Moms to rally on Labor Day

URBANA — When Anne DeAtley's first son was born, her long labor ended in a delivery method she'd rather have avoided: cesarean section.

Three years later, she'll be among the moms and others standing outside hospitals across the nation on Labor Day to take part in Improving Birth's National Rally for Change.

Locally, a rally is planned for outside Carle Foundation Hospital, Urbana, from 10 a.m. to noon Monday.

The local rally's organizer, DeAtley, a Savoy mother of two, said Carle isn't being singled out for attention about its maternity practices.

"The rallies are being held outside hospitals because that's where most women today give birth," she said. "We want to partner with hospitals. We're not angry with them."

Among some of the issues being raised in national rallies, DeAtley says:

— Obstetricians and hospitals should follow evidence-based maternity care practices for the best outcomes for moms and babies.

— Induced labor and cesarean deliveries should be used only when medically necessary, and never for the convenience of mothers and doctors.

— Continuous fetal monitoring can up the risk of cesarean births but hasn't been shown to increase fetal outcomes.

The cesarean risk rises with continuous monitoring, DeAtley said, because a baby's heart rate could slow down, the mom could be rushed to surgery, but the baby could bounce back in minutes.

C-section births in the U.S. rose 53 percent from 1996 to 2007, when they reached a record high at 33 percent, according to the Centers for Disease Control and Prevention. The rate was 32.8 percent of births last year.

Dr. John Weisbaum, Carle's medical director of women's health services, says Carle already follows evidence-based practices in maternity care.

Carle also helps laboring moms follow their birth plans, he said, but "a lot has to do with keeping mom and baby safe."

Among Carle's policies: There must be a clear, medical indication to induce labor or deliver by C-section, Weisbaum said.

Laboring mothers tend to be up on their feet and fetal monitoring is done only intermittently for laboring mothers unless they're considered high-risk, he said.

"We don't tie the moms to continuous fetal monitoring," he said.

Carle's 2010 total cesarean rate (including repeats for moms who have had first births by cesarean) was about 33 percent.

Carle's cesarean rate reflects the inclusion of Carle's Level III perinatal center, which serves a wide region, Weisbaum said. The sickest babies and moms in most of eastern Illinois wind up coming to Carle for care, he said.

"We deliver very high-risk moms, and very often they have to be delivered very early in their pregnancy to save the baby and often to save the moms," he said.

Cindy Reno, interim director of maternal child services at Provena Covenant Medical Center, said Covenant doesn't do elective cesareans and induced births before 39 weeks without medical necessity. The hospital's rate for induced labor and cesarean deliveries without medical necessity last year and this year to date is zero, she said.

Reno disagrees continuous fetal monitoring leads to more C-section births but said it's used at Covenant depending on whether the mother is high-risk or low-risk.

Covenant's sister hospital in Danville, Provena United Samaritans Medical Center, doesn't take cesarean requests lightly but leaves those decisions up to doctors, says Sue Brown, director of obstetrics.

United Samaritans doesn't induce labor for a mother under 39 weeks into her pregnancy without medical necessity for the mother or baby, she said, but the hospital does do continuous fetal monitoring for the protection of the baby, Brown said.

"We don't want to lose a mom or baby due to fetal heart rate," she said.

Total cesarean rates at the Provena hospitals last year were 28 percent for Covenant and 27 percent for United Samaritans, according to those hospitals.

DeAtley said everyone in the community is welcome to join the rally.

For more information, see the Facebook page at http://www.facebook.com/NationalRallyForChangeChampaignUrbanaIllinois.

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Joe American wrote on August 31, 2012 at 10:08 am

Well, it's on the internet.......so it must be true.

There's no doubt that the most central point that this "expert" was trying to make was intentionally placed #9 on the list and not first, where logically it should have been.  This way people are forced to read through this ridiculous compilation of misguided opinions only to realize by the time they get to #9 exactly how bizarre they are.

ashrprice wrote on August 31, 2012 at 10:08 am

I'm one of the organizers of the rally and there are a few points that I feel need to be clarified.

