ICAN Twin Cities Blog

New Year's Babies

2012-01-01T18:35:00.000-08:00

Every New Year's Day I brace myself for the onslaught of stories about the year's first newborns. It so often seems that most are born by cesarean just after the clock strikes midnight. But this year, two stories stand out and give me hope.

In Louisville, KY:

“I didn’t plan it that way,” Ashbaugh said from her bed at the downtown hospital. “I was paying attention to pushing and getting her out.”

Norton officials could not recall the last time a birth other than a cesarean section delivery took place so close to the start of a new year, spokesman Steve Menaugh said.

In 27 years at the hospital downtown, labor and delivery nurse Lynne Young said Sophia’s arrival was the first she could recall taking place just after midnight.

And even more amazing, a couple refuses a cesarean for their twins in Middletown, CT:

Bredwood delivered twins at 7:39 Sunday morning — a boy and a girl. Technincally, the couple’s newborn son M’ale was first, followed six minutes later by his sister, M’layah.

Aadil did most of the talking during the interview, as Faith was exhausted—the couple agreed to go natural for the births—no epidural or any other painkillers, and no Cesarean section, as doctors recommended.

Congratulations to all new mamas, papas, and babes this New Year! To any women recovering from cesarean, whether planned or not: thoughts of healing and peace to you. We are here if you need us!

Twin Cities Hospital Cesarean Rates, 2010

2011-12-21T14:40:00.000-08:00

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!

2011-12-08T19:00:00.000-08:00

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

Things We Wish We Could Say

2011-11-29T08:05:00.000-08:00

Even though I just spent 12 hours working an overnight shift in a Pediatric Emergency Room, I came home, looked on Facebook and read this post about "Things I Would Say To The Hospital Staff If I Saw Them Today" by The Feminist Breeder. I should have just gone to bed as I feel I've resolved a lot of my feelings about my first birth, but I felt there was a little extra insight worth sharing, so I had to stick my own comment in there. And then I got to thinking, I would love to hear the comments from my fellow Twin Cities ICANers. I've posted my comment below - and that is the short version. I would love to get even more detailed, but I think this will do for now. Would you please - if you have just a couple of minutes, share your own candid thoughts in our comment section on what you would like to say to staff (it can be GOOD or BAD) if you saw them today. I think we can all use a little reflection from time to time. And I personally always learn from each of the mothers I hear from.

Here is my comment:

"To the staff who was likely waiting until shift change: When I signed that cesarean consent after a 14 hour induction (that was necessary - I'm not denying that) that involved cytotec, pitocin, Magnesium sulfate, a 36w5d fetus, a puking mom, a mom whose liver enzymes were 1100, a broken bag of waters and repeated late heart decels - why in the HELL when I signed that consent at 2:15pm, was I still not taken back to the OR at 3:25pm? Why did you wait until he became bradycardic to the 60s and didn't recover? I already had an epidural that was supposed to be rebolused, but instead it became a dramatic end with people throwing me onto the OR table and an anesthesiologist telling me to take a deep breath into a mask and proceeding to knock me out. You had over an hour to prep me for surgery. As awful as my end of pregnancy was - it became even more of a nightmare when I missed my first child's birth and I didn't have to. I have always mourned that.

And to the two nurses who both told me that I would always need a c-section from here on out (without me even soliciting info on VBAC) because there is too much risk for mom and baby with that route (and apparently no risks for repeat c-sections) - I have always wanted to return to your workplace and tell you what happened with baby number 2. I always smiled and nodded, but in the back of my mind I was thinking - "Oh no - I AM going to have a VBAC." - and guess what - I did! And to the OB who did my section, even though I was overall not really impressed with you at prenatal appointments, thank you for reassuring me that even though you cut me vertically on the outside, that my uterus was cut horizontally and that I could for sure have a VBAC.

Oh - and when a mom says she is breastfeeding on admission - do not just stuff her 5lb 2oz baby with gobs of formula from a bottle. At least syringe feed the baby for crying out loud. You led to many tears, sadness, and a breastfeeding relationship that was ruined. Oh sure, I pumped tons of milk, but I could never get that baby to the breast - not when he was given bottles for the first 17 hours of life before seeing his mama, and then was told he couldn't attempt to breastfeed until mama was off the Mag (which I now know is not true).

Thanks to my midwife with Baby #2, husband, doula, and all of those who believed and supported me in my VBAC. I didn't realize how much my fears from baby #1 would play into this labor. But you kept me going, you stuck with me and that birth, and you made sure that the best outcome occurred for me and baby!"

VBA2C twins-in the hospital!

2011-11-10T12:41:00.000-08:00

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.....

2011-07-09T12:03:00.000-07:00

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

2011-04-25T20:09:00.000-07:00

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

2011-01-30T13:41:00.000-08:00

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

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

2010-11-22T20:01:00.000-08:00

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

Highlights of the 2010 Twin Cities Birth & Baby Expo

2010-11-21T18:19:00.000-08:00

Watch this video of highlights from the 2010 Twin Cities Birth & Baby Expo! Photos courtesy of Elizabeth Dahl Photography.

Large malpractice settlement following c-section!

2010-10-25T13:20:00.000-07:00

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 naïve, I know, but I really believed that I was safer with a trained OB and delivering in the biggest private maternity hospital in the state. It just didn’t dawn on me that overused technology is not a good thing in the case of normal, low risk birth. This boggled my brain. When I went to Bradley classes with my VBAC hopes when pregnant with my 2nd, I knew I needed to switch to a midwife (in a hospital setting), but still wasn’t sure about my body. I also was shocked but interested to learn that my instructor “caught babies” at home! Wow—I remember thinking how could this women know what to do in case something goes wrong? At home? This is nuts. Now fast forward to baby #3, and we are having him at home. And you know what? I feel safest there. I know that my midwives are better trained and have higher skills in vaginal birth and all its potentials for problems than most OB’s (who, in my opinion are one trick ponies as skilled surgeons). I know that should something catastrophic happen I am a few minutes from a hospital that can handle an emergency c-section (and I know I could get there in the same time they would prep me in the hospital), and I know that if I stall and just can’t finish at home we are blessed to have an OB here who believes in birth and will let me finish my labor without shame. This is the way it should be. Birth is as safe as life gets and midwives are incredibly skilled. I am so lucky to be able to have a baby where I feel safe, and know that if I need a c-section, it will be truly necessary. When I heard this story about this poor family, I thought, “and they say homebirth isn’t safe!” Hospitals have a whole set of problems that need to be fixed before they can start pointing fingers at homebirth. Finally, I will end with saying women matter! Our birth matters! The end does not justify the means, and often the means is killing us women. This needs to be talked about.

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

Presenting VBAC in a Positive and Non-threatening Light

2010-08-31T16:34:00.000-07:00

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!

ACOG and Less Restrictive Guidelines

2010-07-25T15:16:00.000-07:00

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.

Beautiful frank breech VBAC at home

2010-07-05T12:14:00.000-07:00

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.

Star Tribune Features Low-tech Birth & Midwives in MN

2010-06-12T12:21:00.000-07:00

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.

Good News for our MN Birth Centers

2010-05-26T16:45:00.000-07:00

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.

"The Real Risks of Cesareans"

2010-04-27T06:43:00.000-07:00

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. I "met" Pam through babycenter.com on the VBAC Support board. I've purused several message boards over there and I have to say, this one honestly did not have the little cat fights that go on in birth boards. It was full of sound women who either knew their stuff, or who were open to finding out about more on VBAC vs. RCS, and women who were open minded to whatever another one might decide.

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.

Awareness...

2010-04-24T18:05:00.000-07:00

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.

Minnesota Governer Proclaims April as Cesarean Awareness Month

2010-04-06T11:35:00.000-07:00

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."

Headed in a Better Direction?

2010-03-11T10:58:00.000-08:00

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.

Why Is VBAC a Vital Option?

2010-03-06T10:53:00.000-08:00

Why is VBAC a vital option? by Heather Deatrick and Jessie Bridgeford

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

Jessie: 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.

Jessie: Let me start by stating that I had a successful VBAC in January 2009. My c-section was in December 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.

Jessie: 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.

Three Birth Centers Opening in the Twin Cities!

2010-02-24T16:59:00.001-08:00

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!

Save the Date: "Laboring Under an Illusion"

2010-02-18T08:26:00.000-08:00

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.

More Hope for VBAmC

2010-02-14T10:51:00.000-08:00

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.

Being prepared matters

2010-01-31T11:15:00.000-08:00

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.

