“An Unnecessary Cut”, 20 min video on Hospital VBAC

This video is timely and a valuable resource for birth workers. It’s a good length (20 mins) and it addresses that large number of women who are not ready for a home birth for a VBAC. It’s also a very good promotion for hiring a doula. Chileshe Nkonde-Price, a cardiologist at the University of Pennsylvania, wants to avoid an unnecessary Cesarean. This is the last week of her pregnancy. Enjoy and tell me what you think of it. Gloria

An Unnecessary Cut? How the C-section Became America’s Most Common Major Surgery – The New Yorker

Producer: Sky Dylan-Robbins

New Thinking in OBGYN

Want to see the future in OBGYN? Just keep reading my blog. This morning’s email (2014) contained a newsletter that updates obstetricians on the latest trends. Some of which I wrote about in 2009 and 2011. Now, if we could just get these ideas into practice.

OBGYN Clinical Updates/ July 23, 2014 Analysis Questions Use of Antibiotics for Group B Strep During Labor
Do prophylactic antibiotics for group B strep do more harm than good? The practice of giving prophylactic antibiotics to women in labor who are positive for group B Streptococcus was based on studies with poor methodology, an analysis finds.
Gloria’s blog Sept 2011: http://wisewomanwayofbirth.com/group-b-strep-what-you-need-to-know/

OBGYN Clinical Updates/ July 23, 2014: Medicare Costs for Screening Mammos Have Soared: New Strategies Needed
Spending on screening mammography has increased 44% ($296 million) in 8 years, without a corresponding increased benefit of earlier detection of breast cancer. Analysts suggest this spending increase is unsustainable, and new screening strategies are needed.
Gloria’s blog 2009: http://wisewomanwayofbirth.com/seven-ways-to-reduce-unnecessary-medical-costs-right-now/

OBGYN Clinical updates/ July 23, 2014 POLL
Is the Pelvic Exam Important?
New recommendations against routine pelvic exams in adult women with no symptoms have been issued by the American College of Physicians. Many women will be happy to hear this. As a provider, are you?
Gloria’s blog 2009: http://wisewomanwayofbirth.com/7-tips-for-creating-a-calm-joyous-homebirth/

Just say "no" to stripping membranes.

Just say “no” to stripping membranes.

Added to post April 10, 2015
AROM (Artificial Rupture of the Membranes) October 30, 2007
Vital Signs
Childbirth: Purposely Breaking Water Does Not Speed Delivery By NICHOLAS BAKALAR


A large review of studies suggests that a common procedure in labor, intentionally breaking the water, has no effect in reducing the labor time or assuring the baby’s health.

The procedure, sometimes called amniotomy, involves rupturing the amniotic membranes to speed contractions. The procedure has been in use for at least
250 years, although its popularity has varied.

The researchers reviewed 14 randomized controlled trials involving almost
5,000 women and found little evidence for any benefits. Amniotomy did not shorten the length of labor, decrease the need for the labor-stimulating drug oxytocin, decrease pain, reduce the number of instrument-aided births or lead to serious maternal injury or death.

The report, published Oct. 17 in The Cochrane Reviews, did find that the procedure might be associated with an increase in Caesarean sections and a reduced risk of a lower reading on the Apgar scale, which rates the baby’s condition at birth. But neither finding was statistically significant.

“We advise women whose labors are progressing normally to request their waters be left intact,” said the lead author, Dr. Rebecca Smyth, a research associate at the University of Liverpool. “There is no evidence that leaving the waters intact causes any problems, and there is not sufficient evidence to suggest any benefit to either themselves or their baby.”

Cytotec (misoprostol) injuries or death? Medical records needed.

Hyper Stimulation of the Uterus cuts off Oxygen to fetus.

Hyper Stimulation of the Uterus cuts off Oxygen to fetus.

    From Jette Aaroe Clausen

I am engaged in the public discussion on induction of labor and misoprostol in Denmark. I and a colleague, Eva Rydahl, have addressed the Health committee in the Danish parliament. They have not banned cytotec but they have announced that they will do more monitoring of this and they issued a new circular making it mandatory for midwives and doctors to report side effects to off-label medication.

Eva and I strive to learn more about hyper stimulation and the way cytotec works. To do so we need patient records. We will of course treat them in confidence and not reveal any names. We will be grateful if we can be allowed to read any medical notes from patients (or their families) who have had adverse reactions to Cytotec (misoprostol). Fetal monitor tracings are especially useful to us. My colleague, Eva Rydahl (who is also on facebook), will also be happy to correspond with families. My e-mail address is jecl@phmetropol.dk I work at the Danish midwifery education in Copenhagen. I am an Assoc Prof of Midwifery and a researcher. Jette Aaroe Clausen, May 21, 2014

$70 million Birth Injury Case – Largest Arbitration Award in U.S. History (Cytotec Brain Injury)

David Woodruff, Attorney
Posted on 07 May 2012.


