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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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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Charis “Teaching Birth” Workshop

THIS IS GOING TO BE A FANTASTIC WORKSHOP!!!
SPREAD THE WORD!!!

Charis “Teaching Birth” Workshop
Saturday, February 21, 2009
9 a.m. – 5 p.m.

At the Breath of Life Birth Center
1900 East Bay Avenue
Largo, FL 33771

For childbirth educators, doulas, midwives, or anyone who would like to improve her ability to communicate with and educate expectant families. 

At our workshops, learning is interactive, hands-on, fun, and interesting.  All Charis workshops are taught from a Christian perspective, giving God the glory for His marvelous creation and how He so wonderfully created women to bear children. 

You will spend the day making new friends and becoming more skilled in preparing effective introductions, asking powerful questions, creating a learner-friendly environment, capturing the attention of learners, helping clients embrace their responsibility of making informed decisions, and so much more. 

In addition to the valuable skills acquired at the workshop, you will also take home with you an assortment of visual aids and other valuable teaching tools to enhance your future students’ learning experience. 

A delicious lunch will be provided for all the workshop attendees to enjoy as you get to know each other better during a midday break.

The cost is $200 for Charis members and $230 for non-members (includes one-year Charis membership).

To register, complete the registration form and mail it to:
Charis Childbirth
P.O. Box 6900
North Port, FL 34290

Registration must be received by January 28, 2009.

Register early… space is limited.

Scriptures and Prayers for Pregnancy and Birth

Strength for Childbearing
Lily Bateman & Kristin Schuchmann
(all scriptures quoted are from the New International Version of the Bible)

Exodus 1:19
“The midwives answered Pharaoh, ‘Hebrew women (God-fearing women) are not like Egyptian women, they are vigorous and give birth before the midwives arrive.’”

Lord, thank you that I have vigor and strength to deliver this child you have given us!

Exodus 15:2
“The Lord is my strength and my song.  He had become my salvation.”

Lord, You are my song in the light and in the dark.  I will always sing to you, my Savior and my strength.

2 Samuel 22:33
“It is God who arms me with strength and makes my way perfect.”

Lord, You make the way of our baby’s delivery perfect.  You cause my body to be strong and work perfectly in order to glorify yourself in the delivery of our child.

Psalm 18:6
“In my distress I called to the Lord, I cried to God for help.  From his temple he heard my voice; my cry came before him, into his ears.”

Lord, I call to you for any help I will ever need, no matter what my situation.  I call on You first… and you hear my call.

Psalm 46:1-2
“God is our refuge and strength, an ever-present help in trouble.  Therefore we will not fear…”

Lord, You are the only ever-present one.  Thank you for being with us during labor and delivery.  I will not fear.

Psalm 139:14
“I praise you because I am fearfully and wonderfully made…”

Lord, You made me.  You created me to carry and deliver children.  Thank you for making me in such a wonderful fashion.

Isaiah 26:3
“You will keep in perfect peace him whose mind is steadfast, because he trusts in you.”

Lord, You are my supernatural, perfect peace.  I know your peace and will know it during labor and delivery of this child.  My focus is on You and your goodness.

Isaiah 40:30-31
“Even youths grow tired and weary, and young men stumble and fall, but those who hope in the Lord will renew their strength.”

Lord, You will renew my strength during delivery.  My strength will not wear out because it is from You and my hope is in You.

Isaiah 41:10
“So do not fear, for I am with you.  Do not be dismayed for I am your God.  I will strengthen you and help you.  I will uphold you with My righteous right hand.”

Because You, Lord, are staying with me throughout my labor and delivery, I have no reason to fear.

Isaiah 43:2
“When you pass through the waters, I will be with you…”

Lord, thank you for not leaving us alone.  Thank you for being with our baby as it passes through the waters in my womb.

Isaiah 51:12
“I, even I, am He who comforts you.”

Thank you, Holy Spirit, for always being my comfort.  You always bring the comfort I need.

Philippians 4:13
“I can do everything through him who gives me strength.”

Lord, I confess I can do this through You.  It is You who gives me strength.

Psalm 119:165
“Great peace have they who love your law, and nothing can make them stumble.”

Proverbs 14:30
“A heart at peace gives life to the body.”

Isaiah 54:13
“…and great will be your children’s peace (shalom).”

Thank you, Lord for your promise of peace.  I receive the peace that is mine in you, Jesus.  Thank you that my baby’s shalom, peace and total well-being, is secure because of your faithfulness to your servants and to your Word.  May your peace rule and reign and give life during my labor and the delivery of this child you have given us.

(C) Copyright Charis Childbirth, Inc.  All rights reserved.  Used with permission.

Singing to Relax during Labor

I have helped many women through the wonderful miracle of labor and birth over the last 20 years and am always brought to tears as new life enters the world.  It has always been a huge honor and privilege to help families prepare for their births and to assist them through their labors and deliveries.  It brings me great pleasure to help women have healthy, fulfilling birth experiences.

It is very sad to me, however, that so many women face childbirth equipped with so much bad information and fear; which, consequently, leads to greater pain and less-than-fulfilling birth experiences.  It doesn’t have to be that way! 

Here is a video of a woman singing through labor as a way to stay focused and relaxed– just before the home birth of her 10 lb baby.  It is beautiful and encouraging.

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~

“I will sing unto the LORD, for he hath triumphed gloriously…” Exodus 15:1

“I will sing unto the LORD, because he hath dealt bountifully with me.” Psalm 13:6

“But I will sing of your strength, in the morning I will sing of your love; for you are my fortress, my refuge in times of trouble.”- Psalm 59:16

“I will sing unto the LORD as long as I live: I will sing praise to my God while I have my being.” Psalm 104:33

“O God, my heart is fixed; I will sing and give praise, even with my glory.” Psalm 108:1