Response to ACOG's recent statement on Home birth

PushNews from The Big Push for Midwives Campaign

CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill{at}kc.rr.com

FOR IMMEDIATE RELEASE: Thursday, February 7, 2008

ACOG: Out of Touch with Needs of Childbearing Families

Trade Union claims out-of-hospital birth is “trendy;”

tries to play the “bad mother” card

(February 7, 2008) — The American College of Obstetricians and Gynecologists (ACOG), a trade union representing the financial and professional interests of obstetricians, has issued the latest in a series of statements condemning families who choose home birth and calling on policy makers to deny them access to Certified Professional Midwives. CPMs are trained as experts in out-of-hospital delivery and as specialists in risk assessment and preventative care.

“It will certainly come as news to the Amish and other groups in this country who have long chosen home birth that they’re simply being ‘trendy’ or ‘fashionable,’” said Katie Prown, PhD, Campaign Manager of The Big Push for Midwives 2008. “The fact is, families deliver their babies at home for a variety of very valid reasons, either because they’re exercising their religious freedom, following their cultural traditions or because of financial need. These families deserve access to safe, quality and affordable maternity care, just like everyone else.”

Besides referring to home birth as a fashionable “trend” and a “cause célèbre” that families choose out of ignorance, ACOG’s latest statement adds insult to injury by claiming that women delivering outside of the hospital are bad mothers who value the childbirth “experience” over the safety of their babies.

Hundreds of Missouri home birth families in support of midwives fill a Senate Hearing room in 2005

“ACOG has it backwards,” said Steff Hedenkamp, Communications Coordinator of The Big Push and the mother of two children born at home. “I delivered my babies with a trained, skilled professional midwife because I wanted the safest out-of-hospital care possible. If every state were to follow ACOG’s recommendations and outlaw CPMs, families who choose home birth will be left with no care providers at all. I think we can all agree that this is an irresponsible policy that puts mothers and babies at risk.”

The Big Push for Midwives calls on ACOG to abandon these outdated policies and work with CPMs to reduce the cesarean rate and to take meaningful steps towards reducing racial and ethnic disparities in birth outcomes in all regions of the United States. CPMs play a critical role in both cesarean prevention and in the reduction of low-birth weight and pre-term births, the two most preventable causes of neonatal mortality.

Moreover, their training as specialists in out-of-hospital maternity care qualifies CPMs as essential first-responders during disasters in which hospitals become inaccessible or unsafe for laboring mothers. In addition, CPMs work to ensure that all babies born outside of the hospital undergo state-mandated newborn screenings and are provided with legal and secure birth certificates.

Currently, Certified Nurse-Midwives, who work predominantly in hospital settings, are licensed and regulated in all 50 states, while Certified Professional Midwives, who work in out-of-hospital settings, are licensed and regulated in 24 states, with legislation pending in an additional 20 states.

The Big Push for Midwives http://www.TheBigPushforMidwives.org is a nationally coordinated campaign to advocate for regulation and licensure of Certified Professional Midwives (CPMs) in all 50 states, the District of Columbia and Puerto Rico , and to push back against the attempts of the American Medical Association Scope of Practice Partnership to deny American families access to legal midwifery care.

Media inquiries should be directed to Steff Hedenkamp (816) 506-4630, RedQuill{at}kc.rr.com.

Is It Safer to Have Another Cesarean or Attempt a Vaginal Birth (VBAC)?

And the evidence in favor of vaginal birth over repeated cesareans just keeps piling up!
Check out this most recent study, just published in the journal of
Obstetrics & Gynecology
(2008;111:285- 291).

The study's OBJECTIVE:
To estimate the success rates and risks of anattempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs.

METHODS:

From a prospective multicenter registry collected at 19 clinical
centers from 1999 to 2002, we selected women with one or more prior low
transverse cesarean deliveries who attempted a VBAC in the current
pregnancy. Outcomes were compared according to the number of prior VBAC
attempts subsequent to the last cesarean delivery.

RESULTS:

Among 13,532 women meeting eligibility criteria, VBAC success
increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%,
and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively
(P<.001).

The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52%(P=.03) .

The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.

CONCLUSION:

Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy. Contrast that study with another from Obstetrics & Gynecology (2006;107:1226- 1232) which found that there is maternal morbidity associated with multiple repeat cesareans.

OBJECTIVE:

To estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.

METHODS:

Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002). RESULTS: There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay *significantly increased *with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.

CONCLUSION:

Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.

Miscarriage... Is There an Answer?

I think so, and I want to write a book about it!

