Transitions Birth Services, LLC

The Evansville Birthnetwork has received a grant from Birthnetwork National to have an online survey asking local women about their maternity care experiences.  The survey is open to any woman who has given birth in the last three years within a 50 mile radius of Evansville, IN.  We hope to use the responses to help other women make informed decisions about their maternity care.  If you would like to take the survey, click here-

https://www.surveymonkey.com/s/EvansvilleAreaBirthSurvey" target="_blank">https://www.surveymonkey.com/s/EvansvilleAreaBirthSurvey

All questions, except the first, are optional.

The Indiana Perinatal Network has a goal that all hospitals in Indiana will discontinue the practice of handing out free infant formula discharge packs by the end of 2013.  All birthing hospitals have received letters asking them to stop this practice.  Studies have shown that mothers who receive the formula packs breastfeed for a shorter length of time than those who do not.  The Indiana Perinatal Network has provided this fact sheet on the dangers of providing formula gift packs to mothers. 

Hospitals that give free formula samples do so in violation of the World Health Organization Code on Marketing Breast-Milk Substitutes.  A 2009 survey found that 34.2% of hospitals nationwide no longer provide formula samples.  Rhode Island recently became the first state where no hospitals distribute the formula packs.

The Evansville Birthnetwork joins with the Indiana Perinatal Network and La Leche League of Southwestern Indiana in asking our local hospitals to discontinue providing formula discharge packs to new mothers.  We want to see more mothers succeed in breastfeeding and we know these gift packs often undermine that success.  We encourage area mothers to contact our local hospitals and ask them to stop providing these packs. 

 We are proving three ways for you to let local hospitals know you want them to stop proving formula packs to new families.  We have started an online petition that you can sign: Stop Giving Formula Samples to New Mothers.

Or, you may write a letter to each of the following people.  A sample letter follows.

We will also have preprinted postcards available to sign at Birthnetwork and LLL meetings.

The Women’s Hospital

Attn: Chris Ryan

4199 Gateway Blvd.    

Newburgh, IN 47630

St. Mary’s Medical Center

Attn: Jeanne Braun

3700 Washington Ave.

Evansville, In 47750

Sample Letter-

Dear Ms.Ryan (or Ms. Braun),

I join with the Indiana Perinatal Network, the Evansville Birthnetwork and La Leche League of Southwestern Indiana in asking your hospital to stop providing infant formula discharge packs to new mothers. Studies have shown that mothers who receive the breastfeeding packs tend to breastfeed for a shorter length of time than those who do not.  Breastfeeding provides many health benefits to mothers and babies.  By making it harder for mothers to succeed, you are preventing mothers and babies from receiving the full health benefits they would receive from a longer duration of breastfeeding. 

I want mothers to succeed with breastfeeding and believe these formula marketing packs provide an unnecessary obstacle.  Please support breastfeeding mothers.  Stop providing formula discharge packs.

Sincerely,

On May 19th from 1-2:30pm, I will present a Birth Options Class at Little Ants, 1450 Bellemeade Ave.  Mothers/ couples who are expecting or planning to become pregnant can come learn about options they have in labor and birth.  I will be answering questions such as "How can I tell if my doctor or midwife is supportive of a low intervention birth?"  "Should I have a birth plan?"  and "What choices make having an unmedicated birth most likely?"  Having attended dozens of births, I have good insight into local birthing practices.

The class is free.  Please RSVP to andie.gunter@insightbb.com.

If a mom has had a cesarean and is planning another birth, she has two options.  She can have a repeat cesarean or a vaginal birth after cesarean (VBAC).  There are risks and benefits of both options.  The main risk of having a VBAC is uterine rupture.  Uterine rupture happens about .8% of the time during a VBAC.  Most uterine rupures are not dangerous- many aren't even noticed until a cesarean or other abdominal surgery is done.  But occasionally, a rupture can cause serious consequences- the death of the baby or mother. 

