Useful site for medical literature

A (medical) student’s guide to medical literature site: designed especially for medical students but can be used by anyone who wants a guide to the medical literature. Quite useful to those of us wanting to understand for ourselves what science reveals about birth insofar as it has been studied by the medical industry, or community.

“If you are having trouble researching a medical question, or want an easy guide to critical appraisal of journal articles, this is the site for you!”

Some of the features of this site are:

• A Tutorial outlining a simple 4-step approach to reading medical literature

• Search Strategies with links to the best web sites

• A Guide to Critical Appraisal of journal articles with step-by-step explanation of the “User’s Guide approach

•  An interactive Glossary with over 150 statistical terms hyperlinked to the text

• Calculators for finding relevant outcome measures from a study

• Student’s Guide Pocket Version to use on your Palm or Pocket PC

Childbirth classes no longer needed?

Busy times, as usual. Classes are hectic, the holidays brought guests and much-enjoyed socialization and much-appreciated camaraderie and closeness, and traveling is on the horizon. Little time right now for the essays, my book. Now and again only can I check in with the listservs or email groups. Here is something of interest you may have already seen, though I see the blog is still getting comments even today. Columnist Tara Parker-Pope reports on her Well blog that pregnant women “cutting childbirth class.” Before going to the content, I must say how grateful I am to see her use of the word “women” rather than the usual “ladies” (yes, truly!) that I am seeing all the time on certain email groups. Ladies! Parker-Pope says:

Although women are more obsessed than ever with health during their pregnancies, they seem to have lost interest in learning about the end of pregnancy, also known as childbirth, reports the November issue of Fit Pregnancy magazine.

“Fewer women are taking classes,’’ said Jeannette Crenshaw, president of Lamaze International. Ms. Crenshaw told the magazine that she believes several issues explain why women aren’t as interested in learning about childbirth. Many women, she says, are convinced they can’t deliver a baby without epidural pain relief. Television shows often depict birth as a dangerous event, even though serious problems are exceedingly rare among women delivering in the United States. And because many women work until nearly the last day of pregnancy, busy schedules often prevent them from scheduling a birthing class.

Marjie Hathaway, co-director of the American Academy of Husband-Coached Childbirth, which teaches what’s known as the Bradley Method of natural childbirth, also told the magazine that interest in childbirth classes has waned. “Today, women are more focused on prenatal testing and monitoring the pregnancy than in learning how to give birth,’’ she said.

Research shows that there’s no real difference in pain, labor interventions or birth outcomes among women who take childbirth classes and those who don’t, the magazine reports. The classes appear to attract women who are the most vigilant about their health during pregnancy. Women who enroll in a childbirth class are more likely to have quit smoking, keep prenatal appointments and to breastfeed after birth, the magazine notes.

…

But today hospital-based classes tend to focus more on a tour of hospital facilities rather than techniques to cope with labor pain. The magazine argues that women’s declining interest in childbirth classes is worrisome because it’s happening even as childbirth has become more “medicalized’’ than ever. During childbirth, a number of variables can arise and women have to make informed decisions about procedures like epidurals, episiotomies, induction and C-sections. “That’s where you reap the dividends of having had a teacher who explained each possible intervention and showed you how to be your advocate,’’ the magazine reports.

What is most instructive and interesting, however, as is often the case, is to be found in reading the comments.

ICAN webmaster asks for help

The ICAN webmaster wrote in to the support group email list today asking for list members to help get the ICAN website up higher in Google searches. Evidently, her Google search last night for the term “VBAC” did not return ICAN until page 12.  I think she is right to say that “no one is ever going to go 12 pages to find ICAN.” She makes specific requests to help change the situation. One is to make a post with a link to a new YouTube video, which I am happy to do. The video is attempting to make the point that many women who were told that cephalopelvic disproportion (CPD) — “the baby’s head is too large to fit through the pelvis” — necessitated that they have a c-section. In fact, CPD is not so prevalent as the medical professionals are seemingly so quick to have their patients believe. The video documents the birth weights/sizes of the c-sectioned babies of mothers who were told they had CPD and the same stats of the subsequent babies’  born to these same women via VBAC (vaginal birth), and in some cases, HBAC (home birth). The point is documented clearly so do pass it on to those who could use this education. You can find the video here (Try to ignore the music choice!)

My hope is to have time in the near future to spend some more time on the ICAN issues, as well as other birth activism groups and issues. I have been asked many times about the information I posted so long ago about my seeking the information regarding the organization’s membership, work, goals, and so on, and I have had to continually say that I am getting to it! Sorry to report that I am still short of the time to give this the attention it deserves. However, thank you for the inquiries and for bearing with me.

