Labor
Mamas on Bedrest: Introducing One World Birth
August 31st, 2011Mamas on Bedrest, introducing One World Birth.
is an online continuous stream documentary created and produced by Toni Harman and Alex Wakeford. The concept is to present international experts on normal birth and to make information on normal birth readily available to the public. They have created a video trailer promoting the site and the official launch is tomorrow, September 1, 2011.
So what the heck does normal birth have to do with Mamas on Bedrest??? That’s a fair question. Many of us who experience high risk pregnancies also experience the most invasive and (traumatic) mechanized births. We’re already feeling guilty for being high risk in the first place, we question ourselves incessantly as to whether or not our situation isn’t somehow our fault. I’ve said it before and I’ll say it again, having a high risk pregnancy is not your fault! And having a baby who has physical and/or developmental challenges as a result is also not your fault. How can videos and commentary on “normal births” pertain to us?
As I was watching the trailer I was struck by the comments that “women are losing touch with, and their confidence in, their ability to give birth.” Several women who had adverse birth outcomes spoke out about their experiences and how they felt offended by the statement. The person moderating the trailer comments says that many issues will be addressed in upcoming footage and I for one will be interested to see how they address management of high risk pregnant women and the complicated health issues that we bring to the table. I don’t believe that we Mamas on Bedrest are any less in tune with our bodies than our less complicated pregnant counterparts. If anything, we have heightened awareness of every twitter and flutter going on! I am really looking forward to the responses on this topic.
Overall, I think that this is an interesting project, worthy of a look. I can’t make any hard and fast recommendations because there really isn’t that much to comment upon in the trailer. My hope is that once the site is up and running it will be another place from which all pregnant women can gather information to make wise health care choices.
I do want to encourage Mamas on Bedrest to lend your voices to the discussion. As I said previously, we experience some of the most medically invasive pregnancies and births of all women. Ask your questions and share your concerns. See what this panel of “experts” has to say. How does their advice compare to what your OB or perinatologist has to say? How do their words resonate with you? I find that in situations such as this, where there are often such polarizing views (OB vs. Doula/midwife), you are able to glean useful information from both poles and come up with a workable solution in the middle that suites you.
Mamas on Bedrest I also hope that you will lend your voices to the discussion because so often our stories are not heard. Not everyone will have a transformative, empowering, “Lights shining from the heavens” birth experience. Heck, many of us aren’t even able to experience all of the “joys of pregnancy”! The birth world needs to hear from us.
I understand this movement to drive birth out of the hands of surgeons and back into the realm of normal (whatever that is). In uncomplicated situations birth should be a “hands off” process where nature takes its course. But if the mama is like me, someone had better intervene and pretty damned quickly or, as could have been the case during my first delivery, my daughter and I may not have made it. How do we balance the need for less intervention for the majority while making provision for those minority situations in which things just don’t go right? Are we placing too much emphasis on labor and delivery and not enough on prenatal supportive care (my personal opinion)? Yes, yes, I want to hear what these experts have to say about women like you and me.
One World Birth is going to be a useful website for thousands, maybe even millions of women to learn more about the birth process and the choices that they have. Let’s make sure that Mamas on Bedrest are included amongst that number and that our wants, needs and issues are addressed as well.
I can’t wait to hear your stories and opinions. Share them below, especially if you post a comment on the One World Birth website. We Mamas on Bedrest want to support our own. Perhaps you’re more comfortable commenting amongst your peers. Feel free to do so on our Facebook Page. And as always, follow us on Twitter, @mamasonbedrest to hear what we’re up to and our perspective.
Mamas On Bedrest: FDA Warns Against the Use of Terbutaline To Prevent Preterm Labor!
February 18th, 2011The below safety announcement it taken directly from the FDA website. For more news about the (discontinuing) use of terbutaline for the prevention of preterm labor, visit the FDA website.
Safety Announcement
[02-17-2011] The U.S. Food and Drug Administration (FDA) is warning the public that injectable terbutaline should not be used in pregnant women for prevention or prolonged treatment (beyond 48-72 hours) of preterm labor in either the hospital or outpatient setting because of the potential for serious maternal heart problems and death. The agency is requiring the addition of a Boxed Warning and Contraindication to the terbutaline injection label to warn against this use. In addition, oral terbutaline should not be used for prevention or any treatment of preterm labor because it has not been shown to be effective and has similar safety concerns. The agency is requiring the addition of a Boxed Warning and Contraindication to the terbutaline tablet label to warn against this use.
