Tag Archives: United States

Of birth and renewal: Of spring

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It was 41 degrees Fahrenheit when we got up this morning here in Chicago, but this weekend, the Memorial Day weekend, marks the unofficial beginning of summer in the United States.

Officially, it's still spring, though. Here is a poem by e. e. cummings that relates both to the season and to our topic here on Birth Story:

O sweet spontaneous
earth how often have
the
doting

fingers of
prurient philosophers pinched
and
poked

thee
,has the naughty thumb
of science prodded
thy

beauty        how
often have religions taken
thee upon their scraggy knees
squeezing and

buffeting thee that thou mightest conceive
gods
(but
true
to the incomparable
couch of death thy
rhythmic
lover

thou answerest

them only with

spring)

Home-birth share small but rising

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A study released this week on home birth in America shows a substantial increase in the still very small numbers of women who are choosing to have home births.

The study, released online in Birth: Issues in Perinatal Care, shows that of the 4.2 million births in the United States in 2008, 28,357 were home births. That is 2/3 of one percent of the total, but it represents a 20 percent increase, from 0.56 percent in 2004.

Non-Hispanic white women accounted for most of the growth, with an increase of 28 percent between 2004 and 2008. More than 1 percent of those women now have their births at home.

The study was based on United States birth-certificate data.

Birth news

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Yipes! That was a long hiatus! So sorry. Hope not to do that again.

I am back on Birth Story with huge new respect for teachers, after serving winter quarter as an undergraduate lab instructor at Northwestern University's Medill School of Journalism. What teachers do in the classroom, I discovered, is the tip of the iceberg of the job.

I am back. Yes! So back to our topic, sort of. Well, a tangent, actually.

Nearly every time I Google "birth news" looking for, you know, something to blog about — my topic is birth — I come up with some permutation on the "birther" flap calling for President Obama to produce (on a daily basis, as far as I can tell) his birth certificate. Otherwise, critics will assume he was born in Kenya, his father's country of origin.

Barack Obama

Is he? Or isn't he?

Donald Trump and Whoopi Goldberg got into a dustup on "The View" last week about Obama's alleged reluctance to produce his birth certificate. (Just Google "birth news.")

The next day, "The View" ladies showed what they said was a copy of Obama's birth certificate.

Ben Smith at Politico wrote yesterday that the document Trump claimed was his own birth certificate, produced to needle the President, is not in fact Trump's official birth certificate. (But then Trump did come up with the right one.)

All of which just tells you that you can't go wrong, publicity-wise, getting a corner of this issue, or non-issue, as the case may be. Maybe I'll get a lot more hits today than I do ordinarily, writing about boring old childbirth.

The Arizona legislature is considering legislation that would require the state to sign off on proof of U.S. birth from presidential candidates. (They wouldn't let me teach at Medill until I produced proof of U.S. birth. Surely presidential candidates don't get a pass on that.)

The House version of the Arizona bill calls for evidence that that baby dropped onto U.S. soil, while the Senate version of the bill includes a definition of a "natural" U.S. birth as one to individuals who were U.S. citizens at the time.

I think both those elements have to be there, actually. That is, proof of either of those things ought to be enough, and I think maybe we need some laws to clarify that.

Even though some people go to great lengths to manipulate the law to convey U.S. citizenship to their infants like, allegedly, the Chinese women Jennifer Medina writes about in the New York Times today, it is important for anyone born in the United States to be an "automatic" citizen. Anything else is a total repudiation of what the United States has been, and stood for, for more than two centuries.

At the same time, we live in a small world. Pregnant U.S. citizens travel all the time for work and pleasure, and probably some other reasons, too, and they shouldn't be terrified about losing their children's full rights of citizenship if they happen to be abroad when their water breaks.

The Administration and numerous officials of the state of Hawaii, where Obama was by all accounts born on Aug. 4, 1961, have repeatedly confirmed the President's birth to a U.S. citizen on U.S. soil. Two for two. (So that's settled, right?)

And whatever you think of Barack Obama, he is a stellar example of the promise the United States has made to its residents, going even beyond its citizens — that if you work hard, the sky is the limit on what you can achieve.

Well, that's my two cents for today. It's nice to be back, although like teaching, blogging is a whole lot more time-consuming than I thought it would be before I actually tried it.

Happy spring, dear reader!

Birth Story 2010

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Following one topic, childbirth, for an entire year has given me an unusual perspective on what is happening on that front, both here in the United States and also globally.

If you ask me, the newly apparent muscle of the holistic birth community was the most important “birth story” of 2010. One sign of this was the passage of the so-called Midwifery Modernization Act in New York, which eliminated a requirement that midwives obtain a written practice agreement from a physician or hospital to practice in New York State.Pregnant Graffiti

Also, as we just discovered from a new report from the Centers for Disease Control, released last week, birth by Cesarean section reached a new high, 32.9 percent of births in 2009, up from 32.3 in 2008. The steadily rising rate — up every year since 1996, when the rate was 20.7 — has been a major story all year.

