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

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

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

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!

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!

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!

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

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

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

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

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

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!

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!

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

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

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.

ICAN and You Can Too: Choosing a Homebirth After Cesarean Section

Cross-post from the ICAN Blog...

From Bellies to BirthCast:

Have widespread hospital bans on VBAC (vaginal birth after cesarean section) made a repeat c-section your only hospital birth option? Did lack of access to VBAC make you choose a homebirth after cesarean section (HBAC)?

Pamela Udy, President of ICAN, the International Cesarean Awareness Network (www.ican-online.org), and a HBA2C mother herself, discusses why more women are choosing homebirth after cesarean section (HBAC) due to widespread hospital bans on VBAC (vaginal birth after cesarean section).

Listen to Bellies to BirthCast Episode 1 or read the full interview transcript

VOTE!

Today's the day!

I was inspired to read this story of a very dedicated voter:

One woman had just given birth through Cesarean section at a nearby hospital. Instead of going home, her husband drove his wife and their new baby directly from the hospital to the Library, just so she could vote on the last day of early voting. She knew she couldn't come on Tuesday, so she stood in that line, just so that she could vote for Barack Obama. Her tiny, newborn baby stayed in the car with her husband; this woman was still wearing slippers from her hospital stay. She could barely walk in her condition, yet she waited stoically at the Model City Library to vote.

Now that's patriotism!

ICAN Responds to the Coalition for Childbirth Autonomy's Statement on the Cesarean Rate

A cross-post from the official ICAN blog:

The Coalition for Childbirth Autonomy (CCA) released a statement today questioning the World Health Organization’s recommended cesarean rate of 10 - 15%. CCA suggests that a woman should be able to request a cesarean without medical indication. While ICAN supports both updated research on this topic and an increase in patient education and autonomy, we maintain that many women who are choosing a cesarean are making that decision without full informed consent.

Research shows that cesareans introduce additional risk in dozens of areas when compared to a vaginal birth. For the mother, these increased risks include death, hysterectomy, bood clots, increased pain & recovery time, infection, and post-partum depression(1). For the infant, additional risks include respiratory problems, breastfeeding problems, asthma in childhood(1), and type 1 diabetes(2). In addition, there are increased risks in future pregnancies, such as infertility, ectopic pregnancy, placenta abnormality, uterine rupture, preterm birth, and stillbirth(1).

ICAN does not believe that cesarean should be the typical solution for fear of childbirth. With appropriate counseling, most women who fear childbirth are comfortable attempting a vaginal birth (3, 4). Most show long-term satisfaction with their decision to change modes of delivery (4), and with intensive therapy, labor times were shorter (3).

ICAN will continue to work to improve maternal-child health and to protect a woman’s right to ethical and evidence-based care during pregnancy and childbirth.

(1) Maternity Center Association. 2004. What Every Pregnant Woman Needs to Know about Cesarean Section. New York: MCA. www.maternitywise.org.

(2) Cardwell, CR et al. Caesarean section is associated with an increased risk of childhood-onset type 1 diabetes mellitus: a meta-analysis of observational studies. Diabetologia. 2008 May;51(5):726-35.

(3) Saisto, T et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol. 2001 Nov;98(5 Pt 1):820-6.

(4) Nerum, H et al. Maternal request for cesarean section due to fear of birth: can it be changed through crisis-oriented counseling? Birth. 2006 Sep;33(3):221-8.

Pioneer Press: Can childbirth be orgasmic?

ICAN of the Twin Cities helped co-sponsor the recent local screening of Orgasmic Birth. The St. Paul Pioneer Press interviewed the filmmaker, Debra Pascali-Bonaro and local doula trainer and midwife Gail Tully who spearheaded our coalition of birth advocates sponsoring the screening. Here is the article:

Can childbirth be orgasmic? Filmmaker Debra Pascali-Bonaro thinks so

A lot of mothers might say their experience of childbirth was intense, maybe even satisfying. But orgasmic?

It can be, according to Debra Pascali-Bonaro, a birthing assistant-turned-filmmaker who was in the Twin Cities recently for a screening of her documentary 'Orgasmic Birth.'

With that provocative title, she is quick to elaborate that while some women do have a sexual experience during labor, she's using the term more broadly.

