Pregnancy, Parenthood & Playtime

Remember that tonight, on the biggest drinking nights of the year.

There are people out and about with their families and children traveling to their destinations for their Holiday tomorrow.
If you are going to go out and drink, do the right thing and have a designated driver or call a cab.

It seems as though there is an epidemic of teens losing their lives needlessly recently in motor vehicle accidents. The last one this past weekend in Shelton, in which my husbands fire department responded to. Such a sad loss of life that could have easily been prevented by safe driving, not speeding and following the rules of the road, and we are seeing this more and more.

Several times over the summer we learned about speeding teens in accidents, some fatal, some not, but the common factor in most of these accidents was speed. During a News Channel 8 interview with a friend of one of the victims of the Shelton crash this weekend, she discussed how the 19 year old driver of the car, Larry Morra, had discussed totaling 4 or 5 cars, and how she was lucky to be alive after a accident where she recently totaled her car. Unfortunately this accident not only took his life but the life of his 18 year old girlfriend, and almost took the life of another 18 year old friend.

We see shows like “My Super Sweet 16″ on MTV which is directly geared towards this age group, so why not promote, record and air a show on safe driving and feature all these horrible accidents that kill young people long before it is their time to leave this Earth. Maybe it will help these teens to learn that they are not invincible like some seem to think they are.

As parents we need to monitor their driving more, be more involved in their teen years, it is not a time to become less hands on, but more hands on as there is more trouble, and danger that these children can still put themselves into. Especially while operating a motor vehicle.   I fully believe the changes that have been put onto drivers licenses in the state over the past couple years have been positive, but if we keep seeing accidents like this, we need more done.

There has been a lot of talk in Canada about breech babies being automatically delivered via cesarean section as they are currently in Canada and The United States, when a new study shows breech vaginal delivery to be a better option in most cases. A new article published goes into detail about why this should change.

“Physicians should no longer automatically opt to perform a cesarean section in the case of a breech birth, according to new guidelines by the Society of Obstetricians and Gynecologists of Canada.”

Unfortunately the problem in Canada as well as The United States is a serious shortage of providers that are trained or even educated in breech birth because of the long thoughts of serious risks that came along with vaginal breech birth. Now that studies have shown breech vaginal birth can be safely done, there are no providers who will attend or know how to attend these kind of births. Sadly I do not see a change in this anytime soon.  Across the state of Connecticut, I am not personally aware of any providers who will allow or attend a vaginal breech delivery currently as I have had mothers contact me in search of such providers to avoid cesarean delivery. While there are methods to help position the baby into the ideal birthing position, not in all cases is this successful.

“Breech presentations occur in 3-4 per cent of pregnant women who reach term. That translates to approximately 11,000 to 14,500 breech deliveries a year in Canada.”

While these are not numbers for The United States, our numbers closely echo that of Canada. If ACOG would follow SOGC and change their guidelines on breech birth, it would help to lower the already incredibly high cesarean section rates in our country.

“Vaginal birth is the preferred method of having a baby because a C-section in itself has complications.”

Is personal political animosity clouding the judgment of officials in two Fairfield county towns?
Today the Connecticut Post published an article on the refusal on the part of current Mayor James Miron to sign an emergency request for two new fire trucks which the town of Stratford is in great need for, on the upper part of the River Road, we in Shelton now worry about the same lack of concern for our current all volunteer fire department after Echo Hose Company #1 fireman Chris Jones ran against current Shelton Mayor Mark Lauretti in the past Mayoral election earlier this month.

In Stratford we are seeing blatant disregard for public safety considering the article not only highlighted that the Stratford Fire trucks have broke down in route to calls, but also that the Stratford Fire Union backed Republican John Harkins who won the November election over Miron for Mayor. Unfortunately for Stratford, because of Miron’s selfish actions the town may lose the bid for these two pieces of fire equipment before the new Mayor elect is sworn in on December 14th.  From an outsider, and a lifelong resident of Stratford until 2 years ago, it looks as though the current Mayor is acting like a child pitching a fit on his way out.

Lets move up to Shelton, a town in which my husband is currently a volunteer firefighter. In Shelton there are 4 fire companies, in which all are in need of some type of equipment, fire trucks, or simply new gear for the men being brave enough to risk their own safety for the safety of the public. If we look at the downtown fire department who sees the most calls out of all 4 companies in the city, and is also fire headquarters, they are seriously lacking in essentials, one being a fire house. The current building is falling apart in every which way. There is also the need for equipment for the firefighters themselves. Gear that fits appropriately, appropriate communication equipment, etc.  Don’t get me wrong, the fire department in our area is great, but unfortunately for the men themselves it seems like local government is always forgetting about them.

