More Cesareans Than Even Before.

The CDC has just released the  report on births for the US, and yet again the cesarean section rate has risen. The National C/Section rate went up 2 % from 2008, hitting 32.9% for 2009!!!

Not surprisingly to any natural childbirth advocates, the national birth rate fell by 3 percent less than 2008  with a birth rate of 4,247,694 in 2009, compared with 4,131,019 in 2008.  Is it any wonder that it fell?!  It is a fact that many women are actually choosing to forgo having another baby due to the fear of having a repeat Cesarean Section.  Add to that fact that many women who do decide to have another baby after  a C/Section suddenly discover that they are incapable of getting pregnant again naturally, because the surgical scar can cause infertility problems.  When as many as 1 in 3 women suffer from fertility problems after a C/Section is it any wonder that the American National Birth rate is falling?

Last February  it was announced   that having a VBAC birth (Vaginal Birth after Cesarean Section) was actually safer than they originally thought, especially for women with multiple uterine scars. BJOG  ( an International Journal of Obstetrics and Gynaecology), found that women with 3 previous Caesarean Sections have similar outcome rates of success as women with only one previous Caesarean section in a study of 25000 women attempting a vaginal birth after a Ceasarean section. The study shows that not only did the women with 3 previous C/Section uterine scars have a very similar rates of success in having a VBAC birth, but that the rates of morbidity were also very similar between the women that had a VBA3C and those that chose to be delivered by elective repeat caesarean.  A few month later ACOG made an official announcement that:

ACOG states that VBAC is a safe and reasonable option for most women, including some women with multiple previous cesareans, twins and unknown uterine scars.  ACOG also states that respect for patient autonomy requires that even if an institution does not offer trial of labor after cesarean (TOLAC), a cesarean cannot be forced nor can care be denied if a woman declines a repeat cesarean during labor.

Shall we gather here again at this time next year to see if the new official party line has had any effect at all on the rising Cesarean Section rate?  Are you holding your breath?  Me neither.

ACOG can make all the grand pronouncements they want, but if the hospitals and Doctors and Midwives don't listen and change their policies accordingly, then it's all just a  waste of the paper that the studies were printed on.

After I wrote: "New ACOG guidlines for VBAC births"- I sat at the computer and once the initial high of elation had worn off, I had a bit of a sad.  I stared at the words on the screen and thought to myself "how many women out there are reading this news with a sense of unbearable sadness for the births they didn't have.  Couldn't have.  Because last week these people and their grand pronouncements said they couldn't."  Five months ago I fought tooth and nail, and had to signed a stack of waivers pretty much as tall as my eldest son, to have a VBAC birth.  And I live in Canada and have the good fortune to have a Charter of Rights that gives me the legal Right to refuse a surgeons knife, I can't imagine  how my American sisters feel.

We, the women and mothers, have been  telling them for years. We have been in a ridiculous battle against the "powers that be" to be able to birth our babies OUR way.  To follow our intuition and allow ourselves the  dignity of choosing where, when and how we will give birth. It has ALWAYS been OUR births. We shouldn't of needed a big green light from a commercially motivated "association" (just another word for "corporation") to tell us this- to allow this to be denied to hundreds of thousands, if not millions, of mothers!!

Mama Birth said it so well in her article "ACOG Still Sucks"

Thousands of women have fought, bled and died for this change to come about. They have gone through the stigma of birthing at home in order to have a birth that they chose. They have been attended by supportive midwives. Some of them have birthed unassisted. Some of them have had hospital births in hostile environments where they were disrespected but in the process have shown hospital staff that VBAC is possible.
These are the women who deserve the praise for this recent statement.

Not ACOG. To ACOG I want to say this:

What can you do for all of those women who were denied VBAC because of you? Can you remove their scars? Can you remove their fears? Can you give them their births back? Can you change what you have already done?

You can do none of these things. Thousands if not hundreds of thousands of women have already suffered at your hands. Many more will because of the refusal of many OB's within your community to even acknowledge these new recommendations. You can not fix the pain that you have caused.

Thank you ACOG for changing your policy.

Shame on you for all of the bad births, scars, pain, depression and death that have come at your hands because of your unwillingness to do this sooner.

