Thursday, October 16, 2014

Why Chiropractic Care for the Whole Family?

Many years ago I met Leslie Kasanoff, mother and chiropractor, when she was planning the homebirth of her second child. Since that time I have grown to understand she is a fierce wellness advocate on many different fronts. As a chiropractor Dr. Leslie practices low force or non-force techniques which work gently with your nervous system to help restore structure & function. Through analyzing the nervous system, she can detect where your body is willing to allow change & work with these areas to allow the unwinding of other problem areas. Allowing her to use 'brains instead of brawn'. No pops or cracks needed! Good thing cause she isn't any bigger than I am. Here is what she writes about why chiro care is a cornerstone of wellness.

"So what is chiropractic & how might it help you & your family? The basic tenants of chiropractic have little to do with back pain. Chiropractic theory states (and modern medicine has proven) that misalignments in the spine (subluxation) can put stress on delicate spinal nerves & cause them to misfire. Indeed science has shown us that as little as 10mm of mercury pressure- about the pressure caused by weight of a dime- can cause misfiring of nerve impulses in the spine. If you think realistically about this, you realize you could likely have several areas like this in your own spine right now and be totally unaware of it. Further, all the nerves in your entire body ultimately connect to nerves that enter & exit the spinal cord so when you think about it, every function in your body, from your heart beat to your hormone function to your immune system & more depends on the messages of nerves running into & out of your spine. AND you have NO way of knowing if all these messages are getting through unimpeded or not. The chiropractor’s job is to make sure they Are. 
Well, this all sounds like it makes good sense, you may be thinking; but what is the practical aspect of this? What can I expect chiropractic care to have an effect on? While we can’t say with 100% certainty that chiropractic will have an effect on any particular problem, I can say that in my 25 years experience, the care I’ve provided has had a positive effect on problems as varied as ADHD, colic, asthma, allergies, back pain, headaches, fibromyalgia and more. I can also say that pregnant woman under chiropractic care have easier deliveries & recoveries and that difficulty nursing can often be traced to a baby being less able to latch on to one breast due to spinal subluxation in the neck. The bottom line is that every function in your body will happen better when it is unimpeded."

Most of us don't know the history of chiropractic care and why Americans are so conflicted about utilizing this basic form of health care. This unease keeps them from attaining real health. Dr. Leslie gives us a history lesson and gets to the roots of this distrust.

"As a chiropractor who has practiced for almost 25 years, I continue to be surprised (and a little disappointed) that more people don’t recognize the positive role that Chiropractic care can play in their children’s and in their own lives. Today, I hope to help you understand the value a little better.
Thanks to the medical establishment, most people think of chiropractic in terms of a quick fix for lower back or neck pain. While chiropractic may help with these issues, this represents a very limited view of an art & science that has really been around for thousands of years.
Hippocrates is quoted as having said “in case of disease look first to the spine.” Throughout history there have been practitioners who were the ancient equivalent of the modern-day chiropractor.  In fact, the results chiropractors got during the great flu pandemic of 1917 were one of the major factors that lead to the California Chiropractic Initiative of 1922, recognizing that we are separate & distinct from medicine. But like many other ancient forms of healing, chiropractic fell out of favor with the advent of drugs, surgery and the symptomatic approaches established by modern medicine. While most people are at least aware that chiropractic care exists, herbal medicine, homeopathy & many other forms of care have been so vilified by modern medicine that many people equate them with witchcraft, quackery and worse. The real truth is that most of that is propaganda and organized medicine did, among other things, promote leeches and blood letting well past the 1900’s. It was only their steadfast organization, pressure, propaganda & boycotting of anything non-medical that lead to the decreased popularity of these forms of care. Ultimately, chiropractic is the only non-allopathic healing science that survived this assault (until the recent resurgence of others). In fact, in 1985, the AMA and several other organizations were found guilty of collusion and anti-trust for trying to systematically destroy chiropractic as a profession in the United States.
I bring this up because to this day, people have negative views of chiropractic but have no idea where those views came from. I like to say its like the wallpaper of the way we grew up; so intimately connected with the American view on health, we don’t even see it." 