'How come, in our culture, the common perception is that birth is about pain and emergency and a terrible event to get through?' she said. 'A small percentage of people need emergency care, but for the vast majority, birth is a normal experience. I think we've lost sense of the sensualness of birth as we've moved it into this realm of technology. And I want us to reclaim it as a sensuous and sacred arena.'

Pascali-Bonaro has found a sympathetic audience in the Twin Cities, where a screening earlier this month at the Riverview Theatre in Minneapolis was organized by a coalition of natural childbirth activists, midwives and doulas.

It drew 500 people, a turnout boosted by the fact Minneapolis has the nation's highest percentage of births attended by a doula, someone trained to provide support to a mother during birth. Pascali-Bonaro is a doula.

Individual DVDs of the film go on sale this week, and the film is capturing national and international attention for the way it redefines childbirth.

"It gives us a metaphor for the joy of actual labor," says Gail Tully, a doula and one of organizers of the Twin Cities screening.

So what exactly does birth have to do with sex, other than the obvious fact that one follows from the other?

"The same hormone that we release in lovemaking is also released in childbirth and in breastfeeding — oxytocin," said doula Gail Tully. "It's a hormone that gives us a heightened perception, and it can take the edge off of pain."

The problem, according to Tully and others, is many things that happen during a typical birth in the United States may inhibit the natural release oxytocin, which is necessary to stimulate contractions and dilate the cervix so the baby can come out.

Research suggests oxytocin is released when a woman feels safe and secure, when lights are dim, when there are few disturbances and there is quiet and privacy — not exactly the conditions in most hospitals.

Even routine questions can knock a woman out of the zone, says Tully, such as "What's your maiden name?" or "Is the temperature comfortable for you?"

"We know that if you want an animal to give birth, you don't surround them with bright lights and with a lot of people," Pascali-Bonaro says. "You will disturbthem, and their labor will slow down or stop. The same is true for humans."

In other words, the same conditions that are necessary for making love are necessary for having a baby.

"If we gave couples instructions on how to have an orgasm while they are lovemaking, well, we laugh at the idea," Tully says. "We understand that it would disrupt them, and they wouldn't have that hormonal release. You don't have sex with a cheering crowd. But we accept that at birth because we think it's necessary for safety."

Some women will experience an actual orgasm during birth, Pascali-Bonaro says, though that's obviously not a goal.

"I'm getting e-mails like crazy from people saying thank you for talking about this," Pascali-Bonaro says. "There are women who are saying, 'I literally had the most incredible orgasm, and I never told anyone because I thought it was kind of unusual.' It's not the kind of thing that you tap your doctor on the shoulder and tell him about. Many women hadn't even told their partner."

DRUGS, OPERATIONS

Medical interventions have become commonplace at most births in the United States. Nearly one in three births is by Caesarean section, even though many researchers say the medically necessary rate is closer to 10 percent to 15 percent.

Inductions are also on the rise. For example, a study published last month in the journal Medical Care found one in four pregnant women had labor induced at a scheduled time rather than waiting for contractions to start on their own, a rate that has tripled since the 1990s. The use of the artificial hormone pitocin to start or intensify contractions is now nearly routine.

"There are times when all our medical technology has a benefit and is life-saving for the mother and the baby," says Pascali-Bonaro, who lives in New Jersey. "But I know some hospitals are using pitocin 80 percent of the time. We need to question why that is. Are we in a rush?"

Pascali-Bonaro interviews nurses, doctors and midwives in the film who point out possible negative consequences of these interventions — higher rates of postpartum depression for women who have Caesareans, for example, or research that suggests women who deliver vaginally respond differently to the cries of their newborn babies than women who have had a Caesarean.

But the real focus of the film is on the couples in the United States and abroad who gave permission for Pascali-Bonaro to film their births. The film opens with a woman who gives birth outside on the deck of her house with her husband close at hand.

Most of the subsequent births, which are edited tastefully and artistically, are also home births without pain medication or medical interventions. Whether you question epidurals or embrace them, it's difficult to walk away unmoved.

The point of the film, says Pascali-Bonaro, is to show women, especially young women who have not yet given birth, an empowering image of birth that may certainly include pain but isn't about suffering.

"I hope it touches people in an emotional level to open their heart to see that birth is not just a day to say OK, we've got to get through it," she says. "It's a day to really think about and to really make an informed decision about. I hope it's a day that people will begin to enjoy so we can welcome our babies with absolute joy, ecstasy and bliss."

