Received this email alert and thought I’d pass on thru my blog… and encourage all to take action!
It takes 5 seconds to add your name to the list!
e-CIMS Action Alert Sept. 28, 2010
CIMS Urges ACOG to Remove Additional Barriers to VBAC
Join us in asking ACOG to take steps that will increase VBAC, reduce cesareans, and ultimately avoid unnecessary harms to mothers and infants.
In a Sept. 9, 2010, letter to Dr. Richard Waldman, president of the American College of Obstetricians and Gynecologists (ACOG), CIMS and 18 co-signing organizations urged ACOG to revise its current recommendation that VBACs (vaginal birth after cesarean) should take place in hospitals where emergency cesareans are “immediately available.”
CIMS will collect the names of additional organizations and individuals in support of this request through October 31, 2010, and will send the updated list of co-signers to Dr. Waldman. Add your name or your organization’s name now!
This request follows the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC, which found that VBAC is a reasonable choice for the majority of affected women. The NIH also reported that the “immediately available” recommendation was not based on strong support from high-quality evidence and had influenced about one-third of hospitals and one-half of physicians to stop providing care for women who wanted to plan a VBAC.
CIMS and the co-signing organizations also urged ACOG to revise its patient education publications and online consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC. Without transparency about the short- and long-term benefits and risks of routine repeat cesarean and VBAC, women cannot make a truly informed choice about how they want to give birth.
Additional Information:
CIMS Press Release “CIMS Responds to Promising but Conflicting Revised VBAC Guidelines”
American College of Nurse-Midwives Responds to ACOG’s 2010 VBAC Recommendations (PDF)
Take Action: Add your name or your organization’s name now!
Submitted for the Healthy Birth Blog Carnival #6: MotherBaby Edition
Skin to Skin immediately after birth is an extremely important part of the continuum of the nurturing of pregnancy, the process of birth and the transition of nurturing from inside mom to outside mom. This is the natural habitat where baby should transition and begin his own regulations of breathing, heart rate, temperature etc… This is recognized by the AAP in their changes to the Neonatal Resuscitation Algorithm back in 2000. The recommendation was to keep baby with mom and provide all initial evaluations and steps with baby on moms chest for all healthy babies! We all know that babies have an inborn innate ability to self attach and nurse right after birth. These recommendations are not just for vaginal births. Kathy Petersen has a beautiful description of the importance of STS after a Cesarean birth on her Woman to Woman Childbirth Education blog in her 5/30/10 post Skin-to-Skin in the O.R. after a C-section.
As soon as I heard about the last edition of Science and Sensibility’s Healthy Birth Blog Carnival with a theme about “keeping moms and babies together after birth”, I wanted to write about my tiny little efforts, struggles and some successes in providing moms and babies with an environment that supports and protects their need to stay together. My recent role in the protection of such an environment and subsequent privilege of watching a baby self attach in the OR 15 min after a C/S birth has re-energized my efforts to get more mother’s and nurses to speak up and make this a standard for healthy babies!
Then….. I saw a link on Laura Keegan’s Facebook fan page for her book Breastfeeding with Comfort and Joy to an awesome video and a beautiful photo posted by the author of Cesarean Parents Blog about her birth. I had heard of Laura’s search for images of STS after C/S and asking for mother’s experiences. Amy Romano from Science and Sensibility alerted Laura of the photo: Kathy blogged about STS after C/S and I was working on this post! Such uncanny timing! I am just in awe of this marvelous networking community! Head over to Laura’s facebook link and share your experience for her info gathering. Here is the fabulous video they are all talking about “Breast is Best” from Norway:
Why is it so hard for the doctors and nurses to get on board?Most of them understand the word “bonding”. But what many don’t realize is that it took a long time for the actual concept to take hold, to allow “time” for bonding to occur. It sounds silly but many times if the baby and mother are still together after 2 hours…the nurses call that “extended bonding”. I have been doing this for over 35 years now and the changes from the 70’s to now are fascinating and frustrating at the same time. To understand the process of change, we have to sometimes remember where we’ve been. I wrote about Medical Science vs Natural Childbirth a year ago because I feel history IS important to help us move forward. Often it is about control… but many times nurses and doctors are simply task oriented/focused and not patient centered. They want to complete all their procedures and charting and move on to the next task. I understand this, there is always a lot to do and document. I work there too! The environment provided to us, the health-care workers, is one in which regulations are abundant and staffing is not always optimal. Flexibility is needed. I know there is a way. This culture just has to change. And it happens in small little doses.
