Ignoring medical evidence and studies seems to be what modern obstetrics does best.  I rant quite often about the blatant misuse of medical tests and procedures that are used during pregnancy and childbirth. It drives me crazy that so many people are blind to the fact that the vast majority of medical interventions used during labour and birth not only do NOT help, they many times facilitate problems and end up cascading into a waterfall of more interventions.  Worse is the fact that most of these interventions are PROVEN to either NOT work to the benefit of the labouring mother and/or her baby and yet they are still the daily special on the menus of the vast majority of hospitals in North America!

WHY?! 

Do not think that just because YOUR doctor does it "this way" or your hospital has standard procedures that they follow that they are right or that they are to the benefit of you and your baby.  We are living in a society that is forcing us to do our own research and make decisions that are the best for ourselves and our babies. We cannot afford to blindly trust in the omnipotent medical professionals to know whats best or right or even safe, because it's a proven fact that modern obstetrics is ignoring the evidence and just blithly doing whatever they want- be it from blindly following tradition, lack of study into new research, or driven by the need to make more money: because lets face it- a truly natural childbirth costs a fraction of one that's full of medical procedures and drugs and equipment.

Where’s The Evidence? 10 Ways Modern Obstetrics Ignores Evidence

I was recently both amused and not surprised to read a comment written by a physician who was disparaging midwives for their lack of scientific research and evidence-based practice.  The physician wrote:

“Modern obstetrics, in contrast, has always been, and continues to be based on scientific research.”

I will be one of the first to admit that midwives have been guilty of poor interpretation of statistics, embracing various clinical practices and promoting them as if they were evidence based when in reality they are not, and recommending things to their clients for which they have no evidence of benefit.  A clear example of this is the many midwives who still recommend evening primrose oil (EPO) to their clients in order to “ripen” the cervix, even though study after study has cast doubt upon EPO’s efficacy.
But what about the physician’s comment that modern obstetrics is based on science?  Could this be a case of the Emperor that has no clothes?  Modern obstetrics is riddled with accepted procedures that demonstrate how wide the gap is between practice and evidence.

• Inductions/elective c-sections for suspected macrosomia (big baby): I can’t count the times that I have had a patient put on my schedule for induction or elective c-section because the OB thinks her baby is getting big.  The best evidence shows that early induction or elective c-section have not improved outcomes for these babies, and may carry greater risk of complications.  Evidence, please?
• Pitocin to speed labor: Although evidence shows that pitocin given without indication of medical need is not beneficial and may increase fetal distress and/or risk of c-section, it continues to be widely used for any (or no) reason.  What science supports this practice?
• Amniotomy to speed labor: In my practice, I am almost always called by the nurse at some point early in the woman’s labor to “come and pop her bag and get this baby out”.  Despite the clear evidence that amniotomy does not significantly speed labor, and carries with it a risk of infection and increased fetal intolerance of labor, this practice is nearly universally performed on laboring women.  How is this based on science?
• Continuous electronic fetal monitoring. Another “sacred cow” of obstetrics that is not evidence based.  For low and moderate risk labors, intermittent monitoring has been shown to have outcomes as good as with continuous monitoring, without the increased rate of c-section associated with continuous monitoring.  Where’s the evidence?
• Requirement of “immediate” emergency services for women attempting a VBAC. Although the NIH states there is little evidence to support this recommendation, it continues to be the standard practice.  The effect of this policy is to create barriers to VBAC availability for many women.  Every OB I talk to about this problem admits there is not adequate evidence for this requirement, but seems at a loss (or doesn’t care) what to do about it.  What science is this continued practice based upon?
• Episiotomy: Still practiced by physicians in as many as 20% of births.  This procedure was taught for years as an essential to reducing pelvic floor problems in women later in life.  Only in the last few years has science supported what midwives have always practiced–avoiding episiotomy unless it is necessary to get the baby out quickly.  If modern obstetrics is always based on science and evidence, why do we get these polar opposite policies?
• Routine ultrasound to estimate fetal size: Although we know late term ultrasounds are very inaccurate in estimation of fetal weight, obstetricians continue to order them.  Where is the evidence for this practice?
• Immediate cord clamping: Most physicians I discuss this with will agree the evidence shows benefit of avoiding immediate cord clamping, but it is a hassle and takes a few minutes more.  They largely feel that it just doesn’t matter that much.  What science are they basing this opinon on?
• Directed (purple) pushing: In spite of clear evidence of benefit of spontaneous pushing, most doctors and nurses are still using the old “hold your breath and count to ten” method of pushing.  Most are aware of the evidence, but state they “feel” like more progress is being made when the mother is pushing long and hard.  Is modern obstetrics based on fact or feelings?
• Supine Pushing: Perhaps one of the best-documented practices in modern obstetrics is supine pushing.  This is a practice which has absolutely no evidence of benefit and plenty evidence of potential harm.  Yet almost every OB I know routinely delivers his/her patients in the supine position.  Why?

An organization which flip-flops as drastically as the American Congress of Obstetricians and Gynecologists (ACOG) did this year, in its dramatic loosening of VBAC guidelines, is hard pressed to defend the statement that their practices are evidence-based.   Did we suddenly discover new science that told us the woman who was refused a VBAC early in 2010 on the grounds that she was risking death to her baby and herself, is now out of danger and can safely attempt a VBAC?  Where is this amazing new information that ACOG discovered?
In my next post, I will be discussing the problem of evidence and how the average woman can decipher the myriad of conflicting information.

 HERE to read the original article on Birth Sense

For more information on medical interventions that are unnecessary in the vast majority of births, please read:

Conspiracy of Labour: Electronic Foetal Monitoring

"Canada’s reputation for low infant mortality takes stunning decline"

"In Defense of the Amniotic sac"

"Technology in Birth: First do no Harm"

Everything you NEED to know about pitocin!!

 

 

 

 

 

"Canada’s reputation for low infant mortality takes stunning decline"

WEll, now... can any of my wonderful readers point out some of the REAL reasons that our infant mortality rate has risen?  Shall we list them?

