Twin Cities Hospital Cesarean Rates, 2010

Jill at The Unnecesarean recently posted a listing of Minnesota cesarean rates by hospital for 2010. This list is long, so below are the rates just for Twin Cities metro area hospitals.

Abbott: 37.1%
United: 34.9%
Fairview Southdale: 33%
Fairview University: 32.1%
Fairview Ridges: 31.5%
Maple Grove: 27.6%
Mercy: 27.2%
Unity: 25.4%
Woodwinds: 24.9%
St. Francis: 24.0%
Methodist: 24.0%
Regions: 23.5%
HCMC: 21.9%
North Memorial: 21.6%
St. John's: 20.9%
St. Joseph's: 13%

As these numbers show, only one hospital in the metro area has a cesarean rate that is within the World Health Organization's recommended safe range of 10-15% - St. Joseph's in St. Paul.  All other metro hospitals are well above that range.There are no real surprises in the hospitals that rank highest in cesarean births. Abbott, United, and Fairview Southdale have long vied with each other for the top three spots.

Evidence shows that choice of birthplace is a key factor in determining the kind of maternity care you get. These numbers should give you one piece of information to weigh when considering where you would choose to give birth in the metro, which should also shape who you choose as a care provider. For more information on choosing a birthplace, see ICAN's excellent white paper on the topic.

Also important to consider is whether or not the hospital(s) in your area support VBAC. Go to our local chapter's website for information on hospital VBAC policies in Minnesota.

Follow us on Twitter!

Ok. We admit it! As busy moms, it's hard for us to post on this blog frequently. So, we've joined the Twitterverse to keep you updated more regularly on important cesarean, VBAC and other birth topics. So, if you tweet, be sure to look us up and give us a follow: http://twitter.com/#!/ICANTwinCities

VBA2C twins-in the hospital!

It always makes my day when I run across a Birth Warrior in an unexpected environment. This one came via my son’s preschool teacher. I love amazing birth stories, and then VBAC birth stories are really fun to hear, but TWIN VBA2C? And she didn’t go through ICAN? I was beside myself.

I will share the link to her blog at the end of this post, but want to say that what I find amazing about us women is we all come in different shapes and sizes and wear different armor. Meaning this is one of those women who just did it, she just did it! She wanted it and it happened. There are women like that, and there are women like me who share and talk and preach and then put up photos and would even post a video. There are those who are so quiet, and those that are loud. Those that do it all alone, and those that are surrounded by people. What matters is that we do it the way we feel the safest and most supported, no matter where that is, and who is there. And that everyone around us believes in us.

This is how it should be here in the US. It isn’t though, without alot of fighting, demanding and preparing. In the meantime, we will keep working, and of course women will keep having babies.

So enjoy this birth story-and if you are a mama out there wanting a VBAC, or vaginal birth of twins or a breech baby, or don't want to end in cesarean unless truly necessary, it can happen!

Jessica's amazing birth story:

http://followart.blogspot.com/2011/10/buzz-that-never-fades.html

~Heather

WHAT TO EXPECT when you are a good little patient.....

Babble has a nice little "10 things every expecting woman should know" post, and the first one was to throw out your What to Expect book. I know I don’t need to say the whole name of the book because I am sure every one of you have it, probably from a baby shower, or coworker, or sister in law or whatever. It is like the Baby-Book-Bible. In fact, I received two copies-one from my sister and one from a free new-baby care package through my insurance company!

