ACOG Smartens Up While DONA Throws Baby Boys To The Wolves...

I know. Has the world gone mad?! You read the post title right. I woke up this morning to find a published position from ACOG that discourages elective inductions and cesareans overall, and especially discourages either for macrosomia (big baby). Whaa??

Here are a few highlighted quotes from ACOG's statement:

“Let nature take its course.” Over the years, I’ve found this saying particularly applies to the process of giving birth. My personal experience as an ob-gyn and reams of scientific research demonstrate that Mother Nature knows best when a child is ready to be born."  - James Breeden, President of ACOG

Wait. Did you read that too? He said to let nature take its course. Sadly, I fear that these words are going to fall on the deaf ears of women who will still believe, due to long-time conditioning by Obstetricians themselves, that as long as baby is "term" then baby is ready. The funny thing is, state medical boards are ALL OVER regulating Midwives, citing the safety of women and babies as the reason. Where has the regulation been with Obstetricians who are happy to perform elective inductions and cesareans, which put baby's life at higher risk than home birth does? Where is the outcry for public safety?

Okay, okay...I give ACOG serious credit for taking a stance on this again. Yep, ACOG has long since discouraged elective anything, in favor of labor starting naturally. But, it seems that Obstetricians have not been held responsible when they do otherwise. Here's another quote from an article on Improving Birth:

"For one, induction or surgery for “suspected big baby” (macrosomia) is not medically indicated. This is one myth we hear about all the time, even though ACOG has been talking about the “imprecise” nature of diagnosing macrosomia for at least ten years. Bottom line: induction for big babies is NOT medically indicated.

Elective inductions prior to 39 weeks gestation is, again, not recommended. Studies have shown that babies do better when they are able to remain in utero until 39 weeks. In the article above, ACOG sais, “Early-term infants have higher rates of respiratory distress, respiratory failure, pneumonia, and admission to neonatal intensive care units compared with infants born at 39 to 40 weeks gestation. Infants born at 37 to 38 weeks also have a higher mortality rate than those born later." - Dr. Capetenakis, OBGYN in Encinitas, CA

So again, I have to ask where the accountability is? I am very excited that ACOG has published this. However, I am skeptical that all of a sudden Obstetricians will start practicing evidence-based medicine when it is more profitable for them and the hospital in which they have privileges to keep doing what they've been doing. And going back to the factor of women in all of this - it's going to take a LOT of effort if there is ever going to be a hope of women waking up and realizing that being uncomfortable is better than putting their baby at risk.

I was recently told a story. A friend of a friend is a L&D nurse. She kept saying that she was not going to term. She got a stomach bug at 36 weeks, contracted from the vomiting, and went in to L&D. Even though it was not causing any cervical change, she decided it was just time to get baby out. Because she was 36.6 though, they waited until just before midnight to induce, because otherwise it was against hospital policy. But she went ahead with it, with an epidural in place before the induction was started. Kept saying that she KNEW she wasn't going to term. After the delivery, she told everyone about what a blessing it was that she was in the hospital (and not at home, like my crazy friend) because baby ended up having complications.

I will keep my comments to myself here, because they aren't nice. They even include much foul language. But THIS - THIS is the type of system that women are in. The one where it's perfectly acceptable to choose to rip your baby out of the womb, just because you don't feel like being pregnant anymore. The one where it's perfectly acceptable for Obstetricians to manipulate, coerce, and even FORCE women into intervention, procedures, and consent when they had previously denied consent. My heart is heavy in knowing that we have a loooong way to go.

I also woke up this morning to a find that DONA (Doula certification organization) has published an article in their magazine that is in favor of routine infant circumcision.

"A family's decision about circumcision should come from personal values. Religious and cultural reasons usually win out over all other arguments. Otherwise, you can make the case that circumcision is mainly a cosmetic procedure, with some potential medical benefits. It typically takes less than five minutes, and complications are very rare."

