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Thursday, December 31, 2009

Maple Grove's Opening Act? A C-Section

The first hospital to be built in the metro area in 10 years opened it's doors to business today. It's first act? A scheduled cesarean.

WCCO reports:

Melissa Bistodeau, had a scheduled C-Section in the afternoon. She, along with her husband Joe Bistodeau, and son Cole, got the royal treatment.

Nurses and doctors gave them a standing ovation as they made their way to their room.

The hospital is opening in stages, due at least in part to the current recession. It's current focus in on labor and delivery, and it's marketing campaign to attract patients appears to be working. The hospital website heralds its facility as the "region's premier birth center" and boasts of labor and delivery suites that help you feel "at home."

According to the Star Tribune (emphasis added):

On Saturday, nearly 6,000 visitors showed up for an open house at the new facility. People milled around the lobby clutching gift bags and chatting with Cochrane as the Maple Grove High School jazz band played. Kids got their faces painted. Outside, families posed for photos in front of a North Memorial helicopter.

Todd and Christine Nelson of Ramsey were in a long line waiting to tour the birth center and surgical area. Christine is expecting her first baby in April. She says she changed obstetricians so she could deliver at Maple Grove.

Hmmmm. The birth center AND surgical area? Since when do these two things go together? I guess the state's 26% cesarean rate might tell us something about that.

While Maple Grove Hospital may be selling itself as the best maternity care around, evidence from scientific research suggests other standards. The Milbank Report on Evidence-Based Maternity Care: What it is and What it Can Achieve, based on a rigorous analysis of the best scientific studies of childbirth available, states (emphasis added):

Although most childbearing women and newborns in the United States are healthy and at low risk for complications, national surveys reveal that essentially all women who give birth in U.S. hospitals experience high rates of interventions with risks of adverse effects. Optimal care avoids when possible interventions with increased risk for harm. This can be accomplished by supporting physiologic childbirth and the innate, hormonally driven processes that developed through human evolution to facilitate the period from the onset of labor through birth of the baby, the establishment of breastfeeding, and the development of attachment. With appropriate support and protection from interference, for example, laboring women can experience high levels of the endogenous pain-relieving opiate beta-endorphin and of endogenous oxytocin, which facilitates labor progress, initiates a pushing reflex, inhibits postpartum hemorrhage, and confers loving feelings. Large national prospective studies report that women receiving this type of care are much less likely to rely on pain medications, labor augmentation, forceps/vacuum extraction, episiotomy, cesarean section, and other interventions than similar women receiving usual care. Such physiologic care is also much less costly and thus provides outstanding value for those who pay for it. Burgeoning research on the developmental origins of health and disease clarifies that some early environmental and medical exposures are associated with adverse effects in childhood and in adulthood. Recognition of known harms and the possibility that many harms have not yet been clarified further underscores the importance of fostering optimal physiologic effects and limiting use of interventions whenever possible.

Unless the care providers at Maple Grove Hospital (or any birth place, for that matter) support this kind of evidence-based care, expectant mothers and families in the Twin Cities might want to think twice before signing up for this "premier" birth center.

Tuesday, December 15, 2009

Dads get post partum depression, too

The great discussion at last night's support meeting ("Healing From Traumatic Birth") reminded me of this recent article from the New York Times on fathers and post partum depression.

According to the article:

Up to 80 percent of women experience minor sadness — the so-called baby blues — after giving birth, and about 10 percent plummet into severe postpartum depression. But it turns out that men can also have postpartum depression, and its effects can be every bit as disruptive — not just on the father but on mother and child.

We don’t know the exact prevalence of male postpartum depression; studies have used different methods and diagnostic criteria. Dr. Paul G. Ramchandani, a psychiatrist at the University of Oxford in England who did a study based on 26,000 parents, reported in The Lancet in 2005 that 4 percent of fathers had clinically significant depressive symptoms within eight weeks of the birth of their children. But one thing is clear: It isn’t something most people, including physicians, have ever heard of.

 I guess it really shouldn't be surprising. Childbirth certainly transforms life for a woman who becomes a mother, but men go through a significant change as well, often bringing up new worries about the health and well-being of their partners and children, as well as increased financial and other strain. In the case of men whose partners have had traumatic birth experiences, the rate of post partum depression might be even higher.

So, why don't we know more about this? Again, from the article:

Unlike women, men are not generally brought up to express their emotions or ask for help. This can be especially problematic for new fathers, since the prospect of parenthood carries all kinds of insecurities: What kind of father will I be? Can I support my family? Is this the end of my freedom?

And there is probably more to male postpartum depression than just social or psychological stress; like motherhood, fatherhood has its own biology, and it may actually change the brain.

A 2006 study on marmoset monkeys, published in the journal Nature Neuroscience, reported that new fathers experienced a rapid increase in receptors for the hormone vasopressin in the brain’s prefrontal cortex. Along with other hormones, vasopressin is involved in parental behavior in animals, and it is known that the same brain area in humans is activated when parents are shown pictures of their children.

There is also some evidence that testosterone levels tend to drop in men during their partner’s pregnancy, perhaps to make expectant fathers less aggressive and more likely to bond with their newborns. Given the known association between depression and low testosterone in middle-aged men, it is possible that this might also put some men at risk of postpartum depression.

Well, duh. I guess we could have guess at the whole men-don't-express-their-emotions well. But the biological links are not something that I had ever thought about.

So, what can we women, their wives and partners, do about it? One thing is to get help for our own depression. The reason is this:

By far the strongest predictor of paternal postpartum depression is having a depressed partner. In one study, fathers whose partners were also depressed were at nearly two and a half times the normal risk for depression. That was a critical finding, for clinicians tend to assume that men can easily step up to the plate and help fill in for a depressed mother. In fact, they too may be stressed and vulnerable to depression.

There are lots of resources in the Twin Cities community for support in healing from depression and other difficult emotions after birth. Whether you had a traumatic experience or the most wonderful birth imaginable, post partum depression can be a serious, but not insurmountable, issue - not only for moms, but for dads too.

Click here for a list of local resources.

Tuesday, November 24, 2009

Welcome new bloggers!

We welcome three new mamas to our roster of contributors:
  • Jessie Bridgeford - mother of two, most recently to Alex by VBAC
  • Chandra Fischer - mother of two, our fearless chapter librarian and founder of the chapter in 2005
  • Vanessa Coldwater - midwife, mama and "tub lady". Vanessa plans a regular "ask the midwife" column
Stay tuned for great posts to come from these ladies!

Tuesday, November 17, 2009

Post-partum Depression Study

Opportunity to Participate in a Research Study on Postpartum Depression

A study investigating women’s experiences of pregnancy after recovering from Postpartum Depression is being conducted. Candidates for participation are women who have been diagnosed with moderate to severe Postpartum Depression by a mental health or medical professional and then had a child after recovering from that depressive episode. All participants must have given birth between nine and twenty-four months ago (i.e. their most recent child is between nine months and two years old) and be free from symptoms of Major Depression at the time of participation.

This study is comprised of a short, 10-15 minute phone interview consisting of some demographic questions (e.g. age, ethnicity, date of initial diagnosis, current psychological functioning). Additionally, some women may be asked to participate in two 1-2 hour audiotaped interviews to take place in a private, convenient location of their choice. The first interview will consist of questions aimed at gathering information on the experience of pregnancy after recovering from Postpartum Depression. The follow-up interview will be used to clarify ideas that arise from the first interview and will provide a chance to gain new information that may have been left out in the first interview. Women who participate in the 1-2 hour interviews will be compensated with a $5.00 Target gift card after each interview. Additional benefits of the study include informing mental health professionals about the process of preparing for another child as well as another potential episode of Postpartum Depression. In this way, professionals can be better informed of what women find helpful, what is not helpful, and what they wish they would have done differently. This information has the potential to enable professionals to aid other women who are in similar situations. Your participation in this research is completely voluntary and confidential. You may choose to withdraw from the study at any time.