SO–> Skin to Skin immediately after a C/S? I have been told by coworkers, doctors and anesthesia:
“It’s impossible, “
“It can’t be done”
“There’s not enough room”
“This patient (the mom) is in the middle of major surgery!”
“The baby needs to be under the warmer, it’s too cold in the OR.”
Really? Seriously? Watch Me………
I have actually been working on this issue for the past few years…… Ever since I began staff education for World Breastfeeding Week 2007′s theme “Breastfeeding: The first hour — Welcome Baby Softly”. The focus from ILCA was: ‘Establishing a welcoming environment that keeps mothers and babies together.’ It was then that I gently tried to introduce the concepts for C-Sections as well as all vaginal births. I was getting a lot of positive response for vaginal births…not so for C/S.
Anesthesia is our biggest barrier. The chest area of the mother seems to belong to them somehow. The arms too.. I always politely ask the doctor for permission to have at least one arm released so she can touch her baby. (they are secured on armboards to her sides.) Really the OB’s didn’t mind what was happening outside of their draped domain. The Pediatrician is the next barrier because they want to finish a complete exam…. in the nursery…. before they returned to the office or whatever. So I started with the Peds… hoping they would stop expecting the baby to be quickly removed from the OR. I started with just simple requests for prolonged “bonding”… because they all get that. “Look how well this baby is transitioning.. so alert and PINK! ” “I’ll write all the measurements in your exam note…. I’m fine… I know you’re busy….” I’d say. Sometimes mom and baby got to stay together. Soon, for some of the doc’s, the expectation of baby leaving mom was gone. They got tired of waiting around and would leave. More moms and babies got to stay together…even if it was dad doing the holding. My co-workers were not always so understanding because of the work flow on the unit. It would work best when the birth happened any time other than first thing in the morning when it’s busy everywhere. Isn’t that sad? Sitting here writing this I’m thinking of ways to work on that….. another time…..
Anesthesiologists or Nurse Anesthetists are all different. There are some wonderful ones who are releasing both arms and pushing things out of the way for the baby and others who are constantly telling moms they are “under” anesthesia and can’t hold the baby, or they have given meds to mom right after baby is born so mom is now groggy. I talk to each of them respectfully and differently depending on their own approach. I have discussed my plans for STS if baby stable ahead of time. I have discussed how it is up to us to provide this protected environment for moms etc… I have used the patient satisfaction discussion, the scientific evidence discussion, the patient centered care discussion, and the increased patient numbers due to higher satisfaction talk. I have let them know that when a mother requests that–> we must do everything possible to help her experience this.
Slowly, over the last few months, I was able to facilitate some babies really getting skin to skin in the OR for short periods before going to the nursery. There were a variety of factors for why it wasn’t very long each time but at least it was happening!! It’s not a standard of care yet and I’m the only one working on it but others are getting interested… Communication has been very important to create the environment and reduce barriers. We still have a long road ahead. But we did pave a path for this mom….
She came in with an unknown double footling breech presentation in active labor and the doctors wanted to do a C/S right away. She was really upset and had a beautiful birth plan that was already getting discarded. “STS until first breastfeed accomplished” was on her plan and I was determined to help her with that! Things were happening fast. The anesthesiologist wasn’t my best STS supporter.. “oh well” I thought, “I’ll do what I can to help.” The baby was crying and pink when born and without thinking about it, the doctor, nurses and myself had him on the baby unit drying him. Mom went panicky! “Give him to me, give him to me! He has to be ON me! You just took him OUT of me, now he HAS TO BE ON ME!” She was literally trying to sit up. Anesthesia was drawing up meds for her (that was his answer). I said “OK here he comes!”. So I didn’t ask anyone’s permission this time….. just held that naked baby in one hand, snapped open her gown with the other and helped him move in. I asked for a warm blanket and looked up to see the other nurse and doctor staring at me. I said “Seriously… she’s exactly right, he does belong ON her!” Anesthesia saw the immediate transformation of his frantic patient to one with calm maternal bliss, admiration and cooing. He was then helpful to let her other hand out. This little boy stayed with mom, breastfed before he was 15 min old and went to the PACU with mom. She was so incredibly happy. I never got to see her after that since it was near the end of my shift and I wasn’t on shift the next few days. I saw that she exclusively breastfed in the hospital and without complication went home on day 3. At least part of her birth experience went according to plan!