1- mass use of chemical induction methods to start child birth instead of waiting until baby is READY to be born
2- mass use of epidurals on labouring women which then leads to further medical interventions, which in turn leads to more medical interventions, and most often associated with "emergency" caesarean sections due to fetal distress.
3- constant electronic monitoring of the labouring mother and baby- interfering with the mothers ability to move around and follow her bodies instincts to bring baby to birth, and giving out false information on the condition of the baby, leading to diagnosis of "fetal distress" sending the mother directly to the OR for a Caesarean Section.
4- the inability of the medical machine to leave well enough alone and let mothers labour as they wish without being hammered on by medical staff "trying to help" by constantly meddling and coercing mothers to allow medical interventions that they do not want or need.
5- Hospitals  and doctors that have sky high 9-5 caesarean section rates- pushing the national average to almost 1 in 4 surgical births
6- hospital and doctors that  pretend to be VBAC friendly, yet create hurdles so high that it is virtually impossible for a labouring mother to have a Vaginal birth after previous Caesarean section.
7- hospitals, doctors and midwives that  out right REFUSE to care for a woman who wishes to have a VBAC birth after 2 or more previous C/S's- regardless of the fact that the studies show it is just as safe as a VBAC after only 1 previous C/S, and that the statistics for uterine rupture are less than .75%!!!!
8- mass scale use of Ultra Sound technologies, that give unpredictable results and have a very high margin for error, leading to premature inductions and surgical births.
9- even the most seemingly innocent interventions and policies- like limiting a labouring mothers food intake, or making her change into a hospital gown, or having student/residents/interns in the room during  discussions with medical personnel can disrupt the natural cycle of a birthing woman and lead to unnatural interventions.

Each and every one of the above listed problems with our current childbirth methods is KNOWN to increase the risk of  infant deaths. Multiple studies show that Caesarean Sections increase the incidents of infant respiratory distress and infant mortality exponentially as compared to natural vaginal birth.  And each of the medical interventions that are so carelessly used in L&D wards lead to a much high risk of having to have a C/S.

Yes, the reasons given below in the article are valid reasons, but they are not the most important nor the most common. The cause of most preterm births is still a mystery to the medical community and further studies definitely should be done to determine the cause....But instead of putting all their focus on this one "unknown", they need to focus the majority of their attention on the problems that they DO understand, the reasons that already have been studied, that the Facts that are already known.  Hospitals and Doctors need to analyse the way they approach birth and start taking responsibility for THEIR actions and how they effect the Canadian Infant Mortality Rate. A "National Birthing Plan" is great- but it needs to address the REAL statistics and the REAL reason that the infant mortality rate is climbing.  Yes, focusing on preterm and low birth weight births is important and will save the lives of thousands of babies in our country each year, but without dealing with the most common birthing occurrences that relate to and cause infant deaths they will only be putting a small bandage on an arterial bleed.

As usual, WE the birthing parents need to bring these matters to the attention of the powers that be!!  Write letters, email MPPs and MPs, phone your local city councilperson...It all starts with ONE.

(as usual, the highlighted areas are my addition)

Canada’s reputation for low infant mortality takes stunning decline

Once at No. 6 in world ranking, ‘shockingly high’ death rate now puts Canada at No. 24, prompting urgent request to Health Minister

Lisa Priest-From Saturday's Globe and Mail Published on Saturday, May. 22, 2010 3:00AM EDT Last updated on Saturday, May. 22, 2010 9:58AM EDT.

 

Once able to boast about its high world ranking for low infant mortality, Canada has now dropped from sixth to 24th place – just above Hungary and Poland.
The death rate of infants less than one year of age – 5.1 per 1,000 live births – has been called “shockingly high” and translates into 1,881 mortalities in 2007, according to the most recent data collected by the Organization for Economic Co-operation and Development.
About three-quarters of those deaths occurred in the first 27 days of life.

“ It should always be a little bit embarrassing if you are not number one. ”— Douglas McMillan, a neonatologist at the IWK Health Centre in Halifax.

The drop in ranking below countries such as Sweden, Japan, Finland, France, Ireland and Greece has prompted a prominent doctors group to request an urgent meeting with the federal Health Minister to push for a national birthing strategy.
“We’re losing our reputation,” said André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada. “We have fallen way behind.”
The main causes cited by researchers are poverty, isolation, premature births and to some degree, the way the data are collected. For example, in Canada, infant mortality includes the death of any breathing infant, even very early births and terminations due to congenital abnormalities after 20 weeks gestation, but other countries have different measures.
Still, experts say Canada could learn from other countries – Japan and Sweden among them – that have low infant death rates. Japan is successful in resuscitating premature babies, while Sweden has regulations dictating that with IVF treatments, only one embryo can be transferred into the womb at a time. (Other countries implant multiple embryos, leading to more multiple births and higher risk.) Canada’s aboriginal community has traditionally seen high infant death rates due to poverty and remote locales, but those numbers alone do not explain the country’s low ranking, says Michael Kramer, scientific director of the Institute of Human Development, Child and Youth Health, Canadian Institutes of Health Research.
“The concern is that we’re not really making any impact on reducing the incidence of these spontaneously born very pre-term infants,” Mr. Kramer said. “We don’t really know enough about what causes them, that’s the challenge – that’s where we need to make improvements.”
Premature babies are at increased risk for infant mortality. About 54,000 out of 350,000 babies were born prematurely or small for their gestational age in 2006-07, according to the latest Canadian Institute for Health Information figures.
Part of a solution, according to Dr. Lalonde, is a national birthing plan, which he estimates would cost $43.5-million over five years. It recommends federal leadership in seven key areas, including a mechanism to accurately gather data, a focus on maternity patient safety, implementing national standardized practice guidelines, and a coalition that would create a model of sustainable maternity and newborn care.
Tim Vail, spokesman for Health Minister Leona Aglukkaq, said representatives from the minister’s office will meet with the doctors group, and are currently working on a date.
Prakesh Shah, a neonatologist at Mount Sinai Hospital, belongs to an advisory group for Ontario’s strategy on late pre-term births. Socioeconomic factors – such as impoverishment – are a big part of preterm births, he says, as are delaying pregnancy and the increasing number of in-vitro fertilization pregnancies.
Dr. Shah recently sent a team to Estonia – which was tied in 2005 with Canada for its infant mortality – and found that other countries treat premature babies and their mothers much differently than in Canada.
“In Estonia, mothers stay in hospital until baby is discharged home and provide most of the care for their babies. Nurses act as consultant to mothers,” said Dr. Shah. “Here, we have medicalized the care in such a way that parents are less involved during hospitalization and suddenly, one day when baby comes home, they are expected to provide complete care. It’s an entirely different concept.”
Even the Conference Board of Canada has described this country’s rate of infant mortality as “shockingly high,” causing many to wonder: How can such a rich country do so poorly with its most vulnerable citizens?
“It should always be a little bit embarrassing if you are not number one,” said Douglas McMillan, a neonatologist at the IWK Health Centre in Halifax. “You are dealing with the most precious thing the family will have in their whole life; we need to be cognizant of that.”

 HERE to read the original article

Canada's Rising Caesarean Section Rate

 A brilliant article that comes clean about Canada's rising Caesarean Section rates.  It doesn't white wash the statistics, it doesn't hide the TRUTH:  Caesarean sections cause more Caesarean sections!!!  And every medical intervention in labour and delivery causes an increased risk of "having to have" a C/Section. 

