Kudos to the Ventura County Star newspaper for continuing to print letters on the midwife ban and keep the story alive. Thanks to Ina May Gaskin, Deborah Frank, Patti Reis and Kim Rivers for their contributions. To read and comment please go to:
www.vcstar.com and put the leyword "midwives" into the search box. Dr.F
Sunday, February 28, 2010
Thursday, February 25, 2010
Jen from Sundance Doulas recent blog
Jen points out, logically and eloquently, how the policies and procedures at St. John's seem to repeatedly violate the teachings and doctrines of the Catholic Church. I would recommend all my readers follow this link and participate in the process of reclaiming your rights. Thanks, Dr. F
http://sundancedoula.blogspot.com/2010/02/calling-all-catholics.html
http://sundancedoula.blogspot.com/2010/02/calling-all-catholics.html
Monday, February 22, 2010
Ina May's 2 Cents Worth
Let’s be honest. The decision to take away the option for women to have a midwife-attended birth at St. John’s Pleasant Valley Hospital in Camarillo as of February 8 had nothing to do with concerns for the safety of women or babies. If it had, the hospital would not have cancelled privileges for midwives Lynn Olson and Joyce Weckl. There is plenty of evidence that indicates that putting midwives in charge of caring for healthy women during pregnancy and birth actually produces better results for mothers and babies with fewer interventions at lower costs than having an obstetrician (who is trained to deal with pathologies of birth, not with normal birth) be the sole caregiver for healthy women. There is no evidence that newborns or mothers at St. John’s were put at any increased risk because of midwifery care. CEO T. Michael Murray knew this, I suspect, or he would have presented some with his cowardly statement that rescinded the midwives’ privileges.
A recent U. S. study showed that nurse-midwives spend an average of 24 minutes with a woman during each prenatal visit, compared with obstetricians, who spend only 10 minutes per visit on average. Another study of more than 4 million U. S. births found that midwife-attended low-risk births had 33 percent fewer newborn deaths and 31 percent fewer babies born too small, which means fewer brain-damaged babies. It is well known that midwife-assisted births are far less likely to be induced or to result in a cesarean. No wonder approximately 60 women in the Camarillo area per year took advantage of this option last year. But that’s over now—at least in Camarillo. This bullying of pregnant women and midwives is outrageous; it is especially insulting to explain it as a “safety” measure.
Without exception, the European nations in which 75 percent of births are attended principally by midwives (usually with no obstetrician in the birth room) have lower rates of newborn and maternal deaths than we have in the U. S. None of these countries spends nearly as much money per capita on maternity care as we spend, and in none of these countries are licensed midwives kept from working in hospitals providing maternity care. The U. S. is the only country among the highly industrialized nations that even has the concept of midwives who must beg for privileges, which can later be summarily withdrawn without any right of appeal.
It’s ironic that the St. John’s decision against midwifery took place only days after Californians learned that maternal death rates in California had nearly tripled between 1996 and 2006. Some have suggested that this rise in due to better reporting, which is unlikely, because California has so far done very little to improve the accuracy and completeness of maternal death reporting. Even if it were due to better reporting, it is about 5 times the maternal death rate set as our national goal for 2010 (3.3 deaths per 100,000 live births).
Some might expect that such a shocking news report would have been accompanied by a systematic analysis of the causes for such a quick increase in maternal death—a problem that most people think was solved long ago by high-tech obstetrical care. That has not yet happened. In fact, the state Department of Public Health has so far refused to issue a report on this trend that could help people learn the reasons for the sudden increase in this worst of maternity care outcomes. Surely, California’s women of childbearing age deserve better than this.
For over a decade, I have been tracking the problem of poor reporting of maternal deaths in the U. S., because I was so shocked to find out that the Centers for Disease Control (CDC) is unable to fix the problem they first stated in 1998—that the true maternal death rate in this country could be three times what is officially reported. I began collecting the names of U. S. women who died from pregnancy-related causes since 1982, the year of our lowest reported maternal death rate. I recently learned that by using Google and taking reports from family members or friends of women who have died, I have a considerably larger database of maternal deaths than the Joint Commission, the closest thing we have in this country to a certifying organization for hospitals and other health organizations. (It is suggested, but not mandatory, for hospitals to report maternal deaths to the Joint Commission). Judging by the stories of maternal deaths in my database, the rise in the death rate has much to do with the rising rates of cesarean and induced labors.
There are also similar sounding stories of women dying in hospitals of hemorrhages following birth, suggesting that some hospitals may not be employing enough nurses to provide the kind of watchful care that is necessary in the hours following birth. Making a greater use of midwives is an obvious way to begin reducing high rates of cesareans and induced births.
Ina May Gaskin, PhD (Hon.), CPM, MA
Speaker/Author: Ina May's Guide to Breastfeeding, Ina May's Guide to Childbirth, Spiritual Midwifery
Founding member of The White Ribbon Alliance for Safe Motherhood
www.whiteribbonalliance.org
Curator: The Safe Motherhood Quilt Project
149 Apple Orchard Lane
Summertown, Tennessee 38483
www.inamay.com
www.rememberthemothers.org
home: 931 964 2519
cell: 931 279 2992
The opinion of Ina May was reproduced with her permission. Comments welcome. Dr F
A recent U. S. study showed that nurse-midwives spend an average of 24 minutes with a woman during each prenatal visit, compared with obstetricians, who spend only 10 minutes per visit on average. Another study of more than 4 million U. S. births found that midwife-attended low-risk births had 33 percent fewer newborn deaths and 31 percent fewer babies born too small, which means fewer brain-damaged babies. It is well known that midwife-assisted births are far less likely to be induced or to result in a cesarean. No wonder approximately 60 women in the Camarillo area per year took advantage of this option last year. But that’s over now—at least in Camarillo. This bullying of pregnant women and midwives is outrageous; it is especially insulting to explain it as a “safety” measure.