Several years ago, I was contacted by several women who were having repeated miscarriages. They desperately wanted to have a baby. These women found their hopes soaring several times a year when they would find themselves pregnant, only to be harshly crushed a couple of months later when they began spotting... bleeding... cramping.... staying in bed, calling their doctor or midwife.... and then miscarrying.

Some of them would call me sobbing, saying, "All I want is a live baby! Why can't anyone tell me what's wrong with me? Why doesn't my doctor know what to do? I've done every test that modern medicine has invented and they still don't know why this keeps happening!"

I didn't know any more than their doctors did.
All I could say was, "I'm sure there's an answer somewhere. Obviously, something's wrong, and usually when there is something wrong, there is almost always a way to fix it..."

Their agony of miscarriage after miscarriage compelled me to try to find answers. I read books.
I spent days and months online, researching. I waded through big, fat textbooks, and boring Swedish studies on reproductive health. I read fertility books. I talked to mothers and their doctors and midwives.

I began to find bits and pieces here and there... things that sounded reasonable and helpful. I began forwarding articles and information on to my friends who were struggling with miscarriage.

Before long I began receiving calls - I'm four months pregnant and I'm doing fine!"
Mothers would beam, "This baby is our miracle baby!" and then they'd tell me about taking vitamins, drugs, herbs, hormone supplements, additional testing - all kinds of things that I had found info on.

One of those success stories!

I began to see things that were working for some of these women. They were solving their own problems with lots of information in front of them. They started passing my number on to their friends. Soon I found myself besieged with calls from desperate women from across the country who would call me at all hours, apologizing for their call, but explaining that they were spotting or cramping and thought maybe I could help them because their friend had told them about me.

I really couldn't "prescribe" anything to them. I couldn't tell them what to do. I wasn't a medical professional, and I wasn't their caregiver. But I had several big folders, packed with studies, articles, recommendations from both the medical field and alternative healthcare practitioners.
And now, I had personal stories from women who had live, healthy babies, and credited it to what they had done with both modern medicine and things as simple as herbal teas and healthy foods.

I decided to find the best book to recommend to these women... And I began searching for a "miscarriage bible" - an all encompassing book, explaining miscarriage and it's many causes and a whole range of possible solutions. When I realized it didn't exist, I began looking for a book from the medical model, focused on miscarriage and how to prevent it and a book from the holistic perspective as well. I bought most of the books I could find, but none of them seemed to be what these mothers needed.

So, I decided that I would write the book, since no one else has. I have a lot of information. I need to find a lot more. I need to know more of the most puzzling questions about miscarriage and what women want to know about it. My work on this project has been on hold for nearly two years now, as I have had other things to focus on. But, I want to get back to work on it shortly, because I know that every day there are women looking for answers, and I want them to find them somewhere...

If you have any suggestions, or questions about miscarriage that you would like to see answered, or if you have ideas for studies that you wish somebody was doing, or... whatever you think would be most helpful in the arena of miscarriage, I'm looking for more material and questions.

If you know of anyone who is currently researching miscarriage, or who has a special "remedy" or unique information in their practice, I'm anxiously waiting to hear more!

I'm interested in anything and everything that can be done to prevent a miscarriage - drugs, herbs, surgery, vitamin and mineral supplements, hormones, nutrition, family relationships, essential fatty acids....

I'd like to know what testing is most helpful and practical, and what has not be helpful in determining the causes of miscarriage.

I'd also love to include stories of women who have struggled with miscarriage, and of course, some success stories!

Email me at: betterbirth4you {at} gmail {dot} com.

The Struggle to Be Skinny Enough

It was a few weeks ago. I found myself sitting in a little restaurant, the walls covered with retro advertisements and old Coca Cola signs from the 50’s.

I sat there, sipping my drink and waiting on my food, when the thighs of a bright and smiling girl with bouncy curls on a poster on the wall caught my eye. She wore a yellow pleated mini skirt, and was leaning back, holding her Coke. Her thighs were prominent in the picture and they were so … uh, normal sized. She wasn’t fat, or chubby, but her rosy cheeks glowed. She looked healthy and hearty. I couldn’t stop staring at her. It just seemed so weird to see a model about my size, not rail thin, on the wall.

I spent more time starting at the rosy cheeked girl with a huge smile on the Coca Cola poster than I did eating my food. How different from the models that are held up today as the perfection of beauty, I mourned to myself. The models from fifty years ago weighed far more than the stars of today. They weren't fat; they were healthy weights, with some curves, and actual flesh on their bones!

