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Posts tagged ‘VBAC’

Amazing Woman has an Amazing Home Water Birth

Go GINA GO!

I lit my Blessingway candle in the wee hours of the morning when I saw that her labor at home was underway.

I faced the candle in a window towards her home 1500 miles away.

I like how the reflection makes it appear as though the light keeps spreading west towards her…….

sending love and support…..

Not only did she have a VBAC today–

She had a HOME VBAC !!

AND during Cesarean Awareness Month!

Gina of The Feminist Breeder is one of the most courageous women I have ever met!

Yep- I met her! She invited me … little ole me… to her Blessingway in March when I happened to be in town. I was so incredibly excited to meet her and all her fabulous birth team! Yep- I’m in that Blessingway post she did.

Photo of the TFB Blessingway Group

Here’s one of the beads I gave her for her necklace.

ICAN Cesarean Awareness Bead

Congratulations Gina and John!

Welcome Jolene!

But it’s her story to tell……. Head over to her blog and check the coolest EVER live blog birth event. The whole thing can be read and viewed from last night thru til this morning. The audio and video clips are for QuickTime player and each clip may take a few moments to load before you can push play.

I had it on today … at work… in the NICU and took the opportunity to try to educate..

Thanks for sharing Gina!

I am so so happy for you!

CIMS urges ACOG –> Remove Barriers to VBAC

Received this email alert and thought I’d pass on thru my blog… and encourage all to take action!

It takes 5 seconds to add your name to the list!

e-CIMS Action Alert Sept. 28, 2010

CIMS Urges ACOG to Remove Additional Barriers to VBAC
Join us in asking ACOG to take steps that will increase VBAC, reduce cesareans, and ultimately avoid unnecessary harms to mothers and infants.

In a Sept. 9, 2010, letter to Dr. Richard Waldman, president of the American College of Obstetricians and Gynecologists (ACOG), CIMS and 18 co-signing organizations urged ACOG to revise its current recommendation that VBACs (vaginal birth after cesarean) should take place in hospitals where emergency cesareans are “immediately available.”

CIMS will collect the names of additional organizations and individuals in support of this request through October 31, 2010, and will send the updated list of co-signers to Dr. Waldman. Add your name or your organization’s name now!

This request follows the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC, which found that VBAC is a reasonable choice for the majority of affected women. The NIH also reported that the “immediately available” recommendation was not based on strong support from high-quality evidence and had influenced about one-third of hospitals and one-half of physicians to stop providing care for women who wanted to plan a VBAC.

CIMS and the co-signing organizations also urged ACOG to revise its patient education publications and online consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC. Without transparency about the short- and long-term benefits and risks of routine repeat cesarean and VBAC, women cannot make a truly informed choice about how they want to give birth.

Additional Information:

CIMS Press Release “CIMS Responds to Promising but Conflicting Revised VBAC Guidelines”

American College of Nurse-Midwives Responds to ACOG’s 2010 VBAC Recommendations (PDF)

Take Action: Add your name or your organization’s name now!

NIH Conference on VBAC’S ~ Continuing to Spread the Word

Spreading the word from the NIH VBAC conference….It’s now coming thru via AWHONN Vitals!!!

This is at least a month old news to most birth junkies but….. but I find it encouraging that the news is coming thru from AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses). There are many many nurses and birth professionals out there that haven’t even heard about this conference. I know the big AWHONN convention is coming up in Nashville June 12th, and possibly this topic will be presented somewhere although late to get on agenda. Sometimes the nurses can help educate the docs…… ya think?

One topic on the Nashville Agenda is:

“SOLUTIONS FOR SURVIVAL: Working where Birth is NOT Considered NORMAL”

Boy~ would I love to go to that presentation!!!!!

