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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.

 

Resources

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/

If I Plan a VBAC, What Are the Odds that I’ll Have a Normal Birth?

7 Sep

There is research that tells us which women are more likely to have a VBAC than others, but we also know that having a normal birth depends greatly on a woman’s state of mind and how she is cared for during pregnancy, labor and birth.

Goer and Romano tell us that mothers and babies have healthier outcomes if their careproviders respect the natural (physiologic) process of labor. Introducing interventions only when medically necessary.

We know that mothers and babies have healthier outcomes when mothers are full participants in making decisions about how they want to give birth and when all careproviders work together to make sure that mothers and babies receive optimal care. The care that is best for them, not care that is beneficial or convenient for the careproviders or hospitals.

Simkin and Ancheta teach us that a woman’s psycho-emotional state can facilitate or complicate the progress of her labor. “ Labor is facilitated when a woman feels safe, respected, and cared for by the experts who are responsible for her clinical safety, when she can remain active and upright, and when her pain is adequately and safely managed.”

Here Is What ACOG Tells Us About the Odds of Having a VBAC

Women who labor after a cesarean have a 60−80% chance for a vaginal birth. A mother is more likely to have a vaginal birth if:

She had a prior vaginal birth before her cesarean

She has a healthy pregnancy weight

Her prior cesarean was for malpresentation (for example a breech)

She goes into labor at or near term

Her cervix has started to dilate or her bag of water had already spontaneously ruptured when she is admitted to the labor and delivery unit at the hospital

Her VBAC labor is not induced or augmented, and if

She does not have a medical complication such as preeclampsia

Other Significant Factors That Can Increase the Odds for a VBAC

Each labor and birth is unique but the way a woman is cared for can make birth easier, safer and more satisfying for mothers.

A mother is more likely to have a vaginal birth if she has freedom of movement for labor and birth. Pregnat Woman in Hosptail Using Exercise BallIf she is free to walk, change positions during labor and if she doesn’t give birth on her back. Many tried and true labor positions can help make labor easier and less painful. Hospital-based careproviders can safely monitor a VBAC labor by using a hand-held Doppler or ambulatory telemetry monitors to provide fetal monitoring so the mother can move about and benefit from comfort measures.

If a mother can avoid an epidural in early labor she is less likely to end up with a cesarean. An epidural can slow down labor and make it necessary to use Pitocin to get labor going again. It can interfere with the baby’s ability to move through the pelvis and rotate to an anterior position for birth (easiest way for the baby to be born). An epidural can lower a mother’s blood pressure to a dangerous level and affect the baby’s heart rate. We now know that with an epidural, a mother can take up to two additional hours to give birth.

With the help of labor support from a doula (continuous emotional and physical support during labor and birth), careproviders that practice evidence-based care, and maternity care nurses who are trained in a variety of non-drug options for pain relief mothers are much more likely to have a normal birth. Evidence shows that with a midwife women have more prenatal education and counseling time, fewer labor interventions, fewer complications of birth, fewer cesareans and more VBACs.

Mothers can have safer and healthier births if their caregivers support Mother-Friendly care. The Ten Steps of Mother-Friendly Care was developed by The Coalition for Improving Maternity Services (CIMS). It is evidence-based, collaborative care that supports optimal, physiologic care for mothers, babies, and families. Mother-Friendly care has been shown to improve the odds for a VBAC, reduce complications, and improve health outcomes and satisfaction among mothers and their families. Mother-friendly care is the safest and most satisfying for mothers and families.

CIMS has published a brochure for parents to help them find a mother-friendly caregiver. It’s called, Having a Baby? Ten Questions to Ask.

To Increase Your Odds for a VBAC Look for a Supportive Maternity Care Team

How do your caregivers view VBAC? With confidence or fear?

Are they giving you enough information to help you make decisions about your birth?

Are your careproviders taking the time to answer your questions? To discuss the benefits and risks of treatments, procedures,  and drugs?

What are their VBAC rates? Repeat cesarean rates? Routine intervention rates?

Are they treating you with respect?

Are they supportive of your wishes?

Do they make you feel safe?

Do they view labor and birth as a normal process?

Do they encourage doulas, family members or partners to help you when you give birth?

Are they offering you community resources that may be helpful to you?

What are your caregiver’s hesitations about VBAC? Can you discuss them so that you can labor with confidence?

If they are not comfortable with VBAC, are they giving you referrals to other providers, birth centers or hospitals that support VBAC?

If you don’t feel that your caregiver can give you full support to labor for a VBAC, are you willing to consider making a change?

Look for a Supportive Environment in which to Give Birth

žDo you have the space to walk? Sit? Kneel?

žDo you have furniture, pillows, a bed or rails to lean on?

žDo you have a squat bar, birth stool, rocking chair or birth ball?

žDo you have access to a bath or shower?

žDo you have access to light foods and drink?

žCan the light be dimmed? Can noise be eliminated?

žCan you listen to the music of your choice?

žDo you have privacy?

It may take much more time and effort than you anticipated to find the right caregiver and birth place to have your VBAC. But, it will probably be the most important work you would have done to help you have a safe and normal birth.

