ICAN of DC

39 weeks isn't that long

2011-03-01T07:13:00.000-08:00

How many times have you heard (or said yourself) "I am so ready for this baby to just get here already"? Many women are told by their care provider that 37 weeks is long enough for the baby to develop. But this simpy is not true, nor is it based upon current research. Much has been brought to light about inducing and cesarean birth before 39 weeks. How as much as a day or two can mean the difference.

In this article in the Wall Street Journal, the problems with early and especially convenience deliveries are outlined well. Respiratory and neurological problems in the immediate and long term are common. Insurance companies are taking note as well and partnering with such groups as March of Dimes to ensure that women are encouraged to gestate for as long as possible.

Upcoming Teleseminar on Birth from Karen Brody

2010-11-03T10:58:00.000-07:00

November 19, 2010
1:00pm-2:00pm

This tele-seminar will discuss preparing for your pregnancy and birth. It looks like an excellent resource for mothers-to-be and a good way get useful information in a world of misinformation.

To learn more about the tele-seminar or to register go to:

http://birthsecrets.eventbrite.com/

Support H.R.5807: The REAL MOMS Bill

2010-10-21T06:52:00.000-07:00

Recently the Maximizing Optimal Maternity Services for the 21st Century bill was introduced in Congress. It needs our support and the support of our legislative bodies to become a reality. In this bill there would be more educational funding for more midwives (CNM and CPM) and family practice doctors to enter the workforce. These care providers offer lower-cost, less intervention heavy care for pregnant women. This adds up to less cesareans and better care for women in general. It also helps to increase the awareness of the public regarding racial disparities and evidence-based medicine. This can help close the gaps in maternity care.

True to form the American Congress of Obstetricians and Gynecologists have introduced their own "MOMS" bill. They have taken some of the key points of the MOMS Bill introduced in July and turned them around to suit OB/GYNs. Is this a surprise that a lobbying organization to protect the interests of OB/GYNs should do this? No, but it is underhanded to name their bill an approximation. And it takes the collaborative aspect out of the equation and reinforces the paternalistic nature of the current medical maternity model.

So please support the MOMS bill introduce by Congresswoman Lucille Roybal-Allard. Let ACOG know you cannot be swayed by clever relabeling and faulty research. Let your Congressperson know you stand for evidence-based, low-cost and effective maternity care from an array of providers.

Rethinking "Too Posh to Push"

2010-10-12T14:19:00.000-07:00

A recent study in the United Kingdom has come out that takes a closer look at the "Too Posh to Push" phenomena. For many the idea of a truly elective (no medical indication, just preference) seems like a good way to make the rising cesarean rates appear like they are consumer driven. But it seems like that is not the case. While there do exist truly elective cesareans and repeat elective cesareans, they were not found in the study to be a majority or even a strong contender for majority within the causes for cesareans studied. Many of the cesareans in the study were the result of a medically indicated factor like breech or a repeat cesarean.

While this still does not excuse the rapidly increasing cesarean rates, it does take some of the blame off women. Because in many cases the mothers may have chosen an elective cesarean without medical indication due to lack of informed consent or fear of trauma. It seems unfair to label these women "too posh to push" if they are consenting to a cesarean based on faulty knowledge of recovery and risk to subsequent pregnancies.

And for the women who feel they are truly educated before they consent to an elective cesarean, we can only hope them a safe surgery and speedy recovery. It would be sour grapes to hope for them to have an adverse outcome simply because of birth choice.

Doulas and Cesarean Section

2010-10-09T10:01:00.000-07:00

I recently found this in response to a query about finding doulas on a local expectant mother listserv:

Word to the wise...when choosing a doula, make sure that the contract you sign does not state that they can keep your money (or half of it) if you end up going into pre-term labor or have a c-section.

Not taking anything away from the mother who went through this, but is a doula really irrelevant within the confines of a cesarean section? While I understand that many hospitals have in place protocols that allow for only one support person in the operating room, can a doula enhance your experience when you have a cesarean birth?

