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TRIAL OF LABOR, A New Film About Four Mothers and Their Determination To Give Birth Naturally After A Prior Cesarean

22 Jul

Two fathers, Robert Humphreys, an independent, award winning film maker and Dr. Elliot Berlin, a Chiropractor specializing in alternative prenatal care, set out to make a documentary film about the VBAC Ban in U.S. hospitals and its impact on the physical and psychological health of women who want to birth naturally after a prior cesarean. TRIAL OF LABOR, a documentary initially conceived as an educational film about the medicalization of birth in the U.S. and the pros and cons of VBAC and repeat cesarean, evolved into a powerful and inspiring personal journey of four mothers who had a prior cesarean and who were determined to find caregivers who would support their choice for a VBAC. The children of both Humphreys and Berlin were born at home. As men and fathers, they witnessed how powerful and validating birth can be.

With a healthy pregnancy, and a low horizontal scar on the uterus, women who go into labor on their own at term have about a 70% to 75% chance that they will have a safe VBAC. Avoiding a routine repeat cesarean protects women from complications of major abdominal surgery as well as potential complications in a subsequent pregnancy.

However, current controversial ACOG guidelines (Practice Bulletin #115) requiring that trial of labor (TOLAC) should take place in hospitals where resources for emergency cesarean are “immediately available” make it very difficult for expectant mothers to find VBAC supportive careproviders.

The National Institutes of Health (NIH) found that this “immediately available” recommendation was based on consensus and expert opinion rather than strong support from high-quality evidence.  The NIH also found that this recommendation had influenced about one-third of hospitals and one-half of physicians to no longer provide care for women who want a VBAC.

Told from the mothers’ own point of view, TRIAL OF LABOR is a sensitive and insightful look at four strong and courageous mothers who challenge an irrational and un-affirming medical care system to escape from a routine repeat operation-initially, the only option they thought they had.

Their journey to VBAC forces them to look back at their unexpected and unwanted cesarean birth. Face conflicting emotions about their ability to give birth and examine carefully the benefits and downside of both a natural birth and another operation.

“It was the most surreal Kafkaesk experience,” said one mother about her cesarean. “When I reflect about it,” says another, “I get visibly angry. That I didn’t inform myself enough.”

The mothers’ decision to give birth vaginally, where and with whom , did not come easy. “It’s very difficult to step away from the medical establishment,” expressed one expectant mother and yet,  chose to have a VBAC at home, her last resort, despite the lack of published evidence about its safety. Each mother decided for herself how she can best give birth this time.

The U.S. saw an increase in VBACs from the 1980s through the mid 1990s, but the VBAC rates have consistently declined since. One in four women had a VBAC in 1996 compared to 1 in 100 today.

Filmmaker, Robert Humphreys said, “Women have the power and wisdom to give birth. They have been doing it for thousands of years. We men need to step back and respect their strength and ability to give birth on their own.“

The producers of TRIAL OF LABOR have received an encouraging response to their request for  funding to complete the film and meet their post-production costs. They also plan to produce DVDs of the film. Humphreys and Berlin have launched a Kickstarter campaign to raise the funds and are asking the birthing community and the public at large to view the trailer and spread the news about this important and much needed film.

To view the trailer and find out more about the film visit, TRIAL OF LABOR.

How Do Mothers Make Choices About VBAC or Repeat Cesarean?

7 Jun

Yasmine L. Konheim-Kalkstein, Ph.D. is Assistant Professor of Psychology at Mount Saint Mary College, in Newburgh, New York. As a mother who had a prior cesarean, she is one of the very few women in the United States who are given a choice to plan a VBAC or schedule a routine repeat cesarean. Less than 10 percent of U.S. women with a prior cesarean have a VBAC.

Dr. Konheim-Kalkstein is conducting a research study to better understand how women in the U.S. make a decision about planning a VBAC or having a repeat cesarean.

She writes:

I am, probably as a result of my own experience, conducting research on psychological factors that influence women’s decisions to try for a VBAC or choose a repeat c-section.

