$20 in advance/ $30 at the door/$15 for 3-day workshop participants/$10 for students with valid ID PREGNANT MOTHERS FREE!

Location: Ridgedale Public Library , 12601 Ridgedale Drive, Minnetonka, MN

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Ticket proceeds for the public lecture are being generously donated to Ten Moons Rising & APPPAH (Association for Prenatal & Perinatal Psychology & Health)

Healing Childbirth for Mothers & Children: The Invisible Crisis
by William Emerson, Ph.D.  (SCROLL DOWN FOR BOOK EXCERPT)

Mother's Day has barely passed with nary a mention that millions of mothers suffer daily, mostly in silence, as a result of their experiences during childbirth.  Maternity care systems are routinely evaluated and compared worldwide by their rates of infant and maternal mortality, and the world watches, listens, and learns. 

The US is doing poorly, in spite of providing consumers with one of the highest per capita expenditures in the world. The U.S. has a higher maternal mortality rate than twenty-eight other countries, and the rate has been increasing for more than twenty-five years. The likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany and three times greater than in Spain.  In addition, 1.7 million women suffer complications each year that have adverse effects on their health. As disturbing as these statistics are, there are no federal requirements to report maternal deaths, and US authorities estimate that maternal deaths could be twice as high (Berg, 2001).

The infant mortality rate is no better.  The U.S. rate is worse than forty-one other countries, and twenty-two of these are industrialized nations with excellent birth technology, including Hong Kong, Canada, France, Australia, Singapore, and England.

In addition, there are more than 25,000 stillbirths every year, half with no known causes, and more than 4,600 sudden unexpected infant deaths each year of unknown causes.  It is a real risk giving birth in this country, a land that prides itself on state-of-the-art medical care, and spends more on maternal health care than any other country in the world.   

Most medical experts agree that preterm births are a factor, but if so, what causes preterm births?  Other than medical reasons, a likely cause is social and psychological factors. Dr. Rupert Linder, a practicing German gynecologist, obstetrician, medical psychotherapist and researcher, did extensive research on the causes of preterm birth and prevention methods.  A key feature of his approach is not to attempt to get rid of pre-term symptoms, but to understand their meaning.  (SEE BOOK EXCERPT BELOW.) 

Birth experts also think that rising cesarean rates are a key factor, and research backs this up. USA Today (2008) reported that pregnancy-related deaths in 2003-2004 were associated with increases in the cesarean rates, saying, "As the [c-section] rate has risen, so has the rate of pregnancy-associated deaths. Childbirth Connection (2010), in an article entitled "Relentless Rise in Cesarean Section Rates," disclosed that c-sections cause serious degrees of morbidity in mothers and babies, involving considerable expense for private payers, employers, Medicaid, and taxpayers.

Three decades of research in the field of Birth Psychology has unturned other fascinating findings that provide solutions to the mortality and morbidity crisis.  Clues can be found by asking questions:

• Why do some mothers experience birth as a transformational life experience, and others experience it as a life draining and life inhibiting process?
  
• Why is it that some mothers thrive when provided with cesarean surgery, and others suffer.
• Why do some mothers appreciate and benefit from multiple interventions, while others are despairing and distraught?
• Why is it vital that some women give birth out-of-hospital, and others not.
• What is the single most important thing that women must overcome before they give birth?
• What causes the high maternal and infant mortality and morbidity (injury, disability, etc.) rates?

In his upcoming lecture and workshop, Dr. Emerson shares the answers to these questions and sheds light on how we can turn the tide on these disturbing trends.

Dr. Emerson will field questions of personal interest in an ample Q&A segment.

Join us for a thought-provoking and insightful evening!

BOOK EXCERPT

The Causes of Infant Mortality: The Silent Crisis
by William R. Emerson, Ph.D.
Excerpted from his upcoming book Childbirth: Exploring Realms of Darkness and Light.
Stonebrook Publishing House, 2011. 

1. Prematurity

As indicated above, the number of American babies that die each year is staggering.  Why is this? Blue (2009) reported that infant deaths are most prominent in preterm babies, and that the US preterm birth rate moved from 9.4% in 1981 to 12.7% in 2007, meaning that about 30,000 American babies die each year before their first birthday.  This is tantamount to filling an entire small-sized American city with the coffins of babies who die at birth or within their first year. Blue notes that more infants die in America than in almost every other industrialized country in the world. Many of these babies are born premature, the single biggest risk factor for infant death. Boasting one of the top technological systems in the world, Blue contends that the US prematurity rate should be decreasing rather than increasing because babies are housed in specialized intensive care units and cared for by world -class experts.  This care cost the US some $26 billion in 2005, a substantial insult to our national debt, and has been seemingly ineffective in preventing deaths.

