Cesarean rates in rural Minnesota

A story on MPR appeared last week regarding the rate of cesareans in rural Minnesota. A report by the Minnesota Department of Health purported that the lack of physicians in rural Minnesota leads to increased rates of cesareans in rural counties as compared to more urban locations. Part of the explanation included:

“ Health providers can't count on being able to mobilize a team of doctors and nurses quickly enough for a more spontaneous natural birth, according to the work group.”

A very interesting statement I think, considering the recent report from the National Institutes of Health earlier this year showing that women today are actually taking longer to labor than in the past. As we know, most “spontaneous” natural births are in reality, not all that spontaneous. This statement definitely typifies the modern attitude that many have towards birth and labor as always being an “emergency” and a disaster waiting to happen. No doubt complications occur in labor and birth – many of us involved in ICAN have experienced them firsthand, whether naturally occurring, or created by unnecessary (or necessary) interventions. But personally, I feel like it is a little overkill to assume that all labors require the “mobilization” of a “team” of doctors and nurses at a moments notice.

Another statement that struck me in the article was:

“The problem is that with an aging rural Minnesota population, there aren't enough births in some parts of the state to support full time obstetricians.”

The lack of physicians in rural Minnesota is a problem, with that I agree. Physician shortages in rural areas of the state are cause for legitimate concern. But the above statement again typifies the assumption in our society, that pregnancy, even a healthy, normal pregnancy, mandates the care of an obstetrician. In reality, many women could, and would benefit from a less medicalized model of care. The article touches on a promising idea: “increasing the use of mid-level providers.” The article specifically mentions nurse-practitioners, which I think is a promising start, but the next logical step might be to support and encourage the acceptance and utilization of midwives in rural Minnesota. The use of midwives has seen growth in popularity in recent years, particularly in urban areas, even leading to an article proclaiming their “trendiness” recently in the New York Times. 

But when we look beyond the “trendiness” of the midwifery model of care, what we often find are professionally trained providers who endeavor to provide holistic, evidence-based health care to women. Midwives are the go-to in many European countries for women experiencing healthy, normal pregnancies.  Midwifery is expanding into the mainstream here in the United States – it holds a lot of potential for decreasing the cost of care for pregnancy and birth in the United States, and I think, would allow for obstetricians to focus on the cases that truly require their care and technical expertise.

This article was admittedly a bit disheartening. It highlighted some of the real problems that our maternity care system is experiencing in the United States, and obviously, even more so in rural areas. Some of the assumptions it is based on (that every birth and labor is an “emergency” and that obstetricians are the default care providers for all pregnant women) are flawed and problematic. But I wanted to share a glimmer of hope to round out my post. It was fitting that a couple of days after this article came out, that my close friend, a registered nurse in practicing in rural Minnesota happened to mention a lovely story about the doctors in her practice, who had recently attended the natural, vaginal birth of twins, one breech, in their tiny rural Minnesota hospital. She described it as complication-free, and “no big deal.” So there doom and gloom!

What has ICAN done for me?

Almost 6 years ago I found ICAN via my childbirth educator, in my attempt to have a VBAC. I had no idea I needed ICAN. After all, my cesarean was quite necessary and all I needed THIS time was a midwife who didn’t want me to schedule a second one. It was truly astounding, to think of the pre-ICAN Heather and the post-ICAN Heather.

It took a couple of meetings at most when suddenly my world shifted, titled, spun a little faster, became wobbly and almost rolled away into oblivion. To find out my cesarean was not only probably not necessary (well, the induction anyway), but more likely instead of saving my baby and me really almost killed us was quite a shock, even to a suspicious liberal feminist type like me. I had NO IDEA. No idea. Medical model vs. Midwifery model. Cytotec. Inductions. Unnecessary c-sections. Homebirths. Doulas. I could go on and on.

So much changed. I learned so much. I wanted to shout it from the roof top. I wanted to call the dean of the Women’s Studies department at my women’s college and let her know what was going on! I wanted to tell every woman I knew--OUR BODIES KNOW HOW TO HAVE A BABY, and birth is not a medical emergency waiting to happen, and I am the one doing this, not a doctor, or a midwife, or a nurse or a doula, but me. And I CAN!!! So ICAN, thank you. You made my life better, for me, my children, my husband and countless others around me.

So what can I do for ICAN? Become a subscriber! For the month of April, the rate is only $25 for individuals and $50 for professionals. Please, let us know what ICAN has done for you, and become a subscriber! Help us keep on doing this life changing and lifesaving work!

New Year's Babies

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

In Louisville, KY:

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

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

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

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

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

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

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

Twin Cities Hospital Cesarean Rates, 2010

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

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

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

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

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

Follow us on Twitter!