If she hadn’t have been so vocal about what she wanted, so adamant… she would not have experienced what she did.
SPEAK UP AMERICA…. MAKE IT HAPPEN
Want to see more? This stunning video of a baby skin to skin then breastfeeding at birth in the operating room via @MothersUtopia @Laura_Keegan. What were your experiences? Please don’t forget to head on over to Breastfeeding with Comfort and Joy on FB to comment on your experience or opinion about this important topic!! Calling for women to share their experiences with skin to skinhere, to help give a voice to the real need to make skin to skin in the OR routine practice in all ORs.
In the world of childbirth, Mother’s Day is a very special day. I have enjoyed years of watching a women become a mother either for the first time or again and again on this very day. It is always wonderful to share that experience with them. Fabulously Joyful!
But today, I get to be home, pampered by my hubby and just milling about… I came across some wonderful websites carrying fabulous vintage engravings and various clip art. I absolutely adore antique engravings! I have some framed and others saved for something I’ll get to one day… 😉
This first few photos above are images courtesy of antiqueprints.com depicting mother and children. There are two WONDERFUL Antique Breastfeeding Engravings! These are all steel engravings with hand color in the first two.
The remainder of art below is from a website called “The Graphics Fairy” and all of these photos are to Karen’s credit over there. Beautiful!
Enjoy!
Victorian "The Mother" engraved by the Illman Brothers
Spreading the word from the NIH VBAC conference….It’s now coming thru via AWHONN Vitals!!!
This is at least a month old news to most birth junkies but….. but I find it encouraging that the news is coming thru from AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses). There are many many nurses and birth professionals out there that haven’t even heard about this conference. I know the big AWHONN convention is coming up in Nashville June 12th, and possibly this topic will be presented somewhere although late to get on agenda. Sometimes the nurses can help educate the docs…… ya think?
One topic on the Nashville Agenda is:
“SOLUTIONS FOR SURVIVAL: Working where Birth is NOT Considered NORMAL”
“Panel Urges New Look at Caesarean Guidelines”
The New York Times, Denise Grady
A government panel recently took steps that will increase women’s ability to find doctors and hospitals that will let them attempt a normal birth after a previous caesarean section. The recommendations came from a panel at a National Institutes of Health (NIH) conference convened to assess why the rate of vaginal birth after Caesarean section (VBAC) has gone from 28.3% in 1996 to less than 10% today. The repeat surgeries are contributing to the growing rates of C-sections in the U.S., which today account for nearly a third of all deliveries. Repeat C-sections were previously deemed safer due to concerns that the uterine scar would rupture, putting both the mother and the baby at significant risk. According to the chairman of the NIH conference, “We found the use of VBAC is certainly a safe alternative for the majority of women who’ve had one prior” C-section, as long as the incision was horizontal and low on the uterus. Approximately 70% of women who have had C-sections are good candidates for attempting a normal birth, and 60% to 80% of those who try succeed. The government panel urged the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists to “reassess” their guidelines, which have rendered many clinicians and hospitals unwilling to allow VBACs. The groups’ current guidelines require that surgical and anesthesia teams be “immediately available” during labor if a women has had a prior C-section. Some institutions were unable to comply, and thus banned VBACs altogether. Link to Article
I haven’t ever sat through a whole episode of The Office…. maybe that’s why I didn’t ever really like it. Perhaps I just didn’t “get” it! This is a smart and funny show. Last night, they had a large viewing audience and great forum to send a positive message to America. They delivered… in a big way! This was a planned hospital birth so I am mentioning what I thought was positive about the reality of how this was portrayed.
Here’s what I liked:
Insurance issues … very real for some and guides some of parents decisions
Calm approach to early labor …no need to rush to the hospital with first contraction
Could be that she just wants another night in hospital but still comes off as a calm early labor
Many people in the Office were crazy & nervous except the mom –Pam
Pam feasts and enjoys the food while contracting..nobody said you better not eat!