While the Society of Obstetricians and Gynecologists of Canadais finally realizing that the soaring rates of medical interventions- such as inductions, epidurals, and C/Sections- are having a detrimental effect of the health of our women and children, they have yet to address the worst problem:

The Doctors and the Hospitals themselves.

 The Society of Obstetricians and Gynecologists of Canada has made comments that the C/Section rate is too high, that inductions shouldn't be done so often, that Vaginal  breech births are healthier than C/section deliveries, and that VBAC births should be encouraged.... but that's all just whistling in the wind if the doctors and hospitals are adamantly turning their backs with their fingers in their ears singing "Lalalalalalala..."

It's all very wonderful that they are making these recommendations and statements, but that's not helping the mothers who are out there searching for a birthing attendant who will allow them to have a VBAC or to deliver their breech baby naturally/vaginally. 

And don't just blame the doctors- finding a supportive midwife can be equally difficult.  When I was pregnant with my second child back in 2002, I had three different Toronto midwifery groups turn me down point blank because I had had a previous Caesarean section.  The fact that it happened 10 years previously didn't matter even slightly.  When I was pregnant with my 4th child- having had 2 C/S's and one natural  HBAC (homebirth after C/S)- I had to search for MONTHS and had to beg and cajole to find a midwife to support my wishes to have another HBAC birth.  ...and my 5th child? after THREE Caesarean sections?!?  I was SHOCKED to hell and back when one lone midwifery group in a 100 km radius actually accepted me as a client.  But even then, while they took me on, they did so with a lot of trepidation and scepticism.

If I hadn't been so damn stubborn, (and knowledgable), I probably would of given up on trying to have a vaginal birth years ago and would now be sporting 5 uterine scars.

NOT a Healthy situation.

So yet again, as with just about everything worth having in life, we need to fight to achieve and support our Rights.  If women do not demand that hospitals/doctors/midwives accept their wishes to have a VBAC birth, then change will not happen, no matter how many "recommendations" the Society of Obstetricians and Gynecologists of Canada wants to make.

Worries surround Canada's rising C-section rate

 

 

By Sharon Kirkey, Canwest News Service

 

Dr. Jan Christilaw was in the operating room the day a routine incision was made into a young mother's abdomen to deliver her baby.
What happened next, Christilaw says, "is something we never want to see."
Normally, the placenta separates from the wall of the uterus after birth. It's lacy almost, and not like solid tissue. "You can take your hands and sort of scoop it up, it's like breaking cobwebs as you go," says Christilaw, an obstetrician and president of B.C. Women's Hospital and Health Centre in Vancouver.
But the placenta had eroded through the wall of the uterus, a condition known as placenta accreta. As soon as they stretched the opening of the uterus to deliver the baby, "the placenta started bleeding everywhere," Christilaw says.
They couldn't get the bleeding to stop. The woman was losing two cups of blood every 30 seconds.
"You get into this place where you think, OK, this is what I'm trained to do, I know exactly how to do this," Christilaw, who was a senior resident at the time, says. "You don't panic, but you're calling in everybody you can possibly get into the room." People had to squeeze the bags of blood, because the pump could not put it in fast enough.
The only way to stop the bleeding was an emergency hysterectomy. The woman was in the operating room for eight hours, and lost 15 litres of blood.
It used to be that obstetricians might only ever see one or two cases of placenta accreta in their practice lifetime. Although still rare, obstetricians across Canada say one of the most feared complications of pregnancy is increasing as a direct consequence of the nation's rising caesarean-section rate.
Virtually all placenta accretas occur in women who have had a previous C-section, and the risk increases with each additional surgical delivery. The placenta attaches to the old C-section scar. Scars don't have a proper blood supply to feed a placenta, so the it keeps burrowing into the uterus until it finds one, sometimes pushing through the uterus completely and into the bladder or other organs.
The condition can be detected by ultrasound, but not always. "You almost never see it in a woman who has not had a C-section," Christilaw says.
Today, about 28 per cent of babies born in Canada are delivered by caesarean. In 1969, Canada's rate was five per cent.
More than 78,000 caesarean sections were performed in Canada last year, making it the single most frequently performed surgery on Canadian women.
Ellen Hodnett wonders how so many C-sections could be justified.
"Women have stopped being able to give birth vaginally, in such numbers?" says the professor and Heather M. Reisman Chair in perinatal nursing research at the University of Toronto's Bloomberg Faculty of Nursing.
The World Health Organization says no more than 15 per cent of deliveries should be done by C-section.
"We don't know what the ideal rate is," says Dr. Mark Walker, a high-risk obstetrician at the Ottawa Hospital and senior scientist with the Ottawa Hospital Research Institute. "I think it's fair to assume it's lower than where we are now."
Walker says changing demographics — older first-time mothers, more multiple births from fertility treatments, more mothers with hypertension, diabetes, obesity and other health problems — are not enough to explain an almost doubling in the C-section rate since the early 1990s.
Neither is there evidence to support the idea that women are seeking C-sections on demand. Studies from Ontario suggest less than one per cent of caesareans are for "maternal request."
The Society of Obstetricians and Gynaecologists of Canada says the vast majority of caesareans are done for medically valid reasons. But there are concerns that too many are being ordered because labour isn't progressing quickly enough, and that thousands of "routine" interventions are now being done that increase the odds of a woman needing a surgical birth.
What's more, the number of women who give birth vaginally after a previous C-section is dropping dramatically, meaning more and more women are having repeat C-sections.
"The percentage of caesareans we're doing for repeats because we didn't do a trial of labour, those are the ones we need to be asking ourselves about," Walker says.
Dr. Michael Klein calls it the industrialization of childbirth, where, in today's risk-averse society, women in labour are being treated "as an accident waiting to happen" and where doing something is always better than doing nothing.
"Physicians and society have helped women basically believe that childbirth is no longer a natural phenomenon, but an opportunity for things to go wrong," says Klein, emeritus professor in the departments of family practice and pediatrics at the University of British Columbia.
"But the fundamental issue is, we aren't improving outcomes by doing more C-sections. For the first time in Canada, we are seeing the key indicators for mothers and babies going in the wrong direction."
Risks to babies range from accidental lacerations when the surgeon cuts into the uterus, to neonatal respiratory distress. Research suggests two times as many babies born via C-section will end up in an incubator with water on their lungs, or with serious respiratory problems compared to babies delivered vaginally, because a C-section interferes with the normal hormonal and physiological changes associated with labour that prepare a baby to take its first breath.
Risks to women include higher risks of hemorrhage requiring a hysterectomy, major infections including blood infections, wound infections and bladder infections, and blood clots in the lungs — and every C-section increases the risk for another.
"If you have a caesarean section for the first birth, the probability of having one the second time around is huge, because of the difficulty women have in getting a doctor to look after them once they have a uterine scar," Klein says.
The worry is that the scar will pull apart during labour, causing a uterine rupture.
"If you have a catastrophic rupture, you can get into big trouble," Christilaw says. "You can have a negative outcome for mom or baby. In severe situations, the baby can die or become damaged — but that's a very rare outcome."
Her hospital is encouraging more VBACs — vaginal births after caesarean — in carefully selected women. "In those women who attempt a VBAC, our success rate is well over 80 per cent."
But less than one in five women in Canada with a previous C-section delivered vaginally in 2007-08. Eighty-two per cent had a subsequent C-section.
Christilaw says the only thing preventing Canada from seeing "horrific" complication rates from C-sections is the fact women are not having as many babies as they once did.
"A C-section can be a life-saving manoeuvre for a mother or baby. Nobody is saying differently," she says. "What we're trying to say to people is, a C-section is not a benign thing. If you need one, that's different. But you should not be doing this unless you absolutely have to."
C-sections are frequently the end result of a cascade of interventions that often starts with inductions.
Tens of thousands of women in Canada have their labours artificially induced every year, often via intravenous infusion of artificial oxytocin. Oxytocin is naturally produced by the human body. It's what creates contractions in labour. Today in Canada, one in five women who gives birth in hospital is induced.
What doctors fear are stillbirths. But alarmed by the rising rates of inductions, the Society of Obstetricians and Gynecologists of Canada recently urged doctors not to consider an induction until a woman is at least one week past her due date.
Claudia Villeneuve says that women are getting induced "if they're two, three, four days overdue."
"Inductions are rampant," says Villeneuve, president of the International Cesarean Awareness Network of Canada. "You have a perfectly normal mom who comes in with a perfectly normal baby, and now you put these powerful drugs into her system to force labour to start."
The "humane" thing is to offer an epidural, she says. With an epidural, a woman can't feel pain in the lower half of her body. But epidurals slow labour, sometimes so much that labour stops. "Now you have to get this baby out," Villeneuve says. Two-thirds of first-time C-sections are done for "failure to progress."
Klein says epidurals are too often given before active labour is established.
"The majority of women today get their epidurals in the parking lot."
So the cascade continues: epidurals increase the use of electronic fetal monitoring, where electrodes are strapped to the woman's belly to monitor her baby's heart rate.
"It's hard to change positions when you have a fetal monitor on, and an epidural with its little things taped to your back, and an IV in your arm," Hodnett says. "Why would labour progress normally, if you're stuck in a labour bed with all this machinery on you?"
What's more, EFM is an imperfect technology. It detects subtle changes that can't be picked up by just listening to the baby's heartbeat after contractions, "and those subtle changes are often false positives," Klein says. "In other words, the fetus is OK, you just think it isn't OK."
Kayla Soares had been in mild labour at home for 24 hours when her contractions suddenly stopped. Doctors told the Edmonton mother she would have to be induced. She was three centimetres dilated when they started the oxytocin drip.
"It was the worst pain I've ever felt in the world," she remembers. "I wasn't having contractions at all and then they put me on the oxytocin and every half-hour they would boost it up, so the contractions were coming every minute, pretty much. It was like going from nothing to being in crazy, absolute labour, and in so much pain." Eleven hours later, she was still just three centimetres dilated. "That's when they said it was enough, and they were doing a C-section.
"I didn't want to do it. I was asking, could we just have more time?"
Three weeks later, she still couldn't get out of bed without help. Her incision had become infected. "It felt like I was ripping apart every time I moved. It was a pretty brutal recovery."
Soares had her second baby in June. "I was dead set on having a VBAC," a vaginal delivery after caesarean. "It was a fight, an uphill battle the whole time with doctors." One obstetrician asked her her shoe size. "She said that because I was a size five and smaller framed that I definitely was going to have another caesarean and that a VBAC wouldn't happen. She said that because I was a 'failure to progress' the first time I'll be a 'failure to progress again.'"
Two weeks before her daughter was born, Soares started going in and out of labour. "They had me convinced it was causing stress to the baby even though the tests said everything was fine. They had me convinced it was enough, because I was overdue and they said my incision was going to rupture," she says.
"They just kind of scared me into having another C-section."
skirkey@canwest.com

