How to Avoid an Unnecessary Cesarean - 1/2 of the cesareans in the US are unnecessary

The Public Citizen Health Research Group in Washington, D.C. has estimated that half of the nearly 1 million cesareans performed every year are medically unnecessary. With more appropriate care during pregnancy, labor, and delivery, half of the cesareans could have been avoided. Clearly, there are times when cesareans are necessary. However, cesareans increase the risk to both mothers and babies. These are suggestions of things you can do to avoid an unnecessary cesarean and can help insure that your birth experience is as healthy and positive as possible.



BEFORE LABOR

* Read and educate yourself, attend classes and workshops inside and outside the hospital.

* Research and prepare a birth plan. Discuss your birth plan with your midwife or doctor and submit copies to your hospital or birth center.

* Interview more than one care provider. Ask key questions and see how your probing influences their attitude. Are they defensive or are they pleased by your interest?

* Ask your care provider if there is a set time limit for labor and second stage pushing. See what s/he feels can interfere with the normal process of labor.

* Tour more than one birth facility. Note their differences and ask about their cesarean rate, VBAC protocol, etc.

* Become aware of your rights as a pregnant woman.

* Find a labor support person. Interview more than one. A recent medical journal article showed that labor support can significantly reduce the risk of cesarean.

* Help ensure a healthy baby and mother by eating a well-balanced diet.

* If your baby is breech, ask your care provider about exercises to turn the baby, external version (turning the baby with hands), and vaginal breech delivery. You may want to seek a second opinion.

* If you had a cesarean, seriously consider VBAC. According to the American College of Obstetricians & Gynecologist, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesareans can go on to birth their subsequent babies vaginally.



DURING LABOR

* Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you.

* Continue to eat and drink lightly, especially during early labor, to provide energy.

* Avoid pitocin augmentation for a slow labor. As an alternative, you may want to try nipple stimulation.

* If your bag of water breaks, don’t let anyone do a vaginal examination unless medically indicated for a specific reason. The risk of infection increases with each examination. Discuss with your care provider how to monitor for signs of infection.

* Request intermittent electronic fetal monitoring or the use of a fetoscope. Medical research has shown that continuous electronic fetal monitoring can increase the risk of cesarean without related improvement in outcome for the baby.

* Avoid using an epidural. Medical research has shown that epidurals can slow down labor and cause complications for the mother and baby. If you do have an epidural and have trouble pushing, ask to take a break from pushing until the epidural has worn off some and then resume pushing.

* Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the hospital, instead of being admitted, walk around the hospital or go home and rest.

* Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on you and your baby, and what are your other options.

* Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.

Cesarean Rates by State - MS is 35.4% - 1 in 3 children enter the world by abdominal surgery

2006 Cesarean Rates by state


United States 31.1

1 NewJersey 37.4
2 Florida 36.1
3 Louisiana 35.4
4 Mississippi 35.4
5 West Virginia 35.2
6 Kentucky 34.5
7 Connecticut 34.1
8 Alabama 33.4
9 Oklahoma 33.3
10 Arkansas 33.2
11 Massachusetts 33.2
12 Texas 33.2
13 South Carolina 32.9
14 New York 32.6
15 Tennessee 32.4
16 Virginia 32.4
17 Nevada 32.3
18 Maryland 32.2
19 California 31.3
20 Georgia 31.3
21 Rhode Island 31.1
22 Delaware 30.7
23 DC 30.6
24 Missouri 30.2
25 Maine 29.9
26 New Hampshire 29.9
27 North Carolina 29.9
28 Michigan 29.8
29 Pennsylvania 29.7
30 Illinois 29.6
31 Kansas 29.3
32 Ohio 29.3
33 Indiana 29
34 Nebraska 28.8
35 Washington 28.4
36 Oregon 28.2
37 Montana 28
38 North Dakota 27.8
39 Iowa 27.7
40 South Dakota 27
41 Wyoming 26.3
42 Vermont 26
43 Arizona 25.6
44 Hawaii 25.6
45 Minnesota 25.4
46 Colorado 25.3
47 Wisconsin 24.6
48 New Mexico 23.3
49 Alaska 23
50 Idaho 22.8
51 Utah 21.5

The Farm Free standing Birthing Center TN - 1.8%

Access to VBAC is Shrinking

Access to VBAC is Shrinking
Date:
Feb 19 2009

New Survey Shows Shrinking Options for Women with Prior Cesarean

Bans on Vaginal Birth Force Women into Unnecessary Surgery



For Immediate Release



Redondo Beach, CA, February 20, 2009 – The International Cesarean Awareness Network (ICAN) has released the results of a new survey showing an alarming increase in the number of hospitals banning vaginal birth after cesarean (VBAC). The survey shows an 174% increase from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with “de facto” ban.[1] Full results of the research can be seen http://ican-online.org/vbac-ban-info.