Without exception, the European nations in which 75 percent of births are attended principally by midwives (usually with no obstetrician in the birth room) have lower rates of newborn and maternal deaths than we have in the U. S. None of these countries spends nearly as much money per capita on maternity care as we spend, and in none of these countries are licensed midwives kept from working in hospitals providing maternity care. The U. S. is the only country among the highly industrialized nations that even has the concept of midwives who must beg for privileges, which can later be summarily withdrawn without any right of appeal.
It’s ironic that the St. John’s decision against midwifery took place only days after Californians learned that maternal death rates in California had nearly tripled between 1996 and 2006. Some have suggested that this rise in due to better reporting, which is unlikely, because California has so far done very little to improve the accuracy and completeness of maternal death reporting. Even if it were due to better reporting, it is about 5 times the maternal death rate set as our national goal for 2010 (3.3 deaths per 100,000 live births).
Some might expect that such a shocking news report would have been accompanied by a systematic analysis of the causes for such a quick increase in maternal death—a problem that most people think was solved long ago by high-tech obstetrical care. That has not yet happened. In fact, the state Department of Public Health has so far refused to issue a report on this trend that could help people learn the reasons for the sudden increase in this worst of maternity care outcomes. Surely, California’s women of childbearing age deserve better than this.
For over a decade, I have been tracking the problem of poor reporting of maternal deaths in the U. S., because I was so shocked to find out that the Centers for Disease Control (CDC) is unable to fix the problem they first stated in 1998—that the true maternal death rate in this country could be three times what is officially reported. I began collecting the names of U. S. women who died from pregnancy-related causes since 1982, the year of our lowest reported maternal death rate. I recently learned that by using Google and taking reports from family members or friends of women who have died, I have a considerably larger database of maternal deaths than the Joint Commission, the closest thing we have in this country to a certifying organization for hospitals and other health organizations. (It is suggested, but not mandatory, for hospitals to report maternal deaths to the Joint Commission). Judging by the stories of maternal deaths in my database, the rise in the death rate has much to do with the rising rates of cesarean and induced labors.
There are also similar sounding stories of women dying in hospitals of hemorrhages following birth, suggesting that some hospitals may not be employing enough nurses to provide the kind of watchful care that is necessary in the hours following birth. Making a greater use of midwives is an obvious way to begin reducing high rates of cesareans and induced births.
Ina May Gaskin, PhD (Hon.), CPM, MA
Speaker/Author: Ina May's Guide to Breastfeeding, Ina May's Guide to Childbirth, Spiritual Midwifery
Founding member of The White Ribbon Alliance for Safe Motherhood
www.whiteribbonalliance.org
Curator: The Safe Motherhood Quilt Project
149 Apple Orchard Lane
Summertown, Tennessee 38483
www.inamay.com
www.rememberthemothers.org
home: 931 964 2519
cell: 931 279 2992
The opinion of Ina May was reproduced with her permission. Comments welcome. Dr F
Sunday, February 21, 2010
Op-Ed in Ventura County Star
Hi, By now, I am sure you all have heard that the newspaper published my piece on Pediatric Policy and the banning of midwives at PV. Seemed well received except for one ugly commentor. I am used to that by now. It is standard fare for those that lack the facts on a different viewpoint to resort to name calling. Does not amount to much and we should not engage those that hide behind anonymity. Wonder what someone does for a life that they spend so many hours at the computer on a lovely Sunday spewing venom?
Also, BAC led another street corner protest last Saturday. Happily good weather, sadly no press this time. But about 50 people gathered for 2 hours to politely demonstrate for midwives and birth choices. I suspect you can see some of the photos on the BAC website shortly. They plan to keep up the noise and let corporate CHW know that a integral part of the local community is not happy with the midwife ban.
Dr. F
Also, BAC led another street corner protest last Saturday. Happily good weather, sadly no press this time. But about 50 people gathered for 2 hours to politely demonstrate for midwives and birth choices. I suspect you can see some of the photos on the BAC website shortly. They plan to keep up the noise and let corporate CHW know that a integral part of the local community is not happy with the midwife ban.
Dr. F
Thursday, February 18, 2010
Thoughts on Pediatric Policy
As the motivation behind the banning of Certified Nurse Midwives at Pleasant Valley Hospital becomes clearer, I believe it deserves some logical analysis. By now, it is apparent that a major driving force behind the policy was the displeasure of some of the pediatricians at Pleasant Valley. They did not want to take responsibility for babies who were not going to become their patients and for whom they would be reimbursed poorly and feared liability. The merits of this fear are debatable but its existence is a fact and a byproduct of today’s medical-legal world. There was also distaste by the pediatricians for the desires of some of the parents of midwife delivered babies who often had differing views on newborn care. Pressure from them on their committee in turn became pressure on the obstetric committee and the administrative cascade was set in full swing. Whether any alternatives were ever considered is unknown as the process all resides behind a veil of secrecy. Had this been an open discussion, it is possible that another, far better, alternative might have been reached.
