Preventing First Cesareans- Consumer Statement

May 14, 2014 by

Many expectant parents are concerned about the high rate of cesareans. Indeed, they have reason for concern. One in three women in the United States (32.8%) now give birth by cesarean, and the dramatic rise in the cesarean rate has not improved outcomes for women or babies.  The World Health Organization recommends a cesarean rate between 5 and 15 percent, because data suggest that rates above 15 percent may do more harm than good. Cesareans can be lifesaving when they are needed, but when they are used without a medical reason, the risks can outweigh the benefits.

In order to bring down the rising cesarean rate in the U.S., the American College of Obstetricians and Gynecologists (AGOG) and the Society for Maternal-Fetal Medicine (SMFM) released guidelines for the “Safe Prevention of the Primary Cesarean” in February 2014. These groundbreaking guidelines recommend changing many standard elements of maternity care and have the potential to dramatically improve the quality and experience of maternity care for the women of New York City and across the United States. CiC has created a summary, available for free download, of some of the key recommendations made by ACOG and SMFM so that you can discuss them with your doctor or midwife.

Ask how your doctor or midwife and your hospital or birth center are responding to these new recommendations

Preventing First Cesareans- Consumer Statement

CiC Conversation: Suzanne’s VBAC

April 28, 2014 by

In 2009, when I first became pregnant, I knew very little about pregnancy and childbirth. One thing I did know was that when you have a c-section you are (usually) awake for the surgery. Being a person who is pretty afraid of even small needles, the thought of this frankly terrified me. So I started reading every pregnancy book I could get my hands on, and I learned that one of the best ways to avoid a c-section is to have an out of hospital birth with little or no interventions, attended by a midwife. And that was the path I chose. I was going to have an unmedicated birth at Brooklyn’s only free-standing birth center. Unfortunately when I reached 16 days past my due date, I was diagnosed with low amniotic fluid, skipped right over the birth center, and went straight to the hospital for an induction. After 40 hours and every intervention under the sun, I had only reached 5cm.  The decision was made that my son would be born by c-section. This was a devastating moment for me. The exact situation I had worked so hard to avoid was now facing me, but it seemed like the only way. The surgery was not easy. It left me emotionally and physically scarred. I felt totally betrayed by my body, and I questioned every detail of the birth. Why didn’t I go into labor on my own? Why didn’t my body respond to the induction? Did I take the epidural too early? Should I have walked more? Hired a doula? Refused the induction? What if…? Compounding all of this were people who constantly said to me, “Well, you have a healthy baby, and that’s all that matters.” This was so difficult to hear, because of course it goes without saying that the health of my baby was the priority. However, I was still trying to process my traumatic experience and mourn the beautiful birth I so desperately wanted for myself and for my son. These comments made me feel selfish and guilty for being sad. I felt so alone in this deep state of grief. I had no idea that these emotions are commonly felt by women who have had unplanned c-sections.

Years later as I considered getting pregnant again I knew I wanted to have a Vaginal Birth After Cesarean (VBAC), but I still did not trust my body and was really fearful of a repeat scenario. I heard about a Choices in Childbirth VBAC workshop and decided to go. I was so inspired by the stories of success, but most importantly the midwife on the panel simply said, “If you have a low, transverse incision and the will to do it there’s no reason why you can’t have a VBAC. You can do it!” It was such a simple yet totally transformative moment for me. I left that room feeling for the first time that this dream of mine could actually be possible.

Fast forward to 2013. I was finally pregnant again and determined to do some things differently this time. I decided that home birth was the best option for me. I didn’t want to be under the looming pressure of hospital policies and time limits. I wanted a care provider who would be completely focused on me throughout my labor as opposed to being one of many blips on a screen being monitored in another room. I wanted to be in the comfort of my home where my mind and body could be at ease. I went to the chiropractor and acupuncturist. I joined ICAN (International Cesarean Awareness Network) where I received amazing support and advice. I hired a doula. And then, defying all the doubts I had about my body functioning as nature intended, I went into labor.

Our doula arrived. We made the bed. We inflated the birth pool. I had my coconut water and my yoga ball. I was ready. I couldn’t believe it was actually happening! The next thing I knew, my water broke. There was a little meconium so my midwife arrived early to see that everything was ok, which of course, it was. In the wee hours of the morning I reached 10cm and I started to push. And push. And push. And push. After 9 hours of pushing, castor oil, black and blue cohosh, a catheter to drain my bladder, walking, squatting, hanging, and acupuncture my contractions had slowed way down, and I wasn’t making much progress. The baby would get to +2 station and float back up between contractions.

We decided it was time to transfer. This moment was extremely surreal for me. I felt I had been so present in my mind and body until that point, and all of the sudden I could barely remember how to put my shoes on. Because my transfer was not an emergency we decided to go to the hospital where my midwife had privileges even though it was an hour away. Somehow I made it out to the car and through the 1-hour ride trying not to push and actually dozing off occasionally.

At the hospital I received a light epidural, which relieved the back and hip pain I had been having. My midwife started a small amount of pitocin to get things going again, and before I knew it, I was pushing again. I pushed for another 3 1/2 hours. At some point during that pushing my belly changed shape. It had been full and round, and then it was lopsided with a dip in the middle. The attending OB suspected a uterine window, but she allowed us to continue on our own with careful monitoring. The baby was incredibly strong through all of this, for which I will be forever grateful to her. When I reached +2 again they agreed to do 3 vacuum attempts to try and assist my daughter’s descent on the condition that they would do it in a double prepped OR. The OB said that if the vacuum didn’t work, I was going to c-section.

