August 3rd, 2010

New VBAC Guidelines

After being so involved in the National Institute of Health’s VBAC consensus earlier in the year, I, as well as so many others were really anticipating the new ACOG VBAC Guidelines. The decline in VBAC began when they changed their guidelines suggesting only certain women, and certain hospitals were candidates for a Trial of Labor after a previous Cesarean delivery.  We saw a peak in the VBAC numbers in 1996, then a drop consistently there after.

ACOG included in their release something new that previously had been unthinkable in the medical community as a valid option for most women, and that is a trail of labor after two previous cesarean sections. Studies show that it is a safe and valid option for women who wish to attempt a VBA2C, which I have been saying all along.  But maybe now because a huge medical organization with MD after their names says it, people will understand it truly is a safe choice for mothers to make.

Also included in these guidelines are women pregnant with twins, with a prior cesarean delivery, and an unknown uterine scar, which in the past have meant automatic repeat cesarean deliveries.

Just some numbers to include into this also.

In 1970, the cesarean delivery rate was 5%, in 2007 it increased to over 31% of all deliveries with very little improvement to maternal and neonatal outcomes. VBAC was at about 5% which increased all the way up to 28% in 1996. Then the decline started, in 2006 the VBAC rate dropped down to a little over 8%.  Which is horrible for our women here in the U.S.

While I stand by women being informed on making their own choices regarding their care, as a mother who has had two cesarean deliveries, researched, learned the numbers, the risks, and everything involved in VBAC vs. ERCD (Elective Repeat Cesarean Delivery) the risks for a repeat c-section are much higher than a trial of labor after a previous cesarean. You are more likely to have long term complications, be re-hospitalized, need a type of blood product, and all the risks that go along with major surgery when opting for a cesarean over a trial of labor.

The risk for a uterine rupture is between 0.6-0.8% with one previous cesarean delivery, and the most recent studies and numbers has not shown a neonatal death from uterine rupture. I am not sure the amount of years it has been, but per the information from the NIH VBAC consensus, it has been at least 10 years since they have documented a case.

Maternal mortality rates are higher with elective repeat cesarean deliveries over VBAC also. When comparing ERCD to VBAC, per 100,000 births, there are 9 less maternal deaths with VBAC than elective repeat cesarean delivery. Hence showing that VBAC is safer, despite all the discussion of risks.  Those are 9 mothers, sisters, daughters that can and should be saved!

I think that these new VBAC guidelines are certainly a step in the right direction, while the change may not take place overnight, we are seeing that it is something now being addressed on a large public forum as the backlash of high cesarean rates are starting to take their toll on our women and babies.

May 17th, 2010

Happy First Birthday Benjamin!

Well, this time a year ago, I was getting set up for an epidural. I had been awake for 30 hours, my labor wasn’t progressing, and we were all really at a loss. I needed sleep, and everyone, except for my husband really agreed the epidural may be most helpful. I think Will disagreed with it so much because I had told him and basically drilled it into his head for 9 months that I would not be having one this time around, but none of us anticipated a back labor that would span over 26 hours either.

Complication after complication started when I woke up a little before noon. My cervix was starting to swell, and Ben just wouldn’t come down past -1 station. We tried everything to get him to budge, and he wouldn’t move.  At this point I think the giant elephant in the room became more and more apparent to everyone. It took me about an hour to come to terms that the only way Benjamin was safely coming into this would was by a second cesarean section, which I worked so hard through my entire pregnancy to avoid.

Benjamin Emil Elwood was born at 1:59 pm via cesarean section weighing in at 7 pounds, and 3 ounces. Smaller than my oldest, even though I was diagnosed with gestational diabetes with my pregnancy. The moment I saw him, right after they removed him from the incision in my abdomen, I could see a giant bruise on his forehead. It took the on call OB, and the Resident on staff for the day to get him out. He was JAMMED in there.  No way he would have descended anymore than he had.  I think that made me feel slightly better than I originally felt with the decision to consent to the second cesarean.

I know looking back at all that happened with his birth, there is nothing that I could have done differently to change the outcome of my birth experience. I think that is what has helped me be more accepting of his birth than my first. Had I not consented and continued to labor, I not only could have hurt myself, but I could have hurt myself.  I desperately wanted a VBAC, but I am not a martyr, and I would not do it at the expense of anyone’s safety.  Contrary to what some seem to think.

Looking back, there is nothing that I would have changed. Not getting pregnant when Camden was only 8 months old, not choosing the midwives I did, nothing. I loved every moment of my pregnancy with Benjamin, while I may not feel the same about his delivery, I was blessed with such a unique, bright, and beautiful little boy who was always meant to be part of our family.

I certainly do not feel that our family is complete, but for the time being, it certainly is. I think after Ben’s birth, both my husband and I are certainly scared to have anymore children any time soon. The two cesareans have been emotionally trying on both of us, and certainly physically trying on me. It took me nearly 3 weeks to actually feel human after Ben was born, and to remove myself from my dark bedroom and join the rest of the world.

There is so much my little Jo Jo (one of Ben’s many nicknames) has taught me. One being that no matter what we do as parents, sometimes our children have other plans for us.  Ben was exclusively breastfed for the first 5 weeks of his life, during that time, we couldn’t figure out why he was so colicy but in reality, it was a reaction to my milk. We tried everything from dietary changed, to a variety of formulas before we finally found something that would work for him. It was the longest 8 weeks of my life. Cap that off with 3 surgeries (for me) starting when Ben was only 5 weeks old… I think that seriously aided to the stress in the house.

He is the light of all of our lives, including his big brother Camden. I thought there would be some jealousy issues in the house between the two children, but I couldn’t have been more wrong. Camden has been the most attentive big brother. Loving, teaching, and overall infatuated with his little brother. I really could not have asked for a better big brother.

The process of transitioning from a mother of one, to a mother of two would have made me insane if I didn’t have the help of my husband. The day we brought Ben home from the hospital, our oldest got his first flu of his life. Such timing!

There are some days I am sure I am going to lose my mind before my husband gets home from work, but I somehow manage to keep it together till he walks through the door and the kids clamor to him like they haven’t seen him in a year.

