September 7th, 2010

OB’s Aren’t Listening to ACOG

OB’s aren’t listening to ACOG. While this is a huge shock for some people, it is not surprising for others. But how did I come to this conclusion?  Well, becoming pregnant put me in a position I was not comfortable being in yet. Being a woman looking for a trial of labor after two previous cesarean sections.   One that was not medically necessary at all, and one that saved my youngest son. While I believe if things had been done slightly differently the second could have been avoidable, but it was a catch 22.

In July of this year, ACOG released new VBAC recommendations in response to the growing cesarean rate, complications that are a direct result of that, the falling VBAC numbers, and the lack of access for VBAC that was all brought out in the National Health Institute’s VBAC Consensus back in March.  I was lucky enough to be able to watch the entire conference from home, and take a ton of great information from it. But it also hit ACOG hard because their representatives knew that their guideline changes essentially caused the decline in VBAC access for women Nationally.

On July 21st, ACOG made a new press release detailing some of their new VBAC guidelines, which included a statement on women with two previous cesarean deliveries.

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, “The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,” said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

Ok, so what is the big deal right?  It says right there that ACOG supports and finds a trial of labor acceptable and essentially a safe option for women with two prior cesarean sections.

So what is the hang up? Apparently all the same OB/GYN’s out there that were quick to jump ship on VBAC when the guidelines changed years ago with new guidelines on the readiness of Anesthesia in the hospital, are NOT as quick to jump back ON the VBAC bus despite the clinical information showing it to be a safe choice.

Where does that leave me right now?

Screwed!  I have a hand full of options I am looking into at this point, but I can’t go see the midwives I was with because their backup OB practice won’t take me on… I have an appointment with a high risk Perinatology group who seems to be open to my request, but the two words high risk scare me because I know it is going to limit the availability of a natural birth. Although the positive of it all is a friend of mine, who had two home births, and came down with a horrible blood disorder during her third pregnancy had a 100% natural hands off birth with this same practice. So… I have hope…

We’ll see!

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.

June 17th, 2010

Birth By Numbers (Part 1)

I have wanted to share the Lamaze Birth by Number’s video for a while. It features Eugene Declercq one of my favorite Silver fox’s discussing the numbers surrounding maternity care in our country, where we rank in the world and the issues our care system presents. I have tried to find a way to get the video embedded here on my page, but I was unsuccessful in that mission. But the link for the video is :  Birth By Numbers and I highly suggest taking the 25+ minutes to watch this.  Whether you are a first time mother, childbirth educator, veteran mother, or just someone interested in the childbirth community, it is a must watch.,

4,138,349 – The number of births in the United States in 2005, the year this video’s information focuses on. The numbers are still similar, although they have increased and decreased in years since then.
18, 884 – The number of Neonatal Deaths in the United States in 2005. Meaning, the number of babies that died in the first 4 weeks of their lives.
1,248,815 – The number of Cesarean Sections that took place in the United States in 2005. And that number has increased every year since then.
4.6 – 4.6 neonatal deaths per 1000 babies born in the United States in 2005.

42 This is the number that the United States ranks in terms of our neonatal mortality rate. Meaning?  41 other countries have lower neonatal mortality rates than the United States and all of our magical medical technology.  Below is a list of the countries who rank better than we do, which is surprising.

There are several countries on this list that cannot realistically be compared to the United States because of the small number of births they have annually, but if you were to take all the countries that have at least 100,000 live births per year, The United States still falls behind.

Take these 15 countries, and The United States has the 2nd worst rate, only behind France. Still horrible in terms of concern for health in our mothers and babies.  When the numbers are broken down into countries that have at least 300,000 births per year, we are still in bad shape. 8th out of 9 countries with only France worse off than us again.

Now we move onto Maternal Mortality which is even more grim.

Now when we take countries with at least 300,000 births, The United States ranks last. We lose the most women around the time of birth than any other country who have somewhat the same amount of births.
What is most troubling about it all is that the numbers are getting worse, not better as the years go on.

While other countries are decreasing, this shows that we continue to increase or stay the same. A scary statistic for women who are having babies in the United States today.

Back to our mothers again. See that increase? EEK!

But why are we seeing a huge change like this? What has happened over the past 10 years that is aiding this problem?  One thing!  The increase in use of a sometimes valuable medical intervention…. The Cesarean section.

