Among the 26,692 children studied who were conceived by IVF between 1982 and 2005, after adjusting for year of birth, the estimated odds ratio for cancer risk was 1.42 (95% CI 1.09 to 1.87, P=0.01) compared with children who were not conceived via IVF …

… however, IVF itself may not be responsible …

The reason for the increased risk could be a higher rate of preterm birth and neonatal asphyxia among these children or because of unidentified characteristics of the women who undergo the procedure …

… While mothers who used IVF to conceive had a variety of characteristics that differed from other women, including older age and increased rates of multiple pregnancies, none of these were significantly linked with the elevated cancer risk seen in their children.

… several characteristics of the children did appear to play a role.

After adjustment for year of birth, significantly increased risk for cancer in the entire population was associated with preterm birth before week 37 (odds ratio 1.16), for birth weight of 4,500 g (9.9 lbs) or more (OR 1.21), for large-for-gestational-age birth (OR 1.34), and for low Apgar score (OR 1.33).

The deaths of three newborn babies is believed to be behind the closure — but yesterday about 300 women took to the street to protest against it.

Their action triggered crisis talks and last night Queensland Health backflipped, announcing the centre would re-open for the weekend and discussions on its future would resume on Monday.

The two natural birthing suites in the centre, which is separate to the hospital’s labour ward, were closed without notice at 5pm on Thursday.

Griffith University’s Bachelor of Midwifery convenor Dr Kerry Peart said one woman was in labour when an obstetrician came in and said the suite was closed and the woman and her midwife had to move.

… some specialist obstetricians had raised concerns about the safety of the birth centre …

“The birth centre is not closing and we are committed to the birth centre model … we made a decision based on clinical safety to modify that model of care while we made absolutely certain that women and babies of the Gold Coast were safe,” he said.

… following meetings with clinicians, midwives and mothers-to-be yesterday the centre would continue to operate under the agreed model of care until at least Monday evening.

Australian College of Midwives president Jenny Gamble … said there had been three birth centre-related cases in recent months when babies had died … outside the centre and while under further medical care.

A midwife at the hospital … said none of the midwives’ practices had been reviewed or investigated and they wanted an explanation as to what the safety concerns were.

What happened is this: In my 39th week, I am induced because of high blood pressure. At the hospital, I am given Pitocin, a synthetic form of the labor-inducing hormone oxytocin, and Cervidil, a vaginal insert used to dilate the cervix. Within two hours, my contractions are one minute apart. I had lasted as long as I could without an epidural because I had read that they sometimes slow dilation. That’s the last thing I need: I’m at a pathetic 2 centimeters. My doctor comes up with a solution for the pain: a syringe full of a narcotic called Stadol.

“I have a history of anxiety,” I tell the nurse who has brought in the syringe, as I always warn any medical professional who wants to give me drugs. “Is this drug OK for me?” “It sure is,” she says.

It is not. Within 10 seconds, I begin hallucinating. For five hours, I hallucinate that I’m on a swing that’s soaring too high, that houses are flying at my face. My husband has fallen asleep on the cot next to me, and I’m convinced that if awakened, he will turn into a monster — literally. I’m aware this notion is irrational, that these images are hallucinations. But they are terrifying. I buzz the nurse. “Sometimes that happens,” she says …

By noon the next day, 24 hours after I had arrived, I am only 3 centimeters dilated. The new nurse, a nice lady, tells me the induction isn’t working. “Your blood pressure isn’t even high anymore,” she says. “Tell the doctor you want to go home.”

When my OB comes in, I say, “I’d like to stop this induction, if that’s possible. I’m worn out. I hallucinated all night … I just don’t think this is working out.”

“OK,” he says. “Let me examine you. If you’re still not dilating, we’ll talk about going home.”

My previous dilation exams had been quick and painless, if not entirely pleasant. This one takes a long time. Suddenly, it hurts. “What are you doing?” I scream. “Why does it hurt?”