Wow!  I just can’t believe that it has been a year already!  Where does the time go?  It feels like yesterday he was born and I was cradling him in my arms in my hospital bed waiting for one of the nurses to come in and yell at me for co-sleeping!

Benjamin Emil, you have changed my life in so many ways. Given me and understanding of difficult parenting, and children. Taught me the feelings and emotions that go with a medically necessary cesarean section, which has enabled to me help mothers on a whole new level.  You are the light of my life and Mommy loves you so much!

Happy first birthday Ben!

April 22nd, 2010

Post Cesarean Feelings Survey – Question #6

Continuing to unveil the results of the World Wide Post Cesarean Feelings Survey that I recently worked on with Theresa from Health Baby Network, I wanted to move on to question number 6 which was “Did you feel like you were in control or your care and respected through out the process?”

Like every other question on this survey, we saw complete extremes on each side of the question, and very few moderate or middle of  the road answers. 312 women left a comment with their answer for this question, which left me with 14 pages of information, experiences, and comments that could be a trigger for anyone with any sort of a birth trauma. So I truly caution those same people from reading further.

Our of the 851 women who answered this question :
37.4% or 318 women felt like they were in control of their experience, and respected.
35.3% or 300 women felt like they were somewhat in control of their experience, and/or respected.
31.4% or 267 women felt like they were not in control of their experience, and were not respected.

When I discussed some of the comments these women left, Theresa said to me “Man, some nasty treatment” which is horribly sad for any woman who has been subjected to such treatment. It took me nearly 2 weeks to get through these comments and write this post because of the extreme nature of some of it.

So on to the comments.

“They treated me like a number. Like a ticking clock. They seemed to be prepping the OR behind my back, and every request, from ice to squat bar was ignored and almost sneered at.”

“No one treated me harshly at any time, my requests were carried out without protest, good lactation help”

“No respect, no compassion. At the mention of a c-section I started sobbing and the OB just stared at me stone-faced.”

“Dr. came into the room only a couple times the entire day, told me what was going to be done (never asked) she even laughed when she saw me sitting on the birth ball”

“Doctors are experts. I was OK with them being in control.”

“I am disappointed that no one ever explained the risks of c/s to me, especially to subsequent pregnancies, but I do feel like my OB would have respected my choices/opinions had I known better and refused c/s”

“The doctors were very respectful, explaining every step & making sure I understood why & what was going on.”

“I was constantly told what I needed in an effort to wear me down so that I would agree to their demands. I was forced to have my legs open in front of many strangers. I cried and nobody batted an eyelid. I wasn’t important. Childbirth is supposed to be a sensual, sexual, and most significant event in a woman’s and her child’s life which is certainly not acknowledged by the hospital system. I would say that I was sexually abused while in the hospital bed – another doctor (this time male) came and put his fingers into my vagina and the hospital midwife looked on with a smirk on her face that said ” You’re lucky to have such a good looking doctor like that up you”

“my membranes were ruptured without my consent, the OB did an episiotomy without my consent, the midwife was rude and confrontational, students were invited into the delivery room for the birth without my consent, i was left to hemorrhage until i came close to death, and so many more instances of poor care.”

“I felt in control of everything and I was able to explain my desires/wants”

“My first c-section – No. I felt like scare tactics were used to get me to induce w/o medical reason (“every day past your due date your baby has a higher chance of dying”), and then after 13 hours of labor, progressing nicely, I was told I had to have a c-section because my baby’s heart rate was very concerning. Yet, it took nearly 1.5 hours from decision to incision. Doesn’t seem very emergent to me.
Later, when I requested my records, I found that it listed my c-section as ELECTIVE. I still think I was coerced into a c-section because the doctor felt my labor was taking too long, it was the night before Thanksgiving, and she wanted to go home. After the surgery, they told me I couldn’t be with my baby and she HAD to go to the nursery. I didn’t see her for two hours and no one would call the nursery to find out if she was okay. I laid in a hospital bed, unable to move, terrified for my baby who was FINE (the nursery was understaffed). No one seemed to care how I felt or how upset I was. My second c-section was much better supported – however, I firmly believe that was because I demanded it of my caregivers. I knew everything I could know about VBACs and repeat c-sections
and refused to let myself be treated as poorly as I was the first time.”

I feel as though some of these comments are very telling as to the way maternity care works today, and the way that women view their providers, especially the comment above that a woman was happy her Doctor was in control because they are the professionals show us how much faith and trust women are putting into their providers. Good, bad or middle of the road outcome way too much faith and trust is being placed blindly in providers today.

Women need to build relationships with their provider, and build trust, it is not something that we should just automatically be giving because we picked Dr. X to deliver our baby, or provide us with prenatal care.

April 7th, 2010

Post Cesarean Feelings Survey Comments : Positive Experiences

While the comments regarding positive experiences were greatly overpowered by the negative experiences in this survey, as we also have seen in the numbers we got and the results. It would not be fair to only include the negative comments or experiences.
So today I wanted to share the comments on positives experiences from mothers who took part in the survey.

While we cannot include all of the comments, we will surely include as many as we can. Again, I read through over 20 pages of comments on question #5 alone. Question #5 was  :

Would you describe your experience as :
Wonderful – 27.7%  – 227  Mothers
Empowering – 7.4%  – 61 Mothers
Frustrating – 26.7%  – 219 Mothers
Traumatic – 46.8%  – 384 Mothers
Disappointing – 45.5%  – 373 Mothers
41 Mothers Skipped this question
479 left a comment with their answer

WARNING!  : Some of these comments may be hurtful for cesarean mothers who have had a traumatic birth, or birth trauma.

“I don’t view giving birth as a contest or a right and wrong way to do things. As long as baby and mom end up healthy it was a good experience.” – Nancy

“My OB was wonderful. C-section was a very easy thing and not really very scary.”

“I loved every minute of it and was utterly euphoric – I didn’t care how the baby came out. All I cared about was having my baby.”

