Sunday, December 28, 2008

Interesting Article About Midwives

The following was copied from an article in the LA Times on Midwives:

America needs better birth care, and midwives can deliver it.
By Jennifer Block
December 24, 2008
» Discuss Article (23 Comments)

Some healthcare trivia: In the United States, what is the No. 1 reason people are admitted to the hospital? Not diabetes, not heart attack, not stroke. The answer is something that isn't even a disease: childbirth.

Not only is childbirth the most common reason for a hospital stay -- more than 4 million American women give birth each year -- it costs the country far more than any other health condition. Six of the 15 most frequent hospital procedures billed to private insurers and Medicaid are maternity-related. The nation's maternity bill totaled $86 billion in 2006, nearly half of which was picked up by taxpayers.

But cost hasn't translated into quality. We spend more than double per capita on childbirth than other industrialized countries, yet our rates of pre-term birth, newborn death and maternal death rank us dismally in comparison. Last month, the March of Dimes gave the country a "D" on its prematurity report card; California got a "C," but 18 other states and the District of Columbia, where 15.9% of babies are born too early, failed entirely.

The U.S. ranks 41st among industrialized nations in maternal mortality. And there are unconscionable racial disparities: African American mothers are three times more likely to die in childbirth than white mothers.

In short, we are overspending and under-serving women and families. If the United States is serious about health reform, we need to begin, well, at the beginning.

The problem is not access to care; it is the care itself. As a new joint report by the Milbank Memorial Fund, the Reforming States Group and Childbirth Connection makes clear, American maternity wards are not following evidence-based best practices. They are inducing and speeding up far too many labors and reaching too quickly for the scalpel: Nearly one-third of births are now by caesarean section, more than twice what the World Health Organization has documented is a safe rate. In fact, the report found that the most common billable maternity procedures -- continuous electronic fetal monitoring, for instance -- have no clear benefit when used routinely.

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it's better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.

The Obama administration could save the country billions by overhauling the American way of birth.

Consider Washington, where a state review of licensed midwives (just 100 in practice) found that they saved the state an estimated $2.7 million over two years. One reason for the savings is that midwives prevent costly caesarean surgeries: 11.9% of midwifery patients in Wash- ington ended up with C-sections, compared with 24% of low-risk women in traditional obstetric care.

Currently, just 1% of women nationwide get midwife-led care outside a hospital setting. Imagine the savings if that number jumped to 10% or even 30%. Imagine if hospitals started promoting best practices: giving women one-on-one, continuous support, promoting movement and water immersion for pain relief, and reducing the use of labor stimulants and labor induction. The C-section rate would plummet, as would related infections, hemorrhages, neonatal intensive care admissions and deaths. And the country could save some serious cash. The joint Milbank report conservatively estimates savings of $2.5 billion a year if the caesarean rate were brought down to 15%.

To be frank, the U.S. maternity care system needs to be turned upside down. Midwives should be caring for the majority of pregnant women, and physicians should continue to handle high-risk cases, complications and emergencies. This is the division of labor, so to speak, that you find in the countries that spend less but get more.

In those countries, a persistent public health concern is a midwife shortage. In the U.S., we don't have similar regard for midwives or their model of care. Hospitals frequently shut down nurse-midwifery practices because they don't bring in enough revenue. And although certified nurse midwives are eligible providers under federal Medicaid law and mandated for reimbursement, certified professional midwives -- who are trained in out-of-hospital birth care -- are not. In several state legislatures, they are fighting simply to be licensed, legal healthcare providers. (Californians are lucky -- certified professional midwives are licensed, and Medi-Cal covers out-of-hospital birth.)

Barack Obama could be, among so many other firsts, the first birth-friendly president. How about a Midwife Corps to recruit and train the thousands of new midwives we'll need? How about federal funding to create hundreds of new birth centers? How about an ad campaign to educate women about optimal birth?

America needs better birth care, and midwives can deliver it.

Jennifer Block is the author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care."

Tuesday, December 23, 2008

Development Updates

It's been a while since I posted any baby development updates, here are a few weeks worth (borrowed from On a personal note, I have now felt Speck respond to loud noises twice (once to my hair dryer and once to a passing firetruck), and his movements are so strong now that I can watch my belly bounce around when he gets going. Only a couple of weeks left until we enter the third trimester!!