No answer.

“He’s not examining me,” I scream at my husband. “He’s doing something!” My husband grips my hand, frozen, unsure.

I scream to the nurse, the nice one who had suggested I go home. “What is he doing?” She doesn’t answer me, either. I writhe under the doctor’s grasp. The pain is excruciating.

The first sound I hear is the doctor’s directive to the nurse, in a low voice: “Get me the hook.”

I know the hook is for breaking my water, to speed my delivery by force. I scream, “Get off of me!” He looks up at me, as if annoyed that the specimen is talking. I imagine him thinking of the cadavers he worked on in medical school, how they didn’t scream, how they let him do whatever he wanted.

“You’re not going anywhere,” he says. He breaks my water and leaves. The nurse never looks me in the eye again.

Eleven more futile hours of labor later, I am exhausted and terrified when the doctor comes in and claps his hands together. “Time for a C-section,” he says. I consider not signing the consent form, ripping off these tubes and monitors, and running. But the epidural I’d finally gotten won’t allow me to stand up.

It’s nearly midnight when I hear a cry. My first emotion is surprise; I had almost forgotten I was there to have a baby.

I was desperate to find someone who could tell me what had happened to me was normal. To say, “You hallucinated? Oh, me, too.” Or “My doctor broke my water when I wasn’t looking. Isn’t that the worst?” Nothing …

Now, I’d never loved my doctor … I’d found him patronizing — “Normal!” he’d shout at me, when I asked a question — I thought his assuredness might be a good antidote to my anxiousness. It seemed to work, until it didn’t.

… I also didn’t have a birth plan … Sure, I had a plan for the birth: Have a baby using whatever breathing method I’d learned in the hospital’s birth-preparedness class, maybe get an epidural. But I didn’t have the piece of paper that so many of my friends have brought to the hospital with them … in my opinion, the very act of creating such a contract was to ignore what labor is: something unpredictable that you are in no way qualified to dictate.

… people who hear my story ask … Did I consider a home birth? A midwife instead of an obstetrician? … The answer is no. I am not holistically minded. My philosophy was simple: Everyone I know has been born. It can’t be that complicated.

The women who ask me about my preparations for my first son’s birth — who imply with these questions that I could have prevented what happened to me if I’d been more diligent — are part of an informal movement of women who are trying to “take back” their birth — take it back from the hospital, the insurers and anyone else who thinks he can call the shots.

But hospitals aren’t so interested in giving women back their birth … stipulations dealing with labor and delivery (“I want only one medical professional in the room at a time”) garner barely a glance. University OB/GYN in Provo, Utah, even has a sign that reads, “…we will not participate in: a ‘Birth Contract’, a Doulah [sic] Assisted, or a Bradley Method delivery. For those patients who are interested in such methods, please notify the nurse so we may arrange transfer of your care.”

… This question of whether I could have prevented my trauma has lingered in my mind since that day; now that I am pregnant again, it has become deafening. I have a chance to do it all over. Would I benefit from thinking more holistically? Should I bother taking back my birth?

During my pregnancies, friends gave me two books; their spines are still barely cracked. The first is called “Ina May’s Guide to Childbirth.” … The other book is “Your Best Birth” by Ricki Lake and Abby Epstein; it’s an offshoot of their 2008 documentary, “The Business of Being Born.” Their urgent message is that women who want to deliver vaginally can do so if no one intervenes. Instead, doctors and hospitals are doing all they can to “help” the laboring woman along … and failing. Inductions like mine, epidurals given early in labor, continuous fetal-heart monitoring — all of them have been associated with a higher risk for cesarean section. The result is an epidemic — 32 percent of U.S. births were C-sections at last count, the highest rate in our history. Individual surgeries may be medically necessary, but as a matter of public health, the best outcomes for mothers and babies come with a rate of no more than 15 percent, according to the World Health Organization.

