The Midwife: A Steadily Growing and Natural Childbirth Option

http://www.birthtruth.org

Hi!

This is a link to a website set up by a woman from ICAN, and I think it's got some merit combined with chutzpah. It has a lot of commentary about cesareans, US birth culture, so forth. Check it out...

-Rachel Z

#29

From: ICANofBuffalo@...
Date: Fri Jul 28, 2006 10:14 am
Subject: Meeting Reminder!

icanofbuffal...

Offline

Hi Folks,

Just a friendly reminder that our next meeting will be Thursday, August 3, 6pm at HomeGrown Baby - 3113 Delaware Ave at Delwood in Kenmore!

(Warning: shameless plug ahead:) And don't forget to come early and peruse the store for HGB's HUGE August sale ;-)

Also, in case you haven't heard, ICAN will be celebrating 25 years of cesarean education, cesarean support and VBAC support at our bi-annual conference, which will take place right down the thruway in Syracuse from April 20-22! Some details are still pending, but information can be found at www.ican-online.org. Become a subscriber of ICAN of Buffalo for only $30 to receive valuable discounts at the conference (plus other member benefits as well!)

-Rachel

Reply | Forward | Messages in this Topic (6)

#28

From: ICANofBuffalo@...
Date: Wed Jul 19, 2006 10:38 am
Subject: Re: #4 out of 5 top issues!

icanofbuffal...

Offline

Thanks :)

I decided to use this as leverage to try to get the news stations to do a story on the cesarean epidemic. Cross your fingers!!!

-R

In a message dated 7/19/06 1:02:41 A.M. Eastern Daylight Time, renee@... writes:

super awesome!!!
renee
rzeller143@... wrote:
I just found this - it was in the paper about 10 days after my article ran. I'm so excited it made the list! (7/9/06 Buffalo News - http://www.buffalonews.com/editorial/20060709/1006721.asp)\

#27

From: rzeller143@...
Date: Wed Jul 19, 2006 11:10 am
Subject: New VBAC Research

icanofbuffal...

Offline

This came from the ICAN of Rochester. For those who can't deal with all the jargon, it shows that the strict guidelines ACOG set in 1999 regarding VBAC (such as requiring a hospital to have a 24-hr surgical staff) have not improved outcomes.

VBACs in our area and in the US have declined dramatically since the implementation of these guidelines. Hopefully this research will become a turning point to help women get the support they need, rather than being turned away from care providers and hospitals!

-Rachel

www.medscape.com

To Print: Click your browser's PRINT button.

NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/537039

Vaginal Birth After Cesarean in California: Before and After a Change in Guidelines

John Zweifler, MD, MPH; Alvaro Garza, MD, MPH; Susan Hughes, MS; Matthew A Stanich, MPH; Anne Hierholzer; Monica Lau

Posted 07/07/2006

Abstract and Introduction

Abstract

Purpose: In 1999 the American College of Obstetricians and Gynecologists (ACOG) adopted more-restrictive guidelines for vaginal birth after cesarean delivery (VBAC). This study assesses trends in VBAC in California and compares neonatal and maternal mortality rates among women attempting VBAC delivery or undergoing repeat cesarean delivery before and after this guideline revision.
Methods: The 1996 through 2002 California Birth Statistical Master Files were used to identify 386,232 California residents who previously gave birth by cesarean delivery and had a singleton birth planned in a California hospital.
Results: Attempted VBAC deliveries decreased significantly from 24% before to 13.5% after guideline revision (P < .001). Neonatal mortality rates per 1,000 live births for attempted VBAC deliveries were not different from repeat cesarean delivery rates among neonates weighing ≥1,500 g in either the study periods 1996 to 1999 or 2000 to 2002. Neonatal mortality rates for attempted VBAC deliveries were higher for repeat cesarean deliveries among neonates weighing <1,500 g in the same periods (attempted VBAC: 1996–1999, 253.2; 95% Poisson confidence interval [CI], 197.7–308.6; 2000–2002, 336.8; CI, 254.3–419.4; repeat cesarean delivery: 1996–1999, 59.1; CI, 48.3–69.9; 2000–2002, 60.5, CI, 48.4–72.5). Maternal death rates per 100,000 live births for attempted VBAC deliveries were similar for both periods (1996–1999, 2.0; CI, 0.1–11.0; 2000–2002, 8.5; CI, 1.0–30.6).
Conclusions: Neonatal and maternal mortality rates did not improve despite increasing rates of repeat cesarean delivery during the years after the ACOG 1999 VBAC guideline revision. Women with infants weighing ≥1,500 g encountered similar neonatal and maternal mortality rates with VBAC or repeat cesarean delivery.

Introduction

The percentage of babies born by cesarean section increased in the United States from 4.5% in 1965 to 26.1% in 2002.^[1,2] Nearly 40% of cesarean sections are repeats.^[2] Federal reports in the 1980s and 1990s promoted vaginal birth after cesarean section (VBAC) as a safe and reasonable alternative.^[3,4] In 1994 and 1995 the American College of Obstetricians and Gynecologists (ACOG) stated, "A woman with one previous cesarean delivery with a lower uterine segment incision should be counseled and encouraged [italics added] to undergo a trial of labor in her current pregnancy."^[5,6] Safety issues and medicolegal considerations, however, appear to have contributed to ACOG subsequently adopting more restrictive recommendations regarding VBAC deliveries.^[7,8] In 1999, the ACOG revised position became, "... because uterine rupture may be catastrophic, VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available [italics added] to provide emergency care."^[8] Meanwhile, VBAC rates climbed from 1% in 1974, to 27.4% in 1997 before declining to 12% in 2002.^[2,9]

The recommendation that VBAC deliveries should be attempted only in institutions equipped to respond to emergencies with physicians immediately available could have a greater impact on VBAC deliveries at rural hospitals, where there may be less access to physician and emergency services. The 2004 reaffirmation by ACOG of its VBAC guidelines^[10] has been challenged by the American Academy of Family Physicians Policy on Trial of Labor After Cesarean (TOLAC).^[11] Although observational studies conducted in years before 1999 found VBAC deliveries in rural and smaller hospitals to be safe,^[12-14] studies of VBAC deliveries and adverse birth outcomes before and after the ACOG 1999 VBAC guideline revision are still needed.

Our study addresses the following questions: Did the appraoch to VBAC deliveries change after the 1999 guideline revision? Did rates of VBAC change similarly at rural and urban hospitals during this time? Did rates of neonatal and maternal mortality for births among women with previous cesarean sections differ between 1996–1999 and 2000–2002 or between delivery methods? To answer these questions, we analyzed California birth data from 1996–2002 and compared neonatal and maternal mortality in years before and after the ACOG 1999 VBAC guideline revision.

Methods

Birth data were obtained from the California Department of Health Services Birth Statistical Master Files for the years 1996 through 2002. The variables used for analyses included maternal demographics, birth-specific measures, and hospital designation as rural or urban. Maternal demographics included age, race, ethnicity, education, and California county of residence. Birth measures abstracted from the Birth Statistical Master File were date of birth, date of newborn death, type of birth (singleton or multiple), birth weight, method of delivery, pregnancy complications, delivery complications, hospital code, planned birthplace (hospital, birth center, residence, or unplanned), and California county of birth. The University of California, San Francisco, Institutional Review Board approved this study as exempt.

