New Life Thesis — The Birth Guide
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What is Birth? midwives Pregnancy and birth are normal and natural life processes. wikipedia Birth is the act or process of bearing or bringing forth offspring from the uterus. The offspring is brought forth from the mother. The time of human birth is defined as the time at which the fetus comes out of the mother’s womb into the world. obstetrics The branch of medicine that deals with the care of women during pregnancy, childbirth, and the recuperative period following delivery.
When a woman births without drugs‌she learns that she is strong and powerful... She learns to trust herself, even in the face of powerful authority figures. Once she realizes her own strength and power, she will have a different attitude for the rest of her life, about pain, illness, disease, fatigue, and difficult situations. Polly Perez
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Table of Contents 04 1 06 08 09
How it Works evidence based birth Birth Story 01 Birth Story 02
2 14 double standards 16 Are Hospital Births Risky?
3 22 24 26 28 30 32 34
safety of home-birth Is Home-birth Safe? Benefits of Home-Birth 1 in 90 Home-Births Percent of Home-Birth usa 29% Increase of Home-birth Montana Obstetrics
4 36 the great debate 38 The Wax Study 40 Risks for Home-Birth 44 Risks for Newborns 46 The Problem 48 usa Maternity Care
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o 50 is it evidence based? 52 not Supported by Scientific Evidence 54 You Should Ask... 56 Ina May Gaskin p 58 numbers & statistics 60 Cesarean Birth 62 World 2009 Cesarean Rates 64 usa 2009 Cesarean Rates 66 usa 2009 Cesarean Rates 68 Why are Cesarean Rates High? 70 vbac Birth 72 vbac Risk of Uterine Rupture 74 Elective Deliveries 2009 76 Elective Deliveries 2009 usa 78 Delivery Day of the Week 79 Birth by Weeks 80 Acceleration of Labor 84 efm monitoring 86 Breaking of the Waters 88 Postpartum Hemorrhage 89 Postpartum Depression
7 90 my vision
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How it Works 01 the box Your box has 6 components to it. This guide will help you navigate the order in which to use all parts.
02 birth story catalog This catalog is an ongoing subscription that gives you personal stories of women who have given birth, both home-birth, hospital, and birth-centers. Every story is different and inspirational.
03 the folders There are four folders which represent the four trimesters of birth. The fourth trimester is the postpartum period after the baby is born. We call this the fourth trimester because it is just as important as the pregnancy if not more so. The first four months of the babies life is now considered part of the fourth trimester. If it wasn't for the way the bodies and heads develop in babies they would probably come out at 14 months instead of ten months. There are note booklets for each section so that you can take notes. Each booklet is designed to be removed and shared with friends, family, doctors or midwives. The booklets can be switched out as new statistics are available for purchase on the website and for the iPad.
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04 ipad progr a m This program allows you to take along the information in the folders in a digital way. I found it easier to share information or research on my iPad or iPhone while pregnant and during the postpartum. The folders are still there for easy reference and the ability to share the information with friends and family and take notes when needed.
05 birth ga me This game is designed to give the mother to be and her partner a chance to test out different scenarios as to what could happen.
06 workout cards Included a set of work out cards for both during pregnancy and postpartum.
07 w ebsite This online site gives you the chance to purchase the product and for you to access the digital information provided by in the folders. You can also purchase updates to the iPad and the folders, and link to helpful sites about birth.
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evidence based birth Your health care is based on up-to-date medical evidence about what works best.
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Birth Story 01 Rene said to me I'd love to share my motivation in choosing a home-birth. To maximize the odds of a positive birth experience for me and my baby, while minimizing the chance of unnecessary intervention. I wasn't trying to be a hero or earn bragging rights. After the fact, I am now convinced of an unexpected bonus: that the pain of labor is immensely reduced by laboring and delivering at home due to innumerable comfort measures both physical and psychological; I have much more respect for all the women who manage their labors in a hospital
minutes apart they called Kathy their doula to come support. By this time they had taken a walk, rested in bed with music and snacks and were quite comfortable. When she moved into the next phase of labor and the surges were more intense the doula and her midwife offered her new labor positions,offering affirmations, or simply providing a snack and a bendy straw with water. She used breathing techniques, relaxation exeresis, and repeating things like I inhale and widen, I exhale and surrender. Laboring on her side, sitting on the ball and finally on her hands and knees each position and movement of the hips opened the pelvic region even more.
My first story is by her first mom Rene who wanted to have a natural birth, and choose to have a home-birth. She had known a couple of ladies already who had home-births and heard their amazing stories and though wow, maybe I can do that too. I want to be empowered and have the control and experience they had. So she found a midwife and started the process.
By this time they had taken a walk, rested in bed with music and snacks and were quite comfortable. When she moved into the next phase of labor and the surges were more intense the doula and her midwife offered her new labor positions,offering affirmations, or simply providing a snack and a bendy straw with water. She used breathing techniques, relaxation exeresis, and repeating things like I inhale and widen, I exhale and surrender.
She did all the prenatal visits, and really got to know Maria her midwife. They because friends and she felt confident in the birthing classes she had taken. So when her water broke at 40 weeks she was prepared ready and calm. She and her husband checked for color and there was none. They called Maria and let them know about what was happening. When the contraction reached five
At 6 pm nearly 10 hours from the time her water broke Maria checked her dilation because she noticed a change in Rene's breathing, it was heavy and she wasn't able to answer questions. It was the first check of the evening and she was 10 cm ready to push. It took 2 more hours and all the while the babies heart rate was checked, her blood pressure, etc. everything normal.
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Birth Story 02 The second mom also wanted a natural birth. She choose to have her baby in the hospital. For some reason she wanted to wait until her third trimester to receive consultation on pain alternatives during birth. She went to all the birthing classes offered by the hospital and thought her ob/gyn was pretty good and went to all her appointments. She hadn't actually known her doctor for very long but trusted his expertise. Finally at 40 weeks she began to feel contractions she knew it was time to go to the hospital. At the hospital an unknown doctor checked her dilation and told her matter of fact, your not dilated enough, go home and come back later. She was crushed, as the pain of labor was really starting to take hold being only 3 cm wasn't enough to get her into a hospital room. So they went home, took a walk and unable to bear the contractions any longer went back to the hospital, and she was further along so they let her in. They attached and efm and put an iv in her hand for fluids and ease of administering medications.