The bans essentially coerce women into surgery they do not need. In response to bans, women are either submitting to unnecessary surgery or are traveling long distances to hospitals that do support VBAC. Some women are feeling forced out of hospital care altogether and are having their babies at home in order to avoid coerced surgery.



“There is an alarming disconnect between what medical research says about the safety of VBAC, and the way that hospitals and their doctors are practicing medicine” said Pam Udy, president of ICAN, an all-volunteer patient advocacy organization. “These bans are about business, not about the health and well-being of mothers and babies.”



Research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean. According to an analysis of medical research conducted by Childbirth Connection, a well-respected, independent maternity focused non-profit, in the absence of a clear medical need, VBAC is safer for mothers in the current pregnancy, and far safer for mothers and babies in future pregnancies.[2] While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life-threatening risks as well. “The choice between VBAC and elective repeat cesareans isn’t between risk versus no risk. It’s a choice between which set of risks you want to take on,” said Udy.



Studies from the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, one most recently published in the February 2008 issue of the Journal of Obstetrics and Gynecology, demonstrate that repeated cesareans can actually put mothers and babies at greater clinical risk than repeated VBACs.[3]







Hospitals cite strict guidelines set by the American College of Obstetrics and Gynecology as the driver behind the bans. The ACOG guidelines stipulate that a full surgical team be “immediately available” during a VBAC labor, though the stipulation is a “Level C” recommendation, which means it is based on the organization’s opinion rather than medical evidence.



“If a hospital can’t handle a VBAC emergency, they can’t handle any emergency. VBAC-banning hospitals are claiming to be a safe place of birth for non-cesarean moms, but those mothers are just as likely to have an emergency as a mother with a prior cesarean” says Udy. Placental abruption, cord prolapse, fetal distress are all common emergencies that any mother can experience and require immediate attention.



For physicians, repeat cesareans are often considered more convenient, more lucrative and better insulation from lawsuits. VBACs are inconvenient and costly because they require the physician to be on-site and be available to care for the mother. “ACOG created clinical guidelines that are, in effect, good for business,” said Gretchen Humphries, ICAN’s Advocacy Director, who spearheaded the research. “If physicians think VBAC patients need more attention, then they can simply provide that attention by being in the hospital. But it’s easier to just push women into unnecessary surgery.”



“These bans mean that any mother with a prior cesarean is going to have to be aggressive about seeking out balanced information about the pros and cons of a VBAC versus an elective repeat cesarean, and unfortunately, be prepared for an uphill climb if she chooses to have a VBAC,” said Humphries. For more information about the rights of mothers facing VBAC bans, please visit http://www.ican-online.org/vbac/your-right-refuse-what-do-if-your-hospital-has-banned-vbac-q .



For more information about the clinical risks of VBAC and elective repeat cesarean, please visit: http://www.childbirthconnection.org/article.asp?ck=10210#bottom



About the survey: This survey was powered by an all-volunteer team of callers who called, state by state, hospitals across the country. Survey volunteers used publicly available listings of hospitals and made every effort to call every hospital in each state. Surveyors contacted each hospital’s Labor and Delivery (L&D) ward and questioned L&D nurses about the hospital’s practices. Survey questions were designed to elicit information about formal bans, de facto bans, the reasoning behind the bans, and the level of coercion mothers might face if couldn’t find an alternate hospital option. Information from calls were recorded into a central database. A total of 2,850 hospitals were called. Individual records are available for viewing at http://ican-online.org/vbac-ban-info.



About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. http://www.ican-online.org/resources/white_papers/index.html



Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean. There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.



For Interviews: Contact ICAN President Pam Udy at (801) 458-2190 or ICAN Advocacy Director Gretchen Humphries at (517) 745-7297.


[1] A “de facto” ban means that surveyors were unable to identify any doctors practicing at the hospital who would provide VBAC support.

