Tuesday, January 13, 2015

Circumcision’s Psychological Damage

"As psychologists, we are deeply concerned by the recently announced CDC guidelines promoting circumcision for all males, and in particular children.  The CDC guidelines are based on a sharply criticized 2012 policy statement by the American Academy of Pediatrics. The 2012 statement was condemned by a large group of physicians, medical organizations, and ethicists from European, Scandinavian, and Commonwealth countries as “culturally biased” and “different from [the conclusions] reached by physicians in other parts of the Western world, including Europe, Canada and Australia” (Frisch et al., 2013).
The new CDC guidelines highlight methodologically flawed studies from Africa that have no relevance to the United States. They chose to ignore studies that were conducted in the United States and show no link between circumcision and the risk of sexually transmitted diseases, including HIV (Thomas et al., 2004). "


Monday, January 28, 2013

The Red/Purple Line: An Alternate Method For Assessing Cervical Dilation Using Visual Cues

Today’s blog post is written by Mindy Cockeram, LCCE.  Mindy explores the “mystical” red/purple line that has been observed to provide information about cervical dilation without the need for a vaginal exam. – SM
When couples in my classes are learning techniques for coping in labor, such as the Sacral Rub (sacrum counterpressure), Double Hip Squeeze and Bladder32 accupressure points,  I always talk about the great position the partner is in for spotting the red, purple or dark line (depending on skin color) that creeps up between the laboring woman’s buttocks and how – by ‘reading’ that line – he or she may be able to assess more accurately the woman’s cervical progress than the health care providers!  This empowering thought is often met with smiles and laughter especially when I translate ‘natal cleft’ into more recognizable words like ‘butt cleavage’.  Strangely, I’ve never had anyone in class mention having heard of this ‘thermometer’ for accessing cervical dilation by sight and I find this interesting considering the number of medical professionals that come through my classes.
Photo CC http://www.flickr.com/photos/alexyra/214829536/
I first came across this body of research as an Antenatal Student Teacher with the National Childbirth Trust in London.  The article I was reading was inPractising Midwife and was a ‘look back’ at the original article (Hobbs, 1998) published in the same magazine.  The original Practising Midwife article was based on a letter referencing a small study by Byrne DL & Edmonds DK published in The Lancet in 1990.
In the 1990 letter to The Lancet, Byrne and Edmonds outlined and graphed 102 observations from eighteen midwifes on 48 laboring women. It states “The red line was seen on 91 (89%) occasions, and was completely absent in five (10.4%) women and initially absent in three (6.25%).”  The report then goes on to talk about the “significant correlation between the station of the fetal head and the red line length.”  Later the authors write: “To our knowledge, this is the first report of this red line.  We believe that it represents a clinical sign which is easy to recognize and which may offer valuable information in obstetric management.”
So how does this line work?  And why does this it appear?  Practising Midwife Magazine presented a graphic which I have attempted to recreate here.  Basically as the baby descends, a red/purplish (or perhaps brown depending on skin color) line creeps up from the anus to the top of the natal cleft in between the bottom cheeks.  When the line reaches the top of the natal cleft, 2nd stage is probably a matter of minutes away.  A line sitting an inch below the natal cleft is probably in transition.  A line just above the anus probably signifies early labor.
Byrne DL & Edmonds DK, the authors of the original study, surmise that the cause of the line is “vasocongestion at the base of the sacrum.” Furthermore, the authors reason that “this congestion possibly occurs because of increasing intrapelvic pressure as the fetal head descends, which would account for the correlation between station of the fetal head and red line length.”  Fascinating and logical!
Interestingly, I came across a 2nd Scottish study from 2010 published by BMC Pregnancy & Childbirth: (Shepherd A, Cheyne H, Kennedy S, McIntosh C, Styles M & Niven C) which aimed to assess the  percentage of women in which a line appeared (76%. ) The study cited only 48-56% accuracy of vaginal examinations to determine cervix diameter and fetal station.  So why aren’t clinicians using this less invasive visual measure – especially considering how much some women may dread vaginal exams in labor??  Wouldn’t the thought of using a methodology to lower infection rate after rupture of membranes has occurred enthuse Health Care Providers instead of using higher risk techniques?  Or how about using the accuracy of the line at the natal cleft to know when a women using epidural should really be coached to push?
My educated guess is that this information has not yet reached Medical Textbooks and non-standard practices can take years to become mainstream (for example. delayed cord clamping) – and then only if or when women request them or media sensation activates them.  In addition, since laboring women are only intermittently attended by Labor & Delivery staff during early and active labor and often encouraged to “stay in bed,” Health Care Providers aren’t necessarily faced with a woman’s buttocks in labor.  Also vaginal examinations are considered “accurate” so staff have no need to peek between a woman’s natal cleft.   However both these studies, paired with the roughly 50% accuracy rate of manual vaginal exams, show that there is potentially a more accurate and less invasive way ahead.
In The Practising Midwife (Jan 2007, Vol 10 no 1, pg 27), Lesley Hobbs writes “Accurate reading would seem to the key to this practice.  I sometimes notice in myself a wish to see the line progressing more quickly than it actually does; when I do this – and check with a vaginal exam – only to find the line is right, I get annoyed with myself and wish I’d trusted my observations.”  Later she goes on to say “I can now envisage a time when I shall feel confident enough to use this as my formal measurement mechanism and abandon intrusive and superfluous vaginal exams.”
Licensed Midwife Karen Baker from Yucaipa, CA commented “The purple line is a curious thing.  It’s definitely not present on everybody but is more prominent on some than others – especially right before pushing.  It tells us when she’s in full swing if we are in a good position to spot it!”
I often urge couples to send me a picture of the so called ‘purple line’ which I promise I will use only for educational purposes but so far a picture is as elusive as the Loch Ness Monster.  So, as I say in class, ‘show me your purple line’!
Are you a midwife, doctor, nurse or doula who has observed this in a client or patient? Partners, have you seen this when your partner was in labor? Has anyone heard of it or witnessed it?  If you are a childbirth educator, do you feel this is something that you might mention in your classes?  Do you think that the families in your classes might be likely to ask for this type of assessment if they knew about it? Please comment and share your experiences.
Byrne DL, Edmonds DK. 1990, Clinical method for evaluating progress in first stage labour.Lancet. 1990 Jan 13;335(8681):122.
Downe S, Gyte GML, Dahlen HG, Singata M. Routine vaginal examinations for assessing progress of labour to improve outcomes for women and babies at term (Protocol). Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD010088. DOI: 10.1002/14651858.CD010088.
Hobbs 1998. Assessing cervical dilatation without Vaginal Exams. Watching the purple line. The Practising Midwife 1(11):34-5.