First, we are not advocating any particular method of birth, but rather attempting to address the systemic problems that have lead to our maternal mortality rate doubling in 25 years and us ranking #41 for neonatal mortality and #49 for maternal mortality. There are more newborns dying here than in Iran.

Our maternity care practices are not in line with WHO recommendations (no higher than 15% c-setion rate), and only 29% are based on solid evidence. By the way, that statistic is straight from the American College of Obstetrics and Gynecology. http://www.improvingbirth.org/wp-content/uploads/2012/08/ACOGpracticeBulletinsOverview.pdf

I've had a medically necessary c-section, and know first-hand how good and important they can be. But I've talked to hundreds of moms in the past few years, many of whom believe with good reason that they didn't need surgery to have their baby. 

Improving Birth advocates for evidenced based care, informed consent and refusal throughout the birth process, and dignity in birth. This really shouldn't be so controversial.

EL YATIRI wrote on September 02, 2012 at 12:09 am
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The dismal USA stats you refer to are a result of our lousy health care system and absent prenatal care for so many women.  Lawsuits if there are birth complications is the driving force behind the high C-section rate.

What you propose isn't controversial, but your analysis of the reasons things are the way they are is faulty and superficial.

Many physicians have left obstetrics all together because of the high cost of malpractice insurance in that specialty.

jljeppson wrote on August 31, 2012 at 10:08 am

This is a link to The Journal of Family Practice which gives a synopsis of the Cochran Report concerning electronic fetal monitoring. 

http://www.jfponline.com/Pages.asp?AID=9082

The Cohrane Report makes it clear that while EFM will certainly remove at least 1 fetal seizure from the population, it in no way lowers the fetal death rate or cerebral palsy rate.  In the quote, IA stands for intermittent ausculation (this usually means checking the fetal heart tones every 15-30 mins by doppler).

"A 2006 Cochrane systematic review examined 12 RCTs (with >37,000 women) that compared continuous EFM with IA.1 Continuous EFM reduced the risk of neonatal seizure by 50% (relative risk [RR]=0.50; 95% confidence interval [CI], 0.31-0.80), but had no effect on the rate of neonatal death (RR=0.85; 95% CI, 0.59-1.23) or development of cerebral palsy (RR=1.74; 95% CI, 0.97-3.11).

It DID, however, hugely increase the c-section and instrumental vaginal birth rate.

"Continuous EFM raised the rates of cesarean delivery (RR=1.66; 95% CI, 1.30-2.13) and instrumental vaginal deliveries (RR=1.16; 95% CI, 1.01-1.32). The increased rate of cesarean section in the EFM group was consistent regardless of clinical risk status (low- vs high-risk women). One additional cesarean section was performed for every 58 women monitored continuously. For “high-risk” women, 1 additional cesarean section was performed for every 12 women monitored continuously.1"

 

The US Preventive Services Task Force doesn’t support routine intrapartum EFM for low-risk woman. The Task Force found insufficient evidence for using EFM in high-risk pregnancies.5

Joe American wrote on August 31, 2012 at 1:08 pm

Ah, yes, more drivel from the same source "parroted" before. 

Do you have anything from any reliable source?

45solte wrote on August 31, 2012 at 4:08 pm

Joe, do you actually have anything you would like to contribute to the discussion?


 


'Support Normal Birth'


Says it all, kind of.  'Normal.' Organizers claim they are not advoacting one method over another, but, it's the same old thing.  Defining what 'normal' is, thereby indirectly rendering all that fits outside of their poster (facebook link) as not normal.  Don't blindly accept what a give member of the medical establishment tells you and don't blindly accept the claims of groups like Improving Birth.   

mmemartinez wrote on August 31, 2012 at 1:08 pm

I was strep B positive so I had to be hooked up to antibiotics and in turn was also monitored continuously. At Provena they certainly do try to keep you hooked up to the monitors at all times. They really didn't like it when I tried to walk around. I think if I had been able to walk around I may have been better able to naturally induce myself and dialate quicker. Instead, after once rejecting it, I was put on pitocin and it all became a painful, and later pain-killer induced, haze.