Looking back, it is no wonder I walked into my medicalized birth that ended in a failed induction/c-section and never questioned it. It was, after all, all in The Book! Nowhere in that book does it say to get away from your OB and see midwife, do not get induced unless absolutely necessary (and what absolutely necessary even is or how to find out), question your OB, say no, believe in your body, and so on. Right? Or did I miss that? Maybe there were little things like explaining what a midwife is (thought I cannot remember reading this), or even avoiding an unnecessary induction. Maybe. But they didn’t tell me that the OB would order an unnecessary induction. They did not tell me that my body could birth and intervention should only be rarely used. They never, ever said to question any medical protocol at all, so it never occurred to me. They never mentioned any sort of difference between the medical model and midwifery model. If they did and I missed it, my apologies, but I certainly do not remember any. That book helped to support my basic unquestioning belief that there was one right way to have a baby-in a hospital with lots of machines and ORs, and that birth is scary and dangerous and thank goodness for modern medicine!! The only good thing I can say about it was there was a little paragraph about childbirth prep classes and they mentioned Bradley. I ended up buying a Bradley book in my ninth month (too late), and then took a Bradley class for my next birth, my VBAC.

So anyway, Babble has a funny post about the book, and also the 10 tips for first time moms. The tips are good, though I would also add DO NOT WATCH A BABY STORY or any of those TV shows, and to take a long, comprehensive birth class like Lamaze or Bradley. And to ask someone from ICAN if they were to do it all over again, who would they have catch their first baby…..

The Babble posts:

Pregnancy Tips for First-Time Moms

10 things every expecting woman should know

Reason #482 Why You Should Throw “What To Expect When You’re Expecting” Out The Window

This title is my favorite and sums it all up perfectly:

What To Expect When You’re Expecting AKA Call The Doctor, Your Whole Family Is Dying

I always tell people to throw that book out too, and get one or all of the many other fabulous books out there—Ina Mays Guide to Childbirth, Henci Goer’s The Thinking Woman’s Guide to a Better Birth, and so on. I have often complained to the bookstore when I see their huge section devoted to the What to Expect franchise and really nothing of any quality otherwise (they look at me like I am insane). Helping women to have an empowered birth is still a steep uphill battle, but well-worth the fight!

My Journey to Homebirth

Birth story of Gregory Patrick

HBAC (Home Birth After Cesarean) on 01/13/2011

by Heather Deatrick

How I ended up having a homebirth is truly amazing, as it is nothing I ever would have considered before, before I knew things about birth. Homebirth was something I had never even HEARD of, much less considered. Homebirth was something you had accidentally, when you couldn't get to the hospital in time, because after all, the hospital is THE SAFEST place to have a baby.

So the birth of GP starts with the birth of Earl, in March 2003, who was born by “emergency cesarean section.” A day that changed my life in more ways than I could ever had guessed! When I unexpectedly became pregnant with him, I stayed with the OB I had just seen for the 1st time, thinking he is a fancy Edina OB and I will be in the best of hands. I had absolutely no idea about the birth culture in the US. I had heard of midwives and had always planned on using them, but there was something very seductive about a fancy, busy OB clinic in Edina. Ok, I lost all my common sense. It happens to the best of us!

Even though I had a regular OB, I still wanted a natural birth. I came across Bradley (too late-in my 9th month) and had some ideas about things. I had heard to avoid an induction, but how was I to say no for being overdue? My OB said the baby could die after 42 weeks and there was no choice. It never crossed my mind to look further into it. I was induced at 41.3 weeks (why wait for 42 weeks when my OB is on his rotation at the hospital that day!), with Cytotec the night before (without my knowledge or consent-I was only told it was a cervix ripener), and then after a horrendous night of what I believed to be labor coincidentally starting on its own (and the subsequent epidural that I really didn’t want but I just couldn't handle the labor anymore without), Pitocin at 7am. I went to the OR for the section at 12.45 PM. There was no doubt it was needed at that point as Earl was having pretty major decels with each contraction. I remember so clearly my OB demonstrating how the heart rate went down when the Pit went up, and how he hadn't descended at all and yadda yadda yadda. I was just glad it was almost over and couldn't wait to meet my sweet little boy, provided I survived the surgery. I still remember so well when they took him out, showed him to me (after wrapping him and suctioning etc) and then putting him in the warmer and wheeling him off, with my husband in tow, leaving me to think about things like bleeding to death and my baby not being held. It would be at least two hours until I finally got to hold him, but to be honest I don’t think I could have much earlier.