David Woodruff took home Case of the Year honors at last week’s Colorado Trial Lawyers Association Spring Dinner for a birth injury case stretching nearly five years.

“We are fighters for those who can’t fight,” Woodruff told the crowd as he accepted the award.

The partner at Hillyard Wallberg Kudla & Sloane in July helped obtain a $70 million arbitration award against the company which owned both the hospital the family of Abigael Blasco went to and the health maintenance organization covering the family. Nurses at the hospital, per instructions from the HMO, administered Blasco’s mother (Rebecca Blasco) an ulcer medication to induce labor despite warnings from the government and the manufacturer itself against this off-label use.

The medication, which cost more than $100 less than the approved labor-inducing medication, had been indicated in too-forceful contractions during labor, which compromises blood flow to the fetus.

The company provided Woodruff with differing fetal heart tracing reports from the day of the delivery. Comparing the different versions, he was able to show that Abigael had suffered a lack of oxygen during labor, which led to developmental issues for the 12-year-old.

Rebecca and Abigael Blasco with David Woodruff

Rebecca and Abigael Blasco with David Woodruff

Fighting for those who can’t fight seemed a theme of the night. Michael Rosenberg, shareholder at Roberts Levin Rosenberg, one of the two other nominees for case of the year, said of his case helping an accident victim, “If you have to fight for 11 years, then you do it.”

Robert F. Kennedy Jr., the night’s keynote speaker, was seen outside the ballroom pacing the hallways going over what he would later say. Stopped to chat, Kennedy called trial lawyers “my people.”
“These are the most important people to democracy,” he said. “They’re fighting for justice.”
Source: Law Week Online

Birth Injury Case – Largest Arbitration Award in U.S. History
David Scott Woodruff
Case Conclusion Date:July 6, 2011
Practice Area:Medical Malpractice
Outcome:$70 million award, the largest in U.S. history
Description: Case involved a baby born at an HMO hospital in Los Angeles, CA. Mother was given improper dose of misoprostil (Cytotec) and Pitocin, and suffered uterine hyperstimulation, causing fetal asphyxia and severe brain injury. Child is now 11 years old and has severe mental and physical disabilities. Case was tried to a judge/Arbitrator in Orange County, CA.

Source: http://www.avvo.com/attorneys/80237-co-david-woodruff-1412913/legal_cases/72634

Youtube video of a lawyer, Mike Papantonio, talking about the methods of Pfizer (now the owners of Searle) who make Cytotec:
“Ian Read, who is the CEO of Pfizer. . . you talk about a bottom feeder of CEOs, it’s him.” (paraphrased)

High Cesarean rates: all talk, no action

If we look at childbirth from the point of view of a game, the success or failure would be measured by the cesarean rate. When there is a 30% or higher rate of cesarean for first time mothers, there can be no excuse. . . those people playing the game are losing and losing badly. When there can be no denying that something is terribly wrong, what happens? The players get together and try to figure out what can be done to get a winning outcome. This has been done before by medical people with good results when action resulted. Unfortunately for women, it seems to be impossible to maintain positive results once the initial action plan is withdrawn. See my post.

There have been many statements, pledges, admonitions, expressions of concern, etc in the past 10 years about the impact on women’s health of all these major abdominal surgeries. See:
Cesareans Are Seriously Harming Women

Now we have a new statement put out by a team of people who are duly concerned in the USA. It mirrors other team reports. How many teams have to be gathered and how many over-educated people have to produce reports before a concerted program is instituted to stop the cesarean butchery of women in North America? We need action and we need it fast. Gloria Lemay, Feb. 12, 2014


Experts Identify Key to Reducing Cesarean Delivery Rate
News | February 05, 2014 | Pregnancy and Birth
By OBGYN.net Staff

Continued education on reducing unnecessary cesarean deliveries must include particular attention to preventing the first cesarean delivery, as well as tapping into the clinician’s ability to modify and mitigate factors that often contribute to the cesarean, leading experts suggested.

The article in which these suggestions are published is based on a workshop aimed at preventing first cesarean delivery.1 The workshop was a joint effort of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists.