On the other hand, having multiple cesareans poses risks too.  Cesareans increase the risk of placenta problems in future pregnancies such as placenta previa and placenta accreta.  The chances of these occuring increase with each cesarean.  These conditions are serious and can be life threatening.  Cesareans also increase risks such as breathing problems for the baby and NICU admissions.

In 2010, the National Institutes of Health held a conference on VBACs.  You can read their Consensus Statement, which includes information on the risks and benefits of VBACs and repeat cesareans. 

Another helpful resource is A Woman's Guide to VBAC, which explains the NIH Statement. 

The Internation Cesarean Awareness Network (ICAN) has lots of great resources about cesareans and VBACs.  The website includes information to help moms make the decision between repeat cesarean and VBAC, webinars, forums, and a listing of hospitals' VBAC policies. Recently, a chapter of ICAN was formed in Evansville.  You can find information about meetings on their Facebook page or on ICAN's website.

You can also watch vol. 4 of More Business of Being Born:  The VBAC Delimma.  The video is available on demand for $4.  You can also borrow the video from the Evansville Vandergurgh Public Library.  The video includes information about risks, benefits, issues that keep many doctors and hospitals from offering VBAC, and stories of moms who have VBACs. 

If you are a mom considering VBAC, please contact me.  I can provide information on local options for VBAC and give you tips for having a VBAC.  Several moms in the Evansville Birthnetwork have had VBACs and are willing to talk about their experiences.  EBN also has a yahoo group where you can post questions and get input from other local moms. 

In most births, the baby's umbilical cord is clamped within seconds of being born.  Recently, this practice has been called into question.  There have been several studies that show benefits to waiting  even just a minute before clamping the cord.  More moms are beginning to ask for delayed cord clamping, and sometimes their doctors are not familiar with the benefits of it.

Nicholas Fogelson, an OB/GYN, has this blog post which summarizes the research on delayed cord clamping.   Much of the research he looks at focuses on preterm babies.  Some of the benefits seen in preterm babies include fewer cases of intraventricular hemorrhage and late-onset sepsis, higher red blood cell volumes and hematocrits and less need for mechanical ventilation and surfactant.  In term babies, there were higher iron stores at 6 months.

There is this study in the Journal of the American Medical Association which Dr. Fogelson doesn't discuss that looks at term babies:

Late vs early clamping of the umbilical cord in full-term neonates: systematic review and meta-analysis of controlled trials.  Hutton EK, Hassan ES.  Source: Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario.

In that study, babies had better iron status and less anemia. 

Dr. Folgelson also has this video of a Grand Rounds presentation he did looking at delayed cord clamping.  The video is 50 minutes long and divided into four parts.  In the video, he compares immediate cord clamping to robbing the baby of 40% of its normal blood volume.

Some local moms have talked to their doctors about delayed cord clamping.  One objection the doctors have had is that they believe if they put the baby on the mother's belly after birth and do not clamp the cord, the baby's blood will drain back into the placenta, or the blood in the placenta will not be able to get to the baby.  Dr. Fogelson addresses that issue in Part 2 of the video, starting around minute 6:30.  He discusses a study that says that babys who are placed on their mother's stomachs after birth get the same amount of blood from the placenta as babies held even with the birth canal or as babies held slightly lower than the birth canal. 

So if you are interested in having delayed cord clamping at your birth, look at these resources and share them with your doctor or midwife.  Feel free to contact me for more information.  I'd love to hear your experience of asking for delayed cord clamping and whether your doctor or midwife was supportive.

Interested in knowing your hospital's cesarean rate?

The Indiana State Department of Health publishes yearly hospital discharge data.  The reports include information on each hospital stay for all kinds of conditions.  Although the reports are made public, they are in no way user friendly for the average person.  I have gone through the data using Microsoft Access and calculated cesarean rates for each hospital in the state for 2010.  I have listed the cesarean rates in an Excel file here-

Indiana Hospital Cesarean Rates 2010

Some highlights:

• The cesarean rate for Indiana was 31.4%.  There were 81,380 births in Indiana in 2010.
  