WEEK 22 - How your baby's growing:

At 11 inches (the length of a spaghetti squash) and almost 1 pound, your baby is starting to look like a miniature newborn. His lips, eyelids, and eyebrows are becoming more distinct, and he's even developing tiny tooth buds beneath his gums. His eyes have formed, but his irises (the colored part of the eye) still lack pigment. If you could see inside your womb, you'd be able to spot the fine hair (lanugo) that covers his body and the deep wrinkles on his skin, which he'll sport until he adds a padding of fat to fill them in. Inside his belly, his pancreas — essential for the production of some important hormones — is developing steadily.

WEEK 23 - How your baby's growing:

Turn on the radio and sway to the music. With her sense of movement well developed by now, your baby can feel you dance. And now that she's more than 11 inches long and weighs just over a pound (about as much as a large mango), you may be able to see her squirm underneath your clothes. Blood vessels in her lungs are developing to prepare for breathing, and the sounds that your baby's increasingly keen ears pick up are preparing her for entry into the outside world. Loud noises that become familiar now — such as your dog barking or the roar of the vacuum cleaner — probably won't faze her when she hears them outside the womb.

WEEK 24 - How your baby's growing:

Your baby's growing steadily, having gained about 4 ounces since last week. That puts him at just over a pound. Since he's almost a foot long (picture an ear of corn), he cuts a pretty lean figure at this point, but his body is filling out proportionally and he'll soon start to plump up. His brain is also growing quickly now, and his taste buds are continuing to develop. His lungs are developing "branches" of the respiratory "tree" as well as cells that produce surfactant, a substance that will help his air sacs inflate once he hits the outside world. His skin is still thin and translucent, but that will start to change soon.

Friday, December 19, 2008

Nursery Decor

I think that for most people, one of the most exciting parts of finding out the babies gender is knowing how to decorate the nursery. While I do admit that there are more gender specific theme based nursery sets, I really wanted to avoid "assigning a gender role". Plus, assuming we have more than one baby, I wanted to be able to reuse everything I buy. So we're going with monkeys. Who doesn't love monkeys?

I registered for a bunch of items to go with the theme, some of which are at Target and others are at Babies-R-Us. I haven't decided yet what color I want to paint the walls, but I ordered the window valances from the bedding set to that I can take them to the hardware store and match them to paint swatches.

Last weekend we found a great deal on a crib and dresser on Craigslist. I love the crib because it is "convertable". I just switch out a rail and it turns into a toddler bed. Buy a new frame and it can be a full size bed. I'm all about not having to buy things more than once! We did lose a couple of these little screw thingies in transit...does anyone know what this piece is called and where I can find more of them?

Erik keeps pointing out that we could have waited to buy the crib, because for the first few months the baby will probably sleep in our room in the play yard / bassinet. But I feel so happy having some furniture! I guess I'm truly nesting now.

Tuesday, December 16, 2008

Week 23 - Speck's Birth Team

After 6 doula interviews, 3 OB's, and one trip to the birth center, we now officially can announce Speck's "Birth Team".

Team Captain: Mom - my job is to carry Speck around for 9 months, meet his feeding demands, take good care of my body and manage all of the other parts of the team. And lets not forget about labor & delivery!

Coach: Dad - Erik's job is to keep Mom happy and well supported. Dad helps Mom with important decisions, information gathering, resource management, and moral support.

Doula: Miranda Cacek - Miranda is our #1 resource for information. We're very happy to be adding her to our team and think she is well qualified to assist Mom & Dad leading up to and at the birth. Miranda has attended over 50 births as a Doula, has three children of her own, and is also a prenatal massage specialist. As our Doula, Miranda will help us to create a birth plan, be prepared in the event that we aren't able to stick with the plan, and will support us in sticking to the plan and making educated decisions when things get hot & heavy. She has been a wealth of knowledge and information, providing me with a great reading list, resources for diaper info, yoga classes, childbirth education, etc. I'm very happy that we will be having someone there who understands the physiological, emotional, and spiritual elements of birth. I am confident that her knowledge and support will increase our odds of giving birth the way my body is made to. And yes, that last name is Czech.

Midwife: Nichol Chesser - The Center for Midwifery at the University of Colorado Hospital has four midwives who handle clinic appointments, on call, and labor & delivery. Nichol will be our primary provider but depending on when Speck decides it is time to enter the world, one of her colleagues may be the lucky woman to actually catch our little boy. All of the midwives at the center are Certified Nurse Midwives, which in Colorado means that they are (1) a RN, (2) hold a Masters degree or higher, and (3) have experience with labor and delivery. The Midwife can do everything but cut--to me this is ideal. Obstetricians have been trained first as surgeons and as such, their first inclinations tend to be control through surgery and medical interventions. I think that by having the person calling all the shots be someone who can do anything BUT cut, we are more likely to see Speck be given every chance possible for a natural birth.

