Classic Hospital Bed Meets Ancient Wisdom

So you have read Ina May's Guide to Childbirth and plan to birth in an active, upright position. Bravo! You have taken the first step in reclaiming your birth instincts. As a first time mother you have chosen to do a "homebirth in a hospital." You took classes, hired a doula, and crafted a birth plan. Being well educated when labor began you did not rush to the hospital with the first contraction. Instead you listened to your doulas suggestions of eating, showering, baking, gardening on hands and knees, rocking in a rocking chair, swaying on a birth ball, dancing, cuddling, hanging within your partner's loving embrace, climbing up and down your stairs, and going out for a walk or two or three. 

At last the time has come to drive to the hospital. You climb in the car and instinctively know that leaning back in that bucket seat while you sit to ride to the hospital is NOT going to be fun. Each contraction is intensified without being more productive. You are so glad to be able to get out of the car. You get on your feet and instinctively lean forward, drop your knees a bit and sway gently with the contraction that hit as soon as you stood up. Strong but doable you tell yourself. 

Next stop the emergency room doors and waiting for a wheel chair to take you to your room. Now they want you to sit in a chair and wait for a chair. The idea of not having to walk sounds inviting as your labor hormones are coming on strong and making you feel drifty but the actuality is something very different. Labor sensations while in a wheel chair moving forward causes your head to swim and you grip the arms of the chair causing tension through your neck and back intensifying your pain. The pressure of the seat on your bottom causes you to lift one cheek and list to one side. Too late you realize walking would have been much better than this. You traded in your feelings of competency and confidence in exchange for a quicker way to access the privacy of your birth room because you have a strong desire to be away from the bright lights and staring eyes of strangers. 

You finally arrive at the room where you will meet your baby face-to-face and there it is; the bed. It's presence dominates the room. Next to it stands all the technology money can bring to birth; fetal heart monitor, contraction monitor, computer, read out screens, audio controls, blood pressure reader, oxygen saturation tester, IV pole with computerized medication administration box attached, in other words, all "the machines that go beep". Still it is the bed that seems to suck the life out of your idea of an active birth; an instinctual birth. Your nurse cheerily asks you to pee in a cup and climb into the bed. So after all that walking, and sitting, and rocking, and kneeling what should you say or do?  

U.S. mothers are faced with this dilemma every day or more likely night. How should you handle this moment. It will be the opening moment in the long negotiation of your birth. If you have already had a baby and experienced that moment what DID you do? How do you feel about it now? Would you do it again?

This is the theme for July's Positive Birth Movement; the hospital bed's impact on your birth. PBM started in Great Britain and is spreading around the world. I am proud to be the SLO facilitator. We will be discussing the topic of labor beds from many different angles at my coffee & conversation in July.

It is important for modern American women to fill their mind with images of many possible birthing positions. Positions that can be done in or out of a hospital bed. How many different positions do you see portrayed in this short film? Notice how many different ways one may "squat". How deep the squat is, how far apart her feet are set, whether or not she is rounding or arching her back, pushing her feet against something or someone, or pulling on something all make the physics and body mechanics different.  <iframe width="560" height="315" src="https://www.youtube.com/embed/0J5xlBmJHTI?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe> 

For anyone to make the general statement that squatting causes babies to descend too rapidly or causes tearing isn't educated enough about squatting to see all the many nuances that can be obtained. <iframe width="560" height="315" src="https://www.youtube.com/embed/Q3wbuDSio74?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe>

Many of our doctors and nurse midwives are comfortable with mothers moving into a variety of laboring positions but once the mother is in the pushing phase still desire to take over and control the process by moving her into positions they, the care providers, are most comfortable in regardless of the mothers instincts or desires. In which of these birth positions do you think your care provider will be comfortable catching? Which ones will he or she have ever done? <iframe width="560" height="315" src="https://www.youtube.com/embed/HiCgDlxdmPI?list=PL197D9817EDD8A137" frameborder="0" allowfullscreen></iframe>

In many ways I see the pushing phase of labor as the final frontier of the struggle I have been part of for so many years; the struggle to return birth to the birthing woman. As a doula the hospital labor bed represents the Berlin Wall that stands between women and their innate abilities. It is long past time to “Tear down this wall!” 

California Measles Outbreak; What's a Parent to Do?

Yesterday I caught the tail end of Dave Congalton on the radio talking with a local pediatrician who has written a new e-book about baby's first year. She was adamant about vaccinations and was sure that if parents were simply told the facts by their doctor they would automatically want to vaccinate. During the short time I was listening, 2 other docs called in to FULLY support vaccinations.                                 
She also said we were having a measles epidemic in California. At that point I called in. I asked her how many cases there actually were. She backed off and said she shouldn't have called it an epidemic but an outbreak. I told her I thought the cases were in vaccinated people. She said no they were unvaccinated. (Keep reading to see she and I were both right and wrong on that one.) She said this kind of bad information was the problem with the internet spreading false info. She accused parents of getting poor information off the internet and then being too frightened to do the right thing for their kids. So this morning I went to the internet to see what I could find out about measles in CA. Here is some info you should know.

Facts on California's measles outbreak
From the CDC web site:
"Measles causes fever, runny nose, cough and a rash all over the body. About one out of 10 children with measles also gets an ear infection, and up to one out of 20 gets pneumonia. For every 1,000 children who get measles, one or two will die."                

Also from our government:                                                
"HEALTH ADVISORY – February 19, 2014

14 Measles Cases in the State of California in 2014

Fourteen cases of measles with onset in 2014 have been reported to California Department of Public Health. (In all of 2013, 189 people have been reported to have the disease. This represents the second largest number of cases in the U.S. since measles was eliminated in 2000.)
Among the 2014 California cases, four case-patients had traveled outside of North and South America, with three traveling to the Philippines. Nationally, an increase has been noted in the proportion of measles cases with travel to the Philippines. Measles cases from recent years have reported travel to Germany, France, England, India, and China, among other destinations.

Of the 2014 California case-patients without international travel, three had contact with known measles cases, two had contact with international travelers and five are under investigation to identify potential sources.

Of the 12 cases with known measles vaccination status, 8 were unvaccinated (7 were intentionally unvaccinated and 1 was too young to be vaccinated). That means 4 were vaccinated and 8 were not. So a third of the cases were in vaccinated people and 2/3 in unvaccinated. Why are vaccinated people getting sick? Had they only had the initial vaccine and not the booster or did they fave both shots and the life-long immunity they said we would have isn't turning out to be true? 

Please note they are NOT talking about deaths or even tell us how severe the cases were; simply that they had measles.

The last large outbreak of measles in the U.S. occurred during 1989-1991, with 17,000 cases of measles and 70 deaths in California.

Let's compare this to influenza. For the 2013-2014 flu season the California Department of Public Health says there were 332 deaths in California. 

Efforts to increase immunization rates in the 1990s were successful and endemic transmission of measles in the U.S. was eliminated in 2000.

Here is what eliminated actually means. In 2000 there were 86 cases in the US and 19 in California. 

 In 2013-2014, a large measles outbreak in the Philippines has resulted in over 1700 cases and 21 deaths. This outbreak has led to measles importations to Australia, Canada, the UK, and in many U.S. states. Additionally, measles is currently circulating in most regions of the world outside of North and South America."