What to Say, How to Say It

2010-01-24T19:49:00.000-08:00

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.

My VBAC Birth Experience - sort of an analysis

2010-01-15T08:00:00.000-08:00

I wanted to end with the pictures, but since I'm having trouble moving things around, we'll just start with them.

Here I am on the continual monitors - hospital policy as we know it.

Laboring with the ball:

DH helping me:

Meeting our baby!

Happy just to be with Alex:

How to even start this post. . . . . . .I've wanted to do this for a long time - to further elaborate on not just the positive things about my VBAC, but about the not so positive things as well. You can read Alex's birth story in full on the ICAN website. Again, there are many positive things that occurred with her birth, but there are things that I wish could have been different. I almost feel like - geesh - just get over it - I got my VBAC, so what am I complaining about. Don't get me wrong - the goal was to have this baby vaginally and for that I am ever grateful, but I think my story can show how different fears, policies, etc can play into birth.

Let me start back at my 34 week appointment. That appointment was when I went over my birth plan with one of my favorite midwives in the practice. In my plan I wrote something like "I understand the need for continuous monitoring, and am fine with that if the telemetry monitors are available. If they are not, then I will consent to intermittent monitoring." The midwife commented that I really needed to be continuously monitored and I explained that if for some reason the tele monitors were unavailable, I didn't want to be stuck on a 7 foot cord or unable to labor in the tub. She assured me that those monitors are there and that I'd be able to use one. I again emphasized that if they weren't available I really didn't want to be stuck on a short cord. I tried to bring up some of the things that could be issues when it came to the birth so I wouldn't have to be uncomfortable fighting any battles when I was in labor and delivery. One thing I did appreciate at this appointment was that the midwife looked at my file and was like "Oh, you had your VBAC consult with the OB." (Yes, the lovely "consult" where they emphasize all of the horrible things that could happen in a VBAC and then you sign a form.) My midwife goes, "She said that she emphasized the importance of internal monitoring." And I was like "Yeah, she said if I came in labor, they would automatically break my water and place an internal monitor. I'm not letting anyone break my water for the sake of placing that and I will only allow internal monitoring if it really looks like my baby is having problems." And my midwife agreed and said "We don't place internal monitors unless there is a real reason." So, overall I felt good.

I think from here I'm just going to make a list of the good and bad of my VBAC experience:

Starting with the bad or not so good:

My labor started with my water breaking. . . . while I was in the middle of a night shift as a nurse. I was already sleep deprived from nights.

I seemed to have a lot of fears that I didn't realize. I did drive home after my water broke and I had contractions that were every 3-5 minutes lasting 45 seconds to 1 minute long. They were very tolerable. But, I kept worrying about the baby - and what if I spent a lot of time at home, only to learn it was struggling. I kept having this fear of what if the cord had rushed down when my water broke and the baby's head was on it (my mom had put that fear into me.)

My plan had been to have labor start with contractions and I would contact the midwives when I was ready to come in. But when it started wtih my water breaking, I knew I had to tell them the truth. I just wasn't comfortable fudging around with times. I would have felt like I was "lying." And of course when I called and told the midwife my water broke, she advised me to come in.

The hospital environment totally shut down my labor. As soon as I entered the hospital my contractions went to 10 minutes apart, when they had been 3-5 minutes apart for 4 hours.
The waterproof tele monitors weren't working, and I wasn't strong enough to refuse the external monitors. Had they been working I feel like I could have gotten farther into my labor without the epidural, but 5 hours with intense pitocin contractions and being at 4cm, and not able to get into the tub was hard.

With all of the cords attached to me it was hard to walk to the bathroom. I was drinking a lot of water, but when the pain got really bad I didn't want to walk. I think emptying my bladder might have helped me relax and dilate a little more on my own before accepting the epidural (and I instantly went from 4cm to 6cm right after the epidural and catheter in my bladder were placed - but that could have been a combo of things).
I knew that I was on somewhat of a timeline in the hospital. They weren't a strict 1cm an hour or anything. But once I had been at 2cm for 15 hours, I knew I had to accept pitocin, because I wasn't getting anywhere, and I don't think contractions would have increased in intensity - my body was not excited about birthing in a hospital.

I got an epidural. I had a lot of interventions.

Good:

Despite some of the undesireable things. I had a great midwife throughout my labor whose whole goal was to make sure my baby came out vaginally. She let me sit at 2cm for 15 hours from my water breaking without suggesting any interventions. I'm sure many OBs would have sectioned me by then.
She didn't freak out when I was having some high blood pressures on admission and labor (which were due partly from the nurses being around, because when they left, I'd take it again and they'd be better).

My doula explained that my midwife and the nurses were very reasonable in my scenario.

When I felt I needed the epidural, I really felt like it was an informed decision. I hadn't progressed past 4 cm in 3 hours (and prior to that I had been at 2cm for a total of 18 hours) and contractions were very tough (again - pitocin augmented) and I really felt I needed the epidural to relax. My midwife made sure they did everything possible to prevent a fast blood pressure drop, because it was the epidural that made my first baby go into distress. And you know - I really feel like the epidural did what it was actually supposed to do - allow me to relax so my cervix could open. My midwife checked me very shortly after it was placed and I was found to be 6 cm! I got a 2.5 hour nap after that. And after my nap all I had left was a rim of cervix.

No one was anxious about checking dilation. I was only checked when I asked.

When it came to pushing, no one checked me for 2 hours after I was found with only a rim of cervix because I had no urge to push. I finally asked to be checked around 7:30am, and the nurse got maybe two knuckles in, but was still like "Oh, you have time." I finally called the midwife in around 8am and she was like "The head is right there!" And got maybe 1 knuckle in. The epidural allowed me to labor the baby all the way down and I pushed for maybe two contractions.
I was given my baby immediately after birth and she stayed on my chest for almost an hour. No one weighed her, poked her, touched her, etc. It was so important that I get breastfeeding off to a good start as it went so horribly with Matthew.
I was awake for this baby's birth!

One thing that bothers me also is at my 6 week post-partum appointment, I was talking to the midwife who was at the delivery (she had just come on). And I told her how I was disappointed about not being able to try the tub and what would have happened if I would have refused the external monitors - as I was really worried about compromising the relationship between myself and the care providers. And she said "That would have been ok, we wouldn't have thought of you any different. We would have just had to hold a doppler to your stomach." I was kind of like - man, I should have refused.

You can look at this from so many different angles. There were many positives - and I did get a VBAC and I sincerely believe that my whole team was trying to help me in the best ways they knew possible. There are pros and cons about giving birth in the hospital. I've seen my VBAC from so many different perspectives and learn/think something new about it all the time

If my husband ever decides we can have one more, I want to seriously consider homebirth. I feel like if I would have had a homebirth this last time, I could have had my midwife come over, check fetal heart tones, assure me that all was ok, and I could have continued to labor in the peace of my own home.

I hope you all learned something from this or enjoyed it.

Jamie's Breech Birth Story

2010-01-09T21:35:00.000-08:00

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.

Washington Post article on breech birth

2010-01-08T12:20:00.000-08:00

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!

Emergency Childbirth, or common sense?

2010-01-07T07:34:00.000-08:00

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!

Twin Cities Metro Cesarean/Vaginal Birth Rates

2010-01-05T20:02:00.000-08:00

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.

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

2010-01-04T13:58:00.001-08:00

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.

Maple Grove's Opening Act? A C-Section

2009-12-31T14:30:00.000-08:00

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

WCCO reports:

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

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

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

According to the Star Tribune (emphasis added):

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

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

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

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

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

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

My First Birth Experience

2009-12-19T12:17:00.001-08:00

I promised in my first post that I would go over my two birth experiences on this blog. I know that both of my birth stories are posted on the ICAN website (Matthew by C-section and Alex by VBAC), but I'm hoping to give a more honest picture when I tell them here. Matthew's birth story is pretty raw and honest, because I mostly wrote it for myself, but Alex's - I knew family would see it too (since I posted it on my blog) so I wanted to stick with mostly the positives and not get too involved. As I mentioned before, I think it always helps to hear how other mom's have processed their births and what they have been through. I always learn from others' stories. Sometimes I am left shaking my head in extreme disbelief, and other times it is shaking my head in awe. Sometimes I shed tears, sometimes I literally will yell out a triumphant "Yes" or give a joyful fist pump. I'm sure you've all done that too.