From the recent AWHONN newsletter~

“Panel Urges New Look at Caesarean Guidelines”
The New York Times, Denise Grady
A government panel recently took steps that will increase women’s ability to find doctors and hospitals that will let them attempt a normal birth after a previous caesarean section. The recommendations came from a panel at a National Institutes of Health (NIH) conference convened to assess why the rate of vaginal birth after Caesarean section (VBAC) has gone from 28.3% in 1996 to less than 10% today. The repeat surgeries are contributing to the growing rates of C-sections in the U.S., which today account for nearly a third of all deliveries. Repeat C-sections were previously deemed safer due to concerns that the uterine scar would rupture, putting both the mother and the baby at significant risk. According to the chairman of the NIH conference, “We found the use of VBAC is certainly a safe alternative for the majority of women who’ve had one prior” C-section, as long as the incision was horizontal and low on the uterus. Approximately 70% of women who have had C-sections are good candidates for attempting a normal birth, and 60% to 80% of those who try succeed. The government panel urged the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists to “reassess” their guidelines, which have rendered many clinicians and hospitals unwilling to allow VBACs. The groups’ current guidelines require that surgical and anesthesia teams be “immediately available” during labor if a women has had a prior C-section. Some institutions were unable to comply, and thus banned VBACs altogether.
Link to Article

Our Cesarean Section Rates still Below the National Average

002I had checked out a post by Jill from Unnecesarean reviewing ICAN’s Press release on the rising Cesarean Rate and how mom’s really don’t realize or recognize how they can reduce their risk for a surgical delivery. It is very good informative post. It’s just totally shameful and pathetic that one third of our nation’s babies are brought in to this world with a surgical delivery! I’ve been present for thousands of births. I remember when the doctors were under pressure to keep their C/S rates down under 20%!! They had to go under peer review when they hit individual rates over 16%. Those days are over.

I have seen many different changes in the field of obstetrics, I am embarrassed that our national rates are now this high! I don’t feel that this is an advancement in maternal fetal obstetrical care. It feels like such a cop out most of the time when you are there in the trenches experiencing the “call” for a C/S time after time for “failure to progress”; “failure to descend”; “arrest of dilitation” etc…etc..

I came across the perinatal statistics and thought I’d share.

Here are our Actual Cesarean Section Rates so far this year January thru September

for nearly 750 births:

  • Total C-Section Rate =   25.8% (monthly range 16.9% to 34.4%)
  • Primary C-Section Rate =  16.4%  (monthly range 12.5% to 23.6%)
  • Primary Rate in labor =    13.4%  (monthly range 8.9%  to 20.0%)

Our average is about a quarter of the births falling below the national average of a third… for now. Can we keep this up?? I hope so. I really hope so. I hope we can even lower it! With a NICU coming in and sicker patients to go along with that… I am hopeful to just keep it where it is. I will do my best to help educate women, co-workers and the doctors I work with.


We Deliver? How about we make it a better delivery?

permission from CartoonStock

permission from CartoonStock

Our Maternity Services

Need Help!

The Maternal Child care delivery system in this country as a whole needs vast improvement. All of these 10 steps as well as the 10 steps to ensure optimal successful  breastfeeding are very important.

These items are sadly grossly misconstrued or ignored by many facilities offering maternity services in this country. I have been having the same discussions and occasional arguments with co-workers  lately on this battle of the newborn baby staying in the moms room overnight!!! I know~ it is a no brainer to those of you who read, research and understand. Many of my co-workers still defend their philosophy that the baby needs to come into the nursery at night so the mom can sleep!!  Many argue with me about labor positions and inductions!! AARRGGHH! I won’t get into our details right now…….

What I have here for you today is NOT new info but I recently reviewed it again as I was searching for evidence to back my discussions with staff. If you haven’t placed this information in your workplace to nudge some resistant peers, I urge you to do so!

This document : THE COALITION FOR IMPROVING MATERNITY SERVICES:
EVIDENCE BASIS FOR THE TEN STEPS OF MOTHER-FRIENDLY CARE
can show you research studies or data which support the ten steps below.