Recently Leslie joined the staff of Community Health Centers in SLO. She is happy to be able to provide care to many patients who have been unable to obtain it in the past because they have had no insurance coverage. If you have CenCal, Medi-Cal or Medicare, you are allowed chiropractic care and do not need a medical referral. Unfortunately, most chiropractors cannot afford to see these patients (or see them & charge them a discounted cash fee) due to the low reimbursement rate. At CHC, they are a majority of the patients they see. 

So if any of this makes sense to you, Dr. Kasanoff would be pleased and honored to see you and your family. Simply call the Bishop St office at 805-269-0793 or the Casa St office at 805-269-1500 & ask for a chiropractic appointment with Dr. Kasanoff. 

Thanks Dr. Leslie for 25 years of helping families find better health!

Saturday, October 11, 2014

Laboring in a Secret Garden

I never know when I leave my home to join a laboring couple where the journey will take me. Sometimes finding just the right place to labor can be challenging. Driving away from Linda's house I knew from her history she wouldn't feel confident laboring in the hospital. It was also clear to me that as a second time mother her labor could change from 0 to 100 pretty darn fast and being in Arroyo Grande was no longer an option. So where to go on a hot summer day? As luck would have it Dad found us a secret garden, ideal for laboring with the breeze in our hair and the sun on our faces. 

Every birth I witness is indelibly etched into my soul. Some are long and hard; others fast and furious. They are all intense but sometimes within the intensity is a peacefulness; a serenity of love and trust that rises above the physical experience.

Thursday, June 19, 2014

My Heroes

I'm sure you have heard it said that every birth is unique, each its own story. But no one talks about how deeply that story is written into women. Each woman's birth story is carried in their bones and sinews. It has put its stamp on their bodies and breasts and the very energy contained within their cells. This is how they know "birth" to be.

I have been very lucky in my life to able to attend women in birth. I am constantly in awe of womanhood, its power and its grace. Every birth IS a story. I have so many stories jammed in my head and packed into my heart. Some are private stories only shared with a sacred circle. Others are meant to be shared with the world. Some demand to be shared. So it was with my preemie twin vaginal birth. Now I want to speak about cesareans. Next post I'll share a recent positive cesarean birth story.

For many years I struggled with each cesarean birth my clients had. I took it as a personal failure. If I had just been a better doula this wouldn't have happened. I could have, should have, rescued her. Over time I grew to understand that these stories weren't my stories to write. They belonged to the birthing woman. They were her story. I tried to let go of my arrogance in thinking I held the power and turned it back to the mothers. I am there to help a mother find her own path. Success or failure is in her hands not mine. This attitude helped me, but did it help them?

Recently I have begun to question and be more critical of the whole idea of cesareans as being failures. I have never been with a mother who just gave up. Every one struggled mightily; pushed themselves to the edge of their personal precipice and beyond. How can that be labeled a failure? Who is to blame for this stigma?

The ugly truth is the blame lands squarely at the feet of the natural birth movement. A movement which is near and dear to my heart. A movement which sprang up in direct response to the over medicalization of birth. A movement which wanted to give women back their power; their belief in their bodies.We wanted women to be in awe of their own strength and abilities. A movement I signed on to many years ago. It gave me strength to do my work and replenished me when I was tired, weak, or hopeless. A movement which has branded the heart of every woman with a big fat F who began labor with the intention of birthing vaginally and ended up in the operating room . You failed at the very essence of womanhood. Enough.