HERE to read the original article
 

"Mother dies 20 seconds after giving birth"

Tragic mother dies 20secs after birth

A mother who had just cradled her newborn son died seconds later from an unknown cause.

Another tragic and heart rending story, as yet another baby will grow up without his mother.  In this case the mother had just had a caesarean section.  An enquiry is under way to discover the cause of her death, but I  strongly suspect that it will be concluded that she died from a Amniotic Fluid Embolism.  

This is a horrifying tragedy for this family- and my heart breaks for them- but it is not a lone event.  Unfortunately this happens a lot more often then most people could possibly suspect. Besides the very real risk of  having an Amniotic Fluid Embolism, caesarean births are major abdominal surgery and carry with it the risks inherent with any major surgery, including death.

I have to wonder if this family, these new parents, were ever told the risks before she was rolled into the surgery?

In the US, Ina May Gaskin- probably the most famous midwife in the world- has started the  "Safe Motherhood Quilt Project".  

The Safe Motherhood Quilt Project is a national effort developed to draw public attention to the current maternal death rates, as well as to the gross underreporting of maternal deaths in the United States, and to honor those women who have died of pregnancy-related causes since 1982.
The Project is the vision of Ina May Gaskin, midwifery pioneer and author of Ina May's Guide to Childbirth and the classic Spiritual Midwifery, who has been instrumental in bringing this issue to the public light.

The Quilt

The quilt is made up of individually designed squares; each one devoted to a woman in the U.S. who has died of pregnancy-related causes since 1982. One quilt square is designed and dedicated to each mother's memory and may mention the date and place of death and the name of the woman. The Safe Motherhood Quilt is the voice for women who can no longer speak for themselves.

To be honored and remembered on The Safe Motherhood Quilt:

• The woman died as a result of a complication of pregnancy or birth
• The woman's death occurred since 1982
• The woman died within a calendar year after the end of her pregnancy (documented by an obituary, death certificate, relative's or witness' account).

We need to bring these stories out from the dark closet that they are hidden in. We need to bring awareness to women that "This Could Be YOU", that no one is 100% safe from the risks that come with unnecessary medical interventions and Caesarean Sections.  We KNOW that the C/Section rates are far too high.  We KNOW that 9 to 5 C/Sections are becoming more and more mainstream.  And we KNOW that most families are NOT being fully informed of the risks before hand. 

Every woman needs to Know their Rights, and they need to educate, enlighten and prepare themselves before heading to the L&D floor. Because chances are, the hospital staff are going to leave them in the dark.