In 2013 there were 189 cases of measles in the US and 15 cases in California. There were NO deaths. Now I want you to think about the numbers of people you know in California who had the flu this year. We probably each know at least 15 people. Of the California measles cases, 11% needed to be hospitalized, so 17 people were seriously ill. Pneumonia was the reason for hospitalization for 4 of the cases. It is important for pregnant mothers to note that 2 of these hospitalizations were for pregnant women and 1 miscarried. Let's look closer. Ninety-nine percent were import associated. In other words there was contact with someone who brought the virus into the US from abroad or was in contact with someone who was in contact with someone who had been abroad. Another interesting item is that 8% of the cases were in vaccinated people. 

How Does This Compare to the Flu?

Let's see what Web MD says about the flu:

Here's a rundown of some important flu statistics, based on the best available data.

Percentage of the U.S. population that will get the flu, on average, each year: between 5% and 20%.
That is with the current flu vaccination rate. So what percentage of the US population is 159 measles cases? The US Census Record says there are 316.99 million people in the US. So last year's outbreak was .00005% of people in the US.

Number of Americans hospitalized each year because of flu complications: 200,000, on average.
Remember there were 17 people hospitalized for measles complications last year. The last big outbreak of measles occurred from 1989-1991. Each year there were approximately 18,000 cases in the US with approximately 3,600 hospitalizations. 

The number of people who die each year from flu-related causes in the U.S.: ranges from 3,000 to 49,000.
During the last big outbreak of measles in the US approximately 41 people died each year.

In the U.S., influenza and pneumonia were the eighth leading cause of death in males in 2009.

Number of flu vaccine doses available in the U.S. for the 2013-2014 flu season: Between 135 and 139 million.
That means that if all the doses get used they will have vaccinated 44% of the population for flu. The federal government wants a 90% vaccine rate for measles and they say are meeting or exceeding that goal! Less than 1% of young children are not vaccinated  and most of the unvaccinated kids are for economic reasons. So what percent of all the kids in the US are not vaccinated due to parental choice? I couldn't find that number. Obviously it is less than 1%. 

So where does all this fear come from? Most of it stems from one situation in New York where many people in one extended family became ill with measles. This family had chosen not to vaccinate due to philosophical reasons. They had family members who traveled to Europe and brought home an unwelcome souvenir. In total there were 65 cases of measles in New York. Here is the final word of why the the CDC is concerned:  "imported measles cases can result in large outbreaks, particularly if introduced into areas with pockets of unvaccinated persons."

From the National Vaccine Information Center:
(this is the organization which the medical establishment is talking about when they say crazy 
anti-vaccine people)  
"In 1960, three years before the first measles vaccine was licensed in the U.S., there were 380 deaths from measles recorded."            

Are vaccines safe or not?
Now let's explore the possible side effects from getting the MMR vaccine. Remember very little in life is 100% safe so with life there is risk. What are those risks?

From the CDC: 
"Moderate Problems
Seizure (jerking or staring) caused by fever (about 1 out of 3,000 doses)
Temporary pain and stiffness in the joints, mostly in teenage or adult women (up to 1 out of 4)
Temporary low platelet count, which can cause a bleeding disorder (about 1 out of 30,000 doses)

Severe Problems (Very Rare)
Serious allergic reaction (less than 1 out of a million doses)
Several other severe problems have been reported after a child gets MMR vaccine, including:
Deafness, long-term seizures, coma, or lowered consciousness, and permanent brain damage
These are so rare that it is hard to tell whether they are caused by the vaccine.
(Please note they give us NO numbers)

From the National Vaccine Information Center: 

"Common side effects from the MMR vaccine include low-grade fever, skin rash, itching, hives, swelling, reddening of skin, and weakness. Reported serious adverse reactions following MMR vaccination include seizures, brain inflammation and encephalopathy; thrombocytopenia; joint, muscle and nerve pain; gastrointestinal disorders; measles like rash; conjunctivitis and other serious health problems.

As of March 1, 2012, there have been 898 claims filed in the federal Vaccine Injury Compensation Program (VICP) for injuries and deaths following MMR vaccination, including 56 deaths and 842 serious injuries. (Again we have no numbers of doses of vaccines to help us understand what percentage of doses; or true level of risk. I'm not even sure if these numbers include multiple years.)

Using the MedAlerts search engine, as of July 9, 2012 there have been 6,058 serious adverse events reported to the Vaccine Adverse Events Reporting System (VAERS) in connection with measles vaccine since 1990, with over half of those occurring in children 3 and under.

Evidence has been published in the medical literature that vaccinated persons can get measles because either they do not respond to the vaccine or the vaccine’s efficacy wanes over time and vaccinated mothers do not transfer long lasting maternal antibodies to their infants to protect them in the first few months of life."

There are other theories about vaccines long term risks beyond immediate reactions. None of these, as far as I know, have been proven. Conversely I don't know that there are any long-term studies on vaccine safety. Questions out there which I feel bear looking into are the potential vaccine/autoimmune disease link. Especially after seeing that the CDC says one of the moderate immediate reactions can be pain and stiffness in the joints in teens and women. Autoimmune diseases are definitely on the rise. Is this caused by vaccines? The anti-vaccine group would like you to think so. As far as I know we have no scientific studies to definitively make that connection yet. I want long term studies done. I want studies done on bundled vaccines, not individual vaccines. I don't believe the scientific community has done enough research into the possible synergistic effects of bundling vaccines. I think the fact that we now have potential humans to do matched studies on right here in America is fantastic. I don't want studies with unvaccinated people from third world countries compared to people in the developed world. I want us to follow long-term some of the now unvaccinated US kids and a matched group of vaccinated US kids. Let's really find out some concrete answers. Until then I'm not sure anyone knows. 
                                                                                               
What's a parent to do?
Parents need to make wise choices for their children. Are you planning to travel outside the US? Will you be having world travelers come into your home or be in contact with them in some other way, such as, airplanes, buses, trains, or hotel rooms? Perhaps you want to vaccinate. Perhaps 2 measles deaths in a 1000 cases is too high a risk for you to comfortably take as a parent. As doctors love to say (the doctor on the radio yesterday said it too) when it is your child 1 death is too many. Of course they NEVER factor in that, 1 death from a vaccine reaction is also 1 death too many for any parent. What is important to me is that you have solid information to make your own best choices. 

Then I want you to find a doctor who will listen to you as a parent, help educate you and then will allow you to make your choices without shaming you in any way; or worse yet fire you as a client. I want to take a moment to acknowledge one such local pediatrician, Dr. Renee Bravo. Here is what one of my "Whole"istic Mamas said about a recent visit. 

"Just wanted to share my positive experience yesterday. I've known Dr Bravo for probably 25 years & have been bringing my children to him since my 1st was born almost 11 years ago. I respect him & think he's a great person. Yesterday I brought baby #4 in for her 2 mos checkup. I was really nervous to tell him I didn't want vaccines for my baby since I'd unknowingly vaccinated my other 3 children & thought he might possibly hassle me like his associate did. When he asked about shots for this visit I declined & he said "no problem, whatever you want to do I'll support!" He said we could do delayed vaccines (he said he really likes Dr. Sears schedule), even more delayed, or none at all, just let him know. Then he said "you know you really only need most of these if you're traveling to a 3rd world country anyway." No hassle, no debate, just pure support. Yet another reason why I respect him!"

I know this was a lot to read but it is important that all of us base these kinds of parenting decisions on a real understanding of the facts. 