Sam … was five months pregnant when watching “The Business of Being Born” convinced her that hospitals could be dangerous and a home birth would be more meaningful. She and her husband found a midwife … and spent the rest of the pregnancy preparing.

After 24 hours of labor, Sam’s contractions were two or three minutes apart, yet when her midwife examined her, she was only 3 centimeters dilated. The midwife gently told her that she was nowhere close to delivering, despite her contractions, exhaustion and pain. Sam asked to be taken to the hospital.

The change of scenery did her good. “At that point, I had been in labor for 40 hours,” she says. “I entered the relaxed zone. The epidural took the edge off … It was a sacred space.”

After her son’s delivery, Sam passed out, having lost 50 percent of her blood volume in a postpartum hemorrhage. Needless to say, she was relieved that she was in a place where blood transfusions were readily available … she believes she will want midwife care at a hospital next time.

… Bialik’s first birth didn’t go the way she wanted. After three days of labor at home, she stalled at 9 centimeters, one short of the goal. Her midwife suggested they go to the hospital, where after a natural childbirth, Bialik’s son spent four days in the neonatal intensive-care unit. “My son was born with a low temperature and low blood sugar, which isn’t unusual in light of the fact that I had gestational diabetes,” she explains. “I understand doctors need to err on the side of caution, but there was nothing wrong with my child. All of our plans for bed sharing, nursing on demand, bathing him — gone.”

The experience was scarring. “I felt a sense of failure that I had to call my parents from the hospital,” Bialik continues. “Yes, I know vaginal birth in the hospital is the next best thing to a home birth.” …

I point out that natural childbirth in the hospital — her “failure” — was my best-case scenario. But I also understand when she says, “Everyone is allowed her own sense of loss.” She realized her vision when her second son was born at home.

The second time around
I don’t consider myself a candidate for a home birth. The risk of uterine rupture from an attempt at vaginal birth after cesarean (VBAC) makes it unthinkable … I’m also not really interested in a home birth … But I’m also not interested in another C-section …

So I’d like to attempt a VBAC, but I know that it doesn’t always succeed. I have a new doctor — the 10th I interviewed following my son’s birth — at a new hospital, and he has agreed to help me try. But my primary goal is more modest: not to be retraumatized. Even now, my heart pounds at the sight of hospital receiving blankets, the antiseptic smell of the maternity ward.

The common thread in Bialik’s and Sam’s stories that impressed me was how supported and safe they felt with their midwife …

In an e-mail Bialik sends after our meeting, she goes back to my idea that some women weren’t meant to have babies the holistic way. “There are those among us who believe that if the baby can’t survive a home labor, it is OK for it to pass peacefully,” she writes. “I do not subscribe to this, but I know that some feel that … if a baby cannot make it through birth, it is not favored evolutionarily.”

I think about my appendectomy, back in 2003. Had I not made it to the hospital in time, I would be dead. What would it be like to refuse medical intervention? I’d call my family, say my good-byes. “I’m sorry,” I’d say. “But I’m not evolutionarily favored. It’s time for me to go.”

This attitude, that everything was better back when there were no doctors, seems strange to me. C-sections, although certainly done too often, can save lives. Orthodox Jews still say the same prayer after childbirth that those who have been in near-death experiences say — and with good reason. A birth that leaves mother and child healthy may be commonplace, but it’s also a miracle every time.

As the weeks pass and my belly grows, I can’t stop thinking about Sam. Her pregnancy was a sacred time, and she had truly looked forward to labor. Is that what I should try for — a meaningful birth, as well as an untraumatic one? At what point had people like Sam and me learned to feel entitled to a meaningful birth?

“I think that birth should be a beautiful experience,” says obstetrician Kimberly D. Gregory, M.D. She’s the vice chair of women’s health care quality and performance improvement at Cedars-Sinai Medical Center in L.A. “It should be exactly the way you want it, and doctors should intervene only to preserve the health or life of you or your baby.”