“It was great! the staff was caring. My family was supportive. The procedure went well. Baby nursed like a champ.”  – Tomi

“The first emergency cesarean was traumatic to say the least. But my second cesarean, which I was prepared for, was wonderful. In the ensuing years, I’ve come to realize that the first was traumatic for a multitude of reasons, not the least of which were my feelings of failure brought about by the multitude of mothers and ‘experts’ who seem to feel that giving birth by cesarean is somehow cheating. It took me quite some time to accept that I had not done anything wrong, and that contrary to the hype, sometimes a cesarean IS the best choice for both mother and babies.”

“I cannot deny that I was in the hands of some of the best hospital staff ever. I was made fully aware of the procedure and the after effects. I had good care following the surgery. But the differences in my life and the way I handled the Cesarean birth compared to my firstborn (who was a natural homebirth) was incredibly hard. I am still healing from all of it 17 months later, and I still have pain in my incision site on a regular basis. I will always be in fear of birthing another child for fear I won’t be able to control the birth process and will have to have a repeat C/S.”  – Jill

“Anytime you bring a child into the world is a wonderful experience. A cesarean is still a birth and a woman should not feel any less for this.”

“My section was not at all tramatic like my vaginal delivery was. Birth was quick and recovery was better all around.”

“I was in control of my medical decisions, the staff/my physician were helpful and non confrontational, some of the hospital practices were unhelpful and unnecessary during my labor. I think surgery was the best option in my particular case.” – Holt

“How my babies are delivered doesn’t define me as a woman. They are all healthy & happy and arrived in the safest way possible.” – C

“I felt at total peace because I went in feeling secure in my choice”

“I would describe my first vaginal birth as traumatic, my c-sections were calm & stress free”

“I can think of nothing but good things with my c sections. I healed well. The c section produced 4 very healthy babies.”

“Quick delivery, fast healing time, healthy mom, and healthy babies”

“It was fast, easy, pain free, I knew the exact day that I was going to have my babies, I adored both of my c-sections.”

“My experiences were great. No trauma, no feelings of missing anything, totally rewarding birth experiences.”

“We are still talking about a c-section birth, right? My vaginal delivery was horrible, frustrating, traumatic, disappointing, we both almost died because the baby was stuck due to the position of my pelvis. My c-section delivery was absolutley wonderful! Sure there was some fear before and during and pain after, but it was 100 times better experience. With my vag. delivery, it was stressful and the hospital staff were stressed too. For the c-section, everyone was calm and friendly and helpful.”

“The staff did a wonderful job of making it a pleasant experience for me and my husband, despite the fact that I didn’t want c-sections”

I am sure there are many out there that do not agree with, or upset with the comments above. I know myself, some of them upset me on a personal level because of my experiences. But unfortunately I need to remain professional as well as unbiased on reporting the results of this survey.

Please keep the comments free of vulgarity, and no direct insults.

For more information on having a positive cesarean birth experiences, please take the time to read Family Centered Cesarean from ICAN.

April 5th, 2010

Post Cesarean Feelings Comments : Negative Experiences

Because of the overwhelming amount of comments that we received on question #5 on the Post Cesarean Feelings Survey, I felt the need to split up not only the results, but the comments into two categories because they were clearly so powerful, moving, and telling of the current maternity care system as well as the trauma some women are facing during their birth experiences.

Just as a refresher question #5 was :

Would you describe your experience as :
Wonderful – 27.7%  – 227  Mothers
Empowering – 7.4%  – 61 Mothers
Frustrating – 26.7%  – 219 Mothers
Traumatic – 46.8%  – 384 Mothers
Disappointing – 45.5%  – 373 Mothers
41 Mothers Skipped this question
479 left a comment with their answer

479 comments = 20 pages of comments I took nearly two days to read through, and decide which comments would be more appropriate for including in our blog posts on the survey itself.
If you are sensitive, some of these comments may be a trigger for you, or shocking, please read carefully, and exit if they become too much.

“The admitting hospital staff was awful, and I had mentally prepared for a natural birth, having drugs pushed on me and to end up having a C/S was upsetting.”  – Wanda

“My first birth was pre-term after hospital mismanagement, leading into probably the worst three months of my life as I had three babies in NICU and I KNEW the hospital was to blame for it.”

“OB spent the last 15 minutes of labor convincing my husband how dangerous it was to continue pushing despite the fact that I had refused the section 3x and I had known of the risks but was comfortable with continued pushing despite HR accelerations. I had been at this for 26 hrs and didn’t want to give in at the last 15 mins. Hubby had been completely supportive up until the OB keep hounding him and refused to participate in my pushing efforts unless I could get the baby to crowning in 1 more push.”

“Multiple infections, complications, loss of control, hospital staff didn’t listen or support, PTSD afterwards, negative effects on baby and bonding” -  Kayte

“Had no idea baby was over 9 lbs. Dr. policy not to vaginally deliver over 9.”

“I was frustrated with my doctor that she wasn’t paying attention to the fact that my first daughter was breech until it was too late to get her to turn. My 2nd was traumatic because of the uterine rupture and losing my baby’s heartbeat for a time right before delivery. My 3rd c-section was my best because I had the best care and doctors.”  – Corrina

“Felt disjointed, like my daughter was not my own because I didn’t birth her” – Mellissa

“I suffered from Post Traumatic Stress Disorder because I was coerced into an unwanted, unnecessary cesarean”  – Kristen

“Treated like crap at the hospital, had no say in anything, I was uninformed and scared, they rushed me and pumped me with Pitocin and eventually cut me” – Erin

“The operation was horrific and my baby died.” – Diana”

“Felt as if control over my body was taken from me and I was powerless and weak.”

“I enjoyed labor to the point of my caregivers deciding I was no longer progressing, at which point they took over and I felt like a failure, and that I hadn’t been given the opportunity to do what I felt I needed to do. There was no emergency, just impatience on their part.”  – Hannah

“I knew I wanted natural but got talked into every intervention with “do you want your baby to die” as the reason. Of course my answer was no but with no education I assumed the Doctors knew more.”

“I wish I had been better informed about the risks of c/s delivery.”