:scream:  Actually, the medical need for a circumcision later in life is less than the risk of DEATH from routine circumcision. Complications are not, "very rare". From Dr.Momma.org:

Out of 100 Circumcised boys:

75 will not readily breastfeed post-op

55 will have adverse reactions from the surgery

35 will have post-op hemorrhaging to one degree or another

31 will develop meatal ulcers

10 will need to have the circumcision surgery repeated to fix prior surgical problems/error
8 will suffer infection at the surgical site

3 will develop post-operative phimosis

2 will have a more serious complication (seizure, heart attack, stroke, loss of penis, death)

1 will require additional immediate surgery and sutures to stop hemorrhage

1 will develop fibrosis

1 will develop phimosis

1 will be treated with antibiotics for a UTI (urinary tract infection)

1 will be treated with antibiotics for surgical site infection

Of those who do receive pain medication for the surgery (about 4% of those boys undergoing circumcision in the U.S.) some will have adverse reactions to the pain medication injected

Out of 100 Intact boys: 

2 will be treated with antibiotics for a UTI (fewer if the foreskin is never forcibly retracted)

1 will be told to get cut later in life for one reason or another (fewer if the foreskin is never forcibly retracted)

Note: One reader of these statistics (a man cut against his will at birth with 4 intact sons today) critiqued (quite accurately) that it is actually 100 of 100 circumcised boys who experience negative consequences as a result of circumcision. Each and every one has lost an organ responsible for a great deal of his life-long normal health and functioning.

DONA is taking a defensive stance, saying that the article does not reflect the organization's belief as a whole. If that's the case, I wonder if they would allow a guest post about elective inductions and cesareans being a perfectly acceptable choice? Or, as Gloria Lemay put it to them, what about an article endorsing the cutting of females? They have now pissed off a whole lot of people. Personally, I'm not a fan of DONA. Or of any organization, really, that capitalizes on making labor-support a certified position. I've always found that to be completely and utterly ridiculous, especially when said organizations are clear in restricting many Doulas from attending women who choose to birth unassisted, and who have made it a thing of status and income in disproportionate ways. And, as I have heard Nancy Wainer speak about the atrocities that occur in hospitals every day, and the doulas who stand by and are essentially part of the rape and injuries that happen, by holding the woman's hand and telling her that "it's okay".

But this is really a low point for DONA. Another quote from the doctor who wrote the article:

"Often dads have strong feelings about circumcision, so fathers should definitely be included in the decision-making. If the parents care about their son looking different from other boys in the neighborhood, they may research the rate of circumcision in the area." 

Right. Forgot about teaching our children that they need to look like everyone else. Except for the fact that intact is, right now, the majority. Does this apply to girls in the neighborhood who have smaller or larger breasts than average? Should we encourage breast enhancements or reductions in order for our daughters to not be made fun of? Should we start young children on contact lenses so that they will not be made fun of for wearing glasses? What about those who need to wear braces? What about children with Autism and Downs Syndrome? Should they be hidden from the general public so that they never face teasing?

This is a really shitty reason to permanently alter an infant's body without his consent. Period.

Another gem:

"But once they decide, they should be encouraged not to drive themselves crazy with second guesses - in the long run, it will probably be fine either way." - Marjorie Greenfield, MD. 

Yes. We wouldn't want parents to consider the gut feeling that they may be doing the wrong thing. After all, that's lost money! Err, I mean a child who might be ridiculed by his peers! I'm sorry, am I the only one seeing dollar signs here?!? Am I the only one seeing, "Doulas, keep your mouths shut. Do not encourage in-depth research into circumcision."?

Shame on you, DONA. Shame on you for allowing an article of this type in your print. Shame on you for essentially agreeing with the idea that Doulas should NOT be encouraging parents to keep their sons whole. I'm not sure it's possible, but I'm less of a supporter now, than I was before. You just made a joke of your entire organization.

Midwifery Under Attack in California

After serving not just women, but women who need Midwifery care the most for 22 years, Brenda Capps was arrested in California for "Practicing Medicine Without a License". However, she did no such thing. She didn't break any laws. She never perpetrated herself as anything but what she is - a Traditional, Christian Domiciliary Midwife. She had every single one of the families under her care sign a religious exemption that outlined the fact that she was NOT licensed by the state of California, and that she is practicing the ART of Midwifery, not medicine. Most families chose her because of her calling to not be licensed, not in spite of.

