26.Aug.2011 Daemon’s Birth Story

Birth Story: Daemon James

Our day started out as pretty normal, went shopping and had another appointment with Stacey to see how things were going. All was good so we came home to make a belly cast. While preparing and laying on the floor, my back starting hurting so we stopped and I tried to work that out thinking it was just from laying there. Starting having contractions around 7pm and they got stronger and closer. Around 8:30 we called Stacey to let her know that we were 2 minutes apart and about a minute long, she suggested we come down and see her to check and maybe have the baby. We got to the Birth Place at 9pm. Stacey checked us to which we were at 5 centimeters and “Let’s have a baby tonight!” We stayed and labor progressed. We tried didn’t positions and the birthing tub to which that was the best. All was going great, but strong and intense. We started pushing maybe around midnight and at 1:13am Friday the 19th, we pushed out our son. Derrick did a great job catching him and cutting the cord. What an experience, to have a labor that lasted maybe six hours for my first baby was awesome, but for sure really hard work.  Stacey, Katie and Christine were such great help through out the birth with checking on us and encouraging when we needed it. My husband Derrick and my mom Deniece were great coaches and I couldn’t have done this without any of them. 

Thanks to everyone for their help.

11.Aug.2011 International Breastfeeding Awareness Month

For International Breastfeeding Awareness month we did something I’ve always wanted to do. We called all our clients and asked about their breastfeeding duration. Thanks to everyone who responded.
What we learned is that we have great outcomes. We thought we had great outcomes, but now we can document them.
Here’s the study!

Breastfeeding Rates with the Birth Place: a Home and Birth Center Midwifery Practice.
Stacey Haugland, CPM
Abstract
August is International Breastfeeding Awareness Month. In celebration, we prepared a report on our breastfeeding rates since opening our practice here at the Birth Place. We found that our breastfeeding rates far exceed regional and national averages, and in fact surpass the Healthy People 2020 breastfeeding goals. Of the 52 women who worked with the Birth Place between its opening August 2009, and the end of May 2011, 100% breast fed at some point. At three months 91.2% were exclusively breastfeeding, at six months 79.3% were exclusively breast feeding and 96.6 % were breastfeeding, and at 12 months 88.9% were breastfeeding. Montana boasts one of the highest breastfeeding rates in the country. However, the incidence and duration of breastfeeding at the Birth Place exceeds Montana’s rates.
Birth Place Montana CDC Report Card Health People 2020 Goal
Ever breastfed 100% 88.5% 81.9%
3 months exclusive 91.2% 50.8% 46.2%
6 months 96.6% 55.4% 60.6%
6 months exclusive 79.3% 23.0% 25.5%
12 months 88.9% 34.8% 34.1%

Birth Place is the midwifery practice of Stacey Haugland, Certified Professional Midwife and features home and birth center births. Stacey Haugland, CPM, and her assistant Kattie Jones are Certified Lactation Counselors. Breastfeeding education is integrated into the prenatal appointments and supportive home visits are provided at day one, three, and five post-partum. Home visits are followed with post-partum office visits at week one, two, four, and six. Our message to expectant families is that for most women, breastfeeding is easy and pleasurable. The Birth Place provides additional lactation support throughout the nursing relationship including special visits for Times of Teething, Going Back to Work, and Tandem Nursing.
Midwifery care, with its focus on individual care and physiologic birth, provides a solid foundation for successful breastfeeding. We find the in-home support during the early post-partum period essential to long-term breastfeeding success.
Methods
Objective: to determine the rate and duration of breastfeeding among the clients of the Birth Place who gave birth between August 2009 and June 2011.
Participants: All clients who worked with Stacey Haugland, CPM, and the Birth Place in that time period, regardless of location of actual birth.
Process: Between August 2009 and June 2011, 52 women gave birth with Stacey Haugland, CPM, through the Birth Place. Beginning July 2011, each woman was called and asked the same series of questions. 44 women (85%) were reached and agreed to answer the questions. The script is as follows:
August is International Breastfeeding Awareness Month. We are collecting data on our breastfeeding rates. Can I ask you a few questions? [all answered “yes”].
At 3 months of age was (baby’s name)
• Eating breast milk at the breast
• Eating breast milk at the breast and in a bottle
• Eating breast milk only in a bottle
• Eating formula and breast milk
• Eating formula
At 6 months of age was (baby’s name)
• Eating breast milk at the breast
• Eating breast milk at the breast and in a bottle
• Eating breast milk only in a bottle
• Eating formula and breast milk
• Eating formula
And at 12 months of age was (baby’s name)
• Eating breast milk at the breast
• Eating breast milk at the breast and in a bottle
• Eating breast milk only in a bottle
• Eating formula and breast milk
• Eating formula
Whenever a woman indicated that a baby was not eating formula but only eating breast milk, she was asked “and was (baby’s name) eating any other foods, cereals, teas, or juices at this age?”

