The Family Journey

Childbirth International presents this information, geared toward helping doulas and childbirth educators assist their clients in making informed decisions.

This story from mothering.com covers one woman’s account of becoming aware of the powerful choices to be made regarding maternity care.

Canada has some excellent resources for supporting moms and families. The ASAC (Association for Safe Alternatives in Childbirth) puts out a magazine called Birth Issues. Check out the online version, which is chock full of birth stories, information, and articles.

Many times I have heard women say that they HAD to have their water broken before their babies could be born. Well, it isn’t really true, and it just might increase the chance of a cesarean. Just say no to the amnihook.
-TFJ

Amniotomy for Shortening Spontaneous Labour.
[Departments: Cochrane Update]

BACKGROUND: Intentional artificial rupture of the amniotic membranes during labor, sometimes called amniotomy or “breaking of the waters,” is one of the most commonly performed procedures in modern obstetric and midwifery practice. The primary aim of amniotomy is to speed up contractions and, therefore, shorten the length of labor. However, there are concerns regarding unintended adverse effects on the woman and infant.

OBJECTIVES: To determine the effectiveness and safety of amniotomy alone for 1) routinely shortening all labors that start spontaneously and 2) shortening labors that have started spontaneously but have become prolonged.

SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 30, 2007).

SELECTION CRITERIA: Randomized controlled trials comparing amniotomy alone with intention to preserve the membranes. We excluded quasi-randomized trials.

DATA COLLECTION AND ANALYSIS: Two authors assessed identified studies for inclusion. Both authors extracted data. Primary analysis was by intention to treat.

MAIN RESULTS: We have included 14 studies in this review, involving 4,893 women. There was no evidence of any statistical difference in length of first stage of labor (weighted mean difference -20.43 minutes, 95% confidence interval [CI] -95.93 to 55.06), maternal satisfaction with childbirth experience (standardized mean difference 0.27, 95% CI -0.49 to 1.04), or low Apgar score less than seven at 5 minutes (relative risk 0.55, 95% CI 0.29 to 1.05). Amniotomy was associated with an increased risk of cesarean delivery compared with women in the control group, although the difference was not statistically significant (RR 1.26, 95% CI 0.98 to 1.62). There was no consistency between papers regarding the timing of amniotomy during labor in terms of cervical dilatation.

AUTHORS’ CONCLUSIONS: On the basis of the findings of this review, we cannot recommend that amniotomy be introduced routinely as part of standard labor management and care. We do recommend that the evidence presented in this review be made available to women offered an amniotomy and suggest that it may be useful as a foundation for discussion and any resulting decisions made between women and their caregivers.

Smyth RMD, Alldred SK, Markham C. Amniotomy for shortening spontaneous labor. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006167. DOI: 10.1002/14651858.CD006167.pub2. Copyright The Cochrane Collaboration, reproduced with permission.

(C) 2008 The American College of Obstetricians and Gynecologists

Obstet Gynecol. 2008 Feb;111(2 Pt 1):285-91.

Labor outcomes with increasing number of prior vaginal births after cesarean delivery.
Mercer BM, Gilbert S, Landon MB, Spong CY, Leveno KJ, Rouse DJ, Varner MW, Moawad AH, Simhan HN, Harper M, Wapner RJ, Sorokin Y, Miodovnik M, Carpenter M, Peaceman A, O’Sullivan MJ, Sibai BM, Langer O, Thorp JM, Ramin SM; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network.

Department of Obstetrics and Gynecology at Case Western Reserve University-MetroHealth Medical Center, Cleveland, Ohio 44109-1989, USA.

OBJECTIVE: To estimate the success rates and risks of an attempted vaginal birth after cesarean delivery (VBAC) according to the number of prior successful VBACs. METHODS: From a prospective multicenter registry collected at 19 clinical centers from 1999 to 2002, we selected women with one or more prior low transverse cesarean deliveries who attempted a VBAC in the current pregnancy. Outcomes were compared according to the number of prior VBAC attempts subsequent to the last cesarean delivery. RESULTS: Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter. CONCLUSION: Women with prior successful VBAC attempts are at low risk for maternal and neonatal complications during subsequent VBAC attempts. An increasing number of prior VBACs is associated with a greater probability of VBAC success, as well as a lower risk of uterine rupture and perinatal complications in the current pregnancy. LEVEL OF EVIDENCE: II.

PMID: 18238964 [PubMed – in process

From the BOLD Team:

BOLD (Birth On Labor Day) is an organization that uses the arts to inspire social action. The organization has been operating for the last 2 years, has made a great impact on local communities that have participated and has been growing by leaps and bounds!

BOLD has two main projects, first is the Performance & Talkback Initiative in which communities perform Birth a play by Karen Brody, which is a documentary style play about real women’s birth experiences. Afterward, each community hosts a talkback panel at which local leaders discuss with the audience their own community’s maternal child health concerns. Our second project is called BOLD Red Tents. This is a birth storytelling and oral history project. At BOLD Red Tents community organizers create a meaningful and trusting environment to allow women to give voice to their birth experiences, get support and learn from each other.

