New ACOG Guidelines: Vaginal Birth After Cesarean is a Safe Option

For Immediate Release
July 27, 2010

Contact:
Midwives Alliance of North America
Geradine Simkins, President & Interim Executive Director
president@mana.org
info@mana.org
231.228.5857 (O)
231.590.3742 (C)

New ACOG Guidelines: Vaginal Birth After Cesarean is a Safe Option

Washington, DC – The Midwives Alliance of North America (MANA), a professional midwifery organization since 1982, commends the American College of Obstetricians and Gynecologists (ACOG) for their updated practice guidelines on Vaginal Birth After Cesarean (VBAC) released July 21, 2010. ACOG’s recent guidelines are less restrictive than previous ones. The new guidelines state that VBAC is a “safe and appropriate choice” for most women who have had a prior cesarean delivery, including some women who have had two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar.

There has been a dramatic increase in cesarean delivery in the United States (from 5% in 1970 to nearly 32% in 2009) and a rapid decrease of VBACs (from 28% in 1996 followed by a decline to 8% in 2006). Lack of VBAC availability in U.S. hospitals due to practitioner and institutional restrictions, which diminished women’s choices in childbirth, is often cited as the reason for the conspicuous decrease in VBACs. In light of the VBAC restrictions that have become commonplace in most U.S. hospitals, it is noteworthy that ACOG’s new guidelines emphasize a woman’s right to self-determination. The new ACOG guidelines state that even if a hospital does not offer a trial of labor after cesarean (TOLAC), a woman cannot be forced to have a cesarean nor can she be denied care if she refuses a repeat cesarean. In addition, previous ACOG guidelines on VBAC stated that anesthesia and surgery must be “immediately available” for an institution to offer VBAC; the new guidelines have relaxed this restriction.

ACOG has seriously considered recommendations from the National Institutes of Health (NIH) Consensus Development Meeting on vaginal birth after cesarean held in Washington DC in March 2010. Based on the scientific evidence, the NIH expert panel affirmed that risks in VBACs are low, similar to risks of other laboring women, and repeat cesareans expose mothers and infants to serious problems both in the short and long terms. The NIH expert panel concluded that in the absence of a compelling medical reason, most women should be offered a trial of labor after cesarean. The NIH expert panel further recommended that all women be given unbiased educational information during their pregnancies with which to make decisions regarding VBAC in partnership with their healthcare providers. Women should also be offered full informed consent and refusal during their labors.

“While we are pleased that ACOG has issued less restrictive VBAC guidelines and affirmed a woman’s autonomy in her childbirth experience, it is still up to women to take charge of their lives, educate themselves about childbirth practices, and put pressure on their healthcare practitioners to provide the safest birth options for their babies and themselves,” says Geradine Simkins, President and Interim Executive Director of the Midwives Alliance. The Midwives Alliance takes the position that the best interests of most mothers and infants are served when women are given the opportunity to birth under their own power and in their own way with the intention of avoiding primary cesarean deliveries and other unnecessary interventions. An impressive body of research literature shows that the midwifery model of care results in less intervention in the birth process and safe and satisfying outcomes for mothers and babies. In addition, evidence shows that birth in a woman’s home with a trained midwife, or in a freestanding birth center, results in decreased cesarean sections and other obstetrical interventions. “We want women to have all the choices they need to have healthy pregnancies and give birth safely,” say Simkins, “and we are pleased that ACOG’s new guidelines on VBAC will add another choice to the menu of maternity care options.”

For more information on the Midwives Alliance visit http://mana.org/. For information on practitioner and childbirth options visit Mothers Naturally atwww.mothersnaturally.org.

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STATE OF FLORIDA CELEBRATES LICENSED MIDWIVES WEEK OCTOBER 5 – 9

STATE OF FLORIDA CELEBRATES
LICENSED MIDWIVES WEEK OCTOBER 5 – 9

Governor Charlie Crist Signs Proclamation Heralding Midwives for Dedicated Care

SARASOTA, FL (October 5, 2009) – Governor Charlie Crist signed a proclamation today observing October 5 through the 9 as Licensed Midwives Week in the State of Florida, upholding midwives for being “dedicated to the care of pregnancy and childbirth and treat[ing] each woman’s pregnancy according to her unique physical and personal needs.”  Governor Crist’s proclamation also recognized midwives for their role in the need to “improve birth outcomes in the State of Florida and ensure that women are given proper care and treatment in all phases of childbirth.”

In honor of this week, Florida Friends of Midwives (FFOM), a non-profit grassroots organization dedicated to promoting and supporting the practice of midwifery in Florida, will be hosting various community events throughout the state this month to celebrate the more than 110 Licensed Midwives in the Sunshine State.