Blue notes that US infants die at a rate three times as high as in Singapore, which has the world's best infant survival. Japan, France, and Germany are included in the top 14, and should be studied to find out how they are preventing preterm birth and infant death. In 2005, the last statistics garnered, Blue reported that the US ranked No 30 in infant deaths, lagging behind almost every other industrialized nation including Cuba, Hungary, and Poland.  Babies born preterm, before 37 weeks, account for two-thirds of all infant deaths, and the number of preemies in the US is growing.  Today, 1 in 8 American births are preterm, a nearly 20% rise since 1990.  The babies at highest risk are those born before 32 weeks of gestation, who account for just 2% of all births but more than half of all infant deaths. Clearly, the US has a long ways to go.

If preterm birth is the "cause" of infant mortality, what then is the cause for prematurity?  Other than medical reasons, a likely cause is social and psychological factors. Dr. Rupert Linder, a practicing German gynecologist, obstetrician, medical psychotherapist, and researcher, did extensive researach on the causes of preterm birth, and prevention methods.  His research was published in the 2006 issue of JOPPPAH, The Journal of Prenatal and Perinatal Psychology and Health.

His research was done on babies at risk for preterm birth, one of the most difficult, persistent, rising, and costly complications.  He found that by doing relatively straightforward  interventions during pregnancy, ones that most mental health practitioners could manage, that pre-term birth was significantly reduced or eliminated. National preterm births averaged seven percent over fifteen years, while in the same fifteen year period, 80 women received psychosomatic prenatal counseling from Linder, and only one percent had a preterm birth, while only five were hospitalized, an astounding difference. 

A key feature of his approach is to not try and get rid of pre-term symptoms, but to understand their meaning. Symptoms are seen as signs and signals that point toward more appropriate and pregnancy-friendly and health-friendly modes of behavior.  In other words, maladaptive physical symptoms, emotions, and behaviors have a lot to do with pre-term birth, and need to be dealt with. A primary suggestion given to all mothers was to get in touch with their emotional and physical states, and to make contact with their unborn babies. 

Sometimes this resulted in more emotional unrest and disturbance for a while, but was seen as a necessary step to resolve physical and emotional symptoms and make needed lifestyle changes. Rest and relaxation were often prescribed. Presumably, similar psychosomatic interventions can and will be used with women and babies who are at high risk for postpartum clinical depression, birth trauma, injury, or mortality. Linder's paper described four case studies, to provide for a deeper understanding of the process.

2. Inequality of Care          

Amnesty International (2010) published a book entitled "Deadly Delivery: The Maternal Health Care Crisis in the USA, with research data and full citations.  The book cover features Tatia Oden French and her baby daughter Zorah, who both died in 2001 after an induced labor. 

It documents relatively unknown facts: that maternal mortality rates increased from 6.6 deaths per 100,000 live births in 1987 to 13.3 deaths per 100,000 live births in 2006; that two to three women die from pregnancy-related complications every day; that 34,000 women per year come close to dying for the same reason; that the USA spends more than any other country on health care, and more on maternal health than any other type of hospital care; and regardless of the spending, women in the USA have a higher risk of dying of pregnancy-related complications than women in 40 other countries.

For example, the likelihood of a woman dying in childbirth in the USA is five times greater than in Greece, four times greater than in Germany, and three times greater than in Spain. In addition,  1.7 million women suffer complications that have adverse effects on their health. As disturbing as these statistics are, there are no federal requirements to report maternal deaths, and US authorities estimate that maternal deaths could be twice as high (Berg, 2001).                            

According to Amnesty International research, the five main medical causes of maternal mortality are embolisms (20%), hemorrhaging (17%), pre-clampsia and eclampsia (16%), infection (13%), and cardiomyopathy (8%).  Amnesty International claims that over a half of maternal and infants deaths can be prevented by quality prenatal, natal, and postnatal care, but these are not readily available to many minorities and socioeconomic groups.  Thus, more minority and low socioeconomic group members die. 

