my hospital says that they will do a vbac but they aren’t set up for it because the labor side is far away from the c-section side so if i try to do a vbac and end up having a c section it will take a lot longer to get me to surgery. do you think this is a legitimate reason to consider not having a vbac? im too close to my due date ( 7 days left ) to change hospitals or doctors although i am beginning to wish i would have. ..
-NERVOUS in hagerstown maryland

Hi Virginia,

The short answer is: No, that is not a legitimate reason to deny you a VBAC.

The reality is, you are less likely to experience an uterine rupture than a complication that has absolutely nothing to do with your prior uterine surgery.  (Please read Scare tactics vs. informed consent and scroll down to the chart entitled “Risks far outweigh VBAC” to see for yourself.)

Since obstetrical complications arise during labor in women with no history of uterine surgery that require immediate surgical delivery, how can a hospital claim that they are fit to attend those births, but not yours?

Any birth (VBAC or not) could end in a medically necessary cesarean and any hospital (urban or rural) set up for birth should have a plan detailing how they will respond to those inevitabilities.

I have also often wondered how often women with true obstetrical complications requiring immediate cesareans or even car accident victims requiring surgery, have been unable to receive that care due to otherwise healthy moms and healthy babies undergoing  scheduled elective repeat cesareans occupying the operating rooms?  With over 90% of women having repeat cesareans, I’m sure it’s happened, especially in smaller hospitals (Martin, 2006).

The ability of rural hospitals to safely attend VBACs was extensively discussed at the March 2010 NIH VBAC conference.  One doctor spoke during the public comment period and stated that her rural hospital had a VBAC rate of over 30%!  It turns out, if a hospital is supportive of VBAC and motivated, they can absolutely offer VBAC safely.  (I also welcome you to read the commentary of two obstetricians and one certified nurse midwife who argued against the VBAC ban instated at their local rural hospital.)

As David J. Birnbach, M.D., M.P.H (2010), who presented on the impact of anesthesiologists on the incidence of VBAC asserted:

Lack of immediate available of anesthesia may not always be a key factor in outcome [during a uterine rupture], especially in cases where the obstetrician is not present. Many cases of uterine rupture can be stabilized while the anesthesiologists becomes available, and examples have been suggested of ways to reduce the risk associated with such a crisis. These include antepartum [prenatal] consultation of VBAC patients with the anesthesia departments, development of cesarean delivery under local anesthesia protocols, finding methods of improving communication on labor and delivery suites, practice “fire-drills,” and development of protocols matching resources to risk.

I highly recommend you read the Final Statement produced by the conference as it was the catalyst for the subsequent revision of ACOG’s (2010) VBAC guidelines in the Practice Bulletin No. 115 where they affirmed:

Women and their physicians may still make a plan for a TOLAC in situations where there may not be “immediately available” staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk.

This is a huge change.

The term “immediately available,” first introduced in the 1999 Practice Bulletin No. 5 and then reiterated in the 2004 Practice Bulletin No. 45, was the reason why many hospitals ultimately banned VBAC.  Hopefully the removal of that recommendation in this new Practice Bulletin will result in the reversal of VBAC bans and an overall greater support for VBA1C and VBA2C.  ACOG acknowledged that their prior recommendation was resulting in way to many cesareans and the increasing risks that multiple cesareans bring are significant and unacceptable.  (Please read the risks of multiple cesareans detailed by Silver 2006 in Another VBAC Consult Misinforms.)

The removal of the “immediately available” recommendation is supported by the NIH (2010) Final Statement which found it, if implemented in all hospitals, to be an impossible standard that could result in the closing of many Labor & Delivery units:

Would provision of an anesthesiologist standing by waiting for an emergency at every hospital that practices obstetric care increase patient safety?  In truth, that person would need to be doing nothing else clinically, so even being in the hospital might not qualify for “immediately available.”  Looking at the numbers of anesthesia staff currently available, the minimum requirement to provide immediate anesthesia [per the recommendation of the American Congress of Obstetricians and Gynecologist] care for all deliveries would be to have all deliveries accomplished at facilities with greater than 1,500 deliveries annually.  This would require that approximately three-quarters of all obstetric programs nationwide be closed (Birnbach, 2010).

I am excited and hopeful to see the ripple effects of this new Practice Bulletin especially for women in rural areas.  Hopefully the option of VBAC will become a reality for more women.

______________________________________________

American College of Obstetricians and Gynecologists. (2010, July 21). Ob-Gyns Issue Less Restrictive VBAC Guidelines. Retrieved July 21, 2010, from ACOG: http://www.acog.org/from_home/publications/press_releases/nr07-21-10-1.cfm

Kamel, J. (2010, July 21). ACOG issues less restrictive VBAC guidelines. Retrieved from VBAC Facts: http://vbacfacts.com/2010/07/21/acog-issues-less-restrictive-vbac-guidelines/

Birnbach, D. J. (2010). Impact of anesthesiologists on the incidence of vaginal birth after cesarean in the United States: Role of anesthesia availability, productivity, guidelines, and patient saftey. Vaginal birth after cesarean: New Insights. Programs and Abstracts (pp. 85-87). Bethesda: National Institutes of Health.

Martin, J. A., Hamilton, B. E., Sutton, P. D., Ventura, S. J., Menacker, F., & Kirmeyer, S. (2006). Births: Final Data for 2004. National Vital Statistics Reports , 55 (1), 1-102.

National Institutes of Health. (2010, June). Final Statement. Retrieved from NIH Consensus Development Conference on Vaginal Birth After Cesarean: New Insights: http://consensus.nih.gov/2010/vbacstatement.htm

National Institutes of Health. (2010, March 8-10). NIH VBAC Conference: Program & Abstracts. Retrieved from NIH Consensus Development Program: http://consensus.nih.gov/2010/vbacabstracts.htm

Dr. Biter has resigned

I spoke to Dr. Biter. He could not discuss the details of his resignation from Scripps Encinitas Hospital but I’m certain it’s more complex than we know. Anytime a person takes on the system, it’s never cut & dry nor is it ever a fair fight. I know Dr. Biter has always put his patients 1st & is putting together a plan to continue to ensure the safe care of his patients during this transitional time.

5/21/10 4:11pm – Very exciting news per BringBiterBack.com!  While I’m saddened I didn’t get to attend any of the protests, I’m pleased with the outcome!

Friday, May 21, 2010

RALLY CANCELLED!!!

After over 1600 signatures to a petition, days of crowds supporting Dr. Biter, cars and trucks painted with slogans such as “We love Dr. Biter” and “Bring Biter Back,” we are pleased to confirm that an email was sent by the administration at the hospital that obstetric privileges were reinstated yesterday for the popular doctor. His gynecologic privileges were never suspended and also remain in place. While we are all excited to celebrate the reinstatement of Dr. Biter’s OB privileges at Scripps Encinitas, he has contacted one of his biggest supporters to request that no public rallies take place today at the hospital. He has also chosen to not make a public statement at this time.

While the overwhelming amount of support for Dr. Biter and his approach to natural child birth has not gone unnoticed, the organizing members of BringBiterBack.com request that any celebrations take place in the privacy of our own homes with our families and babies.

Thanks for your understanding!

• a list of 4 doctors who “are responsible for suspending Dr. Biter”
• how one of these doctors, as well as the head of OB at Scripps, will benefit financially from Dr. Biter’s suspension
• a summary of a meeting between 5 pregnant moms, 2 husbands,  Carol Yeh-Garner, the Scripps Chief of Staff Dr. MacCormick, the  COO, the Chief Executive RN & a HR representative.

So, a little more information has come to light.

There were 2 emergency staff meetings called earlier in the day at Scripps Encinitas. Usually these meetings are held when there is a big case of something going wrong–like a wrongful death. The meetings were held to discuss “the recent events concerning a staff member”. From what I’ve heard from staff that were present at the meetings, nothing was discussed other than the issue is a confidential matter.

