Sunday, July 1, 2012
Sunday, April 15, 2012
Almost 6 years ago I found ICAN via my childbirth educator, in my attempt to have a VBAC. I had no idea I needed ICAN. After all, my cesarean was quite necessary and all I needed THIS time was a midwife who didn’t want me to schedule a second one. It was truly astounding, to think of the pre-ICAN Heather and the post-ICAN Heather.
It took a couple of meetings at most when suddenly my world shifted, titled, spun a little faster, became wobbly and almost rolled away into oblivion. To find out my cesarean was not only probably not necessary (well, the induction anyway), but more likely instead of saving my baby and me really almost killed us was quite a shock, even to a suspicious liberal feminist type like me. I had NO IDEA. No idea. Medical model vs. Midwifery model. Cytotec. Inductions. Unnecessary c-sections. Homebirths. Doulas. I could go on and on.
So much changed. I learned so much. I wanted to shout it from the roof top. I wanted to call the dean of the Women’s Studies department at my women’s college and let her know what was going on! I wanted to tell every woman I knew--OUR BODIES KNOW HOW TO HAVE A BABY, and birth is not a medical emergency waiting to happen, and I am the one doing this, not a doctor, or a midwife, or a nurse or a doula, but me. And I CAN!!! So ICAN, thank you. You made my life better, for me, my children, my husband and countless others around me.
So what can I do for ICAN? Become a subscriber! For the month of April, the rate is only $25 for individuals and $50 for professionals. Please, let us know what ICAN has done for you, and become a subscriber! Help us keep on doing this life changing and lifesaving work!
Sunday, January 1, 2012
In Louisville, KY:
“I didn’t plan it that way,” Ashbaugh said from her bed at the downtown hospital. “I was paying attention to pushing and getting her out.”
Norton officials could not recall the last time a birth other than a cesarean section delivery took place so close to the start of a new year, spokesman Steve Menaugh said.
In 27 years at the hospital downtown, labor and delivery nurse Lynne Young said Sophia’s arrival was the first she could recall taking place just after midnight.
And even more amazing, a couple refuses a cesarean for their twins in Middletown, CT:
Bredwood delivered twins at 7:39 Sunday morning — a boy and a girl. Technincally, the couple’s newborn son M’ale was first, followed six minutes later by his sister, M’layah.
Aadil did most of the talking during the interview, as Faith was exhausted—the couple agreed to go natural for the births—no epidural or any other painkillers, and no Cesarean section, as doctors recommended.
Congratulations to all new mamas, papas, and babes this New Year! To any women recovering from cesarean, whether planned or not: thoughts of healing and peace to you. We are here if you need us!
Wednesday, December 21, 2011
Fairview Southdale: 33%
Fairview University: 32.1%
Fairview Ridges: 31.5%
Maple Grove: 27.6%
St. Francis: 24.0%
North Memorial: 21.6%
St. John's: 20.9%
St. Joseph's: 13%
As these numbers show, only one hospital in the metro area has a cesarean rate that is within the World Health Organization's recommended safe range of 10-15% - St. Joseph's in St. Paul. All other metro hospitals are well above that range.There are no real surprises in the hospitals that rank highest in cesarean births. Abbott, United, and Fairview Southdale have long vied with each other for the top three spots.
Evidence shows that choice of birthplace is a key factor in determining the kind of maternity care you get. These numbers should give you one piece of information to weigh when considering where you would choose to give birth in the metro, which should also shape who you choose as a care provider. For more information on choosing a birthplace, see ICAN's excellent white paper on the topic.
Also important to consider is whether or not the hospital(s) in your area support VBAC. Go to our local chapter's website for information on hospital VBAC policies in Minnesota.