Anyway. . . . . .Matthew's birth. My sweet little boy was due December 31st, 2006. I remember during my pregnancy that deep inside I was drawn to a childbirth without drugs. I really wanted to avoid pain medication. I think I got inspired to do this because I had a classmate (I was in nursing school at the time) who had her first two children via waterbirth at Woodwinds and then she went on to have Baby #3 in September of 2006 (a couple of months before Matthew was born) in the water as well. He ended up being 11 lbs, but came out easily. I saw a couple of OBs at a clinic that was near my house. I didn't put much thought into my choice. I remember thinking I should look for a midwife, but I was too busy working fulltime and going to nursing school. I'm not sure that different providers would have made a huge difference in this pregnancy.

Besides my lack of thought in a care provider, I personally did not take good care of myself during pregnancy. I mean - I did all right, but I ate a lot of fast food being that my job had me visiting a couple of different sites a day and being that I was going to school after work a couple of nights a week. I know I lacked for adequate water intake. I had at least a couple of cups of caffeine a day, and I just wasn't eating a balanced diet. Some pregnancies do just fine like this, but I definitely think it was a precursor to the pre-eclampsia I developed.

That brief background leads to my induction. I know a lot of us in ICAN have had unnecessary inductions for going post-due, they've been told their baby is getting too big, etc. I'm probably one of the few who truly believes (and has good reason to believe) that their induction was medically indicated. I not only had blood pressures that were 160s/90s - not too terrible, but I had liver enzymes that were ridiculously high - in the 1100s, and normal is 20-50. That would explain all of the itching and just general "I don't feel good" during my last week of pregnancy (the 36th week).

My induction was horrible. I was so embarrassed by what a medical fiasco it was turning out to be. It began shortly after midnight on December 8th with Cytotec and the beginning of my Mag Sulfate infusion. Magnesium Sulfate helps to prevent pre-eclampsia from becoming eclamptic (where you develop seizures). It is a central nervous system depressant. I vomited everything that was in me shortly after that drug was started. I would continue to vomit any time I was moved or aroused.

Fast forward to the next morning and Matthew had some heart decelerations around 9am when I sat up to vomit, but he got back on track shortly thereafter. At this point I'm sure they were cranking out the pictocin - or so I'm guessing as I started this adventure at 0cm and 60% effaced. I know that at noon I was still only 1cm. That's when the OB broke my water and I actually began to progress. I'd been having strong contractions apparently, but they were numbed due to the Mag Sulfate. I will always regret letting the nurse talk me into an epidural which got placed around 2pm or so. I really wasn't having pain, but I was worried about how incredibly weak I was from the Mag. I couldn't move at all - it was like my whole body already had an epidural - a light one though. It was the epidural that caused a huge change in Matthew's heart rate. He began having late decelerations with every contraction.

I'm pretty sure that his birth would have ended in a Cesarean anyway, but I wish I could have seen how far we'd have gotten without an epidural. The reason I think we would have had a c-section anyway is because the pathology report on my placenta showed areas of calcification, thus he was probably having some issues getting the full amount of oxygen he needed, and with all of the pictocin going in - he probably would have gotten stressed out from that too.

There are two things that I probably hang on to the most from Matthew's birth. 1) I missed his birth under general anesthesia and 2) Breastfeeding never worked out. I pumped lots of milk but I was unsuccessful in getting him to breastfeed.

Missing Matthew's birth didn't have to happen. The plan was to rebolus my epidural and take me to surgery. The heart decels were first noticed at 2:30pm. Of course things don't get moving super fast in hospitals (unless they are truly an emergency at that moment), so all of a sudden at 3:30pm (shift change) they notice that his heartrate went down to 60 beats/minute and was not recovering. I won't forget being thrown onto the OR table and having someone put a mask over my face and telling me to take deep breaths. I remember thinking "Crap, I'm going under, I'm going to miss his birth." Wow - as I write that now, it really brings back memories. It is painful to think about the fact that I was not there when he was born. Most mom's come out of the anesthesia fairly soon. But, being that I was still on the Mag Sulfate - and that I was actually "sick", I came to around 6pm and was in and out of it until about 8pm. You'll see a picture below of me "meeting" Matthew for the first time. That was around 8:30pm - 5 hours after he was born! And then he went to the nursery for the rest of the night where they fed him bottles. Granted - there was no way I could have taken care of him - I could not move my arms or legs until about 4am the next day and I was still very out of it. I'm not sure what they knocked me out with - but it sure was strong. Should anything like this ever happen again, my husband would insist on the baby staying with us or at least him regardless of my condition, and he would ensure the baby got fed an alternative way other than bottles. We didn't know any different - we thought there were only two ways to feed a baby - bottle or breast. In the morning of December 9th, I was feeling somewhat better and they brought Matthew to me and a pump. So they knew I planned on breastfeeding, but I think the nurses there also live by the philosophy - breast or bottle. Matthew was a late pre-term baby - he never should have been given bottles, he should have been finger fed, cup fed, syringe fed or something else. I was told that I couldn't try to nurse him until 24 hours after his birth since I was still on the Mag Sulfate and he shouldn't get that. That 24 hours was very damaging. I could never get him to latch on. And I knew nothing about alternative feeding methods. We went home and continued the cycle of attempting to breastfeed for 20 minutes, then pump, then bottle feed. I did pump and bottle feed for 4 months, but I was lucky enough to be able to bring Matthew to work with me - the downside was that I couldn't manage that whole pump, feed, clean parts, and get back to work routine. I just wanted to pop him on the breast and keep working (which I totally could have done with my daughter - VBAC breastfeeding baby).

I learned a lot from Matthew's birth. One thing that will forever impact any future pregnancies is the constant worry about pre-eclampsia. But, at least I know that I HAVE to eat, drink, and be healthy during my pregnancies. I feel like there are no free passes for me in that regards. Sometimes I wonder what would be worse - having a "wrongful" CPD diagnosis - some of you out there have experienced this - where the doctor tells you your pelvis is too small, or knowing that you've had pre-e before and it could come again - even earlier and thus lead to another c-section. Neither scenario is pretty. I think a lot of us mom's who've been through a Cesarean and are seeking or weighing the options of a VBAC beat ourselves up mentally or have a lot of mental/emotional hurdles to get through in order to have the best birth possible.

Oh - one other thing I remember that I wanted to mention - because no one understands this - is that I felt like I kind of had to work at getting to know/love Matthew right away. The whole disconnect and lack of immediate bonding really played into that. I tried to explain this to my husband once and he gave me this look of like "What are you talking about - what do you mean you didn't feel like you loved him." I stopped trying to explain right away. It was also challenging every time I'd try to breastfeed and Matthew was screaming at my breast - I'm sure he was like "Where is that thing that drips at a ridiculously fast rate into the back of my throat? I need that."

When all is said and done - three years later - I can honestly say that the painful parts of Matthew's birth have definitely faded. I will always be sad that I missed it and that we didn't have a breastfeeding relationship. While I was sad a lot about missing his birth, I really focused on holding him, loving him, and getting to know him since our initial bonding was taken away. I was blessed in return with a baby who was very easy going, smiled and laughed a lot. I actually find myself grateful for my c-section, because we need more people to advocate for better births in this country. I am so proud to be a part of this group! I am happy to advocate for VBACs, better births initially, breastfeeding success, etc.

So here are some pictures of Matthew's birth:

I can't believe I let Mike take this. I can't believe I'm trying to smile through all of that hell. This is about 10am - in-between vomits. No epidural yet, but I am out of it from the Mag. I've got the oxygen mask on because that was shortly after that first decel episode of Matthew's. I hated that thing too.

Here he is just born! I'm still proud of his first moments - just wish I would have been there. He was 5lb 2oz at 36weeks and 5 days. Born on a Friday at 3:35pm.

Here is my first meeting with him at around 8pm - almost 5 hours post-birth. I remember that it was just too much work to keep my eyes open. I remember my husband telling me to say something to Matthew, so I mustered up a weak "I love you", but I remember feeling like an idiot that my husband had to tell me to say something.

The next morning about 9am - ahhhh - our nursing relationship is being sabotaged. How I wish I would have known that even though I couldn't attempt actual feeding at the breast for 24 hours that there were other ways to feed him.

Matthew was born on Friday afternoon - here we are on Sunday afternoon. I wish I would have begged to leave that place then. I remember I just wanted to get out of there. We did leave Monday morning. I was lucky that despite how crazy and terrible the birth was - I had a fairly pain-free post-partum period (I remember my bout with mastitis at 1 1/2 weeks post-partum better than my surgery pain). However - part of why I think I label my post-partum period as "fairly pain-free" is that I was just trying to escape for what was a nightmare for me at the time. I really think I was able to kind of push the pain aside and mentally move past any physical pain because I didn't want any reminders of what was a very terrible thing for me.

