I just have to share about a very sweet note tucked into a book that arrived on my stoop today. Both the letter and the book, Artemis Speaks: VBAC Stories and Natural Childbirth Information, were written by Nan Koehler. (The book in 1985, the letter two weeks ago.) Nan says she still has a 1,000 copies of her book "in the barn" but that used book dealers are selling them for $50 a copy. I haven't checked Amazon.
Anyway, in her book it says that Nan is (was?) a traditional birth attendant/botanist/herbalist living in California who was part of the home birth movement back in the day.
In her letter, she remarks that the hormone relaxin is very close to insulin. "One atom different," she writes. "So the solution for easy birth is walking - exercise...to circulation the relaxin in the pelvis."
She also said I should have mentioned that in some cultures there are dietary taboos "that ensure that babies remain smaller - then they are fattened up after birth..." Fair enough. I'd love to know more on this. I bet lots of New York women would buy that diet book.
And then she wrote that the real reason why labor begins at night for so many women is because their hormonal output is greatest at 3 a.m. (when most labors begin) and the low point is 3 p.m., when labor tends to stop. Makes sense.
She also highly recommends castor oil over pitocin. (My response: Anything is better than pitocin...)
She concludes the letter by responded to a section in my last chapter, on the postpartum period, where I discuss various methods traditional midwives have used to dress the cord stump, including cow dung and ashes.
"Cow dung is very sterile," she says. "Check that some more."
Indeed I will!!
Can't wait to read Artemis Speaks.
Friday, February 29, 2008
Thursday, February 28, 2008
Our new baby, installment #28
Much like labor itself, this story may seem to have no end, and to some, it may even be painful. For that, I apologize. But if I could play the role of midwife to my readers, I would say: "Almost there! Don't give up! You've stuck it out this far!"
You would think that I would have many details to share, and that, being a writer by profession, I would have carefully chronicled, perhaps even videoed our planned home VBAC. But I didn't. I didn't want to. I lived every moment of it for myself. So while there were things that I do remember clearly -- the thoughts in my head that played over and over like a skipped record as I was in the birth tub, my lack of self-consciousness, my inability to tell time, my need for silence and the presence of those I knew I could count on -- there are some things about this story I just cannot recall.
I have no idea what my poor husband was doing. I know he was in the room but I did not see him once. My eyes were closed tight. When they were open, I was not seeing. I remember that in that moment, I was dissecting the pain, trying to understand it and get my arms around it. But today, I honestly cannot remember the pain. I cannot explain it. I cannot compare it to anything. Not because it was worse, but because I don't know what it was. I cannot say if I moved from my kneeling position. Ever.
However, I knew the end was near when my hips reflexively thrust forward, uncontrollably. I had read about this. Michel Odent, the French obstetrician credited with "inventing" water birth, calls this, well, something like the reflexive hip thrust! It is nature's way of opening the pelvis to expel the baby. I don't know how many times that thrust happened to me, but sure enough, I felt the head move down quickly. I absorbed the meaning of "ring of fire" and began a high-pitched chant of OW OW OW OW...
The head was out. My midwife reached in. She felt the cord wrapped around the baby's neck. But kept that information to herself.
You would think that I would have many details to share, and that, being a writer by profession, I would have carefully chronicled, perhaps even videoed our planned home VBAC. But I didn't. I didn't want to. I lived every moment of it for myself. So while there were things that I do remember clearly -- the thoughts in my head that played over and over like a skipped record as I was in the birth tub, my lack of self-consciousness, my inability to tell time, my need for silence and the presence of those I knew I could count on -- there are some things about this story I just cannot recall.
I have no idea what my poor husband was doing. I know he was in the room but I did not see him once. My eyes were closed tight. When they were open, I was not seeing. I remember that in that moment, I was dissecting the pain, trying to understand it and get my arms around it. But today, I honestly cannot remember the pain. I cannot explain it. I cannot compare it to anything. Not because it was worse, but because I don't know what it was. I cannot say if I moved from my kneeling position. Ever.
However, I knew the end was near when my hips reflexively thrust forward, uncontrollably. I had read about this. Michel Odent, the French obstetrician credited with "inventing" water birth, calls this, well, something like the reflexive hip thrust! It is nature's way of opening the pelvis to expel the baby. I don't know how many times that thrust happened to me, but sure enough, I felt the head move down quickly. I absorbed the meaning of "ring of fire" and began a high-pitched chant of OW OW OW OW...
The head was out. My midwife reached in. She felt the cord wrapped around the baby's neck. But kept that information to herself.