If you are interested in participating in this study, please contact Amanda Delsman, Doctoral Candidate at the American School of Professional Psychology/Argosy University, Twin Cities, via email at or via telephone at 651-492-3572.

Monday, November 9, 2009

ICAN Webinars: Home Birth After Cesarean

Join the women of ICAN at this month's online events! Online webinars offer you the opportunity to learn and interact in an exciting format. All you need to participate is a computer with internet access and speakers or a headset.

Educational webinars are free to ICAN subscribers. If you are not a current subscriber, you may subscribe or renew through the ICAN Bookstore or through your local chapter, or pay the applicable webinar fee.

Online support meetings are always free for everyone.


Online Support Meeting: Homebirth After Cesarean
Tuesday, November 17, 10:00 pm EST
Free for everyone

Join the women of ICAN in a live online support meeting. The topic for this meeting is "Homebirth After Cesarean." Share your story, your fears, your dreams…and support other women in their journeys.

* * *

Homebirth After Cesarean: What the Research Does and Doesn't Say
Sunday, November 22, 3:00 pm EST
Free for ICAN subscribers - subscribe now:

CEUs available for childbirth professionals

Is homebirth after cesarean (HBAC) as safe as in-hospital VBAC? What elements make it risky? With no studies are available on HBAC, Amy Haas, BCCE takes on the difficult task of applying the available studies on VBAC to the domain of homebirth to give a general idea on its safety.

To unsubscribe from these announcements, login to the forum and uncheck "Receive forum announcements and important notifications by email." in your profile.

You can view the full announcement by following this link:

Wednesday, November 4, 2009

Planning a VBAC

Join us for our monthly support meeting next Monday, November 9th, from 6:30-8:30pm. Our topic will be planning a VBAC. We will discuss reasons to consider VBAC for your next birth as well as resources and things you can do to prepare. Our own Heather Deatrick will be leading our discussion.

Childcare is available for a $5 donation. Please RSVP to

Meeting location:
Holy Cross Lutheran Church
720 E Minnehaha Pkwy, Minneapolis, 55407

Friday, October 9, 2009

Birth & Baby Expo TOMORROW!

Twin Cities Birth & Baby Expo
Tomorrow, 10:00am to 5:00pm
Midtown Global Market

Over 50 Exhibitors (see below)
Door prizes
Goodie bags
"Meet the doulas and midwives" event @ 11:00am

Resources, products, services for healthy birth & parenting!

Presented by: ICAN of the Twin Cities

Sponsored by: Blooma Yoga & Wellness, the Childbirth Collective, Family Times Inc., Health Foundations Family Health & Birth Center, Helping Hands Birth Services, Lake Pointe Chiropractic & Wellness, Morningstar Women's Health and Birth Center, Peapods Natural Toys & Baby Care

  • 3 Bears Chiropractic & Wellness and Bodywork by Liv
  • American College of Nurse Midwives, Chapter 11 Region
  • Americare Chiropractic Wellness Center
  • Awesome Nannies
  • Bellies to Babies
  • Bliss Yoga Studios/Veronica Jacobsen, CD(DONA), LCCB, CLC
  • Blooma Yoga & Wellness
  • Brelle Co. LLC/Child's Health Journal
  • Chamindika Wanduragala (unique, artist-designed baby clothes)
  • Child & Family Chiropractic Center
  • Cindy Miller, Farmers Insurance
  • Cultural Care Au Pair
  • Diaper Free Baby
  • Discovery Toys (Marlene Zoller)
  • Do Good Diapers
  • Earth Mother Midwife
  • E. Dahl Photography
  • Everyday Miracles
  • Family Tree Clinic
  • Health Foundations Family Health & Birth Center
  • Helping Hands Birth Services/Nickie's Naturals
  • Hennepin County Medical Center, Nurse Midwife Service
  • Intentional Environment
  • International Cesaren Awareness Network of the Twin Cities
  • It Works Marketing
  • Joeys by Dar
  • Lake Pointe Chiropractic & Wellness
  • Mama Luna Doulas
  • Minnesota Better Birth Coalition
  • Minnesota Council of Certified Professional Midwives (MCCPM)
  • Minnesota Families for Midwifery
  • Minnesota International Center for Trad. Childbearing
  • Morningstar Women's Health & Birth Center
  • Optimal Health Zone
  • Parenting Oasis
  • Pregnancy & Postpartum Support of Minnesota
  • Revolution Wellness Center
  • Sally Kirwin, RN
  • Soft Bums
  • Spellbound Jungle Photography
  • St. Croix Valley Doulas
  • Swami Baby
  • Sweet Pickles, LLC
  • Ten Moons Rising
  • The Bradley Method of Natural Childbirth
  • The Childbirth Collective
  • Victoria Welch (henna, natural baby items)
  • Vida Baby Boutique
  • Wildtree Herbs
  • Wonderment
  • Young Living Essential Oils

Tuesday, October 6, 2009

A Boring Birth?!? The UC of Isaiah Gideon

by Martha Basham

I just don’t know if there are words to do justice to the way my baby boy came into this world. To put it simply and maybe best, it was a little piece of heaven. I’ve never been closer to God or my family as I was in the moments he was born and after.

Even now, 2 weeks to the day after he was born, I have a hard time believing how amazing his birth was. I feel like I dreamed it all. While I was pregnant I only hoped, dreamed, that it would be what it was. I would live and relive those moments over and over again if I could and will draw on that experience any time in my life that I need strength or courage. Because of his birth I know myself better. His birth was about responsibility from the start. During pregnancy I was responsible for taking the best care of myself that I ever have in my life. During the 2 years prior to his birth I took responsibility for preparing and educating myself about birth and every possible path that birth could take. I surrounded myself with people who were also educated about birth. But ultimately in my mind, my soul, I had a perfect picture of what this birth would be and it was.

What it wasn’t was dramatic. Or scary. Or painful. It wasn’t anything that people typically envision in a birth. And it was nothing like you see on t.v. By all means, Isaiah’s entrance into this world would probably be classified by some, as boring.

A boring birth.

But really, I would not call it boring. Sure, it wouldn’t make for good t.v. but I wouldn’t call it boring. I would call it peaceful. Joyous. Beautiful. Calm. Relaxing. Even triumphant.

On July 22nd at 3:00 pm my family who had just visited prior to leaving for their trip to Hawaii for my brother’s wedding was getting ready to say goodbye. My husband worked the night shift that night and he woke up as they were leaving to see them off. At 3:30 he was getting ready to go to work and I sat down on the couch to relax after a long day. My 3 girls, 5, 3, and 1 were playing. They had woken early that morning and my 1 year old was getting very tired after a long day with no nap. We had spent the day shopping and having ‘girl’ time together as I knew that things would get busy when the baby arrived.