I have researched decision-making in the past, but it was during my second pregnancy, while being faced with the decision to plan a VBAC or choose a repeat operation, and hearing other women’s choices (often very different) that I became interested in the question of what influences women’s decision-making in childbirth. 

As a pilot study, I’m gathering data from women who had to make this decision. It’s an online anonymous survey that takes less than 10 minutes. I hope this study will help maternity care professionals learn how best to support women in their decisions. Women who take the survey have the opportunity to be drawn to win a $25. gift card.

Specifically, our project examines the psychological influences that lead women to plan a VBAC or schedule a repeat cesarean section. When we make any decision, we are often influenced by the knowledge available to us, the way risks are presented to us, our prior experiences, stories we may have heard, and of course, our own personality. This project broadly explores these influences, in order to better understand the components that influence the decision-making. 

Of course, there is no right or wrong choice in the case of a VBAC vs. a scheduled c-section. Our survey seeks only to collect data, not to influence decisions. We are not medically trained; we are interested in the psychology of decision-making. We hope our study will contribute to research that will ultimately benefit women, as well as those involved in supporting women in their healthcare decisions.

I am happy to share my own personal story, but only after women take the survey as I don’t want to bias them one way or another. 

To take the survey, go to www.tweetlink.me/birth .

For additional information about this project, you can contact Dr. Konheim-Kalkstein yasmine.kalkstein@msmc.edu.

Resources:

Childbirth Connection, VBAC or Repeat Cesarean

American College of Nurse-Midwives, What You Need to Know About VBAC and Repeat Cesarean

Northern New England Perinatal Quality Improvement Network, Birth Choices After Cesarean (Patient Education)

American Academy of Family Physicians: Trial of Labor After Cesarean, Shared Patient-Physician Decision-Making Tool

Power To Push Campaign, British Columbia, Vaginal Birth After Cesarean

“Inne-CESAREA”: A Spanish language campaign against unnecessary cesareans

6 Mar

Our thanks to Ana M. Parrilla-Rodríguez, MD, MPH, FABM, LCCE, professor of Maternal and Child Health, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico for contributing this blog post.

Statistics show that Puerto Rico continues with one of the highest cesarean section rates in the world. During the last thirty years the percentage of cesarean deliveries on the island has increased drastically from 18.2% in 1980 to 46.3% in 2010. For the last five years we have annually tripled the World Health Organization (WHO) statement that there is no reason for any country to have a cesarean section rate over 15%. This is a significant public health problem which affects, among other things, the health of Puerto Rican mothers and their babies.

In the face of this reality, the inne-CESAREA campaign has been launched. It is an initiative of the Association of Students of Maternal and Child Health at the Graduate School of Public Health, University of Puerto Rico Medical Sciences Campus. It strives to promote the empowerment of Puerto Rican women through an educational campaign for the prevention of unnecessary cesarean sections. The multi-media educational campaign is appealing, up- to-date and approved by public health experts. It  promotes the humanization of childbirth and its benefits for the health of mothers and babies. It means to address a severe public health problem represented by the unacceptably high cesarean section rates and unnecessary interventions used during labor and birth on mothers and babies.

Campaign director Javier Morales-Nazario, student in the Maternal and Child Health Program, states, “We invite mothers, their partners and relatives to embrace a different experience, where childbirth is seen as a natural process which is beautiful and full of energy.”

“A new chapter has begun in the struggle for humanized childbirth in Puerto Rico. We hope to see changes in maternal and child health care. It is time for women to be the principal decision-makers in what really belongs to them-childbirth,” adds Morales-Nazario.

This public education project encourages women to make their own decisions for themselves and  their babies. Its motto reads: “Decide for yourself, be the protagonist, take control. It includes a theme song and Hip-Hop video, a web page, presence in the social networks Facebook and Twitter, as well as educational posters and fliers. It has been endorsed and supported by over twenty local and international organizations in an effort named “inne-CESAREA Alliance”. It has received support from many people in other Spanish-speaking countries and Amnesty International is working to unite its affiliates in Latin America to join the campaign. Work is being done to caption the video in Portuguese, French, English and sign language.