Wednesday, February 27, 2008
Our new baby, installment #27
The birthing tub, as I had learned the week before labor started by submersing myself in it, brought instant relief in so many way because it took gravity out of the equation. The pressure and weight of a big belly, the inability to move into a comfortable position, these were nonissues in the water. When the home birth midwife suggested I get in the tub, I flung off my nightgown, grabbed an elastic and a headband and twisted my hair into a crazy style, and got in -- quickly -- between contractions, with help. We had set the tub up in the baby's room, which was warm and dark. The house, thankfully, was quiet. I immediately settled into a kneeling position, gripping with white knuckles the side of the tub and pushing my forehead into the padded lip. The midwife checked me for the first time, and said I was fully dilated, after about only 3 hours of active labor. Every time a contraction hit, I marveled at the sound coming from my throat and kept thinking I would wake up our 4-year-old, or the neighbors, as our old town house is attached on two sides. For the next two hours, the only words I remember saying are: "When will this end?" "Soon," was her response.
I also had two constant thoughts running through my head: "Now I know why women considered childbirth the Curse of Eve...because if one did not choose to go through this, and had to do so every couple years, it could make you a very bitter woman."
The second thought was more of a question -- "How many other babies were born in this house, built in 1874? And what was it like for them?"
I also had two constant thoughts running through my head: "Now I know why women considered childbirth the Curse of Eve...because if one did not choose to go through this, and had to do so every couple years, it could make you a very bitter woman."
The second thought was more of a question -- "How many other babies were born in this house, built in 1874? And what was it like for them?"
Sunday, February 24, 2008
Our new baby, installment #26
Continuing my story about planning a home VBAC, when I called the midwife to tell her my water had broken and the fluid was greenish, she very calmly said, "that's OK, about 1/3 of all water is tinged and it's not a problem."
On the other occasions throughout the pregnancy when I needed reassuring (uterine rupture risk? elevated blood pressure? confusion over whether to have a Step B test...)her positive attitude and patient answers propelled me up some hill I could not climb alone. I cannot say how important these little words were. They were little. And they were huge. I cannot say for sure, but I believe that had my greenish waters broken in the hospital, it would have caused more of a stir, which would have made me scared, which would have made me doubt.
On this night, I did not doubt. I gamely timed my contractions on a piece of paper. I broke out into a sweat leaning on my husband and it made me think of all those Hollywood films when the laboring woman has a mop of wet hair. I always thought that was overly dramatic. But I had not worked that hard on a treadmill. Ever.
And when I could not write times anymore, I put down the pen. My husband dialed the phone. The midwife asked to speak with me. She wanted to hear what my voice sounded like. And 10 minutes later the midwife was hauling her bag up the main staircase in our house. She whispered something to my husband, dropped her bag and suddenly a nuclear contraction hit and a sound came from my toes up through my throat. She told me to get in the tub right away.
On the other occasions throughout the pregnancy when I needed reassuring (uterine rupture risk? elevated blood pressure? confusion over whether to have a Step B test...)her positive attitude and patient answers propelled me up some hill I could not climb alone. I cannot say how important these little words were. They were little. And they were huge. I cannot say for sure, but I believe that had my greenish waters broken in the hospital, it would have caused more of a stir, which would have made me scared, which would have made me doubt.
On this night, I did not doubt. I gamely timed my contractions on a piece of paper. I broke out into a sweat leaning on my husband and it made me think of all those Hollywood films when the laboring woman has a mop of wet hair. I always thought that was overly dramatic. But I had not worked that hard on a treadmill. Ever.
And when I could not write times anymore, I put down the pen. My husband dialed the phone. The midwife asked to speak with me. She wanted to hear what my voice sounded like. And 10 minutes later the midwife was hauling her bag up the main staircase in our house. She whispered something to my husband, dropped her bag and suddenly a nuclear contraction hit and a sound came from my toes up through my throat. She told me to get in the tub right away.
Saturday, February 23, 2008
Our new baby, installment #25
So after getting a testy email from my mother, who says I am not blogging fast enough for her taste (yes, she knows it has been school vacation week)I am posting over coffee while my husband cleans up the hot chocolate that our 4-year-old just spilled all over the kitchen.
Where did I leave off?
I was pretty sure I was in labor with intermittent contractions. My husband was rushing home through traffic. I had a car full of groceries and a kid in tow. I emptied the car, thinking it might help me realize if I was, in fact, in labor. With everything put away and my husband home, I began to time the contractions. They were about five minutes apart.
"You should call the midwife," he said.
We called, told her what was happening, and said we were OK on our own for now. She said to call her back as soon as I needed her and she was going to lay down and get some rest. It was about 7 p.m. I wanted to read our son a book before bed. But because I was so huge, and his twin bed sits high, I had been having difficulty reading to him in his own bed. So we all climbed into my bed and plugged in The Polar Express movie. My son and I drifted off to sleep. And then -- S-P-L-A-T. My water broke. It woke me up and I immediately jumped out of bed. My husband ran to get towels. This was no trickle. It was then that I noticed that the waters were tinged, a slight greenish brown.
"Quick!" I said. "Call the midwife!"