Thursday, December 8, 2011
Tuesday, November 29, 2011
"To the staff who was likely waiting until shift change: When I signed that cesarean consent after a 14 hour induction (that was necessary - I'm not denying that) that involved cytotec, pitocin, Magnesium sulfate, a 36w5d fetus, a puking mom, a mom whose liver enzymes were 1100, a broken bag of waters and repeated late heart decels - why in the HELL when I signed that consent at 2:15pm, was I still not taken back to the OR at 3:25pm? Why did you wait until he became bradycardic to the 60s and didn't recover? I already had an epidural that was supposed to be rebolused, but instead it became a dramatic end with people throwing me onto the OR table and an anesthesiologist telling me to take a deep breath into a mask and proceeding to knock me out. You had over an hour to prep me for surgery. As awful as my end of pregnancy was - it became even more of a nightmare when I missed my first child's birth and I didn't have to. I have always mourned that.
And to the two nurses who both told me that I would always need a c-section from here on out (without me even soliciting info on VBAC) because there is too much risk for mom and baby with that route (and apparently no risks for repeat c-sections) - I have always wanted to return to your workplace and tell you what happened with baby number 2. I always smiled and nodded, but in the back of my mind I was thinking - "Oh no - I AM going to have a VBAC." - and guess what - I did! And to the OB who did my section, even though I was overall not really impressed with you at prenatal appointments, thank you for reassuring me that even though you cut me vertically on the outside, that my uterus was cut horizontally and that I could for sure have a VBAC.
Oh - and when a mom says she is breastfeeding on admission - do not just stuff her 5lb 2oz baby with gobs of formula from a bottle. At least syringe feed the baby for crying out loud. You led to many tears, sadness, and a breastfeeding relationship that was ruined. Oh sure, I pumped tons of milk, but I could never get that baby to the breast - not when he was given bottles for the first 17 hours of life before seeing his mama, and then was told he couldn't attempt to breastfeed until mama was off the Mag (which I now know is not true).
Thanks to my midwife with Baby #2, husband, doula, and all of those who believed and supported me in my VBAC. I didn't realize how much my fears from baby #1 would play into this labor. But you kept me going, you stuck with me and that birth, and you made sure that the best outcome occurred for me and baby!"
Thursday, November 10, 2011
It always makes my day when I run across a Birth Warrior in an unexpected environment. This one came via my son’s preschool teacher. I love amazing birth stories, and then VBAC birth stories are really fun to hear, but TWIN VBA2C? And she didn’t go through ICAN? I was beside myself.
I will share the link to her blog at the end of this post, but want to say that what I find amazing about us women is we all come in different shapes and sizes and wear different armor. Meaning this is one of those women who just did it, she just did it! She wanted it and it happened. There are women like that, and there are women like me who share and talk and preach and then put up photos and would even post a video. There are those who are so quiet, and those that are loud. Those that do it all alone, and those that are surrounded by people. What matters is that we do it the way we feel the safest and most supported, no matter where that is, and who is there. And that everyone around us believes in us.
This is how it should be here in the US. It isn’t though, without alot of fighting, demanding and preparing. In the meantime, we will keep working, and of course women will keep having babies.
So enjoy this birth story-and if you are a mama out there wanting a VBAC, or vaginal birth of twins or a breech baby, or don't want to end in cesarean unless truly necessary, it can happen!
Jessica's amazing birth story:
Saturday, July 9, 2011
Monday, April 25, 2011
Birth story of Gregory Patrick
Thank you ICAN and my ICAN sisters Sarah, Kara and Chandra, midwives Emme and Clare, apprentice Janine, doula Veronica, Mom, DH Greg, kids Earl and William, and of course Gregory Patrick.
I am truly blessed.
Sunday, January 30, 2011
I've been thinking a lot lately about my external scar - mostly because next week I am going on a trip to Aruba with my husband and brother and sister-in-law (yea me!). And to be honest, I'm kind of excited to wear a bikini (yep, I'm going to) and proud to as a matter of fact. You see, there was a time when I was quite embarrassed by this scar. Not so much because of how it looked, but because of how it got there.
My son's birth was an emergency cesarean under general anesthesia. Apparently you can save time doing the section by making a vertical incision on the outside of your body, yet still making the low-horizontal cut on your actual uterus. I didn't have to have that vertical incision if people weren't putzing around at my hospital. I remember that the doctor came in and told me at 2:45pm that we were going to do a c-section because my son was having repeated late decelerations of his heartrate during my medically necessary induction (and I do feel my induction was medically necessary). Ok, fine, section me. But who knows what was going on, and all of a sudden it's 3:30pm, and instead of a somewhat planned and calm c-section, it is mad chaos - thus my vertical scar. Apparently my son's heartrate went to 60 beats/minute and stayed there. It took the physician 2 minutes from that first cut to get him out.