Rural hospital names were identified according to the California Office of Statewide Health Planning and Development designation of "small/rural hospital."^[15] Because we noted that 4 hospitals were not consistently designated, hospitals ever designated as rural in this time frame were considered rural for our study. Hospitals not matching the rural list were considered urban.

The State of California Certificate of Live Birth-VS-10A Medical Data Supplemental Work Sheet defined all the codes used to document complications of pregnancy. We created a composite variable for pregnancy complications that took into consideration all reported complications.^[16] Although birth certificates categorized electronic fetal monitoring and ultrasound examinations as pregnancy complications, we did not include them as pregnancy complications. If any pregnancy complication besides "none" or electronic fetal monitoring or ultrasound examination was coded, the composite variable for that record was categorized as having a pregnancy complication.

Data were analyzed using SAS (Version 8.2; SAS Institute Inc, Cary, NC). We considered records of all California residents with a singleton birth planned in a California hospital and then created a subset of women who had had a previous cesarean section. Certificate of Live Birth information was used to categorize the delivery method as either attempted VBAC, successful or failed (including other delivery assistance), or repeat cesarean delivery. Method of delivery options on the Certificate of Live Birth included "cesarean section-repeat" and "vaginal birth-after previous cesarean section" (successful VBAC). The Certificate of Live Birth codes "unsuccessful attempt at vaginal birth after cesarean section" as a delivery complication. This code was used to identify a failed VBAC. We summed the successful and failed VBAC deliveriess to derive the numbers of attempted VBAC deliveries. "Maternal death (within 72 hours of delivery)," also coded as a delivery complication, was used to define maternal death, although the standard World Health Organization (WHO) definition of maternal death is within 42 days. We calculated neonatal deaths using the standard WHO definition of newborns living for less than 28 days. The neonatal morbidity—hypoxicischemic encephalopathy—and the maternal morbidity—uterine rupture—are not included as Certificate of Live Birth codes and were therefore not part of this analysis. Newborn very low birth weight was defined as less than 1,500 g, low birth weight as 1,500 to 2,499 g, normal birth weight as 2,500 to 4,000 g, and large birth weight as more than 4,000 g.

We calculated percentages of women who attempted VBAC deliveries within categories of maternal demographics for 2 time spans: 1996 to 1999, before the ACOG VBAC guideline revision; and 2000 to 2002, after the ACOG VBAC guideline revision. A χ² test was used to examine the difference in VBAC attempts in the 2 periods. Neonatal death rates were calculated per 1,000 live births with 95% Poisson confidence intervals (CI).^[17] Neonatal death rates were then stratified by delivery method, birth weight category, and the period before or after the guideline revision. A power calculation, at 80% power and 5% significance level, based on our sample size of neonates weighing more than 2,500 g indicated that we would be able to detect a difference of 0.1023 deaths per 1,000 live births between the categories of repeat cesarean section and attempted VBAC. Multiple logistic regression was used to test whether neonatal death rates differed by location of hospital (rural or urban), study period, delivery method, pregnancy complications, or birth weight category. Maternal death rates with confidence intervals were calculated per 100,000 live births by study period and delivery method.

Results

Demographics of Vaginal Births After Cesarean (VBAC)

There were more than 3.5 million singletons delivered to California residents at California hospitals during our study time span, 1996–2002 (Figure 1). Of those births, 10.9% (386,232) were to women with previous cesarean sections, which comprised our sample. The VBAC rate (VBAC among women with previous cesarean sections) was 16%, and the success rate of attempted VBAC deliveries was 79.5% in rural and 83.3% in urban settings (data not shown). Overall, 3.9% (138,275) of all births in California occurred at rural hospitals, and 4.5% (17,380) of all previous cesarean section births were rural. Rural and urban differences in the decline of VBAC over the years were not significant and, although VBAC deliveries declined more rapidly at rural hospitals after 1999, the decline started at least as early as 1997 (Figure 2).

Figure 1.

Singleton births in California hospitals by California residents, 1996–2002.

Figure 2.

Successful vaginal births in women with previous cesarean section delivery: California, 1996–2002.

Table 1 displays by maternal demographic characteristics the percentage of women with a previous cesarean delivery (386,232) who attempted vaginal birth. Overall, the percentage of women who attempted VBAC deliveries decreased significantly from 24% before the revision to 13.5% after the revision (P < .001). The percentage of decrease in attempted VBAC between the 2 periods was less in older mothers, in black mothers, and in those with pregnancy complications. Overall, recorded pregnancy complications were higher in women who attempted VBAC than in those who had a repeat cesarean section in both before the revision and after the revision periods, as were specific complications including diabetes, premature labor, preeclampsia, anemia, or polyhydramnios/oligohydramnios (data not shown). The rate of attempted VBAC in both periods was positively associated with education level.

Neonatal and Maternal Deaths

Table 2 displays neonatal mortality rates per 1,000 live births among women with a previous cesarean delivery by birth weight category, delivery method, and the period before and after the revision. Neonatal mortality rates for attempted VBAC deliveries were not different from those for repeat cesarean deliveries, except among neonates of very low birth weight in both periods (highlighted in table). Neonatal mortality rates for failed VBAC deliveries were not significantly different from rates for successful VBAC or repeat cesarean deliveries, except for a higher rate in the after-revision normal–birth-weight category (highlighted in table). The proportion with successful VBAC was inversely related to birth weight (very low birth weight 92.9%, low birth weight 87.6%, normal birth weight 84.3%, and large birth weight 73.4%; data not shown).

Among all births, multiple logistic regression analysis showed the strongest predictor of neonatal death to be very low birth weight ( Table 3 ). There was no significant association between neonatal death and delivery method in a rural hospital, and a slightly protective association with the period before the revision, ie, the odds of death were higher in the period after the revision. These associations did not change when only newborns weighing <2,500 g were analyzed. Finally, in a regression analysis including only newborns of normal and large birth weight, pregnancy complication was the only significant predictor of neonatal mortality (OR, 3.1; CI, 2.2–4.5; data not shown).

During the 7-year span of this study, only 35 maternal deaths occurred within 72 hours of delivery. Table 4 displays maternal death rates per 100,000 live births by delivery method and study period. For each delivery method, maternal death rates were not significantly different between the periods before and after the guideline revision. Maternal death rates for repeat cesarean section and attempted VBAC deliveries were also not significantly different.

Discussion

We investigated VBAC delivery rates in California before and after the ACOG 1999 VBAC guideline revision that called for the immediate availability of cesarean section capability. We found that VBAC deliveries declined rapidly after 1999. This decline, however, seems to be the continuation of a trend that began in 1997 and mirrored national trends, perhaps reflecting unease among obstetricians and foreshadowing the 1999 revision.^[2,18,19] Our successful VBAC rate of 83% is higher than the 76% success rate found in a recent meta-analysis.^[11] The higher rate may reflect our inability to distinguish between planned and unplanned VBAC deliveries using birth certificate data.

