Birth From a Cesarean Awareness Perspective

So Far Away

2008-10-24T23:10:00.001-07:00

Tonight, I'm sitting with my mother discussing life. I'm visiting home and I can't help but think that I am so far away from everything she knows. She tries to talk about birth, babies and "trying to nurse" so that we have something in common. She's reaching and I'm cringing.

How many stories can I hear about this mom or that mom who is "totally breastfeeding their kid" but gives them a bottle during the day because the baby has latch issues and really has problems intestinally. The baby is nursed at night, when it's convenient, but I guess at three months old, after being forced into the world a month early, it's too much to ask for the mom to just nurse him and not bottle feed him so that he will get over the latch issues. But get this...he's getting formula for 8-10 hours a day but NURSING is giving him GERD and gas issues. Yes, and the mom should wean on a bad hair day, too, I'm sure.

Then there is the story of the other mom who is going to be having her first birth ON her due date. She's really smart, has done a lot of internet research, she's really on the ball. Then two seconds later, she's too stupid to realize that a due date is an imaginary number based on a semi-coherent guess.

I could go on, discussing how another family member's son HAD to have XYZ or how another one HAS to have a csection (with the implication being that being too fat was a medical indication or that she DESERVED this somehow.)

Ok. So this was really a vent. But what makes people think that because I love helping concerned moms bring their babies into this world in love, cherishing the journey and jumping the pitfalls of medical standards of practice....
....that somehow I would want to share, relish or talk about stories of mothers being duped, or not putting that kind of cherishing into their little infant's lives?

It's no wonder that she was knocked out for three of her births. Disconnect appears to be a motherhood bloodsport in this particular arena. How about being encouraging to moms or even to your daughters?

May every mother one day tell her little girl the story of how she was informed and powerful and had options during her birth and she used her brain as well as her vagina to give birth...after all, no matter which power you believe created us, they did give us the ability to learn and rationalize even when our neighbor, our doctor, or even our mother is telling us how impossible it is.

Report on Evidence-Based Maternity Care

2008-10-09T17:42:00.000-07:00

My advice? Read the report and look at how women with insurance are still not getting good care even though 98% of them use surgical obstetrical specialists and the "newest and best" technology.

Sometimes the Section is worse than the Section!

2008-10-01T21:04:00.000-07:00

I wound up going to this site:
http://www.healthywomen.org/healthcenters/pregnancyandparenting/cesareansection#
because it was linked from another story on how women are not prepared for surgical adhesions or informed of the risks. (See that story HERE)

After about five seconds on the site, I decided to search for Cesarean.
The section on cesareans brought me to angry in about five seconds flat.
Where to start?
"The rate of cesarean section in this country has never been higher. Part of the reason is that more women are requesting elective cesarean to avoid the pain of labor. Another is that doctors are more reluctant to let women who had a previous cesarean attempt a vaginal birth, for fear of rupturing the uterus (although the risk of uterine rupture is extremely small). Regardless, there are times when a cesarean is necessary. For instance, if labor has slowed, you experience complications, the baby is in distress or the size of your baby compared to the size of you makes a vaginal birth unlikely."
1. So, let's blame the mom. It's her fault. She wanted it.
2. Let's not blame the doctors for doing the first cesarean, after all, that was mom's fault. And let's let them off the hook for giving moms surgery to protect themselves from malpractice lawsuits. After all, we're back to the "it's ok to cut moms if I don't have higher premiums" defense.
3. The doctors have the right to cut every woman out there (1 in 3 in a "best case" scenario in the US) and btw, they have the right to cut you all AGAIN to keep your less than .5% rupture from happening. You don't get a say so.
4. Since when is "labor slowed down" a medical indication?
5. A vaginal birth "unlikely"? wait..so "wow, you have a big baby" is a medical indication because someone gave Dr Swami, OB, a crystal ball?
6. A baby stands a lot less chance of being in distress if mom is supported and taken care of during labor rather than induced, drugged, refused food and water and forced to lie in a bed for the good of the practitioner.

Never mind, I just can't do it. I thought I could blog about this and it's hideousness, but today, I'm just so angry that we can write these things and call them journalism or blogs or even "good information". I went to this site looking for good information on women not being aware of their risks of adhesions and yet the most common surgery done to women in the US today doesn't even have adhesions listed as a RISK? Wait. It does say "scar tissue", doesn't it? This is their idea of a factual list of risks? It doesn't even mention wound infection. This is informing women of the potential risks? A woman can't even go and google search for "scar tissue" because you will notice it's not worded as what it is, adhesions.

And since I don't want to discuss this site any further on a point by point breakdown of it's awfulness, I'll mention the last of them on the page.
"But don't worry; the delivery room staff will rub the baby to restore color and movement and/or provide some supplemental oxygen to help it pink up."
It. Yes. We'll Pink It Up.
Somehow, that doesn't do justice to either the baby or the lifelong risk of asthma and allergies IT carries because IT was born by cesarean. Or the fact that in many cases, that same sweet baby will be parked in a NICU for the first few days of life or spend some time next week in the PICU because some OB thought it was more important to not get sued than to attend a trial of labor.

But, this site has the USA TODAY seal of approval: "USA Weekend Magazine recognizes HealthyWomen.org as "a website to trust," ranking it as a top women's health resource! so I guess I should just believe everything it says.

Bias from the OB's becomes Bias for the media

2008-10-01T14:53:00.000-07:00

Asian-white couples have distinct pregnancy risks

http://latimesblogs.latimes.com/booster_shots/2008/10/asian-white-cou.html

I read this and thought "The media bought it, hook line and sinker. They didn't even LOOK at the obvious biases that might occur, the most obvious being that a doctor looks at "short Asian mom" and offers her a cesarean or doesn't give her as long in labor or says "big baby, let's induce" and that becomes the cesarean in a few hours for a baby that wasn't ready to be born.

This story highlights what is wrong with obstetrical care and the media reporting of it.
Where is the science here and where is the journalist's integrity?

How a 17yo opened my eyes to the cesarean issue.

2008-09-26T09:06:00.000-07:00

Last night, I was helping a young girl write an essay based on her professor's requirements. Her professor required a description of a place that could only be positive. No "buts" and no "negatives". No detractors. How does this apply to a Cesarean Awareness blog?

"Oh, but my cesarean was necessary."

I heard this again Thursday and once again thought to myself...we are conditioned to respond to a cesarean. My first instinct was to tell this mom that the tissue of lies she had been fed did NOT equal a medical indication for a cesarean, but in fact were an obvious attempt by her OB to make her "lawsuit proof". This was a closed and shut case just from the most obvious markers. The mom didn't even get a chance to have a trial of labor because, well, it's so much easier to just schedule since you are going to 'have' to wind up with one anyway! And then I thought, there has to be a better way to LISTEN to a mom, UNDERSTAND her feelings, DISCUSS with her the facts and slowly but surely remove the gauze from her eyes that help her to SEE that she could have made her own choices and decisions and not blindly followed down a path that might have led to giving birth. And at the same time, just plain validate that you understand why she walked the path she did. You get it. You know why she believed what she believed. And she can be angry, pissed, accepting, or whatever she feels once she realizes that the OB made these decisions for her and not with her and take whatever actions she wants to, but that it's ok for her to have been where she stood and that you get it. You've been there, too.

No. My cesarean was not necessary. My OB sure thought it was, he did it in all belief that what he was doing was the right thing. He didn't do it based in science or in anecdote, he was just blindly following what he had been taught to believe. As this mom was doing. She was blindly taught to believe her OB, even Elmo says "do what your doctor says". And I was blindly following my OB as he made my decisions for me. Her Ob was blindly taught to believe his teachers or at least, to regurgitate their beliefs in order to pass the class. He was taught that the only way to defend himself in a court of law was to do what these other "peers" said to do or he would lose his lifestyle, his position, his money.

She's never going to have another baby because of these beliefs. I'm sure her OB will go on to deliver plenty more.
And the 17yo will write her papers to fit in to a society that says she has to, according to the will of her instructors.
Because it's not about developing the future of a mother or an individual.
It's about bending to the societal mores that says it doesn't matter as long as you get the degree.
And it doesn't matter how a baby is born as long as you get a "Healthy Baby".

Who's Laughing Now?

2008-09-25T16:41:00.001-07:00

Ok...so last week in the store, I did something I've never been tempted to do before. I picked up a Jenny McCarthy book. Her first book on dealing with her son's autism (There is a new one due out in the stores soon or now?) and as I sat there, reading her parenting thoughts, I was overwhelmed by what we had in common. I was floored by that "moo" that her son gave her, because I remember coming home from the ICAN conference in 2003 and sobbing because someone else's little 2yo told their mommy "I love you" and mine couldn't. Mine couldn't say "I love you" because his tongue couldn't make those sounds. His brain wasn't there. He was lovable, sweet, but refused to be touched. I heard her anger, hurt, self-pity and it felt so real...

So I picked up her other books and wanted to see what was there, underneath, in her life. I wanted to hear her ridicule other women and be mean about "Breastfeeding Nazis" and make comments about how great her epidural was (though it helped to cause her cesarean). I wanted to know what her life was like before she really had to care about her choices. How it felt back when things just "happened" and before the reality hit. How cavalier life is before the impact crater sends out wave after wave of destruction through your life, rewriting everything you thought you knew. She took everything for granted that it would all just work out...right?