So will the leopard change it's spots?  Will the American national   Cesarean Section rate fall for this year?  Maybe next year?  Yea, I'm definitely not holding my breath on this one.

New ACOG guidlines for VBAC births

*doin' the happy dance, doin' the happy dance*

This is so amazing that I'm literally grinning from ear to ear!!! Yesterday ACOG (The American College of Obstetricians and Gynecologists... also known as "the Black Hats"...usually!) released a new set of Guidelines for VBAC births. And the news is Hip Hip Horay Goooooooood!!!

For Release:

July 21, 2010

Ob-Gyns Issue Less Restrictive VBAC Guidelines

Washington, DC -- Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists.
The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in 1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to 28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC) as well as decisions by patients when presented with the risks and benefits.
"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."
In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.
VBAC Counseling on Benefits and Risks
"In making plans for delivery, physicians and patients should consider a woman's chance of a successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).
Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.
Uterine Rupture
The risk of uterine rupture during a TOLAC is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available.
"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."
Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added.
The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center.
Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August 2010 issue of Obstetrics & Gynecology.

 HERE to go to the original Release by ACOG


What does this mean for women birthing in America with a previous Caesarean section scar?   ICAN (International Cesarean Awareness Network..also known as "the White Hats")  breaks it down this way:

ACOG states that VBAC is a safe and reasonable option for most women, including some women with multiple previous cesareans, twins and unknown uterine scars.  ACOG also states that respect for patient autonomy requires that even if an institution does not offer trial of labor after cesarean (TOLAC), a cesarean cannot be forced nor can care be denied if a woman declines a repeat cesarean during labor.

“ACOG’s updated recommendations for VBAC are much more in line with the published medical research and echo what ICAN has stated for years .” says Desirre Andrews, President of ICAN.  “The benefits of VBAC cannot be overstated and if ACOG is truly ‘serving as a strong advocate for quality health care for women’ then this is a long overdue action on their part.”

ICAN hopes ACOG’s new VBAC guidelines will enable women to find the support and evidence-based care that they need and deserve.  Every woman must understand the capabilities and limitations of the  care provider and facility she chooses.  Less restrictive access to VBAC will lead to lower risks to mothers and babies from accumulating cesareans.  However, more than a revision of the VBAC Practice Bulletin is required to reverse the over a decade long trend of increasing cesarean rates and decreasing VBAC rates.  ICAN challenges ACOG to take an active role in educating both women and practitioners about healthy childbirth practices; practices that not only encourage VBAC but discourage the overuse of primary cesareans....

 HERE to read the entire ICAN statement

And what does this mean for Canadians (and possibly citizens of other countries like Canada)?  Well seeing as the Canadian medical associations seem to live in the back pockets of similar American organizations, I'm strongly suspecting that the trickle method will apply here, and soon Canada's SOGC (Society of Obstetritians and Gynaecologists of Canada...also known as the "black hats"), will respond with their own version of VBAC guidlines that will help to unfetter women and give at least some power back to make their own decisions on when, where, and how they will birth!!!

But, while I'd like to bask in the knowledge that a step has been taken in the right direction, this is no time for birth advocates to sit back and take a vacation.  We still need to have these "recommendations" enforced, and turn the tide to save women from being cut in the first place.   There is no rest for the advocate and the actvist.

Amnesty blows the whistle on Maternal Mortality rates in the US

Even Amnesty International sees it, yet main stream medical organizations seems to think that there is absolutely nothing wrong with Maternity care in the US (...and don't be fooled, it's almost as bad in Canada). The maternal death rate has almost doubled since 1987- 6.6 deaths per 100,000 births in 1987 to 13.3 deaths per 100,000 births in 2006. And since there is no federal reporting requirements in the US, the actual death rate may actually be much higher.

Amnesty points a finger at the lack of accessible health care as a reason for America's horrifying statistics (They are currently ranked 40th out of 40 developed nations), but also points to the high rates of Inductions and Caesarean Sections causing the maternal mortality rate to be climbing instead of falling. Currently the US spends the most amount of money on maternity care of any nations on the planet.... yet obviously they are spending too much money pushing medical and surgical interventions and not enough money on supportive health care and natural childbirth education- for parents and medical practitioners alike. Instead of encouraging and funding midwifery training and recognising the role of doulas as an essential part of supporting birthing mothers, they have instituted a dictator-like regime that bans mothers from having VBAC births and takes away their human rights to make decisions on how, where and when they will give birth.

