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Monday, November 22, 2010

Your Feedback Requested! Potential New Quality Measures for Maternity Care in MN

We recently received the email below asking for public comment on potential new quality measures for maternity care in Minnesota. Please read and send in your feedback to paul@mncm.org!

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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.

Thank you!
Brenda


Brenda Paul
State Quality Measurement Program Development Project Manager
MN Community Measurement
3433 Broadway Street NE  # 455
Minneapolis, MN 55413
612.454.4829
paul@mncm.org

Sunday, November 21, 2010

Monday, October 25, 2010

Large malpractice settlement following c-section!

I first heard about this as a teaser for the upcoming 10:00 news. They only said ‘large malpractice lawsuit settlement nets 4.6 million after mom dies after giving birth’, or some variation of that. I said to my husband “c-section!” Of course while he is used to the c-section talk and takes it very seriously, he really wanted to know why I was so sure. I said because women in the US don’t die from vaginal births anymore-that is so rare. They die from c-sections-they die from bleeding to death or from a blood clot (my statement wasn’t too scientific, so now that I look up the numbers, I see that hemorrhage is number one, though I can’t find it directly tied to c-sections).


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 na├»ve, 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.


Heather
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

Presenting VBAC in a Positive and Non-threatening Light

Shortly after I had my first c-section I roamed the internet for information on VBAC, as you may remember from previous posts, I knew I was going to VBAC just hours after that initial first cut. I learned a lot, but I was like a loose cannon. For example, when my c/s baby was 6 months old a co-worker was almost to 41 weeks and said she was going to get induced at 41 weeks. I practically begged her to leave the baby in until the baby was ready. Afterwards I called her pager and left her a message apologizing. I am pretty sure I came off as offensive.

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

ACOG and Less Restrictive Guidelines

On July 21st, this press release informed us of ACOG's less restrictive guidelines for VBAC. For the most part, the immediate Twin Cities area does not have an issue with access to VBAC per say, but I am hoping this helps out not only our sisters in outstate Minnesota, but our VBAC sisters throughout the US who live in areas that restrict VBACs in one way or another.

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

Beautiful frank breech VBAC at home

Gail Tully, local midwife and "Spinning Babies Lady" has published a wonderful video and narrative on her blog about a recent frank breech VBAC at home. Don't miss this - click over and be awed and inspired by the beauty of birth, the strength of birthing women, and the safety of vaginal breech birth.

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

Star Tribune Features Low-tech Birth & Midwives in MN

The Star Tribune recently published two stories highlighting one Minnesota woman's journey to VBAC despite many roadblocks and St. Joe's Hospital's extraordinarily low cesarean rate. Both articles are valuable in what they have to say about birth in our area.

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

Good News for our MN Birth Centers

The birth center bill was signed into law recently, which is a very exciting thing. But, if you are like me, trying to decipher the language of the law and what exactly that means can be a little bit of a challenge (just like I have no clue and cannot explain what my electrical engineer husband does at work - likewise he really cannot articulate exactly what goes into the day of a wife who is a nurse and takes care of critically ill children).

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 Real Risks of Cesareans"

I can't take credit for much of this post, but it is too good not to pass along. It was written by Pamela Candelaria over at Natural Birth for Natural Women.

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.

Buyer beware.

Saturday, April 24, 2010

Awareness...

We had a fantastic time today celebrating Cesarean Awareness Month in Minnesota by watching the film, "Laboring Under an Illusion," eating cake, and reading Governor Pawlenty's proclamation. Here are a few pictures. Thanks to all who turned out!

Sarah Shannon reading Governor Pawlenty's proclamation declaring April 2010 Cesarean Awareness Month in Minnesota.


Delicious lemon creme filled VBAC Victory Cake!


ICAN Twin Cities Board Members (left to right): Heather Deatrick, Kara Wurden, Sarah Shannon, Chandra Fischer.

Tuesday, April 6, 2010

Minnesota Governer Proclaims April as Cesarean Awareness Month

Yes - the state of Minnesota has an official proclamation with a seal that reads at the end:

"Now, therefore, I, Tim Pawlenty, Governer of Minnesota, do hereby proclaim the month of April 2010 as:
CESAREAN AWARENESS MONTH
in the state of Minnesota."
How wonderful for us to have some official recognition.
In the proclamation it notes that Minnesota has a 25% cesarean rate which is indeed major abdominal surgery, and that the World Health Organization recommends a cesarean rate of 15% or lower.
It also lists some of the complications that can arise from a cesarean section.
The proclamation also states that while cesareans can be life-saving in some circumstances, the women of Minnesota should have "full and complete information on the risks and benefits of vaginal birth and cesarean section in order to make informed choices about their health care."

Thursday, March 11, 2010

Headed in a Better Direction?

If you are at all involved in the birth world or consider yourself somewhat of a VBACtivist I'm sure you've heard of the National Institutes of Health consensus conference where they discussed VBACs in light of the decline of VBACs in the last 15 years and the increasing cesarean rate. I won't get into the whole conference on this post - because there is SO much to blog about in regards to that. But I must say that my following of this has almost led to a renewed explosion and passion in my heart for better birth in America.

What I really want to talk about is this particular article that stems as a result of the conference: Base VBAC Decision on Evidence NIH Panel urges. That title just gives me chills. There were many OBs, midwives, PhDs, etc in attendance at this conference. Along with some birth activists just like you or me. This article sums up the conference for you. There are six questions that the conference was asked to look at and answer after conference discussion. The first link I posted has all of the questions and the long answers. It also provides many statistics and evidence to support the answers.