Melissa gives us the hard truth and a reality check about birth in American (and don't be fooled- in Canada too).  She writes about two births- 
Having a baby in the ideal, family-friendly United States
And
Having a baby in the real United States

Reading the first half gave me a happy glow.  Reading the second half reduced me to tears.  Tears because I KNOW that this is the birth experience that most women in the US and Canada are having.  Tears for the babies that have been born into a cold world that bundles them up in harsh cloth, under glaring lights  and yanks them away from their other self, their lifeline, their whole world.

Is it a wonder that so few mothers breastfeed their babies for at least the first 6 months? The impact of birth plays a huge role in how a breastfeeding relationship is started and continues- for both baby and mother. 

est is being processed...

Melissa Bartick

Posted: April 14, 2010 12:15 AM

Peaceful Revolution: Motherhood and the $13 Billion Guilt

"....Birth number 1: Having a baby in the ideal, family-friendly United States:

You give birth with the help of a birth doula. She helps you avoid a c-section or vacuum assisted birth, which is why your hospital hired her. Your baby is wiped off, then put directly onto your chest, skin to skin, with his head between your breasts. The nurse puts a blanket around you both, and then your partner cuts the cord. The nurse evaluates his initial transition to life outside the womb as he rests on your chest. As you lay semi-reclining, happy and exhausted, your baby uses his arms and legs to crawl over to your breast and he starts nursing. You and your partner are left undisturbed for an hour to enjoy your new baby, who has now imprinted the proper breastfeeding behaviors thanks to this initial breastfeeding. You are then transported to your post-partum room with your baby on your chest. The nurse returns and weighs, measures, and examines your baby right there in your room. You are with him as she gives him his vitamin K shot and antibiotic eye ointment. Your baby is handed back to you, and again placed on your chest skin to skin. He stays in your room with you until you go home. From your prenatal class, you knew in advance to ask most of your visitors wait until you go home, so that you can get some rest, and you turn the ringer off your phone, so that no phone calls will wake you. Before you leave the hospital, your baby's routine heel-stick blood test is done while he is nursing, and you are amazed to see he doesn't cry at all. You are discharged with clear instructions around breastfeeding, and phone numbers to call if you need help. You are not given samples and "gifts" from a formula company...... Birth number 2: Having a baby in the real United States: Your give birth to a healthy baby, and you've never heard of a birth doula. The umbilical cord is clamped and cut before anyone can say, "It's a boy!" Immediately, your baby is whisked across the room to the warmer where Apgar scores are assigned, he's given a shot of Vitamin K, and antibiotic eye ointment is slathered in his eyes, clouding his vision. He's placed on a cold scale and weighed and measured. He is examined by his nurse, who takes him to a different room to do her evaluation. He is bathed, washing off his mother's scent. At last, he's professionally swaddled into a nice tight parcel and handed to you to hold, cradled sideways in your arms. He's not skin to skin, and he can't move his arms and legs to crawl to the breast. Before you know it, an hour has passed since his birth, and since he's missed the window of "alert time" after birth, he slips into a deep sleep without having spontaneously breastfeed. You attempt to interest him in the breast, but he is really too tired to try very hard. Because he's wrapped up and has been given a bath, he can't use his sense of touch and smell to crawl his way over to find your breast. You don't know enough to unwrap him and feed him immediately after birth, because your prenatal class didn't stress the importance of skin to skin contact during the first 3 days of life. That was all discussed in a separate breastfeeding class and you didn't really have time or money to take two classes. Just as you're getting to know your new bundle of joy, the staff decides to check his temperature and his blood sugar. His glucose level is 45 -- normal for a newborn, but low for an adult. His temperature is a little low, too -- all that time in the bath, the cold scale, the swaddling, and the time away from his mom's body heat has led to hypothermia. Hypothermia and hypoglycemia can be signs of a serious infection, so immediately he is taken from your arms down to the nursery, where he gets what's known as a sepsis evaluation. Lying under a warmer down the hall from you, he gets his blood drawn, and then is left in his bassinet in the nursery to be observed for a few hours so you can't spend time with him as you recover from giving birth. He gets a 2 ounce bottle of formula, most of which he vomits, since the stomach of a five-hour-old baby is no bigger than a teaspoon, the perfect size to digest the colostrum your breast secretes for him in the first few days. Finally, your baby's brought back to you, swaddled in a nice package. He's more alert, but never imprinted breastfeeding very well, and he's very stressed from all the day's events. He might be full from the formula he's given, and doesn't breastfeed well. He tries later in the day. The nurses try to help you, but it feels like they all give you different advice, much of it conflicting. Little do you know, their advice is based on their personal experiences rather than any scientific evidence because they haven't had much training in breastfeeding. You don't know what to believe. Finally, your baby goes to the nursery for the night "so you can sleep," and he is brought in for you to feed him. He doesn't like it in the nursery, so he cries, and you don't get much sleep either. You have some pain when he latches on, and you're told that's normal. You're so excited about his birth that you talk to everyone by phone, and lots of people come to visit. They pass him around. Maybe someone wants to give him a bottle, and you figure, ok, why not. He's chewing on his fist, but no one ever told you that means he's hungry, so you give him a hospital-issued pacifier to suck on instead of his hand. You don't know that giving formula and pacifiers in the hospital will undermine your efforts to breastfeed. It's surprising the nursing staff doesn't inform you of this, and you didn't learn it in your prenatal class. You're too embarrassed to feed him with everyone there. Finally, your guests leave, but by this time, your baby's frantic, and nursing doesn't go well as a result. Overnight, as he stays in the nursery, he gets weighed, and he's lost more weight than he should have. The doctor says it's because your milk isn't in yet, and recommends more bottles. He still sucks happily on a pacifier and sleeps in the nursery despite his alarming weight loss, and no one suggests that you nurse him more often, room in with him, get rid of the pacifier, or see a lactation consultant, all of which would help put him back on track with breastfeeding. An hour before you're due to go home, the lactation consultant comes in briefly to check on you, but because her department is so understaffed, she couldn't see you earlier when you needed it most, and she has little time to spend addressing your problems. On your way out, a nurse hands you a marketing bag from a brand-name formula company, complete with free samples of formula and information on breastfeeding that makes it sound a little hard and scary. She tells you if you have any questions, to just call your pediatrician. The first night at home, things don't go well. It's the middle of the night, and your baby won't stop crying when you try to breastfeed. You wonder if you should just give up. You reach for that ready-made bottle and his crying mercifully stops. The problem is solved, at least for now....."

 HERE to read the entire article

 

A Mothers Victory: My VBA3C Birth Story

“Boobalumba has arrived!”