The Data
This report encompasses all clients who birthed with the Birth Place between July 2009 and June 30, 2011, 52 women in all.
Of the targets for the Health People 2020 Goals, this set of women surpassed each target marker.
Ever breastfed: Healthy People 2020 Goal is 81.9%. Birth Place data 52 out of 52, 100%
Breastfeeding at 3 months: data set n=34, 33 reported breastfeeding at 3 months, 31 were exclusively breast feeding. Healthy People 2020 Goal is 46.2% for exclusive breastfeeding: Birth Place 91.2%
Breastfeeding at 6 months: data set n=29, 28 reported breast feeding at 6 months, 23 exclusive breast feeding. Health People 2020 Goal is 25.5% for exclusive breast feeding at 6 months/60.6% breast feeding at 6 months. Birth Place data shows 79.3% exclusive breast feeding at 6 months/96.6% breastfeeding at 6 months.
Breastfeeding at 12 months: data set n=18, 16 report breastfeeding at 12 months. Healthy People 2020 Goal is 34.1% breastfeeding at 12 months. Birth Place data reports 88.9% breastfeeding at 12 months.

General Practice Data
General practice demographics are located in appendix A.
Discussion
The Birth Place provides midwifery care to low risk women and their full term babies. All births are planned to occur out of hospital, either at the Birth Place or at the client’s home. Stacey Haugland is a Certified Professional Midwife and has been attending births in Southwestern Montana since 1997. She is also a certified lactation counselor.
All clients birthing with the Birth Place plan on having a physiologic birth, i.e. labor starts on its own, is not made stronger than the body would naturally make it, and no pain medication is utilized. The majority of women birthing with Stacey Haugland, CPM, choose to labor either in upright position and/or use submersion in water at some point in their labor as a method of relaxation and pain control. Because the babies are full-term and un-medicated, they rarely need assistance with breathing. Consequently, babies are put directly on their mother’s chests and left skin-to-skin until after the first nursing is completed. In general no palate disruption or overstimulation occurs because these un-medicated babies do not need assistance clearing their airways, i.e. bulb syringe or deLee trap. However, women in this study who transported in labor and birthed either vaginally or by cesarean section in hospital show no difference in breast feeding rates as women who birthed out of hospital with the Birth Place. This lack of difference suggests that the ante-natal education and post-partum breastfeeding support are of essential importance in breastfeeding outcomes.
Limitations: All clients self-select for midwifery care. They may already be pre-disposed to breastfeed and to extend breastfeeding beyond the regional and national norms. All responses were self-reported and could not be externally verified. The sample size is small.
Acknowledgements
Many thanks to assistance Christine Clark for her technological skills and data tabulation. And my deepest thanks to each client who responded to my call and agreed to answer these questions.
References
Health People 2020 http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26
Montana Department of Vital Statistics 2009 report

http://www.dphhs.mt.gov/statisticalinformation/vitalstats/index.shtml

State Health Facts

http://www.statehealthfacts.org/profileind.jsp?ind=501&cat=10&rgn=28

CDC state report cards

http://www.cdc.gov/breastfeeding/data/reportcard2.htm

Appendix A
Practice Demographics
The 52 women who gave birth with the Birth Place between August 2009 and June 2011 have the following demographics. Demographic categories are taken from the Montana Office of Vital Statistics.
Race
White American Indian Other
47 (90.5%) 1 (2.5%) 4 (8%)