Not only from these articles, but from the bits and pieces I've picked up from Facebook, twitter, etc - it is my impression that the conference was very positive in that VBAC is seen as a vital option and that true informed consent should be given to women (not just a speech about all of the dangers of VBACing and uterine rupture and no mention of the RCS risks). However, I am cautiously optimistic, as it is one thing to urge providers to use evidence when helping women choose VBAC or RCS, it is another thing for providers to put it into practice. But, hey - one step at a time, right?

One item that really sticks out was this mention by ACOG's president:

"The report in general is very good," ACOG president Gerald F. Joseph, Jr., MD, said during public discussion of the draft report. His only suggestion was to strengthen the report's comments on liability issues.

It was found that liability is a prime reason that some OBs won't support VBAC, or are quick to abandon the VBAC attempt. If that is where the true inhibition lies for OBs, we must make a difference somewhere in order to take that liability away from OBs. If that's what we need to do to give women a fair chance, we need to fix that, however, that in itself is a whole other discussion.

I hope with all of my heart that this conference is the start of an upswing in our country. So that women actually have a CHOICE in how they birth and that they are presented with true informed consent of the risks on both VBAC and Repeat C-sections.

To read ICAN's official statement on the VBAC statement, click here.

Saturday, March 6, 2010

Why Is VBAC a Vital Option?

Why is VBAC a vital option? by Heather Deatrick and Jess B.

*This post is the combined thoughts of Heather, ICAN Twin Cities member; and myself, Jess, ICAN Twin Cities member. Written for the ICAN Blog Carnival and for all birthing women out there.

Jess: How do we even start this post? Why is VBAC a vital option – I have reams and reams of information in my head – and I know that there is evidence upon evidence to support why I think and know that VBAC is a vital option. I am a perfectionist and like to wait until things are perfect before I submit them. But, in order for me to meet the deadline for this post – I am afraid that I will not be addressing every issue – besides the fact that I think this would turn into a doctoral thesis if I did!

Heather: To me it is obvious. The c-section rate is climbing. The rate it is going, followed by subsequent c-sections, means women are facing surgical birth as the norm. This defies logic as women have been giving birth for thousands and thousands of years and we have been a very successful species. The most successful actually, and hand washing to prevent disease only started in the last 100 years! To suddenly, in a matter of two decades, have birth become something that women cannot do without the help of a surgeon is arrogant and dangerous.

Jess: Let me start by stating that I had a successful VBAC in 2009. My c-section was in  2006 after an induction for pre-eclampsia at 36w5d. A nurse talked me into an epidural at 3cm (easy to do when the mom is in a fog due to Magnesium Sulfate running through her veins) even though I wasn’t feeling any pain. Shortly thereafter, my bp dropped significantly and my son responded by giving a bunch of whopping late heart decelerations. Hence my “emergency c-section” under general anesthesia. I knew before I even left the hospital that my next birth was going to be a VBAC. I even had nurses telling me, without me even mentioning my desire to VBAC, that I will never be able to have a vaginal birth as there would be too much risk for me and the baby. I must admit that my initial decision to VBAC was highly emotionally driven. I mourned the lack of initial bonding with my baby and the fact that he was given bottles by the nurses right away, thus ruining our breastfeeding relationship. But, hey, in no particular order of one reason being the best or that type of thing, there is reason number one why VBAC is a vital option – for the emotional health of the mother. Honestly – I’m tired of people who brush aside the emotional importance or significance of a vaginal birth – these factors are also important – so let’s start supporting mothers in that quest.


Heather: We know that while childbirth certainly has been dangerous in the past, this did really change with the advent of washing hands, and the ability to stop hemorrhages. Though while it was dangerous, it certainly wasn’t 30%, the way the c-section rate is now. I think it is abundantly clear that the rising c-section rate has to do with other things-technology, fears of litigation, time constraints for the doctors.

So why is VBAC vital? With every c-section comes a woman’s higher chance of death, comes a babies higher chance of breathing problems and asthma and who knows what else. We know that nature does everything for a reason, and vaginal birth is no different. The only way we are going to stop the runaway rising c-section rate is to start making VBAC the norm. When that happens, the provider will start to view vaginal birth as the norm again. It seems to me that vaginal birth is viewed as abnormal and a woman is “lucky” these days to have one.

Jess: I want to point out what some of our resources show. The Mayo Clinic states that the cons to C-section are: Your hospital stay will probably be longer than if you'd had a VBAC, Pain and fatigue linger longer after a C-section, you may wait longer to bond with your baby and begin breast-feeding , A repeat C-section makes it riskier to attempt VBAC for your next baby. C-section poses rare — but real — risks to your baby, such as premature birth and breathing problems. The risk of needing a hysterectomy to stop bleeding after delivery increases with the number of repeat C-sections. A C-section costs more than a successful VBAC does.

I once heard the quote “A C-section is a controlled rupture of the uterus.” I’ve had so many people throw uterine rupture in my face during my VBAC pursuit, a real risk no-doubt, but maybe I should have countered with the controlled rupture line.

Generally, if you have a low-transverse scar on your uterus, your risk of rupture is less than 1%. This article helps put VBAC and uterine rupture in perspective.