“Given the risks associated with the initial cesarean and its implications in subsequent pregnancies, the most effective approach to reducing overall morbidities related to cesarean delivery is to avoid the first cesarean,” said George R. Saade, MD, of the division of maternal-fetal medicine, department of obstetrics and gynecology, University of Texas Medical Branch, Galveston and chair of the Society for Maternal-Fetal Medicine’s health policy committee. “The implications of a cesarean rate of 30% or more—since approximately 1 in 3 pregnancies are delivered by cesarean—have significant effects on the medical system as well as on the health of women and children. It is essential to embrace this concern and provide guidance on strategies to lower the primary cesarean rate.”

In 1995, the total rate of cesarean deliveries was 20.8%, and the rate of primary cesarean deliveries was 15.5%.2 The rise in the rate of cesarean delivery compared with these 1995 rates is due in part to an increase in the frequency of primary cesareans, the authors noted, but it is also because attempts at labor after cesarean have declined.

Workshop participants developed a set of guidelines for preventing first cesarean delivery. They included the appropriate ways to identify failed induction, arrest of labor progress, and non-reassuring fetal status. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed, as long as the maternal and fetal conditions permit, they noted. The experts also determined that the adequate time for each stage appears to be longer than traditionally thought.

Other key points included:

Accepting operative vaginal delivery as a birth method when indicated. Given its declining use, training and experience in operative vaginal delivery must be facilitated and encouraged.
Counseling pregnant women about the effect of cesarean delivery on future reproductive health.
If cesarean deliveries are conducted for non-medical indications, the gestational age should be at least 39 weeks and the cervix should be favorable, especially in the nulliparous patient.

The complete study is available here.

1. Spong CY, Berghella V, Wenstrom KD, et al. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists workshop. Accessed January 31, 2013. Available here.

2. Curtin SC, Kozak LJ. Cesarean delivery rates in 1995 continue to decline in the United States. Birth. 1997;24:194-196.

Source http://www.obgyn.net/news/experts-identify-key-reducing-cesarean-delivery-rate?cid=newsletter#sthash.UuS7x6rD.dpuf

INDUCTION: Reasons you won’t believe

These are reasons for inducing the birth process that have appeared in hospital documents:

From the physicians:

“Patient lives in Mexico”
“PTL” needing cervical ripening
“Physician Distress”
“Patient lives far away”
“Worrisome weather”
“She has a note from her husband” (he stated he understood all the risks and promised not to sue if there was a bad outcome)
The patient wants to fit in her prom dress
impending macrosomia
Approaching post dates
“Avoid unlucky birthday on the Chinese calendar”
“placental lakes”
Because the baby is sitting right there.
History of rapid labor ……. (this was for a first time mother)
Multip with history of rapid deliveries…for cytotec induction…
“her husband’s team is playing in town and he (professional athlete) wants to be at the delivery”.

Don't let them induce you

From the patients who want to
schedule their own inductions:
“My doctor scritched my membranes and told me to call you”
“Fireballs in my uterus” and “Fireballs in my Eucharist”
” I am here for “instruction” for labor”
“my doctor is going to indulge me next week”

Birth in North America circa 1975

I just saw this photo on Flickr and it reminded me of what it was like when I was looking for a gentle birth in 1976. Thank heaven I found a midwife to attend me at home. Gloria

Woman Who Has Just Given Birth in the Delivery Room of Loretto Hospital in New Ulm, Minnesota...

Woman Who Has Just Given Birth in the Delivery Room of Loretto Hospital in New Ulm, Minnesota…

Original Caption: Woman Who Has Just Given Birth in the Delivery Room of Loretto Hospital in New Ulm, Minnesota. Her Husband, Who Observed the Birth, Holds His Wife’s Head as She Turns to Gaze at Her Newborn Child. There Are Two Hospitals in the Town, Union Which Is Non-Denominational and Loretto Which Is Catholic. They Have Divided Their Services to Specialize and Give More Efficient Service New Ulm Is a County Seat Trading Center of 13,000 in a Farming Area in South Central Minnesota.

U.S. National Archives’ Local Identifier: 412-DA-15716

Photographer: Phillips, Kathy

College of Midwives of B.C.

Parents, grandparents, children and birth rights activists picketed the College of Midwives offices on Nov. 28, 2012. The College of Midwives conducts secret investigations and flagging operations to undermine the alternative birth workers in the province. By sending negative press releases and spreading half-truths and innuendo, they attempt to claim a monopoly on who shall attend births in the province.