Next, since it is "going around", I wanted to give you info on how to tell if your child has measles and what your doctor can do. If you think you or your child has measles, or you have been exposed to measles, the sooner you go to your doctor the better if  you want to utilize their help. 

IMPORTANT: Do NOT go to your doctor without FIRST calling. Let them know you think your child has been exposed to or come down with measles. Ask IF they wish you to come in and HOW they plan to minimize risk to their other clients. Babies do not get vaccinated for measles until they are 12 months old. Therefore the kids most vulnerable to having difficulty fighting off the infection are not vaccinated.   

What do measles look like?
From the Mayo Clinic web site:

Description: a red, blotchy rash that usually appears first on the face and behind the ears, then spreads downward to the chest and back and finally to the feet.

Measles signs and symptoms appear seven to 14 days after exposure to the virus. Signs and symptoms of measles typically include:
Fever
Dry cough
Runny nose
Sore throat
Inflamed eyes (conjunctivitis)
Sensitivity to light
Tiny white spots with bluish-white centers found inside the mouth on the inner lining of the cheek, called Koplik's spots
A skin rash made up of large, flat blotches that often flow into one another
The infection occurs in sequential stages over a period of two to three weeks.

Infection and incubation. For the first seven to 14 days after you're infected, the measles virus incubates. You have no signs or symptoms of measles during this time.

Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.

Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first, particularly behind the ears and along the hairline. Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, fever rises sharply, often as high as 104 or 105 F (40 or 40.6 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.

Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.
When to see a doctor


What if I think my child has measles?

More from Mayo
Call your doctor if you think you or your child may have been exposed to measles, or if you or your child has a rash resembling measles.

No treatment can get rid of an established measles infection. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.

Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus, to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.
Immune serum globulin. Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Medications

Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles. Don't give aspirin to children because of the risk of Reye's syndrome — a rare but potentially fatal disease.

Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or your child has measles, your doctor may prescribe an antibiotic.

Vitamin A. People with low levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large dose of 200,000 international units (IU) for two days.

How do you tell if it is measles or chicken pox? 
Also from the Mayo Clinic site:

Chickenpox infection usually lasts about five to 10 days. The rash is the telltale indication of chickenpox. Other signs and symptoms, which may appear one to two days before the rash, include:

Fever
Loss of appetite
Headache
Tiredness and a general feeling of being unwell (malaise)Once the chickenpox rash appears, it goes through three phases:

Raised pink or red bumps (papules), which break out over several days
Fluid-filled blisters (vesicles), forming from the raised bumps over about one day before breaking and leaking
Crusts and scabs, which cover the broken blisters and take several more days to heal
New bumps continue to appear for several days. As a result, you may have all three stages of the rash — bumps, blisters and scabbed lesions — at the same time on the second day of the rash. Once infected, you can spread the virus for up to 48 hours before the rash appears, and you remain contagious until all spots crust over.


The disease is generally mild in healthy children. In severe cases, the rash can spread to cover the entire body, and lesions may form in the throat, eyes and mucous membranes of the urethra, anus and vagina. New spots continue to appear for several days.

What if my child has Chicken Pox?

Most children do not need to see a doctor other than to tell you they have chicken pox. When do you need to see a doctor?

From the CDC:
For people with chickenpox at risk of serious complications, call a health care provider if the person:
is older than 12 years of age
has a weakened immune system
is pregnant
develops any of the following:
fever that lasts longer than 4 days
fever that rises above 102°F (38.9°C)
any areas of the rash or any part of the body becomes very red, warm, or tender, or begins leaking pus (thick, discolored fluid), since these symptoms may indicate a bacterial infection
extreme illness
difficult waking up or confused demeanor
difficulty walking
stiff neck
frequent vomiting
difficulty breathing
severe cough

Good luck with your decision and good parenting!

How to Not Gain My Trust

Dear Doctor,

You will not gain my trust by pigeon-holing me at an unrelated professional public event and in a loud confrontational tone telling me I don’t know what I am talking about. Do you realize how disrespectful it is to assume that if people just knew what you know they would obviously agree with you?

You will not gain my trust by going on and on with rarely a break long enough for me to get in a word. This was not a respectful rational dialogue between two equally intelligent individuals. Instead it was an overly emotional barrage of highly charged personal experiences bound up with concern for your own children.

You will not gain my trust by not being considerate of time and place. Did you give any thought to the fact that you were in the middle of an organization that has worked very hard to establish trusting relationships between often competing parties by keeping our focus on the ways in which we agree, respectfully sharing information, and focusing on a common goal? Did you take a moment to consider that I was about to get up in front of a room full of people and speak? Luckily I am confident enough to be gracious to you, while not backing down in my defense of parents who you feel make the wrong choice about vaccine, and immediately after still get up and give a caring, warm introduction for a woman I greatly admire. Did you know that about me? No because you don’t know me at all.

You will not gain my trust by not being conscious of who else is around you and how they might be affected by our exchange. Did you know that it was mortifying to me that the evening’s presenter, a professional who inspires me, was listening to you? Did you never give it a moment’s thought that sitting all around you might be parents who have chosen not to vaccinate or are following less traditional vaccination schedules? How do you think this made them feel? Do you think you gained their trust?

As I said to you that night you are obviously sincere in your concern about the potential for children to become ill and die because of parents choosing not to vaccinate. I can tell you care deeply. I too care deeply. It is very important to me that I give out as accurate information as I can to parents and prospective parents. What they do with that information is up to them. I believe in their abilities to make good choices for their children. In the past when it has been brought to my attention that I may have printed inaccurate statistics I have gone back and taken a second look at my original information and, with guidance by far better statisticians than I, I have made corrections as needed. Based on the discrepancies between your numbers and mine I am reviewing my original measles outbreak post, my sources and the original numbers, and will be posting an up-date. I will also be working on a post as to how the medical establishment as a whole lost our trust. Unfortunately you, dear doctor, did nothing to re-gain mine.

  

Listen to National Experts: What the Birthing Women of San Luis Obispo Need to Think About!

These posts originally appeared as my Food for Thought series on Facebook. I wanted to provoke the women of San Luis Obispo county into thinking about their birth and parenting choices. By quoting directly from books I wish to stimulate discussion and encourage women to seek out information and become more educated. My hope is you will empower yourself through this process.

“Our lives begin to end 

the day we become silent about things 

that matter.”

~ Martin Luther King, Jr. 

from his unforgettable

 "I Have a Dream" speech

Doctor or midwife: How to choose which is right for you.

Baby Bonding and Attachment: Getting Parenting off to a good start.

Induction and Due Dates: What you need to know to keep anyone from scaring you into a decision.

Understanding Risks: Learning more so you can choose the risks you are most comfortable taking.

Parenting in Labor: Things to know about the decision to use pain medication.

Labor & Birth: Things to remember about normal labor and birth.

Get Inspired

"Never doubt that a small group of thoughtful committed citizens can change the world; indeed it is the only thing that ever has." Margaret Mead, woman, daughter, wife, mother and controversial cultural anthropologist.



Inspired? Join the Birth & Baby Resource Network or International Cesarean Awareness Network. You can find the info about meetings in the side bar under Meet Me or go to my Labor of  Love Virtual Rally event page and find out the next step.