I don’t think ever I heard epidural or C-Section mentioned!! (YAY)
Dwight decides he wants a baby and makes a contract including the “baby will be breastfed for the first 6 months” after-which he plans to feed some weird stuff but HEY… at least he indicated exclusive breastfeeding to start…right?
Pam still doesn’t want to go to hospital when her water broke
She showed a real but pretty brief fear of really “doing this” and becoming a parent
She didn’t have her ipod w/ birth music.. but this showed she was really planning and preparing for her birth
Pushed her baby out! YAY
I don’t think I EVER heard epidural or C-Section mentioned!! (I know I already said that but still— 🙂 No talk of interventions!)
Breastfeeding was the NORM in this episode! I did not SEE a bottle even though it was mentioned. The roommate was ALSO breastfeeding!
Trouble latching in the beginning is a common situation… It didn’t stop Pam
THE NURSE! Oh. My. God.!!! What a TRUE portrayal of the inept ignorant rude comments made by the nursing staff at many many hospitals!! (even mine.. but I’m working on that) Good for Pam to question her and stick her plan.
A male Lactation Consultant!
The fact that they used a Lactation Consultant…. YAY!
Great support from new dad Jim… even though it was funny how his facial expressions were not supportive of a male lactation consultant! (did we see the birth attendant? don’t remember)
They reach over in the middle of night and grab the wrong baby to breastfeed… I’m sorry—> that was really funny, I hope it didn’t offend any one. It’s not like a nurse gave Pam the wrong baby……
They have common new parent issues ie diapering, car seat, not feeling ready to go home etc…
Breastfeeding works out at the end of the show and Pam looks incredibly peaceful and happy… 🙂
The funky cover –> hey..it worked for her so really–who cares..?? I didn’t feel like that was a big part of the overall message IMHO.
My rating : Big A+
After the show– I find out via twitter that I actually know the writer and supervising producer! So cool!
(I work with his father who is an excellent Pro-Breastfeeding Pediatrician!)
😎 Psych 😎
What did you think?? The episode is called “The Delivery”. If you haven’t seen it, you can catch it online here.
I have been very very busy over these past months and I’ve spent very little time on the computer….. many of you have had the same situation. Thanks to all of you who keep checking my blog anyway!
I’m here now to talk about one of my big concerns.
Your due date…
Every single year around the holidays, we have a surge of elective, social induction requests. Here are some comments we occasionally may hear each year around this time on an L&D unit:
“Please, please induce me so I can have the baby and be home for Christmas…please!”
“I’m only 2 1/2 weeks from my due date anyway so I’m ready…”
“I can’t have this baby on Christmas day..I just can’t…you HAVE to help me!!”
“I’m so tired of being pregnant and I have so much to do…can’t you do SOMETHING and make me have this baby today??” (37weeks)
“I really really need another tax deduction this year… ” (heard quite often!)
“Please do something so this baby is born by the end of December…I’ll even have a C/S if you want.”
“Can you induce me while my family is all here?? Please??”
Young pregnant women~ Please don’t do something crazy for a special delivery date.
Please!
Please educate yourself about the risks of induction and the risks of late preterm births.
PATIENCE
“A little patience now adds up to long-term health benefits for your new baby.”
I have received this following information from the Mother-Friendly childbirth community.
Please read, check out their website link above and the other resources listed below the letter.
Thanks so much!
“For Expectant Families
What you need to know about your due date and late preterm birth
A little patience now adds up to long-term health benefits for your new baby.
You’re not alone if you’re secretly (or openly!) hoping that your baby will get here sooner rather than later. But when it comes to your due date, it’s important to understand what it represents, what it does not represent, and the potentially serious consequences of agreeing to an induction or c-section before your baby is ready to be born.
Mayri Sagady Leslie, CNM, MSN, clinical faculty at Yale University School of Nursing, recently penned an insightful post for Lamaze International’s Science and Sensibility blog. In “Beyond Due Dates: How Late is Too Late,” we’re reminded that, despite widespread belief that EDD stands for ‘due date’, it actually stands for ‘estimated date of delivery’! Mayri writes, “No matter what you call that date on the calendar, it is nothing more than a formula derived from statistical averages which says that sometime within a range of 4-5 weeks your baby will probably be born. Smack dab in the middle of that range is one of days on which the labor may start. Yet when it comes to dates in our life, few take on more significance than this one.”
