ICAN of Western Maryland

Sharing Notes from the ICAN 2011 Conference - Part 3

2011-05-12T14:41:00.000-04:00

Another plenery session, Gail Tully, CPM (spinningbabies.com) gave a presentation titled, "Breech Update for Parents"

Gail Tully is a homebirth midwife and doula. She supports women finding their way with breech and other births in Minneapolis, Minnesota. The Spinning Babies website can be located here. This website is full of fantastic information about belly mapping, techniques, as well as research, links and real stories. The site isn't just for women with breech babies. Any woman, pregnant or not, would benefit from visiting and reading on this site, to learn more about our bodies.

Some notes from Gail's presentation:

-during a breech birth many practitioners are now practicing, "hands off". The baby knows how to work its way out and can do some in most instances without assistance or touching, which may startle the baby. Frank Louwen, German OB is leading new emergent ideas in breech vaginal delivery. "Hands and knees, hands off". Mother on hands and knees, no touching the baby. Baby rotates out of the pelvis, down the birth canal.
-2009 Canadian ACOG (SOCG) set precedent for no more automatic breech cesarean deliveries.

A concurrent session with Dr. Poppy Daniels, OB/GYN, "The 3 Ps of VBAC: Pregnant Woman, Provider, Proviso: Navigating the Waters"

Dr. Poppy Daniels is an OB/GYN in Poplar Bluff, MO. Her interests include midwifery/physician collaboration and VBAC support. She is the mother of five boys. She has a website and a blog (you can read about her surprise VBAC!)

Some notes from this presentation:
-Vitamin D deficiency and low progesterone levels are being linked to pre-term birth, women should be tested for both levels during their pregnancy and given necessary supplements.
-more than 40 lb weight gain tends to decrease VBAC success
- recommends A Woman's Guide to VBAC to read if planning a VBAC
-No prostglandins for women with scarred uterus
-Mobility during labor should be allowed
-Heplock preferable to IV
-Food/drink during labor permitted
-Continuous labor support (doula) shown to reduce risk of cesarean
-Tell your nurse what you want
-Epidural alone is associated with higher rates of surgical delivery

A plenery session with Pam England, MA, CNM, gave a presentation titled "Gates of Cesarean Birth Story Healing"

Pam England, MA, CNM, homebirth midwife, internationally known speaker, author of Birthing From Within and her newest book, Labyrinth of Birth. Pam has a website and blog, Birth Peeps. She lives in Albuquerque, New Mexico.

Some notes from Pam's presentation:
-Healing from a traumatic or cesarean birth that was felt to be traumatic or a loss: "finding the scattered and shattered bones of your story, collecting them and putting them back together. Merging together what you wanted, with what happened is the ultimate goal and can take years."
-Seeing birth as a hero's journey
-Passing through the Nine birth story gates to complete the hero's journey

Thanks to Lisa Garcia of ICAN of Montgomery County for sharing her notes with me. Combining our notes together helped me to make these 3 posts possible!

Blog Posts around the Birthy Sphere

2011-05-06T21:07:00.000-04:00

There are too many interesting one today!

http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2011/4/26/touring-ldrs-around-the-country.html Great overview about hospital L&D maternity units, great for a first time parent to read and know if what they say in the tours are really the limits of your behavior in a hospital.

http://birthunplugged.blogspot.com/2011/05/theres-more-to-back-labor-than-fetal.html What else can be done for back labor?

http://wonderfullymadebelliesandbabies.blogspot.com/2011/02/would-you-rather.html About vaginal tearing and options...with graphic photos.

http://naturalbirthinkitsap.blogspot.com/2011/04/why-natural-birth-isnt-beneficial.html A nice viewpoint on natural birth....without aids an interventions it is the biological norm.

The VBAC Conference A Year Later: How far have we come?

http://www.themidwifenextdoor.com/?p=1540 Please go to this link and watch the video, very enlightening and features Jill from The Unnecesarean being interviewed!

Sharing Notes from the ICAN 2011 Conference - Part 2

2011-05-02T19:46:00.022-04:00

One of the concurrent session choices that we had was Kristen Oganowski's presentation, "A Woman's Guide to VBAC: Advocacy and Empowerment in the Web 2.0 Era".

Kristen Oganowski, CD(DONA) is a doula, writer, PhD candidate, and mother of two boys in Columbus, Ohio.

Kristen is one of the co-coordinators of the VBAC resource, "A Woman's Guide to VBAC: Navigating the NIH Consensus Recommendations". You can check it out here. She also runs a blog, Birthing Beautiful Ideas.

Kristen shared her experience of attending the NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights, March 8-10, 2010 in Bethesda, MD. The NIH Consensus Development Program generates evidence-based consensus statements addressing controversial issues important to healthcare providers, policymakers, patients, researchers, and the general public.

You can view the final panel statement and the archived webcast on the NIH Consensus Development Program's website.

A plenery session at the conference, Henci Goer's presentation, "The Gap Between Evidence and Practice".

Henci Goer is an award-winning medical writer and internationally known speaker, author of The Thinking Woman's Guide to a Better Birth and Obstetric Myths Versus Research Realities. She is a resident expert for the Lamaze Ask Henci Forum. She is also a regular guest blogger on Science and Sensibility.

In this presentation Henci presented routinely/frequently used procedures, drugs, tests, and restrictions that do not constitute evidence-based care.

Some of my notes from this presentation, definitely NOT everything that was presented:

Ineffective and Harmful Practices:
-elective induction and induction for suspected big baby
-supine positioning
-induction for ruptured membranes
-fundal pressure
-induction for post dates at less than or equal to 42 weeks
-median episiotomy
-instrumental vaginal delivery
-not allowing oral intake during labor
-administering narcotics
-epidurals (especially combined spinal epidural with narcotic)
-confinement to bed in labor
-active management of labor
-preset time limits for making progress/pushing
-routine IV

Notes Part 3 coming soon: Notes from Gail Tully's (spinningbabies.com) presentation, Breech Update for Parents, Dr. Poppy Daniels, OB/GYN presentation, The 3 Ps of VBAC: Pregnant Woman, Provider, Proviso: Navigating the Waters, and Pam England's presentation,
Gates of Cesarean Birth Story Healing

Pain in Labor, Fear and Coping

2011-05-02T06:13:00.001-04:00

Many first time mothers and those who have never had an unmedicated birth often doubt their ability to handle labor. I think it is unrelated to your general ability to handle 'pain' as labor pain is a functional change in the body not a malfunction like a broken bone or cut.

At Your Cervix wrote a nice post about how to measure pain in labor and how Peggy Simkin rewrote it into a coping chart! Please read it! Below is Peggy Simkin's chart. Here is a link to her 3R's.

I do think that generally following the 6 Healthy Birth Practices written out by Lamaze helps minimize unneeded pain in labor.

Thoughts on the purpose of pain in labor-

http://www.lauriefremgen.com/articles/trustyourself.html

http://empoweredbirth.typepad.com/empowering_birth_blog/labor_pain/

Perceptions of labor pains in culturally diverse women- http://www.medscape.com/viewarticle/465812_5

Sharing Notes from the ICAN 2011 Conference - Part 1

2011-04-13T13:59:00.034-04:00

One of the things that I remember thinking, and hearing the first day of the conference is that it wasn’t really going to be “fun”. While it is true, that it wasn't really fun, it WAS amazing. The topics were interesting, intriguing and exciting. I learned lots of new things, met some great people who I have never met, but read their books or posts online.

The conference started with Dr. George Macones delivering the Keynote presentation, VBAC to the future: Trends in VBAC research.

Dr. Macones is the chairman of obstetrics and gynecology at Washington University in St. Louis and a spokesman for the American College of Obstetricians and Gynecologists. He was quoted in a recent article by The New York Times. And, here is ICAN’s blog about Dr. Macone’s quotes from the article.

Some of his main points (supported by several mentioned studies):
-Choosing better VBAC candidates, can we predict who will be successful?
-Altering Labor Management (rate of induction going up, max dose Pitocin, intra-partum monitoring)
-As oxytocin goes up, risk of uterine rupture goes up
-There is a lack of data about foley bulb safety with VBAC
-Avoid long inductions

One of the plenery sessions at the conference: “Practical Post-Partum Cesarean and Pelvic Scar Care for New Moms and Health Care Professionals. Excerpts from Ending Female Pain, Woman’s Manual, by Isa Herrera, MSPT, CSCS”, Speaker Isa Herrera

Isa Herrera is a women’s health physiotherapist. She owns and operates Renew Physical Therapy, a healing center in New York City. This presentation was so full of wonderful, useful information.

A couple useful websites:
Renew Physical Therapy
Renew Physical Therapy Blog - News You Can Use

Some of my notes from this presentation:
-Women are not getting the tools they need to fully recover from cesarean sections
-Covering of how cesarean sections are performed (abdominal muscles pushed apart, not cut. The fascia that covers the rectus abdominus is cut and moved.)
-Stressed that women who have had a cesarean section should find a PT who specializes in scar care and specifically women’s health physical therapy.
-Presentation of some of the exercises, techniques, massage methods that can be used to strengthen the core after surgery.
-Explained how to evaluate for diastasis. Here is a link to her blog explaining how to check for diastasis.

Notes Part 2 coming soon: Notes from Kristen Oganowski's presentation, "A Woman's Guide to VBAC: Advocacy and Empowerment in the Web 2.0 Era" and Henci Goer's presentation, "The Gap Between Evidence and Practice"

ICAN 2011 Conference, St. Louis Missouri, April 8-10

2011-04-04T20:42:00.006-04:00

The ICAN 2011 Conference is this week! April 8-10 in St. Louis, Missouri. I (Dawn) am attending, along with Lisa Garcia, leader of ICAN of Montgomery County. Here is a link to the conference site: http://conference.ican-online.org/index.htm

I will be attending the Chapter Leader training as well as other sessions. It is my hope that I am able to bring back as much information as possible to share with you all!

Here are the sessions I am attending:
-A Woman's Guide to VBAC: Advocacy and Empowerment in the Web 2.0 Era with Kristen Oganowski

-The 3 Ps of VBAC: Pregnant Woman, Provider, Proviso: Navigating the Waters with Dr. Poppy Daniels

-When VBAC Doesn't Happen: Supporting the CBAC (cesarean birth after cesarean) Mother

This is on top of the other speakers that will be presenting to everyone:
-VBAC to the future: Trends in VBAC research, speaker Dr. George Macones

-"Practical Post-Partum Cesarean and Pelvic Scare Care for New Moms and Health Care Professionals. Excerpts from Ending Female Pain, Woman's Manual, by Isa Herrera, MSPT, CSCS", speaker Isa Herrera

-The Gap Between Evidence and Practice, speaker Henci Goer

-Breech Update for Parents, speaker Gail Tully

-Gates of Cesarean Birth Story Healing, speaker Pam England

Perhaps at our next meeting we can go over the highlights of the conference.

Links-a-Doddle

2010-01-26T08:30:00.002-05:00

Woman planning her VBAC after 2 c-sections at
http://www.theunnecesarean.com/birth-stories/i-found-that-vbacs-are-so-possible.html

Restriction of Food and Drink in Labor from a Medical Anthropologist point of View
http://www.birthactivist.com/2010/01/restriction-of-food-and-drink-in-labor-from-a-medical-anthropologist%E2%80%99s-perspective/

Lilly's Homebirth- a Dad's Perspective
http://www.homebirth.net.au/2010/01/lillys-homebirth-dads-story.html

Book Review at 'Talk Birth' Blog : Dance of the Womb: The Essential Guide to Belly Dance for Pregnancy and Birth By Maha Al Musa
http://talkbirth.wordpress.com/2010/01/25/book-review-dance-of-the-womb/

The Biophysical Profile

2010-01-19T20:50:00.002-05:00

According to Babycenter a biophysical profile (BPP) is
"a simple, painless test used during pregnancy to assess your baby's well-being — specifically, whether he's getting enough oxygen in the womb. It's typically done if you've gone past your due date, or sometime in your third trimester if you're having a high-risk pregnancy. " http://www.babycenter.com/0_biophysical-profile_1276703.bc

You may have had a few or were offered one in your last pregnancy. How accurate are the measurements and conclusions from a BPP. What are the ranges of measurements and what do they mean? Do certain measurements mean more (or less) in combination with other pregnancy or fetal symptoms? Do the risks of induction or a repeat c-section outweigh the advantages of staying pregnant?

This is a post on Midwifery Today's blog.

http://midwiferytoday.livejournal.com/15493.html

There is a link to-

Suspect Diagnoses Come with Biophysical Profiling
by Gloria Lemay http://www.midwiferytoday.com/articles/biophysical.asp

which contains a description of all the items contained in a BPP.

Lemay writes "An unusually large number of diagnoses seem to be made that 'there is not enough amniotic fluid." This seems to be the factor in this outline that is most often used as an excuse for induction." (see the blog post on this - http://icanwesternmd.blogspot.com/2009/04/low-amniotic-fluid.html )

and

"The risks of induction, which can be catastrophic, and the resulting increase in the need for pain relief medication and cesarean section are usually not discussed with the parents prior to embarking on induction of the birth. Be warned that this latest suspect diagnosis using ultrasound is increasing in frequency and causing increased harm to mothers and unborn babies through aggressive use of induction."

This is an interesting UK page on BPP. Worth a look- http://www.ultrasoundcare.com.au/services/pregnancy-ultrasound-24-42-biophysical-profiles.html -medical/interventionist viewpoint to balance out the midwifery model of Lemay's post.

In combination with the known inaccuracies of late pregnancy ultrasound measurements (such as fetal weight, amount of fluid) this tests conclusions should be questioned and researched. For example, your measurements could vary greatly considering the skill of the ultrasound technician. It is a combination of numbers and not a simple 'pass' or 'fail'. Many practitioners offer to retest if a number is borderline. Like any pre-natal test the BPP can be very useful, unfortunately the results can also be misused by an aggressive medical care person.

Legal Rights of the Pregnant Woman

2010-01-16T08:54:00.002-05:00

The state of Florida forces bed rest on a pregnant woman.
http://www.aclu.org/blog/reproductive-freedom/court-forces-bed-rest-pregnant-woman

The Unnessecarean comments on this with extensive links to other commentaries/articles/news reports at the bottom.
http://www.theunnecesarean.com/blog/2010/1/15/media-coverage-of-burton-v-state-of-florida.html

From the ACLU post "medical organizations like the American College of Obstetricians and Gynecologists and the American Medical Association, [which] uniformly oppose the use of coercive measures during pregnancy."

Please check out ICAN's page on the legal rights of the pregnant woman.
http://ican-online.org/pregnancy/legal-rights-pregnant-woman

A great ICAN article on Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After Cesarean (VBAC): A Primer
http://ican-online.org/vbac/enforcing-and-promoting-rights-women-seeking-vaginal-birth-after-cesarean-vbac-primer

It is important for any patient to read up on their rights before that information is needed. ICAN does have lawyers available for questions should you ever feel advice is needed. You are in charge of your body and the care you receive or refuse!

Miracle or Not?

2010-01-12T08:28:00.003-05:00

You might of read about the mother who died (and was resuscitated) on the operating table on Christmas Eve. She was about to get a Cesarean and according to the hospital and doctors involved "did a thorough evaluation and can't find anything that explains why this happened".
Here is a link to how the story was presented to the general populous.
http://www.huffingtonpost.com/2009/12/29/christmas-miracle-as-moth_n_406645.html?&just_reloaded=1

Here is a link to An Obstetrical Analysis of “The Christmas Miracle”
http://academicobgyn.com/2010/01/10/an-obstetrical-analysis-of-the-christmas-miracle/

Here is a blogger's post that analyses the ABC coverage and quotes by the OB. http://www.blogher.com/there-more-christmas-miracle-mom-baby-mystery

Henci Goer writes on her blog http://www.scienceandsensibility.org/?p=903 about the incident.
"The moral of the print version would be: have your baby in a hospital where you can be saved should this happen to you. The video interview, however, reveals a different picture. The real moral of the tale is that the safest and healthiest births will be achieved by avoiding medical intervention whenever possible."

Standing Up Births, Newborn Breastfeeding, Due Dates and More..BLOG LINKS GALORE!

2010-01-11T18:58:00.004-05:00

Doula blog post about some hospital staff being reluctant to let women labor or birth in any non-bed bound position.
http://phdoula.blogspot.com/2009/11/reply-turned-post-warning-this-post.html

Same doula about hospital protocol and politics surrounding immediate post-birth breastfeeding. http://phdoula.blogspot.com/2009/11/reply-turned-post-warning-this-post.html

An OB nurse blogs about the ever suffering 'due date'.
http://obnurse35yrs.wordpress.com/2010/01/07/for-expectant-families-your-due-date/

And advice from a childbirth educator on ways to push during labor.
http://thebirthteacher.blogspot.com/2009/12/ways-to-push-during-labor.html

Do you have some favorite blog posts to share?