It came to my attention late last night from someone that there are 4 doctors that are on a medical board of the hospital that are responsible for suspending Dr. Biter. They are:

Dr. Ronald MacCormick, Chief of Staff
354 Santa Fe Dr. Encinitas, CA 92024
760-633-6807 fax 760-633-6807

Dr. James La Belle, Internal Medicine
354 Santa Fe Dr, Encinitas, CA 92024
760-633-7686

Dr. Thomas Chippendale, Neurology
320 Santa Fe Dr Ste 101 Encinitas, CA 92024
760-942-1390

Dr. Michael Lobatz, Neurology
320 Santa Fe Dr. Ste 108 Encinitas, CA 92024
760-942-1390

Please send letters to these people since they are the ones that have decided to suspend Dr. Biter. With this public outcry, they need to reinstate him immediately. They need to know that it’s not their call, that it’s our call & we are demanding to have Dr. Biter & that they can’t bully him or us. This bullying won’t be tolerated. Thank you for all of the letters you are writing! My email box has been inundated with letters. If you sent me a letter & asked me a question or wrote me something, I want you to know that I haven’t even opened them yet. I’ve been so busy. So if you have an important question or issue, please email me & let me know. Thanks for understanding.

It is also interesting that Dr. MacCormick (& Dr. Fenton–Head of OB) will make money off of Dr. Biter’s suspension IF moms in labor come into Scripps Encinitas & use the hospitalists (on-call OBs) because guess who owns the hospitalist company? Dr. MacCormick! Isn’t that a conflict of interest?

A group of 5 pregnant moms, 2 husbands & I went at 3 pm yesterday (Wed) to Scripps Encinitas to request a meeting with Dr. MacCormick, Chief of Staff. We were surprised that he came back on campus to meet with us along with the COO, the Chief Executive RN & someone from HR. The statement they made is that the issue is confidential & they are not at liberty to share any information. They are sympathetic to the situation & understand that it is a stressful situation for the pregnant couples, but there is nothing that they can share. Dr. MacCormick stated that the hospital has made provisions for their OB hospitalists (on call OBs) to care for the pregnant moms when they go into labor & that he fully trusts in their ability to support their birth plans. One of the moms took the lead & stated that we were there to get answers but understood that it was a legal issue & that we might not get answers. She said that we also just wanted to be heard & have our opinions shared with them. She stated that we all know that Dr. Biter was delivering babies as of Thursday & delivered a baby on Friday that had meconium aspiration that was discovered at the time of birth. She stated that the baby is doing fine & that meconium aspiration is something that is fairly common. So, why was it that he was delivering babies Thursday & Friday but them as of Friday afternoon, was deemed to be too dangerous to deliver any more babies? They couldn’t comment on that because it is a confidential issue. Several of the moms spoke & some cried about how emotionally stressful this situation has been on them & they have developed strong ties to Dr. Biter & can’t & won’t consider birthing with anyone else. A dad shared that they’ve been building a relationship with Dr. Biter the past 31 weeks & they trust him & know that he will honor their wishes for a natural birth for their birth. He said that it’s their 1st birth & they really want it to be a wonderful experience. He said that he knows that Dr. Biter will provide that for them and that they will be loyal to him wherever he goes. One of the moms shared that they recently moved to San Diego. They are in the military & chose to go outside of the military hospital to birth their 2nd child because they had a negative birth experience the 1st time. She researched & learned that Scripps Encinitas was supposed to be the most natural-birth supportive hospital in town. She called the Labor & Delivery dept to get a recommendation for a great OB & the nurse said that she’d have to give 3 referrals but that Dr. Biter got a “gold star”. This mom said that she specifically chose their hospital & this doctor because she wants a better birth. She said that she is committed to having Dr. Biter be at her birth & that she was really unhappy with the decision to suspend him. I shared that I’m a childbirth educator & have had over 350 couples come through my classes. I’ve always referred my clients to Scripps Encinitas because they promote themselves to be the most natural-birth supportive & because they are a mother-baby friendly hospital. I asked them how they could be either of those if they continue getting rid of natural birth supportive care providers like the midwives & Dr. Biter, who is the MOST natural-birth supportive OB in town. They were defensive about the midwives & wanted to clarify that they didn’t make the midwife group leave, but that the midwife group left on their own accord. I stated that they technically may have left, but it was only because the environment was hostile & that we all really knew what happened. I suggested to them that they rethink their decision to suspend Dr. Biter because in doing so, they’ve now tainted their reputation as a natural-birth supportive & mother-baby friendly hospital. In suspending him, they’ve also put themselves in a poor financial situation because almost all of his patients will follow him or choose other hospitals. I shared with them that I was aware of 5 moms that were due & chose to have homebirths with midwives & that NO ONE has chosen to birth in Scripps Encinitas with the on-call doctors since the suspension occurred. The COO & the Chief Exec. RN were defensive again saying that I shouldn’t make blanket statements that include their nurses because their nurses are mother-baby friendly & natural-birth supportive. Dr. MacCormick also stated that there are other OBs on staff who support natural birth & will respect a woman’s birth plan. I then stated that I used to refer clients to several other doctors who say they support natural birth only to find that my couples consistently would report back to me that they were pressured & didn’t have the birth experience they wanted. Yet, every client that went to Dr. Biter for their birth had only positive things to say about their birth experiences. So, they may say they have other doctors, but as they can see, the group of people before them would NOT be coming to their hospital unless Dr. Biter was present. A dad, who is also a doctor, ended the meeting by saying that this small group represents the larger group of Dr. Biter patients & that most if not all of Dr. Biter’s patients would not be coming to the hospital to birth their babies. The dad requested that they reinstate Dr. Biter immediately so the women in the room could birth where they wanted to & with the OB they desired & developed a relationship with. The dad requested that the decision be made as soon as possible & that if they weren’t going to reinstate him, that that decision be made as soon as possible as well. We thanked them all for their time & they did the same. They repeated that they are sympathetic to the situation & that they heard our requests.

Here’s the latest information we have about the rally:

We are expecting over 500 people to come to the rally [Friday, May 14th, 2010]. Please do NOT park on Scripps property. There is a parking lot across the street & residential parking west of the hospital.

If you’d like to order a t-shirt that says Bring Dr. Biter Back!, please contact Deanna at opporders@gmail.com for details.

Here are the new recommendations for signs:
STOP BULLYING BITER!
Bring Dr. Biter Back!
Bring Biter Back!
Dr. Biter IS Mother-Baby Friendly!
www.BRINGBITERBACK.com
Dr. Biter is THE VBAC doc!
Dr. Biter has the lowest C-section rate!
RNs (heart) Dr. Biter
Biter is the only OB that teaches surgery in San Diego!
Best DOCTOR 2 years in a row!
Reinstate Dr. Biter NOW!
My baby needs Dr. Biter!
My birth needs Dr. Biter!
Dr. Biter respects women’s rights!

We want this rally to be positive but we also want to make our point. Please keep your signs focused on what we want–Dr. Biter to be reinstated immediately–and what we love about Dr. Biter.

Feel free to contact the news–TV, radio, online, & print–to encourage them to cover this story & our rally. John Gardner’s sentencing is scheduled to happen at 1:30 pm so they will be covering that, but we’ll be rallying until 3:30 pm, so they can still come cover our rally. If they need a contact person, you can refer them to me: Carol Yeh-Garner 858-837-1259 or to Sheri Menelli: 760-522-2829.

On behalf of all of the people working behind the scenes to make this rally happen & to help get Dr. Biter reinstated, we THANK YOU for your support!

If you are not familiar with Dr. Biter, aka Dr. Wonderful per the Navelgazing Midwife, and the unique obstetrical care he offers, please read the article Rally for Dr. Wonderful on Mother’s Day from the Dou-la-la blog.  It chronicles a birth (home birth transfer) he attended, features amazingly touching photographs, and provides a summary of the first protest dated Sunday, May 10th.  This is how hospital birth should be and it’s a damn shame that the women of San Diego are losing access to this incredible OB.