THE RIGHT TRACK

Pascali-Bonaro, who has worked in childbirth education nationally and internationally for 26 years, says she literally woke up one morning from a dream and knew she had to make a film.

With no cinematography experience, she enrolled in filmmaking classes. At one point, she had the opportunity to pitch her idea, along with dozens of other aspiring filmmakers, in front of a panel of established producers and directors.

"It was sort of like the 'American Idol' of film," she said. "You got 10 minutes to stand up and explain your idea."

When her turn came, she told the panel she was working on a film called "Ordinary Miracle: Global Models of Care." A panel member brusquely told her to sit down and said, "What makes you think anyone would be interested in that?"

She was humiliated. A friend happened to be with her who had heard her speak at a workshop about birth and sexuality. The friend nudged her and told her to stand up again and say, "Orgasmic birth."

"I figured, well, this is my one opportunity, and so I jumped up and said, 'Orgasmic Birth,' and the entire auditorium laughed, and the panel said, 'Is that for real? Because if you can make that film, you've got something,' " recalled Pascali-Bonaro.

She knew she was on the right track after she met with a focus group of young men and women. She asked if they would watch a childbirth film. A third of the women said yes, and none of the men did. When she asked if they would watch a film called "Orgasmic Birth," everyone raised his hand.

Pascali-Bonaro and a few other doulas filmed the births themselves, but the finished product is anything but amateur.

One of the women filmed in labor is the wife of composer John McDowell, who wrote the soundtrack for "Born Into Brothels," which won the 2004 Academy Award for best documentary. His soundtrack for "Orgasmic Birth" is sung by Sabina Sciubba, lead singer for the Brazilian Girls. Producer Kris Liem, who has won three Emmys for film editing, signed on to edit after being wowed by the music and raw footage.

EMBRACING LIFE

Stephanie Johnson and her husband Andre Fischer of Minneapolis were at the screening.

"I haven't been thinking about the nursery or names, things that other people ask me about," says Johnson, whose first child is due later this month.

"All I've been thinking of is that day of labor. I liked what someone said in the film, that pain of a contraction isn't a warning sign, something to get over. It's squeezing and embracing the baby."

Her husband, Andre Fischer, who has children from a previous relationship, was also moved by the film.

"I cried, because not all the other births of my children were like these," he said. "It was very emotional for me."

Maja Beckstrom can be reached at 651-228-5295.

ONE WOMAN'S STORY: 'OH, THIS IS KIND OF COOL'

Debra Pascali-Bonaro is collecting birth stories on her Web site orgasmicbirth.com for a companion book to the film. In that spirit, the Pioneer Press talked to Liz Abbene, 28, of Lakeville about the birth of her third child, Lucia, born this summer.

Abbene is a doula and agrees with Pascali-Bonaro that women need to share their positive birth stories so other women facing childbirth can go into the experience with less fear and more confidence.

Abbene's first two children were induced, the first because Abbene didn't know the exact due date and the second because doctors feared the baby was getting too large. She had an epidural for the second, pushed for three hours, and the baby had to be taken to neonatal intensive care. As she recalls, "It wasn't a good experience."

This summer, when she went to her midwife appointment, she was nearly two weeks overdue and knew the medical staff would want to induce her the next day. The midwife "swept her membranes," a simple technique that can release hormones and lead to contractions. She explains:

"It just kicked my contractions into high gear. I went into labor in the hospital at 4 p.m., and my husband and I were not prepared for it. We thought we were going to go home again. So, we called a friend to bring our stuff to the hospital.

"My husband and I were alone in the room for a while. And as soon as I could get out of bed, we just hung out in the bathroom. We had made a birth playlist on my iPod, and we played Ray Lamontagne's "Be Here Now," Joe Cocker's "With a Little Help From My Friends" and Bob Marley's "Three Little Birds."

"I wanted to be really present for the birth. I wanted to feel exactly what was happening in my body.

"The contractions weren't painful. It was an intense feeling but nothing painful. I only felt it in my back. Within an hour, I was a couple of more centimeters dilated.

"Two hours into labor, my mom arrived. She used to be a labor and delivery nurse. She was using the shower head on my back, and I realized as I was standing in the shower that the feelings I was having were those feelings you have after you have an orgasm. I was like, 'Oh, this is kind of cool.' It wasn't ever painful, it was just intense.