I want all the mothers who have courageously fought to win that medal of female honor, only to see it fade from their grasp, to know they are heroes. They are the walking wounded who gave it all in battle for their comrades; their partner and child. Many suffer with post traumatic stress disorder. Some face on-going health issues. All of them have had their bodies invaded by friendly fire and have the scars and internal adhesions to prove it. Why do we treat them as shoddily as the returning Vietnam Vets? If you are for the war, people who believe in the medical model, you are numb to their tremendous sacrifice. If you are an anti-war protester, pro-natural birther like me, you actually have the unbelievable gall to question their loyalty to the cause. Enough!

Isn't it enough that she stayed the course for 9 hours at 8 centimeters without ANY pain medication? What about the fact that the last 4 hours were with pitocin to make her contractions even harder? What if you knew she was in active labor for 26 hours with back pain from a posterior baby? Enough?

Isn't it enough to join the club of "successful" birth if you labored with no medication and then pushed with ALL your strength for 3 hours at home AND THEN had to face your fears of transferring to the lion's den? Your midwife, your doula, your husband, your mother, didn't they all do everything they could? Why isn't that enough?

What about the mothers who train for the war but never get to feel their mettle tested? Herpes outbreaks, breech babies, high blood pressure, intrauterine growth retardation, or their baby's size can have them falling on their sword and relinquishing their bodies to be invaded for the sake of their children before a single shot has been fired. Their birth dreams laid waste upon the surgical table as the fog of war descends upon them.

What about this mom so great fully full of life? First she was told she would have to have a cesarean because her baby was breech. Then she went through an external version to turn her baby, only to have her water break with no labor. She did everything she could to make labor start. She and her husband held off the medical staff for hours and hours and finally, with time running out, submitted to one of her biggest fears; pitocin. After many hours on pitocin her baby's heart rate climbed. Could this be from infection? No mother wants to risk her baby. So she said yes to her deepest fear; a surgical birth and was wheeled off to the operating room. Surely she did enough. Would you have had her say no? She allowed them to cut her body open for the sake of her son. Isn't that enough?

                                             It should be enough.

Welcome home to ALL the mothers who began their births with the bright shiny intention of a natural un-medicated vaginal birth. As you marched off to do battle, you hoped against hope you would come home whole. You raised the banner of natural birth high above you. You held tight to your talismans of homebirth, nurse midwives and doulas believing they could bring you home safe from the war. You counted on your training from Bradley, Hypnobirth, or yoga to sustain you in the trenches. Bravo to those of you who made it through; war weary, battle hardened and whole. But let us not forget the walking wounded that sacrificed it all. Our highest motherhood medal of honor should be reserved for them for their bravery and selflessness. My heroes.

Welcome Home

Ruth M.      Miriam M.       Rebecca P.       Megan B.       Larissa H.

Yselle L.      Kelly B.          Kristina G.        Suraya S.       Wendy M.

Fara H.      Rochelle W.       Shelly F.          Sarah M.R.         Shannon L.

Katelen F.    Anna R.           Jenna M.          Star A.           Colby L.

Janet M.        Eva N.         Gwendolyn S.     Amy E.         Kambria D.

Stacie S.     Jennifer W.        Bridget B.       Georgie W.       Amy O.

DeAna C.     Amy H.           Jennifer K.         Traci C.        Heather S.

        Kat K.        Michelle L.        Tomi M.            Cindy L.          Linda S.       
   Patti D.         Steph W.        Sarah R.          Kendra W.       Lisa N.
Sabrina S.       Anna T.       Glo       Stephanie A.       Annie R.

Kathryn D.       Sara M.  

Do you have a hero that belongs on my memorial wall?

After 20 years of listening to mothers and witnessing births;
I have more names than I can remember.
Each is an important story.

If you or a loved one or friend belong on my wall please let me know and I will include them.

Thank you to the mothers who allowed me to use their stories and photos.

Next post will be a mother facing down her fears 
with a planned cesarean birth!

Friday, June 6, 2014

What's a Mother to Do?