Heather: I have a feminist slant too as to why VBAC is vital. To me it seems that this a way to take away the controls from women that used to be 100% ours. Once, women gave birth out of our vaginas and women, midwives, throughout cultures and throughout time, caught them. This was one part of a woman’s life that was sacred and males were not a big part of, but certainly were in awe of. After all, to have a baby is almost god-like—to create and birth life is incredible. My own father told me when I was girl how lucky I was, and what an honor it was. While it is wonderful to have men part of this now, I would never change that, it is no longer a woman who does it. It is a monitor, a fetal scope, a suction, an epidural to sleep, a scalpel, a doctor delivering. It is our body totally controlled by an institution the minute we walk into a hospital. It is the ultimate handing over of our body to another.

To me, a c-section should really be only life saving. A woman today should be able to really say “thank goodness for modern technology that saved my baby and me.” While maybe a lot of women ARE saying that (even I did!), it isn’t the truth and really, modern technology has actually killed many. In this day and age there is no excuse or valid reason for a rising maternal mortality rate. I truly believe that changing the tide on VBACs is the answer.

Wednesday, February 24, 2010

Three Birth Centers Opening in the Twin Cities!

Wow - three birth centers are opening/have opened in the Twin Cities. I am so excited about the increase in options for women here. These are exciting times!

This article at Twin Cities.com talks about the birth center opening in St. Paul. Midwife, Amy Johnson-Grass is opening up this one and it is called Health Foundations. It also touches on Morningstar Birth Center as well, which is connected with the Menomonie birth center in WI.

This article discusses Health Foundations Birth Center, the Morningstar Birth Center that will open in St. Louis Park, and a Minneapolis Birth Center that will be in the vicinity Abbott and Children's hospital.

One of the quotes I really like is the one that talks about how birth centers fit with the "cultural norm" of going somewhere else to birth, but are a low-intervention option for birth that is similar to homebirth.

Take some time to look over these articles. Like I said - exciting stuff for the metro area. More options for women. Let me or other ICAN members know if you have questions about the birth centers. I'll try to stay on top of all of the new developments, births, and etc. in relation to these exciting new developments!

Thursday, February 18, 2010

Save the Date: "Laboring Under an Illusion"

ICAN of the Twin Cities is proud to announce a film screening of "Laboring Under An Illusion: Mass Media Childbirth vs. The Real Thing" to celebrate April's Cesarean Awareness Month. Please save the date and time on your calendar!

Saturday, April 24th, 3:00pm
Washburn Library, Minneapolis

Donations will be accepted for admission. Refreshments will be served!

A brief description of the film:
"Breathe!  Push!  Hurry!  Give me drugs!  Oh no!  I love you!  I hate you!  Help!  Are we bonding yet? There are more pregnant women watching TV birth scenes than attending childbirth classes.  So when labor starts, they may be surprised by the real thing. A new documentary film, “Laboring Under An Illusion: Mass Media Childbirth vs.The Real Thing,” contrasts actual birth footage with the fictionalized commercial version.  In
over 100 video clips, anthropologist Vicki Elson explores media-generated myths about childbirth."

More information here.

Sunday, February 14, 2010

More Hope for VBAmC

VBAmC - that stands for Vaginal Birth After Multiple Cesareans. I ran across this article the other day and appreciated the hopeful information that it had for women seeking a VBAmC. I know of women who had a repeat cesarean after their first cesarean just based on information from their doctor telling them that a subsequent c-section would be in their best interests. It's not until after that repeat c-section that they discover that maybe they can still deliver vaginally. Or there is the woman who attempted a VBAC and for whatever reason it ended in a c-section and she may be wondering about the safety of VBAC for her - or better yet (in my opinion) - how she is going to convince a care provider that it is safe. I believe that one of the biggest issues for VBAmC is finding care provider support - especially if it is a woman's preference to deliver in the hospital setting. One may have the best luck finding support with home-birth midwives or birth centers - but what about those who need to/want to deliver in the hospital setting?

In short summary this article highlights the fact that of the 89 women who attempted a vaginal delivery out of 860 - all of who had 3 prior c-sections or more - none of those women experienced a uterine rupture. The article notes that it is a small sample size as it is difficult for women to try or "be allowed" to try a VBAmC.

Overall - there is a positive tone and it appears that VBAmC is being looked at more closely. I hope that this conference in March will provide fair, insightful, and continued overall positive change towards the VBAC movement.

Let me just conclude this by saying that I believe if the mother has looked at her options, knows her risks vs. benefits and believe that a VBAmC is for her, then by all means, she should pursue it and believe in herself. Like I stated above, the challenge for her is finding a supportive care provider willing to stand alongside her.

Sunday, January 31, 2010

Being prepared matters

Just over a week ago I got a text message from a friend asking for prayers. His wife was being induced at 35 weeks due to low amniotic fluid.

My first thought?

Oh crap. She's gonna end up with a c-section. Yet another friend to "welcome" into the Sisterhood of the Scar.

Turns out, I was wrong. Even though she was induced at the hospital with the 3rd highest cesarean rate in the Twin Cities (30%), she escaped a surgical birth.

How did this happen?

I bumped into her at church this morning. She told me that she was freaked out when she knew she was headed for induction. She had the same thought I did, that she was probably going to end up with a cesarean. The chances were certainly good - a high risk situation, induction, a preemie on the way...