Want to express your displeasure of the hospital’s actions?  Here is a list of ideas:

• Write a letter to the chief of staff.
• Contact your local representative.
• Write letters to the editor to the local news media & newspapers.
• Write supportive statements on your car windows with window paint.
• Go show your support at a daily vigil in front of Scripps Encinitas hospital.
• Come to the Bring Dr. Biter Back Rally this Friday, May 14th from 1:30-3:30 pm in front of Scripps Encinitas hospital.
• Sign the online petition to help reinstate him immediately.

As Carol says, “Time is of the essence. He must get reinstated within the next 9 days or his case will go in front of the Medical Board, therefore, delaying any chance of him getting reinstated in the near future.”

Please see the email below for more information on each of these action items.

Stay in touch via the Bring Biter Back blog or the I love Dr. Biter Facebook fan page.

____________________________________________________

Hi everyone- Please share this information with your clients, your friends, your family & anyone else that knows Dr. Biter. This is an important issue regarding women’s rights–the right to choose WHO to birth with & the right to choose WHERE to birth! If Scripps Encinitas doesn’t reinstate him immediately, hundreds of women will be left without a care provider that truly understands the normalcy of birth. Thanks–Carol Yeh-Garner

Dr. Robert Biter is a unique physician in the San Diego community. He embraces the concept of a woman’s right to choose a natural birth. He literally embodies the entire gamut of birthing options that an informed health care provider can offer to a woman and her family in a society that increasingly demands baby-friendly and healthy/organic birthing solutions. In supporting his patients’ natural birthing decisions, he also offers the best possible medical and surgical expertise should emergency medical intervention become necessary in the birth process. The patients choose their births, Dr. Biter makes those choices possible as long as the choices are safe, and the patients love him. They call him Dr. Wonderful.

Dr. Biter has held staff privileges at Scripps Memorial Hospital Encinitas in Encinitas, California for the last 8 years. During his time at Scripps, he has held the title of Department Chair of Obstetrics and Gynecology, as well as having headed up the hospital’s ethics committee. He has won Best Doctor in San Diego two years in a row by Ranch and Coast Magazine.

With no warning on Friday May 7, 2010, Scripps Memorial Hospital Encinitas suspended Dr. Biter’s obstetrical privileges effective immediately.

Scripps decision to suspend Dr. Biter’s privileges has left both Dr. Biter and Dr. Biter’s expecting patients reeling and confused. At the most critical time in their pregnancy, Scripps has made it impossible for these women to have the doctor of their choosing deliver their babies; and the likelihood of finding another physician who understands and supports natural birthing is slim to none. The majority of these women would follow Dr. Biter wherever he practices; but for him to establish staff privileges elsewhere is a time intensive endeavor. To make Scripps’ actions even more unclear, there have been no claims of obstetrical malpractice filed against Dr. Biter…EVER.

On Mother’s Day, May 9, 2010, the local community rallied around Dr. Biter and the message that families want the option to choose natural births in a hospital setting. The result was a Mother’s Day rally in support of Dr. Biter held with less than 24-hours notice at Scripps Memorial Hospital Encinitas in Encinitas, California. Approximately 150 people attended.

Scripps Encinitas Hospital has consistently touted themselves as a very holistic, mother-baby friendly hospital. How can they be so mother-baby friendly if they have suspended THE most mother-baby friendly obstetrician in town?

We know that the last couple whose birth he attended had no unforeseen complications that would indicate a need for suspension. The baby had meconium aspiration, which was found only at the time of the c-section. Mother & baby are doing fine. The baby is in the NICU but is breathing & eating on her own. The parents are thrilled with the way that Dr. Biter assisted them during the birth of their daughter & in no way made any complaints against him to bring about the suspension. The father attended the Mother’s Day rally even though he had a newborn in the NICU. His wife recuperated in her hospital room while holding a sign that read, “We support Dr. Biter”.

Dr. Biter needs to be reinstated immediately so that he can provide continuity of care to his patients that are expected to go into labor at any moment. He is such a dedicated person that he has come up with a backup plan of being an unpaid doula to all his patients that are in labor at Sharp Mary Birch Hospital. Anyone who wants to labor at Scripps Encinitas can change doctors or show up & birth with whoever is on call at the moment, but we believe that most, if not all, his patients will want to stay with him to continue to receive the wonderful care he has provided to them.

Here are the latest things you can do to help:

Please send all letters demanding Dr. Biter’s reinstatement to:
Dr. Ronald MacCormick, Chief of Staff
Scripps Encinitas Hospital
354 Santa Fe Dr
Encinitas, CA 92024
His phone number is 760-633-7686. Ask to leave a voicemail for Dr. MacCormick.
Please CC Chris Van Gorder, CEO at: 4275 Campus Point Ct, San Diego, CA 92121.

Please contact your local & state politicians to bring light to this situation:
Assemblyman, Martin Garrick
Assemblyman, Nathan Fletcher
Susan Davis
Francine Busby
Barbara Boxer
Diane Feinstein

Write letters to the editor to the local news media & newspapers highlighting Dr. Biter’s suspension & the travesty of it. Call them to alert them of the upcoming rally this Friday (details below).

Write on your car windows with window paint:
Bring Dr. Biter Back!
The more people that know about this issue, the better! Sheri Menelli will have window crayons at the morning daily vigils in front of Scripps from 9-11 am so stop by & get your windows decorated.

Go show your support at a daily vigil in front of Scripps Encinitas hospital every day until he is reinstated. The vigils will be held from 9-11 am everyday until he is reinstated.

Come to the Bring Dr. Biter Back Rally this Friday, May 14th from 1:30-3:30 pm in front of Scripps Encinitas hospital. We need a lot of people so bring friends, family & neighbors. Kids & babies welcome! Wear green in significance of peace, nature & eco-consciousness, which are all thing Dr. Biter supports. RSVP at the I love Dr. Biter fan page EVENT page. Ricki Lake, author, actress & filmmaker will be there along with Anna Getty, author, actress, great-granddaughter of John Paul Getty III and creator or Pregnancy Awareness Month. There may be other celebrity supporters there as well.

SIGNS for the vigil & rally should read:
BRING DR BITER BACK!
BRING BITER BACK!
HOW IS THIS MOTHER-BABY FRIENDLY?
THIS IS NOT MOTHER-BABY FRIENDLY!
HEY CHIEF OF STAFF! BRING BITER BACK!
SHAME ON SCRIPPS!

Please sign the online petition at: http://www.facebook.com/l/bf255;www.ipetitions.com/petition/bringbiterback/ to help reinstate him immediately.

We have a blog (http://www.facebook.com/l/bf255;www.bringbiterback.blogspot.com) or the I love Dr. Biter Facebook fan page that will keep you updated with the latest information.

Time is of the essence. He must get reinstated within the next 9 days or his case will go in front of the Medical Board, therefore, delaying any chance of him getting reinstated in the near future.

Thank you again for your help & support!

Live, Love, Laugh…Often~
Carol Yeh-Garner, LCSW, HBCE
858-837-1259
http://www.facebook.com/l/bf255;www.AWellLivedLife.Net
read my http://www.facebook.com/l/bf255;blog~AWellLivedLife.blogspot.com

We are concerned about the barriers that women face in accessing clinicians and facilities that are able and willing to offer TOL [trial of labor after cesarean]. . . We are concerned that medico-legal considerations add to, as well as exacerbate, these barriers.

Many women assume that their local hospital has banned VBAC, or their OB doesn’t attend them, because VBAC is excessively dangerous.  Most women are unaware of the many non-medical factors that play into VBAC accessibility.

What disappointed me, however, was the panel’s surprise at the misinformation and bait & switch tactics to which many women are subjected.  I think when you are a VBAC supportive practitioner, it may be hard to believe that your colleagues practice in a manner like I describe below.