The 10 steps for Mother-Friendly Care from CIMS {Coalition for Improving Maternity Services} taken from their website…..are:

Ten Steps of the Mother-Friendly Childbirth Initiative
For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

  1. Offers all birthing mothers:
    • Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
    • Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
    • Access to professional midwifery care.
  2. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
  3. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
  4. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
  5. Has clearly defined policies and procedures for:
    • collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
    • linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.
  6. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:
    • shaving;
    • enemas;
    • IVs (intravenous drip);
    • withholding nourishment or water;
    • early rupture of membranes*;
    • electronic fetal monitoring;
    • Has an induction* rate of 10% or less;†
    • Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
    • Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
    • Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.
  7. other interventions are limited as follows:

  8. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
  9. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
  10. Discourages non-religious circumcision of the newborn.
  11. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:
    1. Have a written breastfeeding policy that is routinely communicated to all health care staff;
    2. Train all health care staff in skills necessary to implement this policy;
    3. Inform all pregnant women about the benefits and management of breastfeeding;
    4. Help mothers initiate breastfeeding within a half-hour of birth;
    5. Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
    6. Give newborn infants no food or drink other than breast milk unless medically indicated;
    7. Practice rooming in: allow mothers and infants to remain together 24 hours a day;
    8. Encourage breastfeeding on demand;
    9. Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
    10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

I endorse these steps. You can visit their website to also endorse.

Kathy from Woman to Woman Childbirth Education wrote about the CIMS press release on the Need for Transparency regarding the rising C/S rates. Excellent information is discussed here by the CIMS and I enjoyed the discussion between Kathy and RealityRounds.

I also would urge you all to visit and give information to The Birth Survey.

How is your birth place measuring up to these initiatives?

Let’s all continue to make this a better world

in which to give birth!!

No VBAC’s Banned: So Far so Good

iStock_000004564778Small My little hospital is not one of those hospitals which has banned VBAC’s.

We’ve been doing VBAC’s since 1984. Here is our first VBAC story. You may have read and heard that some places had specific policies against a mother attempting a VBAC.  There is really only a small percentage of women who truly are not a good candidate for a vaginal delivery after a cesarean. (Having a previous vertical incision in the uterus for example). There are several places a mother can go to for facts, scientific research, honest information and support if her provider or hospital has denied her an opportunity to VBAC. If this has happened to you, it will be important to do your homework, get the facts and have a really good conversation with your provider. It is important to make an informed choice weighing your benefits and any potential risks.

We do just under a thousand deliveries a year.

From January through July 2009~

We had a 100% successful VBAC rate!!!!

We had 2 mom’s last month that ended up having to go for a cesarean after labor began. I don’t know all the numbers but I had looked over the perinatal data sheets yesterday and I was so very happy to see how we were doing.

Let’s hope we keep it up!

😉

Our HOSPITAL’S First Planned VBAC

I say our hospital’s first planned VBAC (Vaginal Birth After Cesarean)….. however a prelude is necessary because the actual first VBAC I can remember…. totally freaked everyone out. Here are the stories:

Sometime in the mid 70’s -circa 1976, a mom came in to L/D for a labor check. She was near term with some regular contractions, a little bit of bloody show. The nurse calmly wrote her name down in the notebook…. [Yes– a notebook, that’s the only way we kept track of labor checks back in those days. No medical record, no registration, just a name in a book and the day they were here and checked]… She was getting ready to gather more information when the mom said she had a history of a prior C/S.
Suddenly all the nurses were scrambling—“Quick, call the doctor!” “Quick, shave her belly,” “Get the Fetal Hearts” “Call the OR and tell them we have a STAT C/S”…We were all busy quickly getting her ready for the OR.
This little baby, however, definitely had other ideas. The mom told them she had to go to the bathroom…
Someone said: “Not now honey, we’re going to get you to the operating room to have your baby.”
The Mom: “But—I have to go….. AUGHHHH” (loudly grunting)
One of the seasoned nurses threw the sheets back and low and behold, that little baby was crowning!! “Doctor W– No time for the OR– This baby is coming!”
She did deliver vaginally, quickly, and everyone was in a state of shock!
I was thinking– I didn’t think that was possible–they told me once a cesarean always a cesarean—they told me the uterus would rupture–that the mother would hemorrhage. She and her baby were just fine. I realized once again that I had a lot to learn!