I think it was her preparation (and no doubt support of her husband and others) that made a huge difference. This was her second birth. Her first had been at the same hospital, but they were well-prepared the first time, too. They had taken Bradley classes and stayed home as long as possible during labor. She had a drug-free birth the first time around. That same mindset and preparation helped her avoid more interventions during her induction this time. She told me, "The only bummer was that I had to be in the bed the whole time [for monitoring, Pitocin, etc]. But I used having to go to the bathroom a lot as my excuse to get up often. So, I got the drug-free birth I wanted. Well, except for the Pitocin...."

My friend was prepared to meet the challenges of an unexpected, stressful birth because she knew from experience as well as from childbirth eduction that sometimes you have to work with what you've got. She knew that moving around is so important in labor. So, she used a little trick to work the system and get up as  much as she could. It wasn't a completely ideal situation, but she worked for the birth she wanted even despite the odds. 

Sunday, January 24, 2010

What to Say, How to Say It

I just wanted to ponder the issue that a lot of us at ICAN have run into. And that is -how to present/give birth advice in a way that people will listen, not be offended, not go in the wrong direction, and again - actually listen and take in what you have to say.

Let's face it - most of us are a part of ICAN because we have been affected by birth in one way or another. (If you just happen upon this blog or are passing by - welcome!). I also think that most of us find opportunities all of the time to inform others about birth. Some people ask for suggestions, and there are others who are just talking about their pregnancy or birth and we can't seem to keep our mouths shut - I mean - it would be a sin to withhold all of the information we have.

I ponder this topic because the last thing I want to do is turn someone off so much that they won't even listen to what I have to say. And I must say, my approach has changed a lot over the past couple of years. There was a time when I would just jump in and say things when my advice wasn't asked - ie) "Don't induce 1 week past your due date - inductions are horrible - let your baby stay in ." - to a 2nd time mom that had a vaginal birth her first time.

I'm still struggling with the right balance. Just recently I made it known, subtly, to someone I have to see daily, that I don't exactly agree with weekly cervical checks from 36 weeks on out. I'm kind of wishing I would have just kept my mouth shut. Yet, I know I've slowed down more, listened more, and have gotten better at trying to put information out there in a factual, somewhat non-biased sounding way. I really try to affirm actions and decisions that seem informed by mothers. I seek to encourage and uplift all mothers regardless of whether or not I agree with them. I have to remember that the last thing that I want any mother to feel is put down by what I say - because that is the opposite of what we are trying to do. Sometimes my passion for wanting the best for all mothers and babies is without inhibitions.

So, tell me - what is your best approach with pregnant mothers and birth advice? Or perhaps, share an instance that you regret and wish you could have approached differently. I'd love to hear people's tactics for giving information in a sensitive way - yet with the mission towards better birth in mind.

Saturday, January 9, 2010

Jamie's Breech Birth Story

On April 1, 2008, I found out that Baby (gender at the time was unknown) was breech.  Approaching 33 weeks pregnant, I was unafraid because I knew there was plenty of time for Baby to turn around.  For curiosity's sake, I posed a question in an online community, asking what typically happens if a woman goes into a hospital in labor with a breech presenting baby.  The answers I received were, to say the very least, shocking, eye-opening and frightening.  I had women point me in the direction of "Pushed" by Jennifer Block in which there is at least one story of a woman forced by court order to have a c-section against her wishes because her doctor thought it best for her particular situation.  The general reply I received from the women in their replies was that to refuse a c-section would be unwise since most all doctors nowadays are not taught the art of breech vaginal delivery.  Many were helpful, offering links to Gail Tully's "Spinning Babies" website, as well as ICAN.  I was told about the various techniques to help coax a breech baby to turn.  To be honest, I didn't follow any of the advice or techniques yet, Baby was once again head-down by April 7, 2008.

I didn't worry about it and, in fact, I went to that same online community and did a little online happy-dance and bragged that Baby had resumed a vertex position.  If I'd only known...Toward the end of my 37th week of pregnancy, May 5, 2008, I went in for my weekly appointment with my midwives at a large hospital in Minneapolis.  She laid hands on me and got a strange look on her face and said something about breech presentation.  She left the room and returned with a portable ultrasound machine.  I held my breath as the midwife spread the lovely goop on my belly.  BAM!  There was a little head pushing into my ribcage where there was supposed to be an ass.  I was not amused.  My midwife was going to schedule an external cephalic version (ECV) but by the time we were finished with my appointment, the scheduling office was closed.  She spent a lot of time with me showing me various positions to get in to to coax Baby to turn and gave me other tips as well; much along the same lines as what can be found on the Spinning Babies website.  She also made an appointment for me to have a moxibustion session later that week.  Moxibustion is a traditional Chinese medical practice that involves the burning of herbs to stimulate acupuncture points.  In pregnancy, the herbs are burned near the pinkie toe on the woman's foot.  When I finally did get in to have a session, it was just for the woman to show me how to do it myself at home.  I went to my mother's house and had her do it for me and it was quite surreal.  It certainly did get Baby moving around a whole lot but all that movement was a whole lot of nothing and Baby still remained breech.  The session did make for a neat video to add to the story!  I swear, it was like something out of the "Aliens" movie!  I wasn't able to get the supplies needed for the moxibustion until what turned out to be 2 days before I gave birth.  The session had been scheduled for the middle of my 38th week of pregnancy but the night before I was supposed to go in, I got a call from my surgeon's office saying a surgery I'd previously been turned down for due to my late stage of pregnancy, was back on.  So the moxibustion was canceled and instead I spent the better part of the day on an operating table getting my right hand sliced open for the second time during my pregnancy in order to repair a tendon injury.  Because of this surgery, I was unable to do the water therapy I'd wanted to try to get Baby to turn.  I did go to the pool on Mother's Day (I even got in for free!) but I had a splint on my hand and could not go underwater so it was all but pointless, at least from the point of view of someone attempting to get a breech baby to turn.