To give you an idea of the kind of advice that many, many moms seeking VBAC receive, here are excerpts of an email from Brooke Addley of northeastern Pennsylvania.  She decided to ask her OB about VBAC at her annual exam on March 11, 2010.  This is what happened:

Once I brought the subject up stating that I really would not be open to a c-section unless it was medically necessary he said “they are all medically necessary” and then went on to mention that just within this last month there were two major ruptures at the local hospital.  From there he just talked about the risk of VBAC and how catastrophic it could be if there was a rupture.

A uterine rupture can be catastrophic, but it is rare and the incidence of uterine rupture is comparable to other obstetrical emergencies such as placental abruption which has a worldwide rate of 1%.  As Mona Lydon-Rochelle MD said at the NIH VBAC conference, “There is a major misperception that TOLAC [trial of labor after cesarean] is extremely risky” and George Macones MD who stated in terms of VBAC, “Your risk is really, really quite low.”  Additionally, the risk of infant death during a VBAC attempt is “similar to the risk” of infant death during the labor of a first time mom (Smith, 2002).

One of the factors discussed at the NIH VBAC conference is that a practitioner is less likely to offer VBAC if they have experienced a uterine rupture, particularly if there is a bad outcome.  However, that ethically should not interfere with him providing his client with accurate information on the rate of uterine rupture as well as studies that substantiate the rate provided.

When I cited the low rate of uterine rupture [of 0.5% - 2% after one prior low transverse cesarean] he said “that information is incorrect and the rate is actually higher.”  Yet when I asked him to lead me in the direction of the study or studies where he found that out he said there isn’t any because many women have repeat [cesareans] and once in the OR it is discovered that they have a thin window in their uterus and if they labored/pushed it would have ruptured for sure.

The rate of rupture in a spontaneous labor after one prior low transverse incision is 0.4% (Landon, 2004). So not only did he give her an inaccurate picture about the rate of rupture, but he led her to believe that there are no studies on VBAC.  (I always wonder in situations like these: Is the OB really actively trying to mislead the patient or is he really so misinformed?)  This OB should read the NIH VBAC conference Program & Abstracts, or my VBAC Class bibliography, to see that in fact there are many studies on VBAC.

Then the OB gives her inaccurate information on VBAC success rates:

I asked the VBAC success rate and he said that most fail.

VBACs have a success rate of about 75% which has been the conclusion of many studies  (Coassolo, 2005; Huang, 2002; Landon, 2005; Landon, 2006; Macones, 2005).  Success rates vary based on a variety of factors, but to say that ‘most fail’ is absolutely false.  What this OB should say is, “Most women who attempt a VBAC with me as their care provider fail,” which is probably 100% true.

And then the OB gives her the line that many women fall for:

He did however say that although he really does not recommend it . . . he would allow me to try.

And there is the hook.  So many women are satisfied to simply be given the opportunity to VBAC.  Unfortunately, from what this OB has said already, I do not believe Brooke would have a genuine opportunity to VBAC.  Surely this OB would come up with some “valid medical reason” that she needs a cesarean sometime during her pregnancy or labor.  Here come the requirements to be granted a trail of labor:

…yet there are many things that would have to be taken into consideration, including my unproven pelvis. He mentioned that in the hospital I would have to have continuous monitoring and 18 hours after my water broke, if I was not progressing, they would want to use Pitocin to advance the labor.  He also mentioned that he does not allow any woman under his care to go past 40 weeks.

The unproven pelvis standard is bizarre.  Don’t all women pregnant with their first child have an unproven pelvis?  Do we offer them all of them an elective primary cesarean to prevent a “failed vaginal delivery?”

No stereotypical VBAC consult full of misinformation is complete without a healthy helping of repeat cesarean risk minimization:

He did not mention risks to repeat c-sections.  When I brought it up he said there aren’t any except the obvious risks that come with any surgery.

False, false, false.  According to Silver (2006), a four year study of up to six repeat cesareans in 30,000 women:

Increased risks of placenta accreta, hysterectomy, transfusion of 4 units or more of packed red blood cells, [bladder injury], bowel injury, urethral injury, ileus [absence of muscular contractions of the intestine which normally move the food through the system], ICU admission, and longer operative time were seen with an increasing number of cesarean deliveries…. After the first cesarean, increased risk of placenta previa, need for postoperative (maternal) ventilator support, and more hospital days were seen with increasing number of cesarean deliveries…Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, 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.

It is quite typical for a woman to receive inflated rates of uterine rupture while the practitioner minimizes the risks of repeat cesarean.  This OB goes one step further and claims there are no risks at all besides the general risks associated with surgery.

It is no wonder that most women ‘chose’ repeat cesareans and only 45% of American women are interested in the option of a VBAC (Declercq, 2006).  What kind of choice is it when you make major medical decisions without even a fraction of accurate information?

There is much discussion and debate about what constitutes informed consent.  However, there is no debate that informed consent fundamentally consists of understanding the risks and benefits of your options.  When a woman only hears the (inflated) risks of option one and the (inaccurate) nonexistent risks of option two, it is clear that her practitioner is trying to influence her final decision by skewing the information provided.

Finally, the OB suggests that the desire to have a vaginal birth and avoid medically unnecessary surgery warrants psychological help:

I flat out said to him that I just cannot have another c-section [without medical indication] and he told me that I need to see a therapist, [that] it’s not that big of a deal and it is the safest way to go!

It might be helpful for this OB, and others who think like him, to learn more about how women are impacted by their cesareans.  Cesareans performed on otherwise healthy babies and healthy moms are absolutely a big deal to many women.  Even when cesareans are medically indicated, there are women who still mourn the loss of a vaginal birth even as they celebrate their healthy baby and the technology that made their entrance into the world safe.  Read American Women Speak About VBAC for more personal stories.

Then the OB makes it sound like he’s the only game in town:

Oh and then at the very end he said I could always go with another provider but he is pretty much the most open to VBAC.  I flat out told him that he is not VBAC friendly at all and that if he is the most open in town I have quite the battle ahead of me.

The emotional fallout of the appointment:

The entire visit I just had to hold back tears and once I hit the street I lost it.  I just want to hit my head against a wall!! I’m just sad, sad that it has to be this way – sad that, as much as I want to have another baby, I dread getting pregnant.  Sad that women are told this shit and forced to believe it.  I’m just in such a funk now…..just a sad, sad funk.

But it’s not just Brooke.

Michelle was told by her OB that uterine rupture rates increase with each VBAC which contradicts a 2008 study that concluded the risk of uterine rupture drops 50% after the first VBAC (Mercer, 2008).  One of the women who attended the VBAC class this past Sunday said that her OB quoted a uterine rupture rate of 6-10% after one prior low transverse cesarean. Sarah was quoted a rate of 10% “after the first section.”  Karla was also quoted 10% and called “selfish” by her OB who was “appalled that [she] would risk the life of [her] baby.”  Once again, the correct rate for uterine rupture in a spontaneous labor after one prior low transverse cesarean is 0.4% (Landon, 2004) and these women are quoted rates 15 – 25 times higher.

And who can forget the irate mom who left a comment on the VBACfacts Facebook fan page expressing her disbelief that any “selfish idiot” would pursue a VBAC.  Her OB told her that there was a 10% infant and maternal mortality rate with trials of labor after cesarean.  When I emailed her with the correct rates of 0.02% for maternal mortality and 0.05% for infant death or brain damage (Landon, 2004) and requested she forward any studies supporting a 10% mortality rate, she didn’t reply.

VBAC consults that misinform are all to common and help contribute to the 90% repeat cesarean rate in American (Hamilton, 2009).  If you are a VBAC supportive practitioner, and would like to make it easier for women in your community to find you, please read: How to best connect moms with VBAC supportive practitioners?

