|February 15, 2012|
Volume 14, Issue 4
|Midwifery Today E-News|
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Attend the full-day Beginning Midwifery workshop at our conference in Harrisburg, Pennsylvania, April 2012. Designed for the aspiring and beginning midwife, this class features experienced teachers who will share their wisdom and love of midwifery. Topics covered include Prenatal Care, Normal Labor Physiology, Emotional Issues in Labor and Anatomy of a Birth Bag.
Mark your calendars and save the date. This is your chance to learn from teachers such as Gail Hart, Elizabeth Davis, Cornelia Enning, Carol Gautschi and Lisa Goldstein. You can choose from a wide variety of classes, including Essentials of Midwifery, Second Stage of Labor, Techniques from Mexico, and Waterbirth.
In This Week’s Issue
Quote of the Week
Giving birth should be your greatest achievement, not your greatest fear.
— Jane Weideman
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The Art of Midwifery
VBAC women are so grateful for the opportunity to birth normally that they are often shy to ask for the extra things that make a birth beautiful, such as a Blessingway ceremony or a waterbirth. The midwife must remember to offer and encourage the mother to think “really beautiful birth” rather than “bare minimum birth.” I find it helpful to ask, “This is the only second baby you will ever have—what would make it really special?”
— Gloria Lemay
ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn! Share them with E-News readers by sending them to firstname.lastname@example.org.
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The Human Face of Birth Trauma
To me, the subject of VBAC begins with cesarean prevention. Midwifery Today has a clinical series book on this subject, titled, The VBAC and Cesarean Prevention Handbook. Cesarean may be the most important issue around birth today because it is becoming a worldwide epidemic that does considerable damage to mothers and babies. The flip side of this is, of course, the damage that happens when necessary cesareans are unavailable. Regrettably, this lifesaving operation can be turned into a life-taking one through mismanagement.
How can we change the world? How can we make the people in the medical system care about the birth experience as well as the safety of it? The question of what the cesarean rate should be is controversial. Many of us believe it should be around 3–5%, but the World Health Organization says 10–15%. There is yet another issue—how do we help women become healthy? One-to-one midwifery care is one answer.
Another answer would be to put a human face onto this issue because every cesarean involves two or more lives. My friend, Sister MorningStar, pondered how we do statistics on cesareans. The statistic is counted per mother cut, but a stat should be counted on how many babies have been cut out of their mom and correctly represent when two or more babies are born per abdominal surgery. All of these mothers carry in their being trauma from birth rather than the miracle of birth. What might be the lasting effect on each of these babies? How do moms process this incredible trauma and why do they have to? Visit the International Cesarean Awareness Network Web site to find out answers to these questions and also to get help if you need it. There are so many questions here with very few answers, but I think if we could each put a human face on each statistic that would be a start. Midwifery Today magazine and the conferences we host provide opportunities for solutions to be discussed.
Birth stories shared by real women might be the most powerful way we can put a human face on this situation (see “Birth Q&A” below). One reader named Shasta Marine shares one of the joys she had from her VBAC, “I got to touch my baby first! My baby, my hands, my body! I reclaimed ownership.” A midwife, Susan DiNatale, shares her experience with VBAC moms, “They glow like something from another dimension must.” So let us all put a human face on cesareans and both prevent unnecessary ones from occurring and help sweet mommas and babies to heal from their cesarean experiences. Ask your doctor and nurse friends to “First, do no harm,” and let’s make sure we are doing the same.
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
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US Cesarean Rate Dips Slightly; Is There Hope for More VBACs?
The Centers for Disease Control and Prevention released a report on birth in 2010 in the United States. The data showed a 3% decrease in births from the year before and a 0.1% decrease in cesareans. This is the first decline in cesarean rates since 1996. However, 17 states and the District of Colombia showed an increase in cesarean rates.
Academics, health care quality groups, state lawmakers and the like have been voicing their concerns recently about reducing the number of maternal and newborn complications associated with cesareans, which will have the added bonus of reducing health care costs.
In the US, more than 4 out of 10 births are paid for by Medicaid. Because of shrinking state budgets, cesareans have been a main topic of discussion. In 2009, the average cost for a cesarean was between $13,000 and $20,000.
Repeat cesareans put mothers at an increased risk of death and early elective deliveries are linked with short- and long-term neonatal morbidities.