Now, if you know me, or have been reading my blog for a while, you know that I preach religiously about the over use of the cesarean section rate, and how it is causing more harm than good in our country. This next graph shows the issue with this, and why we as a country should truly be concerned by the number of surgical births taking place.

Since the 1990′s the cesarean birth rates have steadily increased, along with the maternal death rates.  Also with the preterm birth rates, and other complications that this video does not go into detail on. How do I know?  Because this is now something I have spent over two years of my life looking at, researching, and learning about.

When you take a minute to look at the cesarean section rates by state (below) it shows that it is not evidence based medicine being practiced across the board, it is more of a cultural impact in certain areas that impacts the overall cesarean birth rate.

What stands out to me personally, areas like Utah, Nevada, Arizona, New Mexico, Colorado, which have a couple trends to me have these low cesarean rates.  One is a strong religious or Christian population. The other is a strong immigrant population. Although California has the same immigration rates with a much higher cesarean rate.

Some argue that the mothers are driving these rates up with Maternal Request Cesarean sections, but in fact that is not the issue at all. Check out this information and quote from the Listening to Mothers Survey :

I am not sure what world she lives in. No pain?  No hassle?  LOL!  This must have been BEFORE she actually had the c-section!
But all in all, blaming the 50% increase in cesarean births on women choosing them is ridiculous because women are not signing up.

I want to keep my post to a minimum toady before it gets way too long I am going to stop here, and pick up in a couple days on the second half of this video. Considering it is almost 25 minutes long, putting it all into one post would be overkill, and slightly foolish.

May 16th, 2010

One Year Ago

Where was I one year ago?

Well, the day began (it was a Saturday) by packing up all of my ICAN of Connecticut materials, brochures, information hand outs, and heading out to the Griffin Hospital Baby Fair (which I did yesterday).  When I got there I was just fine. I had repeatedly told my very pregnant belly to stay put until after the baby fair. Griffin is the only hospital in the area that really hosts a baby fair anymore, and it was my second year doing it.  I was lucky enough to have a booth outside, right next to my Chiropractor!

I talked to new mothers, cesarean mothers, and my amigo Liz who came down all the way from the Hartford area to help with the booth, as I met her through ICAN. My parents stopped by, my best friend Leigh came by. It was like one big party, and we were all having a great time. Around noon time I started to feel a little…. under the weather so everyone forced me to eat the lunch which was provided for us. A turkey wrap and some chips with a bottle of water. Which was followed by a nice adjustment from my Chiropractor.

That was the last straw. I felt worse.
I started having  contractions, closer, and closer together and by the time 2pm rolled around, everyone packed my car up for me and I was on my way home to attempt a nap. I figured the contractions would stop, like they had previously, and we would be welcoming a June baby, not a May boy.

Boy was I wrong!

By 7 I was in full blown labor. I called my doula and my best friend, and a short time later the entourage arrived at my front door. Karen (my doula) gave my midwife (Sarah was on call) a quick call to let her know what was going on, and she told me sternly to stay at home as long as possible!!!!

With strict instructions from Sarah I stayed home and labored with the support of my friends, and my husband.  He was my comic relief in it all.  His job virtually the whole time was to keep music going.  I think the music when I was in labor helped the most.  (For a laugh, check out a sample of our playlist)

We also watched the Nascar all star race, while I was using the birth ball, on my hands and knees in the living room trying desperately to help with my back labor.

It seems like hours were only minutes, and around midnight we were discussing calling my midwife again as my contractions were about a minute apart and we had a 30-45 minute drive to the hospital of my choice.   My VBAC was so important to myself, and my health that I interviewed several local providers, checked into hospital VBAC and cesarean statistics, and made an educated decision this time around, instead of picking a provider that simply took our insurance, and delivered at the hospital I wanted to.  (While the hospital I had Camden, my oldest at was nice, I would not go back there for another delivery after researching their statistics and reputation).

We headed out in a 3 car convoy. In the first car was my doula Karen, and myself. I was laying across the back seat with my cup of ice, which was all I wanted to eat at that point.  I went with her so I could continue to listen to her iPod relaxations materials. Then behind us was Will, and then behind Will was my best friend Leigh.

I will leave you with this until tomorrow…. with the Happy Birthday post for my Benjamin’s first birthday.

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!

