If You Don’t Do This Your Baby Will Die

Seriously?  When it comes to maternity care the emotional tie of a baby’s health can be used unscrupulously.  Of course a mother doesn’t want to do anything that would hurt her baby, but is the emotional blackmail of responses such as these really necessary?:

“Well, if you don’t care what happens to the baby…” “If you don’t do this your baby could die.” “You can choose that if you’re going to take all of the responsibility for the risks and sign this waiver.” ~ What Are They REALLY Saying?

Natural or ‘normal’ birth advocates and educators are sometimes labeled as rebellious, extreme, etc. with the opponents claiming in the same breath to also being focused on healthy birth outcomes.  Kathy Petersen, IC member, muses more about the same team issue.

There may not be an “I” in ‘team’, but there certainly is a “me.”  The only ‘team’ that exists is the one you put together and at its center is you.  You are the “me” in team.  You are an active participant in your birth and that actually benefits your practitioner because you get to give informed consent or informed refusal.   Are practitioners so afraid of the legal system that it’s easier to just have women go along with what makes a lawsuit least likely to arise?  The truth is most consumers don’t want to have to deal with a lawsuit either.  It may appear to be easier and simpler to just go along but it isn’t.  If Big Baby Bull doesn’t help you see ‘malpractice’ intertwined with emotional tugs perhaps a mother or a baby dying from the misuse of the drug Cytotec for an induction (for the suspected big baby??) will.

Informed refusal gets dicey because a practitioner must be able to prove that their client/patient was aware of the consequences of not following a specific protocol.  Yet when it comes to maternity care, a system so fraught with the overuse of technology that many in the field admit they’ve never seen a natural birth, can practitioners really convey to a mother what will happen if they refuse technology?  We can hear that conversation now: “Well, if we just sit here and wait you will have to have this baby completely on your own!”

A practitioner’s ability to understand normal birth is greatly undermined by their own failure to appreciate the litigious environment they created themselves.  ACOG recently admitted, for example, that the guidelines for external fetal monitoring are left open to interpretation.  What they are not making clear to the consumer though is that it is the obstetricians who have failed to understand and deploy external fetal monitoring prudently but it is the mothers who are shouldering the consequences, the fear of malpractice:

“Our goal with the ACOG guidelines was to define existing terminology and narrow definitions and categories so that everyone is on the same page,” says Dr. Macones. One of the problems with FHR tracings is the variability in how they’re interpreted by different people. The ACOG guidelines highlight a case in which four obstetricians examined 50 FHR tracings; they agreed in only 22% of the cases. Two months later, these four physicians reevaluated the same 50 FHR tracings, and they changed their interpretations on nearly one out of every five tracings. ~ ACOG Refines Fetal Heart Rate Monitoring Guidelines, June 2009

Desirre Andrews, IC member and President of ICAN, shares Alexandra Orchard’s experiences spanning six years of trying to achieve a natural birth.   Again, as Alexandra and her family learned, it is not the VBAC itself that is to be feared but rather fear that the practitioner’s judgement, recommending surgical delivery in the first birth, will be called into question is what drives a practitioner’s loathe to attend a VBAC mother.

Last, the public itself is brought into the drama with irresponsible headlines such as this one from the New York Times blog, Refusing a C-Section, Losing Custody of a Baby.

Contrast Alexandra’s letter to her obstetrician (watch the video to the end!) to this scenario ripped from the headlines today over the mother who supposedly lost custody of her daughter solely because she refused a repeat cesarean.

Independent Childbirth supports the natural birth community through the use of quality and self-earned birth knowledge about natural childbirth.  Mothers are the birth experts.  We share normal birth and because we do, more mothers today recognize medical interventions are sometimes needed but they do not justify today’s rate of surgical deliveries, birth injuries and denying mothers of patient rights.  Let calmer heads prevail, that of a thinking mother (who isn’t?) choosing normal birth experienced practitioners who value a mother’s instincts.

**For more on “informed refusal” visit The Risk Management Handbook for Healthcare Professionals.  For more information on the New Jersey case visit Knitted in the Womb and VBAC Facts.

 

Celebrate Women’s Real Birth Wisdom!