[2] http://www.childbirthconnection.org/article.asp?ck=10210#bottom Best Evidence: VBAC or Repeat C-Section, Childbirth Connection

[3] Mercer et al, Labor Outcome With Repeated Trials of Labor Am J Obstet Gynecol 2008;VOL. 111, NO. 2, PART 1

Silver et al, Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries, Am J Obstet Gynecol 2006; VOL. 107, NO. 6

The Trouble With Repeat Cesareans from Time Magazine

Time Article 2/19/09 - The Trouble with Repeat Cesareans


The Trouble With Repeat Cesareans

For many pregnant women in America, it is easier today to walk into a hospital and request major abdominal surgery than it is to give birth as nature intended. Jessica Barton knows this all too well. At 33, the curriculum developer in Santa Barbara, Calif., is expecting her second child in June. But since her first child ended up being delivered by cesarean section, she can't find an obstetrician in her county who will let her even try to push this go-round. And she could locate only one doctor in nearby Ventura County who allows the option of vaginal birth after cesarean (VBAC). But what if he's not on call the day she goes into labor? That's why, in order to give birth the old-fashioned way, Barton is planning to go to UCLA Medical Center in Los Angeles. "One of my biggest worries is the 100-mile drive to the hospital," she says. "It can take from 2 to 3 1/2 hours. I know it will be uncomfortable, and I worry about waiting too long and giving birth in the car."

Much ado has been made recently of women who choose to have cesareans, but little attention has been paid to the vast number of moms who are forced to have them. More than 9 out of 10 births following a C-section are now surgical deliveries, proving that "once a cesarean, always a cesarean"--an axiom thought to be outmoded in the 1990s--is alive and kicking. Indeed, the International Cesarean Awareness Network (ICAN), a grass-roots group, recently called 2,850 hospitals that have labor and delivery wards and found that 28% of them don't allow VBACs, up from 10% in its previous survey, in 2004. ICAN's latest findings note that another 21% of hospitals have what it calls "de facto bans," i.e., the hospitals have no official policies against VBAC, but no obstetricians will perform them.

Why the VBAC-lash? Not so long ago, doctors were actually encouraging women to have VBACs, which cost less than cesareans and allow mothers to heal more quickly. The risk of uterine rupture during VBAC is real--and can be fatal to both mom and baby--but rupture occurs in just 0.7% of cases. That's not an insignificant statistic, but the number of catastrophic cases is low; only 1 in 2,000 babies die or suffer brain damage as a result of oxygen deprivation.

After 1980, when the National Institutes of Health (NIH) held a conference on skyrocketing cesarean rates, more women began having VBACs. By 1996, they accounted for 28% of births among C-section veterans, and in 2000, the Federal Government issued its Healthy People 2010 report proposing a target VBAC rate of 37%. Yet as of 2006, only about 8% of births were VBACs, and the numbers continue to fall--even though 73% of women who go this route successfully deliver without needing an emergency cesarean.

So what happened? In 1999, after several high-profile cases in which women undergoing VBAC ruptured their uterus, the American College of Obstetricians and Gynecologists (ACOG) changed its guidelines from stipulating that surgeons and anesthesiologists should be "readily available" during a VBAC to "immediately available." "Our goal wasn't to narrow the scope of patients who would be eligible, but to make it safe," says Dr. Carolyn Zelop, co-author of ACOG's most recent VBAC guidelines.

But many interpreted the revision to mean that surgical staff must be present the entire time a VBAC patient is in labor. While major medical centers and hospitals with residents are staffed to provide this level of round-the-clock care, smaller hospitals typically rely on anesthesiologists on call. Among obstetricians, many solo practitioners are unable to stay for what could end up being a 24-hour delivery; others calculate the loss of unseen patients during that time and instead opt to do hour-long cesareans, which are now the most commonly performed surgeries on women in the U.S.

Some doctors, however, argue that any facility ill equipped for VBACs shouldn't do labor and delivery at all. "How can a hospital say it can handle an emergency C-section due to fetal distress yet not be able to do a VBAC?" asks Dr. Mark Landon, a maternal-fetal-medicine specialist at the Ohio State University Medical Center and lead investigator of the NIH's largest prospective VBAC study. (See 9 kid foods to avoid.)

Part of the answer has to do with malpractice insurance. Following a few major lawsuits stemming from VBAC cases, many insurers started jacking up the price of malpractice coverage for ob-gyns who perform such births. In a 2006 ACOG survey of 10,659 ob-gyns nationwide, 26% said they had given up on VBACs because insurance was unaffordable or unavailable; 33% said they had dropped VBACs out of fear of litigation. "It's a numbers thing," says Dr. Shelley Binkley, an ob-gyn in private practice in Colorado Springs who stopped offering VBACs in 2003. "You don't get sued for doing a C-section. You get sued for not doing a C-section."