Normally I take photos at births and write notes throughout the process. I think it is important to chronicle this important family event. I give them to my families and hope that they will treasure them forever. After two back-to-back high risk preemie births I felt these special stories needed to be shared. I had never experienced any births quite like these before. I learned an incredible amount and my hope in posting these stories is to educate future parents. Hopefully it will take some of the fear out of an incredibly fearful situation. 

Yesterday Ada Rose came into this world.
All 1 pound 10 ounces of feisty little girl.
Thank you to Ada's parents for allowing me to share a part of their birth story. 

When babies come unexpectedly in the middle of pregnancy it is quite challenging for everyone involved. Suddenly needing to have a surgery to save your little one's life is scary as hell. Being separated from your new child fills a mother with fear and grief in every fiber of her being. Not being able to put her baby to her breast is an additional sorrow. Keeping it together under these conditions is heroic.

So what's a mother to do? Like every other mother she is going to do the best she can for her baby at that moment on that day. In this situation nothing helps a mother more than getting her colostrum to her baby. And of course the colostrum is VERY helpful to the baby. The colostrum of the mother who just gave birth to a premature baby is designed specifically for them. It has a special balance of nutrients to help their brains and bodies continue to grow outside the womb.

Getting the colostrum out of mom and into a teeny weeny baby who can't suck, swallow and breath yet is quite a trick. So what's a mother to do? Pump! Ada's mama was pumping by the time Ada was 2 hours old. The nurse at Sierra Vista tracked down a hospital grade pump. She brought it to mom's bedside and showed her all about it. I talked to her about tricks to help her let down her breastmilk to a pump.  We had just gotten started when dad got the word he could come be with their daughter in the NICU. I told dad to take photos and send them to mom. 

Poor mom looked devastated after he left the room. Of course she wanted him to go be with Ada. Of course she wanted him to not to leave her yet. After all she just went through major abdominal surgery; a really scary experience. Of course she felt it was totally wrong for him to be the first to touch and see her. Of course she felt horribly guilty for all of these conflicting thoughts. So what's a mother to do? Pump out way more colostrum than anyone expected!

Many mothers of preemies are able to only produce a few drops the first day or so. Vickie, the lactation consultant who came in said, "every flood begins with just a few drops. Don't worry how much you get. Just keep at it and your body will eventually respond." Wise words from a woman who works with breastfeeding moms every day.

While mom was pumping dad sent photos and a video back to the room of precious baby Ada. The photos were hard for mom to see; all the tubes and wires. Seeing her wiggle in protest weighed heavy on a mom's heart. I pointed out her perfection. That her color being so pink was a good sign. It meant she could get the oxygen they were giving her into her lungs, into her blood and circulate it through her body. How much better that she was trying to push them away than lying there limp. What a strong little girl she created. 

So what's a mom to do? Why pump out 3 whole milliliters of colostrum. That's what! It wouldn't all fit into the teeny weeny syringe the nurse had brought. They had to go get a larger one. The nurse exclaimed. The lactation consultant exclaimed. The NICU nurse exclaimed. They said, "Why that's about a week's worth of food for such a tiny little person." Yippee!

Mom sent the milk down the hall to her baby. They carefully put some on a swab and ran it around inside her mouth. Now mom's immune system is protecting her baby even though they are apart. Her colostrum is stuffed full of antibodies which can help give her the best chance on life. Right now she is too young to be able to suck, swallow and digest breastmilk. That day is coming though. It is just around the corner. Not to worry, mom will be ready. At 24 hours from birth she pumped out this much liquid gold. Priceless!
so the flood begins...
Every day in the nicu is a scary, hopeful, exhausting roller coaster ride for a family. Neonatal Intensive Care Units across the country are filled with babies and families every day. Please take a moment to hold them in your heart.

Read Eleanor and Caroline's premature twins story

Thursday, June 5, 2014

When Home Birth Intentions Meets High Risk Birth

Thank you to Amanda and Jose for allowing me to share their story. 
Amanda hopes it will help other parents.