I had 2 versions performed during the last week and a half of my pregnancy.  The first one was at the hospital.  I went in early in the morning and was placed in a triage area of the maternity ward surrounded by other women in various stages of pregnancy.  I laid in the bed hooked up to an IV for fluids and a fetal heart rate monitor for about an hour and a half before they brought me into the ultrasound room with the OB who attempted the version.  The lights were kept low as a technician stood by and checked periodically with the goop-covered transducer to see if any progress was being made on Baby's position.  Let me tell you, if you think having a human kicking its way around in your uterus is a strange feeling, try having someone on the outside attempt to get that tiny human to move in a direction it does NOT want to go.  I walked around for days afterward feeling as though I'd been punched repeatedly in the stomach.  I left that day feeling sad and defeated.
 
That weekend I networked in a way I never had before.  I called my aunt who gave me the number to my other aunt who gave me the number to a home birth midwife that she had met through some group or other.  I called the midwife and left a voicemail, practically in tears, and let her know of my situation.  She called me back the next day and we talked some things over.  She said that she would gladly have me come to her house and she would make another attempt at a version.   It was a Monday morning when my boyfriend and I drove to her home in St. Paul.  I ran into a friend of mine in the lobby of her building and he got a kick out of my story behind being there in his building!  The midwife buzzed us in and when we walked into her apartment, I felt very welcomed.  Her kids were running around playing and were very respectful of the fact that Mommy was with a client.  They just kind of played off to the side while the midwife and her assistant laid hands on me while I was laying on a mat on her carpet.  She was very gentle and despite still feeling bruised from the hospital's attempted ECV, I didn't feel any pain.  The assistant listened with the fetoscope while the midwife worked.  She must have had her hands on me for 10-15 minutes before she finally gave up and let me know that this baby was wasn't going to turn.  She told me she was not going to charge me anything for the attempt, which was a welcomed silver lining amidst a sea of mucky grey.

She then offered to attend my birth at home.  The thought hadn't occurred to me, though I had been told that was about the only way to accomplish a vaginal breech delivery.  If I knew then what I know now, I would have jumped at the chance.  To be honest, that little voice in my head told me to have my birth with her and I really did want to despite knowing virtually nothing about home birth, especially considering my first birth was a stereotypical hospital birth with an epidural and a midwife I'd never before laid eyes on.  But I really knew I could trust this midwife.  However, after discussing it with my boyfriend and my mother (I'd be giving birth at her house if that's the route we took), they were not comfortable with the idea therefore the midwife was not comfortable since they were my support persons.

So there I was, 9 months pregnant and knowing I was going to have a c-section despite the fact that women have been birthing babies who present in all forms of presentations since the dawn of time.  It sounds extreme but it was like a death sentence for me, the c-section, I mean.  I had done everything I could think of to get Baby to turn.  I spent so much time inverted hanging off the end of my couch that upside-down began to look like right-side-up to me.  I talked to Baby so often that I thought for sure it would be born so sick of my voice that it would cry whenever I spoke.  I played music via headphones between my legs while holding a cold pack on baby's head near my rib cage.  I tried a heat pack in place of the head phones.  My best girlfriend had brought me her Ab Lounger that allowed me to get into an even better inverted position than I was able to accomplish on my couch.  I watched a lot of TV upside down with a cold pack on my ribs and a heat pack and headphones down below while I sang little songs to Baby about how it needed to go toward the sound and flip around for Mommy.
  
At 39 weeks exactly, I had my last midwife appointment.  My favorite midwife was there that day and she had no choice but to send in an OB who told me all of the scary stories about why my wanting to have a vaginal delivery could very well kill me and my baby.  She brought in copies of statistics and studies (I know now that this was excerpts from the Hannah Term Breech Trial that has since been proven to be so full of holes that it's almost laughable that a medical professional was showing them to me) and I read through them while listening to her and this little voice in my head was telling me to run very very far away.  But at that point, I didn't have a choice.  I'd called all the area hospitals and no one would accept me for a vaginal breech delivery.  A nurse at one hospital I called went so far as to lay into me about how unwise of a choice I was making by trying to have a vaginal breech delivery.  I think I simply hung up on her.  In general, I got the same tone from every place I called.

 I didn't give up trying to call to find a provider but I had no luck.  Finally I was at a coffee shop near my house writing up a new c-section birth plan when my favorite midwife from my hospital called me.  She said she'd just left a conference and met a perinatologist from a different hospital who wanted to meet me for a consult the following day.  She got his office on the phone via 3 way and I went to the consult the next day.

During the consult, I was told that in the practice of 15 doctors, 12 would be open and welcoming for my vaginal delivery, but that 3 would push strongly for a c-section.  He basically said that, while those 3 would push for the surgery, they were ALL more than trained and competent enough to do a vaginal delivery.  He made sure I knew the risks but made it clear that he felt those risks only really applied to women with larger babies and who had not given birth before.  He didn't warn me in a frightening way that the choice I was making was going to harm me or my baby.  He did say there was a risk, but also said there were many risks to c-sections and said that if there was such a thing, I was a perfect candidate for a breech vaginal delivery.  He did a quick ultrasound which showed Baby was 6 pounds even and he told me what to do when I was in labor.