We suspected that the more-stringent VBAC criteria established by ACOG would disproportionately affect rural hospitals, because rural obstetric clinicians presumably would have more difficulty being immediately available.^[20] VBAC deliveries did decline faster in rural than in urban hospitals after 1999, although other factors, such as declining numbers of family physicians providing obstetric services or patient preferences, may have played a role.

We also investigated neonatal and maternal mortality in California before and after the ACOG guideline revision. California's neonatal and maternal mortality rates did not improve in the years after the 1999 revision, nor was rural hospital status a significant predictor of neonatal mortality. Although these findings do not support such a policy as ACOG's 1999 revision, which could be construed to especially discourage VBAC deliveries at rural hospitals, we cannot exclude the possibility that residual confounding by risk status might make rural hospitals compare more favorably. For example, rural pregnant women with high-risk conditions identified prenatally might preferentially select or be referred for delivery in urban settings better prepared to handle newborn complications. The finding that pregnancy complication for newborns >2,500 g was the only significant predictor of neonatal mortality emphasizes the continuing need for detecting complications and referring when necessary.

Our finding of higher VBAC neonatal mortality rates confined to infants of very low birth weight is similar to that of a previous report.^[21] One possibility is that women with previous cesarean sections who have precipitous premature deliveries are classified as VBAC, even if they had planned to have a repeat cesarean section, which is supported by the higher rates of "successful" VBAC deliveries for infants of very low birth weight when compared with infants of other birth weights. Women who give birth precipitously have less time to receive antenatal steroids that improve neonatal mortality in infants of very low birth weight.^[22] Additionally, physicians and patients may be reluctant to subject pregnant women to an operative procedure if the newborn is unlikely to be viable. The finding that women with very low birth weight newborns who attempted a VBAC but ultimately had a cesarean section (failed VBAC) had similar neonatal mortality rates as women giving birth to very low birth weight infants by repeat cesarean section suggests the differences in neonatal mortality rates for infants of very low birth weight may be less a function of attempting a VBAC or electing to have a repeat cesarean section than a reflection of factors such as those described above.

This analysis reinforced important findings from previous studies of VBAC deliveries. No significant difference was found in maternal deaths for women who attempted a VBAC compared with those who had an elective repeat cesarean section.^[23-26] A much larger sample would be needed, however, to have the power to detect differences in maternal mortality. The proportion of older women and black women who attempted a VBAC delivery did not decrease after the 1999 revision to the same extent as the proportion of women from other age and racial/ethnic groups, a finding consistent with national VBAC trends.^[27]

Our analysis of birth certificate information did not permit us to assess important neonatal or maternal morbidities, including neonatal hypoxic-ischemic encephalopathy or maternal uterine rupture. A recent prospective, nonblinded, multicenter observational study found higher rates of neonatal hypoxic-ischemic encephalopathy and maternal uterine rupture for women who underwent a trial of labor after cesarean (TOLAC) than women whose babies were delivered by repeat cesarean section.^[26] Our results agreed with those of Landon et al in finding no differences in neonatal mortality for term infants delivered by TOLAC or repeat cesarean section. Similarly, we both found no differences in maternal mortality, nor did Landon et al find higher rates of hysterectomy despite the higher rates of uterine rupture in their TOLAC group.^[26] Our study is not directly comparable with the Landon et al study, because there were differences in data collection methods (birth certificate analysis vs prospective chart review), population (State of California vs academic health centers), rates of successful VBAC (83% vs 73%), and sample size (311,989 repeat cesarean deliveries with 74,243 attempted VBAC, compared with 15,801 repeat cesarean deliveries and 17,898 TOLAC). Landon et al included higher proportions of women who were younger than 30 years, black, and on government aid in their TOLAC group. Landon et al classified women who arrived dilated 4 cm or more in the TOLAC group, which could have selected for women at higher risk because of less compliance with labor and delivery instructions or limited prenatal care.

Our study was further limited by other factors. Our results depended on proper coding of birth certificates, which are subject to misclassification.^[28] We were unable to determine whether there was under-ascertainment of VBAC or whether ascertainment occurred differently in patients with adverse outcomes. Birth certificate data are limited to what is routinely collected. Information not systematically collected includes gestational age or use of antenatal steroids, which are of particular importance in delivery outcomes for infants of very low birth weight. Birth certificate data of maternal mortality records only death within 72 hours, much less than the World Health Organization's standard definition of maternal death within 42 days. Finally, it might be difficult to generalize our results to populations outside California, since California births may occur in settings more or less ethnically diverse or rural than others, and the successful VBAC rate for all women with previous cesarean births in California in 2002 was 8.0%, compared with the national rate of 12.6%.^[2] Even so, California's 528,000 births in 2002 constituted 13.1% of the 4,022,000 US deliveries in that year.^[2]

Our findings warrant further investigation. We recommend an assessment of the response of rural hospitals to the 1999 ACOG guideline revision, the capacity of rural hospitals to accommodate cesarean deliveries, and the risk status of mothers who give birth at rural or urban hospitals. We also recommend a study of neonatal mortality and morbidity associated with very low birth weight for women with previous cesarean sections that accounts for precipitous or unplanned VBAC deliveries.

During the last decade, the pendulum in the United States has swung dramatically away from VBAC deliveries and toward repeat cesarean section.^[29] The ACOG 1999 VBAC guideline revision reflects concern for VBAC delivery safety and may have accelerated this trend, particularly at rural hospitals. Our findings suggest that women expecting to give birth to normal– or large–birth-weight infants can anticipate similar neonatal mortality with a VBAC or a repeat cesarean section. These findings, based on 386,232 California births after previous cesarean delivery, do not contradict the AAFP TOLAC statement. Concerns, however, regarding medicolegal consequences of complications, such as uterine rupture, which we were unable to assess using birth certificate data, may continue to temper patient and physician enthusiasm for VBAC deliveries. We recommend that a balanced presentation of risks and the encouraging outcomes found in this analysis be included in discussions with pregnant patients who have had a previous cesarean section. An evidence-based approach to VBAC delivery incorporating these findings may lead to further refinements in guidelines for medically managing women with a previous cesarean delivery.

Portions of this manuscript were presented at the 38th Annual Spring Conference of the Society of Teachers of Family Medicine in New Orleans, La, May 2, 2005.

To read commentaries or to post a response to this article, see the online version at
http://annfammed.org/cgi/eletter-submit/4/3/228 .