Next time - I'll analyze my VBAC story a little more. While I was thrilled to have a VBAC - having one in the hospital definitely got in the way of things at times. More about that later!

Dads get post partum depression, too

2009-12-15T13:45:00.000-08:00

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

According to the article:

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

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

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

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

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

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

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

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

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

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

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

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

Click here for a list of local resources.

Introducing myself

2009-11-29T23:25:00.000-08:00

I am thrilled to be introducing myself as a blogger here for ICAN of the Twin Cities. I am so excited to be doing this for so many reasons. But before I get way off track already, let me tell you a little bit about myself.

My name is Jessie Bridgeford. I am a mama of two: Matthew, who will be 3 on December 8th and Alex (Alexandra) who will be 1 on January 13th. I've been married to my husband Mike for 6 1/2 years and we live in Blaine. I first graduated from Concordia University, St. Paul in 2001 with an Elementary Education degree and a minor in Confessional Lutheranism. I taught 5th grade for a year out of state and came back to MN and worked for a group home company for the next 5 years. In the meantime I went back to school and have been an RN now for 2 years! Somewhere in all of that I managed to have my two babies. I'm currently working as a Pediatric Float Nurse at the U of M Fairview Hospital. I love having the variety of the two Med/Surg Peds Units, the Peds BMT (Blood/Bone and Marrow Transplant)Unit, and the Peds ICU. However, I really want to be working over in the Birthplace, but the job market for RNs is currently very slow.

So - the reason I'm here. . . . . .after my son was born, about the second I was coherent again I knew I would do everything in my power to have a VBAC. Even though there were a lot of things I didn't know about birth during my first pregnancy, I knew enough to know that VBAC was an option if things "did not go as planned" with my first birth. And boy, did they ever not go as planned. You can read the long story here: http://www.icantwincities.org/ and then click on "Birth Stories" and "Matthew's Birth Story (Ceserean)". I think one of the worst things about Matthew's birth was the fact that I missed his birth and was under general anesthesia and having a severed nursing relationship due to lack of staff knowledge about breastfeeding and them giving him bottles for the first 24 hours of life (great way to transition a late pre-term baby to the breast ). I've definitely done my fair share of processing his birth and will save all of that for another post later on. One final introductory thought on his birth - I wouldn't be where I am today had I not had his birth experience. I think I would have still developed a strong interest and maybe even a passion for childbirth like I have now, but my mind may not have been opened in the way it is now - or coming from the point of view that it currently comes from.

You can read my daughter's birth story at the same link as above, just click on "Alex's Birth Story (VBAC)". I also have done lots of processing on her birth because it was definitely a less than ideal VBAC (in my mind anyway) and I went down the road of many interventions, and learned even more about what I need to birth the way I want and need to birth. I did have a VBAC with her, but there are definitely limitations to a hospital VBAC. But, at least I knew the interventions I was choosing, why I was choosing them, and what the risks/benefits were. Continued reflections on her birth is also another post in itself.

I know, at first anyway, that a lot of my posts might have to do with my own experiences. But, in my research and quest for a better birth, I found that hearing from women just like myself was helpful, therapeutic, and insightful. I hope that I can provide some of the same insight and inspiration for other mothers out there. I love to think that I have special insight into pre-eclampsia and high blood pressure in pregnancy. While I avoided pre-eclampsia with Alex, I did end up having post-partum hypertension that resolved by 6 weeks post-partum, but was a pain to deal with nonetheless.

All that being said - thanks for inviting me to be a part of this blog. Coments and thoughts are always welcome!

Welcome new bloggers!

2009-11-24T10:42:00.000-08:00

We welcome three new mamas to our roster of contributors:

Jessie Bridgeford - mother of two, most recently to Alex by VBAC
Chandra Fischer - mother of two, our fearless chapter librarian and founder of the chapter in 2005
Vanessa Coldwater - midwife, mama and "tub lady". Vanessa plans a regular "ask the midwife" column

Stay tuned for great posts to come from these ladies!
..

Post-partum Depression Study

2009-11-17T11:28:00.000-08:00

Opportunity to Participate in a Research Study on Postpartum Depression

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

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

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

ICAN Webinars: Home Birth After Cesarean

2009-11-09T17:27:00.000-08:00

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

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

Online support meetings are always free for everyone.

http://ican-online.org/webinars

NOVEMBER

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

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

* * *

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

CEUs available for childbirth professionals

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

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

You can view the full announcement by following this link:

http://ican-online.org/forum/index.php?topic=1945.0

Planning a VBAC

2009-11-04T12:48:00.001-08:00

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

Childcare is available for a $5 donation. Please RSVP to icantwincities@gmail.com

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

Birth & Baby Expo TOMORROW!

2009-10-09T18:33:00.000-07:00

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

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

Resources, products, services for healthy birth & parenting!

Presented by: ICAN of the Twin Cities

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

Exhibitors:

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

A Boring Birth?!? The UC of Isaiah Gideon

2009-10-06T21:19:00.000-07:00

by Martha Basham

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

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

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

A boring birth.

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

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

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

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

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

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

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

Mother-Sized Activism for VBAC!

2009-10-02T18:41:00.001-07:00

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

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

Photo credit: Birgit Amadori

Expo Exhibitors as of 9/17

2009-09-19T11:45:00.000-07:00

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

Celebrate healthy birth & parenting!

2009-09-10T19:25:00.001-07:00

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

What the Expo is all about:

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

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

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

What you can do:

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

Informative Birth Videos

2009-08-22T12:21:00.000-07:00

Cross-post from ICAN-Blog:

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

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

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

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

Reducing Infant Mortality from Debby Takikawa on Vimeo.

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

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

2009-08-22T12:19:00.000-07:00

Cross-post from ICAN-Blog:

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

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

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

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

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

Twin Cities Birth & Baby Expo - October 10th

2009-08-21T20:01:00.000-07:00

Only seven weeks to go until October 10th!

Twin Cities Birth & Baby Expo
Saturday, October 10th
10am-5pm
Midtown Global Market
Minneapolis, MN

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

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

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

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

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

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

VBAC Webinar

2009-08-15T18:16:00.000-07:00

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

Why is this Webinar Important?

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

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

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

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

Objectives

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

Content

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

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

* Why do VBACs have a bad reputation?

* Cesarean Section: Immediate & long term risks to mom

* Cesarean Section: Risks to newborn

* Cesarean Section: Risks to future pregnancies

* Benefits of cesarean section

* Case study of a hospital VBAC ban

* VBAC success factors

* The marketing of "risk"

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

* Uterine Rupture: An overview

* VBAC: Risks to baby

* VBAC: Risks to mom

* Benefits of spontaneous vaginal birth

* The risks & benefits of hospital vs. home vbac

* How to select a truly supportive care provider

* Coping with unsupportive friends & family

* Reading list & learning more

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

Click here for more information.

What I Love About My Cesarean

2009-07-28T21:04:00.000-07:00

Cross-post from ICAN Blog:

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

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

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

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

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

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

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

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

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

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

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

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

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

Pitocin: A Cautionary Tale

2009-07-11T18:33:00.000-07:00

Cross-post from ICAN blog:

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

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

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

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

Respectful Cesarean?

2009-07-08T11:23:00.000-07:00

"Yeah, right."

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

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

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

Prevent Cesarean Surgery video

2009-07-01T10:45:00.000-07:00

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

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

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

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

Home birth featured on local TV news

2009-06-30T19:36:00.000-07:00

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

Read/watch the story here.

Cesarean Prevention Webinar

2009-06-22T18:13:00.000-07:00

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

http://ican-online.org/none/ican-birth-class-cesarean-prevention

ICAN Birth Class: Cesarean Prevention
NEW Online Webinar

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

This 2-hour online session will help you learn:

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

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

$20.00 fee benefits ICAN - click here to register:
https://www2.gotomeeting.com/register/999201490

Empowered Birth After Cesarean (EBAC)

2009-06-04T08:53:00.000-07:00

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

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

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

Postpartum phone support

2009-06-01T13:29:00.000-07:00

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

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

See this link for details. http://postpartum.net/info-sessions/

Great photography for cheap!

2009-05-13T20:41:00.000-07:00

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

Here are the details:

Date: Saturday, June 6th

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

Location: Minneapolis Sculpture Garden (rain or shine!)