Pre-natal Ultrasound- Informational Links

2009-12-28T18:59:00.003-05:00

Should you have one? Should you have 2, 4, 6, 8 or 1o? What does a measurement mean. How accurate in dating, sizing or predicting birth weight or defects are they? There are many good questions to ask when thinking about ultrasound.

Prenatal Testing: Ultrasound Safety and Accuracy
by Kmom (cautious viewpoint)
http://www.plus-size-pregnancy.org/Prenatal%20Testing/prenataltest-ultrasoundsafety.htm

Obstetric ultrasound by Joseph Woo (medical and interventionist viewpoint) http://www.ob-ultrasound.net/index.html

Ultrasound: Weighing the Propaganda Against the Facts
by Beverley Lawrence Beech (not a fan of ultrasound)
http://www.midwiferytoday.com/articles/ultrasound.asp

Take charge of your medical care, ask questions and do your own research.

What is Full Term, Really?

2009-12-26T20:57:00.003-05:00

There are a couple different views on what is full term. There is 'term' if you go into premature labor and have a baby who is small and needs helps with breathing. There is 'term' if you feel you are ready and have an induction or elective section. There is 'term' if there is a slight issue that your medical care persons insists will be fixed by delivering 2,4,6 weeks early. What does the baby think is term (feels he/she is ready to be born?) Is 40 weeks and 1 day overdue? Was the pregnancy even dated correctly enough to be that picky?

Here is an interesting article on the perception of safety of births at various gestational ages. http://journals.lww.com/greenjournal/Abstract/2009/12000/Women_s_Perceptions_Regarding_the_Safety_of_Births.15.aspx
Excerpt- "Twenty-four percent of women surveyed considered a baby of 34–36 weeks of gestation to be full term, and 50.8% believed full term to occur at 37–38 weeks of gestation, while only 25.2% considered full term to occur at 39–40 weeks of gestation. In response to, “What is the earliest point in pregnancy that it is safe to deliver the baby, should there be no other medical complications requiring early delivery?” 51.7% choose 34–36 weeks of gestation, and 40.7% choose 37–38 weeks of gestation, while only 7.6% choose 39–40 weeks of gestation."
The ACOG (American College of Obstetricians and Gynecologists) recommends that elective deliveries not occur before 39 weeks of gestation.

Articles supporting the importance of those last weeks of pregnancy-

New Research Shows Why Every Week of Pregnancy Counts-
http://online.wsj.com/article/SB122999215427128537.html
Late-stage premature babies face complications
Some experts wonder if doctors taking more risks- http://www.chron.com/disp/story.mpl/nation/5563880.html

ICAN White Paper on induction-
http://www.ican-online.org/pregnancy/induction-labor
ICAN Cesarean Fact Sheet listing common reasons given for induction or Cesarean and those situations where a section/induction would be indicated
http://www.ican-online.org/pregnancy/cesarean-fact-sheet

Pregnancy and the H1N1 Virus

2009-12-08T09:41:00.002-05:00

This flu season is presented as particularly scary for pregnant women. Just like any other health choice, research is important.
Here is one viewpoint.
http://www.midwiferytoday.com/articles/preg_H1N1fluvirus.asp
"vaccination in pregnant women is very similar to the issue of childhood immunization—both are deeply personal issues that require rigorous investigation and consideration. At the end of this article, I have included a list of references for further investigation into the swine flu vaccine and its safety in pregnant women."

And a letter to care providers encouraging vaccination of pregnant clients-
http://www.cdc.gov/h1n1flu/clinicians/pdf/Dear_Colleague_FINAL.pdf

Flu season has also restricted visitation at some hospitals to those over 18. If you plan to birth at a hospital please check the current policies so you are aware if your older children will be able to vist.
Out of hospital births can avoid some of the complications of the season. See this blog post with links examining the idea- http://empoweredbirth.typepad.com/empowering_birth_blog/2009/10/index.html

The first link (from Midwifery Today) includes many ideas for improving general heath during flu season. It is a good idea to keep your immune system healthy no matter if you decide to vaccinate or not!
Have a happy holiday season! I hope to see you at our last ICAN meeting of the year- Thursday December 17th at the Common Market in Frederick MD.

What is PUPPS?

2009-11-15T10:45:00.002-05:00

PUPPS stands for Pruritic Urticarial Papules and Plaques of Pregnancy.
Luckily it is harmless to mother and baby but many who have had it express the overwhelming annoyance it creates. It is an itchy rash that is statistically more prevalent in those that are carrying boys. It usually occurs later in pregnancy. Diagnosis is simply a clinical process meaning only based on the appearance of the rash. There are no laboratory tests for this diagnosis.

There are many changes in skin that are possible during pregnancy. Talk to your care provider about any symptoms and possible treatments.

Interesting links-
http://dermatology.about.com/cs/pregnancy/a/puppp.htm
http://enjoybirth.wordpress.com/2009/11/15/pupps-horrible-pregnancy-rash/
http://www.pregnancybirthandbabies.com/pregnancy_rash_aka_pupps.htm
http://heartofmidwifery.blogspot.com/2009/10/pruritic-urticarial-papules-and-plaques.html

Walk, Move Around, and Change Positions Throughout Labor -HBP 2

2009-11-12T10:06:00.002-05:00

Second post dedicated to Lamaze Healthy Birth Practices
First post- http://icanwesternmd.blogspot.com/2009/11/let-labor-begin-on-its-own-hbp-1.html

Walk, Move Around, and Change Positions Throughout Labor
http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/FreedomofMovement/tabid/484/Default.aspx

"Walking, moving around, and changing positions throughout labor make the birth of your baby easier. It is the best way for you to use gravity to help your baby move down and to increase the size and shape of your pelvis to make it easier for your baby to fit and rotate as necessary. Movement helps you respond to pain in an active way and shortens the length of the first stage of labor (Lawrence, Lewis, Hofmeyr, Dowswell, & Styles, 2009)."

"Like many women throughout the world, you can use movement to make labor more comfortable and your contractions more effective. Your freedom to choose and respond in your own way allows your birth to unfold without artificial restrictions. Birth is an active process and, with support from your labor companions, you will respond to make birth easier and safer for yourself and your baby. Lamaze International encourages you to plan to be active throughout labor, to practice labor and birth positions during pregnancy, and to choose a care provider and birth setting that provide many different options for using movement."

Other resources on this subject-
http://www.birthactivist.com/2009/11/move-walk-around-change-positions-throughout-labor/
http://www.theunnecesarean.com/blog/2009/10/25/women-describe-walking-moving-and-changing-positions-in-labo.html
http://www.theunnecesarean.com/blog/2009/7/12/getting-upright-in-labor-injoy-and-lamaze-push-vertical-push.html
http://www.birthingnaturally.net/birth/progress/position.html
"A good labor position is one in which the mother is comfortable. What she finds comfortable will change throughout the labor as the baby moves and changes positions. It may also change as labor progresses and she finds herself more fatigued."

It is important to be aware that certain labor interventions will limit a mother's ability to change positions. CFM (continuous fetal monitoring) usually requires a mother to lay in bed. Talk to your care provider about intermittent or no monitoring instead. Epidurals numb the body so laying in bed is also required. Talk to your care provider about alternative methods of pain management...including changing of positions in labor!
http://icanwesternmd.blogspot.com

Let Labor begin on its Own -HBP 1-

2009-11-10T08:14:00.003-05:00

"The six Lamaze Healthy Birth Practices below are supported by research studies that examine the benefits and risks of maternity care practices. Therefore, they represent "evidence-based care," which is the gold standard for maternity care worldwide. Evidence-based care means "using the best research about the effects of specific procedures, drugs, tests, and treatments, to help guide decision-making." http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/tabid/90/Default.aspx

The first listed Healthy Birth Practice is to let labor begin on its own.
Please read the entire page that clarifies common reasons given for early induction. It also lists recommended reasons for induction including post 42 weeks but adds more useful information.

"It is important to know that “postterm” means you are 2 weeks past your due date. The ACOG and international obstetric associations define a normal pregnancy as lasting from 38 to 42 weeks. If you go past your due date, there is some controversy about whether it is safer for your baby to be born at 41 completed weeks of gestation or 42 completed weeks. Nevertheless, in a recent medical survey, researchers concluded that there is no significant difference in perinatal mortality (the number of babies who die) between induction of labor at 41 weeks and expectant management (allowing the pregnancy to continue) (Wennerholm, Hagberg, Brorsson, & Bergh, 2009)."

Please note that induction of labor after previous uterine surgery is controversial at best-
Please see ICAN's induction of labor page http://ican-online.org/pregnancy/induction-labor

Other resources-
http://www.injoyvideos.com/mothersadvocate/pdf/healthybirth_1.pdf
http://www.birthactivist.com/2009/11/labor-begins-on-its-own/
http://saffrondoula-coloradosprings.blogspot.com/2008/02/quick-reply-avoiding-labor-induction.html

Preeclampsia - Information and Viewpoints

2009-11-07T23:13:00.003-05:00

According to the Preeclampsia Foundation "Preeclampsia is a disorder that occurs only during pregnancy and the postpartum period and affects both the mother and the unborn baby. Affecting at least 5-8% of all pregnancies, it is a rapidly progressive condition characterized by high blood pressure and the presence of protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms; however, some women with rapidly advancing disease report few symptoms." The foundation website also states that Pregnancy Induced Hypertension (PIH), toxemia, eclampsia and HELLP Syndrome are closely related conditions.

There are some risk factors for developing preeclampsia and its related conditions including age (under 20 or over 35 with first pregnancy), having pre-pregnancy hypertension, multiple pregnancy and diabetes.

Signs of preeclampsia are high blood pressure, swelling and protein in the urine. Diagnosis can be complicated but make sure your care provider is thorough in discussing your symptoms and possible treatment.

How can I prevent or simply lessen my chances of developing hypertension in pregnancy?
Many have had success with the Brewers Pregnancy diet http://home.mindspring.com/~djsnjones/id96.html
http://www.bradleybirth.com/PD.aspx
Exercise is said to help as is supplemental vitamin C and vitamin E.
Adequate calcium intake and long chain fatty acids are also said to be beneficial.
Garlic and other antioxidants have been researched to see if they help-
http://www.cochrane.org/reviews/en/ab004227.html
http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006065/frame.html The conclusions were that they had insufficient data to recommend either but the study sizes were too small to notice a clinical difference- (100 women).

What is the treatment for mild to moderate hypertension in pregnancy? Bed rest, antihypertensive medication, nutritional supplementation have been used in these cases. As always, talk to your care provider and get other options if you feel they are needed.

What is the treatment for severe preeclampsia and eclamsia?
Reduction of the mothers blood pressure is usually the first priority. Treatment can include antihypertensive medications, anticonvulsant agents. After 34 weeks gestational age the most common treatment is the delivery of the baby by induction or c-section. ICAN does list Eclampsia or HELLP with failed induction of labor as one of the medically indicated reasons for a cesarean.

Other links-

Screening for preeclampsia http://www.childbirthconnection.org/article.asp?ck=10024
Hypertension in Pregnancy http://www.childbirthconnection.org/pdfs/gecpc3ch15.pdf
Henri Goer answers questions regarding the induction of hypertensive pregnant women http://www.lamaze.org/OnlineCommunity/AskanExpert/tabid/363/aff/11/aft/31642/afv/topic/Default.aspx
Don't cut out the salt (a Midwifery Today e-newsletter)http://www.midwiferytoday.com/enews/enews0216.asp

Other sources used in this post-

http://www.preeclampsia.org/about.asp
http://www.childbirthsolutions.com/articles/pregnancy/preeclampsia/index.php
http://www.storknet.com/ip/reproductive_years/high_risk/preeclampsia.html
http://ican-online.org/pregnancy/cesarean-fact-sheet

Talk with your care providers!

ICAN Video

2009-11-06T08:59:00.000-05:00

This is a great video about ICAN

http://www.youtube.com/watch?v=gAkW7TDmPtY

Has the WHO changed it's recommended cesarean rates?

2009-10-31T08:28:00.001-04:00

WHO is the World Health Organization

Why no, they haven't!

http://www.scienceandsensibility.org/?p=483

Does your Uterus Lean?

2009-10-29T20:37:00.002-04:00

According to the American Pregnancy Association "The uterus is normally in a straight vertical position. Some women have a tipped or tilted uterus, in which the uterus is tipped backwards toward the back of the pelvis. " The site also mentions "Usually between the 10th -12th week of pregnancy, your uterus will no longer be tipped or "backwards." This should cause no difficulty for the pregnancy or for labor and birth."

If my uterus is tipped can it have an effect on my pregnancy or birth?
Most sources say no (see above link). For more interesting information and discussion see the below links-

Mothering.com thread asking about tipped uteruses and vaginal birth-
http://www.mothering.com/discussions/archive/index.php/t-525561.html

Midwifery Today on Maya Abominal massage for a very displaced uterus-
http://www.midwiferytoday.com/articles/ancientmaya.asp

This UK site has an excellent diagram showing a tilted uterus-
http://www.womens-health.co.uk/retrover.asp
"Many women are simply born with a uterus that is tipped in this position, and this is entirely normal. During pregnancy, the uterus becomes enlarged and the ligaments that hold the uterus in place become weakened. As a result, many women find that their uterus becomes retroverted after they have delivered their babies"

Uterine prolapse seems to be an drastic version of uterine placement shift.
Make sure you are clear about the level of 'different' about your uterus you are diagnosed with.

A Step in the Right Direction at Least!

2009-10-27T10:02:00.002-04:00

Article on MSNBC online-
Hospitals to crack down on induced labors
Regulators will introduce guidelines in spring to reduce too-early babies
http://www.msnbc.msn.com/id/33483153/ns/health-pregnancy/

"New guidelines will require that a mother's cervix be nearly ready for natural labor, and limit the hospital beds available for elective inductions.
(see the previous post on The Bishop Score)
More hospitals are expected to start enforcing that criteria this spring, when the Joint Commission that regulates health quality will require hospitals to report all elective deliveries and the gestational age to its public database, providing peer pressure for improvement. Hospitals also will have to report cesareans for first-time mothers, too often a result of a failed induction."

"1 in 4 inductions were before 39 weeks-
National guidelines from the American College of Obstetricians and Gynecologists have long discouraged elective deliveries before the 39th week of pregnancy. But some hospitals that took a close look were surprised. At Utah's Intermountain Healthcare, for example, 28 percent of elective deliveries were breaking ACOG's rule in 2001, Oshiro told a March of Dimes meeting on preventable prematurity this month.
Most were being induced in week 37, such a small difference that local obstetricians argued it wasn't a problem. So Oshiro pulled the medical charts and found those near-term babies had more than double the risk of ending up in neonatal ICU, suffering respiratory distress, even needing a ventilator."

Demystifying the 'Bishops Score'

2009-10-20T10:30:00.002-04:00

Below from http://www.birthsource.com/Scripts/article.asp?articleid=480
(click link for chart showing measurements)
"Nearly 40 years ago (1964), Bishop (Bishop, E. Pelvic scoring for elective induction. Obstetrics and Gynecology 24(2), 266-268) developed a pelvic scoring system to predict inducibility by evaluating the position of the cervix as it relates to the vagina, the cervical consistency, dilation, effacement and station of the presenting part.
The higher the score, the more favorable the cervix with a clinical trial showing a score of 6-7 or more associated with successful inductions.
But the cervix should not be the only item considered in determining readiness of an induction. The baby's readiness to survive on the outside should also be considered, as well as how well the baby will tolerate the cascade of medications he/she is about to endure."

below from http://linkinghub.elsevier.com/retrieve/pii/S0020729298002628
"Abstract
Objective: To identify the risk factor(s) for secondary arrest of labor among women with an unfavorable cervix at >41 weeks' gestation. Methods: Prospectively all gravid women with a Bishop score of ≤4 and no contraindication to a vaginal delivery were candidates for this study. Univariate analysis followed by logistic regression modeling were used to identify variables with a significant association. Results: Over a 9-month period, 115 women entered into the study. In univariate analysis, variables with a significant association with cesarean delivery: (1) non-Caucasian race (P=0.007), Bishop score <7 p="0.001," p="0.017).">41 weeks with an unfavorable cervix, non-Caucasian race and a failure to achieve a Bishop score of ≥7 prior to hospitalization were significant risk factors for abdominal delivery."

Trends and Controversies in Labor Induction article - http://www.nursingcenter.com/prodev/ce_article.asp?tid=839763

"The current acceptable American College of Obstetricians and Gynecologists (ACOG) indications for elective induction of labor are as follows:
* pre-eclampsia/eclampsia (and other hypertensive disorders)
* maternal diabetes mellitus
* premature rupture of membranes
* chorioamnionitis
* intrauterine fetal growth restriction
* fetal demise
* postterm pregnancy (ACOG, 1999)

Fetal macrosomia is not considered an indication for elective induction because it has not been shown to alter the risk of maternal or neonatal morbidity. Fetal macrosomia does increase the risk of cesarean birth (Irion & Boulvain, 2000; Sanchez-Ramos, Bernstein, & Kaunitz, 2002). Contraindications to labor induction include active genital herpes infection, placenta or vasa previa, umbilical cord prolapse, fetal malpresentations that preclude vaginal birth (e.g., transverse lie, shoulder, some face presentations), or previous classical uterine incision (ACOG, 1999)."