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

VBA2C twins-in the hospital!

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

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

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

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

Jessica's amazing birth story:

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

~Heather

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

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

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

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

The Babble posts:

Pregnancy Tips for First-Time Moms

10 things every expecting woman should know

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

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

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

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

My Journey to Homebirth

Birth story of Gregory Patrick

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

by Heather Deatrick

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

My fabulous labor team-DH and doula

I was a little loud for William

Moments after birth

Amazing midwives!

Earl cutting the cord

A very happy family!

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

I am truly blessed.

The Scar

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

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

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

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


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

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

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

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

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

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

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

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

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

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I have been working with a group of physicians and other health care experts to develop clinical quality measures around maternity care.  But I need some feedback from people who are pregnant, who have been pregnant, or know someone who is pregnant!  Will you think about your/her experience and let me know what you would like to know about a doctor or doctor’s office?

We’re considering reporting:

• The percent of a doctor’s office births that are c-sections to low-risk, first time mothers
• The percent of times a doctor’s office induces a pregnant woman (without a medical reason) before 39 weeks
• The number of deliveries per year by a doctor or doctor’s office
• Whether or not a doctor’s office offers vaginal birth after deliveries (or VBAC)

We’re also considering other measures around maternity care for additional reporting.  Would you be interested in:

• Prenatal care topics like education, tobacco cessation, screenings, etc.?
• Postnatal care topics like breastfeeding, postpartum depression, etc.? 
• Other procedures at the time of birth like injuries or tearing?

It really helps to hear about what people would find helpful.  I know what I would consider valuable information, but others might have different ideas.  Please forward this message to your colleagues and friends if you can think of people who are interested in maternity care quality.

I would love feedback before the end of November so I can share your thoughts (anonymous of course) with the doctors and experts on the workgroup.  The topics they end up recommending could become state-wide measures for all of Minnesota.

Thank you!
Brenda


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

Highlights of the 2010 Twin Cities Birth & Baby Expo

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

Large malpractice settlement following c-section!

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


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


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

I will end with talking about my own birth journey. With my first, I thought having a fancy OB would keep my baby and me safe. It never entered my mind that he has a different list of priorities than I. I was naïve, I know, but I really believed that I was safer with a trained OB and delivering in the biggest private maternity hospital in the state. It just didn’t dawn on me that overused technology is not a good thing in the case of normal, low risk birth. This boggled my brain. When I went to Bradley classes with my VBAC hopes when pregnant with my 2nd, I knew I needed to switch to a midwife (in a hospital setting), but still wasn’t sure about my body. I also was shocked but interested to learn that my instructor “caught babies” at home! Wow—I remember thinking how could this women know what to do in case something goes wrong? At home? This is nuts. Now fast forward to baby #3, and we are having him at home. And you know what? I feel safest there. I know that my midwives are better trained and have higher skills in vaginal birth and all its potentials for problems than most OB’s (who, in my opinion are one trick ponies as skilled surgeons). I know that should something catastrophic happen I am a few minutes from a hospital that can handle an emergency c-section (and I know I could get there in the same time they would prep me in the hospital), and I know that if I stall and just can’t finish at home we are blessed to have an OB here who believes in birth and will let me finish my labor without shame. This is the way it should be. Birth is as safe as life gets and midwives are incredibly skilled. I am so lucky to be able to have a baby where I feel safe, and know that if I need a c-section, it will be truly necessary. When I heard this story about this poor family, I thought, “and they say homebirth isn’t safe!” Hospitals have a whole set of problems that need to be fixed before they can start pointing fingers at homebirth. Finally, I will end with saying women matter! Our birth matters! The end does not justify the means, and often the means is killing us women. This needs to be talked about.


Heather
Mom to two boys-one by c-section due to failed induction and one by hospital VBAC.

Boy #3 due in January, planned homebirth



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

From the Star Tribune:
Malpractice lawsuit nets $4.6 million award
A woman bled to death after giving birth at a hospital in Wright County.
By SARAH LEMAGIE, Star Tribune


The family of a woman who bled to death after delivering her first child was awarded $4.6 million Thursday by a Wright County jury in a malpractice and wrongful-death suit brought against the hospital where she gave birth.


Claudia Calcagno of Albertville began hemorrhaging and died hours after her son was born on Jan. 18, 2008, at Monticello-Big Lake Community Hospital, now New River Medical Center. Her doctors were unable to perform surgery that could have saved her life because the hospital failed to provide enough blood for transfusion in time, even though it was "sitting right in their refrigerator," an attorney for Calcagno's family argued.


