CDC Birth Rates for 2007 - 50% increase in the last 10 years!

The preliminary cesarean delivery rate rose 2 percent in 2007, to 31.8 percent of all births, marking the 11th consecutive year of increase and another record high for the United States (Table 8; Figure 3). This rate has climbed by more than 50 percent over the last decade (20.7 percent in 1996). Increases between 2006 and 2007 in the percentage of births delivered by cesarean were reported for most age groups (data not shown), and for the three largest race and Hispanic origin groups: non-Hispanic white (32.0 percent in 2007), non-Hispanic black (33.8 percent) and Hispanic (30.4 percent). The rise in the total cesarean delivery rate in recent years has been shown to result from higher rates of both
first and repeat cesareans (1).

VBAC and Scar Integrity

VBAC and scar integrity,
or "Why my uterus isn't going to explode"

Myth: It takes two years or more for uterine scar tissue to heal.
Fact: Your uterus is just like any other cut that is bound with stitches or staples, and does all the healing it's going to in the first few weeks. While a few studies suggest that the risk of rupture (more on what "rupture" is later) is higher if you get pregnant within 18 months, it is still far less than 1%, and while it is often recommended to wait, this does not reflect whether or not a real risk exists following initial healing. Most authorities agree that by the time your fertility returns (2-3+ months), conception happens and the uterus begins to expand (12 weeks), healing is done. The gentle pressure of a slowly expanding uterus is unlikely to cause any damage, and since we don't go into labour immediately following conception it's likely a year or more would have passed since the surgery. Healing can continue even during pregnancy.

(taken from Birthlove.com)

From BIRTH AFTER CESAREAN by Bruce Flamm: "Rumor has it that its safer to wait several years after a cesearen section before attempting a vaginal birth. There's absolutely no evidence for this belief. Studies on wound healing have shown that tissue regains the majority of its strength within a few weeks of an operation. The tissue that gives a healing wound its strength is called collagen. According to a general surgery textbook, 'Collagen content of the wound tissues rises rapidly between the sixth and the seventeenth days but increase very little after the seventeenth day and none at all after the forty-second day.' Since the uterine scar is almost fully healed within weeks after a cesarean section there is no reason to postpone plans for another baby."

Myth: If you rupture, you and your baby will die.
Fact: Catastrophic ruptures are extremely rare, and much more likely if you have oxytocin induction, cyotec, prostaglandins or lay flat on your back unable to move around. Included in rupture statistics is harmless and asymptomatic dehiscences, which unfairly skews the numbers. When people think of rupture they think of a uterus imploding, they don't think of scar tissue pulling away from where it's gotten stuck, or a small break that heals easily and poses no risk to mother or baby. Dehiscences are the most common type of "rupture", by far. It is usually diagnosed when a second c-section is performed or the doctor physically puts his hand inside a woman's uterus and feels around after birth. Some evidence suggests that many dehiscences actually occur before labour begins.

Catastrophic rupture (the dangerous kind) more often happens due to uterine integrity as a whole (with the vast majority following labour augmentation). The cases of true rupture are not the 1-2% figure we hear all the time, that is for dehiscences. When a true rupture occurs, a cesarean must occur within 30 minutes (ideally 20) to prevent neurological damage to the baby. Death does not occur immediately. Most women attempting a home VBAC are well within 20-30 minutes of a hospital, particularly if 911 is called.

'A Guide to Effective Care in Pregnancy and Childbirth', which is a well-respected summary of evidence-based practice, says that the rate of reported uterine rupture has ranged from 0.09% to 0.8% for women with a single baby, head-down, who planned a vaginal birth after one previous lower-segment cesarean. The authors comment:

"To put these rates into perspective, the probability of requiring an emergency cesarean section for acute other conditions(fetal distress, cord prolapse, or antepartum hemorrhage) in any woman giving birth, is approximately 2.7%, or up to 30 times as high as the risk of uterine rupture with a planned vaginal birth after cesarean"

What does this mean for women who want a VBAC? Up to 99.91% of you will labour normally.
True rupture is not asymptomatic, and the first signs are a steadily falling heart rate (now heavily debated over whether or not this is a true indicator) and/or intense pain that you'll feel even with an epidural. While external fetal monitors, in theory, are meant to catch this kind of thing as it happens - they often do not. External fetal monitoring has not been shown to save any lives, and has only been shown to increase the amount of unnecessary c-sections being performed. It is just as effective, and safer overall, to have a nurse or midwife come in every so often and have a listen with the doppler or fetoscope - particularly during a contraction. This also keeps you off your back, where you are often strictly told to stay if you are hooked up to EFM. This position increases your chances of complications. Move around! Stay hydrated! Stay strong! Avoid drugs! Labour isn't made so you that you can lie back with your feet up.
Home dopplers and fetoscopes are available to rent or buy. Fetoscopes can be purchased online or at any medical supply store for $30 or under, and home dopplers can be rented for as little as $35-$40 a month. Do keep in mind that dopplers, being ultrasound, carry risks. A fetoscope poses no risk to the baby.

Risk of rupture also depends on the type of incision you received. Except in rare cases, modern c-sections are performed by low transverse incision (a horizontal scar just along your pubic bone, usually hidden by a bikini). The risk is highest with a vertical incision over the middle of the stomach. This requires more healing time as well.

VBAC.com reads:

Overall, attempted vaginal birth for women with a single previous low transverse cesarean section is associated with a lower risk of complications for both mother and baby than routine repeat cesarean section. The morbidity associated with successful vaginal birth is about one-fifth that of elective cesarean. Failed trials of labor, with subsequent cesarean section, involve almost twice the morbidity of elective section, but the lower morbidity in the 80% of women who successfully give birth vaginally means that overall women who opt for a planned vaginal birth after cesarean suffer only half the morbidity of women who undergo an elective cesarean section.

