Volume 38 ~*~ 31 May 2007

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• Rehospitalization a Risk after Planned Cesarean

  In a recent study, the risk of rehospitalization for mothers undergoing a planned, medically-elective cesarean was found to be 2.3 times greater than that of mothers planning vaginal births.  In addition, hospital costs for planned cesareans were 76% higher, and average length of stay 77% longer than for planned vaginal births, even when the latter group includes emergency, unplanned cesareans.  Dr. Eugene Declerq, author of the study, concludes, "Clinicians should be aware of the increased risk for maternal rehospitalization  after cesarean deliveries  to low-risk mothers when counseling women about their choices."

• Possible New Clue to Higher Cesarean Risk in Obese Women

  Explanations for the undeniable and significant difference in the cesarean rate in obese women can be controversial and debatable.  The real reasons probably lie somewhere in between all of them.  But a recent study published in the British Journal of Obstetrics and Gynecology adds another possible explanation to the pool:  inadequate uterine contractions, possibly due to high cholesterol.  More research is needed, the study authors state, to confirm this link, and to determine if lowered cholesterol might also lower obese women's risk of cesarean section.  

• Support for Midwifery Care Legislation Gains Momentum

  The American Nurses Association (ANA) and the American College of Obstetrics and Gynecologists (ACOG) both endorsed the "Midwifery Care Access and Reimbursement Equity Act of 2007" (S.507/H.R.864).  This legislation seeks to improve access for Medicare benificiaries to the services offered by both Certified Nurse Midwives (CNMs) and Certified Midwives (CMs).  While most states reimburse midwives at the same rate as other obstetrical and gyecological providers under Medicaid, a 35% disparity in reimbursement exists under Medicare.  This legislation seeks to correct that disparity.

• Across the World, Activists Prepare to be BOLD

  Accross the World, small groups of women are being BOLD and doing big things.  Tapping in to their inner actresses, women are rehearsing for their part in Birth: The Play to be held throughout the month of September in locations across the world. Last year, it was produced in over 40 locations, raising funds for local charities; this year, it looks to be a continued success.  Look for it in a city near you!
  

• Safety and Efficacy of Attempted VBAC at or beyond 40 weeks

  In this study, the authors conclude that the rate of success of attempted VBAC decreases significantly at or beyond 40 weeks of gestation.  At the same time, it appears that the risk of uterine rupture and overall morbidity is not increased after 40 weeks, validating the safety of VBAC at 40 weeks and beyond.

• The Royal College of Obstetricians and Gynaecologists Issues Practice Paper on VBAC

  In this practice guideline, issued in February of 2007, the RCOG recommends the following to inform the care of women undergoing either VBAC or elective repeat cesarean section (ECRS):

• Women should be informed that, overall, the chances of successful planned VBAC are 72-76%.
• Women should be informed that attempting VBAC probably reduces the risk that the baby will have respiratory problems after birth.
• Women should be informed that elective repeat cesarean section may increase the risk of serious complications in future pregnancies.

• Women undergoing VBAC carry an additional 1% risk of either blood transfusion or endometritis.
• Women undergoing planned VBAC carry an addtional 2-3/10,000 risk of birth-related perinatal death, though the absolute risk of such birth-related perinatal loss is comparable to the risk for women having their first birth.
• Induced and/or augmented labors carry a two- to three-fold increased risk of uterine rupture and a 1.5-fold increase of cesarean section compared with spontaneous labors.

The Incredible Post of the Month from the ICAN yahoogroup comes to us from Kimmi.  Kimmi inspires all of us facing difficult decisions with her perseverance and determination.

~*~*~*~*~*~

After my 4th c/s I was thinking we were done having kids. Then, two perinatologists told me the OB was wrong, and the "window" didn't mean I would rupture next time. So it was safe to get pregnant again.

