ICAN Presents New Date

This event was rescheduled because of the unexpected snowstorm. We hope that all who had previously gotten tickets will be able to attend. There are still a few tickets left. Thank you for supporting ICAN of DC.

ICAN of DC is pleased to present a free showing of the film, "It's My Body, My Baby, My Birth" on Sunday January 10, 2009 at 3:00pm at the Marting Luther King Jr Library (901 G St NW Washington DC) in room A-9. This excellent film tells the story of 7 mothers and their journey to natural childbirth.

Limited amount of tickets left. Hopefully the weather will cooperate this time.


The schedule will be as follows:

3:00pm: Welcome
3:15pm-3:45pm: Film
4:00pm-4:30pm: Dicussion: Birth Choices in DC


To get a ticket to this free event please visit:

http://icanofdcpresents.eventbrite.com

Space is limited, so please make sure you get a ticket.

The District of Columbia chapter of the International Cesarean Awareness Network provides an online forum for women seeking information about cesarean prevention, recovery and support for healthy and non-surgical birth after cesarean surgery(VBAC)

For more information about our monthly meetings or to join please visit our Yahoo! Group page:

http://health.groups.yahoo.com/group/icanofdc/

Maternity Care and the Military

In the Washington DC Metro area it is a pretty good chance you or someone you know works for one of the branches of the military. So that means many of the active duty members and their spouses are covered by TRICARE. In looking at TRICARE's page regarding maternity care, it does not look like it gives a lot of options. Maternity care is expected to be carried out at an MTF or military treatment facility. However there is a catch if the local MTF does not provide obstetrical services:

If the local MTF does not provide obstetric services, the service member's primary care physician can refer her to a civilian provider.

So does this mean that in theory the primary care physician would refer to a midwife or a family physician? Would they consider out of hospital births? According to a local nurse-midwife, there are versions of the TRICARE plan (Standard and Prime) that allow for homebirth and out of hospital birth, but it takes some doing.

Why is this important? Well, because if a woman covered by TRICARE is limited to her MTF for care and her MTF has a high rate of cesarean or does not allow VBAC, that is not much of a choice is it. Many women with non-military insurance face these limitations as well, but they are not promised insurance for risking their lives or having their spouses risk their lives.

That being said, a study designed to find ways to reduce primary and repeat cesarean found that military hospitals represented lower rates for both compared to civilian plans. This was found to be the result of cost saving measures by a managed care plan rather than any special consideration towards physiological birth.

A Happy End to a VBAC Ban Story

Many people read about Joy Szabo's journey from pregnant mom looking for a repeat VBAC to fight with local hospital complete with threatening court-ordered cesarean if she arrived in labor to her eventual move to Phoenix to be able to have a trial of labor. Well as CNN reports, Ms Szabo had a successful and wonderful VBAC. It is a real happy ending to a journey that no woman should have been forced to take.

Pregnancy is a time of anticipation and excitement. It is also exhausting and sometimes a little scary. It represents the great unknown. Sure birth is wonderful and trusting it is the right of every woman, but what is going to happen with your body and your birth. And unfortunately many women do not get the support necessary or the informed consent/education required to make decisions that are truly in their best interests. They get instead anecdotal advice and scare tactics. And that is not to say it does not come from both sides.

What women really deserve is clear-cut information that allows them to make their own "best decision". And doctors and hospitals should be able to listen and work with women in a fair and equal partnership without the fear of unnecessary litigation or protocol that benefits the overhead of the hospital.

Postpartum Depression and Men

Even though most people generally associate it with new mothers, postpartum depression can affect fathers as well. As highlighted in this NY Times article, it is poorly understood and less diagnosed than should be, perhaps.

This may be of greater importance to families that experience birth trauma related to an unexpected cesarean. Some studies have shown that postpartum depression increases in frequency among women who have had a cesarean birth. And since studies have shown depression in a partner leads to increased depression in the other partner, we can conclude that more fathers of children born via cesarean experience postpartum depression.

When many women join support groups like ICAN to talk through the experience, men are often left out for various reasons. Part of this is the societal expectation that men do not talk about their feelings and may not have any claim to feelings about the birth. But neither thought is appropriate as men are as entitled to talking about and expressing their feelings as women and men are usually half of the equation in a birth. And men often find themselves left out of the postpartum experience. They return to work, they cannot breastfeed, etc.

So how to help men through postpartum depression? It varies from person to person based on personal history of depression and such, but the first step is for the father to find a professional who will understand and validate their experience. As stated before this may be the most difficult hurdle as men often do not know how to express what is wrong. So it may be beneficial for the mother to share signs and symptoms of postpartum depression with their partner before the birth.