My third set of vaginal twins has a unique story. Like many of my clients Amanda came to me committed to a natural vaginal birth free of medical interventions, including pain medication. She wished for a home birth but she knew that wasn't possible in our area because she was carrying twins. So she settled on hiring a doula and planned to turn down as much medical "help" as possible.

But of course life rarely goes as planned...

One day, WAY too early in pregnancy, she begin to be concerned about how her body was feeling. Being a smart mama she listened to her intuition and took herself in to see her OB. Yes, her blood pressure was climbing dangerously. Before she could really grasp what was happening she was admitted to the hospital and begun on medication to bring it down.

I begin to capture Amanda's journey with my phone camera.
I came to the hospital and we talked for a long time about all the natural ways she could support her system and help bring things into a better balance, including her blood pressure. I reassured her I would come to give her birthing classes in the hospital. We strategized over how to deal with a long hospital bed rest.

One week later her water broke. Her body decided it was time to have her babies, 26 weeks or not. With contractions came climbing pressures. When I walked in Amanda was laying in bed surrounded by and attached to more medical contraptions than I have ever seen before. Blood pressure cuff, IV meds for blood pressure, IV fluids, heart monitor for mom, contraction monitor and 2 baby heart rate monitors. A bewildering array. The nurse was glued to the screen giving her all the info from all the machines. Amanda had to remain horizontal for her labor.

Let me explain. I have seen lots of moms hooked to LOTS of things but NOT a mom who was birthing without labor stimulants and/or pain medication. Here was Amanda in the midst of a high tech, high risk birth doing it "au natural".

So we labored. We breathed. We visualized. We relaxed. I sprayed the room with lavender and smoothed essential oil on her feet. We massaged her shoulders and gave her sips of water. Absolutely no food because of the high potential of an emergency cesarean. When her back began to ache I showed Jose how to use my purple rebozo to provide counter pressure with a mom on her back in bed.

The sensations were coming closer and getting more intense. With such tiny babies, with tiny heads the magic number of 10 as a goal for dilation goes out the window. You are ready to push whenever the cervix is pulled back far enough for a head to slip through. I was pretty certain we were closing in on pushing. Then Amanda began to make pushing sounds and spoke of pressure. I alerted the nurse and she did a vaginal check. Yep. No more cervix. Time to push out baby A.

Now everyone began to scramble. I don't know why they were all so surprised.

Vaginal twins are unheard of in some areas of the U.S. but here moms can birth vaginally as long as the babies are positioned right. Amanda's OB, stuck to that promise although he had plenty of opportunity to use the situation to send the birth down a cesarean path. He never once brought it up. When things got tricky he stayed calm and talked mom through exactly what needed to be done, including the urgency of the situation, enlisting her help without scaring her.

But twin births are required to take place in the operating room, just in case. So here we go...
Heading down the hall at Sierra Vista on the way to the OR.

On our way to push out two babies sans pain medication or pitocin.


At the last moment they separated us and made Jose and I wait in the waiting room while they got mom "prepped". I nervously wondered what they were prepping her for? Usually they make us wait outside while they put in an epidural before a cesarean. Poor Amanda was told to not push, even though you can't stop your body from pushing once it begins. A doula can really make a difference when this chaotic circumstance arises, but there I sat in the waiting room, waiting. So I snapped this handsome photo of dad sporting his hazmat birth suit.

At last we were reunited. The room was FULL of people. They had to have the whole OR team as if she was having a surgical birth just in case it suddenly became a surgical birth; obstetrician anesthesiologist, surgical nurses, labor nurse, plus 2 sets of recovery teams for the babies, respiratory specialists, Neonatal Intensive Care Unit (NICU) nurses, and pediatrician. Jose and I squeezed our way in next to Amanda's side.