After three Caesarean sections, I knew I wanted a natural birth for my fifth child. I had written a detailed birth plan describing how I was to be involved and treated during my labour and birth at the hospital, with as little intervention as possible. My plan notwithstanding, this is my story of the very difficult labour and birth of my son on February 8, 2010.

by Danielle Arnold-McKenny


It all started with a week of annoying, stop and start prodromal labour. There really is nothing quite so frustrating as playing the guessing game every time the contractions start. Is this it…this time?! But after a week of lots of contractions and various other questionable symptoms, early evening on Saturday (February 6, 2010) I was pretty certain that we were onto the countdown.

Contractions continued during the night for the first time. Although they slowed right down and became erratic, they kept getting stronger. Sunday morning they slowed to a halt for about three or four hours. When they started up again, it was like being back at square one.

So I kicked my husband Nick and the kids out of the house to go to a friend’s to watch the Super Bowl. Then I set out to do some serious relaxing: filled the living room with candles, put some of my favourite aromatherapy oils in a burner, put on soothing music, got settled into my super comfy rocking chair, and just…R E L A X E D.

Soon enough the contractions became steady at about 8–10 minutes apart. Nick brought the kids home and tucked them into bed late that night, and we called my best friend Lynda over to be with us.

By 3 AM I was definitely in labour. While still only about 6–8 minutes apart, the contractions were strong enough for me to need to support myself and focus on breathing through them—rocking and swaying. We called our midwife, to put her on alert that the party was definitely on. By 5 AM the contractions were still 6 minutes apart but very strong. I had to decide what to do next.

I knew that the kids would be waking up soon and really didn’t think I could deal with my labour and them. So I made the decision for us to head off to the hospital. It was too early—I knew it was—but I was so tired, having not really slept in two nights. I just wanted to know where I was in my labour, to know how far/fast I was progressing.

I think that this is one of the worst things that most labouring women do—worry about the numbers: how many minutes apart, how many centimetres dilated, how many hours of labour…This turns so easily into a downward spiral.

When we arrived at the hospital, we were met by one of our midwives—and so started that downward spiral. She checked me at 6:30 AM. I was only 3 centimetres…3? Just 3 centimetres?!? Oh gods!!! Immediately I became depressed, completely despondent. Three centimetres was exactly where I’d been when I’d gone to the hospital in labour with my youngest daughter Keira, and exactly where I stayed with that labour, which this one had so far exactly mirrored. Keira’s birth ended up being a Caesarean section…

On my midwife’s advice, Nick and I started walking the hospital hallways, to try to “ramp up the contractions,” as she was convinced that I wasn’t in active labour yet—another very disappointing announcement that brought me down even further. How was I supposed to continue like this? In my opinion, my contractions were damn strong, as strong as they were when I was close to transition with Quinlin, my home-birth, vaginal-birth-after-one-Caesarean (VBA1C) baby.

So we walked the halls, stopping to lean on whatever I had available during contractions. We talked and I cried. I was so despondent, and after two nights of almost no sleep, I was completely exhausted. How was I going to make it through this if the contractions were already this strong and I wasn’t even in “active labour”!?!

Nick was a huge support both physically and emotionally. While we walked, we talked: about my fears, about the “options,” both of us knowing what the “option” was…We returned to our room and talked to our midwife about the jumble of emotions, about the labour and my fears. We decided that we would talk to the obstetrician on call. Even then I knew that we were taking the first step down the road to another Caesarean. But I was so caught up in my anxiety and despondency that I had lost hope.

When the doctor arrived finally at around 9 AM, I was desperate for some relief from the contractions. Luckily I had an OB who wasn’t a pusher. Oh, he definitely wanted me to have the C/S, to remove the “risks” of my trial of labour, and to save the staff from the obvious stress of having a VBA3C on their labour & delivery floor. But he suggested that he see how far along in my labour I was before we made the final decision. For this alone, I have much respect for the man, because at that moment I was so vulnerable that he could have pushed me right down to the operating room himself and knocked me out. I wouldn’t have uttered a peep. But instead he checked me over.

I was 8 centimetres!!!!

From down in the valley of emotional despair so dark and heavy that I could barely breathe, I flew up to the top of the tallest mountain of elation!! 8 centimetres?!? I could do this!!!! Nick’s face lit up in what I knew was a mirror expression of my own. Eight centimetres were unimaginable.

“What do you want to do?” the OB asked. “I want to continue to labour!!!” I almost shouted in excitement.

He then started on the litany of risks, and rules I “had to” follow. He suggested that we break my water to help get things moving along. I readily agreed. Hell, if he’d suggested cartwheels while holding a bottle of nitroglycerine, I’d have eagerly agreed with him!

So he quickly broke my membranes. With a huge rush of lovely, clear amniotic fluid, I instantly felt Baby Boobalumba (as we had nick-named him) drop down a bit farther. Continuing with his sermon, the OB warned me that he’d give me one hour to show some progress, and that we would discuss “the options” when he returned.

For 20 minutes or so, the contractions eased off in severity, while coming closer together. I was laughing between contractions and joking with Nick and my midwife. That break was short-lived, though. Very soon transition fell on me like a lead curtain.

Oh, it was bad.

After an hour, the doctor returned and checked me again. Still 8 centimetres. “Tsk tsk tsk” is what I got, and again he started listing the risks and lecturing me on the dangers of having a uterine rupture if I didn’t hurry up and progress. I argued that Boobalumba moving lower was progress. I immediately lost my high regard for him when he began shushing me and telling me off like a naughty child.

Have I mentioned that I don’t take lightly to someone treating me as an inferior being? Hackles were raised, and Nick quickly set about to calm me down. We were given another hour.

Oh gods!!! Contractions were now never-ending waves that carried away any semblance of humanity I had left. The logical Dani was left behind by the primal Dani, who ruled unchecked over the writhing body that had been human just a few hours before.

Occasionally the logical Dani had flashes of insight that penetrated the haze of transition: thoughts of caged mountain lions screaming in rage at their captors; the lone wolf caught in a trap that gnaws its own leg off to try to escape…for I was the trapped animal, trapped by the hospital staff, policies, doctors, and my midwives. I was hooked up to a fetal monitor that inhibited my ability to move. I was suppressed by people telling me where to go and how to position myself, and reminding me of the clock that continued to tick towards the “deadline.”

Some of what happened that I’m about to relay, I learned later from Nick. At this point my chronological memory that was recording the events as they happened became seriously erratic (resulting in gaping holes big enough to drive a truck through).

At some point during my transition to a blubbering mess, my friend Lynda showed up after taking my kids to her parents’ house. Between Lynda and Nick, I had a small bit of calm to cling to. They took turns talking to me, feeding me sips of water, rubbing my back, and helping me be as comfortable as possible.

Then my second hour was up. The OB arrived and announced that I was still just 8 centimetres and my cervix was inflamed.