Another option is to work together as a couple to create as healthy and open an environment as possible before the baby is born. This will not guarantee no postpartum depression afterward, but it will help you get through it as a couple easier. Some good resources for expectant fathers are popping up recently as well:

http://www.fatherstobe.org/
http://www.fathersatbirth.com/
http://theothersideoftheglassthefilm.blogspot.com/

HIV/AIDS and Elective Cesarean

Since today is World AIDS Day, ICAN of DC is discussing elective cesarean for HIV positive mothers. This is a topic most people do not think about when they think about cesarean or women healing from cesarean. But it is one worth discussing, especially in the District of Columbia where the HIV/AIDS rate is at at least 3% of the population which is on par with certain areas of Africa.

So what special considerations does an HIV-positive woman have during pregnancy? During pregnancy she should be taking antiretroviral drugs to lower her viral load. In doing this she can lower the risk of transmitting the virus to her fetus in utero and at the time of birth. She should also be avoiding unnecessary tests that would disrupt the membranes within the womb and potentially expose the fetus to maternal blood (ie. amniocentesis,etc). And of course a healthy diet is essential since the mother will have increased nutritional needs and lower immune response compared to a mother who is not HIV-positive.

But what sort of birth is appropriate for a mother who is HIV-positive? According to this article, if the mother's viral load is less than 1000 copies/ml, then she may attempt vaginal birth. But that birth must have special considerations as well. The less interventions the better to keep the likely hood of maternal blood/cervical fluid transmission low. If a woman's viral load is above 1000 copies/ml, then an elective cesarean prior to rupture of membranes is the course of action recommended to bring risk of transmission to 8%. But of course cesarean and HIV-positive status means a longer and more difficult recovery time for a woman who has a compromised immune system.

So where does that leave most HIV-positive women who are pregnant? Without the proper resources the mother is staring down an elective cesarean. With proper treatment and a care provider who is knowledgeable about HIV transmission and pregnancy, the same mother could have avoided a major abdominal surgery. Ultimately the decision is up to the mother and her decision for what is best for the health of herself and her child, but it is nice to know that there is a choice and different paths to follow safely.

Upcoming December ICAN of DC Event

ICAN of DC is pleased to present a free showing of the film, "It's My Body, My Baby, My Birth" on Sunday December 20, 2009 at 3:00pm at the Marting Luther King Jr Library (901 G St NW Washington DC) in room A-9. This excellent film tells the story of 7 mothers and their journey to natural childbirth.


The schedule will be as follows:


3:00pm: Welcome
3:15pm-3:45pm: Film
4:00pm-4:30pm: Dicussion: Birth Choices in DC


To get a ticket to this free event please visit:

http://icanofdcpresents.eventbrite.com

Space is limited, so please make sure you get a ticket.

The District of Columbia chapter of the International Cesarean Awareness Network provides an online forum for women seeking information about cesarean prevention, recovery and support for healthy and non-surgical birth after cesarean surgery(VBAC)

For more information about our monthly meetings or to join please visit our Yahoo! Group page:

http://health.groups.yahoo.com/group/icanofdc/

Local Woman Seeks VBA3C

I came across this video on the main ICAN blog page. It is about a local woman who has had 3 previous cesareans and is pregnant again. This time she would like the opportunity to try for a vaginal labor. Unfortunately she has been denied care by physicians due to the previous cesareans. Whether it is three previous cesareans or one, this is a critical issue for many women throughout the United States.

So what does the research say about the risk of vaginal birth after cesarean? Well, research points to a less than 1% risk in women with primary cesareans with a lower segment transverse uterine incision and a 1%-7% risk for women with a lower vertical incision and a 4%-9% risk with women who have had the extremely rare "T" or "J" incision. Given that most women of childbearing age have a lower segment transverse incision or "bikini cut", this is a very small risk. And though the incidence of uterine rupture does increase with multiple cesareans, it is still a minimal precentage of births that result in uterine rupture. Another side to look at is increased risk of rupture with induction. Research has shown that induction is not safe or indicated for the majortiy of vaginal births after cesarean, but it is still used because of fear of stillbirth or rupture.

So despite the evidence that each mother should be allowed at least a "trial of labor" when uterine rupture is less than 1% and the sucess rate of vaginal birth after cesarean should be 85%, why are more mothers not allowed to at least attempt a vaginal birth after cesarean? As the mother in the video states, many doctors are fearful of litigation. There is an unspoken understanding in the medical community that you will not be faulted for a cesarean section. It is a shame that such fear leads to extreme measures like major abdominal surgery without true medical indication.