Florida Licensed Midwives Week coincides with National Midwifery Week, a time to recognize the contributions of Certified Nurse Midwives (CNMs), Certified Midwives (CMs) and Certified Professional Midwives (CPMs) nationwide.  The American College of Nurse Midwives (ACNM) publicly announced the week with an introduction to midwifery.  “The heart of midwifery care for women and newborns lies more in the nature of that care than in its specific components. Midwifery practice has a firm foundation in the critical thought process and is focused on the prevention of disease and the promotion of health, taking the best from the disciplines of midwifery, nursing, public health and medicine to provide safe, holistic care.”

Midwives have a long and valued history in Florida. The state first passed legislation to license direct-entry midwives in 1931. In the 77 years since, Florida’s licensed midwives have continued to tirelessly serve the families of Florida and to ensure the continued availability of safe, evidence-based birthing options for Florida’s families.  In 1992, Governor Lawton Chiles declared the first-ever Licensed Midwives Week. More women than ever before are seeking out licensed midwives for maternity care. According to the latest data from the Florida Council of Licensed Midwifery, births managed by Licensed Midwives in the state grew by about 5.5% from 2005 to 2006.

“We are honored every day to serve Florida’s mothers, babies, and families,” says Sarasota Licensed Midwife Alina Vogelhut, LM. “It means so much for our profession to be honored by Governor Charlie Crist and the State of Florida.”

Midwifery in Florida

In Florida, two types of midwives are allowed to practice:  Certified Nurse-Midwives and Licensed Midwives (a Florida state licensure), also known as direct-entry midwives.  Throughout the state, about 11.2 percent of births are estimated to be managed by midwives, rather than by OB-GYNs. Many birth centers and midwives have reported a significant increase in business in the past year. This increase is believed to be a result of various factors, primarily a greater number of women seeking alternative birthing choices due to an unhealthy increase in caesarean sections and other unnecessary interventions that frequently occur in hospital settings.  In a 2006 report on Florida Licensed Midwives, midwives had a caesarean section rate of 6.3 percent compared to a 36.64 percent statewide average in hospitals the same year.

For more information of midwifery in Florida, please visit www.flmidwifery.org.

About Florida Friends of Midwives

Florida Friends of Midwives is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida’s families.  For more information, please visit www.flmidwifery.org.

MEDIA CONTACT:

Laura Gilkey

(941)915-8115

info@flmidwifery.org

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Reducing Infant Mortality

Reducing Infant MortalityOn Wednesday evening at at 11:00 PM Reducing Infant Mortality, Improving the Health of Babies went LIVE!!!

The video can be seen and downloaded at the website:
www.reducinginfantmortality.com

This is a free film. Please use it, show it, put it on your website, link to it, and most of all, send the link to policy makers. Send it to your State and National Senators and Representatives. Until the end of August, your representatives and senators are in their home offices. This is the perfect time to make an appointment to see your legislator and talk to them personally. Can you imagine if 10 people from your district insist on having an appointment to talk about maternal/infant health care20in the next 2 weeks? What if we continue on,. making appointments and showing up to talk to their aides after they return to Washington? What if they each have many copies of Reducing Infant Mortlaity on their desks, and showers of emails with letters about the rights and needs of infants and women and links to the film? I can imagine this. Can you? This is one way we can make a material difference.

Send it to your local Health Department. Send it to your local Hospital. Send it to your State  Department of Health! (In Georgia, they requested a copy!) Link to it on Facebook and My Space! Post it on your favorite networking sites. It is open source which means you can use it any way you like as long as you don’t change it or delete the credits. We are counting on you to use this film to help your voice to be heard.

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The Lie of the EDD: Why Your Due Date Isn’t when You Think

The Lie of the EDD: Why Your Due Date Isn’t when You Think

September 24, 2008 by Misha Safranski

We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The “due date” we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call ourselves “overdue” and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because “that’s the way it’s always been done”.

The folly of Naegele’s Rule

The 40 week due date is based upon Naegele’s Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele’s rule. Strictly speaking, a lunar (or synodic – from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we’ve been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman’s EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth. 

The inaccuracy of ultrasound

First trimester: 7 days

14 – 20 weeks: 10 days

21 – 30 weeks: 14 days

31 – 42 weeks: 21 days

Calculating an accurate EDD

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose. Complete classes on tracking your cycle are also available through the Couple to Couple League.

ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG’s official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery. Remember, babies can’t read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.

Sources:

Mittendorf, R. et al., “The length of uncomplicated human gestation,” OB/GYN, Vol. 75, No., 6 June, 1990, pp. 907-932.