I don't question that being forced into my bed to be monitored slowed my labor and because of the pitocin, made it more painful. At the same time however, my baby's heartrate was fluctuating because he had the umbilical cord around his shoulder and as he tried to move down, it would compress. Had I not been hooked up we wouldn't have noticed this and it could have created a horrible situation.

Additionally, after the cesarean we also learned he was flipped the wrong way. So it seems like either way I would have ended up with a c-section. You really have no way of knowing.

Yes there are things, in my mind, that lead you down the c-section path. I think part of my experience typifies what happens during most hospital births (let's put you on pitocin. no? ok, how bout now? now? how about now? yay we all love pitocin, let's free up this free room of yours!! i mean, get the baby out because he is in danger!)

At the same time, you want a healthy baby after all is said and done. You have to decide what is the most important thing for you and hope it goes well.

ashrprice wrote on August 31, 2012 at 2:08 pm

One of the slogans for the rally is "Birth Matters." Obviously everyone wants mom and baby alive at the end, but that process does absolutely matter for both mom and baby. Interventions have their place, but if they're overused they cause problems. That's very often the case in the US, which is probably why we have such a high maternal and neonatal mortality rate. It's really not about having a good birth experience vs. having a living baby, these are not mutually exclusive, and I have never met a natural birth advocate who cares more about their experience than their child. But, as we'll have on signs on Monday, birth matters. 

 

mmemartinez wrote on September 01, 2012 at 5:09 pm

In my case I do not think the interventions led to my c-section. I felt like my ob did what was right for me and my baby. Interestingly it was my midwife who was pushing the pitocin on me, which I was not happy about. At the same time I had been laboring awhile and my water had been broke for 12 hours. I did a lot of research and felt because there could be more risk for an infection I would deal with the pitocin. The pitocin then led to the epidural, which again would have happened anyway because of the baby's positioning.

I guess my point is that c-sections are births too and they matter because they can be necessary and it's not right to put them all in a negative light. If the c-section rate were lower, might the infant mortality rate be higher? In the u.s. c-section rates are up but is that also true of infant deaths over time? I don't know I am just floating that out there. Both sides should think critically.

mmemartinez wrote on September 01, 2012 at 5:09 pm

Also making c-sections and other interventions seem like the worst thing ever leads moms to make decisions with guilt or just bad decisions. A friend of a friend opted to have the ob break her baby's collarbone so he would come out "naturally" because she didn't want a c-section. He was in a variety of casts at the beginning of his life. Fear of the c-section as a bad thing clearly was a factor in her "of the moment" decision. So I don't believe that best labor ideals aren't always trumped by what's best for the baby, especially during an intense and disorientating birth experience.

ashrprice wrote on September 01, 2012 at 7:09 pm

I had a very positive c-section experience (unplanned, due to severe malpositioning) in 2009, and I believe that choosing a c-section can be a very empowering experience. I'm by no means anti-cesarean, but the vast majority of c-sections are not positively chosen. We support all birth choices. The rally is about promoting education about birth and highlighting just how far US practices are from the evidence. Even ACOG says only 29% of labor practices are based on research, the rest instead chosen from tradition, staffing concerns, and liability fears. We deserve better. 

I can't speak to exactly what happend with your friend, but the vast majority of the time breaking a collarbone only occurs after the head's been delivered, and is safer than shoving baby's head back up through the pelvis. I have a similar story of a friend (at Provena in 2008) only the doctor broke the collarbone without parental consent and before any sign of shoulder dystocia. 

myrae wrote on August 31, 2012 at 2:08 pm

If Carle Hospital's procedures are evidence-based, why don't they allow laboring mothers to eat and drink?  If you are induced or have pitocin for any reason, you are hooked up to be continually monitored.  There's no laboring in water with a monitor around you.