The more a midwife speaks to a mother and spends quality time with her, the more likely a mother is to open up and reveal more of her daily routines and habits that can affect her pregnancy and birth.  For example, the midwife will ask a mother the most basic yet critical questions like what is she eating and follow up with nutritional counseling, a topic in which the midwife owns expertise. She’ll ask her what is occurring in her life today, yesterday, expecting for tomorrow. A mother’s every day peace and stress contributes to her body’s sense of well-being and reaching the point where mother and her body believe it is time now to give birth safely and securely.

The psychology of labor is addressed during the med school L&D rotation by incorporating finding other resources for emotional and mental support.  Subsequently we have a number of practitioners in all fields lacking in bedside manner today, but in birth this aspect has an impact intangible to the practitioner but very real to the mother and her family.  The average obstetrical course of education includes fewer than three credit hours in understanding nutrition.  The focus on prenatal nutrition is only a small portion of the syllabus (do your homework choosing a careprovider!).  The home birth midwife also follows the mother into the immediate postpartum and continues home visits to see how mother and baby function as a unit.

It is the midwife who is better versed in delivering babies in various but normal birth situations.  A breech baby can be birthed safer in the hands of a midwife than a hospital attendant.  She has not let her skills fall behind because medico-legal liability has dictated a breech birth to be enough of a risk as to deem a cesarean to be the required course of action; therefore, she continues to hone both her observational and palpating skills.

The American College of Obstetricians and Gynecologists (ACOG), America’s leading organization promoting the benefits of clinical obstetrics in the sterile rooms of trained physicians, has found itself in a dilemma.  The technology and protocols ACOG promotes are the very ones that directly influence our birth statistics negatively.  The birth technology ACOG promotes to prevent or lower risks in birth for both mothers and their babies has not been proven to be beneficial, yet it is used profusely.  Birth in America rarely includes the intimacy of the act that culminated in procreation.  Images of an infant gently caught into its own mother’s arms are so rare that they cause the general public to question the safety of such an event. Debate for and against the licensing of midwifery – and the definition of midwifery itself – is gaining momentum, because statistics for hands off care of normal, natural childbirth are far better than those of managed birth.

In fact, Rebecca Watson of the New Mexico Department of Health has stated, “I sometimes wonder why [we bother compiling statistics on midwives], since their statistics are so much better than everyone else’s.”

While home birth is stereotyped as dangerous because of the lack of medical supervision, it is the lack of that technology and medicine that actually makes birth at home safer than birth in a hospital under today’s protocols.

Studies have shown that once a technology is introduced and mandated, it is difficult to remove it from care practice despite being proven unsafe or unnecessary.  For instance, although the rates involving an episiotomy (cutting the perineum to create a larger opening for the baby to pass through) have dropped drastically since 1980, it is still a common practice.  Ironically, episiotomy rates today are justified as integral to the higher use of vacuum-assisted deliveries or unfounded fears that a baby is stuck because it is a large baby or presenting in a less than optimal position, (posteriors, for example, where a baby faces away from the mother’s back during labor).

America is one of the few nations where birth is managed more with technology than with the hands and eyes of the care provider, but other countries will soon catch up. In a country that boasts technology superior to other developed nations and is not known for undernourishing its citizens, our mothers and babies are faring no better at birth than underdeveloped nations such as Croatia. No improvements have been made in the maternal mortality rate in America since 1982, and  America’s infant mortality rate in the past two decades also has not improved. Our birth technology has increased and the number of routine prenatal screening tests have multiplied since the early 1960s, but our maternal and fetal outcomes have gone progressively backward.

“Despite a significant improvement in the U.S. maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that – essentially – no progress has been made in most U.S. states since 1982. Additionally, the U.S. Centers for Disease Control and Prevention has stated that most cases are probably preventable.” states C.T. Lang in a 2008 obstetrics and gynecology report.  Further, the Centers for Disease Control (CDC) reported in 1983 that the maternal mortality rate in the U.S. was 8.0 for every 100,000 live births (Monthly Vital Statistics Report).  In 1993, the rate was 12.0/100,000 live births (CDC).

Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure (World Health Organization) as well as those that are physician-caused including infection and hemorrhage.  Bacterium can be introduced first by the mother arriving in an environment where diseases are being treated as well as from infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. In addition, there are higher incidences of hemorrhage from forced delivery of the placenta as when a care provider intentionally pulls on an umbilical cord to tear the placenta away from the uterine wall of the mother’s womb. In all instances, normal birth evidence training of the professional birth attendant is critical.