Playing Field: The Birth Center at University of Colorado Hospital’s Anschutz Inpatient Pavilion -The birth center is part of a mega medical complex located about 30 minutes from our house. The Birth Center itself is a little bit unique in that it is actually located INSIDE the hospital, which means that should something come up where an OB is required, we're already there (no stressful relocating). And being a University hospital, the technology there is cutting edge if we need it. The labor and delivery rooms are designed to be comforting and soothing, and even have hot tubs to help relax and soothe labor pains. And the feature that makes me laugh, they have dial up internet!

Other Medical Professionals - As I said above, being as the Center is actually located inside of a hospital, all of the amenities and resources that we might need are on hand.

We get the impression that some of our family might still be feeling a little unsure of our decisions to use a midwife & doula rather than a more "conventional" OB. I hope that anyone who reads this will take the time to look at the links and information I've provided. We've put a lot of time and energy into these choices and I feel we're on the path to creating a birth that is right for my body and our baby.

Saturday, December 13, 2008

23 Weeks (almost) - Job Changes

It has been a couple of weeks since my last post and I have all kinds of thoughts I could write about, but there has been one major change that has me in a bit of a panic. This week, Erik decided to return to Dalbey, the job where he was working at this time last year.

I've been feeling really guilty the last few months about my role in Erik's decision to leave Dalbey in the first place. The money there was really good, but I hated the hours and didn't see how we would raise a family that way. This was months before I decided to throw away my birth control pills.

For several years, Erik's work hours were long and he often didn't get home till 9:00 or later at night. I got lonely and it was hard to motivate myself to eat right when I was cooking for one. Of course, I found ways to fill the time -- book club, yoga, pottery lessons, spanish, etc. And in all honestly I've missed the "me" time a bit.

So now he's going back to a position where the hours are 10:00 am - 9:00 pm. And if history is any indicator, I can also expect that he will work till 9:30 on a regular basis and some weekends as well. I fully support this decision and hope that he will be happy there and make good money.

So why is this going in the baby blog? Because I'm kind of freaking out about it. I've spent the last couple of months living with the expectation that Erik would have flexible hours and the option to work from home. I thought we would find some part time help around the house, I'd rearrange my hours at work a little, and everything would work just great.

Now I'm picturing a world where I work 8-4 or something like that, then I swing by the daycare where the baby spent the day, then I come home and figure out how to change out of my work clothes and cook dinner for myself with a baby in tow, then bath feed and entertain the baby, then go to bed...all before Erik is even home from work. Then ideally Erik would have baby morning shift while I get ready to go to work and do it all again.

I am having a really hard time with the day care idea for a 7 week old baby. First of all, it looks like an expense of about $1200 a month. Second, I'm concerned about having to work around daycare hours, diaper rules, feeding schedules, and the extra chore of drop off and pick up. Third, I hate the idea of sending my little baby off to a playpen for the day, when he's so little he should be getting cuddles and love all day. I really wanted to keep the baby at home for the first year or so, until he is old enough to actually PLAY and interact at day care.

I've been looking into home care options. Nanny's are expensive -- I've read to expect $2,000-$3,000 per month, plus having to pay taxes for their social security and medicare. This week I also looked into AuPaire programs. These seem like a good option--you pay an annual program fee of about $8,000 and a $200 per week "stipend" for a live in. The aupair attends the local community college and is here as part of a cultural exchange program. The idea of having a young foreign student live with us for the first year of baby's life seems a little scary too--and I've read that the total cost for this program tends to average $25,000 for a year after you factor in the extra cost of food, helping the student get to school, etc.

Of course, one of us could always quit our jobs and we could be a single income household with a stay at home parent. But we both like our jobs, and we like to have the money.

Reading back through this, it doesn't look too bad, just expensive. If Erik can make the kind of money he made the last three years at Dalbey, I guess the cost would be manageable. But being as I am considering these costs from where I stand right now (where I haven't even had the cash to buy a single baby item), it seems totally undoable.

I'll write more later about the other baby news: ultrasound, midwife, belly touches, weight gain, etc...