The Licensed Midwifery Practice Act of 1993 states that it is a misdemeanor (not a felony, as she has been charged with) to perpetrate oneself as a Licensed Midwife when one is not. Brenda never did this. She was flagged and warned to stop practicing after she was named in another case against a Midwife a few years ago. She upheld her commitment to her families, and agreed to be the Midwife of a couple who was undercover, posing for the Medical Board. That's it. No one died. No one reported her. Brenda's record is IMPECCABLE!

The medical board is saying that women are too stupid to choose a safe care provider. The irony here is that women in CA have had far more injury, permanent consequences after births with fully licensed Obstetricians than ever with Brenda in 22 years. She has a safety record to rival MOST Obstetricians, when comparing her clients to an OB's low-risk patients.

If this pisses you off, and it should, please sign this petition. The hope is to reach at least 2,000 signatures (we're almost there!) and take it to the Governor's office. We want to show them that WOMEN should have the right to choose their care provider. As of right now, the Medical Board is shuffling their feet. They know they don't have a case. Court dates have been cancelled because of this, and Brenda hasn't even been formally charged yet! This is nothing more than a circus.

Please sign it. Please share it. Pass it on!

Petition to the Medical Board of California - Brenda Capps 

St. George Home Birth Article and My Response

This article came out online yesterday. I take issue with much of what is said in it, and even the picture of the Midwife holding baby while mom is nothing but a blur in the background. One thing that I have learned is that I have to fight to be seen as credible. I do this by knowing what the research says. Writers and Obstetricians need to be held to the same accountability. 

Mothers, midwives, physicians reckon with home birth options

My Response: 

Dear Alexa Morgan,

I recently read your article about home birth in Southern Utah, and find myself asking where the research is. I am a Home Birth Midwife here in St. George – one with a zero transfer rate in labor – and a birth advocate. I see that you mentioned a study that was released, highlighting why some women might choose to birth at home, but then you erroneously stated:

“A myriad of studies have been conducted on the risks of home birth versus hospital birth with no conclusive results, due mainly to the low percentage of babies born at home.”

Yes, many studies have been done comparing home birth to hospital birth among low risk women since the 1970s. In fact, there have been 17 studies in the last 15 years alone. Even more when you include the number of studies done outside of the U.S. which shows better outcomes over all, outside of the hospital. But they all have one thing in common: They all show, very conclusively, that not only is home birth just as safe as hospital birth but that there is a much lower incidence of maternal morbidity when birthing at home. Fewer unnecessary interventions such as induction/augmentation of labor, artificially rupturing the amniotic sac, delivering in the lithotomy position, episiotomy, and instrumental deliveries lead to much better outcomes on the level of injury to mom and/or baby. 

While I have had nothing but an amazing professional relationship with several Obstetricians in town, and while I thoroughly respect Dr. Fagnant for the positive changes that he has made within the labor and delivery department of DRMC, I disagree with a few of his statements. 

There is no research to back up his blanket statement of which conditions preclude birthing at home. While there are most definitely situations and circumstances that may preclude a woman from birthing at home with a Midwife, it is not evidence-based to simply state: 

“Any woman who has an illness, has had uterus surgery, is before or after their (due date), (is carrying) multiple babies, a large baby or (breech) baby should not deliver at home,”

It entirely depends upon which illness he speaks of. One cannot simply state that any women with an illness should not birth at home. While there are certainly illnesses that would necessitate a hospital birth, some chronic illnesses may not require it. Some conditions that might require hospital birth would be uncontrolled, insuline dependent diabetes; illness with medications that caused abnormalities in the fetus; certain heart conditions, etc. 

As a mother who has had a VBAC (Vaginal Birth After Cesarean) at home, as a woman who has been researching VBAC for the past seven years, and as a Midwife who fully supports women who have had prior cesarean surgery, I also disagree that this precludes women from birthing at home. The research shows us that the main risk associated with VBAC is uterine rupture, and this occurs in 0.3-07% of VBACs. Less than other emergencies, such as cord prolapse, that would necessitate immediate hospital transfer. With a care provider who knows the research, who is experienced with VBAC, and who isn't afraid to transfer if anything seems to be off, VBAC at home can be very safe and continues to be a reasonable choice. For many women, it is the hospital or physician protocol which puts them in the position of choosing to birth at home after a prior cesarean. Some hospitals have banned VBAC altogether. Most have certain criteria for VBAC labors that must be closely followed. Sadly, many VBAC hopefuls find themselves in the operating room again, and know it was avoidable. 