Injuries and deaths related to the physician’s care range from the off-label use of medicine such as Cytotec (also known as Misoprostol) for the inducing of labor as well as the sanctified use of surgical delivery, which gives us embolism, one of the leading causes of maternal mortality and a risk directly associated with cesareans.  Cesarean rates for delivery rose by 46 percent from 1995 to 2006.

Women around the world, the time to look again at the image of women birthing with women versus a medical obstetrical group in normal birth is now. WE can improve global maternal and newborn birth outcomes and experiences. WE know birth. WE know women’s hopes and fears.  A new generation of birth wisdom and experiences is here!

Wishing you a truly happy Mother’s Day secure in the knowledge of your body’s innate wisdom!

Learn more about the wisdom of utilizing your best resource: an Independent Childbirth member led birth education class like Dorene Vaughn’s All Natural Baby!

Visit our comments section (this post) to find some of the most awesome birth wisdom posts our readers have found on the web and to add the ones you’ve found!

 

The Independent Childbirth Woman

Just a quick look at the birth outcomes for Independent Childbirth educator led birth classes led by Sheridan Ripley, Gretchen Vetter, Olivia Sporinsky, Molly Remer, Aimee Crane, Joni Nichols, Ruth Trode, Dale Bernucca, Brandy Segin, Helen Loucado, Sara Wallbaum and Dorene Vaughn.

PLANNED OUT OF HOSPITAL BIRTHS  (132)

Free Standing Birth Center = 45; Planned Home Birth = 55; Planned Unassisted Birth = 4; Unplanned Unassisted Birth = 3; Transfers = 25

Combined Spontaneous, Unmedicated, Unmanaged Vaginal Births = 107

Combined Transfer Medicated, Vaginal Births = 8

Combined Transfer Medicated, Cesarean Births = 2

Combined Transfer Unmedicated then OR for Cesarean = 13

Combined Transfer Unmedicated, Vaginal Births = 2

  C/S Rate for all OOH Births:  11.36%

  Transfer Rate for all OOH Births :  19%

  C/S Rate for Transfers of OOH Births:  60%

 

PLANNED HOSPITAL BIRTHS  (101)

OB Attended = 75; Family Physician Attended = 6; CNM Attended = 19; Other = 1

Combined Spontaneous, Unmedicated, Unmanaged Vaginal Births = 57

Combined Managed, Unmedicated, Vaginal births (i.e. AROM) = 6

Combined Managed (includes pitocin/induction only) Vaginal Births = 25**

Combined Managed Resulting in Cesarean Births = 11**

Combined Spontaneous, Unmedicated, Unmanaged Resulting in C/S = 2

   C/S Rate for all Planned Hospital Births: 12.88%

   C/S Rate for all Managed Hospital Births**:  26.19%

   Percentage of Hospital Births Managed**:  41.58%

 

We did not penalize hospitals by including cesareans from homebirth transfers in their statistics.  We did however include c/s for breech in their statistics because medical training trends have forced those cesareans by no longer training medical practitioners to catch breech babies.

Amber Marlowe anticipated an easy delivery when she went into labor on January 14, 2004. But after a routine ultrasound, doctors at Wilkes-Barre General Hospital, in Pennsylvania, decided that the baby–at what looked like 13 pounds–was too big to deliver vaginally and told her that she needed to have a cesarean. The mom-to-be, however, wasn’t convinced: After all, she’d given birth to her six previous kids the natural way, including other large babies. And monitoring showed that the fetus was in no apparent distress.

After she said no to surgery, doctors spent hours trying to change her mind. When that didn’t work, the hospital went to court, seeking an order to become her unborn baby’s legal guardian. A judge ruled that the doctors could perform a “medically necessary” c-section against the mom’s will, if she returned to that hospital. Meanwhile, she and her husband checked out against the doctors’ advice and went to another hospital, where she later gave birth vaginally to a healthy 11-pound girl. “When I found out about the court order, I couldn’t believe the hospital would do something like that. It was scary and very shocking,” says Marlowe. “All this just because I didn’t want a c-section.” ~ Could You Be Forced To Have A C-Section?, Lisa Collier Cool, Baby Talk Magazine

Although the c-section rate for planned out of hospital births appears to be the same as that for planned hospital births here is the difference:  the c-section rate for planned hospital births doubles when the labors are managed (ANY intervention is used).