While useful for determining success of induction, the actual need for induction should be questioned.

How safe is a Cervidil strip, especially for a woman with a previous cesarean?

2009-10-19T19:37:00.002-04:00

Lately I have been hearing about women that had a Cervidil strip to induce labor or quicken cervical dilation. I didn't know much about it so I thought I would share the information that I found with you.

"Cervidil (this info from http://www.drugs.com/pro/cervidil.html )
Generic Name: dinoprostone
Dosage Form: vaginal insert
Rev. 5/06 Rx only
Dinoprostone vaginal insert is a thin, flat, polymeric slab which is rectangular in shape with rounded corners contained within the pouch of an off-white knitted polyester retrieval system. Each slab is buff colored, semitransparent and contains 10 mg of dinoprostone in a hydrogel insert. An integral part of the knitted polyester retrieval system is a long tape designed to aid retrieval at the end of the dosing interval or earlier if clinically indicated. The finished product is a controlled release formulation which has been found to release dinoprostone in vivo at a rate of approximately 0.3 mg/hr.

Cervidil is contraindicated in: (selected list, see link for more)
Patients in whom oxytocic drugs are contraindicated or when prolonged contraction of the uterus may be detrimental to fetal safety or uterine integrity, such as previous cesarean section or major uterine surgery.

Patients already receiving intravenous oxytocic drugs. (do not use with pitocin--this link advises at least 30 minutes between removing the strip and administering other oxytocic drugs)

In Postmarketing Experience Reports, uterine rupture has been reported in association with the use of Cervidil."

Cervidil strips have many of the same risks as other Synthetic Oxytocins do. Please read http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/LaborBeginsOnItsOwn/tabid/487/Default.aspx
The added risk that the strips have is infection (after all it is inserted like a tampon into the vagina) It is especially important to avoid if your water is broken as the infection rate does increase.
This is certainly something to think about and do your own research. Talk to your care providers and come to your own conclusions!

Additional thoughts and links-
The other thing inserted that induces labor is Cytotec...a VERY dangerous drug. Please read - http://www.scienceandsensibility.org/?p=467
Questioning any routine induction http://www.dare-to-give-birth-naturally.com/labor-induction.html
Interesting OBGYN nurse thread http://allnurses.com/ob-gyn-nursing/cytotec-48471.html

Reclaim Your Right to Birth...Right

2009-10-18T08:50:00.002-04:00

Article by Christiane Northrup, MD Read it!
http://www.huffingtonpost.com/christiane-northrup/c-section-or-natural-birt_b_323422.html

"As an obstetrician/gynecologist, I have spent the last 30 years educating women about the wisdom of their bodies, including their innate ability to birth normally. Yet our so-called healthcare system, which is a direct reflection of the beliefs of our culture, sees the female body and its processes (like labor) as an accident waiting to happen. Media images of birth as an emergency play right into this. The truth is that labor and birth need not be the emergencies we think they are. And the medicalization of birth actually does more harm than good."

Being Plus-Size and Pregnant

2009-10-13T08:25:00.002-04:00

Kmom has an excellent blog called The Well-Rounded Mama.
This is an excellent post on Pregnancy and a HAES Crisis of Confidence
HAES stands for Health At Every Size. Please read some other posts at the blog of this birth advocate and ICAN member. This site is useful and inspirational no matter what your size!

Excerpt
"All of a sudden I went from being a take-no-prisoners fat-acceptance advocate and empowered health care consumer to being a meek little sheeple who didn't question anything her OB said. "Whatever you say, doctor; you must know best," became my mantra. I now know all those tests ended up actually causing more harm than good, but then I dared not question anything; I was just intent on getting through my pregnancy and having a live baby.The truth is that I was paralyzed with fear that somehow my fatness was going to end up hurting my baby, and so I checked my brain at the OB clinic door. That directly led to many of the very negative experiences of that pregnancy and birth, and sadly, most of them were avoidable."
"Unfortunately, this situation often becomes a self-fulfilling prophecy, simply because you and your doctor expect problems to happen and therefore go looking for them. The more your doctors perceive you to be "high-risk," the more likely they are to submit you to multiple tests where a false-positive result is a real possibility, or to interventions (like early induction of labor) where the risk of harm is significant. The mere expectation of problems often results in those problems.But when you are living in a state of fear that your body might harm your baby, you just assume that these tests and interventions are necessary to get you and your baby through pregnancy alive and well. And because you are fat, you may not question whether they might be causing more harm than good, whether the risks outweigh the benefits. And in that rare situation when you do start to question your doctor about these things, out comes the "obesity ooogabooga" fear tactics and the "dead baby" trump card, which shuts down those kinds of inconvenient questions really fast."

After a Second Cesarean

2009-10-02T08:00:00.002-04:00

Medically indicated or not, a second cesarean (CBAC) can have emotional and physical impact on the woman and her family. If a VBAC was desired it can be more intense. Here are some resources.

Recovery after Cesarean links-
http://ican-online.org/recovery/home
http://ican-online.org/recovery/recovering-cesarean-tips-healing
http://www.plus-size-pregnancy.org/CSANDVBAC/bfaftercesarean.htm
http://www.plus-size-pregnancy.org/CSANDVBAC/csemotionalrecov.htm
http://www.plus-size-pregnancy.org/CSANDVBAC/csemotionalrecov.htm#Repeat%20Cesarean%20or%20Vaginal%20Birth%20After%20Cesarean

The Impact of Cesarean or Curing the Emotional Wounds of Cesarean
http://ican-online.org/recovery/impact-cesarean-or-curing-emotional-wounds-cesarean

Of course your local chapter leader is always available!

Other online connections-

Main ICAN e-mail list group-

http://groups.yahoo.com/group/ICAN-online/

ICAN CBAC e-mail list group- http://health.groups.yahoo.com/group/CBACsupport/

ICAN online forum- http://ican-online.org/forum/

Laboring under an Illusion - Movie coming soon!

2009-09-29T14:47:00.001-04:00

"Anthropologist Vicki Elson explores media-generated myths about childbirth. As a childbirth educator for 25 years, she observes daily how our culture affects our birth experiences. In this film, she contrasts fiction with reality. The result is hilarious, engaging, and enlightening."
http://www.birth-media.com/
"To understand what it's really like to have a baby, we have to debunk the silly and scary images served up by the profit-driven media. In reality, birth is hard work, sometimes simple, sometimes complicated, but always miraculous and unforgettable."

Laboring under an Illusion

Vaginal Birth after Two Cesareans?

2009-09-28T08:44:00.002-04:00

Depending on the birth culture in your area, access to hospital VBAC after multiple cesarean can be limited. Generally in western Maryland a woman might have to search around and assert their desires but it does happen under TOL. Homebirth is also an option.

ICAN's VBAmC link
http://ican-online.org/vbac/vaginal-birth-after-multiple-cesareans
VBAmC Birth Stories
http://www.plus-size-pregnancy.org/CSANDVBAC/VBA2Cstories.htm

Posterier Labor......

2009-09-27T12:57:00.002-04:00

A baby in a less common presentation is still a variation of normal.

from Baby Center http://www.babycenter.com/0_posterior-position_1454005.bc
"What does it mean when a baby is in the "posterior position"?
When a baby is head-down but facing your abdomen, he's said to be in the occiput posterior (OP) position — or posterior position, for short. The term refers to the fact that the back of your baby's skull (the occipital bone) is in the back (or posterior) of your pelvis. You may also hear this position referred to as "face-up" or "sunny-side up."

http://www.gentlebirth.org/archives/postrppr.html
"I have become increasingly frustrated and angered that posterior presentation (back of the baby's head toward the mother's back) and its ensuing complications in labor and delivery have accounted for an inordinate number of cesarean sections. "

"The incidence of a posterior presentation occurring at the onset of labor is 15 to 30 percent, and many such babies rotate spontaneously to an anterior position. "

Did you labor with a baby in a posterior presentation?

Get a Doula...even if you wish for Privacy in the Hospital!

2009-09-26T20:02:00.001-04:00

Great post at nursing birth on Doulas...give it a read!

"And just for the record, there is NOTHING private about a hospital birth experience. Even in the most well meaning hospitals with the most well meaning birth attendant and the most well meaning nurse(s). Albeit some women’s hospital births might be more private than others and I personally have had the priviledge to be a part of a few totally amazing hospital births. But to not hire a doula for your hospital birth (especially at a university hospital!) because you want a “private” experience is a very VERY naive and misguided idea! I am not saying that to hurt anyone’s feelings and I am certainly not judging anyone out there who decided not to hire a doula for one reason or another. I am just telling it like it is. Some food for thought…"
http://nursingbirth.wordpress.com/2009/09/26/no-doula-in-the-name-of-privacy-oh-come-on/

Search for 'Cesarean' on MSNBC site

2009-09-25T09:07:00.003-04:00

It is not surprising how often cesareans are mentioned in articles considering the amount of the population that have had one.
Here is an overview of the recent articles on this one news site after searching for 'Cesarean'.
http://www.msnbc.msn.com/?id=11881780&q=Cesarean&p=1&st=1&sm=user

Some of these are not the best to read if you are GIP (gestating in peace) please use discretion.

List of headiness- Top ten results for search on Friday, September 25th.
Anti-seizure drugs risky during pregnancy
First lady makes health-care pitch
Worst nightmare: Babies stolen from their beds
Chewing gum after C-section may aid recovery
Man denies knowing baby was cut from womb
Pregnancy likely to be swine flu shot priority
Baby who lost mother to swine flu dies
No ‘Farewell’: Hemingway lives on Ark. town
Spanish woman with swine flu has healthy baby
Puzzling disparities found in childbirth injuries --- this last article is very pro-cesarean, watch out for this one.

What kind of section?

2009-09-24T13:16:00.001-04:00

http://www.theunnecesarean.com/blog/2009/9/24/best-of-week-enjoy-birth.html

"Types of Cesareans
There seems to be an epidemic of Emergency Cesareans. When I talk with moms, or read birth stories, many label their cesareans as emergency’s. But as I ask questions or as I read details, I see that it wasn’t a true medical emergency, but mom has been led to believe it was. Even my cesarean, which I have always called an emergency cesarean, really was ‘urgent’, not an ‘emergency’, the difference being the timing. "

The Cord Around the Neck

2009-09-11T11:56:00.002-04:00

How common is having the cord around a babies neck during birth?
Does it always have dire consequences?
What other effects does the umbilical cord have for birth?

http://pregnancy.about.com/od/laborcomplications/f/cordneck.htm
http://jeremyscorner-grifter.blogspot.com/2009/02/cord-around-neck-is-not-emergency.html
http://www.birth.com.au/Variations-of-the-2nd-stage-of-labour/Occasional-variations-of-the-2nd-stage-of-labour.aspx
http://www.drspock.com/article/0,1510,5332,00.html

Beyond a birth plan...How to get a Natural Hospital birth.

2009-09-10T13:00:00.002-04:00

Birth plans can only help you so much. Being aware of what your hospital does everyday, and what the L&D department is used to doing can go a long way to anticipating your hospital birth. I was alerted to a great blog called Talk Birth...You should check it out!

This is a GREAT article..Please read it!
http://talkbirth.wordpress.com/2009/09/09/what-to-expect-when-you-go-to-the-hospital-for-a-natural-childbirth/

Some more advice from the same blogger on getting a great birth in the hospital- http://talkbirth.wordpress.com/2009/06/03/can-i-really-expect-to-have-a-great-birth/ Advice on picking an OB, getting your body ready for birthing, preparing the father and more.

Informed Consent and Refusal

2009-09-09T20:14:00.003-04:00

"Who is responsible for making informed maternity decisions?
When pregnant, giving birth, and after birth, women are responsible for making informed decisions for themselves and on behalf of their babies. They have the legal right to give "informed consent" or "informed refusal." Most women report a high degree of interest in knowing what a proposed maternity intervention would involve, alternatives (including no action), and potential benefits and harms of the different choices.Maternity professionals are responsible for providing scientifically supported care and for carrying out established legal processes for informed consent. Legally, "patient viewpoint standards" are in effect in many or most states. This means that clinicians must tell those in their care about the possible benefits and harms that a reasonable person in that situation would want to know to make an informed decision.Much time and effort are required to meet these legal and ethical standards for informed consent. Women need full and accurate information about labor and birth decision points and interventions well before labor to be able to pursue the care of their choice and make informed decisions around the time of birth."

"What are women's legal rights to "Informed Consent" and "Informed Refusal?"
Whenever a medical procedure, drug, test, or other treatment is offered to a woman, she has the legal right to "informed consent." This means that her doctor, midwife or nurse is responsible for explaining:
*why this type of care is being offered
*what it would involve
*the harms and benefits that are associated with this type of care
*alternatives to this care, and their respective harms and benefits, including the possibility of doing nothing and simply waiting longer.
A woman has a right to clear and full explanations about her care and answers to any and all questions about her care. She also has the right to request and receive a copy of her medical records and to get a second opinion. Then, by law, she has the right to decide whether to accept the care that is offered. If she disagrees with her caregiver and decides not to accept care that is offered, she has a right to this "informed refusal." And, even if she signed a form agreeing to a particular type of care, she has the right to change her mind. Although these are well-established legal rights, they have been challenged in a few recent cases.It can be difficult to carry out the informed consent process in busy health care settings. Yet, a woman and her caregiver should set aside the time to discuss these issues in advance whenever possible, and again when it is time to make a decision. It is crucial that women do not learn about procedures and options for the first time while in labor and facing important decisions. At that time, it may be too late to get all questions answered, weigh options, and pursue specific preferences."

What happens if a woman and her caregiver disagree?
Caregivers have rights, too. They have the right to agree or disagree to provide care that a woman may request. For example, if a woman requests a cesarean and has no medical need for this procedure, her caregiver has the right to refuse to do the surgery. Increasingly, fear of lawsuits is leading caregivers and hospitals to refuse to provide some types of care that would be a good and reasonable choice for many women, such as vaginal birth after cesarean (VBAC). Forcing healthy pregnant women with a previous cesarean to have major surgery against their wishes seriously compromises the quality of maternity care. Major liability system reforms are needed to improve this situation.These issues speak to how important it is to have a good collaborative relationship that includes open communication, mutual respect, and shared points of view. A woman who takes care to find a doctor or midwife who respects her needs, values and goals can help avoid conflict down the road."

Please follow the link for the full article!
http://www.childbirthconnection.org/article.asp?ck=10081

What does your care provider really think about informed consent?
Read this post at Enjoy Birth http://enjoybirth.wordpress.com/2009/09/09/choose-your-careprovider-carefully/

Survivor Stories- Birthing after sexual abuse

2009-09-08T16:27:00.002-04:00

Pregnancy, birth and mothering are different for women who have experienced sexual trauma.

Great link with stories- http://mickeysperlich.blogspot.com/2009/09/jennies-story.html

Childhood Sexual Abuse and Its Effects On Childbirth-
http://www.gentlebirth.org/archives/abusepaper.html
Helping Survivors of Sexual Abuse Through Labor- http://www.gentlebirth.org/archives/abuselbr.html

Childhood Sexual Abuse and the Potential Impact on Maternity-
http://www.radmid.demon.co.uk/abuse2002.htm

Pregnancy to Parenting: a Guide for Survivors of Child Sexual Abuse-
http://www.angelfire.com/moon2/jkluchar1995/abuse.html

Ricki Lake: Childbirth Healed Wounds of Sexual Abuse-
http://www.foxnews.com/story/0,2933,518278,00.html
http://www.people.com/people/article/0,,20275242,00.html

A calm hosptial birth with a OB in disbelief

2009-09-08T12:58:00.003-04:00

http://www.crucialminutiae.com/calm-birth

She labored all day and showed up at the hospital later-

"by the time I got to the hospital, after laboring at the mall, my friend’s party, our bathtub and bedroom, I was fully dilated and all I had to do was to push."

Cristina describes how she avoided back labor and improved the ease of the baby's positioning and how her doula was helpful.

This story seems like a great way to envision a hospital birth if that is in your future!

Routine Vaginal Exams During labor

2009-09-04T19:54:00.003-04:00

Vaginal exams during pregnancy and labor are rarely questioned by patients. It is certainly a routine. Certain care providers expect it and woman don't ask why. What does a check of dilation tell you? What does it matter if you are dilated 3cm two days before your 'due date'. These are questions worth asking your care provider. If they respond with "I just like to know what is going on down there" press them for more specific, evidenced based reasoning.

