Monday, January 23, 2006

Calendar of the Soul

Calendar of the Soul

[January 22, 2006 - January 28, 2006]

Forty-fourth Week

In reaching for new sense attractions,
Soul-clarity would fill,
Mindful of spirit-birth attained,
The world's bewildering, sprouting growth
With the creative will of my own thinking.

Sunday, January 22, 2006

Go Massachusetts!

Massachusetts Becomes First State to Prohibit Formula Marketing in

Boston, Dec 20, 2005
In a groundbreaking step for mothers and babies, Massachusetts became
the first state to prohibit hospitals from giving out free formula
company diaper bags to new parents. Giving out these bags reduces the
duration and exclusivity of breastfeeding and is considered unethical by
many national and international groups, including the World Health
Organization. Multiple studies, even from prestigious medical journals
such as the Lancet, have shown that the bags interfere with
breastfeeding, causing moms to switch to formula sooner, or quit nursing
altogether-- even when the bags do not contain formula samples.

For decades, formula companies used hospitals to hand out diaper bags
stocked with coupons and free samples. Most parents see these as a "free
gift," but the bags are a marketing technique that implies that the
hospital endorses the product, successfully boosting sales of formula at
the expense of breastfeeding. "One day, formula marketing in hospitals
will go the way of cigarette ads on TV," said Melissa Bartick, MD, Chair
of the Massachusetts Breastfeeding Coalition.

The new rules on formula marketing are part of a much larger update of
existing perinatal regulations written by the Department of Public
Health and today approved by the Public Health Council. Hospitals must
follow DPH regulations in order to be allowed to operate in the state.
The regulations contain many other mandates that help promote and
support breastfeeding and otherwise limit formula marketing.

In banning the distribution of these items, the DPH acknowledges that
there is no medical justification for the institutional marketing of
formula products to new parents. The vast majority of hospitals in
Massachusetts and the US give out free diaper bags containing formula to
new moms, and also accept free formula for in-hospital use. This
marketing practice deviates from the standards followed by health care
providers and hospitals in every other respect. For example, hospitals
do not give out coupons for name-brand clothing, name-brand foods
outside of maternity. "We'd never tolerate the thought of hospitals
giving out coupons for Big Macs on the cardiac unit," said Dr. Bartick,
an internist. Since lack of breastfeeding is clearly associated with
multiple adverse health outcomes in children and mothers, distribution
of formula marketing materials by hospitals and health care providers
has been recognized as unethical since at least 1981, when the World
Health Organization approved the International Code of Marketing of
Breastmilk Substitutes.

Members of MBC on the taskforce that drafted the new regulations helped
make the case for eliminating the diaper bags. The formula bags may
actually cost families money: "Not only is there the expense of formula,
but parents and society end up paying for medications and time lost from
work to care for a sick child," says Dr. Kimberly Lee, a neonatologist
at Beth Israel Deaconess Medical Center in Boston.

As proof of the companies' influence, Dr. Lee notes that parents almost
always continue to use the brand of formula their baby got in the
hospital - and those formulas are typically the most expensive. These
new regulations will go far in improving the quality of care to mothers
and their newborns.

Saturday, January 21, 2006

Betsy's Wise Words...

trust and surrender
How do we access a deep trust in the universe, a deep trust that everything that happens in our life is an opportunity for us to learn from, to grow from, to move forward on our path with?
How do we trust that life provides us with what we need, maybe not what we want, but certainly what we need to learn our life lessons from?
How do we accept the things that happen to us as gifts, welcoming them with appreciation and gratitude, and be open to what those gifts are?
How do we learn to trust that we have come to this life equipped with the power, the strength, and the wisdom that we need in order to move forward, move through that which we need to move through?

I think of the women I observe in labor....
They learn through the journey of pregnancy and labor how to trust their to trust that their bodies were made to do this, that their bodies know how to birth their babies. They learn how to surrender to the powerful forces that ride through their bodies in waves, opening their wombs, their hearts, their minds, to finally deliver of their own efforts the life they have created. Fighting and pulling away from these inevitable contractions can prolong their effects, while surrendering can open us more.
And so it seems in life, what we fight inside of ourselves and in what happens to us, only comes back again and again until we fully learn from it and move through it.