A little history is now appropriate. Before the 1980’s healthy newborns were not seen by pediatricians in the hospital setting. Healthy babies were taken to the nursery or roomed in with mothers and cared for by trained hospital nursing staff. Usually within a few days to weeks after going home the baby would be taken to the local family doctor’s office for a check up. Only if problems were discovered by the nurse or parents would a doctor be called. However, in the 80’s doctors were generally paid well by third party payers and pediatricians soon realized that newborn exams were a decent source of revenue. So, policies were created by hospital committees that began mandating newborn exams on every new baby, regardless of necessity or not. These policies were also justified under the guise of “safety” but were really self-serving and revenue generating. In fairness, this tendency was not limited to pediatricians but that is what is relevant here.
For 3 decades the well-baby exam became the norm. This habit was formed before the age of evidenced-based medicine. As Thomas Paine said, “The habit of not thinking a thing wrong gives it the superficial appearance of being right”. No one questioned it as long as everyone was paid well by third party payers. But, in the last decade there has been a steady decline in reimbursement for this service. Medi-Cal pays almost nothing. Pediatricians have come to resent having to come to the hospital and have their work be undervalued and their opinions questioned. Patients of the midwifery model often want early discharge but have to wait hours to have their baby discharged as there is no incentive for the pediatrician to be inconvenienced for a well newborn. Frustration and sometimes hostility ensue. Lost in this frustration is the mission of why we do what we do. The original monetary motivated, non-evidence related policy of requiring a doctor to see every newborn baby, regardless of need, has now risen up to bite them and, by default, all of us in the ass.
So, my suggestion would be for St. John’s staff and administration to reconsider their policy banning midwives and look at another evidenced based option. Eliminate the requirement that every newborn be seen by a doctor before going home. Create a new policy that restores low risk midwife patients to Pleasant Valley and allows the delivering practitioner and the well trained nursing staff at Pleasant Valley to decide which babies are in need of an exam and which can do just fine with loving parents following up with their family doctor or pediatrician in the office. Truthfully, there is no reason a well newborn needs to be taken away from its mother to be examined in the sterile environment of the little nursery area there. It would be rare indeed to find anything that is life threatening. And for babies that are sick, well, those babies are going to be transferred to St. John’s NICU anyway. On the rare occasion that a low risk mother delivers a baby in need of resuscitation there can be a trained technician or nurse in house while the NICU team is on the way. Quite frankly, most office based pediatricians are not comfortable with advanced resuscitation anyway. Some being years removed from it and wise enough to leave it to those that perform it frequently.
I believe there is a better solution to the pediatricians' concerns. There most certainly is a better process that could have been used. The committees that decided the policy to ban midwives should have opened up dialogue between the concerned parties. The midwives and the doctors that work with them were never consulted in the process. Secrecy has no place in this issue. This was not a peer review process so why the hiding behind confidentiality? Questions have been asked and gone unanswered for 10 days now. The pediatric committee was motivated by financial and legal concerns. The OB committee was all too eager, in their pettiness, to oblige and failed to consider other options. The administration has its agenda which may very well include closing the labor and delivery unit at Pleasant Valley Hospital. Since they are all forbidden by their lawyers to speak and they have offered no other logical explanation this must be true.
Bring Thomas Paine’s “common sense” back to Pleasant Valley. Let’s change the habit of not thinking something is wrong simply because it has been done that way for a long time. Pediatricians do not want to see some newborns at PV. So let’s have a policy that says they don’t have to unless a doctor or nurse requests it. Leave the healthy babies alone and let them thrive with their new families. Being born is not a disease!
Stuart Fischbein, MD FACOG
A little history is now appropriate. Before the 1980’s healthy newborns were not seen by pediatricians in the hospital setting. Healthy babies were taken to the nursery or roomed in with mothers and cared for by trained hospital nursing staff. Usually within a few days to weeks after going home the baby would be taken to the local family doctor’s office for a check up. Only if problems were discovered by the nurse or parents would a doctor be called. However, in the 80’s doctors were generally paid well by third party payers and pediatricians soon realized that newborn exams were a decent source of revenue. So, policies were created by hospital committees that began mandating newborn exams on every new baby, regardless of necessity or not. These policies were also justified under the guise of “safety” but were really self-serving and revenue generating. In fairness, this tendency was not limited to pediatricians but that is what is relevant here.
For 3 decades the well-baby exam became the norm. This habit was formed before the age of evidenced-based medicine. As Thomas Paine said, “The habit of not thinking a thing wrong gives it the superficial appearance of being right”. No one questioned it as long as everyone was paid well by third party payers. But, in the last decade there has been a steady decline in reimbursement for this service. Medi-Cal pays almost nothing. Pediatricians have come to resent having to come to the hospital and have their work be undervalued and their opinions questioned. Patients of the midwifery model often want early discharge but have to wait hours to have their baby discharged as there is no incentive for the pediatrician to be inconvenienced for a well newborn. Frustration and sometimes hostility ensue. Lost in this frustration is the mission of why we do what we do. The original monetary motivated, non-evidence related policy of requiring a doctor to see every newborn baby, regardless of need, has now risen up to bite them and, by default, all of us in the ass.