She thought she was perfectly aware that the final decision to have pain meds would be her own. She had great anticipation and fear of birth stories gone wrong that she had heard of in the past few months. She began repeating the statement Birthing is unlike any other pain that a human can experience, in her mind, dwelling on this the last few weeks before the birth. The nurses began to mention, the great advances in obstetric anesthesia and the option of a controlled customized pain free relief. She finally gave in and uttered the dreaded word epidural, after they administered several shots however she wasn't feeling much relief so they gave her even more. Her baby was born perfectly healthy and normal and she did not tear. There was one slight problem, her legs didn't work. She literally could not walk. They wanted to discharge her from the hospital but she refused to let them. It took a week for the epidural medication. Looking back she used these circumstances to build up her character as a mom, she feels like she was pressured into having the epidural, and that she wasn't aware of the consequences, or that there were other ways to alleviate the pain besides medications.
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True Line Supporting a Woman-Centered Birth relying on Evidence Based Practices for Women During Pregnancy
A women who labors at home and comes into hospital Fully dilated and pushing is praised. — She did a great job.
A woman who chooses to birth at home with the constant attendance and monitoring of a skilled professional midwife, intentionally. — She is considered to be doing something unsafe and dangerous
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double standards Women’s access to their birth space should not rely on them meeting arbitrary measurements which involve invasive clinical assessments. They should
be able to use early labor to get to their safe place and settle in for birth, and not turned away for not dilating enough or admitted with a increase risk of interventions.
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Are Hospital Births Risky? obstetrics claims... A normal pregnancy might instantly become an acute condition requiring an emergency intervention. This statement is true. However, in order for this statement to be used to support hospital birth over home-birth for low risk women the following 3 statements, known to be false, would have to be true... 01
Hospital has significantly better outcomes than home-birth for all acute conditions for all types of pregnancy.
02
Hospital birth does not cause more acute conditions than it corrects.
03 Hospital birth does not cause
acute conditions that don’t exist at home-births.
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hospital births are risky, know the facts 01
01 Practice of obstetrics is based off of fear of prob lems and this creates fear a bad outcome, can be a self-fulfilling prophesy. 02 Increased fear releases adrenalin and other adrenergic neurotransmitters which can slow down or even stop the birth process. 03 Unfamiliar environment, strangers, people in uniform, unfamiliar smells during labor counter mammalian birth instinct. 04 Hospital staff are a reservoir of bacteria, which the mother and the baby lacks immunity to. 05 Lower access to food, drink can cause hypoglyce- mia and dehydration, increase use of interventions through the use of an iv. 06 Fear and unfamiliar environment increase pain level, which sends stress signals to fetus, provoking negative influence on fetal heart rate. 07 Collusion among hospital workers takes prece- dence over commitment to client and safe protocol
these acute conditions happen more often at hospital birth? 02
01 Chorioamnionitis and uterine infection caused by vaginal exams 1/1000. 02 Fetal distress associated with laying on your back and being on and efm 10% higher. 03 Cord prolapse from routine artificial rupture of membranes arom 10% of cord prolapse is associated with arom. 04 Shoulder Dystocia because of delivering in a hospital bed instead of on all fours 3/1000. 05 Shoulder Dystocia with mid forceps delivery 3/100. 06 Induction or augmentation is associated with increased cord prolapse 1/1000, increased ruptured uterus in total 1%, increased afe 1/25,000 and increased placental abruption 3/1000. 07 Fetal scull crushed by vacuum or forceps delivery is 1/300,000. 08 Paralyzed for life from epidural, 1/250,000.
08 Lack of accountability of staff to patients contributes to poor outcomes.
09 Bleeding to death from unnecessary elective cesarean, 1/3000 cesareans.
09 Laying on the back which is the preferred method of delivery, especially if an epidural is involved, compresses the aorta and vena cava decreasing oxygen delivery to fetus.
10 Anesthesia death during cesarean, 1/10,000 cesareans.
10 Continuous fetal monitoring increases pain, decreases oxygenation of fetus, decreases mobility and increases anxiety.
11 Car accidents to or from hospital 1/10,000.
When a certified midwife was present, babies born at the home fared just as well as those born in hospitals.
If not attended by a certified researchers found that, in general, babies born at home were more likely to have seizures and low apgar scores. Dr. Yvonne Cheng, obstetrician and gynecologist at the University of California, San Francisco
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safety of home-birth 1 The Home-birth is planned 2 A skilled attendant is present 3 Medical back-up and
consultation is available.
Women who are healthy and have a profile for having a good outcome for them and their babies have come to understand that the equipment and personnel a hospital has to offer is not.
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Is Home-birth Safe? The absolute risk of planned home-births is low. acog 2011, http://www.medscape.com
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Emergency transfers to hospitals are less than 2% and the fetal and newborn mortality rate is less than .5 per 1,000 births, which is comparable to hospital figures for low-risk women. Mary Lawlor, executive director of the National Association of Certified Professional Midwives
The debate over the safety of home-birth is deeply divided and emotionally charged. Reliable information is required to allow productive debate and informed decisions. In an era of evidence-based medicine, it is incomprehensible that the medical society opinion can be formulated on research that does not hold to the most basic standards of methodological rigor. Even though the acog American College of Obstetricians and Gynecologists does not support home-birth in 2011 they did finally acknowledge that The absolute risk of planned home-birth is relatively low.
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Benefits of Home-birth The list below assumes that you have interviewed midwives and hired one who has the necessary experience and education to attend your birth including quickly identifying complications and coordinating transfer if necessary.
I'd love to share my motivation in choosing a home-birth; which was to maximize the odds of a positive birth experience for me and my baby, while minimizing the chance of unnecessary intervention. I wasn't trying to be a hero or earn bragging rights. After the fact, I am now convinced of an unexpected bonus: that the pain of labor is immensely reduced by laboring and delivering at home due to innumerable comfort measures both physical and psychological; I have much more respect for all the women who manage to have their babies in a hospital. Author Anonymous 01
benefits to home-brith
01 Your provider specializes in normal, vaginal birth. 02 Your wishes are discussed before hand and are honored. 03 Unmedicated birth is supported with options to help manage the pain naturally. 04 You are in comfortable surroundings. 05 Not limited to choice in food, clothing, or anything. 06 Long intimate prenatal appointments. 07 One midwife for the mom, second for the baby continuous care the entire birth.
08 Countries with low risk home-birth using mid wives and high risk hospital birth with ob have the best birth outcomes. 09 A skilled midwife can spot problems and arrange for transfer quickly. 10 Lower interventions. 11 Similar to lower neonatal mortality for hospital. 12
Naturally occurring unavoidable complications rarely occur such as uterine rupture, placenta abruption, umbilical cord prolapse, and placenta previa with hemorrhage, which are associated with hospital birth.