Dr. John T. Queenan, author of the article, “How to Stop the Relentless Rise in Cesarean Deliveries,” expects the US cesarean rate to reach 50% unless cesarean rates are reduced and access to VBAC is increased. Similarly, Dr. James R. Scott, author of the article “Vaginal Birth After Cesarean: A Common-Sense Approach,” promotes an ethical approach to caring for women with a previous cesarean, giving preference to VBACs over repeat cesareans despite fears of malpractice suits.
Hopefully the call for fewer cesareans and more VBACs will be a trend that continues in years to come. Perhaps a more significant dent than the current 0.1% decline in the cesarean rate will occur.
— Jukelevics, Nicette. “US Cesarean Rate Dips Slightly; Is There Hope for More VBACS?” vbac.com. November 19, 2011. http://www.vbac.com/2011/11/u-s-cesarean-rate-dips-slightly-is-there-hope-for-more-vbacs/
VBAC and Choice
Recently, I received an e-mail from a VBAC client. “When I agreed to have a cesarean, was I really making a choice?” she asked. “First of all, I, the chooser, was not truly informed; second, my doctor lied to me. Third, my insurance company limited my choices in many ways. Many of us women are so acculturated as to be unable to think outside the box, so if our insurance doesn’t pay for midwives or cover homebirth, we think we can’t choose it. Fourth, my family and friends were also ill-informed and thus played into the hands of the doctor; and in fact, I didn’t even have the doctor I chose—I ended up with the one who happened to be on call that evening.”
She went on: “[M]any women just like me end up having the primary c-section because of the ‘choices’ they made, even though, again, many of those choices were false and ill informed! Then, they are really stuck when trying to plan a VBAC in this climate and culture. The truth as I see it, Nancy, is that the choices are false, the lies are rampant and the truth (some c-sections are needed; some babies will die) is simply hard for people to face.”
Each baby has only one opportunity to be born, there are no second chances; so whenever possible, the experience ought to be safe, wonderful, natural, empowering and amazing. I have a sincere passion to assist women in having the best births possible. VBAC feels like my baby. Having had my own VBAC in the early seventies and having coined the term, I’ve spent my adult years researching the subject—teaching it, talking about it, thinking about it and writing about it. Along with many other midwives and childbirth educators, I’ve done my best to bring the subject of VBAC to light and to assist women who choose to birth normally after having been surgically delivered. My heart still drops into my toes every time I learn about a woman who received a c-section and leaps with delight when I either hear from, or am able to assist, a woman who has had a VBAC.
When Barbara birthed her 9 lb 4 oz son (vaginal birth after two cesareans—VBA2C) out of her supposedly contracted pelvis, in the privacy of her own bedroom, five hours after I walked through the door, and when I saw the look of relief-accomplishment-ecstasy on her face, I was happier for her than I could express. Ditto for Laura’s 11 lb VBAC daughter, who slipped out of her body one crisp winter night. In one capacity or another, I’ve assisted thousands of women who have chosen to have a VBAC; many have had births that exceeded their wildest expectations. Sadly, some of the women who have sought my help didn’t have the births they were hoping for, and some have had a repeat c-section.
We have learned in newspapers across the country this month that the cesarean rate has been consistently increasing. It is well documented that the rate has increased at least 48% in the last nine years—one in three women are now having c-sections. Before that I remember someone telling me that the rate was “barely 20%.”
Barely? Many of us remember back to the days when the c-section rate was approaching 15% and the headlines all over the country stated that the cesarean epidemic was indeed upon us and something had to be done! We were told that, conservatively, at least three-quarters of the one million cesareans that were being done were preventable and that this major abdominal surgery was far more dangerous than vaginal delivery.
Was anybody listening?
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Q: What part of your VBAC did you enjoy experiencing the most compared with your previous cesarean?
— Midwifery Today
A: After my first VBAC I looked at my husband and said, “I don’t feel like I just had a baby. I’m coherent and everything!
— Ashley Klemm
A: The power I felt was amazing. The fact that I was needed for my birth was healing. With my c-section I felt like the only reason I got to go was because my uterus happened to be connected to the rest of my body. With my home VBACs (3 of them), I didn’t feel like someone else knew more about my body than I did. The simple act of me setting up my own birth supplies was empowering.