Learn more about finding a supportive care provider:

• The Three Types of Care Providers Amongst OBs and Midwives
• Questions to Ask a Provider
• Finding a VBAC Supportive OB or Midwife
• Scare tactics vs. informed consent aka why I started this website

______________________________________________________

Coassolo, K. M., Stamilio, D. M., Pare, E., Peipert, J. F., Stevens, E., Nelson, D., et al. (2005). Safety and Efficacy of Vaginal Birth After Cesarean Attempts at or Beyond 40 Weeks Gestation. Obstetrics & Gynecology , 106, 700-6.

Declercq, E. R., & Sakala, C. (2006). Listening to Mothers II: Reports of the Second National U.S. Survey of Women’s Childbearing Experiences. New York: Childbirth Connection.

Hamilton, B. E., Martin, J. A., & Ventura, S. J. (2009, March 18). Births: Preliminary Data for 2007. Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_12.pdf

Huang, W. H., Nakashima, D. K., Rumney, P. J., Keegan, K. A., & Chan, K. (2002). Interdelivery Interval and the Success of Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology , 99, 41-44.

Landon, M. B., Hauth, J. C., & Leveno, K. J. (2004). Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery. The New England Journal of Medicine , 351, 2581-2589.

Landon, M. B., Leindecker, S., Spong, C., Hauth, J., Bloom, S., Varner, M., et al. (2005). The MFMU Cesarean Registry: Factors affecting the success of trial of labor after previous cesarean delivery. American Journal of Obstetrics and Gynecology , 193, 1016-1023.

Landon, M. B., Spong, C. Y., & Tom, E. (2006). Risk of Uterine Rupture With a Trial of Labor in Women with Multiple and Single Prior Cesarean Delivery. Obstetrics & Gynecology , 108, 12-20.

Macones, G. A., Cahill, A., Pare, E., Stamilio, D. M., Ratcliffe, S., Stevens, E., et al. (2005). Obstetric outcomes in women with two prior cesarean deliveries: Is vaginal birth after cesarean delivery a viable option? American Journal of Obstetrics and Gynecology , 192, 1223-9.

Mercer, B. M., Gilbert, S., Landon, M. B., & Spong, C. Y. (2008). Labor Outcomes With Increasing Number of Prior Vaginal Births After Cesarean Delivery. Obstetrics & Gynecology , 11, 285-91.

Silver, R. M., Landon, M. B., Rouse, D. J., & Leveno, K. J. (2006). Maternal Morbidity Associated with Multiple Repeat Cesarean Deliveries. Obstetrics & Gynecology , 107, 1226-32.

Smith, G. C., Pell, J. P., Cameron, A. D., & Dobbie, R. (2002). Risk of perinatal death associated with labor after previous cesarean delivery in uncomplicated term pregnancies. Journal of the American Medical Association , 287 (20), 2684-2690.

I see things daily that I want to write about, but never actually have the time between laundry, dishes, meal prep and daydreaming of going to the National Institutes of Health’s upcoming free conference entitled Consensus Development Conference on Vaginal Birth After Cesarean: New Insights.  I’m hoping to use my Southwest credit from the cancelled Controversies in Childbirth conference to make a little trip out to Bethesda.  We shall see.

I’ve been on Facebook a lot, where you can become my friend or a fan of the site, because committing to a small little 420 character blurb fits in quite well as I unload the dishwasher and retrieve my toddler off yet another piece of furniture. 

However, the best way to stay in touch with me and receive updates and coupons for upcoming classes, is to join my mailing list.  I am investigating my options for doing an on-line webinar as well, so stay tuned!

So I’m using this quiet moment, at 3am when my children are asleep and I can write this uninterrupted (oh, the luxury!!), to share something that is really special.

In the last few days, a woman had a VBAC with triplets with the legendary Dr. Tate of Atlanta, Georgia.

According to Doula Momma:

The details are just coming out about this VBAC but apparently the woman had her triplets in a hospital attended by Dr. Tate. I am assuming she went natural, as in unmedicated, as that’s generally the way with a VBAC with Dr. Tate.  From what I am reading so far, the first two babies were head down and the third was footling breech. Here are the babies stats according to the ICAN of Atlanta chapter posting.
3 girls, all vaginal, all Apgar 8/9.

A= 4# 6oz, 18.25in @ 10:24pm, vertex.
B= 6# 4oz, 18.25in @ 10:37pm, vertex.
c= 3# 11oz, 16.5in @ 10:39pm, double footling breech extraction.

All three babies are successfully breastfeeding as well.

In a time where VBAC is banned in 50% of US hospitals, either through formal or defacto bans, (ICAN 2009 Hospital Survey) and women of multiples believe that they have no other option but a surgical delivery for their children, this is a huge victory.  There are practitioners that support VBAC.  Maybe even one that lives close to you.  Learn more on finding a provider and your options for planning a VBAC here: I’m pregnant and want a VBAC, what do I do?

I want to plan for a VBAC I am not pregnant as of yet but will be ttc in 2 months. I am from La Crosse WI area and they have two hospitals Gunderson Lutheran and Franciscan Skemp..when I called them to get there statistics about VBACs they told me they didn’t have any. So how should I choose which hospital to go to for the better chance of succeeding with my VBAC. I also do not have any doulas in the area is it necessary to have a doula for a successful VBAC? Any thoughts or suggestions would be great. Thank you.

Hi Jeri!

It’s ironic that the person you spoke with at the hospital said that they didn’t have any VBAC statistics, because when I googled “Gundersen Lutheran VBAC,” I found a page entitled "Births by Cesarean and Vaginal Births After Cesarean” on Gundersen Lutheran’s very own website where they state:

A vaginal delivery is the preferred, naturally-designed way to have a baby but when needed, delivery by Cesarean section is a second option. At Gundersen Lutheran, efforts are made to choose a vaginal birth, even after a previous C-section unless there are reasons that would put mother or baby at risk.

“Generally, successful VBAC is associated with shorter maternal hospitalizations, less blood loss and fewer transfusions, fewer infections, and fewer thromboembolic events than cesarean delivery.” [ACOG Practice Bulletin #54 2004)

AIMS
1. To have a cesarean section rate below the national rate
2. To have a VBAC rate higher than the national rate

They have succeeded in their goals as Gundersen Lutheran boasted a 27.3% VBAC rate in 2006.  That is exceptional considering that the national average is 9.2% (CDC 2006) and the Wisconsin state average is 12% (Wisconsin: Infant Births and Deaths 2006).

Ted Peck, M.D. is named “activity leader” on that page so I would contact him and ask for the top three VBAC doctors at Gunderson Lutheran.  I would also check out the resources here for additional referrals and to see if any of the names overlap.  Keep in mind that just because the hospital has a great VBAC rate doesn’t mean that all the OBs are supportive of VBAC.  You will still want to ask the same questions and interview a couple different doctors, just like you would get more than one quote if you wanted work done on your house.  You are the consumer, you have the power to chose who you will hire!  It’s important for you to understand the risks and benefits of VBAC vs. repeat cesarean to you, your baby, as well as your future children and health, but be on the look out for scare tactics masquerading as informed consent.

I also googled “Franciscan Skemp VBAC” and was directed to ICAN’s VBAC Hospital Policy Information where Franciscan Skemp is listed as a de facto VBAC ban hospital.  This means that while there is no formal ban in place, the hospital does not attend VBACs.  They could give you a whole list of reasons like, “Our OBs don’t want to do them” or “Our anesthesiologists don’t want to sit in the hospital during a VBAC labor,” but Dr. Stuart Fischbein gives us another perspective:

[Hospitals] ban VBACs under the guise of patient safety. But patient safety is a euphemism for “we don’t have a good evidence-based reason to do it, other than we don’t want to get sued, it’s more expedient, and we make more money from c-sections—the hospital does, not necessarily the physician, but the hospital does—so we’re going to ban it because it’s easier for us, and we’re going to say it’s for patient safety because of the risk of rupturing the uterus.” But you know what? That risk should be something that the patient decides. Patients have a right to be given informed consent, free from misinformation or coercion, free from skewing information that benefits the practitioner or the hospital. And they have the right to consent or refuse to accept the treatment that’s offered. That right is frequently being denied.