So, my suggestion would be for St. John’s staff and administration to reconsider their policy banning midwives and look at another evidenced based option. Eliminate the requirement that every newborn be seen by a doctor before going home. Create a new policy that restores low risk midwife patients to Pleasant Valley and allows the delivering practitioner and the well trained nursing staff at Pleasant Valley to decide which babies are in need of an exam and which can do just fine with loving parents following up with their family doctor or pediatrician in the office. Truthfully, there is no reason a well newborn needs to be taken away from its mother to be examined in the sterile environment of the little nursery area there. It would be rare indeed to find anything that is life threatening. And for babies that are sick, well, those babies are going to be transferred to St. John’s NICU anyway. On the rare occasion that a low risk mother delivers a baby in need of resuscitation there can be a trained technician or nurse in house while the NICU team is on the way. Quite frankly, most office based pediatricians are not comfortable with advanced resuscitation anyway. Some being years removed from it and wise enough to leave it to those that perform it frequently.
I believe there is a better solution to the pediatricians' concerns. There most certainly is a better process that could have been used. The committees that decided the policy to ban midwives should have opened up dialogue between the concerned parties. The midwives and the doctors that work with them were never consulted in the process. Secrecy has no place in this issue. This was not a peer review process so why the hiding behind confidentiality? Questions have been asked and gone unanswered for 10 days now. The pediatric committee was motivated by financial and legal concerns. The OB committee was all too eager, in their pettiness, to oblige and failed to consider other options. The administration has its agenda which may very well include closing the labor and delivery unit at Pleasant Valley Hospital. Since they are all forbidden by their lawyers to speak and they have offered no other logical explanation this must be true.
Bring Thomas Paine’s “common sense” back to Pleasant Valley. Let’s change the habit of not thinking something is wrong simply because it has been done that way for a long time. Pediatricians do not want to see some newborns at PV. So let’s have a policy that says they don’t have to unless a doctor or nurse requests it. Leave the healthy babies alone and let them thrive with their new families. Being born is not a disease!
Stuart Fischbein, MD FACOG
Tuesday, February 16, 2010
Update from Joyce Weckl, CNM
Dear Friends and Colleagues;
Here is a little background and update on our struggle in Ventura County. St. John's Oxnard and St. John's Pleasant Valley (Camarillo) are sister hospitals owned by CHW. Recently it was passed through peds committee (where this started), OB committee, MEC, and the Board of DIrectors that hospital policy would change so that CNMs were no longer allowed to deliver at St. John's Pleasant Valley. The reason cited was safety. Pleasant Valley is a small community hospital with no NICU. St. John's Oxnard is a large regional medical center with a NICU. We are still able to deliver in Oxnard but our office is in Camarillo. Not to mention, women want to deliver in their local hospital and for some women this access to care is extremely prohibitive.
There has never been any sort of peer review over the quality of CNM care nor were we invited or aware of any of these proceedings. In fact, the letter they sent me (3 days before this became effective) stated that this was no reflection whatsoever on my care. It also stated that I was not entitled to a hearing or review. Our belief is that this policy is the result of several political agendas of certain members of the medical staff and has no basis in evidence or statistics. I also feel that this is not just about midwifery but also about women's health care options being determined by back room dealings and not evidence based medical care.
The local group that is spearheading the campaign is called Birth Action Coalition (BAC) their website is the go to place for current information. We've been on the news, had lots of coverage in the local paper, and are trying to organize letter writing and protests. Please see the website for more information. All of the media links are on there.
I urge you to let your voice be heard, please forward this to anyone and everyone that you can think of. This is a travesty. One other note, Mike Murray the CEO of St. John's is "resigning" in March. This will leave us without any main person to complain to. That's why it is imperative to contact his boss and other members listed on the contact sheet.
Many thanks,
Joyce Weckl, CNM
http://birthactioncoalition.org/
Here is a little background and update on our struggle in Ventura County. St. John's Oxnard and St. John's Pleasant Valley (Camarillo) are sister hospitals owned by CHW. Recently it was passed through peds committee (where this started), OB committee, MEC, and the Board of DIrectors that hospital policy would change so that CNMs were no longer allowed to deliver at St. John's Pleasant Valley. The reason cited was safety. Pleasant Valley is a small community hospital with no NICU. St. John's Oxnard is a large regional medical center with a NICU. We are still able to deliver in Oxnard but our office is in Camarillo. Not to mention, women want to deliver in their local hospital and for some women this access to care is extremely prohibitive.
There has never been any sort of peer review over the quality of CNM care nor were we invited or aware of any of these proceedings. In fact, the letter they sent me (3 days before this became effective) stated that this was no reflection whatsoever on my care. It also stated that I was not entitled to a hearing or review. Our belief is that this policy is the result of several political agendas of certain members of the medical staff and has no basis in evidence or statistics. I also feel that this is not just about midwifery but also about women's health care options being determined by back room dealings and not evidence based medical care.
The local group that is spearheading the campaign is called Birth Action Coalition (BAC) their website is the go to place for current information. We've been on the news, had lots of coverage in the local paper, and are trying to organize letter writing and protests. Please see the website for more information. All of the media links are on there.
I urge you to let your voice be heard, please forward this to anyone and everyone that you can think of. This is a travesty. One other note, Mike Murray the CEO of St. John's is "resigning" in March. This will leave us without any main person to complain to. That's why it is imperative to contact his boss and other members listed on the contact sheet.