As they rolled me into the OR with the harsh, bright lights shining down on me, I thought about how my water breaking in my bedroom seemed a million miles away. The threat of c-section was weighing heavily on me. I felt like it was “now or never.” I pushed with all my might 3 times, but the vacuum was not successful. As the staff started to mill around and prep for surgery I called out to my midwife, “Wait! Hold on! Why can’t I push more on my own? I’m not done yet. I don’t want to give up on this! Why can’t I push more?” I couldn’t just let the clock run out on this dream. I felt like I still had strength and my baby was tracing beautifully. My midwife consulted with the OB and they agreed to hand over the OR to us for more pushing. I was tapping some source of power that I didn’t know I had. People started coming back in to the OR to watch me push. I think they couldn’t fathom why I wanted to continue or how I physically could. Everyone was yelling and cheering me on. My husband standing next to me could see our daughter’s head coming out, but after each tremendous push she would float back in again. After 90 minutes I looked into my midwife’s eyes, and I knew it was time. We decided to have the c-section.

It was then that I remembered a conversation I had with my doula during my pregnancy. She asked what would be most important to me in the event of a repeat c-section. I almost didn’t answer her question, because I didn’t even want to face the idea of another surgery as I thought it would completely break me emotionally. At that moment in the OR I was glad that I did answer, because I remembered to ask for those most important things. I wanted double layer sutures on my internal incision in case I ever get pregnant again. I wanted to see my daughter all bloody and goopy before they examined her. And I wanted skin to skin contact and nursing in the OR. The surgical team was incredibly respectful. All of my requests were honored without question.

During the surgery they confirmed that I did have a large uterine window along my previous c-section scar. This thinned area was disabling my uterus so much that no matter how much I pushed my little girl just wasn’t coming.

In February of this year, I returned to a Choices in Childbirth VBAC workshop. Only this time I was on the panel of parent speakers. It was an incredible moment for me to be able to share my story looking back at the faces of so many women who were standing where I once stood. I felt so privileged to have shared the most meaningful and surprising aspect of my journey – it was not the success or failure of my VBAC that determined my healing, but the fact that I gave birth on my own terms, in an environment of knowledge, respect, and love. It was a big disappointment to not achieve this VBAC, but I still feel triumphant – something I NEVER imagined feeling in this scenario. My faith in my body’s ability to birth was restored. I feel if it wasn’t for the primary c-section I would have absolutely birthed this baby on my own. I am confident that I gave it my all and so did my daughter.

 

CHOICES IN CHILDBIRTH would like to thank Suzanne for sharing her story. We welcome expectant parents to our monthly Healthy Birth Choices Workshops to join in the CiC Conversation with other parents and birth professionals. To learn more click here.

Choices in Childbirth Welcomes New Members to our Board of Directors!

April 9, 2014 by

Choices in Childbirth envisions a world where every mother and child has access to care that is safe, healthy, respectful, and deeply satisfying.  We are thrilled to announce two new board members to help us realize this vision!

It is with great pleasure that we welcome our newest Board Members,, Samantha Hillstrom and Dana Huber, to the Choices in Childbirth Board of Directors!  This is a critical moment for Choices in Childbirth and for the birth movement, at large, and we feel blessed to have such capable and passionate women helping guide this organization.

Samantha Hillstrom is a DONA International birth doula, cooperative childbirth educator (CEA/MNY), and a Communications Director for a department within a New York City medical school. She currently sits on the Board of Directors for the Childbirth Education Association of Metropolitan New York and is the founder of Lavender Labor and Birth Services. Samantha works with pregnant couples across the city and teaches evidence-based, family-centered childbirth education in Manhattan and Brooklyn. She started the only LGBTQ-specific childbirth education class aimed at providing a supportive and positive space for LGBTQ parents-to-be. Prior to her work in birth, she was an Associate Producer in primetime television at CNN. Samantha graduated from Marymount Manhattan College with a Bachelor of Arts in Communications, Cum Laude. 

samanthahillstromnyu2“It is an honor and privilege to be joining the Board of Directors for Choices in Childbirth, a groundbreaking organization for which I have the utmost respect. As a childbirth educator and birth doula, I am passionate about informing and educating people on their pregnancy and birth options. I am delighted to join such a talented and fearless team of individuals committed to improving the landscape of maternity care in New York City and across America.”

 

Dana Huber has spent her career working to elevate women’s health on state, national and global agendas. As a Senior Associate at Rabin Martin (a public health consulting firm), she currently collaborates with clients and partners to develop comprehensive programs to improve maternal health in the U.S. Before joining Rabin Martin, Dana supported the Gender, HIV/AIDS and Security program at the Social Science Research Council, where her work focused on the relationships between gender-based violence, health and human security.  Dana has a Bachelor of Arts in International Development Studies and Political Science from UCLA, a Masters in International Relations from the University of Chicago and a Masters of Public Health in Healthy Policy and Management from the Columbia University Mailman School of Public Health.

danahuber“As a passionate advocate for reproductive rights, I am thrilled to join the accomplished and dedicated Board of Directors for Choices in Childbirth. Choice should be a fundamental tenet of all sexual and reproductive healthcare services; Choices in Childbirth provides education and safe space for conversation about these issues to help women and their partners make informed decisions about their own healthcare.”

 

The Choices in Childbirth staff and Board of Directors are extremely excited about the year ahead as we continue to work towards helping families make informed choices about how they give birth. Please join me in welcoming Samantha and Dana to the Choices in Childbirth Board of Directors!

Élan McAllister

Founder and Executive Director, Choices in Childbirth


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