Think Twice Before You Say Yes to a C-Section Because Your Baby is Arriving Prematurely

Last week in the New York Times Roni Rabin reported on a new study coming out of John's Hopkins School of Medicine which throws a wrench into the machinery of conventional medical thinking. Until now doctors have believed that it is safer for your premie to be born via surgery. The study included 2,560 babies. When they compared babies born mother nature's way to those born in a surgery suite the babies delivered by C-section were 30 percent more likely to develop respiratory distress syndrome, a serious breathing disorder that can lead to organ damage.

It must be tough to be an Obstetrician. You are constantly practicing medicine on women with the best of intentions only to have studies prove that what you are doing is not only medically unnecessary but harmful. No doctor goes into medicine to harm women, so I have to wonder how they feel about it each time one of these issues comes to light and they have to reverse course. Do they think back over the women they sectioned who had complications? Do they remember the babies who ended up with serious respiratory infections and wonder if their belief in the "preventative" cesarean may have caused that baby to suffer? What about the extra stress on families separated even longer from their babies? What about all the money families spent on additional NICU care for premies with breathing issues? I wonder if someone will try to figure out what that bill was for our nation?

So how did OBs get into such a mess? It is grounded in the systemic belief which underlies much of the medical model thinking about birth that women's bodies are essentially unsafe for babies, especially the vagina. To understand where this bedrock of the medical view of the world came from you have to go back to male dominated religion, Eve, sin and the apple, the Greek belief in the perfection of the male body, and an unwavering belief in man & technology over nature and women's bodies. Time and time again this flawed way of thinking has led them into relying on drugs to fix problems only to learn later that they were harmful to mothers or babies. They rely on machines, tests and statistics to give us flawed due dates which lead to inductions of accidentally premie babies, continuous fetal monitoring which led to many more c-sections for fetal distress with no lowering of the fetal death rate, and windows of normal so narrow that fewer and fewer women can thread the needle of pregnancy & birth without being labeled as high risk. So this line of thinking led them to believe, without any studies being done, that it would be safer for premies to be saved from the rigors of a vaginal birth. It apparently never entered their minds that traveling through the vagina served a purpose in a complex system of birth, growth and life long health. Or that being squeezed would push fluid out of the lungs and that the sides of the vagina would coat the baby with beneficial flora. These two items may be why there are less respiritory infections in vaginal birth babies. Instead as the medical provider they donned their super hero robes and stepped in as saviour. The problem with being a super hero is the responsibility. So now they are left to face their responsibility. Of course I'm not looking for some kind of loud national apology. That never happened in the past and it won't happen now. Read the Times article below and then take Dr. Werner, the lead author of the study's advice and have a frank discussion with your doctor.

New York Times
February 9, 2012, 3:22 pm
C-Sections Pose Respiratory Risks for Some Small Preemies
By RONI CARYN RABIN

Small premature babies born by Caesarean section are at increased risk of respiratory distress syndrome, a new study has found.Very small babies delivered prematurely by Caesarean section because they were not growing properly in the womb developed more respiratory problems than those who had induced vaginal deliveries, a new study found. The study adds to growing concern over the high rate of Caesarean section deliveries in the United States, which reached 32 percent, or nearly one in three deliveries, in 2007.

On Wednesday, the federal secretary of health and human services, Kathleen Sebelius, announced a public health campaign to educate families that it is best for both the mother and the baby to let a problem-free pregnancy go for as long as possible, and to let labor start naturally. The campaign is a partnership that expands on a March of Dimes public awareness drive emphasizing that “healthy babies are worth the wait.”

The latest study looked at babies who were extremely small for their gestational age and not growing properly in utero, so waiting was not a medical option. But the findings raise new questions about the risks of Caesarean section.

For the study, researchers analyzed nine years of data from births in New York City, identifying 2,560 babies who were small for their gestational age and delivered between 25 and 34 weeks of pregnancy. Forty-six percent were delivered vaginally, and 54 percent by Caesarean section.

“The conventional thinking, though nobody really knew, was that maybe it would be less traumatic for this group to have a C-section, and they might benefit,” said Dr. Erika F. Werner, an assistant professor at Johns Hopkins School of Medicine and the study’s lead author. “Our study suggests that may not be true.”

In fact, the babies delivered by C-section were 30 percent more likely to develop respiratory distress syndrome, a serious breathing disorder that can lead to organ damage and that is more common in premature infants, Dr. Werner and colleagues from Brown and Yale Universities found.

The C-section deliveries were not associated with improved outcomes in terms of other complications, including hemorrhages, seizures, low Apgar scores and sepsis, the researchers found. Results were adjusted for differences in the mother’s age, ethnicity, education, health status and weight.

The findings are being presented today at the annual meeting of the Society for Maternal-Fetal Medicine in Dallas.

“The takeaway is that if you’re in this situation, you should have a frank discussion with your doctor that maybe a vaginal delivery is equivalent, or even better,” Dr. Werner said. “We need further research to determine if there is any benefit to C-section” for such infants, she said.

Another consideration is that when a woman has one baby born by Caesarean section, subsequent children are far more likely to be delivered by C-section as well.

As to why vaginal deliveries appear to improve respiratory function, Dr. Werner said, “We don’t have the perfect answer.” Some experts believe that the physical compression the baby experiences during labor helps remove fluid from the lungs and prepares the baby to breathe air.

Dr. Diane M. Ashton, deputy medical director of the March of Dimes, who has been overseeing the organization’s Prematurity Campaign to educate the public, said similarly improved outcomes are seen with infants delivered further along in a pregnancy.

“This is consistent with what is seen in infants even at 37 weeks,” she said. “They, too, have better respiratory outcomes when delivered vaginally versus C-delivery.”

Studies suggest that premature births of single babies have been increasing in recent years and that more are being delivered by Caesarean section, including C-sections that are not medically necessary. At the same time, recent research shows that a baby’s lungs and brain undergo important growth and development during the last few weeks of pregnancy, and that babies born just three to six weeks before their due dates are more likely to suffer disabilities or developmental delays in kindergarten.

Last year, the American College of Obstetricians and Gynecologists issued new medical guidelines meant to lower the rate of repeat Caesareans by making it easier for women to find doctors and hospitals that will let them attempt a vaginal delivery even when a previous baby was delivered by C-section. Although these women are at risk for a serious complication called uterine rupture, ruptures affect fewer than 1 percent of women, while C-sections, which involve major abdominal surgery, carry many other risks both to the mother and to the child.

Having a Baby? Read these books...

One April a few years ago I picked up the phone. It was Brenda Ramler, a local midwife calling.

"Hi. I'm working on a recommended reading list. Do you have any books you think I should include?" Brenda is someone you can always count on to get straight to the point; a real straight shooter. One of the straightest shooters I have known in my life.

"Why? What's up?" I on the other hand am an information gatherer. I never like to express my opinion until I feel I know all the facts. You know, a lay of the land type person.

"I'm working on something to hand out at the Fair. I have a list but I'm looking for new ideas to add to it." She was talking about Birth & Baby Resource Network's annual Birth & Baby Fair. This fair was almost as old as BBRN itself and Brenda & I had been involved in some way every year since its founding.

That's another thing about Brenda, she is a worker. She never sees something she feels needs to be done and says, "I'm too tired" or "too busy." Besides that she is an organizational wizard and perhaps one of the most detail oriented people I know. On top of that she is passionate about birth. I should say natural birth. Birth the way she feels it was meant to be. Her vision of birth encompasses pregnancy, birth and parenting. To her birth is one piece of the whole; not an isolated, stand alone event.

