Born in the USA (49 page)

7
.  W. Rayburn and K. Farmer, “Off Label Prescribing during Pregnancy”
Obstetrics and Gynecology Clinics of North America
24, no. 3 (1997): 471–78. In this paper, a survey of 731 pregnant and birthing women showed that 22.6 percent had received drugs for off-label indications and none of these women had ever been told that the use was off-label. Such widespread off-label prescribing is not found in other fields of medical practice.

8
.  Two examples of studies reported in the mid-1990s with insufficient sample size to adequately measure risks are L. Sanchos-Ramos et al., “Labor Induction with the Prostaglandin 1 Methyl Analogue Misoprostol Versus Oxytocin: A Randomized Trial,”
Obstetrics and Gynecology
91, no. 13 (1993): 401–5; and D. Wing and R. Paul, “A Comparison of Differing Dosing Regimens of Vaginally Administered Misoprostol for Preinduction Cervical Ripening and Labor Induction,”
American Journal of Obstetrics and Gynecology
179, no. 1 (1996): 158–64.

9
.  G. J. Hofmeyr, “Misoprostol Administered Vaginally for Cervical Ripening and Labour Induction with a Viable Fetus,”
Cochrane Library
, 2, 1999 (Oxford: Update Software).

10
. For detailed data on childbirth in the United States collected by the federal government, including rates of induction of labor, go to the Web site
www.cdc.gov/nchs/birth
.

11
. 
Listening to Mothers
(New York: Maternity Center Association, 2002), the first national survey of childbearing women in the United States, was conducted by the Maternity Center Association (now called Childbirth Connection), 281 Park Avenue South, New York, NY 10010.

12
. The protocol states, in part, that the hospital's “induction time slots are as follows: (1) Monday through Friday at 0500 [5:00
A.M.
], 0700, 1000, or 1200 and for miso [misoprostol, Cytotec] at 2000. Two patients may be scheduled for each time slot. (2) Saturday and Sunday: May schedule up to three patients; time may vary. (3) No ‘on call' inductions unless scheduled induction is delayed due to bed availability. . . . (4) Any patient designated by the physician as a medically indicated emergency admission will be accepted for induction at any time. . . . (5) All Misoprostols need to be booked through the ANM, Charge RN, or Induction Nurse in L&D. (6) Induction may be scheduled up to 14 days in advance.” There is a waiting list for slots, so the doctor and the woman must plan ahead for the induction, which can be tricky if the induction supposedly is to be done for medical reasons. However, the protocol list of approved reasons for induction includes (albeit at the bottom of the priority list) “social indication,” a euphemism for convenience. How dehumanizing this assembly-line approach is can be seen in the way the protocol refers to the woman (“All Misoprostols need to be booked . . .” ) as well as in the woman's realization that her baby's birthday will be forever determined, not by the optimal physiological moment, but by an empty slot in the hospital's schedule.

13
. D. Wing et al., “Disruption of Prior Uterine Incision Following Misoprostol (Cytotec) for Labor Induction in Women with Previous Cesarean Section,”
Obstetrics and Gynecology
91, no. 2 (1998): 828–30.

14
. M. Plaut, M. Schwartz, and S. Lubarsky, “Uterine Rupture Associated with the Use of Misoprostol in the Gravid Patient with a Previous Cesarean Section,”
American Journal of Obstetrics and Gynecology
180, no. 6 (1999): 1535–40; H. Blanchette, S. Nayak, and S. Erasmus, “Comparison of the Safety and Efficacy of Intravaginal Misoprostol with Those of Dinoprostone for Cervical Ripening and Induction of Labor in a Community Hospital,”
American Journal of Obstetrics and Gynecology
180, no. 6 (1999): 1543–50.

15
. Goldberg, A. B., M. B. Greenberg, and P. D. Darney, “Drug Therapy: Misoprostol and Pregnancy,”
New England Journal of Medicine
344, no. 1 (2001): 38–47.

16
. 
Dateline NBC
, November 4, 2001.

17
. ACOG Practice Bulletin number 10, “Induction of Labor,” November 1999.

18
. G. J.. Hofmeyr and A. M. Gulmezoglu, “Vaginal Misoprostol for Cervical Ripening and Induction of Labour (Review),”
Cochrane Database of Systematic Reviews
, 1, 2003, art. no. CD000941.