Your Birthright blog did a post on this subject-
http://yourbirthright.info/2009/06/19/skip-this-routine/
Great thinking material- check it out!

An inclusive list of reasons for this routine exam-
http://pregnancy.about.com/cs/interventions/a/vaginalexam.htm
"Vaginal exams. I don't know a single woman who likes them.
However, there is a myth perpetuated in our society that vaginal exams at the end of pregnancy are beneficial. The common belief is that by doing a vaginal exam one can tell that labor will begin soon. This is not the case.
Most practitioners will do an initial vaginal exam at the beginning of pregnancy to do a pap smear, and other testing. Then they don't do any until about the 36 week mark, unless complications arise that call for further testing or to assess the cervix. If your practitioner wants to do a vaginal exam at every visit, you should probably question them as to why."

Interesting discussion about insurance reimbursement for vaginal exams and the difference in the frequency depending on care provider-
http://www.healthinsurancecolorado.net/blog1/2007/12/03/pelvic-exams-during-pregnancy/

This site has a good list of thing to think about before you consent to a VE and more--Great Resource!!! BellyBelly is based in Australia.
http://www.bellybelly.com.au/articles/Pregnancy/vaginal-exams

"Make sure that:

You understand why the exam is being done and what the examiner hopes to ascertain from it.
The procedure is explained to you and you are asked if you consent to it or not
Inform the examiner if you have a latex or any other contact allergy
You have an empty bladder
You are warm
Are comfortable
Adequately covered
Privacy is ensured
Ask for extraneous people to leave the room
Lie flat and squarely on your back with your bottom on the bed
Breathe deeply throughout the exam
Try to relax your pelvic floor muscles
Ask the examiner to explain clearly to you what he finds on exam.

I wouldn't do a vaginal exam:

If the woman asked me not to
If I thought the woman was in the latent phase/early stages of labour, as it would only discourage her. I'd encourage her to rest instead.
If I wanted to know if the cervix was fully dilated. I'd just wait and see!
If I thought the baby was in posterior position – there is nothing I can do about it if it is!
Unless my findings were going to alter what we were doing.

It's inappropriate to do a vaginal exam:

Because the shift is changing and we want to know where you are at.
Because the staff want to know where you are at in your labour but don't have the time to sit and observe or be with you.
Because the anaesthetist is going home and doesn't want to be called back in an hour to give you an epidural (unless you have indicated you are considering one)
Because the Registrar is going off duty and wants to hand over your care to the incoming Registrar.
Just to check how you are doing
Because it is hospital policy to do routine 4-hourly vaginal exam
Because your obstetrician wants to be present for birth but not to be standing around for hours waiting, or miss the whole thing (unless you specifically want your obstetrician present).

When vaginal exams are contraindicated:

If the woman refuses the procedure for reasons of culture or FGMetc
When there is a placenta praevia
With extreme care when there is any abnormal vaginal bleeding pre-natally
Unnecessary if the woman is GBS pos with ruptured membranes
If the woman has an active Herpes lesion"

The last links closing words by Brenda Manning at BellyBelly are said wonderfully!

"Again ask why – ask specifically, is there a problem? What is the reason for the vaginal exam, what info they hope to obtain and how will it alter the labour management?
It’s very important to ALWAYS remember that when you are in a hospital, no-one HAS TO DO ANYTHING! All treatment is by consent and patient choice ONLY. Policy is not law and procedure being done against your will is grounds to sue. Doctors / midwives need YOUR permission to do anything to your body. If they aren't convinced there is a good reason for a procedure then decline it."

Hospital VBAC Story....Staying home untill more active labor!

2009-09-04T06:38:00.002-04:00

http://nursingbirth.wordpress.com/2009/09/03/natural-vbac-hospital-birth-one-readers-empowering-experience/

Some highlights!

"The contractions seemed very strong to me, I was concentrating on them and they were consistently 5 minutes apart, so we decided to head to the hospital. I called Meredith and told her to meet us there. Once I got there, my contractions stopped pretty much, likely due to my nerves. They got me into a room and set and checked me and I was 2cm and 80% effaced. I was devastated! I told them I wanted to go home. The doctor on call was leery of that since I was a VBAC and they said they would really like me to stay but I refused and we packed up and came home. (In hind site, this was the reason it all worked out!! Best Decision!!!)"

" went back up to L&D and they put me in the same room and got me all set up again. The nurse said, “We were waiting for you!” I was so nervous that I would only be 3 centimeters and they wouldn’t let me go! She checked me (about 11:00am) and I was 6cm, fully effaced!!! I cried when she told me, I was so happy!! Rob, Mom and Meredith clapped! LOL! They told me I had to stay. I said that was fine! They put me on the monitors and said I would be able to get off of them, but then the Dr. on call said “NO!” so I was worried I would be stuck in bed. The nurse said, “You can move as much as you want, so long as the cord is long enough,” so I got out of bed and stood next to it for most of the day. We said I didn’t want to be checked again except by the doctor or if they thought I was complete (i.e. pushing) so when the doctor got there at 1:00pm she checked me and I was a stretch 8!! I was still concerned that it wasn’t going to happen, but everyone else was excited."

Go to link to read more and see the pictures!

10 Ib HBAC by a 5'2" woman

2009-09-04T06:29:00.001-04:00

Rachel's Story-- 10 lbs., 2 oz.-- Home Birth After Cesarean (HBAC)

Go to this link-
http://www.theunnecesarean.com/birth-stories/rachels-story-10-lbs-2-oz-home-birth-after-cesarean-hbac.html

A Natural Hosptal Birth with a Midwife

2009-09-03T07:46:00.002-04:00

(Please note, there are no midwives in Frederick County that do births in the hospital. In neighboring counties midwives are available. There are a few homebirth midwives available for care in Frederick county but are unable to transfer into (FMH) the hospital with you in that need arises)

http://www.associatedcontent.com/article/132923/the_birth_of_rose_mae_.html?cat=25

- Includes membranes stripping, water for comfort, transitional behavior, labor poop and a 'sunny side up' presentation.

Induction of labor immediately after pre-term rupture of membranes?

2009-08-31T07:26:00.002-04:00

Lamaze international sponsors a blog titled Science and Sensibility and "is a series of brief critiques of influential studies that have shaped policy and practice, despite having serious flaws, significant limitations, or both."
Henri Gocer writes - When Research is Flawed: Should Labor Be Induced Immediately with Term Prelabor Rupture of Membranes? http://www.scienceandsensibility.org/?p=475
Please read the entire article-

Highlights

"Neonatal infection rates were confounded by vaginal exams at trial entry. A secondary analysis of trial data found that having a vaginal exam at trial entry increased the risk of neonatal infection by 250%, even after taking into account GBS status (Hannah, 1997). This difference is likely to be greater than appears because the analysis authors chose to combine digital and speculum exams, although only digital exams are believed to increase the risk of infection."
"The primary argument for immediate induction has always been reducing neonatal infections, which ACOG acknowledges it does not do, and, as can be seen in this deconstruction, with optimal care other benefits are likely to be smaller than currently appear."
"In summary, in the absence of signs of infection, expectant management remains a viable option. Nonetheless, the secondary analyses have given us a more nuanced picture."
"In any case, regardless of GBS status or decisions around whether or when to induce, to minimize the risk of infection, women should avoid digital vaginal exams until established in labor, and their use should be minimized during labor. "

Famed midwife Gloria Lemay and her take on pre-labor rupture of membranes
http://www.glorialemay.com/blog/?s=water+broken+how+long
and inspiring HBAC3 slide show with at 10 day interval between rupture of membranes and birth - http://www.onetruemedia.com/otm_site/view_shared?p=2a4e81fbf0f66accb8afce (you will tear up when you watch this!)

ACOG - Limiting your choices?

2009-08-30T08:43:00.004-04:00

The ACOG is a trade union of 'woman's heath care physicians'. The organization's statements are referred to often in the care OB's give pregnant women. Woman's physicians have been known to inconsistently implement ACOG's recommendations; using some statements to refuse a procedure but ignoring another to push treatment. Contrary to popular belief, if ACOG is against something it is not 'illegal'. http://vbacfacts.com/2009/02/28/is-vbac-illegal/

Not surprisingly, ACOG is against using another care provider other then an OB for pregnancy. Even if you would never have your baby at home, limiting other's access to choices in care providers and birth location is similar to banning VBACs.

This is the ACOG's statement on homebirth-
http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
And some pro-homebirth responses
http://vbacfacts.com/2008/06/26/a-vbac-supportive-obs-response-to-the-amas-statement-on-homebirth/
http://cfmidwifery.blogspot.com/2008/06/what-would-evidence-based-statement.html
http://www.blogher.com/midwives-home-birth-proven-safe-contrary-acogs-false-assertion

Recently the ACOG asked OB's to fill out a survey listing the complications they see during a homebirth transfer-
http://www.theunnecesarean.com/blog/2009/8/30/acog-survey-complications-related-to-home-delivery.html
The birthing community flooded the survey with successful homebirth stories and it has since been put in a password protected area of the site.
It is true that OB's might only see the homebirths that have problems because all the handled at home ones stay at home. They have a warped viewpoint of homebirth because of this. Transfer into a hospital is how it should be if a birthing woman needs the skills of a hospital and OBs, it should not be considered a failed homebirth; just a location change for care needed depending on the developing situation. If hospitals would treat homebirth transfers with less hostility - woman and babies health would improve.

Here are are some further comments and blog posts on this issues
You MUST read this one for direct retort - a survey on a hospital birth! --
http://enjoybirth.wordpress.com/2009/08/28/response-to-acog-homebirth-survey/

Everyone does not feel comfortable with having a homebirth, and that's OK. If you're on the fence or wonder why others choose it read ahead-

Is homebirth for you?
http://www.gentlebirth.org/format/myths.html
http://www.gentlebirth.org/archives/hmbrtwhy.html
http://www.vbac.com/
http://www.associatedcontent.com/article/446255/why_i_am_choosing_home_birth.html?cat=25
http://www.associatedcontent.com/article/2084855/homebirth_waterbirth_and_midwives_modern_pg4_pg4.html?cat=52
and lastly a commentary on the frequent reasons people say homebirth is 'not good' http://www.unorthodoxdad.com/blog/?p=331

ICAN Official Statements regarding the ACOG
Critique of ACOG Practice Bulletin # 5, July 1999, "Vaginal birth after previous cesarean section"- http://ican-online.org/vbac/critique-acog-bulletin-5-july-1999-vaginal-birth-after-previous-cesarean-section
ICAN homebirth links
http://ican-online.org/community/users/ican-blog/blog/ican-and-you-can-too-choosing-homebirth-after-cesarean-section
Won't play nice, anymore.- http://ican-online.org/community/blogs/advocacy/wont-play-nice-anymore
http://ican-online.org/community/users/advocacy/blog/wont-play-nice-anymore-part-3

Shoulder Dystocia ?

2009-08-27T15:00:00.004-04:00

"Shoulder dystocia occurs when, after delivery of the fetal head, the baby's anterior shoulder gets stuck behind the mother's pubic bone." See this site -
http://www.shoulderdystociainfo.com/whatis.htm Many online definitions blame shoulder dystocia (SD)purely on the infants weight when malpostioning combined with other complex issues is more likely the cause. According to The Farm Midwives Site "The problem of shoulder dystocia has received increasing attention in the medical literature in recent years, probably because of the tremendous potential for litigation that accompanies this disastrous complication. It has been estimated that at least 8% of malpractice claims alleging fetal damage involve a birth complicated by shoulder dystocia." This certainly add to the pressure a care provider might have at any possible, however unlikely indication of that possibility. Talk to your care provider about their skills regarding SD.

http://www.theunnecesarean.com/blog/2009/6/17/i-had-shoulder-dystocia-once-will-it-happen-again.html
http://www.theunnecesarean.com/blog/2009/8/26/misdiagnosis-of-shoulder-dystocia-bed-dystocia-and-snug-shou.html

Keep your eyes open for iatrogenic shoulder dystocia (SD caused by medical interventions) See these blog with interesting conversations regarding this-
http://www.theunnecesarean.com/blog/2009/1/14/iatrogenic-shoulder-dystocia.html
http://momstinfoilhat.wordpress.com/2009/01/06/long-dystocia-reply-turned-post/ quote below...
"The triad of labor induction, oxytocin use, and birth weight greater than 4500 g yielded a cumulative odds ratio of 23.2 (95% CI 17.3-31.0) for shoulder dystocia.

This is a subject worth some reading!

How to tell if your care provider is truly VBAC friendly.

2009-08-26T18:22:00.003-04:00

Many care providers may start off appearing capable of letting a labor go without interventions. Without direct questioning (or even with it) you may never know a doctor, midwife or nurse's true feelings regarding VBAC, birth without medication or laboring in an upright position. Finding out where your care providers stand on these things is crucial to navigating your pregnancy and birth.

Hospital VBAC turned CS due to constant scare tactics -- Great story and commentary by Jen at VBAC Facts http://vbacfacts.com/2008/06/03/hospital-vbac-turned-cs-due-to-constant-scare-tactics/
"A huge red flag for me is when an OB states upfront at the first prenatal visit, “the main goal is a healthy baby and mom.” Why would the OB say something that is really so obvious, it should go without saying? Because by explicitly vocalizing it as a response to a VBAC inquiry, the OB infers that the goal of VBAC and the goal of a healthy baby are incompatible. It’s a way of distracting the mom. It’s a way to wear down her confidence. It’s a way to slowly erode her desire to VBAC until she can’t, or doesn’t want, to fight anymore and schedules that cesarean or crumbles during labor and consents to a cesarean. The OB behaves as if you can only have one thing: a VBAC or a healthy baby. This philosophy makes the distinct connection between CS = healthy baby and VBAC = dead baby and, given those options, who would pick a VBAC, right? What insane woman would chose a VBAC if it meant her baby would die?"
Please read more at the above link!

The Red Flags she talks about is important in your first consultation with a potential care provider and each meeting afterwards.
On this page Jen lists the three types of care providers. The second is the most likely to 'bait and switch' . http://vbacfacts.com/2008/04/13/the-three-types-of-care-providers-amongst-obs-and-midwives/comment-page-1/#comment-3035
" But, they have strung you along for so long – usually this starts in the last couple months of your pregnancy – that you feel stuck and you think that it’s to late to find another provider. Sometimes it is, and sometimes it isn’t. It never hurts to check out other providers, regardless of how far along you are. When you have a provider like this, what do you have to lose? (read link for more!)

Read Some Birth Stories!

2009-08-18T07:59:00.002-04:00

It is so nice to have other's stories to read that are beyond the sensationalism of 'The Baby Story' or "Maternity Ward'. A lot of births are so boring that the producers of the show may not even air them! In a lot of ways- the less drama of a birth the better!
Read away -find your own- write yours down too!

A few at http://www.icaniowa.com/stories.html
CBAC
VBAC
VBAC2
HBAC

http://pregnancy.about.com/library/stories/blkatie.htm HBAC

A large selection http://pregnancy.about.com/library/stories/blkatie.htm
Many hospital VBAC's
VBAC3
Many using hypo-babies technique

So you are 'plus-size'.... Now What?

2009-08-15T22:34:00.002-04:00

Being a larger woman is another barrier towards respectful evidenced based care in pregnancy and birth. (see previous post on AMA)
Here is some reading on the subject-

Article - PLUS SIZE PREGNANCY By Kmom- http://www.size-acceptance.org/without_measure/wom0805_page18.html
Excerpt from the above link-
"Many websites with information about pregnancy at larger sizes are actually supported by weight loss surgeons or diet companies, hardly objective parties. They recognize that many of their clients are women of childbearing age who have been told that they "must" lose weight before they have children. They know this a market ripe for the picking and that their best sales tactic is fear. So these websites publish distorted risk summaries, highlight only the studies that show the worst outcomes, imply that complications are inevitable for most fat women, and tell worst-case scenario stories as if they were everyday events. Some authors even suggest that obesity during pregnancy is akin to child abuse. It is a misperception that fat women must lose weight in order to have a baby. In reality, many women of size have healthy pregnancies and healthy babies without losing weight first. This is the underground truth that the Profiteers in the War On Fat don't want you to hear."

Plus size Pregnancy website- http://www.plus-size-pregnancy.org/firstindex.html more information, research and links
Kmom's blog - http://www.wellroundedmama.blogspot.com/

“Fat Women Can Give Birth Vaginally”: Obesity and the Skyrocketing Rate of Cesarean Sections
Posted by Christine C. - http://www.ourbodiesourblog.org/blog/2008/04/fat-women-can-give-birth-vaginally-obesity-an
Quote from above link

"Many of the cesareans in women of size today may be ‘iatrogenic’ — that is, caused by the attitudes and management protocols of the doctors, rather than by the woman’s size.”