Gift your organization

Every year for the holiday season in place of money we might spend on gifts to one another, my family gives a contribution to a worthy organization. This year we decided we wanted to support an organization that is doing good for pregnant women, mothers and babies. For several months now, I have been studying several organizations to see which might actually be the doing the most good. We now have decided the National Advocates for Pregnant Women will get our support this year. You can read about NAPW at their website. Here is what Katha Pollitt, The Nation, said about NAPW:

This spirited group, headed by the brilliant civil liberties lawyer Lynn Paltrow, supports the rights of poor, often minority, sometimes drug-using women to respectful healthcare and social services, and fights punitive “fetal rights” prosecutions and legislation. The women NAPW supports are at the center of a perfect storm made of antichoice politics, racism and the “war on drugs”: They need support and treatment, not to be arrested in their beds in the maternity ward, as happened in South Carolina, and clapped into prison. Pregnant women have constitutional rights too. And remember, as with all civil liberties issues, today it’s them; tomorrow it could be you. Send checks to 153 Waverly Pl., 6th floor, New York, NY 10011

I am very pleased with our choice.

Cyberbullying — thinking, part II

Online, some good information on bullying in the midwifery profession provides insight into how this may work with women on email lists, listservs, or groups. This comes from Midwifery Today .

So many times I hear it characterized as conflict among “powerful women”—as though we are bullying one another simply because we are so strong. The truth is that our bullying reflects the fact that we are powerless and fearful.

Horizontal violence — hostile and aggressive behavior by individual or group members towards another member or groups of members of the larger group

“Bullying is not about anger. It is not a conflict to be resolved. It is about contempt—a powerful feeling of dislike toward someone considered worthless, inferior or undeserving of respect. Contempt allows [bullies to harm others] without feeling empathy, compassion or shame.” This sense of contempt frees a bully to feel “[a] sense of entitlement…an intolerance to difference…and a freedom to exclude, bar, isolate, and segregate others.”

Identifying the fact that [midwives] are an oppressed group with the fears endemic to counterculture groups—such as isolation, ridicule and economic suppression—allows us to develop a language to prevent mimicking the painful behavior of the dominant medical hierarchy.

And so, to the last, substitute women who have felt victimized in place of midwives, and it is quite well understood how this can take place, this mimicking of the painful behavior — this redirection of aggression onto  other women. All in the guise of “not being politically correct” or “not sugar-coating,” as I have heard such excuses made.

But I am much too tired after a long night of work and writing, and must call it a night. I am hoping to be able to return soon to my essay, dealing with my mother and aunt and their strength of support through everything other than speech. For this, I need a quieter head and heart, which means rest and solitude.

Thank you to all my readers. It is fun to watch the stats each day climb higher and higher. I will hope to have useful information  posted soon on all I am learning about VBACs, HBACs, and, of course, c-sections.

Birth Stories by Rachel

I am far behind on everything. Have been traveling and finishing grant documents that are due. I am preparing a presentation on cyber bullying. Still, trying to gain trace of my records of retired OB and no longer in existence hospital. So, so much to do but all intriguing and energizing. Meanwhile, here are Rachyl’s birth stories. Be sure to read about her MA thesis, Composing Birth.

The birth of Grey Forest Walt

The birthrite of Samuel Rune

Uterine rupture rates for classical c-section

I am considering having a baby with my new husband, which means a lot of research for me as a 38-year old with 2 previous c-sections behind me and I will only consider having a VBAC (vaginal birth after caesarean), preferably a HBAC or homebirth. My incisions were classical, meaning long and vertical and not low and transverse, or horizontal, as most are today. It has been about 13 years since the last c-section.

Here I will compile the beginnings of my findings on uterine rupture rates for incisions like mine, of classical c-sections. This is what comes to light through a cursory search, but I will add more as I find it.

As frightening as this sounds, we know through medical research that uterine scar breakdowns (and especially uterine ruptures) are relatively uncommon events, occurring in 5-12% of classical incisions and 1/2 of 1% of low-transverse incisions.

http://home.cfl.rr.com/dahmd/vbac.htm

by D. Ashley Hill, MD,
OBGYN.net Editorial Advisor,
Associate Director – Department of Obstetrics and Gynecology,
Florida Hospital Family Practice Residency, Orlando, Florida

Prior classical uterine incision is associated with a rate of uterine rupture of up to 12%.

http://www.phyins.com/pi/risk/minimize/vbacs.html

Classic cesarean delivery is infrequently performed in the modern era and currently account for 0.5% of all births in the United States (Chauhan, 2002). In a meta-analysis, Rosen et al (1991) reported an 11.5% absolute risk of uterine rupture (3 of 26 cases) in women with classic vertical cesarean scars who underwent an unplanned TOL. Chauhan et al (2002) reported that the uterine rupture rate for 157 women with classic uterine cesarean scars was 0.64% (95% CI, 0.1-3.5%). All patients underwent repeat cesarean delivery, but a high rate of preterm labor resulted in 49% of the patients being in labor at the time of their cesarean delivery.

