Repeat C-sections Rise By Over That 40 Percent In One Decade, USA

- Nearly one-third of the 4.3 million childbirths in 2006 were delivered via C-section, compared with one-fifth in 1997.
- C-sections are more costly than vaginal deliveries, $4,500 versus $2,600 in deliveries without complications, and $6,100 versus $3,500 in deliveries with complications.
- Therefore, although C-sections account for 31 percent of all deliveries, they account for 45 percent of all costs associated with delivery.
- C-sections account for 34 percent of all deliveries by women who are privately insured but only 25 percent of deliveries by women who are uninsured.

For complete article, read here.

Terri's comments: Come on people, wake up. This section rate is absolute lunacy!
And VBACs are safe and possible- but, you have to be prepared. Get a good midwife, childbirth educator, doula, and read, read, read!

Home births "as safe as hospital"

The largest study of its kind has found that for low-risk women, giving birth at home is as safe as doing so in hospital with a midwife.

(Click here for audio interview)

Research from the Netherlands - which has a high rate of home births - found no difference in death rates of either mothers or babies in 530,000 births.

Home births have long been debated amid concerns about their safety.

UK obstetricians welcomed the study - published in the journal BJOG - but said it may not apply universally.

The number of mothers giving birth at home in the UK has been rising since it dipped to a low in 1988. Of all births in England and Wales in 2006, 2.7% took place at home, the most recent figures from the Office for National Statistics showed.

The research was carried out in the Netherlands after figures showed the country had one of the highest rates in Europe of babies dying during or just after birth.

It was suggested that home births could be a factor, as Dutch women are able and encouraged to choose this option. One third do so.

But a comparison of "low-risk" women who planned to give birth at home with those who planned to give birth in hospital with a midwife found no difference in death or serious illness among either baby or mother.

"We found that for low-risk mothers at the start of their labour it is just as safe to deliver at home with a midwife as it is in hospital with a midwife," said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research.

"These results should strengthen policies that encourage low-risk women at the onset of labour to choose their own place of birth."

Hospital transfer

Low-risk women in the study were those who had no known complications - such as a baby in breech or one with a congenital abnormality, or a previous caesarean section.

Nearly a third of women who planned and started their labours at home ended up being transferred as complications arose - including for instance an abnormal fetal heart rate, or if the mother required more effective pain relief in the form of an epidural.

“ The NHS is simply not set up to meet the potential demand for home births ”
Louise Silverton Royal College of Midwives

But even when she needed to be transferred to the care of a doctor in a hospital, the risk to her or her baby was no higher than if she had started out her labour under the care of a midwife in hospital.

The researchers noted the importance of both highly-trained midwives who knew when to refer a home birth to hospital as well as rapid transportation.

While stressing the study was the most comprehensive yet into the safety of home births, they also acknowledged some caveats.

The group who chose to give birth in hospital rather than at home were more likely to be first-time mothers or of an ethnic minority background - the risk of complications is higher in both these groups.

The study did not compare the relative safety of home births against low-risk women who opted for doctor rather than midwife-led care. This is to be the subject of a future investigation.

Home option

But Professor Buitendijk said the study did have relevance for other countries like the UK with a highly developed health infrastructure and well-trained midwives.

“ Women need to be counselled on the unexpected emergencies which can arise during labour and can only be managed in a maternity hospital ”
RCOG

In the UK, the government has pledged to give all women the option of a home birth by the end of this year. At present just 2.7% of births in England and Wales take place at home, but there are considerable regional variations.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said, the study was "a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place.

"However, to begin providing more home births there has to be a seismic shift in the way maternity services are organised. The NHS is simply not set up to meet the potential demand for home births, because we are still in a culture where the vast majority of births are in hospital.

"There also has to be a major increase in the number of midwives because they are the people who will be in the homes delivering the babies."

The Royal College of Obstetricians and Gynaecologists (RCOG) said it supported home births "in cases of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system.

