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/
Wednesday, December 30, 2009
Monday, December 28, 2009
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.
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.
Thursday, December 17, 2009
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.
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.
Friday, December 11, 2009
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/
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/
Tuesday, December 1, 2009
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.
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.
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