• The hospital with the highest cesarean rate was Scott Memorial Hospital, with a rate of 57.8%.
• The hospital with the lowest cesarean rate was St. Elizabeth Medical Center with a rate of 14.3%.
• 5 hospitals had cesarean rates lower than 20%.
• 2 hospitals had rates higher than 50%.*
  
• Local hospitals-
• St. Mary's Medical Center's cesarean rate was 39.6%.
• The Women's Hospital's cesarean rate was 35.9%.

*I am not including information for hospitals that had less than 5 births.

Want to lower your chance of having a cesarean?  Read 10 Tips for Avoiding a First-Time Cesarean.

Do you live in Kentucky and want to know your local hospital's cesarean rate?  Looking for information on Kentucky hospitals' VBAC rates?

The Kentucky Cabinet for Health and Family Services makes information on hospitals' quality indicators and rates of utilizations of certain procedures on its website.  This information includes number of cesareans performed, cesarean rates, VBAC rates, and cesarean rates for first time mothers.  To see the information on their website, go here:

Kentucky 2010 Quality Indicators: Childbirth 

It can be difficult to sift through all the data available on that website.  It includes information on all types of condtions and procedures.  So I have gathered some of the info parents and birth advocates may be interested in.  I have taken the information for risk-adjusted cesarean rates, risk-adjusted VBAC rates and risk-adjusted cesarean rates for first time mothers and put them into an Excel spreadsheet.  I also took the information from that website on the number of cesarean performed at each hospital and divided it by the number of births at each hospital (found here) to calculate the actual cesarean rate.  I was curious how the actual rates and the risk-adjusted rates compared.  For most hospitals, the risk-adjusted rates were 1-3% lower than the actual rates.

Kentucky Hospital Cesarean Rates 2010 (Excel Spreadsheet)

Some highlights from the data-

• Kentucky's cesarean rate in 2010 was 36.2%. 
  
• The hospital with the highest cesarean rate is Paul B. Hall Regional Medical Center with a 71.0% cesarean rate.  The hospital's VBAC rate was 0%.
  
• The hospital with the second highest rate is Three Rivers Medical Center with a 66.3% rate.
• The VBAC rate for Kentucky is 4.3%.  In other words, 95.7% of women who have a cesarean and then have another birth have a repeat cesarean.  The University of Louisville Hospital has the highest VBAC rate at 11.6%.
• 20.6% of first time moms gave birth by cesarean in Kentucky.
  
• Hospitals in our area-

• Methodist Hospital in Henderson had a 43.4% cesarean rate and a 1.3% VBAC rate.  21.7% of first time moms gave birth by cesarean
• Owensboro Medical Health System Inc. had a 42.6% cesarean rate and a 1.5% VBAC rate.  23% of first time moms gave birth by cesarean.
• Regional Medical Center in Madisonville had a 40.8% cesarean rate and a 8.9% VBAC rate.  25.9% of first time moms gave birth by cesarean.

These statistics are a great reason to have a doula at your birth.  Doulas lower a mother's chance of having a cesarean section and other interventions.

Eating and drinking during labor can give a mother energy and keep her hydrated.  It also helps her avoid feelings of hunger and thirst, which keeps her more comfortable.  Many birth locations restrict moms from having anything more than ice chips.  But are these restrictions necessary?

Not allowing moms anything to eat or drink started in the days when most moms gave birth while unconscious- under twilight sleep.  When someone is unconscious, they can vomit and the contents of their stomach can enter their lungs, causing a serious and sometimes fatal condition called aspiration pneumonia.  Today, it is rare for moms to give birth under general anesthesia.  And even when it happens, precautions are taken to help prevent aspiration.  A breathing tube is inserted into the mom's trachea to help prevent stomach contents from entering the lungs.  An antacid is given to help neutralize the acid in the mother's stomach. 