Where did I leave off?
I was pretty sure I was in labor with intermittent contractions. My husband was rushing home through traffic. I had a car full of groceries and a kid in tow. I emptied the car, thinking it might help me realize if I was, in fact, in labor. With everything put away and my husband home, I began to time the contractions. They were about five minutes apart.
"You should call the midwife," he said.
We called, told her what was happening, and said we were OK on our own for now. She said to call her back as soon as I needed her and she was going to lay down and get some rest. It was about 7 p.m. I wanted to read our son a book before bed. But because I was so huge, and his twin bed sits high, I had been having difficulty reading to him in his own bed. So we all climbed into my bed and plugged in The Polar Express movie. My son and I drifted off to sleep. And then -- S-P-L-A-T. My water broke. It woke me up and I immediately jumped out of bed. My husband ran to get towels. This was no trickle. It was then that I noticed that the waters were tinged, a slight greenish brown.
"Quick!" I said. "Call the midwife!"
Wednesday, February 20, 2008
Our new baby, installment #24
The cousin is home, feeling better and the hospital says they have no proof it was an infection, at least that was what they said when she inquired if it could be staph...Hm...Don't know why they would put her on antibiotics if it wasn't an infection. But anyway.
As I waited for my own labor to begin, I cleaned the refrigerator (naturally) and had to squeeze in one more trip to the grocery store. I was like a squirrel with a nut, having to put everything in order quickly, before the first frost.
It's amazing how strong the mind-body connection can be. On my way home from the grocery store, with my entire to-do list checked off, and my son picked up from school, I started getting contractions. Of course, it was a Friday and I knew my whole family would be around that night and through the weekend. My husband called to say that he had to stay a bit late for work. I told him he needed to come home.
As I waited for my own labor to begin, I cleaned the refrigerator (naturally) and had to squeeze in one more trip to the grocery store. I was like a squirrel with a nut, having to put everything in order quickly, before the first frost.
It's amazing how strong the mind-body connection can be. On my way home from the grocery store, with my entire to-do list checked off, and my son picked up from school, I started getting contractions. Of course, it was a Friday and I knew my whole family would be around that night and through the weekend. My husband called to say that he had to stay a bit late for work. I told him he needed to come home.
Monday, February 18, 2008
Our New Baby Installment #23
My cousin is still in the hospital with a postpartum infection....
But I figured I would add another installment about my journey toward a home VBAC.
At our next midwife appointment (horns and drum roll, please...) my blood pressure was FINE. Back to normal. I was relieved. My family was relieved. My midwife didn't say 'I told you so.' But she had told me so. I tried to listen. I gagged myself on protein, soaked in the tub, quit working and tried to be nice to my poor husband.
Now, with my blood pressure in the 117/70 range, there were no worries. I was just really eager and centered. When I went home and started cleaning my refrigerator, I knew I was ready for labor.
But I figured I would add another installment about my journey toward a home VBAC.
At our next midwife appointment (horns and drum roll, please...) my blood pressure was FINE. Back to normal. I was relieved. My family was relieved. My midwife didn't say 'I told you so.' But she had told me so. I tried to listen. I gagged myself on protein, soaked in the tub, quit working and tried to be nice to my poor husband.
Now, with my blood pressure in the 117/70 range, there were no worries. I was just really eager and centered. When I went home and started cleaning my refrigerator, I knew I was ready for labor.
Sunday, February 17, 2008
Another birth in the family
I have been a delinquent poster not just because of my own family circus, but because of an extended family drama. We were delighted on Thursday to welcome another baby into the family: My cousin had a baby girl, Elyse. Anyone who has read my book knows that one of the things that inspired me to write about the history of childbirth was trying to understand three generations of births (my grandmother, my mother and aunt, my own) all of which were quite different, and also quite bad. As I was concluding the book, my sister-in-law's twin had a baby, which became fodder, and I ended the book questioning whether my sister-in-law, when she had a baby, would schedule a c-section, as she hoped to do. Well, I've already blogged about my sister-in-law here, who had her baby about 7 months ago. Today, I am focused on my cousin, who had a relatively easy vaginal birth in the hospital with her first son. This being her second child, labor progressed just fine and despite being 7 cm and feeling no pain, she got an epidural. A couple hours later, she had a girl and a few stitches. The next day, she said she felt an unusual amount of stomach pain. And the next day they sent her home. Last night, she raced back to the hospital with a raging infection. Her baby stayed home with her dad. The last three women I have personally known to give birth in a hospital have had to return to treat an infection. And given the post below, this is very frightening in an age when infections are becoming resistant to antibiotics. More women should know that this happens.
