Congenital Heart Defect Awareness Week: Feb. 7-14

Did you know that heart abnormalities are the most common birth defect? I didn't, until a few weeks ago. A Facebook friend posted a link to the Cora's Story blog and I casually clicked over to see what it was about. Cora died suddenly in her mama's arms at just 5 days old from an undetected congenital heart defect (CHD). I can't imagine suffering such a devastating loss, and I thank my lucky stars for my kids' healthy hearts. But Cora's mother Kristine has turned her pain into a wonderful mission in her daughter's name: to raise awareness about CHD and how easily it can be detected. With Kristine and Cora's help, hopefully more CHDs will be caught and treated early, saving babies' and children's lives.

Another fact I learned from Cora is how easily many CHDs can be detected. A simple pulse oximetry test (aka "pulse ox") done 24-48 hours after birth in conjunction with a newborn exam can detect a large proportion of CHDs, with a low false-positive rate. A pulse ox test is noninvasive and very simple: the reader is typically attached to the baby's toe and determines the oxygen saturation of the blood. An abnormal reading (typically below 95) is indicative of a problem. The research on pulse ox screening bears out the effectiveness of pulse ox screening tests for newborns.*

So why hasn't pulse ox testing become routine for all newborns? As I mentioned, the test is completely non-invasive and hospitals already have the equipment. Portable pulse ox readers are also available, which means both birth center and homebirth midwives could also easily carry them. Kristine is working on Cora's behalf to get laws passed nationwide mandating a pulse ox to be done on every newborn. I applaud her efforts and admire her strength at turning her pain into an effort to save lives.

What can YOU do? Request this test for your own babies and tell the pregnant moms in your life to request it when their babies are born. Pass this information on, and tell others to pass it on too. Write your Congressman and your state representatives and tell them you want pulse ox testing to be mandatory for all newborns. You might just save a baby's life.

*More information and research:
Medscape Medical News
British Medical Journal
University of Michigan
Medical News Today
1in100

A Bit of History That Gives Me Chills

Yesterday one of my favorite bloggers, The Unnecesarean, posted an excerpt from a history text about birth in the early 20th century. The excerpt presents the practice of putting women under "twilight sleep" for labor and delivery as a way to convince WASP women to have more babies because "modern" birth practices render it painless-- or at least without the memory of pain. I had never heard of this racist/classist perspective of twilight sleep before. But it got me thinking, especially since I recently read that the tv show Mad Men featured a character giving birth within the haze of twilight sleep.

I can't remember the first time I heard about women being "put under" to have their babies- it was probably as a child or teen. Until a few years ago, I guess I thought it was a benign but clumsy attempt to spare women the pain of birth. No big deal. But then I happened to see "The Business of Being Born, " a documentary by Ricki Lake that covers a little bit of the history of birth in the US. The historical aspect was eye-opening, to say the least. When you start to think about the fact that this is the way many of our parents came into the world (and maybe even some of us, considering twilight sleep was prevalent well into the 60s and even the 70s in some hospitals), it can be downright scary.

Beginning in the 1900s, a combination of scopolamine and morphine was administered to all women entering the hospital for birth. Women had no recollection of the birth, and certainly no recollection of any pain. Feminists heralded this as a fantastic medical breakthrough, and demanded its widespread availability for birthing women. As word spread of this wonderful new pain-free way to give birth, women across the country chose to deliver in hospitals offering twilight sleep. In fact, there are reports of women being put under for delivery whether they wanted it or not, even against their own explicit refusal. But since women had no recollection what actually happened during their births, and husbands at that time were not part of the birth process, it was years before the true horror of twilight sleep was exposed.

Since the women were not fully sedated, and not fully relieved of the pain of labor, they had to be placed in restraints in their hospital beds so as not to thrash themselves onto the floor. When husbands started questioning the marks on their wives' wrists and ankles left behind by the leather restraints, the practice of restraining was not abandoned. Instead new restraints made of lambswool were designed so as not to leave any marks. Women were left, tied down, to writhe through their labors until the doctor arrived with forceps to extract the baby. (See photo at top.)

When the effects of the medicine wore off, women were presented with a freshly bathed, blanketed bundle of baby. Some women complained of feeling detached from their babies, like they weren't even sure it was their own child. The drugs also crossed the placenta and often sedated the baby, resulting in breathing problems. Over time the method was eventually abandoned, as a result of the negative side effects and the second wave of feminism. As women reclaimed control of their reproductive lives, including access to birth control pills, they also began increasingly demanding unmedicated births and fathers' involvement in births. The development of epidural anesthesia also played a role in the demise of twilight sleep.

Maybe it's my own personal bias against hospitals, but the thought of literally being dropped at the door of the maternity ward by my husband and literally having no recollection of anything else until being handed a baby two days later utterly horrifies me. I don't think the method would have taken off if husbands had been allowed in- I cannot imagine any man permitting such barbaric practices to be visited upon his wife. But they didn't know, so they couldn't help.

There was (and I think there still is) a certain mystique around birth: We don't know exactly how labor starts, and can't predict when it will happen. Regardless of a mother's weight gain or belly size, we don't know the size of the baby until it's born-- even ultrasound measurement can be off by a pound or more in either direction. This mystique allowed generations past, and still allows many people today, to maintain a certain degree of ignorance about birth. It's very easy to assume that the doctor has all the knowledge, the hospital has all the equipment, so all the expectant parents need to do is show up when it's time. I think that is a dangerous attitude. The same people who wouldn't hesitate to seek a second opinion from a doctor who said they need a heart transplant... the same people who would consult with three different orthopedic surgeons about a knee replacement... don't think twice about their choice of care provider, birth place, or pain management options. I could write a whole other post on the topic of informed birth choices... But suffice to say for now, If you don't know your options, you don't have any.