Comments for Giving Birth With Confidence

Comment on Do We Need a Cochrane Review to Tell Us that Women Should Move in Labor? by Science & Sensibility » Repost: Do We Need a Cochrane Review to Tell Us that Women Should Move in Labor?

Mon, 04 May 2009 14:40:53 +0000

[...] Read the full post and leave comments at The Giving Birth with Confidence Blog. [...]

Comment on Why the largest study of planned home births won’t sway ACOG by Science & Sensibility » YouTube Delivers Where a Maternity Care System Doesn’t?

Sun, 03 May 2009 12:31:31 +0000

[...] warning of a maternity care system that doesn’t function as well as it could. In an era when home birth and birth centers are under attack, while a possible flu pandemic is making hospitalization a risky [...]

Comment on A “Ripe” New Market by Science & Sensibility » Repost: What’s Behind the Cochrane? (or…, “The Good News About Midwives Gets Better!”)

Wed, 22 Apr 2009 12:35:57 +0000

[...] be woefully misleading, even when it is not carefully orchestrated by those with a vested interest (which it often is). Being advocates for “evidence-based care” means not just knowing that a study has been [...]

Comment on Rotating Theories of the Increasing C-section Rate: Vitamin D Edition by Science & Sensibility » Repost: Rotating Theories of the Increasing C-section Rate: Vitamin D Edition

Tue, 21 Apr 2009 17:59:07 +0000

[...] Read the full post and leave comments at the Giving Birth with Confidence Blog. [...]

Comment on Why the largest study of planned home births won’t sway ACOG by Amy Romano

Amy Romano — Tue, 21 Apr 2009 01:14:09 +0000

Thanks for posting this, Peggy. I am a big supporter of MANAStats, and in fact contribute data from my midwifery practice. When this data becomes available for researchers, it will be a gold mine for investigating home birth practice and outcomes. I am also delighted that the collaboration with ACNM and AABC is moving forward, so that we can continue to collect data on midwifery care in all settings. If only such data were collected for all women in all settings going to all kinds of providers (like in the Netherlands!) If ACOG supported such an effort, we could make huge leaps forward in understanding and improving our maternity care system and improving the health of women and babies. Until then, midwives will chug along with our datasets, continuing to demonstrate our outcomes and improve our profession!

Comment on Why the largest study of planned home births won’t sway ACOG by Peggy

Peggy — Mon, 20 Apr 2009 16:30:16 +0000

The Midwives Alliance Division of Research maintains a database of (mostly) out-of-hospital births that is capable of addressing homebirth outcomes with statistical power. Pregnancies are logged prospectively and all records are reviewed for errors. Data is entered, when available, for all clients referred out in pregnancy or transported during labor. The database now contains over 12,000 completed and reviewed records, many thousands more awaiting review and many thousands more awaiting the completion of the pregnancy. Thousands of births are added every year. In addition, the Midwives Alliance has entered into a collaborative agreement with the America College of Nurse-Midwives Division of Research and the Association of Birth Centers Research Committee to identify a core set of common data elements with the same definitions so that there will be congruency among all midwifery datasets. This work will be reported on at the ACNM Annual Meeting in Seattle in May.
This will eventually create the ability to study many aspects of midwifery processes and outcomes in all settings and with all providers. Midwives Alliance data will be available soon. Interested readers should keep an eye on the main MANA webpage http://www.mana.org for notice of its availability.
We owe it to ourselves to collect this information and study all these important topics, whether ACOG pays any attention or not!!!!!

Comment on Do We Need a Cochrane Review to Tell Us that Women Should Move in Labor? by Amy Romano

Amy Romano — Sat, 18 Apr 2009 23:35:12 +0000

Thanks Jill for your comments, and for welcoming me to the blogosphere, where you have held court with a wonderful blog of your own!

One of the big problems we face in maternity care is that evidence-based practice has come on the scene so late that “comparative effectiveness research” (testing one intervention against another or “placebo”) is too often comparing the frying pan with the fire, e.g., one ineffective or harmful treatment against another ineffective or harmful treatment. What we really need in maternity care is a lot more placebo - i.e., don’t fix it if it ain’t broke. Our system has lost sight of the basic needs of laboring women - support, comfort, movement, nutrition, hydration, patience, freedom to move/vocalize/ask for help, and so on. Only when these needs are met and labor *still* isn’t progressing, or the baby is in distress, or her pain is overwhelming, must we swoop in with modern medicine to safely get the baby out. But to deny women these elements of care and then “treat” problems that occur as a result is just plain bad medicine.

Comment on Do We Need a Cochrane Review to Tell Us that Women Should Move in Labor? by Jill-- Unnecesarean

Jill-- Unnecesarean — Sat, 18 Apr 2009 14:56:15 +0000

By the way, Amy, I’m really glad you’re blogging.

Comment on Do We Need a Cochrane Review to Tell Us that Women Should Move in Labor? by Jill-- Unnecesarean

Jill-- Unnecesarean — Sat, 18 Apr 2009 14:55:51 +0000

It is actually absurd (and not in the funny way) that supporters of normalcy in birth have the onus of proof. Publicizing studies that “prove” common knowledge is good because of the trickle up effect. A woman says she heard that she can eat in labor and tells her care provider, who might go read the study and maybe tell a colleague, who might join them in changing hospital policy, etc.

But really, do we need to produce evidence that vaginal birth is superior health-wise (not morally) to cesarean surgery? Do we need to provide evidence that carrying babies to term is healthier than inducing at 38 weeks, which is a common practice? Do we need to prove that species-specific milk is superior to something from a can?

There’s a internet skeptic culture that makes me laugh because I think they have no idea how ridiculous they look. No RCT? Then it doesn’t exist or happen. Who’s to say the c-section rate is too high? Are there studies to show that these cesareans were not necessary? Then we must assume that they were necessary until proven otherwise. These people (almost always claiming to be physicians) pop in to comment threads to say that if it weren’t for modern medicine and science, women would be dying in childbirth in drove like they did 100 years ago. No other variables there? Just medicine?

It’s not good, hard science. It’s not skepticism or they would be equally skeptical of poor obstetric practice that defies both evidence and common sense. So if it’s not science and not skepticism, it’s really just doctors feeling demonized and wanting to defend their and their colleagues’ profession. Their positions are spot on ONLY if you operate from the assumption that there are no medical errors and the clinical judgment of a physician is always correct. Toss in a few red herrings about the allegedly rare and isolated cases of practice-gone-awry (and subsequently suspension of the pariah’s license) and then the big picture can be totally ignored.

Comment on NICUs: If We Build It, They Will Come? by Amy Romano

Amy Romano — Fri, 17 Apr 2009 03:20:34 +0000

That baby needed to be with its mother! And the baby and mother were so fortunate you were the nurse there that day. Preterm babies need skin-to-skin contact, late cord clamping, and the whole “package” of physiologic transition even more than term babies, as you well know. Of course some need another level of care, but for the babies on the margins, why can’t that extra observation happen with the baby in its mother’s arms? It’s simple, healthy, and it works!