Many thanks,
Joyce Weckl, CNM
http://birthactioncoalition.org/
Saturday, February 13, 2010
Thought provoking article in VC Star today
Read this article tonight while surfing for stories on today's rally. Really interesting and hopefully signaling further crumbling of the house of cards that is the medicalization of birth. Dr. F
The mortality rate of California women who die from causes directly related to pregnancy has tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of Caesarean sections.
For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
California Watch spoke with investigators who wrote the report, and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.
“The issue is how rapidly this rate has worsened,” said Debra Bingham, executive director of the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state. “That’s what’s shocking.”
The problem may be occurring nationwide. The Joint Commission, the leading healthcare accreditation and standards group in the United States, issued a “Sentinel Event Alert” to hospitals on Jan. 26 stating: “Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”
The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.
In 2007, the U.S. Centers for Disease Control and Prevention reported the national maternal mortality rate had risen. But experts such as Dr. Jeffrey C. King, who leads a special inquiry into maternal mortality for the American College of Obstetricians and Gynecologists, chalked up the change to better counting of deaths. His opinion hasn’t changed.
“I would be surprised if there was a significant increase of maternal deaths,” said King, who has not seen the California report.
But Shabbir Ahmad, a scientist in California’s Department of Public Health, decided to look closer. He organized academics, state researchers and hospitals to conduct a systematic review of every maternal death in California. It’s the largest state review ever conducted.
The group’s initial findings provide the first strong evidence that there is a true increase in deaths — not just the number of reported deaths.
Changes in the population — obese mothers, older mothers and fertility treatments — cannot completely account for the rise in deaths in California, said Dr. Elliott Main, the principal investigator for the task force.
“What I call the usual suspects are certainly there,” he said. “However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase.”
Main said scientists have started to ask what doctors are doing differently. It’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased, he said.
The task force has found that changing clinical practices could prevent a significant number of these deaths.
One maternity expert not involved in the report, Dr. Thomas R. Moore, chairman of the Department of Reproductive Medicine at UC San Diego, said about the data: “This could be a sentinel finding, and I could see other states taking a closer look and finding the same thing.”
Low numbers, high consequences
Despite the increase in the mortality rate, pregnancy is still safe for the vast majority of women.
In 2006, 95 California women died from causes directly related to their pregnancies — out of more than 500,000 live births. That’s a small number by public health standards. If California had met the goal set by the U.S. Department of Health and Human Services to bring the state’s maternal mortality rate down to a level achieved by other countries, the number of dead would be closer to 28.
It’s not clear who is most at risk, but researchers have long known that African-American mothers are three to four times more likely to die from pregnancy-related causes than the rest of the population. That racial association is not stratified by socio-economic status: Even high-income black women are at greater risk.
The task force found a more dramatic increase in deaths among white, non-Latino mothers. There is not yet enough data to show if the risk of death is associated with poverty.
‘I knew something was wrong’
What’s certain is that each maternal death shatters families. That cold sum — 95 dead — represents 95 stories of people such as Tatia Oden French. In 2001, she was newly wed and had just finished her doctorate in psychology. She was about to have a baby girl she would name Zorah Allie Mae French.
“She’s the type of person who just walked into the room and lit it up,” said her mother, Maddy Oden.
During her daughter’s labor, Maddy Oden was at home in Oakland, waiting for a call announcing the birth of her granddaughter. Instead, her daughter needed an emergency C-section. “I woke up at 4 in the morning, and I knew something was wrong,” Oden said.
Then the phone rang. French was in trouble. Powerful contractions had forced amniotic fluid into her bloodstream, stopping her heart and killing the baby. When Oden got to her daughter at an Oakland hospital, there was only one thing she could do: “We said a prayer,” Oden said, “and I closed her eyes.”
The subsequent lawsuit was dismissed: The doctor had not deviated from the standard of care.
Rather than track down the cause of every death and assign blame, the California task force is focused on finding solutions. Bingham and Main have found that doctors and nurses are eager to help after seeing the numbers.
In 1996, the maternal death rate in California was 5.6 per 100,000 live births, not far from the national goal of 4.3 per 100,000. From 1998 to 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.
In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.
The best estimates show that less than 30 percent of the increase is attributable to better reporting on death certificates. Even accounting for these reporting and classification changes, the maternal death rate from 1996 to 2006 has more than doubled, Main said.
Report not yet public
When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience, according to participants at the San Diego event. The idea that California was moving backward even in an era of high-tech birthing was implausible to some.
Confirmation of the trend was noted in the 2008 report written by 27 doctors and researchers. The report was described in detail to California Watch.
The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009, according to Ahmad.
Al Lundeen, the department’s director of public affairs, said, “There was no effort to hold that report back. It just needed some more revisions.”
Researchers say it is important for the public to be aware that these trends are worsening. Diane Ashton, deputy medical director for the March of Dimes, has seen the numbers. She said they demand a concerted response.
“Even though they tend to be small numbers in terms of maternal mortality, it is important — it’s very important — that these trends be looked at,” she said. “And efforts need to be made to try and reverse them when they are going in the wrong direction.”
Nearly one in three babies is now born by C-section. Many scientists have acknowledged that at some point, as the number of surgeries spiral upward, the risks will outweigh the benefits. But the C-section remains a useful tool, and in the middle of labor, doctors say, it’s hard to balance the potential long-term harm against immediate crisis.