Terbutaline is approved to prevent and treat bronchospasm (narrowing of airways) associated with asthma, bronchitis, and emphysema. The drug is sometimes used off-label (an unapproved use) for acute obstetric uses, including treating preterm labor and treating uterine hyperstimulation. Terbutaline has also been used off-label over longer periods of time in an attempt to prevent recurrent preterm labor.
Although it may be clinically deemed appropriate based on the healthcare professional’s judgment to administer terbutaline by injection in urgent and individual obstetrical situations in a hospital setting, the prolonged use of this drug to prevent recurrent preterm labor can result in maternal heart problems and death. Terbutaline should not be used in the outpatient or home setting.
The decision to require the addition of a Boxed Warning and Contraindication is based on new safety information received and reviewed by the FDA. Specifically, FDA has reviewed postmarketing safety reports of terbutaline used for obstetrical indications (see Data Summary below), as well as data from the medical literature.1-6 These label changes are consistent with statements from the American College of Obstetricians and Gynecologists (ACOG).6
Additional Information for Patients
- Be aware that serious side effects, including maternal heart problems and death, have been reported after prolonged use of terbutaline to manage preterm labor.
- There are serious situations where a healthcare professional may decide that the short-term use of injectable terbutaline in the hospital setting may benefit a pregnant woman.
- Oral terbutaline should not be used either to treat preterm labor or prevent recurrent preterm labor.
- If you are taking terbutaline for another medical condition (e.g., asthma), talk to your healthcare professional if you are pregnant or become pregnant to determine whether terbutaline is still right for you.
- FDA encourages patients to talk to their healthcare professional if they have concerns about any treatment they are receiving.
- Report any side effects from the use of oral or injectable terbutaline to the FDA MedWatch program, using the information in the “Contact Us” box at the bottom of the page.
Additional Information for Healthcare Professionals
- Be aware that death and serious adverse reactions, including increased heart rate, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia have been reported after prolonged administration of oral or injectable terbutaline to pregnant women.
- Treatment with terbutaline administered by injection or by continuous infusion pump should not be used beyond 48 to 72 hours. In particular, injectable terbutaline should not be used in the outpatient or home setting.
- There are certain obstetrical conditions where the healthcare professional may decide that the benefit of terbutaline injection for an individual patient in a hospital setting clearly outweighs the risk.
- Oral terbutaline is contraindicated for the treatment or prevention of preterm labor.
- Report adverse events involving terbutaline to the FDA MedWatch program using the information in the “Contact Us” box at the bottom of this page.
In November 1997, FDA issued a Dear Colleague letter to notify healthcare professionals about concerns regarding the safety of long-term subcutaneous administration of terbutaline. The Precautions section of the labeling was revised to warn about serious adverse reactions, including cardiovascular adverse events that may occur after administration of terbutaline to women in labor.
Publications in the medical literature have reported a lack of safety and efficacy of terbutaline for the treatment of recurrent preterm labor.2-5 Despite labeling changes, FDA’s communication to the public, and professional association recommendations, prolonged use of terbutaline continues, with serious and sometimes fatal consequences.
FDA reviewed postmarketing reports of maternal death and serious cardiovascular adverse events submitted to the Adverse Event Reporting System (AERS) associated with obstetric use of terbutaline.
A search of AERS identified 16 maternal deaths that were reported since initial marketing of the drug in 1976 until 2009. Three of the 16 cases reported outpatient use of terbutaline administered by a subcutaneous pump, while nine cases reported use of oral terbutaline alone or in addition to subcutaneous or intravenous terbutaline. Of these nine cases, two reported use of oral terbutaline on an outpatient basis and seven cases involved inpatient use of oral terbutaline. The routes of administration in the remaining four cases were subcutaneous, intravenous, or unknown.
FDA identified 12 maternal cases of serious cardiovascular events associated with use of terbutaline that were reported to AERS between January 1, 1998 (after FDA issued the Dear Colleague letter) and July 2009. These events included cardiac arrhythmias, myocardial infarction, pulmonary edema, hypertension, and tachycardia. Three of the 12 cases reported use of the terbutaline administered by subcutaneous pump. Five cases involved use of oral terbutaline alone or in addition to subcutaneous terbutaline. Of these five cases, three cases involved use of oral terbutaline on an outpatient basis and two cases involved inpatient use of oral terbutaline.
In summary, based on this information, FDA has concluded that the risk of serious adverse events outweighs any potential benefit to pregnant women receiving prolonged treatment with terbutaline injection (beyond 48-72 hours), or acute or prolonged treatment with oral terbutaline. FDA is requiring the addition of a new Boxed Warning and Contraindication to the terbutaline drug labels to warn healthcare professionals about these risks.
