All Topics – Page 9

The arrogance of doctors and episiotomy without consent

June 24, 2016 By Deena Leave a Comment

Part 2 of my “Dear Diary” series for Giving Birth with Confidence brings us to 1920. You can read the full, historical fiction piece here.

Episiotomy without consent

Episiotomy, (sometimes called a perineotomy) a cut from the vagina towards the anus (midline) or a bit to the side (medio-laterally), was once a routine procedure for obstetricians during the pushing phase of labor. Sounds pleasant, doesn’t it? Ok, no, not really…

So, what’s up with this episiotomy without consent, as mentioned in the “Dear Diary” story? Let me take you back in time, specifically to the Chicago Lying-in Hospital in 1920. Dr. Joseph Bolivar DeLee wrote and published a paper called, “The Prophylactic Forceps Operation”. In it, he takes childbirth from a natural, normal occurrence and makes it something pathological that requires preventative intervention. He wanted to elevate the profession of obstetrics to a higher status among other fields of medicine and he needed a reason to do so.

Labor has been called and still is believed by many to be a normal function. It always strikes physicians as well as laymen as bizarre, to call labor and abnormal function, a disease, and yet it is a decidedly pathologic process. Everything, of course, depends on what we define as normal. If a woman falls on a pitchfork, and drives the handle through her perineum, we call that pathologic, abnormal, but if a large baby is driven through the pelvic floor we say that is natural and therefore normal. If a baby were to have its head caught in a door very lightly, but enough to cause cerebral hemorrhage, we would say that it is decidedly pathologic, but when a baby’s head is crushed against a tight pelvic floor, and a hemorrhage in the brain kills it, we call this normal, at least we say that the function is natural, not pathogenic.

In both cases, the cause of the damage—the fall on the pitchfork and the crushing of the door—is pathogenic—that is, disease-producing, and in the same sense labor is pathogenic—disease-producing, and anything pathogenic is pathologic or abnormal.

See, if birth is normal, then we really only need to catch the baby, which anyone can do. We only need an OB if there is a problem – and then we *really* need one! So, DeLee created a problem that needed solving. (He sounds like a rather expert marketer to me.) One aspect of the problem he created was he wanted women to come out of childbirth looking “virginal” at their perineums. Yes, you read that correctly, “virginal”.

Now, should virginal conditions be restored? Did not nature intend women should be dilated in the first labor so that subsequent children will come easily? Are not the lacerations normal?

I do love The Oatmeal dearly. I play Exploding Kittens with my kids 🙂

Right. Moving on…

DeLee makes a big leap and says,

We can take direct action to save the fascial and muscular structures of the pelvic floor, in addition to practicing the measures just mentioned for preserving the connective tissues of the upper pelvis. By incising the fascia at its most vulnerable point, and reuniting it after delivery, we are almost always, not invariably, able to eliminate all damage to the pelvic floor.

Except that this is not an evidence based statement. He makes a huge assumption to justify this new method of birth which is fully controlled by the doctor while the mother is unconscious during her labor with a “Twilight Sleep” birth. So, the mother is unable to consent to anything being done to her body.

I can’t even begin to tell you how angry that makes me. Informed consent/refusal are one of the core topics of my childbirth classes. We, as women and mothers, need and deserve respect. A lack of informed consent for any medical test, procedure or medication shows a profound lack of respect for the mother from the medical care providers.

DeLee’s writing firmly illustrates the “doctor as god” concept. This is the idea that the doctor knows best in all cases and should not be questioned. His entire paper reads as self-indulgent with an air of superiority. He speaks of how he can “save” mothers and babies with his techniques. His arrogance is profound.

As for the forceps operation—in skillful hands the danger is nil. By means of the head stethoscope we are able to recognize danger to the infant from asphyxia, and since the resistances of the soft parts are gone, there is no compression on the child’s brain. We should not blame the operation for faults made in its performance.

So, where does this leave us? Thankfully, in 2016, where you can affect the outcome of your birth and avoid unnecessary medical interventions. These tips will help.

Mothers need to know their legal rights during childbirth and advocate for them.
Mothers should feel comfortable asking questions of their doctors and midwives.
Partners play an important support role physically, emotionally and intellectually. Their advocacy is of the utmost importance during pregnancy and birth.

I am grateful that we are beyond the days of Twilight Sleep. However, we still have a long road ahead. Some mothers still have episiotomies and other medical procedures done without consent and are treated disrespectfully during labor by some staff members. Hopefully, you and I, dear reader, can make birth better for our daughters when their time comes to be mothers years from now.

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Chloroform, Childbed Fever and Historical Fiction

May 23, 2016 By Deena Leave a Comment

http://www.marycassatt.org/Mother-and-Child,-1900.html

I am writing a new historical fiction series for Lamaze‘s blog, Giving Birth With Confidence, entitled, “Dear Diary”. The people are fictitious, but their experiences reflect common ones for their time period. The series will continue monthly until we reach the end of the 20^th century. What you find below are some expanded details from the story which I have written.