"When I was about 7 centimeters, I got into birthing tub. Then, things picked up and got intense. Whenever I had contraction, I had my husband's hand touching my face. I felt very, very close to him. The midwife said, 'I can tell you're nearing the end of the labor.'

"I had one more contraction. I felt a pop. My husband put my hand down, and I don't think I even pushed. The head came out, and he received the baby and laid her right on my chest.

"We didn't know if we were having a boy or a girl. It was incredible. Just so relaxing and such a moving experience. It was so completely different from my other two births. I could never give birth any other way now.

"I think so much about birth, being a doula. And I think so much of the experience is in your mind. I teach childbirth preparation classes, and we talk a lot about fear and about how fear is what creates pain. Any time you're afraid of something, the more tension you have, and the more tension you have, the more pain you have. It's a vicious circle.

"You have to decide to let go and not be afraid.

"I always tell women, 'The power to give birth is within you.' If you're fortunate enough to get pregnant, your body knows what to do to give birth."

-- Maja Beckstrom

Consumer Reports: High tech birth = poor outcomes

Consumer Reports has published a summary of a study recently released by the Childbirth Connection on the overuse of high tech interventions in childbirth:

Back to basics for safer childbirth

Too many doctors and hospitals are overusing high-tech procedures

Noninvasive measures can mean better outcomes for baby and Mom.

When it's time to bring a new baby into the world, there's a lot to be said for letting nature take the lead. The normal, hormone-driven changes in the body that naturally occur during delivery can optimize infant health and encourage the easy establishment and continuation of breastfeeding and mother-baby attachment. Childbirth without technical intervention can succeed in leading to a good outcome for mother and child, according to a new report. (Take our maternity-care quiz to test your knowledge.)

"Evidence-Based Maternity Care: What It Is and What It Can Achieve," co-authored by Carol Sakala and Maureen P. Corry of the nonprofit Childbirth Connection analyzed hundreds of the most recent studies and systematic reviews of maternity care. The 70-page report was issued collaboratively by Childbirth Connection, the Reforming States Group (a voluntary association of state-level health policymakers), and Milbank Memorial Fund, and released on Oct. 8, 2008.

Overuse of high-tech measures

The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:

• Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005
• Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests
• Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization's recommended national rate of 5 to 10 percent
• Electronic fetal monitoring, unnecessarily adding to delivery costs
• Rupturing membranes ("breaking the waters"), intending to hasten onset of labor
• Episiotomy, which is often unnecessary

In fact, the current style of maternity care is so procedure-intensive that 6 of the 15 most common hospital procedures used in the entire U.S. are related to childbirth. Although most childbearing women in this country are healthy and at low risk for childbirth complications, national surveys reveal that essentially all women who give birth in U.S. hospitals have high rates of use of complex interventions, with risks of adverse effects.

The reasons for this overuse might have more to do with profit and liability issues than with optimal care, the report points out. Hospitals and care providers can increase their insurance reimbursements by administering costly high-tech interventions rather than just watching, waiting, and shepherding the natural process of childbirth.

Convenience for health care workers and patients might be another factor. Naturally occurring labor is not limited to typical working hours. Evidence also shows that a disproportionate amount of tech-driven interventions like Caesarean sections occur during weekday "business hours," rather than at night, on weekends, or on holidays.

Underuse of high-touch, noninvasive measures

Many practices that have been proven effective and do little to no harm are underused in today's maternity care for healthy low-risk women. They include:

• Prenatal vitamins
• Use of midwife or family physician
• Continuous presence of a companion for the mother during labor
• Upright and side-lying positions during labor and delivery, which are associated with less severe pain than lying down on one's back
• Vaginal birth (VBAC) for most women who have had a previous Caesarean section
• Early mother-baby skin-to-skin contact

The study suggests that those and other low-cost, beneficial practices are not routinely practiced for several reasons, including limited scope for economic gain, lack of national standards to measure providers' performance, and a medical tradition that doesn't prioritize the measurement of adverse effects, or take them into account.

Thanks to Emily Ward for the link! Send us your blog ideas: icantwincities@gmail.com

Birth Stories - Monday, October 13th

Birth Stories Night!

Four recent VBAC (vaginal birth after cesarean) mamas will share their stories at our upcoming support meeting.

Join us!
Monday, October 13th
6:30-8:30pm
Holy Cross Lutheran Church
1720 E Minnehaha Pkwy, Minneapolis

Each mama will share about her preparations for VBAC, how the labor and delivery went, and lessons she learned. Come to be inspired and encouraged!