The possibility of a cesarean section should be discussed with every patient as part of the patient’s birth plan, with contingent consent for a cesarean section obtained early in the woman’s pregnancy. The woman must sign the consent form herself; her husband should not be asked to sign it. At the time the cesarean section becomes necessary, the woman should be asked to resign the original consent form, indicating that the conditions for needing a cesarean section have now occurred. The fact that the mother may have had some pain-relieving drugs does not render her legally incompetent to acknowledge the need for the procedure. Her husband has no authority to sign the consent to her surgery unless she has given him this right in a power of attorney. If the mother is medically unable to consent because she is psychotic or comatose, the surgery may go forward based on the consent signed as part of the birth plan. – Excerpted from LSU’s Law Center Medical and Public Health Law Site

Practitioners presenting the information for acquiring a mother’s informed consent are not always comfortable with how to explain the procedure they want to do and why they want to do said procedure.

It isn’t always easy for birth practitioners to call their colleagues’ errors to public attention and in the process perhaps admit that they themselves crave a better quality of training.  

It is necessary to call attention to and demand spontaneous, normal, unmedicated, vaginal birth over an intact perineum be the gold standard for birth care.  We do so for the greater benefit to global maternity care.  Independent Childbirth educator members are at the forefront of making a difference.  When women are educated as to all of their birth care choices including planned out of hospital birth our combined c-section rate is 12.02%. The World Health Organization declares no region in the world should have a c-section rate greater than 10% to 15%; based on the cesarean rate for managed births we know our combined cesarean rate could be improved dramatically with increased use of better birth care practices by medically trained personnel.

*In our statistics there were 7 successful VBACs and 2 successful VBA2C; 2 VBACs became repeat CS for a successful VBAC rate of 81.82%.  There were 29 waterbirths.  There was one vaginal breech birth while 5 other breech presentations were automatic cesareans.  All 7 unassisted births were successful, healthy outcomes.  There were four sets of twin births, two with both vaginal but very managed labor, one scheduled c/s for breech at 31 weeks, one singleton born vaginally at term with sibling stillborn vaginally and it was known sibling had died inutero but mother chose to continue pregnancy for her other daughter’s health.  Learn more about gentle stillbirths and remembrance at Now I Lay Me Down To Sleep.

 

Positive Birth

Our thanks to Laura Shanley for catching Birth Love re-open on the web!

For many women, both birth advocates and just your every day mothers (not!), Birth Love was the top, up-to-date birth support site.  It has returned and we recommend you visit Birth Love for great info and great birth choices support.   

Since your tea is likely to get a little cool after spending time zoomng around Birth Love, why not warm it up and return to read some Positive Birth Stories next?

 

ACOG: fear.com/VBAC

Fear is a primal tool for humans to use to protect themselves and our overuse of it is causing Americans to stop thinking rationally in order to make educated choices.  All too often American public policy is driven by fear and that is the worst motivation for action.  Fear motivated calls to action have historically led to both famous and infamous events which we must stop and examine in an effort to avoid failures in American government which leads to personal tragedies in our lives.  We are bombarded every day with messages telling us the right thing to do implying we bring negative consequences upon ourselves ~ and sometimes on others around us ~ if we don’t.  

I first heard this acronym for fear, False Evidence Appearing to be Real, when I began researching the banning of VBACs (vaginal birth after cesarean) in America’s hospitals.  The rate of uterine rupture with a trial of labor ranged anywhere from 0.2 to as high as 1.5 percent (Rinehart).  A uterine rupture sounds horrible and it is.  However, that was the sole impetus for driving a policy to ban VBACs: let’s avoid it by just doing repeat c-sections.  Upon closer inspection however, it is the methods used for managing labor that leads to most uterine ruptures.  An often ignored and misused but very important tool for assessing the risks of labor induction is the Bishop’s Score (University Klinikum Bonn).  This system not only indicates the likelihood of an induction being successful it also provides for induction methods to be avoided. Yes, the original interpretation actually calls for avoiding induction if the bag of waters has ruptured and to consider no induction as an option if mom is a first-time laboring mother.  Boston’s famed research clearly concludes induction is contraindicated for a VBAC, yet induction with VBAC is still done and it is a major cause of uterine rupture.  Women who are unaware that inductions and augmentation in VBACs are a no-no and doctors do NOT have the patience for an unmanaged birth agree to repeat C/S.  Their decision is driven by the atmosfear driving OBs to make more money in less time and by-passing due diligence in confirming a procedure is both safe and justified.  In this example, you see, fear of uterine rupture caused a ban on VBACs in hospitals rather than ensuring medical protocol follows evidence-based research.