“I cannot deny that I was in the hands of some of the best hospital staff ever. I was made fully aware of the procedure and the after effects. I had good care following the surgery. But the differences in my life and the way I handled the Cesarean birth compared to my firstborn (who was a natural homebirth) was incredibly hard. I am still healing from all of it 17 months later, and I still have pain in my incision site on a regular basis. I will always be in fear of birthing another child for fear I won’t be able to control the birth process and will have to have a repeat C/S.” – Jill

“It was induction at 39 weeks for no reason, artificial water breaking, pitocin, laying in bed, epidural and very little progress after 17 hours. I was uneducated and thought the OB and hospital knew what they were doing. I was wrong.” – Lisa

“It has ruined me”

“Labour was a battle ground with no communication between OBs and Hospital Staff. Non-evidence based care where my labour was pushed to a point where my baby’s heartrate became critical.”

“There was no emergency – I was fully conscious and felt wonderful – I just timed out. I had drugs forced upon me that I didn’t need, an epidural was forced upon me as well with”You’re getting tired” and I WAS NOT TIRED. The epidural has left nerve damage in my vagina that continues 11 years after the cesarean. For a normal physiological process to be taken out of my hands, and “needing to be
controlled” is utterly ludicrous and a complete blow to my womanhood.”

“I never imagined I would end up with a cesarean, I never even read the chapter in the pregnancy books.”

“Being coerced into a cesarean because the OB had somewhere to be has made me lose all faith in the medical profession. It was traumatic, degrading and unnecessary.” – Mari

“Insensitive medical team (made rude remarks), not fully aware of options during operation and suffered with reaction to epidural, inadequate support post operative for breastfeeding.”

“I was scared into having a c-s because my OB said I was going to be having a “big baby.” I had a c-s at 39 weeks and my daughter was a very normal 7 lbs 13 oz. I never even got a chance to have a trial of labor.”

“I was disrespected and no one cared about my needs or wants. It was more about the hospital’s experience then mine.”

“I felt dehumanized as all the hospital staff poked and prodded my naked body around me without acknowledging my humanity. I lost all dignity in that moment. It was scary and horrific.”

“Currently suffer from P.T.S.D. from birth, rude Ob who took over, no communication during surgery and newborn exam, thought baby was near death turned out a medical student was practicing weighing and measuring newborn, before I’d even seen him.”

“Felt ignored, belittled. OB’s ignored me during surgery, no one told me what was going on. Was separated from my son for 3 hours after the c/s.”

“I did not want a CS, epidural. Was asked if I wanted my baby to die.”

“Started with well informed, educated, empowered couple trying to birth, wound up with Failure to Wait doctor and staff wielding scapels, seemingly unknowing what this would do to me forever.”

“The hospital staff & doctor were assuring me that a c-sectoon was the right thing or else my baby and I would die because he would get stuck coming out the “other” way and there was no way they could get him out then. During the surgery they talked about Ikea furniture and their wedding rings ignoring me when I told them I needed to throw up as a result I threw up on the floor & someones shoes which they were quick to pony out were brand new.”

“My babies were kept from me even though they were healthy. Didn’t get to nurse them until 4 days old. Felt physically and emotionally incapable to care for both of them and myself post surgery.”

“I felt like an utter failure, felt like I was dying”

“What birth Experience? I had a c-section”

“Once I gave in to the 1st section, I was run through the mill as if I was only a slab of meat. No one paid human attention to me, talked to me, etc. except for one sweet nurse intern who took pity on my pleas & came held my hand.”

“I didn’t get to hold my baby right away, I heard the doctors say whoops! we can fix that!, and my DH got so scared and sick he wasn’t able to be in the room with me   “

“I have always felt that my birth was a traumatic experience bc of the complete lack of control I felt throughout the process and the repeated dismissal of my feelings by attending OB along with other inappropriate statements made during the delivery by OB.”

“Bad recovery, devastating unnecessary cesarean due to ridiculous hospital protocols”

“HATED the feeling of being vivisected and paralyzed. Felt clinical, not maternal.”

“Based on my doc’s history of high cesearan rates I couldn’t trust that he did all possible before demanding a cesarean”

“I was lied to, manipulated, and rushed into surgery. There was no emergency, they just wanted me cut open before my doula could get there to remind me that I still had options.”

Most of these comments really speak for themselves.
No woman should be made to feel like so many of these women felt, and were treated, no matter what kind of birth they are having.

Remember, these were the most extreme out of almost 500 comments.

I can say I look forward to writing up the positive experiences as I need some kind of relief of the negative comments that were left on the survey.

April 1st, 2010

April is Cesarean Awareness Month!

Many do not know this unless you are heavily involved in the childbirth community, but the month of April is recognized as Cesarean Awareness Month. When I first started my ICAN Chapter in 2008 here in Connecticut, we submitted a request to our governors office to have Cesarean Awareness Month recognized in Connecticut.  To my surprise it was denied.
That is when my project began. I created a petition which in the end collected over 300 signatures and come 2009, we submitted our request for our Proclamation, with the petition. I guess they realized we weren’t going to go away huh?

In 2009 we got our first CAM (short for Cesarean Awareness Month) proclamation, and this year in 2010 we continued our tradition and again it was granted.

But why is this important?

With the growing cesarean birth rate nationwide it is so important that we take some time and realize that the 32% numbers we are seeing are not healthy, nor are they improving maternal or neonatal outcomes. In the past month we have seen several reports in large national news sources about this, and while bringing attention to this is great, it is not going to make the change that we need.

Cesarean Awareness is important to me because of the births of my two children, so different, but much alike.

My Birth Journeys from Danielle Elwood on Vimeo.

So how can you get involved?

• Are you involved with your local ICAN Chapter? Is there no ICAN Chapter in your area? START ONE!
• Does your local hospital have a VBAC Ban in place?  Contact them and encourage them to practice evidence based medicine, and consider the new statement from the NIH VBAC Consensus.
• Protest!  Make some signs, and stand out in front of those hospitals with high c-section rates, or VBAC Bans and have your voice heard!
• Write a letter to the editor!  Your voice is powerful and important!
• Check out the ICAN Blog and read the birth stories of some amazing women.

