Less Restrictive Guidelines for VBAC

With the cesarean section rate in our country reaching an alarming 31% The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines in hopes to allow greater access to vaginal birth after cesarean (VBAC). In a statement issued today, ACOG says:

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

The World Health Organization (WHO) recommends that for the best maternal and fetal outcomes that cesarean rates in industrialized countries should be no more than 10-15%. ACOG's recommendation is a step in the right direction to allowing more women the choice of a VBAC. While it moves us forward, we still need to keep the doors of communication open between women and their doctors and fully support their childbirth options. You can find the full text of the press release from ACOG here.

Celebrating Memorial Day & Doula-ing for Our Troops

While you are enjoying your time off, grilling with family and friends or relaxing at the beach, take a moment to remember our brave men and women who put their lives on the line everyday for our freedom. They do so without hesitation and with great sacrifice. I have family and friends who have served in the armed forces and I am a proud volunteer doula with Operation Special Delivery. OSD provides doulas for pregnant moms whose husbands or partners are deployed or have been severely injured serving our country. If you or someone you know is pregnant and their spouse is deployed please visit Operation Special Delivery to learn more about the program. If you don't qualify for OSD, I do offer a discount for military families. It's just my small way of saying thank you for all that you do!

Mother & Baby Friendly Cesarean

The United States cesarean section rate is rising at an alarming pace. While we need to educate ourselves about and discourage the use of unnecessary cesareans, the medical necessity of the procedure has allowed for healthy outcomes for countless mothers and babies. (me to be included!)

For those mothers and babies that medically require delivery by cesarean I argue that we should explore the option of a mother/baby friendly experience. The Natural Cesarean: A Woman-Centred Technique (pdf file) is an article published in the BJOG: An International Journal of Obstetrics and Gynaecology exploring the option of the parents being active participants in the birth of their baby.

What would a mother/baby friendly cesarean look like? According to the authors of the article:

• The drape would be lowered and the mother's headed elevated so that she may witness the birth.
• The partner would be allowed to observe as well
• Baby would be allowed to slowly emerge helping to expel liquid from its lungs as it would during a vaginal birth
• Rest of delivery is allowed to occur passively as the uterus continues to contract
• Clamping of the cord is done in front of both parents and the partner is permitted to cut if desired
• Baby is brought between the mother's breasts for immediate skin to skin contact and offered a chance to suckle
• Baby is allowed to remain on mother's chest until the surgery is complete. Procedures (labeling, Vitamin K, etc.) that can be completed in this position are.
• Once surgery is complete, partner accompanies baby for weighing and remaining procedures
• Upon completion of procedures, baby is immediately returned to mother for skin-to-skin contact

A cesarean section is major abdominal surgery. This birth experience is not suitable for all cesarean births, but I think, as suggested by the authors of the article, this option can be explored for non emergent situations. The International Cesarean Awareness Network has also written details about how to have a family centered cesarean.

If your medical situation dictates that a cesarean is the safest way to deliver your baby discuss your options with your doctor.

Don't Be Quiet - Share Your Amazing Birth Story!

You know if you're pregnant everyone has some advice for you. How you should do this or how you should do that. The other thing that often happens is that you will start to hear more birth stories. Not to make lite of the individuals who have had difficult births or things they wish they could change about their experience, but I think it's time to celebrate our amazing births.

If you had an inspirational birth tell your story. Don't be shy. Share what made your birth experience incredible. It doesn't have to be the birth you dreamed of or the one that was carefully laid out in your birth plan, but share it nonetheless. Your words of wisdom could help to empower and inspire other women throughout their pregnancy.

Don't be quiet. SHARE your amazing birth story!

Here. I'll start.......

While the birth of my twins was by no means the birth I thought I was going to have when I found out I was pregnant, it was very empowering. I went into labor on my own, I was able to see them being born via c-section and I had the support of my husband and amazing nurses that I had gotten to know during my antepartum stay in the hospital. If you wish to read the birth story of my twins visit my Twins Make 5 Blog. My experience was empowering because I was educated about my pregnancy and birth options and I strongly advocated to let my body and my boys make the decision about when they were going to come.

Pregnant? Consider a Midwife

Our Bodies Ourselves has posted a video on their blog asking the question "Why Choose a Midwife?" The video is mainly being used to address legislation in Massachusetts governing midwives, but it has the added benefit of detailing the benefits of the midwifery model of care.