According to this checklist on Pregnancy Today, a doula can help in many ways though the process of cesarean; be it scheduled or emergency. If the doula is comfortable with the process and knowledgeable, she can in fact enhance the process. For many families they are so wholey unprepared so it can be a blessing to have an objective support person there who is not part of the medical team to help guide you and your partner through the process. Here is one mother's story about how her doula facilitated her cesarean birth. She was thankful for her doula.

So perhaps instead of amending the contract to state that the doula will not get paid in the case of the cesarean birth, you should have an open and honest conversation with the doula you are interviewing about her services if you end up with a cesarean. Many mature and responsible doulas are able to work with clients appropriately and interface with the hospital staff to make the process a little less scary and clinical.

Defining "Unnecessary"

2010-10-04T09:49:00.000-07:00

Many women feel that their cesarean section was "unnecessary". They felt that, given a different set of criteria and birth setting, they should have been allowed to have a vaginal birth. Recently a obstetrician wrote this piece titled "The Myth of the Unnecessary Cesarean". In this article he explains how he finds the term tiring and incorrect. But for many women, his arguments fall flat.

He argues that one could not conclusively say the cesarean was necessary or unnecessary since you cannot guarantee birth outcome either way. Sure, "hindsight is 20/20" plays a big role in the term "unnecessary", but that does not mean it cannot be a legitimate term. If the cesarean, that was medically indicated at the time of incision, was precipitated by a series of interventions that were NOT indicated, would this not be deemed unnecessary? No one is saying that definitively the woman would have gone onto a vaginal birth. They are just saying given the terms of their OWN birth, they felt it was not necessary to have been coerced/rushed into the cesarean.

And as to elective cesareans, it could be said that many of them are "unnecessary" as well. It could be possible that a woman who is having an "elective" cesarean was not given true informed consent (realities of risk for this pregnancy, future pregnancies and a realistic expectation of recovery) or was expected/forced to have a repeat procedure due to lack of support for VBAC (vaginal birth after cesarean).

Birthing Beautiful Ideas also has an eloquent post devoted to this topic. I think this blogger also understands the sentiment of women who have had cesarean birth and the emotional/physiological/psychological impact of an "unnecessary" one.

Multiple Cesareans Present Increased Risk to Placenta

2010-09-29T06:22:00.000-07:00

This video from NBC 4 in NYC is making the round on the blogs. It tells the story of a NJ woman who discovered she had placenta percreta (placenta growing through the uterine wall) and placenta previa (placenta covers the opening of the cervix) during her pregnancy. She had 3 prior cesarean births and did not realize that they presented an increased risk for placental abnormality.

She luckily found out about the complication before birth as it would have presented an issue for increased risk of hemorrhage and/or hysterectomy. The comments from both the mother and the physician interviewed are important.

The mother comments, "if you haven't given yourself the chance at labor, you should". This is a woman with 3 previous cesareans. While we do know her circumstances exactly, we can guess that her 2nd and 3rd cesareans were scheduled. If she were given the chance to have a trial of labor and successful VBAC, her odds of developing placental abnormalities would not be as high.

And the doctor comments, "if we don't do anything about decreasing cesarean section rates in this country we are going to have a lot of mothers who are going to lose their lives". NJ had a cesarean section rate of 40% in 2009.

Update:

According to Rixa's Stand and Deliver blog, the journalist quoted the 40 deaths wrong. There were 42 maternal deaths total, with 12 of those being attributed to "preventable loss" such as placenta acreta. This is still a disturbing number of deaths.

Test to Predict Necessity of Cesarean?

2010-09-25T09:26:00.000-07:00

According to this BBC article, there are now European companies using a test to determine if a prolonged labor will result in cesarean section. They base the outcome on the presence of lactic acid in the body. The higher the acid, the more likely it is that the uterus will become fatigued and not be able to birth.

Could this test be a good thing that would allow mothers to go one with longer labors if their acid levels remain low or another tool to further burden women with more unnecessary cesarean sections? Looking at the article it seems like it would swing more towards the latter. The doctors interviewed did not seem to grasp what could be the cause behind the increases in prolonged labors: artificial inductions, no positional change, lack of motility, etc. Perhaps they should look into fixing the standard hospital birth experience before coming up with more technology to interfere with a natural life process.