She has strong opinions about all of it and doesn't mind sharing them. Actually I believe she feels it is her calling to share them with women and their families; a duty to herself and to God. Of course she shared them with her clients, but she would also share them with pregnant women she met at a coffee shop or in line at the grocery store. She moves through the world strong in her beliefs that women need to know. Why? So they can be responsible for themselves, for their births and for their babies.

This is not a unique belief in the "alternative" birth world. It is the founding principle of BBRN and many other organizations, but Brenda is unique in her power of conviction and willingness to clearly state the truth without fear of repercussions. Many people find this not an endearing trait. But as far as I can tell it never fazed Brenda what other people thought of her. She brought that power, conviction and confidence to every birth. It served her clients well.

She safely caught lots of San Luis Obispo county babies during her years here. She educated many women in their birthing and mothering abilities. She made an impact in our world one family at a time. She also impacted our birth community; educating assistants, doulas, teachers, and even doctors and midwives. I was one of those people. I was lucky enough to doula at a few homebirths with Brenda and she always made herself available to discussclient issues or situations. Now she has moved on to new adventures in new places with her husband. The women whose lives she touched will never forget her. Myself included.

Recently I found a copy of the list of books Brenda and I spoke about that day on the phone. I was in the home of one of her assistants who is currently training to be a midwife. I recognized it as soon as I saw it and asked Heather if I could have a copy. Many of these books are classics. The basics of birth and parenting do not change but the context of the cultural/financial politics which surround it continually changes. These books continue to be relevant because the underlying foundation of greed, power and mistrust of women's bodies remain as a constant at the core of our birth culture. I am happy to announce that these books and many others will soon be on loan again through the Birth & Baby Resource Network in the library at the Santa Lucia Birth Center.

Here is Brenda's Recommended Reading List:
Nutrition/Exercise
***********
Active Birth
Janet Balaskas

The Vegetarian Mother's Cookbook
local author Cathi Olson

Pregnancy & Childbirth
************
American Way of Birth
Jessica Mitford

A Wise Birth
Penny Armstrong

Birth as an American Rite of Passage
Robbie Davis-Floyd

Birth Reborn
Michel Odent

Gentle Birth Choices
Barbara Harper

Immaculate Deception II
Suzanne Armstrong

Natural Childbirth the Bradley Way
Susan McCutcheon

Pursuing the Birth Machine
Marsden Wagner

Special Delivery
Rahima Baldwin

Pregnant Feelings
Rahima Baldwin

Choosing Waterbirth
L. Bertram

Seasons of Change: Growing through Pregnancy & Birth
Suzanne Arms

Creating a Joyful Birth
Lucia Capprioni

Mind Over Labor
Carl Jones

Cesarean/VBAC
********
Open Season
Nancy Cohen

Birthing from Within
Pam England & Robin Horowitz

Rights & Responsibilities
****************
Birthing Normally
Gayle Peterson

Birth Your Way
Shiela Kitzinger

Obstetric Myths Versus Research Realities
Henci Goer

The Thinking Woman's Guide to a Better Birth
Henci Goer

Breastfeeding
*******
The Womanly Art of Breastfeeding
La Leche League International

The Nursing Mother's Companion
local author Kathleen Huggins

Babies & Children
**********
Natural Medicine for Children
J. Scott

Take Charge of Your Child's Health
G. Wootan

The Baby Book
Dr. Sears

Women of SLO County Help Empower Your Sisters & Friends!

There is nothing more powerful than women sharing information. Most women make important decisions about their health care based on things they have learned from other women in their community. This exchanging of information and wisdom is a staple of women's conversations from time immemorial; from the local well at the oasis to the local quilting bee on the prairie. Today women go on-line in droves to connect on social networks; from chat rooms to blogs to web sites devoted to women's issues. It is time information about our local birth community was part of this conversation. You can help your sisters, friends, workmates and all the birthing women of SLO County. It is simple. You don't even have to leave your home.

If you have given birth in the last 3 years I urge you to let your voice be heard. By answering the questions on the Birth Survey you can easily let other women in our community know how happy or unhappy you are with your care provider, place of birth, doula & childbirth educator. You also will be helping the Coalition for Improving Maternity Services compile national statistics on what is really happening out there with issues, such as, induction & pitocin, epidurals, and cesareans. Perhaps just as important for other women to hear is how the office staff treated you, if your care provider listened to you, were you able to get all your questions answered, did they provide their statistics for c-sections, episiotomies and natural births. How would you rate the hospital staff? Did you feel well cared for? Did they offer breastfeeding help and was it helpful, etc.? Wouldn't you like the women in our community to know about the quality of care you received during your pregnancy, birth & early postpartum period?

For a pregnant woman finding a care provider, doula, educator and place of birth that match her values surrounding birth is critically important. These choices can make or break her feelings about her birth. Her birth has the power to impact her either positively or negatively. As an example, if she wants an epidural she should go to a doctor who supports that choice and if she doesn't want one she needs to find a care provider that supports THAT choice. Why? Because if she desires to birth with an epidural and doesn't receive one she will feel disempowered during the birth. For the woman that wished to birth without medication and then feels pressured to give in to an epidural she will feel victimized and helpless. The key is finding the right match for you. Look up a doctor, midwife or hospital.

Guess what? Sierra Vista isn't even on the survey yet because in the 2 years it has been going no one has input any information about their experience there. We owe it to our sisters, friends, coworkers and all the women in our community to stand up and be counted. Please take the Birth Survey!

A Woman’s Guide to VBAC

Wow!!! Great new site full of just the right info for women considering trying to go for a vaginal birth after a cesarean! Thanks to Megan Bochum, a local student midwife and member of our local ICAN, for posting this link on facebook.

A Woman’s Guide to VBAC

Weighing the Pros and Cons of Planned Vaginal Birth after Cesarean and Repeat Cesarean Section

VBAC Success Rates and Prediction Models: Understanding Your Chances of Important Outcomes

Putting Uterine Rupture into Perspective

Are You an “Ideal” Candidate for VBAC? What Are Your Choices If Not?

The “Immediately Available” Standard: Where It Came from, What It Means, and How to Move Forward with New Evidence and Guidelines

What We Don’t Know: Critical Gaps in Evidence and How to Make Informed Choices In Spite of Them

Discussing Your Options with Your Care Provider

Legal Rights and Protections for VBAC: Issues from the NIH Consensus Conference

Take Action!

If Your Baby's Breech

I have had several couples over the years who were planning natural births only to be told at the end of their pregnancy their baby was breech. This is a very upsetting situation. First the medical establishment doesn't give the parents much options or hope. Second they don't seem to understand why the mother is upset; surgical births are second nature to them. For them it is no big deal. For the moms it is a very big deal. They feel boxed in, frightened of a cesarean, frightened of a vaginal birth, the clock is ticking, they scramble about to educate themselves on ways to get the baby to turn, and they begin the grieving process for their dream birth before the birth has even begun. All of my moms have tried hard to get their babies to turn. So far none of them has been successful. I feel some of this is due to how late in the game they were told about the situation. Some have toyed with going ahead with a vaginal birth and what that would entail; finding a care provider in or out of the hospital willing and qualified to assist the mother, dealing with everyone else's opinions on the subject and facing down their fears. Some were completely demoralized by their cesarean experiences others were not. No matter what you decide here are some things you should know.

