While researching this on the internet, I’ve stumbled upon some fascinating information which flies in the face of conventional wisdom.  Conventional wisdom suggests that kegel exercises are the answer to this sort of pelvic floor weakening problem, and in fact they’re what I have been doing primarily, and have been teaching my patients how to do for years now.  Kegels, kegels, kegels!  However, after reading this amazing post over on MamaSweat where Kara Thom of MamaSweat interviews Katy Bowman of Aligned and Well, I am beginning to change my mind.  Katy is a biomechanical scientist who has done a lot of research into the mechanics of the pelvic floor, and in her radical departure from conventional wisdom, she suggests that squats are the answer rather than kegels.  Naturally, rocking the boat like this has brought with it a bit of a back lash, including this hilarious video aimed at Katy from the “Kegel Queen” (an RN who also believes highly in the merits of kegels); even a year after the initial interview, the debate is still alive and well.

So in addition to kegels, I’ve decided to add some squats to the mix, and I’m even squatting and peeing in the shower each morning (apologize for the potential TMI right there, loyal readers!).  There are also some pretty cool exercise systems out there which can be purchased, as well as physical therapists who specialize in nothing but the pelvic floor, so I’ll keep all of you posted on pelvic progress 6 months from now.  But I’m also a firm believer in sexercises, too!

“[Rep. Mike] Pence [R-Ind.] has acknowledged that health centers use Title X money to perform valuable services that he supports, but he contends that the funds are also being used to support abortions indirectly by covering operating costs and other related expenses for Planned Parenthood and other abortion providers.

“Eliminating Title X funding has never been my goal,” he said on the floor Thursday. “My focus has and will remain on denying taxpayer dollars to Planned Parenthood or any organization that provides or promotes abortion as a means of birth control.”

My argument with this is that once again, abortion and birth control are getting mixed up, and they are two totally different things.  This frustrates me no end.  Family planning and birth control helps to avoid abortions!  If our country is so strongly anti-abortion, this is EXACTLY the type of organization we should be supp orting, not defunding.  I have personally used Planned Parenthood before as a student in order to obtain birth control, and as a midwife I personally send many of my patients to their clinics since 1) they accept medicaid (and all of my patients are medicaid-only recipients) and 2) they have the Mirena IUD and are willing to insert it into medicaid-only patients (my hospital unfortunately only has the copper-T IUD on offer, so patients seeking the Mirena need to go elsewhere; the Mirena, of course, is a form of BIRTH CONTROL).

Planned Parenthood is now currently trying to raise money and defend itself in the Senate against further legislative attacks.  Luckily, I seriously doubt that the Senate will approve the same level of draconian cuts to Title X funding, and even if they do, President Obama has vowed to veto such a bill.  Nevertheless, Planned Parenthood NEEDS YOUR HELP! With the anti-woman climate in Washington right now, it is very naive to sit back on our heels and assume that the Senate will automatically turn this aside.  Write a letter to your Senator, call or speak with your Senator, or sign PP’s Open Letter to Congress.  Or, if you’re in  the NYC area, attend the Planned Parenthood New York’s Rally at Foley Square at 1:00 pm this Sat. 2/26.

“The bill in South Dakota is an invitation to murder abortion providers,” says Vicki Saporta, the president of the National Abortion Federation, the professional association of abortion providers. Since 1993, eight doctors have been assassinated at the hands of anti-abortion extremists, and another 17 have been the victims of murder attempts. Some of the perpetrators of those crimes have tried to use the justifiable homicide defense at their trials. “This is not an abstract bill,” Saporta says. The measure could have major implications if a “misguided extremist invokes this ‘self-defense’ statute to justify the murder of a doctor, nurse or volunteer,” the South Dakota Campaign for Healthy Families warned in a message to supporters last week.

Thankfully, for the moment, due to a national media outcry against H1171, the bill has been momentarily shelved, while Representative Phil Jensen, the bill’s sponsor, decides to either include language to protect abortion providers,or  cancels the bill altogether, since South Dakota law already includes an “unborn child” in the definition of “person”, and Rep. Jensen admits there may not be a need for a separate bill.  The NY Times also has the article here. There is supposed to be a further decision made on whether to go forward with H1171 today, so I will try to update this as the news arrives.

Even if the justifiable homicide aspect is dropped in H1171, there is still another bill pending in the South Dakota legislature which proposes to make getting an abortion in SD even more arduous.  This bill, H1217, would require women to undergo counseling at a Crisis Pregnancy Center (CPC) before being allowed to go forward with an abortion.  As it stands right now, the requirements to get an abortion in SD are already nearly insurmountable.  There is only one clinic in the state which provides abortions, the doctor who does them is flown in from a neighboring state only one day a week, and women are forced to see a sonogram of the fetus and are read from a script emphasizing that the baby is a living, separate entity and that they are connected, before going forward with the procedure.  Adding a visit to a Crisis Pregnancy Center, which are often run by religious/ pro-life organizations, throws up yet another obstacle.  H1217 also proposes adding a mandatory 72 hour wait time between counseling at the CPC and the actual procedure itself.

