Wiregrass Birth Network

Are you using the right healthcare provider for your pregnancy?  I just found this great quiz you can take to find out:

http://www.delivermybaby.org/

The month of November had us meeting to discuss choosing health care providers. Knowing how important a health care provider is to a woman’s birth experience, we opened up to freely discuss what each of us felt was important in who we invite to oversee our births.

Who you choose to take care of you through your pregnancy and birth experience will shape the way you feel about the experience, and even how you feel as a mother. This critical decision is often left to chance - insurance or location being the deciding factor - rather than a thorough educational decision.

Choosing a provider based on who your friend had, who’s on the top of the insurance list, whose office is closest to you, who is female, or who looks the nicest are common, but misguided, ways of finding this critical person.

Why Who You Choose is Important:

Who you choose to accompany you through birth is probably the most influential decision for your birth outcome. Even if you are well-educated in what you want, if your provider doesn’t support your choices, it’s not going to turn out your way. The provider/patient relationship should be one of mutual trust.

This story was shared at the meeting by a mama who felt that her care provider did not have her best interest at heart:

Dr. _____seemed to be a nice doctor until it came closer to my due date. My baby’s due date was estimated to be July twelfth. I informed Dr. _____ that with my first child, not only did she come later than her scheduled due date, but that I had a scary experience with being induced with pitocin, and so I did not want to be induced again unless it was medically necessary. He didn't seem to listen to what I had to say, and scheduled me to be induced a week before her due date. I kept reminding him of my feelings to not be induced and to let the baby come when she was ready. He informed me of the "risks" of the baby staying in too long such as a still born birth etc. I told him that I was aware of those risks but still wanted to let the baby come when she was ready. In my mind, it was just as risky to be induced before my body was ready than the risks of keeping her in longer than he thought was necessary.

Each appointment I had with Dr. ______ he would push me to be induced by scheduling an appointment with the hospital without even asking me how I felt about his decision. On July fourteenth an ultra sound made it clear that everything was fine and the baby was well. After scheduling different dates for me to be induced that I would just later have to call the hospital and cancel, Dr. ______ said that he wasn't willing to allow me to go over 41 weeks. I asked him when the 41 weeks started and he said Saturday the eighteenth. He wanted me to be induced Friday the seventeenth. I asked if I could wait until I was actually at forty one weeks and he then told me that he wasn't delivering that week and a different doctor would be. I felt so frustrated and discouraged because I knew in my heart that my baby would come when she was ready and I wanted to work around her schedule and not his.

This woman was so uncomfortable with her doctor, that she considered switching care providers at 40 weeks gestation, but had trouble finding someone who would take her that late in pregnancy.

Another mama at the meeting was lucky enough to see her doctor’s true colors early on in her pregnancy

Every time I went in for a check up, Dr. ______ would tell me that I was gaining too much weight. I was a vegetarian, I ate real healthy, I went to spinning classes three times a week. What I gained was not due to being unhealthy. Yet, she kept insisting that I was gaining too much and that I “needed to watch what I was putting in my mouth”. I thought that I could just put up with her for those few minutes I saw her during our monthly appointments, after all, she probably wouldn’t even be at my birth. But, I decided I couldn’t take anymore and switched to a different doctor. He was really respectful, and open to the type of birth that I wanted. I was glad I changed doctors.

Many women don’t realize that they can change care providers, even late in their pregnancy! It is the doctor that works for the patient; you are paying them for a service they are providing. It’s a good thing to search around for the one you feel best meets your needs, and the one you feel most comfortable with.

How to Find The One:

The mom in the first story said that her doctor was really nice and seemed to listen to what she wanted throughout her pregnancy, but when she got closer to her due date, his whole attitude toward her changed. How do you go about finding a care provider that will respect you and NOT pull the “bait and switch” tactic?

• Ask better questions. Instead of asking friends, “Who did you have, and did you like them?” Instead of finding someone who is “nice”, ask what your friends liked about them. See if their birth experience is one that you would like to have. Ask your doctor, and ask the nursing staff at the hospital what this doctor’s record is. Do they have a lot of inductions? How do they handle natural childbirth? It’s important to find out beforehand if they are the type to say one thing and then do something else.

• Ask someone experienced. Ask your local childbirth educators and doulas. These woman have a lot of experience with different types of births with all different doctors in different hospitals. See who they recommend for the type of birth that you want.

• Trust your instincts. They are usually right! The mom in the second story did not like the way she felt when she saw her first doctor. That was her intuition telling her that that doctor was wrong for her! Luckily she listened to her internal voice and switched when it was still easy enough.