Fast forward 4 years and husband #2. I knew I wanted a VBAC, and I knew it wouldn't be with my former OB who was not so interested in my baby, my birth or me when I asked about VBAC and he patted my knee condescendingly and said “of course not--you will just have another c-section now,” as though it were a bonus. Not to mention how he never even bothered to meet the baby he delivered that was in the waiting room with my sister. It was sad, but it was enlightening. I knew I had been so stupid then, but I didn't know just how stupid. I still didn’t know it was en entire system, the whole medical model that was failing us, not just an OB here and there.

So this time we went to Bradley classes, and it was there I really started to learn about birth. The instructor was a homebirth midwife and I remember thinking that was CRAZY, but by the end I was starting to feel the effects of the deconstruction and subsequent reconstruction of my knowledge and beliefs about birth (and she directed me to ICAN, so I will be eternally grateful to her for that).

In May, 2007, after 36 hours of labor (only eight of them in the hospital), and no epidural, I triumphantly gave birth vaginally with the assistance of a doula and hospital midwives, and my vigilant and amazing husband. The labor itself was long and hard, but compared to the Cytotec labor it was manageable. I just stayed focused on each contraction individually and knew it would end, and knew an epidural would lead me straight to the operating room. While it was truly so amazing, there were some things I didn't love, like no tub, continuous EFM, the hovering OB, the episiotomy that I wonder about sometimes. But since I never thought I would be so blessed to have this second child, I basked in the glory of this moment, thinking we were done.

Fast forward again three more years (two of those spent trying to conceive), and we are blessed once again with one more child! This time I knew what I wanted-a homebirth. I told my husband this, but that I also really wanted to take this journey with him and that we would both agree on where he was born. He agreed to consider all options and to do his own research and homework. We started with a certain OB in Hudson. I knew that if we were to have another hospital birth, it would only be with him. I assume his reputation is well known, but in a nutshell he believes in birth like no other OB, and has the power to let a VBACer have a water birth that a hospital CNM doesn't usually. My husband really liked him as well and we saw him until halfway through the pregnancy. We also toured one of the birth centers here. It was really nice, but my husband agreed with me--that if we do it there, we may as well do it at home. We then met with the homebirth midwives. I knew I wanted them all along, and when DH met them, he really liked them too. Also, the OB was so supportive and actually told them we were coming to meet them before we had! We are very lucky here in the Twin Cities to have so many options for birth.

So by week 24 we were set on having the baby at home. We did have an ultrasound and found out it would be another sweet little boy. It was a relief to know that there weren't any major abnormalities, but I was conflicted about doing it. I realize now that my journey to homebirth has been one of really understanding that there are no guarantees in birth, and that there can be things wrong with the baby, and I was OK growing a baby in a perfect state and then finding out and accepting whatever may be at the end. I had heard from a fellow ICAN member that maybe people who have homebirths are more accepting of death, not because it is more dangerous, but because we really do know all the real risks with birth. The risks they don’t tell you about with the OB’s (unless you want a VBAC, of course). I totally get now the saying “birth is as safe as life gets.” So we chose homebirth, because to me it was the safest and gentlest thing I could do for my baby and me. I found that I had no fear whatsoever of anything catastrophic happening-I do know it is a rare possibility, but I knew what we would do (we live 5 minutes from a hospital, where my first two were born), and what the odds were with different things. More importantly, we had our more realistic plan of what to do if labor stalls or stops progressing. In that case we would transfer to Hudson. To know that there was an OB and a hospital out there that wouldn't shame us for having a homebirth was a tremendous relief. Most important of them all was the relief I felt knowing that if the baby got stuck or something of that sort, I had the most skilled people I could have at a vaginal birth. There is no one I could trust more to get the baby out safely than my midwives!