Appreciating this fact is something of considerable consequence when it comes to the immediate and long-term health of your baby. There is mounting evidence that only the baby should have the right to choose her/his birthday. Two recent reports add to this evidence.
The CDC’s National Center for Health Statistics recently reported a 20% increase in the nation’s late preterm (34 to 36 weeks ) birth rate from 1990 to 2006. The report also cites alarming increases in the number of late preterm births among births for which labor was induced as well as among births that were delivered by c-section. The report cautions, “…it is becoming increasingly recognized that infants born late preterm are less healthy than infants born later in pregnancy. Late preterm babies are more likely than term babies to suffer complications at birth such as respiratory distress; to require intensive and prolonged hospitalization; to incur higher medical costs; to die within the first year of life; and to suffer brain injury that can result in long-term neurodevelopment problems.”
For the March of Dimes, prematurity is an extremely important public health issue. The March of Dimes launched a multimillion dollar, multiyear campaign in 2003 to prevent premature birth and raise awareness of its serious consequences. Last month, the March of Dimes released its annual Premature Birth Report Card. Sadly, for the second consecutive year, the U.S. earned only a ‘D’ grade, “demonstrating that more than half a million of our nation’s newborns didn’t get the healthy start they deserved.”
We know you’re anxious to meet your baby. It’s perfectly understandable too if you’re just plain tired of being pregnant. We just want to remind you that a little patience now adds up to long-term health benefits for your new baby.
I haven’t disappeared… I’ve just been too busy outside for computer time!
This is a copy of a letter I received today trying to
spread the word
about Prematurity in this country……
Today is the release of the second annual Premature Birth Report Card, and I wanted you to hear the news from me: America receives a “D.” As a country, we are failing to give our babies the healthy start they deserve.
Your state has received its own report card. I’m afraid you’ll agree we have a long way to go. In fact, before the end of this year, more than half a million babies will be born too soon, some very sick.
It’s Prematurity Awareness Day® — the day when we’re all focused on the terrible toll of premature birth on babies and families. The report card reminds us how urgent the problem is. But with the support of people like you, we can continue to fund lifesaving research and programs.
If you haven’t already, I hope you’ll visit our Web site and join the fight for preemies.
I had checked out a post by Jill from Unnecesarean reviewing ICAN’s Press release on the rising Cesarean Rate and how mom’s really don’t realize or recognize how they can reduce their risk for a surgical delivery. It is very good informative post. It’s just totally shameful and pathetic that one third of our nation’s babies are brought in to this world with a surgical delivery! I’ve been present for thousands of births. I remember when the doctors were under pressure to keep their C/S rates down under 20%!! They had to go under peer review when they hit individual rates over 16%. Those days are over.
I have seen many different changes in the field of obstetrics, I am embarrassed that our national rates are now this high! I don’t feel that this is an advancement in maternal fetal obstetrical care. It feels like such a cop out most of the time when you are there in the trenches experiencing the “call” for a C/S time after time for “failure to progress”; “failure to descend”; “arrest of dilitation” etc…etc..
I came across the perinatal statistics and thought I’d share.
Here are our Actual Cesarean Section Rates so far this year January thru September
for nearly 750 births:
Total C-Section Rate = 25.8% (monthly range 16.9% to 34.4%)
PrimaryC-Section Rate = 16.4% (monthly range 12.5% to 23.6%)
Primary Rate in labor = 13.4% (monthly range 8.9% to 20.0%)
Our average is about a quarter of the births falling below the national average of a third… for now. Can we keep this up?? I hope so. I really hope so. I hope we can even lower it! With a NICU coming in and sicker patients to go along with that… I am hopeful to just keep it where it is. I will do my best to help educate women, co-workers and the doctors I work with.
For the March of Dimes, prematurity is an extremely important public health issue. The March of Dimes launched a multimillion dollar, multiyear campaign in 2003 to prevent premature birth and raise awareness of its serious consequences. Last month, the March of Dimes released its annual Premature Birth Report Card. Sadly, for the second consecutive year, the U.S. earned only a ‘D’ grade, “demonstrating that more than half a million of our nation’s newborns didn’t get the healthy start they deserved.” 
I had checked out a post by Jill from 
TheFeministBreeder
StorkStories..... 