I laugh now when I think of the conversation I had with him that day.  He said just in case I came in in labor to one of the 3 doctors that would push for surgery, to labor at home as long as possible and to only come in when I felt I was very far into labor.  Overall, he made me feel really calm.  Well, that was the calm before the storm I suppose, but I'll get to that later.

My labor had kind of started that Monday, when I was 39 weeks along.  Contractions were regular but they were 15-19 minutes apart, though slowly getting closer together.  I knew I wasn't going to make it to the end of the week.  I drank a few glasses of wine over the course of those few days before I had my consult with the perinatologist because even though I'd accepted that I had to have surgery, I almost knew I wasn't going to have to; the same little voice that told me a c-section was not the "right" thing for me also told me to have faith.  No sooner did I get home from the consult than my contractions started to pick up.  By 9pm that night they were 7 minutes apart and getting closer.  I got no sleep that night.  I'm not comfortable sharing the story of my labor that night because it's pretty much littered with personal drama, for lack of a better way to put it.  My boyfriend never really saw me in labor with our first daughter, not TRULY in labor.  With her, my water broke, we went to the hospital, got the epidural when contractions started and I pushed her out in 47 minutes, there was no primal woman in labor going on as there was with my breech baby.  With my breech baby, it was a lot more primal, I was listening to my body, I was having contractions to signify I was really in labor and labored at home as opposed to having waters break and immediately going to the hospital.  I was a lot more in touch with myself as a mom, and as a pregnant woman and I think I must have been like a complete stranger to him and he was not there for me in any sense.

By around 2pm the next day, I'd been up all night walking the sidewalk in front of my place.  Mike's mom came over that morning and had spent a good portion of the night talking to me on the phone.  I was living next door to my mom's house so my mom was there as well as my best friend.  Mike was at home right next door but I don't think I saw him until hours later when we were all getting ready to go to the hospital and, to be honest, I didn't care.  I was deliriously in love with being in labor; I can't think of a better way to describe it.  It was beautiful; everything I'd read about in Ina May Gaskin's books.  I felt so empowered and beautiful and I laughed through the (quite painful) contractions as I dropped to my knees to moo like a cow or blow raspberries.  During a late lunch, my mom and Mike's mom realized that my contractions were barely over a minute apart and they convinced me it was time to go to the hospital.  I agreed about half an hour after that; it was around 3 in the afternoon.

I don't remember a whole lot about the ride to the hospital aside from arguing with my mom for going over bumps in the road because it made my contractions unbearable.  Since I'd just switched practices the day before, I didn't have any idea where to go once I got to the hospital.  I tried calling 411 to get the number to the hospital but a woman in active labor strapped behind a seat belt, mooing like a cow and arguing with her mother does not lead to a successful phone call.  We just parked in the ER parking lot and were directed to the maternity ward.  The walk down the hallway and the ride in the elevator is a complete blur to me of leaning against walls and I think I may even have sat on the floor once or twice.  I was still laughing.  I feel like the perinatologist who did my consult really set my mind at ease and despite the fact that I was going to be giving birth in a hospital again, I felt at peace because I knew I was going to get the safe, vaginal breech birth I knew I and my baby deserved.

Of course, I wound up with a doctor who wanted to do a c-section.  I had a huge fight with the doctor and kicked him out of my room and said if he wouldn't do it, to find someone who would.  He left and came back 45 minutes later with what I love to call the "waiver of baby death" and said that while he was uncomfortable doing it, he was probably one of the most trained for breech delivery, having been in practice since the mid 70's when breech delivery was a normal thing.  During that 45 minutes that he was out of the room (and I was in the sterile maternity intake room hooked up to monitors laying flat on my back, of course), my labor all but stopped.  Mike was nowhere to be found because he'd found other more important things to tend to like locking his keys in the car outside the hospital.  My contractions became unbearably painful and according to my mom and Mike's mom, I was losing it completely; hyperventilating, crying, shaking, angry.  While I calmed down after he agreed to "allow" me my vaginal delivery (gee, how generous of him, right?), I never did regain that sense of peace and calm I'd had when laboring at home.  I think that's why I finally broke down at 7pm or so and got the epidural.  It wasn't really for the pain, which I was managing quite well again at that point.  I was more than afraid the doctor would find a "reason" to do the surgery and I did not want to risk there not being enough time and my having to use general anesthesia.

I basically gave up.  I don't blame myself for it, but I know I gave up.  I let him break my waters and I let him administer Pitocin.  I did have a LONG conversation with him about not wanting to have him perform an episiotomy during the pushing stage, that I knew my body could push Baby out without one and that if it came down to it, I'd rather tear along the path of least resistance.  Just shy of 2am, I felt that burning feeling and I knew from my previous birth that I was ready to push.  That's when it got crazy...I was wheeled in to the OR (I already knew I'd be giving birth in there, which was kind of frightening) and there I was, Mike was the only person allowed in the room, covered head to toe in a gown and mask, holding the video camera.  I don't remember exactly how many people were in the room but they had the doctor's surgical team and the NICU team in there with us.  I don't remember exactly how long it took to push her out but I know it had to have been less than 10 minutes because I had her out with the 3rd contraction.  After the 2nd contraction, he asked the nurse for the tool so he could do an episiotomy and I screamed out NOOOOOO.  He told me her heart rate was dropping and that he needed to get her out RIGHT AWAY.  Of course I went with it.  She was born at 2:04am on May 16th 2008.  Six pounds 3 ounces of perfection.  I was able to hold her immediately while he stitched me.