With my second child, my VBAC, I went into labor just after 38 weeks. This was a great relief to me since I was “overdue” with my first. So when I hit 38 weeks with this baby (GP), I thought for sure I would go into labor at any time. I had such a feeling of all-knowing, of assurednss, that I should have KNOWN it wouldn't happen like that! Sure enough, week 39 and still no labor. Then week 40! I really started to psyche myself out in anticipation. I had alot of prodromal labor that last week, and each night I would think this would be the night. I really love how labor is so unpredictable and so its own thing. I love that it is bigger than I, than what we all know. That it is its own amazing mysterious thing in perfect harmony with the baby. Too bad the mama was tyring to outsmart it!

Finally, on a cold Tuesday night, I had fairly strong (but very manageable) contractions all night long. I awoke my husband at some point and told him to blow up the pool, but not fill it yet. I figured I was doing the work just to get to a 3cm, like last time, and had a day to go. So we prepared, but made no phone calls. We did keep Earl home from school. The contractions stopped in the morning, but this happened just like this with William so I was not alarmed, I sat on the birth ball all day. I did become alarmed when they didn't come back. AT ALL. I couldn't believe it. I was so confused. Was this another false start? I assumed my labor this time would be about half as long and at least half as intense. I even held out hope for an “orgasmic birth!”

I tucked in the boys and went to sleep. I was now hoping it didn't start again until I had some sleep since I had been up all night before. Once again, my brain messing it all up. But no, no good night sleep when it was time for the baby! At about midnight I was literally thrown out of bed by what was absolutely no doubt a very strong contraction. I had no time to feel tired or crabby as its strength overrode any of that! I stumbled down the stairs and told my husband to fill the pool as this was it! I then headed straight to the big bathtub. Once there I laid on my stomach, sort of on my hands and knees. I remember thinking I must tell my husband not to call anyone yet because we will have a long way to go, as it takes my babies a long time to descend down, and I hadn't even lost my plug or dropped or anything (hah). But instead all I could do was moan loudly through each contraction as he called my doula, the midwives and my mother. Oh well, I thought, they will know what to do and when to come.

Much to my relief, in less than an hour my doula was there. I vomited just as she arrived. This really surprised me because it was still so early and I only vomited last time when in transition! It was only afterward that she told me she thought I must be in transition-I had no idea! The pool was about ready then so we moved there. I wasn't in it very long before the midwives and the apprentice all showed up, and my mother to watch the kids. I was not able to pay too much notice to any of them however, as I really needed my doula and my husband to help me through each contraction. I seemed to be much louder this time, and each moan was very deep. I finally said that maybe I felt like I wanted to push, but it was so early (at this point I had been in labor for about two hours)! The midwives said they thought it sounded like maybe I was already and to do it if I felt I needed to! Wow, I was really caught off guard at this--at their trust in me, in my body knowing what it needed. I asked if they needed to check me and they said only if I wanted them to. I did not and started pushing.

With William I thought I was a pretty good pusher. I pushed him out in about 45 minutes. I assumed, once again wrongly, that this would be the case again. Instead I just couldn't seem to get a good position. I was in the water and couldn't seem to move from the position I was in due to the strength of the contractions. While it was a good position to get through them, it wasn't great for pushing. We tried this for a while-an hour maybe, and it was suggested that maybe I move to the bathroom and sit on the toilet. I did agree (though I did not want to) and we went in there. I did one contraction facing forward that was very very intense, and then another facing the wall. With that one the baby seemed to move to where he needed to be and we decided to head back to the water.