Table 1. Women With a Previous Cesarean Section Delivery Who Attempted Vaginal Birth, by Maternal Demographic Characteristics and Study Period, California, 1996–2002

Table 1: Women With a Previous Cesarean Section Delivery Who Attempted Vaginal Birth, by Maternal Demographic Characteristics and Study Period, California, 19962002

Table 2. Neonatal Death Rates by Birth Weight, Delivery Method, and Study Period, California, 1996–2002

Table 2: Neonatal Death Rates by Birth Weight, Delivery Method, and Study Period, California, 19962002

Table 3. Multiple Logistic Regression Analysis of the Association Between Delivery Characteristics and Neonatal Death in California from 1996–2002

Table 3: Multiple Logistic Regression Analysis of the Association Between Delivery Characteristics and Neonatal Death in California from 19962002

Table 4. Maternal Deaths by Delivery Method and Study Period, California, 1996–2002

Table 4: Maternal Deaths by Delivery Method and Study Period, California, 19962002

References

Scott JR. Avoiding labor problems during vaginal birth after cesarean delivery. Clin Obstet Gynecol. 1997;40:533–541.
Martin JA, Hamilton BE, Sutton PD, et al. Births: final data for 2002. Natl Vital Stat Rep. 2003;52:1–113.
National Institutes of Health. Cesarean childbirth. NIH Consensus Statement Online. Available at: http://odp.od.nih.gov/consensus/cons/027/027_statement.htm#1. Accessed: 23 August 2004.
Healthy People 2000. Washington, DC: US Department of Health and Human Services; 1990.
Vaginal delivery after a previous cesarean birth. Washington, DC: American College of Obstetricians and Gynecologists. ACOG Committee on Obstetric Practice; 1994. Opinion No. 143.
ACOG Practice Patterns. Vaginal delivery after previous cesarean birth. Washington, DC: American College of Obstetricians and Gynecologists; 1995. Practice bulletin No. 1.
Flamm BL. Vaginal birth after cesarean: what's new in the new millennium? Curr Opin Obstet Gynecol. 2002;14:595–599.
Clinical management guidelines for obstetrician-gynecologists: vaginal birth after previous Cesarean delivery. Washington, DC: American College of Obstetricians and Gynecologists. ACOG Committee on Practice Bulletins; 1999. Practice Bulletin No. 5.
Harer WB, Jr. Vaginal birth after cesarean delivery: current status. JAMA. 2002;287:2627–2630.
ACOG Practice Bulletin #54: vaginal birth after previous cesarean. Obstet Gynecol. 2004;104:203–212.
Wall E, Roberts R, Deutchman M, et al. Trial of Labor After Cesarean (TOLAC), Formerly Trial of Labor Versus Elective Repeat Cesarean Section for the Woman With a Previous Cesarean Section. Leawood, Kan: American Academy of Family Physicians; 2005.
Raynor BD. The experience with vaginal birth after cesarean delivery in a small rural community practice. Am J Obstet Gynecol. 1993;168:60–62.
Holland JG, Dupre AR, Blake PG, Martin RW, Martin JN, Jr. Trial of labor after cesarean delivery: experience in the non-university level II regional hospital setting. Obstet Gynecol. 1992;79:936–939.
Cameron B, Cameron S. Outcomes in rural obstetrics, Atherton Hospital 1991–2000. Aust J Rural Health. 2001;9(Suppl 1):S39–S42.
California Office of Statewide Health Planning and Development. Annual Hospital Utilization Pivot Profiles, 1999–2001. Available at: http://www.oshpd.state.ca.us/HQAD/HIRC/hospital/util/pivot/index.htm. Accessed: 10 October 2003.
California Department of Health Services Health and Welfare Agency. Certificate of Live Birth - VS-10A Medical Data Supplemental Work Sheet. Available at: http://www.avss.ucsb.edu/layouts/vs10a.htm. Accessed: 10 November 2003.
Armitage P, Berry G, Matthews JNS. Statistical Methods in Medical Research. 4th ed. Oxford: Blackwell Science Ltd; 2002.
Flamm BL. Once a cesarean, always a controversy. Obstet Gynecol. 1997;90:312–315.
Vaginal birth after cesarean birth–California, 1996–2000. MMWR Morb Mortal Wkly Rep. 2002;51:996–998.
Pinette MG, Kahn J, Gross KL, et al. Vaginal birth after Cesarean rates are declining rapidly in the rural state of Maine. J Matern Fetal Neonatal Med. 2004;16:37–43.
Riva HL, Teich JC. Vaginal delivery after cesarean section. Am J Obstet Gynecol. 1961;81:501–510.
Effect of corticosteroids for fetal maturation on perinatal outcomes. NIH Consens Statement. 1994;12:1–24.
Socol ML. VBAC–is it worth the risk? Semin Perinatol. 2003;27:105–111.
Smith GC, Pell JP, Dobbie R. Caesarean section and risk of unexplained stillbirth in subsequent pregnancy. Lancet. 2003;362:1779–1784.
Guise JM, Berlin M, McDonagh M, et al. Safety of vaginal birth after cesarean: a systematic review. Obstet Gynecol. 2004;103:420–429.
Landon MB, Hauth JC, Leveno KJ, et al. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med. 2004;351:2581–2589.
Menacker F, Curtin SC. Trends in cesarean birth and vaginal birth after previous cesarean, 1991–99. Natl Vital Stat Rep. 2001;49:1–16.
Green DC, Moore JM, Adams MM, et al. Are we underestimating rates of vaginal birth after previous cesarean birth? The validity of delivery methods from birth certificates. Am J Epidemiol. 1998;147:581–586.
Grady D. Trying to avoid 2nd Caesarean, many find choice isn't theirs. New York Times. November 29, 2004: A1, A19.

Acknowledgements

We wish to thank Norman Hearst, MD, MPH; Kathleen Ramos, PhD; and Sean Schafer, MD, for commenting on our manuscript.

Reprint Address

John Zweifler, MD, MPH, Department of Family and Community Medicine, UCSF Fresno, 155 N Fresno St, Fresno, CA 93701, john.zweifler@...

John Zweifler, MD, MPH,¹ Alvaro Garza, MD, MPH,² Susan Hughes, MS,¹ Matthew A Stanich, MPH,² Anne Hierholzer,³ and Monica Lau,³

¹Department of Family and Community Medicine, University of California, San Francisco, Fresno, Calif
²Latino Center for Medical Education and Research, University of California, San Francisco, Fresno, Calif
³Summer Biomedical Research Internship Program, University of California, San Francisco, Fresno, Calif

Conflicts of Interest: None Reported.

#26

From: Renee Herman <renee@...>
Date: Wed Jul 19, 2006 3:24 am
Subject: Re: #4 out of 5 top issues!

renee@...

super awesome!!!

renee

rzeller143@... wrote:

I just found this - it was in the paper about 10 days after my article ran. I'm so excited it made the list! (7/9/06 Buffalo News - http://www.buffalonews.com/editorial/20060709/1006721.asp)\WE GOT MAIL 134 letters received this week
Here are the top five issues on the minds of those who wrote to Everybody's Column this week:1. State Legislature $1 billion vote
2. Bush administration woes
3. Palestinian/Isreali conflict
4. My View about Caesarean section
5. Buffalo Public Schools
-Rachel

#25

From: rzeller143@...
Date: Tue Jul 18, 2006 1:51 pm
Subject: #4 out of 5 top issues!

icanofbuffal...

Offline

I just found this - it was in the paper about 10 days after my article ran. I'm so excited it made the list!