As to his statement about not birthing at home if you are before or after your due date, again I ask where the research is. Any skilled Midwife that I know would not attend a woman at home who is less than 36/37 weeks gestation. However, 37 weeks is full term and is normal for some women. For others, it can be completely normal and a part of their maternal history to gestate until 42/43 weeks. With proper monitoring, research shows us that expectant management is completely acceptable in terms of risk/benefit. Many women do not understand that normal gestation length is 38-42 weeks. Most believe that they are "overdue" and at risk beyond 40 weeks. This is simply not true. 

Twins and breech babies can also be birthed at home without complication, with a skilled care provider. A Midwife who is experienced with multiples and breech knows what to look for in risk assessment, and knows which women should be in the hospital and which are safe to deliver at home. In the hospital, moms of multiples or of breech babies are often limited to cesarean surgery. Or may be allowed to birth twins vaginally, but in the operating room. Understandably, some women don't want to spend this most incredible and life-changing event in a cold, bright operating room with the thought of surgery being so close. 

As a mom of ten pound babies, I am concerned with the blanket statement that women carrying a large baby should not birth at home. Weight is not nearly as relevant as head circumference. So much is misunderstood about the ability to birth babies of all sizes, particularly when there are no abnormalities causing the size of baby. There are things that make a dramatic difference in the ease of birthing a large baby. Mobility, ability to get into different positions that open the pelvis more than the semi-sitting or lithotomy position, and patience. Most often, these things are not available in the hospital. While there are wonderful Obstetricians who are thoroughly researched and are willing to offer these things to women, it is more the exception than the norm. One also takes into consideration that it is the structural size of the baby that matters, not how many pounds the baby weighs at birth. I have often heard of care providers stressing induction of labor at 40 or 41 weeks because, "The baby looks to be getting quite large.". However, the baby's structural size does not change between 40-42 weeks. For example, my 10lb 10oz VBAC baby, who was born onto my bed at home, had the same exact head, shoulder, and chest size as my friend's 8lb baby. It is simply not evidence-based to say that all women with a large baby should not birth at home. 

I can completely understand Dr. Fagnant's concern with the transfers that he sees each month. I am concerned with particular things as well, regarding the health and safety of moms and babies at home. There are certain practices and beliefs in our community which have caused incredibly concerning transfers. I know that sometimes all care providers are lumped together, and I find this particularly true of the reputation of Midwives as a whole. But it is damaging for Dr. Fagnant to mention transfers, and then mention the deaths that he has seen in his time as an Obstetrician. An Obstetrician is simply going to see more death than a home care provider, because Obstetricians deal with not only higher risk pregnancies, but also have much higher rates of intervention in labor. Obstetricians deal with things like labor-inducing drugs which have side effects - including death - to go with them. They deal with emergencies that are more prevalent with intervention, such as cord prolapse, hemorrhage, and embolism. 

So many aspects of pregnancy, labor, and birth are misrepresented and risks are inflated. Unfortunately, most people are less likely to do research than they are to take an authority figure's word as gospel. The concrete research is there. It is vitally important for families to thoroughly research their options in childbirth, and their potential care provider. But there has to be balanced information based on empirical research. 

http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies

http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies http://www.cmaj.ca/content/181/6-7/377.abstract

http://www.bmj.com/content/330/7505/1416.abstract

http://www.ncbi.nlm.nih.gov/pubmed/9271961?dopt=AbstractPlus

Honesty and Ethics

One thing that I value probably far above most other things in my relationships (spouse, family, friends) is honesty. Due to some emotional events when I was a teenager, I developed the inability to put up with bullshit. And yes, I cursed. I won't apologize for the word used, because it fits this all too well. One thing that I cannot tolerate is dishonesty, manipulation, or flat out underhandedness.

If you're an adult - for crying out loud, act like one. If you don't want to get caught in bad behavior, in a lie, in treating a friend in a really crappy way, or lying about your "competition"...it's simple. Don't. Do. It. Don't lie to avoid having to take responsibility for your words or behavior. If you're going to say or do something, make sure it's something that you can stand by.