Parts of the video are drawn from Natural Born Babies which is told by 10 mothers describing their journey to have a natural childbirth. The video is amazing! I promise I'm not just saying that because I'm biased having worked with Executive Producer, Lorri Walker at South Coast Midwifery & Women’s Health Care or having had the blessed opportunity to serve as doula to the family who helped direct the film. If you are pregnant and are looking for a healthcare provider these films will give you pause and a reason to consider hiring a midwife.

Are You Familiar With The Mother-Friendly Childbirth Initiative?

If you are pregnant or trying to conceive take the time to familiarize yourself with The Mother-Friendly Childbirth Initiative (MFCI). It is the first and only consensus document on maternity care in the United States. MFCI is evidence based and focuses on prevention and wellness while promoting a mother, baby and family friendly model. MFCI takes the approach the childbirth is a normal, natural and healthy process and should be respected as such.

Mother-Friendly Childbirth Initiative

Consensus Document by the Coalition for Improving Maternity Services

A mother-friendly hospital, birth center, or home birth service:

1. Offers all birthing mothers:

• Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;
• Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;
• Access to professional midwifery care.

1. Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.
2. Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.
3. Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.
4. Has clearly defined policies and procedures for:

• collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;
• linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.

1. Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:

• shaving;
• enemas;
• IVs (intravenous drip);
• withholding nourishment or water;
• early rupture of membranes*;
• electronic fetal monitoring;

1. other interventions are limited as follows:

• Has an induction* rate of 10% or less;†
• Has an episiotomy* rate of 20% or less, with a goal of 5% or less;
• Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;
• Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

1. Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.
2. Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.
3. Discourages non-religious circumcision of the newborn.
4. Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

• Have a written breastfeeding policy that is routinely communicated to all health care staff;
• Train all health care staff in skills necessary to implement this policy;
• Inform all pregnant women about the benefits and management of breastfeeding;
• Help mothers initiate breastfeeding within a half-hour of birth;
• Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;
• Give newborn infants no food or drink other than breast milk unless medically indicated;
• Practice rooming in: allow mothers and infants to remain together 24 hours a day;
• Encourage breastfeeding on demand;
• Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;
• Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

As you look for healthcare providers talk with them about their approach to the Mother-Friendly Childbirth Initiative. Here are 10 questions to ask and help as you explore your options.

The Realities of Working and Breastfeeding

"When providing breastfeeding support we must listen to the mother and meet her where she is."

Last month I attended the Breastfeeding and Feminism 2010 Symposium: Informing Public Health Approaches. It was an inspiring and educational conference. This is the quote that came from my workgroup at the conference that really spoke to me. It is where I believe all individuals need to come from when working with a breastfeeding mother.

As I look at breastfeeding and work there are certain realities that we cannot escape. One of the most recent breastfeeding accomplishments in public health was the health care reform law that allows women employed in businesses with over 50 employees to be permitted to pump and have a place to do so. This is an amazing accomplishment that we need to applaud, but at the same time we must also recognize the limitations of this legislation and work with breastfeeding mothers to help them overcome whatever obstacles prevent them from continuing a breastfeeding relationship.

I returned to work when my oldest son was 3 months. I had an office job that allowed me the flexibility to pump when I needed. Even when I was on the traveling, I built in time to pump. I also worked from home a few days a week, so I had the added benefit of being able to breastfeed my son and not pump at least one day a week. Like many, I struggled with supply issues here and there, but I was able to recover and continued pumping until he turned 1. Our breastfeeding relationship continued until he was 22 months. I was lucky. I had an ideal pumping and breastfeeding scenario. Sure I pumped in the car before a meeting, while typing an email to a coworker and while on a conference call (muted of course-have you heard how loud the pumps can be?). However, I fully recognize how lucky I was.

If my scenario was perfect, what happens in real life? What happens if the breastfeeding mother is:

• The teacher who needs to be in her classroom for the majority of the day?
• The doctor or nurse who works a 12 hour shift?
• A waitress who has customers to attend to during her entire shift?
• A woman who works in the chicken processing plant who never freely walks off the production line?

These scenarios assume that mother is fully able to breastfeed? What happens if:

• Baby never learned to latch so mom needs to exclusively pump?
• Mom's supply starts to wain?
• Mom wants support in combining breastfeeding and formula?

How can we help these women? This goes back to my initial quote. We must listen to the mother. What does she need? As a doula I know the logistics. I know the positions. I know the how and why of breastfeeding, but I don't have all the answers. I know we must listen to her and help support her whatever she needs.

I do know that there are somethings we can do in our day to day lives to help. We can help normalize nursing and continue to make it easier for mothers who want to continue to support policies that encourage breastfeeding when mom returns to work.