Today, doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.
Main said this complication from C-sections has increased eight- to tenfold in the past decade. Nonetheless, most women survive the ordeal. The point, said Catherine Camacho, deputy director of the state Center for Family Health, is that the rise in deaths is indicative of a larger problem.
“For every maternal death, there are 10 near misses. For every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there are another 10 morbidity cases related to childbirth,” Camacho wrote in an e-mail.
Other factors are contributing to the rise in deaths, but the researchers in California are most interested in the areas where they have control, such as the high C-section birth rate. It’s easier for doctors to improve medical care than to fix more intractable problems like poverty and obesity.
Induced labor more common
In 2002, Dr. David Lagrew, medical director of the Women’s Hospital at Saddleback Memorial Medical Center in Orange County, noticed a lot of women were having their labor induced before term without a medical reason. And he knew that having an induction doubled the chances of a C-section.
So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions.
As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.
All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts any hospital has increased its C-section rate in pursuit of profit, but he does note the first hospitals to adopt controls on early elective inductions have been nonprofit operations.
According to a report issued by the advocacy group Childbirth Connection, “six of the 10 most common procedures billed to Medicaid and to private insurers in 2005 were maternity-related.” On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.
“If all these guys were losing money on every C-section, well, what’s the old saying? Whenever they tell you it’s not about the money, it’s about the money,” Lagrew said.
The California task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions — as Lagrew did at Memorial Medical Center.
Although the state hasn’t released the task force’s report, the researchers and doctors involved forwarded data to the national Joint Commission, which issued incentives for hospitals to reduce inductions and fight what it called “the Caesarean-section epidemic.”
“You don’t have to be a public health whiz to know we are facing a big problem here,” Bingham said.
The mortality rate of California women who die from causes directly related to pregnancy has tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of Caesarean sections.
For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
California Watch spoke with investigators who wrote the report, and they confirmed the most significant spike in pregnancy-related deaths since the 1930s. Although the number of deaths is relatively small, it’s more dangerous to give birth in California than it is in Kuwait or Bosnia.
“The issue is how rapidly this rate has worsened,” said Debra Bingham, executive director of the California Maternal Quality Care Collaborative, the public-private task force investigating the problem for the state. “That’s what’s shocking.”
The problem may be occurring nationwide. The Joint Commission, the leading healthcare accreditation and standards group in the United States, issued a “Sentinel Event Alert” to hospitals on Jan. 26 stating: “Unfortunately, current trends and evidence suggest that maternal mortality rates may be increasing in the U.S.”
The alert asked doctors to consider morbid obesity, high blood pressure and diabetes, along with hemorrhaging from C-sections, as contributing factors.
In 2007, the U.S. Centers for Disease Control and Prevention reported the national maternal mortality rate had risen. But experts such as Dr. Jeffrey C. King, who leads a special inquiry into maternal mortality for the American College of Obstetricians and Gynecologists, chalked up the change to better counting of deaths. His opinion hasn’t changed.
“I would be surprised if there was a significant increase of maternal deaths,” said King, who has not seen the California report.
But Shabbir Ahmad, a scientist in California’s Department of Public Health, decided to look closer. He organized academics, state researchers and hospitals to conduct a systematic review of every maternal death in California. It’s the largest state review ever conducted.
The group’s initial findings provide the first strong evidence that there is a true increase in deaths — not just the number of reported deaths.
Changes in the population — obese mothers, older mothers and fertility treatments — cannot completely account for the rise in deaths in California, said Dr. Elliott Main, the principal investigator for the task force.
“What I call the usual suspects are certainly there,” he said. “However, when we looked at those factors and the data analyzed so far, those only account for a modest amount of the increase.”
Main said scientists have started to ask what doctors are doing differently. It’s hard to ignore the fact that C-sections have increased 50 percent in the same decade that maternal mortality increased, he said.
The task force has found that changing clinical practices could prevent a significant number of these deaths.
One maternity expert not involved in the report, Dr. Thomas R. Moore, chairman of the Department of Reproductive Medicine at UC San Diego, said about the data: “This could be a sentinel finding, and I could see other states taking a closer look and finding the same thing.”
Low numbers, high consequences
Despite the increase in the mortality rate, pregnancy is still safe for the vast majority of women.
In 2006, 95 California women died from causes directly related to their pregnancies — out of more than 500,000 live births. That’s a small number by public health standards. If California had met the goal set by the U.S. Department of Health and Human Services to bring the state’s maternal mortality rate down to a level achieved by other countries, the number of dead would be closer to 28.
It’s not clear who is most at risk, but researchers have long known that African-American mothers are three to four times more likely to die from pregnancy-related causes than the rest of the population. That racial association is not stratified by socio-economic status: Even high-income black women are at greater risk.
The task force found a more dramatic increase in deaths among white, non-Latino mothers. There is not yet enough data to show if the risk of death is associated with poverty.
‘I knew something was wrong’
What’s certain is that each maternal death shatters families. That cold sum — 95 dead — represents 95 stories of people such as Tatia Oden French. In 2001, she was newly wed and had just finished her doctorate in psychology. She was about to have a baby girl she would name Zorah Allie Mae French.
“She’s the type of person who just walked into the room and lit it up,” said her mother, Maddy Oden.