Resources

Pain Relief During Labour

Short Videos on Labor and Birth Positions,Birth Pool, Birth Ball

Preparing for Vaginal Birth: Pushing Past a Previous Cesarean,a webinar

Healthy Birth Your Way: Six Steps to a Safer Birth

Rebecca Dekker, Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned C-sections

Laboring for a VBAC: Why the Discrimination in U.S. Hospitals?

22 Apr

Childbirth

Childbearing women have a fundamental right to choose how, where and with whom they want to give birth, but in the United States  women who choose to labor for a VBAC (known as TOLAC, trial of labor after cesarean) in a hospital are often being denied that right. Effectively giving thousands of women no choice but to concede to  major abdominal surgery that put women and babies at risk for complications and mothers with multiple cesareans at risk for placental problems.

According to the National Institutes of Health (NIH), since 1996 about one third of hospitals and one-half of physicians have stopped providing care for VBAC. In 1996 the VBAC rate in the U.S. was 28%. Today it’s less than 10%. A report on the trends of  home vaginal birth after a cesarean indicates that denial of access to care for VBAC has prompted an increasing number of women to labor for a VBAC at home.                                                                                             Childbirth

Three out of four women who labor for a cesarean do give birth vaginally and the risks of major complications from laboring for a VBAC are less than 1%. The reason given by physicians and institutions to deny medical care for these expectant mothers have no foundation in science. Denying care for VBAC  also presents a clear conflict of interest for providers and institutions who want to protect themselves from a potential medical malpractice suit, a frequent explanation given to deny care.

Physicians who do want to support these mothers are forced to pay additional malpractice insurance premiums and are often discouraged to support women who want to labor for a VBAC by their hospital’s administration.

Here is what the National Institutes of Health say about laboring for a VBAC:

Given the available evidence, trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision.

Women who have a trial of labor, regardless of ultimate mode of delivery, are at decreased risk of maternal mortality compared to elective repeat cesarean delivery.

žComparing mothers (pregnancy with all gestational ages) with a uterine scar who labored for a VBAC with mothers who had a scheduled repeat cesarean the NIH found:

Maternal Mortality at Delivery Per 100,000 live births
Women who labored for a VBAC

3.8

Women who had a planned repeat cesarean

13

For low-risk women, the risks of laboring for a VBAC are the same as for any other woman giving birth for the first time.

According to the NIH, these are the odds of a uterine rupture in low-risk women laboring for a VBAC compared to other unpredictable complications that also require an emergency cesarean.

Per 1,000 women who labor Risk for Complications
Uterine rupture (separation of uterine scar)

7-8

Shoulder Dystocia ( baby’s shoulders are too wide to fit through the pelvis)

6-14

Placental Abruption ( placenta separates from the uterus before the baby is born)

11-13

Umbilical Cord Prolapse (umbilical cord precedes the baby’s head through the cervix)

14-62

 

The risk of laboring for a VBAC is the possibility of a uterine rupture, the separation of the uterine scar from the previous cesarean. It is a serious medical emergency that occurs in less than 1% of  VBAC labors and requires an immediate cesarean. Hospitals who deny women the option to labor after a cesarean say they cannot provide an “immediate” emergency cesarean as recommended in the American College of Obstetricians and Gynecologists (ACOG) guidelines for VBAC (Practice Bulletin #115) .

But, the National Institutes of Health concluded that there is no evidence to support ACOG’s selective safety recommendations for VBAC.  The “immediately available” recommendation was based on consensus and expert opinion rather than strong support from high-quality evidence. Dozens of maternity care organizations and individuals also objected to the restrictive guidelines.

Women giving birth for the first time are also at risk for unpredictable complications that require an emergency cesarean. However, they are not denied medical care nor are they told that the hospital cannot provide an emergency cesarean, should they need one.

The NIH encouraged leaders in maternity care and insurance companies to work together to change the status quo and give more women access to medical care for those who want to labor for a VBAC.

ACOG and the Society of Maternal-Fetal Medicine recently admitted in their Safe Prevention of the Primary Cesarean guidelines that too many cesareans are being performed exposing mothers and babies to avoidable harms without improved outcomes. Providing low-risk women medical care to labor for a VBAC can reduce their exposure to the harms of a cesarean section.

Denial of Informed Consent and Informed Refusal

Physicians have an obligation to provide women with a prior cesarean with information about the benefits and risks for both repeat cesarean and for a VBAC. Women have the right to an informed consent or informed refusal of either options based on the accurate information provided.

ACOG’s Committee Opinion on Ethics (#439) states:

Seeking informed consent expresses respect for the patient as a person; it particularly respects a patient’s moral right to bodily integrity, to self-determination regarding sexuality and reproductive capacities, and to support of the patient’s freedom to make decisions within caring relationships.  

Refusing to provide medical care for women who want to labor for a VBAC and forcing them to “consent” to a repeat surgery denies their right to bodily integrity, self-determination and the freedom to make their own healthcare decisions. It also questions the integrity of that “caring relationship.”

Physicians have an ethical obligation to provide the best care possible for their patients including the primary ethical obligation, First Do No Harm.

Many hospitals and providers have found a way to safely support women who want to labor after a cesarean. All it takes is the will to make that happen.

Resources for Informed Decision Making and Childbearing Women’s Rights

ACOG

Affordable Care Act

Childbirth Connection

Human Rights in Childbirth

Informed Medical Decisions Foundation

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