Email us to sign up for a time slot: icantwincities@gmail.com

Cesarean Awareness Month

2009-04-07T19:08:00.001-07:00

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

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

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

2009-03-18T20:50:00.000-07:00

For Immediate Release

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

1. A “de facto” ban means that surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.
2. http://www.childbirthconnection.org/article.asp?ck=10210#bottom Best Evidence: VBAC or Repeat C‐Section, Childbirth Connection
3. Mercer et al, Labor Outcome With Repeated Trials of Labor Am J Obstet Gynecol 2008;VOL. 111, NO. 2, PART 1 Silver et al, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries, Am J Obstet Gynecol 2006; VOL.107, NO. 6
4. http://www.childbirthconnection.org/article.asp?ck=10575 Evidence‐Based Maternity Care: What It Is and What It Can Achieve

Two VBAC bills in Minnesota Senate

2009-03-12T17:30:00.000-07:00

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

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

1.1A bill for an act

1.2relating to health; regulating hospital policies on cesarean section under certain
1.3circumstances;proposing coding for new law in Minnesota Statutes, chapter 144.
1.4BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.5 Section 1. [144.566] VAGINAL BIRTH AFTER CESAREAN SECTION.
1.6A hospital licensed under sections 144.50 to 144.56 must not prohibit a pregnant
1.7woman from choosing a vaginal birth solely because the woman has previously undergone
1.8delivery by cesarean section.

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

1.1A bill for an act

1.2relating to health; prohibiting an individual health plan from refusing to issue
1.3coverage because of a previous cesarean delivery;amending Minnesota Statutes
1.42008, section 62A.65, subdivision 4.
1.5BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.6 Section 1. Minnesota Statutes 2008, section 62A.65, subdivision 4, is amended to read:
1.7 Subd. 4. Gender rating prohibited. (a) No individual health plan offered, sold,
1.8issued, or renewed to a Minnesota resident may determine the premium rate or any other
1.9underwriting decision, including initial issuance, through a method that is in any way
1.10based upon the gender of any person covered or to be covered under the health plan. This
1.11subdivision prohibits the use of marital status or generalized differences in expected costs
1.12between principal insureds and their spouses.
1.13(b) No health carrier may refuse to initially offer, sell, or issue an individual health
1.14plan to a Minnesota resident solely on the basis that the individual had a previous cesarean
1.15delivery.

Cesaren Voices on KFAI - Sunday March 8th!

2009-03-05T19:35:00.000-08:00

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

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

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

Access to VBAC is Shrinking

2009-02-22T07:52:00.000-08:00

Feb 19 2009

New Survey Shows Shrinking Options for Women with Prior Cesarean

Bans on Vaginal Birth Force Women into Unnecessary Surgery

For Immediate Release

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

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

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

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

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

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

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

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

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

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

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

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

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

________________________

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

(2) http://www.childbirthconnection.org/article.asp?ck=10210#bottom Best Evidence: VBAC or Repeat C-Section, Childbirth Connection

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

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

TIME: The Trouble with Repeat Cesareans

2009-02-19T19:14:00.000-08:00

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

The Trouble With Repeat Cesareans

By Pamela Paul Thursday, Feb. 19, 2009

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

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

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

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

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

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

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

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

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

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

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

ACOG under question by an insider

2009-02-13T11:23:00.000-08:00

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

See you March 9th at St Joes or Regions!

Heather

***************************************************************************************

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

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

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

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

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

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

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

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

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

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

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

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

REFERENCES

American Medical Association (AMA). (2008). Resolutions. Retrieved November 1, 2008, from http://www.ama-assn.org/ama1/pub/upload/mm/38/a08resolutions.pdf
Block, J. (2008, July 9). Big medicine's blowback on home births. Los Angeles Times. Retrieved October 29, 2008, from http://www.latimes.com/news/opinion/commentary/la-oe-block9-2008jul09,0,3357453.story
Hale, R. A. (2008, September). ACOG's positions advocated at AMA meeting. ACOG Today, p. 2.
Janssen, P. A., Lee, S. K., Ryan, E. M., Etches, D. J., Farqukarson, D. F., Peacock, D., et al. (2002). Outcomes of planned home births versus planned hospital birth after regulation of midwifery in British Columbia. Canadian Medical Association Journal, 166, 315-323.
print_JCIT('TYPE=JCIT&BIBID=BIB4&SNM=Janssen&SNM=Lee&SNM=Ryan&SNM=Etches&SNM=Farqukarson&SNM=Peacock&FNM=P. A.&FNM=S. K.&FNM=E. M.&FNM=D. J.&FNM=D. F.&FNM=D.&ATL=Outcomes of planned home births versus planned hospital birth after regulation of midwifery in British Columbia&JTL=Canadian Medical Association Journal&PYR=2002&VID=166&PPF=315');
Links
National Perinatal Association (NPA). (2008). Position paper: Choice of birth setting. Retrieved October 16, 2008, from http://nationalperinatal.org/

Let's read again Dr. Wagner's critique of ACOG's VBAC recommendations

2009-02-10T11:29:00.000-08:00

Today, Sarah was shamed on her blog by a physician’s assistant for having an HBAC. Today, I read a nurse defend St. Joe's VBAC ban policy by saying it would be impossible for them to defend themselves against litigation because of ACOG's recommendations. Last night, I watched again Orgasmic Birth and saw what birth can, and should be. Today, I read the most amazing VBAC story from a woman we didn’t even know we were helping. In theory, most people agree that the c-section rate is too high, but as to why it continues to climb, well, I see alot of blame, and alot of reasons, and alot of excuses. But in the end, it is the doctors performing the c-sections and the doctors wanting more c-sections, and they all point to ACOG as to why they must.

As we prepare to march for better birth, and think about VBAC bans, such as the one at St. Joe's, I think it would be good to read this again. From Midwifery Today:

What Every Midwife Should Know About ACOG and VBAC: Critique of ACOG Practice Bulletin No. 5, July 1999, “Vaginal Birth After Previous Cesarean Section”
by Marsden Wagner, MD, MSPH
[Editor's Note: To order copies of this practice bulletin (ISSN 1099-3630), contact:
The American College of Obstetricians and Gynecologists409 12th Street, SWP.O. Box 96920Washington, DC 20090-6920]

