ICAN meetings, Essex Cty NJ

ICAN of Greater Essex County Meeting dates
Tuesday, February 28, 2012
Tuesday, March 27, 2012
Tuesday, April 24, 2012

Held @ Seton Hall University, South Orange
Arts & Science Building, Room 208A, 6:30 pm

This is shaping up to be an exciting year for ICAN of Greater Essex County!
We will be hosting our first meeting of 2012 on Tuesday, February 28 @ 6:30 p.m. Trish DeTura*, RN, CNM, MS will presenting on Mayan Abdominal Massage and about how it can help moms recovering from birth, particularly our moms who have had c-sections! Not to be missed!
We will be celebrating our first anniversary this March.
Elaine Diegmann, ND, CNM, Director of the Nurse-Midwifery Program at UMDNJ will be presenting in April. She will speak about the work happening at Newark Beth Israel to reduce their c-section rate and to move from Worst to First! Trish DeTura will also give an encore presentation for those who could not make the February 28th meeting. So excited to see the transformation in our community! If you plan to attend any of the meetings, please RSVP either by email or on our Facebook page, under events. Looking forward to seeing you at the next meeting!

* Trish is amazing - you owe it to yourself to get in to see her!

cesarean rates: NJ, NY & the nation

Do you know the cesarean rate of the hospital in which you intend to birth? Here are the stats for NJ and for NY. And if you click on the state link at the right side of the hospital break out stats, there is a bar chart covering 20 years of stats and a list of which hospitals support VBAC - very helpful information.

NJ folks, NJ's cesarean rate is among the highest in the nation - looks like we lost the dubious distinction of being number one to LA last year; NY is not far behind.

While it's great news that there was a measurable decline in cesareans from 2009 to 2010 (according to most recent stats available and thought to be because fewer teens, who are at high risk for cesarean, are giving birth), it's still way too high. Childbirth Connection (a wonderful resource, if you don't already know it) notes that,

The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006)

Time magazine photo

VBAC discussion with Dr. Stuart Fischbein

LISTEN HERE

Listen to internet radio with ProgressiveParenting on Blog Talk Radio

This was broadcast earlier in the week on Progressive Parenting on Blog Talk Radio. I found the host's introduction tedious (sorry), so don't give up...Dr. Fischbein is worth the wait - lots of great, crystal clear information for those seeking a VBAC.
And for those who have not yet given birth, remember that avoiding the primary cesarean is the best plan of all.
Read more about Dr. Fischbein

I am blessed to regularly work with several care providers who value and actively support VBAC for my clients...the good ones are out there and finding true support rather than mere tolerance is key. If your gut is not agreeing with your ears, go with your gut.

For more information on VBAC, check out ICAN & VBAC.com

April is Cesarean Awareness Month

Sadly, "32.9% of Births Resulting In Major Abdominal Surgery; 13th Consecutive Year to Show Increase"...read about it on the ICAN site

Hopefully ACOG's reversal of their prior position against VBAC will stem the tide. But we must prevent unnecessary primary cesareans whenever possible.

If you are pregnant, considering getting pregnant or know someone who is, consider downloading "What Every Pregnant Woman Needs To Know About Cesarean Section" (2006, revised) The numbers are worse now, but still good information.

welcome Xavier Erwin

Born via a powerful, all natural VBAC at 4:42p today, weighing 8lb 7oz, and 21" long...your parents should be so very proud...your daddy was a wonderful support (we got our own squat workout today with your labor!) and your momma did tireless research and homework to make this birth what she wanted it to be. She was so in her own zone, doing all that needed to be done to bring you into this world. Thank you for cooperating, Xavier! And have fun with all your grandparents and especially your big brother Jack!

Happy birthday (not April Fools!)

high-touch birth

Lessons at Indian Hospital About Births

...In Tuba City last year, 32 percent of women with prior Caesareans had vaginal births. Its overall Caesarean rate has been low — 13.5 percent, less than half the national rate of 31.8 percent in 2007 (the latest year with figures available). This is despite the fact that more women here have diabetes and high blood pressure, which usually result in higher Caesarean rates...

How do they do it? Check out the entire NY Times article here.

I read this makes-you-shake-your-head-because-it-can-be-so-simple article after coming home from a birth at a hospital five minutes from my home where MANY doctors (whole practices) don't take call on weekends. Period. So there is a very good chance the doctor you stayed at this hospital for will not even be there, won't even know you're in labor. When you get there, get ready to sit in an office not unlike that of a car dealership, where copies will be made of your driver's license and insurance card before you can go to triage. Where you stay in bed if your water is broken. Use a bedpan, 'cause you're not getting out of bed to pee. Be ready to have "concerned" conversations over the birth ball you brought. A hospital where the Friedman Curve is king. Where there isn't even a pantry room because nothing but ice chips is permitted, so why would you need a fridge or microwave or electric tea kettle. Where one can feel truly lucky if not among the 49.3% of birthing women who have a cesarean at this hospital.