November ICAN of DC Meeting

ICAN of DC November Meeting

"Midwifery Model of Care"

November 22, 2009
4:00pm-5:00pm
Healing Arts of Capitol Hill
320 G St NE Washington DC


Have you ever wanted to know more about the Midwifery Model of Care? How does it compare to the standard Medical Model of Care offered by most OB/GYNs? What are your options for midwifery in the DC Metro Area? Come learn more about this topic and meet other mothers who have used midwifery care for their births.

The International Cesarean Awareness Network is a non-profit organization devoted to cesarean prevention and healing. The DC Chapter works to educate and empower local women in their pursuit of their best birth. All meetings are free and open to the public.

More Coverage of Peggy Roberston's Trip to Washington

Thankfully Peggy's story has garnered national attention and is making its rounds through many other blogs and other national media outlets. And she is also making a positive statement not just for health insurance gender discrimination, but for VBAC access as well.

ABC News covered her story for their "Closer Look" segment when she was here. You can watch the video here.

Her story is also used in an ad for health care reform sponsored by the Americans United for Change. You can see the ad here.

Interesting Article on "C-Section Backlash"

In a recent article on the Daily Beast the subject of the cesarean backlash is discussed. While the author attempts to make the article unbiased, it is always in the "eye of the beholder," as it were, to interpret the meaning of the article. You can read the comments to see how across the board each person reacted.

In general, the article brings up important points: women are becoming increasingly discouraged by the current state of maternity care and the options available and the cesarean rate has increased over the past 11 years and continues to do so. But to use words like "angry" and "subculture" implies that the women who join ICAN or begin blogs, etc to heal from birth trauma are somehow fringe or misplacing their emotions. That is a disservice to the women and their experiences.

And to other women to assume that not wanting a primary or repeat cesarean somehow makes you "subculture". That is assuming a blanket acceptance from all women when it comes to cesarean. In general, most women do not assume they will end up with a cesarean. They may be open to induction or epidurals, etc, but they trust that the outcome will be vaginal birth. For some women, the shock and dismay of not getting the vaginal birth they assumed was going to happen is traumatic. For others, the treatment in the hospital creates trauma. Whatever the case, their feelings and response are valid, not angry.

And for what it is worth, the artist of cesarean art they mention in the article was not always anonymous. She used to list a contact email and her name on the website. Unfortunately she received so much hate mail that she was forced to temporarily take the site down and then, once reinstated, remove any and all personal data from it. Her healing passage, that was a help to many women who had experienced similar trauma, was seen as "angry" and "subculture".

Doulas Now Covered Under Insurance

According to a recent email sent out by CAPPA , certified doulas are now able to apply for a National Provider Identification number to submit paperwork for reimbursement for their work. This is a great opportunity for more mothers to have doulas attend their labor. How it will work for doulas getting reimbursed what they would have made is another story. But considering that doulas help women avoid unnecessary interventions and unecessary cesareans, it is very good news.

The change in policy for insurance reimbursement took place October 1, 2009, so everything is still very new. No word yet on what insurance companies and plans have added or will add doula services to their plans since the change took effect. But just to know that there is a legal recognition of what doulas do as part of the birth team is good news.

ICAN Needs Your Help

After a very successful day in Washington, DC, ICAN was asked to provide more stories of discrimination in cases of health insurance. Peggy Robertson did a great job speaking in front of a rather impressive panel of the HELP committee. You can see a video of her testimony here. (Her testimony starts at the 83:59 mark)

So if you or anyone you know has a story about insurance discrimination and cesarean section (higher premiums to out-right denial of benefits), please email your contact information and a brief summary of your story to Gretchen Humphries via email or you can snail mail to ICAN of Ann Arbor, PO Box 48, Stockbridge, MI 49285.

ICAN is coming to DC!

ICAN Advocacy Director Gretchen Humphries and an ICAN member who faced discrimination for cesarean section as pre-existing condition were invited to come speak at a Senate hearing tomorrow. This is very exciting news. The forum is called, "What Women Want: Equal Health Care for Equal Premiums." It is geared towards providing fair coverage for women under private insurance policies.

Unfortunately as it stands now, women should expect to pay higher premiums and be denied potential coverage for "pre-exisiting conditions" such as previous cesarean, previous childbirth in general and even history of domestic abuse. While to the average person such denials seem barbaric and unconstitutional, to an insurance actuary (who job it is to come up with dollars and cents numbers) these women represent an increase in what the insurance company will have to pay out.