Problems With Final RecommendationsProblems With the First Recommendation in Level C: “Because uterine rupture may be catastrophic, VBAC [vaginal birth after cesarean] should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”
The first problem with this recommendation is that of the eight final recommendations, it is this one which has the largest impact on maternity care in the United States. Yet by the American College of Obstetricians and Gynecologists' (ACOG) own admission, there is no evidence to back up this recommendation. This is of course the reason this recommendation has been placed in Level C, thus making it ACOG's confession that since there are no data, ACOG will simply have to go on the basis of “expert opinion.” This is a sad regression to the days of “Trust me, I'm a doctor”—in spite of the new direction of medical care to evidence-based practice.
This is not the first time ACOG has been willing to make recommendations without any evidence base. For example, ACOG's written statement that homebirth is not safe also doesn't try to reference any data and flies in the face of overwhelming scientific evidence that planned homebirth and planned birth in an out-of-hospital freestanding birth center are perfectly safe options for the great majority of pregnant women.
So this recommendation—“VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available”— has no data to support it, no studies showing improvements in maternal mortality or perinatal mortality related to the characteristics of institutions or availability of physicians. What ACOG doesn't say is that one study included in their reference list in their document compared VBAC and repeat cesarean section in three types of hospitals—community, regional and tertiary care—and while community and regional hospitals had more repeat cesarean sections and more failed VBAC, no difference in mortality rates for these two procedures by type of institution is reported1. This study suggests the ACOG recommendation is scientifically unfounded.
The second problem with the recommendation “VBAC should be attempted in institutions…” is that it is based on an unproven assumption: Cesarean section can be accomplished faster if the labor takes place at a tertiary care hospital. ACOG presents no data in support of this assumption.
On the other hand, out-of-hospital birth has been shown scientifically to be safe when attended by midwives who, when necessary, can be in close contact with a hospital capable of emergency cesarean section. This is why homebirth and freestanding birth centers have been proved safe in those places in the United States with good communication and respect between home and hospital. The midwife can telephone the hospital and describe the emergency, and while the woman is in transport, the hospital staff is preparing, scrubbing in, etc.
How long does it take to do a cesarean section if the labor is in a tertiary care hospital in the United States? While ACOG has recommended in the past that the "decision to incision" time be no more than 30 minutes, in one study at a university hospital in the United States2, 52 percent of the emergency cesarean sections for fetal distress had a decision to incision time that exceeded 30 minutes.
One reason for this delay is that in the United States it is not the laboring woman who is in transport, it is the absent doctor who is in transport, the doctor who has been trying to monitor the labor in the hospital by telephone. The ACOG recommendation “to have a physician immediately available” is in reality a criticism of the U.S. system, in which the laboring woman's doctor is usually not available and must be called to come in.
The elegant solution is not to take away valid choices for childbirth from the woman and her family but to change the system. Rather than insisting that the woman having a VBAC be transported at the beginning of labor to a big hospital that is away from her primary caregiver, her family, her friends and familiar community, instead do what is done in the other highly industrialized countries with maternal and perinatal mortality rates lower than ours: Develop a system in the United States in which there is close communication during childbirth between primary care in the community—home, birth center, small hospital—and the big hospital so that when the woman in labor needs to be transported, the decision to incision time is no greater than if the same woman were laboring in the big hospital and needed to be transported from the delivery suite to the surgical suite for a cesarean section.
A third problem with the recommendation “VBAC should be attempted in institutions…” is that it is aimed entirely at the treatment of uterine rupture and not at the prevention of uterine rupture. The increasing rate of uterine rupture in the United States during the past decade has been alarming, which rightly concerns ACOG. But ACOG's solution is analogous to responding to an increasing rate of drowning at a summer camp by placing some life rings out in the lake rather than teaching children how to swim better.
Attempts have been made to identify risk factors for uterine rupture, but the focus has been on maternal factors such as number and type of uterine scars. There has been insufficient attention in the obstetric literature or by ACOG to any relationship between the management of the VBAC and uterine rupture. The key issue here is pharmacological induction of labor with VBAC, which leads us to look at another final recommendation.Problems With the Second Recommendation in Level B: “Use of oxytocin or prostaglandin gel for VBAC requires close patient monitoring.”
After delaying for years while Cytotec induction spread like wildfire in the United States—resulting in thousands of VBAC Cytotec inductions, which led to hundreds of uterine ruptures and dozens of dead newborns—ACOG finally closed the barn door on Cytotec induction of VBAC, but only after research showed a rate of uterine rupture with Cytotec induction of VBAC 28 times higher than the rate of VBAC uterine rupture without Cytotec induction3.
But the ACOG recommendation on VBAC under review here does not shut the barn door on the use of other pharmacological agents to induce VBAC, as this recommendation (under Level B, meaning based on limited or inconsistent scientific evidence) states: “Use of oxytocin or prostaglandin gel for VBAC requires close patient monitoring.” Take note that this means it is OK to use it as long as you closely monitor.
Read carefully the paragraph titled “Induction” in this ACOG document. It is an example of trying to torture the data until they confess to what you want them to say.
Induction or augmentation with oxytocin has been suspected as a factor responsible for uterine rupture. A meta-analysis found no relationship between the use of oxytocin and rupture of the uterine scar. However, other studies indicate that high infusion rates of oxytocin place women at greater risk. Although there are studies that suggest that prostaglandin gel applied to the cervix or vagina appears to be safe, there are occasional reports of uterine rupture with prostaglandin preparations.
The statement “A meta-analysis found no relationship between the use of oxytocin and rupture of the uterine scar” is false. The meta-analysis they are referring to—by Rosen et al.—found a uterine rupture rate of 2.3 percent with oxytocin induction of VBAC, compared with 1.5 percent with no oxytocin induction of VBAC4. So there is a relationship, but it does not reach a level of statistical significance. It would take a larger sample size to reach statistical significance because uterine rupture is an unusual event. But it is what scientists call a "trend," and this trend is consistent with a relationship found in other studies. As ACOG states in this same paragraph: “However, other studies indicate that high infusion rates of oxytocin place women at greater risk [of uterine rupture].”
So the evidence, while not totally conclusive, strongly suggests that using oxytocin with VBAC increases the chance for uterine rupture. Yet ACOG does not recommend against oxytocin VBAC induction. Why? If the evidence is inconclusive, the cautious, conservative approach would be to follow the basic rule of medical practice: “First do no harm.” But induction is extremely obstetrician friendly, as it allows the practitioner some control of a busy practice through scheduling the induction at a convenient time rather than waiting for spontaneous labor, which is 24/7. Proof? Data from the Centers for Disease Control (CDC) show induction of labor in the United States ruing the past 10 years doubled, to 20 percent of all births from 10 percent. The same CDC data also show an increasing trend throughout the last decade for more births Monday through Friday5. This is the same decade in which uterine rupture also increased. The CDC data strongly support the possibility that the increase in uterine rupture the past 10 years is due to increased induction of labor, including induction of VBAC.
ACOG's Process for Making These Recommendations
Who Made These Recommendations?
In the practice bulletin's summary it says Level C recommendations are based “primarily on consensus and expert opinion.” Who was involved in the consensus, and who are the experts? There is an urgent need for transparency here. I contacted ACOG, but they were unwilling to say who was in the group making this practice bulletin. Since the first recommendation in Level C—“Because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care”—affects the care of a large group of pregnant women at the time of giving birth, consensus needs to include not only obstetricians but also midwives, nurses, family physicians, perinatal epidemiologists and consumers. Were any of these groups represented, or were only obstetricians? This is particularly important when a recommendation, such as this one, is of the “you need more of us” variety. Since this recommendation is friendly (an advantage) to obstetricians and unfriendly (a disadvantage) to family physicians, midwives and many women, the recommendation easily could be seen as self-aggrandizing for obstetricians.
Here, an editorial from The Lancet, January 8, 2000, is instructive:
Advocacy guidelines developed by a single-specialty group in isolation may be counterproductive, because those disciplines and professions that were not involved in the development of the guidelines but may be required to implement the recommendations mount their attacks and lodge their disclaimers. Some of the guidelines may be of the Good Old Boys Sat at Table (GOBSAT) variety, based on received wisdom rather than current scientific evidence, and may be biased by undeclared conflicts of interests.…Studies have shown that the balance of disciplines within a guideline-development group has considerable influence on the guideline recommendations. Widespread multidisciplinary participation is essential not only to ensure that the guideline is valid, but also that it is valued by all the members of the multidisciplinary team, in order to be incorporated successfully into practice.6
Inappropriate Influence of Non-Medical Factors
Near the beginning of the document, mention is made of ACOG's fear of litigation: “Physicians in the United States, facing increased medical-legal pressures…” Furthermore, in this document, ACOG’s fear of litigation focuses on fear of VBAC litigation: “Increasingly, these adverse events during trial of labor have led to malpractice suits.” ACOG’s fear of VBAC itself is revealed in the Figure 1 algorithm, which includes the need to “counsel patient regarding benefits and risks of VBAC” but does not include a similar need to counsel patient regarding benefits and risks of the woman's other choice: cesarean section. To what extent do ACOG’s fear of VBAC and fear of litigation influence the recommendations in this document? To understand the importance of this question, it is necessary to understand ACOG.
ACOG is not a college in the sense of an institution of higher learning, nor is it a scientific body. It is a “professional organization” that in reality is one kind of trade union. Like every trade union, ACOG has two goals: promote the interests of its members, and promote a better product (in this case, well-being of women). But if there is conflict between these two goals, the interests of obstetricians come first.
Proof that ACOG puts members’ interests first? In September 1998 ACOG published Committee Opinion No. 207, “Liability Implications of Recording Procedures or Treatments,” which includes the statement: “Recording solely for the purpose of patient memorabilia or marketing is not without liability.…The Committee strongly discourages any recording of medical and surgical procedures for patient memorabilia.” In other words, ACOG recommends that doctors and hospitals refuse permission for women and families to make a videotape of their baby’s hospital birth. Fear of litigation against their members has higher priority for ACOG than women’s rights and family values—the need of the family to record one of the most important events in their lives. This is why ACOG recommendations cannot always be considered the gospel and the recommendations in this document are suspect. Should the United Auto Workers have the final say on standards of auto safety?
Impact of Recommendations
The first Level C recommendation, “VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care,” has a huge impact on the system of maternity care in the United States that goes far beyond obstetric practice. If this policy is followed, it drastically reduces or eliminates several options available to women with previous cesarean section, including having their birth at home, in a freestanding birth center or in a small community hospital. Because of all the unnecessary cesarean section in the past, American women with a scarred uterus are a significant minority of pregnant women—in the neighborhood of 15 percent. If the nearest large hospital is at some distance, it makes a family-centered birth difficult or impossible and is likely to eliminate continuity of care throughout pregnancy and birth. Scientific data show such continuity of care significantly improves birth outcomes.
In addition to this impact on women and families and birth outcomes, this recommendation also has a major impact on community-based midwives, family physicians, birth centers and small hospitals.