There will also be time for general support and discussion. Childcare available with a $5 donation!!! Please email to RSVP for childcare: icantwincities@gmail.com

Orgasmic Birth!!!

WOW—what an amazing night! It was an honor to work with the other groups in presenting Orgasmic Birth. Gail Tully from Spinning Babies, Emme Corbeil—midwife, Susan Lane—activist and doula, Donna Corbo—childbirth educator, and Monica Matos—founder of Ten Moons Rising. And there were many more, so I don’t mean to leave you off. But it was an amazing evening that left me energized and excited for the possibilities of birth. I left believing in my body’s ability to not only birth a baby (this is due to a successful VBAC), but to even enjoy it, to love it, to feel ecstasy from it—and why not? Isn’t that what it is all about? Making love, joyfully birthing our love and then raising them with unconditional love for the rest of their lives? Yes, it all comes together so perfectly.

So this is the beginning of organized birth/mama/baby/dad events in the Twin Cities. We are next going to work on a website, and a march in March, and a fundraising walk next summer and much much more. I will keep you all posted as things materialize. In the mean time, if you would like to order Orgasmic Birth, I have purchased 50 copies. Please email me at heathdeath@gmail.com if you would like one. They are $40.

Everyone needs to see this film!

See you soon,
Heather

Newsflash! Orgasmic Birth will be featured on ABC's 20/20 on October 24th, barring any preempting news stories. Plan to tune in!

ICAN Forums

ICAN (International) now has forums! If you join, you can enter into discussions with others about various topics related to cesarean recovery, prevention and VBAC. It's great!

Click here to join the forums.

Orgasmic Birth Tomorrow- Don't miss out!!!

ICAN of the Twin Cities is proudly co-sponsoring ORGASMIC BIRTH Thursday, September 25 - 7:00pm Riverview Theater, Minneapolis, MN (3CEUs/Contact Hours) BUY TICKETS HERE ********************************************************************* IMPORTANT NOTE: The theater has an event letting out immediately prior to ours. Advance online ticket purchases are HIGHLY RECOMMENDED. ********************************************************************* The film will be introduced by Orgasmic Birth's producer, Debra Pascali-Bonaro.

OTHER OPPORTUNITIES TO HEAR DEBRA SPEAK: Pleasure in Birth: Is it Possible? Thursday, September 25, 1:30-3:00 pm Woodwinds Health Campus, 1925 Woodwinds Dr., Woodbury, MN 1.5 CEUs/contact hours Directions, with map, provided when you buy a ticket. Price: $19 BUY "PLEASURE IN BIRTH" TICKETS NOW Becoming a Birth Activist (Lecture & Brunch) Friday, September 26, 9:00am - 1:00 pm Corondolet Center, 1890 Randolf Ave., St. Paul, MN 4 CEUs/contact hours Directions, with map, provided when you buy a ticket. Price: $50 (includes brunch) BUY "BECOMING A BIRTH ACTIVIST" TICKETS NOW Also: MN State DONA Gathering/Annual Meeting Wabun Park, Minneapolis Thursday, September 25, 3:00 - 6:00pm (1 contact hour for DONA certified doulas) TICKET SPECIALS TRIPLE TREAT - Register for all 3 events for $69. COUPLE SPECIAL (expectant or not) - Two for $30. CEU INFORMATION Up to 9 CEUS available for only $85! Visit www.MinnesotaOrgasmicBirth.com for full details. Receive a certificate of attendance for no extra fee.