Fear of AMA - Advanced Maternal Age

2009-08-08T22:10:00.002-04:00

Advanced maternal age is usually defined as over 35. Some risks do increase at this age, but gradually. High blood pressure is considered to be something an AMA mother's might have more of but if you don't have it your age alone should not determine more intervention solely on this risk.
See this link for general AMA information- http://www.marchofdimes.com/professionals/14332_1155.asp
Do c-sections increase with older mothers? According to the previous link yes- "47 percent of mothers over age 40, 41 percent between ages 35 and 39" Is this number inflated because of actual increased danger of those laboring over 35 or perception of that age group of laboring woman as a problem waiting to happen?

This is an interesting link on AMA - http://www.expectantmothersguide.com/library/stlouis/ESLadv_maternal_age.htm
"Due to the increasing popularity of late pregnancy, it is imperative to consider more desirable and friendly terms to use when referring to older pregnant women. The terms elderly primigravida, post-mature, and obstetrically senescent are somewhat negative. Less offensive terms such as mature primigravida or advanced maternal age may be more appropriate."

AMA can be used against a mother to justify excessive interventions when no clear indication other then the age exist. This is similar to the treatment of plus size, VBACing, very young and other types of mothers. Make sure that a medical need is present beyond the year you were born.

ICAN's Cesarean Fact Sheet lists AMA as one of the reasons to question.
"Many reasons given for cesarean, especially prior to labour, can and should be questioned. This includes macrosomia (large baby),6,7,8 maternal age,9 and parity,10 assisted reproductive technology,11 CPD,12 dystocia, failure to progress, breech,13,14 fetal distress or even prolonged second stage.15 There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth.16 "

Why would my doctor do a c-section if it wasn't necessary?

2009-08-02T05:53:00.002-04:00

I don't know about your specific situation but fear of litigation does drive a good number of c-sections "just in case" the patient later decided to sue.

There is a great post on The Unecesarean Blog - http://www.theunnecesarean.com/blog/2009/8/2/unnecesareans-obstetrics-and-blaming-lawyers.html
that first mentions this post at Stand and Deliver Blog - http://rixarixa.blogspot.com/2009/07/litigation-and-obstetric-mindset.html

At the Unecesarean she writes about Dr. Kurt Barnhart who commented on the results of a ACOG 2009: Liability Fears article.

Barnhart’s comments are a cry for compassion for physicians, who are afraid of their patients and therefore perform cesareans because of this fear. Because they feel victimized, we as patients should not blame them for performing an unnecesarean; rather, we should accept our own victimization. Is it really ethical or socially acceptable for doctors to victimize their patients with
unnecessary procedures because they fear that they themselves will be victimized?

CDC Says Cesarean Triples Neonatal Death Risk

2009-07-29T22:03:00.001-04:00

http://www.associatedcontent.com/article/1980192/cdc_says_cesarean_triples_?cat=25

Please go read this article... Hopefully a 'wake-up' for those that casually suggest to 'just get a c-section' for no medical indication.

"MacDorman, et al. analyzed national birth and death data for 5,762,037 live infants and 11,897 neonatal deaths, for the years 1998-2001. The purpose of the study was to examine the neonatal outcomes of primary cesarean delivery in women who had no other known complications or medical risk factors. The logical result of this examination would seem to be comparable neonatal mortality rates among cesarean and vaginally born infants. In fact, what the results show is that cesarean independently raises the risk of neonatal death by almost three-fold - .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies.Even more astounding than the simple fact that cesarean section raises the risk of infant death - regardless of the reason the cesarean was performed - is that even when the researchers adjusted for sociodemographic, medical and congenital factors, and removed infants with APGARs under 4, the risk of death was only reduced "moderately". A stark difference in the death rates between cesarean born infants and vaginally born infants remained even with no medical explanation."

Enforcing and Promoting the Rights of Women Seeking Vaginal Birth After Cesarean

2009-07-28T14:07:00.002-04:00

Excerpts from ICAN main website - http://ican-online.org/vbac/enforcing-and-promoting-rights-women-seeking-vaginal-birth-after-cesarean-vbac-primer

The Legal and Ethical Foundations of the Rights of Pregnant Women
"The doctrine of informed consent/refusal is upheld by common law; case law; Constitutional law (the right to privacy and self determination protected by the 1st and 14th amendments); federal law (The Emergency Medical Treatment and Active Labor Act and The Patient Self-Determination Act); international tort law (which US courts sometimes cite); state law; state mandated medical ethics; and the ethical guidelines of the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG). The doctrine of informed consent/refusal upheld by these laws provides all patients, pregnant or not, with certain fundamental rights" including
" The right to make medical decisions free from coercion or undue influence from physicians.

• The right to have informed medical decisions witnessed, signed and documented by the attending physician and another adult.

• The right to revoke consent to treatment at any time, either verbally or in writing."

"The legal doctrine of informed consent/refusal developed from the laws on battery. In a medical setting battery is defined as touching or treatment that occurs without obtaining proper informed consent; medical treatments that are substantially different from the ones a patient consented to; treatment that exceeds the scope of consent; or treatment provided by a physician other than the physician who obtained the patient’s consent."

Regarding Patient Abandonment and the Right to Care
"Many people are under the mistaken impression that in instances where they disagree with their physician about a course of treatment, their doctor has the right to discontinue care. However, professional ethical guidelines stipulate that a physician may only terminate care after reasonable notice and after providing for necessary interim or emergency care. Physicians who fail to meet these guidelines may be charged with patient abandonment, which is grounds for malpractice and constitutes a violation of ethical conduct that could result in loss of licensure. As a general rule, physicians who wish to discontinue care in a non-emergency situation must notify patients in writing, give 30 days’ notice and offer a general referral to other physicians in the area.
Regarding Holding Your Hospital Accountable
"While birth plans can be a useful tool for educating physicians and hospital staff about your wishes, a more effective means of enforcing your right to informed consent/refusal is to customize the hospital’s blanket consent form. Physicians often fail to let patients know exactly how all encompassing these forms are, and many people sign them without a full understanding of their legal implications. Moreover, most patients are unaware that they are not, by law, required to sign the hospital’s consent form or that they have the right to make it reflect their specific treatment wishes."
"While many physicians will tell you that such forms do not protect them from lawsuits, in fact, as long as your refusal is documented, under US law it’s very difficult, if not impossible, for hospitals or physicians to be held liable for not doing a procedure a patient has refused.
Moreover, if your refusal is documented and you underwent a cesarean anyway, your doctor and hospital would be subject to criminal battery charges, regardless of whether your or your baby was harmed by the cesarean."
Regarding Addressing Grievances After the Fact: Filing Complaints With the Board of Medicine
"Lawsuits can cost a great deal of time and money and may not be the best means of addressing the issue of coerced cesareans, but until more women begin to pursue this route, physicians will continue to view cesareans as a no-fault course of treatment in virtually every clinical situation."

Please vist the link for the entire paper.

This material may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All rights reserved.

Preparing for birth, what should a first time mom watch on TV?

2009-07-20T18:42:00.002-04:00

Most TV dramas and documentaries like The Baby Story usually have high interventalist story lines and are very edited for time so seem like it magically just happens. Each time a woman watches a highly managed birth she may internalize it as 'the norm'. There is a danger that 'the norm' could come to mean a pregnant or laboring mother does not question steps or procedures. The best thing is to watch, read and talk about women and their various labor and birth stories. For every woman who had "a bad reaction to _______" there is likely a few who "loved my _____". For every doula, OB, midwife, nurse, intern, husband, mother-in-law, child, hospital cafeteria or health department who was wonderful and co-operative there is a good number that were horrible and offensive. There are some generalizations that "this will help me avoid a c-section" or "this will alleviate pain" which probably will benefit most but not all.

Don't be all fearful or all open. Approach all media, books, friends, neighbors, medical professionals and our own inner dialogue as all parts to the puzzle that lead to your birth. Get stories from multiple sources, ask multiple medical professionals and filter your influences if you have securely decided on something. Share you openness for birth with young people and newly pregnant woman. Let us change our cultures fear of birth and it be known as the life changing and varied experience it already is. Birth is not homogenized...regardless of modern obstetrics attempt at making it so.
.
Birth is the making of a mother

Things You Can Do to Avoid an Unnecessary Cesarean - ICAN 'White paper' Spotlight

2009-07-16T14:22:00.001-04:00

Things You Can Do to Avoid an Unnecessary Cesarean - http://www.ican-online.org/pregnancy/things-you-can-do-avoid-unnecessary-cesarean

The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly 1 million cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, half of the cesareans could have been avoided. Clearly, there are times when cesareans are necessary. However, cesareans increase the risk to both mothers and babies. These are suggestions of things you can do to avoid an unnecessary cesarean and can help insure that your birth experience is as healthy and positive as possible.

BEFORE LABOR
Read and educate yourself, attend classes and workshops inside and outside the hospital.
Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center.
Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest?
Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor.
Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc.
Become aware of your rights as a pregnant woman.
Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of cesarean.
Help ensure a healthy baby and mother by eating a well-balanced diet.
If your baby is breech, ask your care provider about exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion.
If you had a cesarean, seriously consider VBAC. According to the American College of Obstetricians & Gynecologist, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesareans can go on to birth their subsequent babies vaginally.

DURING LABOR
Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you.
Continue to eat and drink lightly, especially during early labor, to provide energy.
Avoid pitocin augmentation for a slow labor. As an alternative, you may want to try nipple stimulation.
If your bag of water breaks, don’t let anyone do a vaginal examination unless medically indicated for a specific reason. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection.
Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.
Avoid using an epidural. Medical research has shown that epidurals can slow down labor and cause complications for the mother and baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing.
Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest.
Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on you and your baby, and what are your other options.
Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.

This may be copied and distributed with retained copyright. © International Cesarean Awareness Network, Inc. All Rights Reserved.

Conversation with a Labor and Delivery Nurse

2009-07-13T16:43:00.003-04:00

This is taken directly from a post on a New Jersey Forum - http://www.city-data.com/forum/new-jersey/691256-suggest-doctor-pregnancy-jersey-city.html

Me: Do you allow VBACs at your hospital?

L&D Nurse: No, I am sorry we don’t. We are not equipped to handle the potential emergency that could arise. The doctors don’t mind attending them. It’s really the anesthesiologists that have a problem with them.

Me: Why would the anesthesiologists have a problem with VBACs?

L&D Nurse: Because they don’t like rushing in if there is an emergency

Me: How do you handle other obstetrical emergencies like a cord prolapse or acute fetal distress?

L&D Nurse: Well the anesthesiologists will come in but it’s a matter of the known risk of VBAC vs the unknown risk in other births.

Me: So it would annoy an anesthesiologist to have to rush in for an emergency with a VBAC even though, statistically speaking, uterine rupture only occurs in 0.4% of VBACs that avoid induction or pitocin, and even though uterine ruptures can occur in women who have never had uterine surgery? But your anesthesiologists would be okay rushing in for a cord prolapse that might have been avoided if the doctor didn’t artificially rupture the woman’s membranes?

L&D Nurse: Uhhhh…. Well….. we just don’t think we are able to handle them properly if an emergency arises

Me: So, basically, you can’t handle an emergency in birth which means it’s not safe to birth there at all.

L&D Nurse: Well, no….

ACOG Practice Guidelines on 'Big Babies'

2009-07-11T18:35:00.003-04:00

Have you or someone you know been told induction or cesarean is needed because the baby is too big? This is definitely an issue to read more about!
Practice Guidelines- ACOG Issues Guidelines on Fetal Macrosomia- http://www.aafp.org/afp/20010701/practice.html

From the link

"The term fetal macrosomia implies fetal growth beyond a specific weight, usually 4,000 g (8 lb, 13 oz) or 4,500 g (9 lb, 4 oz),"
"Weighing the newborn after delivery is the only way to accurately diagnose macrosomia, because the prenatal diagnostic methods (assessment of maternal risk factors, clinical examination and ultrasonographic measurement of the fetus) remain imprecise."
"According to the ACOG committee, the risk factors (excluding preexisting diabetes mellitus) for fetal macrosomia, in decreasing order of importance, are as follows: a history of macrosomia, maternal prepregnancy weight, weight gain during pregnancy, multiparity, male fetus, gestational age more than 40 weeks, ethnicity, maternal birth weight, maternal height, maternal age younger than 17 years and a positive 50-g glucose screen with a negative result on the three-hour glucose tolerance test. "

Comments on the above passages

1. Having suspected fetal macrosomia is not a necessary reason for a c-section according to ICAN's Cesarean Fact Sheet http://www.ican-online.org/pregnancy/cesarean-fact-sheet . "There are very few true indications for a cesarean section in which the risks of surgery will outweigh the risks of vaginal birth"

2. A good number of cesareans happen because of a "big baby scare" where a woman is told how large her baby will be and how she would never birth it vaginally. Read this for inaccuracies in ultrasound for predicting fetal weight- http://www.plus-size-pregnancy.org/Prenatal%20Testing/prenataltest-ultrasoundsafety.htm#Ultrasound%20for%20Estimating%20Fetal%20Weight According to one study referred to " 23% were more than 1 pound overestimated, and 50% of the babies predicted to be macrosomic weren't macrosomic at all." Read this commentary here http://ican-online.org/community/blogs/rachael-kelly/random-ramblings-stressed-out-student

3. Induction or cesarean purely based on risk factors and/or estimated fetal measurement does not dissolve all risk. One of the things that slightly increases with a bigger baby is shoulder distocia (but can happen with any size). Read this post from The Unecesarean http://www.unnecesarean.com/blog/2009/6/17/can-my-doctor-really-predict-shoulder-dystocia.html In it she quotes Munro-Kerr’s Operative Obstetrics (2007) by Baskettit "the risk of serious fetal injury associated with shoulder dystocia is rare. The hope that ultrasound prediction of fetal weight and more detailed ultrasound measurements such as shoulder width would provide an accurate level of risk have been unfilled. Indeed, for the macrosomic fetus clinical estimation of fetal weight is as accurate as that predicted by ultrasound. Even if one could predict fetal macrosomia accurately, it would be of limited value. About 95% of infants weighing over 4000 grams will not have shoulder dystocia. It has been suggested that elective caesarean for fetuses weighing more than 4500 grams would reduce shoulder dystocia and fetal injury. A decision analysis model has shown that this strategy would be both clinically and cost ineffective; it was estimated that to prevent one permanent brachial plexus injury 3695 caesarean sections would be required. Furthermore, the majority of cases of shoulder dystocia occur at fetal weight less than 4500 grams."

Past posts on how 'big babies' effect birthing trends- http://icanwesternmd.blogspot.com/2009/06/big-baby-scare-and-elective-primary-c.html http://icanwesternmd.blogspot.com/2009/05/cephalopelvic-disproportion-cpd-and.html

ICAN Blog Tour

2009-07-10T17:51:00.001-04:00

Here are some blogs from ICAN chapters across the country.

ICAN of Jackson MS http://icanofjacksonms.blogspot.com/

ICAN of Somerset County NJ http://romancathanachronism.typepad.com/ican_somerset

ICAN Twin Cities Blog http://icantwincitiesblog.blogspot.com/

ICAN of Central Iowa http://www.icaniowa.com/

What is going on about birth in those areas?

Great post at 'Nursing Birth' blog!

2009-07-09T21:10:00.003-04:00

Below is just the title of each section..please follow the link to read all that she wrote! http://nursingbirth.wordpress.com/2009/07/09/%e2%80%9cpit-to-distress%e2%80%9d-part-2-top-6-ways-to-protect-yourself-from-unnecessary-harmful-interventions/

TOP 7 WAYS TO PROTECT YOURSELF FROM UNNECESSARY AND HARMFUL OBSTETRICAL INTERVENTIONS (including “Pit to Distress”!)

#1 Interview different birth attendants/practices before or during early pregnancy and CHOOSE a birth attendant that practices in a way that aligns with your personal childbirth/postpartum philosophy, is appropriate for your health status, and (optimally) who practices a midwifery model of care!

#2 Ask the RIGHT QUESTIONS and the RIGHT PEOPLE when researching potential birth attendants.

#3 Do NOT agree to an induction of labor unless there is a legitimate obstetrical, maternal, or fetal reason for delivering the baby before natural spontaneous labor begins!! PLEASE Do NOT agree to an unnecessary elective induction of labor.

#4 If you have to be induced or augmented with pitocin for a true medical or obstetrical reason, be honest with your nurse about how you are feeling and have one of your labor companions keep track of how often your contractions are coming.

#5 Learn about and practice non-pharmacological methods of pain relief as part of your childbirth preparation and consider not getting or postponing an epidural until all other methods of non-pharmacological pain relief have been exhausted.

#6 If you feel like you are contracting strongly at least every 2-3 minutes (3-5 in a 10 minute period) and the nurse or birth attendant desires to increase your pitocin, you might want to consider requesting a vaginal exam.

#7 You could always try writing something about pitocin administration in your birth plan.

Who's Getting Their Membranes Swept Today?

