Highland Midwife

Location: Pacific Northwest Highlands, United States

Saturday, August 21, 2010

New Herb Site

My official website for the herbal tinctures and colloidal silver is now up and running. There is still a lot of info to post on it, and lots more herbs, but the basics are done! {Whew}

Take a look -
Silver Sage Herbs

Wednesday, August 11, 2010

2010 AOL Health

As if we needed another reason to want nice safe home births, here is a whopper:

"At least 103,000 lives are lost each year due to hospital-related infections..."

Read the article here:   AOL Health

2010 JPE Article

The Journal of Perinatal Education: They Said So on the News: Parsing Media Reports About Birth. Don't trust a source until you check facts for yourself.

Read entire article here:   JPE 2010

2010 Medscape

Science and Sensibility: Choice of Birth Place in the United States. A hard-core logical analysis of safety studies that sets the record straight. This is a great read! 

View here:  2010 Medscape

2009 BJOG Study

Study published in An International Journal of Obstetrics and Gynaecology of over a half million births reaffirms safety of home birth.

"Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births."

View details here:   BJOG_2009

2009 CMAJ Study

"Outcomes of planned home birth with registered midwife
versus planned hospital birth with midwife or physician"
Read complete study here: CMAJ_2009

2007 Stark Study

Compilation of studies:  "Every study that has compared midwives and obstetricians has found better outcomes for midwives..." 

View details here:  Stark, PhD 2007

2006 Boston Globe Article

The Boston Globe
For expectant women, it's not too much to ask

By Tina Cassidy | December 8, 2006

WHEN I TALK to women about the relatively recent history of childbirth -- mothers strapped to hospital beds, doctors not washing their hands between vaginal exams and performing caesareans without anesthesia -- their typical response is that we're lucky to live in this day and age.

That is true. But new dangers and indignities in standard maternity care have begun to replace the old ones. Most notably, health care providers are pushing expectant mothers to have medical interventions they may not need or want, and may be better off without.

A new survey unprecedented in scope of women who gave birth in the hospital last year found that women's wishes were not always respected and they were not necessarily asked permission before procedures.

The Listening to Mothers II report by Childbirth Connection , a New York group founded in 1918 to improve maternity care, revealed that 82 percent of women who experienced an episiotomy said they were not consulted first -- and so a doctor went ahead, without warning, and snipped the opening of the birth canal to make it wider. Of the women who wanted a vaginal birth after having had a caesarean , 56 percent said a doctor denied them that option.

One out of every 5 women polled who were induced said they felt pressured to have their labor artificially started. And 1 out of every 4 who had caesarean said they felt squeezed to have the surgery.

This is all rather alarming given that: unnecessary caesareans can be more dangerous than vaginal births for mother and baby, episiotomies have long been known to cause more perineal damage than a small natural tear, although the incision is often easier for doctors to repair, and Pitocin can over stimulate the uterus. Essentially, many of these routine procedures can complicate birth further, introducing dangers or making the experience more difficult for mother and child.

The irony is that women today are more in control of their reproductive lives than ever , choosing to delay pregnancy until the twilight of their fertile years, writing birth plans telling the doctor how they would like labor to proceed, inviting friends to witness their babies being born, and rejecting hospital johnnies in favor of their own Natori nightgowns. But such decisions can give some mothers a false sense of empowerment and, arguably, make them more vulnerable during birth.

It is also interesting to note that although society and the media have been fixated on the idea of mothers (a la Britney Spears) requesting caesareans out of convenience rather than medical need, only one woman surveyed, representing a fraction of 1 percent, said she asked for and received a c-section just because she wanted it. Meanwhile, the story that has not received enough attention -- this story -- is that women are being subjected to procedures they never expected, and perhaps should not have had.

Of course, there's no way to know just how many medical interventions chronicled in the survey were truly necessary, but 27 countries -- including Britain , Australia, Japan, and Slovakia -- have lower maternal mortality rates than America, according to the World Health Organization. Many of these countries also have higher midwifery rates and lower caesarean rates. More than 40 countries also have lower infant mortality rates than America, a country that spends twice as much or more per capita on health care than any other industrialized nation.

When it comes to birth, sometimes less is more.

And so, instead of automatically strapping on monitors to detect whether the baby is in distress (despite that these machines have not reduced cerebral palsy rates since being invented decades ago), connecting IVs (which can limit ambulation that helps the baby move through the birth canal), and casually reaching for the scalpel, health care providers should -- at the least -- ask women first.