There is information at this website about the award we have applied for:

The process is very democratic – winners are the ones with the most votes! Hence my email to you! I hope that you can take a minute to go to the ideablob.com website and vote for BOLD. The award would be the first real infusion of cash to our efforts and would make a very real difference in our success!

Of course, feel free to pass this information around and forward it to anyone you think might be interested in supporting BOLD!

With sincere gratitude for your past and future efforts supporting moms and babies everywhere,

The BOLD Team

From Hannah Gaitten, owner of Natural Choices, who is hosting a film discussion. Please read below, and contact Hannah for specific information.

Join us for a film followed by discussion; this month, we are featuring Birth As We Know It. Everyone is welcome- children, fathers, grandparents, etc. I ask that everyone who attends is healthy as a courtesy to others that will be here. Please feel free to bring a friend and/or pass this invitation to anyone that you think would be interested in joining us. If you feel inspired to do so, please bring a snack for the group (however, this is not required).

Please RSVP for the date(s) that you would like to attend.
Wednesday, March 26th 1-3pm
Thursday, March 27th 6-8pm
Saturday, March 29th 11am-1pm

Place: Hannah Gaitten’s Home in Longmont, CO.
303.525.1470
Email: hannah@naturalchoices4baby.com

Experience Birth As We Know It in this groundbreaking new film featuring 11 births, all completely unique and all natural. This new movie from The Sentient Circle offers all a deeper insight into the nature of birth and leaves viewers in awe of its beauty.
To read more about this film, go to its website.

Hannah Gaitten
Owner, Natural Choices
303.525.1470

ABSTRACT: Background: The percentage of United States births delivered by cesarean section continues to increase, even for women considered to be at low risk for the procedure. The purpose of this study was to use an “intention-to-treat” methodology, as recommended by a National Institutes of Health conference, to examine neonatal mortality risk by method of delivery for low-risk women. Methods: Low-risk births were singleton, term (37–41 weeks’ gestation), vertex births, with no reported medical risk factors or placenta previa and with no prior cesarean section. All U.S. live births and infant deaths for the 1999 to 2002 birth cohorts (8,026,415 births and 17,412 infant deaths) were examined. Using the intention-to-treat methodology, a “planned vaginal delivery” category was formed by combining vaginal births and cesareans with labor complications or procedures since the original intention in both cases was presumably a vaginal delivery. This group was compared with cesareans with no labor complications or procedures, which is the closest approximation to a “planned cesarean delivery” category possible, given data limitations. Multivariable logistic regression was used to model neonatal mortality as a function of delivery method, adjusting for sociodemographic and medical risk factors. Results: The unadjusted neonatal mortality rate for cesarean deliveries with no labor complications or procedures was 2.4 times that for planned vaginal deliveries. In the most conservative model, the adjusted odds ratio for neonatal mortality was 1.69 (95% CI 1.35–2.11) for cesareans with no labor complications or procedures, compared with planned vaginal deliveries. Conclusions: The finding that cesarean deliveries with no labor complications or procedures remained at a 69 percent higher risk of neonatal mortality than planned vaginal deliveries is important, given the rapid increase in the number of primary cesarean deliveries without a reported medical indication. (BIRTH 35:1 March 2008)

from: Birth: Volume 35 Issue 1 Page 3-8, March 2008
Abstract
Neonatal Mortality for Primary Cesarean and Vaginal Births to Low-Risk Women: Application of an “Intention-to-Treat” Model

* Marian F. MacDorman, PhD11Marian F. MacDorman and Fay Menacker are Statisticians in the Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MarylandMarian F. MacDorman, PhD, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 7318, Hyattsville, MD 20782, USA.,
* Eugene Declercq, PhD22Eugene Declercq is a Professor in the Department of Maternal and Child Health, Boston University School of Public Health, Boston, Massachusetts,
* Fay Menacker, DrPH, CPNP11Marian F. MacDorman and Fay Menacker are Statisticians in the Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland, and
* Michael H. Malloy, MD, MS33Michael H. Malloy is a Professor in the Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA.
*1Marian F. MacDorman and Fay Menacker are Statisticians in the Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland; 2Eugene Declercq is a Professor in the Department of Maternal and Child Health, Boston University School of Public Health, Boston, Massachusetts; and 3Michael H. Malloy is a Professor in the Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA.

From Kristi Conroy of Denver ICAN:

In April, the ICAN membership fee is reduced to $25.00! We keep
$5.00 here and send $20 to our National office. What a bargain! If
you get a nice tax refund, you can even send in more and remember to
deduct that amount next year from your taxes.

This is the perfect time to call for some postcard applications! I
will get them to you and you can help us distribute them to your
family and friends, midwives, your doctors, your pediatricians, your
hair stylists etc!

Keep 4/4/08 on your calendar! ICAN is planning an art exhibit
(location to be announced this week). We will be showing off how we
heal as women – through art! All different types of pregnancy, birth
and mothering art will be welcome and shown. If you have something
to share, please contact me.

It will be a wonderful evening of wine and cheese, fellowship with
other “sisters of the scar” and the people that support them, and
beautiful art.

We are planning a cash bar and donations, as always, will be
accepted.

More information to follow shortly! Thank you for your support! (If
you need applications, please contact me at 303.477.6243!)