Merry Christmas from the Swain family!

Thanks to all of you who allowed me to serve and support you through your wonderful and amazing births this year.

Here is an excerpt from her article and you can plainly see how where you go to give birth can play a huge role in your outcome.

Advocate Good Shepherd Hospital in Barrington—35 percent (1,724 births 601 C-sections)

Advocate Medical Center in Oak Lawn—35 percent (4,233 births 1520 C-sections)

Resurrection Saint Joseph Hospital, Chicago—34 percent (1895 births 647 C-sections)

Advocate Condell Medical Center Libertyville, 30 percent (545 births 165 C-sections)

University of Chicago Medical Center, 29 percent (2,013 births 585 C-sections)

Advocate Illinois Masonic Medical Center, Chicago, 29 percent (2,931 births 866 C-sections)

Northwestern Memorial Hospital, Chicago, 28 percent (11,958 births 3,418 C-sections)

Elmhurst Hospital, 26 percent (1,426 births 374 C-sections)

Evanston Hospital, 26 percent (3,590 births 966 C-sections)

Adventist Hinsdale Hospital, 26 percent (2,252 births 588 C-sections)

Swedish Covenant Hospital, Chicago, 25 percent, (2,464 births 618 C-sections)

West Suburban Hospital, Oak Park, 20 percent (2,175 births 453 C-sections)

University of Illinois Medical Center, Chicago, 14 percent (2,893 births 433 C-sections)

Some notes about the three hospitals with the lowest cesareans:

• UIC is one of the few hospitals in the area that supports vaginal birth after 2 cesareans (VBA2C).  Most hospitals in the area view women who have had multiple cesareans as too risky for vaginal births and schedule them for repeat cesareans.
• West Suburban and Swedish Covenant both have alternative birthing centers on the premises used by midwifery practices that support natural childbirth and evidence based maternity care.  Women birthing in these birth centers aren’t forced to having labors conform to a curve or else face called cesareans for: “Failure to Progress”, “Arrested Labor,” or “Cephalopelvic Disproportion- CPD.”

if your hospital is not listed here, leave a comment and I’ll crunch the numbers and post your hospital’s rate.  Or you can check out the report yourself and leave it in the comments.

2008 Illinois Hospital Profiles

It does make a difference where you choose to give birth.

Check out the AP’s article here.

The burden of so many cesareans is starting to weigh on more than just the women and families involved.  Regulators are beginning to hold practitioners and hospitals accountable:

Hospitals also will have to report cesareans for first-time mothers, too often a result of a failed induction.

“That’s not a good outcome for the baby or the mom,” says joint commission president Dr. Mark Chassin. “We believe this will be a very important driver of improvement in perinatal care.”

It’s time that those who set the rules and protocols for hospital birth start to realize that unnecessary cesareans are not a good outcome -  as more babies have respiratory problems, moms have much longer and more difficult recoveries while simultaneously caring for a newborn and possibly other small children, and many moms suffer from post-op infections, not to mention many other risks and side-affects of major abdominal surgery.

For more info on inductions check out Henci Goer’s articles on elective induction and due dates. Henci Goer has made combing the medical research for best practices and translating that evidence for the rest of us her life’s work.  She is the author of The Thinking Woman’s Guide to a Better Birth.

Nursing Birth gives some great advice in her “Don’t Let This Happen to You” series when describing how one couple dealt with an induction.   Nursing Birth accurately describes the birthing climate in many of today’s hospitals and writes from an evidence-based point of view.

Related Posts:

• Do We Even get a Choice?
• One Choice We Make: Where Do We Give Birth?
• Good Things Come to Those Who Wait

I know that culturally to Americans, this makes no sense at first glance.  We are programmed culturally to respond that when we throw more money and gadgets at a given situation, we feel  like it has to be “better.”  But in the case of childbirth, less is actually more.  The less we interfere with high tech measures and the more low-tech emotional and physical support we give women,  we have more healthy moms and babies.

Check it out here:   Midwives: A Safe, Cost-Saving Alternative

And here: The Milbank Foundation Outlines how midwifery care has better outcomes and lower costs.

Reducing Infant Mortality from Debby Takikawa on Vimeo.

Screnshot from the trailer of Reducing Infant Mortality

Just saw on UnneCesarean a post about a free online film being released on July 26th: Reducing Infant Mortality and Improving the Health of Babies.  It highlights the sad fact that too many babies are dying in the U.S. around the time of birth.   As health care is debated on Capitol Hill this summer,  this film is hoping to bring light to a particularly dark corner of our health care system.