Black women are nearly four times more likely to die from pregnancy causes than white women.  For high risk black and white women, the disparities are even greater:  5.6 times as many high risk black vs. white women are likely to die.  When hypertension is involved, Afro women are 9.9 times, and Latinos 7.9 times more likely to die than white women. (All statistics are on page 19.) 

In concluding their documentation,  Amnesty International outlined some of the reasons for the high mortality rates, "This is not just a public health emergency - it is a human rights crisis. Women in the USA face a range of obstacles in obtaining the services they need. The health care system suffers from multiple failures: discrimination; financial, bureaucratic and language barriers to care; lack of information about maternal care and family planning options; lack of active participation in care decisions; inadequate staffing and quality protocols; and a lack of accountability and oversight" (Amnesty International, 2010).

3. Physical Risks and Impacts of Cesareans and Obesity  

On a physical level, cesarean sections are not as benign as portrayed. Multiple studies describe the physical and psychological trauma mothers and babies endure when they undergo cesarean surgery. Many medical experts view the rising rates of maternal and infant mortality as sequelae of the rising cesarean rate. 

Goer (1995) calculated that 125 women die needlessly each year because of cesarean surgery, and commented that thousands more mothers and babies suffer from cesarean-related morbidity (injuries, malformations, etc.). Obstetrician Joel Evans, speaking at the Nelson (Canada) APPPAH Regional in 2008, reported that deaths are 3.25 times more likely in cesarean versus vaginal births (.13 maternal deaths per 1000 births). In 2009, Wagner re-assessed maternal mortality and found  that 240 women die needlessly each year because of cesarean surgery, and almost half (46%) of mothers who die around childbirth,  do so because of cesarean surgery.

USA Today (2008) reported that pregnancy-related deaths in 2003-2004 were associated with increases in the cesarean rates, saying, "As the [c-section] rate has risen, so has the rate of pregnancy-associated deaths (USA Today, 2008, para. 7). In a recent article entitled "Relentless Rise in Cesarean Section Rates (DeClercq et al., 2008))," research discloses that, "...c-sections cause serious degrees of morbidity in mothers and babies, involving considerable expense for private payers, employers, Medicaid, and taxpayers."

The California Maternal Quality Care Collaborative (CMQCC) reported on recent data (CMQCC, 2010) showing that in the 1990s, California's mortality rates ranged from 5.6 to 10.7 deaths per 100,000 live births, which is consistent with the overall US rate, but beginning in 2000 the rate climbed to 10.9, then to 14.6 and recently to 16.9.   This increase nearly tripled the previous maternal mortaity rate, and sent researchers scurrying for answers.

The analysis of the California mortality data indicated that cesarean rates are implicated, "Analysis of maternal mortality data for the state of California, with 14% of the nation's births, strongly suggests that maternal mortaity is increasing in tandem with rising rtes of cesarean section and obesity." ( page 1)  An eleven-year study by Evard and Gold (1977) found that the rate of death from cesarean section was twenty-six times higher than the rate of death from vaginal delivery. Petitti et al., (1982) compared morality rates of cesarean and vaginal births.  They found that the risk of maternal death was two to four times greater for cesarean versus vaginal delivery.  Most medical experts believe that the increased mortality rates are associated with increases in cesarean surgery rates and use of pitocin for inductions and augmentations, resulting in failed labor. The latter studies were cited by Childbirth Connection's  recent info column: "Rising Maternal Mortality."          

Aside from maternal death, which is tragic, there are a hundred-fold other problems associated with cesarean surgery.  Obstetrician Joel Evans (2008) described some of them. In a keynote address to the APPPAH Regional Conference (2008), he documented that, "...infections occur in 2.5-85% of cases, hemorrhages increase with numbers, thromboembolisms occur 4 to 7 times more frequently, and hysterectomies are 13 times more likely.

In addition, all women having cesareans require narcotics versus 11 percent of those birthing vaginally, and narcotics are known to negatively impact bonding and attachment, breastfeeding, and possibly postpartum mood, where depression is more likely. Cesarean moms are twice as likely to have breastfeeding difficulties, and about a third report emotional or physical handicaps in caring for their newborns."  They are less likely to breastfeed, and many believe this is because of the pain and discomfort mothers are in following major abdominal surgery.  In addition, cesarean moms are more likely to suffer long-term from complications due to surgical wounds, bowel obstruction, chronic pelvic pain, infertility, or subfertility.           