How I wish I had an initial picture with my 25 staples covering my incision.
My scar used to conjure the emotion of embarrassment. Who has a vertical c-section incision? No one I know. And who has one THIS thick??!! And at the time of my c-section, I didn't know anyone who had a failed induction such as I. I didn't know anyone who was so helpless after birth and who had struggled - and again - failed - to get their child to breastfeed. This scar represented for so long, all of the failures of that birth and the consequences that came with having a cesarean birth.
Here it is again, while I was 37 weeks pregnant with my VBAC baby (who came at 38 weeks).
Monday, November 22, 2010
I have been working with a group of physicians and other health care experts to develop clinical quality measures around maternity care. But I need some feedback from people who are pregnant, who have been pregnant, or know someone who is pregnant! Will you think about your/her experience and let me know what you would like to know about a doctor or doctor’s office?
We’re considering reporting:
- The percent of a doctor’s office births that are c-sections to low-risk, first time mothers
- The percent of times a doctor’s office induces a pregnant woman (without a medical reason) before 39 weeks
- The number of deliveries per year by a doctor or doctor’s office
- Whether or not a doctor’s office offers vaginal birth after deliveries (or VBAC)
We’re also considering other measures around maternity care for additional reporting. Would you be interested in:
- Prenatal care topics like education, tobacco cessation, screenings, etc.?
- Postnatal care topics like breastfeeding, postpartum depression, etc.?
- Other procedures at the time of birth like injuries or tearing?
It really helps to hear about what people would find helpful. I know what I would consider valuable information, but others might have different ideas. Please forward this message to your colleagues and friends if you can think of people who are interested in maternity care quality.
I would love feedback before the end of November so I can share your thoughts (anonymous of course) with the doctors and experts on the workgroup. The topics they end up recommending could become state-wide measures for all of Minnesota.
State Quality Measurement Program Development Project Manager
MN Community Measurement
3433 Broadway Street NE # 455
Minneapolis, MN 55413
Sunday, November 21, 2010
Monday, October 25, 2010
When I watched it on the news they made no mention to the c-section. They only said she bled to death after the birth. I went to find it online and the Strib had a much more in depth article. Honestly, I was so shocked to hear that it was much more than a woman bleeding to death after a c-section. I was so shocked to read that a hospital would actually perform one when they didn’t even think they had blood on hand! In my mind, I immediately assumed it was because they view c-sections as so common and ordinary that they didn’t think they would need it?! I don’t know, I am at a loss. It is bad enough—the risks with having one’s labor induced, the risks of having a c-section, but honestly I never feared personally that there wouldn’t be blood on hand. I thought it was common knowledge that the blood loss from surgery is high, and the potential for blood loss postpartum, whether vaginal or surgical was high as well! Stunning. What a tragedy.
Unfortunately, the culture of c-sections is so accepted that there is no question of being induced at 41 weeks. Now, I am not saying I know everything—maybe she was showing signs of preeclampsia or the baby was stressed and the c-section was necessary, but I was induced at 41 weeks just for “post-dates,” and how many of us are there were induced at 40 or 41 weeks for no reason, or “post-dates?” This is so common that no one bats an eye at it. This woman did not have to die and the hospital certainly was negligent and deserves to pay that settlement, even more. But the fact is, we live in c-section culture and these death will continue to happen until the rate comes down. The fact is, this hospital was not safe to have a baby. How many others out there? Or is the medicalization of birth that is at fault?