Fast forward now to 1984.

I was sent a nicely written post on the VBAC Pendulum by Dr Shelley Binkley which discusses the rise and fall of VBAC’s in the US and makes for very interesting reading. There’s been tremendous controversy surrounding this topic.

VBAC’s were widely discussed in the literature at early to mid 80’s and many women were interested…the doctors???– not quite so sold on the idea.  However, in the late 70’s early 80’s, we had one very progressive young doctor (Dr.B)  in the main OB practice.  He was responsible for many of the advances we had in a more natural approach to childbirth.  He was willing and eager to give this a try. 

I am not sure what he may have discussed in the office with his patients or how he may have selected his first patient who could try for a VBAC.  Knowing him, he may have brought it up to mom’s instead of the mom bringing it up to him. Anyway– sometime in the summer of 1984 we heard we would be having our first VBAC! She was due in December with her second child. Her first baby had been delivered at our hospital by Dr. B via C/S because of some fetal distress.  He knew her history and had full access to her records to know exactly what type or uterine incision she had.  She was young, healthy and continued her pregnancy to term without any complications. She was very excited. 

The hospital staff was a nervous wreck.

Where oh where were we going to labor her so that should ANY complication arise, we could do the fastest C/S possible??? We didn’t do C/S’s on our unit. The OR was down a floor and in another wing!!! Such a dilemma.  They finally decided to use the tiny windowless isolation room of the Recovery Room right outside the OR.  They decided to bring all the equipment from L/D down to that room to see how it all fit. We had a regular bed,overbed table, the fetal monitor, some other IV equipment/meds/ supplies etc.. a chair for dad, stool and sm desk for nurse…all crammed in the room. (OK- we scrapped the desk..that was rediculous) We were literally practicing like when they do separation surgery for conjoined twins!!  Quite the production. 

Ready or not, here she comes…….arriving in labor almost a week late at 40 5/7 weeks.  She was in very early labor much to the relief of everyone involved. OF COURSE I was on duty! OF COURSE I was elected to be her nurse! I was after all, the most prepared (say all my co-workers).  So while other’s got the room ready downstairs, I admitted her. There were no special consents at the time.  My orders were continuous fetal monitoring,  start an IV right away, AND insert a Foley catheter so we would keep the bladder drained, avoid any excess pressure on the uterine scar and keep her from needing to get up.  I also had to do a big shave prep in case of an emergent C/S. We took her down to that tiny closet of a room when it was ready, around noon. She was still in early labor.  The plan was to do a double set-up in the OR for delivery. That meant a whole set-up for a vaginal birth and a whole set-up open for a C/S complete with the entire OR team. They would call them in when she was in active labor. She had progressed to 7 or 8 cm with her first baby before needing a section so the thought was she’d go fast this time. 

Early labor continued into the late afternoon. All the managers involved kept stopping in repeatedly with all the same questions:….. “Is everything alright??”….. “Any problems??” …..”Any sharp pain in the lower abdomen?”….. “Any blood in the urine?”…….. “How about any excess vaginal bleeding?” ……..They were making me crazy.  We didn’t do any Pitocin augmentation. This poor mom was just in bed the whole time, in the closet with the single bright light, moving around when I suggested changing positions. Finally she headed into active labor and then did progress quickly to transition.  The membranes ruptured spontaneosly and the fluid was clear. The baby was great on the monitor!  The mom was a trooper, never complained, always smiling in between contractions, agreeable to whatever we said.  They asked me to stay and I stayed…. long past my shift.  

They called in the OR teams. I wasn’t nervous anymore. Get me alone with my patient– away from the nervous Nellies and we can connect and work together through labor. It helped that I had seen that unplanned VBAC so many years before and that I had tremendous trust in and respect for Dr. B.. He was there past his shift also. I had already helped her through so many contractions. She didn’t have the slightest symptom of problems. I had her pretty relaxed, she went thru transition and headed into the second stage in good shape.  At this point, they wanted to move her to the OR for pushing. I think back and feel so bad for her… She was however, still excited and still very agreeable.  She pushed on the hard delivery table in the OR in front of the assembled teams. Talk about performance anxiety.  She sure had a lot of coaches!!