13 If induction is needed your midwife will transfer you to an ob. 14 If labor needs to be augmented your midwife will transfer will be done. 15 Your water is broken only if there is a medical indication, never without your approval. 16 Vaginal exams can be declined, the less invasive indicators can be used instead of which there are many.
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17 Stalled labor is fine as long as you and baby are ok, this is normal and gives you a chance to relax. 18 Eating & Drinking what you want when you want. 19 iv's are very rarely needed. 20 Episiotomies, very rarely needed. 21 Fetal Monitoring, periodic monitoring is utilized, even underwater doplers are used. 22 Home-birth model allows for a 42 week and one day as over due, not as strict as hospitals. 23 Big babies are considered normal, ultrasounds are very unreliable, other positions are allowed to help babies out if it's suspected to be big. 24 Weight gain, the focus is on what you eat, not necessarily how much weight you gain, keeping a food diary and giving health alternatives. 25 Breech birth is viewed as a variation of normal, Some midwifes attend breech births make sure your is an expert in this area as they are complicated. 26 Time Limits on labor. There usually isn't a time limit as each woman will dilate differently and the arbitrary dilation of 2 cm an hour is evidenced- based and not used. As long as you are laboring well, and all health signs are normal you are fine. 27 Movement, not restricted or incumbered by machines, iv's or people around you. 28 Noise, you are allowed to make any sound or noise you deem necessary. 29 Private Room, you are in your house.
30 Clothing is optional. 31 Travel, your midwife comes to you. 32 Shower, you can labor in the shower, not all hospitals have one to labor in. 33 Labor in water, you can use your bathtub or a birthing tub to labor and delivery in. 34 Deliver in the position that feels right for you. You can even catch your own baby if you wish. 35 Nothing happens with out your consent to the baby. 36 Routine Testing for medications will be discussed pros and cons before hand. 37 Nursery, there is none, you are at home, baby stays with you the whole time. 38 Skin to skin, it is expected that once the baby is born they will immediately be placed on you. 39 Breast-feeding, midwife can assist as necessary, no pacifiers or sugar water or formula will be pushed on your baby by anyone. 40 Babies born at home have the highest number of bifidobacteria good bacteria and the lowest number of c. difficile and e. Coli bad bacteria. 41
If you do transfer to a hospital which is about 12 – 20% for non emergency first time mom's you will have your midwife there to work on your behalf, she can keep doctors or nurses from entering, especially ones that can derail your wishes. She is a great advocate and has been with you so knows your cues and gives you full attention which is something that you will not get from the nurses or doctors who have other patients to care for.
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1 in 90 For white women, home-births account for 1 in every 90 births. Home-births are more common among women aged 35 and over, and among women who have had other children. The reason for this is usually linked to bad experiences in the hospital. CDC
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If women are considering a home-birth, it’s important to make sure they select an American Midwifery Board Certified Midwife, and have a low-risk pregnancy.
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Percent of Home-birth usa 1.67
.50
2.55
Washington
North Dakota
Montana
1.96
.48
1.69
Oregon
South Dakota
.66
Idaho
Wyoming
.36
Nebraska
1.5
1.55
Nevada
Utah
1.22
Colorado
.52
.77
Kansas
California
.68
Arizona
.52
1.03
Oklahoma
New Mexico
.42 Texas
1.49 Alaska
1.33 Hawaii
.85
1.91
Minnesota
Vermont
1.66
1.00
New Hampshire
Maine
Wisconsin
1.11
New York
Michigan
Iowa
1.38
.36
1.07
Missouri
Kentucky
.64
.69
Arkansas
.21
.26
Mississippi
Ohio
.90
West Virginia
Alabama
.41
.69
.45
Connecticut
NJ
MA
Virginia
Tennessee
.26
CT RI
Pennsylvania
.37
NH
MS
1.62
.83
Indiana
Illinois
VT
.73
.72
DE
1.31
.43
Massachusetts
.38
Rhode Island
.25
New Jersey
.42
Delaware
.52
Maryland
North Carolina
.32
Georgia
.45
South Carolina 10 Lowest
Louisiana
Signicangly lower than us Average
.54
Florida
No significant change Signicangly higher than us Average 10 highest
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29% Increase of Home-Birth
66.3% 29%
Home-Births increased between 2004 – 2009
+28+72 29%
Birthed at home
Of the 42,746 births in the usa that were out-of-hospital births in 2008, nearly two-thirds were in a resident, home, 66.3% and 28.1% were in a free standing birthcenter. cdc National Vital Statistics Report 2008 pg 9
+66+34
+29+71
28.1%
Of the 42,746 births in the usa that were out-of-hospital births in 2008, nearly two-thirds were in a resident, home, 66.3% and 28.1% were in a free standing birth-center.
cdc National Vital Statistics Report 2008 pg 9
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Home-births are more common among women aged 35 and over, and among women who have had other children. The reason for this is usually linked to bad experiences in the hospital.
+66+34
62%
Midwives
Attended home-births
62%
Non-Hispanic White Women Home-births
cdc National Vital Statistics Report 2008 pg 9
cdc National Vital Statistics Report 2008 pg 9
80%
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Montana Obstetrics 1 Bozeman Deaconess Hospital Women's Center 2 Engaged in meaningful conversation with midwives 3 Staff is comfortable with natural birth n Have Midwifes/Doula support o Restrict elective deliveries p Collaboration between midwives,
hospitals and birth-centers
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Montana had the highest percentage of home-births, at nearly 2.6%
Here in Bozeman Montana a celebrated midwife Mikelann opened the door between the hospital and birth-centers, claiming she was not able to give her clients the best care possible unless the two establishments worked together for the women who transferred to the hospital. Over the last five years the obstetrics department was loosing patients to the midwives and birth-centers. Because there was open communication the ob/gyn's went to the midwives and asked, what are you doing differently that our patients are leaving us to go to you? The answer was, We practice Evidence Based Birth; we let women birth how they want to, naturally. This was the start of a good conversation that lead the hospital to completely overhaul the entire department. First they brought midwives back into the hospital, they completely redesigned and build a new maternity ward and changed policies to reflect evidence based care such as only using the efm on women with medical conditions that required continuous monitoring. Also they restricted most elective delivers.
I witnessed first hand the attitude and acceptance of these new policies by the nurses in the delivery room. They were quick to point out what they considered to be evidence-based care and were happy to explain what and why they made these changes. Bozeman Deaconess Hospitals Maternity ward is one of the first of it’s kind and a gold standard for what birth should be like in the hospital. Hopefully we will see changes like this happening across America in the next 10 years. Collaboration between midwives, hospitals, and birth-centers is essential, basing practices of off evidence-based birth.