Babies are impacted too.  Cesarean babies are 3 times more likely to have breathing problems, 30% more likely to be admitted to the hospital for asthma during childhood, and somewhat more inclined to bacterial infection and depressed immune functioning. The March of Dimes published the growing opinion that C-sections may contribute to the growing number of babies who are born "late preterm,", between 34 and 36 weeks gestation.  They conclude, "While babies born at this time are usually considered healthy, they are more likely to have medical problems than babies born a few weeks later at full term" (2010, page 3). Dr. Catherine Spong at the Eunice Kennedy Shriver National Institute of Child Health and Human Development, warns that cesarean-sections have many risks and that vaginal births are by far the safest.  She says, "Unequivocally, I can state that the safest method is an uncomplicated vaginal delivery.   (Health.com, page 3)

4. Inductions and Maternal Trauma

As far back as the early twentieth century, world-renowned psychoanalysts Freud and Rank described the trauma of birth and it symptoms and treatments.  Almost seventy years later, Sheila Kitzinger (1990) completed her decades-long observations of pregnant women. She found that 64 percent were induced or augmented with oxytocin, and afterward, 58 percent described themselves as depressed. 

A significant proportion of women are traumatized by childbirth, at the severest level.  In 2000, Czarnocka and Slade interviewed and diagnosed postpartum mothers and documented that 3% of the mothers were very upset about their childbirth experience and tested positive for all dimensions of PTSD, the most severe level of trauma, while 24 percent tested positive for at least one dimension of PTSD, leading to the obvious conclusion that between 3 and 24 percent were severely traumatized.

Creevy, Schochet, and Horsfall (2000) used interviews and the PTSD scale to assess trauma in 499 women 4 to 6 weeks after birth, and discovered that 33 percent of mothers identified a traumatic birthing event,  and exhibited at least 3 trauma symptoms. In addition, 5.6 percent of the mothers met the full criteria for PTSD.  More recently, the 2008 Childbirth Connection Report on 1,573 postpartum mothers, authenticated that 18% of mothers experienced some but not all PTSD symptoms after childbirth, while 9% met all the criteria for PTSD (Declercq, Sakala, Corry, & Applebaum, 2008).

Other studies show that ten percent of women are clinically depressed after childbirth, a level of depression that requires psychotherapeutic or medical treatment to recover from.  These are profoundly indicting statistics, and in most other professions, would incite deep self exploration and collective action toward further research and radical change. PTSD is the most severe level of psychological wounding, the kind that men come back with from the battlefield.  It is extremely debilitating and depressing, and a risk to the very lives of mothers and their babies.  In my clinical experience with women, extensive grief reactions after birth transfer to their newborns, who are very sensitive and who bond with the psychological state of their mothers.  A new mom who has no will to live generates the same in her baby, a process called psychological permeation, described in chapter 7 of Childbirth: Exploring Realms of Darkness and Light.

References

Amnesty International. (2010). Deadly delivery: The maternal health care crisis in the U.S.A. Retrieved from Amnesty International website:  HYPERLINK "http://www.amnestyusa.org" http://www.amnestyusa.org /dignity/pdf/DeadlyDelivery.pdf

Berg, C. et al., (2001). Strategies to reduce pregnancy-related deaths: From identification and review to action. Centers for Disease Control and Prevention.

Blue, Laura. (2009). "Preventing Premies." Time Magazine, Vol. 174, No. 4,  pp. 36-40.

Creevy, D., Shochet, I., Horsfall, J. (2000). Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors. Birth, 27(2), 104-111.

Czarnocka, J. & Slade, P. (2000). Prevalence and Predictors of Post Traumatic Stress Symptoms Following Childbirth. British Journal of Clinical Psychology, 39 (1), 35-51.

Declercq, E.R., Sakala, C., Corry, M.P., and Applebaum, S. New Mothers speak Out.: National Survey Results Highlight Women's Postpartum Experiences.  New York: Childbirth Connection, 2008

Evans, Joel. (2008). "A Holistic Approach to Pregnancy.    Paper presented at the Nelson (Canada) APPPAH Regional Conference.  Available from The Center for Women's Health, Stamford, CT.

Goer, H. (1995). Obstetric Myths Versus Research Realities: A Guide To The Medical
Literature. Westport, CT: Bergin & Garvey.

Kitzinger, S. (1990). The Crying Baby. New York, NY: Penguin Books.
Linder, Rupert. (2006). How women can carry their babies to term. The prevention of premature birth through psychosomatic methods. Vol.20 ~ Iss.4  Pages: 293 - 305