Wednesday, March 21, 2012

5 Quotes to Remind You Not to Induce

“We can make a woman have contractions, but we don’t always succeed in forcing her body to release the baby and give birth. If we start a labor with chemicals, we may very well have to finish it with a surgeon’s scalpel.” – Gail Hart, Midwife
“Inducing tends to create longer, more difficult, more painful births in general, and it ups a woman’s chance of having a c-section by two to three times.” – Jennifer Block, Author of Pushed
“I firmly believe that mothers are not informed enough to know that this [labor induction or augmentation with Pitocin] is not a good idea, and that any woman who has the right information would not want to have her baby induced.” – Kathleen Rice Simpson, PhD, professor of nursing at St. Louis University School of Nursing
“French obstetrician and author Michel Odent, also a critic of the induction ‘epidemic’, as he calls it, argues that labor begins when the baby is ready to be born. Odent likens gestation to apples ripening on a tree: ‘You wouldn’t pick them all on the same day, would you?’ ” – Jennifer Block, Author ofPushed (Michael Odent
“It used to be that a pregnancy lasting beyond 42 weeks was considered ‘post-term.’ But today, inducing on or before 41 weeks is fairly standard across North America.” – Jennifer Block, Author of Pushed

Hep B Vaccine Damages The Liver It Is Supposed To Protect

“According to Hippocratic tradition, the safety level of a preventive medicine must be very high, as it is aimed at protecting people against diseases that they may not contract.” ~ Marc Girard,Autoimmune hazards of hepatitis B vaccine.
Startling new research published in the journal Apoptosisindicates that hepatitis B vaccine, which is designed to prevent Hepatitis B virus-induced damage to the liver, actually causes liver cell destruction.
In the study titled “Hepatitis B vaccine induces apoptotic death in Hepa1-6 cells,” researchers set out to “...establish an in vitro model system amenable to mechanistic investigations of cytotoxicity induced by hepatitis B vaccine, and to investigate the mechanisms of vaccine-induced cell death.”
They found the hepatitis B vaccine induced a “loss of mitochondrial integrity, apoptosis induction, and cell death” in liver cells exposed to a low dose of adjuvanted hepatitis B vaccine. The adjuvant used wasaluminum hydroxide, which is increasingly being identified as a contributing cause of autoimmune disease in immunized populations.
The discovery that the hepatitis B vaccine damages the liver (hepatotoxicity) confirms earlier findings(1999) that the vaccine increases the incidence of liver problems in U.S. children less than 6 years old by up to 294% versus unvaccinated controls.

Full Article...

The Most Scientific Birth Is Often the Least Technological Birth

When I ask my medical students to describe their image of a woman who elects to birth with a midwife rather than with an obstetrician, they generally describe a woman who wears long cotton skirts, braids her hair, eats only organic vegan food, does yoga, and maybe drives a VW microbus. What they don't envision is the omnivorous, pants-wearing science geek standing before them.

Indeed, they become downright confused when I go on to explain that there was really only one reason why my mate -- an academic internist -- and I decided to ditch our obstetrician and move to a midwife: Our midwife could be trusted to be scientific, whereas our obstetrician could not.

Many medical students, like most American patients, confuse science and technology. They think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this makes them dangerous. In fact, if you look at scientific studies of birth, you find over and over again that many technological interventions increase risk to the mother and child rather than decreasing it.

But most birthing women don't seem to know this, even if their obstetricians do. Paradoxically, these women seem to want the same thing I wanted: a safe outcome for mother and child. But no one seems to tell them what the data indicate is the best way to get there. The friend who dares to offer half a glass of wine is seen as guilty of reckless endangerment, whereas the obstetrician offering unnecessary and risky procedures is considered heroic.

Full Article...