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the great debate The Joseph R. Wax Study
Stated less medical intervention during planned home-birth is associated with a tripling of the neonatal mortality rate.
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The Wax Study Facts Major flaws, inaccurate conclusions. Does not give information on different types of midwives or differentiate between licensed or unlicensed, credited or uncredited. All the studies used for data — expect one study — are old or too small of a study to include, and one retrospective study. The best way to fight incorrect information is to counter it with the truth. Don’t buy into fear. Look for the truth, the facts, and research.
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Risks for Home-Birth Planned Home-birth during labor three main concerns 1 Cord prolapse 1 in 5,000 births 2 Amniotic Fluid Embolism 1 in 500,000 births 3 Placental Abruption
Mostly High Risk of High Blood pressure 9 out of 1,000 births
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Planned attended home-birth outshines hospital birth for low-risk women in every category of acute emergency.
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The deaths caused by rare acute conditions at planned attended home-birth of low-risk women that might have had a better outcome in hospital are outweighed by the deaths and morbidity due to common acute conditions caused by many of the hospital interventions that increase their risk.
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Risks for Newborns The main causes of newborn deaths are prematurity and low-birth-weight, infections, asphyxia lack of oxygen at birth and birth trauma. These causes account for nearly 80% of deaths in this age group, mostly associated with high-risk pregnancies, and hospitals. Home-birth outcomes are better partly because the mothers are arguably healthier and more engaged than your average hospital patient; they also have better outcomes because it would be unethical to practice many standard hospital interventions at home. Therefore, even accounting for transports, there are lower Cesarean rates, lower numbers of forceps deliveries, and fewer mothers requiring induction or anesthesia among mothers who planned to birth their babies at home. Although each intervention was created for a good reason, with each one offered, the morbidity and mortality rates rise, especially when used on low-risk pregnancies.
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Obstetrics Opinion 1 Society of Obstetricians and Gynecologists of Canada States Home-birth & birth-centers should coexist as a viable option. 2 Royal College of Obstetricians & Gynecologists United Kingdom States Home-birth & birth-centers should coexist as a viable option. 3 American College of Obstetricians and Gynecologists usa States Home-birth places the process of giving birth ahead of the goal of having a healthy baby and does not support it.
cmaj Canadian Medical Association Journal
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The Problem For many people, surviving birth is the goal and the only thing that matters is having a healthy baby. When we reduce birth to the extraction of a fetus from a womb, without regard to the physical, emotional, and mental implications of how it happens, it can be seriously detrimental to the postpartum period after the birth. This includes how women recover from birth, parent their newborns, relate to their partners, and make decisions about future births.
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Part of the problem is public perception of birth. For many people, surviving birth is the goal.
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usa Maternity Care
$98 billion of health care spending in the usa goes towards maternity care, more than any other country in the world Despite this, the usa currently ranks 50th in the world for maternal mortality and 46th for infant mortality occurring during the first year of life. Something is clearly wrong with this picture.
Research has shown that it takes — on average — twenty years for evidence to make its way into clinical practice. This means that it is possible that pregnant women may receive standard care that is outdated, carries no benefits, and may increase your risk of harm.
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is it evidence based? 1 Measuring the Pelvis
2 Measuring Baby in the Womb 3 Measuring Dilation in Labor 4
efm Electronic Fetal Monitor
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not Supported by Scientific Evidence Procedures should be based on Good and Consistent Scientific Evidence.
01 measuring of the pelvis is not Supported by Scientific Evidence here's why...
Only L of acog clinical guidelines meet Level a standard of care.
1 Diagnostic of cephalopelvic disproportion.
M are based on limited or inconsistent evidence & Expert Opinion Which are known to be inadequate predictors of safety or efficacy!
3 Babies head molds into shape.
2 The pelvic girdle is not a fixed, solid structure.
4 The position that a woman adopts during labor and delivery changes the pelvic dimensions, squatting, or example, can increase pelvic measurements by up to 30%. I was lucky when they measured my baby and said it was 7 lbs and there for I would not need a c-section. Like I said my baby was 8 lbs 12 oz that's a huge difference, had that been right they would have pushed a c-section.
02 measuring baby in the womb is not Supported by Scientific Evidence here's why...
03 measuring dilation in labor is not Supported by Scientific Evidence here's why...
1 Haddock Formula most accurate and widely used method these days.
1 Measurements lying down are not reliable.
2 Estimates fetal weight within 10% of actual size in 70% of cases. 4 This Estimate is not accurate, having a difference of 2 lbs. I was lucky when they measured my baby and said it was 7 lbs and there for I would not need a c-section. Like I said my baby was 8 lbs 12 oz that's a huge difference, had that been right they would have pushed a c-section.
2 It is invasive, can cause retraction of the pelvic muscles, giving inaccurate results. 3 Dilation amount can change at any moment 4 Many non invasive tests that are better at assessing active labor, but generally not used in hospitals as they require 24 hr assistance. I was diagnosed with this, the doctors measured my pelvis and said I had cephalopelvic disproportion, meaning my pelvis was too small to fit a baby through. I did some research and found the way of measuring was not inaccurate and not a evidence based practice. My baby was 8 lbs 12 oz with a HUGE head of 14". He came out just fine and did not break my pelvis.
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You Should Ask... Whenever a treatment option is suggested. ask What’s the evidence for that? ask What are the risks? ask What are the benefits? ask Are there any other options that I should consider? research On your own before making a decision. Ultimately, I believe that the power to move towards evidence-based care is in the hands of pregnant women and their families. It's important to understand what the current situation of medical care is at for the united states in order to make an informed decision.
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In May Gaskin The mother of authentic Midwifery Less intervention is better care.
In 1971 Ina May Gaskin, with her husband Stephen, founded The Farm Midwifery Center in Summertown Tennessee, One of the first out-of-hospital birth centers in the United States. They have been able to maintain extremely low rates of medical interventions, and fantastic birth outcomes for the past 40 years. Gaskin and many of her fellow midwives have no formal medical training in the hospital, but are certified through credible establishments and the fact that they have good outcomes even with births that obstetricians consider high-risk — breeches, big babies and vaginal births after c-section — is evidence, she says, that for most women less interventionist is better care.
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numbers & statistics The numbers say it all
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+1.4+2.3+6 Cesarean Birth
The term arrested dilation or Failure to Progress — is estimated to account for approximately 60% of c-section's in America.
The Farm
Transfer to hospital
1.4%
Home-Birth
Transfer to hospital
2.3 – 6.4%
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6.+64 +32.8 Cesarean birth in the usa has become overly used and dangerous to the point of putting women and babies in danger. It is estimated that birth-centers helped save 60 million dollars in the health care system by not performing c-section as they would have in the hospital.