Now, today...I wonder...does she regret her choices? Is she aware that her choices might have MEANT something, in the case of her son?
Knowing that pitocin, epidurals, cesareans, not nursing..lead to higher rates of autism.

I don't know. I only know that I'm not laughing. As I watch these rates rise, I can't help but wonder how many women don't know that autism is one more thing affected by interfering in birth without respecting the process.

Terminator 16: Rise of the Machines

2008-07-23T20:36:00.001-07:00

http://rixarixa.blogspot.com/2008/07/more-better-birth-track-tm.html

I'm posting this without much explanation because I like her explanation better and at least she was able to keep her sense of humor.

I read this and went "does it scar the cervix? How will we know? Will it impact dilation? How do we know? How can a woman get up and walk around and act NORMAL (the best way to act while birthing) if she's strapped to this thing?"

Frankly, this is a huge reason why giving birth in hospitals is dangerous these days. Even with seemingly good intentions, they have no common sense about what is good for mothers or babies.

Why Homebirth is Important

2008-07-18T08:53:00.000-07:00

There are many people out there that are currently debating the AMA's and the ACOG's positions on homebirth. Actually, that's not really true.
What's really going on is this:
AMA mentioned their stance on homebirth.
The homebirth community went "WTH"

So let's get down to the Skinny of it.
Homebirth is important to the Cesarean/VBAC community because it's the ONLY place they are getting good, individually-based care. They get low cesarean rates, low transfer rates, low complication rates and healthy babies and VBAC's but even more importantly, they are treated well throughout their pregnancy, they aren't scared to death constantly about all the "risks" (less than 1%) of uterine rupture, they aren't told constantly what a risk they are to the physician's practice, they aren't told at every appointment that their baby could die, they aren't told that beginning at 36 weeks, they want the cesarean scheduled (without medical indication) and they aren't told that they have to give birth by 38-39-40 weeks and oh, if you get a REALLY nice dr, 41 weeks.
In other words, they are given good, conscientious, evidence-based care and then, if they do need transfer, their midwife goes with them and tries to maintain that care through what is often a completely nasty process where the OB, nurses and hospital staff feel the need to constantly tell them what risks they were taking rather than treating them where they are standing. A woman who presents with a 102 fever and asks for a cesarean shouldn't be reprimanded for over half an hour about the dangers of VBAC, dangers of a big baby, dangers of uterine rupture and dangers of homebirth. She should be treated clinically and appropriately. Here's wishing that will actually begin to occur in this state or country.

And why is the AMA/ACOG contingent against this? Because they want everyone to believe that VBAC's are dangerous to women and babies rather than just to their wallet. They know that they are not giving good care to women. Not good prenatal care, not complete prenatal care, not accurate care. Their system is built largely on checks on a list and "see you next time" and "screenings" rather than education and choices. They based an entire system on these things and now they are trapped trapped trapped and turn on one another if one OB steps out of line and doesn't practice this way, too.

So the Skinny on why AMA/ACOG want homebirth declared unsafe? illegal?
It's a threat to the way they practice. It's a threat to the money they make. It's a threat to the way they define birth and how they charge for it. It's a threat to the belief system they have set up that others have to follow.

Why do we care?
Because under AMA/ACOG practices, women and babies are being harmed at higher and higher rates. Protocol has replaced the practice of medicine and defensive medicine has replaced the peer relationship between patient and doctor. There is no respect for women or babies or individually-based care in the current world of obstetrics. There is no place for it. It takes too much time and time costs money. Being a doctor is supposed to be a job of prestige and importance with a requisite monetary compensation. But in a world where people realize that most of the time, you can go get tylenol sinus and skip the doctor visit or go to the midwife and just have a baby rather than going to surgeon for specialty care....life is far too simple to pay specialists unless you really need them. And ACOG is terrified women will realize that specialists shouldn't be doing LOW RISK NORMAL CARE.

A Blog to Remember

2008-06-11T18:11:00.000-07:00

In many articles on the web it's now being promoted that obesity is an obvious reason for cesarean or at least an obvious complication leading to cesarean. Here's an enlightening blog that helps to challenge some of these assumptions:

http://www.wellroundedmama.blogspot.com/

The Multiple Cesarean Debate

2008-06-11T11:59:00.000-07:00

This morning a beautiful child was born into the world. VBAC after multiple cesarean.

Just taking a few minutes to remind women it's still happening :)

ACOG's Recent Admission.

2008-06-09T22:47:00.000-07:00

From their statement on the Midwifery Year in Review:

"Declining availability of VBAC.

The situation with hospitals declining to do VBAC deliveries has complicated our
advocacy efforts on midwives. ACOG Fellows in California, Washington and other
Western and Rocky Mountain states report that women are seeking out alternatives,
including home birth with midwives, in their desire for a VBAC. The VBAC issue was
one of several sticking points in California as stakeholders weighed-in on regulations to
implement a midwife licensure law"

In reading this, one has to wonder.
ACOG's guidelines are the reasons hospitals decline to do VBAC's and while over 300 hospitals have specific bans on vaginal birth after cesarean, violating women's civil rights and rights to informed refusal for medical procedures....the vast quantity of people denying women VBAC are OB's themselves. One office and one practice at a time, they have eliminated safe birth for women after cesarean in the US. And read what this really says. ACOG is having problems getting RID of the care providers who OFFER choice, midwives.

Did the NYT get it right?

2008-06-02T11:24:00.001-07:00

The multi-level issues of the insurance crisis in US Maternity care made it into the NYT this week. The issues at hand:
1. Women are being denied maternity or health coverage by local health insurers and national health insurers for preexisting conditions like cesarean.
2. Women who have cesareans are being denied payment to their care providers, despite their care provider's insistence on the surgery
3. Obstetricians are perpetrating insurance fraud by refusing to offer safer vaginal birth or forcing women into cesareans without indication and causing cesareans through nonmedically indicated induction.
4. States with legal midwifery coverage and medicaid reimbursement are not giving out midwives names as a part of the plan because the medicaid providers don't have them in their "plan" despite the legality and safety.
5. Malpractice insurers are determining whether or not obstetricians can do VBAC and therefore, whether or not hospitals or care providers are causing more women and babies to be harmed by elective cesarean without indication.
6. Many insurance organizations have OB's in the industry helping to advise them or owning the insurance policies driving these acts, such as PLICO in Oklahoma.
So what does this say? The entire insurance industry from top to bottom is a mess in regards to the health of women and babies and are completely complicit in the cesarean crisis.

For more on the NYT article, go here:
http://www.nytimes.com/2008/06/01/health/01insure.html?_r=1&th&emc=th&oref=slogin

Yet another "We Can't Think out of the Box" Article

2008-05-30T11:36:00.000-07:00

So the WSJ has encouraged us to realize that they no longer hire true reporters either, but simply biased ones who want to slam childbirth educators. I love how she winks subtly at the slam of her educator who obviously thought that those who use drugs are selfish, then fails to realize that in the next sentence she reveals that she had to force herself into a one hour class because that's all she had time to give for her birth plans and enjoyed the relaxation of the event and the focus like it was a sudden awareness that this might be something she wants to give thought to or relax with.

I wonder how much time she spent buying a stroller? a bed? her car?

The point being missed is rather obvious: Childbirth classes are becoming unnecessary because women ARE more selfish about their births, less worried about the eventual consequences, more trusting of care providers who have done nothing to earn their trust, more accepting of the abuses in a hospital birth because they are told it's protocol and the hospitals have completely co-opted the birthing process, up to and including controlling the information given out by their childbirth educators.

Another "fox guarding the henhouse" moment brought to you by this blog.

Defining Reproductive Health

2008-05-27T21:17:00.001-07:00

At a non-birth conference on Women's Health this week, I was confronted by the enormity of "Reproductive Health".
The table was made up largely of women who thought it meant "birth control" and access to the medications and processes that keep women from having babies and two women who thought it should incorporate those women who's lifespan had chosen to not have children or could no longer have children. Then, there was the one "advocate" across the table who said she just wanted to know how to keep women from having "them". I wonder if her clients (Health Department) are aware of her attitude? If so, I can see why they aren't really reaching out to her for care, kwim?
Then there was me. The only one at the table advocating for informed consent, informed rights, a campaign for midwifery awareness. The entire idea behind "birth affects life" seemed lost in the race to prevent it from happening, denying that women have been having sex at age 14 for thousands of years (if not longer, depending on your belief systems) and even worse, in the arguments about how to prevent sex from happening. Where was the bigger picture about teaching women about their cycles? Teaching teens how to understand their bodies, how to track what was going on with them? Trusting them with information in the hopes that they will use it positively?
Another thing that caught my attention was that in the final review, anything about birth that I had said was dropped out or dropped into the realm of "pregnancy". As long as we keep treating women like pregnancy simply means "prenatal care in the form of going to doctor, peeing on stick and doing as told" in the welfare (and more upper class world) we're ignoring the passages of women into adulthood and capability. We are refusing to allow them to say with authority, I don't WANT to pee on a stick, I don't WANT a vaginal exam without medical reason and acknowledgement that women have every right to say NO to procedures or talk to their care providers as equals who deserve information and evidence NOT simply fear tactics and anecdote. I wasn't trying to discuss -pregnancy, but address the cesarean crisis and the way women are treated, without power. These women who thought that we should hand out condoms to every woman on a street corner couldn't see that VBAC bans or empowering women to make DIFFERENT choices from them or even choices they wouldn't approve of would be a part of the Reproductive Health picture.
When will women's rights advocates stop trying to force us AWAY from birth and actual reproduction as empowering events that almost all women will go through and start encouraging women to actually look at their births and motherhood as POWER?