When I sat down on the couch I felt the baby drop. It happened very quickly and noticeably. Shortly after that I had this feeling that labor would be starting soon. By 4:00 Nick was ready to go to work. I wasn’t having regular contractions, just the same Braxton hicks/ prodromal labor that I had experienced for weeks prior. Instinctually I knew that it was going to happen that night. I just knew. I let him know this but told him to go to work anyway ’just in case it wasn’t’. We all said goodbye and he was off to work. It took him about an hour to get to work and would take him another hour to get home. By 5:00 I was still not having regular contractions. They were still the same and still barely noticeable. I cleaned my house, helped my girls get ready for bed, washed all the laundry and took care of anything that I knew I wouldn‘t want to worry about once the baby did arrive. I was doing these things instinctually and that instinct was telling me that baby would be on the way very soon. I took a bath because I was tired and just wanted to relax. I sang along to my Ipod and could hear my older girls singing along from in their room while they were playing with their toys. I called Nick at work. He called back just after 5:00 and I told him he should come home or he might miss the birth. He was home by 6:00 and I was playing barbies with our girls. Our 1 year old had fallen asleep and it was just my oldest 2 still awake. When Nick got home he thought maybe my call was a false alarm. I was calm, relaxed, and not in pain. I did ask him to rub my back because it was tired after a long day. I was still keeping busy and my girls helped me switch the clothes from the washer to the dryer. It was almost 7:00 and I decided to lay down and rest a little. Still no regular or painful contractions. I went to the bathroom and half expected some signs of labor but nothing.

I went to go back to our room and lay down when my dh said, something along the lines of ‘so, we’ll have the baby tomorrow maybe?’ He was thinking he could go to sleep. I said, ‘no, baby will be here soon’. It was after 7:00 (7:15? I’m not sure…time is fuzzy at this point) I couldn’t sit still. I needed to be moving, pacing, walking, and I walked down our hall, into our living room, and then back into the bathroom. That was transition. It lasted about 5 minutes from the time I told Nick baby would be here soon and it never hurt. It was also the only time I had a regular contraction pattern or contractions that felt slightly more noticeable than Braxton hicks. My body then started to bear down. I wanted to be in the tub at first and the feeling of the water from the shower was very relaxing and soothing. Nick checked in on me and I think he finally believed that baby was going to be born soon. I reached down and felt the bag of water bulging. I told him that it was very close. Then I wanted to be out of the tub. I got out and Nick gave me towels to dry off. I made my way to our room and onto our bed.

Once I got on the bed I reached down again and felt a hairy head and shortly after that I knew I needed to slowly breathe him out. Nick and my girls were there with me, they were just watching and waiting quietly and patiently. When baby’s head came out I heard my older daughter say “I see the baby’s head!” I had my hand on baby’s head as it crowned and in the same contraction as the head was born the shoulders turned and baby’s body slid gently out into my hands onto the bed. He cried right away and was immediately pink. He looked around and then gave another good cry. I was so busy looking at him that I didn’t even think to look and see if he was a boy or a girl. We didn’t find out because we opted not to have an ultrasound. Nick asked and when I looked I half expected him to be a girl. I said “it’s a boy!!”

Within 15 minutes of his birth he was breastfeeding and the placenta came out. He ate for a half hour nearly every hour for the first 12 hours of his life, my milk came in the 2nd day, and has been a great eater! I’ve even kept up with the demands of cloth diapering a newborn (this is the biggest surprise for me!). He weighed in at 9lb 2oz on the fish scale Nick bought for his birth...our “catch of the day” as he called him :)

Isaiah Gideon was born exactly how I hoped he would be. He had a peaceful entrance into this world. I was able to listen to my body and my instincts and do everything I needed to so he could have a safe and peaceful birth. I knew myself enough to know exactly what I needed for his birth and I know birth enough to know exactly what I needed to bring him safely into this world. I had hoped I would “know” I was “in labor” sooner this time (last time I didn’t know until an hour before she was born!) and I did. Even though my labors aren’t ’traditional’, instinctually I *just knew*. I had hoped I would enjoy it and soak it all up and I did. I had hoped my husband and my girls would be able to witness it and they did. I had hoped for the birth that was perfect for me and our baby and it was. I am so thrilled that my girls were able to see a baby, their brother, brought into this world in such a way, that they too may someday birth without pain or fear and it might be a joyous and beautiful event for them too. I feel so incredibly blessed!

Friday, October 2, 2009

Mother-Sized Activism for VBAC!

Click over to the official International Cesarean Awareness Network's blog to learn about our new feature: "Mother-sized Activism" where we break down the big issues (like VBAC bans) into mother-sized bits.

When we all do our little (but significant!) part, we can make a big difference for birthing women!

Photo credit: Birgit Amadori

Saturday, September 19, 2009

Expo Exhibitors as of 9/17

We have the following confirmed exhibitors for the Expo on October 10th: Blooma Yoga & Wellness, Morningstar Women's Health & Birth Center, Helping Hands Birth Services/Nickie's Naturals, Lake Pointe Chiropractic & Wellness, Health Foundations Family Health & Birth Center, The Childbirth Collective,International Cesaren Awareness Network of the Twin Cities, Family Tree Clinic, The Bradley Method of Natural Childbirth, Cultural Care Au Pair, Optimal Health Zone, Awesome Nannies, St. Croix Valley Doulas, Do Good Diapers, Child & Family Chiropractic Center, Cynthia Miller - Farmers Insurance, Brelle Co. LLC, Wonderment, MN Families for ...Midwifery, MN International Center for Trad. Childbearing,Ten Moons Rising, Parenting Oasis, Bellies to Babies, Swami Baby, Soft Bums, MN Better Birth Coalition. There's still room for you - email us for more information to exhibit:

Thursday, September 10, 2009

Celebrate healthy birth & parenting!

The first-ever Twin Cities Birth & Baby Expo will take place on Saturday, October 10th from 10:00 to 5:00 at the Midtown Global Market (920 E. Lake St, Minneapolis).

What the Expo is all about:

This exciting event is presented by our ICAN chapter and sponsored by eight awesome Twin Cities organizations and businesses: Blooma, Childbirth Collective, Family Times, Inc., Health Foundations, Helping Hands Birth Services, Lake Pointe Chiropractic and Wellness, Morningstar Birth Center, and Peapods.

The purpose of the Expo is to showcase the phenomenal and diverse resources in our community that promote and celebrate healthy birth and parenting. Exhibitors will include doulas, midwives, childbirth educators, wellness service providers, natural products, support groups and more!

The event will also feature door prizes, goodie bags for the first 350 guests, and special times to "Meet the Doulas" and "Meet the Midwives."

What you can do:

* Attend and bring friends! It's FREE!
* Encourage a business or organization you love to exhibit at the Expo. Visit our website for info on exhibiting.
* Promote the Expo. Become a fan on Facebook. Contact us for fliers or postcards to distribute.
* Volunteer to help with spreading the word, setting up, or cleaning up. Email us to find out how to help

Saturday, August 22, 2009

Informative Birth Videos

Cross-post from ICAN-Blog:

Three new, thought-provoking videos related to childbirth are available online.

This video compares the cesarean experience with VBAC for both mom and baby:

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

The video below discusses infant mortality, especially among communities of color, and highlights the role of reducing unnecessary obstetrical interventions in improving outcomes.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

Finally, this video shows an economist elaborating on the cost savings of increasing out-of-hospital birth:

Less Cesareans with Induction of Labor? Read the Fine Print!

Cross-post from ICAN-Blog:

Media reports this past week have hyped a recent study claiming that induction of labor may actually reduce the need for cesarean. These findings appear to contradict previous research and generally held opinion.

