CIMS Urges ACOG to Remove Additional Barriers to VBAC 
Join us in asking ACOG to take steps that will increase VBAC, reduce cesareans, and ultimately avoid unnecessary harms to mothers and infants.

 In a Sept. 9, 2010, letter to Dr. Richard Waldman, president of the American College of Obstetricians and Gynecologists (ACOG), CIMS and 18 co-signing organizations urged ACOG to revise its current recommendation that VBACs (vaginal birth after cesarean) should take place in hospitals where emergency cesareans are “immediately available.”

 CIMS will collect the names of additional organizations and individuals in support of this request through October 31, 2010, and will send the updated list of co-signers to Dr. Waldman. Add your name or your organization’s name now!

    

This request follows the March 2010 National Institutes of Health (NIH) Consensus Statement on VBAC, which found that VBAC is a reasonable choice for the majority of affected women. The NIH also reported that the “immediately available” recommendation was not based on strong support from high-quality evidence and had influenced about one-third of hospitals and one-half of physicians to stop providing care for women who wanted to plan a VBAC.

CIMS and the co-signing organizations also urged ACOG to revise its patient education publications and online consumer resources to include comprehensive information on the benefits and risks of cesarean section and VBAC. Without transparency about the short- and long-term benefits and risks of routine repeat cesarean and VBAC, women cannot make a truly informed choice about how they want to give birth.

Additional Information:

 

• CIMS Press Release “CIMS Responds to Promising but Conflicting Revised VBAC Guidelines” 
   

• American College of Nurse-Midwives Responds to ACOG’s 2010 VBAC Recommendations (PDF)
   

Take Action: Add your name or your organization’s name now!

    

 

 

 

 

For Release: May 5, 2010

Despite International Decline, Maternal Deaths a Growing Concern in U.S.

- Women Can Reduce Their Risk by Using Healthy Birth Practices -

WASHINGTON – Most pregnant women will think of dying in childbirth as a relic of the past or a problem for women in poor, third-world countries, but data show that women in the United States are not as insulated from the problem as they might think.

Recent research published in April 2010 in The Lancet indicates a significant drop in maternal deaths, which is encouraging news for maternal health advocates worldwide. In the United States, however, research shows that the rate of women dying in childbirth has, at best, failed to improve in decades, and at worst, shows signs of increasing in prevalence.

“For a nation that’s spending more on maternity care than any other nation in the world, the U.S. trend line on mothers’ health is going in the absolute wrong direction,” said Sharon Dalrymple, president of Lamaze International. “The irony is that too much medical care may be fueling the growing number of women being injured or dying in childbirth.”

Most childbirth experts agree that there is a “sweet spot” of safety for medical interventions like induction or cesarean surgery. In countries where too few medical interventions are available, women have increased risk of death in childbirth. However, when otherwise healthy women are exposed to the risk of cesarean surgeries or induction without a distinct medical need, these women also will have an increased risk of death and injury in childbirth.

“The challenge for women and their providers is to find that ‘sweet spot’ and use medical interventions only when they are truly beneficial to mother and baby,” said Dalrymple. “At Lamaze, we’re dedicated to helping women see the role that they can play in protecting their own health, and their baby’s.”

While better record keeping may account for part of the increased rate of maternal deaths in the United States, many experts agree that these data indicate a real increase in the number of women dying in childbirth. During this same time period, the Centers for Disease Control and Prevention identified a 27 percent increase in maternal injuries, which were primarily related to cesarean surgeries. Additionalresearch also showed that for every 5 percent increase in the cesarean surgery rate, there are an expected 14-32 more maternal deaths and a total of 5,000-24,000 more surgical complications.

The risk of death following cesarean surgeries is more than three times higher than for vaginal births.5 According to an Amnesty International report, American women have a higher risk of dying from pregnancy-related complications than those in 40 other countries and cesarean surgeries are performed in nearly one third of all deliveries in the United States – twice as high as recommended by the World Health Organization (WHO).

“Maternal mortality is not just a third-world problem,” said Debra Bingham, president-elect of Lamaze. “Women in almost every other industrialized nation are better off than American women. It also is alarming that maternal injuries have increased in the United States over the same time period that maternal mortality has more than doubled. Women in the United States expect and deserve better outcomes for themselves and their babies.”

Lamaze teaches women that there are things they can do to reduce the risk of complications, such as being as healthy as possible prior to getting pregnant, getting prenatal and postpartum care, as well as allowing labor to start on its own unless there is a clear medical problem. Lamaze also is encouraging hospital-based clinicians to allow women to move freely in labor. Currently most women’s movements are limited since they are tethered to fetal monitors with cords that are only a few feet long. Additionally women in labor will also benefit from better access to labor support measures. These practices can help reduce the chance of a cesarean surgery, and increase safe and healthy birth outcomes.

To support women in their efforts to have safe and healthy births, Lamaze International developed the Six Healthy Birth Practices based on recommendations by the WHO and backed by extensive research that support a woman’s natural ability to give birth. The Six Healthy Birth Practices are:
• Let labor begin on its own
• Walk, move around and change positions throughout labor
• Bring a loved one, friend or doula for continuous support
• Avoid interventions that are not medically necessary
• Avoid giving birth on your back and follow your body’s urges to push
• Keep mother and baby together; it’s best for mother, baby and breastfeeding

To learn more about Lamaze’s Six Healthy Birth Practices, please enroll in a Lamaze childbirth education class and visit http://www.lamaze.org/Default.aspx?tabid=251.