1. National Asthma Education and Prevention Program (NAEPP). Working Group Report on Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment—Update 2004. NIH Publication No. 05-5236. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute, 2004. Available from: http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg/astpreg_full.pdf1. Accessed November 19, 2010.
2. Wenstrom KD, Weiner CP, Merrill D, et al. A placebo-controlled randomized trial of the terbutaline pump for prevention of preterm delivery. Am J Perinatol. 1997;14:87-91.
3. Guinn DA, Goepfert AR, Owen J, et al. Terbutaline pump maintenance therapy for prevention of preterm delivery: a double-blind trial. Am J Obstet Gynecol. 1998;179:874-878.
4. Sanchez-Ramos L, Kaunitz AM, Gaudier FL, et al. Efficacy of maintenance therapy after acute tocolysis: a meta-analysis. Am J Obstet Gynecol. 1999;181:484-490.
5. Berkman ND, Thorp JM, Lohr KN, et al. Tocolytic treatment for the management of preterm labor: a review of the evidence. Am J Obstet Gynecol. 2003;188:1648-1659.
6. American College of Obstetricians and Gynecologists (ACOG). ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologist. No. 43. Management of preterm labor. Obstet Gynecol. 2003;101:1039-1047.
“Baggage Check” An Essay on Releasing Expectations
October 27th, 2010Baggage Check By Angela Quinn
This article originally appeared on The Unnecesarean Wanna know a little secret? Not all homebirthers are free-spirit, hippie-types who run barefoot and bra-less through life without a care in the world. Some are (and I’m totally jealous) but a good many of us are really type-A, compulsive, control freaks. I wanted to have a homebirth for a number of reasons: lack of confidence in the non-evidence-based medical model of labor and delivery, lack of desire to fight policy and procedure during contractions, and mostly because I wanted to be in control of my own birth process. But I also wanted to be able let go at any time without feeling like someone was right there hovering over my shoulder waiting to take that control from me.
So there it was in a nutshell – why I chose homebirth. On July 29th, 2010, I had a “successful” HBAC and brought my beautiful little girl into the world to join our family. However, I’ve struggled for the past couple months with why I have felt cheated, dissatisfied and disappointed. After all, healthy mom, healthy baby – that’s all that matters, right?
Recently I realized that I am suffering from the loss of my expectations. I thought that I could control the whole process of birth. If asked, before the birth, I would have smiled serenely and said things like, “I don’t know what to expect, we’ll just wait and see,” or, “I’m just going to let things play out and see how they go,” or, “I’ll just go with the flow.”
But inside, I just knew. This birth, maybe my last baby, was going to be the most awe-inspiring-amazing-empowering-healing-example-setting-I-am-woman-hear-me-roar example of childbirth EVER. Here’s how it would go, I imagined. I would realize I was in labor, I mean, having surges, and I would immediately put on my Hypnobabies CD and go into hypnosis. I would recognize the surges for what they were, functional and opening my cervix like a flower. I would light some candles, send my husband out for Rita’s Italian Ice, read a book, and get into my nice warm birth tub where I would labor in stoic silence, a pillar of strength, telling my midwife and doula that they could rest and I’d let them know when the baby was born. I would push for a few minutes, because (this time) my baby would be in an optimal position since I’d done everything right during this pregnancy (I exercised, ate well, saw a chiropractor, sat on my birth ball for work, watched my posture, did pelvic tilts, visualized). I would have a waterbirth. The Hallelujah chorus would play as I reached down to feel the baby crowning and usher her into this world into calm, loving, peaceful surroundings. I would immediately place her on my chest. She would crawl up to my breast, just like the videos, and latch on by herself. And, cut! Fade to black with mother and baby happily bonding and music from a Summer’s Eve commercial playing in the background.
My mom says I’ve always been like that, expecting things to go the way I plan them. When I was 9 or 10 years old, I’d write these skits that my younger siblings and I would put on for my parents. Somehow I expected Broadway, and was always surprised and disappointed by the reality of 5 little kids who forgot their lines and had safety-pinned towels and paper hats for costumes. In preparing for this birth, I thought I was just visualizing and being positive, but what I had really done was written my birth story ahead of time. Well, guess what? It didn’t follow the script.