Sheep Analogy

2008-05-25T20:14:00.000-07:00

An evangelist spoke this morning at a local church. His talk went something like this:
"A sheep is one of the stupidest animals in Creation. There was a shepherd/farm researcher doing a study on sheep. He discovered that if you put a barricade at the bottom of a single file sized ramp coming out of a semi truck that the first 30 sheep would jump the barricade and if you removed the barricade, the next thirty would jump over air because they had seen the first 30 jump."

This defines modern maternity care.
We see "A Baby Story" and we think that's normal birth.
We hear "that's protocol" and we think that we have no choices.
We think "birth is scary" and we medicate ourselves because we don't realize that we are strong enough to do this and that pain from birth is something that women can cope with if they believe in themselves.
The OB's see one induction work and think all women can be induced.
The nurses see one bad strip and think that all women should be treated one way in order to avoid another.
The lawyers get a successful case off an OB who made bad decisions and think they can make a lifestyle out of the medmal practice without ramifications to how all other women are treated.
The women out there don't realize there is something wrong with the system surrounding birth in our country. They are sheep, jumping over hurdles that don't exist, being saved from problems that are small and infrequent but believing in them nonetheless and helping their OB's to create the very situations that they will need to be saved from.

The Power of Cesareans

2008-04-15T08:19:00.000-07:00

I had a visible reminder this weekend of the power of cesareans. That unseen, tangible angst of a woman who is planning her next pregnancy. Or not. And I want to ask OB's how they treat the aftermath of the cesarean?

Have you ever walked into a room to find your wife sobbing, not because she can't get pregnant, but because she is terrified to make that journey? I know husbands and wives who daily are facing those tears because they can't stand the thought of having their choices taken from them, forced into a surgery they MUST comply with or be refused care or seek care wherever they can find it, or give birth at home alone, without a midwife to help them. Frankly, I find it reprehensible and tragic that we allow these doctors to put women in that kind of state over simply deciding if they want to have another child in their lives.

This is mass control of reproduction, for the sake of defensive medicine and malpractice. Many times, these women are asked repeatedly during their cesarean, or leading up to it, if they want to have a tubal ligation. Pushed because of the "risks" of multiple cesareans. And yet, no one wants to do VBAC because it might risk the care provider. Not the mother or the baby. The care provider.

Studies show that more women choose to be infertile after the trauma of a cesarean, EVEN if it was a planned cesarean. What does this say about the process of surgery and recovery?

Cesarean Awareness Month

2008-04-01T09:51:00.000-07:00

Two things about Cesarean Awareness Month:

1. ICAN memberships are cheaper. While this may not sound like much...it means that you can do more for women for less money. Help em out, would you?

2. Oh, yeah..and there is this little statistical analysis that came out yesterday or so..

From the summary:

"Some factors that help explain the rising caesarean rates are:
increasing maternal age, rates of hypertension, diabetes, obesity and
multiple gestations. However, the increase in proportion of caesarean
births exceeds actual increases (individually and collectively) in the
prevalence of these conditions among pregnant women. In other words,
the caesarean birth rate is rising faster than medical or demographic
conditions would justify."

The report is available here:

http://www.cmnh.ca/cesarean.htm

In OTHER words..it aint cause we're fat, unhealthy or any other reason. Let's pin that blame back squarely on the shoulders of those who are making the choice to cut:
The Medical Care Providers.

Motivation.

2008-03-31T19:15:00.000-07:00

Today, something occurred again that makes me wonder why there is so much pain and anger directed at women who don't choose to have a repeat cesarean, no matter how many cesareans they had, be it one or be it five.

I wonder if it's the anguish over the choice. Not knowing if you made the right call. Knowing you will never know if you made the right call. The lack of control over the issue in realizing that you made a sacrifice and worried and wondered about the outcome while someone else "had" a vaginal birth. Or worse, had a loss that they can then be blamed for. It's that woman's fault, after all, that her uterus ruptured or that her baby died. Obviously, if she had made the other choice, then that NEVER would have happened.

But the truth is still the same. Life is not safe. Birth is as safe as life gets. And life...is 100% fatal.
And that VBA4C mom doesn't care less for her baby, no matter what you might think. She cares differently and is in a different process from you. I sincerely doubt that most women who sign up for elective repeat fifth cesareans are told of the risks of their baby dying from stillbirth or the first few weeks of life from respiratory issues. They aren't warned of the placental abnormalities that kill more and more women and babies as the cesarean rate rises. They don't worry about those things because they feel that by scheduling, they are circumventing those risks. They are doing "safest." and "the best they can."

But the truth is still the same. Elective repeat cesareans are more risky than vaginal births. So..if you feel that you care more because you would pick "your baby" over "your VBAC" then perhaps you should ask yourself ...what if they are one in the same and you have control...over neither?

Noah's Ark - A Midwive's Tale Found on the Internet.

2008-03-31T09:55:00.000-07:00

God told Noah..you will need midwives on the Ark. There are a lot of babies to be born, both animal and human. They need a loving touch.

So...Noah brought two midwives.
The first was a CNM and the second was a CPM.
The midwives said that anyone who had had more than one baby could not be on the Ark. It was not in their protocol. The wolves got off, because they had litters. The Cows who had had twins got off, because their calves had come together.
The midwives said that anyone who had large babies had to get off the Ark, because it was out of their protocols. All of the hippos got off. Their babies were always large.
The midwives said that anyone who had small babies had to get off the Ark, because it was out of their protocols.
All of the mice got off. Their babies were always small.
The midwives said that anyone who did not go to 40 weeks gestation had to get off the Ark, because it was out of their protocols. All of the guinea pigs got off the ark. They would never make it to 40 weeks.
The midwives said that anyone who went over 42 weeks gestation had to get off the Ark, because it was out of the their protocols. So all the elephants got off. Their babies never came at 40 weeks.
The midwives said that anyone who's babies came breech had to get off the Ark, because it was out of their protocols. All of the horses got off because their babies often come out feet first.
The midwives said that anyone who had a cesarean had to get off the Ark, because it was well-known that many midwives can't or won't attend a VBAC. So all the bulldogs got off the Ark.

At the end, all the CNM and the CPM had was each other, sitting on the Ark, with Noah's wife who was done having children, condemning the younger generation for their lack of activism and using low risk care with midwives...

...and meanwhile, across the Earth...those animals bred and birthed and flourished...because life finds a way to happen despite protocol.
-Author's name withheld.

ICAN's Response to ACOG and AABC statements

2008-02-08T19:19:00.000-08:00

Thursday, February 7, 2008

ICAN's response to ACOG and AABC statements
Redondo Beach, CA, February 7, 2008: The International Cesarean Awareness Network (www.ican-online.org) would like to publicly condemn both the AABC (American Association of Birth Centers) and the ACOG (The American College of Obstetricians and Gynecologists) for their statements* this week that limit not only women's choices in birth but imply that birth is a fashion trend rather than a safety concern.Since VBAC is the biological normal outcome of a pregnancy after cesarean, ICAN encourages women to get all of the facts about vaginal birth and elective cesarean before making a choice. This decision should not include weighing the choices of your doctor's malpractice payments but only be a concern of the mother, her baby and their health and safety.Since some mothers will make the choice to give birth outside of the hospital, we encourage the AABC to not cave into ACOG's demands that all women give birth in a hospital facility with a surgical specialist, but instead allow women to make their own choices about care providers, birth settings and risk factors. ICAN respects the intelligence of modern women and accepts that the amount of information available about VBAC and elective repeat cesarean should serve as informed consent.ICAN further encourages the governments of individual states to look closely at their cesarean rates (31.1% national cesarean rate as of 2006) and the informed consent laws that apply and help women to reach a standard of care that lowers the risks of major surgery and the risks of elective or coerced cesarean without medical indication. Women and children should not bear the brunt of malpractice risks being conveyed into physical, mental, emotional and spiritual health risks in order to protect their physicians.Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are more than 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.* AABC statement: http://www.birthcenters.org/files/file.php?id=2&file=file&file_type=file_typeACOG statement: http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm

A new Look...

