Unassisted Childbirth

The Washington Post has an article today on Do-It-Yourself Delivery. Though I am not a supporter of unassisted childbirth, I do have an interest in the positive - or at least fair and unbiased - portrayal of normal birth in the media. The article contained this gem:

To [Mairi Breen] Rothman, [a nurse-midwife and spokeswoman for the American College of Nurse-Midwives, which does not support unassisted childbirth], Shanley's beliefs underscore a more fundamental problem with maternity care. "To me the really interesting question is, Why would someone go outside the system?" Rothman said. "What is so broken that they don't want to use it?"

[Heather] Jones, the Navy wife, has an answer. Her first delivery in a hospital four years ago was marred by "interventions and interferences based on someone's outside judgment" of how well her labor was progressing, she said. She said she felt pressured to have epidural anesthesia, was not allowed to move around as she wished and was denied access to her baby until he was two hours old because he was being observed by the hospital staff.

Jones said she decided to give birth to her third child unattended after her second was born five minutes after the midwife arrived at her home."

She was like, 'See, you didn't need me,' and I thought, 'You know, maybe I don't,' " she said, as baby Gideon, now 5 months old, cooed in the background.

This Week's Legal News

Breasts, placentas, midwives, and the TSA -

Woman wins settlement in breastfeeding case:

Watch-maker and clothier Fossil Inc. agreed to pay $3,600 to a woman who was barred from breast-feeding her infant while visiting a company showroom, the New York Civil Liberties Union said on Tuesday.

Lass King, 37, a buyer for a Maine clothing store and a mother of two, said she received a letter of apology and the payment from Fossil after threatening the company with a lawsuit.

In its letter to King, Fossil also said it had issued a policy affirming that breast-feeding was permitted in all Fossil stores and showrooms, said Galen Sherwin, director of the NYCLU's Reproductive Rights Project.

Representatives of Fossil could not immediately confirm details of the settlement.

New York law states that women are permitted to breast-feed "in any location, public or private, where the mother is otherwise authorized to be."

Hospital told to return placenta to mom:

A woman has won a court fight to keep the placenta after her daughter's birth. She had planned to grind it up and ingest it as a way to fight postpartum depression, but now plans to bury it.

Clark County District Court Judge Susan Johnson granted a preliminary injunction Tuesday, ordering Sunrise Hospital and Medical Center in southern Nevada to return the placenta to Anne Swanson. Hospital officials said they will comply.

What is interesting was that the plaintiff was expecting a ruling on a temporary injunction, not a ruling on the merits (see Swanson vs. Sunrise Hospital for the blow-by-blow). Doesn't sound as if the hospital will fight this decision, but they are not changing their policy either:

Amy Stevens, system vice president for Sunrise Health, which operates Sunrise Hospital, described the ruling as specific to Swanson. She said the hospital must comply with strict regulations in handling human biohazardous waste.

There is no Nevada law prohibiting hospitals from returning placentas to mothers. But several Las Vegas area hospitals told the Las Vegas Review-Journal the organ is usually destroyed unless a physician designates it for medical tests or a patient seeks it for specific religious or cultural reasons.

USA Today ran a piece this week on placentophagia (Ingesting the placenta: Is it healthy for new moms?) which mentions the Swanson case.

After numerous complaints, the Transportation Safety Administration (TSA) has changed its policy regarding breastmilk:

TSA is also modifying the rules associated with carrying breast milk through security checkpoints. Mothers flying with, and now without, their child will be permitted to bring breast milk in quantities greater than three ounces as long as it is declared for inspection at the security checkpoint.

Breast milk is in the same category as liquid medications. Now, a mother flying without her child will be able to bring breast milk through the checkpoint, provided it is declared prior to screening.

Birth Without Boundaries lawyer Jake Marcus comments:

Under the old TSA rule, pumped breastmilk had to be packaged in 3 oz containers all of which had to fit into one 12 oz ziplock bag. Birth Without Boundaries has assisted many women whose pumped milk was confiscated and dumped by TSA security officers, either because it was not packaged according to regulation or because the TSA officer did not know what the regulation was. All of our complaints to the TSA have gone unanswered, until now.

Marcus also recommends that women traveling with expressed milk carry a copy of the modified policy, just in case they encounter an employee who has not yet gotten the memo.

Judge dismisses Mendon midwife lawsuit:

A federal judge has dismissed a lawsuit filed earlier this year by a former Mendon midwife in a bid to have her license to practice in Vermont reinstated.

Roberta Devers-Scott claimed in the lawsuit that the state violated her due process rights, leading to the revocation of her midwife license. Secretary of State Deborah Markowitz, whose office oversees professional licensing of midwives in Vermont, was among the defendants named in the lawsuit.

Judge J. Garvan Murtha issued a six-page ruling in U.S. District Court in Brattleboro granting a motion filed on the defendants' behalf dismissing the lawsuit, ruling, in part, Markowitz had immunity from the lawsuit.

Michael Sussman, Devers-Scott's attorney, said Friday he planned to appeal the judge's ruling to the 2nd Circuit Court of Appeals in New York City.

And that's what is making news this week.

Huntington Beach Bans Nudity

Aren't there state regulations on this?

The [Huntington Beach] City Council unanimously voted to ban public nudity during its Monday meeting after a brief debate that resulted in striking portions of the proposed ordinance.

The council decided to limit the law to being nude where it is visible from a public area. They deleted regulations on a women breastfeeding an infant older than age 2, and restrictions on wearing a costume or device that simulated nudity.

The article goes on to say:

This type of ordinance is not new to cities in Orange County. More than half of the cities in the county have approved similar bans on public nudity, said [Police Chief Kenneth] Small.