I left after she was 12 hours old, much against medical advice.  I knew I wasn't going to stay as long as they wanted me to but I left so soon because the pediatrician came in when she was around 10 hours old or so and before asking me how I or she was doing, he said he'd taken a look at my chart and saw that I was still nursing my 19 month old and that I should probably stop now that I had the new baby.  I barked at him about how the WHO recommends nursing for 2 years and as long as is mutually desired thereafter and that if I wanted parenting advice from him, I would have asked.  He checked her from head to toe and quickly left the room!

Fast forward to this past February, I got a copy of her medical records and mine as well.  I got her records to be able to get her social security card (she didn't get one in the hospital because she didn't have a name when we left).  I got my records just for curiosity's sake.  In both of our records, there is no mention of her ever having a problem with her heart rate and the only mention with the episiotomy is that tearing was likely.  In her records, it very clearly states that her fetal heart tones were reassuring throughout.  Her heart rate was never a problem, there was no need for the episiotomy, he gained my consent through lying to me before cutting me from my vagina down toward my anus.

All in all, I'm VERY happy that I was able to have my vaginal delivery.  But I very much feel as though my entire birth experience was a form of emotional, and at times, physical rape.  I can't watch a video of a woman giving birth, be it in a hospital or at home, without longing to be in labor with her again, to be able to have a do-over.  I cry a lot when I think about it.  I have a copy of "The Business of Being Born" from Netflix that's been in my possession for several months now that I've not been able to force myself to watch.  I'm afraid of everything flooding back to me again.  My little breechling is now 19 months old.  I wasn't able to begin facing my birth experience with her until about 4 months ago.  Sure, I've been "bragging" about it since I gave birth, but it wasn't until recently that I really allowed myself to feel the emotions.

Mike videotaped the birth.  I watched it for the first time a month or so ago and I was a crying mess just by halfway through it.  I got to the part where he cut the episiotomy and I heard the loud cry I made and it was like being on that hospital bed all over again.  He didn't wait long enough for the numbing medication to set in before he took the tool to me and I FELT my flesh being cut open.  I had blocked that out of my mind.  The time on the video after she was born, I look like someone else.  I don't see myself when I watch the video.  I was shaking from the epidural and perhaps the adrenaline pumping through my body.  I was completely detached from the entire situation.  Mike was off near the table where they'd brought her to weigh her and clean her off and I was listening to all the conversations around me and adding babbling sentences to other people's conversations.  I think the most telling part of the entire video and the entire story is that I didn't cry when she was born.  When they placed her in my arms it was like I was holding A baby but not MY baby.  I had no attachment to her whatsoever.  I continued to feel like that for the first month or so of her life.  I had this baby with her mouth on my nipple and I was changing her diapers and she was like this strange little alien that had just dropped from the sky and I was expected to take care of her.

Around the time she was able to start smiling and became more interactive with others around her, that's when I felt a bond and I *knew* she was mine and I felt that surge of love hormones.  Before that time, I was just going through the motions.  I knew she needed to eat so I offered my breast.  I changed her diapers and her clothes, I bathed her, she slept next to me at night and I did all of the other things a mother does for her child and that I did for my first daughter but for that first period, I didn't feel as though I was doing these things for my own child.  Knowing what I know now, I was in a state of shock after giving birth to her.  I don't see myself in the video or in pictures because the self I've come to know and love after 20-some years on this planet was not really present.  That "me" took a hike the moment the doctor came into the room and barked at me about how he would never take the kind of risk I was taking with his own child and he didn't understand why I would take it with mine.  While I am very much bonded with my daughter now, and have been since she was around 2 months old, I feel as though now that I'm finally facing my birth experience head on, ugliness and all, I'm finally getting to know myself again, the self that ran away and hid when I got to the hospital that day.

In September of 2009, I made a choice to finally go to college, having graduated from high school in 2000.  I think the reason I waited so long to go back to school is that I didn't know what I wanted to be when I grew up.  Now I know I want to be a midwife.  As of January 11, 2010, I will be attending classes to gain the general education credits necessary to enroll in the nursing program.  The next step after becoming a nurse is to complete the training to become a certified nurse midwife.  Through personal experience, I have found that there is a frighteningly MASSIVE amount of incorrect information out there for women who are pregnant, about to give birth, nursing a baby, a toddler and raising children in general. There are blanket statements passed around to women who, through no fault of their own, just don't know any better and believe that doctors (OBs and pediatricians specifically) are infallible. For a long time, I was one of those people. I felt that doctors were bound by their oath to "do no harm" and that if they'd gone to school for so long for their specific field, obviously they must be right.  My experiences over the years have taught me otherwise.  And I am grateful for those experiences and both of my daughters for the parts they have played.

Friday, January 8, 2010

Washington Post article on breech birth



The woman featured in this article who had two cesareans for breech and then went on to have a breech VBAC is an ICAN chapter leader!

Breech is near and dear to me since a young woman contacted our chapter a year and half ago desperate for help with finding an OB to deliver her breech baby. I was at a loss. I knew of none at that time, except for homebirth midwives, who would or could. To tell this woman I couldn’t help her prevent this cesarean was devastating and I will never forget it. Fortunately, she went on to deliver vaginally in a hospital.