My hope for 2010 is that in Shelton, the run for Mayor by a fireman does not cloud the judgment of our current Mayor and put the safety of our public in danger because of a possible personal vendetta.

Today The March of Dimes released its annual report card which looks at The United States, and at individual states across our country to see how we are doing in terms of premature birth rates, health conditions and behaviors that may increase premature birth, and medical procedures that are electively delivering babies prematurely.

The article published in HealthDay, pinpoints several different factors for our babies being born prematurely.

Each year, the March of Dimes ranks each state according to its rate of premature births — babies born before 37 weeks of gestation. Preterm births contribute to infant mortality and can put children at risk for lifelong problems, including cerebral palsy and developmental disabilities. The U.S. premature birth rate was 12.7 percent in 2007 (the year the birth data was collected), nearly twice the goal of 7.6 percent set by the federal government’s Healthy People 2010 campaign.

Connecticut, among the states with a premature delivery rate of over 10%. Many will go on to say it is because in Connecticut we have two major fertility labs, one affiliated with the UCONN medical center, and the other at Yale, and the increased amount of multiples is a risk factor in these numbers, but not according to this report. While further looking into Connecticut’s”report card” from this study, I noticed that while we may not score a D on the overall report card, a C is not much better.

A couple of the risk factors that were looked at in Connecticut were the number of uninsured women, women who smoke during pregnancy, and late pre term birth which is described as

“The rise in late preterm births (34-36 weeks) has been linked to rising rates of early induction of labor and c-sections. We call on hospitals and health car professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines.”

Not too long ago, I wrote about hospitals starting to crack down on elective inductions before 39 which was contributing to these numbers, as well as elective cesarean sections which could be non medically necessary primary cesarean sections or repeat elective cesarean sections with no medical reason.”
When the study looked at the number of uninsured women, Connecticut is moving in the right direction. The previous uninsured rate for pregnant women in Connecticut was 13.5% which dropped to 12.2%. While it is a small jump, it is still a step into the right direction. Any improvement is improvement that will impact our children and that is a good thing.

Unfortunately the study see’s a negative in the other numbers. The amount of women who continue to smoke cigarettes while pregnant went from 16.7% to 18.7% and while it does not seem like a big increase, when over 40,000 babies were born in Connecticut in 2007, that is over 7000 babies.  As well as a small but significant increase in the late pre term babies, from 7.1% to 7.2%. I fully believe more guidelines being put into place regarding elective inductions and cesarean sections will help to curb this number in the future.

While there were some improvements on a national level in other states such as Arizona, the March of Dimes is concerned that the small amount of progress we made from 2007-2008 will drop from the economic climate which started to take a dive in 2008 and continued to impact families in 2009.

“Howse said she was concerned that the recession, including job losses and loss of medical benefits, could reverse the trend when the birth statistics from 2008 and 2009 are analyzed. “I think we’re moving in the right direction, but I am worried we are going to see slippage,” Howse said.”

I personally do not see the loss of insurance as a reason to not receive pre natal care because of all the programs put in place to aid people in these situations. Our babies should be more important to us than bills, especially when the economy is slowly increasing. I am not being pushy or putting others down, as someone who has been there, I simply find no excuse to gamble with my child’s health. No one should!

Another thing that we do see here in Connecticut that may or may not contribute to our late pre term baby numbers are elective cesarean sections before 39 weeks gestation. Earlier this year there were several reports not only from ACOG but also from the March of Dimes encouraging providers to wait until their patients are atleast 39 weeks gestation before an elective cesarean section. Yet we continue to see elective cesarean sections taking place at 37, and 38 weeks still. The same goes for labor inductions.

“The March of Dimes recommends babies not be delivered by elective C-section or induction before 39 weeks.”

As I spoke of above, the number of twin and triplet pregnancies increasing is also adding to these risks. Maybe not as much in Connecticut, but as a whole in the United States it is starting to have an impact.

“In New Jersey, a key reason for premature births is the number of twins, triplets and higher-order multiples being born as a result of invitro

procedures, Perl said. Twins are delivered on average, at about 35 weeks, triplets at 33 weeks, and quadruplets at 29 weeks, according to the American College of Obstetricians and Gynocologists”

I think that the number of multiples also calls for a national standard in IVF and other types of fertility treatments, like the calls we saw earlier in the year after the famous Octomom case. While there may not be extreme cases like that woman, there are still some Doctors who may not be practicing as ethically as they should be.

