeration to say that every single time we go, parents do not adhere to this rule, allowing children to all jump randomly around the trampoline together. As one mother said to me today as our son waited his turn,

The sexual revolution continues...

...in the battle for reproductive choice.

The death of Helen Gurley Brown, long-time editor of Cosmopolitan magazine and advocate of women's sexual freedom, reminded me of these words, which I wrote in one of the first ever pages of my website.

While (in many countries) women now have greater freedom than ever before in terms of sex, their own bodies and their reproductive choices, until planned cesarean delivery is widely accepted as a legitimate birth plan, this journey will not be complete - as we discuss in Choosing Cesarean, A Natural Birth Plan.

Maternal request study: women are satisfied and educated

The main focus of this new U.S. research was on which nonmedical factors might be addressed in order to reduce record-high rates of cesarean delivery.

As such, the research is presented in terms of which factors affected the risk of having a cesarean most (e.g. "higher educational attainment was associated with an increased risk").

But look again at the study of 1308 Californian mothers;

Diabetes could bankrupt the NHS - and maternity care?

The Health and Social Care Information Centre have released a report showing that "Diabetes prescriptions have for the first time topped 40 million in year, a rise of nearly 50% on six years ago."

And in an interview with the Daily Mail, Barbara Young, Chief Executive of Diabetes UK, warns: "About 2.5 million people in England have been diagnosed with the condition and the number of people with diabetes is expected to reach 4.2 million in England by 2025.

"We face the real possibility of diabetes bankrupting the NHS within a generation."

What does this have to do with maternity care?

Brazilian women rebel against c-section births

Some, but not all.

The Associated Press article published this weekend, Rebelling against Brazil’s record C-section rate, women rediscover virtues of natural birth, makes for very interesting reading.

I'd like to draw attention to the reported information about how obstetetricians are paid - i.e. THE SAME for a cesarean as for a natural birth (and in fact the article provides an example of doctors being paid R$10 more for a natural birth).

Why is this important?

Israel: greater risk of PTSD with natural birth

This postpartum study of 89 women will not come as a surprise to organizations such as The Birth Trauma Association and Birth Trauma Canada, but more generally, the sometimes very traumatic experiences of mothers can be lost in descriptions of 'empowering and beautiful' births.

Study questions cesarean 'financial incentive' role

A frequent accusation in the cesarean debate is that doctors are carrying out more cesareans because they can earn more money this way than with a natural birth.

But a new study from Michigan State University in the U.S., which asked, Does medical insurance type (private vs public) influence the physician's decision to perform Caesarean delivery? has concluded that no, it doesn't.

10% risk of cesarean infection

There have been a number of articles reporting on the BJOG study today, and this is the comment I've posted on many of them:

Firstly, the study has shown a 9.6% rate of infection for ALL caesareans, the vast majority of which were emergencies and/or medically indicated. Of these, 88% were minor infections; which leaves us with a 1% total caesarean risk for serious infections.

Compare this with the risk of pelvic floor trauma in women who deliver vaginally:

Membership of The White Ribbon Alliance

My organisation, electivecesarean.com, has joined The White Ribbon Alliance For safe Motherhood, whose Mission, Vision and Principles include working to create a world where:

*It is a woman's basic human right to achieve optimal health care throughout pregnancy and childbirth for herself and her newborns.

*Women are empowered to demand quality, safe and respectful motherhood services and to help other women to do the same.