Naturally, one would assume that Dr. Gregory advocates birth plans. When I ask her this, she laughs. “We always say, ‘If you show up with a birth plan, just get the C-section room ready,’” she says. “You get everything on that list that you don’t want. It’s like a self-fulfilling prophecy.” Dr. Gregory led an unpublished study that compared women who took traditional hospital birth classes with those who employed Bradley-like training and a birth plan. The birth-plan group trended toward a higher C-section rate and more interventions. “There’s a certain personality type that tends to be more anxious. Maybe the anxiety hormones themselves put them at risk,” Dr. Gregory theorizes. “It seems that being open and honest and choosing the right doctor is probably a better option than writing everything down. Walking in with this list appears to set up an antagonistic relationship.” …

… In the past three weeks, I’ve had the same dream. I’m in a field (I believe at Ina May Gaskin’s Farm), and women in braids are dancing around me as my baby is born, painlessly, joyously. As I reach down, I notice my C-section scar is gone.

I wake up upset. Am I truly under the impression, subconscious though it may be, that taking back this birth will undo the damage of the last one?

“I don’t understand this phrase ‘take back your birth,’” nurse-midwife Pam England, creator of “Birthing From Within,” … tells me. “Who took it? What would a woman tell herself it meant about her if she failed to meet the criteria she made up for ‘taking back’ her birth? I am concerned that this phrase, meant to generate action and a feeling of empowerment, may actually be generated by or feeding the victim part of her.”

England is right: Having a childbirth that I deem successful this time will not change what I haven’t overcome from the first. I try to find a way to make what my doctor and nurses did to me OK, but my mind rebels. I feel loss — no, theft — of an opportunity for me to have a baby the way so many other women do: a carefree pregnancy, a labor that could still go any way.

Maybe I’m not so different from the women I spoke with, after all. Bialik had a successful natural childbirth but felt like a failure because it was in the hospital. Women who had a C-section also used words like failure. Perhaps part of the problem is that our generation of women is so ambitious, so driven, that we don’t know how to do anything without quantifying it as a success or failure.

According to Dr. Gregory, women are now requesting a C-section for their first birth, even without indication. “A lot of people are uncomfortable with the unknown,” she says. Plenty of people are wary of C-sections by choice, from holistic moms to obstetricians. But isn’t this, too, taking back your birth? Refusing to be out of control seems to me the epitome of taking it back. You don’t have to have an unattended birth in the woods to be considered a real woman.

Deciding that you can’t control the uncontrollable — and committing to that decision when you are, in fact, out of control — is also taking back your birth. It’s what your grandmothers did. It’s what their grandmothers did.

With this, I realize that I have already taken back my birth, but not as part of any movement. I have stopped judging women who take extra precautions as defensive and started to understand that everyone has to find her way.

I don’t know how this story ends. I’m still not convinced my body was made to deliver vaginally. But here’s what I do know: I will insist on kindness. I will insist on care. And I hope I will be open to being treated kindly. It’s harder than it seems.

So when I recently learned that my wife is pregnant … I did not anticipate that accompanying her to obstetrical appointments would change my understanding of the doctor-patient relationship in a profound way.

The pregnancy has been healthy … We have been diligent–my wife faithfully takes her prenatal vitamins, exercises and watches what she eats, and we established a relationship with an excellent obstetrician right away to monitor the pregnancy.

However, due to the fact that my wife celebrated her 35th birthday last week … we were encouraged by our well-meaning obstetrician to see a perinatologist as well.

Perinatologists are also known as maternal-fetal medicine specialists, and are sometimes more aptly referred to as “high-risk obstetricians.”

These specialists care for pregnant patients with complicated pregnancies–gestational diabetes, unborn children with congenital defects, and other chronic health problems that women may have prior to pregnancy or may develop during pregnancy.

“But wait ” I can hear the average reader’s double-take: I thought your wife and the pregnancy were healthy? Why see a high-risk doctor? It turns out that it’s all about how to evaluate risk.