“Perl recommends fertility doctors follow American Society for Reproductive Medicine guidelines that call for implanting no more than two embryos at a time for women under 35, and no more than three for women with poorer chances of becoming pregnant. About 540,000 babies are born prematurely in the United States each year, costing more than $26 billion in additional health care costs. “

As pointed out in this same article, it is no wonder the United States is ranked 30th in infant mortality behind many other developed or developing countries. This number has risen over 30% since 1986. We are not taking steps forward with all of the medical advances that we have had in the past 2 decades in many cases and our statistics continue to show this.

Most women are not aware that here in Connecticut we have a free standing birth center that is not inside, or part of a local hospital. The Connecticut Childbirth & Women’s Center is located in Danbury. During my second pregnancy, I discovered the birth center and the midwives, unfortunately for me, I was unable to birth in the actual birth center itself because of rules on previous cesarean sections and the birth center, but I was able to have my birth attended by the wonderful midwives that run the birth center. All three who are amazing providers, wonderful women, and greatly educated on what they do.

The birth center provides the best of both worlds, professional care attended by Certified Nurse Midwives, while care for any kind of an emergency is nothing more than a stones throw away at Danbury hospital located directly across the street. Because of my previous cesarean section, I birthed at the hospital, and the experience I had at Danbury hospital was also wonderful. The facilities are beautiful, comfortable, and exactly what a laboring mother needs and wants, especially if you would rather just be at home. The birth center in Danbury also became the first “baby friendly” birthing facility in southwest Connecticut. By the term “baby friendly” it refers to the most breastfeeding friendly facilities in the state. In Connecticut we only have 3 of these facilities at this point in time.

There are three wonderful midwives who I had the chance of getting to know, and bonding during my pre natal care and pregnancy. While I did not see them all frequently, I can say they are all amazing women. Cathy Parisi MSN, CNM, Catherine Gallagher, CNM, and Sarah Najamy C.N.M. All wonderful providers. For most of my pregnancy, I spent it with Sarah, and over that time our relationship developed into something more than just a patient/care provider which is exactly what I needed for my care, and my chance at having a real VBAC.  I also had the pleasure of many appointments with Catherine Gallagher who experienced her own VBAC just in a home setting rather than in the hospital, I was able to really pick her brain a lot about having a VBAC.

After having my care for the past year with them, I cannot imagine going anyplace else.

For any questions you can refer to their website.

I highly recommend them!

This time they featured “12 Surgeries You may be better off without” and not only do they include cesarean sections, but they also include episiotomies, which have been common practice for a long time in our Obstetric model of maternity care. Some women even getting them without consent or even being told by their doctor that he/she was cutting an episiotomy. Long term studies have shown little to no benefit to having an episiotomy, so it is a wonder why they are still being done in relatively large numbers.
Here in Connecticut alone, we have numbers well over the “recommended” 5%, some hospitals even exceeding 25%!!

As women, and consumers, we need to be educated on the procedures we undergo, the providers we choose for our care, and the risks and benefits that are associated with these choices, which I fully believe are not being truly detailed for many women, and the repeat cesarean section numbers in Connecticut alone show that. The vast majority of hospitals have a 90%-100% repeat cesarean section rate. Don’t believe me? I obtained these statistics yesterday from an e-mail directly from the Connecticut Department of Health.These statistics are for low risk pregnancies. Another alarming number is the amount of women in 2007 who were considered low risk, as well as the number of primary (first) cesarean sections that are taking place in our state hospitals.

Now, back to what consumer reports has to say.

“Two of the most frequently performed major operations in the U.S. are exclusively for women: hysterectomy, or surgical removal of the uterus and often the ovaries, and cesarean section. In both cases research suggests that most physicians fail to follow treatment guidelines from the American College of Obstetricians and Gynecologists (ACOG). More than 700,000 women a year are also subjected to episiotomy, a less invasive but even more dubious procedure in which physicians make a short incision to widen the vaginal opening during childbirth.”

“Cesarean section. Most C-sections are done because labor is progressing too slowly. But several less-invasive approaches—medication, deliberate rupture of the membranes around the fetus, even a shoulder or foot massage or a warm shower—may be enough to stimulate labor. Physicians also perform cesareans in the vast majority of women who’ve already had one. But ACOG says that most of those women could safely try for a vaginal delivery, which would succeed about 70 percent of the time; if it doesn’t, the doctor could simply switch to cesarean delivery.”