Angelina Jolie, thin limbs, gaunt and hollow face. Our culture has adjusted to thinking this is as good as beauty gets! Every magazine and billboard shouts out that sharp and stark cheek bones are more beautiful than gently rounded cheeks, legs are more beautiful with nothing but bone, and waists are most beautiful when they are impossibly small.

This is what our girls try to be. They starve themselves, live on diet sodas, protein shakes, low-calorie fillers… binge and purge because of the array of food set before them hourly. …Always feeling fat and ugly and hoping to catch a guy’s attention by getting as skinny as their friends. Size 4 jeans have almost become a status symbol.

Growing up in a culture that values an almost starved look (one that most people cannot obtain in a healthy way) carries over into motherhood.

A few months ago, I was visiting with a pregnant doula client and her husband. This beautiful woman who I’ll call Grace [details changed to protect her identity] is slender – 10-20 pounds underweight, and half-way through her pregnancy weighs less than she should as a non-pregnant person.

Grace was talking about her baby’s movement. I asked if I could touch her belly and feel the baby. She smiled and said, “Of course. He’s right here.” As I laid my hand on her nearly flat stomach (yes, she was half way through her second trimester!), she grimaced and said, “Sorry, there’s a huge blob of fat there. You’ll just have to ignore it.” Then she turned away and looked embarrassed.

Of course, I said something positive back to her about her body, but as I left I wondered how many other pregnant mothers feel the same way about their bodies, not because there is any truth to the way they feel, but because our culture makes them feel that way.

How many women feel like Grace? How many women are starving their babies for fear of “getting fat”?

I’m not advocating obesity or being overweight or gaining a huge amount while pregnant, or pigging out, or…

I’m advocating that women feel pressure to be healthy, not skinny!

New York City Midwifery Care - 1931-1961

The Maternity Center Association, New York City ~ 1931-1961

From 1931 the Lobenstine Midwifery Clinic of New York City, in affiliation with the Maternity Center Association (MCA), offered home birth services to help meet the needs of the most economically deprived and needy families of the upper Manhattan tenements. Between 1931 and 1961, 5,766 mothers registered with the clinic, of which 87% gave birth at home, attended by midwives. Their maternal mortalities were less than one third the national rates of the time. Their average neonatal death rates were only 16 per 1,000, while that of New York City as a whole ranged from 28.9 in 1931 to 18.4 in 1961. These results by the MCA midwives are even more remarkable in light of the fact that poor nutrition was prevalent among their clients. 36.4% of them suffered from secondary anemia, 6.3% tested positively for syphilis and 6% were in their tenth pregnancy. The MCA discontinued its home birth services years ago, but retains its legacy of superior outcomes.

~ From Law, M., Report on the Maternity Center Association Clink, NY, 1931-1951, American Journal of Obstetrics and Gynecology, 69:178-184, 195S.

~ Faison, J., The Maternity Center Association Clinic, NY, 1952-1958, American Journal of Obstetrics and Gynecology, 81:395-402, 1961.

These data and additional studies which I will be posting and crediting to Dr. David Stewart's work have been excerpted from his book, The Five Standards for Safe Childbearing, by Dr. David Stewart, Ph.D. Dr. Stewart is a medical statistician with special education in obstetrics and is one of the leading world authorities in the area of midwifery and home birth statistics. He has been an invited lecturer at meetings of the American College of Obstetrics and Gynecologists (ACOG) and the National Perinatal Association (NPA) and numerous other childbirth-related functions throughout North America. He has served on committees of the American Public Health Association (APHA) and the American College of Nurse Midwives (ACNM). Dr. Stewart is the author or co-author of more than 200 publications, including 13 books. He serves as the Executive Director and co-founder of the International Association of Parents and Professionals for Safe Alternatives in Childbirth - NAPSAC International.

For more information, or to purchase The Five Standards for Safe Childbearing, contact:

NAPSAC International

Rt. 4, Box 646

Marble Hill, MO 63764

Phone/Fax: (573) 238-2010 or

(800) 758 - 8629

A Clearly Defined Risk of Cesarean Birth: Hysterectomy

The American College of Obstetricians and Gynecologists’ “Green Journal” contains some enlightening news in the January 2008 issue that every pregnant woman should know. It’s contained in a report about a very recent study titled, “Cesarean Delivery and Peripartum Hysterectomy” -- Obstetrics & Gynecology, Knight et al, 2008; 111:97-105-

Check it out here: http://www.greenjournal.org/cgi/content/abstract/111/1/97

I hope you have a friend with access to the medical journal who can get you a copy of the complete study. It’s a great resource to keep on hand… and to give to anyone who has been told that “cesarean is about equally safe when compared to vaginal birth”!