2009-07-08T16:09:00.002-04:00

Sweeping or stripping of the membranes is done - "via a vaginal exam, typically very close to your due date. During the exam your provider will separate your amniotic sac from the cervix using his fingers.
You will typically feel some discomfort and it may feel like a longer and more painful vaginal exam than normal. It is not unusual to have some spotting for several days after you have had your membranes stripped."
From http://birthing-options.suite101.com/article.cfm/stripping_membanes

It is a pretty common practice used for induction of labor but it is not an evidence based practice. It is sometimes believed to 'stimulate local prostaglandin release, leading to cervical ripening'. According to the June 2008 issue of Obstetrics and Gynecology "No benefit in gestational age at delivery or reduction of postmaturity occurred from membrane sweeping. "

Occasionally a practitioner will strip membranes without alerting or asking the mother during a vaginal exam. Another viewpoint is "If membrane stripping is actually considered to be indicated, there should be written, informed patient consent so as to ensure patient knowledge and reduce professional liability." (Dr. James A. McGregor is visiting professor of obstetrics and gynecology at the University of Southern California, Los Angeles.)
Much of the risk of any vaginal exam during pregnancy or labor is the introduction of infection. That issue will be another post!

Epidurals--Real Risks for Mother and Baby- ICAN White Papers Spotlight

2009-07-05T12:15:00.002-04:00

Epidurals--Real Risks for Mother and Baby
(excerpted) by Sarah Buckley, Brisbane, Australia
http://www.ican-online.org/pregnancy/epidurals-real-risks-mother-and-baby

An epidural will often slow a woman’s labour, and she is three times more likely to be given an oxytocin drip to speed things up (Ramin et al., Howell). The second stage of labour is particularly slowed, leading to a three times increased chance of forceps (Thorpe et al.). Women having their first baby are particularly affected; choosing an epidural can reduce their chance of a normal delivery to less than 50% (Paterson et al.).

This slowing of labour is at least partly related to the effect of the epidural on a woman’s pelvic floor muscles. These muscles guide the baby’s head so that it enters the birth canal in the best position. When these muscles are not working, dystocia, or poor progress, may result, leading to the need for high forceps to turn the baby, or a caesarean section. Having an epidural doubles a woman’s chance of having a caesarean section for dystocia (Thorp, Meyer et al.)

When forceps are used, or if there is a concern that the second stage is too long, a woman may be given an episiotomy, where the perineum, or tissues between the vaginal entrance and anus, are cut to enlarge the outlet and hurry the birth. Stitches are needed and it may be painful to sit until the episiotomy has healed, in 2 to 4 weeks.

As well as numbing the uterus, an epidural will numb the bladder, and a woman may not be able to pass urine, in which case she will be catheterised. This involves a tube being passed up the urethra to drain the bladder, which can feel uncomfortable or embarrassing.

Other side effects of epidurals vary a little depending on the particular drugs used. Pruritis, or generalized itching of the skin, is common when opiate drugs are given. It may be more or less intense and affects at least 25% of the women who take them (Lirzin et al. & Caldwell et al.): morphine or diamorphine are most likely to cause this. Morphine also brings on oral herpes in 15% of women (John Paull).

All opiate drugs can cause nausea and vomiting, although this is less likely with an epidural (around 30% [ibid]) than when these drugs are given into the muscle or bloodstream, where larger doses are needed. Up to a third of women with an epidural will experience shivering (Buggy et al.), which is related to effects on the bodies heat-regulating system.

When an epidural has been in place for more than 5 hours, a woman’s body temperature may begin to rise (Camman et al.). This will lead to an increase in both her own and her baby’s heart rate, which is detectable on the CTG monitor. Fetal tachycardia (fast heart rate) can be a sign of distress, and the elevated temperature can also be a sign of infection such as chorioamnionitis, which affects the uterus and baby. This can lead to such interventions as caesarean section for possible distress or infection, or, at the least, investigations of the baby after birth such as blood and spinal fluid samples, and several days of separation, observation, and possibly antibiotics, until the results are available (Kennell et al.).

There is a noticeable lack of research and information about the effects of epidurals on babies. Drugs used in epidurals can reach levels at least as high as those in the mother (Fernando et al.), and because of the baby’s immature liver, these drugs take a long time—sometimes days—to be cleared from the baby’s body (Caldwell, Wakile et al.). Although findings are not consistent, possible problems, such as rapid breathing in the first few hours (Bratteby et al.) and vulnerability to low blood sugar (Swantstrom et al.) suggest that these drugs have measurable effects on the newborn baby.

As well as these effects, babies can suffer from the interventions associated with epidural use; for example, babies born by caesarean section have a higher risk of breathing difficulties (Enkin et al.). When monitoring of the heart rate by CTG is difficult, babies may have a small electrode screwed into their scalp, which may not only be unpleasant, but occasionally can lead to infection.

There are also suggestions that babies born after epidurals may have difficulties with breastfeeding (Smith, Walker) which may be a drug effect or may relate to more subtle changes. Studies suggest that epidurals interfere with the release of oxytocin (Goodfellow et al.) which, as well as causing the let-down effect in breastfeeding, encourages bonding between a mother and her young (Insel et al.).

(An edited version of this paper was first published in Australia’s Parents magazine, Aug/Sept 1998)

References:
Buggy D, Gardiner J. The space blanket and shivering during extradural analgesia in labour. Acta-Anaesthesiol-Scand 1995; 39(4): 551-553
Caldwell LE, Rosen MA, Shnider SM. Subarachnoid morphine and fentanyl for labor analgesia. Efficacy and adverse effects. Reg Anesth 1994;19:2-8
Caldwell J, Wakile LA, Notarianni LJ et al. Maternal and neonatal disposition of pethidine in child birth—a study using quantitative gas chromatography-mass spectrometry. Lif Sci 1978;22:589-96
Camman WR, Hortvet LA, Hughes N, et al. Maternal temperature regulation during extradural analgesia for labour. Br J Anaesth 1991;67:565-568.
Enkin M, Keirse M, Renfrew M, Neilson J. A Guide to Effective Care in Pregnancy and Childbirth. P 287 Oxford University Press 1995
Goodfellow CF, Hull MGR, Swaab DF et al. Oxytocin deficiency at delivery with epidural analgesia. Br J Obstet Gynaecol 1983; 90:214-219
Howell CJ. Epidural vs non-epidural analgesia in labour. [Revised 6 May 1994] In: Keirse MJNG, Renfrew MJ, Neilson JP, Crowther C. (eds) Pregnancy and Childbirth Module. In: The Cochrane Pregnancy and Childbirth Database. (database on disc and CD-ROM ) The Cochrane Collaboration; Issue 2, Oxford: Update Software 1995 (Available from BMJ publishing group, London)
Insel TR, Shapiro LE. Oxytocin receptors and maternal behavior. In Oxytocin in Maternal Sexual and Social Behaviors. Annals of the New York Academy of Sciences, 1992 Vol 652. Ed CA Pedersen, JD Caldwell, GF Jirikowski and TR Insel pp 122-141 New York, New York Academy of Science
Kennell J, Klaus M, McGrath S, et al. Continuous emotional support during labor in a US hospital. JAMA 1991;265:2197-220
Lirzin JD, Jacquintot P, Dailland P, et al. Controlled trial of extradural bupivicaine with fentanyl, morphine or placebo for pain relief in labour. Br J Anaesth 1989; 62: 641-644
Paterson CM, Saunders NSG, Wadsworth J. The characteristics of the second stage of labour in 25069 singleton deliveries in the North West Thames Health Region. 1988. Br J Obstet Gynaecol 1992;99:377-380
John Paull, Faculty of Anaesthetists, Melbourne. Quoted in: "The perfect epidural for labour is proving elusive" New Zealand Doctor. 21 Oct 1991
Ramin SM, Gambling DR, Lucas MJ et al. Randomized trial of epidural versus intravenous analgesia during labor. Obstet Gynecol 1995; 86(5):783-789
Swanstrom S, Bratteby LE. Metabolic effects of obstetric regional analgesia and of asphyxia in the newborn infant during the first two hours after birth I. Arterial blood glucose concentrations. Acta Paediatr Scand 1981; 70:791-800
Thorp JA, Meyer BA, Cohen GR et al. Epidural analgesia in labor an cesarean section for dystocia. Obstet Gynecol Surv 1994; 49(5): 362-369

This may be copied and distributed with retained copyright. © International Cesarean Awareness Network, Inc. All Rights Reserved.

"Misconception" Birth matters VA -HONORABLE MENTION

2009-07-01T14:08:00.001-04:00

http://birthmattersva.org/videocontest.html
"As a step toward our goal of educating women about their choices and options during the childbearing years, Birth Matters Virginia solicited short videos about evidence-based maternity and delivery care. With our nation ranking 41st in maternal mortality and our cesarean rate surpassing 30%, it is more important than ever for women to be educated about their options."

A short film by Becky Carey, Josh Epperson, and Andrew Campbell

Labor Pain

2009-06-29T15:36:00.003-04:00

Childbirth Connection has a great page on labor pains-
Here it is - http://www.childbirthconnection.org/article.asp?ck=10191

"How does labor pain differ from other types of pain?
Labor pain differs from other kinds of pain in ways that make coping easier.
Labor pain: is not a symptom of injury or illness: When pain signals that something is wrong, anxiety can increase painful sensations. Labor pain, however, is simply a sign that your body is working hard and well.
is self-limiting: Labor rarely takes more than 24 hours.
is rhythmic: Contractions last no longer than a minute or so and come in a regular pattern with one to several (usually) pain-free minutes in between them. This means you can predict and prepare for each contraction and rest between them.
intensifies gradually over time: Contractions almost always start off mild and gradually grow longer, stronger, and closer together, thus allowing you time to adapt. "

"What factors affect my experience of labor pain?
Labor pain is widely viewed as being nothing more than the perception of unpleasant sensation. The reality, however, is much more complex. Your experience of labor pain depends on many factors, including:
your belief in your ability to cope: Confidence in one's ability to cope with the pain strongly influences how much pain women report experiencing in labor. Overall, more confident women report less pain.
societal expectations and beliefs about labor pain: A woman's experience of labor pain and what she thinks is necessary to remedy it are influenced by popular and cultural beliefs, including images in the media.
your labor environment:

Elements affecting how much pain you experience include:
-who is with you
-their verbal and nonverbal communication with you
-the quality of support you receive
-the philosophy of care and the practices of medical staff
-the familiarity and comfort of your surroundings, including noise, lighting, and temperature.
-your previous experience with pain: If labor is not your first painful experience, you are less likely to feel overwhelmed and more likely to have developed coping skills. These experiences can reduce fear and pain."

The next page is about pain relief options - http://www.childbirthconnection.org/article.asp?ck=10185

And next page is on the best evidenced choices for pain relief - http://www.childbirthconnection.org/article.asp?ck=10183

"Key Messages----Despite the challenges of conducting research on labor pain relief and limitations within the best available research, the following conclusions seem clear:
*A woman's labor pain relief options depend in large measure on where and with whom she chooses to give birth; women in other western industrial nations appear to have more options for labor pain relief than women in the U.S. (Marmor and Krol 2002).
*The factor that best predicts a woman's experience of labor pain is her level of confidence in her ability to cope with labor (Lowe 2002).
*Receiving continuous support during labor decreases the probability of using pain medication and increases the likelihood of satisfaction with the birth experience in North American settings (Simkin and O'Hara 2002, a systematic review) and more generally (Hodnett and colleagues 2004, a systematic review).
*Various non-drug techniques can offer pain relief and comfort in labor and have little or no probability of causing adverse effects. If a concern arises or a woman dislikes a technique, discontinuing it should reverse its effects (Simkin and O'Hara 2002, a systematic review).
*We lack good information to answer many questions about unwanted effects of pain medications on babies, mothers, and labor (Bricker and Lavender 2002 and Lieberman and O'Donoghue 2002 — systematic reviews, Caton and colleagues 2002).
*The epidural/spinal family has become the most common approach to labor pain relief in the U.S. It is the only pain relief method that can completely abolish pain, but it also has a high profile of adverse effects, both minor and major (Leighton and Halpern 2002, Lieberman and O'Donoghue 2002, and Mayberry and colleagues 2002 — systematic reviews).
*Although widely used in the U.S. and elsewhere, injected narcotics appear to have little effect on pain and considerable potential for adverse effects (Bricker and Lavender 2002, a systematic review).
*Nitrous oxide could be a useful method for coping with labor pain, but is rarely available in the U.S. (Rosen 2002, a systematic review).

These four factors make the greatest contribution to women's satisfaction in childbirth:
--having good support from caregivers
--having a high-quality relationship with caregivers
--being involved in decision-making about care
--having better-than-expected experiences, or having high expectations.

Pain relief only becomes important for satisfaction in childbirth when expectations are not met (Hodnett 2002, a systematic review)."

Go and read some more at this well balanced and well referenced site! http://www.childbirthconnection.org

Did You Know-ACOG Refines Fetal Heart Rate Monitoring Guidelines?

2009-06-24T19:43:00.004-04:00

In a press release on June 22 2009 the ACOG announced "Refinements of the definitions, classifications, and interpretations of fetal heart rate (FHR) monitoring methods." This is important to *you* -the laboring women- because often fetal heart rate monitoring is required (or rather requested of the staff) in a hospital for certain women especially after usage of certain medications.
Although The American College of Obstetricians and Gynecologists (ACOG) is less concerned about the skyrocketing c-section rate then ICAN is, some of the information is this document might be helpful in avoiding unnecessary surgery. Has your OB read the new guidelines?
For example "An abnormal FHR (print-outs of the fetal heart rate) reading may require providing oxygen to the pregnant woman, changing the woman's position, discontinuing labor stimulation, or treating maternal hypotension, among other things. If the tracings do not return to normal, the fetus should be delivered."

Read it yourself here- http://www.acog.org/from_home/publications/press_releases/nr06-22-09-2.cfm

More on fetal heart rate monitoring-

Descriptions of different kinds and how it is done.
http://www.webmd.com/baby/electronic-fetal-heart-monitoring

An e-news from Midwifery Today on Electronic Fetal Monitoring-
http://www.gentlebirth.org/archives/decels.html

VBAC Facts interpretation of ACOG's Guidelines-
http://vbacfacts.com/2009/06/24/the-role-of-interpretation-acog-refines-fetal-heart-rate-monitoring-guidelines/
"Note that VBAC is not listed under “high-risk conditions” that “should be monitored continuously during labor.” Also, with a 99% false positive rate for cerebral palsy, I wonder how effective EFM is for detecting uterine rupture"

Thinking about Stadol?

2009-06-20T19:52:00.002-04:00

Pain relief in labor can be useful but knowing its implications and side effects will help any laboring woman make educated decisions.

Stadol is considered more potent then demoral and is commonly given during the first stage of labor to 'take the edge off.' Narcotics like stadol can have side effects for baby and mother.

Using Stadol as Labor Pain Relief
How Narcotics affect Mother, Baby and the Mother's Labor
© Brenda Lane - http://childbirth---labour-

Stadol is now generic and can be referred to a BUTORPHANOL INJECTION. (or butorphanol tartrate injection)
It is used in other medical situations- here is a site that has more information on this drug- http://www.medicinenet.com/butorphanol_injection/article.htm

This site has the FDA drug label for Stadol-
http://www.rxlist.com/stadol-drug.htm

Do your reading and be prepared!

ICAN 'White Paper' Spotlight -- Choosing a Primary Caregiver

2009-06-19T21:17:00.002-04:00

The ICAN White Papers are a series of short informational documents produced by The International Cesarean Awareness Network, Inc.
Today's pick is--

Choosing a Primary Caregiver

One of your first goals is to find a caregiver with whom you feel comfortable and who shares your philosophy of birth. Your caregiver should respect your wishes and will agree not to override your decisions even if she or he would personally choose something else.

It is important to find a caregiver who understands and supports the kind of birth for which you are striving and is prepared to help you towards that goal. When making your first appointment, tell the receptionist that you wish for consultation rather than an examination. Once you have selected a caregiver, it may also be necessary to meet his or her partners in the event one of them attends the birth if the caregiver you are seeing is not on call.

Direct Entry Midwife (DEM)

Also called Registered Midwives (RM), Traditional Midwives or Certified Midwives (CM), they enter the field of midwifery through an apprenticeship, community-based training, or a field other than formalized nursing education. They have a long-standing commitment to women’s health care and experience-based training. Most often, DEMs provide care to women giving birth at home, though that is changing as birth centers become more popular and where DEMs are granted admitting privileges (several provinces in Canada, the UK, etc.).

Midwives are specialists in normal pregnancy and birth. Midwives view birth as a safe and normal passage in a woman’s life. They instill pride and confidence in women and consequently you are less likely to experience interventions during your pregnancy and birth. A midwife provides "continuity of caregiver" which means she supplies all your care form early pregnancy, through the birth and into the postpartum. Usually your primary midwife works with a back-up midwife who comes later in labour to join your midwife for the birth.