"Her doctors needed blood to save her life. It was as simple as that," said attorney Kathleen Flynn Peterson.


The jury's award isn't the largest ever seen in a Minnesota malpractice case, but multimillion-dollar verdicts against health-care providers are unusual, said Flynn Peterson.
In a statement issued Friday, the hospital declined to release expert-witness documents supporting its position, saying they contained private medical data. "Our thoughts and sympathy go out to the Calcagno family," the statement said. The hospital is considering an appeal.


Flynn Peterson said the hospital argued in court that Calcagno's doctors were negligent, and should have gone ahead with the surgery. On Friday, the hospital said that "clinical staff members can only act under the direction of a physician, and we believe [hospital] staff members acted according to the orders of the attending physicians."


Two doctors were named in the suit along with the hospital, but Flynn Peterson said it became clear to her before trial that they were not at fault.


The jury found that neither doctor was negligent. The award includes compensation to Claudia Calcagno's family for past and future economic loss, as well as the loss of her companionship.
For Claudia's husband, Bob, "not a day goes by I don't think about her," he said in an e-mail Friday. "To put it simply, I miss my wife."


Claudia was as an executive assistant for Catholic Health Initiatives, Flynn Peterson said. She and Bob met on the job in 1999: He worked for a company that installed furniture for her office. They began dating, and married in 2004.


"The day we found out we were pregnant I cried like a baby," Bob Calcagno said.
As Claudia's pregnancy developed, their excitement grew. She got the house ready for a baby, and "you just knew she was going to knock this whole mothering thing out of the park," he said.
Calcagno, 36, was 41 weeks pregnant when admitted to Monticello-Big Lake Community Hospital on Jan. 17, 2008, to have labor induced. Her labor stretched into the next day, and after she had pushed for two hours, her obstetrician ordered a caesarean section. At 6:50 p.m., she gave birth to a healthy son, Vico.


But mistakes that contributed to her death had already been made, Flynn Peterson argued. Court documents say that a routine order to type and screen Calcagno's blood put in before her C-section wasn't done until hours later. And following its own policy, the hospital did not stock blood of her type -- A negative -- falling short of accepted standards of practice, Flynn Peterson said.
At 8:50 p.m., nurses checking on Calcagno found that she was bleeding heavily. Her doctors were called, and a surgery team was paged.


A doctor who examined Calcagno ordered blood for her. The hospital lab sent the O negative blood, traditionally the universal donor type, it had in stock. A 911 call was also made to get blood from a hospital 12 miles away, but it's unclear when it arrived.
Calcagno could have received A or O positive blood that the hospital had in stock, but her doctors said they were never told it was available, Flynn Peterson said.
She was taken to the operating room for an exam under anesthesia and possible treatment, including surgery to remove her uterus. But her doctors decided against that.
According to documents, they were concerned that, given the hospital's resources, they wouldn't be able to control potential bleeding problems if they went ahead with surgery. They also felt they had stabilized Calcagno. So instead, they decided to transfer her to North Memorial Medical Center in Robbinsdale. As a medical crew from North Memorial wheeled her to a helicopter, two more units of blood arrived and were sent with her.


During the postpartum hemorrhage, Calcagno lost at least 4,000 milliliters of blood. By the time she reached North Memorial, she was in critical condition, with dangerously low blood pressure. Despite treatment, including a blood transfusion, her heart stopped beating shortly after she arrived at the hospital. Doctors started an emergency hysterectomy, but despite efforts to revive her during surgery, she died.


With help from Vico's grandparents, Bob Calcagno is staying at home for his son's early childhood. The couple had planned to have one parent stay home for their son's first five years, and "he wants to keep that pledge to Claudia," Flynn Peterson said.
Bob Calcagno said Friday that no amount of money will bring his wife back, "but I take comfort knowing that our futures, especially Vico's, are financially secured."
Sarah Lemagie • 952-882-9016

Presenting VBAC in a Positive and Non-threatening Light

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

The thing is - I just wanted to (and still want to) change the world in regards to birth in America. But, after things settled down I learned that I had to let some things go, and be careful on how I talk with women, otherwise I will turn them off to the very thing I'm trying to turn them on to. I don't think I'm quite there yet, but I'm getting closer - I am really trying to embrace the philosophy of "helping women make informed choices that are best for them - and doing it in a way that they don't feel judged." And sometimes that is so hard when you are screaming things on the inside like "Get rid of that bogus doctor", or "That is the worst decision ever." It's even hard to make those subtle suggestions - ie) when a friend says "I'm just going to say - load me up with drugs [for labor]" and you try to give education related to that and why getting "loaded up with drugs" right away in labor may not be the greatest.

