VBAC Varies by Hospital Type

From The Feminist Breeder

NIH VBAC Consensus Conference is live NOW

You can watch it at: http://consensus.nih.gov/2010/vbac.htm

VBAC is Vital

Vaginal birth after cesarean (VBAC) is a crucial option in maternity care today. I see VBAC as one of the key ways for us to attack the growing maternal mortality.

Many people do not think about the cesarean rate as a two-part issue. There is the primary cesarean rate, the number of women having their first cesarean. There is also the secondary or repeat cesarean rate. Currently, both numbers are growing.

The primary cesarean rate is growing for many reasons. Some of these reasons women can help control, like choosing practitioners who have faith in the process and only intervene when truly necessary. A good example of an intervention that can increase the cesarean rate and isn’t truly needed would be non-medical inductions.

But the secondary cesarean rate is where VBAC comes in. This rate is growing as well, largely because women are not being offered the ability to give birth vaginally after a previous cesarean. The growing body of research is showing that VBAC is safe and successful for more women who try it. Many women want to try it but are turned away by their doctors or midwives – leaving them the option of a repeat cesarean or fighting for a VBAC.

More and more women are choosing to fight for the VBAC. The question becomes – why should women have to fight for something that is likely to be safer for her and her baby?

This is part of the ICAN Blog Carnival.

But Why is VBAC so Important?

I am sure that I am not the only person to ask myself this with the announcement of the National Institute of Health VBAC Conference announcement.  But unlike most, I know more than my fair share about VBAC after having a cesarean with my first child it became more than a healthy obsession to me. But sadly the more I learned, the more sad I became about the access to VBAC nationally.

In a 2009 survey from The International Cesarean Awareness Network, it was found that nearly 50% of all hospitals in The United States has some sort of a VBAC Ban in place. Whether it be a formal policy written by hospital administrators, or a de facto ban, meaning there simply are no providers who will take on a patient who wishes to have a Vaginal Birth after Cesarean.

But what does this mean for women nationally? For the women who have had cesarean sections, whether medically necessary, or unnecessary?  It means that once they have experienced once cesarean birth, they have no choices regarding future pregnancies or deliveries. Essentially leaving them with no real informed consent.  To me, as a huge activist, that is not only a violation of a patients rights, but it is a major human rights and bodily anatomy violation.

Right now, 90% of women who have had one cesarean section will go on to deliver all of their children through multiple major abdominal surgeries, the next more risky than the last. When the safe and relatively low risk  option of a VBAC is not available.  But lets look at the numbers regarding the risks of VBAC as opposed to repeat cesarean sections.
The major risk associated with a Vaginal Birth after a Cesarean section is something most near the most not knowing the risk is so low. Uterine Rupture.  Not something we should discount or not worry about, but when we look at the statistics, the average healthy woman who has had one previous cesarean section has a 0.6% chance of experiencing a uterine rupture.

When I went through the process of filling out and signing my VBAC consent form for my second pregnancy, there was paragraph after paragraph panting VBAC in a scary pictre, then a small paragraph with the minor risks of a repeat cesarean, almost like the practice of Obstetricians backing my midwives wanted me to change my mind and run in fear.
This form was not informed consent by any means, it was skewed, biased, and provided misinformation, but sadly this is what we are seeing Nationwide today.

But I can hope with the NIH VBAC conference we can start to see a change in the way that VBAC is handled nationally.
Women have the right to real informed consent, and give birth vaginally if that is what they choose for their own birth.

For more information on Cesarean Awareness, and Advocacy, check out The International Cesarean Awareness Network.

What does it mean to be a birth activist?

Luckily, I know many women who are great activists. I have to admit I’ve had a couple of women tell me that they didn’t feel like they were activists. They felt that the word was too strong.

an especially active, vigorous advocate of a cause, esp. a political cause.

Hmmm, doesn’t sound too strong to me, but I understand, in a sense, what they mean. When asked what activists did, many came up with picketing, or going door to door. While I certainly haven’t had the opportunity to do either of those, I think that is largely because the Internet has changed activism, hopefully for the better, if not easier. Many women said that they see themselves more ad advocates:

a person who writes or speaks in support of a cause or person.

So does the different between activist and advocate have to do with passion? What are your thoughts on the differences between advocacy and activism? How do you identify yourself?

Breast Milk Bust in Haiti?