19
. 
Goldberg, Greenberg, and Darney, “Drug Therapy: Misoprostol and Pregnancy.”

20
. J. Tickner, C. Raffensperger, and N. Myers, The
Precautionary Principle in Action: A Handbook
, Science and Environmental Health Network, posted at
www.biotech-info.net/precautionary
.

21
. P. Saunders, “Use and Abuse of the Precautionary Principle,” submission to U.S. Advisory Committee on International Economic Policy, biotech working group, July 13, 2000, posted on the Web site of the Institute of Science in Society,
www.i-sis.org
.

22
. L. Sanchos-Ramos et al., “Misoprostol for Cervical Ripening and Labor Induction: A Meta-Analysis,”
Obstetrics and Gynecology
89 (1997): 633–42.

23
. Sanchos-Ramos et al., “Misoprostol for Cervical Ripening and Labor Induction,” p. 640.

24
. R. Hale and S. Zinberg, “Use of Misoprostol in Pregnancy,”
New England Journal of Medicine
344, no. 1 (2001): 59–60.

25
. The FDA alert in May 2005 on the risk of use of misoprostol in labor and delivery may be found at
www.fda.gov/cder/drug/infopage/misoprostol
.

26
. See M. Wagner, “Adverse Events Following Misoprostol Induction of Labor,”
Midwifery Today
71 (Autumn 2004): 9–12.

27
. M. Enkin et al.,
A Guide to Effective Care in Pregnancy and Childbirth
, 3rd ed. (New York: Oxford University Press, 2000), p. 375.

28
. For an excellent review of the indications for induction and the evolution of labor induction, see G. Hart, “Induction and Circular Logic,”
Midwifery Today
63 (Autumn 2002): 24.

29
. L. Sanchez-Ramos et al., “Expectant Management versus Labor Induction for Suspected Fetal Macrosomia: A Systematic Review,”
Obstetrics and Gynecology
100, no. 5, part 1 (2002): 997.

30
. Wilkes et al., “Premature Rupture of Membranes” (2004), posted on
www.emedicine.com
; M. Hannah et al., “Induction of Labor Compared with Expectant Management for Prelabor Rupture of the Membranes at Term,”
New England Journal of Medicine
334, no. 16 (1996): 1005.

31
. J. McClure-Brown, “Postmaturity,”
American Journal of Obstetrics and Gynecology
85 (1963): 573–82.

32
. R. L. Williams et al., “Fetal Growth and Perinatal Viability in California,”
Obstetrics and Gynecology
59 (1982): 624; P. Bergsjo et al., “Comparison of Induced vs. Non-induced Labor in Post-term Pregnancy,”
Acta Obstetrica Gynecologica
68 (1989): 683–87.

33
. D. Weinstein et al., “Expectant Management of Post Term Pregnancy: Observations and Outcome,”
Journal of Maternal Fetal Medicine
5, no. 5 (1996): 293–97.

34
. For detailed data on childbirth in the United States collected by the federal
government, including rates of induction of labor, go to the Web site
www.cdc.gov/nchs/birth
.

35
. Information on Cytotec must always make a careful distinction between Cytotec for medical abortion early in pregnancy, which is thoroughly studied and recommended, and Cytotec for stopping postpartum hemorrhage, which is also thoroughly studied and recommended, and Cytotec for induction of labor at the end of pregnancy, which is currently under investigation and not approved because of serious risks.

36
. 
Dateline NBC
, November 4, 2001; Canadian Broadcasting Company (CBC), The
National
, October 2002; CBS Boston affiliate evening news segment, 2005; I. M. Gaskin,
Ina May's Guide to Natural Childbirth
(New York: Bantam Books, 2003), pp. 280–84; H. Goer,
Thinking Woman's Guide to a Better Birth
(New York: Penguin Putnam, 1999), pp. 60–65; “Cytotec: Dangerous Experiment or Panacea?” posted on
www.salon.com
, July 11, 2000.

37
. For a detailed discussion of the issues in the regulation of the newer reproductive technologies such as in vitro fertilization, see P. Stephenson and M. Wagner,
Tough Choices: In Vitro Fertilization and the Reproductive Technologies
(Philadelphia: Temple University Press, 1993).

38
. For more information on the Internet support group for women who survived uterine rupture, see
[email protected]
.

FIVE. HUNTING WITCHES

1
.  Mortality rates for California hospitals for the years 1968 to 1970 are available from the State Department of Health.