However, these reports have underplayed and underreported the substantial caveats offered by the researchers about their findings. Although the authors do report a 22% reduction in cesareans in women who had elective inductions after 41 weeks, they temper their findings with the following:

1) These findings may not translate to many, if any, hospitals in the U.S. because of how obstetricians tend to practice in reality. According to the press release, “Prior research has indicated that doctors often tend to proceed from starting an induction to cesarean fairly quickly.” Thus, in order for these findings to be relevant, doctors must have patience to allow inductions to work. (Which begs the question: Why not just wait for spontaneous labor to occur?)

2) Induction of labor, on the whole, remains vastly understudied and further analysis is needed. As one of the lead researchers on the study states, "It’s pretty surprising that something obstetricians do all the time hasn’t been studied all that well."

With these substantial caveats in mind, it’s far too soon to rush to the conclusion that induction of labor is “safer” than spontaneous labor, even in post-dates pregnancies. The fact remains that women must be aware of the risks associated with any obstetrical intervention and have the freedom to make choices that they believe are best for themselves and their babies, not doctors’ protocols and hospital time clocks.

Friday, August 21, 2009

Twin Cities Birth & Baby Expo - October 10th

Only seven weeks to go until October 10th!

Twin Cities Birth & Baby Expo
Saturday, October 10th
Midtown Global Market
Minneapolis, MN

The mission of the Twin Cities Birth and Baby Expo is to connect local families with empowering, multicultural resources and education that promote healthy birth and parenting and to celebrate the transformative experience of becoming parents.

The Expo will showcase local businesses and organizations that operate in line with this mission. We aim to connect parents and families in the Twin Cities with businesses and organizations that offer products or services promoting healthy birth and parenting from diverse perspectives.

Sponsors: We have collected an amazing line-up of sponsors for the Expo and our heartfelt thanks go out to them: Blooma, Childbirth Collective, Family Times magazine, Health Foundations, Helping Hands Birth Services, Lake Pointe Chiropractic and Wellness, Morningstar birth center, and Peapods.

Advertising: We will be offering reusable welcome bags with goodies and informational inserts to the first 350 visitors to the Expo. For $25, you can have your organization's or business' inserts included in the bags. If your organization or business would like to donate goodies forthe bags, let us know (e.g. product sample, promotional pen/magnet/waterbottle/etc). We will also be doing door prizes. If you would like to donate an item for the door prizes, please contact me.

Exhibiting: Prices for exhibitor tables are: $75 for a for-profit business, $50 for a non-profit. If you feel that the prices are out of reach for your organization, we encourage you to join up with someone else to share a table or contact us to discuss. The deadline for applications is September 25th.

Volunteering: We are also looking for volunteers to help out the evening before, during, and after the Expo. Email me if you think you might be available to help with set-up, clean-up, or during the Expo.

Saturday, August 15, 2009

VBAC Webinar

Presented by VBAC Facts, “The Truth About VBAC” answers all your questions about vaginal birth after cesarean giving you the information you need to make an informed decision.

Why is this Webinar Important?

We live in a time where 50% of American hospitals have formal or de facto VBAC bans, where women are told VBAC is illegal, and where the practice of “pit to distress” is common.

Women who schedule their repeat cesarean do so believing that VBAC is not an option while others fight during labor to avoid unnecessary surgery after unknowingly hiring unsupportive medical professionals.

Women are not told that the risk decreases with each VBAC and yet increases with each cesarean. Women are not told that there is an approximately 99.6% chance they will not rupture and a 99.95% chance that their baby will be born alive and without permanent injury.* In short, women are led to believe that VBACs are risky, cesareans are safe and they believe it.

* Risk of uterine rupture during a spontaneous labor after one prior low horizontal cesarean is 0.4% or 1 in 250. Risk of infant death or brain damage is 0.05% or 1 in 2000. (Landon 2004)


The goal of the webinar is to make information available and digestible for people to make their own decisions, never to convince anyone to have a VBAC or homebirth. Although women are more likely to have a successful VBAC in the out-of-hospital environment, many women prefer hospitals and are looking for ways to increase their likelihood of VBAC success. The webinar provides women with fully cited, research based information as well as specific, practical tools to plan their VBACs in either location through a comprehensive review of the latest VBAC research.


Over the course of two 90-minute sessions, “The Truth About VBAC” provides women with a extensive analysis of their options as well as the encouragement they need to successfully VBAC:

Part 1: Sunday, September 27 9:00 pm EDT (6:00 pm PDT):

* Why do VBACs have a bad reputation?

* Cesarean Section: Immediate & long term risks to mom

* Cesarean Section: Risks to newborn

* Cesarean Section: Risks to future pregnancies

* Benefits of cesarean section

* Case study of a hospital VBAC ban

* VBAC success factors

* The marketing of "risk"

Part 2: Sunday, October 4 9:00 pm EDT (6:00 pm PDT):

* Uterine Rupture: An overview

* VBAC: Risks to baby

* VBAC: Risks to mom

* Benefits of spontaneous vaginal birth

* The risks & benefits of hospital vs. home vbac

* How to select a truly supportive care provider

* Coping with unsupportive friends & family

* Reading list & learning more

The fee for this 2-part webinar is only $30. Click here to register.

Click here for more information.

Tuesday, July 28, 2009

What I Love About My Cesarean

Cross-post from ICAN Blog:

Jasmine Ojala is a mother of two children and a member of ICAN of the Twin Cities. In this post she shares her reflections on what she’s learned from her births.

I have learned and grown so much through my two birth experiences. I had a traumatic cesarean three and a half years ago and a beautiful unattended homebirth just under 2 years ago… but, I am still so raw and emotional when it comes to my cesarean… I know there are many others here who can relate… I carry a lot of guilt around for the decisions I made during my cesarean born baby’s pregnancy, labor and delivery. I know now that I was very ignorant about my rights, my options, the scientific facts, etc.

Thinking about the VBAC a lot today, and with every wondrous, beautiful thing that happened with my VBAC baby’s birth, it has made me mourn even more deeply what I missed with my cesarean born child’s birth. I should be happy that I even got to experience a birth like that at all, painless-orgasmic-peaceful, everything I wanted… but I am just even more angry now that I /really know/ what I lost out on before… My husband is so supportive, but I think he secretly thinks I should be "over" everything by now, especially since the VBAC. But, I am still talking about, pouring over and investigating anything and everything I can get my hands on even remotely relating to birth. He doesn’t get it. He understands that I do what I am doing now to help any woman I can, even if I only can help one…. But I can tell it is getting old for him.

Anyway, I recently did the thing where you write out the positive things about your cesarean experience. So here is my list in no particular order:

1. I am not so ignorant anymore. The cesarean brought me out of my self-imposed ignorance. That was one of the best things the cesarean did for me. It taught me that I have a mind and I can study and I /should /put that to use. And I have.

2. The cesarean served as a way for me to receive some attention that I was craving from my mother. That may sound horrible, and I guess in some ways it is, but I didn’t realize that until I started to make my list. My mother has never been a "mothering" type- I hardly ever saw her, much less spent time with her. But she sure was a-motherin’ me after the cesarean. It was nice to have a mom.

3. Recovering from the trauma of the cesarean provided me and my husband with the opportunity to communicate on a whole new level. We have always had great communication but I had trouble allowing my "weakness" or "vulnerability" out in the open. I don’t like to ask for help- I don’t like to not handle things myself. The aftermath and recovery from the cesarean eliminated all choice I had in the matter, and all the better too, we are even closer now.