Some of the recent news stories that include great information why Cesarean Awareness is important are  :

• United States Urged to Confront Shocking Maternal Mortality Rates
• Too Many Women Dying in US While Giving Birth
• Are C-Sections Too Common?
• Women Need a Chance to Avoid Repeat Cesareans
• Newsweek : VBAC Access Makes Medical Sense
• ACOG Spokesman : The Rise in Cesareans are Not Good for Anyone
• Cesarean Rate Jumps a Record High since 1996

Get out and get involved!

Listen to the Momotics Radio Show all month Cesarean related shows!

April 7th – Isa Herrera author of Ending Female Pain
April 14th – Dr. Stuart Fischbein discussing VBAC and preventing cesarean births
April 21st – Barbara Stratton, the ICAN VBAC Ban chair will be discussing VBAC bans nationwide.

I will also be on The Feminist Breeder’s Radio show this coming Sunday night at 10pm CST (11 pm for us east coasters) to kick off Cesarean Awareness Month and talk about the Post Cesarean Feelings Survey I recently worked on with The Healthy Baby Network.

HAPPY CESAREAN AWARENESS MONTH!

March 30th, 2010

Post Cesarean Feelings Survey Question #3 & #4

Since I have been moving through the questions relatively easily, on to questions #3 and #4 from the survey. Question number three turned out to be a very popular question with many comments. In fact I had to read through 20 pages, yes, 20 pages of comments to see which should be used or stood out the most.

Question #3 was :
Question #3 – If Elective or Planned, What was the reason?
Previous Birth was Cesarean, Doctor Recommended :  33.9%   112 mothers
Knew what to expect, was the birth I wanted: 10.3%  34 mothers
Fear of labor & Natural childbirth : 2.4%  8 mothers
Previous Traumatic Birth, Cesarean was Less risky : 6.4%  21 mothers
No VBAC Support or availability : 5.5%  18 mothers
Other : 56.1 %  185 mothers
531 mothers skipped this question

There is so much more that could be shared about this subject in general, but I am just going to share some quotes from others instead of breaking this one down because it can certainly be a touchy subject, or carry feelings for some women.

April shared this quote with us as well as gave us permission to use it

“[The] Doctor scared me into it by telling me the baby was too big to have [give birth] to without losing her”

While we do not know how big April’s daughter was born at, in my follow up e-mail contact with her she said

“Hopefully it can help someone else not be scared into a decision they may later regret.”

Lindsey shared her experience with her quote

“[I had] no trust in my body, or support from my OB”

Which was a comment that was frequent while looking through the results of the survey, and the comments that were being left by the mothers who took this survey. I think one of the common misconceptions today is women are looking to their Obstetricians for support that they are not going to receive. With the maternity care system today, the way it is set up, we should be utilizing doula’s more than we do, especially for this type of support. Or opt for care with Midwives.

We had mothers who had truly medically necessary cesarean births also :

Anya told her story of a very scary situation leading to the birth of her child “Baby was IUGR – had to come at 36 weeks with less than 24 hours notice” IUGR stands for Inner Uterine Growth Restriction.

Corrina shared “Baby #3 needed to be born via cesarean because of previous uterine rupture”

Though I wish I could say the medically necessary cesareans really took up the majority of the comments, there were some comments that just made me want to yell. LOL

But the one comment that stood out to me the most was :

I had a ‘medwife’, whom I didn’t know was beholden to the hospital. They later bought out her practice. She’d had a number of other births that day and was tired. This was the easy way out for her. I trusted her completely to take care of me and to see that I would have a vaginal birth. I was completely blindsided; my ‘birth’ was the furthest thing from my mind.

It is horrible that any woman would have to endure this kind of treatment because of their provider simply being tired, and something like this came up recently around the internet with “L&D Staff Behaving Badly“  which became widespread across the internet.

More and more women are starting to have cesareans for suspected fetal macrosomia which is just a fancy tern for a suspected big baby. But since we are all aware of the lack of accuracy in ultrasound measurements in the last trimester, these estimates should really be taken with a grain of salt.

“I was told I was having a 10-11 lb baby that I probably wouldn’t be able to deliver naturally, who ended up being 7 lbs 13 oz.”

“insulin-dependent GD, drs feared 11-12 lb baby, turns out he was 8.6, my smallest”

Then we had a couple mothers with HSV2 which essentially is genital herpes. There is a lot of misinformation today which makes mothers with this virus feel as though a vaginal birth is not an option for them. ICAN has a great bit of information for mothers who do have this virus, Herpes in Pregnancy which offers a great amount of information to mothers.

“Had HSV2 and since I did not know much about it, I didn’t know whether I contracted before or after pregnancy and was told a cesarean was playing it safe. I was, however, told that I could birth vaginally for subsequent births.”

It is sad to read some of this, but uplifting to see that there really are and have been some medically necessary c-sections taking place in the sea of unnecessary surgery.

I must say I am pleasantly surprised about the extreme number of news articles regarding the skyrocketing cesarean rate and how truly dangerous it is to our mothers, and babies. Women are still dying at alarming numbers and I hope that with all this coming out practice patterns of OB/GYN’s will change, because they certainly are the ones driving these numbers, not women.

Question #4 talked about support persons in labor and read :

What support did you have during labor?
Midwife : 18.2%
Doula : 9.3%
Spouse/Partner : 90.7%
Family/Friend : 37.0%
Hospital Staff : 49.2%

I do not have very much to say about this in general, but there are a couple alarming trends with this.
One thing that I am not happy to see is women depending on hospital staff for support during labor. Unfortunately in hospital situations and settings we know that nurses as well as hospital staff are completely over worked, and there are some serious shortages across the nation. Depending on a hospital staff member could be a contributing factor to the cesarean rates.

Another issue I can see is the lack of professional support, like using a doula which is connected directly with lowered cesarean birth rates. Women are depending on their partner, or husband which is what I did with my first child. I thought that I could “train” him to be my doula during my labor, but I think we all know how that ended.

Women really need to know how valuable the support of a doula is. With more insurance companies starting to actually cover doula services I hope that more women start to utilize them for births in a hospital setting.

March 28th, 2010

Weekly Round Up

I have found that some of my readers really enjoy the weekly round up posts, so I am going to continue them as long as I have things to round up each week! Hahah!