All of my moms seemed to intuitively know something wasn't right about what they were feeling in their uterus before anyone confirmed their suspicions. They would say, "this just doesn't feel like a butt to me" or "if this is his bottom why am I getting kicked way over here?" Most of these were first time moms but they just knew. If you think this might be your situation ask for an ultrasound to verify position earlier rather than later. Don't rely on the doctors skill in "feeling" baby positioning because they can be wrong. Don't let your doctor talk you into putting this off until 37 weeks. The best time to start natural turning methods is 35 to 36 weeks. The bigger your baby, the tighter the space, the more difficult she will be to turn!

There are many alternative things to try: acupuncture, homeopathy, slant board, Watsu massage, prenatal massage, chiropractic adjustment, headstands or somersaults in a pool, frozen peas on your belly, and more. Use this link to learn more: One Midwife's Collection of Breech Turning Techniques

If the natural methods don't work you can try an external version where your care provider tries to manipulate the baby into turning by pushing on your abdomen. If this is done by a doctor they will want you in the hospital. They will have an i.v. in place so they will be ready to do an immediate c-section if the process causes the baby fetal distress which can't be resolved any other way. This is one of the reasons they will try to put you off and tell you not to worry until 37 weeks. They have nothing else to offer you and they want the baby to be considered "term" in case it needs to come by emergency c-section. I have watched this done a few times now. For some moms it is quite uncomfortable and for others only mildly uncomfortable. I have to say the doctors all spent quite a bit of time and really tried hard to get the babies to turn. Here is a link to view a version.

If none of these methods turn your baby you will need to say to yourself, "now what?"

Consider going for a vaginal birth anyway. Some of you may think I am being reckless, too "radical", in even suggesting such a thing. But guess what? In Canada, that bastion of radical thinking the Society of Obstetricians and Gynecologists new guidelines say to NOT automatically go for the cesarean with a breech. Here is a study from Canada on which they are basing this new approach. For them the "wisdom" of doing a c-section depends upon what type of breech position the baby is in. Study.

Do your own research! Read the chapter on breech birth in The Thinking Woman's Guide to a Better Birth by Henci Goer. Then go more in depth with Breech Birth by Benna Waites. Watch this video of a breech homebirth: Aurora's beautiful and inspiring frank breech home birth. 

If you are going to go for a vaginal delivery of a breech baby who will be your care provider? Ask your doctor or midwife. Ask them if they know any doctors or midwives in your area who do breeches. It is very hard to find any doctor willing or skilled anymore in breech deliveries because with all breeches being automatic surgeries non of them have had much practice at it. This of course compounds their distrust of a vaginal delivery because they don't have the skill. Talk to the homebirth midwives in your area. Are any of them skilled in breeches? Will any of them do a planned breech baby at home? Ask yourself if you are comfortable with the idea of having a baby at home?

If you find a care provider and a place you will need to prepare yourself and anyone else who will be at your birth with positive images and stories of vaginal breech births. You can find this in the book, Breech Birth-Woman Wise by Maggie Banks. Find a copy of Birth Reborn, the movie, through your birth educator or a midwife. This video has some intense footage of a breech birth which made me hold my breath with fear the first time I watched it because it was so foreign to me. You and your partner need to get beyond that feeling.

So what do you do if you can't find a care provider willing to "let" you birth your baby vaginally? Well you can be really radical and just show up at the hospital in labor and then refuse to go to the operating room. Once they have informed you of the risk you are taking you have the legal right to refuse consent to any procedure. This is not an option I am advocating because for labor to go well the mother needs a peaceful and relaxing environment. This sounds far from peaceful to me. My point is you have this option; it is your right. Some women have chosen this path; it has been done before.

If you are still thinking you want to have a cesarean birth the next decision is whether or not to let labor spontaneously happen or to simply choose a day, book the O.R. and schedule your baby's birthday. Here are some things to think about. We know that labor is physiologically good for babies and for mothers. It stimulates the babies breathing, pumps the baby full of hormones that spring the brain into activity, and prepares the baby for life outside the womb and for bonding. The down side to this approach is not having control of the cesarean itself. If you schedule it you can have a meeting with the head nurse of your hospital's labor and delivery unit and make special requests. The number one thing to ask for is to have mom, dad and baby together continuously. In other words the baby and dad stay with mom in the O.R. throughout her repair and go with her into recovery. At most hospitals this is not the standard procedure. It may require special staffing or shuffling of staff at your hospital. It is much more likely to happen when it is arranged ahead of time. You can also arrange to have a lactation consultant be there to help with latching the baby on in the recovery room or perhaps even in the O.R. Of course your doctor may be concerned about "allowing" you to go into labor at all because your water could break. They have concern about "letting" the water break because of possible cord emergencies with a breech presentation. Again this comes down to presentation. If your baby is presenting their butt firmly down into your pelvis and not a foot or feet than common sense tells us the risk of cord prolapse is about the same as for a head. If not than you need to consider that about 30% of the time a woman's water breaks before any signs of labor and the risk of cord prolapse with a foot presentation is considerably higher.

If you are scheduling a cesarean consider asking your doctor to try to do the external version one more time after you have an epidural. Sometimes with the mother unable to feel anything her muscles will relax enough for a version to be successful. If you are successful you would have to decide to go forward with an immediate induction or risk having the baby slip back into breech position.

So much to do. So much to learn. So much to think about. So many decisions to make. So little time and so little energy for any of it those last few weeks of pregnancy. This is why it feels so overwhelming. Of course the easy choice is to simply abdicate your authority and responsibility for your birth to your doctor and say yes to a cesarean without any further thought. Unfortunately abdicating your responsibility isn't what motherhood is all about. Whatever you decide make it your choice because you will have to live with this birth for the rest of your life. Your heart will heal better if you take the time, think it through and take up the role of mother. Parenting starts now!

Read one of my birth class client's breech birth story.

Breastfeeding and Kangaroo Care in a Neonatal Intensive Care Unit

I met Jessica when she came to give a talk at an ICAN meeting. Even though this birth was not local I felt her poignant story was so important I asked her if she would be willing to share it on my blog. It is full of many of the issues I have currently been writing about; changing our "plans", creating a partnership between mothers and medical staff, pairing the best of mothering with the best of science so our most vulnerable babies get the best of both worlds, and when is the moment we are reborn into the role of parent. It is of particular interest to me that although Jessica is a Certified Nurse Midwife when it came to her own child she was no different than most first time moms. It took time for her confidence in her mothering abilites to grow enough for her to step into her parental role, stand on her feet and stand up for her son and her rights.

A Nursing Story

Oliver was born under the bright lights of the operating room. At three pounds, seven ounces, he was lucky to be born in 2006. He had a statistically high chance for survival in the neonatal intensive care unit. I was told he cried when he was lifted from my belly and when his delicate little body was subjected to IVs and wires and tubes just moments after birth. The details of Oliver’s birth and my operation were finally made clear to me many months later when I reviewed the operative note. It’s all I have of his birth. But I have Oliver and I am grateful.
Magnesium sulfate kept me from holding my baby for the first 24 hours after his birth. 


(Dad stepped in providing Kangaroo Care, skin-to-skin continuous contact.)