FEAR FACTOR
The American College of Obstetrics and Gynecology has long held the position that once a woman passes the magical age of 35, she should be considered of “advanced maternal age” …

Most of this arbitrary distinction comes from the risk of having a child with Down syndrome, also known as trisomy 21 … [and] other rare chromosomal and congenital defects …

Our first appointment with the perinatologist could have been renamed “Fear Factor–Pregnancy Edition.” We first met with genetic counselors. These well-meaning master’s-degree-level health professionals have the job of counseling parents about their risk of having a child with some genetic defect.

During this session, I was wearing many hats–doctor, columnist–but most importantly, concerned husband and expecting father.

While the counselors presented chart after chart detailing the myriad genetic defects our child could (might, maybe, perhaps) have, my wife’s smile morphed into a furrowed brow filled with tension and concern. We were offered genetic testing–something I will get back to later.

Upon leaving the appointment, I found my role was to help my wife–a teacher–understand how to think about the risk that had just been communicated to us.

We have a 1-in-400 chance of having a baby with Down syndrome. Another way to communicate this risk is to say that for every 400 women who are 35 years old and who become pregnant, 399 of them will have a baby without Down syndrome. Sounds a little different, right?

Statisticians have computed that each of us in America has a 1-in-83 chance of dying in a car accident over the course of a lifetime. Yet we drive every day, and we are not in constant fear of a fatal crash (though a little fear would be nice for those who text-message while driving, no?).

Inherently, we have a great deal of difficulty in understanding risk. Emotions often trump rational analysis, leading to overestimation of risk–which directly leads to unnecessary biopsies, procedures, tests and medications.

COMMUNICATING RISK
It is the role of the physician to do his or her best to communicate risk to a patient. But studies over the years have demonstrated that doctors are not very good at communicating risk, and patients hear different take-home messages even when presented with the same words.

Out of a desire to advise patients of potential risks, physicians often scare patients instead …
Since I am an internist, I have a different set of common conditions about which to counsel patients, and I find the need to constantly improve how I communicate risk. Should my 80-year-old patient with a mildly elevated PSA get a prostate biopsy? Should a 35-year-old with chest pain have a cardiac stress test? Should a 40-year-old woman have a mammogram to screen for breast cancer?

I have a newly strengthened appreciation of the need to properly, carefully communicate risk to my patients–and to talk about that risk in the context of the patient’s individual value system. Each patient may have a different comfort level when it comes to taking on risk and uncertainty in his or her life.

UNNECESSARY DISCUSSION
In retrospect, we should never have agreed to see the perinatologist.
At the very beginning of the pregnancy, my wife and I thought deeply about our values and decided that we would never consider an elective abortion if our child were found to have any condition, including Down syndrome.

The proportion of surgical births should be reduced to 20 per cent by 2015, from 30 per cent now, and first-time mothers would be attended by the same midwife throughout labour.

The Minister for Health, Carmel Tebbutt, said the directive was ”designed to support women to have a birth that is as free as possible from invasive medical intervention, while also recognising that labour occurs across a wide spectrum … The safety of mother and child are, of course, paramount.”

The president of the Australian College of Midwives, Hannah Dahlen, said: ”For the last 15 to 20 years [birth interventions] have just gone up and up and up. At some point we have to start coming down again. The policy says, ‘Let’s stop, let’s regroup and try to get a balance.’ ”

She emphasised it would remain ”the safest option for some women to have a caesarean section, and women should not feel lesser because they had to have an intervention”.

Only about 13 per cent of women now achieved a vaginal birth after a caesarean, while up to 80 per cent could do so if properly supported. The NSW targets specify a 30 per cent rate by 2012 and 50 per cent by 2015.

Dr Weaver said the appropriate caesarean rate was about 25 per cent of all births, because the current generation of women represented ”an older population, a fatter population, and a lot of first-time mothers”, Factors which raised their risk.