To view the campaign materials in Spanish visit www.inne-CESAREA.org.

To view the campaign materials in English (a Google translation) visit www.inne-CESAREA.org.

California Community Foundation Funds a Grant for Hospital Improvements and Nursing Education

19 Feb

The California Community Foundation has awarded a grant to the Association for Wholistic Maternal and Newborn Health of Los Angeles for hospital improvements and nursing education. The Association is taking advantage of this opportunity and has developed a program to educate maternity care nurses in Mother-Baby Friendly Care.

Mother-Baby Friendly Care is evidence-based, high quality maternity care which can improve health outcomes for mothers and babies, reduce costs of maternity care, and help achieve public health objectives for maternal and infant health. Mother-Baby Friendly Care combines the “Ten Steps of the Mother-Friendly Childbirth Initiative for Mother-Friendly Hospitals, Birth Centers and Home Birth Services and the “Ten Steps of the Baby Friendly Hospital Initiative (BFHI) developed by the WHO and UNICEF to promote a breastfeeding supportive hospital environment.

“Heart and Hands The Art and Science of Mother-Baby Friendly Nursing, A Proposal for High Quality Maternity Care,” a training for hospital labor and delivery nurses and nurse-managers will be offered in Los Angeles May 22, 23, 24, 2012. To learn about the health benefits and potential health care cost reductions of Mother-Baby Friendly Nursing, maternity care nurses, nurse managers, and hospital administrators are invited to attend a free Introduction and Information Session to Mother-Baby Friendly Nursing on Thursday, February 23, 2012 from 2:00pm-5:00 pm at the California Endowment Center for Healthy Communities, Sierra 2 Room, 1000 N. Alameda Street, Los Angeles, California, 90012. The Information session will be simultaneously offered as a webinar and will be available for future viewing on the Coalition for Improving Maternity Services website.

The training is co-sponsored by The Association for Wholistic Maternal and Newborn Health in collaboration with the Coalition for Improving Maternity Services, and Educate. Simplify. Creative Resolve Healthcare Training Company.

Representative Lucille Roybal-Allard (CA-34) will be recognized at the event with the Champion for the Mother-Baby Friendly Maternity Care Award for her legislative initiative, the MOMS for the 21st Century Act (HR 2141, 112th Congress) by the project’s collaborating organizations. The Maximizing Optimal Maternity Services for the 21st Century Act  places a national focus on evidence-based maternity care practices to help achieve the best possible maternity outcomes for mothers and babies.

In a press release, Congresswoman Lucille Roybal-Allard stated, “Despite the vast body of knowledge regarding best evidence-based maternity care, current maternity practice does not follow that research. For example, the widespread over-use of maternity procedures including Cesarean sections and scheduled inductions, which credible evidence tells us are beneficial only in limited situations, has resulted in longer maternity hospital stays and multiple costly procedures…sadly, despite our exorbitant expenditures on maternity care, childbirth continues to carry significant risks for mothers and babies, especially in communities of color.”

In its report, The Future of Nursing: Leading Change, Advancing Health, the Institute of Medicine (IOM) concluded that nurses can play a vital role in helping to transform the health care system and can and should play a fundamental role in its transformation. The role, responsibilities and education of nurses will need to change to meet the increasing demand for safe, high-quality, and effective health care services.

Maternity care nurses are on the front lines, and the Mother-Baby Friendly Nursing educational program can serve as an evidence-based guide to assist labor, delivery and neonatal nurses provide safe, high-quality and effective care.

To register for the free February 23rd Introduction and Information session link to http://mother-baby-friendly-nursing-training.eventbrite.com/ .

To register for the free webinar that will be available from 2pm to 5pm that day link to https://www4.gotomeeting.com/register/852801407 .

To find out more about the Mother-Baby Friendly Nursing or to bring the training to your community, please contact Cordelia Hanna-Cheruiyot by phone at 626-388-2191 or Email: cordeliahc@socalbirth.com .

blog post updated, 2/29/2012, 1:20 pm

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