Hopefully the panel tomorrow will shed more light onto the unfair practices and out right gender discrimination women face when they apply for insurance.

Rethinking Preterm in Regards to Repeat Cesarean

According to the March of Dimes, preterm is any baby that is born before 37 weeks. They say about 12.8% of all births in the United States are preterm and this rate is steadily rising. But a recent study came out that highlighted the risk of increased complications like respiratory distress and lung/digestive prematurity for babies born before 39 weeks via cesarean section.

In the past the trend has gone towards earlier, repeat cesarean, rather than waiting until closer to term (39 weeks). As this study shows, this has lead to an increase in complications for the baby. And since many of the determinations of gestational age were based on ultrasound and/or a "guess" at conception date, there is a chance that this time frame was off. So perhaps many families went in to a cesarean thinking they had a healthy, term baby only to end up in the NICU.

How can this be helped? With increased research into the incidence of complications regarding cesarean before 37 weeks and a clear VBAC policy that respects women. Many of the women who have repeat cesareans are not given the option of VBAC. And if the hospital is not set up for emergencies that would necessitate cesarean in cases of VBAC, what are the odds that they will have a top-of-the-line NICU to accommodate the newborn in case of complications.

Doulas and Flu Season

Here in DC a local hospital group had declared that only one person may be in the room with a laboring woman at a time. This left many local doulas out in the cold as they were considered "visitor" rather than part of the birth team. Many women (and doulas) were upset about this because they were counting on continuous labor support.

The hospitals logic was that it was too much a risk during this particular flu season because of the added risk of Swine Flu. The CDC and other medical groups consider pregnant women and children under 6 months of age to be especially vulnerable to the Swine Flu, so it understandable that they would want to take some extra precuations for preventing the flu.

But would not allowing doulas into the labor rooms (or even the hospital) violate the rights of the laboring women? Number 15 in the brochure "The Rights of Childbearing Women" put out by Childbirth Connection states

Every woman has the right to receive continuous social, emotional and physical support during labor and birth from a caregiver who has been trained in labor support.

Luckily the hospital group has since, after pressure from consumers and doulas, reversed this policy and added the doula to the list of "birth team" so that they may be allowed into the room with the laboring mother and the father. This is a win for responsible maternity care in the DC Metro area. I can only hope other hospitals will realize the vital role doulas play in labor and birth during this flu season.

October 4-10 is Midwifery Week

The American College of Nurse-Midwives are celebrating National Midwifery Week starting October 4, 2009. This is an excellent opportunity to spread the word about the Midwifery Model of Care. In general, midwives have a much lower cesarean rate than that of other prenatal care providers. It is time midwives of all stripes were celebrated as the necessary care providers that they are. Information is provided on the ACNM website link about hosting a party of your own.

Being Grateful

For many of us who have had a cesarean section, we are often told we should "be grateful" about the experience. Be grateful we have a healthy baby. Be grateful we have the opportunity to have such top-notch medical care. And on and on. And for many of us, this marginalizes our experience as we are not "grateful" for our cesareans.

But for many people who did not have a birth trauma or others in the medical community our reluctance to accept or even embrace the cesarean is baffling. Our grief and feelings of loss are compared and compartmentalized as some sort of affliction of affluence. At least we are not squatting in a mine field, laboring for days. All we had was a minor surgery that saved the life of our babies. Show a little gratitude.

But this is where it gets interesting. The medical community has accepted that other surgeries (even minor foot surgery) do something the the psyche. That surgery has the ability to make us face mortality and puts us at risk, no matter the type of surgery. But all that thought and preparation for any other type of surgery is thrown out the window when it comes to cesarean. Instead the consent forms are brief and options are not discussed. Afterward, the patient is expected to recover quickly and quietly and be happy-go-lucky. But cesarean should be treated as an even more special case than other forms of major surgery. Because the mother has not only faced her own mortality, but the potential mortality of her own child. And she may have also lost a trust in her own body's natural abilities. This kind of loss and mixed-up emotions, combined with the hormone cocktail of postpartum recovery, is often a lot to take in. Instead of support, the women often gets pat answers and judgmental comments.

It is a real shame. And the feelings this "ingratitude" often brings up is something that is difficult to vocalize. Gretchen Humphries of ICAN wrote a lovely piece that may be helpful to read. In it she sums up many of the feelings women experience after having a cesarean.