March 13th, 2010

2011 ICAN Conference Chair

Well, as many of you already know, I am heavily involved in ICAN, better known as the International Cesarean Awareness Network, and I have been since shortly after the birth of my first child. I started my own chapter in my local area, and then I moved on around the time that I was ready to give birth to my second child to become the Northeast Regional Coordinator also. Because I am so passionate about ICAN and what they do, I have been always willing to go above and beyond to help.

So when the opportunity came up to be on the 2011 ICAN Conference Committee, I of course applied. Knowing that this conference, I will not be too pregnant to travel, heck, I won’t be pregnant at all! LOL So I knew there would be nothing holding me back this time. I desperately wanted to go in 2009, but Ben decided to join us just 3 short weeks after the conference in Atlanta, so had I gone, who knows what would have happened!

I originally applied to be the 2011 Speaker Chair, with a second option as the Registration Chair. I thought the speaker chair would not only be fun, but because of the awesome connections I have made in recent months, would be perfect. (Not only that but I am starting an ICAN movement towards a “Silver Fox” panel for the conference which would include Marsden Wagner, Eugene Declerq, and Sutart Fischbein) and the registration chair was simply a second pick.

Yesterday, Maureen, the woman who is the head for the conference in 2011 contacted me with a favor and of course, like I always do, I took on the challenge. Which was to accept the National Promotions and Publicity Chair instead of what I had applied for because of the lack of interest in the chair position. I was truly surprised at that because with all the social media today, I would have assumed that people would have jumped on something so easy!

Of course I told Maureen, like I normally tell any ICAN Board member, I would help where ever they needed me to, and then she told me to consider myself the official 2011 ICAN Conference National Publicity and Promotions Chair. Score!  While I was pretty confident that I would obtain a position on the conference board, I did not think it would be anything as important.

So what exactly am I supposed to do with this title right?  Sounds like it is pretty broad?  Well some of my duties include what I already do on a pretty much daily basis with social media connections.
Some others include :

• Advertising the Conference to ICAN members, and other National Organizations that would be interested.
• Develop advertisement for the conference.
• Communicate with National Publications (which I have already been doing heavily with the recent media on c-sections, maternal mortality, and the NIH VBAC Conference).
• Networking… Facebook, Twitter, Blogs, etc.. (So if you want to blog about the conference as it gets closer, I am your woman!)
• Work with the Local Publicity and Promotions director to write press releases

So many more things, it seems to be like a great position, and like I said before, I am in the habit of really doing most of anything they ask of me. One example is a video I made earlier in the year for ICAN. I obtained the music from a friend of mine (Rob Taylor) who is a local musician in my area, and all the pictures came from ICAN chapters and members Nationally.

I hope you enjoy!
I had a really great time making it, and I am super excited in my new future at ICAN, at least until it is over in April of 2011!

March 12th, 2010

Wrapping up NIH VBAC Coverage

So much came from this conference this week, so I wanted to share a ton of links that may be helpful for those who were not able to participate.

If you were not able to watch the coverage, you can use these links for viewing of what took place.
Day One of the National Institute of Health’s VBAC Conference
Day Two of the National Institute of Health’s VBAC Conference
Day Three of the National Institute of Health’s VBAC Conference

All three links are video feeds.

The Original Draft Statement
Current Statement after Revising
The final statement should be out within a week or so, until then I will leave the slot for this blank.

The Conference Abstract

In the aftermath of this conference, there are an incredible amount of articles not only addressing the rising cesarean rates, increasing maternal mortality rates, and lack of VBAC access, but human rights issues that the panel at NIH did not address in their statement.
So, because I have been a media junkie the past couple days, I started tracking all the links.

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?

As more stories come out, I will continue to include the links!

March 11th, 2010

Joy Szabo, NIH, & What Wasn’t Addressed

Last night I was lucky enough to have a 45 minute slot with Joy Szabo on my radio show. I was certain people would call in with questions to ask her about her experience, but it seemed as though the National Institute of Health VBAC Conference has really been overshadowing the whole week, especially in the birth and activism community who happen to be the main readers of my blog!
So half way through the show, when I realized that no one was calling in with questions for Joy, after talking about her story, feelings, and experience, we turned the table over to the final draft letter from the NIH panel.

That is when the show started to pick up, because people are MAD!  No matter how many times the same topic was brought up, it was left out not only in the draft letter, but in essentially their revised draft. While we do not know if it will make it into the final statement, most of us are not optimistic.
The topic?  Women being able to make their own choices, and say NO to their provider, repeat surgery, and NOT have to go through any type of legal recourse or court ordered intervention like we are we are slowly starting to see in our country.