I fully admit that sometimes I speak badly about people. Sometimes I'm not so nice when I see someone else treating people badly, or I see stupidity spill out into one's behavior. However, I only say things about people that I would say directly to them. And no, that's not a justification for speaking badly of someone or gossiping. But I'm human. And I make sure that I can take responsibility for my words and behavior if/when I get called out on it.

This is called being a big girl.

I also have the inability to pretend that everything is okay when it's not. I have seen memes on the internet which say that it is the adult thing to do (and it not being fake), but while I can be civil and professional, I cannot pretend like things are honky dory if you've treated me like crap. And especially lately with my experience of calling people out on behavior towards me, and flat out being lied to. I know the truth. You know the truth. You know I know the truth. And yet, you still lie to me. All to avoid further confrontation and acceptance of responsibility for really crappy behavior. Really?!

I recently found out that a Midwife in town - Elizabeth Camp Smith - has been telling women that I am UNTRAINED, DANGEROUS, and INEXPERIENCED with VBAC. This is 100% untrue. I have the proof to back up the fact that I am trained (and trained by the best!) in a wide variety of birth possibilities - like VBAC, twins, breech babies, hemorrhages, shoulder dystocias, etc - and I have the references of former clients, both VBAC and non alike, to back up my experience. I have b een living and breathing VBAC research for the past 7 years. In fact, I actually discussed VBAC research with this particular Midwife on a midwifery list, and she flat out admitted that she doesn't think following medical research is relevant to her. Hmm. Interesting.

I am not lying down and giving up yet. This Midwife was notified that if she continued to slander my name, she would hear from my attorney. And really? I hate attorney involvement. I think it's ridiculous to have to "tattle" in an adult way. But what else can be done when the other party is underhanded, lies, manipulates, and is threatening your "business"?

The people-pleaser in me wants to apologize for the angry post. But I can't apologize for feeling the way that I do. Being screwed over (and I watched my language there!) sucks. Especially when it's by friends, or it has to do with your calling/profession/business.

I am trying to move on, and clear any toxic people from my life.  I don't need, nor do I want, drama of any kind unless it's in my favorite television shows.  ;)   I am tired of letting it affect me.

More Business of Being Born VBAC Segment

I was so excited to watch this. I thought that I would enjoy lending it to clients of mine, and had even prematurely asked if my Professor friend over at the college would help me set up another campus screening with a followup Q&A about VBAC.

Boy was I wrong. So, so wrong.

The VBAC segment was not only mostly one-sided, the risks were over inflated and misrepresented. The title of the segment is a load of crap, because it really DOESN'T talk much about what a woman's options are. It shows the incredible amount of unbalanced information that is out there, especially from OBs.  A sound resembling a dying cat escaped my throat every time I heard the words, "attempt a VBAC", "try to have a VBAC", and "trial of labor". Yes, this is OB lingo. And while I will agree that in the hospital it really IS "attempting" a VBAC, because hospital VBAC "attempts" are rarely successful...and even less so if we look at the big picture and include women that start out interested in having a VBAC, and then are dissuaded by the OB...it is hurtful language. I believe in the power of words. What if we told each mom who wanted a natural birth that she was, "attempting a natural birth", or that she could, "try for a natural birth"? What does this imply? This, to me (and many other women) implies great room for FAILURE. Never mind that most natural birth "attempts" are hindered by the hospital staff, or by lack of support, or by lack of knowledge.

What if I told my clients that I would be happy to help them "attempt" a home birth? Holy cow, that would be scary! That would leave their minds open to the idea that they are likely to end up in the hospital, and not with the home birth that they planned for.

One thing that they did portray accurately - though I'm sure wasn't the intention - is the fact that the Obstetric system is NOT set up to support VBACs. The doctors interviewed spoke openly about issues with hospital protocol, and mainly, liability insurance. And that's what it comes down to. Not risk. Not a woman's ability to have a VBAC. Politics.

One of the most common things I have heard from women and OBs is that a VBAC isn't allowed at a certain hospital because they are not equipped to handle emergency surgery. Let's think about this for a moment. A uterine rupture is HARDLY the only emergency that can come up during childbirth, necessitating immediate surgical delivery. Cord prolapse, placental abruption (both of which occur more often with intervention, for the record) both would fall in this category. If a hospital isn't equipped to handle a VBAC, it isn't equipped to handle ANY birth. Period.