There are hospitals within spitting distance where the level of care is as good (better, in my opinion) but people don't have to put up with this way of doing birth. Yet many people still flock to this institution. I don't know why and will continue to offer information on alternatives and then meet them where ever they are, trusting that they know what feels best for them. But in my heart, I'll likely wish we were someplace else...maybe Tuba City.

OK - rant over.

Glorious VBAC...welcome Riley!

Every birth is special (and I have been remiss with a few announcements lately...) but some are just awe-inspiring & majestic!
Today I had the pleasure of bearing witness to the all natural VBAC of a healthy baby girl, Riley. She weighed 11lb 15oz (!) and was 22.5" long.

Riley, your momma worked so hard to have the best possible chance at this VBAC (including crossing state lines to have you in NJ)...I am so humbled to meet and serve women this strong and tenacious, supported by partners like your daddy every step of the way. Many blessings for a life filled with everything good - happy birth day!

finding peace

Today I received a comment from someone full of sadness & regret about her own three cesarean births in regards to a prior post from last January on VBA3C (vaginal birth after 3 cesareans) -

Here was my response:

Dear Anonymous,
I wish your story was uncommon, but it is not, as I'm sure you know.
I don't want to be dismissive (at all), but I do hope you can look back on your births (- yes, I said births... you had unwanted c-sections but you also gave birth to wanted babies -) and can find the victories too. The questions you asked, the thought of what you would prefer even if no one was able to help you make that happen...
I really encourage every woman who feels any sort of trauma or sadness from her births to find someone to listen and help you frame your stories to find the power. Pam England from Birthing From Within & author/doula Penny Simkin are two names to consider for potential phone consults. And the fine folks at ICAN & VBAC.com...
I wish you peace. Please feel free to be in touch if more info is needed.

Kim/DoulaMomma

April is

Cesareans can save lives & I'm glad they are available. But they can also cost lives; a cesarean is major abdominal surgery and should be avoided unless absolutely necessary. According to Childbirth Connection.org,

Recent studies reaffirm earlier World Health Organization recommendations about optimal cesarean section rates. The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%. Rates above 15% seem to do more harm than good (Althabe and Belizan 2006).

2007 data shows that it is nationally 31.8%. My state, NJ is the highest in the nation at nearly 40%! Women who have this surgery are four times more likely to die than women who give birth vaginally.

There is much that can be done to lessen chances of giving birth by cesarean unnecessarily. Educate yourself. Do all that you can to prevent primary cesareans and support VBAC in your community. Check out ICAN for information.

repeat cesareans

Check out a Time Magazine piece on Cesareans:

The Trouble With Repeat Cesareans
By PAMELA PAUL
Thursday, Feb. 19, 2009

For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car."

Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that "once a cesarean, always a cesarean"--an axiom thought to be outmoded in the 1990s--is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them. (Read "The Year in Medicine 2008: From A to Z.")

Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.

After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean.

So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.

But many interpreted the revision to mean that surgical staff must be present the entire time a VBAC patient is in labor. While major medical centers and hospitals with residents are staffed to provide this level of round-the-clock care, smaller hospitals typically rely on anesthesiologists on call. Among obstetricians, many solo practitioners are unable to stay for what could end up being a 24-hour delivery; others calculate the loss of unseen patients during that time and instead opt to do hour-long cesareans, which are now the most commonly performed surgeries on women in the U.S.

Some doctors, however, argue that any facility ill equipped for VBACs shouldn't do labor and delivery at all. "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study. (See 9 kid foods to avoid.)

Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."

Of course, the alternative to a VBAC isn't risk-free either. With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.

"The decline in VBACs is driven both by patient preference and by provider preference," says Dr. Hyagriv Simhan, medical director of the maternal-fetal-medicine department of Magee-Womens Hospital of the University of Pittsburgh Medical Center. But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

Zelop is among those who worry that "the pendulum has swung too far the other way," but, she says, "I don't know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid." So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: "When the problems with multiple C-sections start to mount, we're going to look back and say, 'Oh, does anyone still know how to do VBAC?'"

is your care provider REALLY supportive of VBAC?

I submit that there is a world of difference between a doctor or midwife who say's they will "let you try" and one who really supports VBAC. Be on the look out for whether it seems that your provider is truly supportive or whether s/he is just tolerating the idea. It is not uncommon for those in the second camp to have a change of heart at the end of a pregnancy and end up suggesting that you not go for a VBAC after all. Listen with your gut. If you are not feeling true advocacy, shop around and move on.

