13 Mar

Los Angeles, CA (March 2015) — Ninety percent of American women who give birth by Cesarean will have all future babies by surgery. The new feature-length documentary film, Trial of Labor TOLgives a voice to four California women fighting those odds: planning births after Cesarean (VBAC).

Access to VBAC remains extremely restricted in the U.S., with many hospitals maintaining mandatory surgery policies (also known as “VBAC bans”) for women who have had Cesareans. These policies, based primarily on non-medical factors, mean that tens of thousands of women every year have no choice in how they give birth: they are pushed into surgery whether they need it or not.

This situation persists despite a top-level push to increase access to VBAC. The American College of Obstetricians and Gynecologists calls VBAC, “safe and appropriate” for most women, while the National Institute of Health and American Academy of Family Physicians urge increased access to VBAC as a pressing issue of public health, warning against the life-threatening risks of harm from multiple Cesareans. When a woman is given the chance at a “trial of labor,” she has about a three-in-four chance of avoiding the operating room.

The women featured in Trial of Labor are determined not to have unnecessary surgeries, but face a gauntlet of self-doubt, unresolved feelings about previous births, limited support, and even ultimatums from their care providers. The film presents the poignant, sometimes messy, reality of their journeys: in their own words, from their own perspectives.

As the process unfolds, we watch the women learn to trust themselves again. For them, giving birth is more than just the means to an end: it’s a profound reclaiming of the right to use their own bodies to get there.

Trial of Labor premiers in Los Angeles on March 18, 2015. For a limited time, beginning March 20, it will be streamed to about 150,000 members of the public via multiple national and international childbirth, consumer, and advocacy organizations. The film will be released to the general public on March 31.

To watch the Trailer, visit www.trialoflabor.com

Epidurals For Labor: Telling It Like It Is

11 Feb

A national survey of women who gave birth in U.S. hospitals in 2011-2012 reported that 6 out of 10 mothers had an epidural for pain relief in labor. An epidural is a very effective form of pain relief, but it can also lead to complications that eventually makes it necessary for the mother to have a cesarean.

At Spectrum Health Gerber Memorial in Fremont, Michigan expectant mothers are educated about the benefits and risks of using an epidural in labor and their informed choice is respected. Dr. Tami Michele, DO, FACOG, OB/GYN, Medical Director CassieEhard3746461480_ba31648524_zand Obstetrics and Gynecology Department Chair is a strong advocate of women’s informed choices. Mothers are educated about the benefits and risks of epidural anesthesia for labor and also given a Plan for Vaginal Birth form that includes many options for pain relief: massage; hypnosis techniques; use of whirlpool or  shower; use of a birth ball and freedom of movement and positions for birth.

This is the information that women are currently given if they are considering an epidural for pain relief.


Epidural Anesthesia

Expected Results

A temporary decrease or loss of feeling and or movement to lower part of the body, which may provide relief from pain during a prolonged or difficult labor. This type of anesthesia/analgesia does not alter the mental status as occurs with IV or injection pain medications. Occasionally the anesthesia does not completely take away the pain, or only provides numbness on one side.


Medication is injected through a needle, and a catheter is placed outside the spinal canal in the epidural space.


  1. HIGH SPINAL BLOCK: you could experience shortness of breath, respiratory depression or respiratory/cardiac arrest. You may need an emergency cesarean section and resuscitation.
  2. ADVERSE REACTION TO ANESTHETIC AGENT: May lead to respiratory paralysis, cardiac arrest, brain damage, heart attack, convulsions, stroke or death.


  1. Reduced blood supply to the placenta may cause fetal distress, brain damage, or death.


  1. Continuous electronic fetal monitoring will be used to check for signs of fetal stress.Epidural anesthesia/analgesia may cause slow, less effective labor contractions. Pitocin may have to be added to the IV to stimulate stronger contractions.
  2.  More epidural medicine may be needed to relieve the pain of stronger Pitocin induced contractions. Pitocin can cause more risk to the baby. Arrested labor may result in cesarean section, which is a major abdominal surgery and poses increased risk for the mother.
  3. If an epidural is given in early labor, it increases the chance that the baby is in the wrong position as it comes into the pelvis. This may increase the need for a cesarean delivery.
  4. Epidural anesthesia decreases the mother’s ability to push and increases the need for forceps, vacuum, or cesarean section. Forceps or vacuum assisted deliveries have a greater need for an episiotomy and deep tears into the perineal muscle. This can increase the pain and healing time after giving birth.
  5. Back strain or injury to the hips and knees may occur due to the inability to feel if the body is in an awkward position.
  6. The mother cannot respond naturally to labor cues, and may not feel as much control over the birth process.
  7. You will not be able to walk around, or use the tub, shower, or toilet.
  8. The epidural may cause the mother’s temperature to rise requiring additional tests for you and the baby to evaluate for possible infections.
  9. You may need a catheter inserted into your bladder if you are unable to urinate.
  10. You will be limited to a clear liquid diet only after an epidural because of increased surgical risk if a cesarean is needed.
  11. You will be monitored often for vital signs after an epidural, so a blood pressure cuff will be placed on your arm, a pulse oximeter will be placed on a finger, and you will receive intravenous fluids.