Tuesday, February 12, 2008
C-section leads to quadrupal amputation
This is the first installment of a two-part piece being published in the Boston Globe.
http://www.boston.com/bostonglobe/magazine/articles/2008/02/10/saving_monica/
http://www.boston.com/bostonglobe/magazine/articles/2008/02/10/saving_monica/
Our new baby, installment #22
In the days before we were to meet with our home birth midwife again, a few things happened. First, our midwife, who knew I was at my tattered edge with the elevated blood pressure issue and just generally Done Being Pregnant, sent me a long and thoughtful email that basically boiled down to this: Relax. Soak regularly in the birth tub to get used to it (it will also lower the BP). Stay home and listen to your body. Force feed the protein (a homeopathic remedy for elevated BP). Walk twice a day. Let your husband do nice things for you -- and stop yelling at him (I had entered the grouchy phase I am sorry to say...) She wrote many other thoughful words but I will keep those for myself. I was moved that she sensed I could use a pep talk. And it worked. I did as she advised. I did NOT go back to the doctor for a blood pressure check, a decision I came to on my own. And given my recent frustrating experiences going to those medical offices I decided to forgo a Strep B test, embracing instead a prophylactic homeopathy.
At our next appointment, I was eager to see what my blood pressure was.
At our next appointment, I was eager to see what my blood pressure was.
Monday, February 11, 2008
Our new baby, installment #21
Continuing the story of my plan for a home VBAC, I was mulling what to do about Strep B testing, the enormous birthing tub was finally set up, and I was meeting with the midwife for a weekly appointment. It was then that she took my blood pressure and found that in the space of a week, it had jumped from about 115/70ish to 139/80ish, with 140/80 being the benchmark for preeclampsia, a mysterious and potentially fatal afflication for which the only cure is delivery of the baby. Yikes. For the first time, I was worried, even though she did not appear to be. She said she did not think I was preeclamptic; that elevated blood pressure was just one symptom and I had no others. I was swollen but not more than most pregnant women in the last weeks. Still, we agreed to monitor this closely.
The next day, I felt a bit more swollen, so instead of trekking a few miles to my midwife's office, I thought I'd go to the medical practice right next door to my office. In my naivete I thought I could simply call up and ask to have my BP taken. Which I did. And they all but laughed. Who is your primary care doctor, they asked. My primary care doctor had left the state some time ago and I never bothered to find a new one. (There is a shortage in Massachusetts, by the way, and long waiting lists.) Anyway, I was outraged that no doctor or nurse would take my BP, even though I had insurance and saw doctors in that practice.
I quit working that day and followed the midwife's advice to consume as close to 120 grams of protein per day as possible. Not easy to do. I tried to pack in the protein by drinking Kashi protein shakes, eating lots of eggs. It was gross.
A couple days later I felt a bit more swollen and wanted to check my blood pressure again. Although my midwife's office was not far away -- just a few miles -- it was more convenient to go to the medical practice office where my kids go for their pediatrician visits and where I had been seeing a certified nurse midwife for my primary screens and GYN appointments long before I was pregnant. I had not seen an OB in about 4 years, since my first son was born. So, I waddled into the office and asked if I could have my blood pressure checked.
"Do you have an appointment?"
"No," I said, giving her the name of provider I last saw there.
"Why do you want your blood pressure checked?"
I told her it was elevated.
She told me to take seat.
Then someone whom I think was a nurse called me in and asked with big huge eyes and hushed tones what was wrong. I repeated the situation again. She looked very concerned. She asked me what hospital I was delivering at. I stuttered. I said I just wanted my blood pressure checked. She asked me who my OB was. I felt like I was about to be grounded. For some reason I panicked and gave her the name of my last OB. I thought I would get kicked to the curb if I told her straight. Anyway, it was no surprise that when she took my blood pressure it was 140/80. The. Stress. Of. Going. To. That. Office. Was. Awful. She told me to get to the OB immediately.
I left really upset and called my midwife. She told me to go home and rest and offered to come to me to take my BP. It seemed like a silly thing for her to have to do, given that I had closer options.
I demurred, went home and had a protein shake. The next day, I was feeling stubborn. I figured I would go to the local health clinic around the corner from my house, a clinic where people without health insurance go. I knew they would gladly take my health insurance and co-payment and take my blood pressure. They did. It was a few points lower. I skipped the blood tests, went home, and had more protein. I talked my midwife, who reassured me that all was well.
Again she said she would come to me. But I figured I could wait until my next appoinment with her a few days out. At least I hoped I could. In the meantime, I fumed about the health care system.
The next day, I felt a bit more swollen, so instead of trekking a few miles to my midwife's office, I thought I'd go to the medical practice right next door to my office. In my naivete I thought I could simply call up and ask to have my BP taken. Which I did. And they all but laughed. Who is your primary care doctor, they asked. My primary care doctor had left the state some time ago and I never bothered to find a new one. (There is a shortage in Massachusetts, by the way, and long waiting lists.) Anyway, I was outraged that no doctor or nurse would take my BP, even though I had insurance and saw doctors in that practice.
