April: Cesarean Awareness Month

Cesarean Awareness Month (CAM) is an internationally recognized awareness month which sheds light on the impact of cesarean surgery on mothers, babies, and families worldwide.  Cesarean birth is major abdominal surgery for women with serious health risks to weigh for both moms and babies.  Cesareans may be safer now than they ever have been, but this surgery is being conducted more frequently than is prudent or safe.  The acceptable rate established by the World Health Organization (WHO) is 10-15% – what is your community’s cesarean rate?

The blogosphere is atwitter about Cesarean Awareness Month.  Here are some posts I found today that deal directly with CAM:

  • Instinctual Birth’s post
  • No Womb Pod’s post
  • Strain Station’s post
  • Cesarean Awareness’s post
  • CT Birth Experience’s post
  • She Got Hips’s post
  • CT Doula’s post

If you have blogged about Cesarean Awareness Month and don’t appear on my list, please leave a comment so we can read your post.

To learn more about cesarean awareness, support, and education, visit the Internation Cesarean Awareness Network (ICAN) website and/or look for a chapter in your area.  Another great resource to consult when weighing the benefits and risks of intervention in chilbirth is Childbirth Connection.  Also, I recommend looking at and considering the Mother-Friendly Childbirth Initiative.

How do you plan to honor Cesarean Awareness Month?  How can you let people know that natural birth is an important issue for you and for them?  I promise that there is some way, no matter how small it may seem, that you can have a positive impact on your birth community.  Even wearing a cesarean awareness ribbon several days this month will help.  If you need ideas, feel free to ask.

Thought Provoking

By now most people involved in childbirth advocacy are aware that ACOG released a statement reaffirming its opposition to homebirth.  I was directed – via Bellies and Babies and Enjoy Birth- to House of Harris’s response and dissection of the statement. 

People who read my weblog know that I’m certainly all for a woman’s choice of childbirth venue.  I’d like to think that birth can be empowering regarless of venue, but the most likely location for empowering, rewarding, and safe birth is home, assuming that you feel safe in your home.  I am not suggesting that homebirth is necessarily safer than hospital birth.  But I cannot show any evidence that hospital birth is necessarily safer than homebirth for low-risk women and babies.  Even though I bear a cesarean scar, I am not “high risk”.

One thing that concerns me as I consider and plan for a homebirth in the Fall is what might happen to me and the baby should we need to transfer.  I’ve asked the midwives I interviewed about their experiences with transfers.  Most of them say that it really depends on which OB is on call.  Great.

Team Harris addresses this in the comments section of the above post:

I’ve heard the argument that it’s inconvenient for hospitals to have to rally around and scramble when a homebirth mother takes that risk and it fails. While I see what these people are saying, I must also point out that we also rally around for every other emergency in life. We don’t judge the drug addicts who come in overdosed – we treat them. We don’t judge the obese who come in with MI’s. – we treat them. We don’t judge the diabetic who refuses to take his meds yet wants medical help when he has a diabetic crisis – we treat him. We don’t judge the elderly for forgetting their CHF meds and overloading – we treat them. We don’t judge many other behaviors which really ARE obviously poor choices – because they are just that – choices. Mothers deserve the same treatment.

What an excellent point!  Why is it that homebirth transfers are treated as “trainwrecks” and sometimes subjected to chastisement, intimidation, and contempt at a particularly vulnerable time?  I wish OBs who have no appreciation for and understanding of homebirth would take the above comment to heart.

I know in our area, the midwives are very good about calling ahead to apprise of situations so that we CAN have all hands on deck when they arrive. In fact, we did a section recently for a homebirth transfer (a very needed section) and the timing was perfect. Midwife called ahead to warn us. We called the team, and everyone arrived at the same time. Will it always work out that easily? Sadly, no. But that is life. I’ve had to really learn to come to grips with what life is all about. Sometimes bad things happen. And while it’s tragic and horrific, we can’t save the world.

Again, I read last night in Marsden Wagner’s Birth Plan book that the decision to incision time is about 30 minutes, even if a woman has been laboring in a hospital.  Because homebirth midwives are in direct and regular contact with normal/natural birth, they are better able to recognize emergent problems that can only be rectified at the hospital.  In most cases there should be enough time to transfer and receive an emergent cesarean should it be necessary.  I live 10 minutes away from our hospital, so I feel comfortable with the choice to birth at home.

