Fascinating Stuff

First, thanks everyone for replying and letting me know how you're finding me! I find that ever since I left xanga and came over to blogspot, that I've had fewer readers. So for now, I keep hoping people will just keep checking and I guess I'll keep posting it on FB! :-)

So, on October 16th I attended the 8th Annual Perinatal Education Day at Douglas College. This is necessary for me to keep up to date with the latest in perinatal health. As usual, it was a fantastic day chock full with fabulous information. Never boring! (So yes, this is a "birth" blog ...you can stop reading now James). :-)

Just wanted to share some of what I learned.
First, we had two presenters. One was Penny Simkin .....some of my readers will know exactly who she is ......and the other was .................... drum roll ...........Doctor MARK SLOAN!

Yeah. Not the Mark Sloan of Grey's unfortunately. Besides what would McSteamy have to say about birth eh?

But seriously, his name was Mark Sloan, and he started his talk with dispensing with the whole Grey's character thing. :-)

Anyways - he did a presentation on "Pain and Politics", taking us through a history of labour pain management.

He went as far back as A.D. 23-79 with Pliny the Elder who documented labour pain remedies like ground earthworms, eel gall, snake tongues, powdered donkey hoof. UGH!
Then to the Middle Ages - where mandrakes was a common herb plant to deal with pain. And alcohol too. (hey - that does work well! -- but I shudder to think of the problems with babies in the immediate postpartum!).

Then he took us to 1848 - 1900 - the age of Chloroform. Queen Victoria of England - mother of nine was the one who really pushed for it. She apparently hated being pregnant and hated giving birth. "I think much more of being a cow or dog at such moments, when our poor nature becomes so animal and unecstatic" - can you relate to that?

An interesting historical tidbit - her daughter Victoria's first son was born with shoulder dystocia and had permanent brachial plexus injury - he was Kaiser Wilhelm II of Germany.

There were serious objections to using chloroform - and the religious objections included that God intended for women to have pain, and therefore the pain shouldn't be dulled. We still hear that today! But when Queen Victoria used chloroform successfully for her 8th and 9th children, the powers that be couldn't object to it anymore. However, after that, more and more doctors started using it without due care and attention leading to overdosage and overuse, leading to more maternal and infant deaths.

Then in the early 1900's came Twilight Sleep. It was a mixture of scopolamine and morphine, and it produced "clouded consciousness with complete forgetfulness". It was founded in Germany and "successfully" used there with well to do women who wanted painless childbirth. An American woman named Mrs. Francis X Carmody came to Germany to try this, and brought it to America. Twilight Sleep hospitals sprang up almost overnight coast to coast. This was in line with the rising tide of feminism. It was called the fight for Twilight Sleep. However, it quickly showed itself dangerous and certainly not the picture of "peaceful, painless childbirth". (and the second time Mrs Carmody used Twilight Sleep - she died in childbirth) Women were left all alone during labour, were restrained with blindfolds and earplugs. The reason was because a woman on Twilight Sleep was super sensitive to sound and light and would thrash and act crazy. So they covered their head/face and bound them. Sounds lovely eh? Forceps became almost routine. Family members were banished from the labour room. Here's a telling quote: "I wish I could tell you about it, but you see, I wasn't really there," (had 7 babies between 1948 - 1961) One hospital in New York was forced to close down because of complaints from neighbours about the noise that came from there at all hours ...women under the influence of Twilight Sleep, screaming.

In the 1950's birth was completely medicalized - and heavy sedation was being used - Trilene and Penthrane were drugs of choice. This was also the age of Thalidomide - a horrible reminder of the risk of drugs on unborn babies.

In the midst of all this though rose Grantly Dick-Read who promoted natural childbirth through understanding the fear tension pain syndrome, as well as Fernand Lamaze. Epidurals first appeared in the early 1900's and was even promoted by natural childbirth advocates as awake-birth alternative to sedation. But now? Epidural rates are as high as 80-90% in some hospitals - even with all the known risks associated with epidurals for both moms and babies. Nitrous oxide (laughing gas) remains a very viable alternative to all drug choices as having the least effect on babies, and the least effect on mothers labours.


Some interesting stats from Penny Simkin's speech related to prenatal education and the spiralling issue with our health care. I know we're in Canada, so some of it doesn't quite match us, but we're "connected" to the USA, and we should take note!!

The USA is worst among industrialized countries in almost all indicators of quality care:
maternal mortality and morbidity
infant, perinatal, neonatal mortality/morbidity
racial disparities in outcomes
access to quality care and continuity of care
cesarean section rates
induction rates
financial costs.
Now? 1 out of 3 to 4 women now describes her birth as traumatic
and 1 out of every 3 or 4 women has a postpartum mood disorder.

Here's some stats about Canada:
HEALTH CANADA REPORT, 2005-06
Cesarean rates (up from previous years)
- total - 26.3% (with BC being the highest)
- primary c-sections - 18.6 %
- repeat c-sections - 81.9%!!!!!
Epidural rates
- of all vaginal births --- 54% in 2005, and up to 57% in 2006
- of all births - vag and c-sec --- 47.9%!! ALMOST HALF!

Here's CAnada rankings in key outcomes:
Between 1990 and 2007 Canada slipped among developed countriees:
- from 2nd to 11th in maternal mortality (in other words: MORE WOMEN ARE DYING in childbirth!!)
- from 6th to 21st in infant mortality: MORE BABIES ARE DYING!!
- from 12th to 14th for perinatal mortality

Is the association causal or coincidental? Due to increased interventions, declining expertise in manual skills, and less tolerance of non-medical personnel (ie - midwives, doulas etc) ........this is NOT coincidental.
Despite all our medical and technological advances ..........we are NOT improving maternity care, or maternal and infant outcomes. They are steadily getting worse.
And we should sit up and take notice - and not presume that our birth experiences and our lives and that of our babies lives are free from these numbers.
The end point of Penny's presentation was that prenatal education needs to take more of a front and center location in maternity care - and I couldn't agree more.

The midwives that I know well can always tell which women have had quality prenatal education and those who have had nothing or poor quality. (and by poor quality, I mean the hospital based classes). They always support their clients choices for prenatal education, but despite the outcome (vaginal or cesarean) - there is often a huge difference in how women handle their labours and postpartums.
And I've said it before and I'll say it again ..... there is a rising number of women suffering from postpartum depression and anxiety. But that's a whole other blog topic!!

For now ....what are your thoughts on the "pain and politics" section and the stats I listed? Cheers!