I quit working that day and followed the midwife's advice to consume as close to 120 grams of protein per day as possible. Not easy to do. I tried to pack in the protein by drinking Kashi protein shakes, eating lots of eggs. It was gross.
A couple days later I felt a bit more swollen and wanted to check my blood pressure again. Although my midwife's office was not far away -- just a few miles -- it was more convenient to go to the medical practice office where my kids go for their pediatrician visits and where I had been seeing a certified nurse midwife for my primary screens and GYN appointments long before I was pregnant. I had not seen an OB in about 4 years, since my first son was born. So, I waddled into the office and asked if I could have my blood pressure checked.
"Do you have an appointment?"
"No," I said, giving her the name of provider I last saw there.
"Why do you want your blood pressure checked?"
I told her it was elevated.
She told me to take seat.
Then someone whom I think was a nurse called me in and asked with big huge eyes and hushed tones what was wrong. I repeated the situation again. She looked very concerned. She asked me what hospital I was delivering at. I stuttered. I said I just wanted my blood pressure checked. She asked me who my OB was. I felt like I was about to be grounded. For some reason I panicked and gave her the name of my last OB. I thought I would get kicked to the curb if I told her straight. Anyway, it was no surprise that when she took my blood pressure it was 140/80. The. Stress. Of. Going. To. That. Office. Was. Awful. She told me to get to the OB immediately.
I left really upset and called my midwife. She told me to go home and rest and offered to come to me to take my BP. It seemed like a silly thing for her to have to do, given that I had closer options.
I demurred, went home and had a protein shake. The next day, I was feeling stubborn. I figured I would go to the local health clinic around the corner from my house, a clinic where people without health insurance go. I knew they would gladly take my health insurance and co-payment and take my blood pressure. They did. It was a few points lower. I skipped the blood tests, went home, and had more protein. I talked my midwife, who reassured me that all was well.
Again she said she would come to me. But I figured I could wait until my next appoinment with her a few days out. At least I hoped I could. In the meantime, I fumed about the health care system.
Sunday, February 10, 2008
Thanks
Can I just say that I am grateful for all of the amazing posts I've been getting from this blog's readers. Intelligent. Witty. Insightful. That includes you, mom. You are all keeping me going.
Saturday, February 09, 2008
Pushing back
In response to the ACOG statement on homebirth, The Big Push for Midwives Campaign issued the following press release, quite well done. If you aren't familiar with the Big Push, check out the link below.
PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@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.
“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 (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@kc.rr.com.
#####
PushNews from The Big Push for Midwives Campaign
CONTACT: Steff Hedenkamp, (816) 506-4630, RedQuill@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.
“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 (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@kc.rr.com.
#####
Latest ACOG statement against home birth
On Feb. 6 the American College of Obstetricians and Gynecologists issued the statement below on how the group is opposed to home birth. What is interesting to me is why they are issuing the statement now. A clue comes in the paragraph that begins: "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre." Does this mean ACOG ackowledges that home birth is suddenly trendy? Did you all see the article in Vogue a couple months ago, a favorable essay by a New York City mom who gave birth at home? Perhaps the people at ACOG saw that and got worried... home birth was literally in Vogue...Then of course there is also the Ricki Lake documentary, "The Business of Being Born," which comes out this month on Netflix! I would be worried if I were ACOG, too, as the film makes a compelling case against The System.
The statement goes on to say: "Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades..." (SO WHY DOES THE RATE KEEP GOING UP, NOW EXCEEDING 30 PERCENT, WHEN THE WORLD HEALTH ORGANIZATION ESTIMATES THAT ANY RATE ABOVE 10-15 PERCENT IS DOING MORE HARM THAN GOOD?)..."Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice" (THIS IS A SMALL PERCENT BUT GROWING AS DOCTORS BOTH ALLOW AND ENCOURAGE SECTIONS FOR NO MEDICAL REASON; SCARE THE DAYLIGHTS OUT OF WOMEN WHO THEN THINK THEY MUST HAVE A SECTION; AND REFUSE TO ATTEND VBACS) "and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes." (SO BLAME THE MOM). Nowhere in this statement is there any mention of malpractice fears among OBs, how overly managed labor is resulting in countless iatrogenic problems, leading to even more sections, etc.
Finally, where ACOG questions studies about the safety of home birth (there have been many large-scale ones, recognized around the globe as being well done)it is important to note that in the UK, the government there is actually advocating for MORE home birth, precisely because it is safe and because they recognize that birth in the hospital will almost always end up being more complicated because it is made so by the people who work there. Period.
Anyway, here is the ACOG statement in full. Feel free to write a letter. The address is at the bottom.
Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.
ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).
Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.
Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.
The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.
It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.
ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.
http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
ACOG Office of Communications
202.484.3321
communications@acog.org
The statement goes on to say: "Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades..." (SO WHY DOES THE RATE KEEP GOING UP, NOW EXCEEDING 30 PERCENT, WHEN THE WORLD HEALTH ORGANIZATION ESTIMATES THAT ANY RATE ABOVE 10-15 PERCENT IS DOING MORE HARM THAN GOOD?)..."Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice" (THIS IS A SMALL PERCENT BUT GROWING AS DOCTORS BOTH ALLOW AND ENCOURAGE SECTIONS FOR NO MEDICAL REASON; SCARE THE DAYLIGHTS OUT OF WOMEN WHO THEN THINK THEY MUST HAVE A SECTION; AND REFUSE TO ATTEND VBACS) "and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes." (SO BLAME THE MOM). Nowhere in this statement is there any mention of malpractice fears among OBs, how overly managed labor is resulting in countless iatrogenic problems, leading to even more sections, etc.
Finally, where ACOG questions studies about the safety of home birth (there have been many large-scale ones, recognized around the globe as being well done)it is important to note that in the UK, the government there is actually advocating for MORE home birth, precisely because it is safe and because they recognize that birth in the hospital will almost always end up being more complicated because it is made so by the people who work there. Period.
Anyway, here is the ACOG statement in full. Feel free to write a letter. The address is at the bottom.
Washington, DC -- The American College of Obstetricians and Gynecologists (ACOG) reiterates its long-standing opposition to home births. While childbirth is a normal physiologic process that most women experience without problems, monitoring of both the woman and the fetus during labor and delivery in a hospital or accredited birthing center is essential because complications can arise with little or no warning even among women with low-risk pregnancies.
ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births. Nor does ACOG support the provision of care by midwives who are not certified by the American College of Nurse-Midwives (ACNM) or the American Midwifery Certification Board (AMCB).
Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby. Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death. Unless a woman is in a hospital, an accredited freestanding birthing center, or a birthing center within a hospital complex, with physicians ready to intervene quickly if necessary, she puts herself and her baby's health and life at unnecessary risk.
Advocates cite the high US cesarean rate as one justification for promoting home births. The cesarean delivery rate has concerned ACOG for the past several decades and ACOG remains committed to reducing it, but there is no scientific way to recommend an 'ideal' national cesarean rate as a target goal. In 2000, ACOG issued its Task Force Report Evaluation of Cesarean Delivery to assist physicians and institutions in assessing and reducing, if necessary, their cesarean delivery rates. Multiple factors are responsible for the current cesarean rate, but emerging contributors include maternal choice and the rising tide of high-risk pregnancies due to maternal age, overweight, obesity and diabetes.
The availability of an obstetrician-gynecologist to provide expertise and intervention in an emergency during labor and/or delivery may be life-saving for the mother or newborn and lower the likelihood of a bad outcome. ACOG believes that the safest setting for labor, delivery, and the immediate postpartum period is in the hospital, or a birthing center within a hospital complex, that meets the standards jointly outlined by the American Academy of Pediatrics (AAP) and ACOG, or in a freestanding birthing center that meets the standards of the Accreditation Association for Ambulatory Health Care, The Joint Commission, or the American Association of Birth Centers.
It should be emphasized that studies comparing the safety and outcome of births in hospitals with those occurring in other settings in the US are limited and have not been scientifically rigorous. Moreover, lay or other midwives attending to home births are unable to perform live-saving emergency cesarean deliveries and other surgical and medical procedures that would best safeguard the mother and child.
ACOG encourages all pregnant women to get prenatal care and to make a birth plan. The main goal should be a healthy and safe outcome for both mother and baby. Choosing to deliver a baby at home, however, is to place the process of giving birth over the goal of having a healthy baby. For women who choose a midwife to help deliver their baby, it is critical that they choose only ACNM-certified or AMCB-certified midwives that collaborate with a physician to deliver their baby in a hospital, hospital-based birthing center, or properly accredited freestanding birth center.
http://www.acog.org/from_home/publications/press_releases/nr02-06-08-2.cfm
ACOG Office of Communications
202.484.3321
communications@acog.org
Thursday, February 07, 2008
Our new baby, installment #20
As I was pondering how to handle testing (or not) of Group B Strep, we began to set other plans in motion for a home VBAC, or HBAC. My primary focus was on setting up the birthing tub. Our midwife said her favorite (lucky) tub was one that was six feet around, which sounded enormous. I knew I wanted the tub for labor, but was unsure whether I wanted to actually give birth in it. I thought about the origins of water birth, how in some tropical climates women would have waded in the ocean during labor. I also saw how strongly my midwife encouraged the use of the tub.
We made arrangements with another family who had the tub on loan(that home birth went swimmingly)and were ready to pass it along. The dad dropped off the tub, which was broken down into a large box and several hockey bag-sized duffles. I nagged my husband for days to set it up, which he finally did, in the baby's room upstairs. And then we realized that in our ancient house, with 130-year-old original faucets, no modern hose would connect with them so we could fill the tub!