About Lamaze International
Lamaze International promotes a natural, healthy and safe approach to pregnancy, childbirth and early parenting practices. Knowing that pregnancy and childbirth can be demanding on a woman’s body and mind, Lamaze serves as a resource for information about what to expect and what choices are available during the childbearing years. Lamaze education and practices are based on the best and most current medical evidence available. Working closely with their families, health care providers and Lamaze educators, millions of pregnant women have achieved their desired childbirth outcomes using Lamaze practices. The best way to learn about Lamaze’s steps to a safe and healthy birth is to take a class with a Lamaze certified instructor. To find classes in your area, or for more information visit www.lamaze.org.

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Hogan MC et al. Maternal mortality for 181 countries, 1980-2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet, April 12, 1020. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)60518-1/fulltext.
Joint Commission. Preventing Maternal Death. Sentinel Event Alert, Issue 44, January 26, 2010. http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_44.htm.
Kuklina, EV et al. Severe Obstetric Morbidity in the United States: 1998–2005, Obstetrics & Gynecology, Vol. 113, No. 2, Part 1, February 2009.
Plante, LA. Public Health Implications of Cesarean on Demand. Obstetrical and Gynecological Survey, Vol.61, No. 12, 2006. Amnesty International. Deadly delivery: the maternal health care crisis in the USA, March 2010. http://www.amnestyusa.org/dignity/pdf/DeadlyDelivery.pdf.

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http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/ApprovedProducts/UCM182401.pdf.  

8.1 Pregnancy
Pregnancy Category C:  Animal reproduction studies have not been conducted with Influenza A
(H1N1) 2009 Monovalent Vaccine or AFLURIA.  It is also not known whether these vaccines
can cause fetal harm when administered to  a pregnant woman or  can affect reproduction
capacity.  Influenza A (H1N1) 2009 Monovalent Vaccine should be given to a pregnant woman
only if clearly needed.
 
 
8.3 Nursing Mothers
Neither Influenza A (H1N1) 2009 Monovalent Vaccine nor AFLURIA has been evaluated in
nursing mothers.  It is not known whether Influenza A (H1N1) 2009 Monovalent Vaccine or
AFLURIA is excreted in human milk.  Because many drugs are excreted in human milk,
caution should be exercised when Influenza A (H1N1) 2009 Monovalent Vaccine is
administered to a nursing woman.
 
 
8.4 Pediatric Use 
Neither Influenza A (H1N1) 2009 Monovalent Vaccine nor AFLURIA
has been evaluated in children. Safety and effectiveness in the pediatric population have not been established.

Hazardous cosleeping environments and risk factors amenable to change: case-control study of SIDS in south west England

¹ Department of Community Based Medicine, University of Bristol, ² Health Sciences Research Institute, University of Warwick

Abstract

Objectives To investigate the factors associated with sudden infant death syndrome (SIDS) from birth to age 2 years, whether recent advice has been followed, whether any new risk factors have emerged, and the specific circumstances in which SIDS occurs while cosleeping (infant sharing the same bed or sofa with an adult or child).

Design Four year population based case-control study. Parents were interviewed shortly after the death or after the reference sleep (within 24 hours) of the two control groups.

Setting South west region of England (population 4.9 million, 184 800 births).

Participants 80 SIDS infants and two control groups weighted for age and time of reference sleep: 87 randomly selected controls and 82 controls at high risk of SIDS (young, socially deprived, multiparous mothers who smoked).

Results The median age at death (66 days) was more than three weeks less than in a study in the same region a decade earlier. Of the SIDS infants, 54% died while cosleeping compared with 20% among both control groups. Much of this excess may be explained by a significant multivariable interaction between cosleeping and recent parental use of alcohol or drugs (31% v 3% random controls) and the increased proportion of SIDS infants who had coslept on a sofa (17% v 1%). One fifth of SIDS infants used a pillow for the last sleep (21% v 3%) and one quarter were swaddled (24% v 6%). More mothers of SIDS infants than random control infants smoked during pregnancy (60% v 14%), whereas one quarter of the SIDS infants were preterm (26% v 5%) or were in fair or poor health for the last sleep (28% v 6%). All of these differences were significant in the multivariable analysis regardless of which control group was used for comparison. The significance of covering the infant’s head, postnatal exposure to tobacco smoke, dummy use, and sleeping in the side position has diminished although a significant proportion of SIDS infants were still found prone (29% v 10%).

Conclusions Many of the SIDS infants had coslept in a hazardous environment. The major influences on risk, regardless of markers for socioeconomic deprivation, are amenable to change and specific advice needs to be given, particularly on use of alcohol or drugs before cosleeping and cosleeping on a sofa.

Citrus County Florida is much like it was in South Florida back in 1994.  Most people are still learning what a doula is.   Although the demographics are different in this rural part of the state, pregnant women and new mothers and families still need support.    It is our goal to educate this community and to be able to provide doula support when it is needed.  

In addition, Postpartum doula training is a vital part of ensuring a doula for every woman, which is one of the goals of  Dona International .  Tenth Month has providing DONA approved training since 2002, and will continue to train doulas in Florida and elswhere.  This will increase the trained doulas in Florida and allow for more families to have access to doula care.