Taking off our rose-colored glasses

Our closed Facebook group continues to grow and to be an incredible resource and support for more and more women.  I can hardly keep up with it all and am grateful my fellow board members, especially Katie Champ, have been doing an exceptional job at keeping it safe and relevant. 

I have been thinking about fear tactics, and the effect they have on all of us.  Let me remind you that I am speaking as a mom.  I am not a professional.  It seems to me every time I hear a birth professional in the hospital setting talk about VBAC and homebirth, they all seem to have been part of some horror story that involves the loss of the baby.  As the years have gone by, I have become suspicious of how many actually witnessed this, or if it is just stories passed around.  And they never report any horror stories that occur in the hospital, as though everything is just perfect there.  So I built up resentment over it and distrust. 

(start here if coming in from the Newsletter)

But something happened just recently to remind me, to remind many of us, that there are real people out there who do experience loss, and I don’t ever want to be a part of minimizing this.  I wonder what those families would think if they knew they were being used as horror stories to shame other moms for their birth choices.  It doesn’t seem to honor or respect either family, certainly not the baby, and really just seems to use them to suit their own needs and/or fears. 

So I do not presume to speak for all other women preparing to VBAC, but when I did, I learned a lot about what could go wrong, including that I could lose my baby.  I learned statistics, I learned about drugs, methods, risks, and on and on.  I made educated decisions that were best for me at the time.  With my first VBAC, I needed to be in the hospital.  I felt more secure knowing there was a “safety net.”  I don’t know what that safety net was exactly, in my mind, but it was important for me based on where I was in my journey.  With my HBAC, it was the opposite-I was more afraid to be in the hospital and all the risks that are there. That is where I was then in my journey.  Both were OK choices, and both should be made available to all women because we need to birth where we feel safe and are fully supported. 

This is completely opposite from my first birth-I had never heard of placental abruption, cord prolapse, uterine rupture, placenta accreta, nor had I ever heard of side effects from epidural, risks of Cytotec (I was never even told about Cytotec, even though it was used on me), risks of induction, risks of cesarean, etc.  The only thing I was ever told by my OB was that after 42 weeks there is a higher chance of stillbirth.  So there, that was it.  I was led to believe that everything would be just fine as long as we got the baby out before 42 weeks, and I did everything they told me.  “Thank God for modern medicine that saved my baby’s life,” was something I said regularly until I started preparing for my VBAC and the bombshell was dropped on me.  I was completely unprepared for anything bad happening, and if my baby had died I would have been bewildered, as I really didn’t think things went wrong to the baby when you had good prenatal care and did everything your doctor told you to do.

So with my VBAC’s I knew very well  that sometimes things go wrong, that not everything can be controlled, not everything explained, not every baby saved  no matter what you do, no matter who is attending.  I learned about all the things that can go wrong.  But in learning about it all, I wasn’t any more fearful, just realistic.  I learned that birth is as safe as life gets.  I saw this on a bumper sticker of my midwife, and soon understood what it meant.  So with all that knowledge, I made what I believed were the best decisions for both my baby and me and our health and our lives.  Now had I lost a baby, maybe I would feel differently, and I am grateful to not be in that position, but it would be hard to believe I would feel any differently, since I knew all the risks.  I was prepared and empowered, and it was important to my midwives that I knew all these things, as opposed to my OB who never mentioned one statistic, one negative, one drawback to being induced.

But one thing I never, ever want to do is try to guess what other families may be going through after a loss, other than supporting them and honoring their baby.  Because when we talk about loss, there really is a baby, and a mom, and a family, and the story is theirs to tell.  I think a hospital worker spewing out a horror story at a pregnant woman dishonors both families .  Women have the right to make their own decisions, no matter what others think.  And I believe they have a right to not have people spew horror at them.  I do encourage all women to learn about all the risks, and advantages, so they can make their own best decisions, and then please, let them gestate in peace!

Meet our Board: Heather Deatrick

As we usher in a new Board for the Twin Cities Chapter, we wanted to give you some insight into our backgrounds and experiences as ICAN mothers. First up is our leader, Heather Deatrick. Here is her short biography, in her own words.