4. The cesarean opened my eyes to birth in our culture and opened up my options and alternatives for future births. I know many other women have said this before, but I would not know what I know now and be the person I have become if it weren’t for the cesarean. It is a shame that a major, traumatizing birth experience is what I needed to shake my beliefs and values like that but unfortunately, in our culture, that is usually how it is done. I wish that could be changed. Why is it that I needed a sledgehammer to the guts in order to ‘wake up’??

5. The cesarean has also shown me my great capacity to love my children and myself. I have a love for my children that is open and endless. I know I would sacrifice myself for them in a heartbeat because I’ve already done it once. I have learned to love my body too- it tried so hard. I used to think it failed me, but the reality was that I failed it, and my body was so resilient. Despite all the obstacles I allowed in it’s way, I *almost* gave birth. My body took to healing itself right away and did a great job… I love this magnificent body and mind of mine that can conceive, bear, birth and raise such beautiful people!

6. I have learned much about my own strength and my abilities to cope and grow. I feel like I am a better person, a stronger person, a more patient person. I am a lot more empathetic than I’ve ever been before. I also have a deep respect for myself that never existed before. I see myself the way I really am, rather than what I think I "should" be.

7. The cesarean taught me that no matter how much control I want or how much I think I have, life isn’t fair and never will be. Sometimes things just happen.

8. I learned it is up to me to deal with the consequences of my decisions, good or bad- no matter who/what I may feel is at "fault." That is what I love about my cesarean.

But you know what- I still desperately wish I’d had a blissfully ignorant vaginal birth. There is much longer list of all the things I hate about my cesarean, but that is too familiar a story.

Saturday, July 11, 2009

Pitocin: A Cautionary Tale

Cross-post from ICAN blog:

The blogosphere lit up this last week with posts about “pit to distress” (see here, and here), the practice of administering the maximum dose of Pitocin (synthetic oxytocin) to a laboring women until the baby shows signs of distress. Such overuse (and misuse) of Pitocin in labor raises the risk of cesarean, traumatic vaginal delivery, and other negative outcomes. Yet induction and augmentation with Pitocin is virtually unquestioned by birthing mothers and their medical providers.

This week’s announcement of Ohio’s largest jury award for medical malpractice tragically illustrates this problem. The jury awarded a family $31 million in compensation for their son’s severe cerebral palsy brought on by a uterine rupture during a mismanaged VBAC labor. The complaint cited the continued use of Pitocin despite the hyperstimulation of the mother’s uterus as demonstrated by an inappropriate contraction pattern. Although some might point to the VBAC labor itself as the cause, in fact the misuse of Pitocin in this case is most likely to blame for the rupture and ensuing disability. Use of Pitocin in VBAC labor is known to increase the likelihood of uterine rupture.

Such heartbreaking incidents highlight the need for reform in current maternity practices. Many routine obestetic interventions are not based on the best available evidence and increase risk rather than safety for mothers and babies. In addition, care providers frequently do not proivde women with full, informed consent/refusal about all interventions, despite ethical and legal mandates to do so.

In light of this reality, women who are pregnant or planning to become pregnant should educate themselves about routine obstetric interventions, such as induction/augmentation of labor with Pitocin and consider the risks/benefits for themselves and their babies. Doing so should influence decisions about type of provider, model of care, and place of birth.

Wednesday, July 8, 2009

Respectful Cesarean?

"Yeah, right."

At least, that was my response when I first saw the title of Joni Nichol's talk at ICAN's International Birth Conference in Atlanta last April. But after a few minutes of listening to Joni's descriptions of cesarean births with soft music playing in the OR and parents talking to their babies as they are born, I was warming up to the idea.

Joni is a midwife practicing in Guadalajara, Mexico. Her description of respectful cesareans included the following elements: cesarean is used only as an absolute last recourse, it is preceded by spontaneous labor whenever possible, the place of birth changes but not the philosophy of care, and the experience is made personal, positive, and memorable. Joni's talk left me dreaming of what changed attitudes in our medical community could do for women who truly need cesareans but who still want a peaceful, beautiful birth experience.

You can read about a respectful cesarean here on Joni's website.

Wednesday, July 1, 2009

Prevent Cesarean Surgery video

This excellent video won first prize ($1,000) in the "Birth Matters Virginia" video contest.

“Such great myth-busting and important information for all women, I loved your use of natural scenes. I'd love to see this video getting lots of airplay in the public arena.” –Dr. Sarah Buckley, MD

“The directness and statistics worked well together…” –Ricki Lake and Abby Epstein

“Very well done.” “One of my favorites. Talk about evidenced-based care; this really motivates someone to take action.” “This really puts it out there. Cesareans aren’t pretty.” “This was so emotional for me. The film does an excellent job questioning the idea that c-sections are easy, normal, and no big deal.” --from the BMV Judging Panel

Tuesday, June 30, 2009

Home birth featured on local TV news

WCCO-TV featured the home birth experience of one local family on their 10pm newscast last night. Their coverage was overwhelmingly positive. Unfortunately, they did give the last word to the head of obstetrics at Abbott Northwestern, the hospital with the highest cesarean rate in the Twin Cities (35.9% in 2007, according to the Minnesota Department of Health data). Nonetheless, this was certainly good press for normal birth. Kudos to Liz Collins and WCCO!

Read/watch the story here.

Monday, June 22, 2009

Cesarean Prevention Webinar

There is still time to register for ICAN's cesarean prevention

ICAN Birth Class: Cesarean Prevention
NEW Online Webinar

Planning YOUR birth? Are you keeping your fingers crossed and hoping
for the best? Well, take charge and find out ways you can increase
your chances of having an easier and safer birth. First-timers and
experienced mothers both can benefit from this class.

This 2-hour online session will help you learn:

* Different kinds of care providers you can use, and the pros and cons of each
* How to empower yourself to make educated choices during your
pregnancy and during labor
* What factors contribute to your chances of having an unnecessary or
preventable cesarean
* What is the "downward spiral of intervention"
* Why avoiding an unnecessary cesarean is safest for you and your baby
* When cesareans are truly necessary

Tuesday, June 23rd - 10:00 pm EDT (7:00 pm PDT)

$20.00 fee benefits ICAN - click here to register:

Thursday, June 4, 2009

Empowered Birth After Cesarean (EBAC)

I recently learned a new term: EBAC, or Empowered Birth After Cesarean. Marisa Ring from ICAN of the Northland used it and I am hooked. The reason I like EBAC is because it can include all types of birth after cesarean, even CBAC (Cesarean Birth After Cesarean).

I think we often assume that VBAC is the only positive type of birth to have after a cesarean. Most of the time, it is the best birth to plan for. But it is not the only birth that can be empowered. I have heard women from our group talk about their repeat cesareans (what some might call "failed VBACs" - an awful term) as very empowering experiences because they were in control and making fully-informed decisions this time around, even though another cesarean was the best option.

CBACs can be empowered, VBACs can be empowered, HBACs can be empowered, UBACs can be empowered. What matters most no matter how we give birth is that we give birth. To me, this is what ICAN is all about: education and support for empowered birth.

Monday, June 1, 2009

Postpartum phone support

Every Monday and Wednesday, Postpartum Support International has free open phone sessions, called "Chat with an Expert." These sessions provide a free forum for information and contact. Wednesdays are for moms and supporters, and Mondays are for Dads.

You can join the call to talk or just to listen to others discuss resources, symptoms, options and general information with an experienced member of Postpartum Support International. You can talk from the privacy of your own home and there is no need to pre-register or give your name. Sessions are informational only and open to anyone with questions and concerns about themselves, a loved one, friend or family member.

See this link for details.