I was at a Le Leche League conference and there were some tables by midwives. On a whim I asked them about a vbac after 4 c/s and NO prior vaginal deliveries. I was shocked when they said there was no reason not to consider it.

So when we were pregnant with our 5th the research began in earnest. I EXPECTED to find that I needed a c/s. I was sad, but knew that would be the only sane choice. Only I found the opposite. I found mounds of research stating I "needed" to have a VBAC, in the name of safety and sanity.

My DH flipped. Only a little at first. Then he found out I was going to see a midwife or a D.O. not an O.B. and thought that was really insane. When he found out that my chosen care provider only does home births he LOST IT. He loves me, he loves his children, he loves this family. How could I risk EVERYTHING he treasures? He believed I was conspiring to commit suicide, murder, or both.

We had some terrible moments. Some soul crushing times. Some "this may be the end of my marriage" minutes. My heart, and his, split open. I TRIED then to agree to "just reschedule" but it cut me to the core. I cried like I have never cried. I fell into a pit of despair the likes of which I hadn't known EXISTED. One night sobbing I typed out the raw emotion of it all. It took days to muster the courage to email it to him. To say "I'll do this for you, but ONLY if you help me through the emotional trauma of it". He was sad, angry, scared. He said I needed therapy. He didn't understand. He said I was crazy. Days, maybe weeks, went by where we didn't speak of it. Finally I asked him to read my research and meet my Dr. In exchange I would see an O.B. and I would read his research. He agreed. He sent me ONE article, and I had already read it. I told him to keep emailing, printing, etc. I said it was important to ME that I read the SCARIEST articles out there. If I wasn't willing to LOOK at the worst-case then it was very irresponsible of me to take these risks. He was relieved. The next day I sent him 2 articles and he didn't read them. I said he needed to look at the RISKS of a repeat section if he wanted me to take those risks. That it was irresponsible for HIM to choose this option if he wasn't willing to look at all of its pros and cons. He stopped sending me things, he didn't read what I sent him. He said he knew I was going to "try" and that he wanted no part of it.

At first I was upset. Then he said a hospital OB birth (c/s) is free. We can't afford a home birth. He wouldn't even pay co-pays on my appointments. I was devastated AGAIN! But I started emailing the midwives and the D.O. again. The few who would take on a VBA4C. Now I was asking them to do it for ONLY what the insurance covered plus whatever I could do to "work it off". To my surprise the D.O. said No Problem. She said "its more about the births than the dollars" My poor DH. He must have been equally devastated to learn I didn't need his support, his presence, or even his MONEY LOL!!

He says he won't be here. He'll meet me at the hospital when I transfer. He's taking the 2 littlest kids to his sister's house. My friend is coming to be with the older 2 kids, to meet their needs, explain things etc. I trust her to respect MY needs whatever they may be (in case I decide I CAN'T have them in the room or whatever). Another friend who has been at 3 births will come be my support person. My doc is very calm and reassuring and will stay for a long labor and for several hours afterward. Its going to be great. I'm 40 weeks now. Soon I'll be holding my first vaginally born baby, nursing him or her in my own room. I can't wait!

You can do this.

Gentle Birth World Congress

September 27 to 30, 2007
Portland, Oregon, U.S.A.
Barbara Harper, Waterbirth International, is putting together an international conference that is sure to inspire and educate (go to the link above for full information and list of speakers). Mark your calendars now! Early bird discount registration until May. I hope to see you there. Gloria Lemay, Vancouver

GoodSearch

When you are searching online, go to www.goodsearch.com and type in "International Cesarean Awareness Network" as the organization to support. ICAN's main address is Redondo Beach, which should pop up automatically (typing "ICAN" won't get it to come up). Each search gives .01 to ICAN. Doesn't sound like much, but the pennies add up!  Don't forget, you can add GoodSearch to your toolbar to make it even easier to search and do good at the same time!  

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ICAN's mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC). This newsletter is for informational purposes only and does not replace the advice of a qualified birth professional.

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