My name is Heather Deatrick and I have 3 boys.  I found ICAN through my Bradley instructor when I was attempting a VBAC with my 2^nd child.  I remember thinking at the time I didn’t feel “traumatized” by my c-section, and I was quite sure modern medicine had saved his life, so wasn’t sure why I needed to go.  But she kept urging me so I finally went to a meeting.  I had no idea how much my life was going to change!My first birth ended in a cesarean after a failed induction for being post-dates.  It never occurred to me to question the induction as I still had not entertained the thought that it would not be medically necessary.  Now I know that the only reason for the induction was for being 41w3d, not for any fetal distress or condition on my part.  I was given Cyctotec without my knowledge, necessitating an epidural, followed by Pitocen, then regular heart decels sending us off to the OR.  The Cytotec was given at 7PM, the c-section at noon the next day.  I was devastated but grateful he was OK and I lived through he surgery.  Thankfully, breastfeeding went OK and I had no complications.  I never thought I would have any more children, so when I found myself pregnant 3 years later, I was very excited to try for a VBAC.  While I didn’t know a lot about the politics of birth, I DID know I didn’t want another c-section.  I also knew my OB had a different agenda when he patted my knee at my 6 week checkup and told me that next time I can just schedule the birth, as though that were a plus.  So with this child, I went back to trusting my instincts, and found a midwife and took a comprehensive childbirth education class.  It was on my VBAC journey that I not only had to learn so much, but more importantly, I had to UN-learn so much.  The biggest thing I found I had to unlearn was that childbirth is a disaster waiting to happen and we need someone to save us.  That was a massive indoctrination to unlearn.  My VBAC was a success and after a long labor that involved a lot of movement and rocking and moaning and a little yelling, I was able to push my 2^nd son out.  It was incredibly empowering to do what women have been doing for thousands and thousands of years.  I felt honored to be totally present at his birth. I felt strong, making my own decisions, rather than turning my body over to a doctor.  My midwife was there for me, and I felt that power.  My baby latched immediately and we went home from the hospital the next day.  Fast forward 4 more years and I was lucky enough to give birth one more time, in my dining room, into water, with my partner, my kids, my mother, my midwives and my doula.  Not everyone should give birth at home, but for me, it was truly the best experience.  Going from the tub to bed where I stayed for two weeks nursing my newest son, was perfect, for the whole family.  The care we received from our midwives was like none other too. They spent so much time with us, before, during and after the birth that I felt I was truly in the best hands possible.  (Both of my VBAC birth stories can be found on the ICAN Twin Cities website)

My Journey to Homebirth

Birth story of Gregory Patrick

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

by Heather Deatrick

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My fabulous labor team-DH and doula

I was a little loud for William

Moments after birth

Amazing midwives!

Earl cutting the cord

A very happy family!

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

I am truly blessed.

Large malpractice settlement following c-section!

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


When I watched it on the news they made no mention to the c-section. They only said she bled to death after the birth. I went to find it online and the Strib had a much more in depth article. Honestly, I was so shocked to hear that it was much more than a woman bleeding to death after a c-section. I was so shocked to read that a hospital would actually perform one when they didn’t even think they had blood on hand! In my mind, I immediately assumed it was because they view c-sections as so common and ordinary that they didn’t think they would need it?! I don’t know, I am at a loss. It is bad enough—the risks with having one’s labor induced, the risks of having a c-section, but honestly I never feared personally that there wouldn’t be blood on hand. I thought it was common knowledge that the blood loss from surgery is high, and the potential for blood loss postpartum, whether vaginal or surgical was high as well! Stunning. What a tragedy.


Unfortunately, the culture of c-sections is so accepted that there is no question of being induced at 41 weeks. Now, I am not saying I know everything—maybe she was showing signs of preeclampsia or the baby was stressed and the c-section was necessary, but I was induced at 41 weeks just for “post-dates,” and how many of us are there were induced at 40 or 41 weeks for no reason, or “post-dates?” This is so common that no one bats an eye at it. This woman did not have to die and the hospital certainly was negligent and deserves to pay that settlement, even more. But the fact is, we live in c-section culture and these death will continue to happen until the rate comes down. The fact is, this hospital was not safe to have a baby. How many others out there? Or is the medicalization of birth that is at fault?