Parity
The women in this sample were fairly evenly split between first and second time mothers.
One Two Three Four Five
22 (38.5%) 23 (44.2%) 5 (9.6%) 3 (5.8%) 1 (2.5%

Birth Weight
There were no low birth weight babies in this sample
Birth Weight 2500-3999 grams B irth Weight 4000+grams
41 (79%) 11 (21%)

Completed weeks of pregnancy
Midwifery care as practiced by Stacey Haugland, CPM, at the Birth Place is for low risk women. Consequently any labor before 36 ½ weeks is transferred to medical care. In this sample none of the women initiated labor prior to 37 weeks. Of interest is that the majority of women gave birth after 40 weeks gestation. All out-of-hospital labors were physiological, i.e., none were induced.
37-39 weeks 40-42 weeks
23 (44%) 29 (56%)

Mother’s Age
20 – 24 25 – 29 30 – 34 35 – 39 40 – 44
1 (2.5%) 15 (29%) 22 (42%) 10 (19%) 4 (7.7%)

Location
Of the 52 women in this sample, all but two initiated labor intending to birth out-of-hospital. One woman was transported in her 38th week for pre-eclampsia and one woman was induced for post-dates pregnancy.
Out-of-hospital (home and birth center) Hospital
44 (85%) 8 (15%)

Cesarean Section
The majority of women transported had surgical births, including two women who had had previous cesarean births.
Total C-section 7 (13%)
Primip 5 (9.5%) Multip 2 (4%)

Waterbirths
Of the women who birthed out-of-hospital with the Birth Place, the majority labored and birthed in the water.
Waterbirths 31 (70.5%)

11.Jul.2011 Puppies,Babies, and our ability to love

My Puppy and My Poppa

I had a lovely al fresco breakfast in my backyard. Every other bite of spinach salad was interrupted by my 7 month old puppy. She wanted me to toss her ball, to rub her ears, to play tug-of-war and then she would wander off to eat a peonie or watch the chickens or patrol the fence line or chewchewchew on her stick. We had already spent 45 minutes at the park playing fetch and practising our sit/down/stay/catch/come.  She had had lots exercise. What she needed was attention and reassurance. She’s a puppy. In another 2 years, she will be able to sit quietly while I eat my breakfast. She will grow up. Right now, she’s a baby dog.

It got me thinking. I have a friend in her 50′s who has never had children, has never been around young children, and can not stop complaining about the children she interacts with in public spaces. Really, she is an incredible person. (She wouldn’t be my friend if she weren’t.) I have always thought of her as just missing a component of “humanness”, the ability to nuture.  Children are not little adults. And all adults should, by the time they are adults, understand the needs of children and understand what behaviors are realistic. But many of us don’t learn this. Many. I am sometimes quite surprised even by my clients’ beliefs about children. (That babies eat 3 times/day. That babies can wait 45 minutes until you finish your report,etc). My clients are by and large amazing, intellegent people. But many have grown up without this knowledge. Sitting at my breakfast table,  I started to think about what I knew about my friend’s parents — good, Godly, pillars of the community who raised her and her siblings with a strict, military discipline. She never got softness. She never got attachment. And in my inbox this morning was this: http://www.psychologytoday.com/blog/moral-landscapes/201106/believing-children-are-resilient-may-be-fantasy  How timely.

While eating my salad and playing with my dog, and in that special way we have with our friends, I figured out how to fix her. She needs a puppy. She needs to love some small, fragile being so much that she will gladly bend her needs to meet the needs of another. (I really don’t think it would be fair for her to learn this with an actual child). She needs to feel the absolute joy that comes from caring for another, small being.  Her cats don’t count. Her plants don’t count. She needs someone truly dependent.