ACOG Practice Bulletin #55: Clinical Management of Post-term Pregnancy

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Current Resources for Evidence-Based Practice

Four times each year, Childbirth Connection contributes “Current Resources for Evidence-Based Practice” to both Journal of Obstetric, Gynecologic and Neonatal Nursing and Journal of Midwifery and Women’s Health. The March/April column includes discussion of the new perinatal standards endorsed by the National Quality Forum (read more about the measures below).

Download JOGNN March/April (free PDF)
Download JMWH March/April (free PDF)
Click here for all Evidence Columns 2003-2009

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Soup Recipe to Raise Hemoglobin

Here’s a recipe for “Blood Soup” that I recently shared with the Charis midwifery and doula students.  I call it “blood soup” because it builds the blood (and looks like blood, too), assisting in increasing hemoglobin.  My daughter Rose thinks it should be called “Beauty Soup” because it looks beautiful in the bowl and helps people look more beautiful when the color returns to their face after being pale from anemia.

As birth professionals, you will come across women who are anemic.  This is just one good recipe to pass along to them.  Although I believe the best way to get our nutrition is to eat the plants raw, some people will not eat them that way; so here is a cooked alternative to eating the veggies raw or juicing them.

“BLOOD SOUP”

2 T extra virgin olive oil
1 large onion, diced
3 cloves garlic, minced or pressed
Juice of 1 medium lemon (or 1 really large lime)
2 large fresh beets, diced
4 medium red potatoes (with skin), diced
2 large handfuls of chopped fresh kale
2 large ripe tomatoes, diced
2 large handfuls of fresh spinach leaves
2 C kidney beans (If using dried beans, soak and cook ahead of time)
1 large handful of chopped fresh dill
Salt and pepper to taste

In large soup pot, sauté the onion and garlic in the olive oil for a few minutes.  Fill the pot a little more than half full with pure water and add the lemon juice, potatoes, beets, and kale.  Boil until the beets are tender.  Add tomatoes and boil for about 5 minutes.  Add all other ingredients and boil until the spinach turns bright green, about 5 or 10 minutes.  Serve with whole grain bread or rolls.

Other vegetables can be added as well.  I especially love big chunks of squash in this soup.  Carrots, celery, cauliflower, other dark green leafies (turnip, dandelion, mustard, watercress, collards, etc), or any other favorite veggies are great.  If you want to add whole grains to the soup, amaranth and barley contain iron.  Other beans (like black beans, lima beans, etc) would work in this soup as well.  The most important ingredients are the ones high in iron and the ones high in Vitamin C.

In addition to improving diet, pregnant women may find it necessary to take a supplement to raise the hemoglobin count rapidly.  Floradix+Iron is a good liquid supplement.  (I have seen very little improvement in women who just take extra iron in the form of pills.  They just get constipated.)  I personally like to see ALL pregnant moms take one or two tablespoons of World Organic liquid chlorophyll and drink one quart of an infusion of Nettles, Oatstraw, Alfalfa, and Red Raspberry leaf every day.

We’ll be posting iron-rich, blood-building recipes in upcoming Charis newsletters.  If you have a good one, please share it!  Send the recipes to newsletter@charischildbirth.org

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Evidence-Based Maternity Care

Consumer Reports has published an excellent article based on the report “Evidence Based Maternity Care: What It Is and What It Can Do” published last fall by Childbirth Connection, the Reforming States Group and Milbank Memorial Fund.  The article summarizes the main points made in the much longer report.

The Consumer Reports article can be read at:

http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/overview/maternity-care.htm


and includes a quiz (http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/maternity-care-quiz/maternity-care-quiz.htm).  The first question is (answer true or false): An obstetrician will deliver better maternity care, overall, than a midwife or family doctor.  Each question includes an explanation of the correct answer.

To learn more about the Millbank Report, see February’s Charis e-newsletter.

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Beneficial Herbs For Pregnancy

Beneficial Herbs For Pregnancy


Nettle (Urtica Dioica)

For those who have wandered into woodlands near water, stinging nettle will be a familiar memory. Nettle is a popular table green still today, eaten much the same way as cooked kale or spinach. Rich in chlorophyll, nettle is a world favorite for all urinary tract problems.

Contains: Chlorine, chlorophyll, formic acid, iodine, magnesium, potassium, silicon, sodium, sulfur, tannin, Vitamins A and C, protein, iron, copper, histamine, glucoquinine, and facilitates absorption of Vitamin D from the sun.