(7/9/06 Buffalo News - http://www.buffalonews.com/editorial/20060709/1006721.asp)\

WE GOT MAIL 134 letters received this week
Here are the top five issues on the minds of those who wrote to Everybody's Column this week:

1. State Legislature $1 billion vote
2. Bush administration woes
3. Palestinian/Isreali conflict
4. My View about Caesarean section
5. Buffalo Public Schools

-Rachel

#24

From: rzeller143@...
Date: Fri Jul 14, 2006 6:55 pm
Subject: The Informed Patient

icanofbuffal...

Offline

Interesting Wall St. Journal article as posted from another list...

-Rachel

#23

From: rzeller143@...
Date: Fri Jul 14, 2006 6:55 pm
Subject: Oops, here's the article...

icanofbuffal...

Offline

The Wall Street Journal
7/12/2006 – P. D1

THE INFORMED PATIENT

By LAURA LANDRO

New Practices Reduce Childbirth Risks

Amid Soaring Liability Costs, Hospitals Curb Use of Drugs And Other
Procedures to Speed Labor

Hospitals are conceiving new programs to make childbirth safer, amid
mounting evidence that overuse of labor-inducing drugs for preterm
deliveries and other common practices in the delivery room are endangering
both mothers and infants.

Driven by soaring liability-insurance premiums for their obstetrics units,
hospital groups are adopting policies to discourage or prohibit births
induced before the minimum 39 weeks recommended by maternal and child health
experts, unless medically necessary. They are curtailing the use of drugs
such as the hormone oxytocin to start or speed up contractions, which in
too-high doses can lead to ruptures of the uterus, fetal distress and even
death of the infant. And they are limiting the use of forceps and vacuums
that can help coax babies from the birth canal but also lead to injuries
such as bone fractures and nerve damage.

With communication breakdowns at the root of 85% of all adverse events
reported in obstetrics units, hospitals are also taking steps to ensure
better teamwork, such as making sure electronic fetal monitors that trace
baby's heartbeats are interpreted the same way by both doctors and nurses.

Despite the sharp rise in elective inductions in recent years, which may
account for a third or more of all induced births in some hospitals,
research shows that delivering babies even a few days early is associated
with higher rates of emergency Caesarean deliveries, admissions to the
neonatal intensive-care unit with respiratory distress and other problems,
and longer-term health issues for children.

The new programs are already changing the experience of childbirth in a
growing number of hospitals around the country -- making it harder to
schedule deliveries on a convenient day for the doctor or patient, or to
give the maximum dose of oxytocin to advance a long and difficult labor. But
they are also helping to reduce risks that can lead to devastating harm.
Salt Lake City-based Intermountain Healthcare began requiring doctors to
obtain special permission to induce delivery earlier than 39 weeks.
Intermountain, which operates hospitals in Utah and Idaho, reduced elective
inductions at less than 39 weeks to 5% of all births today, from 27% before
the program started in 2001.

"The OB is its own little world in a hospital setting, and 99% of the time
it's a happy and nice place," says Kathy Connolly, assistant vice president
of risk management at the insurance-management unit of Premier Inc., an
alliance of 1,500 nonprofit hospitals. But obstetricians don't always adhere
to guidelines for elective induction set by groups like the American College
of Obstetricians and Gynecologists. They often schedule deliveries around
their own office hours or travel plans, and don't always take the time to
document care in patient records, increasing hospital liability, she says.

While harm during labor and delivery is rare, relative to the number of
births, obstetrics-related cases accounted for 8.1% of all
physician-malpractice payment reports to the National Practitioner Data
Bank, a federally maintained clearinghouse that maintains data on physician
conduct. The median award for a childbirth-related claim involving hospitals
and obstetricians was $2.5 million between 1997 and 2003, the highest of any
specialty.

The nonprofit Institute for Healthcare Improvement is now expanding a
program it launched last year with hospitals affiliated with Premier and
Ascension Health, the largest Catholic health system, called "Idealized
Design of Perinatal Care." It offers two "bundles" of practices -- one to be
used during a decision to electively induce, and one for managing labor that
isn't progressing -- which include determining fetal age, monitoring the
fetal heart rate, and assessing the readiness of the mother's cervix. While
hospitals have long followed such practices to improve outcomes in
childbirth, IHI says the key is using all the practices in concert more
consistently than many hospitals do.

Managed-care giant Kaiser Permanente, with 32 hospitals, is rolling out its
own perinatal patient safety program in its eight national regions,
including drills of simulated maternal and fetal emergencies. Doctors and
nurses who undergo the new training program interact with specially designed
mannequins implanted with a mechanical baby. "Emergencies are rare events in
labor and delivery, so it's hard to keep your skills up," says Annie Herlik,
Kaiser Permanente director of national risk management.

One of the biggest challenges is reconciling two different sets of terms
that nurses and doctors have long used to read fetal heart monitors,
developed by their respective professional organizations. Nurses for
example, used the term "decreased/minimal" to mean zero to five beats per
minute, while to doctors, the same term means three to five beats per
minute. The differences have lead to miscommunication about when a baby
might be in distress -- and created big liability risks for hospitals.

A new, single set of guidelines was published eight years ago by the
National Institute of Child Health and Human Development, but doctors and
nurses often fall back on habits they were trained in. Many hospitals are
now requiring nurses and doctors to learn the newer guidelines together;
Kaiser, for example, is using 20-minute videos that introduce the common
language.

Hospitals also are educating mothers-to-be about the risks of early
induction, which both mothers and doctors sometimes push for. At
Premier-affiliated Baystate Medical Center in Springfield, Mass, for
example, staffers conduct informed-consent discussions about oxytocin at the
hospital instead of leaving it to a doctor's office visit.

Oxytocin is a hormone released during labor that causes contractions of the
uterus. The most common brand name is Pitocin, which is a synthetic version.
It's often used to speed or jump-start labor, but if the contractions become
too strong and frequent, the uterus becomes "hyperstimulated," which may
cause tearing and slow the supply of blood and oxygen to the fetus. Though
there are no precise statistics on its use, IHI says reviews of
medical-malpractice claims show oxytocin is involved in more than 50% of
situations leading to birth trauma.

"Pitocin is used like candy in the OB world, and that's one of the reasons
for medical and legal risk," says Carla Provost, assistant vice president at
Baystate, who notes that in many hospitals it is common practice to "pit to
distress" -- or use the maximum dose of Pitocin to stimulate contractions.

Some hospitals in the IHI program are already meeting or exceeding the
target of reducing rates of harm to infants below 3.3 incidents per 1,000
births, compared with a national average of 6.34. At the eight-hospital
Seton Health Network, part of the Ascension system, birth-trauma rates have
fallen to nearly zero from about three per thousand, and doctors are using
vacuums and forceps just 4% of the time, compared with 7.5% before the
program's launch in January of 2004, says Frank Mazza, vice president of
medical affairs for Seton, based in Austin, Texas.

Intermountain Healthcare says its program has led to a sharp drop in birth
complications and decreased the lengths of stay in labor and delivery,
cutting costs by $500,000 annually. However, the new efforts are meeting
some resistance from obstetricians, who aren't used to having their wings
clipped. "It has been hard to get doctors to go along because they don't
necessarily believe the risks," says Ware Branch, who heads Intermountain's
39-weeks-gestation program.