Certified Nurse-Midwife (CNM)

CNMs are Registered Nurses who have taken their post-baccalaureate specializing in midwifery and are unique to the US. CNMs practice in public, private, university, and military hospitals. They work in health maintenance organizations, in private practices, and in birth centers. Many nurse-midwives work in public health clinics, while others choose to provide home birth services. Nurse-midwives are also active in international health programs, working worldwide to improve the health of women and children.

CNMs practice in collaboration with physicians. The degree of collaboration in this team approach depends on the medical needs of the individual woman and the practice setting. For example, a nurse-midwife providing care for a women whose pregnancy is at low risk for complications may need no physician input. That same nurse-midwife providing care to a woman at higher risk would have more contact with the collaborating physician.

Primary Care Physician (PCP) or General Practitioner (GP)

Primary Care Physicians deliver basic or general care that is intended to be the patient’s first level of contact with the medical care system. Primary care physicians attend to the general health-care needs of the entire family. Trained in every major area of medicine, they serve as the primary source of a patient’s health care throughout life. When appropriate, PCPs refer their patients to specialists such as obstetricians or perinatologists. Primary care physicians may specialize in areas such as family practice, obstetrics, anesthesiology, or pediatrics.

Obstetrician/Gynecologist (OB/GYN)

An obstetrician is a physician who has successfully completed specialized education and training in the management of pregnancy, labor, and pueperium (the time-period directly following childbirth). A gynecologist is a physician who has a successfully completed specialized education and training in the health of the female reproductive system, including the diagnosis and treatment of disorders and diseases.

Typically, the education and training for both fields occurs concurrently. Thus, an obstetrician/gynecologist is a physician specialist who provides medical and surgical care to women and has particular expertise in pregnancy, childbirth, and disorders of the reproductive system. This includes preventative care, prenatal care, detection of sexually transmitted diseases, Pap test screening, and family planning.

An OB/GYN, can serve as a primary physician and often serve as consultants to other physicians. Should you select an OB as your primary caregiver, the likelihood of experiencing interventions is increased as they are trained in surgery and tend to view birth from a pathological viewpoint. The use of obstetricians for a normal low risk woman is unnecessary because of the increased chance of intervention as well as limiting the obstetrician’s availability for high risk women genuinely in need of their service.

Perinatologist

Perinatologists are maternal fetal medicine specialists. A midwife, primary care physician or obstetrician can handle most pregnancies, as complications are rare. When complications are anticipated because of the mother’s medical history, or if they crop up during the pregnancy and threaten to affect the health of the fetus or mother, a specialist may be required. The perinatologist, a specialist in maternal-fetal health, is the person who often receives these referrals. The referrals are frequently made when the mother’s health provider wants her to receive care where there is a neonatal program.

In addition to basic obstetrics and gynecology training, the perinatologist has completed a two-year or three-year clinical and research fellowship. During this fellowship, he or she receives advanced training in comprehensive diagnostic ultrasound imaging of the fetus.

Many perinatologists also develop diagnostic skills and can perform complicated procedures when serious fetal disorders are suspected.

History and Regulations

During the past 50 years, many pregnant women have chosen obstetrics for their method of care and midwifery experienced a decline. Within the last 10 years, there has been a push to standardize the education of DEMs through certification and credentialing. Midwifery is currently experiencing an upswing in popularity.

Laws and regulations governing the practice of nurse-midwifery and midwifery are rapidly changing. Midwives are regulated on the state or provincial level in the US and Canada, thus professional practice and interaction with other health care professionals, such as physicians, can vary. New Zealand allows midwives complete autonomy, meaning that midwives do not have to have backup or work in a shared care arrangement with physicians. Find out what options are available in your area.

Once you have established who you will have as your caregiver, take your Doula to meet him or her. Everyone will be more comfortable at the birth if they have met beforehand. If at any time you become uncomfortable with your caregiver, feel free to change. It is never too late, women have been known to change during their labours! Women often feel that changing would be disloyal, but remember you are a consumer and you cannot afford to compromise your health or the health of your baby. Even if health and safety are not a risk you still have the right to a personal, satisfying birth experience. If you thought the mechanic working on your car was compromising your personal safety or simply not listening to your concerns, you wouldn’t hesitate to find a different mechanic!

Caregiver Questions

You should feel free to ask any potential caregiver any questions you may think are relevant to your care, such as:
What is your training and how many births have you attended?
How do I contact you between visits if I have any concerns?
How do I contact you when I am in labour?
How much time do you normally spend with a labouring woman?
If a woman is in labour and you are not there, who provides her care?
Do you have a working relationship with another doctor/midwife if needed? Who and where? What happens in the event that you are unavailable?
Do you do prenatal checkups? How often? Do you do postpartum checkups?
Do you offer prenatal classes? Where are they held?
How will you assist me in preparing for labour?
What percentage of women receives episiotomies in your practice? How do you prevent the need for episiotomies?
What percentage of women receives cesarean sections in your practice?
How long does it take, on average, to prepare for a cesarean section?
What do you do in emergency situations?
Do you encourage family-centered maternity care? How do you see this working in practical terms?
Are medications available?
How do your services differ from that of other birth attendants?
Do you offer water births?
What is your policy on informed decision-making by the parents?

This may be copied and distributed with retained copyright. © International Cesarean Awareness Network, Inc. All Rights Reserved.

Long Labors

2009-06-17T08:17:00.002-04:00

How long is too long to labor?
In the 1950's 36 hours was considered the normal upper limit for labor. When 'active management' of labor was introduced in 1972 12 hours was the limit for OB's. This Babycenter poll is interesting- the highest number is 6-12 hours. Was this due to active management?

Dr Marsden Wagner (MD, MSPH) writes "All of these time limits were arbitrarily based on clinical concerns and not on scientific evidence. putting a stop watch to labor, as is done in active management, precipitates many problems. When to start the stop watch and declare the race on is difficult and subjective. The final component of active management is taking care to diagnose labor only when progressive dilatation or effacement of the cervix is observed. "
Another quote from Dr Wagner-
"In active management, if a woman's labor was not progressing at a rate they arbitrarily defined as satisfactory, the doctors said she was suffering from "dystocia" and needed oxytocin." (see Failure to Progress post)

If baby and mother are doing fine what is the motivation to 'do something'?
Campaign for Normal Birth link on Long Labors
"Labours wax and wane in intensity and progress: there is no 'right length' for a labour. One should be on the lookout for any clinical indications that might suggest fetal distress or other concerns but a longer labour need not, of itself, be seen as a problem."

Dr Wagner writes on The Active Management of Labour

Australian midwife writes on Long Labours
"Active management of labour was brought in initially by Odriscoll in 1973 as a means of speeding up labour. They had a busy unit and wanted to guarantee birth within 12 hours, they felt this would enhance the experience for the mother."

What might be some reasons why a labor might be longer then others?
Reasons might include- mother's body just predisposed to longer labor, baby posterior, anxiety, induction and others.
Great little article- Long Labors and What to do?
Why having a long labor may be beneficial and necessary.

Was the clock running out for your birth?

Big Baby Scare and Elective Primary C-sections

2009-06-15T16:17:00.003-04:00

(ICAN of Western MD Blog site with links)
I have already posted on this but it is so common (unfortunately) you will likely see many more!
Automatic Cesarean because of suspected Big Baby?-- See this link
http://www.pregnancybirthandbabies.com/Big_baby.htm

and this blog by Nursing Birth
http://nursingbirth.wordpress.com/2009/06/12/don%e2%80%99t-let-this-happen-to-you-22-gina-tony%e2%80%99s-%e2%80%9celective%e2%80%9d-primary-cesarean-section-part-2/#comments
where she goes in depth about common reasons given to perform a c-section ("That baby is huge and your pelvis inlet is little! Oh MY!")and arguments against this course of action. Please visit and make sure you browse the comments too.

2009-06-11T17:40:00.004-04:00

Vocabulary Words 2

2009-06-10T09:30:00.004-04:00

continuation of the vocabulary series started Here (click for link)

puerperal uterus- Relating to, connected with, or occurring during childbirth or the period immediately following childbirth.
Postpardum and postoperative ileus- an absence of normal intestinal function caused by a loss of peristaltic muscular action of the intestine after surgery [or childbirth]. (why they always ask you if you have passed gas!)

febrile(or fetal)fibronectin- fetal fibronectin (fFN) is a protein produced during pregnancy and functions as a biological glue, attaching the fetal sac to the uterine lining.

There is a section from the book
Textbook of Perinatal Medicine By Asim Kurjak, Frank A. Chervenak
that talks about the impact of language. "How do we determine the appropriate language for our specialty?" "Maximise the information provided to pregnant woman. The words we used should be descriptive and easily understood by the majority of pregnant women"
Often I hear of a conflict during a laboring woman's care where she is not accepting the next course of action suggested by her care provider. This is when complicated and unfamiliar terms can be used to suggest a power differential between the two parties.

For humor- From http://maldiveshealth.wordpress.com/2007/12/22/new-slang-words-doctors-use/ I have seen this!

"Testiculation escription of a gesture typically used by hospital consultant when holding forth on a subject of which he or she has little knowledge. Gesture is of an upturned hand with out stretched fingers pointed upward, clutching an
invisible pair of testicles. HEHEHE"

Terms Used by OB's and Their Effect on Gestating Mothers

2009-06-06T10:15:00.003-04:00

I often think about all those term applied to our bodies while pregnant or laboring and the effect it has on our confidence in our bodies ability to birth. How would you feel if you were labeled with having a lazy uterus, sloppy cervix or a boggy fundus?

UK midwife and birth activist Sheila Kitzinger wrote and excellent article called Obstetric Metaphors and Marketing (click link to read)

Obstetric language employs metaphors of conflict, war and aggression: “the
aggressive management of ruptured membranes”, “the oxytocin challenge test”,
“trial of labor”, and the “trigger factor” for labour. In the Swedish language
to perform artificial rupture of the membranes is to “explode” them, and in
Swedish and Dutch the crowning of the baby's head is “cutting through”.

Cylotec Usage in Pregnant Women

2009-05-31T09:50:00.003-04:00

Do you see the little symbol of a pregnant woman and her crossed out?

Cylotec is an ulcer medicine that is often used off label in labor induction. It is particularly dangerous to use in VBACing woman because of the severe increase of rupture risk.

Here is a website that talks about how unsafe the drug is for induction of any pregnant woman.
http://www.cytoteccase.com/
This site has two particular points I want you to know about-
*The American College of Obstetricians and Gynecologists has declared that Cytotec® should never be used to induce a vaginal delivery following a Cesarean Section, which is also called a "VBAC" (Vaginal Birth After Cesarean).
*Cytotec® occasionally, unpredictably causes uterine ruptures in women who have no identifiable risk factors.

Other links
Forced Labor
Why are obstetricians speeding deliveries with an ulcer drug that endangers mothers and their babies?
Misoprostol (Cytotec) for Labor Induction: A Cautionary Tale

Wonderful Little 'Kids Talk About Birth" Video

2009-05-27T18:59:00.000-04:00

US Maternity Care Numbers...What do they Mean?

2009-05-27T06:46:00.004-04:00

Have you ever wondered why we are number 42 in infant mortality rates?
The materal death rates are even worse!
This link has a great clip from Birth by the Numbers. The statistics are fascinating and worth investigating. Please watch it and discuss on the Yahoo group.

http://www.orgasmicbirth.com/birth-by-the-numbers

"In Birth by the Numbers, Eugene R. Declercq, PhD, Professor of Maternal and Child Health, Boston University School of Public Health, presents the sobering statistics of birth in the United States today."

More risks for Babies with Elective Repeat C-sections

2009-05-24T13:56:00.001-04:00

http://nursingbirth.wordpress.com/2009/05/24/more-risks-for-baby-with-repeat-c-sections/

On study published in the June issue of Obstetrics & Gynecology (aka “The Green Journal” published by American College of Obstetrics & Gynecology (ACOG)) Has your OB read this?

Failure to Progress and The Freidmans Curve

2009-05-19T20:15:00.002-04:00

Many of us have looked back on our hospital birth records and see FTP (or labor dystocia) listed as a reason for an intervention or eventual c-section. Failure to Progress is defined by Pregnancy Today website as "occurring when there is no fetal decent of cervical change (with adequate contractions) for more than two hours." FTP is also referred to as failure to wait by those of us who might of liked more time. As Rita Rubin writes in her Pregnancy.org article "Women today are held to a half-century-old labor standard called the Friedman curve, one of the first things obstetrics students learn in their training."

What is the Friedman's Curve?
According to this Journal entry from Medscape Today "Dilation in the active phase was much slower on the modern curve than on the Friedman curve (mean time from 4 cm to complete dilation, 5.5 vs. 2.5 hours). Among the current study's patients, labor lasting more than 2 hours without apparent change was not uncommon before 7 cm of dilation."
Essentially Friedman's curve is an "An Obsolete Approach to Labor Assessment"

Here are some more links on the Freidman's Curve

The Friedman Curve on the Homebirth Debate Blog
Use of abnormalities in the Friedman curve as a predictor of operative delivery in macrosomic babies.
Reevaluation of Friedman's Labor Curve: A Pilot Study
The “Rule of 10” Versus Women’s Primal Wisdom
by Lydi Owen
Editorial: Love that Protects
by Jan Tritten
The “All That Matters” Phenomenon: Grieving the Loss of a Vaginal Birth

May 12 Links and Articles

2009-05-12T07:46:00.004-04:00

Hospitals to review birth policy ......to make it more VBAC friendly!
Keeping C-sections to a minimum .....ABC 7 news clip
You Try Saying No to a C-Section .......blog entry by member of National Advocates for Pregnant Women (NAPW) (this could be a controversial read for some people, please keep that in mind.... here is a link to another article on the same idea. ICAN does not have an official position on abortion but occasionally parallels are drawn under the general 'pregnant woman's rights' umbrella) There is a lot of really interesting, thought provoking comments after this article too!
VBACs: Breaking the repeat cesarean cycle .....San Francisco based article.

Don't forget about our next meeting...Thursday May 21st in Hagerstown!

Childbirth Choice

2009-05-08T07:02:00.002-04:00

How many options for care do you have in western MD? Midwives are not allowed in Frederick Memorial hospital and VBAC is banned at Garrett County hospital. We used to have a birthing center near DC but now we don't and it was too far for most western MD mothers to drive to. There are a few homebirth midwives around if you choice this route but they are stretched thin because of the demand. How easy is it to have 'shadow care' so you can get a few tests your other care provider cannot do or special 'just in case' care. How easy is it in this area to switch care providers, have a doula or have your birth plan respected?
Post your search experience.
Did you pick someone because your sister, friend or co-worker did or did you really look around? Did you contemplate the difference in types of care providers and birthing location? Have you switched care providers during a pregnancy or between births?

A link-
"a full spectrum of childbirth choices "
http://www.ourbodiesourblog.org/blog/2009/04/an-essay-on-the-factory-model-of-childbirth

Due Dates

2009-05-03T20:37:00.002-04:00

"The concept of [a due date] is based on a gestational length established by fiat in the early 1800s. Franz Carl Naegele officially declared that pregnancy lasted 10 lunar months (10 x 28 days), counting from the first day of the last menstrual period). However, when Mittendorf et al. measured the median duration of pregnancy, they found that healthy, white, private-care, primiparous women with well-established due dates averaged 288 days and multiparas averaged 283 days, values significantly different from both Naegele's rule and each other. Others have found similar results."
"Wood's method: Carol Wood, Yale nurse-midwifery professor, came up with a method to calculate the due date that takes into account individual variations in the menstrual cycle as well as the effect of a woman's having had previous pregnancies.
1. Add 1 year to the first day of the last menstrual period, thenFor first-time mothers, subtract 2 months and 2 weeksFor multiparas, subtract 2 months and 2.5 weeks (18 days)2. Add or subtract the number of days her cycle varies from 28 days
*1st-time mothers with 28-day cycles: LMP + 12 months - 2 months, 14 days = EDD*Multiparas with 28-day cycles: LMP + 12 months - 2 months, 18 days = EDD*For cycles longer than 28 days: EDD + (actual length of cycle - 28 days) = EDD*For cycles shorter than 28 days: EDD - (28 days - actual length of cycle) = EDD
EDD: Estimated day of deliveryLMP: Last menstrual period"
Both quotes above from Midwifery Today E-News “Due Date”

Check out Figuring Your Due Date by Kmom
"Figuring due dates accurately is tricky and has very important implications for your pregnancy. If your due dates are figured incorrectly, you may be pressured into all kinds of unnecessary interventions at 'term' when you are not really at term at all. A common result is to be pressured into a pitocin induction of labor, which when done on an unripe cervix has a very high failure rate, can be quite painful, and often ends in a C-section for "failure to progress." In addition, babies who are induced due to incorrect dating may be born earlier than nature intended, and can have immature lungs and other problems, needing special care. It is in Mother's and Baby's best interest to date the pregnancy correctly; this procedure is of critical importance! "

Here is a nice due date calculator- http://www.empoweredchildbirth.com/duedate.html

This is important stuff!