Eventually, we rigged a board and hose and used gravity to accomplish the job but my husband sat there for hours directing the water into the tub. We treated the water, ran the motor to heat the pool to a safe temperature and put a lid on it to make sure the 4-year-old didn't go for a dip when we weren't looking. I couldn't wait to get in the water, as even our deep clawfoot tub was no longer big enough for me to submerge my entire belly.
We made arrangements with another family who had the tub on loan(that home birth went swimmingly)and were ready to pass it along. The dad dropped off the tub, which was broken down into a large box and several hockey bag-sized duffles. I nagged my husband for days to set it up, which he finally did, in the baby's room upstairs. And then we realized that in our ancient house, with 130-year-old original faucets, no modern hose would connect with them so we could fill the tub!
Eventually, we rigged a board and hose and used gravity to accomplish the job but my husband sat there for hours directing the water into the tub. We treated the water, ran the motor to heat the pool to a safe temperature and put a lid on it to make sure the 4-year-old didn't go for a dip when we weren't looking. I couldn't wait to get in the water, as even our deep clawfoot tub was no longer big enough for me to submerge my entire belly.
Tuesday, February 05, 2008
Our new baby, installment #19
OK. So that was not so brief a pause after all. Whoo.
But I am moving on here, perhaps to even more controversial territory in this serialized tale about a journey back to the future, with a home VBAC.
One of the bigger questions I was facing was: What to do about having a Strep B test? Did I need it? Did I want it? Is it necessary? What were the homeopathic options and were they effective?
I knew that testing positive for Strep B COULD prove fatal to a newborn, which might pick up the bacteria on its way down the birth canal.
These were some of the homeopathtic options up for consideration -- things one might do prophylactically, in place of being tested.
ORALLY:
500-1000 mg Vitamin C with bioflavinoids, twice per day.
Vitamin C is water soluble and extra is excreted by the kidneys.
Eat cranberries and garlic daily; or take cranberry capsules and garlic pearls three times per day.
Plenty of live culture yogurt; or Acidophilus capsules daily.
Bee propolus; or tincture.
Echinacea is very Strep specific, according to one source. As a preventative, use 10-15 drops of tincture in a glass of water twice a day for a minimum of five days. [As a curative, use two cups of E. infusion daily for five days followed by one cup daily for another five days. Continue for a full ten days. If only the tincture is available, use 1 drop per two pound of body weight. (ie.. 150 pound Mama = 75 drops.) Repeat the dose three to four times a day until fever abates, then two times a day for an additional week.]
Estragalus tincture ½ tsp or one dropper full 2 times a day. Can use equal parts with Echinacea tincture.
Note: Tinctures can be purchased in either a glycerine or alcohol base. Might have to special order glycerine based tinctures.
VAGINAL RINSES FOR GROUP B BETA STREP:
Do not douche in pregnancy. Rinse. Go easy. Separate labia and spray externally. Rinse anal area also. Remember to treat your partner.
1. Thyme, Rosemary, Calendula, Yarrow: Mix equal parts of herbs in a bowl.
Take 6 tablespoons of mixture and add 1 quart of boiling water. Infuse in covered
container 4 hours. Strain into a clean jar. Discard herbs.
Use 1 ½-2 cups per time as a rinse.
Optional: Add ¼ cup sea salt, 10 drops of lavender oil, 1 oz Echinacea tincture.
2. Echinacea infusion.
3. After 37 weeks, use Golden Seal gel capsules, deep in the vagina, if possible up
behind the cervix (not in cervix). Can cause uterine contractions.You can use these infusions for Sitz baths too.
4. Some practitioners recommend a very dilute solution of Hibiclens (an over-the-counter product which has in it an antimicrobial skin cleaner), Hydrogen Peroxide (food grade), or a very dilute solution of bleach: one teaspoon in a quart of water as a genital area rinse.
VAGINAL SUPPOSITORY RECIPE:
Place 1 cup Echinacea agustifolia root, cut; 1 cup Usnea lichen, cut; and 1 cup Calendula flowers in a quart jar.
Melt 8 oz. cocoa butter with 16 oz. coconut oil; pour over herbs.
Heat-infuse by placing the covered jar in a crockpot; add water to immerse the jar three-quarters of the way; set on low and cook 12-24 hours. Cool and strain.
To 1 cup of the infused oil add 1 tablespoon of these herbs: Slippery Elm Bark, Comfry Root, and Marshmallow Root.
Add 20 drops of these essential oils: Lavender, Rosemary and Tea Tree.
Chill slightly in an ice cube tray. When blocks are solid, cut them into quarters.
Insert one small cube into vagina before bed.
MISCELLANOUS CONSIDERATIONS:
Use cotton underpants.
Use vinegar or baking soda in the rinse cycle of washing machine when washing your
underpants.