That CDC report also showed the birth rate for U.S. teen-agers hit its lowest level last year since records began to be kept seventy years ago — 39.1 births per 1,000 teens, down from 41.5 per 1,000 in 2008. The record low held true for all racial and ethnic groups.

A couple of other big birth stories of 2010, sadly, revolved around the fact that too many mothers are still dying in childbirth.

In March, Amnesty International called out the American childbirth establishment on a rising rate of maternal mortality in a report called “Deadly Delivery: The Maternal Health Care Crisis in the USA.” The human-rights advocacy organization pointed out that while the United States spends more on health care than any other country in the world, “maternal mortality ratios have increased from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006.”

Many other groups joined in that call for changes to improve birth safety in this country.

Meanwhile, in the developing world, the United Nations’ Millennium Goal 5, which aims to bring down rates of maternal mortality by three-quarters in places like sub-Saharan Africa and Southern Asia, is the subject of much scrutiny, with a major push in some places creating bright spots in what appears to be a generally gloomy picture with just five years to go.

Pregnant Graffiti by Petteri Sulonen / Wikimedia Commons

Women’s health fail

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For every step forward the United States takes toward improving women's health, the country appears to be taking one back — or more.

The overall picture is so bad that the nation got a big, black "Unsatisfactory" grade on a report card issued recently by the National Women's Law Center, in conjunction with Oregon Health & Science University.Art deco woman

We are doing all right in some areas. Women are smoking less. The percentage of women getting regular mammograms, annual dental checkups and colorectal screenings has held steady since 2007. In only one area, cholesterol screenings, have we actually improved.

On the negative side, more women are binge drinking, and fewer are getting Pap screening tests for cervical cancer. More women are obese, diabetic and hypertensive, too. More are turning up with chlamydia, a sexually transmitted disease.

Not a single state got a "Satisfactory" mark this year; in 2007, three states made the grade. Massachusetts and Vermont have the best scores, a limp S (for satisfactory) -minus.

Many of the goals have to do with things people can conceivably control themselves, like quitting smoking, and drinking only moderately.

However, nearly 20 percent of women ages 18 to 64 have no health insurance. The disparities are troubling: 38 percent of Hispanic women, 32 percent of Native American women, 23 percent of African-American women — but only 14 percent of Caucasian women — lack health coverage.

And only seven states now require comprehensive maternity care — prenatal care, childbirth and postpartum care — be included in all individual and group health plans.

Most of the goals the report card addresses come from the Healthy People 2010 campaign of the U.S. Dept. of Health and Human Services. On its website, Healthy People is already hoping for better results in 2020, its new goal year.

"The Favorite" by Leon-Francois Comerre, courtesy of Wikimedia Commons

The March of Dimes

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President Franklin Roosevelt founded the forerunner of the March of Dimes, the National Foundation for Infantile Paralysis, in 1938, to raise money for research to find a cure for poliomyelitis, and to care for victims of the disease.

Roosevelt himself was paralyzed after being stricken by "polio," also called infantile paralysis, in 1921. The NFIP itself was an expansion of Roosevelt's Warm Springs Foundation, which sponsored a rehabilitation center for polio victims in Warm Springs, Ga.March of Dimes poster

In 1938, during a radio fund-raising campaign for the NFIP, the entertainer Eddie Cantor coined the term "The March of Dimes" as he urged listeners to contribute their spare change to defeat polio. The term, as Cantor used it, was a play on the popular newsreel series "The March of Time."

The campaign against polio is one of the great medical success stories. The March of Dimes provided the money for the development of two effective vaccines, by Jonas Salk and Albert Sabin. Within little more than a decade, polio was reduced from one of the scourges of the 20th century to a footnote in the 21st.

A global effort to eradicate polio altogether by the year 2000 fell short; the latest target date for eradication, in parts of Africa and Asia, is 2013.

In 1958, with polio under control in the United States, the March of Dimes re-directed its efforts toward a new campaign, to eliminate birth defects. The following year, Dr. Virginia Apgar, who in 1953 had devised a scoring system for the well being of newborns, joined the organization that was then still headed by President Roosevelt's former law partner, Basil O'Connor.

For the past half-century, the March of Dimes has been involved in virtually every effort undertaken to improve the health of babies in this country and, more recently, around the world.

The March of Dimes supported research that showed that a pregnant woman's consumption of alcohol could cause birth defects, as well as the development of surfactant therapy for premature babies with respiratory distress, to name a couple.

Image from Wikimedia Commons

Easy to be hard

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Birth is the most common reason for a person to be hospitalized in the United States, a major point of intersection for a healthy population with the health-care system.

But while birth may be common, it isn't cheap. The average cost of maternity care in the United States in 2004 was $8,800, according to a report by the March of Dimes, and that figure can take off for the stratosphere — into the tens and even hundreds of thousands of dollars — in the event of complications.Pregnant Graffiti

With the national mid-term elections just a few weeks away, many politicians are drumming up votes by weighing in on the health-care reform legislation Congress passed earlier this year, and on government programs that subsidize health-care services like maternity care for low-income people.