Unfortunately for women, and their health, especially here in the state of Connecticut, finding a provider who will attend a VBAC (Vaginal Birth After Cesarean) is almost like looking for a needle in a haystack, especially if you want to have your VBAC in a hospital. If you have had more than one cesarean section, for whatever reason, you have no options if you want a hospital birth, it is repeat cesarean, or do not have any more children in most cases.  But what concerns me the most is what many major health organizations have to say about the growing cesarean sections rates in the United States, which as a whole is at 31.8% nationwide, but here in Connecticut we are higher at 34.6% as of 2007. If we turn the tables back 20 years, the vast majority of women who had a cesarean section at one point in their life went on to have a successful VBAC without having to fight tooth and nail.
The other day I blogged about a woman who was dropped by her providers because she would not consent to a repeat cesarean section, which in turn was completely unnecessary. She went on to have a perfectly fine, uncomplicated, vaginal birth, and her and her 6th daughter were perfectly happy and healthy. She would have been subjected to an unnecessary surgery had she not stood up to the providers she chose, who were supportive of her VBAC her entire pregnancy.  The problem is the ramifications of these cesarean sections that people are not taking into consideration today.

There are so many risks when you start getting into the second, third, or fourth cesarean section.
Here are a couple examples of the risk factors with increasing cesarean section surgeries.

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion’s : 21.6% (1 in 5)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion’s : 32.2% (1 in 3)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in
Risk of Dense Adhesion’s : 42.2% (2 in 5)

Note : “Major complications” include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.

Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.

Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.

Nisenblat, V., Barak, S., & Griness, O.B., et al. Maternal complications associated with multiple cesarean deliveres. Obstetrics & Gynecology 2006; 108: 21-6

All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.

But back to what consumer reports went on to discuss.

“Recommendation. Ask what percentage of normal deliveries as well as births following a prior cesarean the physician delivers by C-section. Ideally, look for rates below 15 percent in women who haven’t had the procedure and about 60 percent in those who have. (Those rates can be higher if the physician treats many high-risk patients.) Ask about the doctor’s willingness to try nonsurgical steps first. Alternatively, consider delivery in a hospital by a certified nurse-midwife, if available. Deliveries by those practitioners tend to require C-sections less often than those done by obstetricians, with equally good results overall. And nurse-midwives have access to an obstetrician, who can perform a cesarean if needed.”

Also remember, your provider, or a provider you may be interviewing as a possible care provider does have these numbers, and does keep track of these numbers annually, not only for their practice, reporting to the department of heath, but also for insurance purposes including medical malpractice insurance. If a provider tells you they do not know their numbers, or do not keep track of it, that is a clear red flag.

Remember, you are a consumer and your health care is important to you.
So many people spend months researching cars, big screen TV’s, or other big purchases, but spend no time, or very little time researching their care provider and often go with the first person a friend recommends, or their insurance will cover. Demand better care, in the end it is your choice, and you have the final say.

Connecticut Hospital Cesarean Statistics for 2007

Connecticut Hospital Repeat Cesareans Vs. VBAC Statistics 2007

93.94%

4,999 Deliveries

10 years ago, to think about an international organization, or a website designed to help women get through having a cesarean birth would have been completely unheard of. But with the rising cesarean section numbers, for a number of reasons across the board, the number of women unsatisfied, hurt, and damaged by their birth experience is also climbing.

After the birth of my first child by cesarean, which I still feel to this day was not a necessary or lifesaving procedure, I felt hurt, confused, and overly emotional. I did not know that there were other women out there that felt as I did. I had no one to relate to, no one to share my feelings with. Then I discovered ICAN. The International Cesarean Awareness Network, a international support group that helped me to deal with my negative feelings from the birth of my son, and strive to make a difference in my community helping women like myself who had these same feelings and experiences. I have been doing this for going on two years now, and it is rewarding, and has helped in my own personal recovery immensely.

As time goes on and I get more involved in the birth community, support systems, and other blogs which run along the same lines of what I write about, I learned about a website called BirthCut. A site focused on women who have had negative experiences with cesarean sections, and giving them a safe and comfortable environment to share their story, and use artwork to express their feelings. After viewing the website on several occasions, I met the creator Michele Demont of Danbury, through ICAN. What an inspiration to anyone who has been through the experience of a traumatic cesarean or birth in general.

Before I leave you, there is another organization I would like to praise for their work with cesarean mothers who have been hurt by their experience. Solace For Mothers is a great resource for any woman that has had a traumatic birth experience, whether it be a cesarean or not.

Not all mothers who have c-sections will feel this way, and many may even enjoy their experiences, but this should not discount the hurt that others may feel, and the same should go for any birth including a vaginal birth. Cesarean sections are amazing and lifesaving procedures when used appropriately and correctly, but at the increased numbers we are seeing today, some may be very unnecessary. A woman’s feelings regarding her birth should be respected, not put down.

To close, I would like to share a video of my two experiences.
I hope people can be mature enough to understand these are my experiences, and my experiences only.

My Birth Journeys

My Birth Journeys from Danielle Elwood on Vimeo.