Gary Hankins, professor at the University of Texas Medical Branch at
Galveston and chairman of the practice committee of ACOG, says doctors can
cite hospital policies in declining to do preterm elective deliveries, which
are sometimes requested by mothers tired of being pregnant. Elective
inductions are "a real life dilemma" for doctors, he says.

LABOR ISSUES

The top six contributors to obstetrics litigation:

• Failure to recognize fetal distress

• Failure to perform timely Caesarean birth

• Failure to properly resuscitate depressed baby

• Inappropriate use of labor-inducing drugs

• Inappropriate use of vacuum/forceps

• Failure to communicate

Source: Premier Inc. (from industry data)

• Email me at informedpatient@wsj.com1 <informedpatient%40wsj.com1>

URL for this article:
http://online.wsj.com/article/SB115266494103204113.html

#22

From: rzeller143@...
Date: Wed Jul 12, 2006 3:09 pm
Subject: Re: [ICAN-online] Reaction to my article

icanofbuffal...

Offline

Thanks, Tami :)

At this point, I don't care what people say about it so long as they're saying *something*. My skin is pretty thick. Buffalo tends to be a pretty complacent area in a lot of regards - and although our c/s rate is lower then the national and I think state average, and although it even went down from 2003 to 2004, not enough people know, and not enough people are talking about it.

Now, bring up the Buffalo Sabres hockey playoff game of '99 (known despondently around these parts as the "no goal" incident), or the four consecutive Buffalo Bill's SuperBowl losses, and people STILL get riled up...

Case in point, despite a spike in hits on my website in the days immediately after the article ran, only one woman has inquired.

But she said she's read my article over and over again because it helps her know that "the crazy feelings" she's been having are normal in the context of her c/s, which she had a little over a month ago.

I'd love more, but I'm pretty happy that at least one person who needed to hear it got the message...

-Rachel Z

In a message dated 7/12/06 12:40:48 P.M. Eastern Daylight Time, tami.groth@... writes:

Rachel -- thank you for sharing these -- and thank you for opening yourself up to such comments. I can imagine it can be challenging to have such comments coming in as the last one you shared. We do need to have this dialogue going that's for sure. Unfortunately the importance of our experiences and how they effect our children (and therefore so many other things!) are continually underestimated and this woman that commented "do we need a support group for every disappointment" is a perfect example of that. And the round head comment -- blech.

Hugs,

Tami

#21

From: rzeller143@...
Date: Wed Jul 12, 2006 11:18 am
Subject: Reaction to my article

icanofbuffal...

Offline

http://buffalonews.com/opinion/everybodyscolumn1.asp

Some reaction from my article which was printed in the Buffalo News on 6/29 (no longer available online). I thought I should share:

The first one:

Caesarean aftermath can be quite difficult

7/9/06

Just having finished the June 29 My View, "Undergoing a Caesarean can be very emotional" I had to say it gave me a real emotional jab in the heart. I also had two C-sections, I also felt like I wasn't doing "my job" at birthing, especially after hearing some of my friends telling me about their hours of labor before birthing their babies. In my case the C-section was for my health rather than my two children. My blood pressure went sky high and only by the C-section and the help of God did the babies and I come out alive!

Loretta H. Onufer, Orchard Park

The second:

Enjoy babies, regardless of the birthing process

7/9/06

The June 29 My View, "Undergoing a Caesarean can be very emotional" was a little disconcerting to me. I had two C-sections, 29 and 30 years ago. The first was a little surprising, perhaps a little unsettling since my husband had planned to be right next to me coaching, holding hands, breathing, etc. It was not to be. I had an emergency C-section and never felt cheated, or ashamed or defeated. I delivered a beautiful son and 13 months later, via C-section, a wonderful daughter.

Perhaps I was lucky and never got depressed nor felt a lack of bonding, but I really think the authors's view was a tad bit too much about herself. Must we have a support group for every disappointment in our lives? Enjoy your babies, however they come out. And on a very positive note for C-sections, I'll bet the author's baby has a perfectly round head!

Elizabeth Merrick

Hamburg

(Sort of funny, that last one, saying it was too much about myself - that's kind of the point of that column, called "My View" and part of the guidelines for writing it is that it should be based on personal experience! And as for the round head - A) No, she didn't, because there was some vacuum suction used - which I think resulted in the silliest cowlick ever on her head, and B), my VBAC baby is the one who had the round head. Just had to vent that out.)

If you are interested in submitting a response to these (start the dialogue, light the fire!), I have included the guidelines below.

Guidelines for Everybody's Column:
The Buffalo News™ welcomes letters. Write to Everybody's Column, The Buffalo News™, One News Plaza, P.O. Box 100, Buffalo, NY, 14240.
Alternatively, you may fax your letter to 716-856-5150 or you may send an email to LetterToEditor@....
Every single letter which we print in the paper is verified by telephone, so be sure to sign your letter and include your address and a day-time phone number.
Maximum letter length is 200 words.

-Rachel Z
ICAN of Buffalo

#20

From: rzeller143@...
Date: Fri Jun 30, 2006 11:37 pm
Subject: VBAC after 2+ Cesareans

icanofbuffal...

Offline

A fantastic article if you are a woman who has had multiple cesareans but still wish to VBAC!

-Rachel

---

Study backs natural birth after C-section

Posted 6/29/2006 9:28 PM ET

By Rita Rubin, USA TODAY

A study out today could lead to an increase in the number of pregnant women
who try for a vaginal birth after a cesarean section, a type of delivery
called a VBAC.

The study, published in Obstetrics & Gynecology, involved 17,890 women with
a prior C-section who delivered at one of 19 academic U.S. medical centers
from 1999 through 2002.

It found that those who'd had multiple C-sections were no more likely to
have a uterine tear, or rupture, than those who'd had only one C-section.
Ruptures occurred in nine of 975 women with multiple previous C-sections, or
0.9%, and 115 of 16,915 women with just one prior C-section, or 0.7%. Women
with multiple C-sections were more likely to need a blood transfusion or a
hysterectomy if they tried for a VBAC, but their actual risk was just 3.2%
and 0.6% respectively.

"I think most practitioners have with time shied away from offering VBAC to
women with multiple prior cesareans because of a perceived risk of uterine
rupture," says lead author Mark Landon, a professor of obstetrics and
gynecology at The Ohio State University in Columbus. If such women have an
increased risk of rupture, it must be quite small, Landon said.

Gary Hankins, chairman of the American College of Obstetricians and
Gynecologists' obstetrics practice committee, said he expects his group will
now revise its VBAC advice for women who've had multiple C-sections.

In 2004, Hankins' committee said that the only women with multiple
C-sections who are candidates for a VBAC are those with a prior vaginal
delivery. The new study found that having a prior vaginal delivery made no
difference.

VBAC has become one of the most hotly debated topics in obstetrics. In 1999,
the obstetricians and gynecologists group advised that it only be allowed in
hospitals with an "immediately available" surgical team. That guideline
stemmed from concerns about the risk of a potentially catastrophic rupture
in laboring women with a C-section scar on their uterus.