The 1940s and 1950s brought us McCarthyism, the fear of communism which is in direct conflict with the American ideology of democracy.  It eventually led to our nation’s Cold War whereby we fought wars on foreign soils in the name of stopping the spread of communism.  We can never forget the tragedy of the Vietnam War nor the total cost to the world over four decades.  The cost of both American troops’ lives and that of both soldiers and civilians in Vietnam including children lives on in infamy (PBS).  Decades of fear driven international policy on foreign soil.  The use of unproven and unsafe technology on women today, or as these mad scientists would call women “maternal environments”, is akin to the Cold War.  As long as its done on someone else’s body in a way that the doctor does not see the depth of his/her actions, well, then it is rationalized to be simply a necessary cost.

Finally, we have the fear of spreading illness as the leading motivator for vaccinating newborns, babies and young women in spite of the record numbers of injury to children in the form of Autism and death to girls and women from the new Gardasil vaccine.  The public should be demanding vaccine manufacturers undertake more expensive but quality trials as well as demand the pharmaceutical companies prove just cause for an aggressive vaccination schedule.  Instead, we continue to push for the restriction of parental rights by actually posing a poll question of whether or not parents who decline vaccinations should be jailed.  Sadly, our government heard the pharmaceutical companies and allowed for them to be protected from major lawsuits before conceding vaccines may be a direct cause of autism.

Fear robs us of our greatest natural skill for protecting ourselves.  Just because the people we face today are not carrying a literal bayonet it doesn’t mean our lives and our babies’ lives are not at stake literally.  In America today women must take the step to seek independent counsel on their birth care options.  We must protect our right to credible information in order to make informed decisions not fear driven decisions.

 

VBAC Bans: Yes there is help

The ICAN offer below is a genuine offer and has been posted through VBACtivism, an organized yahoo support group.  It is our understanding that you should contact the group below if you are seeking help protecting your access to VBAC health care because you have been denied the right to VBAC.  You will be asked to provide information pertinent to your situation and a determination will be made as to whether or not you have a case.  Please, if you’re thinking about contacting the email below, do it!  Just the fact that you are thinking about it is enough to warrant following through.  You and your baby deserve to exercise your rights to choose your health care for yourself.  Write a letter to your careprovider first but don’t wait for a response that may never come, learn more now!

I’m a lawyer with the Northwest Women’s Law Center in Seattle.  I’m investigating possible legal responses to bans on vaginal birth after cesarean at hospitals in the northwest states - Alaska, Idaho, Montana,Washington and Oregon.  If you are currently pregnant and want to have a VBAC, but are facing a hospital policy that would require you to have a c-section regardless of whether you want it and whether it is medically necessary, and are willing to consider working with a lawyer on this, we’d like to talk with you.  Please email us at vbacbanhelp@ican-online.org.  Our services will be provided free of charge.  

 

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VBAC: Before and After ACOG’s Statement of 1999

     California is diverse in presenting both urban and rural hospital settings, education levels, income levels and ethnicity and so we like this paper on the merit of good demographics to draw from and the educated observations made by the authors.  Zweifler et al reported in the Annals of Family Medicine that they also studied the type of data collected on a birth certificate and took into consideration the definitions of infant and mortality rates as utilized on California’s birth certificates versus the World Health Organization’s definition.

     In 1999 ACOG issued its recommendations for VBAC and the guidelines restricted VBAC delivery “attempts” to be made only in hospitals that could respond immediately to emergencies.  The study’s objective was to compare the infant and maternal mortality rates before and after the guidelines’ implementation and secondly, the affect on rural women as their local hospitals were less likely to have immediate access to emergency physicians and services.  In 2004, ACOG reaffirmed its policy and the American Academy of Family Physicians (AAFP) challenged ACOG’s stance in 2006 by analyzing the California Birth Statistical Master Files from 1996 through 2002, three years before and three years after ACOG’s policy was issued and before it went into full effect.  Bad news travels fast.