Nettle is a gentle yet powerful tonic to the adrenals, and is known to rebuild the adrenal cortex, improving energy levels. It has been used with great success in the treatment of adrenal exhaustion, one of the primary underlying causes of Chronic Fatigue and a host of other auto-immune disorders. As the adrenals are the fundamental glands of immune health, Nettle is used to improve general immune function, increasing resistance to illness caused by viruses or bacteria. With its strong affinity to the adrenals, Nettle is used extensively to eliminate allergy and hayfever symptoms. It has been used throughout time to restore kidney function, eliminating edema, cystitis, incontinence, and urinary tract infections. Improving liver function, Nettle reduces jaundice. The high Vitamin C content of Nettle ensures that dietary iron is properly absorbed, reducing headaches. By improving nerve signal to the muscle, Nettle helps increase muscle response time, reducing incidence of postpartum hemorrhage. By improving elasticity of the skin, Nettle helps prevent tearing of vaginal tissue. Combined with burdock root, Nettle is extremely helpful in the treatment of eczema. Nettle is an excellent promoter of abundant breastmilk.


Oatstraw (Avena Sativa)

Oatstraw, as any livestock breeder will confirm, builds the strongest possible body, with the greatest resiliency. Used extensively in European cultures throughout time for health and beauty, the United States has let this valuable herb slide into disuse.

Contains: Starch, silicic acid, calcium, Vitamins A, C, B-complex, LE, G, phosphorus, potassium, mucin, and protein.

Oatstraw contains Avenin, an amorphous alkaloid which is highly nutritive to cells, improving normal cellular reproduction. Its calcium is so easily absorbed that oatstraw is considered the premier food/herb for the nervous system. Working directly on the brain and endocrine system, oatstraw reduces nervous disability, anxiety, and epilepsy. Due to its ease of absorption, oatstraw has been used with great success in addiction recovery. As calcium is responsible for the enzymatic process by which nutrients are laid down in the muscle, oatstraw improves muscle tone throughout the body, reducing leg cramps and heart palpations, improving digestion and elimination. Improving muscle tone allows the cardiovascular system to function more vigorously, improving circulation to the uterus and placenta, and therefore, to the baby. Its high levels of minerals make oatstraw invaluable in building excellent bone density and enamel on teeth. Oatmeal’s high levels of silicic acid are responsible for its international fame for helping heal skin disorders such as acne and relief from topical inflammations such as chicken pox and poison ivy. Oatstraw, in cases of allergic reactions, seems not to affect the individual to the same degree as the oat grain and is often used without aggravation by those who cannot eat oats.


Red Raspberry (Rubus strigosus or idaeus)

Likely the most well-known pregnancy herb, red raspberry has been used throughout Europe and the Americas for centuries as the premier herb for the childbearing years. Growing easily in almost every environmental condition, even the youngest country child can identify the wild, briary canes as they overtake everything in their path.

Contains: Fruit sugar, pectin, citric acid, malic acid, Vitamins C and B2, niacin, carotene, magnesium, manganese, molybdenum, selenium, and improves Vitamin D absorption.

Red Raspberry is a specific muscle toner, working on the smooth muscle of the body, including the uterus. As it soothes spastic muscle behavior, it improves contractibility of the uterus during labor. The particular properties of the herb tone and nourish the ovaries and, by relation to the pituitary, reduces nausea, morning sickness, and intestinal spasm caused by excess progesterone. This same relationship has made red raspberry a popular herb for menstrual cramps and hot flashes. Due to its astringent qualities, it is used for mouth ulcers, bleeding gums, hemorrhage, hemorrhoids, and cold sores. The unique mineral blend in red raspberry promotes healthy nails, bones, teeth, and skin.


Alfalfa (Medicago Sativa)

One of the richest mineral foods in the world, alfalfa’s roots grow as deep as 130 feet into the ground, allowing it to reach minerals not available at higher levels. The name “alfalfa” is Arabic and means “father of all foods”.

Contains: Calcium, magnesium, phosphorus, potassium, chlorophyll, biotin, choline, inositol, iron, PABA, sodium, sulfur, tryptophan, Vitamins A, B complex, C, E, G, K, P, and U,

Alfalfa is a restorative tonic which promotes pituitary gland function. It contains 8 enzymes known to promote a chemical reaction that enables food to be assimilated properly, helping to normalize weight, reduce incidence of ulcers, diabetes, and other digestive disorders. It alkalinizes the body, reducing arthritis symptoms, neutralizing uric acid, improving kidney function, and reducing edema. A toning agent to the intestines, it improves peristaltic action of the bowels, improving colon disorders and normalizing bowel movements. It contains anti-fungal properties. Alfalfa’s tryptophan levels help improve sleep patterns. In tablet form, alfalfa has been used successfully to reduce heart disease and improve arrhythmia. Alfalfa has been shown, in laboratory trials, to reduce cholesterol levels by reducing plaque.

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