I hope you find the article interesting. And I hope it helps in those moments when you hear (inside your own head or out), “You’ll spoil the baby”, “Let him cry it out”, “Oh, she’ll get over it”, “What about your needs?”, or any of the million other immature thoughts that try to keep us from responding to our babies. It really matters that you are responsive to your baby. It matters their whole lives. And it matters for the next generation too.

Now maybe I should call me friend and ask if she managed to figure out how to fix me while she was eating breakfast this morning.

05.May.2011 Happy International Midwives Day!

14.Feb.2011 Nurse-IN in Nation’s Capital Has Bozeman Connection

Kudos to Amber and Mark and their beautiful daughter for their part in the successful Nurse-IN at the Smithsonian.  I was lucky to be their midwife and attend their amazing birth. I am thrilled to know that they are such great agents of change for families and babies.

Here’s a Washington Post article about the Nurse-In.  A woman was approached by a security guard and asked to nurse in the women’s restroom. When she found there was no actual seating in the restroom,  she was advised to sit on the toilet to nurse. The incident is a great example of barriers to nursing and how far we, as a culture, have moved away from natural parenting. The security guard was, no doubt, well intentioned but needed to be educated about nursing. The Nurse-In was a great way to bring attention to the issue.

Alas, I cannot get the photos to load. Mark is wearing a great shirt that says “real men support breastfeeding.”  Check out the article. Way to go Mark and Amber!

31.Jan.2011 Let’s Reframe the Debate Already

12.Nov.2010 The Economics of Birth are Killing Us

I’ve just returned from the Midwives Alliance of North America Conference where we spent a lot of time discussing maternal and infant mortality.  What is clear from the data is that what we midwives do is the safest for mothers and babies. And it is also clear that what the US medical industry does to healthy women and children is causing death.  The world health community was present at MANA this year with the plea — help change US birth culture. Right now more babies die in Memphis than Sri Lanka, more mothers die here than in 40 other developed countries (and the CDC estimates that we under count maternal deaths by a factor of 3). (The workshops on maternal death in the US were chilling.)

Why does the world health community care what happens in the US? Because the US provides 50% of all international aid dollars.  By doing so, we export our model of care around the world. And our model of maternal and infant care is dangerous.  Why was the world health community at MANA?  Because we Certified Professional Midwives are the experts on physiologic birth. We don’t have access to inductions, augmentation, epidurals, vacuum extraction, c-section, etc.  We have become experts in how women’s bodies give birth. And we have documented our findings through the MANA statistics project. (See the CPM 2000 report in the British Journal of Medicine, for example) (And huge kisses to all of my clients who have consented to be part of the data collection project. Thank you. The world is watching.) [And here’s a little article from the Huffington Post that shows that mainstream Americans are watching too. http://www.huffingtonpost.com/tabby-biddle/women-speak-out-about-wha_b_781205.html?ref=fb&src=sp#sb=370053,b=facebook

MANA, the Canadian Association of Midwives, the Internation Confederation of Midwives, ACNM, along with support from the American Public Health Association and the World Health Organization are working jointly on public policy to improve maternal and infant health. And MANA has issued the 2020 challenge. By 2020 in the United States we need 20% more midwives and we need to be attend 20% of all births. It will take that level of saturation of the birth market for the midwives model of care to impact the US health care industry — and that’s when we will see a dramatic reduction in maternal and infant death rates.

The MANA 2020 challenge is very doable. Breaking it down to achieveable goals: each midwifery preceptor needs to take on 2 students and each midwife needs to do 45 births a year. We can do this.  Other countries have made this change to improve maternal and infant outcome.  Canada legalized direct-entry midwifery about the same time Monana did. Canada has the advantage of having a health care system as opposed to a health care for-profit industry. And now in Quebec there are more midwives than OBs. And direct-entry midwives are integrated into the health care system. They attend births in home, birth center, and hospital. In the same time frame, New Zealand made the same changes. We have bigger battles than either country because of our profit-based health care industry. But I know that 2 students and 45 births a year are doable. I am already doing it.

If you have ever considered midwifery as a possible career now is the time to act. Midwifery schools are accredited. Federal policy is changing. Science and the international health community are on our side. The women who brought midwifery back from the brink of extinction here in the US  have positioned us to succeed. Now we need to step forward and move midwifery into the mainstream. Mothers and babies need us.