I will end with talking about my own birth journey. With my first, I thought having a fancy OB would keep my baby and me safe. It never entered my mind that he has a different list of priorities than I. I was naïve, I know, but I really believed that I was safer with a trained OB and delivering in the biggest private maternity hospital in the state. It just didn’t dawn on me that overused technology is not a good thing in the case of normal, low risk birth. This boggled my brain. When I went to Bradley classes with my VBAC hopes when pregnant with my 2nd, I knew I needed to switch to a midwife (in a hospital setting), but still wasn’t sure about my body. I also was shocked but interested to learn that my instructor “caught babies” at home! Wow—I remember thinking how could this women know what to do in case something goes wrong? At home? This is nuts. Now fast forward to baby #3, and we are having him at home. And you know what? I feel safest there. I know that my midwives are better trained and have higher skills in vaginal birth and all its potentials for problems than most OB’s (who, in my opinion are one trick ponies as skilled surgeons). I know that should something catastrophic happen I am a few minutes from a hospital that can handle an emergency c-section (and I know I could get there in the same time they would prep me in the hospital), and I know that if I stall and just can’t finish at home we are blessed to have an OB here who believes in birth and will let me finish my labor without shame. This is the way it should be. Birth is as safe as life gets and midwives are incredibly skilled. I am so lucky to be able to have a baby where I feel safe, and know that if I need a c-section, it will be truly necessary. When I heard this story about this poor family, I thought, “and they say homebirth isn’t safe!” Hospitals have a whole set of problems that need to be fixed before they can start pointing fingers at homebirth. Finally, I will end with saying women matter! Our birth matters! The end does not justify the means, and often the means is killing us women. This needs to be talked about.
Mom to two boys-one by c-section due to failed induction and one by hospital VBAC.
Boy #3 due in January, planned homebirth
From the Star Tribune:
Malpractice lawsuit nets $4.6 million award
A woman bled to death after giving birth at a hospital in Wright County.
By SARAH LEMAGIE, Star Tribune
The family of a woman who bled to death after delivering her first child was awarded $4.6 million Thursday by a Wright County jury in a malpractice and wrongful-death suit brought against the hospital where she gave birth.
Claudia Calcagno of Albertville began hemorrhaging and died hours after her son was born on Jan. 18, 2008, at Monticello-Big Lake Community Hospital, now New River Medical Center. Her doctors were unable to perform surgery that could have saved her life because the hospital failed to provide enough blood for transfusion in time, even though it was "sitting right in their refrigerator," an attorney for Calcagno's family argued.
"Her doctors needed blood to save her life. It was as simple as that," said attorney Kathleen Flynn Peterson.
The jury's award isn't the largest ever seen in a Minnesota malpractice case, but multimillion-dollar verdicts against health-care providers are unusual, said Flynn Peterson.
In a statement issued Friday, the hospital declined to release expert-witness documents supporting its position, saying they contained private medical data. "Our thoughts and sympathy go out to the Calcagno family," the statement said. The hospital is considering an appeal.
Flynn Peterson said the hospital argued in court that Calcagno's doctors were negligent, and should have gone ahead with the surgery. On Friday, the hospital said that "clinical staff members can only act under the direction of a physician, and we believe [hospital] staff members acted according to the orders of the attending physicians."
Two doctors were named in the suit along with the hospital, but Flynn Peterson said it became clear to her before trial that they were not at fault.
The jury found that neither doctor was negligent. The award includes compensation to Claudia Calcagno's family for past and future economic loss, as well as the loss of her companionship.
For Claudia's husband, Bob, "not a day goes by I don't think about her," he said in an e-mail Friday. "To put it simply, I miss my wife."
Claudia was as an executive assistant for Catholic Health Initiatives, Flynn Peterson said. She and Bob met on the job in 1999: He worked for a company that installed furniture for her office. They began dating, and married in 2004.
"The day we found out we were pregnant I cried like a baby," Bob Calcagno said.
As Claudia's pregnancy developed, their excitement grew. She got the house ready for a baby, and "you just knew she was going to knock this whole mothering thing out of the park," he said.
Calcagno, 36, was 41 weeks pregnant when admitted to Monticello-Big Lake Community Hospital on Jan. 17, 2008, to have labor induced. Her labor stretched into the next day, and after she had pushed for two hours, her obstetrician ordered a caesarean section. At 6:50 p.m., she gave birth to a healthy son, Vico.