I screamed outright at the screen when a woman was interviewed who had found a supportive OB, and planned for a VBAC. She labored at home before going in. Once in the hospital, her OB discussed the need for her to progress consistently and timely (?!?!?!?!) in order for her to have her VBAC. He discussed breaking her water to speed things up if need be. (!?!?!?!?!?!?!)  She was a good girl and progressed from 7cm to 8cm in an hour. Then an on-call OB came in 2 hours later and checked her AGAIN, and found her to "still" be at 8cm. Started talking cesarean immediately. She mentioned breaking her water (!!!!!!) and asking for her OB to be called in. The doctor was upset that she was refusing medical advice. Her baby was fine. She was fine. But she had not progressed in 2 hours - or so the new OB said. Her OB was called back in, and in this Mama's words was, "So gracious to allow me more time". OMG! So gracious to ALLOW you and your perfectly healthy baby more time in labor?!?! Let's give her OB of the year award, shall we? The OB said she MUST progress to 10cm quickly, and baby must be descending.

She got to 10cm. But baby was not descending. What did she do?

She said that she had already put her OB in a difficult situation, and she knew it wouldn't BE FAIR to her OB to expect more. She agreed to a cesarean.

SHE AGREED TO A CESAREAN AT 10CM, BOTH HER AND BABY WERE FINE. ALL SO THAT HER OB WASN'T MADE TO BE UNCOMFORTABLE?!?!?!?!?!?!?!?!?

This is what happens to a HUGE chunk of women who think they are going to have a hospital VBAC. They get HUGELY manipulated into thinking that they should be FAIR to the person they *hired*. At the expense of their body, and their baby. They agree to surgery that is NOT medically warranted...because they love their doctor.

One OB who was interviewed said that the risks of VBAC may *seem* low, but that those low risks can come with catastrophic results. Hmmm...so can induction of labor. How many women has he ordered induction for, in his years as a doctor? How many amniocentesis has he performed? An amnio comes with a higher risk of death to the baby than a VBAC does. (1 in 200-400 vs 1 in 2000)Yet, many women wouldn't blink an eye at having an amnio done if their doctor said it was best.

I recently read a study that said that women are more likely to go along with whatever their doctor says is the right course of action, regarding a VBAC or a ERCS. Regardless of empirical research that shows that a cesarean comes with a 2-4x greater risk of death for both mom and baby, if a doctor says it's best to do - most moms will go with it.

The study was a survey provided to women upon admission for their elective repeat cesarean section (ERCS) or trial of labor after cesarean section (TOLAC).  I am really shocked at the level of knowledge most of the women had. 73% of the women admitted for a ERCS did not know the chances of a successful VBAC and 64% did not know the risk of uterine rupture.  54% of women choosing a TOLAC did not know the chances of a successful VBAC and 45% did not know the risk of rupture.

So then I question - are WOMEN really making the choice if they are presented with inaccurate information? If they are willing to agree to major abdominal surgery on the suggestion of their OB? This is NOT informed consent. This is manipulation in the most base of forms. Women need to do their research. I've said it before - women research the type of car seat to buy, crib, diaper bag, more than they research their options in birth and weigh the risks/benefits of each. In our culture, however, we are pretty much brainwashed to view our doctor as our authority figure and not question. I have seen this with friends. Their OB lied to them or misrepresented risk, and they ended up with a cesarean. They go BACK to the same OB and talk to him/her about a VBAC. One of two things occurs most often:

1) OB says, "Well, you could TRY, but with your history of __________, the chance of needing an emergency cesarean - which is more dangerous for baby - is high. It's up to you though."  (yeah RIGHT)

2) OB says, "Sure, you can TRY for a VBAC. It doesn't LOOK like your issue should repeat." and then finds a reason at the end of pregnancy as to why a VBAC isn't going to happen. OB seems supportive, and then lovingly (HA!) finds a gentle way of telling mom that it doesn't look like a good idea after all.

Do you think she's going to switch care providers? For most women, no. It's this sick dependency thing we have going on, along with a very twisted romancing of complications and emergencies in birth and "needing" to be saved. Apparently this ranks higher than empowerment and an innate knowing that we are MADE to birth.

