Women Face the Risk of Pelvic Organ Prolapse after Childbirth

Elizabeth Carrollton writes about defective medical devices and dangerous drugs for Drugwatch.com.

 One of the main reasons pelvic organ prolapse (POP) occurs is due to childbirth. The stress of birth can, in some cases, shift the organs in the pelvis from their normal positions. The most common organs affected during childbirth are the bladder and the uterus itself. When this occurs, the symptoms can be mild or severe, depending on the type and extent of the prolapse.

 The most common symptom is a feeling of fullness or pressure in the lower abdomen. Frequent urination and incontinence are common with a prolapsed bladder. As the prolapse worsens, the feeling of pressure can change to pain, and the condition can be very uncomfortable and debilitating.

 There are several treatments for pelvic organ prolapse, and recently, the use of an implant called transvaginal mesh has become very common. During this procedure, a light mesh material is inserted through the vagina to help secure the prolapsed organs. While in theory this seems like a great solution for pelvic organ prolapse, in reality there have been numerous complications associated with this procedure.

 These complications have been reported with increasing frequency to the Food and Drug Administration (FDA). Between the years of 2008 and 2010, more than 2,800 complaints about the transvaginal mesh procedure were logged. The FDA has made these complaints public in order to help patients realize the risk they are facing if they elect to go ahead with this procedure.

 The most common side effect following transvaginal mesh surgery is the erosion of the mesh into other organs. This erosion can cause bleeding and other side effects. Another common complication is the actual wearing through of the vaginal walls, as the mesh presses against them. This is a very serious complication that can result in internal bleeding and serious infections. Because of such severe complications, mesh users have started to file a transvaginal mesh lawsuit against the mesh manufacturers.

 Other side effects noted by the FDA include pain and neuromuscular problems following the procedure. Unfortunately, many doctors are not aware of the complications that their patients are facing with this procedure. It appears that few are properly trained in the insertion of the transvaginal mesh, and this in part explains the high rate of complications associated with the procedure.

 The FDA is continuing to monitor the problems associated with transvaginal mesh surgery. The agency has ordered dozens of mesh manufacturers to conduct safety studies on their products.

 If your doctor has recommended transvaginal mesh, it is vital to understand the potential risks you may face. While all surgical procedures carry risks, the number of complaints associated with mesh are cause for real concern.

 Ask your doctor if there are alternatives to this procedure. For minor cases, simple muscle exercises can be used to help shift the prolapsed organs back into place and strengthen the vaginal walls. Serious cases can be fixed with a surgical procedure that does not include the insertion of the mesh.

 If you feel that you are not receiving enough treatment options, don’t be afraid to ask for a second opinion from another surgeon or specialist. You deserve to know the true complications associated with transvaginal mesh, and you deserve to have a surgeon who has been properly trained in the procedure before going ahead with surgery.

Exploring The Home Birth Option

“I really want a home birth but…” How doulas and childbirth educators can help expectant parents explore the home birth option. By Monica Basile, CPM

 How many times as a doula or childbirth educator have you heard someone say, “I really want a home birth, but…?” Usually this is followed by a list of perceived barriers to home birth or misconceptions about home birth, rather than personal convictions, structural barriers, or health concerns that might make hospital birth preferable or necessary. When a woman says to me, “I really want a home birth but…” what she is usually communicating is that she has an active desire for home birth but does not know how to realize that desire, or has not explored it fully enough to feel confident in her decision about her birth place.

  As a home birth parent myself, and as someone who has been teaching childbirth classes and attending births for 16 years, it’s taken me a while to discern how to best respond to clients when they say this. Years ago, I would simply let it go. I’d be thinking to myself, “this person needs better information,” but because I didn’t want to be perceived as trying to sway anyone’s birth decisions, I’d respond by saying things like, “it sounds like you’ve thought about your choices and that the hospital is the right place for you.” What I now realize is that this expression can be an important invitation to us to share information and engage parents in a process of self-discovery to help them clarify their desires and options.