I begged for relief. The last piece of human Dani was ready to admit defeat. But I managed to beat back the primal contractions and somewhat coherently tell the doctor that if I could just relax for a minute, just have a moment’s respite to regain control of myself…If I’m heading down the hallway to the operating room anyways, then give me the epidural so that we can try just one last time to finish this dilation thingy that you’re all so hyper about!!

Then the human spark slipped away, having said its final piece, and the primal Dani took over again. Nick discussed it all with the doctor. They arranged to get me an epidural, and Nick bargained a further half hour to see if we could achieve the final 2 centimetres that they wanted.

Immediately the room seemed to fill with people. Two maternity nurses bustled in to set up an IV…I remember biting the head off one for even thinking about putting the IV into the back of my hand…my second midwife was there.…the noise levels rose substantially and I felt like I was in a stadium surrounded by overwhelming crowds. I vaguely recollect my midwife checking me again and saying that she thought the cervical lip could be moved…and she did something down there that wasn’t pleasant.

Then they all decided that I needed to be lying down right now. “Take the pressure off the cervix”…“let the swelling go down”…snippets of directions, with me arguing that I didn’t want to lie down. I can’t lie down, I won’t lie down…yet somehow they had me down flat on the bed, taking away the last vestige of control that I had over this three-ring circus.

More people flooded into the room. The anaesthesiologist came with cartloads of paraphernalia. At some point they kicked Lynda out of the room on some flimsy excuse, leaving me with one fewer island of support to cling to.

At this point I remember feeling “the push.” I told “them” that I needed to push, that I felt that pressure, that I needed to poop…and I remember “them” telling me not to push, that it was too early, that I wasn’t fully dilated to the golden 10. They rolled me to my side to get ready for the epidural, hands on me everywhere, voices ordering me to do this and do that, curl into a ball, hold still, don’t move…I tried to follow orders. The small inner voice of logic screamed at the primal me to listen: “Don’t move, you idiot!! That’s a needle in your spine!!!”

All of a sudden my primal self was engulfed by an all-consuming command to push…Out of the confusion of the moment, standing out from the roaring crowds came the scream: “I have to push!!! I have to push!!!!!”

The crowds yelled back at me: “Don’t move!!” “Don’t push!!!”…

What came next is a moment of clarity that I will remember to my last breath. It came so clearly and so powerfully that it is permanently etched into my brain. I pushed. With every fibre of my being. Every muscle, every tendon, every vital organ. I pushed once, then again. And I felt Baby Boobalumba burst through some invisible barrier and move down into my vagina. I felt every contour, every millimetre of his descent.

A primal growling scream rose out of me that was pure energy. I was filled with a sense of exhilaration as endorphins flooded my system. I CAN DO THIS!!!! I CAN BIRTH MY BABY!!!—only to be cut off by grabbing hands and barking orders from the madding and maddening crowds…“Stop!! Don’t push!! Don’t move!!”

Voices tumbled overtop each other. “Is the baby coming?” “Can you see the head?” “I can see the head!” “Turn her around!” “Lie on your back!” Voices bellowing at me…

The human Dani fought with the primal Dani to take back control. The human Dani knew logically what she needed to do. Knew that she needed to retake control of her body, not just from the primal Dani, but from all of these people who were trying to control her.

I needed to get up. I needed to get off my back and upright. I needed to find my voice and make these people all shut up and listen to me.

Another contraction and another push. This time my midwife cheered me on: “Push!!!!!” and I did, feeling the baby’s head start to crown, the burning that brought with it that all-encompassing need to keep pushing—only to have it all come to a crashing halt. The epidural kicked in, to block all sensation of the contractions.

The voices yelled at me to push, but the urge was simply gone. Along with the realization that my guide had disappeared came the awareness that I couldn’t breathe. “They” kept yelling at me to push, to lie back and grab my legs and pull them back…but I couldn’t find my centre, couldn’t breathe in the air deeply enough to get a full breath, couldn’t feel the contractions to cue me to push…I needed to get up. I had to get up, I tried to tell them to let me up…but they just kept pushing me back down and telling me to grab my legs…

“Tsk tsk tsk we missed another contraction.” “Dani, you have to push, the baby’s head is half way out!!! You have to push!!!”

HELLO?! I’m perfectly aware of exactly where the baby’s head is, thank you very much!!!!

I tried again to tell them that I couldn’t feel the contractions, that I couldn’t breathe…but the crowds drowned me out with their incessant commands and annoying nattering verbal diarrhea.

I reached down and felt the top of my baby’s head, and ran my fingers through the masses of soggy hair. Someone pushed my hand away and forced me to grab the back of my thigh. The human Dani sighed in resignation. They couldn’t hear me, they wouldn’t listen. I had no choice but to do it “their” way. So ignoring the roaring of the masses surrounding me, I breathed in as deeply as I could and P U S H E D.

The relief of his head coming fully out is one that every woman who has given birth can no doubt relate to. Again I reached down. I wanted to birth my baby. I wanted to grasp his slippery body as it came out of me, as we started our journey as two separate beings. I wanted to be the first to hold him. Then someone pushed my hands away again and forced them back to my legs. And so again I pushed as “they” ordered, and Baby Boobalumba was born.

Strange, but as soon as he was delivered onto my belly, the human Dani completely took over. I immediately reminded my midwife not to clamp the umbilical cord, and asked for a warmed blanket to put over both of us.

Once the cord was cut a few minutes later, my midwife asked me to push to deliver the placenta. At that point one of the nurses made a motion to press on my belly. I immediately slapped her hand away and told her No, then told my midwife that I did not want any cord traction applied. As the epidural was now firmly in place and I had no feeling at all, I concentrated on muscle memory and pushed…hard, delivering the placenta in one quick swoosh.

When one of the nurses tried to rub Boobalumba down with a towel, I pushed her away again. After that, no one interfered with me and the baby; no one tried to weigh him or measure him or clean him. They left me alone to be with my baby.

Now that clarity had returned, I could concentrate on him and interact with the people around me as a rational being again. I immediately started asking Nick for details and found out only then that Lynda had been kicked out of the room and he had run out into the hallway as soon as Boobalumba was born to grab her and bring her back in. He also told me that the nurses wouldn’t allow him to take a picture as our son was crowning. That made me so angry.

Oh, I was mad, really mad!!!

But on the surface I was able to enjoy the victory for what it meant to me personally: a validation that I was not broken. Though the birth had not gone even remotely as I had wished, and my birth plan was basically trampled on by galloping hordes, I did it.

Writing this down now, a little over a week later, I am able to verbalize many things that at the moment were just notes stored away for later analysis. The basic need for understanding and support for the VBAC mother. Support and care that are different from what other birthing mothers need.