May we all access our power and beauty and learn to co-create a beautiful and peaceful world in which to live.

January Births

So there is this rule in midwifery. If you want to go to a birth you don't say "tonight is the night" because it just won't happen. And if you don't want to go to a birth you can't say "no babies for blank days" or whatever...Recently though this rule was broken....I was called to a birth around 11 pm on a Wednesday night and after the birth (around 11pm Thurs) one of the midwives I worked with said "ok. NO more births for at least a few days." Needless to say, about 2 hours after arriving home and finally being snuggled down in my bed, I got the phone call: another woman in labor, 6 cm. dilated. Grrr. So off I went on virtually no sleep...
Both births were long and hard, not that birth is at all easy, but we as the birth attendants had to pull out our bag of tricks--herbs, homeopathics, visualization, soft and firm encouragement, position changes, hip rotations--and then we had to let it all go and just trust our own knowing that these women were strong, powerful, and going to birth beautifully at home.
The first baby was born in the water, with the amniotic unruptured. This little white ghost came swimming out and then behind and into it the head. Dad's hands right there with mine, waiting. Behind the white film of the amniotic sac (caul) I could see tufts of hair floating in the water, and the smallest, sweetest ears. The baby moved slowly, with his mother's body, birthing shoulders and heart and limbs into Dad's waiting arms. And then we brought this new, calm spirit up to Mom's heart so she could discover and fall more deeply in love with his perfect face and perfect soul...The old wife's tale goes that babes born in the caul are put on this earth as spiritual leaders, healers, or midwives...

Wednesday, January 18, 2006


This is an article from ACOG from
ACOG Releases Guidelines for Vaginal Birth After Cesarean Delivery

matthew j. neff

The American College of Obstetricians and Gynecologists (ACOG) recently issued clinical management guidelines for vaginal birth after cesarean delivery (VBAC) in various situations. The complete guideline, ACOG Practice Bulletin no. 54, appeared in the July 2004 issue of Obstetrics and Gynecology.

According to the report, the cesarean delivery rate in the United States increased from 5 percent to nearly 25 percent between 1970 and 1988. The authors attribute this increase to pressure on physicians to not perform vaginal breech deliveries and midpelvic forceps deliveries, and an increasing reliance on continuous electronic monitoring of fetal heart rate and uterine contraction patterns. Several large series found that a trial of labor after a previous cesarean delivery was relatively safe, prompting organizations such as the National Institutes of Health and the ACOG to endorse VBAC as a way to reduce the number of cesarean deliveries in the United States. Between 1989 and 1996, the cesarean delivery rate decreased as the VBAC rate increased. However, reports of uterine rupture and other complications during trials of labor after previous cesarean deliveries caused this trend to reverse.

No randomized trials have compared maternal or neonatal outcomes for repeat cesarean delivery and VBAC. Rather, VBAC recommendations have been based on data from large clinical studies suggesting that the benefits of VBAC outweigh the risks in most women with a previous low-transverse cesarean delivery. Most of these trials have been performed in university or tertiary-level centers with in-house obstetric and anesthesia coverage. ACOG notes that only a few studies have documented the relative safety of VBAC in smaller community hospitals or facilities where resources may be more limited. The report adds that women who fail a trial of labor are at risk for several maternal complications, including uterine rupture, the need for transfusion, hysterectomy, endometritis, and perinatal morbidity and mortality.

Clinical Considerations and Recommendations

According to the report, the evidence suggests that most patients who have had a low-transverse uterine incision from a previous cesarean delivery and who have no contraindications for vaginal birth are candidates for a trial of labor. Criteria for selecting candidates for VBAC include the following: (1) one previous low-transverse cesarean delivery; (2) clinically adequate pelvis; (3) no other uterine scars or previous rupture; (4) a physician immediately available throughout active labor who is capable of monitoring labor and performing an emergency cesarean delivery; and (5) the availability of anesthesia and personnel for emergency cesarean delivery.