Once back in, I still felt as though I couldn't quite get him out and we talked about my bulging bag of waters. While I loved the idea of birthing him in his bag, I just didn't think I had the strength and I asked them to break it. They agreed but this is just not standard protocol for them, bless their hearts. Once it was broken they noted it was very thick and strong, and that the water was clear. It was at that point that I felt him start to crown. For some, the ring of fire may be scary or painful, but for me I love it-it means the best part is so so so close. I pushed with everything I had left and little by little he made his way down. Finally I felt his head come out and I so wanted to just finish it right there and push his body out, but the midwives told me to wait for the next contraction. Funny how until then they seemed on top of each other, then suddenly I had to wait for what seemed to be minutes!

Finally it came and I pushed him out. I remember trying to savor that moment, there is nothing like it--all that work, the intensity, the preparation and with a big swoosh he is free and there is this moment in time that is just magic. It is almost as though God is there with us, like I have felt the hand of God, of what a miracle life is and how amazing my body is to do this. Indescribable, really. I then heard the midwife tell us to pick him up because she couldn't reach him!! Both my husband and I reached down to pick him up from the bottom of the pool and he was fine of course, not having yet taken his first breath. I held him and he looked at me so calmly. I waited for the midwives to suction him, but they don’t do that! Instead they tickled his foot and helped us rub him and he started to make some sounds. He was so peaceful, even as he picked up steam and let out some good cries. He was perfect and handsome and peaceful. I wanted to just stay in that tub forever and hold him, still attached to me.

But it was time to get out, so we moved to the bed. Birthing the placenta was more painful than I had remembered with William, but I think I just wanted so much to be cozy in my own bed that I had little patience for any more pain. The midwives and doula took such good care of us all, and my oldest son cut the cord. I tore only a tiny bit, which was impressive since I had had a prior episiotomy and this baby was almost a pound bigger. I am sure that is because of the midwives skill. The care and attention I received from them was incredible-so much more than in the hospital. They were so gentle and attentive and made me eat and drink and pee and made sure my mother and husband and kids were all OK too. The midwives and doula did all this. An incredible experience, so unlike the hospital. It made it really easy for me to snuggle and bond with the brand new little baby that just made a really amazing journey. My doula managed to help him latch on within 15 minutes. What a joy, all in my own bed!

My closing thoughts are how natural this all seemed. It is very unfortunate that women don’t feel and are told they can't do this without assistance from modern technology, when in fact the technology just makes it worse, and even more painful in many cases, unless truly needed. Not to mention what a truly successful species we are, thanks to childbirth! I had no idea my body was so amazing and powerful. At one point in the labor I swear I could feel with me all the laboring women over thousands of years, telling me I can do this! Though I will admit It definitely was not orgasmic in any way, and while it was only 5 hours or so in length, it was much more intense than Williams. GP was also a pound bigger (though still just a peanut at 7lbs 6oz compared to so many women I know), so that may account for some of the intensity, not to mention one hour to transition, which maybe didn't give my body quite the time it could have used to prepare... maybe, maybe not. It is amazing how in such short time afterward I think I could do it again! Also, the midwives really hated breaking the water, being such non-interventionists, but I am very glad they did as I really think it moved things right along. It is pretty amazing to watch the video and see his head out, eyes open, mouth moving!

Birth is so primal, so incredible, so powerful, beautiful and scary too. I feel very fortunate to have been able to find out that my body works just fine and that I can even have a baby in my dining room! I wish that more women could experience this, as it truly is the most empowering thing I have ever done in my life, by far. I dream of a day when C-sections are once again only the amazing life-saving procedure they should be, and all women will get to experience their full and natural power, for them and their baby. If only women could be taught that birth is not a disaster waiting to happen while at the same time promising a perfect baby-it is all so unrealistic and wrong. Birth is normal but there are no guarantees, in anything of course. For me, having the baby at home was safest, for me and the baby. And to have my boys there, and even my mother (poor mom), and of course my husband, was a dream. It is really hard to believe that just over four years ago I truly believed my OB had saved my first baby’s life and “thank goodness for modern medicine and hospitals to make it all so safe;” to today when I know the studies and the mortality and morbidity rates for both moms and babies in the US say exactly the opposite.