• Be educated. Find out about normal birth. Look into the various procedures, the different options, their benefits and risks and evidence-based care. This will enable you to have a much deeper discussion with your provider about what you want from him/her and how you wish your birth to be. It will enable you to make a more educated decision about your care and who will oversee it.

Doing all of the above still will not guarantee a beautiful outcome, but choosing a care provider whom you trust will lead to a birth experience which allows you a greater amount of control, input in the decision making process, and to feel you did the right thing if you need to let your doctor make the choice for you if an emergency arises.

You probably are wondering what the Wiregrass Birth Network is, and what’s our purpose here in the Wiregrass region. We wondered that for awhile too!

The Wiregrass Birth Network is a local chapter of a national, non-profit organization called BirthNetwork National. BirthNetwork National was started by a group of women who saw a need for more education and support for evidence-based maternity care in the area they lived. Though the organization has grown tremendously, this purpose has remained the same for each and every BirthNetwork National chapter.

Here at the Wiregrass Birth Network, our mission is three-fold.

 First, it is the purpose of the Wiregrass Birth Network to help women and families of Southeast Alabama to be aware of evidence-based care. It is our purpose to help them become informed of mother-friendly maternity care and the rights they have to receive it.

Second, it is the purpose of the Wiregrass Birth Network to support a woman’s desire for mother-friendly maternity care, support the providers who offer it, and support efforts that encourage it. It is our purpose to support mothers through their hardships and through their joys, and to offer mother-to-mother care and camaraderie.

Third, it is the purpose of the Wiregrass Birth Network, through encouragement and opportunity, to nourish the desires in women to make a difference. We purpose to do this through encouraging advocacy through letter-writing, speaking out, becoming doulas, breastfeeding counselors, childbirth educators and midwives.

Some people may be turned off by our natural childbirth topics. Do we only support one way of giving birth? We support natural childbirth because it is most often the safest way for moms and babies. We are not anti-drugs, anti-intervention, or anti-cesearean. Our main goal is to help moms and families have a deeper understanding of their choices, to understand the risks and benefits of the choices they make, and to feel confident in their ability to make decisions that are right for their situation. There is plenty of support out there for inductions, epidurals and cesareans. It’s the sad reality of the society we live in. For those moms who are interested in something other than what has become normal, we are here for them.

Why are we here? Well, there are not a lot of normal births happening in this area. The normal birth in the Wiregrass region is usually an induction with cervadil and pitocin, lots of fetal monitoring while mom is restricted to the bed, an epidural to ease the pain of the pitocin contractions, pushing with legs in stirrups, or, nearly as often as not, a rush down to the O.R. for a cesarean due to fetal distress, or a baby who just refuses to come down. This may be a cultural normal, but it is far from how birth is meant to be.

Evidence is showing that, while most moms say they had a good birth, underneath those words a lot of women have conflicted feelings. A lot of women feel like all of the control was taken out of their hands, that their voice was not heard, and that, while they are so thankful for a healthy baby, there might be more to birth than just that.

Why is birth like this in the Wiregrass area?

•Obstetricians are trained specialists. They are trained in all that can go wrong in childbirth, and therefore tend to see childbirth as a dangerous event. When they can monitor and have control over the event, they feel that they can prevent a lot more bad from occurring.

•Midwifery care here is very minimal and so restricted, it is unable to bring balance to the medicalized view of birth.

•Women in this region are not making a fuss about normal birth because they have been taught that induction, epidural and cesareans are normal.

•Obstetricians have such high malpractice insurance rates that they are overbooked in order to gain any profit. They do not have time to wait around for normal birth. And normal birth doesn’t bring in that much money.

What can we do about this? First of all, speak up. This is your body, your birth. You have the right to ask for reasonable requests. If you feel your care was not adequate, please let it be known by writing letters to that care provider, the hospital, the Alabama Medical Board, and to your political representatives. If you have been pleased with your care, write letters about that as well! Second, support doctors and midwives who respect women’s choice and their opinion. Third, bring in back up. A kind, compassionate, and strong support person can do wonders for making this life event into something wonderful and empowering. Lastly, be educated! Learn about normal birth. Research the risks and benefits of all your options; seek out evidence-based care.

For our October meeting, we had president of Alabama Midwives Alliance (ALMA), Shannon Burdeshaw come to speak about why Alabama has a need for midwives.

In our country, the idea of obstetricians as the only provider of maternal health care is so prevalent, that many people do not know what a midwife even is, or they have a very narrow understanding of midwives.