In reality, I went into labor in the morning and worked through the first 6 hours or so finishing up stuff for my boss and sending emails. Then I went to a scheduled appointment at my midwife’s office (an hour away), dropped off the kids at my mom’s, run some errands, and threw up in the car. The Hypnobabies stuff worked in the beginning, but once it got harder, damn, that woman’s voice got annoying. Surges, my ass! How about hot knives being shoved into my lower back. I had excruciating back labor (again!) because, despite my best efforts, I had another occiput posterior baby. I didn’t like the birth tub after a couple hours and got out. I whined and moaned…a lot. I considered transfer to a hospital since I really thought she wasn’t coming out at one point, but the only reason I didn’t transfer is because I was so wimpy that I knew I wouldn’t be able to handle my contractions (or the back pain in between) in the car. I never felt the urge to push since she was face up, but I pushed for over 2 hours, painfully, and she finally came out once my tailbone broke (again!). She didn’t crawl to my breast by herself, because she wasn’t breathing and didn’t breathe until after about 5 minutes of resuscitation attempts. It was the scariest few minutes of my life, and I’ll never be able to think about her birth without remembering that heart-stopping, throat-constricting fear. Fear that we would become a statistic, that this whole thing had gone horribly wrong. After this birth, I knew I didn’t want to have any more children.
This wasn’t how it was supposed to go. This birth was supposed to be healing. I was supposed to overcome the physical and mental obstacles of the birth process through sheer determination and feel so powerful afterwards. My education and knowledge was supposed to carry me through any tough times. I was supposed to have a wonderful, idyllic story to tell to those considering homebirth. I was going to be an example to others of how the female body is made to birth naturally and effortlessly. My birth was to be a statement about what’s broken in maternity care today. I don’t know about you, but I’m thinking that’s a pretty freakin’ huge burden to put on one vagina. That’s a hell of a lot of baggage to hang on the shoulders of one tiny little baby.
That’s not to say that I’m not allowed to be disappointed. Or grieve the loss of the perfect birth story that lived in my imagination. Or to feel betrayed by my body once again. I’m allowed to be sad about it sometimes. But I think I would have been less so if I had not decided ahead of time that my birth story would be defined by what it could DO for me. Assigning a value to the birth process based on a pre-determined “yes or no” outcome is exactly what frustrates us so much sometimes about the “quit whining you have a healthy baby” attitude of society. So why do we do that to ourselves with the other outcomes of a birth?
I wrote down my actual my birth story a couple days afterwards, and it had a lot of grief and anger and sadness in it. I could barely see to type it up because I was crying so much while I wrote it. It was only later, when I started looking through my camera to add pictures to the story, that I began to see the details that I had been missing because I had so many pre-conceived ideas that were clouding my perspective.
As I saw the pictures taken around my house, I remembered that there were times of peace during the process and that I was comfortable in my surroundings, allowing me to focus on what I needed to do. I can say without a doubt that had I not been at home I would have had another cesarean. The picture of my doula putting a wet washcloth on my forehead and pouring warm water on my back made me realize that I did need to rely on others around me and that it is OK to ask for help. Seeing how often my husband’s hands were in the pictures as I leaned on him for support made me realize how much he was there for me. Our relationship has been on the rocks for the past few years, and I even said to him that it didn’t matter to me if he was present for the birth. I didn’t need him or anyone else. I prided myself on my independence. But I did need him, surprising both of us just how much. He felt needed and I felt taken care of. It’s quite possibly the first time in 11 years of being together that I have ever relied on him to that extent, and it changed something subtle in the dynamic of our marriage, for the better. When I saw the picture of my husband cutting the cord and the one of her lying on my chest afterwards, I was grateful for the decisions I made leading up to and immediately after her birth. I remembered that I was smart enough to choose a competent, knowledgeable midwife who understood the benefits of natural birthing, delayed cord clamping, skin-to-skin contact and the power of the human body. My faith in my instincts as a mother returned as I looked at the picture of her nursing for the first time, strong, alert, and healthy. And when I looked at the pictures of myself laboring in different positions, my muscles straining, my face a mask of determination, I realized that I was not a wimp. I am strong. Not with the kind of strength that wills away the presence of obstacles altogether, but with the strength that allowed me to overcome and to persevere despite the unexpected difficulties and challenges I faced.
We can do our research; we can prepare our minds and bodies; we can make sure that we are healthy and ready. But we can’t define our birth story ahead of time. We can’t go into it assuming it will be healing or empowering or a message or a political statement. When we do that, we risk that we will not see our birth for what it is – a beautiful, amazing process that helps define us as women and mothers in ways we may not expect. It may not be pretty. It may not live up to our standards of perfection. Sometimes birth just….is.
And now, cheesy as it may seem, I have to close this post with this quote. Ask not what your birth can do for you…nah, just kidding. Worse, a Beatles song. It’s been going through my head since I started writing, so I guess it has to make it in here somewhere: “Let it be, let it be, let it be-ee, let it be. Whisper words of wisdom, let it be.” There, now it’s in your head too.
Thanks so much for that reminder, Angela!