Birth-Centers
Transfer to hospital
c-section's have become routine surgeries, and often times are used to avoid litigation and lawsuits, used to promote the doctors time and energy to the hours and days they prefer rather than what is happening naturally in the woman's body.
6%
Hospitals Lowest 3.2% Highest 52%
32.8%
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World 2009 Cesarean Rates
Netherlands
Findland
Sweden
Norway
14.8%
16.1%
16.8%
16.8%
Canada
Germany
Australia
Israel
28.2%
30.0%
31.2%
31.2%
w.h.o. says for Developed Nations Cesarean Birth w.h.o. Health Standards w.h.o. says for Developed Nations Cesarean Birth should be between 10 – 15% usa average 32.9% rate As you can see there are no states in the usa that abide by this standard.
c-Section Rates that Decreased There have not been any significant decreases in c-sections rates from 1996 – 2009 New Mexico dropped 1% from 2007 – 2009 but increased 22% from 1996 – 2009 Alaska dropped 32% from 2007 – 2009 with a 2% change from 1996 – 2009 Massachusetts dropped .1% from 2007 – 2009
France
United Kingdom
23.9%
23.5%
Germany
United States
Italy
20.3%
31.4%
32.8%
New Zeland
38.4%
should be between 10 – 15% usa average 32.8% Perinatal Core Measurement Mandatory In November 2012, the board of commissioners of the Joint Commission announced that the perinatal core measure set would now be mandatory for hospitals with more than 1,100 births per year, starting January 1st, 2014. This is the first time in history that the Joint Commission has required a core measure set to be mandatory for a specific type of situation — in this case, any kind of a hospital with more than 1,100 births per year. http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_02.pdf
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usa 2009 Cesarean Rates 29.2
29.3
29.6
Washington
North Dakota
Montana
29.4
26.3
24.5
Oregon
South Dakota
28.1
Idaho
Wyoming
31.7
Nebraska
33.8
22.9
Nevada
Utah
26.4
Colorado
33.0
30.1
Kansas
California
27.4 Arizona
34.6
22.8
Oklahoma
New Mexico
35.3 Texas
23.8 Alaska
27.0 Hawaii
27.4
Minnesota
30.8
27.9
New Hampshire
Vermont
25.8
Maine
Wisconsin
30.3
New York
Michigan
Iowa
30.5
31.5 31.7
Missouri
34.6
Arkansas
39.6
Kentucky
33.8 37.8
Mississippi
Ohio
35.9
West Virginia
Alabama
35.6
Connecticut
NJ
MA
34.6 Virginia
31.2
Tennessee
35.6
CT RI
Pennsylvania
36
NH
MS
31.8
31.1
Indiana
Illinois
VT
39.4
32.1
DE
29.6 33.4
Massachusetts
32.8
Rhode Island
39.4
New Jersey
35.7
Delaware
33.5
Maryland
North Carolina
33.6 Georgia
35.3
South Carolina
0 – 15%
Louisiana
15 – 20%
38.1
Florida
20 – 30% 30 – 40%
68
usa 2009 Cesarean Rates w.h.o. Health Standards w.h.o. says for Developed Nations Cesarean Birth should be between 10 – 15% usa average 32.9% rate As you can see there are no states in the usa that abide by this standard.
c-section Rates Decreased There have not been any significant decreases in the c-section r ates from 1996 – 2009 New Mexico dropped 1% from 2007 – 2009 but increased 22% f rom 1996 – 2009 A laska dropped 32% from 2007 – 2009 with a 2% change from 1 996 – 2009 Massachusetts dropped .1% from 2007 – 2009
32.8 Maryland Maryland 31.8 39.6 39.6 39.6 35.6 Rhode Island 35.3 0 –015% 35.335.3 31.2 31.2 – 15% Pennsylvania Louisiana Louisiana Louisiana Connecticut 30.5 TexasTexas 31.5 31.1 Tennessee 33.8 33.8Tennessee Texas North North Carolina Carolina 4.6 6 39.4 NJ Indiana Illinois Ohio MA New Jersey 69 snsas 35.3 35.3 36 15 15 – 20% – 20% DE 31.737.8 35.7 South South West 37.823.8 35.6 35.6 33.6 33.6 Carolina Carolina Delaware Virginia 34.6 Missouri Mississippi Mississippi Alabama Alabama Georgia Georgia 38.1 Nations Cesarean Birth should be between 1038.1 – 15% usa aver 35.9 Kentucky Alaska Virginia 20 20 – 30% – 30% .6 33.5 27.0 Florida Florida Maryland w.h.o. says for Developed Nations Cesarean ana 1996 2007 %Change 1996 2007 2009 Birth %Change Hawaii 2009 31.2 0 – 15% Tennessee 33.8 Carolina 34.6 should 3030 – 40% – 40% Alabama 20.7 between 31.8 35.6North41% 26.4 35.9 32.8% 39.6 39% be 10 – 15%Louisiana usa average Arkansas Alaska 23.3 33.8 35.3 23.8 2.0% Maine 20.8 30.0 29.6 29% 20% Arizona 16.7 22.6 27.4 Maryland 21.6 33.1 33.515 – 33% South 39% 37.8 35.6 33.6 38.1 Carolina Arkansas 16.1 38.1 26.2 34.6 53% Massachusetts 19.8 33.5 33.4 33% Mississippi Alabama Georgia w.h.o. ations Nations says Cesarean Cesarean for Developed Birth Birth should Nations be be between between Cesarean 1010 –30.4 Birth 15% – 15% should usa avera ave be California 20.6 32.1 33.0should 38% Michigan 20.2 32.1 usa 32% Florida Florida 30% 39.6 Colorado 15.1 25.8 26.4 43% Minnesota 16.9 26.2 27.420 –27%
ouisiana