MSNBC is reporting that there is no need for breast milk in Haiti.  Not only that, but it’s not wanted:

“The international Emergency Nutrition Network has asked one group, the Human Milk Banking Association of North America, to retract a press release this week that issued an “urgent call” for breast milk for orphaned and premature infants in Haiti, saying the donations contradict best practices for babies in emergencies.” (emphasis added)

The real kicker is that this is a totally inaccurate statement. Breast milk, even when it comes from another mother, is preferable, according to the World Health Organization (WHO), when it comes to infant nutrition.  Formula requires clean water, something sorely lacking in a disaster.  You can’t even turn on the radio without hearing how it is hard for people to get drinking water.  The ramifications of using formula in this instance is of great public health concern.

Emergencies and breastfeeding was the recent subject of the World Breastfeeding Week Campaign last August.  It prompted the WHO to put out documents discussing the benefits of breast milk in such crises as they are facing in Haiti.

VBAC Conference by the NIH

March 8-10, 2010 will have a consensus conference on vaginal birth after cesarean (VBAC).  It will address questions, including:

• What are the rates and patterns of utilization of trial of labor after prior cesarean, vaginal birth after cesarean, and repeat cesarean delivery in the United States?
• Among women who attempt a trial of labor after prior cesarean, what is the vaginal delivery rate and the factors that influence it?
• What are the short- and long-term benefits and harms to the mother of attempting trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the short- and long-term benefits and harms to the baby of maternal attempt at trial of labor after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
• What are the nonmedical factors that influence the patterns and utilization of trial of labor after prior cesarean?
• What are the critical gaps in the evidence for decision-making, and what are the priority investigations needed to address these gaps?

Going in person isn’t really an option for most of us, but you can also sign up for the webcast online and/or to have the transcripts sent to you when it’s up. I’m sure that there will be a lot of activists there, I can’t wait to hear the guest list.

Tell Zales How You Feel About Breastfeeding & Diamonds

I rarely see commercials anymore thanks to my DVR.  But the other night I caught the standard sappy, Holiday fair from Zales Diamonds.  I was outraged within seconds when it showed a mom leaning over an empty crib while dad bottle fed a baby in the background.  I mean come on, wouldn’t it be better to give mom a diamond for breastfeeding?  Or even as a push present?  But this was just sad.  If you’re as outraged as I am, you can write them online or call them at: 1-800-311-JEWEL

Violence in Maternity Care

The non-profit organization Solace for Mothers: Healing After Traumatic Childbirth is asking anyone who has experienced or has witnessed violent maternity care, to write a letter to Lynn Rosenthal, the presidential advisor on violence against women, and First Lady Michelle Obama.

Solace explains:

We invite you to join us in writing to Lynn Rosenthal and Michelle Obama in an effort to bring awareness to the violence women experience at the hands of some maternity care providers. First Lady Michelle Obama has made recent remarks championing the rights of childbearing women, and may be an ally for this cause. Lynn Rosenthal is a former executive director of the National Network to End Domestic Violence.

We are calling for an official review of perinatal practices to investigate common and flagrant violations of patients? rights; mainly the right to informed consent and refusal. We are asking that enhanced and enforced mechanisms for accountability follow the investigation.

What can be considered violent maternity care? Solace states,

The World Health Organization (WHO) defines violence in this way:

“the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”

Violence in maternity care is expressed in many different ways. There can be physical violence, such as forcing procedures which women have explicitly refused. There can be emotional violence, such as coercion, manipulation, or verbal abuse. There can be an exertion of power or force over women’s legal rights by individual health care providers and/or by hospital policies such as threatening to call child protective services if a woman does not agree to a procedure or threatening to withhold care in labor if a woman does not agree to the provider?s suggested intervention. ?Informed consent? refers to the legal right of all patients to have the risks, benefits and alternatives clearly explained prior to any procedure. All patients ? including laboring women - have the right to accept or refuse any suggested treatment. Withholding informed consent through the use of physical force, coercion or manipulation is an act of violence and is illegal.

Provider-perpetrated violence during childbirth can result in the birthing woman suffering traumatic stress, anxiety disorders such as posttraumatic stress, postpartum depression and other disabling mood disorders.

For more direction, please click here to visit the Solace for Mothers webpage about the campaign.

To read the letter sent to Lynn Rosenthal and First Lady Michell Obama from Solace for Mothers, Click Here.

Please write letters and spread the word to anyone who may have experienced or witnessed violent maternity care.

Healthy Baby Bounty Bag

Photo (c) Lansinoh

Have you seen these cool bags from Cottonwood Kids? They are the alternatives for other breastfeeding discharge bags - but breastfeeding friendly. Now you can be your own activist and send a letter ask for your hospital to carry them! So download your sample letter now!