Tina Cassidy is author of "Birth: The Surprising History of How We Are Born."
© Copyright 2006 The New York Times Company

Sunday, December 17, 2006

2006 World Statistics

Newborn Mortality in the Industrialized World

Newborn Deaths per 1000 Live Births*

Listed from best to worst:

(Rate = 2 or less / 1000)
1. Japan
2. Czech Republic
3. Finland
4. Iceland
5. Norway
(Rate = up to 3 / 1000)
6. Austria
7. France
8. Germany
9. Israel
10. Italy
11. Luxembourg
12. Portugal
13. Slovenia
14. Spain
15. Sweden
(Rate = up to 4 / 1000)
16. Australia
17. Belgium
18. Canada
19. Denmark
20. Estonia
21. Greece
22. Ireland
23. Lithuania
24. Netherlands
25. New Zealand
26. Switzerland
27. United Kingdom
(Rate = up to 5 / 1000)
28. Hungary
29. Malta
30. Poland
31. Slovakia
32. United States
(Rate = 6 / 1000)
33. Latvia

*Source: World Health Organization

Saturday, December 16, 2006

2006 Birth Research


1. American Public Health Association. (2001) 20004: Supporting Access to Midwifery Services in the United States (Position Paper). American Journal of Public Health. 91(3): 7-10.
The American Public Health Association takes a position in support of midwifery as a key strategy for improving access to care for childbearing families. In terms of quality, satisfaction, and costs, the midwifery model for pregnancy and maternity care has been found to be beneficial to women and families, resulting in good outcomes and cost savings.

2. Anderson, RE, Anderson, DA. (1999) The cost effectiveness of home birth. Journal of Nurse Midwivery. 44(1): 30-35.
This study lists average costs (1998, 1991, 1987) for home, birth center, and hospital births from data collected in U.S. The results show that home and birth center births are significantly less expensive than hospital births.

3. Baldwin, KA. (1999) The midwifery solution to contemporary problems in American obstetrics. Journal of Nurse Midwifery 44(1):75-79.
This article focuses on midwifery as one solution to many of the problems that confront contemporary American obstetrics. Documented evidence with historic perspective that supports the view that midwifery should become the mainstream in maternity care in the United States, not an alternative, is presented.

4. Campero L, Garcia C, Diaz C, Ortiz O. et al. (1998) Alone, I wouldn't have known what to do: A qualitative study on social support during labor and delivery and Mexico. Social Science and Medicine. 47(3): 395-403.
Sixteen in-depth interviews were held with women in the immediate postpartum period (eight of whom had been accompanied by a doula and eight who had not) before they were discharged from hospital, and the results were analyzed using qualitative techniques. The interviews showed that the women accompanied by doulas had more positive childbirth experiences. The differences between both groups related to their perceptions of the childbirth experience; the treatment they received from hospital staff; the information they were given and how well they understood it; their perception of hospital routines; and their feelings about cesarean sections.

5. Cawthon L. (1996) Planned home births: outcomes among Medicaid women in Washington State. Olympia: Office of Research and Data Analysis, Washington State Department of Social and Health Services.
This retrospective study found very low rates of poor outcomes among Medicaid women in Washington State who planned home births and received some or all of their prenatal care from licensed midwives.

6. De Koninck M, Blais R, Joubert P, Gagnon C. (2001) Comparing women's assessment of midwifery and medical care in Quebec, Canada. J Midwifery Womens Health 2001 Mar-Apr;46(2):60-7.
Two to three months after birth, 933 midwifery clients and 1,000 physicians' clients, matched on several characteristics, responded to a mailed questionnaire. Results showed that women from both groups were generally satisfied with the care they received, although women who received midwifery care were assessed as more positive on every issue surveyed. Midwifery clients had a greater number of and longer prenatal visits, they perceived their care to be more personalized, and more of them breastfed their infants.

7. Dower, CM, Miller JE. Taskforce on Midwifery. (1999) Charting a course for the 21st century: the future of midwifery. San Francisco: Pew Health Professions Commission and UCSF Center for the Health Professions.
The Taskforce offered recommendations incorporating its vision that the midwifery model of care should be embraced by, and available to all women and their families. To access the full report: Charting a Course for the 21st Century: The Future of Midwifery

8. Durand, AM. (1992) The safety of home birth: The Farm study. American Journal of Public Health. 82(3): 450-453.
In this study of 1,707 midwife-attended home births, birth outcomes were comparable to those for low-risk hospital births. The rate of operative assistance for home births was much lower than for hospital births. "Support by the medical and legal communities for those electing and those attending, home birth should not be withheld on the grounds that this option is inherently unsafe."