  1. Epidurals may cause severe headaches, migraines, temporary or permanent nerve damage, muscle weakness in legs, numbness or tingling sensation, and long term backache.


The epidural may decrease the newborn baby’s ability to nurse well for the first 12-72 hours.

_____ All forms of anesthesia or medications have some risk, and rare unexpected complications other than what is listed here may occur.

_____I understand that it is my choice to choose the type of pain relief method I feel is appropriate for my baby’s birth including an epidural, IV pain medications, or comfort measures as listed on my birth plan.

_____If I choose an epidural, I understand that every effort will be made to get an epidural administered in a timely manner. I understand an epidural may not be appropriate if the labor is advancing quickly and the procedure cannot be done safely.

_____If a cesarean delivery becomes necessary, the epidural may be adequate anesthesia for surgery but general anesthesia may be necessary if complete pain relief is not achieved.

_____I have had the opportunity to ask my OB physician or midwife questions regarding pain relief methods for labor and delivery.

____I understand this is NOT A CONSENT FORM FOR THE PROCEDURE OF THE EPIDURAL, but is confirmation that I have been educated on the effects of an epidural which may affect the obstetrical care I receive from my physician or midwife.   If I choose to have an epidural during my labor, the anesthesia provider who will be administering the epidural will also inform me of risks associated with the procedure.

Please initial the above statements, and sign below.


Patient Signature ____________________Date

OB Provider Signature________________ Date


To download a copy of the Epidural Anesthesia and Plan for Vaginal Birth Decision-Making Tools link to the American College of Nurse-Midwives’ BirthTOOLS.org website and click on Patient Education/Shared Decision Making


Take A Sneak Peak at The Mama Sherpas, a Documentary by Filmaker, Professor, and VBAC Mom

12 Dec

Brigid Maher, a tenured, associate professor of Film and Media Arts Division in the School of Communication at American University will soon be releasing a documentary about the health benefits and advantages of midwifery care for women with a prior cesarean.

The Mama Sherpas is a feature-length documentary film about women receiving their maternity care through midwife-doctor teams.  For two years Maher followed nurse midwives, the doctors they work with, and their patients to provide an investigative lens into how midwives work within the hospital system. The official TRAILER has just been released. Sherpaslogo

A Sherpa refers to a member of a Tibetan people living on the high southern slopes of the Himalayas in Eastern Nepal known for providing support for foreign trekkers and mountain climbers. Here, it is the midwives who are the sherpas or guides for the expectant mothers’ journey through pregnancy, labor and birth.

Evidence shows that collaborative care reduces interventions, lowers cesarean rates and improves health outcomes. Maher was inspired to make the film after her VBAC of a 9 pound 10 ounce daughter. She knew that the midwifery model of care she received made all the difference and wanted women with a prior cesarean to know about their options for care providers.

Why is this film important?

About one in three babies are born by C-section today, though the World HealthOrganization recommends that the best outcomes for mothers and babies are achieved when that rate remains below 15%.  Additionally, according to the Center for Disease Control, the U.S. has one of the highest infant mortality rates among industrialized countries.

How can these disturbing trends be reversed?

In recent years, the idea of a “collaborative care” practice where doctors and midwives manage women’s care together has begun to gain traction in the U.S.  So far, research has demonstrated that collaborative care models produce better outcomes for mother and baby, including fewer C-sections.

Maher and her team plan to release the film in the fall of 2015.  You can follow The Mama Sherpas on the film’s website where you can read several of the mothers’ birth stories and check Facebook and Twitter for updates on the film’s world premiere.



Find a Midwife

Citizens for Midwifery

Mothers Naturally

National Association of Certified Professional Midwives

Bringing Birth Back: A New Infographic for Parents on Lowering the Odds for a Cesarean

1 Oct

Bringing Birth Back: The Rise of Cesareans & the Movement to Safely Prevent Them is a review of the rise in U.S. cesarean rates, the risks of the surgical procedure and how parents can take advantage of the new practice guidelines to lower their odds for a medically unnecessary cesarean.

Mothers’ choices for how they want to give birth is theirs to make and should be respected. This easy-to-read format gives mothers information they may not have to help them make an informed decision on how they want to give birth. You can upload this helpful infographic from the nursing website.

Bringing Birth Back
Source: TopRNtoBSN.com/

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