Of course, the alternative to a VBAC isn't risk-free either. With each repeat cesarean, a mother's risk of heavy bleeding, infection and infertility, among other complications, goes up. Perhaps most alarming, repeat C-sections increase a woman's chances of developing life-threatening placental abnormalities that can cause hemorrhaging during childbirth. The rate of placenta accreta--in which the placenta attaches abnormally to the uterine wall--has increased thirtyfold in the past 30 years. "The problem is only beginning to mushroom," says ACOG's Zelop.

"The decline in VBACs is driven both by patient preference and by provider preference," says Dr. Hyagriv Simhan, medical director of the maternal-fetal-medicine department of Magee-Womens Hospital of the University of Pittsburgh Medical Center. But while many obstetricians say fewer patients are requesting VBACs, others counter that the medical profession has been too discouraging of them. Dr. Stuart Fischbein, an ob-gyn whose Camarillo, Calif., hospital won't allow the procedure, is concerned that women are getting "skewed" information about the risks of a VBAC "that leads them down the path that the doctor or hospital wants them to follow, as opposed to medical information that helps them make the best decision." According to a nationwide survey by Childbirth Connection, a 91-year-old maternal-care advocacy group based in New York City, 57% of C-section veterans who gave birth in 2005 were interested in a VBAC but were denied the option of having one.

Zelop is among those who worry that "the pendulum has swung too far the other way," but, she says, "I don't know whether we can get back to a higher number of VBACs, because doctors are afraid and hospitals are afraid." So how to reverse the trend? For one thing, patients and doctors need to be as aware of the risks of multiple cesareans as they are of those of VBACs. That is certain to be on the agenda when the NIH holds its first conference on VBACs next year. But Zelop fears that the obstetrical C-change may come too late: "When the problems with multiple C-sections start to mount, we're going to look back and say, 'Oh, does anyone still know how to do VBAC?'"

The ‘‘Authorities’’ Resolve Against Home Birth Nancy K.

http://www3.interscience.wiley.com/cgi-bin/fulltext/121645508/HTMLSTART

This editorial has been gathering momentum in
my mind since I heard about a resolution introduced
by the American College of Obstetricians
and Gynecologists (ACOG) to the House of Delegates
of the American Medical Association’s (AMA)
annual meeting in June 2008. American College of
Obstetricians and Gynecologists’s resolution #205
was adopted by the AMA and is titled ‘‘Home
Deliveries.’’ So that I cannot be accused of misquoting
the AMA or ACOG, you will find the text
of the adopted resolution at the end of this editorial.
In his ‘‘College News’’ column of ACOGToday (September
2008), ACOG Executive Vice President
Ralph W. Hale reported on his attendance at the
AMA Annual Meeting and wrote, ‘‘Also, there
was model legislation related to home deliveries
supporting the ACOG position against home
births.’’ The point of this resolution is to lobby
against home birth as an option for women and
against providers of home birth services. This type
of resolution by ‘‘authoritative’’ bodies such as
ACOG and AMA will certainly in£uence decisions
made by third-party payers when women request
home birth services and by liability insurance carriers
when providers seek coverage for home birth
services.

Rumor has it, as stated in the Los Angeles Times
on July 9, 2008, that in the original ACOG
resolution, there was another ‘‘whereas’’ that was
deleted before adoption. It read, ‘‘Whereas, there
has been much attention in the media by celebrities
having home deliveries, with recent ‘Today
Show’ headings such as ‘Ricki Lake takes on baby
birthing industry.’’’ You may not be aware that in
2007 producer Ricki Lake and director Abby Epstein
released a documentary film The Business of Being
Born. The film asked the question ‘‘Should most
births be viewed as a natural life process, or should
every delivery be treated as a potentially catastrophic
medical emergency?’’ If you have not seen
this film, I encourage you to do so and to view it with
an openmind, an open intellect, and an open heart.
The DVD can be purchased for a modest price at
http://www.thebusinessofbeingborn.com/
Evidently, ACOG felt it necessary to highlight
Ms. Lake’s coverage of this issue as a potential
threat to the safety of mothers and babies. It is
beyond the scope of an editorial to review the international
and national data about maternal
and infant outcomes and the relationship of these
outcomes to location of birth. However, one instructive
example is a prospective cohort study
of maternal and infant outcomes in British Columbia
during the first 2 years after women were
given the choice to plan a home birth with regulated
midwives (Janssen et al., 2002). After controlling
for appropriate confounding variables, the data
showed no increased maternal or neonatal risk
for the 862 planned home births compared
with 1,314 planned hospital births.The overall transfer
rate to hospital care was 21.7% in the home
birth group with 16.5% transferred during labor.
The multivariate analysis showed that the
women who planned to have home births were
significantly less likely to undergo induced or
augmented labor, epidural analgesia, episiotomy,
or cesarean delivery.