The 2006 CDC Waxman report has already noted that CPC’s are notorious for providing false and misleading information, and that the majority of counselors are pro-life activists, not trained healthcare professionals.  RH Reality Check has a great article on this.  Mother Jone’s also wrote extensively about the Waxman report and the false information provided by Crisis Pregnancy Centers.  Here are a few other links to blogs discussing H1217:

Our Bodies Our Blog

The Curvature

Blog For Choice

While our focus is caught up on the Federal level and the House’s swift and drastic attack on women’s reproductive rights (more on this to come), it’s easy to lose sight of the smaller state battles which can do a lot to set precedent and undermine Federal laws in the first place. If you’re looking to directly support the women of South Dakota, here is a good place to start: South Dakota Campaign for Healthy Families.

Related links:

The Daily Kos: an account from an abortion clinic escort

Belly Tales: post from 2008 on the eve of the 2nd SD referendum vote (which didn’t pass)

In early December, shortly after the nomination of Tom Daschle as Secretary of Health and Human Services (HHS), the Big Push for Midwives launched a campaign to get Mr. Daschle to attend a community meeting on midwifery and its advantages.  Per the change.gov initiative, discussions on healthcare reform will be occurring around the country between 12/15 – 12/31, and Senator Daschle has promised to attend a few of them in person.  Thanks to the Big Push for Midwives, he was invited to several heartland discussions, including this one in Lees Summit, MO.  I haven’t been able to find any updates or reports from this meeting yet.  I’m not sure if Mr. Daschle was able to attend, but it’s definitley the sort of discussion he (and the Obama administration) should be listening to. (Was anyone actually able to attend that meeting?  If so, give us an update, please!!  I’ve been searching the internet for reports on the meeting, but I haven’t found any yet.)

As this excellent recent article in the LA Times (Midwives Deliver by Jennifer Block) points out, midwives deliver much safer care for much lower cost:

The most cost-effective, health-promoting maternity care for normal, healthy women is midwife led and out of hospital. Hospitals charge from $7,000 to $16,000, depending on the type and complexity of the birth. The average birth-center fee is only $1,600 because high-tech medical intervention is rarely applied and stays are shorter. This model of care is not just cheaper; decades of medical research show that it’s better. Mother and baby are more likely to have a normal, vaginal birth; less likely to experience trauma, such as a bad vaginal tear or a surgical delivery; and more likely to breast feed. In other words, less is actually more.The Obama administration could save the country billions by overhauling the American way of birth.

It seems like instead of encouraging midwifery care, the opposite is happening.  Birth Centers around the country are closing at a rapid pace, and Medicaid has recently started to resfuse to fund birth center care:

Over the past few years, CMS (the federal agency that runs Medicaid/Medicare) has begun disallowing federal matching funds for state Medicaid payments for freestanding birth centers services. Birth centers have been recognized by CMS (and earlier, by HCFA) as a Medicaid provider type in State Medicaid Plans since 1987. Recently, however, CMS has disallowed such payment by several state Medicaid Agencies, including Alaska, South Carolina, Texas, and Washington State, claiming that it lacks clear statutory authority and direction to do so. CMS has directed its regional offices to stop federal payments to any state for birth center services.

As this article points out, this is going to cause a huge squeeze on birth centers around the country, and we’ll soon be seeing even more of them close unless something is done.  This is an urgent call to action.  The AACB has several resources on their website listing ways to contact your senators and let them know about this issue, including using this lovely flyer which lists all of the important talking points you’ll need when composing your e-mail or making your phone call (calls are preferrable, apparently, since e-mail is more likely to be lost in the midst of all the e-mails on the federal bail-out).  The reason this is so important is that Medicaid generally sets the standard for insurers.  If Medicaid stops insuring birth center care, other insurance companies will follow suit.  Birth centers are a crucial link in many communities, providing quality health care to diverse populations (including women on Medicaid – you only have to look at the work of Ruth Lubic and the Morris Heights birth center to appreciate that), and we need to keep as many of them open as possible.  Not only does it make great health sense, but it saves money too.

And here’s another great cost-saving suggestion: stop insuring preterm elective cesareans.  When I read this article I just about choked.  I can’t believe insurance companies are willing to pay for this when research has consistently shown that there are still a lot of complications with “near-term” infants (babies born between 34 – 36 wks) such as respiratory distress, jaundice, temperature instability (hypothermia), delayed brain development and feeding difficulties.  Forget the fact that a cesarean delivery is several thousands of dollars more expensive than a vaginal delivery; the real damage in this practice is caused by the increased number of preterm babies and the burden of care they demand.  Prematurity and NICU care accounts for one of the largest chunks of healthcare expenditure.  Even the March of Dimes is calling for a decrease in preterm cesareans.