I knew that in the US,  we ranked very poorly overall, especially when compared to other developed nations (42nd in fact).  I learned watching the trailer that it is even more perilous for African American babies in the U.S. With a rate of 16 deaths per 100 births, African American babies are close to 2.5 times more likely to die around the time of birth than babies from the general population in the U.S.  This is scandalous.

Experts interviewed for the film are Obstetricians, Family Physicians, Midwives, MD’s, Doulas, and PhD’s including:  Michel Odent, Thomas Verny, Marshall Klaus, Phyllis Klaus, Marsdsen Wagner, David Chamberlain, Karen Strange, Robbie Davis-Floyd, Jennie Joseph, Sarah Buckley, Bruce Smith, Yeshi Neumann, Paul Fleiss, Maria Iorillo, Stuart Fischbein, Debra Bonaro-Pascali and Judith Prager.

Watch the trailer here:    Reducing Infant Mortality

Get Involved Here:  Reducing Infant Mortality: Take Action

The Lie of the EDD: Why Your Due Date Isn’t when You Think
How the 40 week pregnancy myth came about and why it’s totally wrong.

Just another reason to sit back and not fiddle with mother nature. It’s crazy to think that if  mama has a funky cycle she’s more likely be induced for being post-date which could result in a premature baby because the way  due dates are calculated doesn’t account for variations in women’s cycles.

When mama and baby are OK, there is no good reason to hurry things along.  Waiting for Baby to come on his/her own time (even if that time is closer to 42 weeks) gives everyone the best chance.

I spoke with a woman last weekend who would love to have a home birth but her insurance won’t cover one.  And the homebirth practice she was considering would cost her close to $7,000.  So then I asked her about going with a group of midwives who have an alternative birthing center.  She informed me that the only maternity reimbursements that her insurance provides are for MD’s.  She is healthy and low-risk and cannot even consider maternity care from a midwife.

I have heard of women whose coverage wouldn’t apply to the birth  if they were “allowed” to go past 41 weeks.  So in order to make sure that the birth was covered by their insurance they must undergo a costly, invasive, medical induction that increases their chances of a cesarean simply becasue their insurance policy arbitrarily states that it must be so.

So now we turn toward Texas where a judge recently ruled that Medicaid is not required to reimburse birthing centers for their facility fee when a woman using Medicaid gives birth there.  Medicaid will continue to reimburse hospitals (at a much higher cost) when women birth there, but the more cost effective option of the birthing center is being denied any reimbursement.  Also this ruling is not limited to Texas; it would apply nationally. Once again a medical plan is not even giving women  a choice when there exist several good options.  I’m not advocating that all low-risk women must give birth in a birthing center, only that if they have that option in their area they should be able to consider it.

If you would like to communicate your opinion about this ruling you can go here to do so: Consumer Letter to Congress

Childbirth Connection has great information on evidence-based maternity care and an excellent discussion of how current reimbursement practices actually encourage more intervention and less tolerance of supporting normal physiologic birth.  Pages 59-67 of their report Evidence-Based Maternity Care: What It Is and What it Can Achieve adress these concerns specifically.

As a childbirth educator and a doula I see my role as helping women to see the full range of options they have in various cincumstances so that they can make an informed decision about their care.  Unfortunately, the reality is that unless these women happen to be of certain means, their options are in reality much more limited than they appear at first glance.

Now they’ve turned their eye toward how we give birth here in the US.  What they concluded was that we overuse high-tech intervention like Electronic Fetal Monitoring and cesarean section and underuse low-tech non-invasive measures like warm baths and early skin-to-skin contact with mother and baby.

Consumer reports based its assessment on a paper published by Childbirth Connection. I have a copy of the paper, and it is an excellent evaluation of what the research shows to be best practices in maternity care. You can get a free copy of their report here.  If you don’t want to read the whole thing, you can get the summary on the Consumer Reports Page.  What’s even cooler is that they’ve designed a quiz to see how much you know about maternity care best practices.  Some of the answers go against conventional wisdom (like “once a cesarean always a cesarean”) and may surprise you.

What I love about the Childbirth Connection paper and the Consumer reports page is that they describe what research is showing to have best outcomes for mothers and babies.  And since at last check the US was 29th in the world for infant mortality, we could use all the best practices we can get.