My personal story is one of vindication of a VBA3C mom. We are not broken. We are perfectly capable of birthing our babies without the surgeon’s knife. My story will, I hope, inspire those that were there—the OB doctor, the labour & delivery nurses, my midwives—to realize that it is possible if only women are given the choice.

I wasn’t given the “choice.” I demanded that they allow it. I didn’t have their support or their understanding. I had to rely solely upon myself and my husband, knowing that if we wavered even for a moment, as we came so close to doing several times, we would be engulfed by the medical machine and processed as yet another number.

Sure, our birth is a number, but a very different and more important one: the first VBA3C in Cambridge Memorial Hospital (Cambridge, Ontario, Canada) and by the Cambridge Midwives Group. I hope that through my experience they will open doors to more VBAC mothers. I hope that my story inspires others to make choices for themselves and to learn from my mistakes and my victories. We can do it. But we have to fight for our rights and continue to fight to make changes so that other women will not have to fight the battle I did.

Vaginal birth OK after several C-sections- Reuters

The word is spreading, even making the main stream media now: Women CAN birth vaginally after 2, 3 or more Caesarean Sections!!!! Now if we can just get the Obstetricians and Hospital policy makers to actually read the study and then change how they think about VBAC births. VBAC's are not a liability. Women wanting to have a VBAC birth are NOT a liability: they are women who are trying to give birth to their babies the way that nature intended. The medical machine needs to realize that they have caused countless years of pain and suffering - both physical and emotional - to women by denying then the right to birth their babies as they want. Birth trauma is very real. Women who've been abused by the hospital system need to heal, and the first step for many of them is being allowed to face their fears and be given the support they need to birth naturally- Vaginally. This I can attest to!!!

Just 11 days ago I gave birth to my youngest son Kael in a historical VBA3C - the first of it's kind at Cambridge Memorial Hospital, and the first for the Cambridge Midwives Group. You can read my story here: http://iinformedparenting.blogspot.com/2010/02/victory-my-vba3c.html

We VBAC moms and dads and families and friends need to make the public and the hospitals aware that there ARE options for those women who've had multiple C/Sections. We need to continue to fight for our rights and stand up to the policy makers and make them realize that they do NOT have the RIGHT to tell us how to birth.

We Are NOT Broken.

Vaginal birth OK after several C-sections

Study reconsiders risks and could change guidelines

updated 2:09 p.m. ET, Thurs., Feb. 18, 2010

Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who've had only one prior C-section, a new study suggests.

At one time, doctors believed that once a woman had a C-section, she would have to have one for all subsequent pregnancies — mainly out of concern that the scar on the uterus could rupture during vaginal childbirth.

That thinking has changed, and vaginal delivery is now considered a safe option for many women who have had a past C-section. Because C-sections also carry risks and downsides — such as blood loss or infection from the procedure, and a longer hospital stay and recovery time — many women may prefer a try at labor.

Still, the American College of Obstetrics and Gynecology (ACOG) does not currently recommend vaginal delivery for women who have had three or more C-sections, as their risk of uterine rupture has generally been thought to be higher.

In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.

In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.

Based on past research, the expected rate of uterine rupture among women with one prior C-section would be less than 1 percent; a large 2004 study of U.S. women, for example, found a rate of 0.7 percent.

These latest findings suggest it would be "reasonable to reconsider" the current ACOG recommendations for women with three or more prior C-sections, according to lead researcher Dr. Alison G. Cahill of Washington University School of Medicine in St. Louis.

In an interview, she noted that next month, the National Institutes of Health is holding a consensus conference on the overall issue of vaginal birth after cesarean. According to the NIH, the conference will look at the scientific evidence on a number of questions -- including the short- and long-term risks and benefits of vaginal delivery versus repeat C-section; an independent panel will then develop a consensus statement on those issues.

For now, Cahill said, it is important for women with a history of three or more C-sections to be aware of the current ACOG recommendation. But, she added, they can also talk with their doctors about the possibility of vaginal birth as an option, as "recommendations can change as new science emerges."

For their study, Cahill and her colleagues reviewed the records of 25,000 women at 17 U.S. hospitals who gave birth after having at least one prior C-section. The group included 860 women with at least three prior C-sections, 89 of whom attempted a vaginal delivery; the remaining 771 elected to have a repeat C-section.

There were no cases of uterine rupture in either group, the researchers found.

The 89 women who chose to try labor also had no instances of bladder or bowel injury, or lacerations of the uterine artery — the other main complications the researchers assessed. That compared with just over 2 percent of the women who had a repeat C-section — though that difference, the researchers say, is not significant in statistical terms.

When it came to successful delivery — meaning the doctor did not have to switch to a C-section during labor — the chances were similar regardless of the number of prior C-sections.

Just over 13,600 women with one or two prior C-sections elected to try vaginal delivery, with a success rate of about 75 percent. That rate was 80 percent among women with a history of three or more C-sections.

Cahill pointed out that all of the women in the study had had C-sections done with what is called a low transverse incision — a horizontal cut across the lowest part of the uterus. These types of incisions have a lower risk of rupture compared with the "classical" high vertical incision, an up-and-down incision made higher on the uterus.

Another factor to consider in the decision to try vaginal delivery after cesarean, according to Cahill, is whether a woman has ever had a previous vaginal birth. Previous vaginal deliveries increase the chances of success with a post-cesarean attempt at vaginal birth.

HERE to read the original article on MSNBC

"Delayed Cord Clamping Should Be Standard Practice in Obstetrics"

Here is a link to a brilliant blog by Dr. Nicholas Fogelson OB about delayed cord clamping. I know that many of you will feel vindicated by his article and will want to read the numerous links and studies that he posts at the end of his blog.

In the comments at the end of the blog Dr. Fogelson comments thathe might develope this further into a peer-reviewed article. That is an article that I will look forward to reading.

Delayed Cord Clamping Should Be Standard Practice in Obstetrics

Dr. Nicholas Fogelson

There are times in our medical careers where we see a shift in thought that leads to a completely different way of doing things. This happened with episiotomy in the last few decades. Most recently trained physicians cannot imagine doing routine episiotomy with every delivery, yet it was not so long ago that this was common practice. ...

...For the majority of my career, I routinely clamped and cut the umbilical cord as soon as it was reasonable. Occasionally a patient would want me to wait to clamp and cut for some arbitrary amount of time, and I would wait, but in my mind this was just humoring the patient and keeping good relations. After all, I had seen all my attendings and upper level residents clamp and cut right away, so it must be the right thing, right?

Later in my career I was exposed to enough other-thinking minds to consider that maybe this practice was not right. And after some research I found that there was some pretty compelling evidence that indeed, early clamping is harmful for the baby. So much evidence in fact, that I am a bit surprised that as a community, OBs in the US have not developed a culture of delayed routine cord clamping for neonatal benefit.

HERE to read the complete blog and studies