What is a midwife?  According to the International Confederation of Midwives,

A midwife is a person who, having been regularly admitted to a midwifery educational programme, duly recognised in the country in which it is located, has successfully completed the prescribed courseof studies in midwifery and has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.

 

The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.  This care includes preventive measures, the promotion of normal birth, the detection of complications in mother and child, the accessing of medical or other appropriate assistance and the carrying out of emergency measures.

 

The midwife has an important task in health counselling and education, not only for the woman, but also within the family and community.  This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and childcare.

 

A midwife may practice in any setting including in the home, the community, hospitals, clinics or health units.

In 26 of the 50 states in our country, midwives are duly recognized as legal providers of maternity care to low-risk women. Midwives are trained in a variety of different capacities, though all midwives are required to have a vast knowledge of womens’ and babies’ bodies, clinical skills, ability to assess risks, and have hands-on training of attending births.

While all midwives, being unique as individual human beings, are different, the cornerstone of the practice of midwifery is the belief in birth as a normal, physiological life event, rather than as a medical emergency. Midwivesare trained in the Midwifery Model of Care, put together by the Midwifery Task Force, which practices:

• monitoring the physical, psychological and social well-being of the mother throughout the childbearing cycle
  
• providing the mother with individualized education, counseling,and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
  
• minimizing technological interventions and;
  
• identifying and referring women who require obstetrical attention
  

The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.

What stands out most to me when comparing the medical model of care with the midwifery model of care is the amount of time a midwife spends with her clients.

In Alabama, we have one of the worst maternal and neonatal outcomes in our country. Obstetrical care doesn’t seem to be making many strides toward improving the health of women and babies. Obstetricians don’t have enough time for that! They are good at taking care of the emergencies as they happen, but one cannot truly care for a woman by looking at her chart, and spending five minutes with her once a month. True care begins with having a conversation witha woman; talking with her about her life situation.

Midwives provide women with respect, nutritional counseling, childbirth education, emotional care. They get to see a woman in her own environment, with her family, and truly see what her situation is.  Looking at a woman as a whole, seeing her as part of her community, this is where true change can occur.

If you are interested in midwifery care, please visit www.alabamamidwivesalliance.org and send an email to info@alabamamidwivesalliance.org.

Well, in case you missed the meetings this month...

We started off with letting everyone know that the Walk for Midwives happened on October 3rd, and talked about how many people attended and how much money was raised statewide.

Next, our guest speaker, Shannon Burdeshaw, the president of ALMA (Alabama Midwives Alliance, check out the website here: www.alabamamidwivesalliance.org) gave a wonderful presentation on why we need Certified Professional Midwives (or CPMs) in Alabama.

I think everyone involved learned a lot, including the Network.

After the presentation, we discussed midwives and how to become a CPM, as well as other midwifery related topics.

Thanks to everyone that attended the meetings, in both Fort Rucker and Dothan!!

To get involved in making midwifery legal in our state, visit the Alabama Birth Coalition's website, and become a member.  You'll get updates and information on what is happening, and how you can help.  Also, write, and then call your insurance company (if you have one) to tell them you want them to cover midwifery care.  And, don't forget about your local legislature.  Make sure you let them know this is something that you want.

If you want more information, you can always email us at wiregrassbirthnetwork@gmail.com and we can point you in the right direction.

See you at the next meetings!

We are now Affiliates with Earth Mama Angel Baby!  If you purchase your products through any of the links of banners on our website, a portion of your sale will go to us at the Wiregrass Birth Network!  This is an easy way to support the network, and still pamper yourself and your baby in wonderful products!

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The Alabama Birth Coalition’s Walk for Midwives was held at Eastgate Park on Saturday October 3rd, 2009.  Walkers gathered in Dothan as well as Birmingham, Hunstville, and Cullman to raise awareness about maternity care in Alabama and the need for licensure of Certified Professional Midwives in the state.  Pictured are local childbirth educators and doulas who are also members of the Alabama Birth Coalition:  Amy Hoyt, Shayne Slingluff, and Ashley Motzenbecker.  Following the Walk for Midwives, the Wiregrass Birth Network hosted a Red Tent Event where mothers were invited to share their birth stories and listen to others’ in a safe environment.

Here are the newest birth rates in our region:

Over the past 12 years there has been a steady increase in theamount of Cesarean Sections. The overall rate in Alabama for 2005 was32.4%, and for 2006 was 34.0%. Both are higher than the national rateand increasing.