Pushing in the OR is very difficult. A mother has to block out everything going on around her and stay focused on her body's sensations. At the same time she has to tune into the directions she is given by her OB. It takes a tremendous amount of concentration. Plus she is flat on her back. Not an ideal position for pushing something out of one's body.

Keeping lovingly connected is also a challenge with so many on lookers; especially when your heart is racing with fear for your little girls. Jose's physical presence was a powerful support.

Soon a slippery teeny tiny Eleanor is born...

 to a room FULL of people ready to help.

A relieved Jose; one down, one to go!

2 pound 4 ounce Baby Eleanor gets help getting started

        Is there a baby in that bundle?

Mom meets Eleanor outside her womb room.
   Now we wait for Caroline to make her entrance...

Mom's blood pressure is up; Baby's heart rate is dropping.
Time to get serious about birthing this baby.

Forty minutes after her sister tiny Baby Caroline arrives;
 raising her fist in the air to say, "I made it!"

A very short cord makes for a very rough trip.

         Whew two babies born!            A relieved mom and grateful dad celebrate.

Two pound Caroline gets help getting started.
Preemies have no body fat and lose heat fast.  Saran Wrap traps heat.     
 Daddy gets as close as he can.

First father daughter photo with Caroline.
It's official! They're here.
I'm so blessed to be part of miracles.
I am grateful to all the many people who helped at this birth and who continue to help provide care to these teeny weeny babies. When I first began working as a doula these babies would have been flown to a hospital with a higher level of care than we had in the county at that time. Mom and dad would have been left behind to wait and worry until Amanda was healthy enough to discharge from the hospital.

Don't get me wrong. I still feel way too many babies born at Sierra seem to "need" to be taken to the Neonatal Intensive Care Unit. Almost all my clients have their babies spend at least a short period in the NICU for observation before being given the "all clear" to reunite with mom and dad. Please keep in mind most of my clients are not high risk and birth their babies vaginally. The conundrum for me is when a baby truly needs NICU care I am eternally grateful they can receive high quality, high risk care right her in our community. I am also grateful they are trying to move the NICU in a more family-centered, baby-friendly direction. 

Three days later I snapped this photo of an exhausted dad getting skin to skin time 
snuggled up with Caroline in the NICU.   
Shhhhh!!! Don't wake the baby.


Throughout it all Amanda has stayed strong. Threading her way through her increasingly complicated birth and postpartum period. She stuck to her goals of having as natural a birth as possible while never forgetting to safeguard her babies. The nurses at Sierra are blown away. They say, "You birthed preemie twins vaginally with no pain meds? Amazing!" It brings home for me the difference in our frame of reference because I never doubted Amanda a bit.

Twelve days old 
Cuddle time with mom at last!
 With all the stress Anna unfortunately ended up with a cold. 
She had to delay the sweetest of moments in a mother's life.

Monday, May 19, 2014

What a VBAC Calculator Shows

This morning I noticed this intriguing post in our local ICAN group's Facebook page:

I know this isn't an active group, but this is the only one of my groups where it seems appropriate to post this. Does anyone know where I can find info about the VBAC rates for home births and hospital births? I found this cool VBAC calculator, but it doesn't account for birth setting.

A Vaginal Birth After Cesarean calculator? Really? So I decided to try it.

It is always important to know who you are playing with so I investigated who created this calculator. OK it says it is based on data collected from an article "Development of a nomogram for prediction of vaginal birth after cesarean". A nomogram? Huh? That is just a geometric way of looking at multiple variables. The data set came from the Maternal-Fetal Medicine Unit Network. Here is their mission statement: "The MFMU Network conducts clinical studies to improve maternal, fetal and neonatal health emphasizing randomized-controlled trials. The aims of the Network are to reduce maternal, fetal and infant morbidity related to preterm birth, fetal growth abnormalities and maternal complications and to provide the rationale for evidence-based, cost-effective, obstetric practice." They are a network of university based hospitals. These teaching hospitals are where the births happened that form the statistics to base this calculator upon.