Choice of birth attendant is a woman's right

From the film “Freedom for Birth”: — “One of the home birth mothers supported by Ms Gereb (Agnes Gereb, Hungarian midwife) decided to take a stand.
When pregnant with her second child, Anna Ternovsky took her country (Hungary) to the European Court of Human Rights and won a landmark case that has major implications for childbirth around the world.

Toni Harman, one of the filmmakers says, “the “Ternovsky vs Hungary” ruling at the European Court of Human Rights in 2010 means that,. . . now in Europe, every birthing woman has the legal right to decide where and how she gives birth. . .

. . .And across the world. . ., it means that if a woman feels like her Human Rights are being violated because her birth choices are not being fully supported, she could use the power of the law to protect those rights. With the release of “Freedom For Birth”, we hope millions of women become aware of their legal rights and so our film has the potential to spark a revolution in maternity care across the world. In fact, we are calling this the Mothers’ Revolution.”

Added on June 17 2013: EUROPEAN COURT OF HUMAN RIGHTS Fact Sheet
Under Article 37 § 1(c)of the Convention
Home Birth
Ternovsky v. Hungary
The applicant complained about being denied the opportunity to give birth at home, arguing that midwives or other health professionals were effectively dissuaded by law from assisting her, because they risked being prosecuted.
(There had recently been at least one such prosecution.)
The Court found that the applicant was in effect not free to choose to give birth at home because of the permanent threat of prosecution faced by health professionals and the absence of specific and comprehensive legislation on the subject, in violation of Article 8
Right to respect for private and family life.
Source: http://www.echr.coe.int/Documents/FS_Reproductive_ENG.pdf

Confessions of an Obstetrician

Top Ten Signs Your Doctor Is Planning To Perform An Unnecessary Cesarean Section On You

Posted on November 14, 2012 by Jonathan Weinstein

Jonathan Weinstein, ObGyn

I have been a practicing OB/GYN
for fourteen years. I live in Frisco, Texas, one of the fastest growing
cities in the United States, and I truly enjoy living and working here.
It is a great place for my family and, for the first time, my office is
attached to the actual hospital I practice in. This is the third and
final place I will practice medicine. I trained with some of the most
respected academic OB/GYN’s in the country. These physicians have
contributed to books on Obstetrics, created practice guidelines for the
American Congress of Obstetricians and Gynecologists (ACOG), and taught me to practice medicine based on scientific evidence.

I follow a few simple rules: do no harm, give your patients options,
and provide information so they can make
informed decisions. So, last night I was sitting in my office looking
at the fourth Cesarean Section (C/S) operative report
of the day for yet another patient who wants to have a vaginal delivery
following a previous C/S. I am frustrated and feel like I am fighting a
losing battle.

When did Cesarean Sections (C/S) and elective inductions at 39 weeks
become the standard of care? That is not what I was taught,
and that is not in any textbook or ACOG
practice bulletins. So why in Dallas, Texas do people have to drive
more than an hour to find a doctor who actually has no desire to do an
unnecessary C/S? It has become obvious that I cannot attend every
vaginal birth a patient wants to have after their traumatizing C/S
experience. If close to 50% of the patients are getting a C/S each day
and there are hundreds of practicing OB/GYN’s in the Dallas Metroplex,
the math is not difficult. I know at least one physician who only does
C/S’s, and vaginal delivery is not even an option. If one of his
patients delivers vaginally it is only because the baby came faster than he could get to the hospital.
This is the only place I have lived where C/S and elective inductions are king. So, women of the world, I am giving you the knowledge to stand up for yourself before you get that first C/S!

Top Ten Signs Your Doctor Is Planning To Perform an Unnecessary Cesarean Section on You

1. Arrives to Labour & Delivery immediately after office hours and says,“I just don’t think this baby is going to fit.”

2. Third Trimester, Routine Office Visit, “I think this is going to be a big baby. You should just have a C/S” – Did you know? ACOG has very specific guidelines for when it is
appropriate to offer a patient an elective C/S for MACROSOMIA (fancy
word for large baby). ‘Prophylactic (elective) cesarean delivery
may be considered for suspected fetal macrosomia with estimated fetal
weights greater than 5,000 gms (11 pounds) in women without diabetes and greater than 4,500 gms (9.9 pounds) in women with diabetes.

3. “We should induce at 39 weeks because your baby is getting too big” – Did you know that, according to ACOG:
‘Induction of labor at least doubles the risk of cesarean delivery without reducing shoulder dystocia (rare situation where baby’s shoulder can get stuck at delivery) or newborn
morbidity(complications). Suspected fetal macrosomia is not an
indication for induction of labor, because induction does not improve
maternal or fetal outcomes.’

