Tag Archives: VBAC

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/

Turning a Breech is a Safe Option for Women with a Prior Cesarean

5 Mar

Breech presentation occurs in 3-4% of all term pregnancies and is the third most common reason for performing a cesarean in the U.S. More than 90% of breech babies are delivered by planned cesarean section. External Cephalic Version (ECV), a procedure that helps to turn a fetus from a breech presentation to a cephalic presentation has been shown to decrease the incidence of breech presentation at term for women without a cesarean scar thereby reducing the need for a cesarean section.  However, a study published in the January 2014 issue of  the British Journal of Obstetrics and Gynaecology   suggests it is safe for women with a prior cesarean to have an external cephalic version (ECV) in a medical center. This allows women to labor for a VBAC and reduce exposure to complications from a repeat cesarean.

The researchers in Spain compared a group of 70 low risk women with a prior cesarean with 387 low risk women with a prior vaginal birth who had an external version at or after 37 weeks of gestation.  happy mother with newborn babyAll women were expecting one baby. Physicians were successful in turning a breech in 67.1% of women with a cesarean scar and 66.1% of women with a prior vaginal birth. There were no complications in the group of women with a prior cesarean. Of the women with a prior cesarean 52.8% had a vaginal birth (VBAC). More than half of the women avoided a repeat cesarean section. Of the group of women without a prior cesarean 79.4% had a vaginal birth.

The authors of the study concluded that in addition to the 270 documented cases of uncomplicated ECVs for women with a prior cesarean, their data on 70 additional women that underwent the procedure without a uterine rupture or fetal mortality indicates that ECV is a safe option for women with a prior cesarean who want to labor for a VBAC.

Concern from the medical community for the complications of cesarean section and its impact on mothers and babies is mounting. Recently the American College of Obstetricians and Gynecologists and the Society For Maternal-Fetal Medicine issued Obstetric Care Consensus Statement: Safe Prevention of the Primary Cesarean Delivery which called for physician restraint in performing cesarean sections. The guidelines offered safe directives for preventing the first cesarean including offering a breech version to women to reduce the odds for a cesarean section.

This study on the safety of external cephalic version for women with a prior cesarean adds to the existing evidence and may encourage clinicians to also offer the procedure to women with a prior cesarean who may want to labor for a VBAC.

Resources for Mothers

American Academy of Family Physicians

What Can I Do If My Baby is Breech?

Royal College of Obstetricians and Gynaecologists, U.K.,

Turning A Breech Baby In The Womb

 

 

One More Reason to Support VBAC: Fewer Maternal Deaths

24 Aug

Cesarean section is major abdominal surgery can put mothers and babies at risk for several complications.  Pulmonary embolism, a blockage in a lung artery,  is one of the leading causes of maternal mortality.  It is caused by a blood clot in the leg (deep vein thrombosis) that breaks free and travels through the blood stream to the lungs. Cesarean section is an independent risk  factor for deep vein thrombosis.

If given the option to labor for a VBAC, about 75 percent of women would give birth normally and avoid exposure to the risks of a surgical delivery.

On August 22nd ACOG issued this press release to raise awareness about the risk of pulmonary embolism related to cesarean section and published Practice Bulletin #123 “Thromboembolism in Pregnancy” in the September 2011 issue of Obstetrics & Gynecology.

New Recommendations to Prevent Blood Clots
During Cesarean Deliveries Issued

Washington, DC — In an effort to reduce maternal mortality due to blood clots—a leading cause of maternal death in the US—The American College of Obstetricians and Gynecologists (The College) now recommends that all women having a cesarean delivery receive preventive intervention at the time of delivery. The new recommendation was released today along with updated guidance for the prevention, management, and treatment of blood clots during pregnancy.

Thromboembolism—blood clots which can potentially block blood flow and damage the organs—is a leading cause of maternal morbidity and mortality in the US. The majority of blood clots in pregnant women are venous thromboembolism (VTE), usually occurring within the deep veins of the left leg. “Cesarean delivery is an independent risk factor for thromboembolic events—it nearly doubles a woman’s risk,” said Andra H. James, MD, who helped develop the guidelines. Most women who develop clots in the lower extremities will have pain or swelling in the leg. Sometimes, clots travel to the lungs causing a life-threatening condition known as pulmonary embolism. Symptoms include sudden shortness of breath, chest pain, and coughing.

“Fitting inflatable compression devices on a woman’s legs before cesarean delivery is a safe, potentially cost-effective preventive intervention,” said Dr. James. “Inflatable compression sleeves should be left in place until a woman is able to walk after delivery or—in women who had been on blood thinners during pregnancy—until anticoagulation medication is resumed.” The College notes, however, that an emergency cesarean delivery should not be delayed for the placement of compression devices.

Pregnancy is associated with a four-fold increase in the risk of thromboembolism. Clotting problems are more common among pregnant women because of the physiological changes that accompany pregnancy, such as blood that clots more easily, slower blood flow, compression of pelvic and other veins, and decreased mobility. Other risk factors include a personal history of VTE, an increased tendency for excessive clotting (thrombophilia), and medical factors such as obesity, hypertension, and smoking.

“VTE is a major contributor to maternal mortality in this country. The risk of VTE is increased during pregnancy and the consequences can be severe,” said Dr. James. The recommendations explain how to monitor women for these events, address certain risk factors, and treat suspected or acute cases of VTE. “It’s important for ob-gyns to adopt these recommendations to help reduce maternal deaths.”

The College recommends preventive treatment with anticoagulant medication for women who have had an acute VTE during pregnancy, a history of thrombosis, or those at significant risk for VTE during pregnancy and postpartum, such as women with high-risk acquired or inherited thrombophilias. Women with a history of thrombosis should be evaluated for underlying causes to determine whether anticoagulation medication is appropriate during pregnancy. Most women who take anticoagulation medications before pregnancy will need to continue during pregnancy and postpartum.

“Because half of VTE-related maternal deaths occur during pregnancy and the rest during the postpartum period, ongoing patient assessment is imperative,” Dr. James noted. “While warning signs in some women may be evident early in pregnancy, others will develop symptoms that manifest later in pregnancy or after the baby is born.”

# # #

According to a World Health Organization report on maternal mortality, in 2010 the United States ranked 50th among 59 developed countries.

In the September issue of Obstetrics & Gynecology, Howard Blanchette, MD of New York Medical College wrote an article entitled, The Rising Cesarean Delivery Rate in America, What Are the Consequences?

He writes, “In 1998 when the cesarean delivery rate was 21.2% in the United States, the maternal mortality rate was 10 per 100,000. In 2004, with a cesarean delivery rate of 29.1%, the maternal mortality rate increased to 14 per 100,000…To reverse the trend of the rising cesarean delivery rate in America, we as obstetricians must reduce the primary cesarean delivery rate, and avoid the performance of a uterine incision unless absolutely necessary for fetal or maternal indications. For women with one previous low transverse cesarean delivery we must promote a trial of labor after previous cesarean delivery…We must constantly remind ourselves, Primum non nocerum (First do no harm).

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