I was born in the United States and I am very proud
to be an American, but I am embarrassed that our
country founded on the ideals of individual liberty
and freedom, can also support ‘‘authoritative’’ initiatives
such as these by the ACOG and AMA,
initiatives that are founded on neither science nor
an understanding of the physiologic and psychosocial
needs of mothers and babies. What is most
risky about home birth in the United States is that
for most women who desire it there is a scarcity of
qualified providers of home birth services. There is
no system of care that provides the needed
safety net if transfer to a different type of care is required
during labor. Rather, women who desire to
birth at home sometimes chose providers unwisely,
and those who require transfer are often treated
with disdain and disregard as though their decision
to give birth outside the hospital system is irresponsible,
reckless, and perhaps immoral. There is
nothing more inhumane or uninformed than this attitude
toward women who desire to birth at home
and the qualified providers who are willing to attend
them.

When will we remember that pregnancy, childbirth,
and lactation are normal healthy physiological processes
that are a continuum and do not require
medical intervention unless there is a medical problem?
A woman’s body and the physiology of
pregnancy, labor, birth, and lactation are designed
to promote the well-being of the fetus and newborn.
When will we establish optimal outcomes as the
goal of health care during the childbearing cycle,
rather than attempting to reduce by small increments
the incidence of morbidity and mortality that
is compounded by the very interventions we use to
attempt to avoid such problems? We all know that
in our current health care milieu for childbearing
women, the protection of normal is not valued or
supported, except in a very few locales. Those who
support normalcy are usually swimming upstream
against a system that treats every laboring woman
as a surgical case. The idea that a normal spontaneous
birth is by design the best outcome for a
healthy woman and her infant is neither believed
nor entertained as a basic concept. Most U.S.-
trained physicians and sadly most U.S.-trained
nurses have minimal experience with normal labor
and birth. Without fetal monitors, intravenous lines,
infusion pumps, epidurals, pitocin, endless charting,
and rules theses individuals are helpless and
unskilled to provide the kind of informed human
support and wise guidance that a laboring woman
needs while the normal process of labor and birth
unfolds.
In fact, knowledgeable women often must fight to
defend the normalcy of the process and their desire
to labor and birth spontaneously without medical
technology or intervention. In many ways it is reminiscent
of the 1960s when many of us who were
young women at the time fought for our right to natural
childbirth without general anesthesia and to
have our husbands accompany us into the delivery
room. Breastfeeding was not the norm and was not
supported by hospital care. During my 5-day postpartum
stay after a vaginal delivery in 1969, I had to
repeatedly insist that my newborn son be brought
to me during the night for breastfeeding because
as I was told by the nurses, ‘‘Dr. X’s patients are to
sleep at night.’’ How audacious authority can be.
Amazingly, a few years later a headline in the science
section of the Chicago Tribune declared,
‘‘Science finds Breast is Best.’’ Since that time the
accumulation of scientific evidence has overwhelmingly
validated that physiologically obvious
statement, and the system, including its ‘‘authorities,’’
¢nally caught up to actively support
breastfeeding.Will it take a similar declaration: ‘‘Science
finds spontaneous labor and normal vaginal
birth is best’’ to change the course that we are currently
on and to change the rhetoric of the
authorities?

Why do 1% to 2% of U.S. women even want
to birth at home? For most it is simply because
they sincerely believe that the process is normal
and healthy and does not require the environment
of an ‘‘illness’’ system to support it. For these
women, birth has a unique, earthy, and frequently
spiritual component that they want to experience
fully under their own terms. They want to
actively labor and birth, rather than to have labor
happen to them, give over control to a system
and people with their own rules, and be delivered
of their babies. Some desire home birth because of
the subculture of their religious communities,
while others are overtly afraid of what may happen
to them in the hospital. They may be ‘‘on the
edge’’ of the allopathic medical system and be very
resistant to interventions that the system thinks
are in their best interest. Does this make them
wrong? No, it simply means that the system is not
meeting their needs for holistic care that supports
normalcy.