I vaguely remember vomiting, severe headaches, and terrible abdominal pain during that first arduous day. My home birth midwife knew how badly I wanted to have a “normal” childbirth experience and my strong desire to nurse my child. Within the first couple of hours she had procured a hospital grade pump and taught my friends how to pump my breasts. They propped me up every three hours and collected my colostrum until my mother arrived and took over the duty all night (after flying across the country).


The next day I was considered stable and was wheeled to the NICU to meet my son. The NICU nurse carefully handed him to me. He was exactly what I wanted. I felt like I was meeting someone I already knew, his face so familiar yet lovelier than anything I had ever seen. I did what I had seen hundreds of new moms do when holding their babies for the first time. I put him to my breast. The nurse panicked because he was not “cleared” to take anything by mouth. But Oliver’s tiny mouth and weak suckle would have prevented him from nursing anyway at that stage. “We are just bonding,” I explained to the kind nurse. Oliver closed his eyes and breathed in the smell of his mommy. We both relaxed and I knew we would eventually get over his traumatic birth.

Oliver was born at a progressive hospital with an excellent NICU. When I knew I would be delivering him early, I was transferred via ambulance to that particular hospital because I was told it had the best NICU in the state of Connecticut. My husband and I spent hours holding him skin to skin doing “kangaroo care.” Oliver was getting stronger and my bags of breast milk were filling up the small NICU refrigerator. I was so proud of that milk. At every tube feeding the nurses would help me put Oliver to my breast to help him associate my breast with a full belly. Eventually Oliver was strong enough to move to a less intensive care unit. We decided to have him transferred to a smaller NICU closer to our house. I called the nursing manager and was told I would be supported in my desire to do kangaroo care with my child and breastfeed.

We arrived at the small NICU early in the morning on a weekend. I immediately took Oliver out of his isolette for some kangaroo time after the long ambulance ride. After an hour of skin to skin, I was told by the nursing manager to “put him back” because I was making him cold. My husband and I learned that kangaroo care at our new NICU consisted of one hour, once a day. I argued with the nurse and wanted to speak with the pediatrician. I wasn’t able to hold my baby that entire day and evening. I just sat, staring at him though the plastic of his isolette, and cried. I finally cried about everything: the loss of our birth experience, the first precious moments after birth, our special baby moon. It suddenly felt like we were in hell. That night I pumped and noticed a sharp decrease in the amount of milk I was producing. I was concerned so I called my midwife and told her what had happened. She lit a fire under me and gave me the strength to fight for my son. A friend helped me gather articles about the benefits of kangaroo care so I would be armed with information when I met with the pediatrician in the morning.

After a long meeting, the pediatrician agreed to “let” me hold Oliver for one hour, three times a day, as long as his temperature was monitored every fifteen minutes. I agreed because I wanted to show how stable his temperature would be during kangaroo care. The nursing manager stopped speaking to me but I did find compassionate support from many of the nurses. At night, the nurses would “forget” to check on us and I would end up holding him for hours. Slowly, I was able to try to nurse him again at every feeding. I was the only breastfeeding mom at that time in the NICU and the staff had never worked with a mom who was exclusively breastfeeding at discharge. My midwife came to the NICU to show the nurses how to use a supplemental nursing system and how to position a small baby correctly. With her help I was finally able to get Oliver firmly latched on during a feeding.

The last four days of Oliver’s stay at the NICU were the most difficult, but necessary to establish a breastfeeding relationship. I convinced the pediatrician to let me sleep at the hospital. The NICU nurses set up a cot for me near the unit so I could be available to nurse Oliver every few hours. By the time I put Oliver in his car seat to leave the hospital, he was 100 percent breastfeeding. It is my most important accomplishment.. I send the NICU nurses a Christmas card every year to remind them of sweet little Oliver and this annoying mom who made it her mission to breastfeed and succeeded!
Next read about a "miracle" baby and the chemical, biological, and emotional power of a mother's love. http://www.dailymail.co.uk/health/article-1306283/Miracle-premature-baby-declared-dead-doctors-revived-mothers-touch.html

Being a Hospital Doula: My Greatest Challenge

Sometimes I can only bear witness. I am helpless to ward off the blow. I educate. I put a "game plan" in place. I manage. I guide. I manipulate the system. I encourage. I remind women they have a voice; they have a choice. But in the end sometimes I am powerless to protect. My role is to stand and bear witness to the birth unfolding before my eyes. My heart breaks; little pieces crumbling away. Bits of me I will never get back. Moments in my life I will never forget. I hold on to the belief, for her and for me, that grief is transformational if we let it be.

New Guidelines Aim to Reduce Repeated C-Sections

Great reporting on an important birth issue by someone in the mainstream media! This reporter does an excellent job of thoroughly explaining the complexities of the issues surrounding giving women back the right to make their own choice to try for a vaginal birth after a previous cesarean or to go with a repeat surgical birth.

But before you read it let's put it into historical, local, political, and a doula's context.

When I was in my twenties the cesarean rate was rising. Like my sister-in-law most of these women were being sectioned the first time for something called cephalopelvic disproportion. This means the baby's head (cephalo) is too big (disproportion) to fit through mom's passageway (pelvic). How did they figure this out? Two ways. One was a labor that wasn't progressing at the rate of speed the medical community agreed was normal at that time. I say "at that time" because I have worked with plenty of local doctors who no longer practice with this older time frame model in mind. Or before she ever began labor they might xray the mom , take measurements and make a determination without even a trial of labor. Of course this practice has now been abandoned. Xraying moms; it sounds crazy doesn't it? Guess what! We still routinely ultrasound moms who have gone past their due date and one of the things the doctor does is make a recommendation to your OB or midwife about the possible size of your baby and whether you should be sectioned for...wait for it...here it comes...cephalopelvic disproportion or possible shoulder dystocia (shoulders to big to fit) before you even try!

The second reason women were being operated on to give birth was the fact that they had been operated on to give birth. This was the era of "once a cesarean, always a cesarean". The surgical technique of the time was to cut the mom vertically from below the ribs to the pubic bone. This classical cut was associated with a high rate of rupture during future labors. The ghost of this fear based on the rupture rate of classical incisions is still with us today in the doctor's office when women discuss their "options" for future births. It is still in women's hearts too, passed down to them from their mother's birth era.

When I was in my thirties things were changing. The medical community had realized the cesarean rate was sky rocketing and they needed to do something about it. Surgical technique for incisions and suturing had changed; the "bikini cut" had come into vogue, and the risk of rupture had been significantly reduced. Also consumers had put pressure on the medical establishment by taking matters into their own hands; either birthing out of hospitals all together to achieve their V-BAC, or going into the hospital late in labor and refusing to undergo a repeat surgery. Doulas were being asked to labor sit at home with these moms and try to bring them to the hospital at the last moment. These brave pioneers proved women could safely and successfully labor and birth vaginally after a previous surgical birth. They proved V-BAC was a viable option for many women. I remember Dr. Clutter and Dr. Lickness being our first local doctors to support women in this choice.

When I was in my late thirties it was the norm to at least go through a "trial of labor" before deciding to section a woman again. Some of our doctors were much more liberal in their "trials" than other local doctors. As a doula I often felt I had to match wits with some of our more scalpel ready doctors to keep my clients out of the operating room. Another positive change was our local certified nurse midwives being allowed by their supervising doctors to V-BAC women in all our hospitals. Sandy Rodriguez and JoAnne Tarkington caught many, many a successful V-BAC baby.