Wednesday, May 13, 2009

Great photography for cheap!

As a fundraiser for our ICAN chapter, we are offering a special opportunity to have your children and/or family photographed by a professional photographer at a low price. All the proceeds will go to ICAN of the Twin Cities. You get a free CD of your pictures to print the poses you want!

Here are the details:

Date: Saturday, June 6th

Price: $25 for first child, $10 each additional child, $45 maximum/family

Location: Minneapolis Sculpture Garden (rain or shine!)

Email us to sign up for a time slot:

Tuesday, April 7, 2009

Cesarean Awareness Month

The Cesarean Awareness Ribbon debuted in April of 2004 for Cesarean Awareness Month. The burgundy color of the ribbons represents birth and the wearing of the ribbon upside down symbolizes the state of distress many pregnant women find themselves in when their birthing choices are limited. The loop of the inverted ribbon represents a pregnant belly and the tails are the arms of a woman outstretched in a cry for help.

Click here for information on special discounts on ICAN membership in honor of Cesarean Awareness Month, now through April 30th.

Wednesday, March 18, 2009

C-section Rate Jumps to 31.8% in U.S., 26.2% in MN

For Immediate Release

Cesarean Rate Jumps to Record High; 1 in 3 Pregnant Women Face Surgical Delivery

More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery

Redondo Beach, CA, March 18, 2000 – The National Center for Health Statistics has reported that the cesarean rate hit an all‐time high in 2007, with a rate of 31.8 percent, up two percent from 2006.

“Every pregnant woman in the U.S. should be alarmed by this rate,” said Pam Udy, president of the International Cesarean Awareness Network (ICAN). “Half or more of cesareans are avoidable and over‐using major surgery on otherwise healthy women and babies is taking a toll.”

A major driver of cesarean overuse is underuse of vaginal birth after cesarean (VBAC). The VBAC rate currently hovers around 8 percent, far lower than the Healthy People 2010 goal of 37 percent. Driving this decline is the growing practice of hospitals banning VBAC.

In February, ICAN released the results of a new survey showing a startling increase in the number of hospitals banning VBAC. The survey showed a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with “de facto” bans.1 Full results of the research can be seen at http://www.ican‐‐ban‐info. Between formal and de facto bans, women are not able to access VBAC in 50% of hospitals in the U.S.

Research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean. According to an analysis of medical research conducted by Childbirth Connection, a well‐respected, independent maternity focused non‐profit, in the absence of a clear medical need, VBAC is safer for mothers in the current pregnancy, and far safer for mothers and babies in future pregnancies.2 While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life‐threatening risks as well.

“The choice between VBAC and elective repeat cesareans isn’t between risk versus no risk. It’s a choice between which set of risks you want to take on,” said Udy.

Studies from the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, one most recently published in the February 2008 issue of the Journal of Obstetrics and Gynecology, demonstrate that repeated cesareans can actually put mothers and babies at greater clinical risk than repeated VBACs.3

In October 2008, Childbirth Connection released a report called “Evidence‐Based Maternity Care: What It Is and What It Can Achieve,” 4 showing that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence‐based care practices. For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused. The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.

“All pregnant women are faced with important choices in their pregnancies. It is critical for women to understand what their choices are, and learn to spot the red flags that can lead to an unnecessary or avoidable cesarean,” said Udy.

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican‐ for more information. In addition to more than 90 local chapters nationwide, the group hosts an active on‐line discussion group that serves as a resource for mothers.

For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients. The resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure. The guide can be found at http://www.ican‐‐right‐refusewhat‐do‐if‐your‐hospital‐has‐banned-vbac‐q.

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re‐hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal‐child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

1. A “de facto” ban means that surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.
2. Best Evidence: VBAC or Repeat C‐Section, Childbirth Connection
3. Mercer et al, Labor Outcome With Repeated Trials of Labor Am J Obstet Gynecol 2008;VOL. 111, NO. 2, PART 1 Silver et al, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries, Am J Obstet Gynecol 2006; VOL.107, NO. 6
4. Evidence‐Based Maternity Care: What It Is and What It Can Achieve

Thursday, March 12, 2009

Two VBAC bills in Minnesota Senate

The following bills are under consideration in the Minnesota State Senate:

S.F. No. 1468, as introduced - 86th Legislative Session (2009-2010) Posted on Mar 11, 2009

1.1A bill for an act
1.2relating to health; regulating hospital policies on cesarean section under certain
1.3circumstances;proposing coding for new law in Minnesota Statutes, chapter 144.

1.6A hospital licensed under sections 144.50 to 144.56 must not prohibit a pregnant
1.7woman from choosing a vaginal birth solely because the woman has previously undergone
1.8delivery by cesarean section.

S.F. No. 1469, as introduced - 86th Legislative Session (2009-2010) Posted on Mar 11, 2009

1.1A bill for an act
1.2relating to health; prohibiting an individual health plan from refusing to issue
1.3coverage because of a previous cesarean delivery;amending Minnesota Statutes
1.42008, section 62A.65, subdivision 4.

1.6 Section 1. Minnesota Statutes 2008, section 62A.65, subdivision 4, is amended to read:
1.7 Subd. 4. Gender rating prohibited. (a) No individual health plan offered, sold,
1.8issued, or renewed to a Minnesota resident may determine the premium rate or any other
1.9underwriting decision, including initial issuance, through a method that is in any way
1.10based upon the gender of any person covered or to be covered under the health plan. This
1.11subdivision prohibits the use of marital status or generalized differences in expected costs
1.12between principal insureds and their spouses.
1.13(b) No health carrier may refuse to initially offer, sell, or issue an individual health
1.14plan to a Minnesota resident solely on the basis that the individual had a previous cesarean

Thursday, March 5, 2009

Cesaren Voices on KFAI - Sunday March 8th!

Kara, Heather and I have put together a radio program to air at 11:00am on KFAI on Sunday March 8th called "Cesarean Voices." Our show highlights our own cesarean and VBAC birth stories as well as the poetry of Suzanne Swanson, a local therapist and poet.

We hope the show will educate the public about the cesarean epidemic as well as the struggles so many of us face to give birth vaginally after cesarean. We also hope the show will communicate to women who have experienced traumatic birth that they are not alone - that we have a voice!

So, tune in Sunday at 11:00 on KFAI, 90.3 FM in Minneapolis and 106.7 FM in St. Paul. If you are not in the Twin Cities, you can listen online at, click on "Listen Now." The show will also be available on KFAI's online archive if you miss it live.

Sunday, February 22, 2009

Access to VBAC is Shrinking

Feb 19 2009

New Survey Shows Shrinking Options for Women with Prior Cesarean

Bans on Vaginal Birth Force Women into Unnecessary Surgery

For Immediate Release

Redondo Beach, CA, February 20, 2009 – The International Cesarean Awareness Network (ICAN) has released the results of a new survey showing an alarming increase in the number of hospitals banning vaginal birth after cesarean (VBAC). The survey shows a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with "de facto" ban. (1) Full results of the research can be seen in the VBAC Ban Database.

The bans essentially coerce women into surgery they do not need. In response to bans, women are either submitting to unnecessary surgery or are traveling long distances to hospitals that do support VBAC. Some women are feeling forced out of hospital care altogether and are having their babies at home in order to avoid coerced surgery.

“There is an alarming disconnect between what medical research says about the safety of VBAC, and the way that hospitals and their doctors are practicing medicine” said Pam Udy, president of ICAN, an all-volunteer patient advocacy organization. “These bans are about business, not about the health and well-being of mothers and babies.”