The point is that we have no system of maternity
care in the United States that provides a healthy woman
the choice of giving birth at home and if she
needs to transfer to a different type of care during
labor, the transfer is easy. We do not have a system
in which this woman is treated with respect
and kindness, and her provider either maintains responsibility
for her care or professionally and
respectfully is able to transfer responsibility to another
provider. Interestingly, while ACOG and AMA
have declared that hospital grounds are the only
safe place to give birth in the United States, the
National Perinatal Association (NPA) adopted a
position paper in July 2008 titled, ‘‘Choice of Birth
Setting.’’ The paper supports a woman’s right to
home birth services and concludes that, ‘‘The National
Perinatal Association (NPA) believes that
planned home birth should be attended by a quali-
¢ed practitioner within a system that provides a
smooth and rapid transition to hospital if necessary.
Safety for all births must be evaluated through an
objective risk assessment, especially for non-hospital
births. NPA supports and respects families’
right to an informed choice of their birth setting’’
(available at http://nationalperinatal.org/). Further,
in Canada following the model of British Columbia,
the province of Alberta has recently expanded its
health care system to include women’s access to
midwifery services ‘‘in a variety of locations including
hospitals, community birthing centers, or in their
homes’’ (http://www.health.alberta.ca/regions/mid
wifery.html).

Some of you who are reading this know me personally,
most do not. I am a nurse-midwife committed
to the midwifery philosophy of care, however, I have
never attended a home birth. I gave birth to my
own children in hospital, and my daughter is a
board certified obstetrician-gynecologist. I am part
of the U.S. system.Yet the very core of my being, my
scientifically trained brain, and four decades experience
in the business of mothers and babies tell me
it is our system that is not serving mothers and babies
well. There is not some inherent danger lurking
for healthy American women who desire to give
birth at home. The primary danger is that the ‘‘system’’
does not support this choice. To pretend that
a normal healthy woman cannot give birth safely
without the trappings of a U.S. hospital is not only
audacious but also uninformed. Perhaps it is time
for a new woman’s movement, one that embraces
the normalcy of childbirth and puts mothers and
babies back on the center stage rather than the
system’s need to defend the interventionist subculture
it has developed and that it must financially
support. This system has not improved outcomes
for mothers or babies while the cost of care has
continued to escalate keeping pace with unnecessary
intervention. The recent initiatives of our
medical colleagues, the ‘‘authorities,’’ simply highlight
the painful reality that the ‘‘Emperor has no
clothes!’’

REFERENCES
American Medical Association (AMA). (2008). Resolutions. Retrieved
November 1, 2008, from http://www.ama-assn.org/ama1/pub/up
load/mm/38/a08resolutions.pdf
Block, J. (2008, July 9). Big medicine’s blowback on home births. Los
Angeles Times. Retrieved October 29, 2008, from http://www.la
times.com/news/opinion/commentary/la-oe-block9-2008
jul09,0,3357453.story
Hale, R. A. (2008, September). ACOG’s positions advocated at AMA meeting.
ACOG Today, p. 2.
Janssen, P. A., Lee, S. K., Ryan, E. M., Etches, D. J., Farqukarson, D. F., Peacock,
D., et al. (2002). Outcomes of planned home births versus
planned hospital birth after regulation of midwifery in British Columbia.
Canadian Medical Association Journal, 166, 315-323.
National Perinatal Association (NPA). (2008). Position paper: Choice of
birth setting. Retrieved October 16, 2008, from http://nationalperi
natal.org/

Juice Plus Vitamins- Reducing Preeclampsia and Cesarean Section

A retrospective chart review was performed on 356 pregnancies at delivery at the University of Mississippi, USA. Half of the expectant mothers had chosen to add Juice Plus+® to their prenatal diet, including prenatal vitamins. A comparison was made of recorded obstetric complications made by medical staff at the time of delivery. The women who added Juice Plus+® had fewer documented complications, including fewer cesarean deliveries, no delivery before 37 weeks gestation and no diagnosis of preeclampsia. These findings suggest addition of Juice Plus+® to standard prenatal care may be beneficial. A prospective randomized, double blind, placebo controlled investigation is currently underway to confirm these observations. (Odom et al. "Phytonutrients May Decrease Obstetric Complications: A Retrospective Study." Journal of the American Nutraceutical Association, Vol. 9, No. 1, 2006).

http://www.ana-jana.org/reprints/JANA9-1ReprintOdomrevised9-15-061.pdf