 It’s no wonder that many people don’t know how to pursue home birth. We live in the midst of a culture of birth fear, which spreads mostly misinformation and misrepresentations of birth, especially home birth. Depending on where you live, home birth midwives may not be able to practice legally, and may therefore be extremely hard to locate or financially inaccessible. Friends and family members may be skeptical or unsupportive, and your client might not know anyone who has had a home birth. Although many women feel intuitively drawn to home birth, it can be hard to imagine the practicalities of making such a countercultural decision.

 Helping a woman to conceive of ways to manifest her deepest wishes for birth is an important task - one that can inspire a lifetime of empowered decision-making. I encourage all doulas and childbirth educators to not shy away from these conversations, but to undertake them in a compassionate, thoughtful, and nonjudgmental way, without attachment to the ultimate decision. I believe strongly that each person has the right and the ability to decide what kind of birth is most appropriate for them, and that everyone deserves access to information with which to evaluate the choices available. In this spirit, I offer some strategies for sharing information and drawing out clarity with those considering home birth

  Address Common Concerns. First of all, it can be useful to explore the “but” in the statement “I would like to have a homebirth but...” Often, these “buts” are simply misapprehensions about home birth that come from either the imagination or the media. (For example, “I want to have a home birth but I don’t want to have to clean up all that mess.”) Here are some of the concerns I hear most often:

  Mess: Birth is actually not as messy as one might think, and midwives tend to have a very efficient system down for mess prevention and cleanup. Typically, when the midwives leave the home after the birth, it’s cleaner than before they got there.

  Cost: Depending on what state you’re in, and your midwife’s credentials, home birth midwives may be able to accept Medicaid and/or private insurance. If not, it never hurts to ask a midwife about payment plans, bartering, and sliding scales for students or those with low incomes. Often, the cost for a midwife’s services is less than or equivalent to insurance deductibles.

  Small space: Although different midwives have different preferences, I have attended many home births in small apartments; even in boarding rooms. Even in large homes, midwives often find themselves in close quarters when women decide to give birth in the corner of a bedroom, between the bed and the wall, for instance.

  Other children: Depending on the age(s) of the child(ren), and the mother’s preference, it may or may not be desirable for siblings to be present at a home birth. I recommend having someone who can be on call to take care of older siblings, either at home or away, depending on the preferences of all involved. I have never encountered a sibling who was voluntarily present at a home birth who felt traumatized by the experience. This can be an extraordinarily special way for children to bond with the new baby.

  Switching care providers: If your client has an established relationship with a care provider in a hospital-based practice, it can seem difficult to end that relationship. However, this is usually a very straightforward process. There’s no point at which someone is obligated to stay with a care provider they don’t like, or who doesn’t suit their birth plans. Sometimes, people choose to continue concurrent care with the original provider after making plans to switch to a home birth midwife.

  Encourage parents-to-be to interview a midwife -- or several. Know your local midwives, and if an expectant parent is considering home birth, encourage her to contact a midwife for a consultation. This is the number one most important resource you can offer. Most people considering home birth have a long list of questions that only a prospective midwife can answer. Usually people want to know what happens in case of complications, and what reasons a hospital transport would be necessary. Rather than speculating on these answers, it’s much better to talk to a midwife about reasons and protocols for transport. (When I was pregnant, I asked my midwife about complications, to which she replied, “which complications are you most worried about?” I realized then that I didn’t really know – I was just duplicating the fears that others had voiced to me. My midwife empowered me with specific information, and I felt both comforted and capable of educating my concerned family and friends.)

 Your client has nothing to lose by interviewing a midwife; a consultation does not obligate her to enter into a midwife’s care. If she decides to pursue home birth, this will put her on her path. If not, she can rest easy knowing she has investigated every option available and made a truly informed decision.