(To read more of this interview with Dr. Fischbein, please go to: An Inside Look at Hospitals & VBAC Bans.)

If I was unable to easily find this information by googling, I would have gone to Wisconsin’s Department of Health Services and just start searching for VBAC, birth, cesarean, and hospital statistics to see what I could find.  Sometimes this data is so deep within a website, it can be tricky to locate.  You could also call the Department of Health Services and ask them if they maintain hospital birth statistics.  The state of California maintains this data, but I don’t know if all states do and if they make that information available to the public.

In terms of a doula, yes, I think it’s very important for any woman laboring in a hospital, especially women seeking a VBAC, to have a doula.  (Here is more information on what a doula is and the many benefits of having one: DONA’s Birth Doula FAQs.)  Some practices are not supportive of doulas, even going so far as to post a sign in the waiting room detailing their anti-doula policy.  Switch providers immediately if you read a similar sign or if you discover that your provider is not doula friendly.  A great way to find out is to ask your OB or midwife if they have any doulas they can recommend.  Their response will quickly tell you if this care provider and you have the same vision for your birth.

I went to findadoula.com, and found there was one doula listed for La Cross, WI:

Renee Plunkett

Telephone: 608-786-4466

Location: West Salem Wisconsin United States

I also cover the following geographic areas:
La Crosse, WI

Hopefully you two will be a good fit and if not, the list of resources I provide for finding a supportive OB or midwife can also be used for finding a doula.  I would add DONA and toLabor (formally ALACE) which are Doula credentialing organizations as additional resources.  DONA lists 64 birth doulas and toLabor lists 10 birth doulas in Wisconsin.

You can find more VBAC statistics by going to the The Birth Survey’s State Resources page which provides links to each state’s birth statistics.

For Wisconsin, we have Wisconsin: Infant Births and Deaths, 2006 where we are given the following statistics on page 30:

Delivery Method	Number	Percentage
Vaginal (no previous C-section)	52,713	72.9%
Primary C-Section	10,342	14.3%
Repeat C-Section	7,418	10.3%
VBAC	1,017	1.4%
Forceps	812	1.1%
Other	0	0.0%
Total Births	72,302	100%

We can determine the VBAC rate by adding the number of Repeat C-Sections (7,418) and VBACs (1,017) together to get a total number of births after cesarean in 2006 (8,435).

By dividing the total number of VBACs (1,017) by the number of births after cesarean (8,435), and multiplying that number by 100, we get the VBAC rate of 12.06%.  This means that 87.9% of women in Wisconsin have repeat cesareans.

Here’s hoping you are in that 12%!

Warmly,

Jen from vbacfacts.com

This is the same weekend as the Trust Birth Conference, so if you are in town, you will have ample time after the conference is over at noon on Sunday to scoot on over to Century City (10309 Santa Monica Blvd, Suite 300, Los Angeles, CA 90024) and then back again if you want to attend the Stragglers Dinner at 6:30pm.

Additional classes have been scheduled in Claremont in July and Vista in October.

To register for the LA March class, please go here.  Space is limited.

What will the class discuss?

“The Truth About VBAC” delivers a comprehensive review of the medical research to parents, doulas, midwives, nurses and other birth advocates and medical professionals.  Topics include:

• Repeat Cesarean vs. VBAC Realities
• Risks of Hospital vs. Out-of-Hospital Birth
• Finding a VBAC Supportive OB or Midwife
• The Marketing of “Risk”
• Hospital VBAC Strategies
• Factors of Uterine Rupture
• Maternal & Infant Outcomes
• Elements of VBAC Success
• Benefits of Spontaneous Vaginal Birth
• Hospital VBAC Bans

What do past attendees say about the class?

A mom with two prior cesareans:

This class is all about the facts. It is low pressure. It gives you information from scientific journals that will help you make the best decision for you and your baby.   At the end, you get to decide which set of risks you are willing to accept.  It opened my husband’s eyes. Even though I’ve been telling him, he needed to hear the research and the numbers.  Thank you!!!

A Labor & Delivery nurse:

Thanks for an outstanding class! It was very nice meeting you. Your hard work and dedicated research is incredibly impressive. Knowledge is Power, wish it would rub off on the whole OB community. I think the trend to eventually turn that direction for women’s choice of birth options will happen as more people put that kind of pressure on the issue. Bravo to you!

A mom with one prior cesarean:

My husband and I certainly felt even more confident after the class.  I would definitely recommend it to anyone considering a VBAC.

Do I need to be pregnant to attend?

The best time to educate yourself is before you get pregnant when you have time to research, decide what kind of birth you want, and then assemble your birth team without a due date looming.  That said, highly motivated women have decided mid-pregnancy to change gears, reconsider their scheduled cesarean, and plan VBACs.

Why is this class important?

It’s likely either you or someone you know has had a cesarean.  Unfortunately, there is a lot of fear and misinformation about birth after cesarean.  Is VBAC dangerous?  What are the risks of repeat cesareans? What is the safest thing for babies and mothers?  What should you do if you want a large family?  What hospitals are most supportive of VBAC?  Is out-of-hospital (home or birth center) birth an option?

With half of American hospitals actively enforcing VBAC bans and increasing numbers of obstetricians preferring repeat cesareans, many women wonder if their only choice is another surgical delivery.  A 2005 survey revealed that while 57% of American women desire a VBAC, less than 10% succeed.

Banner ads and flyers are available.

Claremont VBAC Class

The "Truth About VBAC" seminar in Claremont, California is 8 days away on Saturday, October 24th from 1p – 4p.  Don’t miss out on your opportunity to experience an extensive review of the best VBAC and repeat cesarean research as well as learn specific, practical tools to maximize the likelihood of hospital or out-of-hospital VBAC success!  To register or sponsor a ticket, please visit: http://vbacfacts1024.eventbrite.com/

Do I need to be pregnant to attend?

The information is targeted towards women with prior cesareans who wish to have more children and the childbirth professionals who support them.  The best time to educate yourself is before you get pregnant when you have the luxury of time to research, decide what kind of birth you want, and then assemble your birth team without a due date looming.  That said, many women, have decided mid-pregnancy to change gears, reconsider their scheduled cesarean, find a new care provider, and plan successful VBACs.

Fullerton Class Recap

The Fullerton class last month was full of inquiring parents, midwives, doulas, Bradley childbirth educators, and labor & delivery (L&D) nurses some of whom drove over two hours to attend.  Not only did the moms and dads learn about VBAC, but they participated in a lively and candid discussion with the L&D nurses and doulas who were able to share exactly what it is like to VBAC in a hospital environment.  It would be very hard, if not impossible, to have these same exchanges on the L&D floor.  We also had homebirth midwives and doulas who provided the out-of-hospital perspective.

Here’s some feedback from one of the L&D nurses, who works in a hospital with an official VBAC ban and is working towards change:

Hi Jen, Thanks for an outstanding class! It was very nice meeting you. Your hard work and dedicated research is incredibly impressive. Knowledge is Power, wish it would rub off on the whole OB community. I think the trend to eventually turn that direction for women’s choice of birth options will happen as more people put that kind of pressure on the issue. Bravo to you!

"The Truth About VBAC" Book

Included with each ticket is one "Truth About VBAC" book which includes all the slides from the presentation, the bibliography, as well as lined paper throughout for easy note taking.  As the class is research heavy, this will enable you to sit back and absorb the information rather than frantically copying statistics and study citations, as I have often done in seminars.