It was brought up yesterday morning during the time in where the audience was able to make comments, suggestions, and ask questions, but again brought up during the Press Conference by Susan Jenkin’s from The Big Push for Midwives.  During the press conference panel members continued to dodge the question, and comments once again.

Now most of us went into this whole week not expecting much from the conference because many of us have been down this road, and knew that change is often not something that comes about, but after the first couple speakers, slides which included pictures of the ICAN logo and the banner from The Unnecesaean, many of us were smiling ear to ear hoping, and praying this would really be the step we needed. By day 3 it turned clear that it would not be what many of us would have liked to happen.

The one positive I find that came from this was the final suggestion for ACOG to revisit and revise their statement including immediate terminology, to something that is much more realistic in our medical community today.

We got a little carried away in the show last night, and went over our time limit, but I wanted to again thank those who did come on the show, speak, and bring a great discussion. Joy Szabo for bringing the issue of VBAC Bans into the mainstream media, Traci Perg for being so passionate, outspoken, and bringing up amazing points about modern day feminists, as well as pro choice supporters, Lauren Cooper, current Chapter Director for ICAN and her reflections on the conference. Lauren is a good friend of mine, as well as a great mentor, and she will be coming back on in April for one of the radio shows focusing on Cesarean Awareness Month, and last but certainly not least, Sarah from Salisbury Connecticut, a local doula, friend and advocate in my community.

Tell everyone what you think about the panel’s statement and leave a comment!

PS!  Please, please please!  If you have had a cesarean section, take our Post Cesarean Feelings Survey, it will ONLY be available till Monday March 15th, and we are trying to hit between 1000 and 1500 mothers!  Pass it along on Facebook, to your friend, family, or clients!
Post Cesarean Feelings

March 10th, 2010

Tackling the Draft Statement

I saw down and listened, read, and watched the question and answer session for the draft statement by the panelist who read it, as well as the audience who was able to add their input. One surprise I found was the President of ACOG who had been at the conference all along finally got up to make a comment, of course only after ACOG was called out in this statement’s conclusion.

I am glad that on several occasions through the document they discuss the NON medical factors that are influencing VBAC today.
I would also like to point out that I enjoy their final statement in the end which includes asking ACOG to reconsider their recommendation of VBAC and the “immediate” wording.

I really wanted to pick this all apart much more, but I am going to wait for the final draft for that.

I encourage everyone to read the draft, and submit comments in the next short couple hours to have your voice heard and suggestions looked at!

March 10th, 2010

The Draft Statement is Available!

The National Institute of Health’s VBAC Draft statement is now available to the public.
You can read it at
http://consensus-nih.org/omar-public/PublicComments/VBAC/PublicComments.aspx?AspxAutoDetectCookieSupport=1

Please read, and leave comments, they will only be taking comments for a short period of time today!

March 9th, 2010

NIH VBAC Day 2 Coverage

While the day was much shorter, I found it had a much more personal level of it as speaker Rita Rubin took on the stories of women around the country who have been victims of VBAC bans, lack of evidence based medicine surrounding VBAC, and women being forced to take matters into their own hands with out of hospital and sometimes unassisted births.
It certainly gave the speakers a much more personal feel and put names and faces to women struggling with this.

But I will get to that later in my post.

The day started with information on epidural anesthesia, as well as the lack of available anesthesiologists nationally to fill the need of the “immediate emergency care/delivery” guideline. I learned a lot about the national crisis surrounding available anesthesiologists.

1. Epidurals do not cause, or mask symptoms of a uterine rupture, if anything they allow for other options other than general anesthesia in the case of a rupture of need for emergent delivery.
2. When the speaker asked ACOG what they mean by immediate in their recommendation, their answer was “Immediate means immediate” kinda like banging your head against the wall?
3. Rural hospitals, and hospitals in rural areas have lower number of anesthesiologists, meaning lower access to an anesthesiologist in an emergent situation.
4. Currently in The United States, there are less than 30,000 current practicing anesthesiologists.
5. 55% of those anesthesiologists are over the age of 55 meaning they will be retiring in the next roughly 10 years.
6. There is an increase in Woman anesthesiologists, but women are more likely to work part time, or less likely to take on over night shifts, or shifts in Obstetric anesthesiology because of the schedule.
7. 4% of hospitals with in house anesthesiologists have 500 or more deliveries a year.