— Natalie Hessell
A: I had a section with my twins (babies number 4 and 5). It took a long time to establish nursing and bonding with them. I didn’t even realize how cheated and violated I felt by the whole thing until I read Silent Knife. I had the next baby at home—it was such a wonderful and healing experience. It felt like something was restored to me. (I went on to have five more babies at home, BTW!)
— Vicki Davis
A: I haven’t had my VBAC yet (I’m 39 weeks right now), but what I can say about this journey already is that is has been one of fear, sometimes anger, determination, emotion, and most importantly healing. I’ve learned to stop blaming myself, and to trust in my body again. I am not broken. I have educated myself and surrounded myself with a team of supportive caregivers, family and friends and have done everything possible to create circumstances for a successful VBAC. No one can know until it happens what the outcome will be, but I can tell you that no matter what it is, a VBAC is about so much more than a single birth. It’s a journey of healing, forgiveness, enlightenment, empowerment, and faith.
— April Murphy
Responses to any Birth Q&A question may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Wisdom from the Web
Quite interestingly, the highest rate of VBAC is in women who have experienced both vaginal and cesarean births and given the choice, decide to deliver vaginally.
— American Pregnancy Association, promoting pregnancy wellness
A VBAC candidate who has had a previous vaginal delivery has an 89% success rate for a VBAC and fewer complications as opposed to a woman who has never had a vaginal delivery. It is therefore not appropriate to ask women who’ve had successful vaginal deliveries to have repeat c-sections based on “hospital policy.”
— Dr. Linda Burke-Galloway, author, physician, public speaker, medical malpractice reviewer
Planning cesarean surgery exposes women to the serious potential harms of major surgery. The best way of determining whether the baby is too big to come out is to go through labor and see. Take home message: don’t plan surgery.
— Henci Goer, obstetrical expert
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to email@example.com.
Gail Tully in Harrisburg
I am so thrilled that Gail Tully of “Spinning Babies” is joining us at the Harrisburg 2012 conference in April. She will be a registrant, but we will engage her with her amazing knowledge at the “Tricks of the Trade Circle” and in other ways. She is so sweet and humble; I am sure she will be willing to answer your questions throughout the conference. There are so many reasons this is going to be an inspiring conference!
A couple of weeks ago I was blessed to attend Gail’s “Spinning Babies” and “Shoulder Dystocia” workshops when she came to our hometown, Eugene, Oregon! We had the events at my friend Anita Rojas’ birth center with the lovely hospitality of Anita and the midwives there.
I learned so very much from Gail. She is a fountain of information which she presents well with models and videos to help us understand what we cannot see within a mother’s body. She spices her presentation with birth stories to illustrate the points. We learned how the baby makes her way down and out and how it involves the mom’s bones, muscles and ligaments. There are dystocias that can happen just from the round ligament! The mom’s body and this process are so amazing. God is brilliant!
Besides these marvelous events, Gail and I got to get Vietnamese food together. If you come to town that is where we will go to lunch! Gail and I talked about our calling, how we got into this amazing field and our journey while in it, along with our birth plans for the future. Much to my joy, these future plans involve us working together. We talked about our families and life, philosophies, ideas and ideals. You know how it is when two midwives get together? We could have talked until midnight! Come join us in Harrisburg where we will have the chance to talk until midnight!
— Jan Tritten
I attended a twin homebirth (also waterbirth) of a first time mom. Another midwife helped birth the placenta. There was no bleeding but we could tell by looking at her uterus that it was descending into the opening of the cervix. The midwife gently supported the cord with gauze, and when the mom pushed, the placenta flew out and hit the assisting midwife in the stomach. The placentas had grown together and needed a forceful push to come out. The midwife was soaked in blood from head to toe and had to strip down in a nearby bathroom putting on a much smaller person’s clothes. We all got a good laugh at her expense.
— DyAnna Williams Gordon
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WomanCraft Midwifery Education Program: a strong foundation of academics and hands-on skills for aspiring midwives. Course includes Doula and CBE Certification. Begins March 10, 2012, Amherst, MA. http://www.womancraft.org
Global health professionals: look here for hard-to-find technologies and tools for midwifery and obstetrics. http://maternova.net/products
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