Today GP is the happiest, calmest, most content child. People ask me if they think it was because of his birth and I say maybe, or maybe it is just being the third boy, or maybe it is just that sperm and egg combination, but I do think the birth has something to with it.

My fabulous labor team-DH and doula

I was a little loud for William

Moments after birth

Amazing midwives!

Earl cutting the cord

A very happy family!

Thank you ICAN and my ICAN sisters Sarah, Kara and Chandra, midwives Emme and Clare, apprentice Janine, doula Veronica, Mom, DH Greg, kids Earl and William, and of course Gregory Patrick.

I am truly blessed.

The Scar

First of all, be forewarned - this post has pictures of my actual scar, but I don't think it will be a problem for two reasons 1) I happen to have an external vertical scar, and 2) I think most women who are a part of ICAN are open and sensitive enough to view these types of images.

I've been thinking a lot lately about my external scar - mostly because next week I am going on a trip to Aruba with my husband and brother and sister-in-law (yea me!). And to be honest, I'm kind of excited to wear a bikini (yep, I'm going to) and proud to as a matter of fact. You see, there was a time when I was quite embarrassed by this scar. Not so much because of how it looked, but because of how it got there.

My son's birth was an emergency cesarean under general anesthesia. Apparently you can save time doing the section by making a vertical incision on the outside of your body, yet still making the low-horizontal cut on your actual uterus. I didn't have to have that vertical incision if people weren't putzing around at my hospital. I remember that the doctor came in and told me at 2:45pm that we were going to do a c-section because my son was having repeated late decelerations of his heartrate during my medically necessary induction (and I do feel my induction was medically necessary). Ok, fine, section me. But who knows what was going on, and all of a sudden it's 3:30pm, and instead of a somewhat planned and calm c-section, it is mad chaos - thus my vertical scar. Apparently my son's heartrate went to 60 beats/minute and stayed there. It took the physician 2 minutes from that first cut to get him out.

How I wish I had an initial picture with my 25 staples covering my incision.


My scar used to conjure the emotion of embarrassment. Who has a vertical c-section incision? No one I know. And who has one THIS thick??!! And at the time of my c-section, I didn't know anyone who had a failed induction such as I. I didn't know anyone who was so helpless after birth and who had struggled - and again - failed - to get their child to breastfeed. This scar represented for so long, all of the failures of that birth and the consequences that came with having a cesarean birth.

While I do give that OB credit as she made statements afterwards such as "I had to give you a chance at a vaginal birth", and "Oh, yes, you can have a VBAC next time, I cut your uterus the right way" (one of my first thoughts upon viewing my incision was that I was doomed for future vaginal births due to the vertical incision), however, she did say one thing that I totally disagree with. She said, "Actually with a vertical incision your stomach will be flatter than those who've had a horizontal incision" (I'm not seeing that difference) and "You will never be able to wear a bikini again" - well, stuff it, because I am! Because, I am not embarrassed by its external appearance.

And not only am I not embarrassed by how it looks, I no longer have this feeling about the experience that gave me that scar. In fact, I actually embrace that scar. Had it not been for that cut, I would not be who I am today. Even if I had not gone on to have a successful VBAC, I still believe that I would be grateful for my cesarean for all it has taught me about birth, women, and myself. It is no longer a painful reminder of a traumatic birth, but more of a revelation of who I've become and what I've learned.

In fact, I love what this scar has done to my life. And whether I like it or not, it is how my lovely son came into the world.

I know that some people will never be able to feel like I do about my scar, and that's ok. This is just my story - and I cannot believe it's my story. 4 years ago, I never would have imagined that I'd be feeling this way. Hopefully someday we can all embrace our scars: physical, emotional, spirtual, intellectual - in one way or another.

Here it is again, while I was 37 weeks pregnant with my VBAC baby (who came at 38 weeks).

*Photo credit to Studio Laguna photography, www.stulagu.com