But it added: "Women need to be counselled on the unexpected emergencies - such as cord prolapse, fetal heart rate abnormalities, undiagnosed breech, prolonged labour and postpartum haemorrhage - which can arise during labour and can only be managed in a maternity hospital.

"Such emergencies would always require the transfer of women by ambulance to the hospital as extra medical support is only present in hospital settings and would not be available to them when they deliver at home."

The Department of Health said that giving more mothers-to-be the opportunity to choose to give birth at home was one of its priority targets for 2009/10.

A spokesman said: "All Strategic Health Authorities (SHAs) have set out plans for implementing Maternity Matters to provide high-quality, safe maternity care for women and their babies."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7998417.stm

Published: 2009/04/15 08:08:24 GMT

© BBC MMIX

Stand and Deliver? Upright Labor Positions Reduce Pain, Speed Birth

Newswise — Women who walk, sit, kneel or otherwise avoid lying in bed during early labor can shorten the first stage of labor by about an hour, according to a new Cochrane evidence review. Women who labored out of bed during the early stages were also 17 percent less likely to seek pain relief through epidural analgesia, the review found.

“This shortens labor by about an hour and, for a lot of women, an hour would be really important,” said Teri Stone-Godena, director of midwifery at the Yale School of Nursing, who had no affiliation with the review.

Fortunately, the review did not find any differences in birth outcomes for mothers or babies due to labor position. There were no differences in terms of interventions like birth by Caesarian section. “I think this means that women can be reassured that any position that they want to get into is OK,” Stone-Godena said.

Overall, the review included 21 studies, examining 3,706 births.

It appears in the latest issue of The Cochrane Library, which is a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

So why would staying out of bed shorten labor and reduce pain?

“Women who are upright and mobile are able to change their positions more easily,” said Annemarie Lawrence, lead review author and a research midwife at the Institute of Women’s and Children’s Health at Townsville Hospital in Queensland, Australia.

“The ability to change positions, to utilize a wider variety of positions, and try other options, such as hot showers, birthing balls and beanbag supports, may help reduce overall pain and give women a greater sense of control over the progress of their labor,” she said.

When women are upright, there is also more room for the baby to move downward because the diameter of the pelvis expands slightly. This puts less pressure on nerves in the spine, which could mean less pain.

“It may also be that women are more distractible when up and moving around,” Stone-Godena said. “When you are lying there looking at clock, it’s a lot different from being up and about.”

Being upright allows gravity to help the baby make her way into the world. Lawrence said, “The physiological advantages of upright positions and mobility include the effective use of gravity, which aids in the descent of the baby’s head. As the head is applied more directly and evenly against the cervix, the regularity, frequency, strength and therefore efficiency of uterine contractions are intensified.”

When the mom-to-be moves, this also helps the baby to get into the best position to hasten birth. “This improves its alignment for passage through the pelvis,” Lawrence said. “There is also a psychological advantage associated with the belief that being upright and mobile empowers women to actively participate in their birth experience and maintain a sense of control.”

Other research has found that feeling in control and able to make choices reduces pain and psychological distress in general.

In contrast, however, lying flat on one’s back during labor can put a great deal of pressure on the blood vessels in the abdomen. “There is widely accepted physiological evidence that the supine position may be harmful in late pregnancy and labor,” Lawrence said.

According to the reviewers, the supine position puts the entire weight of the pregnant uterus on the blood vessels that supply oxygen to both mother and child, which could potentially lead to problems with heart functioning in the mother and reduced oxygen to the baby. These outcomes could be serious in extreme cases. Lying on one’s side has no link with such problems, however.

Stone-Godena said that despite all the attention given to empowering women to have the type of birth experience they prefer, medical professionals still pressure women into lying in bed during labor, because it is more convenient this way for nurses and doctors — and makes fetal monitoring easier.

“I think this research is very vindicating of women being allowed to assume positions of comfort,” she said. “Listening to their bodies is what they need to do. Most of time when we limit people’s activity, it isn’t for reasons that are soundly based on evidence.”