2008-02-06T21:11:00.001-08:00

www.ican-online.org

From the Mouths of Mothers

2008-02-06T17:51:00.001-08:00

This post is not mine. It's that of a woman in pain who has been harmed by her cesareans and her obstetricians. I'm simply borrowing the soul crunch in order to let you know how it really feels to be on the wrong side of ACOG. This week, ACOG once again showed that restraint of trade is alive and well in the United States. As a backlash to so many people noticing that women have safe births at home all the time, even in the Big Apple, ACOG thought it necessary to tell us that it's trendy to do, but not safe. Well, how about those trends in Cesareans? Casual induction? Coerced Cesareans for "big babies"? Let's face it...we know who is really worried about the trend for midwifery. It's a simple matter of economics. If midwives deliver most of the babies, why would anyone spend 12 years in school learning to be a surgeon for the 15% of cases that need more urgent care or surgery? They don't seem to see that they would then be paid MORE due to scarcity and/or simply having an emergent care situation. By making themselves the arbiter of low-risk women, they have simply gotten their hands into the cookie jar and like all raccoons, won't let go until they are torn ripping and screaming from where they have placed themselves.
Here is ACOG:
http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm

And here is that mother's response:
AAARRRRRRGGGGGH!!!!

"The main goal should be a healthy and safe outcome for both mother and
baby"

Pardon my language - but fuck them...with a garden hoe! I'm so so so sick of
their 'we're just cutting you open and rendering you high risk forever for
your own health" BULLSHIT!!!

It's such a safe outcome that they've spent a decade and a half treating my
uterus like a time bomb...such a safe outcome that I couldn't feel my
clitoris for months and STILL can't feel my bladder from surgery 2.5 years
ago...such a safe outcome that I needed oral antibiotics to combat the infection
in my incision this time and prescription-strength antibiotic ointment to
combat it last time (not that those would likely show up in a study, since
they aren't in any hospital records)...such a safe outcome that I've spent
years wanting to DIE (not because of the much-yammered about "pressure" from
natural birth advocates, either - I'd never met one until during my third
pregnancy)...such a safe outcome that my body feels completely destroyed,
and I've never had a really bad recovery or any official complications.

I could scream. If I weren't afraid of freaking out dd, I *would* scream.

I *love* how they mention that the studies haven't been scientifically
rigorous...but they do specify that they're only talking about studies IN
THE US (not that your average person would catch the significance). I
*might* even be willing to say they had a point - *maybe* being in the
hospital would be best, IF it were just about monitoring...but since it's
also about giving us IVs, making us stay in bed, depriving us of food and
water, augmenting and inducing labour, giving us drugs without our knowledge
or consent, threatening us with CPS if we dont' do what we're told,
etc...what validity their claims might have goes right out the window...

"While birth is a normal physiologic process" (from the press release) - not
in a hospital, it isn't.

Who sounds more like they care about mothers and babies? HINT: it's not the trade union.

Have Spinal Column, Will Travel

2008-01-27T11:25:00.000-08:00

So, last night. Tampa's Business of Being Born.
Round and Round it goes.

The CNM's "educate women"
The OB "I practice ethically"
The Doula's "empower women"
A woman in the audience "respect life"

I have a singular frustration as I wake today. It's the same frustration I've awakened with and gone to bed with for the last month. I'm sharing it because it's becoming a bit of an obsession and reframing the argument has to become a reality.

Cesareans are NOT about Malpractice. They are about what an OB is or is not willing to do to keep himself from being subject to malpractice. Would you let someone hold your wife down and cut her baby out of her stomach if they were standing on a street corner telling you they would get sued if they didn't? An OB tells you "I have to practice this way" because he worries about his practice being lost, his livelihood, his home, his ability to pay his bills. He lives in this fear. She lives in this fear. Women OB's are not only as bad, they are often worse, pushing themselves to live to the standard of practice while raising families and trying to fight back against long hours.
Wow. Feel sorry for the OB's, right?
Until you realize the following:
They cut women to get home on time.
They induce women to manage care and timing of their office visits.
They induce or section women in order to keep their cost of doing business low.
They cut women who had a prior cesarean because they are afraid of being sued.

What they don't do is look at the woman in front of them and wonder if she will die at age 45, leaving teenagers or toddlers without a mother due to the bowel adhesions she received from that cesarean. It's not lawsuit material.
They don't look at that same woman at a year postpartum and see her lying on the floor sobbing due to the PTSD results of her failed struggle against failing at birth and having her baby taken from her. She can't sue. She's actually "healthy" after all...physically. Right?
They don't look at that same woman after three cesareans, unable to stop crying because the stillbirth in her arms is the result of those other surgeries. That first OB can't be sued for this.
They don't look at that same woman at six months, unable to have sex because she still has pain. One man successfully sued for not being able to sleep with his wife.
They don't look at that same woman at 6 weeks, having a hard time walking up the stairs because of the infection in her incision that still hasn't healed. This isn't lawsuit material because it's actually a NORMAL complication of cesarean.
They don't look at that same woman sitting in the NICU, staring at her 2 week old who has a respiratory infection. This isn't lawsuit material because once again, it's NORMAL.
They don't hold her hand in her bed while she's trying to figure out how to nurse across a scar when she can't even hold her baby.
They don't hold her hand while listening to complete strangers discuss the news of the day and take her baby to another room.
They don't hear the voice of someone else telling them that their body has failed and it's time to let someone else take over and take her baby out of her.
They don't sit in her labor room trying to fight the pain of the contractions and giving in to the epidural because she's terrified of what will happen next.
They don't help her cry at night, not knowing how to say no to an induction tomorrow which she doesn't need and doesn't want and is secretly terrified of.

They go to their practice, they see her for 5-15 minutes, they weigh her, assess her and leave. And worry that they will get sued because deep down they know they are not giving care. They are providing a business service without compassion and they only look at the plumbing.
God forbid they notice the house has fallen down and the woman is trapped inside. After all, if they don't see her as a person, they can't get sued.

Business of Being Born in Gainesville

2008-01-11T07:50:00.001-08:00

Last evening, at a rather successful fundraising/community awareness event in Gainesville, one woman stood up to say that she's had three cesareans and she doesn't need a ribbon to mark her or anything else. She's fine and cesareans don't have to be a bad thing.

After rehashing why she might have felt the need to do this, it all comes down to the fact that she's right. She doesn't need a ribbon. She's scarred for life, three times. She's going to spend the rest of her life being a statistic with higher risks. Her future insurance companies might deny her for coverage, her future doctors might refuse to take her if she doesn't agree to surgery (regardless of medical condition or health), her risks for hysterectomy, adhesions, bowel obstructions. More surgery. She may or may not wind up with more health problems, but the risks are certainly weighed in favor of it. Enough said.

But she missed the point. Cesarean Awareness is not about branding anyone. It's about being aware of those risks, doing what we can to mitigate the risks, doing what we can to prevent cesareans, doing what we can to encourage women to healthy pregnancies and healthy births that don't end in surgery or if they have surgery, learning new ways to help make these risks lessened.
I don't wear my ribbon to remind ME I had a cesarean, I wear my ribbon to bring attention to the risks and to bring attention to the fact that EVERY childbearing woman should know what I know. She should have informed consent. She should be angry that MORE THAN 1/3 of all births are surgical. She should be livid that women are having to go home after major abdominal surgery and care for their infants alone.

There should be change and for all that this woman was trying to show she's ok on the outside, it's the same old ruse of the cesarean. It's what's on the inside that counts.

Futility of Educating Oneself?

2008-01-07T08:38:00.000-08:00

A link to share with you about a story on childbirth education:
USA TODAY

Maybe most of these women just see the futility of going in to learn about something that DOESN'T APPLY TO THEM???

"don't make me feel guilty"...for what? Understanding the ramifications of your actions?
"don't make me feel bad about wanting an epidural?"...An epidural is a medication often used during labor which affects the entire process and all parties involved in the biology and raises the risk of cesarean if used inappropriately, i.e. the way it's currently used in American medical care.
"don't make me feel bad about choosing a cesarean"...you want surgery instead of going through a normal process. Maybe learning the facts about it isn't making you feel bad, it's making you realize that it's not the same thing as ordering a biscuit with your eggs.

Chilbirth educators aren't dismayed or upset by the amount of women going in for surgery or using drugs, they are floored at the ignorance and apathy of an entire generation of women who don't seem to give a damn about the process, the ramifications on themselves or their future health or their infants. But underlying all of this is a dark secret. It's not really just the moms who everyone is angry at. It's the system. The Obstetricians who feed the fears and cause so many of the issues through iatrogenic induction, monitoring, regulation of food and water. These women are often seeing this "way of birth" through the TV, through movies. They begin to breathe it as small girls when their first baby has a Fisher-Price bottle welded to it's hand or three different kinds of "juice" and "milk" in it's box. When we see birth, we are blinded to the ability of the woman and the normalcy of having a baby out in the middle of nowhere without doctors and a neonatal nurse and an OR. We learn to watch TV to see the "bravery" of a woman on a soap opera abandoned in a snowy mountain retreat giving birth to her infant with no power and when the channel is flipped, we see a screaming woman or worse, one lying defeated in bed, giving her life's choices away in sorrow as the overwording tells us "Well, after 3 hours with no progress, Jamie's doctor decides to do a cesarean"...
Really? Where the hell is Jamie in this process? Does she look like she wants a surgery on top of this? Did anyone talk to her, get her out of bed, feed her LUNCH and buy her some time? Her body quit and so did she.
There, lying strapped to monitors, starving for food, unable to drink more than ice chips and being told her body has failed. "here, we'll do this before something else goes wrong" and the implication is...she will never complete, never succeed. Why Try?
Because if you don't...this is what will happen to you. You will be Broken.
That's the message of a lack of childbirth education and/or the stronger women who are finding their information in books or on the web. Either you quit ahead of time and let go, believing all to save your own sanity and ignorance or you learn and fight the system. Fight those who will tell you over and over again that you cannot do this. You cannot birth a 10lb baby. You cannot birth with low fluid. You cannot birth a 6lb baby. You cannot birth with high fluid. You are going to kill your baby.
So why go to childbirth classes. You've already talked to your OB and he's told you all he needs to. Or she has. A woman OB had to submit to the same system and have her humanity and female fellowship drained out of her or she, too, would have been a failure.
Face it. The futility of fighting the system leaves one drained and incapable.
It's easier to just stay home and watch "A Baby Story."