I skipped the induction of my baby, as I felt it put me straight on the path to c-section.  Instead, I had an easy birth at home, with no ivs and only intermittent monitoring. 

Sandy wrote on August 31, 2012 at 4:08 pm

I gave birth to both my kids at Carle. I was induced both times and had speedy, uncomplicated labor and deliveries, even though I was hooked up to the fetal monitor at all times, and my pregnancies were both high risk. You never know how it's going to go until it's over, so why second guess your doctor?  I remember thinking at the time that all the focus on "the birth plan" was misplaced, because the goal was to have a healthy baby, not a perfect labor. I still think so.

Seriously. wrote on August 31, 2012 at 5:08 pm

It is evidence-based, and the evidence shows that if there is a complication with your labor and you have to be placed under general anesthesia, the odds of you aspirating on your food and drink are very high. That risk outweighs the benefit of your snack. 

myrae wrote on August 31, 2012 at 7:08 pm

Actually, in countries that do not restrict food or drink during labor, there is no statistically appreciable difference in aspiration risk.  Because going through labor and giving birth is physically challenging, it is important to remain hydrated, and food really helps keep one's energy up. 

This fact is acknowledged by Carle's midwives, and presented by them to Carle's anesthesiologists, but the anesthesiologists have the final say-so.  And they choose to ignore the evidence.  This, among other things, is precisely why we're rallying for improving birth.

I agree that a healthy baby is what we want.  I felt my baby was likely to have a better chance of being born healthy without being induced with pitocin. 

Seriously. wrote on August 31, 2012 at 11:08 pm

"Actually, in countries that do not restrict food or drink during labor, there is no statistically appreciable difference in aspiration risk. "

That's a little misleading. That statement does not mean that there's no difference in risk of medical complication should a laboring mother require intubation or longer-term analgesics. I'm not really sure what pitocin has to do with anything, though I'm happy that your delivery uncomplicated.

I was working on quite an expansive additional response when I realized that this is not really a discussion that I can have in text. There are just too many factors in play. The overwhelming trend I see in the last few years is families making demands based on colloquial evidence that supports their desires. In my opinion, it would be brilliant if the hospitals could have everyone sign something that exempts the hospital from any wrong-doing if a family's birth plan doesn't work out they way they would like. Sadly, we live in such a litigious society that hospitals would still be liable because they are supposed to "know better" than the patients.

I can't speak for the policies or practices at Carle. What I can speak for are the increasing numbers of families we see in our newborn intensive care at my workplace. There has been a large increase in home-birth infants with birth injuries in various degrees of severity. By "large" increase, I mean 1-2 per year rather than 1 every couple of years. Parents bring a badly damaged infant and expect us to work a medical miracle. I wish we were always able to ease their pain.

It's thrilling for parents (and medical staff) when everything goes according to plans and wants. Medical emergencies happen. Thankfully, they are rare. There should be no such thing as a preventable loss.

jasrac wrote on September 07, 2012 at 11:09 pm

Well put Seriously

There are to many variables. If you aren't in the field of OB L&D you absolutely can not understand it all. I agree with your brilliant idea of signing a "not responsible for..." but yes when all said and done most of these families or some lawyer would still hold hospital liable......even though  they know best and everything. That said everyone has the right to refuse. No one is forced anything. if you ended up with an epidural that was your choice. NEWS FLASH LABOR IS PAINFUL.