Conclusions
Two of the eight recommendations are without scientific justification. One recommendation—VBAC only with surgeons right there—has a tragic, unnecessary, negative impact on maternity care and maternity care providers in the United States. The second—oxytocin and prostaglandin induction is OK during VBAC—is quite likely dangerous for birthing women.
We see a double standard in ACOG recommendations depending on whether or not they are doctor friendly (are of benefit to ACOG members). If a recommendation has no evidence to support it but is of benefit to obstetricians—VBAC only in hospitals with surgeons standing by—ACOG will make the recommendation. Other solutions to the same problem that are not obstetrician friendly—facilitation of communication, collaboration and transport between primary and tertiary birth care—will not be recommended even though they would benefit many women. As a second example of this double standard, if there is inconsistent evidence on an issue—oxytocin or prostaglandin induction for VBAC—ACOG will make the doctor-friendly recommendation, approving its use even though the data show a trend that is likely to put some women at risk. ACOG recommendations consistently put the needs of ACOG members before the needs of women unless there is overwhelming evidence that may finally force an ACOG recommendation which is not doctor friendly—no Cytotec induction for VBAC.
We also see little evidence that ACOG is trying to find out why there is increasing uterine rupture so that it can be prevented in the future. ACOG should be making every effort to promote research on the management of those labors during the past 10 years that ended with uterine ruptures, including the percent of ruptures associated with VBAC and the percent associated with the use of Cytotec, oxytocin or prostaglandin gels. There is also an urgent need for far more research on the relationship between characteristics of places of birth (home, birth centers, community hospitals, regional hospitals, tertiary care hospitals) and uterine rupture. Armed with this kind of data, ACOG could make evidence-based recommendations, be they doctor friendly or not.
ACOG's primary allegiance to the needs of its members over the needs of women and families requires their recommendations to be suspect unless confirmed by overwhelming scientific evidence. As ACOG recommendations come from a single-specialty organization, they always must be carefully evaluated as to bias and should never be the sole basis, nor even the most important justification, for maternity care policy in the United States.Marsden Wagner, MD, is a neonatologist and perinatal epidemiologist. He was responsible for maternal and child health in the European Regional Office of the World Health Organization for 14 years. Now living in Washington, D.C., he travels the world talking about appropriate uses of technology in birth and utilizing midwives for the best outcome.
References
McMahon, M. (1996). Comparison of a trial of labor with an elective second cesarean section. New Eng J Med 335 (10): 689-695.
Chauhan, S., et al. (1997). J Reprod Med 42 (6): 347-352.
Plaut, M., et al. (1999). Uterine rupture associated with the use of misoprostol (Cytotec) in the gravid patient with a previous cesarean section. Amer J Obstet Gynecol 180 (6): 1535-1542.
Rosen, M., et al. (1991). Vaginal birth after cesarean: a meta-analysis of morbidity and mortality. Obstet Gynecol 77 (3): 465-470.
www.cdc.gov/nchs/birth
Editorial. (2000). Development of practice guidelines. The Lancet 355: 82-83.
Learn more about cesarean prevention and VBAC in Midwifery Today Issue 57. In "Choosing Cesarean Section" Marsden Wagner tells us that the risk/benefit factors of c-sections depend on the reason for doing them: "Where the baby is not in trouble, the risks to the baby still exist, meaning that the woman who chooses CS puts her baby in unnecessary danger."

VBAC Policies in Minnesota

2009-02-04T12:32:00.001-08:00

According to a survey conducted by ICAN of the Twin Cities in 2008, 39 out of 101 hospitals (38%) with labor and delivery services in the State of Minnesota have formal policies prohibiting vaginal birth after cesarean (VBAC). Particularly in rural areas of the state, this means that women must either "choose" unnecessary, repeat cesarean surgery or travel extensively to receive maternity care. An additional 30 hopstials (30%) have policies leaving access to VBAC up to individual doctors' discretion. In total, this means that two-thirds of all hospitals with labor and delivery services in Minnesota have formal or de facto policies that severely limit birthing women's access to choice in childbirth. For more information, please contact ICAN of the Twin Cities: icantwincities@gmail.com.

Download PDF here. Key for hospital #s here.

Click here for a PDF of Twin Cities metro VBAC Map

What woman are up against

2009-02-02T12:02:00.000-08:00

Hi everyone. I don't post much because Sarah does such a wonderful job, but I came across this article and it illustrates so clearly what women wanting a VBAC are up against:

Hart to Heart: Opinions vary on c-sections
Anne Hart Sunday, February 1, 2009 at 12:30 am

Cesarean sections require more time to heal than vaginal births. They're almost twice as expensive. And multiple c-sections bring risk of complications. Despite those disadvantages, c-sections are now more popular than ever. C-sections accounted for 43 percent of the births last year at Candler Hospital and 37.6 percent at Memorial University Medical Center. They're also on the rise nationally, with some hospitals reporting as high as one in two births as cesarean, according to the International Cesarean Awareness Network, which educates women about the risk and dangers of c-sections.

While c-sections are sometimes medically necessary, factors such as the increase in doctors who've stopped performing vaginal births after a c-section (also known as VBAC) are driving up the rate. Candler only had eight VBACs attempted last year out of 3,191 deliveries. Seven were successful. In 2007, the hospital had one attempted and successful VBAC out of 3,040 deliveries.
Instead of VBACs, women undergo elective repeat c-sections, which now represent about 40 percent of the 1.3 million cesareans performed each year nationally. Are c-sections, which are major surgical procedures, being over-performed? Like most medical questions, the answer depends on whom you ask.

VBACs vs. repeat c-sections
A new study in the New England Journal of Medicine found early, elective, repeat c-sections can lead to an increased rate of complications, including infections. According to researchers, more than a third of elective repeat c-sections are performed too early. The American College of Obstetricians and Gynecologists recommends that elective c-sections be performed no sooner than 39 full weeks of gestation, unless there's a medical indication. The study found that 36 percent were earlier. Both Memorial and Candler follow the ACOG recommendation - when and if VBACs are done at all.

VBACs were briefly popular a few years ago, increasing from 3 percent to 28 percent from 1981 and 1996, but now the trend is going the other way. Doctors don't want to take on the medical and legal liabilities linked with VBACs, experts say. A vaginal delivery after c-section carries a one in 200 chance of uterine rupture.

Dr. Glen Scarbrough, chair of the department of obstetrics and gynecology at St. Joseph's/Candler Hospital, doesn't outright ban VBACS among his patients, but he does discourage them. He says the VBAC success rate is low and not worth all the risks involved. He attributes the VBAC decrease to concern for safety. Scarbrough doesn't see the overall c-section trend as necessarily negative. After all, today women undergo emergency c-sections when labors fail to progress. But decades ago, women used to be allowed to labor for hours upon hours, then forceps were used. "I'm not sure we want to go back to that," Scarbrough said. "Now it's a lot less traumatic for moms as well as babies."

However, Dr. William E. Osborne of Provident OB/GYN Associates supports VBACs when appropriate. "It's a safe procedure, but it just has a risk that some people are unwilling to take," Osborne said. Physicians are required to remain in the hospital throughout the entire labor while a mom attempts a VBAC, rather than just be there through the active labor phase. Osborne is concerned about the move toward c-sections overall and the trend of early labor inductions, especially those being done for the sake of convenience.

There are ways for women to decrease their chances of a c-section. Starting with finding a doctor with a low primary c-section rate. But with medical risks, personal concerns and legal liabilities looming over physicians and hospitals, a mom has no guarantee when it comes to avoiding a c-section. In the end, the outcome is what counts. The goal is for a healthy baby and mom.
No matter how the birth happens.

I am so appalled by Dr. Scarbrough's comments (in bold) and attitude towards VBACs and c-sections that I really don't know what to say, except to warn women that this is the kind of rhetoric doctors use to force us into repeat c-sections, or primary c-sections. He sees nothing wrong with it, yet the evidence contradicts this. Just about everything he says is wrong -- VBAC success rate low--at 70%? VBAC not worth the risks involved...for who? Women "allowed" to labor for hours and hours..isnt that normal and necessary for many of us? C-sections less traumatic for women and babies...who says? -- and makes clear, again, what an uphill battle we have to help make VBAC available to all women. This is a reminder to all seeking a VBAC--be sure to ask your doctor or midwife their views on VBACs. Any comments such has Dr. Scarbrough's should be a major red flag!