2
.  J. Rooks,
Midwifery and Childbirth in America
(Philadelphia: Temple University Press 1997), an excellent resource on American midwifery, is one of many books that review the fascinating history of midwifery.

3
.  For a detailed description of the case of Hanna Porn and an excellent analysis of the witch-hunt against midwives in that era and its similarity to the present witch-hunt against midwives, see E. Declercq, “The Trials of Hanna Porn: The Campaign to Abolish Midwifery in Massachusetts,”
American Journal of Public Health
84, no. 6 (1994): 1022–28.

4
.  One example is J. van Olphen-Fehr,
Diary of a Midwife: The Power of Positive Childbearing
(Westport, Conn.: Bergin & Garvey, 1998).

5
.  The two books by nurse-midwives describing their experiences attending home births are van Olphen-Fehr,
Diary of a Midwife;
and P. Vincent,
Baby Catcher: Chronicles of a Modern Midwife
(New York: Scribner, 2002). For information on Citizens for Midwifery, call (888) CFM-4880 or e-mail
[email protected]
. For information on the International Cesarean Awareness Network, see
www.ican-online.org
. For information on the Coalition for Improving Maternity Services, see
www.motherfriendly.org
.

6
.  
E. J. Lehrman, “Nurse-Midwifery Practice: A Descriptive Study of Prenatal Care,”
Journal of Nurse-Midwifery
26, no. 3 (1981): 27–41.

7
.  Lehrman, “Nurse-Midwifery Practice”; B. K. Cypress,
Office Visits by Women: The National Ambulatory Medical Care Survey
(Hyattsville, Md.: National Center for Health Statistics, 1980). The latter study found that physicians spend an average of only ten minutes on each prenatal visit, 32 percent of their prenatal visits took five minutes or less, and they did little counseling.

8
.  M. MacDorman and G. Singh, “Midwifery Care, Social and Medical Risk Factors, and Birth Outcomes in the USA,”
Journal of Epidemiology and Community Health
52, no. 5 (1998): 310–17.

9
.  M. Wagner, “Midwifery in the Industrialized World,”
Journal of the Society of Obstetricians and Gynecologists of Canada
20, no. 13 (1998): 1225–34, is a review of the scientific literature on midwifery, including the research showing the safety of midwives and the research showing that midwives use fewer unnecessary interventions during labor and birth than doctors do.

10
. A review of the scientific literature on the advantages and disadvantages of the various positions of women during childbirth is found in M. Wagner,
Pursuing the Birth Machine: The Search for Appropriate Birth Technology
(London: ACE Graphics, 1994), pp. 150–53.

11
. Data on the number of U.S. births attended by midwives and doctors and data on the rates of obstetric interventions in the United States can be found on the Web site
www.cdc.gov/nchs
. Another source of rates of obstetric interventions is
Listening to Mothers
(New York: Maternity Center Association, 2002), the first national survey of childbearing women in the United States, conducted by the Maternity Center Association (now called Childbirth Connection), 281 Park Avenue South, New York, NY 10010.
www.childbirthconnection.org
.

12
. Wagner, “Midwifery in the Industrialized World.”

13
. See data posted at
www.cdc.gov/nchs
.

14
. For information on doulas, including scientific evidence of the benefits provided by them, contact Doulas of North America (DONA) at
www.dona.org
.

15
. M. Wagner, “A Global Witch Hunt,”
Lancet
346 (1995): 1020–22. Also see D. Korte, “Midwives on Trial,”
Mothering
, Fall 1995, p. 54.

16
. In the past ten years, I have been personally contacted by dozens of midwives in the United States who have been arrested by local authorities or state attorneys general, investigated by state boards, or fired by obstetric groups or by hospitals. I have testified at state board hearings of midwives or at trials of midwives in several states, including Connecticut, Illinois, Indiana, Vermont, and Washington. I have given advice and sent letters to authorities concerning midwives under attack in many states, including New York,
New Jersey, South Dakota, Oregon, California, and others. And I have read many newspaper accounts of midwives under attack.

17
. See Wagner, “Global Witch Hunt.”

18
. For further discussion of how state quality assurance systems are abused for inappropriate, nonclinical purposes to benefit certain groups of doctors and to punish deviance from the style of practice preferred by those in power, see Wagner, “Global Witch Hunt.”