When I heard Canada was reversing its policy on breech it gave me hope. If other countries are changing their policies on birth, we may someday too. Every woman should be prepared. Breech is not abnormal, it is just another way for a baby to come out. So because of this, I do have hope that the US will practice more evidence-based medicine with birth in the hospitals. That one day the VBAC rate will be over 50% and the c-section rate well under 20%. We will see healthier moms and healthier babies, we all know that. It starts with us, trusting our bodies and choosing a professional who does as well, and who is skilled in more than just the knife.


Next post: Jamie's Breech Birth story!

Thursday, January 7, 2010

Emergency Childbirth, or common sense?

This was forwarded to me by another midwife - advice for impromptu birth attendants, straight from the DOD. It would be wonderful if medical practitioners routinely followed this commonsense advice for safe birth! Notice there is no mention of checking for a Cesarean scar first...


Emergency Childbirth Reference Guide Posted at 01:18 AM on January 06, 2010

U.S. Department of Defense

Emergency Childbirth
A Reference Guide for Students
Medical Self-Help Training

Course Lesson No. 11
Emergency Childbirth: What To Do
1. Let nature be your best helper. Childbirth is a very natural act.
2. At first signs of labor assign the best qualified person to remain with mother.
3. Be calm; reassure mother.
4. Place mother and attendant in the most protected place in the shelter.
5. Keep children and others away.
6. Keep hands as clean as possible
7. Keep hands away from birth canal
8. See the baby breathes well.
9. Place the baby face down across the mother's abdomen.
10. Keep baby warm.
11. Wrap afterbirth with baby.
12. Keep baby with mother constantly.
13. Make mother as comfortable as possible.
14. Identify baby.

What Not To Do
1. DO NOT hurry.
2. DO NOT pull on baby, let baby be born naturally.
3. DO NOT pull on the cord, let the placenta (afterbirth) come naturally.
4. DO NOT cut and tie the cord until the baby AND the afterbirth have been delivered.
5. DO NOT give medication.
DO NOT HURRY - LET NATURE TAKE HER COURSE.

{emphasis is not mine - I copied this exactly as written}

This is how I approach attending VBAC as a traditional midwife and it works quite well - just ask the mothers!

Tuesday, January 5, 2010

Twin Cities Metro Cesarean/Vaginal Birth Rates

One of the latest things going around our birth advocacy community is the 2008 cesarean and vaginal birth rates for the Twin Cities metro hospitals. As many of us in ICAN have learned - it's important to consider these rates when giving birth. Just as it's important to consider your provider's individual numbers as well. I was kind of saddened to learn that Unity's c-section rate (where I had my cesarean) was on the low end. I guess I still kind of wish that my induction for pre-eclampsia would have worked out.


Those of us who have had a VBAC or are preparing for a VBAC are considering where to give birth. For those of us who decide that it will be hospital, these rates should be very helpful in deciding where to give birth. A friend of mine just became pregnant for the first time and who did she call right away? Me - and believe me, I do feel honored. She called me because ever since my baby #1 came I've been very vocal about birth - go figure. In just one night I got her thinking about midwifery care, and then after emailing her some information, I got her focused on the East Metro hospitals (minus United) instead of Abbott. All this before this handy little spreadsheet came out:





When looking at these numbers - it's important to consider the cesarean vs. vaginal birth rates. Obviously the higher the c-section rate - the more likely your chances are of having one. That is why it is important to know your provider's c-section rates, vaginal birth rates, VBAC success rates. The World Health Organization recommends a c-section rate no higher than 10-15% to keep the surgeries from doing more harm than good. Only one of our hospitals actually measures up to that - so that's a whole other post, but consider these rates and may you use it to ask questions of your providers, do research before deciding where you are going to birth. I had my VBAC at U of M Fairview, Riverside. They are on the higher end for the metro c-section rates, however, my midwife group had an 85-90% success rate for VBAC deliveries. That number was definitely a factor in helping me choose those particular providers. It all goes back to making an informed decision. Hopefully this will be another piece towards helping women make informed decisions.

Monday, January 4, 2010

Childbirth turns tragic, then joyful—a Christmas Miracle! or The Dangers of Epidurals?

Alarm bells went off when I read this amazing story of a mom and her baby miraculously coming back to life after “mysteriously” dying during childbirth. I knew there had be some reason her heart stopped (like all the drugs?!) I couldn’t find it though—the doctor kept on reiterating what a mystery it all was.

Well, turns out she was induced and had an epidural. So why wasn’t any of this mentioned in the media or by the doctors involved? Have these things become such a common part of birth that no one even thinks of them as unnatural? I am totally baffled and appalled.

Henci Goer explained how epidurals can cause cardiac arrest in a blog post this week:
Her Survival Was a “Christmas Miracle,” but the Disaster Was Man-Made


Every woman needs to know all the facts. When I voiced my concerns for the epidural to my OB, he patted my knee and said “of course you will have it!” The same way he patted my knee and said I would have a repeat c-section instead of a VBAC for any subsequent births……

My point to this is not that epidurals are across the board wrong or bad. They can be very helpful when someone is at their breaking point, too tired, too scared, or in my case pumped full or Cytotec and Pitocin and totally unable to handle the pain. Everyone should be able to decide if it is time. But we need to know the risks! We have a right to know the risks. We deserve to know that it isn’t a miracle cure that will make childbirth a piece of cake.

And maybe we should be really alarmed that a doctor made no mention of this when she said her patient's death was a mystery.

I am glad she and the baby survived, but as a birth activist, a VBACtivist, the end does not justify the means. Our experiences matter.