Until ACOG , the CDC , and other major health organizations stop meddling in politics and accepting backdoor funding from companies with conflicting interests, the Maternal Mortality rate will only continue to climb. Because right now, these organizations are only interested in the bottom line instead of getting to the bottom of the reason that mothers are dying in childbirth in the 21st Century.

Too Many Women Dying in U.S. While Having Babies

By Jennifer Block

Read more: http://www.time.com/time/health/article/0,8599,1971633,00.html#ixzz0i0Lib1Ry

Amnesty International may be best known to American audiences for bringing to light horror stories abroad such as the disappearance of political activists in Argentina or the abysmal conditions inside South African prisons under apartheid. But in a new report on pregnancy and childbirth care in the U.S., Amnesty details the maternal-health care crisis in this country as part of a systemic violation of women's rights.

The report, titled "Deadly Delivery," notes that the likelihood of a woman's dying in childbirth in the U.S. is five times as great as in Greece, four times as great as in Germany and three times as great as in Spain. Every day in the U.S., more than two women die of pregnancy-related causes, with the maternal mortality ratio doubling from 6.6 deaths per 100,000 births in 1987 to 13.3 deaths per 100,000 births in 2006. (And as shocking as these figures are, Amnesty notes that the actual number of maternal deaths in the U.S. may be a lot higher, since there are no federal requirements to report these outcomes and since data collection at the state and local levels needs to be improved.) "In the U.S., we spend more than any country on health care, yet American women are at greater risk of dying from pregnancy-related causes than in 40 other countries," says Nan Strauss, the report's co-author, who spent two years investigating the issue of maternal mortality worldwide. "We thought that was scandalous." (See the most common hospital mishaps.)

According to Amnesty, which gathered data from many sources, including the Centers for Disease Control and Prevention, approximately half of the pregnancy-related deaths in the U.S. are preventable, the result of systemic failures, including barriers to accessing care; inadequate, neglectful or discriminatory care; and overuse of risky interventions like inducing labor and delivering via cesarean section. "Women are not dying from complex, mysterious causes that we don't know how to treat," says Strauss. "Women are dying because it's a fragmented system, and they are not getting the comprehensive services that they need."

The report notes that black women in the U.S. are nearly four times as likely as white women to die from pregnancy-related causes, although they are no more likely to experience certain complications like hemorrhage.

The Amnesty report comes on the heels of an investigation in California that found that maternal deaths have tripled there in recent years, as well as a maternal-mortality alert issued in January by the Joint Commission, a group that accredits hospitals and other medical organizations, which noted that common preventable errors included failure to control blood pressure in hypertensive women and failure to pay attention to vital signs after C-sections. And just this week, a panel of medical experts at a conference held by the National Institutes of Health (NIH) recommended that physicians' organizations revisit policies that prevent women from having vaginal births after having had a cesarean. Such policies, designed in part to protect against litigation, have contributed to the rise of the U.S. cesarean rate to nearly 32% in 2007, the most recent year for which data are available.

The Amnesty report spotlights numerous barriers women face in accessing care, even among those who are insured or qualify for Medicaid. Poverty is a major factor, but all women are put at risk by overuse of obstetrical intervention and barriers to access to more woman-centered, physiologic care provided by family-practice physicians and midwives.

Amnesty is calling on Obama to create an Office of Maternal Health within the Department of Health and Human Services to improve outcomes and reduce disparities, among other recommendations. The report also calls on the government to address the shortage of maternal-care providers.

"Access is only one factor," cautions Maureen Corry, executive director of Childbirth Connection, a research and advocacy organization that recently convened more than 100 stakeholders, including members of the American College of Obstetricians & Gynecologists and the NIH, in a large symposium on transforming maternity care. "We need to make sure that we reduce the overuse of interventions that are not always necessary, like C-sections, and increase access to the care that we know is good for mothers and babies, like labor support."

Read more: http://www.time.com/time/health/article/0,8599,1971633,00.html#ixzz0i0LSUPmk