  Share evidence-based information on home birth safety. In 2005, The British Medical Journal published the largest, most well-designed study to date of out-of-hospital birth in North America. The study found that planned home births attended by Certified Professional Midwives are just as safe for low-risk women and babies as hospital birth, with many significant benefits over hospital birth in terms of lower cesarean rates and lower rates of common interventions, such as induction of labor. This study is just one in a large body of literature documenting the excellent outcomes associated with midwife-attended home births. The World Health Organization, the American Public Health Association, and the American College of Nurse Midwives all support increased access to home birth as a safe, responsible choice. A link to this study, as well as plenty of other good information, is available here: www.mothersnaturally.com

  Be clear about legal status in your state. Some people erroneously believe that home birth is illegal. This is not the case – a parent may choose to give birth wherever she wishes. There are no laws against having a home birth. Laws pertaining to home birth apply to birth attendants. In 27 states, direct-entry midwives (non-nurse midwives trained specifically in home birth, and credentialed as CPMs, or Certified Professional Midwives) are licensed, easily accessible, and accepted as part of the health care system. In the remainder of US states, licensure is not available for direct-entry midwives, and in several of these states, practicing as a midwife is illegal. This does not, however, mean that there are no midwives in states without licensure – it just means finding one to work with will be more difficult. Educate yourself and your clients about the legal status of midwifery in your state. You can find a state-by-state chart of midwifery laws here: http://mana.org/statechart.html and find a link to your state friends of midwives organization here: www.thebigpushformidwives.org

  Encourage honesty and harmony with spouses/significant others. It’s common for a pregnant woman’s partner to feel protective, and sometimes this manifests in disagreements about birthplace. Help pregnant women to remember that they have the same ultimate desire as their partners: a healthy birth with a healthy mom and baby. I always encourage expectant couples to go together to a consultation with a midwife, so they both get a chance to voice their concerns and ask questions. This provides a good foundation for further discussion.

  Encourage autonomy in relationships with parents and siblings. Many people express extreme apprehension about a lack of support from family members. There are several potential ways of dealing with this. Protecting one’s inner peace about the choice to birth at home may mean not sharing this information with family until after the birth. For some, on the other hand, it can be very empowering to discuss their decision and share information with family members. Sometimes, inviting a family member to be present at a home birth can be an effective and mutually satisfying way of garnering support. In any case, and regardless of birthplace, becoming a parent ushers in a growth transition in which new parents differentiate from their own parents, and it can be helpful to put this in perspective.

  Encourage positive community. If a woman or couple has never met other home birth parents, it can be very isolating to choose home birth. Share information about birth circle groups, La Leche League or other breastfeeding support groups, home birth meetups, Holistic Moms Networks, childbirth classes, Babywearing groups, or other potential resources for positive community building.

  First births are important. It’s not uncommon to hear someone say, “Maybe I’ll plan a home birth next time.” This is a good opportunity to ask questions like, “How is it that you envision a future pregnancy and birth as being different from this one?” Many people have the idea that they will “know better what they’re doing” and be more self-possessed with second or subsequent births. This might a good moment to remind your client that her body already knows what to do, and that the capacity to give birth already exists within her. You may also want to help her keep the importance of the first birth in perspective: avoiding a primary cesarean has been identified as a key factor in avoiding maternal and infant morbidity associated with repeat cesareans and birth complications resulting from previous surgery. The cesarean rate for planned home births in the U.S. is roughly 4%, which stands in sharp contrast to the national cesarean rate of 32%.

  Pay attention. Sometimes, a woman will say “I really want a home birth but…” and may not actually feel at all comfortable with home birth. Instead, saying this may be a way for her to communicate her orientation toward a more holistic mindset in general. If this is the case, she will likely not engage actively with attempts to open up an in-depth discussion of home birth. Listen attentively, follow her lead, and remember, it’s up to that mother-to-be to know what’s right for her birth.

  Home birth may not be the right choice. There are several reasons that home birth may not be the right choice for your client. One woman’s perceived barrier may be a very real barrier to another woman. If home birth is ruled out for any reason, you can still provide, or refer her to, doula services to help her maintain continuity of care and preserve other birth preferences. If you don’t have access to home birth midwives in your area, as is unfortunately the case in some parts of the country, further options to explore include traveling to give birth, unassisted birth, birth centers, or hospital birth.

 By sharing this information and giving our clients the opportunity to explore their thoughts, desires, hopes, and fears, we fill an important role: that of taking women’s desires for birth seriously. This is an invaluable service, regardless of the decisions our clients ultimately make about where to give birth.