Wonder what those ordinances say about breastfeeding?

Is it legal for Florida midwives to do VBACs?

Occasionally one will hear that it is illegal for licensed midwives in Florida to attend VBACs (vaginal birth after Cesarian). Not so, as Sarasota midwife Heidi Dahlborg, LM, explains:

It is legal for a Florida LM to do a primary VBAC, but it does carry a risk score of 3, which requires a consult from a VBAC friendly doctor. Some midwives who can not get consults have mistakenly told people "its illegal to do VBACs at home" when they mean "it is illegal for me to do VBACs at home because I can not get the proper consult to comply with the law".

So you can legally have a VBAC with a homebirth Licensed Midwife, as long as she obtains a consult from a physician with OB privileges. There is a state risk assessment score for LMs that assigns points for various risk factors, and when your points reach 3 for any reason, you must have a consult with a physician that does obstetrics. A prior c-section scores 3 points for "prior uterine surgery". Prior uterine surgery with a subsequent successful vaginal birth (a secondary VBAC) is only 2 points. So if the mother has no other point scoring risk factors, she will only have a 2, and thus can have a VBAC with out consult. If she smokes, is over/underweight, or has other factors, she will need a consult based on her overall points. The risk assessment is in the rules, which can be viewed online at http://www.doh.state.fl.us/mqa/midwifery/mw_statutes.html under Rules: Chapter 64B24, its a large document and you must scroll down to Chapter 64B24-7, Midwifery until you see the Midwifery Practice Act, which includes the risk assessment. You can also get a risk screening tool from any practicing midwife.

If the midwife also has a birth center, that complicates things further. The birth centers are governed by a separate law, and it says the birth centers can only do VBACS in the birth center if they are participating in the National VBAC study, which has been closed for 7 years. So there has been no way to comply with birth center law, so there is no way to legally do a VBAC in the birth center. But midwives who own birth center will often do VBACs at home, even though they can not do them in the center.

I know an attorney that was drawing up a consent to allow midwives and moms to choose to go outside of the law or rules, as part of the alternative medicine law, but I do not know if anyone actually does that yet.

The American Association of Birthing Centers, the birth center association, is going to open the National VBAC study up again soon, thanks to Charlynn Daughtery a Tampa midwife that own Labor of Love Birth Centers. She has really been a strong VBAC advocate in political circles, working hard to keep VBAC options open at home and birth centers. Once that study open, hopefully in Fall, Florida women will be able to have VBACs in birth centers if the consults are obtained. You can contact them, AABC, to urge them to get the VBAC study opened again.

So, as it stands- in Florida you CAN have a VBAC at home, but not in a birth center, as long as the proper consults are obtained. Many women travel 3 hours or so to get the consult, at around 28 weeks, but you can usually get the consult anytime including preconception. It is generally just a review of your surgical record, and a conversation on risks and benefits.

Thanks, Heidi, for the great explanation!

I'm so behind, I'll never catch up

Here are a couple things on the radar today:

The Australian parliament is debating whether breastfeeding legislators should be given a proxy vote - that is, to have their vote recorded while they are out of the chamber:

The issue of breastfeeding in Parliament made headlines in 2003 when Victorian Labor MP Kirstie Marshall was thrown out of State Parliament for breastfeeding.

Committee members said the debate had resurfaced in light of an increasing number of new mums in the House of Representatives in the past decade.

The committee found only 10 female MPs had given birth while in office - out of a total of about 130 female MPs.

"Women have faced the difficult choice between prioritising their duties as a member with those of being a mother," members said.

Pennsylvania's governor signed that state's breastfeeding legislation. Although breastfeeding advocates would have preferred a stronger bill, it's better than nothing.

A Missouri judge has issued a temporary restraining order blocking implementation of HB 818 which decriminalizes direct-entry midwifery. This bill has caused a lot of controversy. Apparently, it's a circus over there in the Missouri legislature:

A senator secretly attached the provision to a bill intended to make health insurance more accessible to some Missourians. Gov. Matt Blunt signed the bill into law.

Several physician groups sued last Thursday, claiming the midwife language violates the Missouri Constitution by going beyond the bill’s health insurance title and by changing the bill’s original purpose.

The recently passed legislation says that regardless of the current felony statute, anyone with a “tocological certification” — meaning in obstetrics — from a privately accredited group can provide services related to pregnancy.

The title of the bill that passed described it as “relating to health insurance.”

(link)

Alabama has voted down its midwifery bill. Try again next year?

Nancy Ver Steegh of The Family Law Prof Blog reports Problems at Center Where Mothers Serve Prison Terms With Young Children:

"The authorities in California are investigating accusations that poor health care at a center where mothers serve prison terms with their young children led to the stillbirth of a 7-month-old fetus and endangered the lives of several children.

Staff logs, statements by prisoners and interviews with investigators, staff members and prisoners’ families depict a facility where inmates and their children were denied hospital visits and medications, and where no one kept adequate records of accidents involving injuries that included a skull fracture and a broken collarbone."

Giving Birth With Confidence links childbirth issues to a recently-released government list of hospitals where heart patients are most likely to die in Out of the Dark: Transparency and Birth:

Transparency is suddenly a big deal. This government report follows on the heels of efforts in New York City, and communities across the country, to improve the level of transparency related to childbirth. Giving birth in the dark is an apt metaphor for the current state that women find themselves in when attempting to access information about maternity care. The recent NYC public advocates’ report identified that city hospitals although legally mandated to do so, are still failing to provide maternity information. Public Advocate Betsy Gotbaum is working tirelessly to insure that hospitals do what they are legally mandated to do…including reporting induction and cesarean rates.

Better get this posted before I get distracted by something else...