Evansville Birthnetwork

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

All questions, except the first, are optional.

Dear Birth and Perinatal Professionals,

The Evansville BirthNetwork would like to invite you to have an informational table at our Doula Fest! Birth and Baby Expo on October 20th from 10am-2pm at the Evansville Central Library.

The Evansville BirthNetwork is a non-profit that aims to promote mother-friendly maternity care. We believe:

• Birth is a normal, healthy process; it is not an illness or disease.
• Empowering births can take place in birth centers, hospitals and homes.
• Women are entitled to complete and accurate information on their full range of options for pregnancy, birth, postpartum and breastfeeding.
• Women have a right to make health care decisions for themselves and their babies.   This right includes Informed Consent as well as Informed Refusal.

We are seeking members of our community that offer services to women related to the childbearing years and that also support our mission.  Tables and chairs will be provided.  Per Library rules, vendors may not exchange money for goods and services at this event.  They may, however, take orders and make appointments.

The vendor fee is $10 for Birth Network members, $20 for non-members, and free if you donate a good or service worth $50+ for our raffle.  Set-up is at 9am the morning of the event.  If you would like to participate or if you have any further questions, please contact Laquitha at l.glass@live.com.

By Megan Newhouse-Bailey, CHES, CLD, CD(DONA), CCCE, HCHD, BAIPPD

It is important for a woman to feel safe and comfortable while laboring and birthing. What mama chooses to wear can have an affect on her labor. While some prefer them, hospital gowns tend to be itchy and uncomfortable. They also can put mama in the mindset that she is a sick patient instead of a normal, healthy, birthing woman- especially when it says “Property of X Hospital” on the front of it. Unless you are going in for a cesarean, a mama has every right to wear what she wants, even at the hospital.  Hospital staff will probably warn you about how messy your clothes might get, so of course, plan to wear something you aren’t too attached to.

When thinking about what to wear for labor and birth ask yourself a few questions- will it be comfortable? Will it come off easily? Can I take it off if I have an IV? Do I have easy access to my breasts for breastfeeding?

I found quite a few things that meet that criteria, so I thought I would share them with you!

Tube dresses fit that requirement the best. In the summertime, there are lots of great swim cover ups that fit the bill. This one from Target  is a jersey knit maxi dress.

Another dress option is from the folks at Pretty Pushers. They make really cute “disposable” dresses made specially for birthing mamas. The have ties that open in the front to accommodate monitors, etc. I had a doula client wear one of these in hot pink.  She was really comfortable and looked great walking the halls of L&D.

If you don’t want to wear a dress, there are several skirt options. I love the combination of a simple jersey knit skirt and a nursing bra or tank.

The Old Navy  fold over maternity skirt is a classic to me. They are perfect for birth!

A skirt paired with a simple tank or a sleep bra (like these ones from Target) are great for labor and birth.

I am so glad we live in a time where woman have so many options and they can choose what they wear to give birth.

Megan is a childbirth educator and lactation educator, a birth doula and postpartum doula.  More information about her services can be found at Crazy Love Support.

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.  Giving free formula samples has been shown to lower breastfeeding rates. 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 violationof 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 theformula 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,

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 https://www.facebook.com/ICANofEvansville?ref=ts&fref=ts" target="_blank">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.  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 us at evansvillebirthnetwork@gmail.com.  We can provide information on local options for VBAC and give you tips for having a VBAC.  Several moms in the 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.  We would love to hear from you about your experience of asking for and receiving or not receiving delayed cord clamping.  Feel free to post a comment below or email evansvillebirthnetwork@gmail.com.

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%.
• Good Samaritan Hospital in Vincennes had a 25.5% cesarean rate.
• Memorial Hospital in Jasper had a 34.9% cesarean rate.
• Daviess Community Hospital in Washington had a 24.0% cesarean rate.
  

*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.

The Kentucky Cabinet for Health and Family Services makes information on hospitals' quality indicators and rates of utilization 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 on page 61) 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 Vaginal Birth After Cesarean (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.

For information on lowering your risk of having a cesarean or on Vaginal Birth After Cesarean (VBAC), visit our Cesarean Awareness page.

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.

April is Cesarean Awareness Month.  In honor of that, we are posting one of the Mother's Advocate's videos, Let Labor Begin on its Own.  Induction can double your chance of having a cesarean, so unless there is a medical reason to induce, it makes sense to wait until your body goes into labor on its own.  You can go to the Mother's Advocate website to view all six of Lamaze's Steps for a Safer Birth.  Each video is 2-3 minutes.