March for Better Birth: Ending VBAC Bans in MN!

2009-01-24T12:57:00.000-08:00

The Minnesota Better Birth Coalition, of which ICAN-Twin Cities is a member, is promoting "better birth at lower cost for all women in Minnesota by organizing public support for legislation that will remove barriers to evidence-based, woman-and family-centered maternity care."

Please join us for a Day on the Hill on Monday, March 9th to celebrate better birth for Minnesota women and hope for an end to VBAC bans in Minnesota:

DAY ON THE HILL SCHEDULE
11:15am Meet at St. Joseph’s Hospital or Region’s Hospital
11:30am Depart for the Capitol
12:45pm Assemble on the Capitol Steps
1:00pm Rally in the Rotunda
2:00pm Talk With Your Legislators!

Maternity care costs are increasing while maternal and infant outcomes are
getting worse:
• Minnesota’s infant mortality rate, compared to worldwide figures,
surpasses our national standing but still ranks 32nd.
• Surgical births, which cost up to 3x more than vaginal births, are
performed at a rate of 26% and rising, with some metro area hospitals at
57%. Research suggests a cesarean rate of no more than 10-15%.
• Over 1/3 of Minnesota births are paid for with public dollars..
• Women, lacking appropriate information to make informed choices, are
experiencing unprecedented rates of postpartum depression.

THE PROBLEM?
Current practices are not governed by evidence-based care,
which provides the best care with the least harm.

Bring the whole family and join us in front of St. Joseph’s or Regions Hospital with signs sharing your message about how BIRTH MATTERS to you. Our two groups will meet and march up the Capitol steps together to let legislators know that Minnesota families deserve: better birth. lower cost.

New VBAC Babies!

2009-01-17T12:12:00.000-08:00

ICAN-Twin Cities congratulates Barb Paton and Jessie Bridgeford on the births of their VBAC babies:

Beau Alexander Paton, 12/17/08
Alexandra Rae Bridgeford (read her birth story here), 1/13/09

Way to go mamas!!!

ICAN Conference Scholarships!

2009-01-12T06:42:00.000-08:00

Thanks to our fundraising efforts this past year, we are pleased to offer TWO $500 SCHOLARSHIPS for women from ICAN of the Twin Cities to help defray the costs of attending ICAN's 2009 International Birth Conference. The conference takes place April 24-26th in Atlanta, GA. More information on the conference can be found here.

Application deadline is January 25th. DON'T MISS OUT!

Scholarship Application

Early Elective Repeat C-sections Dangerous for Babies

2009-01-08T08:23:00.000-08:00

Cross-post from ICAN Blog:

A new study published in The New England Journal of Medicine reports that elective repeat cesareans performed prior to 39 weeks of gestation significantly increase the risk or respiratory problems and other adverse outcomes for babies. According to the study, "The rates of adverse respiratory outcomes, mechanical ventilation, newborn sepsis, hypoglycemia, admission to the neonatal ICU, and hospitalization for 5 days or more were increased by a factor of 1.8 to 4.2 for births at 37 weeks and 1.3 to 2.1 for births at 38 weeks."

Read the full abstract here. Read the related article in TIME here.

Maternity Leave Before Delivery Decreases Likelihood of Cesarean

2009-01-07T07:42:00.000-08:00

Cross-post from ICAN Blog:

Researchers at the University of California, Berkeley have found that women who take maternity leave prior to delivery are less likely to have cesarean sections. Women who started their maternity leave in the last month of pregnancy, rather than working up to the point of delivery, were nearly four times less likely to have c-sections. Read the full article here.

January support meeting

2009-01-06T12:17:00.000-08:00

This month we will gather to share and support each other wherever we are on the journey. Have a recent birth story to share? Planning a VBAC? Need to be in a place where your birth experience will be understood? We look forward to seeing you!

There will be childcare available, so please RSVP to icantwincities@gmail.com and bring $5 to donate.

Meetings are held at Holy Cross Lutheran Church, 1720 E Minnehaha Pkwy, Minneapolis. MAP

Orgasmic Birth on 20/20

2009-01-05T09:44:00.000-08:00

We'll be watching Orgasmic Birth at our February support meeting. The film was featured on last Friday's 20/20 episode. Watch the segment here. It's a great preview for the movie!

2008 Birth Honor Roll

2008-12-28T12:39:00.000-08:00

We honor the following women among us who have bravely labored and delivered this past year! These births include VBACs in the hospital and at home, cesareans, vaginal births, and even an unplanned home birth. Go mamas ~ welcome, babies!

Susan Lundquist, Laura & Beatrice, 12/27/07

Lisa Haugen, Oscar Sidney, 1/8/08

Jennifer Bluhm, Charlotte Mae, 3/1/08

Christy Balfanz-Rice, Kovyn Pauline, 3/11/08

Laura Leventhal, Samuel Sky, 4/25/08

Megan Gaffey, Moira Jules, 5/25/08

Sarah Shannon, Luke Alexander, 5/26/08

Lija Greenseid, Adam, 6/16/08

Nicole Shroeder, Logan Michael, 7/9/08

Amy Anderson, Violette Theresa, 7/20/08

Amy Hartman, Shiloh Grace, 8/7/08

Meg Repede, Collin Michael, 8/30/08

Jenelle Kaempf Davis, Anna Margarete, 8/31

Tasya Kelen, Tessie Rose, 9/23/08

Amy Weiss, Ellie, 11/10/08

Ann Clark, Grace Kathryn, 11/28/08

We also eagerly await the babies due to these mamas in late 2008 & 2009:

Megan Salmela, due 11/30/08

Laura Meerson, due 12/26/08

Jessie Bridgeford, 1/26/09

Lori King, due 2/09

Karri Bergren, due 3/09

Marla Cain, due 3/30/09

Ann Kirchner, due 4/09

Jessica Frantz, due 5/17/09

Wendi Frick, due 6/16/09

We are always looking for more birth stories of all kinds for our website to share with and inspire others. Email your birth story to us!

Well done!

2008-12-28T12:04:00.001-08:00

Five years ago, a friend who visited me not long after my first son was born told me, "Well done, Sarah!" It meant a lot to me at the time, especially because I was struggling with the trauma and disappointment of my cesarean section. I now make a point of saying the same to all of the new mamas I know: Well done!

I've been thinking about all that has happened in 2008. Personally, it was a triumphant year for me, having given birth to my second son by HBAC (home birth after cesarean) on Memorial Day. As a chapter, we have also accomplished much to be proud of. Below is a review of our chapter's highlights this year. To all of us, I say, "Well done!"

Launched a new website
Hosted a sold-out screening (300+) of The Business of Being Born
Formed a board of directors for our chapter
Surveyed 100+ hospitals in Minnesota about their VBAC policies
Co-sponsored a screening of Orgasmic Birth with other local birth organizations
Held a booth at the St. Francis Baby Fair
Hosted our First Annual ICAN Twin Cities Family Picnic at Minnehaha Park
Started this blog
Began sending monthly E-newsletters
Held well-attended monthly support meetings
Welcomed new members
Honored mamas and babies who birthed in 2008

It's been a great year...and there's much more to come in 2009!

Registration open for Real Women. Real Lives!

2008-12-10T06:54:00.000-08:00

The International Cesarean Awareness Network's 2009 Conference is now open for registration! World class speakers include Sarah Buckley, Pam England, and Declercq. Registration is $219 early bird before February 1st. We'll be there....will you???

Blooma birth

2008-11-17T11:23:00.001-08:00

We were delighted to see Sarah Longacre's "baby" - Blooma - featured in the Star Tribune yesterday. While many of us might dispute the amenities available in the hospitals described in the article given our cesarean experiences, overall the piece is a great testimony to what WE can do when we allow our bodies to birth.

Blooma is one of our Professional Members and a great friend to ICAN!

Read the article here.

Minnesota gets a "C" on pre-term births

2008-11-12T17:14:00.000-08:00

The March of Dimes released it's national Premature Birth Report Card today. While the U.S. as a whole is getting a "D," Minnesota is only doing slightly better with a "C." Grades were assigned by comparing the states' pre-term birth rates to the national Healthy People 2010 objective of 7.6 percent of all live births.

The report card calls for several actions, including a voluntary evaluation by hospital leaders of all cesareans and labor inductions that occur before 39 weeks gestation. According to the report card, "about 1 in 13 live births in Minnesota is late preterm (34-36 weeks gestation). The rise in late preterm births has been linked to rising rates of early induction of labor and c-sections."

To view the report card, click here. To sign the related petition, click here.