1996 2007 2007 2009 2009 %Change %Change Connecticut 1996 19.8 34.6 35.6 44% 32.1 35.7 41% Alabama Alabama 20.7 20.731.8 31.835.6 35.641% 41% Florida 21.6 37.2 38.1 43% een h.o. says for Developed Cesarean Birth23.8 should be38% between Alaska 23.3 AlaskaNations 23.333.8 33.8 23.82.0% 2.0% Georgia 20.9 32.0 33.6 in– 15% usa average 32.9% rate 16.7 As17.5 you can see there are no states in Arizona 22.6 27.4 39% Arizona 16.7 22.6 27.4 39% Hawaii 26.4 27.0 26% e usa that abide by this standard. 38.1 Arkansas 34.6 Arkansas 16.1 16.126.2 26.2 34.653% 53% Idaho 16.0 24.0 24.5 24% California 33.0 California 20.6 20.632.1 32.1 33.038% 38% Illinois 19.3 30.3 31.5 31% Florida Colorado 15.1 25.8 26.4 43% Colorado1996 15.1 25.8 26.4 43% Indiana 20.3 29.4 30.5 33% e 1996 2007 2007 2009 2009 %Change %Change Connecticut 19.8 34.6 35.6 44% Connecticut 19.8 34.6 35.6 44% Iowa 18.6 29.4 30.3 29% -Section Rates that Decreased Delaware 20.1 32.1 35.7 41% Delaware26.4 20.1 32.1 35.7 41% Kansas 19.2 29.8 30.1 30% Louisiana Louisiana 26.4 35.9 35.9 39.6 39.6 39% 39% 21.6 37.2 38.1 43% Florida 21.6 37.2 38.1 43% Kentucky 21.3 34.6 35.9 35% Maine Maine 20.8 20.8 30.0 30.0 29.6 29.6 29% 29% here have not Florida been any significant decreases in c-sections Georgia 20.9 32.0 33.6 38% Georgia 21.6 32.0 33.6 38% tes from 1996 – 2009 Maryland Maryland 21.620.9 33.1 33.1 33.5 33.5 33% 33% Hawaii 17.5 26.4 27.0 26% Hawaii 19.8 26.4 27.0 26% Massachusetts Massachusetts 19.817.5 33.5 33.5 33.4 33.4 33% 33% ew Mexico dropped 1% from20.2 2007 –16.0 2009 but24.0 increased 22% IdahoIdaho 16.0 24.0 24.5 24% 24.5 24% Michigan Michigan 20.2 30.4 30.4 32.1 32.1 32% 32% om 1996Minnesota –Minnesota 2009 Illinois 19.3 30.3 31.5 31% Illinois 16.9 30.3 31.5 31% 16.919.3 26.2 26.2 27.4 27.4 27% 27% laska dropped 32%Indiana from 200726.6 –20.3 2009 with a 29.4 2% change from Indiana 29.4 30.5 33% 20.3 30.5 33% nge Mississippi 1996 2007 2009 %Change Mississippi 26.6 36.2 36.2 37.8 37.8 37% 37% 96 – 2009 Massachusetts .1%30.3 from 2007 – 2009 IowaIowa dropped 18.6 29.4 30.3 29% 29.4 30.3 29% Missouri Missouri 20.4 20.418.6 30.3 31.7 31.7 31% 31% Kansas 19.2 29.8 30.1 30% Kansas 19.1 29.8 30.1 30% Louisiana 26.4 35.9 39.6 39% Montana Montana 19.119.2 29.4 29.4 29.6 29.6 29% 29% Kentucky 21.3 34.6 35.9 35% Kentucky19.8 34.6 35.9 35% Maine 20.8 30.0 29.6 29% Nebraska Nebraska 19.821.3 30.9 30.9 31.7 31.7 31% 31% Maryland 19.3 33% Nevada Nevada 19.321.6 33.1 33.133.1 33.8 33.833.5 33% 33% Massachusetts 33% New New Hampshire Hampshire20.3 20.319.8 30.8 30.833.5 30.8 30.833.4 30% 30% Michigan 32% New New Jersey Jersey 24.0 24.020.2 38.8 38.830.4 39.4 39.432.1 39% 39% Minnesota 27% New New Mexico Mexico 17.2 17.216.9 23.3 23.326.2 22.8 22.827.4 22% 22% Mississippi 37% New New York York 22.9 22.926.6 33.7 33.736.2 39.4 39.437.8 39% 39% Missouri 20.4 30.3 31.7 31% North North Carolina Carolina 21.1 21.1 30.7 30.7 31.2 31.2 31% 31% Montana 29% North North Dakota Dakota 18.9 18.919.1 28.4 28.429.4 29.3 29.329.6 29% 29% Nebraska 19.8 30.9 31.7 31% Nevada 19.3 33.1 33.8 33% New Hampshire 20.3 30.8 30.8 30% New Jersey 24.0 38.8 39.4 39% New Mexico 17.2 23.3 22.8 22% New York 22.9 33.7 39.4 39% North Carolina 21.1 30.7 31.2 31% North Dakota 18.9 28.4 29.3 29%
w.h.o. Health Standards Delaware 20.1
1996 1996 2007 2007 2009 2009 %Change %Change 1996 2007 2009 %Change Mississippi 26.6 36.2 37.8 37% Missouri 20.4 30.3 31.7 31% 3039% –41% 40% Louisiana 26.4 Louisiana Alabama 20.7 26.435.9 31.8 35.939.6 35.6 39.6 39% Montana 19.1 29.4 29.6 29% Maine 20.8 Maine Alaska 23.3 20.830.0 33.8 30.029.6 23.8 29.629% 2.0% 29% Nebraska 19.8 30.9 31.7 31% Maryland 21.6 33.1 33.5 33% Maryland Arizona 16.7 21.6 22.6 33.1 27.4 33.5 39% 33% Nevada 19.3 33.1 33.8 33% Massachusetts Massachusetts Arkansas 16.1 19.833.5 26.2 33.533.4 34.6 33.433% 53% 33% New Hampshire 19.8 20.3 30.8 30.8 30% Michigan 20.2 Michigan California 20.6 20.230.4 32.1 30.432.1 33.0 32.132% 38% 32% New Jersey 24.0 38.8 39.4 39% Minnesota 16.9 26.2 27.4 27% Minnesota Colorado 15.1 16.92007 25.8 26.2 26.4 27.4 43% 27% New Mexico 1996 17.2 23.3 22.8 22% 1996 2007 2009 2009 %Change %Change Mississippi 26.6 Connecticut 19.8 34.6 35.6 44% Mississippi 26.636.2 36.237.8 37.837% 37% New York 22.9 33.7 39.4 39% Missouri 20.4 30.3 31.7 31% Delaware 20.1 32.1 35.7 41% Missouri 20.433.6 30.3 31.7 31% North Carolina 22.5 21.1 30.7 31.2 31% Oklahoma Oklahoma 22.5 33.6 34.6 34.6 34% 34% Montana 19.1 29.4 29.6 29% Florida 21.6 37.2 38.1 43% Montana 19.1 29.4 29.6 29% North Dakota 18.9 28.4 29.3 29% Oregon Oregon 16.9 16.9 28.2 28.2 29.4 29.4 29% Nebraska 19.8 30.9 31.7 31% Nebraska Georgia 20.9 19.830.1 32.0 30.9 33.6 31.7 38% 31% Pennsylvania Pennsylvania 19.4 19.4 30.1 31.8 31.8 31% 31% Nevada 19.3 33.1 33.8 33% Nevada Hawaii 17.5 19.332.2 26.4 33.1 27.0 33.8 26% 33% Rhode Rhode Island Island 17.7 17.7 32.2 32.9 32.9 32% 32% New Hampshire 20.3 30.8 30.8 30% New Idaho Hampshire 16.0 20.333.4 24.0 30.8 24.5 30.8 24% 30% South South Carolina Carolina22.6 22.6 33.4 35.3 35.3 35% 35% New