Pushed to Write about a Stranger's Cesarean

2008-01-06T18:52:00.000-08:00

http://www.huffingtonpost.com/jennifer-block/open-letter-to-christina-_b_80115.html

She says it so much better than I can...
I wish that Christina would wake up and say ICAN before she is in the throes of healing like the rest of us.

Once again, a stranger on the web reaches out. I guess I'm not in such bad company.

Blogs and Cesarean

2008-01-06T17:58:00.000-08:00

Many people don't realize that when they post on their blog, it can be meta-searched and when they post about their cesareans, vast arrays of women read about it. This sort of vicarious watching becomes almost painful when you see someone young and naive take a nose dive into major surgery for no apparent reason.

Recently, a young woman on a blog posted how her baby was "SO BIG" at well over 10 lbs at 38-39 weeks and so she would have to have a cesarean.
Wait. Since when is having a baby an indication for cesarean? Oh. Since she lives in the US.
Wait. Didn't anyone warn her about the possible ramifications of major surgery? No. Her friends and family all loved and supported her without one mention of complications or risks or why is she making this choice?
Wait. Does she know that ultrasounds aren't reliable and that 10 lb babies are born all the time vaginally? I don't know.

So, a week later, she goes in for the elective surgery that will put both her, her baby and any future children at risk for their entire lives. Her entire gyn history and future merge at this one point and begin to make decisions FOR her rather than WITH her. She will have to fight to birth vaginally, should she ever choose to, or she will have to add surgery on top of surgery, increasing risks at every turn and will most likely have an earlier hysterectomy than her vaginally birthing sisters.
For a baby that one week later still wasn't 10 lbs.
For a general surgery that her husband wasn't able to be at.
For an increased risk in other complications that have already begun to occur.

Does she know these things? Will she care one day?
I don't know. Probably, she isn't even aware of all of this.
My heart broke for her and her baby in an odd sort of way. In all that vast sea of "oh, it's ok, cesareans are easy, I did it...blah blah blah...we love you and your baby...we'll care for you..we'll make you meals."
Not one person said "You can do this. You don't need surgery to birth your baby. You deserve better. Let's just try and I'll be there to hold your hand."
Not ONE person believed in her?
just one. A "stranger" on the internet. I believed.

A Father's Role

2008-01-02T10:57:00.000-08:00

Recently, there have been studies posted in various places about father's increasing a woman's perception of pain and father's increasing the cesarean rate through fear tactics or coercion from the obstetrician involved. What you don't see is the father's role in VBAC or in protecting mothers FROM the treatment involved with birth. So, this is a short, quick five questions to make men think.

1. Why is external fetal monitoring used? Does this work?
2. Why is a woman's amniotic fluid sac usually broken? Is this accurate?
3. Is induction proven to be effective or safe in a normal full-term pregnancy?
4. What is the most common indication for cesarean section?
5. Is it normal birth to be on monitors, lying in a bed, denied food? Would you do it?

I know this is a setup..but if men know better...why do they not speak up for change? Why is it only a woman's job to fight for better births in this country? Do men care that their wives and partners are being treated the way they are or does it feel safer to not speak up and tell the hospitals or obstetricians or nurses "no." Or is it that they are so terrified to be removed, they consent to abuses? Is there a reason why so many men are terrified of homebirth beyond being scared of personal responsibility for the outcomes? Is it worth consenting to the abuses in hospitals? Is there a reason to not step up and say "I will not tolerate you doing this to my wife/my child." JUST to get medical care? Or should we be demanding better care?

Hard thoughts. Hard choices. But where do Real Men stand?

New Year

2008-01-02T10:55:00.000-08:00

The past few months were a trial run to see if I enjoyed keeping the blog and posting information occasionally. As the New Year begins, 2008 will see far more posting about various studies and issues and more information for both first-time and multiple mothers and the people in their lives. I hope that you find the blog helpful in your days to come and check back to see the upswing in posts.

Too Stupid to Push.

2007-12-20T16:54:00.000-08:00

Yes, ladies and gentlemen, it's true.
Christina Aguilera is following a long line of celebrities who think it's smarter to choose surgery and a painful recovery with good drugs than a few hours worth of work for their infant. Let's go through the rundown:
1. Cause baby to be born early.
2. Cause baby's body to be filled with drugs that are totally unnecessary.
3. Expose baby's lungs to normal air before being ready to be born.
4. Deny baby all of the benefits to going through the labor process, including clearing out the lungs and causing the reflexes of normal birth to kick into play, raising the baby's permanent risks for asthma, allergies, SIDS...
5. Cause all future children to be at risk for death due to stillbirth or miscarriage due to elective and unnecessary cesarean.
6. Raise risks for hysterectomy and/or pulmonary embolism to mother.

When oh when will these women realize that they should be learning the responsibilities of caring for children rather than ignoring the obvious risks to their behavior?

Midwifery under fire or Women's Choices Assaulted by legislators?

2007-11-24T09:16:00.000-08:00

http://www.chicagotribune.com/news/nationworld/chi-midwives_bdnov25,1,398264.story

CPD?

2007-11-23T22:48:00.000-08:00

To View ICAN's new CPD video from mother's who have had VBAC's:
http://labortrials.wordpress.com/2007/11/22/thankful-for-this-ican-video/

There is no point in reposting something so well done, so feel free to read Kmom's article and the Caesarean myths article as well as watching the CPD video out from ICAN .

The problem with a CPD diagnosis for any woman is that it's based on a guess.
At term:
CPD means you look too small to have a baby.
During labor:
CPD means we couldn't figure out why your baby wasn't descending.
After the Cesarean:
Well, baby didn't descend, therefore it couldn't have ever descended, right?

While the rare medical condition occurs regarding pelvis structure or size, even those conditions are not anathema to a normal birth, they are simply watchwords to keep an eye open if mother or baby are looking like they need intervention. Instead, we intervene without the obvious caution necessary simply because we can.

To all the New Mothers out there...

2007-11-23T22:26:00.000-08:00

There is a moment during every holiday where I stop and think of all the mothers untimely induced or given cesareans in order to accommodate travel, vacations, family obligations, parental visits and obstetricians vacation schedules. There is a moment afterwards where I wonder how many mothers escaped the knife by going into labor on Thanksgiving itself when no one wants to climb out of bed late at night to come in for a surgery call or wants to spend just another hour out with family.

And I know Christmas is coming and with it all the insane inductions for reasons like tax deductions or family plans. I know how many women will wind up with major surgery between Turkey and New Years. To those women, may you find ICAN (www.ican-online.org) or other healing to go forward in your journey and may your healing be quick. May your holidays be spent being pregnant and enjoying it, aches pains and ickies all around, while waiting for your little one to come rather than forcing that day upon yourself too soon. May you not spend a night in the NICU because of an induction or cesarean that should never have happened. May all your VBAC's be successful. May...the peace of the season and the reason for it, a simple home birth of a small boy child, envelop you with the feeling of sacredness and respect for this process so old and so worth the journey, and may you see that one special moment that millions of women make without ever witnessing the miracle.

And for the perfect Black Friday moment: May you spend more time planning your birth and your care provider than you do buying a new toy or crib item for your layette. After all, you will remember your birth for the next 80 years. A dancing Elmo won't be remembered at all...

So, now I'm going to take time out to say "Happy Birthday" to someone I know who's mother helped make Thanksgiving dinner 28 years ago and then went and had a baby :) Nope, it's not my mom but the mother to a great woman who went on to have a cesarean and become a fellow activist in the field, helping women to overcome their hurts and go on to pursue healthy births. And it's now something to be celebrated when a labor is spent without bells, beeps and whistles and being told what time and when to have the baby, so I think her mom deserves some credit for the work of bringing her into the world. No schedules, no pressure. Amazing that women used to give birth on days where we were giving thanks and now, we strive to make sure there is nothing to be grateful for on that day. Kind of missing the point, aren't we?

You Should Be Grateful...

2007-11-18T18:49:00.000-08:00

...and I am. I'm thankful this week for my lovely children. My cesarean that has given me the ability to help other women has changed my life and in some ways, I'm almost grateful for that, but in so many others...I wonder....
Should we be grateful that insurance companies can deny us coverage due to prior surgery?
Should we be grateful that our state government can override our rights and force us to have a cesarean for the "good" of our infant?
Should we be grateful that the way we garner strength is in having to fight during one of the most precious times of our lives?
How many times must we be "grateful" before the 1.7 million women being cut yearly are seen as an epidemic and not a safe solution to the "problem" of childbirth?