My Body Rocks Cesarean and VBAC Workshop

2010-09-22T07:29:00.000-07:00

Karen Brody, playwright and activist who created "Birth", is holding a workshop in the DC Metro area for women who would like to tell their cesarean and/or VBAC story. This workshop combines storytelling, movement therapy and yoga nidra.

For more information please visit her website. She also offers a pregnancy circle. I had an opportunity to talk to Karen recently about this workshop and it sounds like a wonderful opportunity for all mothers who had cesarean births and VBACs.

http://www.mybodyrocksproject.com/index.html

VBAC Success Predictor Tool: Helpful or Junk

2010-06-21T19:20:00.000-07:00

There is a tool on this website for the purpose of prediciting your potential percentage of success for VBAC. While many would consider such a tool suspect, it can be useful as just another reminder that VBAC is possible a lot more than the standard 4%-10% that we find in most areas.

But with such factors as "BMI" and race as the only determining factors, one can wonder if perhaps they are missing the point. For many women who prepare for VBAC there are several things (emotional and mental support, supportive practitioner and increased healthy lifestyle to name a few) that help them acheive success. And for others still the same set of criteria do not ensure success.

It is hard to imagine that you could plug in a set of numbers and yes/no answers and come up with a set way to determine who will be successful. But it is just another tool, even if it isn't the most useful.

ACOG Articles Highlighting a Potential Change in Perspective

2010-06-19T21:06:00.001-07:00

In this recent post on Our Bodies Our Blog, two recent articles regarding the American Congress of Obstetricians and Gynecologists and their take on the recent forums and studies on VBAC and the rising cesarean rate.

The first is an article from Obstetrics and Gynecology. It highlights the fact that the current VBAC policy of ACOG limits, if not outright denies, the option of vaginal birth after cesarean for most women. It also touches on the subject of informed consent.

The second article is a synopsis from an address given to the ACOG annual meeting. The physician giving the commentary discusses the need to tone down and reassess the current use of induction and cesarean surgery. His tone is encouraging to those who hope to see current trends in maternal care reversed and women given the opportunity to have a say in their own care.

Women Deliver Conference 2010

2010-03-24T12:28:00.000-07:00

Often as we work towards lowering the cesarean rate and improving maternal care in DC, we forget that there is another side to the coin. There are places in the world with poor outcomes where a higher cesarean rate would be a blessing. To shed some light on the plight of women and girls throughout the world Women Deliver is holding a conference in the DC area in June 2010.

From their website:

Women Deliver 2010, a global conference, will be held in Washington DC on June 7-9, 2010. The theme of the conference is: "Delivering solutions for girls and women," and we plan to focus on political, economic, social/cultural, and technological solutions. This global meeting will expand on Women Deliver's hallmark of inclusivity, reaching out to new partners and new communities. With all these partners in one room, we will further prove that maternal and reproductive health is a global priority. Women Deliver 2010 will move the dialogue to the global arena with two strong messages:

•The MDGs will not be achieved without investing in women.
•There is just enough time, if the world commits funding now, to achieve MDG5 — additional US$10 billion annually by 2010 and US$20 billion by 2015.

For more information or to register to attend the conference, please visit their website.

VBAC Petition: Please sign!

2010-03-24T06:20:00.000-07:00

VBAC Access Petition

Please sign this petition to the American Congress of Obstetricians and Gynecologists (ACOG). The authors of the petition and those who sign it are asking that ACOG look at the recent position statement from the National Institute of Health on vaginal birth after cesarean (VBAC). ACOG has stated a rather strict (and some say hardly feasible) set of guidelines for choosing a candidate for trial of labor (TOL). According to the NIH statement, they should rethink their position on VBAC access and include the mothers themselves in the decision making process.

ICAN of DC is Looking for Birth Pictures/Stories

2010-01-23T07:58:00.000-08:00

In April, we would like to hold a multimedia presentation called "Positive Birth: Images to Inspire". But for this even to be a success, we need your birth pictures and stories. We are looking for your pictures and the accompanying stories of your empowering home/birth center/hospital birth, we would really appreciate it. Please know that this will be part of a presentation that will be shown to the public. Thank you for your support of ICAN of DC.