For more information on Midwifery Education, here the Midwifery Education Accreditation Council

17.Aug.2010 SIDS and breastfeeding– the Analytical Armadillo puts breastfeeding as biological norm.

Here’s a great blog post from a kindred spirit.  I have mentioned in the past my bewilderment that we are explaining the benefits of breastfeeding as opposed to detailing the deficits of formula feeding. (An example: breastfed infants have higher IQs vs formula fed infants have lower IQs. Breastfeeding is the biological norm. Data should be presented in reference to that norm — i.e. the story is that formula fed infants have lower IQs).

Blogger “the Analytical Armadillo” looks at breastfeeding and SIDS.  The research is clear: formula fed babies die of SIDS at much greater rates. Why don’t we hear about this? Mothers who are supported can nurse. In the rare instance that nursing doesn’t work, formula is not the first option for infant feeding.  The World Health Organization is clear on this — babies should get mother’s milk at the breast. If that is not possible, babies should get their mother’s milk from a bottle. If a woman is not able to pump sufficient amounts of milk, a baby should get human milk from a bottle.  As a very, very last resort a baby should be given formula.  That the risk of SIDS jumps dramatically with formula feeding is just one example of why it is so important that babies get mother’s milk.

Formula and SIDS — a clear connection. Analytical Armadillo has been thinking about guilt and data. Check out  her blog.  The Analytical Armadillo.

28.Jul.2010 New ACOG Guidelines: Vaginal Birth After Cesarean is a Safe Option

Washington, DC – The Midwives Alliance of North America (MANA), a professional midwifery organization since 1982, commends the American College of Obstetricians and Gynecologists (ACOG) for their updated practice guidelines on Vaginal Birth After Cesarean (VBAC) released July 21, 2010. ACOG’s recent guidelines are less restrictive than previous ones. The new guidelines state that VBAC is a “safe and appropriate choice” for most women who have had a prior cesarean delivery, including some women who have had two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar.

There has been a dramatic increase in cesarean delivery in the United States (from 5% in 1970 to nearly 32% in 2009) and a rapid decrease of VBACs (from 28% in 1996 followed by a decline to 8% in 2006). Lack of VBAC availability in U.S. hospitals due to practitioner and institutional restrictions, which diminished women’s choices in childbirth, is often cited as the reason for the conspicuous decrease in VBACs. In light of the VBAC restrictions that have become commonplace in most U.S. hospitals, it is noteworthy that ACOG’s new guidelines emphasize a woman’s right to self-determination. The new ACOG guidelines state that even if a hospital does not offer a trial of labor after cesarean (TOLAC), a woman cannot be forced to have a cesarean nor can she be denied care if she refuses a repeat cesarean. In addition, previous ACOG guidelines on VBAC stated that anesthesia and surgery must be “immediately available” for an institution to offer VBAC; the new guidelines have relaxed this restriction.

ACOG has seriously considered recommendations from the National Institutes of Health (NIH) Consensus Development Meeting on vaginal birth after cesarean held in Washington DC in March 2010. Based on the scientific evidence, the NIH expert panel affirmed that risks in VBACs are low, similar to risks of other laboring women, and repeat cesareans expose mothers and infants to serious problems both in the short and long terms. The NIH expert panel concluded that in the absence of a compelling medical reason, most women should be offered a trial of labor after cesarean. The NIH expert panel further recommended that all women be given unbiased educational information during their pregnancies with which to make decisions regarding VBAC in partnership with their healthcare providers. Women should also be offered full informed consent and refusal during their labors.