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 Monica Basile is a BirthWorks Certified Childbirth Educator, DONA Certified Doula, and Certified Professional Midwife. She is the mother of a 15-year-old son born at home, and is a co-founder and member of Friends of Iowa Midwives. She holds a PhD in Gender, Women’s, and Sexuality Studies from the University of Iowa.

Fear In Birth

Fear in Birth by Katie Immel

 “You gain strength, courage and confidence by every experience in which you really stop to look fear in the face.” –Eleanor Roosevelt
The light switch for our main bathroom is housed outside the door. This bathroom has no window. Clearly, this setup was designed by an evil prankster (or maybe just someone without kids). The children of the house have, on numerous occasions, found sheer joy in flipping the switch when someone is in the shower behind the closed door, leaving the poor shower dweller in utter blackness. If the shower dweller is under the age of 14, this event is often accompanied by shrieks of indignation from within the bathroom confines, and angry demands to turn the light back on RIGHT NOW. After a few good giggles, the culprit usually turns the light back on, knowing that it won’t take long for a parent or the victim sibling to inflict some undesirable consequences.

 Children are afraid of the dark, and a lot of adults aren’t terribly fond of it either. When I asked my 6-year-old about this curious fact recently, her only comment was “it’s creepy.”

 But when you really think about it, there is nothing about the dark that can hurt you. If we really analyze it, it seems to me that it’s not so much the darkness itself that is frightening, but rather the way that it hides potential danger that can harm us. In darkness, I have no idea what to expect. I don’t know how to find my way. I don’t know how far in front of me the wall is, or what else is in my path that I might crash into. I don’t know whether I’m going to accidentally step on the cat, or reach out and grab ahold of the cactus, or step on a Lego helicopter. In darkness, I am paralyzed, because any move that I make holds the potential for harm to me or someone else.

 We are not afraid of the dark. What we really fear is the unknown.

I don’t know that this philosophical analysis of her actual fear versus her perceived or described fear would mean anything to my daughter. I don’t know that she would even care. All she knows is that when it’s dark, it feels creepy. And she is afraid.

 Many childbearing mothers find themselves in this same situation. In the same way that darkness stops us in our tracks because of the unknown, mothers fear the unknowns in childbirth.

 Unfortunately, we live in a culture that consistently surrounds childbirth with fear. As a result, when a newly expecting mother begins to search for information, she may run into “horror” stories of their own births from well-intentioned friends or family and Hollywood and media portrayals such as One Born Every Minute (link to http://www.mylifetime.com/shows/one-born-every-minute), which portray “normal” birth as a bed-ridden, dangerous medical event in which mothers have very little input on what happens. Add to this a care provider who does not trust birth, is terrified of a lawsuit, focuses on pathology rather than physiology, and provides her with every potential harmful outcome, and the level of fear skyrockets. If nothing changes, when labor arrives, along with it arrives an environment with unfamiliar sounds and people, bright lights, stimulation, questions, needles and monitors, and the result is a mother completely paralyzed by fear. The sum total of all these influences is a big, ugly mess.

 So what can we do about this? How can we empower mothers, help them conquer their fear and restore joy in the journey of bringing new life into the world? It is not an easy task; you may feel like a lone voice in the wilderness, calling mothers to trust their bodies, believe in their inner strength and in the process of birth in the midst of a chorus crying danger and fear. But the first step is simple: turn on the light! Help her break out of the unknown into a place of knowledge by providing solid information on all the things she needs to know: ways to care for her body and nourish her growing baby, the processes the body takes as it prepares for and begins labor, the process of labor, both physical and emotional, what she may need and expect from those surrounding her during her labor, what to expect right at birth and after, and resources for the journey. In addition to this critical information, parents also need tools to help them set healthy boundaries, ask thoughtful questions and take responsibility for the choices that are made, engage in respectful dialog and evaluate whether a complication warrants extra outside measures. With the right information and tools at her disposal, the darkness will begin to dissipate and that paralyzing fear of the unknown will begin to subside. Then, it becomes possible for her to face labor and birth with confidence and joy, trusting herself, her body and those around her. What a wonderful way to begin motherhood! The mother who labors in an environment of confidence, safety and security, who is surrounded by people attentive to her needs, who trusts herself, her baby and the process of birth, who is consistently given respect, encouragement, information and choices, will emerge from her child’s birth transformed, regardless of anything that may happen outside of her control. This is the kind of birth I dream about for every mother, the kind that I define as a success – one in which the veil of fear has been pulled back and the truth of its joy revealed – a birth that she has owned, in which she is left feeling empowered, joyous and loved. For as long as I am able, I will continue to do my part in making this kind of birth a reality for every mother that I can reach.