First Lady Weighing In on Cesarean as Pre-existing Condition

In a recent Washington Post article the First Lady, Michelle Obama weighed in on gender discrimination perpetuated by the health care industry towards women. Because of "pre-existing conditions" like cesarean section or even birth, some women are denied health coverage. For any woman who went through major abdominal surgery, whether out of true need or as an unfortunate outcome of interventions, this is a huge slap in the face. Childbirth should not be seen as a liability by an insurance company, no matter the outcome of labor and birth.

So now that it is out there, what do we as citizens who care about the state of maternity care do about it? Much has been discussed about introducing Certified Professional Midwives into the conversation regarding health care reform to combat the rising cesarean rates. Unfortunately this has not reached the national stage as much as organizations like The Big Push for Midwives or M.A.M.A.S. would have liked. But having someone as public as the First Lady make a mention of the shameful treatment of women by the health care industry, and private insurance in general, helps a good deal. It is now important to keep this dialogue going and let our voices be heard. No one deserves to be denied necessary coverage because of a surgery they may not have asked for in the first place.

What to Do About a VBAC Ban?

The International Cesarean Awareness Network has a new Q and A posted on their website about VBAC bans. This is a very interesting subject. Hospitals enact a VBAC ban under the premise that they would not be able to support the services necessary to be on call for the "catastrophic" emergency that could be a uterine rupture. But if you dig deeper, you realize that this means that they would not be able to handle any emergency situation, should it arise.

So where does this leave women? Often looking for a hospital within a 100 mile radius or looking for care providers outside of the hospital setting. For many women, outside the hospital setting provides them with the support they need without the restrictions of hospital protocol. For other women, they need the feeling of a safety net provided by the hospital setting. In either case, no woman should have to be forced to make a decision about their care that puts them outside of their own comfort zone.

Local Birth Center in the News

Recently the wonderful Family Health and Birth Center and, more specifically, the tireless Ruth Lubic were highlighted on a segment on CBS Evening News. The segment shows the work that Ruth and all of the people who work with her do for the community. Washington DC's infant mortality rate, as highlighted in the segment, is twice the national average. For the nation's capitol, that is a poor representation of the state of birth in the United States. Hopefully more hospitals in the area will take up the initiative of the Family Health and Birth Center and reverse the numbers on infant mortality. Until then I hope the Ruth and the center continue to receive the funding they need to serve all the people of DC. They are such a vital resource for this area.

Location Change for September Meeting

ICAN of DC will have a location change for our September meeting. The meeting will now be held at 628 5th St NE Washington DC 20002. I hope that all who plan to come see the change. The meeting topic again is "Eating for a Healthy Pregnancy." The meeting will be held from 3:00pm-4:00pm.

September ICAN of DC Meeting

September 20, 2009
3:00pm-4:00pm
Eating for a Healthy Pregnancy

Maintaining proper nutrition during pregnancy is key to a healthy pregnancy. But what to eat? How much of each nutrient do you need? This month we will look at what and how to eat to maintain a healthy pregnancy. We will talk about how nutrition and eating properly can prepare your body for a healthy and productive labor and birth. The talk will be led by Janet Brown, LMT a local licensed massage therapist, prenatal yoga teacher and holistic nutritional counselor.

The International Cesarean Awareness Network is a non-profit group
dedicated to cesarean prevention and recovery. All meetings are held
at the Northeast Library 330 7th St NE Washington, DC.

Upcoming Birth Symposium

PERINATAL is an interdisciplinary, multimedia symposium to be held at George Mason University on October 7, 2009, from 9am-11pm. This event is free and open to the public. Click the link to find out more about this event.

This event is shaping up to be a fascinating look at birth and feminism. ICAN of Baltimore's chapter leader Barbara Stratton is one of the speakers. She has worked tirelessly to overturn VBAC Bans in Maryland. This symposium is a great opportunity and resource for the DC Metro area.

Welcome to ICAN of DC

ICAN of DC is the local DC Metro Chapter of the International Cesarean Awareness Network, a non-profit organization devoted to cesarean prevention and recovery and Vaginal Birth After Cesarean (VBAC). ICAN of DC meets each month on the third Sunday of each month. Each month's meeting will cover a topic related to cesarean prevention/recovery and/or VBAC. All are welcome to attend the meetings. We encourage mothers-to-be and their partners, new mothers, birth professionals and anyone interested in learning more about birth and cesarean prevention to come to a meeting and learn more. We offer a wide-range of topics and non-judgmental support for women and families.

This blog will be a place for learning more about upcoming meetings of ICAN of DC as well as interesting birth happenings in the DC Metro Area. It will also be a place to find out more information about cesarean prevention.

Welcome to all! We also invite you to join the Yahoo! Group for ICAN of DC