Anyway, back to the film. A doctor who was interviewed was asked to touch on the subject of HBAC - Home Birth After Cesarean. He inflated the risks. He talked about needing an OR available immediately - which is NOT GUARANTEED in the hospital!!! Nor is it evidence based. Studies show that you have 20-30 minutes to get to baby after a uterine rupture is suspected. Guess what? They can't have the OR prepped and ready in less than that in the hospital. But then he followed with, "Of course, a woman has to make this decision for herself."  HA! How many women do you think would choose this, or even do her own research if she was told that her baby is likely to die if she ruptures at home? (Let's go back to the fact that uterine rupture occurs in only 0.3-0.7% of VBACs, and those include the most common, asymptomatic uterine dehisciences, and that the risk of catastrophic rupture is a fraction of the 0.3-0.7%!)

Even Dr. Moritz admitted that in the hospital a VBAC has to go PERFECTLY. He called it a "Cinderella Birth." Which is realistic, how?? He also admitted that if there are ANY fluctuations in baby's heartrate, that it would be an immediate cesarean, without waiting any time at all to see if things were fine. Never mind that external consistent monitoring is highly inaccurate.

If I had been a mom watching the film for information on VBAC, I wouldn't be compelled to do my own research. I would walk away from the film with the idea that I should talk to my OB, and should act on his/her recommendation. I wouldn't look into my options, I would acquiesce to my doctor's advice and not think twice about it.

Ricky Lake and Abby Epstein had the opportunity to REALLY explore the problem with our current cesarean rates, and the extremely low rate of VBAC in our country - and they failed miserably. The only SLIGHTLY redeeming factor of this film is the birth story at the very end. Mom refused to bow to scare-based protocols of her local hospital, and planned a HBAC instead. Even in the face of the OB who refused her a "TOL" (trial of labor) calling her at 34 weeks to say that he would ALLOW her to TRY after all, she continued with her plan. It showed the very emotionally damaging effect that cervical exams can have, especially in a VBAC, when she was checked to be "only" 1cm, and wanted to give up and go in for a cesarean. Instead, her husband rallied by her side and helped her pick back up her resolve. She had a beautiful HBAC in the water - where she caught her baby herself.

But really, More Business of Being Born?? ONE positive, empowering story in all of an hour?? ONE? And the ONE woman you had talking about the risks of repeat cesareans - which are MANY - was not a "professional", but a mom. How does that look to people? The "professionals" are reiterating the risks and limitations of hospital VBAC, and a non-formally educated woman is citing the risks of surgery. Totally biased in presentation of risk/benefit. The risks of repeat cesareans were skimmed over, and the HUGE problem of care provider manipulation, hospital protocol, and misrepresentation of VBAC risks were barely touched on in the right way.

A study done on the morbidity rates of repeat cesareans:

METHODS:
Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002).
RESULTS:
There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.
CONCLUSION:
Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.

And these are JUST the risks associated with repeat cesarean for MOM. This also doesn't take into account the rates of infection, the increased risk of DEATH, nor does it take into account the difficulty of healing from major abdominal surgery while having multiple children (and a newborn) to care for.

Once a woman has had a successful VBAC, her risks actually DECREASE for future pregnancies.

RESULTS:
Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.
CONCLUSION:
Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy.

The problem is that when women are given the MISREPRESENTED information about VBAC, very few who are initially interested end up having one. So they end up in the category above - at higher risk for serious complications with each subsequent pregnancy. We have a HUGE issue on our hands here, and most days I feel hopeless for change. With women refusing to do research on their own, because it might mean choosing a different OB (or - :gasp: - a Midwife, increasing her chance of a successful VBAC!), or standing firm and choosing a VBAC against the advice of her care provider....we are going to continue to see a very high rate of uninformed women choosing repeat cesarean. We will also see higher rates of complications in pregnancy, and eventually, higher infant mortality.

And the root of the problem lies in the lack of ethics and evidence based protocols in Obstetrics, where it is commonplace to manipulate, scare, and even bully a woman into intervention that increases her risk of that primary cesarean. Women NEED to become better informed of what empirical evidence says about the common issues that arise in pregnancy, labor, and birth. Until women make a stand and demand better care, these risks will only continue to increase.