But mistakes that contributed to her death had already been made, Flynn Peterson argued. Court documents say that a routine order to type and screen Calcagno's blood put in before her C-section wasn't done until hours later. And following its own policy, the hospital did not stock blood of her type -- A negative -- falling short of accepted standards of practice, Flynn Peterson said.
At 8:50 p.m., nurses checking on Calcagno found that she was bleeding heavily. Her doctors were called, and a surgery team was paged.
A doctor who examined Calcagno ordered blood for her. The hospital lab sent the O negative blood, traditionally the universal donor type, it had in stock. A 911 call was also made to get blood from a hospital 12 miles away, but it's unclear when it arrived.
Calcagno could have received A or O positive blood that the hospital had in stock, but her doctors said they were never told it was available, Flynn Peterson said.
She was taken to the operating room for an exam under anesthesia and possible treatment, including surgery to remove her uterus. But her doctors decided against that.
According to documents, they were concerned that, given the hospital's resources, they wouldn't be able to control potential bleeding problems if they went ahead with surgery. They also felt they had stabilized Calcagno. So instead, they decided to transfer her to North Memorial Medical Center in Robbinsdale. As a medical crew from North Memorial wheeled her to a helicopter, two more units of blood arrived and were sent with her.
During the postpartum hemorrhage, Calcagno lost at least 4,000 milliliters of blood. By the time she reached North Memorial, she was in critical condition, with dangerously low blood pressure. Despite treatment, including a blood transfusion, her heart stopped beating shortly after she arrived at the hospital. Doctors started an emergency hysterectomy, but despite efforts to revive her during surgery, she died.
With help from Vico's grandparents, Bob Calcagno is staying at home for his son's early childhood. The couple had planned to have one parent stay home for their son's first five years, and "he wants to keep that pledge to Claudia," Flynn Peterson said.
Bob Calcagno said Friday that no amount of money will bring his wife back, "but I take comfort knowing that our futures, especially Vico's, are financially secured."
Sarah Lemagie • 952-882-9016
Tuesday, August 31, 2010
The thing is - I just wanted to (and still want to) change the world in regards to birth in America. But, after things settled down I learned that I had to let some things go, and be careful on how I talk with women, otherwise I will turn them off to the very thing I'm trying to turn them on to. I don't think I'm quite there yet, but I'm getting closer - I am really trying to embrace the philosophy of "helping women make informed choices that are best for them - and doing it in a way that they don't feel judged." And sometimes that is so hard when you are screaming things on the inside like "Get rid of that bogus doctor", or "That is the worst decision ever." It's even hard to make those subtle suggestions - ie) when a friend says "I'm just going to say - load me up with drugs [for labor]" and you try to give education related to that and why getting "loaded up with drugs" right away in labor may not be the greatest.
My most recent potential "success" recently was when I was given free reign so to speak. Someone at work approached me (and I had known she had a c/s with #1, but did not know she was expecting #2) and asked if I was glad I had a VBAC. I immediately picked up that she was expecting and said "Hell yeah!" But from there was able to reasonably explain my emotional, mental, and physical benefits. Later she told a co-worker "Yeah, I asked Jessie about her VBAC, and it was not what I wanted to hear." She's really looking for someone to just tell her to do the repeat. But I am so happy that she is looking into this further and that somehow I was priveleged enough to be a part of her questioning process.
I would love to hear other people's thoughts on this subject. I am glad that I always have different online resources that I can use to vent on if I need to. But, I really would like to hear how others who generally have the same views as I do, are able to present their birth views in a positive and non-judgmental way.
P.S. I've been dying to write a post on the topic "As long as mom and baby are healthy". Really - I've had this blog post in my head FOREVER. But have not gotten in down on paper because that is somehow overwhelming. I've read many posts on the topic and I feel I have another twist/opinion to add to it. So one of these days - it will come!