This week there were quite a few things to highlight, but certainly not as much as there has been in the past.
I will start off with highlights from my house this week :

• Everyone got sick. Real highlight huh?  Both boys got croup for the first time.
• Camden went to his first Easter Egg hunt!
• Benjamin is starting to try and pull himself up to stand. (I am done for once that happens)
• I opened my own Online Mark Store!  Come by and see if there is anything you are interested in, their products are awesome!!

On the internet blog circle :

• When Labor & Delivery Staff Behave Badly : I have seen posts about this all over the internet on various blogs, but because I love Gina, and she actually had a picture of the exchange, I decided to feature her post. I love some of the comments on it. Last night my Husband sat down and read it while we were having our Pizza dinner and he stopped eating and told me he was completely disgusted. Not much can make make him stop eating!
• Dou-la-la knocks one out of the park with her Weekly Movie about The Food Revolution that aired on ABC Friday Night. Baby was asleep, DH had the toddler with him at the fire house, and I watched it. I was completely disgusted and astounded that this is such a problem and I really hope this opens the eyes of the American public.  Another great post about Jamie Oliver’s Food Revolution comes from Peaceful Parenting.
• Amnesty International Slam Dunk’s craptastic “Dr” Amy’s post on Maternal Mortality in the United States.  I can say that there are only a hand full of people in life I “hate” because it is such a strong word, but the more I read this bitch write, the more I think she is just an internet troll with no real education.
• Great post in Mothering Magazine which turned out to be a very interesting read : Is Aluminum the New Thimerosal?
• Even though I was taking with local superstar Amy Romano about this a couple weeks ago, I finally had the chance to see it : This 1-Year-Old Happy Meal Has Aged Surprisingly Well.
• The ICAN Blog covers the ACOG Spokesmen talking about the rising cesarean section rates.

I hope you enjoy these highlights as much as I did this past week. If you have any highlights you would like to have included in my weekly round up posts, please e-mail them to me at Danielle.Elwood@gmail.com.
You can also leave a comment on the Momotics Facebook Fan Page or Tweet a suggestion at me on Twitter.

March 24th, 2010

NCHS Cesarean Statistics Report

Since the NIH VBAC Conference, and the Post Cesarean Feelings Survey posts that have been going on, I have been trying to avoid any other cesarean related posts or information for the simple overkill factor. But these numbers that came out today from the National Center for Health Statistics just could not be pushed to the side, or left for a later date post. I was just really passing them by until I sat down this evening and read the post about them over on The Unnecesarean.

Now, if you follow me, you know how I feel about the cesarean rates, and elective cesareans, but these numbers should be scary and alarming to all women of childbearing age, or who plan to have children in coming years.  A couple pieces of information I found most important :

• In 2007, 32% of the approximately 1.4 million births in the United States were by cesarean section, the highest rate ever recorded in the United States and higher than the rates in most industrialized countries. The cesarean rate increased most rapidly between 2000 and 2007
• The number of cesarean sections increased by 71% from 1996 to 2007 (797,119 to 1,367,049).
• Cesarean section was the most frequently performed surgical procedure in the U.S.
• According to the NCHS, suggested explanations for the rise in the cesarean rate for eleven consecutive years include many nonmedical reasons, such as maternal demographics, physicians’ practice preferences, maternal request and fear of litigation.

One thing I wanted to point out is that maternal request cesareans showed to make up 0.4% of cesarean sections taking place, so the excuse that women are just telling their Doctors this is what they actually want is something that does not hold much weight with me.

But why is this such a problem?
Because more and more women are opting for this procedure under the assumption that it is the least risky option or way to birth a child, when in fact it is not. Having your scheduled cesarean is nothing like going in to have your teeth cleaned. It is serious major surgery that holds serious risks including a 4 times greater risk for maternal death than a vaginal delivery. 9 out of 100,000 women who opt for an elective repeat cesarean delivery, whether it is the second c-section, or more will die.

Not to sound all gloom and doom, but I dont think our women today are being given accurate information on these risks.

Anyways, I just wanted to share that stuff before I went to bed.
I hope ya’ll have a nice night.

March 21st, 2010

Weekly Round Up

This is becoming a nice habit of mine, and I love taking the time to post my favorite blogs, news stories, and stuff going on in our own household for the week.

First I will start with our family this week.
Benjamin is getting another tooth, his top right one and it has made for a rough week on top of the house full of sniffles.
The boys & I hung out with Amy Romano this week and her little guy Dexter, it was a beautiful day, and I foresee some writing for Lamaze in my future.
Our wireless router finally showed up!
I got a new tattoo and made an appointment to get another fixed up and shaded!
Got picked up for another article in The Fairfield County Weekly.

My favorite blog posts from this past week :

• The Feminist Breeder’s awesome blog post using a Dr. Seuss book to describe modern day birth advocacy.

• Michael a local doula, hypnobirthing Momma, and a friend of mine gave birth early after a difficult pregnancy (after two previous home births) to a little girl and posted the video. It is super amazing!
• Great informational post on Episiotomies by At Your Cervix.
• Dou-la-la knocks it out of the park this week with two posts, one on why public nursing matters, and Bag the Bag sling in light of the sling danger mania this week!
• Gloria Lemay Quotes an OB/GYN on Unnecessary Cesarean Births.
• Jill at the Unnecesarean made an awesome graph of the c-section rates from 1970 till now, very telling!
• Jennifer Block talks about the Amnesty International release calling the US Maternity Care System a crisis.

In the news :

• Doctors say Benefit of Baby wearing out weights the risks!
• Mothering Magazine takes on Baby wearing in their Special Report
• Michael Moore takes on Stupak, and I love every minute of it!  If you aren’t extremely liberal like myself, you probably will not enjoy this one!

Still I have been doing this week that you should really check out if you missed it….