Yes! It is thrilling when it all goes the way they wanted and it is a great experience for the family. However may I say birth (life) is a miracle from God and we can't CONTROL EVERYTHING.....so these families need to maybe not have this controlled picture perfect high expectation of their childbirth, maybe a little more trust in all parties involved and less control. (kinda Gods way of preparing for parenthood LOL)

Comparing USA to other countries stats is kinda ridiculous, I would imagine they don't and aren't required to report the same as USA...so prob not a fair comparison. The Rally is intended to inform and educate but it has turned to the negative opinions of pitocin bad, monitoring bad, birth plans viewed as bad by medical, Carle bad and many other negatives. Carle is evidence based practice. Works with the March of Dimes campaign of 40 weeks is best for infants (look in the offices, posters etc). Does not induce under 39 weeks unless medically necessary and many other positive things. I could go on and on but..... GOAL is always healthy mom healthy baby. 

rsp wrote on September 01, 2012 at 2:09 am

Why is pregnancy, and labor and delivery still treated like a competition? Or like women can't make intellegent decisions about the medical care for our own bodies and that of our child? L & D rooms are set up for the convenience of the medical staff, not to promote a natural delivery. Too much time and effort is spent on telling a woman what she can't do instead of allowing her to listen to her body and to deliver in the position she needs to. 

Acl wrote on September 01, 2012 at 10:09 am

1) It as been turned into a competition by those women who consider themselves superior for giving birth without an epidural.

2) Maybe because most women believe everything they read on the internet (. If you don't believe me, go browse the forums on thebump.com) and don't have medical degrees.

3) The local hospitals have jacuzzi tubs and showers, birthing bars for squatting, birthing balls, and will do water births. You can go as natural as you want.... What more do you expect?

4) I had a great experience with my OB and at Carle when I delivered there; they were professional, compassionate, and I delivered a healthy baby. 

Re: the inaccurate infant mortality rankings: 

 

A: U.S. infant mortality rates (deaths of infants <1 year of age per 1,000 live births) are sometimes cited as evidence of the failings of the U.S. system of health care. 

But in fact, the main factors affecting early infant survival are birth weight and prematurity. The way that these factors are reported — and how such babies are treated statistically — tells a different story than what the numbers reveal.

ADVERTISEMENT

Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.

But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies — considered “unsalvageable” outside of the U.S. and therefore never alive — is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

When Canada briefly registered an increased number of low weight babies previously omitted from statistical reporting, the infant mortality rose from 6.1 per 1,000 to 6.4 per thousand in just one year.

According to research done by Canada’s Bureau of Reproductive and Child Health, “Comparisons of infant mortality rates by place and time should be adjusted for the proportion of such live births, especially if the comparisons involve recent years.”

Norway boasts one of the lowest infant mortality rates in the world. But when the main determinant of mortality — weight at birth — is factored in, Norway has no better survival rates than the United States.

Pregnancies in very young first-time mothers carry a high risk of delivering low birth weight infants. In 2002, the average age of first-time mothers in Canada was 27.7 years. During the same year, the same statistic for U.S. mothers was 25.1 — an all-time high.

Some of the countries reporting infant mortality rates lower than the U.S. classify babies as “stillborn” if they survive less than 24 hours whether or not such babies breathe, move, or have a beating heart at birth.

Forty percent of all infant deaths occur in the first 24 hours of life.

In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive.

If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a “miscarriage” and does not affect the country’s reported infant mortality rates.

The length of pregnancy considered “normal” is 37-41 weeks. In Belgium and France — in fact, in most European Union countries — any baby born before 26 weeks gestation is not considered alive and therefore does not “count” against reported infant mortality rates.

Too short to count?

In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates.

Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States.

 

 

 

 

 

 

 

Joe American wrote on September 01, 2012 at 11:09 am

2) Maybe because most women believe everything they read on the internet.


See 45solte's posts/links above.

rsp wrote on September 01, 2012 at 7:09 pm

The internet? You think this started then? This has been going on since the beginning of time. It has nothing to do with epidurals. It has to do with lack of respect among women. That's all it is, that's all it's ever been. Back in the "olden days" it was competing to see who had the hardest time. The longest delivery. The biggest baby. The longest baby. You see where this is going? And as soon as they find out someone else is expecting it's time to bring out all of the horror stories and see who can top the last one. And heaven forbid a woman to have an opinion about how she wants to have her own baby! We're so dumb it's surprising we even managed to get pregnant in the first place. Without someone with a medical degree that baby will never come out. My kids were born before the internet. Including the one who surprised me at home, but he didn't read blogs. 