I’ve always been consistently amazed that HMOs, managed care systems and Medicaid haven’t latched onto midwifery with more enthusiasm.  I wonder sometimes if this is because ACOG and the AMA are able to counteract the economic practicality of midwifery care with a tons of lobby money.  The economic angle isn’t anything new.  The Business of Being Born said the same thing in 2007, and Michel Odent, Ina May, Naomi Wolf, Suzanne Arms, Robbie Davis-Floyd etc. etc. have been saying the same thing for decades.  Maybe in the midst of the recession, the message will finally get through: midwifery care is better AND cheaper.

South Dakota’s Measure 11 was soundly defeated: “South Dakotans have affirmed by their votes tonight that no vague law can account for every individual circumstance. And that is precisely why women and families, not the government, should make these personal healthcare decisions,” said Sarah Stoesz, President and CEO of Planned Parenthood Minnesota, North Dakota, South Dakota.

The New York Times, in the midst of all the election craziness, published an article on new links between depression and premature delivery which have been recently reported in the Journal of Human Reproduction. The study interviewed 791 women and ultimately gave them scores based on how many depressive symtoms they exhibited–the higher the score, the worse the depression. The study found that the higher the score, the greater the risk of preterm delivery, even after controlling for prior preterm deliveries, miscarriage, socioeconomic status, education and other variables. This is particularly fascinating considering that so little is known about how depression affects pregnancy, and vitally important since depression during pregnancy (and the mental health of women during pregnancy in general) are so often overlooked in prenatal care.

The New Space for Women’s Health (formerly Friends of the Birth Center) is having a fundraiser on November 18th at Babeland called Women Come First. The event, which is co-sponsored by Ricki Lake and The Business of Being Born, offers an opportunity to not only raise money for the new free-standing women’s health and birth center in New York City but an exclusive cocktail party and shopping opportunity. Sounds like a lot of fun! I’d be there if I wasn’t already working that day…

Finally, I’m sure this is going the rounds on the internet, but I think everyone, everyone, needs to watch Keith Olbermann’s special comment on Proposition 8:

Even so, none of this changes the fact that women trying to access reproductive health care in South Dakota face a really tough challenge.  There is only one clinic in South Dakota which performs abortions, and they are done by a rotating staff of doctors who are flown in from neighboring states.  And again, as the Daily Kos has pointed out, the hoops that women in SD have to jump through before actually having the procedure done are incredibly daunting:

The woman must receive state-mandated “counseling.”

The woman must wait at least 24 hours after the state-mandated “counseling” before procedure may be provided.

If the patient is a minor, a parent or guardian of the patient must be notified.

The doctor must offer the woman an opportunity to view a sonogram, and must then record any responses in her permanent medical records.

The doctor must deliver a government-dictated script to women designed to intimidate her and discourage her decision. The mandatory language includes statements of fact which are contrary to all available medical research.

Usually by the time a woman is sitting across from me (a midwife) for her initial prenatal visit, she’s already made up her mind to keep her baby.  But every now and then I come across a woman who’s still conflicted, and we usually have a frank and very difficult discussion about whether she really wants this pregnancy or not, and everything that keeping this pregnancy entails.  This is a hard decision to make in a hospital like mine, sitting across from a provider like me who is resoundingly pro-choice, and is not at all judgemental or discouraging of the woman’s thoughts or decision.  These women are often young, alone, and already scared and intimidated, but if they really don’t feel like they can keep this pregnancy (for whatever reason–and we do talk about the reasons, but only to make sure that she’s thought everything through), I gently refer them to the termination of pregnancy clinic, with compassion and support.  No one is judging them.  Judgement is the LAST thing you should find in your health care provider’s office.

Now, imagine this were South Dakota.  Imagine how much harder it would be to make such a decision if I were legally required to read these women a script containing statements which are medically false and which do nothing but make the woman feel even more intimidated and guilty about her decision.  If I were forced by state regulations to make it very clear that I think abortion is a terrible idea, it would take a very staunch woman indeed to be able to stand up to something like that (and this is not because I’m so terribly persuasive, but only because the power of the white coat is astounding: people automatically trust you a little bit more and believe you’re speaking the truth, just because you’ve got a white coat on.  If you tell them that they need to eat more iron-rich foods because they’re anemic, they generally listen to you.  If you tell them that what they’re doing is wrong, they listen to you too).  And then, to top it off, I’d have to offer these women a sonogram, just so they can see that heart beating some more, and feel even more like a monster for doing what they feel they have to do.  The cruelty of it makes my skin crawl.

In any case, the reproductive rights of the women of South Dakota hang in the balance (and by proxy, the women of the rest of this country too, because if this referendum passes in South Dakota, it’s just opening the door for every other state).  And do not be fooled: the inclusion of exceptions into the wording of the bill in no way changes the fact that this referendum will basically make all abortions in South Dakota illegal, because there is absolutely no practical way to carry out these exceptions, and no doctor willing to test it.  So, what can we do about it?  We can donate money to the South Dakota Campaign for Healthy Families, and we can…(to put a rather neo-conservative spin on it)…pray.