Sunday, July 25, 2010
It is too soon to tell if this will truly promote change, but if it does, I am hoping that even more changes will come about from this - like the overall climate towards VBAC in general. I still remember Gail Tully speaking at one of our ICAN meetings about working with another midwife in another country (Denmark or somewhere - don't quote me on the area, but somewhere else in the world where women give birth - how is that for vagueness) and she asked them how they handle VBACs and they said, "Oh yeah, you guys give that a funny name - for us - it's just a birth." That is my dream that we would not be these ultra high risk VBAC women - we are just women giving birth.
So, we hopefully continue to go step by step in the right direction.
Monday, July 5, 2010
Gail also describes another recent breech birth that led to a necessary cesarean. She writes, "There is no place for ideology in birthing. Each birth has its own story and we must respond to what the baby tells us." How true! Well said, Gail. We are so fortunate to have many skilled and wise midwives in the Twin Cities.
Saturday, June 12, 2010
The first article by Josephine Marcotty tells Danette Lund's search for a care provider to support her desire for VBAC.
Because she had delivered her first child by Caesarean section, a hospital birth would almost certainly mean surgery again. Home birth? Her midwife refused, saying it was too risky. A birth center outside a hospital? She'd have to shell out $7,000 because her insurance wouldn't cover it.
"I felt like I had no options," said Lund, 36, who lives near Waconia. "I was so frustrated."
Lund and other women have discovered that birth in America is rarely the natural event they long to experience.
The article goes on to highlight the overuse of cesareans, the risks involved, and the barriers that so many of us face to having a safe, healthy birth. Marcotty uses Lund's story to illustrate how, despite what media stories and even doctors sometimes say, women are fighting to avoid unnecessary interventions in childbirth. Lund's story will sound familiar to many of us:
"There is nobody advocating for lower C-section rates," Peaceman said. "It's not insurance companies. Not doctors and not women."
Except, perhaps, for women like Lund.
Last year, when she became pregnant for the second time, she knew she was likely to have a C-section again. The surgery has become standard for women like her because there is a small chance that a prior C-section scar will rupture during contractions....
Lund's hospital, Ridgeview in Waconia, will consider a vaginal birth after a C-section. Many hospitals won't because of stringent national medical guidelines for the procedure...
After weighing her options, Lund asked a midwife to deliver her baby at home, but the midwife said it was too risky. She called a St. Louis Park birthing center run by midwives. Although such centers are common in some states, they are new to Minnesota, and Lund's health plan wouldn't pay.
By that point she was 30 weeks pregnant and out of options, she said.
Lund, an attorney and trained litigator, is the first to admit she is not typical of most pregnant women. She's comfortable with confrontation and decided to take matters into her own hands.
Three months ago her labor started at 1:30 a.m. She and her husband waited. And waited. They counted the minutes between contractions, then waited some more. Finally, when she was far enough, she hoped, that it would be too late for a C-section, she went to the hospital.
As soon as she arrived, her water broke. Her cervix was 9 1/2 centimeters dilated. She was ready to deliver her daughter.
"I said: 'Yay, there is nothing they can do to me now,'" Lund said.
The second article by Chen May Yee profiles St. Joe's Hospital in St. Paul, which boasts an incredibly low cesarean rate of around 12%, far lower than Minnesota's 26% rate and the nation's 32.3% rate. The story tells of St. Joe's long history of supporting natural childbirth, especially with its emphasis on midwifery care.
Kara Sime, 38, a first-time mother from St. Paul, arrived one recent Thursday morning, her contractions five minutes apart. By Friday morning, her labor still wasn't progressing. Exhausted, Sime asked for an epidural, a powerful painkiller, and got one. She also got Pitocin, a synthetic hormone to induce labor.
But there was a problem. Her baby was facing backward, increasing the diameter of the head going through the pelvis. Such cases usually require a C-section or a vacuum.
Instead, the midwife and nurse helped Sime onto all fours -- no small feat since her legs were numb from the epidural. With Sime's belly hanging down, the baby turned.
Three pushes later, Catherine Julia was born at 6 pounds 10 ounces.
"I don't have surgical skills," said the midwife, Melissa Hasler. "I'm motivated to get the baby out vaginally."