Some relevant background provided by the authors of this paper:

• Percentage of babies born via cesarean in the U.S. in 1965, 4.5%; in 2002, 26.1%.
• The VBAC lash may be a trend that actually began to show in 1997 and ACOG’s policy is a result of obstetricians discomfort with VBAC for a few years prior to the 1999 ACOG statement.
• Federal reports in the 80’s and 90’s promoted VBAC as a safe and reasonable alternative.  In 1994 and 1995 ACOG promoted VBAC as well for a woman with one previous cesarean of a lower uterine segment incision (low horizontal incision).
• Hospital birth certificates categorized Electronic Fetal Monitoring and Ultrasound exams as “complications.”  Our authors did not place those records into the ‘complications’ category (bravo!).
• Certificate of Live Birth information was used to categorize the delivery method as “Successful”, “Failed” (including delivery assistance other than cesarean) and “Cesarean Section-Repeat.”
• The Certificate of Live Birth codes “unsuccessful attempt at vaginal birth after cesarean section” as a “delivery complication.”
• The Certificate of Live Birth codes maternal death within 72 hours hours of delivery as a delivery complication whereas the World Health Organization (WHO) definition of maternal death is within 42 days.
• The authors calculated infant deaths using the WHO’s definition, newborns living less than 28 days.
• Newborn weights were categorized as follows: <1500g [3lbs) very low birth weight, 1500g to 2499g[3lbs to 5.5lbs] low birth weight, 2500g to 4000g [5lbs to 8.8lbs] normal birth weight and >4000 [8.9+ lbs] large birth weight.
• Rural hospitals may fare better as high risk women identified are transferred to urban hospitals that are better equipped.
• Neonatal morbidity – hypoxic-ischemic encephalopathy and the maternal morbidity – uterine rupture – are not given Certificate of Live Birth codes.  The very reason(s) why ACOG issued their guidelines … and it/they can’t be tracked!

In the years studied 10.9% of all hospital births in California were to women with previous cesareans.  Our researchers believe their results which show a higher VBAC success rate (83% versus the 79% reported by Wall, Deutchman et all in 2005) is due to the lack of clear categorizing of planned and unplanned VBAC deliveries using birth certificate data. 

MATERNAL DEATH RATES     1996-1999          2000-2002

Attempted VBAC                      2.0%                      8.5%

Repeat Cesarean                      8.7%                      11.9%

Total Maternal Deaths w/i 72 hours of delivery: 35

The authors’ results are as follows (Zweifler et al):

• Very low birth weight babies fared the same with VBACs as reported by Riva & Teich in American Journal of Obstetricians and Gynecologists in 1961 (remember our previous post’s claim that there have been no improvements in high risk infant mortality rates in three decades?)
• The above may be attributed to the fact that these births are classified as VBAC even if there was a planned cesarean.  Women with very low birth weight babies who attempted VBAC but “ultimately had cesareans (classified as a failed VBAC) had similar neonatal mortality rates as women giving birth to very low birth weight infants by repeat cesarean section.”  Here’s what shows the quality of these researcher’s knowledge.  They give you a very educated reason for the difference: “..the differences in neonatal mortality rates for infants of very low birth weight may be less a function of attempting a VBAC or electing to have a repeat cesarean section than a reflection of (existing risk) factors.”
• VBAC very low birth weight infants are precipitous and therefore did not have a chance to receive the benefit of steroids prior to birth that have been shown to improve their outcomes (ah, see our previous post on the validity of technology’s effect on ‘saving’ our babies).
• No significant difference in maternal deaths for attempted VBAC v. elective repeat cesarean although it is not possible at this time to narrow down maternal mortality specifics.
• Proportion of older women and black women who attempted VBAC did not decrease after 1999 and that is consistent with national VBAC trends as reported by Menacker in a National Vital Statistics Report of 2001.
• VBAC deliveries declined faster in rural than in urban hospitals in 1999 and that could be attributed the decline in number of family physicians able to provide obstetrical services.  Chalk one up to ACOG for running family physicians, our nation’s previous whole health care experts, out of business.
• Repeating: Neonatal morbidity – hypoxic-ischemic encephalopathy and the maternal morbidity – uterine rupture – are not given Certificate of Live Birth codes.  The very reason(s) why ACOG issued their guidelines … and it/they can’t be tracked!
• Results are dependent on proper coding of birth certificates which are here proven to be subject to misclassification.
• Attempted VBACs were 24% prior to ACOG’s 1999 guidelines and were 13.5% immediately after the guidelines were issued.
• “Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision.  Women with infants weighing [greater than or equal to] 1,500g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery.”