Jersey 24.0 38.8 39.4 39% New Illinois Jersey 19.3 24.026.6 30.3 38.8 31.5 39.4 31% 39% South South Dakota Dakota 20.8 20.8 26.6 26.3 26.3 26% 26% New Mexico 17.2 23.3 22.8 22% New Indiana Mexico 21.7 20.3 17.2 29.4 23.3 30.5 22.8 33% 22% 1996 2007 2009 %Change Tennessee Tennessee 21.7 33.3 33.3 33.8 33.8 35% 35% New York 22.9 33.7 39.4 39% New Iowa York 18.6 22.933.7 29.4 33.7 30.3 39.4 29% 39% Texas Texas 23.1 23.1 33.7 35.3 35.3 35% 35% North Carolina 21.1 30.7 31.2 31% North Kansas Carolina15.9 19.2 21.1 29.8 30.7 30.1 31.2 30% 31% Oklahoma 22.5 33.6 34.6 34% Utah Utah 15.9 22.2 22.2 22.9 22.9 22% 22% North Dakota 18.9 28.4 29.3 29% North Kentucky Dakota 16.5 21.3 18.9 34.6 28.4 35.9 29.3 35% 29% Oregon 16.9 28.2 29.4 29% Vermont Vermont 16.5 26.6 26.6 27.9 27.9 27% 27% Pennsylvania 31% Virginia Virginia 21.1 21.119.4 35.5 35.530.1 34.3 34.331.8 34% 34% Rhode Island 32% Washing Washing tonton 17.7 16.8 16.832.2 29.0 29.032.9 29% 29% South Carolina 35% West West Virginia Virginia 22.8 22.822.6 35.2 35.233.4 36.0 36.035.3 35% 35% South Dakota 26% Wisconsin Wisconsin 15.6 15.620.8 25.0 25.026.6 25.8 25.826.3 25% 25% Tennessee18.3 35% Wyoming Wyoming 18.321.7 26.9 26.933.3 28.1 28.133.8 28% 28% Texas 23.1 33.7 35.3 35% Utah 15.9 22.2 22.9 22% Vermont 16.5 26.6 27.9 27% Virginia 21.1 35.5 34.3 34% Washing ton 16.8 29.0 29% West Virginia 22.8 35.2 36.0 35% Wisconsin 15.6 25.0 25.8 25% Wyoming 18.3 26.9 28.1 28%
dldbebebetween between1010– –15% 15%usa usaaverage average32.8% 32.8%
uld be between 10 – 15% usa average 32.8%
L M M M M M M M M N N N N N N N N
70
Why are Cesarean Rates High? The Journal Obstetrics and Gynecology, college reported that a poll of 5,644 of its members found that 29% said they were performing more Caesareans because. They feared lawsuits because 8% had quit delivering babies 30% or L of those said it was liability issues. There is a cultural myth in this country that cesareans are just as safe as, if not safer than, normal vaginal birth. However, a study by MacDorman et al, published in 2006, specifically looked at infant and neonatal mortality rates and found that the overall neonatal death rate for babies born by c-section is 2.9 times as high as that for babies born via vaginal birth, and 6.7 times as high if the cause of death was intrauterine hypoxia and birth asphyxia. MacDorman, m.f, et al. 2006. Infant and neonatal mortality for primary cesarean and vaginal births to women with no indicated risk, United States, 1998 – 2001 birth cohorts. Birth 175 – 82. Additionally, maternal mortality is three times as high for women who have c-section's. Midwifery today — Deneux-Tharaux, C., et al. 2006. Postpartum Maternal Mortality and Cesarean Delivery. Obstet Gynecol 108 3, part 1, 541–48; Plante, L.A. 2006. Public Health Implications of Cesarean on Demand. Obstet Gynecol Surv 61: 807–15.
71
30%
29 + 30 33 8 + 33%
29% 8%
72
vbac Birth Vaginal Birth After Cesarean Every woman eligible should be offered one
+98+2 The Farm
+82+18 106 Attempted 109 Completed
Home-birth Birthed at home
82% Birthed at home. 6% Transported and had vaginal birth. 11% Transported and had another cesarean. 0% Ended up scheduling repeat cesarean.
Among the 74 women who planned an hbac in a casual analysis of statistics from an ican.
82%
73
In 1971 Gaskin, with her husband Stephen, founded The Farm Midwifery Center in Summertown Tennessee, One of the first out-of-hospital birth centers in the United States. They have been able to maintain extremely low rates of medical interventions, and fantastic birth outcomes for the past 40 years.
+87+13 Birth-Centers
allowed or appropriate for home-birth
Gaskin and many of her fellow midwives have no formal medical training in the hospital, but are certified through credible establishments and the fact that they have good outcomes even with births that obstetricians consider high-risk — breeches, big babies and vaginal births after c-section — is evidence, she says, that for most women less interventionist is better care.
+92+8 +35+65 87%
Hospitals Allowed
8%
Hospitals 65% of those 8%
65% Had vaginal birth. 31% Had cesarean. 2% Ended up scheduling. repeat cesarean.
Twenty-four percent of them were transferred to hospitals during labor; 87% of these had vaginal births. http://www.ncbi.nlm.nih.gov/pubmed/15516382
While not a scientific study, this information does show that Women planning an hbac are much more likely to have one than women planning a hospital vbac. Compiled by Krista Cornish Scott, ICAN, Rochester, New York.
74
vbac Risk of Uterine Rupture
+50+100 Induction of any kind creates a 50% or higher increase in uterine rupture risk depending upon type of induction. Lydon-Rochelle et al., 3; Delaney and Young; Landon et al., Maternal and Perinatal Outcomes; Bujold; Landon et al. Risk of Uterine Rupture, 14 – 15.