Landon et al (2004) reported a 1.9% absolute uterine rupture rate (2 of 105 cases) in women with a previous classic, inverted T, or J incision who either presented in advanced labor or who refused repeat cesarean delivery. These rates of frank uterine rupture in women with classic cesarean deliveries are in contrast to the higher rates of 4-9% that the American College of Obstetricians and Gynecologists (ACOG) had historically reported for women with these types of uterine scars. However, Chauhan et al (2002) observed a 9% rate of asymptomatic uterine scar dehiscence (95% CI, 5-15%). This result suggests that disruptions of uterine scars might have been misclassified as true ruptures instead of dehiscences in previous studies; this error may explain the bulk of the discrepancy.

http://www.emedicine.com/med/topic3746.htm

(Australian VBAC study) Major uterine rupture, before or during labour, after a classical Caesarean section is 5%.

http://www.birthrites.org/guidelines.html

On the other hand, Midwifery Today:

There are a number of contraindications to VBACs that the vast majority of obstetricians and most midwives agree on. Most of these involve significantly higher risks to mother and baby due to increased rates of uterine rupture. There are, of course, anecdotes of successful VBACs in these situations, but the statistics reveal accelerated risks.

These situations include: classical (vertical) scar on the uterus, T- or J-incision on the uterus, previous surgery through the full thickness of the uterine muscle (example, myomectomy), truly contracted or deformed pelvis, inability to perform an emergency cesarean delivery if needed, obstetrical complications that preclude vaginal delivery (example, placenta previa), and a woman’s refusal to have a Trial of Labor/VBAC.

http://www.midwiferytoday.com/articles/vbacprimer.asp

Choosing organizations to support

For a few months, I have been participating in ICAN’s online support group, through Yahoo. I have been trying to decide if I would like to become a member of ICAN, but the website offers very little information. Last week I posted a list of my questions but no one has responded, other than to say, that they were forwarding the list to the president of the organization.

Shouldn’t this information be readily available to all? Shouldn’t anyone else be able to answer it?

I will post my email questions and list below.

Not unsurprisingly, some women on the list give answers, such as my membership fee buys me happiness at supporting ICAN’s work. But what is that work, exactly? How do you know what you are supporting? Are you supporting self-appointed board members’ travel to what end? A mission statement is fine, but where are the annual reports, the accountability that shows how people’s money is being used to support the mission statement?

Another example of answers is  “as for who gets what position, I trust the women on the board to choose who they think is best.” Imagine! The irony is that the women who are volunteering answers like this are the same women who say they never should have trusted OBs or the medical professionals because they wound up with c-sections.

Here was my email:

It looks like some good work was done. I have been reading through the ICAN website trying to learn a few things about the organization before becoming a member. But I don’t see answers to several questions:

1. To become a member you must become a member at a local level, achapter, yes?

2. How do members vote for the board members?

3. How do board members become board members if there is no membership-based nomination and procedure?

4. What are the voting rights that come with the membership?

5. In other words, what is the voice of the individual member in the organization?

6. What is the membership “buying” a member? Other than Clarion, discounts?

7. That is, if it is to do advocacy, etc, I don’t see any annual reports that show how the membership fees are being spent or
contributing to the organization’ s goals, so am I looking in the wrong place? I believe NPOs must make public these facts, right?

8. Is there a strategic plan in place? Projected plans for spending/budgets.

9. These open positions do not show on the website, where I was looking to see how one can be considered to fulfill the position. How does that happen, and what is the process for selecting the ones who fill the position?

10. If you can only join local chapter, if you move within a short time, does your membership move with you to your “new” local chapter?

Let us stay tuned to see if anyone will respond.

Simplify

There is too much to keep up with. Notes everywhere. Emails fill the inboxes and don’t stop. I need respite! So many good women, and people, and friends want to know what is going on. I have decided that having this blog here can be a good way for them to know what is happening, as well as a good place for me to put all the random extra stuff while I am doing the work on my book and other projects.

Recently, it has been found out that the ICAN “moderators” have been BCC (blind copying) private emails that they start with members of the ICAN support group list. Now I will keep all my emails public to the list, which is a shame, because there have been the starts of what seemed to maybe be the beginnings of good private email friendships with these women who emailed be privately off the list. But who can tell who can be trusted, and who is doing this and who is not? I think that this ICAN acts more like a clique or a club than an organization to be taken seriously.

No doubt I will be writing more about this as time goes on. Very disappointing.