The study was a population-based, matched case-control study that studied 318 women who underwent peripartum (around the time of birth) hysterectomy between February 2005 and February 2006 and 614 matched control women. The study was done in the United Kingdom, using the United Kingdom Obstetric Surveillance System.

The conclusion of the study was:

Peripartum hysterectomy is strongly associated with previous cesarean delivery, and the risk rises with increasing number of previous cesarean deliveries, maternal age over 35 years, and parity (number of pregnancies carried to over 28 weeks) greater than 3.

Here are a few of the most interesting and relevant findings of the study:

Women who were having their first cesarean delivery were approximately 7.13 times more likely to end up with a hysterectomy (as compared to an equal control group having a vaginal delivery instead) by the time it was all over.

By the time it was the woman’s second or more cesarean delivery, her risk of hysterectomy was over 18 times greater than the woman having a vaginal birth!

~Women undergoing their first vaginal delivery were found to have a
1 in 30,000 chance of having a peripartum hysterectomy

~Women undergoing their first cesarean delivery were found to have a
1,700 chance of having a peripartum hysterectomy.

~Women undergoing their second cesarean delivery were found to have a
1 in 1,300 chance of having a peripartum hysterectomy

~Women undergoing their third or more cesarean delivery were found to have a
1 in 220 chance of peripartum hysterectomy.

ACOG’s journal said it themselves:

“This study has confirmed the significant risk of peripartum hysterectomy associated with prior cesarean delivery. These data provide evidence that cesarean delivery leads to a greater than seven times increase in the odds of having a peripartum hysterectomy to control hemorrhage. A similar risks was noted in a recent U.S. study using the Nationwide Inpatient Sample. We have also been able to identify that the risk also then extends beyond the initial cesarean delivery into subsequent deliveries; women who have more than one previous cesarean delivery have more than double the risk of peripartum hysterectomy in the next pregnancy, and women who have had two or more previous cesarean deliveries have more than eighteen times the risk. This full quantification of these risks provides the evidence needed to comprehensively counsel women about the risks of primary cesarean delivery and to counsel against cesarean delivery without a specific medical indication.”

The article winds up with a statement:

“Although fortunately a rare condition, peripartum hysterectomy nevertheless represents a catastrophic (and sometimes fatal) end to a pregnancy for any woman, regardless of whether she considers her family to be complete.”

Kudos to your obstetrician if s/he brings up this info when informing you of the risk of Cesarean section birth!

Frank Conversations on Cesareans

Most of the “risk” that we hear discussed for Cesarean section includes the possibility of

~post-operative infection,

~blood clots,

~anesthesia complications,

~damage to the bladder and bowels,

~potential problems with future pregnancies like infertility, miscarriage, placenta accreta

and placenta praevia

~and in some rare cases, even death.

Yet, few obstetricians really cover these potential complications in a way that will give a birthing mother a realistic view of what all her C-section could entail – a whole lot more than her idea of “I’ll be kind of sore for a few days or weeks.”

A friend of mine who recently had an elective cesarean developed blood clots afterwards and was shocked to hear that they could have been a result of how she chose to have her baby. Of course, she could have read up on the potential complications and figured that out herself ahead of time, but really, physicians should either thoroughly inform their patients themselves or see to it that they are reading books and doing research and getting informed during their pregnancies. And more than just reading, “What To Expect When You’re Expecting” or watching birth stories on TV.

Sure, of course, the anesthesiologist comes in and rattles off the usual, “you could die, be permanently paralyzed, etc.” stuff as the laboring mother is doing her best to hold herself together and prepare for the long ride down the hall to the OR, wondering if her baby will be okay. Of course, she nods and says she understands and scribbles her name on the paper in between contractions. But does she really understand what she’s signing up for?

That’s what I wonder. What kind of conversations do doctors have with their pregnant patients about the possibilities of a cesarean? …Not only that it could happen to them for various reasons (some good and some not so good), but that by simply having a cesarean, they are increasing their risk for many more complications.

Do they have frank conversations with their patients about weighing risks and benefits of a cesarean for a non-life threatening issue that comes up in labor (i.e. labor isn’t happening as fast as usual) if they are planning to have more children in the future? Or do they just imply that, “If you end up with a cesarean, trust me, it will be for a good reason to make sure you have a live, healthy baby. Vaginal births are great, but don’t get your hopes too high. You don’t want to be disappointed if it doesn’t work, because, really, your goal is a healthy baby, not how you have your baby.”