Additional books will be available purchase that day for $15.  Quantities are limited.  To guarantee your copy, pre-purchase here: http://vbacfacts1024.eventbrite.com/

VBAC Class Advocacy

If you can’t come to the class but want to spread the word, consider putting a banner ad on your website or blog, posting flyers in your local community, or sharing VBAC FAQ cards with your friends or clients.

Shape the 2010 Class Schedule

You can influence where the next VBAC Class will be held!  I expect to hold 3-4 classes in Southern California throughout 2010.  I’m looking at the area bordered by Santa Barbara, Lancaster, Palm Desert, and San Diego.  If you want "The Truth About VBAC" to come to your city, please email info at vbacfacts dot com with your name, city, and zip code.  Those cities with the most requests will determine the next VBAC Class!

If you have facilities that can accommodate 20-40 people and want to host a class, please contact me at info at vbacfacts dot com.  I will be emailing those who have contacted me in the past in the coming weeks to discuss scheduling a class.

Win Two VBAC Class Tickets at the LA Holistic Moms Open House!

VBAC Facts has donated 250 VBAC FAQ cards as well as two tickets to a 2010 "Truth About VBAC" class to the Holistic Moms Network LA Open House Raffle.  Please join us Wednesday November 4th, 6:30pm at South Pasadena Library Community Room, 1115 El Centro St, South Pasadena, CA.  Here is a flyer with all the details.

Chino Birth Center Open House before VBAC Class

If you would like to tour a birth center and speak to a out-of-hospital midwife before heading over to the VBAC Class, the Oaks House Family Birth Center at 13770 Oaks Avenue, Chino CA 91709 is having an Open House on Saturday, October 24th from 11am – 2pm.  For more information call (909) 464-0974.

mybestbirth San Diego Party & Screening

I’m going to  this event which is scheduled for Thursday, November 12, 2009 at 5:30 PM and can’t wait!  To register please visit: http://mybestbirthsd.eventbrite.com/  All proceeds benefit the Business of Being Born Educational Outreach Project, ICAN and the San Diego Birth Network. Here are the details:

Join us for an exclusive VIP Reception at Babies in Bloom at 5:30 pm. Meet Ricki and Abby, enjoy delicious appetizers and beverages, and see a sneak peek of Ricki and Abby’s new film! We will also have a silent auction of fabulous items from our sponsors.

After the party, "The Business of Being Born" will be shown at the Krikorian Theaters in Vista Village at 7 pm. Several local birth professionals (including midwives Barbara Herrera and Michelle Freund, and Dr. Robert Biter) will join Ricki and Abby for a discussion panel  following the screening.

Private Screening of "Laboring Under an Illusion"

I’m so bummed this is the same night at the mybestbirth event!  Hopefully CABO will host another screening in the future!

Attend a private showing at Laguna Hills Community Center on Thursday, November 12, 2009 5-8pm of "Laboring Under an Illusion," a documentary that depicts how the media portrays labor and birth.  It is quite comical and contrasts delivery and birth.  Hope you will consider this and join us and distribute widely. Women that are pregnant or planning to have a baby may be interested as well!  All proceeds support the efforts of project CABO (Community Alliance for Birth Options). 

Here is a flyer with all the details.

Traumatic Birth Healing Spiral

When is it? Saturday, October 17, 2009

Who should attend? Women who have experienced a traumatic birth experience, either cesarean or vaginal.

What is it?  An interactive workshop to assist in emotional healing.  Storytelling, artwork and a blessingway will highlight the event.

Where? Springdale, Arkansas (Directions will be provided to all attendees at time of registration)

Please RSVP by October 15 to Aly Kirkpatrick 479-251-8446 or alynwaican@hotmail.com

$10 suggested donation per person, scholarships available

The International Cesarean Awareness Network is a nonprofit organization whose 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). Visit our research based website www.ican-online.org or email alyNWAican@hotmail.com

Please feel free to forward this email to anyone you know who may be interested

Perinatal Death Low with Home Births

By Nancy Walsh, Contributing Writer, MedPage Today
Published: August 31, 2009
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
Earn CME/CE credit
for reading medical news

Action Points 

---

• Explain to interested women that there was a very low risk of perinatal death and other complications associated with home birth with a midwife in a Canadian study.
• Caution them that all midwives in the study were highly trained and experienced, and the study was not randomized.
• Also explain that the American College of Obstetricians and Gynecologists does not recommend home birthing.

Planned home births attended by registered midwives were associated with a very low rate of perinatal death, comparable to those of hospital births, a prospective Canadian cohort study found.

The rate of perinatal death per 1,000 planned home births was 0.35 (95% CI 0 to 1.03) compared with 0.57 (95% CI 0 to 1.43) among hospital births attended by midwives, and 0.64 (95% CI 0 to 1.56) among hospital births attended by physicians, according to Patricia A. Janssen, PhD, of the University of British Columbia in Vancouver, and colleagues.

Planned home births also were associated with fewer obstetric interventions and other adverse outcomes, the researchers reported online, ahead of print, in the Canadian Medical Association Journal.

Debates about the safety of home births continue in the literature and among policymakers, with the American College of Obstetricians and Gynecologists having long opposed the practice.

In contrast, the U.K. Royal College of Obstetricians and Gynaecologists considers it a viable choice for uncomplicated pregnancies, while the Society of Obstetricians and Gynaecologists of Canada has not taken a specific stand.

Previous studies of home birth conducted in North America, Europe, and Australia have been limited by inadequate statistical power, incomplete data, and nonrepresentative sampling.

To address these concerns, Janssen and colleagues acquired outcomes data for all planned home births attended by registered midwives in British Columbia between January 2000 and December 2004.

Eligibility requirements for home birth, according to the College of Midwives of British Columbia, include the absence of preexisting or pregnancy-onset maternal disease, a singleton fetus, and gestational age between 36 and 41 weeks.

A total of 2,899 women who began labor with the intention of giving birth at home were compared with 4,752 who also met the eligibility criteria for home birth but began labor planning to give birth in the hospital attended by a midwife.

The same cohort of midwives, all of whom had extensive academic and clinical training, attended both groups.

A second comparison group included 5,331 matched, physician-attended births, all of which took place in the hospital.

Among the women planning to give birth at home 78.8% did so, while among those planning hospital birth, 96.9% did so.

Compared with women planning a hospital birth with a midwife attending, those who planned home birth were significantly less likely to experience these complications:

• Third- or fourth-degree perineal tear (RR 0.43, 95% CI 0.29 to 0.63)
• Postpartum hemorrhage (RR 0.62, 95% CI 0.49 to 0.77)
• Pyrexia (RR 0.45, 95% CI 0.29 to 0.76)

The following neonatal complications also were less likely in the setting of home birth:

• Birth trauma (RR 0.26, 95% CI 0.11 to 0.58)
• Resuscitation (RR 0.23, 95% CI 0.14 to 0.37)
• Oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.24 to 0.59)

The rate of infection did not differ significantly between the two groups (RR 0.39, 95% CI 0.13 to 1.14).

Compared with women giving birth in the hospital attended by a physician, those who planned birth at home had neonates at reduced risk for:

• Birth trauma (RR 0.33, 95% CI 0.15 to 0.74)
• Resuscitation (RR 0.56, 95% CI 0.32 to 0.96)
• Oxygen therapy beyond 24 hours (RR 0.38, 95% CI 0.24 to 0.61)
• Meconium aspiration (RR 0.45, 95% CI 0.21 to 0.93)

However, neonates born at home were more likely to be admitted to the hospital, or readmitted if they were born in the hospital, despite the planned home birth (RR 1.39, 95% CI 1.09 to 1.85).

The reason for this, according to the investigators, may have been a greater incidence of admission for treatment of neonatal hyperbilirubinemia [jaundice]in the home-birth cohort — a condition that can be identified and treated before discharge in up to 40% of neonates born in the hospital.

Among the strengths of the study were the completeness of data and the fact that the same cohort of midwives attended the home and hospital births.

Limitations include the self-selection of women choosing home birth, despite the investigators’ efforts to closely match the comparators.