When I was conducting my interviews I learned that the midwives are required to call the hospital and let them know that a woman is in labor at home.  The midwives are not sure what the hospital does with this information.  I wonder that myself and should probably investigate . . .

As a Healthcare Consumer

I was glad to find this post today.  Sherry Payne is a self-ascribed homebirth enthusiast, and I think it’s wonderful that she brings this enthusiasm to her blog, her other writing, and to her profession.  She is a labor & delivery nurse!!!  Her article is entitled “Consumer First, Patient Second.”  Here is an excerpt:

“Receivers of health care must adopt a more pro-active consumer role in their own healthcare delivery. Nowhere is this more obvious in healthcare than in obstetrics where as a labor and delivery nurse, I have seen care providers of all types routinely bully, control, and dominate their patients. Your care provider should be a competent guide through the process. He or she is not your daddy.”

This is certainly my goal as an ICAN leader and as a woman who now “knows better” than to let another person take charge of her body – to empower women and their families to take on a more involved role and equal position in their health care.  I don’t think there’s a harder “place” to do this than obstetrics, unfortunately.  However, if one woman in my community learns something from me in this regard, I will be thankful.

Trust Birth or Don’t?

I can’t resist.  You would think that since I am new to homebirth and haven’t had a VBAC yet that I wouldn’t bother myself with polemics regarding homebirth.  I’m obviously not that bright.  My homebirth google alert today included a post about the power of positive thinking and the homebirth movement.  I had to check it out. 

I won’t link to this weblog out of principle, but if you search for the quote using your favorite search engine, you’ll find it easily enough . . .

“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

I’d like to play with the words a bit:

“If you refuse to trust birth and insist that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

Some people, practitioners and women, simply refuse to trust birth.  Some will insist that birth is inherently dangerous.  They will likely achieve the birth experience that they desire, and it will likely be overly-managed, overly-medicated, potentially surgical, and definitely exorbitantly expensive.

“If you don’t trust birth and accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

And somewhat similarly:

“If you don’t trust birth even though you don’t believe that birth is inherently dangerous, you will likely have trouble achieving the birth experience that you desire.”

Some people don’t trust birth and have accepted the “fact” that birth is inherently dangerous.  They will likely create that reality in their birth experiences.  If women engage practitioners with this guiding philosophy, they will likely lose faith in the natural processes of life and end up dissatisfied with their birth experience even if the outcome is positive.

Some women know that birth isn’t dangerous most of the time but lack the trust needed to achieve particular outcomes.  Perhaps this was me once upon a time.  I never really considered that birth might be dangerous.  Why would I be created for a particular skill if it were inherently dangerous to me or my offspring?  However, I’m not sure that I trusted myself enough last time.  I didn’t trust my body.  I didn’t trust my instincts.  That’s probably the worst part of it . . . I didn’t listen to my inner voice.

“If you trust birth and acknowledge that birth is inherently natural to our species, you will likely achieve the birth experience that you desire.”

If you trust birth you are fortunate enough to understand that certain life events are natural and far less risky than some of the every day activities in which we engage.  Things like riding in cars.  That single activity is far more risky (statistically speaking) than giving birth.  If you trust birth you may not be “rewarded” with a particular birth outcome but understand that complications and poor outcomes are possible.  Trusting birth is not about sticking your head in the sand.  It’s about understanding that most of the time women can achieve normal birth when given appropriate support, time, and space.

Going back to the original quote:
“. . . if you ‘trust’ birth, and refuse to accept the fact that birth is inherently dangerous, you will be rewarded with the birth experience that you desire.”

“Trust” – in the original text, the blogger puts the word “trust” in quotes; this diminishes the validity of “trust” in relation to childbirth
“Refuse to accept” – ultimatum . . . polemic
“Inherently dangerous” – emotional scare tactic
“Reward” – as if there’s a prize involved???
“Desire” – as if all that matters for homebirthers is what the woman desires

Do you see yourself anywhere in my “play on words” section?  Where do you want to be?  Do you want to be afraid to be pregnant?  Do you really want to go into labor and delivery afraid?  Do you really want to go into labor and delivery lacking trust?  What is positive and proactive about being fearful and lacking trust?  What do you as a pregnant and/or laboring woman gain from that perspective?  I would say nothing.  You have lost your power and are no longer an active participant in your care when you are afraid and can’t trust.  Perhaps you (and your birth experience) are more manageable that way.  How do you feel about that?  Do you want to be managed?