She delivered and 8lb 14oz boy named Michael later that evening!!! He was 20 1/2 inches long, his apgars were 8 and 8, just needing some blow-by oxygen in the OR.

There were no complications. This mom came back and had a few more VBAC’s ending up with 5 children overall. I don’t remeber how many VBAC’s we labored in that rediculous closet of a room before we would keep them in L&D. 

I admire this mom for her strength and courage. I thank her for all she taught me…taught us..

Michael will be 25 years old this December!

If you like this story or have any interest in how any specific childbirth element was first seen or has evolved, Please comment or contact me! Thanks

Medical Science vs Natural Childbirth 

I sat here to write the story of our first planned VBAC and realized as I scanned my other posts that I had to tell just a little more history to help explain the attitudes of the times.

During the mid 70’s early 80’s… our country was changing in many ways. In the medical world, Obstetrical medicine was becoming more specialized with the development of many subspecialties including  “Perinatology” and “Neonatology”.  Perinatology by definition is the study of the unborn fetus and recently born infant during the first several weeks of life. It was the changing concern of obstetricians from a sole focus on the mother’s health to one which is balanced between the mother’s health and the unborn or newborn. ACOG started to offer a specialty certification exam for perinatology  in 1974, and in 1977, the Society of Perinatal Obstetricians (now called the Society for Maternal-Fetal Medicine) was formed.  The term used to describe a Perinatologist today is a Maternal-Fetal Medicine Specialist.  This specialty is the management of high-risk pregnancies and the assessment and treatment of the fetus. Neonatology (established 1975 by the AAP) is the study of a highly specialized care of the newly born infant especially the ill or premature newborn infant usually hospital based in NICU’s.

Young women were becoming more and more interested in a natural approach to childbirth. People all over the country were driving maternity services to offer the availability of birth options for these moms. The ICEA [International Childbirth Education Association] came to our town in the late 70’s and a local chapter was born. “Freedom of choice based on knowledge of alternatives” in childbirth was a motto on their pamphlet information. There were some individuals in the community going for the new certification of childbirth educators. They were educating some new mom’s about birth options…… that we, the staff hadn’t learned about let alone developed as an option for our patients. Many on the staff scorned this movement. It seemed to me that these changes were all happening at the same time. We were learning about advances in observing and monitoring the well-being of both the laboring mother and her unborn fetus, preventing complications etc…. arising from the research studies done from the emerging sub-specialties. We had one fetal monitor and purchased another. As soon as the specialists found that continuous fetal monitoring was advantageous to picking up potential problems in advance, to possibly avoid or prepare for complications, there was a natural childbirth revolt against the constant recumbent positioning that EFM (electronic fetal monitoring) seemed to require. There were more examples as with IV fluids or access and other routine procedures. The nurses didn’t understand. They were just trying to do what science and our doctors were telling them…[though not always willingly as some were afraid of the newer technology.] To them, this group pushing a natural childbirth movement was the same population that had just wanted to be given drugs, put to sleep and “wake me when it’s over” crowd.  

I realize that although these advances in science and the movement of young people seeking natural childbirth options seemed to happen so close to the same time in my world, it probably didn’t happen this way for all of the country. Here, I really think it probably greatly contributed to the attitudes of nurses and doctors I worked with at the time. Those professionals who just couldn’t relinquish control. They were learning more about the science of birth, of monitoring and couldn’t quite allow or see how the “natural” component could fit in. Those individuals often were guilty of the abuse of professional power, the use of misinformation and the blindness and arrogance to maintain control of the birth process… taking it away from the mother.  Those professionals who should have known better.  They did not know of the rights of childbearing Women, or of general patient rights for that matter. Unfortunately– there are some who still have these control issues.

That’s another story….