Thoughts to ponder: www.birthtruth.org/grateful.htm

May this week bring you many thing you give thanks for, in strength and happiness, in trial and pain. May your families be a comfort to you...

This week's Bias in the Media moment...

2007-11-12T16:56:00.000-08:00

Ok. The article is so underfed with facts that it looks like a starving animal voraciously feeding on biases alone.

-"Doctors are growing wary...."

No. Obstetricians are refusing to do VBACs.

-"women..more and more difficulty in finding..."

NO. Obstetricians are choosing to refuse to have clients that want a vaginal birth. Think it's limited to vbac moms? Guess again. Over 35? "Obese"? First time mom? Your birth will be induced or sectioned. The odds of you getting an untampered with birth are under 3% and that's if you are birthing outside of a hospital and without an obstetrician.

-"a risk of uterine rupture, or a bursting of the C-section scar"

A BURSTING? You must be kidding me. Scar ruptures are rare and cover widely varying degrees between an unnoticed separation of muscle to a full split in the tissue or shredding in muscle tissue. The imagery here is hideous from a "reporter"...

-"advocates of vaginal...say fear of lawsuits.."

No. The Obstetricians say that. Or that they can't do them because of their malpractice insurance. Amazing that the same insurance doesn't say "wow, more mothers and babies being damaged is too risky for us" but their job is to protect obstetricians...not women.

-"I really think it's not too far in the future that no hospitals will allow it, just because the liabilities are too big."

Wow. So it's up to hospitals to tell us that we have no rights to use our own vaginas? We aren't "allowed" simply because the hospital might lose money? Are they going to give us back the money they make on our cesareans? Are they going to post the list of damages they are doing to mothers and babies in order to protect themselves from liability?

For every cesarean done, the stillbirth risk for the next pregnancy can as much as double.

-"Some doctors would disagree. A vaginal birth after Caesarean carries about a 1 percent risk of uterine rupture, which can result in brain damage or death to the baby, as well as severe injury or death for the mother."

And yet, EVERY cesarean is a "controlled uterine rupture," slicing open the abdomen and raising the risks for the exact same things for both mother and baby and for far longer into the future.

-For that reason, the American College of Obstetricians and Gynecologists recommended in 2004 that a doctor and an anesthesiologist be available during all VBACs.

Wow. You mean that the trade union for OB's has decided that all OB's actually must be at the births they are getting paid to attend! Or, even better yet, if they can't be at the births they are getting paid to attend, it's ok to refuse to do them!

-"When it happens, physicians have only minutes to perform an emergency C-section to save the baby and also tend to the mother, who could hemorrhage."

And yet, every cesarean is twice the blood loss to mom...not to mention quick cord cutting for baby, putting them at risk as well.

It just goes on and on...but the famous last words belong to this "intellectual"...
"Dr. Susan Hardwick-Smith, for example, who practices privately and delivers at Memorial Hermann-The Texas Medical Center, now refers patients who insist on having one to another physician. She would never take those risks with her own children, she said, so she doesn't take them with her patients' unborn babies."
Um..."Dr." ....you might want to note that every time you refuse to do a vaginal birth and yet, continue to do elective repeat cesareans...you are not only forcing risks on unborn babies...you are raising them for us all... and that mother and baby are being harmed by you. Congratulations...you are causing stillbirths, hysterectomies, infertility, possible slicing injuries to babies, greater risks of allergies and asthma, greater risks of dying due to respiratory issues for baby and mom could throw a PE. All in the name of "prevention"...

This kind of one-sided thinking endangers us all...

Cesareans are not safe simply because they are sometimes necessary. Turning all mothers into cesareans regardless of individual risk may not legally be malpractice (for those who can understand the difference between what is right and wrong vs what is a legal term) but it is damn sure unethical to do so in the name of protecting your practice. It makes one wonder when the humanity left the practice and only the fear was left. As one OB stated it several years ago: "After 38 weeks, the baby is my enemy"...

All in all, though, I can't help wondering how much revenue the newspaper gets from local hospital advertising. I'd like to think it was simply greed that kept them from publishing the truth, but I have the sneaking suspicion that they just simply don't understand how to give both sides of the story.

(Psst...saying repeatedly "advocates for..." doesn't make you unbiased or fair and balanced. It just means that it saved you from fact checking)

VBAMC

2007-10-30T17:41:00.000-07:00

Vaginal
Birth
After
Multiple
Cesareans

VBAMC. Virtually unheard of in a hospital environment, it's also prohibited in most "out of hospital" legislation. The following was emailed to me from a list earlier and it's given me cause for wonder and at the same time, alarm. Last evening, I spent 2 hours with two lovely women who will probably never have vaginal births without a fight. The idea of women having to fight to be able to make their own decisions in health care while pregnant, while gestating, while trying to be at peace simply offends me. Evidently, it doesn't offend the obstetricians who help force through the laws or the midwives who compromise simply to be able to offer care to anyone. Or maybe it does, I don't know. What I am having a hard time grasping right this moment is why we are fighting so hard for legislation that precludes MANY women from using it, due to a perception of risk which is not based in evidence. Those same OB's coerce women into agreeing to the second cesarean through unreasonable expectations (you have to have a 40 week baby under 8lbs? That's REASONABLE? I don't think so!) or through forcing them (I won't take you as a client unless you agree to a cesarean. Sorry, I don't do VBAC) and then have eliminated them through shared practice restraints from being able to do homebirths. So, for the sake of a 1% risk, these women are told they don't have the RIGHT or ability to choose a vaginal birth.

A woman in a hospital setting is not given a chance if she's a normal, low-risk woman having her first baby. I fail to see how mothers who have had more than one cesarean are going to receive fair or balanced treatment based on their needs and not blind protocols.

It's a conundrum. How to make midwifery accessible without making midwives be hunted.
How to make the "system" recognize that women deserve the right to birth where they choose, with whom they choose and with the responsibility of understanding the risks they choose through an informed consent process that matters. I don't see any of that in the legislation.

Oh, and by the way...if you can't have a VBAC unless you have had a VBAC...how in the hell do you get the first VBAC?

http://www.dora.state.co.us/Midwives/Rules.pdf

*RULE 4 – PRACTICE RESTRICTIONS *

The purpose of this rule is to define the practice restrictions applicable
to a direct-entry midwife.

A. The direct-entry midwife shall not provide care to any client whose
medical history exhibits the following signs or symptoms:

11. Vaginal Birth After Cesarean Section (VBAC) unless compliant with Rule
12, or

*RULE 12 – STANDARDS FOR VAGINAL BIRTH AFTER CESAREAN SECTION (VBAC) *

The purpose of this rule is to establish parameters for VBAC patients
seeking midwifery care during pregnancy in order to safeguard the client's
welfare.

A. A direct-entry midwife shall not assume primary responsibility for
prenatal care and birth attendance for women who have had a previous
cesarean section unless all of the following conditions are met:

1. All prospective VBAC women shall sign an informed consent statement,
which shall be retained in the client's records and include the following:

14 (a) VBAC educational information including history of VBAC and client's
own personal information;

(b) Associated risks and benefits of VBAC at home;

(c) A workable hospital transport plan;

(d) Alternatives to VBAC at home; and

(e) Other information as required by the Director.

2. A workable hospital transport plan must be established for home VBAC. The
plan shall be in writing and include:

(a) Place of birth within 30 minutes of transport to the nearest hospital or
emergency medical center able to perform an emergency cesarean;

(b) Readily available emergency numbers for the nearest hospital or
emergency medical center; and

(c) Provision for phone contact with nearest hospital or emergency medical
center prior to any transport notifying the destination that transport is in
progress.

3. There has been at least 18 months from the client's cesarean delivery to
the due date of the current pregnancy.

4. The client with 2 or more cesarean deliveries has also had a prior
vaginal delivery.

B. Direct-entry midwife shall obtain prior patient cesarean records, in
writing, and shall analyze the indication for the previous cesarean, and
retain the records along with a written assessment of the physical and
emotional considerations in client's files. If the direct-entry midwife is
unable to obtain the written records, the direct-entry midwife shall not
retain the woman as a client.

C. Records that show a previous classical uterine/vertical incision or any
previous uterine surgery which required an incision into the uterine fundus
are a contraindication to VBAC at home and shall require immediate transfer
of care of the patient.

D. Direct-entry midwife shall not induce or augment labor by the use of
chemicals or herbal supplements or nipple stimulation.

E. A direct-entry midwife shall be present and manage the VBAC delivery from
the onset of active labor throughout the immediate postpartum period.

Living "at risk"

2007-10-22T20:53:00.000-07:00

I wrote something a while back which I think needs to be reiterated. I've had a very busy month and left the blog a bit empty while I was refocusing and getting organized. So, the renewal period will begin with this:

Obstetricians do know how it feels to be a VBAC mother. They live every day, wondering when someone will give them a gut wrench and hand them a court summons to appear. Knowing that someone else controls their livelihood in the blink of a moment, that gut check controls their existence.
VBAC moms live in daily fear of that gut check. It controls their ability to birth in a safe environment with a care provider they trust. Knowing that at any moment, their "care" could become defensive and controlling, knowing that at any moment, they could be left out to dry and forced to have an unnecessary surgery because of that OB's fear.
The difference is simply meted out in dregs..it's all fear and misery.
The only real difference in the outcome is this:
An OB could lose their practice, their livelihood, their home or their car.
VBAC mothers could lose their life or their baby's life on that table.
Defensive medicine cannot excuse away the unconscionable actions being taken that endanger our women and babies. Maintaining a license is NOT equivalent to maintaining a life.