• Wednesday night I had Dr. Nicolas Fogelson OB/GYN on my radio show discussing delayed cord clamping.
• In light of the recent nice weather, locally there has been one fatal motorcycle crash, and another seriously injuring a friend of our family, both caused by negligent drivers of cars. Remember this time of year, with the nice weather, you are sharing the road with motorcycles!
• Post Cesarean Feelings Survey ended on Monday, and since then it has been a crunch to analyze the numbers, and get consent for comments, and everything we need to do to work on this project more.  The first two posts with information were posted. The first post included the results of the survey as a whole, and the second post on the results of questions #1 and #2 was posted yesterday.  Keep an eye open this coming week for a couple things… More survey’s with a time limit of a month, and the post for questions #3 and #4!
• Check out the Health Baby Network’s post about the Post Cesarean Feelings Survey also!

See ya next Sunday for a hopefully awesome wrap up of this coming week!

March 20th, 2010

Post Cesarean Feelings Survey : Questions #1 & #2

On to Question number one, as well as number two. With the initial question of our survey, we did not opt to allow any questions, so the numbers and information obtained were pretty cut and dry.
Question # 1 :  How many Cesarean Births have you had?
1 Cesarean – 67.4%   580 mothers
2 Cesareans – 23.5%   202 mothers
3 Cesareans – 6.5%    56 mothers
4 Cesareans – 2.6%   22 mothers
1 mother skipped this question

Pretty simple, from the 860 mothers who answered this, it shows the majority have only had one cesarean birth, followed by two cesareans in secion, and so on, and so forth.
No comments, no details, no more discussion to the subject itself.

On question two is where we got more details, comments and really had more information to look through and talk about.

The majority of women in this case did not opt for their cesarean, nor did they have an emergent situation. Many failure to progress answers, which in some cases (in my experience) has been failure to wait on the part of the provider. I certainly cannot speak for all the women who did answer this survey, but I can share some comments that were left.

While all these comments are not directly related to failure to progress, these are the ones I found to be most interesting, telling, and helpful when looking into the statistics we obtained, and the mothers experiences.

One mother, Tammy, shared her experience and said

Always attempted vaginal birth, all resulted in cesareans, first for supposed CPD (cephalopelvic disproportion) was actually a damn golf game, second was fetal distress.”

Another mother shares

Reason : OB’s Failure to Wait

Which like I stated above, and in my own first cesarean experience seemed to be the case. I still stand by my comments that if Doctors are so concerned about their personal lives, as well as their schedules, and time, they should clearly choose a different medical specialty, because babies come when they please, not on your clock.

A great video and example of failure to wait in a stalled labor, and how to avoid it …

Then we have the women who were given no choice, as we are seeing nationally with forced cesarean sections due to providers who do not offer VBAC services, VBAC Bans in hospitals, and some horrible hospital policies.

In response to these policies, several news organizations are covering the National Institute of Health’s new statement on VBAC and VBAC access.

As one mother shares,

“first medical interference, second forced unnecessary”

then we have Vicki  with a slightly different experience,

“First due to hospital policy, then VBAC, then crash c-section at 33 weeks placenta praevia and accreta – result of prior Cesareans”.

The situations being slightly different as previa and accreta are truly necessary and scary reasons for a cesarean delivery.  But what we are seeing with the increase in cesarean deliveries is  the increase in problems like Vicki did experience. Higher numbers of placenta issues, which can be very dangerous.

Another mother, who wished to remain nameless shared her story and said

“my first cesarean was coerced, and all subsequent births were VBAC’s.”

This stood out to me almost as much as a couple other quotes left for mothers regarding provider issues that caused their cesarean.

“First cesarean was caused by medical interference, second was forced and medically unnecessary”
“Unplanned Cesarean, provider lied to me and told me it was an emergency cesarean, but my medical records showed an “elective” cesarean. My second baby was a HBAC (Homebirth after Cesarean)”

While many of us do not want to admit that providers do these things, in some cases it is fact, sadly enough. Another reason women really need to be their own advocates in the maternity care climate today.

While all the mothers who participated in our survey have had c-sections, not all of them were negative situations, or even medically necessary as we have seen in some of the above comments. When a cesarean is necessary, like I have always said, it is an amazing and lifesaving procedure, and we wouldn’t have the backlash of cesareans today if they were not overused.

Angela, a mother of two children elected for a cesarean with her third child

“first two were difficult vaginal births, was told related to the large size of third baby c-section was required.”

And another mother shared

“ one for fetal destress, one because of craniosynostosis”

There are many different types of cesareans, some life saving, and some that do nothing more than compromise the future reproductive health for out mothers.

You tell me what you think!

March 17th, 2010

Post Cesarean Feelings Survey Initial Results

When Theresa Shebib and I embarked on a small survery about cesarean section mothers, we never imagined it would skyrocket so nearly 861 mothers worldwide.  Starting as a simple project of two cesarean mothers, and a passion for internet blogging we threw together a survey with 16 questions that peaked our own interests about other mothers experiences.

Over night the project grew a mind of its own multiplying in size a number of times. The information, numbers, and comments.  Much to our surprise many women were more open and honest than we expected. It was amazing to see the impact of social media today on this project.

What became even more shocking to us were the replies, numbers and information we were able to obtain with this project.  I will go question by question reviewing and sharing some of the results through various posts, but first before getting into each individual question, and the comments and experiences listed, I would like to give a general overview and release of the actual poll results.

Starting with question #1 : How many Cesarean Births have you had?
1 Cesarean – 67.4%   580 mothers
2 Cesareans – 23.5%   202 mothers
3 Cesareans – 6.5%    56 mothers
4 Cesareans – 2.6%   22 mothers
1 mother skipped this question

Question #2 – Your Cesarean Birth was :
Elective or Planned : 14.8%   118 mothers
Unplanned : 39.5%  316 mothers
Emergency : 21.0%   168 mothers
Repeat Cesareans :  15.1%   121 mothers
(First was unplanned cesarean, scheduled subsequent cesareans)
First Birth was Cesarean, VBAC attempt or other births : 5.6%   45 mothers
Always attempted vaginal birth, always ended in cesarean : 3.9%   31 mothers
62 mothers skipped this question

Question #3 – If Elective or Planned, What was the reason?
Previous Birth was Cesarean, Doctor Recommended :  33.9%   112 mothers
Knew what to expect, was the birth I wanted: 10.3%  34 mothers
Fear of labor & Natural childbirth : 2.4%  8 mothers
Previous Traumatic Birth, Cesarean was Less risky : 6.4%  21 mothers
No VBAC Support or availability : 5.5%  18 mothers
Other : 56.1 %  185 mothers
531 mothers skipped this question