Gail Tully, on her Spinning Babies Blog, also shared her own experience with the care providers at St. Joes:
A long time ago, I was at a posterior birth with Deb Monson in which the mom was working hard but staying at 7 cm for 3 hours. Deb's simple trick of 3 pushes against her fingers as they created a false pelvic floor quickly turned the baby and let the labor proceed. Doctors at St. Joe's (I don't know if the Midwives do this) will also occasionally reach in and manually rotate the posterior baby's head to anterior so the birth can finish vaginally. Not all posterior births need any of these interventions, but some do and I believe these skills are a big part of why St. Joe's has a low rate of cesarean section. Plus, the community midwives and doulas have long referred to St. Joe's for their quiet, kind nurses, and mother-centered birthing practices.
With such a low cesarean rate and a practice culture that supports non-interventive birth, St. Joe's may be the best hospital in the Twin Cities for women hoping to avoid a cesarean. Sadly, however, St. Joe's is the only hospital in the Twin Cities metro area that does not allow VBACs.
This means that St. Joe's rich tradition and practice culture described by Yee and Gail are not available to women like Danette Lund who, for whatever reason, did not avoid that first cut. In a conversation I once had with a representative from St. Joe's administration, I was told that this is because HealthEast "cannot afford" the medical malpractice insurance fees involved in supporting VBAC. This stands in stark contrast to St. Joe's reputation for supporting evidence-based childbirth. And, unfortunately, it shuts out women seeking VBAC who could perhaps most benefit from the kind of support and quality care that St. Joe's provides.
Many thanks to Marcotty, Yee and the Star Tribune for writing and publishing these stories on a very important topic for birthing women in Minnesota.
Wednesday, May 26, 2010
So, for those of you who are more savvy with legal things and want to read the bill, you can go here.
For those of us who just want to know the basics, this is what happens when the bill became law:
1. Birth Centers will have a route to become licensed in MN
2. Licensed Birth Centers have access to federal funds
3. Licensed Birth Centers have access to state funds
4. State fund spending often sets a standard for private insurance companies, increasing private reimbursement rates
5. CPMs will now be a medicaid provider type in MN! They will be paid for their work in birth centers, and this is a huge foot in the door to increase the possibility of medicaid covering CPMs in all places of birth (and private insurance covering CPMs in all places of birth).
6. We have increased awareness about what birth centers are, and what they are not.
7. We have forged a great working relationship and friendship between CPMs and CNMs in MN.
The Star Tribune also had a good article covering this news as well.
The article dicusses some of the pros:
"It's a game-changer in giving midwives and birth centers a level playing field in innovative pregnancy care," said Dr. Steve Calvin, an expert in high-risk pregnancy.
The federal health overhaul passed by Congress in March requires Medicaid to cover deliveries at birth centers, which now operate in 33 states.
And it also discusses some of the cons or barriers:
The centers must also develop relationships with local hospitals and physicians, who may be distrustful of the concept and see them as competition.
I also really like this quote from the OB who is looking to help open a birth center close to Abbott Northwestern hospital who specializes in high-risk pregnancies: "We've been taking that high-risk model and applying it to everybody," said Calvin. - He says this in reference to this previous statement: Midwives and other advocates say studies show that birthing centers are just as safe as hospitals, and provide women another option that is healthier for them and their babies.
So, as you can see, this is a very positive movement, not without work to still be done to improve the birth culture in general, but I really feel that overall Minnesota is moving in a more positive direction.
Tuesday, April 27, 2010
The rest are Pam's words - I love how she breaks things down so understandably:
Over 1.3 million babies in the US were born by c-section in 2008, accounting for 32.3% of all births. The most common reason for cesarean delivery is having had one before, but the reasons for a cesarean can vary widely. Sometimes there are medical reasons for planning a c-section prior to labor, and emergencies during labor make other c-sections truly lifesaving. For a huge number of women, though, the picture is less clear. They are told they have small pelvises, or big babies, or their labors aren’t progressing fast enough. Many women are told cesareans are a safe way to avoid the risks of vaginal birth, and an increasing number of mothers are choosing c-sections with no medical indication at all. Whatever the reason for the c-section, though, one thing they almost always have in common is a lack of truly informed consent. Let’s look at the risks listed on a fairly typical consent form—what isn’t on the form may be surprising:
The consent form says:
Infection in the skin incision, usually this is controlled with antibiotics. Sometimes it can require you to be re-admitted to the hospital, but in most cases antibiotics are taken as an out-patient.