Research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean. According to an analysis of medical research conducted by Childbirth Connection, a well-respected, independent maternity focused non-profit, in the absence of a clear medical need, VBAC is safer for mothers in the current pregnancy, and far safer for mothers and babies in future pregnancies. (2) While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life-threatening risks as well. “The choice between VBAC and elective repeat cesareans isn’t between risk versus no risk. It’s a choice between which set of risks you want to take on,” said Udy.

Studies from the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, one most recently published in the February 2008 issue of the Journal of Obstetrics and Gynecology, demonstrate that repeated cesareans can actually put mothers and babies at greater clinical risk than repeated VBACs. (3)

Hospitals cite strict guidelines set by the American College of Obstetrics and Gynecology as the driver behind the bans. The ACOG guidelines stipulate that a full surgical team be “immediately available” during a VBAC labor, though the stipulation is a “Level C” recommendation, which means it is based on the organization’s opinion rather than medical evidence.

“If a hospital can’t handle a VBAC emergency, they can’t handle any emergency. VBAC-banning hospitals are claiming to be a safe place of birth for non-cesarean moms, but those mothers are just as likely to have an emergency as a mother with a prior cesarean” says Udy. Placental abruption, cord prolapse, fetal distress are all common emergencies that any mother can experience and require immediate attention.

For physicians, repeat cesareans are often considered more convenient, more lucrative and better insulation from lawsuits. VBACs are inconvenient and costly because they require the physician to be on-site and be available to care for the mother. “ACOG created clinical guidelines that are, in effect, good for business,” said Gretchen Humphries, ICAN’s Advocacy Director, who spearheaded the research. “If physicians think VBAC patients need more attention, then they can simply provide that attention by being in the hospital. But it’s easier to just push women into unnecessary surgery.”

“These bans mean that any mother with a prior cesarean is going to have to be aggressive about seeking out balanced information about the pros and cons of a VBAC versus an elective repeat cesarean, and unfortunately, be prepared for an uphill climb if she chooses to have a VBAC,” said Humphries. For more information, please visit our page about the rights of mothers facing VBAC bans.

For more information about the clinical risks of VBAC and elective repeat cesarean, please visit Childbirth Connection.

About the survey: This survey was powered by an all-volunteer team of callers who called, state by state, hospitals across the country. Survey volunteers used publicly available listings of hospitals and made every effort to call every hospital in each state. Surveyors contacted each hospital’s Labor and Delivery (L&D) ward and questioned L&D nurses about the hospital’s practices. Survey questions were designed to elicit information about formal bans, de facto bans, the reasoning behind the bans, and the level of coercion mothers might face if couldn’t find an alternate hospital option. Information from calls was recorded into a central database. A total of 2,850 hospitals were called. Individual records are available for viewing here.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

For Interviews: Contact ICAN President Pam Udy at (801) 458-2190 or ICAN Advocacy Director Gretchen Humphries at (517) 745-7297.


(1)A “de facto” ban means that surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.

(2) Best Evidence: VBAC or Repeat C-Section, Childbirth Connection

(3)Mercer et al, Labor Outcome With Repeated Trials of Labor Am J Obstet Gynecol 2008;VOL. 111, NO. 2, PART 1

Silver et al, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries, Am J Obstet Gynecol 2006; VOL. 107, NO. 6

Thursday, February 19, 2009

TIME: The Trouble with Repeat Cesareans

ICAN's national VBAC ban survey is featured in this week's issue of TIME Magazine:

The Trouble With Repeat Cesareans

For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car."

Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that "once a cesarean, always a cesarean"--an axiom thought to be outmoded in the 1990s--is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them. (Read "The Year in Medicine 2008: From A to Z.")

Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.

After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean.

So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.

But many interpreted the revision to mean that surgical staff must be present the entire time a VBAC patient is in labor. While major medical centers and hospitals with residents are staffed to provide this level of round-the-clock care, smaller hospitals typically rely on anesthesiologists on call. Among obstetricians, many solo practitioners are unable to stay for what could end up being a 24-hour delivery; others calculate the loss of unseen patients during that time and instead opt to do hour-long cesareans, which are now the most commonly performed surgeries on women in the U.S.

Some doctors, however, argue that any facility ill equipped for VBACs shouldn't do labor and delivery at all. "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study.

Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."

Of course, the alternative to a VBAC isn't risk-free either. With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.

"The decline in VBACs is driven both by patient preference and by provider preference," says Dr. Hyagriv Simhan, medical director of the maternal-fetal-medicine department of Magee-Womens Hospital of the University of Pittsburgh Medical Center. But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

Zelop is among those who worry that "the pendulum has swung too far the other way," but, she says, "I don't know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid." So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: "When the problems with multiple C-sections start to mount, we're going to look back and say, 'Oh, does anyone still know how to do VBAC?'"

Friday, February 13, 2009

ACOG under question by an insider

I just read this awesome editorial by the editor of Journal of Obstetric, Gynecologic, & Neonatal Nursing, Nancy K. Lowe, here. She really calls it like it is--"audacious." She points out that most doctors and nurses have never witnessed a natural birth, and our "system" has not improved outcomes. She calls into question ACOG's and the AMA's motives for issuing their resolution against homebirth. She sings the rallying cry: "Perhaps it is time for a new woman's movement, one that embraces the normalcy of childbirth and puts mothers and babies back on the center stage rather than the system's need to defend the interventionist subculture it has developed and that it must financially support." AMEN --that is what were are doing! And our numbers are growing!

See you March 9th at St Joes or Regions!



The "Authorities" Resolve Against Home Birth
Nancy K. Lowe Editor
Copyright © 2009 AWHONN

No Abstract
DIGITAL OBJECT IDENTIFIER (DOI)10.1111/j.1552-6909.2008.00300.x About DOI

This editorial has been gathering momentum in my mind since I heard about a resolution introduced by the American College of Obstetricians and Gynecologists (ACOG) to the House of Delegates of the American Medical Association's (AMA) annual meeting in June 2008. American College of Obstetricians and Gynecologists's resolution #205 was adopted by the AMA and is titled "Home Deliveries." So that I cannot be accused of misquoting the AMA or ACOG, you will find the text of the adopted resolution at the end of this editorial. In his "College News" column of ACOG Today (September 2008), ACOG Executive Vice President Ralph W. Hale reported on his attendance at the AMA Annual Meeting and wrote, "Also, there was model legislation related to home deliveries supporting the ACOG position against home births." The point of this resolution is to lobby against home birth as an option for women and against providers of home birth services. This type of resolution by "authoritative" bodies such as ACOG and AMA will certainly influence decisions made by third-party payers when women request home birth services and by liability insurance carriers when providers seek coverage for home birth services.

Rumor has it, as stated in the Los Angeles Times on July 9, 2008, that in the original ACOG resolution, there was another "whereas" that was deleted before adoption. It read, "Whereas, there has been much attention in the media by celebrities having home deliveries, with recent 'Today Show' headings such as 'Ricki Lake takes on baby birthing industry.'" You may not be aware that in 2007 producer Ricki Lake and director Abby Epstein released a documentary film The Business of Being Born. The film asked the question "Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?" If you have not seen this film, I encourage you to do so and to view it with an open mind, an open intellect, and an open heart. The DVD can be purchased for a modest price at

Evidently, ACOG felt it necessary to highlight Ms. Lake's coverage of this issue as a potential threat to the safety of mothers and babies. It is beyond the scope of an editorial to review the international and national data about maternal and infant outcomes and the relationship of these outcomes to location of birth. However, one instructive example is a prospective cohort study of maternal and infant outcomes in British Columbia during the first 2 years after women were given the choice to plan a home birth with regulated midwives (Janssen et al., 2002). After controlling for appropriate confounding variables, the data showed no increased maternal or neonatal risk for the 862 planned home births compared with 1,314 planned hospital births. The overall transfer rate to hospital care was 21.7% in the home birth group with 16.5% transferred during labor. The multivariate analysis showed that the women who planned to have home births were significantly less likely to undergo induced or augmented labor, epidural analgesia, episiotomy, or cesarean delivery.