I can’t really define homebirth for you.  Everyone comes to homebirth from different paths.  Some women always know that they’ll have their babies at home.  Some women are involved in social structures that are more inclined to promote homebirth, homeschool, extended breastfeeding, attachment parenting, and the like.  Some women are disgruntled consumers.  Some women aren’t given the choice to have a vaginal hospital birth and turn to homebirth as their only choice.  Some women who give birth at home don’t fall into any of these generalized categories.

For me homebirth is about safety, sanctity, Faith, Trust, natural life processes, achieving physiologic birth, what’s best for me and baby, avoiding an unnecessary cut, vaginal birth after cesarean, comfort, family, community, and a whole host of other things that I haven’t even discovered yet!

Homebirth in South Dakota

South Dakota isn’t particularly close to me here in Western MT.  However, SD is a neighboring state, and I have relatives who live in that state, so birth news from SD is important to me!

SD is working on legislation that will allow women to birth at home with assistance of certified nurse midwives (CNM). 

Current laws require South Dakota’s Certified Nurse Midwives to have a signed collaborative agreement with a physician as a pre-requisite to practice.  However, South Dakota’s physicians have failed to cooperate with any Certified Nurse Midwife for homebirth.
 
The South Dakota Chapter of the American College of Nurse Midwives supports the measure and provided testimony on Wednesday citing the safety of low risk mothers who have planned home births with Certified Nurse Midwives.

I don’t believe that Montana allows CNMs to attend homebirths.  I do know that doctors who used to provide back-up support for direct entry midwives (different certification and oversight than CNMs) in my community no longer do.  I like the language in the article – “. . . physicians have failed to cooperate . . .” – indeed!

Jeanne Prentice is a CNM from South Dakota that currently attends homebirths in Wyoming. 

Prentice is alarmed at the growing number of mothers who are choosing to deliver without any help at home because they fear what may be forced on them in the hospital delivery setting.

Indeed, many of us know well enough that hospital delivery can be interventive.  Women are not in a position of power with regard to their bodies, their babies, and their birth plans.  I am not talking about balking at medically-necessary intervention.  However, very little of what goes on in labor and deliver is NECESSARY.  Women are subject to a number of routine procedures and protocols upon entrance to to the hospital.  Women are resisting, and I believe this has caused 2 things:

  1. Care providers, especially medical providers, insurance companies, and other medical institutions are becoming more restrictive, more interventive, and less woman-centered.  This is evidenced by declining maternal-infant outcomes, increased cesarean deliveries, increased PTSD & PPD, and declining VBAC rates.
  2. Out-of-hospital birth is on the rise.  Women and finally starting to realize (I know I am) that their chances of having a good and safe childbirth experience are declining in hospitals.  Women are learning and owning the benefits of natural physiologic childbirth, when possible, and insisting on finding care providers who will enable that.

Alliance Defense Fund Supports Homebirth

Maybe this is not news to some of the folks who visit my blog, but I was not aware of:

  • A Pennsylvania court case against a direct-entry midwife named Diane Goslin
  • That the ADF could be an important ally for those who support the patient’s right to choose care

Look at what the ADF says with regard to this case:

“Honoring one’s cultural or religious heritage by using a lay midwife to have a child at home is not a crime,” said ADF Senior Legal Counsel Jeff Shafer.  “The venerable practice of lay midwifery, which has a clear record of safety and is steeped in cultural and religious tradition, should not be banished as an option for Pennsylvania mothers.”

Evidently midwifery is allegal, not illegal but subject to prosecution, in Pennsylvania.  I am glad to see the ADF hailing lay midwifery as “venerable” with a “clear record of safety.”  They clearly recognize the need to preserve and protect viable options such as lay midwifery.

