CNN: Empowered Patient

Today I have the luxury of time and relaxation.  After walking (yep, that’s right) my daughter to daycare, I returned home and swept out the garage.  I finished at 9:30am and have the entire day ahead of me.  I digress.  As I was sitting on my bed checking my e-mail, I discovered that CNN was discussing how women make mistakes with regard to healthcare.  This does not apply to soft-spoken women alone; in fact strong women like me have a hard time demanding the care that we deserve.

This article at CNN discusses resources for various health issues that women face.  Dr. Christine Northrup shares a few gynecological resources.  I hope that the media continues to reach out to female consumers and remind them to be proactive and empowered in their health choices.

Upcoming Interview

In about an hour I will be interviewed for a local news station regarding Montana’s cesarean rate.  I don’t know much more than that.  The reporter has a young child.  The reporter is supposed to be meeting with a local hospital official.  Other than that, who knows what her focus will be.  In anticipation of this interview, I decided to review some things that I have read and wrote regarding cesarean rates.

With regard to rates, it is important to consider that the US cesarean rate (2006, preliminary) is 31.1%.  The rate has increased by 50% since 1996.  The rate recommended by the World Health Organization is 10-15%.  Once the cesarean rate exceeds 15%, the risks (statistically speaking) outweigh the benefits.  The Montana cesarean rate (2006, preliminary) is 28%, nearly a 3% increase from the year prior.  According to a source at the local hospital, our local rate is around 31%.  I was told that only 16 VBACs took place in 2006 at my hospital.  (A local CNM questioned the accuracy of the VBAC figure, suggesting that VBACs were under-reported.)

I can list many contributing factors to the continued increase in the cesarean rate:

  • Medico-legal concerns on the part of doctors, hospitals, and insurance providers (it’s HUGE, actually)
  • “So and so had a cesarean . . .”
  • Hollywood stars having elective cesareans
  • Young and underpriviledged mothers are more at risk for cesarean surgery
  • An unchecked trust in care providers – most women do not seek second opinions when it comes to maternity services
  • Sensationalization of birth – Baby Story and OR Live come to mind
  • Society – our view of birth has changed; the culture of fear has spread to childbirth
  • Cesareans ARE more safe now than they ever have been

Of course I’ll direct the reporter to resources such as:

  • ICAN
  • The Mother-Friendly Childbirth Initiative
  • Childbirth Connection
  • Conscious Woman

Sharing Cesarean Awareness

I found this on ICAN’s eNews (www.ican-online.org/community/eNews/) and want to share it with those who maybe aren’t (yet) subscribers!

Cesareans Affect Lives. Real women, real babies. Lives changed.

How has your cesarean impacted you? Come to www.ican-online.org and blog about your experiences in 100 words or less, tell us your story.

Cesarean Awareness:
is not only about the “bad” cesarean and recovery
is not about guilt for not succeeding at VBAC
is not about not attempting VBAC
is a state of being, whatever that may be for you or me – hope, fear, acceptance, sadness, depression, thankfulness
is about doing the research to understand the reality of the risks taken on every time another mother has another surgery

ICAN is about all birthing women having access to that information.  Cesarean Awareness Month is about encouraging the spread of that information.  We want to encourage you to find a way to spread the awareness in your community. Wear your ribbon. Write on your car. Buy brochures to drop off in the library. Put up a poster at your work. This is about open communication about the health of our women, babies and families.

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.