By my forties the pendulum was swinging back. The fear of uterine rupture was again haunting doctors' offices and labor rooms. A study came out showing that V-BAC women had a greater chance of rupturing than nonV-BAC women. This study lumped all women together without taking into account if the mom went into labor on her own or if she was induced. It also didn't make any distinction as to the method used for induction. (Remember that wonderful induction drug Cytotec? This is the era it is becoming more popular among the medical community. Don't know about Cytotec? Read my piece, Let's Talk about Off Label Use, Cytotec and You.) In reponse to the study the American College of Obstetricians and Gynecologists (ACOG) came out with guidelines requiring hospitals to have anesthesiologists waiting in the hospital the entire time a V-BAC mom labored. Most hospitals found this a financial, practical, legal and bureaucratic impossibility. For a brief time all V-BACs were shut down at our hospitals. Luckily for us Sierra Vista took the bold step of contracting with our local anesthesiologists for enough coverage to allow Sierra Vista to offer the V-BAC option to women in our community. But it is the only hospital within hundreds of miles to do so! I recently had a client who moved back from Santa Barbara to Atascadero just so she could successfully V-BAC at Sierra. ACOGs guidelines also required OBs to be standing by throughout potentially long labors. For many doctors' practices this was a practical, geographic, and financial impossibility. So if your OB's office was located physically close enough to Sierra Vista you could V-BAC, if not you could not. And of course our wonderful nurse midwives were no longer "skilled" enough to catch V-BAC babies. I will never forget the last V-BAC I was at with Sandy and JoAnn. My client had been told she could V-BAC with them but when she was in labor in the hospital she was told the supervising doctors could no longer advise she go for a vaginal birth because she was past her due date. My client decided to refuse to say yes to another surgery. Sandy supported her decision and JoAnn did a great job catching a beautiful healthy baby girl. I have never been more proud of three women in my life. Meanwhile women continue to safely V-BAC with our licensed midwives at home and with doctors at Sierra Vista every day.

When I was fifty I was hired as a doula by a woman who was trying to find some way to not end up with a second operative birth. She was caught in a terrible bind. Her due date fell at a time when one of our homebirth midwives was not practicing and the other was already over committed trying to service all the local women who wanted to birth at home. Her MediCal doctor had deemed her too great a risk for V-BAC and wanted her to have a repeat operation. He put her under extreme pressure to agree to a surgical birth, even sending her a certified letter saying he had explained the risks to her of not agreeing to a surgical birth and requiring her to get a notarized signature. Although the nurse midwives wer supportive of her desire they could not help her. It was suggested to her that she labor at home with me for as long as possible, then come to the hospital and refuse the surgery. You tell me how it can possibly be a good choice to labor at home without a skilled medical attendant, with a woman who has more risk of things going wrong, without anyone who can take the baby's heart tones or has any emergency equipment or training? This is an impossible position to put doulas in. My client called me late into her labor and when I arrived at her home it was quickly obvious to me she would be pushing soon. I told her we needed to go to the hospital and she begged me to stay with her at home and catch her baby. She told me she trusted me. I told her I couldn't do it, I had no equipment and no experience. I convinced her to go to the hospital and she ended up with another c-section. An outcome that will weigh on both our hearts forever.

In the last few months I have seen another change on the horizon. I believe we are witnessing a new V-BAC era being born. There have been a flurry of studies, articles and announcements about the concern over the rise in our national cesarean rate, balancing risks of repeat c-sections versus v-bac and a woman's right to choose. The National Institute of Health came out with their finding which has pushed ACOG to review it's guidelines and make their own announcement. Read Neergaard's great article to see where we are headed.

By LAURAN NEERGAARD
AP Medical Writer

Most women who've had a C-section, and many who've had two, should be allowed to try labor with their next baby, say new guidelines - a step toward reversing the "once a cesarean, always a cesarean" policies taking root in many hospitals.

Wednesday's announcement by the American College of Obstetricians and Gynecologists eases restrictions on who might avoid a repeat C-section, rewriting an old policy that critics have said is partly to blame for many pregnant women being denied the chance.
Fifteen years ago, nearly 3 in 10 women who'd had a prior C-section gave birth vaginally the next time. Today, fewer than 1 in 10 do.

Last spring, a National Institutes of Health panel strongly urged steps to reverse that trend, saying a third of hospitals and half of doctors ban women from attempting what's called VBAC, for "vaginal birth after cesarean."

The new guidelines declare VBAC a safe and appropriate option for most women - now including those carrying twins or who've had two C-sections - and urge that they be given an unbiased look at the pros and cons so they can decide whether to try.

Women's choice is "what we want to come through loud and clear," said Dr. William Grobman of Northwestern University, co-author of the guidelines. "There are few times where there is an absolute wrong or an absolute right, but there is the importance of shared decision-making."

Overall, nearly a third of U.S. births are by cesarean, an all-time high. Cesareans can be lifesaving but they come with certain risks - and the more C-sections a woman has, the greater the risk in a next pregnancy of problems, some of them life-threatening, like placenta abnormalities or hemorrhage.

The main debate with VBAC: That the rigors of labor could cause the scar from the earlier surgery to rupture. There's less than a 1 percent chance of that happening, the ACOG guidelines say. Also, with most recently performed C-sections, that scar is located on a lower part of the uterus that's less stressed by contractions.

Of those who attempt VBAC, between 60 percent and 80 percent will deliver vaginally, the guidelines note. The rest will need a C-section after all, because of stalled labor or other factors. Success if more likely in women who go into labor naturally - although induction doesn't rule out an attempt - and less likely in women who are obese or are carrying large babies, they say.
Thus the balancing act that women and their doctors weigh: A successful VBAC is safer than a planned repeat C-section, especially for women who want additional children - but an emergency C-section can be riskier than a planned one.

Because of those rare uterine ruptures, the obstetricians' group has long recommended that only hospitals equipped for immediate emergency C-sections attempt VBACs. Many smaller or rural hospitals can't do that, and that recommendation plus high-dollar lawsuits have been blamed for some hospital VBAC bans.

"Restricting access was not the intention," the new guidelines say. They say hospitals ill-equipped for immediate surgery should help women find care elsewhere, have a plan to manage uterine ruptures anyway, and not coerce a woman into a repeat C-section.

Educating women about their options early enough in pregnancy for them to make an informed choice is key, said Dr. F. Gary Cunningham of the University of Texas Southwestern Medical Center, who chaired the NIH panel on repeat C-sections.

It requires a fair portrayal of risks and benefits that can differ by patient, added Dr. Howard Minkoff of Maimonides Medical Center in Brooklyn, N.Y., which has women sign a special VBAC consent after counseling yet has a higher-than-average VBAC rate of 30 percent.

"There's no doubt that how things get framed influences how people act," he said.

While the guidelines cannot force hospital policy changes, some women's groups welcomed them.
"I feel like ACOG has really listened to how their previous policies have impacted women," said Barbara Stratton of the International Cesarean Awareness Network's Baltimore chapter, adding that she'll advise women seeking a VBAC to hand a copy of the guidelines to caregivers who balk.
But she called for reducing overuse of first-time C-sections, too, so that repeats become less of an issue.
Read more: http://www.sanluisobispo.com/2010/07/21/1223164/new-guidelines-aim-to-reduce-repeated.html#ixzz0uQm4tHXf