“While we are pleased that ACOG has issued less restrictive VBAC guidelines and affirmed a woman’s autonomy in her childbirth experience, it is still up to women to take charge of their lives, educate themselves about childbirth practices, and put pressure on their healthcare practitioners to provide the safest birth options for their babies and themselves,” says Geradine Simkins, President and Interim Executive Director of the Midwives Alliance. The Midwives Alliance takes the position that the best interests of most mothers and infants are served when women are given the opportunity to birth under their own power and in their own way with the intention of avoiding primary cesarean deliveries and other unnecessary interventions. An impressive body of research literature shows that the midwifery model of care results in less intervention in the birth process and safe and satisfying outcomes for mothers and babies. In addition, evidence shows that birth in a woman’s home with a trained midwife, or in a freestanding birth center, results in decreased cesarean sections and other obstetrical interventions. “We want women to have all the choices they need to have healthy pregnancies and give birth safely,” say Simkins, “and we are pleased that ACOG’s new guidelines on VBAC will add another choice to the menu of maternity care options.” 

For more information on the Midwives Alliance visit http://mana.org/. For information on practitioner and childbirth options visit Mothers Naturally at http://www.mothersnaturally.org/

08.Jul.2010 Huffington Post looks at the state of maternity care in US

Is Having a Baby Bad For Your Health? by Marcia G. Yerman
Most American women might presume that the dangers of maternal mortality are a concern and problem only in developing nations. They’re wrong. A March 2010 report put out by Amnesty International entitled, Deadly Delivery: The Maternal Health Care Crisis in the USA, highlights eye-opening findings. The data is based on research carried out during 2008 and 2009. The organization has framed their conclusions as a call to action for women’s human rights in America. The revelation that “more than two women die everyday in the USA from complications of pregnancy and childbirth,” with half of those death being preventable if appropriate maternal health care was accessible, demands accountability. Since there are no federal requirements to report maternal mortality, the actual number of deaths may exceed those counted by double the amount.

What constitutes maternal health? The World Health Organization defines it as the “health of a woman during pregnancy, childbirth, and the post-partum period.” How does America, the number one global spender on health care, measure up against other nations? The latest available statistics come from 2006, when there were 13.3 maternal deaths per 100,000 live births. In an example of a one-on-one matchup, when compared with Germany, the United States racks up figures at four times the German numbers.

Within our borders, the news is even more dismal. Broken down by state, Maine had the best showing at 1.2 deaths per 100,000 live births. The District of Columbia had the most disconcerting figures: 34.9 per 100,000 live births. What, as a country, are we doing wrong?

As documented in the 138-page hard copy Amnesty International report, there is no shortage of contributing factors.

First and foremost, America has no nationally implemented guidelines and standards for a comprehensive system of maternal health care. Amnesty has suggested that the “U.S. Congress should direct and fund the Department of Health and Human Services to establish an Office of Maternal Health.” Projections show that improving the standard of care could prevent close to 50 percent of deaths.

A starting point is the necessity of prenatal care, which is defined by The Healthy People 2010 Goals as thirteen prenatal visits beginning at the first trimester. Those women who do not receive this medical attention are shown to be three to four times more likely to die of pregnancy-related complications than women who do. The reasons women don’t connect with this crucial care emanates from a health system that currently sustains impediments to care, and is rife with bureaucracy, inadequate services, and even discrimination.

In 2009, more than one in six Americans had no health insurance. Thirteen million women from the ages of 15-44 were part of that demographic. Health care costs can be prohibitive. An uncovered ultrasound costs $1,000. Accessibility in both rural areas and inner cities is a major obstacle. In these settings, it can be problematic for women to obtain transportation to clinics, and even then, many of the serving institutions are seriously understaffed. Quandaries arise when a woman has to choose between showing up for her job and keeping a prenatal visit. Inflexible office hours, lack of childcare for other children, and language barriers also present challenges.

Women of color (African-American, Latina, Native American), women in poverty, and immigrant women are hardest hit by these obstacles to prenatal care. It was documented that African-American women were four times more likely to die of pregnancy related complications than white women.