During her daughter’s labor, Maddy Oden was at home in Oakland, waiting for a call announcing the birth of her granddaughter. Instead, her daughter needed an emergency C-section. “I woke up at 4 in the morning, and I knew something was wrong,” Oden said.
Then the phone rang. French was in trouble. Powerful contractions had forced amniotic fluid into her bloodstream, stopping her heart and killing the baby. When Oden got to her daughter at an Oakland hospital, there was only one thing she could do: “We said a prayer,” Oden said, “and I closed her eyes.”
The subsequent lawsuit was dismissed: The doctor had not deviated from the standard of care.
Rather than track down the cause of every death and assign blame, the California task force is focused on finding solutions. Bingham and Main have found that doctors and nurses are eager to help after seeing the numbers.
In 1996, the maternal death rate in California was 5.6 per 100,000 live births, not far from the national goal of 4.3 per 100,000. From 1998 to 1999, the World Health Organization changed its coding system, which may have increased reporting of deaths. The California rate was 6.7 in 1998 and 7.7 in 1999. Because the number of mothers who die is small, the rate tends to fluctuate from year to year.
In 2003, when California revised its death certificate, the rate jumped to 14.6. And in 2006, the last year for which data is available, the rate stood at 16.9.
The best estimates show that less than 30 percent of the increase is attributable to better reporting on death certificates. Even accounting for these reporting and classification changes, the maternal death rate from 1996 to 2006 has more than doubled, Main said.
Report not yet public
When researchers unveiled their initial findings to a conference of the American College of Obstetricians and Gynecologists in 2007, there were gasps from the audience, according to participants at the San Diego event. The idea that California was moving backward even in an era of high-tech birthing was implausible to some.
Confirmation of the trend was noted in the 2008 report written by 27 doctors and researchers. The report was described in detail to California Watch.
The state of California has yet to share the report with the public. Researchers say that, after reviewing the report in 2008, officials in the Department of Public Health asked for technical clarifications. Revisions were complete and approved in the first half of 2009, according to Ahmad.
Al Lundeen, the department’s director of public affairs, said, “There was no effort to hold that report back. It just needed some more revisions.”
Researchers say it is important for the public to be aware that these trends are worsening. Diane Ashton, deputy medical director for the March of Dimes, has seen the numbers. She said they demand a concerted response.
“Even though they tend to be small numbers in terms of maternal mortality, it is important — it’s very important — that these trends be looked at,” she said. “And efforts need to be made to try and reverse them when they are going in the wrong direction.”
Nearly one in three babies is now born by C-section. Many scientists have acknowledged that at some point, as the number of surgeries spiral upward, the risks will outweigh the benefits. But the C-section remains a useful tool, and in the middle of labor, doctors say, it’s hard to balance the potential long-term harm against immediate crisis.
Today, doctors face a condition called placenta accreta, where the placenta grows into the scar left by a previous C-section. In surgery, doctors must find and suture a web of twisted placental vessels snaking into the patient’s abdomen, which can hemorrhage alarming amounts of blood. Often, doctors must remove the uterus.
Main said this complication from C-sections has increased eight- to tenfold in the past decade. Nonetheless, most women survive the ordeal. The point, said Catherine Camacho, deputy director of the state Center for Family Health, is that the rise in deaths is indicative of a larger problem.
“For every maternal death, there are 10 near misses. For every near miss, there are 10 severe morbidity cases (such as hysterectomy, hemorrhage, or infection), and for every severe morbidity case, there are another 10 morbidity cases related to childbirth,” Camacho wrote in an e-mail.
Other factors are contributing to the rise in deaths, but the researchers in California are most interested in the areas where they have control, such as the high C-section birth rate. It’s easier for doctors to improve medical care than to fix more intractable problems like poverty and obesity.
Induced labor more common
In 2002, Dr. David Lagrew, medical director of the Women’s Hospital at Saddleback Memorial Medical Center in Orange County, noticed a lot of women were having their labor induced before term without a medical reason. And he knew that having an induction doubled the chances of a C-section.
So he set a rule: no elective inductions before 41 weeks of pregnancy, with only a few exceptions.
As a result, Lagrew said, the operating room schedules opened up, and the hospital saw fewer babies admitted to the neonatal intensive care unit, fewer hemorrhages and fewer hysterectomies.
All this, however, came at a cost: The hospital had to take a cut in revenue for reducing the procedures it performed. Lagrew doubts any hospital has increased its C-section rate in pursuit of profit, but he does note the first hospitals to adopt controls on early elective inductions have been nonprofit operations.
According to a report issued by the advocacy group Childbirth Connection, “six of the 10 most common procedures billed to Medicaid and to private insurers in 2005 were maternity-related.” On average, a C-section brings in twice the revenue of a vaginal birth. Today, the C-section is the single most common surgical procedure performed in the United States.
“If all these guys were losing money on every C-section, well, what’s the old saying? Whenever they tell you it’s not about the money, it’s about the money,” Lagrew said.
The California task force isn’t waiting to determine the ultimate cause of these deaths. It has started pilot projects to improve the way hospitals respond to hemorrhages, to better track women’s medical conditions and to reduce inductions — as Lagrew did at Memorial Medical Center.
Although the state hasn’t released the task force’s report, the researchers and doctors involved forwarded data to the national Joint Commission, which issued incentives for hospitals to reduce inductions and fight what it called “the Caesarean-section epidemic.”
