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.