My most recent potential "success" recently was when I was given free reign so to speak. Someone at work approached me (and I had known she had a c/s with #1, but did not know she was expecting #2) and asked if I was glad I had a VBAC. I immediately picked up that she was expecting and said "Hell yeah!" But from there was able to reasonably explain my emotional, mental, and physical benefits. Later she told a co-worker "Yeah, I asked Jessie about her VBAC, and it was not what I wanted to hear." She's really looking for someone to just tell her to do the repeat. But I am so happy that she is looking into this further and that somehow I was priveleged enough to be a part of her questioning process.

I would love to hear other people's thoughts on this subject. I am glad that I always have different online resources that I can use to vent on if I need to. But, I really would like to hear how others who generally have the same views as I do, are able to present their birth views in a positive and non-judgmental way.

P.S. I've been dying to write a post on the topic "As long as mom and baby are healthy". Really - I've had this blog post in my head FOREVER. But have not gotten in down on paper because that is somehow overwhelming. I've read many posts on the topic and I feel I have another twist/opinion to add to it. So one of these days - it will come!

ACOG and Less Restrictive Guidelines

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

It is too soon to tell if this will truly promote change, but if it does, I am hoping that even more changes will come about from this - like the overall climate towards VBAC in general. I still remember Gail Tully speaking at one of our ICAN meetings about working with another midwife in another country (Denmark or somewhere - don't quote me on the area, but somewhere else in the world where women give birth - how is that for vagueness) and she asked them how they handle VBACs and they said, "Oh yeah, you guys give that a funny name - for us - it's just a birth." That is my dream that we would not be these ultra high risk VBAC women - we are just women giving birth.

So, we hopefully continue to go step by step in the right direction.

Beautiful frank breech VBAC at home

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.

Good News for our MN Birth Centers

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

So, for those of you who are more savvy with legal things and want to read the bill, you can go here.

For those of us who just want to know the basics, this is what happens when the bill became law:

1. Birth Centers will have a route to become licensed in MN
2. Licensed Birth Centers have access to federal funds
3. Licensed Birth Centers have access to state funds
4. State fund spending often sets a standard for private insurance companies, increasing private reimbursement rates
5. CPMs will now be a medicaid provider type in MN! They will be paid for their work in birth centers, and this is a huge foot in the door to increase the possibility of medicaid covering CPMs in all places of birth (and private insurance covering CPMs in all places of birth).
6. We have increased awareness about what birth centers are, and what they are not.
7. We have forged a great working relationship and friendship between CPMs and CNMs in MN.

The Star Tribune also had a good article covering this news as well.

The article dicusses some of the pros:
"It's a game-changer in giving midwives and birth centers a level playing field in innovative pregnancy care," said Dr. Steve Calvin, an expert in high-risk pregnancy.

The federal health overhaul passed by Congress in March requires Medicaid to cover deliveries at birth centers, which now operate in 33 states.

And it also discusses some of the cons or barriers:
The centers must also develop relationships with local hospitals and physicians, who may be distrustful of the concept and see them as competition.

I also really like this quote from the OB who is looking to help open a birth center close to Abbott Northwestern hospital who specializes in high-risk pregnancies: "We've been taking that high-risk model and applying it to everybody," said Calvin. - He says this in reference to this previous statement: Midwives and other advocates say studies show that birthing centers are just as safe as hospitals, and provide women another option that is healthier for them and their babies.

So, as you can see, this is a very positive movement, not without work to still be done to improve the birth culture in general, but I really feel that overall Minnesota is moving in a more positive direction.

"The Real Risks of Cesareans"

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

The rest are Pam's words - I love how she breaks things down so understandably:


Over 1.3 million babies in the US were born by c-section in 2008, accounting for 32.3% of all births. The most common reason for cesarean delivery is having had one before, but the reasons for a cesarean can vary widely. Sometimes there are medical reasons for planning a c-section prior to labor, and emergencies during labor make other c-sections truly lifesaving. For a huge number of women, though, the picture is less clear. They are told they have small pelvises, or big babies, or their labors aren’t progressing fast enough. Many women are told cesareans are a safe way to avoid the risks of vaginal birth, and an increasing number of mothers are choosing c-sections with no medical indication at all. Whatever the reason for the c-section, though, one thing they almost always have in common is a lack of truly informed consent. Let’s look at the risks listed on a fairly typical consent form—what isn’t on the form may be surprising:

The consent form says:Infection in the skin incision, usually this is controlled with antibiotics. Sometimes it can require you to be re-admitted to the hospital, but in most cases antibiotics are taken as an out-patient.