A great post from Empowering Birth Blog:

Here is a list of questions to help you find out. Thanks to the NOVA Chapter of ICAN for passing them along.

• Of the last 10 women that have come to you originally wanting VBAC, how many were able to have their VBAC? (kind of asking their VBAC success rate, but this number should represent better, as it will be lower if they tend to talk women out of it during their pregnancy)

• What do you think would prevent me from having a VBAC?

• What do you believe are my chances for having a VBAC?

• I have now read more information regarding my previous c-section, and I’m curious to know what your practice would do in the same situation to help me avoid a c-section, either prenatally or during labor?

• Would your practice allow me go to 42 weeks? If not, how long will I be able to be pregnant?

• If I hit 42 weeks (or whatever gestation you require me to deliver by), would you consider induction, or just schedule a c-section? If induction, what are my options (ROM*, pitocin – how much, etc.)?

• What circumstances, later in my pregnancy would contraindicate a VBAC and make you recommend a repeated cesarean section?

• If I do go past my due date, what testing requirements do you have (BPP, US, NST**), when will they begin, and how often will I need them?

• Will you recommend an ultrasound to estimate weight late in pregnancy (providers who are nervous about a "big baby" may recommend ultrasound)?

• How do you feel about VBACers birthing "big" babies? What do you think is "big"?

• When in labor, what stipulations do you have for VBACing moms? For example, do you require continuous monitoring? Do you have a time limit for progression in labor (ie, I need to dilate 1cm each hour)?

• Do you require your VBACing moms to have an epidural?

• Where is my placenta located? Anterior, Posterior, lower uterine-segment, Fundus?

*ROM, Rupture of membranes

**BPP, Biophysical profile, US Ultrasound, NST Non-stress test (see biophysical profile)

interesting VBAC question

Recently someone asked me if she was a good candidate for VBAC. Her first birth, by cesarean with low transverse incision, was at thirty weeks (due to a rare infection).
Now obviously I asked her what her care provider said, since what she is asking is a medical question. He is encouraging her to VBAC but she is still concerned. I have also suggested that perhaps she should explore whether she is with the right care provider, given her concerns in spite of her provider's reassurance.

In any case, back to VBAC for someone who has had a premature birth by cesarean...
Her question was an interesting one that I had not considered before: is a low trasverse incision on a thirty week uterus the same as on a 40 week uterus, ie. is it still "low" once the uterus grows beyond the size it was when the prior cesarean was done and does this situation mean more of a risk of uterine rupture?

This woman is well-read and had done her research but had not found anything yet. I threw the question out to both an OB & a midwife with whom I work frequently. Both were in agreement that it didn't seem like an additional risk. And fortunately the OB was able to find a study on point that finds this scenario imposes a very, very minimal increased risk for uterine rupture.

perfect day

I have lots of ideas about how a perfect day could be spent. Yesterday was one of those days.

I was woken up by an early morning call that a labor was happening. Hooray - Sunday & kids were covered since my husband was home. It would take some juggling with his tennis game, but no big deal. I knew they had fun plans to spend the day at the pool and Maplewoodstock. And no one else due at the moment so no conflicts - just this birth to consume me for how ever long it lasts. All extra special because I leave for Ann Arbor tomorrow and really wanted to be at this birth.

Contractions had been happening on and off since around her July 4th due date and I felt pretty certain it would all work out and I would get to be there. Thanks, perhaps, to acupuncture, massage, homeopathics and some special castor oil eggs,things were moving. Although it was a somewhat unique VBAC where lots of people could name all sorts reasons it shouldn't work out, I felt calm that it would go well and fairly fast; not sure why. Having a client who is so upbeat and just willing is a joy and I think it helps the birth.

Funny thing: A childbirth class was taking a tour and thought we were part of the show. They actually followed us to the room, so I snapped their picture.

Throughout the birth, even though it was amazingly hard work for the momma, she manifested gratitude throughout. Thankful for her super husband and the spaces in between. The nurse & doctor commented that they were the most friendly & grateful people to come through in a long time.

The birth, as noted below, was fantastic. And I made it home in time to see my family and sleep in my own bed...perfect. I love it when it all works out, as it so often does.

Lucy!

Welcome baby Lucy! You're just stunning & look so much like your big sister. Wow - what a day - so wonderful to see you born just the way your parents wanted. A victorious VBAC! It didn't come easy - so much preparation and planning came to fruition. How wonderful to be with your awesome momma & poppa again - words can't say how cool I think they are. They did what lots of people have a hard time doing; rather than just asking for advise & then finding it too hard to follow through, they did it all. Thanks again to Dr. P, who is truly a guardian of birth in the best sense. Tears of joy, tears of joy!