I have often thought about the spiritual side of childbirth.  Some Christians would say that since God has enabled mankind to develop technology, we should use it.  However, Christianity is about simplicity and directness.  Christians inherit more though they may “have” less.  I wonder if God doesn’t see the over-use of technology in physiological processes as frivolous.  This isn’t about needless subjection to pain, or the stain of sin, or any of that stuff.  This is about simplicity, direction, and belief.  I believe that God gave me a body that works.  My pregnancies may require intervention, but when they do not, I can’t imagine that technological/medical abuse & overuse would glorify God.  For me the overuse of these interventions run contrary to my Belief.

One verse that really speaks to me right now comes from Romans 4:

“[Abraham] was empowered by faith and gave glory to God & was fully convinced that what he had promised he was also able to do.”

In spite of his old age and Sarah’s old womb, Abraham had faith that God would entrust many nations to his care.  Given the last 5 months of my life, I find this encouraging and empowering.

Musings on Birth Safety

Which is it – childbirth is safe, normal, natural or dangerous, wild, and unpredictable?  Do we really need to draw a line in the sand like that?  Isn’t childbirth all of that – normal, natural, wild, unpredictable, sometimes just fine, sometimes not?

No, childbirth is not always safe.  I work with a gal who has nearly died in childbirth several times.  She lost one child along the way.  She birthed at hospitals under the care of a high-risk obstetrician, and that was a necessary reality for her.  A friend of mine recently birthed a baby still.  They don’t know why the baby died during birth.  Another friend of mine suffered an uterine rupture.  Her smart baby was blocking the artery that was compromised, and that is why she is still alive today.

But often pregnancy and childbirth is normal and uneventful.  (Well, it’s always a big life event, but it’s not nearly as dramatic as Baby Story would have you believe.)  It seems like it is more fun for people – some natural birthers and some who want all of the technological bells and whistles – to hype up childbirth.  “Ugh, it was SO PAINFUL I just HAD to have my epidural.”  “No one is going to take away my VBAC.”  “Oh my gosh if I hadn’t had that c-section, I’d have died in childbirth.”  “I’ll have to be dying before I let anyone take me to the hospital again.”  (For what it’s worth, I said that last statement following my October miscarriage.)  Drama drama drama.  Me me me.  I want I want I want.  I’m being a bit extreme here, but I read so much selfishness and self-indulgence and self-glorification on both sides of the proverbial childbirth fence.  Does this help women?  Does this empower women to make informed choices that “make” childbirth safe?

Let’s come back to that term “safe” as it applies to childbirth venue.  If you don’t believe homebirth is a safe choice, then it’s not . . . for you.  If you don’t believe that you can have a natural non-interventive birth in the hospital, and that’s important to you, then you probably won’t have a good experience in the hospital.  If you don’t trust anyone but your self and perhaps your partner in childbirth, you will probably prefer unassisted childbirth.  We’re only “safe” when we believe we’re safe.  I honestly don’t believe that MOST women are safer in the hospital or safer at home or safer at a birth center.  They perceive a level of safety and psychologically, and even physiologically, respond to that way of thinking.  Certainly there are plenty of “yeah, but” scenarios out there, but I very clearly wrote “MOST women” above.

Be afraid to birth at home.  That’s fine.  But don’t call a woman crazy for choosing to feel safe at home, especially if she is surrounded by well-trained and caring support.  You can be afraid even when someone else isn’t.  Be afraid to birth at the hospital.  That’s fine.  But don’t criticize the woman who chooses to deliver at a hospital, especially if she is surrounded by well-trained and caring support.

It is an unfortunate reality that babies die in childbirth . . . that women die in childbirth.  I think doctors, midwives, and other childbirth support providers are all interested in reducing negative outcomes in childbirth.  I just wish, hope, and pray for the day when these parties can meet and work from a point of mutual respect.  That’s when we’ll have a maternal-child healthcare system that is woman-baby centered and certainly safer for all involved.

We can’t make changes if we don’t talk.  Debate is not talk.  People who debate don’t listen.  I think people who get caught up in debating issues without stopping to listen and learn are afraid.  They are frightened sad unhappy people.  I have my own set of fears just like anyone else, but I strive to run my life from a place of power and trust.  I don’t want to pass fear along to my children.  I don’t want to be remembered that way.  I don’t want to approach God that way.

May you find power, faith, and love, now and forever.