You can read the first “Dear Diary” post here. “Dear Diary” – Birth Stories of the Past: Albert Jr., Born May 12, 1900

Chloroform

Chloroform’s first known usage during childbirth was in 1847 by a Scottish physician, Dr. James Young Simpson. Queen Victoria used the drug during her labor with Prince Leopold in 1853 and 1857. It was administered with a cloth over a wire framed mask. A few drops were sprinkled onto the cloth and the mother would breathe it is, feeling it’s effects shortly thereafter. There were no dosages or limits, or testing, for that matter. Some maternal fatalities with use of chloroform did occur. Chloroform and Ether were the earliest form of medical pain management.

Childbed fever

http://www.abpischools.org.uk/res/coResourceImport/modules/infectiousdiseases_timeline/en-images/Semmelweiss.jpg

Childbed fever was the common term for puerperal fever. It’s a fever caused by uterine infection after childbirth.

Although the germ theory of disease was proposed in 1546 by Girolamo Fracastoro, and Louis Pasteur and Robert Koch working in 1850’s – 1880 provided strong evidence to support germ theory, the theory wasn’t widely adopted by physicians.

Ignaz Semmelweis, in 1847 was the first to link puerperal fever to physicians. Physicians would go from performing autopsies, gloveless and without washing their hands, to delivering babies in a ward, one woman after another. Thus spreading germs and disease not only from corpse to mother, but also from mother to mother.

Semmelweis’s pleas to his colleagues to wash their hands, were ignored, even though Semmelweis’s students, having washed their hands, reduced their cases of childbed fever from 18% to 1%. Joseph Lister continued working on aseptic medical practices in the late 19^th century. Physicians were slow to adopt these new antiseptic practices until the early 20^th century.

The births in the inaugural “Dear Diary” post take place before the era of aseptic medicine. As we move forward in time, we’ll explore new advances and maybe a setback or two.

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The Dalkon Shield. A story of corporate greed, a lack of medical testing and an ongoing fear of the IUD.

May 4, 2016 By Deena 6 Comments

I think it looks a bit like a horseshoe crab on it's back. — I think it looks a bit like a horseshoe crab on it’s back.

I have a Secret Santa who sent me a rather large box of interesting objects. My Secret Santa included a new-in-the-package Dalkon Shield IUD. As a collector, I was giddy when I saw it. This particular IUD has caused long term fear and loathing of all IUD’s. Yet, most women don’t know the story behind it. They know that IUD’s caused “problems” and that other methods of birth control were “better”. Even now, I hear women say they’d never get an IUD. That is a shame because IUD’s today are the most effective birth control on the market.

Let’s dig in to the story behind the Dalkon Shield and this pervasive fear of IUD’s.

In 1971, the A.H. Robbins company brought the Dalkon Shield to market, billed as a safer alternative to The Pill. The birth control pill, still being relatively new, had some kinks yet to be worked out. Many women were unhappy with it’s side effects and were searching for something that was safe and effective. Given the hole in the market, it was a prime business opportunity for A.H. Robbins and this new style of IUD.

IUDs have been around for a over a thousand years, in various shapes and forms. The Dalkon Shield, however, had something new going for it – a mass marketing campaign. Well, that and a different physical structure and an entirely different kind of string… but we’ll get to that in a minute.

This marketing campaign was so successful that approximately 2.8 million women eventually used the Dalkon Shield. They were, however, unaware of the lack of proper testing on this device and its safety.

Although A.H. Robbins tested the Dalkon Shield for efficacy, they did not test it for safety. At the time, that was not required before putting it out to market. The company also padded it’s efficacy rate to show a 2-3% failure rate, as opposed to the 10% failure rate it actually had.

Dalkon shield IUD, The Silent Mother — The blue stick is the insertion device. The grey, insect looking thing is the IUD itself.

There was a rather large problem with the Dalkon Shield. The string which attaches to the plastic IUD was made of a multi-filament string instead of a mono-filament string. Why is this an issue? Well the multi-filament string allows bacteria to creep up into the uterus whereas a mono-filament string does not. Bacteria, as we know, causes infection. Infection leads to sepsis. Sepsis leads to hospitalization, massive doses of antibiotics, the potential for surgery and so on. The biggest complaint being pelvic inflammatory disease, which beyond it’s discomfort, can lead to infertility.

All of this lead to five deaths, multiple spontaneous abortions and over 300,000 lawsuits against A.H. Robbins. The company folded under the pressure.

So after all that, there is an upside. Women stood up for themselves and for better medical testing. The success came in 1976 when the FDA added the Medical Device Amendments to their policies. Change is often slow. These women, of my mother’s generation, took to the streets, the media and the courts to protest and affect change. It makes me wonder what we could do now, should we rally.

In the meantime, I’ll hang on to this piece in my collection to remind me of how far we’ve come, and how far we still have to go to support women’s rights with regards to access to safe birth control, safe abortion and bodily autonomy.

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