Message from the Chapter Leader

Hello Birth Warriors!

I think it is time to officially unveil the new face of ICAN of the Twin Cities, as we have had three major changes in our board this year.

The first is to say with a heavy heart goodbye to Sarah Shannon.  She has been part of ICAN of the Twin Cities for 6+ years and has really been the one who knew how to get all our ideas more than just talk.  She is extremely high energy and organized and excellent at setting goals and following up so we all stayed on track.  She just received her Ph.D in Sociology from the U of M, so how she put so much time into our chapter, while working on that, along with being mom to two boys and wife still amazes me.  She has inspired me to act on what I believe in, and she has given me the tools to know how to do it.  Besides all that, I consider her a true friend, so it shouldn't have surprised me when I burst into tears the day I said goodbye to her before they drove to Georgia.  I guess I should add that she and her husband (also a new doctor-congrats to you too, Jerry) have both accepted positions at the University of Georgia in Athens.  ICAN of the Twin Cities owes a debt of gratitude to the Shannon family and we have grown so much together-our boys, our bellies (pregnant ones, I mean), our VBAC journeys.  It is hard to say goodbye to such a momentous part of my life, but Sarah was definitely that and I say Thank you and Onward!  I know they will bring many great things to Athens.

The second big change is that Kara stepped back from her Chapter Leader duties to focus on her career and her family a little more.  She is still on the board, thank goodness, so it isn't sad, but a little scary as I have assumed her position.  Kara has fearlessly led our chapter for 6 years and these are big shoes to fill.  Under her direction, we attended ICAN conferences, held several huge fundraising events, and yes, started the Twin Cities Birth and Baby Expo, not to mention keeping the monthly meetings running and growing.  She has always been the brains of our group-knowing when to put the brakes on something too big, and when to say "go for it."  She is an accountant in her regular life and very organized and good with details, and I have tried to learn as much as I can from her.  I am nervous about running our chapter, but as long as she is still with us, I will always have her knowledge base.  She was also an officer for ICAN International, so is a wealth of insider information.  Not to mention, she is a great person and her family too has grown right along with us.

The third is that we grew our board.  Our "old" board had been Sarah, Kara and me for a long time.  We then invited Jill a year ago, which gave us some much needed new energy and woman-power.  But with the loss of Sarah, we were facing a pretty big hole so we put out a call and received several impressive applications.  And now we are so excited to have Katie (congrats on your HBAC!), Alexis and Kelly as new ICAN of the Twin Cities board members.  We also had a wonderful lady named Ruth, but she suddenly moved back to Chicago so we had only a short time together.  I believe that Chicago has some VBAC challenges, so I have encouraged her to get involved there, as I am sure they need all the help they can get.  We will certainly miss her and appreciate her stepping up to the call.  So now, our "new" board has just the right mix of creativity and high energy and more woman-power we were looking for, as each woman brings fabulous and unique skills.  I know we are on track to grow our chapter in a way that will continue to be on track with the ICAN mission, by reaching more and more women.  Thank you, ladies, for joining!

So from here, we are working on adding to our chapter and getting more visible and organized and accessible.  The addition of the Facebook Group has already added a huge jump in online help-so thank you Katie for managing that.  We are looking to grow our library, our website, our presence in the hospitals and other communities we haven’t been very visible in yet.  Our top priority will always be our meetings and the mother-to –mother support that is critical to healing and learning, so look out for some really great meetings coming up.  And of course the Twin CitiesBirth and Baby Expo is coming Saturday, October 12.  Finally, Kelly will be managing the Blog, so look for upcoming interesting and helpful posts.

We are truly lucky to live in an area that has many options for first time and VBAC moms to have the birth they deserve and should have. We have choices here, and it isn’t like that everywhere.  Little by little, one VBAC at a time, one prevented cesarean at a time, birth gets safer and better.  I feel very rewarded being a part of this and look forward to doing more. 

Rock you birth and your life ladies-there is no one who knows your baby, your body and your needs better than you!

Heather

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.

Being prepared matters

Just over a week ago I got a text message from a friend asking for prayers. His wife was being induced at 35 weeks due to low amniotic fluid.

My first thought?

Oh crap. She's gonna end up with a c-section. Yet another friend to "welcome" into the Sisterhood of the Scar.

Turns out, I was wrong. Even though she was induced at the hospital with the 3rd highest cesarean rate in the Twin Cities (30%), she escaped a surgical birth.

How did this happen?

I bumped into her at church this morning. She told me that she was freaked out when she knew she was headed for induction. She had the same thought I did, that she was probably going to end up with a cesarean. The chances were certainly good - a high risk situation, induction, a preemie on the way...

I think it was her preparation (and no doubt support of her husband and others) that made a huge difference. This was her second birth. Her first had been at the same hospital, but they were well-prepared the first time, too. They had taken Bradley classes and stayed home as long as possible during labor. She had a drug-free birth the first time around. That same mindset and preparation helped her avoid more interventions during her induction this time. She told me, "The only bummer was that I had to be in the bed the whole time [for monitoring, Pitocin, etc]. But I used having to go to the bathroom a lot as my excuse to get up often. So, I got the drug-free birth I wanted. Well, except for the Pitocin...."

My friend was prepared to meet the challenges of an unexpected, stressful birth because she knew from experience as well as from childbirth eduction that sometimes you have to work with what you've got. She knew that moving around is so important in labor. So, she used a little trick to work the system and get up as  much as she could. It wasn't a completely ideal situation, but she worked for the birth she wanted even despite the odds. 

Pitocin: A Cautionary Tale

Cross-post from ICAN blog:

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

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

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

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

Prevent Cesarean Surgery video

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

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

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

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

Cesarean Prevention Webinar

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

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

ICAN Birth Class: Cesarean Prevention
NEW Online Webinar

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

This 2-hour online session will help you learn:

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

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

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