The report also discusses other specific obstetric circumstances where a trial of labor may be offered. According to the report, for women who have had two previous low-transverse cesarean deliveries, only those with a previous vaginal delivery should be considered candidates for a spontaneous trial of labor. They state that 60 to 90 percent of women attempting a trial of labor who give birth to infants with macrosomia are successful, and the rate of uterine rupture appears to be increased only in women who have not had a previous vaginal delivery. Awaiting spontaneous labor beyond 40 weeks of gestation decreases the likelihood of successful VBAC but does not increase the risk of uterine rupture. According to one case series and four retrospective studies, women who have had a previous low-vertical uterine incision were just as likely to have successful VBAC as women who have had a previous low-transverse uterine incision. Two trials showed no significant difference between rates of successful VBAC and uterine rupture between women with twin or singleton gestations.

Success rates for trials of labor

Most published series of women attempting a trial of labor after a previous cesarean delivery demonstrate that 60 to 80 percent have successful vaginal births. ACOG reports that for an individual patient, there is no completely reliable way to predict the success of a trial of labor. Success rates are similar for women whose first cesarean delivery was performed for a nonrecurring indication and for women who have not undergone a previous cesarean delivery. Although most women who have undergone a cesarean delivery because of dystocia can have a successful VBAC, the percentage may be lower (50 to 80 percent) than for those with nonrecurring indications (75 to 80 percent). Women who have given birth vaginally at least once are nine to 28 times more likely to have a successful trial of labor than women who have not given birth vaginally. The likelihood of failure of a trial of labor is reduced by 30 to 90 percent if the most recent delivery was a successful VBAC. The likelihood of successful VBAC is impacted negatively by labor augmentation and induction, maternal obesity, gestational age beyond 40 weeks, interdelivery interval of less than 19 months, and birth weight greater than 4,000 g (8 lb, 11 oz).

Risks and benefits associated with VBAC

Repeat cesarean delivery and VBAC both have risks. Successful VBAC generally is associated with shorter maternal hospitalizations, fewer infections, less blood loss and fewer transfusions, and fewer thromboembolic events than cesarean delivery. However, a failed trial of labor may be associated with major maternal complications, such as hysterectomy, uterine rupture, operative injury, increased maternal infection, need for transfusion, and neonatal morbidity. Multiple cesarean deliveries are associated with an increased risk of placenta previa and accreta.

With VBAC, the incidence of maternal death is extremely low. The incidence of perinatal death is less than 1 percent, and is more likely to occur during a trial of labor than an elective repeat cesarean delivery.

Uterine rupture during a trial of labor after a previous cesarean delivery is a life-threatening complication directly associated with attempted VBAC. The patient's obstetric history influences the risk of uterine rupture. A previous vaginal birth significantly reduces the risk of uterine rupture. Also, the longer the length of time between deliveries, the lower the risk of rupture. Women who attempt VBAC who have interdelivery intervals of less than 24 months have a two- to three-fold increased risk of uterine rupture compared with women whose interdelivery interval is more than 24 months.

Induction or augmentation of labor

A successful VBAC is more likely to result from spontaneous labor than labor induction or augmentation. The report states that evidence shows that cervical ripening with prostaglandin preparations increases the likelihood of uterine rupture. Misoprostol also has been associated with a high rate of uterine rupture in women with a previous cesarean delivery. The report recommends not using prostaglandins for induction of labor in most women with a previous cesarean delivery.

Midtrimester delivery

The decision to attempt a trial of labor in the midtrimester in women with a previous cesarean delivery should be based on the patient's individual circumstances, including the number of previous cesarean deliveries, placentation, gestational age, and the woman's desire to preserve reproductive function.

Summary of Recommendations

The following recommendations are based on good and consistent scientific evidence (Strength of Recommendation Taxonomy [SORT] = A; see page 1201 for an explanation of SORT):

• Most women with one previous cesarean delivery with a low-transverse incision are candidates for VBAC and should be counseled about VBAC and offered a trial of labor.

• Epidural anesthesia may be used for VBAC.

The following recommendations are based on limited or inconsistent scientific evidence (SORT = B):

• Women with a vertical incision within the lower uterine segment that does not extend into the fundus are candidates for VBAC.

• The use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged.

The following recommendations are based primarily on consensus and expert opinion (SORT = C):

• Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.

• After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat cesarean delivery should be made by the patient and her physician. This discussion should be documented in the medical record.

• Vaginal birth after a previous cesarean delivery is contraindicated in women with a previous classical uterine incision or extensive transfundal uterine surgery.