I will end with talking about my own birth journey. With my first, I thought having a fancy OB would keep my baby and me safe. It never entered my mind that he has a different list of priorities than I. I was 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

Beautiful frank breech VBAC at home

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

Gail also describes another recent breech birth that led to a necessary cesarean. She writes, "There is no place for ideology in birthing. Each birth has its own story and we must respond to what the baby tells us." How true! Well said, Gail. We are so fortunate to have many skilled and wise midwives in the Twin Cities.

Star Tribune Features Low-tech Birth & Midwives in MN

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

The first article by Josephine Marcotty tells Danette Lund's search for a care provider to support her desire for VBAC.

Because she had delivered her first child by Caesarean section, a hospital birth would almost certainly mean surgery again. Home birth? Her midwife refused, saying it was too risky. A birth center outside a hospital? She'd have to shell out $7,000 because her insurance wouldn't cover it.

"I felt like I had no options," said Lund, 36, who lives near Waconia. "I was so frustrated."

Lund and other women have discovered that birth in America is rarely the natural event they long to experience.

The article goes on to highlight the overuse of cesareans, the risks involved, and the barriers that so many of us face to having a safe, healthy birth. Marcotty uses Lund's story to illustrate how, despite what media stories and even doctors sometimes say, women are fighting to avoid unnecessary interventions in childbirth. Lund's story will sound familiar to many of us:

"There is nobody advocating for lower C-section rates," Peaceman said. "It's not insurance companies. Not doctors and not women."

Except, perhaps, for women like Lund.

Last year, when she became pregnant for the second time, she knew she was likely to have a C-section again. The surgery has become standard for women like her because there is a small chance that a prior C-section scar will rupture during contractions....

Lund's hospital, Ridgeview in Waconia, will consider a vaginal birth after a C-section. Many hospitals won't because of stringent national medical guidelines for the procedure...

After weighing her options, Lund asked a midwife to deliver her baby at home, but the midwife said it was too risky. She called a St. Louis Park birthing center run by midwives. Although such centers are common in some states, they are new to Minnesota, and Lund's health plan wouldn't pay.

By that point she was 30 weeks pregnant and out of options, she said.

Lund, an attorney and trained litigator, is the first to admit she is not typical of most pregnant women. She's comfortable with confrontation and decided to take matters into her own hands.

Three months ago her labor started at 1:30 a.m. She and her husband waited. And waited. They counted the minutes between contractions, then waited some more. Finally, when she was far enough, she hoped, that it would be too late for a C-section, she went to the hospital.

As soon as she arrived, her water broke. Her cervix was 9 1/2 centimeters dilated. She was ready to deliver her daughter.

"I said: 'Yay, there is nothing they can do to me now,'" Lund said.

The second article by Chen May Yee profiles St. Joe's Hospital in St. Paul, which boasts an incredibly low cesarean rate of around 12%, far lower than Minnesota's 26% rate and the nation's 32.3% rate.  The story tells of St. Joe's long history of supporting natural childbirth, especially with its emphasis on midwifery care.

Kara Sime, 38, a first-time mother from St. Paul, arrived one recent Thursday morning, her contractions five minutes apart. By Friday morning, her labor still wasn't progressing. Exhausted, Sime asked for an epidural, a powerful painkiller, and got one. She also got Pitocin, a synthetic hormone to induce labor.

But there was a problem. Her baby was facing backward, increasing the diameter of the head going through the pelvis. Such cases usually require a C-section or a vacuum.

Instead, the midwife and nurse helped Sime onto all fours -- no small feat since her legs were numb from the epidural. With Sime's belly hanging down, the baby turned.

Three pushes later, Catherine Julia was born at 6 pounds 10 ounces.

"I don't have surgical skills," said the midwife, Melissa Hasler. "I'm motivated to get the baby out vaginally."