42 weeks + Being 42 weeks + gestation increases the risk of uterine rupture. Ibid., 938
75
six risk factors for a case of uterine rupture
1 Previous infection of uterine scar site weakens the sac. note Use of catgut for suturing seems to contribute to a higher rate of infection. Durnwald, C. 2003. Uterine rupture, preoperative and perinatal morbidit y after single-layer and double-layer closure at cesarean delivery. Am J Obstet Gynecol 189: 925–29; Slome Cohain, J., 2004. The Many Ways to Sew Up a Uterus. Midwifery Today 70: 32.
2 Pregnancy less than 24 months after previous c-section. Bujold et al.; Lieberman et al Other studies have shown < 18 months. 3 Placenta covering uterine scar. Lieberman et al., 940. 4 More than one previous cesarean, without previous vaginal birth Landon et al., Risk of Uterine Rupture; Lieberman et al.
.5% to 1.0–1.5% 3 per 1,000 Certain labor management practices increase the risk for uterine rupture 2 – 3 times, although the absolute increase is small from a baseline uterine rupture rate of 0.5% to 1.0 – 1.5%. The association between epidural analgesia and uterine rupture deserves further study. http:// www.ncbi.nlm.nih.gov/pubmed/21838161.
Uterine rupture is a rare complication even in those who have had a previous Caesarean. The rate of uterine rupture for all women with prior Caesarean is 3 per 1,000; the risk is significantly increased with a trial of labour 4.7/1,000. Risk of perinatal mortality and morbidity: the risk of an intrapartum death is small in planned vaginal birth 10 per 10,000 but higher than those having a planned repeat Caesarean 1 per 10,000. The effect of planned vaginal birth or repeat c-section on cerebral palsy is uncertain. Guise j.m, Eden k, Emeis c, et al; Vaginal birth after cesarean: new insights. Evid Rep Technol Assess Full Rep. 2010 Mar 191:1-397.
76
Elective Deliveries 2009 Inducing birth without a medical reason by c-section or Pitocin
+1+99 The Farm
+1+99 5%
Home-birth
allowed or appropriate for home-birth
.5%
77
Elective deliveries are inductions or c-section without medical reason before 39 completed weeks of pregnancy. The Leapfrog Group states that elective deliveries should be below 5%.
+15+85 Hospitals Lowest 3.2% Highest 52%
15%
78
Elective Deliveries 2009 usa 15
-
22
Washington
North Dakota
Montana
13
-
26.3
Oregon
South Dakota
23.7
Idaho
Wyoming
40
Nebraska
17.1
16
Nevada
Utah
12.4
Colorado
10.6
22.3
Kansas
California
18.7
Arizona
45.8
16.7
Oklahoma
New Mexico
22.6 Texas
52.9 Alaska
-
Hawaii
5.6
8.4
Minnesota
New Hampshire
20.6
Maine
Wisconsin
5.5
New York
Michigan
Iowa
26.2
13.8 3.5
Missouri
Arkansas
12.3
Kentucky
3.7 26.3
Mississippi
Ohio
17.8
West Virginia
Virginia
Alabama
Connecticut
NJ DE
11
New Jersey
22
Maryland
23.8
Tennessee
22.5
6.35
MA
11.9
7.1
Massachusetts
CT RI
Pennsylvania
13.1
NH
MS
15.3
6.3
Indiana
Illinois
VT
24.6
10.5
12
10.4
North Carolina
13.5
Georgia
19.4
South Carolina
0 – 10% 11 – 20% 21 – 30%
Louisiana
31 – 40%
12.6 Florida
41 – 50% n/a
80
Delivery Day of the Week 80% of births in the usa that happen in hospitals are born m â&#x20AC;&#x201C; f before 4pm. cdc 2008
81
Birth by Weeks birth at 39 – 41 weeks
Mortality rate by 1,000
Gives the baby the best changes for survival and health.
32 – 33 17.58 34 – 36 7.40 37 – 38 3.13 39 – 41 2.08 42 < cdc 2008
2.69
82
Acceleration of Labor The use of Pitocin is not supported by Scientific evidence for low-risk women without a medical reason
+1+99 The Farm
+12+88 5.4%
Home-birth
allowed or appropriate for home-birth
> 12%
83
Intermittent Auscultation is a systematic method of listening to fetal heart tones with an acoustical device fetascope or a hand-held ultrasound doptone, paying attention to rate, rhythm and variability for at least one full minute, most usually following a uterine contraction uc, and timing with a watch or clock with a sweep second hand.
+7+93 Birth-Centers
allowed or appropriate for home-birth
+47+53 + > 7%
Hospitals Lowest 3.2% Highest 52%
47%
Birth All things birth should be Evidence Based
86
efm monitoring Not supported by Scientific Evidence
The Farm
> 0%
Home-birth
allowed or appropriate for home-birth
> 0%
87
Electronic fetal monitoring is the perfect example of a high-tech, high-cost, low Evidence-Based Care Practice. The evidence against continuous electronic fetal monitoring is so clear that the usa Preventive Services Task Force issued a recommendation saying that it should not be used in low risk women.
The acog has endorsed intermittent auscultation as an appropriate and safe alternative to electronic fetal monitoring. That is listening to the heart beat with a hand held device, as needed. However this practice is rarely used in hospitals yet.
+94+6 Birth-Centers
allowed or appropriate for home-birth
> 0%
Hospitals Lowest 3.2% Highest 52%
94%
88
Breaking of the Waters Not supported by Scientific Evidence
+1+99 The Farm
+1+99 .5%
Home-birth
allowed or appropriate for home-birth
> .5%
89
2+98 Birth-Centers
allowed or appropriate for home-birth
+65+35 > 2%
Hospitals Lowest 3.2% Highest 52%
65%
90
Postpartum Hemorrhage Statistics
+1+99 The Farm
+1+99 1.8%
+100 Birth-Centers
Home-Birth
> 2.5%
+15+85 n/a
Hospitals
10.5%
91
Postpartum Depression Statistics
+1+99 The Farm
+1+99 1%
+100 Birth-Centers
Home-birth
> 1.7%
+15+85 n/a
Hospitals
11 â&#x20AC;&#x201C; 18%
92
7
93
my vision Home-birth is a viable option for 60 â&#x20AC;&#x201C; 80% of low-risk women. L of births should be at Home. L of births should be at a Birth-Center. L of births at the Hospital.
Birth Birth should be viewed as Normal, Natural, and Empowering
colophon
k Designer Stephanie Penland l Photographers 01 Isaiah Beiser Photography 02 Tres Photography 03 Stephanie Penland 04 Catherine Byrd 05 Istock Photography m Writers 01 Stephanie Penland 02 Crystal Wolf 03 Illana Pearlman n Printer 01 Blurb Magazine o Details 01 Font Archer Pro 02 Chartwell