First the questions they ask to help them calculate are telling. They want your age and body mass index. Don't know your BMI? Don't worry they'll calculate it for you. They want to know if you have a "proven pelvis". What's that? It is a woman who has either had a vaginal birth before or after a cesarean. In other words at some point a baby "fit" through. They want to know if your cesarean was for lack of progress dilating, lack of progress moving the baby through your pelvis or some other reason. Other reasons could be twins, breech, high blood pressure, fetal distress, maternal fever, etc. They just lump all the other reasons into one category. Most distressing to me are their questions about race. They break it down by African-American, Hispanic and all others lumped together. What the hell? What on earth should race have to do with it?

So here is what I found when I did some calculations.  I kept all other factors the same except the one I was looking at. Trying to compare apples to apples. Let's look at age first.

They obviously feel age matters. I changed the age from 18 to 30 to 35. 
I had between 7% to 10% less chance of successfully VBACing at 30 than at 18 years old. The low end reflects women who progressed on their predetermined schedule. The top end reflects women who fell off the time chart plus were heavier. At 35 it drops again. Now I have 10% to 15% less chance depending on the other factors. Ugh! Obviously age is NOT something you can do something about or can you? How many 35 year-olds do you know? I have worked with many and some have the physical health of a 40 year old while others could pass for being in their twenties.

By adding 70 pounds to a white woman with no previous vaginal births and allowable progress during labor/pushing she has lowered her chances of VBAC success by 12%. If she had a "failed" labor the numbers move down to 16% because of the additional pounds alone. This may make some sense because weight can cause confounding health issues, such as high blood pressure.So if you want to VBAC stack the decks in your favor by starting at a healthy weight. Oh wait! If you want to avoid that first section be a healthy weight before you get pregnant and then work with someone who knows about pregnancy nutrition to stay on track.

Arrest of Labor
This is defined as absence of progress. So of course one must FIRST note that progress is a very subjective animal. The good news is this calculator says if you had a surgical birth for arrest or "failure" either during dilation or pushing your chances are only 9% to 12% less than the woman who didn't. As a doula I know it is critically important to look at WHY you stopped progressing or weren't progressing fast enough. Was the baby in a poor position? Was this a failed induction? Why were you induced? Too long past due date? How far was too long? Baby "suspected" of being too large? How large was he or she really? Induced for other health concerns, blood pressure, diabetes, etc.? Perhaps your water broke and labor didn't start quickly enough so you were given labor initiating drugs. Did you have an epidural? At what point in the labor? I can't stress how important it is to obtain ALL your records and to go over them with an experienced doula or midwife. Perhaps your "failure" to progress was actually THEIR failure. 

Here is where they doubly fail women. Be prepared to get angry.
I went back and changed only race as a factor. So let's look back at the age issue WITH race added in. If I am a 30 year old woman of color I had a 10 to 16% less chance than an 18 year old. While a white 30 year old has a 7% to10% less chance.  And at 35 I as a white woman would have 10% to 15% worse odds but as a woman of color it plummets to a 21% less chance of success. Excuse me? What about race with weight? If I am a 30 year old white woman with healthy weight, no vaginal births and no "failure" the calculator predicts I have a 80% success rate in their hospitals. That same woman of color? 67.2%! That is a difference of about 13%. If  I am 70 pounds heavier I have a 16% worse chance of success than my white sister. 

So now I compared the best case scenario; 18 years old, healthy weight, no arrested labor c-section, vaginal birth before and after surgical birth, White to Black or Hispanic. Shockingly the numbers say a woman of color automatically gets 4% worse chance of birthing vaginally. That my friends is systemic racism in its most insidious form. It is in how they are treated from the moment they are in their doctor's offices until the moment they are discharged from the hospital. I have witnessed this unequal treatment. Every time it has angered me. Usually it appears to anger me more than the woman trapped in it. Perhaps because she has only her own experience to compare, whereas I can compare her to the white women I have supported. But here the numbers are; in black and white for all to see. A disgrace.