The study findings cannot be generalized to settings where midwives are less highly trained and experienced, they cautioned.

Nonetheless, they concluded, "Our study adds to the body of large cohort studies of planned home births that have reported on the relative safety of home versus hospital birth."

An accompanying editorial acknowledged the study’s "important contribution to our knowledge about the safety of home birth," but called for more research.

"Few issues in maternity care remain as contested and unresolved as the debate surrounding the safety of home birth versus hospital birth," wrote Helen McLachlan, PhD, and Della Forster, PhD, of La Trobe University in Melbourne, Australia.

A well-designed randomized trial would help clarify the persisting questions about home birth, the editorialists argued, but such a trial would pose challenges such as women’s possible unwillingness to be randomized and the large sample size that would be needed.

They suggested that a feasible option would be a multicenter trial using a composite primary outcome.

The study was funded by the Canadian Institutes of Health Research.

The authors and editorialists declared no competing interests.

Primary source: Canadian Medical Association Journal
Source reference:
Janssen P, et al "Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician" CMAJ 2009; DOI: 10.1503/cmaj.081869.

There is also the Claremont class in East Los Angeles County on October 24th.

These are the only classes for 2009.  Register and save your spot!

FOR IMMEDIATE RELEASE

Class Explores Birth After Cesarean Options in Fullerton & Claremont

POMONA, CA (September 2, 2009) – VBACFACTS.com announced “The Truth About VBAC,” a class on vaginal birth after cesarean, will be offered in Fullerton on Sunday, September 20 and in Claremont on Saturday, October 24. Incorporating the latest medical research, the class provides clear and concise information as well as specific, practical tools for women considering or planning a vaginal birth after cesarean (VBAC).

With half of American hospitals actively enforcing VBAC bans and increasing numbers of obstetricians preferring repeat cesareans, many women wonder if their only choice is another surgical delivery. A 2005 survey revealed that while 57% of American women desire a VBAC, less than 10% succeed.

“If you are a candidate for VBAC and have the knowledge, tools, and support, the likelihood that you will successfully VBAC is high, at least 75%,” states Jen Kamel, founder of VBACFACTS.com. “Hire an OB or midwife that is truly supportive, because they will set the tone of your birth. Aim for an unmedicated birth because drugs can impact the mother’s mental clarity and increase the risk of complications resulting in an otherwise avoidable repeat cesarean. Select a birth location that will be encouraging rather than be a source of fear and doubt. Find women who have birthed vaginally after a cesarean or are planning a VBAC and use them as your cheerleaders and sounding board. “

“The Truth About VBAC” provides women with a extensive analysis of their options. Topics include:

• Repeat Cesarean vs. VBAC Realities
• Risks of Hospital vs. Out-of-Hospital Birth
• How to Find a VBAC Supportive OB or Midwife
• Hospital VBAC Strategies
• Factors of Uterine Rupture
• The Marketing of “Risk”
• Maternal & Infant Outcomes
• Elements of VBAC Success
• Benefits of Spontaneous Vaginal Birth
• VBAC Ban Rationale & Rebuttal
• History of VBAC – From Encouraged to “Unsafe”

Cost is $25/person or $40/couple and pre-registration is required. For more information or to register, visit www.vbacfacts.com/vbac-class.

The Fullerton class will be held on Sunday, September 20, 2009 from 1pm – 4pm at Belly Sprout, 426 W. Commonwealth Avenue.

The Claremont class will be held on Saturday, October 24, 2009 from 1pm – 4pm at No Sugar Added, 141 Yale Avenue.

About VBACFACTS.com

An evidence based source on vaginal birth after cesarean, VBACFACTS.com empowers women with information, tools, and resources.

About Jen Kamel

A former commercial real estate research manager, Mrs. Kamel retired upon her daughter’s birth via cesarean section in 2004. After her son’s birth in 2007, a successful VBAC, she created VBACFACTS.com in order to make the information and research she had compiled easily accessible to others.

Contact:
Jen Kamel
E-Mail: press@vbacfacts.com
Website: www.vbacfacts.com
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Women they really believe that if they are good patients, if they are friendly, if they don’t question to much, if they are good-natured, their OB will treat them with the same courtesy by reading their birth plan, respecting their wishes, supporting their desire for a vaginal birth, and creating an environment where VBAC is the goal.  In short, the woman believes that she will receive a genuine opportunity to VBAC. 

However, as we read below, it is not enough to like your OB.  It’s not enough that you feel comfortable with them.  They need to support VBAC.  They need to see the value in vaginal birth.

As I read this letter again, it really breaks my heart to share with you.  This woman is fresh from her repeat cesarean and she is still mourning.  I thank her deeply for sharing her pain and regret with the readers of this site.  I hope that this woman’s pain can be transformed into greater knowledge and understanding for you.  I hope if you are considering staying with your OB/midwife just because you like them, and not because their standard of care is in favor of vaginal birth, that you reconsider your decision.

To learn more about “bait & switch” OBs, read: The Three Types of Care Providers Amongst OBs and Midwives. 

To read more birth stories of women who received less than stellar care in the hospital, please read: Hospital VBAC turned CS due to constant scare tactics and VBACing against the odds.

To support an OB who is currently being targeted by his hospital for attending VBACs, please read: VBAC supportive OB asked to stop attending VBACs by his hospital.

Dear Dr. XYZ:

It is with great reluctance that I submit payment to you for services rendered. 

I hired you for an intervention free VBAC.  Instead I had EVERY intervention I told you I did not want.  Under your care, I failed in the most basic way a woman can fail – I failed to birth my children.   You ignored each and every point on my birth plan.  I cannot help but wonder if you even read it, or if you ever had any intention of following it. 

I needed time for my body to do what it was designed to do.  I needed support from my doctor, from my nurses, and from my hospital.  What I did NOT need was to be pumped full of drugs, have multiple interventions that I specifically stated I did not want and pushed into a surgical procedure.  I am especially struck by our final interaction prior to consent.  Never, for the rest of my life, will I forget how you made your speech, and then stalked out of the room.  I recall thinking “I’m actually paying to be treated like this?  To be verbally bereted and physically tortured?” 

I have no joy when recalling my children’s births.

I have regrets. 

I regret coming in for an appointment that day when labor was in the early stages.  I regret listening to you that I should go to the hospital “just for some monitoring.”  I regret not leaving when labor stalled.  I regret agreeing to pitocin.  I regret allowing you to turn up the pitocin to a point where I could not stand it without pain relief.  I regret getting the epidural instead of just screaming my lungs out until it was over.  I regret letting you artificially rupture my membranes.  I regret allowing the monitoring – internal and external.  I regret not telling you that this was my baby, my birth experience, and I wasn’t having a C-section without a court order.

But what I regret most is choosing you as my provider.  I knew going in that you had a high C-section rate, that you had already given me most of those interventions with my first child.  But I liked you, and allowed that to influence my decision. 

How I wished I had chosen someone I loathed who would have worked with me to get the natural birth I desired.  In the end, liking you got me nothing that I REALLY wanted.

So, here is your money.  I don’t particularly think you have earned it, but I want to be free of this one last reminder of the worst experience of my life. 

Sincerely,

Jenn in St. Louis

What Is It…                                                                 

To further support women’s right to choose their birthing experience, Berlin Wellness is offering gift certificates totally for $100,000 in labor preparation and prenatal services to women planning a VBAC.

What We’re Offering…

In exchange for our amazing giveaways, we’re looking for participants willing to take part in 2 scheduled video recorded interviews – 1 before and 1 after the birth – sharing the route each woman took to decide on a VBAC delivery. The when, why’s and how’s leading up to the big day, followed by the ultimate outcome of the overall experience will provide 100 women with $1,000 each in gift certificates to put towards prenatal preventative care and wellness services.

For more information, please visit The Berlin Wellness Group: $100,000 VBAC Giveaway!