In reality, you are twice as likely to be re-hospitalized following a c-section, infection is almost five times more likely to occur, and infection can extend to the uterine incision. Taking antibiotics while breastfeeding contributes to thrush, adding another challenge when breastfeeding is already less likely to succeed following a cesarean.
The consent form says:
Development of heavy bleeding at the time of surgery with the possibility of hemorrhage which could require a blood transfusion.
Transfusion is required in up to 6% of cesarean sections. If your c-section goes perfectly, you’ll lose over twice as much blood as you would during a normal vaginal birth- and even that number may be grossly underestimated. It is interesting to note that “normal” blood loss during a c-section would be considered a hemorrhage during a vaginal birth.
The consent form says:
Injury to the bladder and/or bowel which could require surgical repair (this occurs in less than 1% of all Cesarean sections)
True- but mild bowel paralysis occurs following up to 20% of cesareans, and some women have bladder injuries that don’t require surgical correction but do require use of a catheter for weeks following delivery. Even if only 1% of women require further surgery to correct these injuries, that is almost 14,000 additional- and largely preventable- surgeries per year being performed on mothers who should be happily caring for their newborns.
The consent form says:
Injury to the ureter (a small tube which passes urine from the kidney to the bladder)
While this injury is unusual, occurring in just 0.1% to 0.25% of cesareans, it often goes undiagnosed until the mother returns to her doctor with symptoms including pain and fever. Another surgery is then required.
The consent form says:
Developing a blood clot in the leg veins after delivery
This occurs in ½% to 2% of c-sections- somewhere between 6,900 and 27,000 women- and can be fatal; yet many women are never told what symptoms to look for or how to reduce their risk.
The consent form says:
Risks for subsequent pregnancies include: placenta previa (where the placenta lies wholly or partly in the lower part of the uterus)
Shockingly, this consent form fails to list any other risks for future pregnancies. Reproductive consequences of a primary cesarean include a risk of uterine rupture that is 12 times higher than it would be with an unscarred uterus, even if a repeat cesarean is scheduled. A woman also faces increased risk of placenta previa, more severe placenta problems like abruption and accreta, miscarriage and unexplained stillbirth, unexplained secondary infertility, and dramatically increased risk of surgical complications in future c-sections. If that is not enough, the scar tissue and adhesions left by cesarean surgery can cause chronic pelvic pain and sexual dysfunction, and in rare cases can cause intestinal blockage that can be fatal.
The consent form says:
Cutting the baby during the incision into the uterus (this occurs rarely).
About 1-2% of babies are cut during c-sections- that could mean over 25,000 babies, every year, receiving anything from a nick to a severe laceration at the hands of the delivering OB. While the consent form ends here, a slippery scalpel is not the only risk babies face when delivered by cesarean. Babies born by elective cesarean are up to seven times more likely to have respiratory problems at birth, and are up to three times as likely to die in their first month of life. C-section babies have lower APGAR scores, higher NICU admission rates, and they are more likely to have ongoing health problems like asthma. It’s important to note, these are low-risk babies, not babies who are delivered by emergency cesarean who may have been affected by complications of labor. No, these babies experience these issues as a direct result of the way they were born.
I’ve talked with hundreds of women about their cesarean births, both online and in real life. There is a pervasive belief that c-sections transfer the inherent risks of birth to the mother, providing babies a safer and lower-risk entrance into the world than they’d have with a vaginal birth. Many OBs perpetuate this myth, but it’s clear they aren’t telling us the whole story. I don’t think I’ve met one woman- not one single mother- who was told up front that in some respects her c-section put her baby at greater risk than vaginal birth would have. Even though many women seem comfortable with the increased maternal risks of c-sections, few are truly aware of exactly what those risks are, how much they are increased, or how they can be reduced. OBs are selling c-sections as a safe and easy way to deliver a baby- and women are buying.