I did not intend for this to be a post about race. I started in thinking I was going to check out this calculator and compare hospital stats with homebirth stats. But the numbers took me a different direction. Here are two links for those of you who wish to compare homebirth and hospital birth numbers. They were posted by Terri Woods of SLO Doula Connection  in response to the ICAN query. She rightly warns that homebirth midwives automatically risk out a variety of complications and so it isn't exactly apples to apples. Still it is worth noting that out of 1,354 VBAC women 87% were successful. There is no way for me to do a straight comparison because I don't know anything about age, weight, reasons for prior sections or if they have had a vaginal birth either before or after their surgical birth. 

Science and Sensibility looks at the MANA homebirth study 

Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009

Planning to VBAC? Hire a doula. Plan a home birth. Hire a midwife. Get healthy and stay healthy. Finally question, question, question; especially if you are a Black or Hispanic woman. 

Monday, May 12, 2014

Consumer Reports: Cesarean Births

“How you deliver your baby should be determined by the safest delivery method, not which hospital you choose.” 

I couldn't agree more with this statement. Consumer Reports is beginning to tackle the issue of our disproportionate cesarean rate. The World Health Organization has determined that NO region, area or country should have a higher rate than 15% rate. Currently the US has a rate twice that and California's is even higher. The rate is "up 500 percent since 1970. All those C-sections have not translated into substantially better outcomes for mothers and babies. The infant death rate in the U.S. is higher than that of most other industrialized nations. And the maternal death rate actually increased slightly from 1990 to 2013, according to an analysis published May 2, 2014, online in The Lancet medical journal."

So What? 
Why should we be concerned? C-sections are safe right? Usually when they are done it is because they are safer for mom, baby or both, than a vaginal delivery right?
"A C-section—the second most commonly performed surgical procedure in the country, requiring a 6-inch incision in the abdomen and a second through the uterus—is major surgery, and thus takes longer to recover from than a vaginal delivery and also carries additional risks." 

Consumer Reports is also concerned that hospitals within a few miles of each other with similar populations can have such drastically different rates of surgical births. "And unfortunately, it’s usually much easier to find a hospital with a high C-section rate than a low one." 

Our Local Hospitals
To earn top marks a hospital had to have a c-section rate of between 5-9.5%. None of our local hospitals earned this ranking. Twin Cities comes in at the next best level between 9.5 and 11.5%. French is in the average zone at 11.5-15%. Both Marian and Sierra show up in the next to lowest ranking with between 15-21%.

Hey That's Not Fair 
You may be thinking Sierra Vista should have a higher rate because they have the high risk mothers. Consumer Reports tried to correct for this. "To level the playing field, the measure controls for some things that affect C-section rates, such as not including multiple gestations and breech births. However, this measure does not account for all differences in patient characteristics (such as chronic illness) that might affect the C-section rates of an individual hospital." So yes their rate should be higher because the high risk moms with chronic illness appropriately deliver there. The question is how much higher? Both Sierra and Marian are just a few percentage points away from being given the worst rating.

“We think it’s time those hidden numbers are brought to light,” said John Santa, M.D., medical director of Consumer Reports Health. 

Well said! Pregnant consumers and their families deserve this information in order to make true informed choices about their births.

Quotes were taken from the following 3 articles by Consumer Reports.

What Hospitals Don't Want You to Know About C-Sections:
Very good in-depth article with an excellent section on things to do to avoid a surgical birth.

Hospital Ratings; Avoiding C-sections: 
Their statistics

Safety Scores:
Finding your hospital's score.

More Research and Reading

What to Reject When You are Expecting
Good list of prenatal and during labor procedures to avoid

My Birth Statistics
Comparing my stats with our local hospitals