She added, “This clearly shows that there are no advantages in staying in bed unless that’s where you want to be.”

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Lawrence A, et al. Maternal positions and mobility during first stage of labor. Cochrane Database of Systematic Reviews. Issue 2, 2009.

Terri here- Very vindicating indeed. This research confirms what midwives and doulas have known all along.

No risk from eating during labour

(Terri here- I am SO grateful to the BBC that we finally have a study to back this up! Midwives and mothers have always instinctively known this. It is SO sad as a doula to be with a client in labor who keeps crying about how hungry she is, after x hours of labor, and to NOT be able to offer her anything to eat for strength and nourishment.)

It is safe for most healthy women to eat during labour, research has found.

The study found eating a light diet during labour has no effect on the duration of labour, the need for assisted delivery, or Caesarean rates.

Since the 1940s it has been common practice to prevent eating during labour to cut the risk of complications if surgery is required.

But the King's College London study, featured online in the British Medical Journal, suggests this is too cautious.

“ Denial of food can be seen as authoritarian and intimidating, which may for some women increase feelings of fear and apprehension during labour ”
King's College London

Some doctors have previously advised women not to eat during labour to minimise the risk that they would breathe food into their lungs should they need an emergency caesarean under general anaesthetic - a condition known as pulmonary aspiration.

But pulmonary aspiration has declined dramatically in recent years, mainly due to the increased use of local anaesthesia for caesarean deliveries.

Many doctors and midwives also argue that preventing food intake during labour can be detrimental to the mother, her baby and the progress of the delivery.

However, previous research on the subject has proved inconclusive.

The King's team focused on 2,426 healthy women having their first baby. Each women was either allowed small, regular amounts of food during labour, such as bread, fruit and yoghurt, or water only.

No differences

The natural birth rate in both groups was the same, at 44%. Average duration of labour was also similar, 597 minutes for the eating group, and 612 minutes for the water only group.

The caesarean rate was also the same - 29% for the eating group, and 30% for the water group.

And in both groups around one in three women vomited during labour.

There were also no differences in the condition of the babies at birth or admission to special care units.

The researchers, led by Professor Andrew Shennan, said the study showed that there was no pressing reason to deny women food during labour.

They wrote: "Denial of food can be seen as authoritarian and intimidating, which may for some women increase feelings of fear and apprehension during labour.

"Eating and drinking may allow mothers to feel normal and healthy."

Current guidelines from the National Institute for Clinical Excellence (NICE) recommend that low risk women in normal labour may eat and drink.

Dr Virginia Beckett, a consultant obstetrician and spokesperson for the Royal College of Obstetricians and Gynaecologists, said it was fine for healthy women at low risk to eat during labour.

But she stressed that it was not a good idea for those who were at higher risk, such as women who were obese.

Women using pethidine to reduce pain during labour, should also avoid food, as the drug relaxed the gut muscles, making problems more likely.

Dr Beckett said: "Eating during labour is not going to make things better, but it is not going to make things worse, and it might make you feel more of a human being, and that is quite important.

"We would not want women to be sitting there eating a roast dinner, but it is reasonable to suggest it is safe for low-risk women to eat small amounts of preferably liquid food during labour."

Story from BBC NEWS:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/7961689.stm

Published: 2009/03/25 00:02:12 GMT

© BBC MMIX

Jennifer Block: Extreme Birth, Indeed

Jennifer Block: Extreme Birth, Indeed

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Writing a Birth Plan

How to Write a Birth Plan
Advice and an example of how to write a birth plan for the woman that desires to have a natural, medication-free childbirth.
http://www.associatedcontent.comarticle/263836/how_to_write_a_birth_plan.html

D&C Versus a Natural Miscarriage

D&C Verses a Natural Miscarriage
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http://www.associatedcontent.comarticle/1276333/dc_verses_a_natural_miscarriage.html

Early Miscarriage

Early Miscarriage - Losing a Baby in the First Trimester
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http://www.associatedcontent.comarticle/76163/early_miscarriage_losing_a_baby_in.html