“You don’t have to be a public health whiz to know we are facing a big problem here,” Bingham said.
Friday, February 12, 2010
Oxnard Demonstration Supporting Midwives
Today there was a gathering of people choosing to speak out for birth choices the right way. Using a public forum with nothing to hide in front of the press and open to all opinions while presenting a logical discussion of evidence based medicine. There are no confidentiality issues here and no need for such secrecy. This is not national security. Write and request an open meeting with CHW adminstration for all sides to be heard. This is the professional and respectful way to treat people. Thanks to Joyce and Kim and everyone who helped to bring forth a voice of reason today. See the clip:
http://www.vcstar.com/videos/detail/protesters-gather-support-midwives/
http://www.vcstar.com/videos/detail/protesters-gather-support-midwives/
Thursday, February 11, 2010
Rally for Midwives
Just a reminder that Friday, February 12, 2010 at 11AM on the corner of Rose and Gonzalez in front of St. John's Regional Medical Center will be a rally in support of midwifery and in protest of the new, illogical policy banning midwives at Pleasant Valley Hospital. By now I am certain you are aware of the unprecedented policy put in effect this past Monday that forbids Joyce and Lynn from caring for low risk women at a hospital designed for low risk patients. Mike Murray says its not safe there for midwife patients but OK for OBs. Dr. Carter says its not even about the CNMs. Yet merrily onward they go. Please consider giving of 2 hours of your time to support midwifery and challenge the absurdity. Show your support for birth choices! Thanks, Dr.F
Monday, February 8, 2010
February 6th, 2010 Article in Ventura County Star
Hi All, My daughter's Bat Mitzvah was a huge success. It is good to be reminded of the joys in life from time to time. I hope everyone now understands why I have not been blogging much the past couple months.
Well, by now you are likely aware of the article in the Ventura County Star concerning the banning of midwife deliveries at Pleasant Valley Hospital in Camarillo, CA. ( http://www.vcstar.com/news/2010/feb/06/st-johns-pleasant-valley-forbids-midwife-as-of/ ) I have written that is was coming and now as of today, February 8th, it is official. Please read the article and consider forwarding it to everyone you know in the birthing world. Have them join up with the Birth Action Coalition now. While my blog has been documenting many absurdities and intrusions into the rightful choices of patients and their families by the OB committee and administration of St. John's Regional and Pleasant Valley, this new "policy" highlights clearly their vindictiveness behind their platitudes and flawed arguments. Mr. Murray and Dr. Carter's comments should be read very carefully. Mr. Murray undermines the safety and reputation of his own institution (Pleasant Valley Hospital). Why would he do that? I still believe one of their intentions is to lower the delivery numbers there to the point where they can justify closing the labor unit at PV. Dr. Carter undermines their whole argument when he says this is a doctor issue about me and has to do with home birth transfers. These patients have nothing to do with the 2 credentialed CNMs on staff who now have had their privileges revoked at one campus in an unprecedented move. And neither Mr. Murray or Dr. Carter legitimately answers the question of why it is unsafe for midwives low risk patients but OK for obstetricians to continue to deliver at PV. What is clear, however, is that behind closed doors, without comment from those affected, without concern of being held accountable and, seemingly, without concern for professionalism, patient autonomy or current medical evidence a persecution is taking place. This is not in the best interest of patients, midwives and anyone who believes in honesty and due process.
Again, please consider joining the BAC ( see link on right) and contacting anyone who might have media connections or pull with the Board of Directors or CHW corporate leaders. Thanks, Dr. F
Well, by now you are likely aware of the article in the Ventura County Star concerning the banning of midwife deliveries at Pleasant Valley Hospital in Camarillo, CA. ( http://www.vcstar.com/news/2010/feb/06/st-johns-pleasant-valley-forbids-midwife-as-of/ ) I have written that is was coming and now as of today, February 8th, it is official. Please read the article and consider forwarding it to everyone you know in the birthing world. Have them join up with the Birth Action Coalition now. While my blog has been documenting many absurdities and intrusions into the rightful choices of patients and their families by the OB committee and administration of St. John's Regional and Pleasant Valley, this new "policy" highlights clearly their vindictiveness behind their platitudes and flawed arguments. Mr. Murray and Dr. Carter's comments should be read very carefully. Mr. Murray undermines the safety and reputation of his own institution (Pleasant Valley Hospital). Why would he do that? I still believe one of their intentions is to lower the delivery numbers there to the point where they can justify closing the labor unit at PV. Dr. Carter undermines their whole argument when he says this is a doctor issue about me and has to do with home birth transfers. These patients have nothing to do with the 2 credentialed CNMs on staff who now have had their privileges revoked at one campus in an unprecedented move. And neither Mr. Murray or Dr. Carter legitimately answers the question of why it is unsafe for midwives low risk patients but OK for obstetricians to continue to deliver at PV. What is clear, however, is that behind closed doors, without comment from those affected, without concern of being held accountable and, seemingly, without concern for professionalism, patient autonomy or current medical evidence a persecution is taking place. This is not in the best interest of patients, midwives and anyone who believes in honesty and due process.
Again, please consider joining the BAC ( see link on right) and contacting anyone who might have media connections or pull with the Board of Directors or CHW corporate leaders. Thanks, Dr. F
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