Acl wrote on September 02, 2012 at 7:09 am

Rsp- did you to read my post in response to you? You missed all the key points. Further, yes, most babies can be delivered without complications, but in the " olden days" maternal and infant mortality ( and countries with no prenatal and poor L&D care) the risk of death was and is much higher. Postpartum hemorrhage, placenta previa/accreta, etc.,   or breech with a prolapsed cord- good luck with no interventions and a lay bystander compared to a medical professional in a hospital.

Again, please reread my post and tell me how our local hospitals aren't set up to accomodate a variety of birth plans.

Re: the rising number of inductions and c- sections:

What disturbs me about the rally/article is that it does not address the driving forces for the bulk of these interventions: doctors are seeing more complications such as preeclampsia, obesity, gestational diabetes, advanced maternal age and a rise of multiples, which result in more interventions. Not to mention the number of patients who demand to to be induced so that they don't have to go overdue, or they need to schedule when family can be around to help out, or, some women hate the idea of a vaginal birth and actually request a c-sec. 

rsp wrote on September 02, 2012 at 9:09 am

Breathe. All you have to do is breathe. No I didn't miss any of your points, about how the American way is the only way, and how we should just disregard the customs involved in our quest to get data. Our local hospitals are not set up for a variety of birth plans, they are set up for a variety of birth interventions. You just need to look a little closer. 

 Not to mention the number of patients who demand to to be induced so that they don't have to go overdue, or they need to schedule when family can be around to help out, or, some women hate the idea of a vaginal birth and actually request a c-sec. 

You need to stop watching reality tv so much. The hospitals already banned these some time ago and they did a story about it. There has to be a medical reason to induce. They don't do it because it affects the baby. 

jasrac wrote on September 07, 2012 at 11:09 pm

TOTALLY DISAGREE!

That is a blanket statement. and unfair

Robert DeAtley wrote on September 02, 2012 at 11:09 am

While I understand that the hospitals quoted in this article all claim to have policies in place to practice evidence based care, my family's personal experience and those of numerous friends are in direct conflict with the hospitals policies and the claims made by the hospitals mentioned within this article.  

rsp wrote on September 02, 2012 at 5:09 pm

I really suspect that it's because most of our contact with hospitals is unplanned that we really don't know how user unfriendly they actually are. There have been a few posters who have stated things about we are not doctors and we don't have medical degrees. We do have the right to make medical decisions for ourselves and to be given the information we need to do that. Having a baby is one of the few times we have to plan ahead and inform ourselves before we go. 

EL YATIRI wrote on September 03, 2012 at 8:09 pm
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The policies are not followed, quality improvement is a sham, and my own experiences at both hospitals was disappointing.

kayote wrote on September 02, 2012 at 10:09 pm

Carle may claim to let mothers walk around, to follow birth plans, and similar--but they don't.

They pretty much stuck me in bed and wanted monitoring all the time. Every labor position they recommended all involved laying down--and I simply couldn't push effectively in that position. By the time they owned up to having a bar I could hang onto and stand, which WORKED, I was so exhausted it didn't really matter. Hands and knees? Never mentioned.

I don't believe they gave a competent effort to have the head untilt because of the limited position suggestions, but the c-section is not why I'm upset at my birth experience. Sometimes, they are necessary.

It's the lack of consideration to my birth plan they pre-approved, the lack of suggesting useful laboring positions, lack of communicating my wishes to the OB that took over for the surgery.

Then, after the birth they let my son cry unattended in a corner of the nursery for an hour and a half rather than bringing him to my recovery room like they'd promised. His father was there as well but they wouldn't give us the baby until I was moved to the other floor when they had time to come get me.