By 2004, the VBAC rate had dropped to 9.2%. Many hospitals and doctors would
not allow any woman to attempt one.

"I think the important message from Landon's paper, and from our work, is
that VBAC in women with multiple prior C-sections is very reasonable," says
George Macones, chairman of the Department of Obstetrics and Gynecology at
Washington University in St. Louis and author of a study last year that
found only a small increased rupture risk in such women.

#19

From: lovejac@...
Date: Fri Jun 30, 2006 8:30 pm
Subject: Re: I've Been Published!

lovejac@...

Yay! Good for you! Great article. Never know what seeds who may have planted!

Quoting ICANofBuffalo@...:

> A recent submission of mine has just been published in the Buffalo� News!
> Check it out at:
> _http://www.buffalonews.com/editorial/20060629/1072668.asp_
> (http://www.buffalonews.com/editorial/20060629/1072668.asp)
>
> -Rachel
>
>

#18

From: rzeller143@...
Date: Fri Jun 30, 2006 2:23 pm
Subject: Meeting Reminder!

icanofbuffal...

Offline

Just a quick note - our next meeting will be held on Thursday, July 6, 6pm at HomeGrown Baby (3113 Delaware Ave. in Kenmore). Hope to see you there!

-Rachel

Reply | Forward | Messages in this Topic (6)

#17

From: rzeller143@...
Date: Fri Jun 30, 2006 2:22 pm
Subject: Epidural Article

icanofbuffal...

Offline

Excerpt from: "The Labor Dispute: Epidural or Natural Childbirth?" - by Daphne R. Howland ... interesting to read

http://www.beliefnet.com/healthandhealing/getcontent.aspx?cid=14686&WT.mc_id=NL44

The Case Against Epidurals

Epidurals aren't without their own consequences and controversies. In rare cases, complications occur due to incorrect administration of the drug. Also rare are side effects like serious headache or drop in blood pressure. As with any form of medication, there is the risk of an allergic reaction to the medication.

Studies have shown that the use of epidurals may lead to longer labor, fever in the mother, or an increased use of forceps to assist with delivery. Researchers are also grappling with whether epidural use leads to increased rate of Cesarean section. One recent meta-study concluded there is no connection. But a critique of that analysis by Ellice Lieberman, MD, DrPH, a scientist at Brigham and Women's Hospital in Boston, says that it's too close to call.

"I think there is conflicting data out there. My feeling is we don't have the answer to the C-section question," Lieberman says.

-Rachel Z

#16

From: "Cindy Whittaker" <cindy@...>
Date: Thu Jun 29, 2006 3:48 pm
Subject: RE: I've Been Published!

cindy@...

www.gentlebirthdoulaservices.com

Nice JOB Rachael. I will also need to get with you I have a check for you.

Cindy Whittaker

Gentle Birth Doula Services

www.freewebs.com/pregnancyexpo

-----Original Message-----
From: icanofbuffalo@yahoogroups.com [mailto:icanofbuffalo@yahoogroups.com] On Behalf Of ICANofBuffalo@...
Sent: Friday, June 30, 2006 9:27 AM
To: icanofbuffalo@yahoogroups.com
Subject: [icanofbuffalo] I've Been Published!

A recent submission of mine has just been published in the Buffalo News! Check it out at:

http://www.buffalonews.com/editorial/20060629/1072668.asp

-Rachel

#15

From: ICANofBuffalo@...
Date: Fri Jun 30, 2006 9:27 am
Subject: I've Been Published!

icanofbuffal...

Offline

http://www.buffalonews.com/editorial/20060629/1072668.asp

A recent submission of mine has just been published in the Buffalo News! Check it out at:

-Rachel

#14

From: rzeller143@...
Date: Sun Jun 25, 2006 3:46 pm
Subject: More Evidence that VBAC is Still Safer...

icanofbuffal...

Offline

www.medscape.com

To Print: Click your browser's PRINT button.

NOTE: To view the article with Web enhancements, go to:
http://www.medscape.com/viewarticle/533539

Repeat C-Sections Raise Risk of Maternal Morbidity

Reuters Health Information 2006. � 2006 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

NEW YORK (Reuters Health) May 31 - As the number of repeat c-sections increases, so does the risk of bowel injury, ICU admission, and other maternal complications, according to a report in the June issue of Obstetrics and Gynecology.

In light of this finding, "the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery," lead author Dr. Robert M. Silver, from the University of Utah School of Medicine in Salt Lake City, and colleagues note.

The findings are based on analysis of data for 30,132 women who underwent c-section without labor in 19 academic centers from 1999 to 2002. "There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries," the investigators report.

The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, ileus, postoperative ventilatory use, ICU admission, and blood transfusion of at least 4 units were directly related to the number of cesarean deliveries. In addition, both the operative time and hospital stay rose as the number of c-sections increased.

The rate of placenta accreta ranged from 0.24% in first-time c-section patients to 6.74% in women with six or more c-sections. In women with previa, the rates were much higher, ranging from 3% in first-time c-section patients to 67% in women with at least five c-sections.

The hysterectomy rate was lowest in second-time c-section patients and highest in those with at least six c-sections, ranging from 0.42% to 8.99%.

"Women planning large families should consider the risks of repeat cesarean deliveries when contemplating elective cesarean delivery or attempted vaginal birth after cesarean delivery," the authors conclude.

Obstet Gynecol 2006.

#13

From: rzeller143@...
Date: Fri Jun 23, 2006 1:37 pm
Subject: "Birth" the Play is Coming to Rochester!

icanofbuffal...

Offline

X-Post: This just in from the ICAN of Rochester yahoogroup! ...

-Rachel

---

The Doula Cooperative and Birth Matters! is elated to announce that BOLD is coming to Rochester.

What is BOLD? It's Birth On Labor Day--a presentation (dramatic reading) of the play "Birth". To get a sneak preview go to http://www.birththeplay.com/home.html. Performances are scheduled for Friday evening, Saturday matinee, and evening, September 1 and 2, 2006. Mark your calendars now to SAVE THE DATE!

Interested in being involved in this event? We invite all you movers and shakers in the Rochester and nearby birth communities to get involved...either by attending this fund-raising event (to benefit The Doula Cooperative), or by helping out with the many event needs (like actresses, publicity & promotion, help onsite at the play, etc.) Contact Pat Predmore at Birthmatters1@... or 585/223-6272, ASAP. Time is short.

Please pass this email on to anyone who is interested!

Pat

Patricia Predmore
Birth Matters!
Fairport, NY
585-223-6272

#12

From: rzeller143@...
Date: Thu Jun 22, 2006 1:04 pm
Subject: The Midwife: A Steadily Growing and Natural Childbirth Option

icanofbuffal...

Offline

http://www.mercola.com/display/router.aspx?docid=33236

From:

The Midwife: A Steadily Growing and Natural Childbirth Option

Since 1990, the number of women giving birth with a midwife has doubled, signaling a growing trend among women who seek a more natural -- as opposed to medical -- childbirth.

While only 4 percent of women gave birth with a midwife in 1990, 8 percent of women chose a midwife in 2003, according to the National Center for Health Statistics.