What does this mean? A repeat c-section is more dangerous than a VBAC. The problem is we don't hear that very often. Some women are only ever offered a repeat c-section by their doctors. If they are truly only ever done in event of "emergencies", how can one justify the risk of denying a woman a VBAC when it is clearly the safest route for both mother and baby?

A 10-year population-based study of uterine rupture.
Obstet Gynecol 2001 Apr;97(4 Suppl 1):S69
Baskett TF, Kieser KE.
Dalhousie University, Halifax, Nova Scotia, Canada
Objective: To review the incidence, associated factors, and morbidity associated with uterine rupture.Methods: A 10-year (1988-1997) population-based review of 114,933 deliveries in one province.

Results: There were 39 ruptures: 16 complete and 23 dehiscence. Thirty-seven cases had undergone a previous cesarean delivery (34 lower transverse, 2 classical, 1 low vertical). Of the 114,933 deliveries, 11,585 (10%) were to women with a previous cesarean delivery. The incidence of uterine rupture in those undergoing a trial for vaginal delivery (4,516) was complete rupture (3/1000) and dehiscence (5/1000). Induction or augmentation of labor with oxytocics was associated with 50% of complete ruptures and 25% of dehiscence. There were no maternal deaths, but 33% of patients with complete ruptures required blood transfusion. There was one neonatal death attributable to uterine rupture.

Conclusion: Induction and augmentation of labor are confirmed as risk factors for uterine rupture. Fetal heart rate abnormality was the most reliable diagnostic aid. Serious maternal and perinatal morbidity was relatively low. PMID: 11275210

Shamelessly stolen from Norwegian_wood's journal:

Here are some statistics to put the risk of rupture in perspective:

* Your risk of rupture from a horizontal LSCS scar is: 1% = 1 in 100 VBAC deliveries (this is the highest statistic)
* Your risk of being diagnosed with dystocia (baby too big) is: 10 - 12% = 10 in 100 vaginal deliveries
* Your risk of a breech baby at full term is: 3 - 7% = 3 in 100 deliveries
* The risk of your baby being diagnosed with fetal distress during labour: 2% = 2 in 100 deliveries
* Your risk of having twins is : 0.4% = 4 in 1000 births
* Your risk of dying from a rupture of the uterus is: 0.0095% = 9.5 in 100 000 VBAC deliveries
* Your risk of dying during any vaginal delivery is: 0.0098% = 9.8 in 100 000 vaginal deliveries

( re-read that one, "Your risk of dying in ANY vaginal delivery is 9.8 in 100,000, compared to a death risk of 9.5 in 100,000 with a VBAC" )

* Your risk of dying during an uncomplicated vaginal delivery is: 0.0049% = 4.9 in 100 000 uncomplicated vaginal delivery.
* Your risk of dying during any ceasarean section is: 0.0409% = 40.0 in 100 000 ceasarean sections
* Your risk of dying during an elective repeat ceasarean section: 0.0184% = 18.4 in 100 000 elective csecs
* The risk of your baby developing cerebal palsy is: 0.25% = 2.5 in 1000 births
* The risk of your baby developing cerebal palsy after fetal distress: 2.84% = 2.8 in 100 fetal distress births
* The risk of your baby dying from a rupture of the uterus is: 0.095% = 9.5 in 10 000 VBAC deliveries
* The risk of your baby dying during any VBAC delivery is : 0.2% = 2 in 1000 VBAC births
* The risk of your baby dying during any type of delivery is: 0.12% = 1.2 in 1000 births



Articles & Links:
Vaginal Birth after 2 or More Cesareans An excellent and informative research-based read analyzing studies, pitocin use and risks of true ruptures versus that of dehiscences. Addresses risks in both VBA1C and VBA2+C.
Twin VBAC not associated with increased risk of rupture
VBAC safe for women with twin pregnancies
Mothering: Fighting VBAC-lash
The Integrity of Caesarean Scars - Originally posted as a reply in a forum, is now an article with a thought-provoking look at the idea that the uterus doesn't heal the same way the rest of the human body does.
Mothering: Cesarean and VBAC index
Birthlove: VBAC is safe!
ICAN: International Cesarean Awareness Network

For those of you convinced that a doctor would only ever have your best interests in mind, I suggest you read articles like this one published in October 2000 entitled, "Getting a Stubborn Patient to Say Yes". This article has since been reposted in many VBAC communities to make women aware of the manipulation tactics that may be used against them.

Don't take your doctor's word for it when he says, "You can't have a VBAC" or, "A VBAC is dangerous". Don't take anyone else's word for it when they say "no one in this town will let you have one". Interview, ask, push and shove - you have the right to the safest birth for your baby. Many midwives will oversee a home, center or hospital VBAC and you can switch to a midwife at any point during your pregnancy, even when your due date is approaching.
Remember, home is safest as far as your risk for dangerous interventions. There's no chance of pitocin induction, epidurals or being kept on your back when you're pacing your own bedroom. Homebirth has been proven to be as safe if not much safer than hospital birth.

Read, educate and inform yourself of the facts so you can be prepared the next time someone tries to scare you out of the best birth for your baby with myths and wives tales. Knowledge is power.

2007 Cesarean Rates for MS

34.9 % Cesarean Rate in MS, slight decrease from 2006 data. US rates will be posted when released from CDC

Homebirth in Mississippi

The good news is that homebirth midwifery is legal in Mississippi and there were 108 homebirths in MS that were reported in 2007. Contact me at icanofjacksonms@gmail.com if you would like info on homebirth and midwifes in MS.

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