9. Gillis SL. (1995) Why do women in Washington State choose licensed midwives as their pregnancy and childbirth care providers and are they satisfied with their choice? Department of Women Studies. Seattle: University of Washington.
Gillis found several recurring themes which influenced women to choose a licensed midwife. These included desires for home birth; personalized care; control of their surroundings and bodies; and a healthy, intimate birth experience. She also found that women in her sample were very satisfied with their midwifery care.

10. Gordon NP, Walton D, McAdam E, et al. (1999) Effects of providing hospital-based doulas in health maintenance organization hospitals. Obstetrics and Gynecology. 93(3): 422-6.
A randomized study of 264 births showed that women attended by doulas during labor had significantly less epidural use and were significantly more likely to rate the birth experience as good than those who did not have doulas.

11. Hayes KE. (1996) Satisfaction with midwifery care among women who choose home birth: the development of a questionnaire. School of Nursing. Seattle: University of Washington.
In this review of the literature on satisfaction and home birth (typically attended by licensed midwives), Hays reported high satisfaction ratings by women who chose home birth. She also found that these women would make the same choice again.

12. Hodnett ED. (1999) Caregiver support for women during childbirth. Cochrane Library of Systematic Reviews. Electronic edition. May 17, 1999.
Fourteen clinical trials, involving more than 5,000 women, were analyzed. The continuous presence of a support person, (including nurses, midwives, childbirth educators, doulas, friends, or family members) reduced the likelihood of episiotomy, cesarean delivery, a 5-minute Apgar score of less than 7, and medication for pain relief. Continuous support was also associated with a slight reduction in duration of labor.

13. Janssen, P. et al. (1994) Licensed midwife-attended out-of-hospital births in Washington state: are they safe? Birth 21(3):141-148.
This study of Washington state birth certificate data, linked to infant death certificates, compared outcomes for births attended by licensed midwives, physicians, and certified nurse-midwives. On outcome measures such as low birth weight, five-minute Apgar scores, and neonatal and postneonatal mortality, the investigators reported no difference in outcomes between midwife-attended and physician-attended births.

14. Johnson, Kenneth C, and Daviss, Betty-Anne. (2005) BMJ 330:1416 (18 June) Outcomes of planned home births with certified professional midwives: large prospective study in North America.
The largest study of home births attended by Certified Professional Midwives; examined birth outcomes for 5,418 women, included all births with CPM's in North America during the year 2000, and found that home birth is as safe for low risk women and involves far fewer interventions than similar (low risk) births in hospitals. Surgical deliveries were very greatly reduced, and successful breastfeeding greatly increased in births attended by midwives compared with similar births in hospitals, and there were similar or even lower rates of mortality and morbidity with midwives.

15. Langer A, Campero L, Garcia C, Reynoso S. (1998) Effects of psychosocial support during labour and childbirth on breastfeeding, medical interventions, and mothers' wellbeing in a Mexican public hospital: a randomised clinical trial. British Journal of Obstetrics and Gynecology. 105(10):1056-63.
This study examined 724 births for the effect of social support provided by a doula. The frequency of exclusive breastfeeding one month after birth was significantly higher in the group of women attended by doulas, as were the behaviors that promote breastfeeding. More doula-attended women perceived a high degree of control over the delivery experience, and the duration of labor was shorter than in the group of women who did not have the services of a doula.

16. Law YY, Lam KY. (1999) A randomized controlled trial comparing midwife-managed care and obstetrician-managed care for women assessed to be at low-risk in the initial intrapartum period. Journal of Obstetric and Gynecology Research. 25(2): 107-112.
This study compared outcomes for 413 women attended by midwives and 637 women attended by obstetricians in a hospital setting in Hong Kong. Women attended by midwives had less oxytocin augmentation and intravenous infusion. Other outcomes were similar for both groups of women. Conclusion: "Midwife-managed care is as safe as obstetrician-managed care for women who [are] assessed to be at low-risk in the intrapartum period."

17. MacDorman, MF, Singh, GK. (1998) Midwifery care, social and medical risk factors, and birth outcomes in the United States. Journal of Epidemiology and Community Health. 52(5): 310-323.
This study compared birth outcomes and infant mortality rates for all births that took place in the United States in 1991 that were attended by physicians and certified nurse midwives. "For singleton, vaginal births at 35-43 weeks of gestation, the adjusted risk of infant mortality was 19% lower for certified-nurse midwife than for physician attended births; the risk of neonatal mortality was 31% lower."