In reality, you are twice as likely to be re-hospitalized following a c-section, infection is almost five times more likely to occur, and infection can extend to the uterine incision. Taking antibiotics while breastfeeding contributes to thrush, adding another challenge when breastfeeding is already less likely to succeed following a cesarean.

The consent form says:Development of heavy bleeding at the time of surgery with the possibility of hemorrhage which could require a blood transfusion.

Transfusion is required in up to 6% of cesarean sections. If your c-section goes perfectly, you’ll lose over twice as much blood as you would during a normal vaginal birth- and even that number may be grossly underestimated. It is interesting to note that “normal” blood loss during a c-section would be considered a hemorrhage during a vaginal birth.

The consent form says:Injury to the bladder and/or bowel which could require surgical repair (this occurs in less than 1% of all Cesarean sections)

True- but mild bowel paralysis occurs following up to 20% of cesareans, and some women have bladder injuries that don’t require surgical correction but do require use of a catheter for weeks following delivery. Even if only 1% of women require further surgery to correct these injuries, that is almost 14,000 additional- and largely preventable- surgeries per year being performed on mothers who should be happily caring for their newborns.

The consent form says:Injury to the ureter (a small tube which passes urine from the kidney to the bladder)

While this injury is unusual, occurring in just 0.1% to 0.25% of cesareans, it often goes undiagnosed until the mother returns to her doctor with symptoms including pain and fever. Another surgery is then required.

The consent form says:Developing a blood clot in the leg veins after delivery

This occurs in ½% to 2% of c-sections- somewhere between 6,900 and 27,000 women- and can be fatal; yet many women are never told what symptoms to look for or how to reduce their risk.

The consent form says:
Risks for subsequent pregnancies include: placenta previa (where the placenta lies wholly or partly in the lower part of the uterus)

Shockingly, this consent form fails to list any other risks for future pregnancies. Reproductive consequences of a primary cesarean include a risk of uterine rupture that is 12 times higher than it would be with an unscarred uterus, even if a repeat cesarean is scheduled. A woman also faces increased risk of placenta previa, more severe placenta problems like abruption and accreta, miscarriage and unexplained stillbirth, unexplained secondary infertility, and dramatically increased risk of surgical complications in future c-sections. If that is not enough, the scar tissue and adhesions left by cesarean surgery can cause chronic pelvic pain and sexual dysfunction, and in rare cases can cause intestinal blockage that can be fatal.

The consent form says:Cutting the baby during the incision into the uterus (this occurs rarely).

About 1-2% of babies are cut during c-sections- that could mean over 25,000 babies, every year, receiving anything from a nick to a severe laceration at the hands of the delivering OB. While the consent form ends here, a slippery scalpel is not the only risk babies face when delivered by cesarean. Babies born by elective cesarean are up to seven times more likely to have respiratory problems at birth, and are up to three times as likely to die in their first month of life. C-section babies have lower APGAR scores, higher NICU admission rates, and they are more likely to have ongoing health problems like asthma. It’s important to note, these are low-risk babies, not babies who are delivered by emergency cesarean who may have been affected by complications of labor. No, these babies experience these issues as a direct result of the way they were born.

I’ve talked with hundreds of women about their cesarean births, both online and in real life. There is a pervasive belief that c-sections transfer the inherent risks of birth to the mother, providing babies a safer and lower-risk entrance into the world than they’d have with a vaginal birth. Many OBs perpetuate this myth, but it’s clear they aren’t telling us the whole story. I don’t think I’ve met one woman- not one single mother- who was told up front that in some respects her c-section put her baby at greater risk than vaginal birth would have. Even though many women seem comfortable with the increased maternal risks of c-sections, few are truly aware of exactly what those risks are, how much they are increased, or how they can be reduced. OBs are selling c-sections as a safe and easy way to deliver a baby- and women are buying.

Buyer beware.

Awareness...

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

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

Delicious lemon creme filled VBAC Victory Cake!

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

Minnesota Governer Proclaims April as Cesarean Awareness Month

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

"Now, therefore, I, Tim Pawlenty, Governer of Minnesota, do hereby proclaim the month of April 2010 as:

CESAREAN AWARENESS MONTH

in the state of Minnesota."

How wonderful for us to have some official recognition.

In the proclamation it notes that Minnesota has a 25% cesarean rate which is indeed major abdominal surgery, and that the World Health Organization recommends a cesarean rate of 15% or lower.

It also lists some of the complications that can arise from a cesarean section.

The proclamation also states that while cesareans can be life-saving in some circumstances, the women of Minnesota should have "full and complete information on the risks and benefits of vaginal birth and cesarean section in order to make informed choices about their health care."