The World Health Organization (WHO) recommendsa Cesarean rate of no more that 15%. Both the Center for DiseaseControl (CDC) and US Department of Health and Human Servicesrecommended that the national cesarean rate be reduced to what wasconsidered to be a reasonable target of 15% by the year 2010.Unfortunately, the rate has continued to steadily grow and we arenowhere near the target goal. In fact, we are still moving in theopposite direction.

Some of the increase seen in Cesarean Delivery Rates is due to adecrease in the number of vaginal births after cesarean (VBAC)deliveries. The overall VBAC rate for Alabama in 2005 was 5.8% and in2006 was 5.0%. This is exceptionally low, well below the nationalaverage which is around 10%, and is unfortunately still decreasing eachyear.

It is also interesting to note that in 2006 the rate of out of hospital births were as follows:

• Total Number of Births: 172
• Number of Vaginal Births: 170
• Number of Vaginal Births after Cesarean Section: 2
• Number of Primary Cesarean Sections: 0
• Number of Repeat Cesarean Sections: 0
• Cesarean Section Rate: 0
• Vaginal Birth after Cesarean Section Rate: 100%

This speaks volumes about the safety and effectiveness of hospital births.

The hospital birth statistics for the Wiregrass area are as follows:

Flowers Hospital Statistics

2005:

• Total Number of Births: 988
• Number of Vaginal Births: 600
• Number of Vaginal Births after Cesarean Section: 6
• Number of Primary Cesarean Sections: 214
• Number of Repeat Cesarean Sections: 168
• Cesarean Section Rate: 38.7%
• Vaginal Birth after Cesarean Section Rate: 3.4%

2006:

• Total Number of Births: 1158
• Number of Vaginal Births: 679
• Number of Vaginal Births after Cesarean Section: 2
• Number of Primary Cesarean Sections: 298
• Number of Repeat Cesarean Sections: 179
• Cesarean Section Rate: 41.2%
• Vaginal Birth after Cesarean Section Rate: 1.1%

Southeast Alabama Medical Center Statistics

2005:

• Total Number of Births: 1505
• Number of Vaginal Births: 937
• Number of Vaginal Births after Cesarean Section: 12
• Number of Primary Cesarean Sections: 309
• Number of Repeat Cesarean Sections: 247
• Cesarean Section Rate: 36.9%
• Vaginal Birth after Cesarean Section Rate: 4.6%

2006:

• Total Number of Births: 1497
• Number of Vaginal Births: 852
• Number of Vaginal Births after Cesarean Section: 10
• Number of Primary Cesarean Sections: 374
• Number of Repeat Cesarean Sections: 261
• Cesarean Section Rate: 42.4%
• Vaginal Birth after Cesarean Section Rate: 3.7%

Medical Center Enterprise Statistics

2005:

• Total Number of Births: 786
• Number of Vaginal Births: 541
• Number of Vaginal Births after Cesarean Section: 7
• Number of Primary Cesarean Sections: 125
• Number of Repeat Cesarean Sections: 113
• Cesarean Section Rate: 30.3%
• Vaginal Birth after Cesarean Section Rate: 5.8%

2006:

• Total Number of Births: 798
• Number of Vaginal Births: 552
• Number of Vaginal Births after Cesarean Section: 7
• Number of Primary Cesarean Sections: 122
• Number of Repeat Cesarean Sections: 117
• Cesarean Section Rate: 30.0%
• Vaginal Birth after Cesarean Section Rate: 5.7%

Dale Medical Center Statistics

2005:

• Total Number of Births: 189
• Number of Vaginal Births: 110
• Number of Vaginal Births after Cesarean Section: 0
• Number of Primary Cesarean Sections: 45
• Number of Repeat Cesarean Sections: 34
• Cesarean Section Rate: 41.8%
• Vaginal Birth after Cesarean Section Rate: 0%

2006:

• Total Number of Births: 209
• Number of Vaginal Births: 116
• Number of Vaginal Births after Cesarean Section: 2
• Number of Primary Cesarean Sections: 49
• Number of Repeat Cesarean Sections: 42
• Cesarean Section Rate: 43.5%
• Vaginal Birth after Cesarean Section Rate: 4.5%

Ultimately, there needs to be more Childbirth Edcation Classesavailable to the public in our area. Those classes need to be of goodquality and unbiased to hospital protocols and common procedures.

Ifthe Cesarean rate is ever going to decrease, the widespread use ofelectronic fetal monitors and non medically indicated inductions alsoneeds to decrease as well.