Making Change in Florida

2007-09-26T20:15:00.000-07:00

Got the time to call and make a difference? Let us know if you do!

From ICAN of Orlando:

If you only make one call in the next 24 hours, MAKE THIS CALL!

LOCH HAVEN OB/GYN: 407-303-1444

webmaster@lochhavenobgyn.com
235 E Princeton St - Ste 200
Orlando, FL 32804

Hello Ladies,

We have it on good authority that the doctors at Loch Haven OB/GYN will be having a meeting on Friday to discuss whether they will go back to doing VBACs now that Florida Hospital has lifted their ban. Loch Haven is a major obstetrical group at Florida Hospital. If they start doing VBACs, other OB's might follow.

Please, please, please! Call, write letters, or send emails to them, (or do all 3!). EVEN IF YOU DIDN'T HAVE A C/S, PLEASE HELP OUT! Please let them know that you will support them in their decision to protect a woman's right to choose how to birth. Encourage them, in whatever way moves you, to give women the option of VBAC. It is our hope that if they see that there is a market for VBACs, they will be more likely to go back to supporting them. (If they ask why you care if you didn't have a c/s, just say "Any pregnancy in the future may cause me to have to go under the knife. I want to know this option is available to me." Or something like that.)

**If you were a Loch Haven client in the past, or are now, it would be especially helpful for you to call.** If you avoided them because they wouldn't do a VBAC, please tell them so.

Letters must be in the mail by tomorrow AM to make it by Friday, but that may already be too late. I would recommend calls and emails just because we have so little time. Michelle is posting the letter she is sending, that would be a great starting point if you are not feeling very articulate about the topic at the moment. Make your calls/emails/letters personal, brief, and to the point. And, you could also point out that their own Dr. Hill was once a VBAC supporter, and you are excited for him to be again! Do it now, while you are thinking about it! :-) Call me if you need help!

Thanks Everyone!

Epidurals vs Narcotics. Klein on the Meta-Analysis.

2007-09-14T04:01:00.000-07:00

Dr. Klein speaking on the Cochrane meta-analysis of the Epidural vs Narcotics issue.

*in the past, these meta analyses showed a 10% increase in Cxion (his word again..sigh) with epidurals. This one doesn't..hmm.

*Quoting him "It is not the fault of the RCT as a methodology!!! It is the fault of the inclusion in the meta-analysis of studies that ought not to be there - or the studies need to be grouped or stratified according to their settings or approaches so one can know if the results apply to one's own setting."

THIS IS IMPORTANT. Cochrane is trusted, so we don't realize that the data is being SPUN!

*There was an inclusion of one study with a LARGE population that gave their epidurals late in labor, only in active labor. Without Sharma, there is a 4.3 hour increase with epidurals, with Sharma, it's only 1 hour increase (1st stage of labor); cesareans were higher, perineal trauma was higher, infant consequences higher. The book for this is very blurry, so I am hoping that Dr. Klein will forward me his slides so I can actually use this information with real stats.

Throwing the Mother out with the Bathwater

2007-09-14T03:47:00.001-07:00

Nope, not my Title. I attended this session at Lamaze with Dr. Michael Klein. I was taking notes on his speech, I bought the CD and I'm still not sure I'm getting all of the nuances, but I wanted to point some things out before time passed...and I'm in an airport at 6:48am.

This session was a talk on Randomized Controlled Studies and how they are misused.
*In a matched cohort of healthy women, one hospital had a 8% cesarean rate, the other a 20% rate (early 1990's...don't we wish that was now!)
Cesarean rates with women having epidurals: 15.4% in the one low hospital and 67.2% in the other. The odds were 3.4x higher. In the low risk hospital, epidurals weren't given until later in labor, typically. The interesting thing is that with women having NO epidural in both hospitals, the cesarean rate was about the same and the women having an epidural in both hospitals, the risk of a cesarean was about the same. Dr Klein states that we don't know that it's causal, but it's a dang good coincidence, eh?

(Janssen P, Klein MC Differences in Institutional Cesarean Rates: The role of Pain Management. J Fam Pract 2001, 50(3) 217-223)

*His research survey also showed some correlation with epidurals and newborn outcomes. The higher the epidural rate, the lower the apgars in newborns and the more newborns in the NICU.
Interestingly, he notes that physicians who spent more time with their patients, even though their patients were in the hospital for a shorter period of time and used epidurals later..had better outcomes.

*universiality cannot be conferred by an RCT, even if done WELL. A small hospital with three doctors ad 1000 births per year is not going to have the same type of situation as a hospital with 30 physicians and 25K births per year. (my numbers, pulled out of my hat.)

More on the Next Blog Entry. :)

Away.

2007-09-13T22:43:00.001-07:00

I'm at work this weekend, hoping to create change. Working to create change. Leaving my family for the priviledge of fighting for our rights. My daughter says "but you're the mommy" when I say I'm just going to work like daddy does all the time. I agree, I'm just the mommy.

But I have three daughters and they stand to lose so much. Their faith in themselves. Their health. Their future fertility. Their choices.
Giving birth in today's climate means that I have to pick one of them to have all of those risks thrown to the wind. And if things continue or they wind up with an obstetrician...their risks go to 1 in 2.

I'm the mommy and if you don't care enough to be doing something, I do. I'm the only one standing between my daughters and that future. Cesareans if necessary, fine, but otherwise, keep your non-evidence based defensive medicine away from my daughters or you will find yourself dealing with me. You may anyway.

Autonomy

2007-09-12T19:47:00.000-07:00

Autonomy.
Freedom to be able to move, make your own decisions.
How does autonomy play into the cesarean epidemic?
A homebirth midwife in many states is required to practice under a law which requires her to follow protocols established by the medical community standards, many times being excluded (Arizona) from seeing VBAC clients.
A CNM in a hospital setting is required to have her protocols reviewed by her "supervising" OB. In order to do so, she compromises on things that are expendable, many times excluding VBAC's from any care or making VBAC's do a variety of hoops such as continuous EFM (non-evidence based care), induction, refusal to allow a woman to continue past 40 or 41 weeks...the list goes on and on.
A Childbirth Educator has to watch what she says in order to keep her job because she might be encouraging women to ask questions, refuse interventions.
A doula is a private practitioner who can be removed from a hospital or banned from a particular practice's patients.
As Henci Goer reminded me this weekend, one particular individual at the NIH's meeting on Maternal Choice Cesarean stated that he was simply a good soldier doing his job, taking orders.

We are all taking orders from the American College of Obstetrics and Gynecology in a trickle down of morbidity and mortality that will touch generations to come. None of us have our hands clean in this debacle. This is not fear of malpractice, though that makes a nice excuse for obstetricians to bring to the table. "We don't want to get sued." Well, I'm not sure who believes this any longer and if they did... let us ask ourselves:
Are we simply taking orders? Are we the bystanders saying "Oh My God. That woman just died due to an elective induction." (the wife of a local arena football player) or "Her boggy uterus wouldn't come back, so she lost her uterus due to an ERCS." (a mom in New Jersey) or "my baby spent 3 weeks in the NICU for an unnecessary cesarean"...are we simply recounting the tales?
Are we standing in horror, unable to move? Are we the resistance?
Or are we the Germans....crawling back into our homes to hide in case that they next come for us?

Activism

2007-09-11T15:54:00.000-07:00

I was so excited to learn that the CPM's where I live do VBAC's. They don't just do VBAC's.
Thirty percent of all births in Florida done by CPM's were VBAC's.
And I just put all of them at risk by posting that. I was asked not to publicize or publish it because almost all of them are under review or investigation, either across the board or surreptiously. The climate of fear is palpable and protocols control birth at every level, even if you aren't an OB because the OB's set the standard for protocols with their trade union, ACOG. If you are a homebirth midwife, you will be hunted.

What is truly evil, however, is that other midwives, childbirth educators and moms will hunt you as well. If you do VBAC's, you "put the others at risk." At risk for what? For losing their licenses, for being investigated, for being lied about, for losing the right to attend "normal" women. In other words, they are forced to choose who to support and VBAC mothers are not who they choose, even when they still attend them. VBAC mothers are expected to step back for the "good of the many" and to walk a line of obeisance to all other women and care providers. When an OB states HIS policies, we are supposed to be grateful he even takes VBAC patients. When they state (without evidence) that we should be continually monitored, have epidural catheters placed, or birth in the OR "in case" we should be GRATEFUL. We should be quiet. We should thank our lucky stars that a surgeon is willing to waste his time to come watch by our bedside. Hell, some OB's charge $1000 up front, no insurance, for this priviledge. We aren't allowed in water to help ease the pains of labor and we should be grateful for them taking away this coping mechanism. And others will back them up, too. If we complain too loudly, they might stop doing VBAC's all together! Well, I disagree.