Gail Tully, on her Spinning Babies Blog, also shared her own experience with the care providers at St. Joes:

A long time ago, I was at a posterior birth with Deb Monson in which the mom was working hard but staying at 7 cm for 3 hours. Deb's simple trick of 3 pushes against her fingers as they created a false pelvic floor quickly turned the baby and let the labor proceed. Doctors at St. Joe's (I don't know if the Midwives do this) will also occasionally reach in and manually rotate the posterior baby's head to anterior so the birth can finish vaginally. Not all posterior births need any of these interventions, but some do and I believe these skills are a big part of why St. Joe's has a low rate of cesarean section. Plus, the community midwives and doulas have long referred to St. Joe's for their quiet, kind nurses, and mother-centered birthing practices. 

With such a low cesarean rate and a practice culture that supports non-interventive birth, St. Joe's may be the best hospital in the Twin Cities for women hoping to avoid a cesarean. Sadly, however, St. Joe's is the only hospital in the Twin Cities metro area that does not allow VBACs.

This means that St. Joe's rich tradition and practice culture described by Yee and Gail are not available to women like Danette Lund who, for whatever reason, did not avoid that first cut. In a conversation I once had with a representative from St. Joe's administration, I was told that this is because HealthEast "cannot afford" the medical malpractice insurance fees involved in supporting VBAC. This stands in stark contrast to St. Joe's reputation for supporting evidence-based childbirth. And, unfortunately, it shuts out women seeking VBAC who could perhaps most benefit from the kind of support and quality care that St. Joe's provides.

Many thanks to Marcotty, Yee and the Star Tribune for writing and publishing these stories on a very important topic for birthing women in Minnesota.

Birth & Baby Expo TOMORROW!

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

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

Resources, products, services for healthy birth & parenting!

Presented by: ICAN of the Twin Cities

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


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

Home birth featured on local TV news

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

Read/watch the story here.

ACOG under question by an insider

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



See you March 9th at St Joes or Regions!


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/

A Response to MN Parent's "Give Birth Your Way" Article

On the whole, I appreciate Dorothy Wickens' article in the September issue of Minnesota Parent called "Give Birth Your Way." Ms. Wickens presents all the options: home birth, midwives, birth centers, hospital births, c-sections, and doulas. I was initially happy to see that home birth was first on the list as a legitimate choice for birthing women. However, I was unhappy to see this sentence in her discussion of who shouldn't choose a home birth: "Mothers with high blood pressure or diabetes or who have had a cesarean section or other uterine surgery are more likely to experience complications during labor and should not give birth at home" (emphasis mine). Previous c-section is, quite frankly, not a reason to exclude women from home birth.

The complication she refers to is no doubt uterine rupture. Although it's true that women who have had a c-section or other uterine surgery are at a higher risk for this, it is extremely rare - less than 1%. This is not to say that the risk should not be taken seriously, but good home birth midwives know how to recognize the signs, are often more closely monitoring the mother and baby's well-being than would be done at the hospital, avoid unnecessary interventions (such as pitocin augmentation) that have been linked to increased risk of rupture, and have plans in place for transfer to the hospital if need be. Every birthing woman faces risk - whether they have had a cesaren or not. Lots of things can go wrong during labor. To say that women attempting VBAC should unequivocally avoid birthing at home is misguided. Every woman who seeks to VBAC needs to make her own decision about where it is best to birth her baby, whether in the hospital or at home. Both home birth and VBAC are reasonable choices to make based on the evidence.*

In fact, an increasing number of women nationwide who desire VBAC are choosing to birth at home because they cannot find supportive providers, are unwilling to submit to unnecessary interventions required by hosptials and doctors in order to VBAC, or who prefer to stay away from the hospital given their previous experiences there. Even the American College of Obstetrics and Gyencology (ACOG) recognizes this trend in their August 2007 legislative update on "lay" midwives and home birth. ACOG notes, "The situation with hospitals declining to do VBAC deliveries has complicated our advocacy efforts on midwives. ACOG Fellows in California, Washington and other Western and Rocky Mountain states report that women are seeking out alternatives, including home birth with midwives, in their desire for a VBAC." Of course, being a trade organization for doctors, ACOG is none too happy about this trend, but that's a whole different post...

*See Best Evidence on the Safety of VBAC and The Medical Literature on the Safety of Home Birth.