About The Organizers

Spinning Babies: Easier Childbirth with Fetal Positioning Contact: Gail Tully Gail@SpinningBabies.com 952-888-6929 www.SpinningBabies.com The mom's job is to dilate, the baby's job is to rotate. Spinning Babies is an educational website devoted to making birth easier with fetal positioning. When a woman's womb is symmetrical, her baby will settle into the ideal position to fit more easily through the pelvis. Come visit Spinning Babies. Ten Moons Rising: Giving Birth to a More Peaceful World Contact: Monica Matos, Founder Monica@TenMoonsRising.org www.TenMoonsRising.org Ten Moons Rising Holistic Family Education is a non-profit organization whose mission is to raise awareness about the profound impact that our earliest experiences - in the womb and at birth - have on one's self-image, perceptions of the world, health, behavior and relationship patterns. The way a baby is born determines whether these foundational patterns are created from traumatic experiences (which can be healed) or gentle, loving ones. The way a mother gives birth impacts her confidence, fulfillment and overall sense of well-being. Birth matters! The Childbirth Collective: A Minnesota Nonprofit Serving Birthing Families Contact: Teri Pier, CD(DONA), CE birthsteps@earthlink.net 651-245-6256 www.ChildbirthCollective.org The Childbirth Collective is a nonprofit organization with chapters in the Twin Cities, Duluth, St. Croix River Valley, Winona/LaCrosse, and Fargo/Moorhead. The goal of "The Collective," through resources such as free weekly Parent Topic Nights, is to enhance the childbearing year for parents by promoting quality doula support, advocating evidence-based care, and providing accessible education based on the wellness model of maternity care. We are a collective of birth professionals inclusive of Doulas, Childbirth Educators, Midwives, Lactation Consultants, Psychological Counselors, Massage Therapists, and others within the birthing community, providing services to support families, and each other. ICAN of The Twin Cities Contact: Sarah Shannon Please check out our NEW website: www.icantwincities.org A local chapter of the International Cesarean Awareness Network ICAN of the Twin Cities is a local chapter of the International Cesarean Awareness Network (ICAN). Free monthly meetings for support and education are held the second Monday of the month in the Minneapolis and St. Paul area of Minnesota. In addition, we have a library of birth-related books, articles and cesarean/VBAC related research, provide individual telephone or e-mail support, do presentations to any group interested in cesarean prevention or VBAC, attend birth-related events, and generate media coverage for group activities and cesarean issues in the news. MN DONA Contact: Susan Lane, DONA State Representative www.dona.org MN DONA is the informal name to designate Minnesota members of DONA International. DONA international is the largest doula training and certifying organization in the world. Minnesota has largest state membership, per capita, of any state in the US. Minnesota comprises 5% of all DONA membership-- 268 members. Our state has more doula-attended births per capita than any other state! Join through the www.dona.org website. When you join DONA you will automatically be joining MN DONA without any additional efforts. Announcement! Our Dona state gathering will be held in conjunction with local Orgasmic Birth events. Watch for location in the next e-newsletter!

REVIEWS OF ORGASMIC BIRTH

Orgasmic Birth is a phenomenal film, with a scientifically-validated message: that birth is an intimate and innately ecstatic event, as evidenced by the laboring woman's release of ecstatic hormones... It is the perfect antidote to 21st century birth fright. Astonishing, thrilling, and transformative. Dr .Sarah J Buckley,GP/ family physician, Queensland, Australia www.sarahjbuckley.com I had the great honor of attending the initial screening with families featured in the film. What an incredible experience and what a most moving and provocative film. It should be mandatory viewing for all families and practitioners involved in the birth process. Dr. Larry Rosen, Pediatrician, Oradell, NJ What a wonderful, empowering, hopeful film! My hope is that women, men, nurses, doctors, and pretty much everybody take the time to see this film. This could be life changing. Thank you so much! Jennifer Steele, Doula, Portland OR I loved the film. It's the best feature-length film about birth I have ever seen - and I have seen them all. Carol Gray, Midwife, Portland OR Orgasmic Birth is the perfect blend of evidence-based information and documentary film making. This blend helps the viewer to understand more thoroughly the normalcy of birth and why, 90% of the time, birth is an uncomplicated event. As a nurse with over 30 years of experience, I can say that every birth consumer and professional should see this documentary film and will come away with renewed faith and trust in the process! Connie Livingston RN, BS, LCCE, CD(DONA) President, Perinatal Education Associates, Inc. www.birthsource.com Orgasmic Birth shows what is possible when healthy women feel loved, confident, secure, uninhibited, and cared for during pregnancy and birth. The moving beautiful images leave no room for fear or loneliness, and show birth as the deeply sexual experience that it can be. Thank you, Debra Pascali-Bonaro and your team, for your vision and courage in portraying the ecstatic, sexual, orgasmic potential that exists in birth! Penny Simkin, Doula, childbirth educator, and birth counselor; Seattle WA Finally, the truth about birth - some ecstasy, some agony, but beyond doubt a celebration! Women must know that birth is indeed the ultimate expression of their female power, in all its possibilities. Birds fly, fish swim, women do birth. Elizabeth Noble, PT, Author, Founder of Women¹s Health Section of the American Physical Therapy Association