     Perhaps we should have titled this post “Chalk One Up for ACOG.”  Certainly, they legally outmaneuvered family physicians for the right to attend births.  You see with the rise of cesareans and the decline of VBACs how could a family physician fight to keep his/her clients let alone practice best birth care protocols?  How long will you be able to afford the right to exercise your health care options?  

Zweifler, John, Garza, Alvaro, Hughes, Susan, Stanich, Matthew, Hierholzer, Anne and Lau, Monica; Vaginal Birth After Cesarean in California: Before and After A Change in Guidlines, Annals of Family Medicine, May-June 2006

 

VBAC Consent Form

Independent Childbirth is sponsoring Orgasmic Birth screenings across the country. One mother shared a copy of a VBAC Consent Form she was asked to sign.  Many hospitals ban VBAC altogether either legally because their insurance carriers will not protect them or with a “de facto” (in practice) ban.   Some hospitals do still allow them, and this form does a fair job of pointing out the risks and benefits of both a repeat C-section and a VBAC. However, it does not point out that women have up to a 3.6x higher risk of death if they have a C-section versus a vaginal birth. Here is a more complete and detailed list of the risks and benefits of both an attempted VBAC and a repeat C-section, based on the available research. Nowhere on the list does it list the risks of cesarean to the unborn baby. Did you know that your future babies’ health in utero is at risk when a cesarean is performed? This is because the growth of scar tissue cannot be controlled. We know of babies born prematurely as their placentas could not adhere at the scar tissue site from mom’s previous c-section. No, we don’t provide this information to scare you out of having a cesarean. If it’s necessary, it’s necessary. Please, the decision to have a cesarean is a serious one. You deserve to know all of the risks and you deserve to know what care practices can lead to unnecessary cesareans, repeat, unnecessary cesareans.

Many doctors state they don’t want to scare women about the risks of the procedures they use for birth care. Doctor, you need practice in communication skills. Women can handle hearing the truth! The risk of death to their baby is nearly 3 times that of vaginal birth. (This is for low-risk women!) Or, what about these risks now or in the future?

Here is a slightly different VBAC informed consent form, and the preface reads like this, in part:

Although the risks of a uterine rupture with a prior low-transverse uterine scar are not higher than the unanticipated risks of other complications that may arise during childbirth, in some communities, women who wish to try for a VBAC rather than schedule an elective repeat cesarean are often expected to assume responsibility for any or all negative outcomes.

To lower the risk of liability, some malpractice insurance companies in the United States have developed VBAC consent forms that physicians are required to discuss with patients who wish to labor after one or more cesareans. Some of these consent forms overstate the risks for laboring for a VBAC or minimize the risks for planning an elective repeat cesarean.

But some “informed consent” forms just ignore the risks of a C-section altogether! This webpage is just such an example, but it has been annotated by someone who is obviously very pro-VBAC to discuss more of the risk-benefit ratio of the two procedures.

The greatest obstacle to women’s health today is lack of public dialogue. Get yourself to an independent childbirth class where we want to hear YOU. We can provide answers outright and answers that help you discover for yourself what you want from your birth.

 

A VBAC Journal: What Happened in Ten Years’ Time?

THIS ENTRY HAS BEEN EDITED TO CORRECT SOME FACTS RELATED BY “TRACY.” Yes, the stories you will be reading are true stories and experiences that occurred and are occurring.

The year is 1997. The place is Hackensack, New Jersey. A mother awakens in the early hours of the morning to go to the bathroom. She has spent the past two months with an uncomfortable ‘burn’ sensation whenever she rises from a sitting position. She is approximately 32 weeks into her pregnancy and out of habit she checks when she wipes. The paper is dark. She turns on the bathroom light and the amount of blood in the toilet alarms her. She calls her doctor’s office then 911 and then quietly awakens her husband not wanting to awaken her sleeping children. She calls a young woman who has babysat for her in the past. Her husband is trying not to panic but he runs outside waiting for the ambulance to arrive so he can direct them to the correct home.