Change your underpants (or panty liner) if damp. Best to go without - to air out!
Use warm water wash from squeeze bottle after pooping, then pat yourself dry.
Beta strep can be more prevalent in conjunction with urinary track infection. Urine should be checked for B-strep in this case.
Yeast infection conditions can give rise to increased Beta strep population.
So...what to do? Sit in a bucket of bleach????
But I am moving on here, perhaps to even more controversial territory in this serialized tale about a journey back to the future, with a home VBAC.
One of the bigger questions I was facing was: What to do about having a Strep B test? Did I need it? Did I want it? Is it necessary? What were the homeopathic options and were they effective?
I knew that testing positive for Strep B COULD prove fatal to a newborn, which might pick up the bacteria on its way down the birth canal.
These were some of the homeopathtic options up for consideration -- things one might do prophylactically, in place of being tested.
ORALLY:
500-1000 mg Vitamin C with bioflavinoids, twice per day.
Vitamin C is water soluble and extra is excreted by the kidneys.
Eat cranberries and garlic daily; or take cranberry capsules and garlic pearls three times per day.
Plenty of live culture yogurt; or Acidophilus capsules daily.
Bee propolus; or tincture.
Echinacea is very Strep specific, according to one source. As a preventative, use 10-15 drops of tincture in a glass of water twice a day for a minimum of five days. [As a curative, use two cups of E. infusion daily for five days followed by one cup daily for another five days. Continue for a full ten days. If only the tincture is available, use 1 drop per two pound of body weight. (ie.. 150 pound Mama = 75 drops.) Repeat the dose three to four times a day until fever abates, then two times a day for an additional week.]
Estragalus tincture ½ tsp or one dropper full 2 times a day. Can use equal parts with Echinacea tincture.
Note: Tinctures can be purchased in either a glycerine or alcohol base. Might have to special order glycerine based tinctures.
VAGINAL RINSES FOR GROUP B BETA STREP:
Do not douche in pregnancy. Rinse. Go easy. Separate labia and spray externally. Rinse anal area also. Remember to treat your partner.
1. Thyme, Rosemary, Calendula, Yarrow: Mix equal parts of herbs in a bowl.
Take 6 tablespoons of mixture and add 1 quart of boiling water. Infuse in covered
container 4 hours. Strain into a clean jar. Discard herbs.
Use 1 ½-2 cups per time as a rinse.
Optional: Add ¼ cup sea salt, 10 drops of lavender oil, 1 oz Echinacea tincture.
2. Echinacea infusion.
3. After 37 weeks, use Golden Seal gel capsules, deep in the vagina, if possible up
behind the cervix (not in cervix). Can cause uterine contractions.You can use these infusions for Sitz baths too.
4. Some practitioners recommend a very dilute solution of Hibiclens (an over-the-counter product which has in it an antimicrobial skin cleaner), Hydrogen Peroxide (food grade), or a very dilute solution of bleach: one teaspoon in a quart of water as a genital area rinse.
VAGINAL SUPPOSITORY RECIPE:
Place 1 cup Echinacea agustifolia root, cut; 1 cup Usnea lichen, cut; and 1 cup Calendula flowers in a quart jar.
Melt 8 oz. cocoa butter with 16 oz. coconut oil; pour over herbs.
Heat-infuse by placing the covered jar in a crockpot; add water to immerse the jar three-quarters of the way; set on low and cook 12-24 hours. Cool and strain.
To 1 cup of the infused oil add 1 tablespoon of these herbs: Slippery Elm Bark, Comfry Root, and Marshmallow Root.
Add 20 drops of these essential oils: Lavender, Rosemary and Tea Tree.
Chill slightly in an ice cube tray. When blocks are solid, cut them into quarters.
Insert one small cube into vagina before bed.
MISCELLANOUS CONSIDERATIONS:
Use cotton underpants.
Use vinegar or baking soda in the rinse cycle of washing machine when washing your
underpants.
Change your underpants (or panty liner) if damp. Best to go without - to air out!
Use warm water wash from squeeze bottle after pooping, then pat yourself dry.
Beta strep can be more prevalent in conjunction with urinary track infection. Urine should be checked for B-strep in this case.
Yeast infection conditions can give rise to increased Beta strep population.
So...what to do? Sit in a bucket of bleach????
Saturday, February 02, 2008
Repeated VBACs are safe; repeated cesareans are not
I am taking a brief brake from my serialized birth story to report on a study out of Case Western that just came out in Obstetrics & Gynecology (2008;111:285-291).
The study's OBJECTIVE: To estimate the success rates and risks of an attempted 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.
Thanks to Carol Sakala at the Childbirth Connection for sending me those...
The study's OBJECTIVE: To estimate the success rates and risks of an attempted 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.
Thanks to Carol Sakala at the Childbirth Connection for sending me those...
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