All in all, having in house anesthesia specifically, and only for Obstetrics, or VBAC is completely unrealistic. Not only that, but one thing that caught my attention of this speaker was the comment that “We need to remove lawyers and insurance companies from this choice” meaning the choice of VBAC vs. elective repeat cesarean delivery.
There was a suggestion at one point that VBAC only be “allowed” at hospitals that have at least 1500 births per year, but unfortunately like the 24 hour anesthesiologist coverage just for VBAC it is simply unrealistic. There are areas of our country that women have a 3 hour drive, or even longer to a hospital of that kind of caliber.
In the end, ACOG blames the OB’s, the OB’s blame the hospitals, the hospitals blame the women… and it is a giant blame game.
We need to stop playing the blame game, and we need to make this an available option for all women, while using the real evidence on its safety!

Moving on to some more things I learned…

1. Placental Abruption & Cord Prolapse are more common than Uterine Rupture.
2. Trial of Labor has much lower rate of perinatal death in women with previous cesareans as opposed to elective repeat cesarean deliveries.
3. In a study, 20% of OB/GYN’s say they reduced their exposure to lawsuits by no longer offering VBAC.
4. The risk of fetal death in a first time mother, is the same as, a mother VBAC’ing.

The last thing there shows a statistical analysis that shows us no difference between a mother VBAC’ing her second child, and a first time mother giving birth to her first child. The fetal death rates are the same. This shows one thing to me, and many others who were also live tweeting during this, women are not being truly informed about all of the risks and benefits of VBAC.  Women are not being given accurate, and real information.

There were several comments about women and their providers needing to be the ones making the decision regarding the mothers choice to VBAC or have an elective repeat cesarean, and some may not agree with me, but in my opinion it shouldn’t have to do with her provider at all. It should be the patients decision, period.

Another part of the survey that made me giggle was one of the reasons cited for women opting for elective cesareans instead of VBAC was to avoid the pain of labor which I have been through twice, also ending both times in a cesarean delivery. Avoid pain? Who are you trying to fool because cesareans certainly are not avoiding pain by any means!

More bits and pieces I learned :

1. 49% of ACOG Fellows in one survey said they do more cesarean sections for fear of litigation.
2. There is more and more clear evidence that women want VBAC but are being denied these services by providers, as well as hospitals.

Then came the discussion of woman’s stories, and what has taken place all over the country to women searching for VBAC as an option. Several ICAN women were quoted, as well as featured which I loved!
Gina also known as The Feminist Breeder was featured, and her struggle to have a VBAC.
Joy Szabo of Arizona who had to drive 350 miles, leave her husband and 3 children behind because of her hospitals choice to ban VBAC after she had already had a VBAC at this facility!  (Joy will be on my radio show tomorrow night at 10pmEST)
The number of women, and their stories were touching, and made the whole experience and conference real it made the panel members, and audience members realize these are real women we are talking about and essentially deciding the future of their childbearing.

In many cases, the question and answer sessions were my favorite part. Although there were a few audience members who continued to get up with their long winded comments sometimes going no where, or no relevance to VBAC at all. Which bothered me because there was a clear line of providers and activists who had short, to the point, and important comments and questions.

Couple comments from the question and answer session which stood out to me :

1. “No one should be brought to the OR against their will or without their consent”
2. “I feel like I am committing a crime when I take a knife to a woman I know has a high VBAC success rate” – VBAC supportive OB working in a hospital with a VBAC Ban

(I promise, I am starting to get to the end)

One of my issues was the discussion on ethics when it comes to VBAC and elective repeat cesarean deliveries. There is such a gray line that is being crossed continually in this country. Women who have Child Protective Services called on them for being a “difficult patient” and that is something we should not be seeing at all. Being a difficult patient, and being an informed consumer should not be something women fear having their children taken because of.
We should not be seeing women rolled into the OR with Sheriffs or court orders.
We should not be seeing women charged with Murder over a stillbirth when a cesarean is declined.
These are real stories!

One last thing that really got me also!
A panel member said something about protecting the rights of patients AND providers… well ya know what.. the rights of the providers are the ones being protected, by these bans, the defensive medicine, women are the MOST venerable ones involved, and that should not be it!

I could sit on my soapbox for hours, so I will stop there.
I hope that the NIH takes this chance to really form a informed and evidence based guidelines and recommendation for this.

We will see tomorrow when they release it at noon!