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We're losing mothers

8/22/2014

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I almost cannot bear to hear these stories about mothers dying in the OR due to placenta accreta caused by multiple cesareans. Everyday women are told 1) That a primary cesarean is necessary to birth her baby for some reason. In many (dare I say, most, cases is just UNTRUE. 2) That attempting a VBAC is dangerous. Which is also just UNTRUE and NOT what is recommended by ACOG. 

These women are left with option to have no more children or put her LIFE at risk to give birth by more cesarean sections. Which isn't usually explained how risky each subsequent pregnancy becomes. If it's explained, it's usually after her second or third cesarean. What kind of choice is that at that point???

And for a doctor, I imagine it is terrible to lose a baby during a delivery. But, a mother? How do they go on? I'm sure they do everything they can and it must be awful to realize you cannot save her. But we need them to STOP doing all of these unnecessary cesareans! Overmedicalizing birth in the first/second pregnancy is the root cause of mother's hemorrhaging on the operating table a few cesareans later.  

Maybe I'm especially emotional hearing of these stories because I lost my mother at age 9. I don't want any other child to endure this kind of loss. And because of my work, I know it can be different. Giving birth doesn't have to be risky. It can be healthy, respected, and trusted in most cases. And, women can be trusted to make their own informed decisions when given the right information based in research and allowing that along with intuition to guide them instead of FEAR...

I don't want to post the stories that have deeply saddened me recently. I know I have other mothers reading, some facing cesareans that have become necessary and possibly complicated and scary pregnancies. Or maybe just like me, a motherless mother who's heart breaks to think of any other mother leaving her children behind. So, instead, if you'd like to read about how another mother managed to survive when facing what became a life threatening pregnancy, read her story included in a previous post below about preventing the primary cesarean.  Below is a great video on VBAC. 
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Info and Support for Preventing Primary Cesareans

7/21/2014

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Today I want to say that ICAN is about supporting the first time mom, too, not just those hoping for a VBAC. It is a great resource for preventing that primary cesarean birth. As is the VBAC facts site and Jen Kamels who runs it and teaches a workshop around the country and online.

http://www.ican-online.org
www.vbacfacts.com

Our local ICAN of SEPA:
http://icanofsepa.wordpress.com
https://www.facebook.com/groups/411506922273373/

I'm also linking a story here that offers a great explanation as to why we fight so hard to help mothers avoid their primary (and too often unnecessary) cesareans and to birth vaginally. It details the risks and dangers to mothers of multiple cesareans. This mother is not alone, more and more of these examples are making news because they are becoming more prevalent problems in pregnancies and in the OR. Just to be aware, though, I had tears in my eyes the whole time while reading. She does a great job writing so that the reader can almost feel her fears through what was a very scary experience. To clarify, MOST 1st and even 2nd repeat cesareans will be manageable by most hospitals and with what blood they have on hand for possibility of transfusing...I do not want to scare moms facing a repeat cesarean where they NEED to trust and depend on a doctor to keep them safe, but this story also shows how a mother did her homework to do just that - be in the best place with the best team to make sure she'd be going back home to her kiddos. This was simply the situation she ended up in during her 7th pregnancy. Her placenta became deeply implanted into her uterus and cervix after multiple previous surgeries to her uterus. 

As a doula, I never want my clients to have any good answer to the question, 'what else could I have done to prevent my first cesarean?' This is especially important when moms desire a larger family. I have had friends and family members tell me that their doctors never once mentioned to them before, during, or after their first cesarean that they'd need to consider limiting family size due to having that surgical birth and the increased dangers of multiple pregnancies and cesarean births following. And not just that, but that they'd not been offered a chance to VBAC and instead told that it is dangerous to try, safer to schedule ANOTHER cesarean, and just accept having 2 children or at most 3 if she really really wants to risk it, but no more! Women are being told this AFTER their second cesareans when their options are nearly nil at that point! It's infuriating. And sad. More women need doula support through their first pregnancies and births, good information, supportive care providers, and to visit their local ICAN group before having their first babies if we want to stop this trend from continuing. Women need the truth! They need their options! They want to make informed choices! 

I recently met a nurse who told me there is a doctor on her floor who frequently says all babies should be born by cesarean and has no problem recommending tube tying after the second to all mothers. I seriously hope he is in the extreme minority. But I have a feeling that while we do have docs who truly believe in the safety of and support less medicalized vaginal birth, the number of docs seeing their norm everyday be cesarean deliveries is increasing by the day. This will just continue to have an effect on moms and babies (physically, mentally, emotionally!!!) if we don't advocate for ourselves and surround ourselves with professional support and evidence based information. 

And while I'm thinking of it. Hug another woman today. Love her with that hug, if even for just a few seconds. We don't always know each other's journey. 


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A Human Rights Failure for sure.