Upon arrival at the hospital it is determined the birth is going to occur. This is her second spontaneous VBAC. The first occurred in 1995. She is advised by her obstetrician that a vaginal birth is the healthiest birth for her baby to receive every hormone he/she needs to signal to her baby that birth is imminent. Her obstetrician tells her matter of factly that she cannot be given pain medications as those drugs will depress babies’ respiratory systems.

Within hours a beautiful little boy is born. He weighs 4 pounds, 4.5 oz. He is the largest preemie in the NICU. She is pumping and bringing her breastmilk to the hospital for her son. She is there from 4am in the morning when her husband is home from work and she remains until late afternoon with him caring for their daughter until he brings her to the sitter and then comes to see his son and wife for a couple of hours before heading back to work again.

In those days while she is holding her son, singing to him, feeding him her milk and trying to coax him to breastfeed himself the nurses talk to her. It is during those days that she learns it is confirmed her son’s premature birth is due to a placenta abruptia and she learns it is common for pregnancies following cesareans. Two births earlier she had had an unnecessary c-section … they wouldn’t stop with the vaginal exams and fetal scalp blood draws …. she was in distress and her son made it clear he felt her distress.

* * * * *

The year is 2002. The place is Connecticut. A mother dreams a foretelling of an appointment with her doctor where she asks her doctor to talk to her now about cesareans and epidurals. She wants to know ahead of time so she can make choices if there is an emergency. Her next appointment is a deja vu. She asks to speak to her doctor now about cesareans and emergency situations. Her doctor brushes her off and tells her she’s fine. Nothing’s going to happen. Just a few days later her water breaks prematurely at 26 weeks. She is at the hospital and she is told if labor begins attempts will be made to stop it. If the medications do not work the birth will proceed. Nurses come in and tell her to sign this form and that form … one form being for a c-section. She says she is not consenting to a cesarean right now. The nurse states it is only in case of an emergency and she won’t have time to sign a consent form. She asks to talk about the procedure and her options first. The nurse tells her someone will come in after the doctor is finished with his observations of the labor and will talk to her then. No one ever comes.

The labor is proceeding. Within a few hours she feels her child emerging. The doctor sees the baby is a frank breech and pushes the baby back in and up the canal. Her husband sees a lot of blood. Mom is scared and no one is answering her questions. An anesthesiologist shows up and gives her directions to position for an epidural. What epidural she asks? The epidural for her c-section anesthesia. What C-Section she asks? Also, if there is going to be one she wanted general. That’s not a healthy option the doctor says. An epidural it is and it is not until after that she sees she was given a classical T incision but the doctor tells her she is triple stitched.

In the postpartum check ups that follow she has questions about what was done and why. Her doctor responds that she is being difficult and she should be happy her baby is healthy and alive. She responds that she has had miscarriages, her baby was ripped from her body and is still in the hospital away from her so please excuse her for not being easier right now. Two years later she receives her hospital records as she requested and sees no one has written why she had a cesarean or any information regarding the surgery other than she has a classical incision.

The year is 2007. She is pregnant and she is joyful in her pregnancy. She wants to refuse a vaginal ultrasound on the grounds of the previous ones coincidentally preceding miscarriages. She is again accused of being difficult and her doctor is defensive of technology and it’s use is solely to know ahead of time if something is wrong with her baby. She dismisses any connection between ultrasounds and miscarriages. NOTE: “Tracy” miscarried twice, within five months of each other, since her cesarean. Her third miscarriage occurred two days after a more invasive type of ultrasound, a transvaginal ultrasound.

She is unhappy with how she, her thoughts, her research into her options and what is healthiest are dismissed. She wants to birth a different way. With someone who will hear her and who will read the research with her and who knows what normal, spontaneous birth looks like, feels like, smells like.

So she begins her search for answers and she comes across research that lists the order for the risk of uterine rupture based on type of incision as:

low transverse 0.5% [Haq 1988] – 2.0% [Clark 1988]

low vertical 1.3% [Enkin 1989]

classical and inverted T 2.2% – 4.0% depending on the study

upright T and J-incision may be higher; data needs to be found

Frye, Anne “Holistic Midwifery Volume I

She comes across articles that foretell the difficult journey she has ahead, a fight for the right to choose her own health care for her body, for her baby.