I was born in the United States and I am very proud to be an American, but I am embarrassed that our country founded on the ideals of individual liberty and freedom, can also support "authoritative" initiatives such as these by the ACOG and AMA, initiatives that are founded on neither science nor an understanding of the physiologic and psychosocial needs of mothers and babies. What is most risky about home birth in the United States is that for most women who desire it there is a scarcity of qualified providers of home birth services. There is no system of care that provides the needed safety net if transfer to a different type of care is required during labor. Rather, women who desire to birth at home sometimes chose providers unwisely, and those who require transfer are often treated with disdain and disregard as though their decision to give birth outside the hospital system is irresponsible, reckless, and perhaps immoral. There is nothing more inhumane or uninformed than this attitude toward women who desire to birth at home and the qualified providers who are willing to attend them.

When will we remember that pregnancy, childbirth, and lactation are normal healthy physiological processes that are a continuum and do not require medical intervention unless there is a medical problem? A woman's body and the physiology of pregnancy, labor, birth, and lactation are designed to promote the well-being of the fetus and newborn. When will we establish optimal outcomes as the goal of health care during the childbearing cycle, rather than attempting to reduce by small increments the incidence of morbidity and mortality that is compounded by the very interventions we use to attempt to avoid such problems? We all know that in our current health care milieu for childbearing women, the protection of normal is not valued or supported, except in a very few locales. Those who support normalcy are usually swimming upstream against a system that treats every laboring woman as a surgical case. The idea that a normal spontaneous birth is by design the best outcome for a healthy woman and her infant is neither believed nor entertained as a basic concept. Most U.S.-trained physicians and sadly most U.S.-trained nurses have minimal experience with normal labor and birth. Without fetal monitors, intravenous lines, infusion pumps, epidurals, pitocin, endless charting, and rules theses individuals are helpless and unskilled to provide the kind of informed human support and wise guidance that a laboring woman needs while the normal process of labor and birth unfolds.

In fact, knowledgeable women often must fight to defend the normalcy of the process and their desire to labor and birth spontaneously without medical technology or intervention. In many ways it is reminiscent of the 1960s when many of us who were young women at the time fought for our right to natural childbirth without general anesthesia and to have our husbands accompany us into the delivery room. Breastfeeding was not the norm and was not supported by hospital care. During my 5-day postpartum stay after a vaginal delivery in 1969, I had to repeatedly insist that my newborn son be brought to me during the night for breastfeeding because as I was told by the nurses, "Dr. X's patients are to sleep at night." How audacious authority can be. Amazingly, a few years later a headline in the science section of the Chicago Tribune declared, "Science finds Breast is Best." Since that time the accumulation of scientific evidence has overwhelmingly validated that physiologically obvious statement, and the system, including its "authorities," finally caught up to actively support breastfeeding. Will it take a similar declaration: "Science finds spontaneous labor and normal vaginal birth is best" to change the course that we are currently on and to change the rhetoric of the authorities?

Why do 1% to 2% of U.S. women even want to birth at home? For most it is simply because they sincerely believe that the process is normal and healthy and does not require the environment of an "illness" system to support it. For these women, birth has a unique, earthy, and frequently spiritual component that they want to experience fully under their own terms. They want to actively labor and birth, rather than to have labor happen to them, give over control to a system and people with their own rules, and be delivered of their babies. Some desire home birth because of the subculture of their religious communities, while others are overtly afraid of what may happen to them in the hospital. They may be "on the edge" of the allopathic medical system and be very resistant to interventions that the system thinks are in their best interest. Does this make them wrong? No, it simply means that the system is not meeting their needs for holistic care that supports normalcy.

The point is that we have no system of maternity care in the United States that provides a healthy woman the choice of giving birth at home and if she needs to transfer to a different type of care during labor, the transfer is easy. We do not have a system in which this woman is treated with respect and kindness, and her provider either maintains responsibility for her care or professionally and respectfully is able to transfer responsibility to another provider. Interestingly, while ACOG and AMA have declared that hospital grounds are the only safe place to give birth in the United States, the National Perinatal Association (NPA) adopted a position paper in July 2008 titled, "Choice of Birth Setting." The paper supports a woman's right to home birth services and concludes that, "The National Perinatal Association (NPA) believes that planned home birth should be attended by a qualified practitioner within a system that provides a smooth and rapid transition to hospital if necessary. Safety for all births must be evaluated through an objective risk assessment, especially for non-hospital births. NPA supports and respects families' right to an informed choice of their birth setting" (available at Further, in Canada following the model of British Columbia, the province of Alberta has recently expanded its health care system to include women's access to midwifery services "in a variety of locations including hospitals, community birthing centers, or in their homes" (

Some of you who are reading this know me personally, most do not. I am a nurse-midwife committed to the midwifery philosophy of care, however, I have never attended a home birth. I gave birth to my own children in hospital, and my daughter is a board certified obstetrician-gynecologist. I am part of the U.S. system. Yet the very core of my being, my scientifically trained brain, and four decades experience in the business of mothers and babies tell me it is our system that is not serving mothers and babies well. There is not some inherent danger lurking for healthy American women who desire to give birth at home. The primary danger is that the "system" does not support this choice. To pretend that a normal healthy woman cannot give birth safely without the trappings of a U.S. hospital is not only audacious but also uninformed. Perhaps it is time for a new woman's movement, one that embraces the normalcy of childbirth and puts mothers and babies back on the center stage rather than the system's need to defend the interventionist subculture it has developed and that it must financially support. This system has not improved outcomes for mothers or babies while the cost of care has continued to escalate keeping pace with unnecessary intervention. The recent initiatives of our medical colleagues, the "authorities," simply highlight the painful reality that the "Emperor has no clothes!"

Introduced by American College of Obstetricians and Gynecologists
RESOLVED, That our American Medical Association support the recent American College of Obstetricians and Gynecologists (ACOG) statement that "the safest setting for labor delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, The Joint Commission or the American Association of Birth Centers"; and be it further
RESOLVED, That our AMA support state legislation that helps ensure safe deliveries and healthy babies by acknowledging that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital or a birthing center within a hospital complex, that meets standards jointly outlined by the AAP and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.


American Medical Association (AMA). (2008). Resolutions. Retrieved November 1, 2008, from
Block, J. (2008, July 9). Big medicine's blowback on home births. Los Angeles Times. Retrieved October 29, 2008, from,0,3357453.story
Hale, R. A. (2008, September). ACOG's positions advocated at AMA meeting. ACOG Today, p. 2.
Janssen, P. A., Lee, S. K., Ryan, E. M., Etches, D. J., Farqukarson, D. F., Peacock, D., et al. (2002). Outcomes of planned home births versus planned hospital birth after regulation of midwifery in British Columbia. Canadian Medical Association Journal, 166, 315-323.
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National Perinatal Association (NPA). (2008). Position paper: Choice of birth setting. Retrieved October 16, 2008, from