The EPI-NO Childbirth and Pelvic Floor Trainer

Written By: Cathy Daub, PT (BWI President)


 When I first read about one of the latest new innovations in technology called the EPI-NO, my thought was, “What will they think of next?” This is a device whose purpose is to increase pelvic floor musculature during pregnancy, and after 36 weeks to stretch out the perineum so that at the time of birth, it will help to prevent the need for episiotomy, reduce the risk of perineal tears, incontinence, and improve overall sexual health. Says Dr. Wilhelm Horkel, the Inventor of EPI-NO, "The human body performs more efficiently in any physical activity when the body has trained and prepared for it. Childbirth is no Exception"

 Advocates of EPI-NO say it is clinically proven to significantly increase the chances of an intact perineum, increase control during delivery, that it is more effective than perineal massage and that it offers women considering having a cesarean another option. A German Study indicated a shorter 2nd Stage of Labor and better APGAR Scores for EPI-NO babies.

 I don’t know about you, but personally, I wouldn’t want my perineum stretched out before labor. Tissues of the body need to maintain their flexibility. They do this by contracting and relaxing as in muscles including the uterus, or by opening and closing, as in sphincters. I don’t believe that it is healthy for such tissues to maintain a lengthened relaxed or opened state for longer periods of time as that can affect their flexibility.

 I believe that at the time of birth, if women are in anatomically advantageous positions for birth (not lying on their backs), and if they breathe their babies out, avoiding forceful pushing, their perineums know how to open just fine to give birth. At the moment of birth, hormones are being secreted to assist the process of birth as they have for women around the world for thousands of years. The EPI-NO sends a negative message to women that their perineums need help to stretch out! Women need to have trust and faith in their bodies’ ability to give birth. I also don’t like the idea of inserting foreign objects into my vagina. And how about the kegel exercises? They work just fine in strengthening the pelvic floor musculature.

 The following is a more detailed description of the device. I’d like to know what you think!

 Description: Prepare your perineum before birth after 36 weeks of gestation by simply inserting a balloon two-thirds of the way into your vagina and then inflating it with a pump to your level of personal comfort. Increase the size of the balloon daily from one session to the next, each lasting about 20 minutes. You have achieved optimal training when the balloon has reached a diameter of 8.5-10cm (3-4 inches), and you can push it out while it is still inflated. The EPI-NO balloon is soft, easily inserted, and naturally shaped so that it fits the vagina perfectly. EPI-NO must be used only with a water based lubricant.

Buy your kit now. It includes a narrow contoured silicone balloon, a hand pump, a pressure display, an air release valve, and connection by a flexible plastic tube. It is recommended that women consult a health professional before using EPI-NO.

 1. EPI-NO Pelvic Floor Muscle Exercises can commence early in pregnancy. A strong pelvic floor supports the weight of childbearing, and is more resilient in it's recovery after the birth. A strong pelvic floor provides more control during delivery. In these exercises the balloon acts as a sensor and is only minimally inflated. Following the birth Pelvic Floor Muscle Exercises recommence after 4-6 weeks and can continue indefinitely. EPI-NO provides bio-feedback on Pelvic Floor strength.

 2. EPI-NO Stretching Exercises commence after Week 36 and continue until the end of the pregnancy term. These exercises gradually stretch the perineum in daily sessions of 20 minutes each, comprising several cycles of 5 minutes duration. In these exercises the balloon is inserted and inflated at the perineum. Women training with EPI-NO will normally achieve a dilation of between 8.5cm and 10cm over 3-4 weeks. Women achieving 8.5cm will achieve the extra 1.5cm when the head is crowning. Following the stretching exercises the balloon can be glided out, simulating the experience of control during delivery.

Feel free to leave your thoughts in the comments section below!