Cephalopelvic Disproportion (CPD) and VBAC

2009-05-02T17:15:00.002-04:00

Were you told you are to small and your babies are too big? Were you given Pelvimetry measurement even before birth and were told you are incapable of birthing vaginally? Question this diagnosis!
Read this ICAN link on Cephalopelvic Disproportion(CPD)
and here is a great inspiring ICAN video on birth after CPD diagnosis.

Low Amniotic Fluid?

2009-04-27T09:20:00.003-04:00

Sometimes late in a pregnancy a woman's amniotic fluid is measured to be low and interventions are suggested based on the possibility of issues related. Lets look at the measurement of low fluid, indications and approaches.

Here is a blog post from Gloria Lemay's blog.
Ms. Lemay is on the advisory board of ICAN.
http://www.glorialemay.com/blog/?p=60
Here is an article she wrote for Midwifery Today with a lot of the same information included-
Suspect Diagnoses Come with Biophysical Profiling

Often induction is recommended or version for breech is denied according to an ultrasound measurement of fluid.
Here is an article from the Journal of Perinatology that disputes induction is necessary. Low Levels of Amniotic Fluid No Risk To Normal Birth (2004) The full article is posted below Gloria Lemay's blog post.

It is certainly worth discussing in depth with your care provider any treatment based on ultrasound measurement of fluid. Ideally there would be other indications of an issue present. Does the intervention create more risk then the possible issue does?

Childbirth Connection has a great paper on ultrasound.
Imaging Ultrasound in Pregnancy

"An unusual number of diagnoses seem to be made that "there is not enough amniotic fluid." This seems to be the factor in this outline that is most often used as an excuse for induction. It is important for parents to know that this is likely an inaccurate assessment.
What the ultrasound technician is doing could be compared with viewing an adult in a see-through plexiglass bathtub from below the tub. In such a scenario, it would be difficult to assess how much water is in the tub above the body that is resting on the bottom of the tub. You might be able to get an idea of the water volume by measuring how much water was showing below the elbows and around the knees, but if the elbows were down at the bottom of the tub too, you might think there was very little water.
This is what the technician is trying to do in late pregnancy—find pockets of amniotic fluid in little spaces around the relatively large body of an eight-pound baby who is stuffed tightly into an organ that is about the size of a watermelon (the uterus). If most of the amniotic fluid is near the side of the uterus closest to the woman's spine, it cannot be seen or measured. This diagnosis of low amniotic fluid frightens the parents into acquiescing to an induction of labor. Even though the official BPP guidelines do not require immediate induction for a finding of low amniotic fluid, in practice the parents are pressured to induce. Stories abound of mothers who are induced for this indication and then report having abundant fluid when the membranes released in the birth process. The risks of induction, which can be catastrophic, and the resulting increase in the need for pain relief medication and cesarean section are usually not discussed with the parents before embarking on induction."
http://www.midwiferytoday.com/enews/enews0620.asp

There are also other treatments possible with a low fluid diagnosis-
"Oligohydramnios: Too Little Amniotic Fluid -
Recent studies suggest that women with otherwise normal pregnancies who develop oligohydramnios probably need no treatment. Their babies are likely to be born healthy. Even so, your provider may want to watch you closely. When treatment is needed, the amniotic fluid may need to be replaced with an artificial substitute once the woman is in labor. "
http://search.marchofdimes.com/cgi-bin/MsmGo.exe?grab_id=6&page_id=11272448&query=low+amniotic+fluid&hiword=FLUIDS+amniotic+fluid+low+

Low fluid diagnosis alone is not an emergency. Talk to your care provider and do your own research!

Meditations on the Rising Cesarean Rate.

2009-04-26T08:23:00.002-04:00

Plante LA. Mommy, What Did You Do in the Industrial Revolution? Meditations on the Rising Cesarean Rate.
"Can it really be that one-third of women are unable to birth without high-level technological support? And is there an endpoint in sight? "

"the American system results in infant mortality nearly twice as high achieved at the cost of twice as many cesareans. It is hard to make the argument on a population basis that abdominal delivery is safer for mothers or babies, at least after a minimal necessary rate is achieved."

"The paradox is this: women wish to be treated as individuals, and assert for themselves a wish to exert control, yet in the commodification and industrialization of childbirth they are so much more likely to be treated as units of production. I know of one large community hospital revamping their labor floor and planning for a 50% cesarean delivery rate"

"Do we really believe that industrial obstetrics is the best model for ourselves and our children? We must clearly understand that real autonomy does not mean cesarean on request, but instead a spectrum of birth options that honor women’s authentic choices. Real autonomy also means, to borrow a sentiment from Gandhi, that women should bring forth the change they wish to see in the world."

Finding A VBAC Supportive Care Provider

2009-04-24T09:54:00.002-04:00

This can be the most important step in a journey towards a VBAC. Remember you can switch care providers at anytime if you feel unsupported!

Choosing a Primary Caregiver
How to Choose a Doctor or Midwife
The Three Types of Care Providers Amongst OBs and Midwives

Hosptial Birth Story- from a L&D Nurses Perspective

2009-04-22T08:12:00.001-04:00

Don’t Let This Happen To You #24 Jessica & Jason’s Back Door Induction

Part 1 http://nursingbirth.wordpress.com/2009/04/13/don%e2%80%99t-let-this-happen-to-you-24-part-1-of-2-jessica-jason%e2%80%99s-back-door-induction/

Part 2 http://nursingbirth.wordpress.com/2009/04/21/don%e2%80%99t-let-this-happen-to-you-24-part-2-of-2-jessica-jason%e2%80%99s-back-door-induction/

"I would just like to say that unlike what many OBGYNs, nurses, friends, family members, moms, journalists, etc will tell you, the journey matters just as much as the outcome. The fact is that women truly amaze me no matter how they give birth. Whether it is a natural home birth or a scheduled cesarean section, the bottom line is that women have superpowers! They can grow people inside of them after all!! And my greatest wish is that all women will feel in control of the decisions regarding their birth and in the end feel empowered no matter the mode of delivery."

Vocabulary Words

2009-04-20T07:52:00.002-04:00

Let's learn some words. It is better to overhear a care provider say you are
"eating a dry diet" then "she has xerophagia." Some terms are legitimately scary but other times a familiar term such as jaundice would be better handled by new parents then "your child has iatrogenic icterus!"

iatrogenic -
induced inadvertently by medical treatment

icterogenic -
causing jaundice

anhidrosis -
not sweating

bradycardia -
a slow heart rate, usually defined as less than 60 beats per minute

cervicitis -
inflammation of the cervix

encopresis -
inability to control the elimination of stool (fecal incontinence)

icterus -
jaundice

mastalgia -
pain in the breast or mammary gland. From the Greek masto-, breast + algos, pain

xerophagia -
eating a dry diet.

4yr old article.....but very interesting

2009-04-17T07:50:00.001-04:00

Doctor Won't Make The Cut: Feeling pressure from hospital for more c-sections, she leaves Wilmington Star Newspaper ---

http://www.earthybirthymama.com/articles/sandlandarticle.html

But the Star-News viewed two letters addressed to her from committee
members. Written on New Hanover Regional letterhead dated July 6 and July 7,
2004, the letters discuss the conversation committee members had with her. The
first letter, written by Dr. Cobern Peterson, chairman of the Professional
Review Committee, stated "concerns" regarding her practice.. They include higher
than average infant birth weights, much lower than average c-section rates and
later than average gestational age of neonates at delivery. The letter states
"the main concern reiterated several times was an overall practice attitude
rather than any individual case." The next letter, written by Dr. Janelle Rhyne,
acting chairman of the Credentials Committee, states Dr. Sandland's privileges
at the hospital would be reappointed for a period of six months but monitoring
would continue. It reads, "Your c-section rate is to be within an acceptable
range as determined by the NHRMC OB/GYN Department with a plus or minus
deviation of two."

A History of VBAC's and C-sections in the US

2009-04-10T16:31:00.001-04:00

http://wellroundedmama.blogspot.com/2009/03/history-of-vbacs-and-cesareans-in-usa.html

Top 7 ways to have birth go the WRONG way!

2009-04-03T13:44:00.001-04:00

Tongue in cheek, but so true!

http://www.faintstarlite.com/2009/03/top-7-ways-to-have-an-unnecessary-c-section/

One in Three

2009-03-31T21:45:00.001-04:00

http://www.ican-online.org/community/users/ican-blog/blog/cesarean-rate-jumps-record-high-1-3-pregnant-women-face-surgical-delivery

"Cesarean Rate Jumps to Record High; 1 in 3 Pregnant Women Face Surgical Delivery
More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery"

"A major driver of cesarean overuse is underuse of vaginal birth after cesarean (VBAC). The VBAC rate currently hovers around 8 percent, far lower than the Healthy People 2010 goal of 37 percent. Driving this decline is the growing practice of hospitals banning VBAC."

Pregnancy Affirmations

2009-03-26T13:38:00.002-04:00

I really love this stuff....It really helped me mentally prepare for my birthing.

Pregnancy is a natural, normal, healthy and vibrant state for my baby and me.
My baby and I are loved and supported.
It is safe for me to have my baby.
There is nothing to fear.
I am calm and relaxed. My baby feels my calmness and shares it.
The baby and I are ready for our lives together to unfold.
The baby is naturally doing what he or she should.
The movements of my uterus are massaging and rocking my baby.
The rhythm of my uterus as it expands and contracts brings me closer to my baby.
The baby is descending naturally.
The baby’s head fits perfectly in my pelvis.
My vagina expands easily as my baby’s head crowns, and then emerges into our hands. from Mothering Magazine Online

10 Pregnancy Affirmations from AC click for link to original page with descriptions behind each one.

1. "I am a miracle."

2."My baby is a miracle."

3."I love myself and my baby."

4."I decide what's best for my baby and me."

5."I'm confident about my decisions."

6."I respect my partner."

7."I face and conquer my fears."

8."I have what it takes to get through labor and delivery."

9."I accept my role as mother."

10."I am in control."

Overdue Thoughts

2009-03-24T15:59:00.001-04:00

What To Do If You’re “Overdue”? - Tips for Ten Month Mamas-by Leilah McCracken and Gloria Lemay

http://www.birthisnatural.net/2008/05/what-to-do-if-you-are-overdue.html

Breech and Caesarean Thoughts

2009-03-20T20:10:00.004-04:00

http://www.breechbirth.ca/
Learn. Educate. Speak out.
"Despite recent research clearly indicating that vaginal breech birth and caesarean section are equal in both safety and risk, obstetricians persist in not informing families that vaginal birth is an option, and nearly all of the breech babies in Canada and the US are born by Caesarean section.."

"Denying vaginal breech birth is a human rights violation in that forces a woman to consent to surgery in order to obtain medical care. The right to informed consent is meaningless where there is no right to informed refusal." - Henci Goer, author of "The Thinking Woman's Guide to a Better Birth

Overweight and Pregnant? Looking closer at the studies!

2009-03-10T21:10:00.004-04:00

Fat pregnant mums and birth complications — study decoding

"The most serious flaw was allocation bias. That’s where the study and control groups are weighted to make obesity appear to be far more unhealthy than it actually is. The group of women chosen to be examined were not taken from the general population, nor was there any randomization to create the study and control groups to enable impartial comparisons.
There was no control group at all."

"Scientists would have designed a very different study: a fair test to objectively explore whether or not obesity was associated with higher risks. This study was not that.
A study that is not a fair test is not a study we can use. It may make good fodder for media, but not for basing medical decisions. This study failed to provide sound evidence to support any of the claims heard in the news. Nor could the authors give a biological explanation for why fat itself could give these findings. And finally, the body of medical research to date contradicts the heightened obesity scares."

From Junkfood Science - a medical blog

The Trouble With Repeat Cesareans

2009-02-19T17:27:00.003-05:00

article in TIME

The Trouble With Repeat Cesareans
"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."

ICAN of WMD wish list

2009-02-17T10:16:00.005-05:00

We would love to have thease books donated to our chapter.

Open Season: A Survival Guide for Natural Childbirth and VBAC in the 90s Pushed: The Painful Truth About Childbirth and Modern Maternity Care
Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First

and any other you think would be good to have!
Thanks!

Back to basics for safer childbirth article

2009-02-13T17:00:00.002-05:00

Back to basics for safer childbirth
Too many doctors and hospitals are overusing high-tech procedures

(click for link)

"The report found that, in the U.S., too many healthy women with low-risk pregnancies are being routinely subjected to high-tech or invasive interventions that should be reserved for higher-risk pregnancies. Such measures include:
Inducing labor. The percentage of women whose labor was induced more than doubled between 1990 and 2005

Use of epidural painkillers, which might cause adverse effects, including rapid fetal heart rate and poor performance on newborn assessment tests

Delivery by Caesarean section, which is estimated to account for one-third of all U.S births in 2008, will far exceed the World Health Organization's recommended national rate of 5 to 10 percent

Electronic fetal monitoring, unnecessarily adding to delivery costs

Rupturing membranes ("breaking the waters"), intending to hasten onset of labor

Episiotomy, which is often unnecessary "

Issues and Procedures in Women's Health

2009-02-05T13:45:00.001-05:00

Vaginal Birth After Cesarean (VBAC)
by D. Ashley Hill, MD, OBGYN.net Editorial Advisor, Associate Director - Department of Obstetrics and Gynecology, Florida Hospital Family Practice Residency, Orlando, Florida

"Furthermore, it is a misconception that c/section is always safer for babies than vaginal delivery. Scalpel injuries and trauma to babies during c/section, although rare, can certainly occur. In most cases vaginal deliveries are safer for mothers than c/sections, with some medical studies indicating that the chance of death for a mother is 7 times higher when delivered by c/section versus vaginally. Contrary to popular belief, a c/section is a *major* operation, not unlike a hysterectomy in it's complexity and potential complications! "

"An unfortunate side effect of our legal system is that many women are led to believe by malpractice lawyers that a c/section will prevent any and all problems for their baby. This is simply untrue and is a very unsophisticated way of looking at this major operation and pregnancy in general."

ICAN Vision Statement

2009-02-01T13:14:00.000-05:00

ICAN Vision Statement
A healthy reduction of the cesarean rate driven by women making evidence-based, risk appropriate childbirth decisions. The International Cesarean Awareness Network, Inc. (ICAN), is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).
ICAN Statement of Beliefs
We, the International Cesarean Awareness Network, Inc., believe that:
1. The inappropriate over use of cesarean surgery is jeopardizing the lives of mothers and babies.
2. When a cesarean is necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved.
3. Birth is a normal physiological process. Research shows that with emotional support, education, and an honest opportunity, the vast majority of women can have a healthy vaginal birth.
4. A healthy birth incorporates emotional, physical, and spiritual well-being.
5. Research shows that VBAC is reasonable and safe for both mother and baby. A repeat cesarean should never be considered routine; it is major abdominal surgery with many risks.
6. It is unethical and unenforceable for hospitals to institute VBAC bans. Women have the right to refuse any procedure, including a cesarean.
7. Women have the right to true informed consent and refusal, which entails full knowledge of the risks and benefits of all tests, drugs, and procedures.
8. It is incumbent upon every care provider and institution to facilitate the informed consent process.
9. Women must be allowed to express all their birth related feelings in a safe and supportive environment. The emotions of a pregnant and birthing woman have profound effects on the birth outcome and recovery.
10. It is unethical for a physician to recommend and/or perform non-medically indicated cesareans (elective). Women are not being fully informed of the risks of this option in childbirth, and therefore make decisions based on cultural myth and fear surrounding childbirth.
11. The trend of elective cesareans is being significantly overstated through distortion of research and data.
12. We as women must now assume more responsibility for our own births.
13. It is critical that women's choice of care provider and location of birth is respected.

Birthing under Labels

2009-01-30T16:50:00.002-05:00

"Birth is birth. Women are women. We’re not mothers, wives, primips, multis or “the VBAC in room 3”, we’re women. We’re women at work, women in the home, women in the revolution and women when we birth. And birth, is just birth."

"Let us leave the acronyms to those who seek to remove our humanity and have the power in naming our own births. No more FBAC, VBAC, HBAC, EBAC, UBAC, BAC, whatever. Don’t give in to the powermongers, and fearmongers, just give birth. "

Above selections excerpted from http://www.joyousbirth.info/articles/onbirth.html

Questioning Early Inductions

2009-01-29T20:19:00.003-05:00

'New Research Shows Why Every Week of Pregnancy Counts'
Tuesday, December 23, 2008 The Wall Street Journal Online Health

http://online.wsj.com/article/SB122999215427128537.html?mod=rss_Health_Journ

Conscious Birth Affirmations

2009-01-28T20:36:00.000-05:00

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From U-Tube user birthecology, http://www.youtube.com/user/birthecology