Pregnancy and birth are expensive when it comes to medical care, so insurance coverage plays a major role in the decision for a lot of families. Many insurance companies do cover the use of a midwife, as long as she is licensed and working in a hospital or birthing center. Coverage for midwives who are not certified, or who work outside of a hospital setting, is less widespread and varies by state and health plan.

However, the major reason why most families chose a midwife was to experience a more natural birth. Contrary to traditional hospital births, midwives generally encourage using drug-free, natural methods of childbirth.

Those who have used a midwife describe the experience as soothing and private, and say having the freedom to go through labor and give birth in a way that feels comfortable to them, such as in a bathtub, was empowering.

Yahoo News May 30, 2006

Dr. Mercola's Comment:

The United States and Canada are the only countries in the world where highly trained surgeons called obstetricians attend the majority of normal births.

Cesarean section can save the life of the mother or her baby. Cesarean section can also kill a mother or her baby. How can this be? Because every single procedure or technology used during pregnancy and birth carries risks, both for mother and baby. The decision to use technology is a judgment call -- it may either make things better or worse.

Merely putting yourself in the hands of a high-tech doctor and a high-tech hospital does not guarantee you the safest birth. You yourself must take responsibility for your own child's birth, including the decision to have technology used on you and your baby.

There is not a single report in the scientific literature that shows obstetricians to be safer than midwives for low risk or normal pregnancy and birth. So if you are among the over 75 percent of all women with a normal pregnancy, the safest birth attendant for you is not a doctor but a midwife.

Doulas Can Improve the Health of Both Mother and Newborn

What is a Postpartum Doula and What Does She Do

Natural Birthing Options: Technology in Birth -- First Do No Harm

#11

From: icanofbuffalo@yahoogroups.com
Date: Thu Jun 22, 2006 2:50 pm
Subject: New poll for icanofbuffalo

icanofbuffalo@yahoogroups.com

Enter your vote today!  A new poll has been created for the
icanofbuffalo group:

When can you come to ICAN of Buffalo meetings?

   o Thursdays, 6pm (current time)
   o Monday
   o Tuesday
   o Wednesday
   o Friday
   o Saturday
   o Sunday
   o Daytime
   o Evening
   o I do not wish to attend ICAN of Buffalo meetings.
   o Unable to attend at any time, but wish to be involved.


To vote, please visit the following web page:
http://groups.yahoo.com/group/icanofbuffalo/surveys?id=12363830

Note: Please do not reply to this message. Poll votes are
not collected via email. To vote, you must go to the Yahoo! Groups
web site listed above.

Thanks!

#10

From: ICANofBuffalo@...
Date: Tue Jun 20, 2006 4:48 pm
Subject: Article from bizjournals.com: Low infection rate for 4 area hospitals

icanofbuffal...

Offline

» Calspan launches new company

Hello from bizjournals.com! Rachel Zeller (icanofbuffalo@...) thought you might like the following article from Business First of Buffalo:

The sender's comment about the article:

Interesting article - note that none of the four Erie County hospitals that offer childbirth services are included on this list - not great news for women who plan on having a hospital birth.

Low infection rate for 4 area hospitals

Published: June 18, 2006

Western New York hospitals have among the lowest incidence of infections from medical care across the state, according to the fourth annual New York State Hospital Report Card.

To continue reading, go to: http://buffalo.bizjournals.com/buffalo/stories/2006/06/12/daily46.html?surround=etf

More news on Moog Inc.

» Moog flight simulator receives top-level status

» Moog, CAE extend delivery pact

Free Events Week

HomeGrown Baby, WNY’s premier holistic mother/baby store is hosting a Grand Opening Celebration Week, with free events everyday June 13^th through the 17^th. Located at 3111 Delaware Ave in Kenmore, HomeGrown Baby offers products, education and services to promote natural family living. Please call 353-3159 or visit our website at www.BuffaloBirth.com for more information.

Tues, June 13^th: Free Sibling Preparation Class ~ this fun class helps siblings of all ages understand what new babies need and the changes that will take place after the new addition. Story time, snack, craft included, and even a gentle birth video at parent’s discretion. 11am to noon. Call to register.

Wed, June 14^th: Free Foot Massage for Pregnant Women ~ Pregnant ladies, bring your aching feet and enjoy a therapeutic massage by licensed massage therapist Shrell Krawczyk. The benefits of massage in pregnancy are numerous; relieve a little stress while your other children play in our kid’s zone. Open 11am to 2pm, no registration required.

Thurs, June 15^th: 11am, Fear Release Session to Prepare for Birth with Hypnobirthing Instructor and Counselor, Sundari Salman, LCSW. Pregnant women are invited to a relaxing session to recognize and work through tension and fears to become more open to the birthing process. We request no small children due to the nature of the session. Free, Call to register.

6pm, Born in the USA video screening, Free! Expectant couples or anyone interested in birth alternatives are invited to view this award winning documentary on what is happening with birth in the United States ~ eye opening and a must-see for anyone going through the birth process in our modern day society. No registration required.

Fri, June 16^th: Free Henna Belly Tattooing, Henna art is a temporary tattoo made from plant source, and is a beautiful way to celebrate your growing belly. 100% natural, lasts for 3-4 weeks. Come between 1pm and 4pm for your free, custom belly art. No registration required.

Sat, June 17^th: Blessingway for all! Pregnant women are invited to participate in a ceremony to bless their journey into birth and new motherhood. Share your dreams for birth, connect to other pregnant women and receive blessings to inspire you in this most sacred of times. Receive a gift to remind you of this connection during your labor. Free! 10 – 11am. Call to register.

Women who sign up for gift registry at HomeGrown Baby in the month of June receive free Natural Childbirth Classes, $150 value!

From: icanofbuffalo@yahoogroups.com
Date: Wed Feb 22, 2006 9:20 am
Subject: Poll results for icanofbuffalo

icanofbuffalo@yahoogroups.com

The following icanofbuffalo poll is now closed.  Here are the
final results:


POLL QUESTION: What is the best time for you to come to ICAN meetings?

CHOICES AND RESULTS
- Daytime, 0 votes, 0.00%
- Evening, 0 votes, 0.00%
- Tuesday, 0 votes, 0.00%
- Thursday, 0 votes, 0.00%
- Saturday, 0 votes, 0.00%



For more information about this group, please visit
http://groups.yahoo.com/group/icanofbuffalo

For help with Yahoo! Groups, please visit
http://help.yahoo.com/help/us/groups/

From: icanofbuffalo@yahoogroups.com
Date: Tue Feb 7, 2006 5:30 pm
Subject: New poll for icanofbuffalo

icanofbuffalo@yahoogroups.com

Enter your vote today!  A new poll has been created for the
icanofbuffalo group:

What is the best time for you to come to ICAN meetings?

   o Daytime
   o Evening
   o Tuesday
   o Thursday
   o Saturday


To vote, please visit the following web page:
http://groups.yahoo.com/group/icanofbuffalo/surveys?id=12253919

Note: Please do not reply to this message. Poll votes are
not collected via email. To vote, you must go to the Yahoo! Groups
web site listed above.

Thanks!