In 2010, the Cochrane Collaboration looked at policies restricting moms from eating and drinking in labor.  They found that, for low risk mothers, policies that restrict eating and drinking are not justified.  The review is available here-

Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2010, Issue1. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub2

Available at: http://www2.cochrane.org/reviews/en/ab003930.html

The American College of Obstetricians and Gynecologists has this to say about drinking in labor:

“According to ACOG, women with a normal, uncomplicated labor may drink modest amounts of clear liquids such as water, fruit juice without pulp, carbonated beverages, clear tea, black coffee, and sports drinks. Fluids with solid particles, such as soup, should be avoided, however. Women who have uncomplicated pregnancies and are scheduled for a cesarean delivery may also drink these clear liquids upto two hours before anesthesia is administered.”          - from the ACOG press release “Recommendations Relax on Liquid Intake during Labor.” Available at http://www.acog.org/from_home/publications/press_releases/nr08-21-09-2.cfm

The American Society of Anesthesiologists has this statement:

“The oral intake of modest amounts of clear liquids may be allowed for uncomplicated laboring patients. The uncomplicated patient undergoing elective cesarean delivery may have modest amounts of clear liquids up to 2 h before induction of anesthesia. Examples of clear liquids include, but are not limited to, water,fruit juices without pulp, carbonated beverages, clear tea, black coffee, and sports drinks.”   - from the statement Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia available at: http://www.guideline.gov/content.aspx?id=10807

And the American College of Nurse Midwives has this to say:

 “The newest Clinical Bulletinfrom the American College of Nurse-Midwives reviews evidence relevant to providing oral nutrition to women in labor and concludes that drinking and eating during labor can provide women with the energy they need and should notbe routinely restricted.”  -from an ACNM press release “AMERICAN COLLEGE OF NURSE-MIDWIVES PUBLISHES CLINICAL GUIDELINES FOR ORALNUTRITION DURING LABOR” available at http://www.midwife.org/siteFiles/news/ACNM_Clinical_Guidelines_on_Nutrition_in_Labor.pdf

So if your doctor, midwife or hospital routinely restricts moms from eating and drinking in labor, you can ask if those restrictions are justified, or consider switching to a different provider or birth location.

Here is a chance to meet me and some other great area doulas.  On Monday, October 17th from 6-8pm, Evansville Birthnetwork will host a "Meet the Doulas Night" at Oaklyn Library.  Area doulas will be present to talk about how a doula can benefit you during labor.  It should be a great time.  Come join us!

The Leapfrog Group, a non-profit organization that compares hospitals on national standards of safety and quality, released a Call to Action this week: Protect Mothers and Babies from Unecessary Harm.  From the press release:

 The employer-driven hospital quality watchdog, The Leapfrog Group, issued a Call to Action in response to its new data finding that thousands of babies are electively scheduled for delivery too early, resulting in a higher likelihood of death, being admitted to a Neonatal Intensive Care Unit (NICU), and life-long health problems.

The group asked hospitals accross the country to voluntarily report their rates of early elective births- inductions or cesareans without a medical indication happening before 39 weeks gestation.  Some hospitals had a rate of zero, showing that it is possible to avoid early elective births all together.  Other hospitals had rates of 50% or higher.

The March of Dimes lists these possible complications for babies born too soon:

• the baby's organs might not be fully developed
• the baby can develop vision and hearing problems that last throughout life
• the baby can have a low birthweight, which leads to problems statying warm
• the baby may have problems eating and breathing at the same time, which makes it difficult to gain weight

The Leapfrog Group released this list of hospitals and their rates of early elective births.  You are encouraged to use the information when deciding where to give birth.  If your hospital chose not to respond, consider writing them a letter and telling them the public needs access to this information. 

 From Leapfrog's press release:

“Hospitals, health plans, providers, and communities need to do more to protect women and babies from this harmful practice,” said Leapfrog CEO Leah Binder. “And women need to protect themselves by refusing to schedule their deliveries before 39 weeks without a sound medical reason, and by knowing the facts about the hospitals they plan to deliver in.” She noted that currently only hospitals that report to Leapfrog’s annual hospital survey are making their rates of early elective deliveries public. “Every hospital should publicly report on their rate and actively prevent the practice, and every woman planning to give birth should demand the information,” Binder added.