Jennifer Dohrn, DNP, has worked on the frontlines as a midwife since 1987, when she joined forces with the Morris Heights Health Center in the southwest Bronx in New York City. As the first freestanding birth center in the country for urban women, the MHHC served those with no access to health care. Dohrn wrote by e-mail, “Maternal mortality is not an unsolvable problem. We have the technology to provide safe motherhood for women in the United States and globally.” When Dohrn started, one-third of the women in the community had received no prenatal care at the time of delivery, and infant mortality ranked amongst the highest in the country. Opening a center that was accessible to women encouraged early entry into prenatal care given by skilled midwives, continuous involvement of the family, and safe delivery with promotion of breastfeeding. There were no long waits, the staff reflected the culture of the clientele, and state financed programs for pregnancy covered the costs. As Dohrn made clear, “This is a model of how it can be done.”

Another key factor in the maternal health equation is the Caesarean section. Almost one-third of all American deliveries fall into this category, a number that is twice as high as the World Health Organization recommendation. The odds of death after a C-section are more than three times higher than vaginal births. 75 percent of maternal deaths occur after a Caesarean delivery.

I spoke with Dr. Charles S. Mahan about the alarming extent of procedures taking place nationally. His primary concern was that women were having unnecessary operations. He has seen an escalation in the procedure over the past five to tens years. Dr. Mahan believes that a major reason in the rise of C-sections is that women are not getting enough facts about potential complications to give “true informed consent.” He stressed that many patients were under the impression that it was safe to deliver their babies at thirty-seven or thirty-eight weeks. The optimum time frame is between thirty-nine to forty-two weeks. Dr. Mahan suggested that doctors might be choosing this form of delivery based on considerations that were not purely medical. He emphasized the inherent dangers, explaining that “the surgical procedure poses short and long term health risks to mothers and infants.” Dr. Mahan pointed out that a “scarred uterus poses risk to future pregnancies and deliveries.” In addition, women who have Caesarean deliveries are more likely to experience “deep venous clots that can result in pulmonary embolism or stroke.” He referenced the CIMS website and their February 2010 fact sheet for cutting-edge data on Caesarean sections. It should be noted that inadequate post-partum care contributes to more than half of all maternal deaths, which occur between one and forty-two days after delivery.

One of the points that the report highlighted was that “women are not given a say in decisions and do not get enough information about sign of complications and risks of interventions–including induced labor and Caesarean deliveries.” Severe complications that almost cause a maternal death during a delivery are euphemistically referred to as “a near miss.” Annually, 34,000 American women have that experience.

Angela Burgin Logan falls into this category. When I spoke with her by telephone she related a hair-raising story that combined elements of medical arrogance, missed and ignored symptoms, and a form of physician brow-beating that made her feel dismissed as an “hysterical” mother-to-be. Her mantra now is “Listen to your own voice.”

A college educated, upper-income African American woman living in western New York State, she took extreme care in researching and picking her OB-GYN. Yet as she described, “Not too long into the pregnancy, something didn’t feel right.” She was gaining weight at a troubling rate, and at five months she could not lie flat on her back. She had pains in her left arm. The red flags were up for orthopnea and heart failure.

Only at her urging did her doctor finally agree to send her for a work up. The nurse/technician on duty alerted her to worrisome symptoms. Despite the presence of protein in her urine–a clear indicator of preeclampsia–her doctor “sluffed it off.”

Burgin Logan spent her final three months of pregnancy sleeping upright in a chair. When she rushed to the hospital ER at thirty-seven weeks complaining that she “couldn’t breathe,” her husband was advised that she was having a panic attack. Rather, fluid had flooded her lungs, making it impossible for her to take in air. An ongoing series of medical missteps meant that Burgin Logan had to be induced into a coma in order for her life to be saved. Miraculously, she and her daughter survived the birth process.

Having been given only a 20 percent shot of survival, Burgin Logan told me, “I’m on a mission to make a difference for mothers and babies.” She writes about her experience on her site, and blogs about related issues for Lifetime Moms.

In retrospect, Burgin Logan believes that the issue of “gender” and “not being taken seriously” played the largest role in her ordeal. If this is the experience of a privately insured, professional woman– one can only imagine the tribulations facing those women who lack financial resources and easy availability to health services.

This article originally appeared on the women’s health site Empowher.

Image courtesy of ©2010 The Safe Motherhood Quilt Project.

This quilt block is in honor of Tamika Lashaie Williams Winston.