The right to choose a VBAC should have women lined up outside of hospitals protesting. Demanding. The media should be writing about the non-evidence based care and assault on these women, the stealing of their civil rights. Midwives, childbirth educators, doulas, mothers, and OB's should all be agreeing on this. And if they don't, it's simply fear at being caught out of the pack and being taken down. The fact that they are allowing women to BE isolated out of the pack and hunted says so much all ready.

Shut up? Sit down? I don't think so. I'm still writing letters and making calls. I may not change things, but I am tired of women being forced to give birth at home without any trained care or agreeing to care that is cruel and uncalled for in the name of appeasing those with the power or those who shudder in fear.

Distortion of Normal

2007-09-11T13:57:00.000-07:00

I wrote this on a late night recently, so I will probably review this post and come back to it. Your thoughts are appreciated.

Lately, I've seen a variety of things that have disturbed me. I've come to call the phenomenon "Distortion of Normal".
For instance: The average size of a newborn infant.
We measure this by comparing all newborns. In fact, we should only be counting newborns who are unmedicated and uninduced, non-cesarean in order to get "real" numbers. But in this day and age, even that number would be distorted. We've come so far into an induction/augmentation culture that most babies are not allowed to reach their potential birth weight nor their potential birth dates. In a world of scheduled birth or scheduled surgery, how do you define the "day most babies are born" or the "average" gestation.

Even a mom choosing an uninduced birth is encouraged to use a variety of methods to "get ready" and hurry the birth along.

Then, to add insult to injury, these numbers are used against mothers who are out of "norm." Full term used to mean 37-42 weeks but now, no mothers are "allowed" to go past 40 or they are over due. Twin and other multiple mothers are reduced to full term at 36 weeks, or less, encouraged to believe that their infants are in fact done.

In less than fifty years, we have so distorted the birth picture with our interference, we have lost our norms. If one out of three babies are being surgically removed, how can we even know how a normal infant responds to birth? We've removed 1/3 of the population, seriously skewing our view.

Your Rates. Your County. What are You Doing?

2007-09-10T10:10:00.000-07:00

http://209.217.72.34/VitalStats/ReportFolders/reportFolders.aspx

This is the CDC's Vital Stats page for cesareans. Do you know your county's risk?

My county had 21 VBAC's in 2004. Twenty-one healthy vaginal births after cesarean.
My county had 520 Repeat Cesareans.
If (being conservative) 70% of all trial of labor would result in a VBAC...that means that 364 women were potentially VBAC mothers and only TWENTY-ONE escaped being cut.

And my county has a 34.89% rate of cesarean and a 23.58% for all first time mothers having cesareans.
I'm going to scream now. I want you to hear this as a scream. I want you to hear it as the same visceral sound as if your mother caught you stealing and you are looking in her shocked face as she says "what the hell are you doing?"

WHAT ARE CARE PROVIDERS DOING TO NORMAL WOMEN IF ONE OUT OF FOUR NEW MOTHERS ARE BEING CUT AND MORE THAN ONE OUT OF THREE TOTAL MOTHERS ARE GOING HOME WITH MAJOR ABDOMINAL SURGERY AND LIFELONG COMPLICATIONS!

They are coming in pregnant and going out high risk. What is happening in the process?
The sad part is..this was three years ago. I guess the hospitals are damn lucky the rates aren't kept real-time, huh?

So what is your county doing to women and what are you doing to change it?

Guess What...there is a Normal....And you get Awards for it!

2007-09-09T20:39:00.000-07:00

I've often thought that it was insane to be giving out awards to people for normal things. It's not like they INVENTED it, at best, they've only recognized it or given it a different term for the world to use it. Let's face it, fire was invented a long time ago and the only reason we like those long lighters is because they keep us from getting too close when we light the grill. But cavemen were using long sticks and they were at least biodegradable .

So...Dr James McKenna, the uberdude of co-sleeping and normal infant sleeping behavior stands up at the Lamaze Conference after being given an award and comments on the ridiculousness of receiving an award for the simple acts of a baby simply sleeping with it's mother! I could have hugged him!
Then he does one better.
"The only authority over parents that these professionals have is what the parents choose to give to them."
If only parents believed that and worked with the intuition and assumption that babies deserve to be with their mothers and that parents should be willing to lay down their lives rather than allow the treatment that these so-called professionals of the world regularly and pervasively assault them and their babies with.

The Legacy of a Cxion Baby.

2007-09-09T19:38:00.000-07:00

Ok, so why did I write Cxion? or C-xion? Because the speaker this weekend, Dr. Michael Klein, used it in all his research presentations. I'm assuming it was born of his need to abbreviate for studies. I mostly hope this does not catch on in trade publications, however...it seriously looks "too posh to push" kind of media hip.
So back to the Legacy.
Dr. Klein shared that he was born by Cesarean section and I found that to be unique in and of itself. How many children will be leaving legacies born of a generation of surgical births? I'm probably going to update this post several times in the process, but here are some highlights I found from listening to him.

1. He's still a doctor. Medical model/statistical significance, those things matter to him so it's a bit like having a spy on the "inside".
2. His statement on the conflict of interest inherent in "informed consent":
"Counseling over the mode of birth should not be in the hands of those who benefit the most from it."
3. He was explaining some data and compared it to cesarean birth, then changed his wording and stated, "See, even I get caught in that trap. I shouldn't be saying cesarean birth. The term is cesarean section."

High points from the Research commentary:
*He stated that the epidemic of placenta accreta has parallelled the rise in cesarean section.
*He emphasized looking at the totality of the environment when assessing research. You can't transfer the results of an optimal environment with excellent care onto the vast audience of women getting substandard medical care in the United States, just as you can't take a midwifery driven program in Israel and transfer those results onto OB care populations in the US. You will not get results that apply to your life, your environment, your hospital.
*Nulliparas (first time moms) should never be compared to multiparas due to the differences that arise in how birth happens the first time vs subsequent pregnancies. Totally different animals. "You have to be a very bad doctor to screw up multiparas"
*Acknowledgement that nurses are not looking at the mother, but watching the machinery.
*He emphasized using both sides of your brain. You can not take only the left-sided thinking of 'this action equals this outcome' without taking into account the larger picture and impact on a variety of consequences. The global approach is necessary if you don't want to cause more problems than you are trying to prevent.

Refusing to Buy IN to the Myth.

2007-09-09T11:38:00.000-07:00

Several times this weekend, the idea has been broached of not buying into the medical model with our language. When I listened to two presenters talk about reframing the conclusions of the studies, it reminded me that how we talk becomes an impacted belief.
It's not simply renormalizing birth (walking in labor is NOT an intervention, it's the NORM biologically for our species) it's also learning how to turn conversations away from defending natural or normal birth and towards proving the assumptions of non-evidence based care.

How do you prove that vaginal birth is normal? How many studies does it take to explain that what happens after an non-interfered (oh isn't this a wishful thought!) with birth is species normal?

ICAN and Childbirth Education

2007-09-09T08:21:00.001-07:00

Once you latch on to a worthy cause, you can never be sure if you are honest and unbiased about it.

That's how I feel about ICAN (www.ican-online.org) and VBAC.

However, at a conference like Lamaze, the split was at least fifty/fifty on who knew about ICAN. The International Cesarean Awareness Network has existed for 25 years as a grassroots entity helping mothers prevent cesarean, recover from the surgery, plan for indicated surgeries and promoting VBAC as a healthy, safe way to birth. With 100 chapters in existence, how can so many mainstream educators not be aware of it? What resources are they giving their mothers to deal with the cesarean rate? To deal with the aftermath in a 1 in three society that is in reality 50% in so many places. How are these mothers being supported after a birth goes in that direction? These are questions to be asked because these are the women helping them prepare for birth.

Sign Language as a Part of Birth

2007-09-09T08:12:00.000-07:00

At Lamaze International's Conference, there was a unique session on using sign language at hearing births. Much of the information and most of the signs was based on the principles that we all sign and we all should know sign, even basically, to help ourselves communicate with one another and help our babies communicate earlier and well. There was an interesting moment when our instructor had us write down words we wanted to know signs for and the first request was for "how is your scar healing". The room broke up in laughter, that slightly manic release of frustration that says "yeah, I know what you mean". The thing is... I wanted to know that sign and even after the session when I asked, there was some discussion about scar healing but the comments from one woman floored me.
"Oh, that area is numb, you can't feel it."
"Oh YES you can"
"I had a cesarean, I didn't feel any pain on my scar"
Wow. Just wow. How many mothers walk away from the hospital still feeling pain? My roommate at the conference still has pain in her scar THREE YEARS LATER. We can be experts in our own situation with a cesarean, but other mothers out there are feeling more or less than we are and we cannot even begin to express totalities. I resisted the urge to ask her how long ago her surgery was and if she wasn't extrapolating her current reality onto what happened in the first few postpartum weeks.
If it doesn't hurt, why are some cesarean moms hooked on oxycodone?

Blogging from Lamaze.

2007-09-09T02:09:00.000-07:00

As previously suspected, childbirth education is not dead. It's alive and well and being graciously attended by vast numbers of caring women. The choir is filled with lovely angels.

So what can we take back from the choir and sing to the masses?

Testing...

2007-09-09T02:07:00.000-07:00

...beginnings are interesting. WHO knows what will happen?