Question #4 – What Support did you have During Labor?
Midwife : 18.2%  152 mothers
Doula : 9.3%   78 mothers
Spouce/Partner : 90.7%   758 mothers
Family/Friend : 37.0% 309 mothers
Hospital Staff : 49.2%  411 mothers
25 mothers skipped this question
*Note, mothers were allowed to choose more than one option

Question #5 – Would you describe your experience as :
Wonderful : 27.7%   227 mothers
Empowering : 7.4%  61 mothers
Frusterating : 26.7%  219 mothers
Traumatic : 46.8% 384 mothers
Disappointing : 45.5%  373 mothers
41 mothers skipped this question
*Note, mothers were allowed to choose more than one option

Question #6 – Do You feeling like you were in control and respected through the process?
Yes : 37.4%   318 mothers
Somewhat : 35.3%  300 mothers
No : 31.4%  267 mothers
10 mothers skipped this question

Question #7 – Were you happy with your birth support team?
Yes: 71.1%  601 mothers
No : 28.9% 244 mothers
16 mothers skipped this question

Question #8 – Do you feel adequately informed about interventions, medications, and complications during labor?
Yes : 41.1%   350 mothers
No : 28.3%  241 mothers
Somewhat : 21.6%  184 mothers
Does not apply : 8.9%  76 mothers
10 mothers skipped this question

Question #9 – Do you feel you were adequetely informed about the risks of a Cesarean section?
Yes : 51.5%   434 mothers
No : 48.5% 408 mothers
19 mothers skipped this question

Question #10 – How do you feel now about your cesarean section?
It was necessary, greatful we are all ok : 48.2%   406 mothers
It could have been avoided : 25.4%   214 mothers
I wish I had made difference choices that may have not resulted in a Cesarean : 30.6%  258 mothers
Neautral/No strong feelings : 6.0%   51 mothers
It was a traumatic experience : 31.8%   268 mothers
I am angry : 22.8%   192 mothers
18 mothers skipped this question

Question #11 – Did you discuss your experience with family and friends?
Yes : 90.8%  768 mothers
No  : 9.2%  78 mothers
15 mothers skipped this question

Question #12 – Please rate your physical recovery in 1 – 10 scale.  1 being easy, 10 being difficult, painful, with compications.

1 – 16.0 % 136 mothers
2 – 12.9%  110 mothers
3 – 12.2%  104 mothers
4 – 7.0%   60 mothers
5 – 8.7%  74 mothers
6 – 8.1%  69 mothers
7 – 9.9%  84 mothers
8 – 11.5%  98 mothers
9 – 7.0%   60 mothers
10 – 6.7 %   57 mothers
9 mothers skipped this question

Question #13 – Please rate you emotional recovery in 1 – 10 scale. 1 being no issues, 10 being difficult, or PTSD.
1 – 17.9%  152 mothers
2 – 10.2%  87 mothers
3 – 7.5%   64 mothers
4 – 5.5%  47 mothers
5 – 8.7%  74 mothers
6 – 7.1%  60 mothers
7 – 11.8%   100 mothers
8 – 13.5%  115 mothers
9 – 7.7%  65 mothers
10 – 13.3%   113 mothers
12 mothers skipped this question

Question #14 – Did you seek counseling or other support?  (Support group)
Yes : 27.8%  234 mothers
No : 66.7%  561 mothers
N/A : 5.5% 46 mothers
20 skipped this question

Question # 15 – How do you plan on birthing your future children?
Elective/Repeat Cesarean : 23.3%  196 mothers
VBAC : 49.3%  416 mothers
Home Birth : 22.8%  192 mothers
Water Birth : 12.1%  102 mothers
No more children : 26.6%  224 mothers
18 mothers skipped this question

Question # 16 – Would you consider having a VBAC?
Yes : 77.5%  628 mothers
No : 22.5%  182 mothers
51 mothers skipped this question

On top of all the questions we included a box to add any additional comments, in which 302 women used to comment about their experiences and even made comments about the survey itself.
In the following posts, we will start to break this information down question by question providing quotes and comments from the real mothers who took the survey, and opinions on the numbers, and what they say for birth, especially cesarean birth today.

Danielle A. Elwood
&
Theresa Shebib co-founder of www.HealthyBabyNetwork.com

March 14th, 2010

This Week’s Round Up

There are a ton of things that have gone on this week, starting with the National Institute of Health’s Vaginal Birth after Cesarean conference in Bethesda Maryland.  Lots of activists, professionals, and reporters descended on Maryland in hopes of a huge change in the maternity care system in our country, and it looks as though it worked!
A couple, or should I say, a ton of articles from this week…

United States urged to confront shocking maternal mortality rates
Too Many Women Dying in US While Having Babies
Doctors Debate C-Section Options
Deadly Delivery by Amnesty International
Women Struggle to Avoid C-Sections
Panel Urges more Choice in Birth after Cesareans
Too Many Preventable Deaths Among New Moms
Group Urges New Rules for Vaginal Birth after Cesarean
Panel Urges new Look at Cesarean Guidelines
NIH Panel : End Bans on Vaginal Birth After Cesarean
Vaginal Birth After Cesarean Underused
Panel : Vaginal Birth after Cesarean not too common
Panel : Women Need a Chance to avoid repeat C-section
Are C-Sections too common?

On to my favorite blogs for the week, from babywearing to ICAN :

Slings & Safety by Doula-la-la
The illusion of Choice
Once a Cesarean, Rarely a Choice
WSJ talking crap about Breastfeeding
New Moms at Risk, and a Wake Up Call to Nurses

I am extending my giveaway another two weeks because of the lack of people who signed up for it. So if you are interested in winning a beautiful nursing reminder, sign up!

Wednesday night wrapping up The NIH Conference, I had Joy Szabo on my radio show also.
Check that out too!

There wasn’t much blog talk this week that didn’t center around the NIH VBAC Conference, but if you have something you wrote, or even loved someone else’s post, please link it up here!