Rand Paul, an ophthamologist who is the Republican candidate for the Senate in Kentucky, remarked last week that half the state's 57,000 yearly births are paid for by Medicaid. “Half of the people in Kentucky are not poor. We’ve made it too easy,” Paul said.

You could say Paul is right. A woman doesn't have to be officially poor in Kentucky to have her baby's birth paid for by Medicaid.  Kentucky allows Medicaid coverage for a woman whose income is 185 percent of the official federal poverty level of $18,310 for a family of three. That is, her family of three can make just under $34,000 and still qualify.

But remember, the average birth experience will cost her almost $9,000.

The March of Dimes analysis found that consumer costs for a birth averaged just under $500, but that pre-supposes that the mother has health insurance that covers childbirth and maternity care.

Analysts for The Guttmacher Institute, which concerns itself with sexual and reproductive health both in the United States and globally, working with recent figures from the U.S. Census Bureau, figure that 2.3 million women of reproductive age lost health insurance in the year between 2008 and 2009 alone.

The National Women's Law Center has found that individual insurance plans, which are exempt from the Pregnancy Discrimination Act of 1978, tend not to offer maternity care. The NWLC found that just 12 percent of the plans it examined offered maternity care, and that the provisions they offered were often limited.

"That’s why having insurance coverage is so critical. Employer-based group plans usually have good maternity care coverage, but most low-income women don’t get insurance through the workplace," the Guttmacher Institute states on its website today.

So looked at from that aspect, Paul is wrong. We're not making things too easy at all. The way thing are set up now, we're making it too hard for women to obtain coverage for maternity care.

Pregnant Graffiti by Petteri Sulonen, courtesy of Wikimedia Commons

How hospitals can promote breast-feeding

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The Baby Friendly Hospital Initiative, an international program, has created a list of things birth facilities in the United States can do to optimize the chances that mothers will choose to breast-feed their babies.

Here are "The Ten Steps To Successful Breast-feeding," from BFHI USA:

    1. Have a written breast-feeding policy that is routinely communicated to all health-care staff.
    2. Train all health-care staff in skills necessary to implement this policy.
    3. Inform all pregnant women about the benefits and management of breast-feeding.
    4. Help mothers initiate breast-feeding within one hour of birth.
    5. Show mothers how to breast-feed and how to maintain lactation, even if they are separated from their infants.
    6. Give newborn infants no food or drink other than breast milk, unless medically indicated.
    7. Practice “rooming in” — allow mothers and infants to remain together 24 hours a day.
    8. Encourage breast-feeding on demand.
    9. Give no pacifiers or artificial nipples to breast-feeding infants.
    10. Foster the establishment of breast-feeding support groups and refer mothers to them on discharge from the hospital or clinic.

The BFHI is underwritten by the World Health Organization and the United Nations Children's Fund (UNICEF).

Surprises in a new study of maternal deaths

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Scratch that last post.

It appears that societies around the world are working to improve the survival rate for mothers in birth after all -- and that their efforts are working.

Even as I was tapping out Monday's post, The Lancet was publishing a new study online that shows that maternal mortality has actually been dropping dramatically in many countries.

"The overall message, for the first time in a generation, is one of persistent and welcome progress," Lancet editor-in-chief Richard Horton wrote in a commentary that accompanied the study.Pregnant Graffiti

The number of maternal deaths per year worldwide has been tallied at 500,000+ in 2005, based on United Nations survey published in 2007. However, the new study, which was conducted by researchers at the University of Washington and the University of Queensland in Brisbane, Australia, and funded by the Bill and Melinda Gates Foundation, shows deaths to have fallen from 526,300 in 1980 to 342 ,900 in 2008. That's good news.

Not only that, but taking out deaths from HIV/AIDS, which has emerged as a major factor in global maternal mortality, the figure would have been 281,500 in 2008.

More than half of maternal deaths are concentrated in six countries-- India, Nigeria, Pakistan, Ethiopia, the Democratic Republic of Congo, and Afghanistan, which has the highest maternal mortality rate in the world, this survey states. (Italy has the lowest rate, according to this report.)

The United States, Canada, Denmark and Norway are among the prosperous nations that are experiencing increases in maternal mortality (less than 1 percent for the U.S.). More comprehensive reporting could account for the increase, the researchers noted.

Not everyone is excited by the new survey's findings, Horton wrote in his commentary.

"Even before the paper ... was submitted to us, we were invited to “delay” or “hold” publication," by some members of  what Horton calls the "global health community" who fret that the relatively rosy picture the new study paints will lead to a flagging interest in working to make birth safer around the world.

Horton dismisses those worries, but expresses concern that the figures in the new report are so different from those in the 2007 UN survey.

"A process needs to be put in place urgently to discuss these figures, their implications, and the actions, global and in country, that should follow," he writes.

So it appears that MDG5, the Millennium Development Goal that has to do with improving birth safety for moms is, after all, alive and well.

"This new evidence suggests there is a much greater reason for optimism than has been generally perceived, and that substantial decreases in the (maternal mortality rate) are possible over a fairly short time," the report states.

Image by Petteri Sulonen