What Are the Risks of Cesarean Section?

What are the risks of having a Cesarean section? …The risk of having two, even three C-sections? …For the mother, for the baby?

What are the risks of vaginal birth? …For the mother, for the baby?

If you are the typical American woman wondering about these questions, you’ll probably ask your doctor, perhaps check out a few resources online and see what the most popular pregnancy guide book, What to Expect When You’re Expecting has to say. You might even ask your childbirth educator about c-sections, and she would probably help you feel more prepared for it, by explaining when it is likely to happen and how you may feel about it if/when it happens to you.

Hearing women talk about cesareans has often made me wonder exactly what the average pregnant woman does and doesn’t know about having a c-section when she walks into the hospital to give birth. I’m on a mission to find out…

Is she adequately informed of the risks? Does she have a clear idea of the risks and benefits? Does she know as much about this procedure on her and her baby’s body as she does about purchasing her new car and comparing models?

I checked out What to Expect When You’re Expecting, and no where in its 437 pages could I find even one paragraph informing mothers of the potential risks for themselves when undergoing Cesarean delivery. The most I found for mothers was information on what a C-section would be like and how to be calm as you were wheeled back to the operating room for an emergency c-section, and then what recovery would entail – pain around the incision, possibly nausea and vomiting, possibly referred shoulder pain for a few hours and possible constipation, then it should be 4-6 weeks before you feel completely back to normal.

And this quote to put everyone’s fears to rest –

Question: “My doctor told me I will have to have a cesarean. But I’m afraid the surgery will be dangerous.”

Answer: “Today…cesareans are nearly as safe as vaginal deliveries for the mother, and in difficult deliveries or when there’s fetal distress, they are often the safest mode of delivery for the baby. Even though its technically called major surgery, a cesarean carries relatively minor risks – much closer to those of a tonsillectomy than of a gall bladder operation, for instance.”

Hmmmm…I’ve heard a few other things about cesareans recently. I’ll post them here as I get a chance…

The Making of Mothers

"It's not just the making of babies, but the making of mothers that midwives see as the miracle of birth."

-- Barbara Katz Rothman,
Sociologist, Author of The Tentative Pregnancy,
Genetic Maps and Human Imaginations and other books.

Ina May Gaskin has this quote up on her site: http://www.inamay.com
as the "quote of the week," and I just couldn't resist posting it here.

It's so true. People ask me how midwifery care is different from seeing an OB for a monthly prenatal check-up. Sometimes it's hard to articulate exactly what it is about the Midwives Model of Care that compels mothers who have experienced it to do almost anything to find a midwife for their next pregnancy. People in the medical field are baffled as they almost never come back to the obstetrical model of care. Why?

This quote sums it up, I believe.

A Christmas Wish for Birthing Women

As everyone rushes around, gathering with family and friends for Christmas, baking cookies, piling their cars high with gifts, and eating more than ample portions of Christmas candy and sweets, I’ve thought about what I really want this Christmas.

What I want isn’t tangible, and I won’t get it tomorrow morning as a Christmas gift.

But I still wish for it, for my future, and that of every young woman who will someday face the prospect of pregnancy, birth, and motherhood.

I dream of the day….

~ When pregnant women are honored and treasured by society as life-givers and very special people.

~ When all women will be informed and educated about their bodies, birth, and babies.

~ When maternity care providers will believe that parents are good decision makers when presented with accurate information.

~ When every woman will have access to a midwife, a doula, a physician, a circle of supportive friends and anyone else she needs or wants to give her the best pregnancy possible.

~ When pregnant women walking through the grocery story will hear, “You can do it!” instead of, “I hope you signed up for an epidural! You have no idea how bad it hurts!”

~ When women aren’t expected to have perfect bodies that show no signs of having carried and birthed a baby.

~ When birth and babies again belong to mothers and fathers…. Not the state, not the American Medical Association, not the insurance companies, or the hospitals or obstetricians.

It won’t happen overnight, but it can happen when committed people work to change their own little corner of the world.

You may not be able to transform your local hospital’s policies, but you can educate your daughters, the girls in your neighborhood, your classmates and colleagues about birth.

You may not be able to stem the rising C-section rate, but you can help this mother avoid an unnecessary one.

You may not write a book that improves birth for other women, but you can write a letter to the newspaper about women’s birth options in your area.

You may never get everyone to breastfeed, but you can convince some people of the huge difference it can make in the future health of any baby.

You may never appear on a talk show about birth, but you can talk to your friends about improving birth.

You may never change the world, but you can change your world!