3/16/2011

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About: MATERNAL MORTALITY IN THE US: A HUMAN RIGHTS FAILURE

http://www.arhp.org/publications-and-resources/contraception-journal/march-2011

I know I'm passionate about birth and everything surrounding it.  It is emotional for me.  And I'm glad actually.  I am proud of the work I do with women and for women.  I really care about women and babies.  It is not something to be handed over to medical technology as a condition (most of the time). So this kind of update just infuriates me and makes me even more vocal.  I respect informed choice.  Truly informed choice.  And good prenatal care. I cannot respect the current state of maternal health care in any way.  I do, however, feel that change is coming.  Because of these maternal and infant mortality statistics and US pride, yes, AND because of people like me, yes.  I am proud of the support, education, and advocacy I provide women. Doulas and other birth professionals and advocates are out there everyday letting women know their options and that there is MORE TO KNOW than they are being told.  We are helping to guide them through their pregnancies and stay with them during their entire labor.  That alone is making a difference!  But, every woman deserves that, not just ones who can pay.  Midwives and doulas are being requested more and more.  Women are taking more independent childbirth classes and opting to have care and births outside of hospitals.  They are asking for more nutrition counseling, yoga classes, chiropractors, and water exercise classes.  Insurances are reimbursing more now for alternative out of hospital care, education, and therapies. AND, I must say, too, that SOME hospitals are taking steps in the right directions.  Yes, maybe accreditation pressures is a push they need, but they are trying to implement changes in some places regarding birth and baby care - I see it when I attend births at different locations.  Praise to them, too!  And shame on those who are banning birth plans, doulas, and VBAC's and those that don't encourage skin to skin time immediately following birth.  Improvements are coming because of the demand for it, though.  But we have lots of work to do!  I must discuss why it is so sickening to me to see our maternal and infant mortality rates so poor. Don't get me started on the disparities those face who are on medicaid.  I've been through a pregnancy on it.  I know firsthand!  And lucky for me I was who I was and I knew health and I knew my options!  Oh, AND I figured out a way to eventually pay my midwife since she was not covered by medical assistance. Lucky for me, right?  That's me - someone who is health, pregnancy, and birth informed and involved.  What about all the other women on medicaid? 

SOOO......Not only does the US (with all of our money and technology) fall 50th in line after 49 other countries for our maternal mortality, but we have THE HIGHEST infant mortality rate among developed nations (18). THE highest! Please read this article and see the research yourself on maternal mortality, and be informed as a woman or someone who loves one. Yes, it applies to you or someone you love. As our cesarean rate continues to increase, so do our maternal deaths.  Even more so if you are a woman of color - 4 TIMES more likely to die during birth than white women.  And no, don't even go there anyone - It is NOT because women of color have higher prevalence of disease!  Treatment and care is NOT equal!  Please recognize the disparities, and acknowledge the truth in that.

"In contrast to many countries where women lack access to life-saving medical interventions, women and infants are often exposed to more procedures than are medically necessary or beneficial. This overuse of medical procedures increases injuries as well as costs. Indeed, we are unaware of any study indicating that the 56% increase in the rate of surgical births from 1996 to 200827 as improved outcomes. However, there are data to show that the overuse of medical procedures has increased both infant28 and maternal morbidity.11, 29"

ALL women need to protect themselves with information and share it with the women we love. Do not trust you are safe because you 'really like your doctor' and you know 'he/she wouldn't ever make choices for you that could be harmful'.  Be an informed party in all decision making.  Get the information you need from other sources in addition to what you get at your office appointments and ASK QUESTIONS.  Demand better choices, chances, and cut your risks down - take an independent childbirth class and hire a doula, learn about proper nutrition during pregnancy, the importance of healthy living, and how to make that all happen so you can prevent hypertensive disorders and interventions that can both lead to riskier births then and later.  

"Because all medical interventions carry risks, their use in situations when they are not demonstrated to offer benefits exposes women to risks that are unwarranted. For example, overuse of induction of labor and of cesarean sections, and lack of access to vaginal births after cesarean sections, all can lead to higher incidences of postpartum infection and higher rates of hysterectomies.30, 31"

And also, we need to stop making excuses when moms do die during childbirth and afterwards.  I'm tired of hearing all the reasons it wasn't related to the 'actual' birth or that there was nothing that they could have done.   Prevention, as far back as we can get prior to pregnancy or early on, is #1.  Cut down on unwanted pregnancies.  Educate our teens on the responsibility not only of having a baby but of gestating!  And hospitals need to learn how to better support women who want to birth without medication or those who want to move freely for a good bit of labor instead of being in bed hooked to a monitor the entire time (continuous monitoring has not been proven to improve outcomes for moms or babies and in fact IS directly related to increasing the risk of cesarean), decreasing surgical births (even more risky as the number of cesareans a mother has), and REAL post partum CARE where someone is checking on mom's uterus and her overall well being - no, not just to document on their checklists, but to actually spend some time sitting with a mom who just had a baby and get a good sense for how she's feeling.

"It is a human tragedy when a woman dies giving birth; her death forever changes her community and family for all future generations. It is both a tragedy and a human rights failure when a woman dies needlessly of preventable causes in a country that lacks the political will to have prevented her death."

The way we are treated and cared for prenatally needs to CHANGE!  More routine procedures prenatally and in the labor room lead to more interventions and technology. More interventions and technology = more deaths.  PERIOD. 

Thank you Ina May for all the work you are doing to bring awareness to the public and to the obstetrical community on what we can all be doing to save mothers, and of course for remembering those lost with the Safe Motherhood Quilt Project.

For more information visit the Healthy Mothers Healthy Birth Summit page.
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