4.Performs routine ultrasounds at end of pregnancy to see how big your baby is. Did you know that ultrasounds at the end of the pregnancy can be 1-2
pounds off? Ask some VBAC patients who were talked into a C/S for this, then had a vaginal delivery of a bigger baby the next time.

5. “You have a positive herpes titer (or history of herpes); the baby will get it if you deliver vaginally.” Try some Valtrex for the last month of the pregnancy that is pretty
much standard of care now. It prevents outbreaks and allows for a
normal vaginal delivery.

6.“Your baby is breech. You need to have a C/S” Ever heard of or performed an External Cephalic Version (process by which a breech baby is turned to the proper position)? It really does

7.“You have pushed for 2 hours” (with an epidural that prevents you from feeling anything so you are
probably not pushing effectively; this is evident on exam because the
baby’s head is still perfectly round, but you do not need to know that)“It’s just not going to come out”

8. “I scheduled you for an induction at 39 weeks. It is just soooo… much more convenient for you!” (and so much higher risk of ending in a C/S, especially if you are not
dilated when you start the induction). At least 80% of my VBAC patients were induced the previous pregnancy. For whose convenience was the induction?

9. First Visit (7 weeks),“Congratulations you are having twins. I will go ahead and schedule
your C/S at 38 weeks, but don’t worry if you go in to labor early I will cut you right away!” Translation, “I am scared out of my mind for you to deliver your babies vaginally because I am not trained on
what to do when the second baby is coming, plus it pays more to cut you
open. Oh yeah, I don’t have that great a rapport with you because I
only spend 2 minutes (fundal height, heart beat and ‘I’ll see you next
time’) with you each visit, so I am afraid I will be sued for trying to
do the right thing.”

10. First Pelvic Exam in Office (7 weeks),“Hmm, your pelvis is pretty narrow”.

Bonus Tip:
11. 38-week visit, “Your blood pressure is a little high today. You are probably developing
preeclampsia or toxemia. That can cause you to have a SEIZURE! The
treatment is to deliver the baby. You need a Cesarean Section, as this
is the quickest way to resolve it. Let’s get you up to L&D NOW!” Translation – Preeclampsia or Pregnancy Induced High Blood Pressure is a pain in the butt. If I induce you, it could take 24 hours or more and then I would have to manage your blood pressure, and put you on
Magnesium. This is way too inconvenient. Do not worry you can try to
have the baby vaginally next time. Yeah right!

Well, I hope you future moms find
use for these tidbits of info. If anyone wants to add anything, please
feel free. Your experience may help other women in the future.
Remember, there are only a few emergent reasons for a C/S such as fetal
distress, unexplained heavy vaginal bleeding, etc. It is okay to ask
your doctor questions. We are not supposed to bite.

Jonathan Weinstein, MD, FACOG

Husband to a Labor and Delivery Nurse with 27-years’ experience
Father to two beautiful children, Zoe and Ashton


If you wonder why obstetrics is so aggressive

Second Largest Medical Malpractice verdict in Pennsylvania since 2000.

Pottstown Hospital Ordered to Pay $78.5 Million (Philadelphia Business Journal)
May 4, 2012

By Jeff Blumenthal and John George, Staff Writers

A Philadelphia jury ordered Pottstown Memorial Medical Center to pay $78.5 million Friday in a medical malpractice verdict in a case involving a child who suffered severe brain damage as a result of alleged negligence.

The child, now 3, has severe spastic quadriplegic cerebral palsy resulting from an 81-minute delay in performance of an emergency cesarean section delivery.

The case was tried, beginning on April 13, in front of Philadelphia Common Pleas Judge Mark I. Bernstein. The damages award includes payments for future medical care, lost earnings, pain and suffering for the child as well as emotional distress for the baby’s mother, Victoria Upsey.

Plaintiffs attorney Daniel Weinstock of Feldman Shepherd Wohlgelernter Tanner Weinstock & Dodig of Philadelphia said birth injury cases are always emotional matters, but the facts of this case were particularly shocking because the reason this delivery was delayed was that the obstetrician thought the baby was dead.

“He performed an ultrasound examination with outdated, insensitive, and poorly maintained equipment provided to him by the hospital, Pottstown Memorial Medical Center,” Weinstock said. “He actually told my client her baby had died, then 81 minutes later, the baby had come back to life.”

“We are disappointed in today’s verdict and plan to appeal,” the hospital said in a statement.

Pottstown Memorial is owned and operated by Community Health Systems (NYSE:CYH), a hospital management company based in Franklin, Tenn. Its lawyers were not available immediately for comment either.