18. Myers-Ciecko, J. (1999) Evolution and current status of direct-entry midwifery education, regulation, and practice in the United States with examples from Washington State. Journal of Nurse-Midwifery. 44(4): 384-393.
This article cites examples from Washington State to describe the reemergence of direct-entry midwifery in the United States. In Washington, state policies have supported the development of direct-entry midwifery and influenced the integration of professional direct-entry midwives into managed care systems.

19. Oakley D, Murray ME, Murtland T, et al. (1996) Comparisons of outcomes of maternity care by obstetricians and certified nurse-midwives. Obstetrics and Gynecology. 88(5): 823-829.
Pregnancy outcomes were compared for 710 women cared for by private obstetricians and 471 cared for by certified nurse-midwives. Outcomes for nurse-midwife clients were superior to those for obstetrician clients, including satisfaction with care, third- or fourth- degree perineal lacerations, number of complications, and infant remaining with mother for the entire hospital stay.

20. Olsen, Ole. (1997) Meta-analysis of the safety of home birth. Birth 24(1): 4-13.
This meta-analysis of six observational studies, including 24,092 primarily low-risk pregnant women, examined the safety of planned home birth compared with planned hospital birth. The principal difference in outcomes was a lower frequency of low Apgar scores in the home birth group. Also, fewer medical interventions occurred in the home birth group. "Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions."

21. Schlenzka, Peter F. (1999) Safety of alternative approaches to childbirth (Doctoral dissertation, Stanford University).
This examination of outcomes and intervention rates in midwife and physician care of women with uncomplicated pregnancies in California found a cesarean rate of 6.3% for women receiving midwifery care compared to 22.1% for women receiving physician care. The author projects a savings of over $2 billion annually in the U.S. if the cesarean rate were lowered to 10% of all births.

22. Scott KD, Berkowitz G, Klaus M. (2000) A comparison of intermittent and continuous support during labor: a meta-analysis. American Journal of Obstetrics and Gynecology. 8(17): 16, 19.
This meta-analysis of 11 clinical trials showed that continuous labor support, when compared with no doula support, was significantly associated with shorter labors, and decreased need for the use of any analgesia, oxytocin augmentation, cesarean sections, and use of forceps.

23. Scott KD, Klaus PH, Klaus MH. (1999) The obstetrical and postpartum benefits of continuous support during childbirth. Journal of Women's Health and Gender Based Medicine. 8(10): 1257-64.
The evidence from twelve individual controlled trials and three meta-analyses was examined. Emotional and physical support provided by doulas significantly shortened labor and decreased the need for cesarean deliveries, forceps and vacuum extraction, oxytocin augmentation, and analgesia. Doula-supported mothers also rated childbirth as less difficult and painful than did women not supported by a doula.

24. Spurgeon P, Hicks C, Barwell F. (2001) Antenatal, delivery and postnatal comparisons of maternal satisfaction with two pilot Changing Childbirth schemes compared with a traditional model of care. Midwifery 17(2):123-32.
In this British study, the birth outcomes of 215 women who received maternity care from midwives and 118 women who received care from obstetricians were compared. Midwifery-led care was much preferred by clients to obstetrician-led care and did not lead to any deficits in clinical outcomes.

25. State of Washington Department of Licensing. (1988) An assessment of childbirth outcomes in Washington SSB 5163 Report to the Legislature.
"Findings: certified nurse midwives and licensed midwives have a lower rate of negative outcomes than physicians and osteopaths, which indicates provision of services within the scope of practice and appropriate referral of potential problems to the medical community."

26. Turnbull D, Holmes A, Shields N, et al. (1996) Randomised, controlled trial of efficacy of midwife-managed care. Lancet 348(9022): 213-218.
This randomized controlled trial compared the birth outcomes of 648 women with low-risk pregnancies assigned midwife-managed care and 651 women with low-risk pregnancies assigned shared care. Women in the midwife-managed group were less likely than women in shared care to have induction of labor, more likely to have an intact perineum, and less likely to have an episiotomy. Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied. "We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care."

27. Zhang J, Bernasko J, Leybovich E, et al. (1996) Continuous labor support from labor attendant for primiparous women: a meta-analysis. Obstetrics and Gynecology. 88(4) part 2: 739-744.
This meta-analysis analyzed the data from four randomized clinical trials on the effects of continuous labor support that were published from 1965 to May, 1995. The analysis suggested that continuous labor support by a labor attendant shortens the duration of labor and doubles spontaneous vaginal birth (through lower incidence of cesarean sections, oxytocin use, and forceps use). Women with labor support also reported higher satisfaction and a better postpartum experience.

Many of the resources are located on Seattle Midwifery's site. Also visit Citizens for Midwifery's Resources pages, where much more information about the wonderful Johnson CPM study can be found.