(If you would like to donate please email me.)

Upcoming Midwifery Booth at NBC Health Fair

2010-01-09T09:05:00.000-08:00

There will be a health fair at the Washington DC Convention Center sponsored by NBC 4next weekend (January 16-17, 2010). At this health fair will be a booth sponsored by the Citizens for Midwifery. They are looking for women willing to speak to others about their positive experiences with midwifery care and/or homebirth. If you are interested in volunteering an hour, please contact:

Cynthia Warren watershedrangers@gmail.com

This is an excellent opportunity to reach an audience that may not normally have much exposure to the midwifery model of care and/or homebirth.

Recent Washington Post Article on Breech

2010-01-05T18:56:00.000-08:00

Today in the Washington Post there was an article about the safety and prevalence of vaginal breech births. Breech is a common reason for primary cesarean sections; something that some mothers and obstetricians are beginning to question. In the article it talks about a flawed study in 2000 that resulted in the thought that across the board cesarean section was indicated for all breech presentations. However since then this article has been questioned as many of the providers who performed the breech extractions/births were not skilled enough in breech birth to attend the women. This provided the authors of the study with inadequate data regarding the true safety of breech.

Recently in Canada the breech protocols were changed and doctors were encouraged to support vaginal breech deliveries under a limited set of criteria. This is promising as vaginal delivery of a breech baby would limit the need for many primary and secondary cesareans. Of course, fear of litigation is a driving factor as not all breech births (or births in general) have a necessarily desired outcome. But that should not limit the ability of other mothers to try. True, individualized care is what is appropriate for women, not fear-based protocols.

And also accepting that not every breech presentation is appropriate for vaginal delivery is another important factor to changing the mindset. It is almost universally accepted that footling breech and transverse presentations are not a good candidate for vaginal birth. That is not to say women have not successfully delivered this way, it is just not optimum for success. For more information about breech and breech vaginal deliveries please click here for the ICAN article on breech.

Upcoming NIH Conference on VBAC

2010-01-04T10:35:00.000-08:00

In March the National Institute of Health (NIH) will be hosting a conference on vaginal birth after cesarean (VBAC) nearby in Bethesda, MD. This conference will be free and open to the public. If you cannot attend the conference, it will be broadcast live via webcam.

This will be an interesting event. Many of the speakers lined up and the topics seem to point to a resistance towards positive outcomes for women looking for vaginal birth after cesarean. I think it is important to have some represenation of mothers who have had successful and empowering VBACs to attend, especially for the Public Discussion on the 10th. It will be interesting to see what the outcome of this conference is. Hopefully not more of the same with a smattering of lip service played to women who are looking for true choice for their maternity care and birth options.

ICAN Presents New Date

2009-12-30T12:15:00.000-08:00

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

2009-12-28T13:21:00.000-08:00

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

2009-12-17T19:41:00.001-08:00

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

2009-12-11T08:40:00.000-08:00

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

2009-12-01T08:02:00.000-08:00

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

2009-11-19T09:00:00.000-08:00

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

2009-11-16T08:30:00.000-08:00

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

2009-11-02T17:45:00.001-08:00

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

2009-10-22T06:53:00.000-07:00

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"

2009-10-19T10:10:00.000-07:00

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

2009-10-18T10:50:00.000-07:00

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

2009-10-17T07:54:00.001-07:00

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!

2009-10-14T08:32:00.000-07:00

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

2009-10-13T09:46:00.001-07:00

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

2009-10-08T07:44:00.000-07:00

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

2009-10-01T07:05:00.000-07:00

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

2009-09-23T06:11:00.000-07:00

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

2009-09-22T08:07:00.001-07:00

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?

2009-09-18T07:18:00.000-07:00

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

2009-09-16T07:43:00.001-07:00

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

2009-09-16T06:42:00.000-07:00

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

2009-09-10T08:28:00.000-07:00

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

2009-09-09T08:24:00.000-07:00

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

2009-09-08T08:03:00.000-07:00

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