Science & Sensibility

Childbirth Connection has just released the Listening to Mothers III study today, and will holding a press conference shortly to share the results.  I plan to listen in and read the study thoroughly to see what the mothers have to say!  Look for a complete post early next week evaluating the current state of pregnancy care, labor, birth postpartum and breastfeeding and how it stacks up to Lamaze International’s Six Healthy Birth Practices.  In the meantime, consider joining the press conference, or reading this new study.  You can also check out the previous two LTM studies to see if things have changed.

Listening to Mothers I

Listening to Mothers II

New!  Listening to Mothers III

Sharon Muza Babies, Cesarean Birth, Childbirth Education, Depression, Healthcare Reform, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternal Quality Improvement, Maternity Care, Medical Interventions, New Research, Research Childbirth Connection, Healthy Birth Practices, Healthy Care Practices, lamaze, Listening to Mothers, research, Sharon Muza

By Geradine Simkins, CNM, MSN, Executive Director of Midwives Alliance of North America

This week, the American Academy of Pediatrics released a policy statement on home birth. While the statement affirmed “the right of women to make a medically informed decision about delivery”, many advocates expressed concerns. The statement failed to recognize Certified Professional Midwives, the providers most likely to attend a home birth in the United States. In this response, the Midwives Alliance of North America helps families, providers, and policy makers understand the critical role CPMs play in safe, healthy birth options. – Sharon Muza, Community Manager, Science & Sensibility

High-quality out-of-hospital newborn and postpartum care is standard for midwives

© http://flic.kr/p/8d52Qc

The Midwives Alliance of North America welcomes the primary concept communicated in the American Academy of Pediatrics’ April 24, 2013, policy statement entitled “Planned Home Birth.” As should be expected, AAP reminds its practitioners that newborn infants—regardless of the setting in which they are born—deserve an equal and unbiased, high-quality standard of care. The Midwives Alliance joins with AAP in affirming the need for a collaborative and integrated maternity care system that addresses the needs of all mothers and infants, regardless of the provider type or birth setting a woman chooses.

We are disappointed, however, in AAP’s decision to align with the American Congress of Obstetrics and Gynecologists’ policy on home birth. Serving the needs of the growing number of families choosing to birth at home, Certified Professional Midwives attend the majority of intended home births in the U.S., when a skilled attendant is present, making them the primary care providers for newborns in the home setting.

Certified Professional Midwives are skilled maternity care providers

AAP’s itemized recommendations for infant and newborn care, contained in their policy statement, are standard practice for credentialed midwives. In that respect, we find much with which we agree. These standard newborn exams, screens, and preventative care practices are wholly part of a credentialed midwife’s scope of practice, and further endorsed by individual state health departments. We also note that as AAP Neonatal Resuscitation Program certificate holders (required for certification and recertification), credentialed midwives follow guidelines laid out in AAP’s recommendations, and typically surpass those standard recommendations by having at least two NRP- and CPR-trained attendants at out-of-hospital births.

In fact, the AAP’s guidelines for the care of infants intentionally born at home parallel those standards practiced by trained midwives in all birth settings. The practices listed—such as working medical equipment, emergency plans of transfer, thorough newborn exams, and so forth—are professional standards exhibited and documented by credentialed midwives, regardless of the place of birth.

The AAP policy statement, however, did not recognize or acknowledge Certified Professional Midwives (CPM), indicating that AAP may not have a thorough understanding of the training, skills, knowledge, and abilities of this country’s primary maternity care provider for infants born out of the hospital. The Certified Professional Midwife is the only national midwifery credential that requires practitioners to be trained specifically to provide prenatal, intrapartum, and postnatal care in out-of-hospital settings. CPMs are knowledgeable, expert and independent midwifery practitioners who have met the standards for certification set by the North American Registry of Midwives (NARM). NARM is accredited by the National Commission for Certifying Agencies (NCCA) to issue the professional credential of Certified Professional Midwife, which is the same agency that accredits the American Midwifery Certification Board to issue the professional credentials of Certified-Nurse Midwife, and Certified Midwife.  

Midwives are the providers of choice for out-of-hospital births, whether they occur at home or in freestanding birth centers. Offered since 1994, the CPM is currently the basis for licensure in 27 states while 11 additional states are actively seeking CPM licensure. In fact, one in nine newly certified midwives in the U.S. are Certified Professional Midwives.  

The AAP policy statement endorses birth center maternity care, which is another area in which we are in agreement. Recent numbers from the American Association of Birth Centers (AABC) indicate that a significant proportion of accredited birth centers are owned and operated by Certified Professional Midwives. A January 2013 study, The National Birth Center Study II , conducted by AABC and published in the Journal of Midwifery & Women’s Health, the official journal of the American College of Nurse-Midwives (ACNM), highlights the benefits for women who seek care at midwife-led birth centers. Findings also reinforce longstanding evidence that providers at midwife-led birth centers provide safe and effective health care for women during pregnancy, labor, birth, and the postpartum period.  

Midwives provide high-quality care that meets both national and international guidelines 

In highlighting the ethic of high-quality care for all infants across the spectrum—regardless of the site of birth—it should be noted that Certified Professional Midwives provide care intentionally similar to that of nurse-midwives and physicians. Yet we also know that CPMs are able to offer additional and valued care in terms of frequency of home visits and intense monitoring of newborns in their homes in the first weeks of life—a benefit not normally conferred to women and babies who have experienced hospital births.

This high-quality midwifery care includes routine newborn APGAR assessments, comprehensive head-to-toe physical examinations, measurements of length, head, abdomen and birth weight, monitoring vital signs including thermoregulation, assessment of respiratory sounds and patterns, assessments of cardiac sounds and peripheral pulses, assessment of gestational age and physical maturity, neuromuscular assessments, and assistance with initiation and ongoing assessment of breastfeeding. All findings are recorded in patient records and shared with mothers, per professional standards.

In addition, CPMs provide newborns with Vitamin K treatment, antibiotic eye ointment, umbilical cord care, metabolic newborn screening, glucose and bilirubin testing as indicated, and either perform Otoacoustic Emissions (OAE) hearing screens or refer to area audiologists. Midwives in a number of states are moving toward, or already offering, pulse-oximetry screening for Critical Congenital Heart Defects (CCHD) per AAP guidelines, in advance of many hospital systems. In the rare cases when newborns require consultation or referral, infants are transferred to the tertiary care system, and pediatricians where available, for active management.

Not only do Certified Professional Midwives and Certified Nurse-Midwives who attend home births provide the level of care outlined by the AAP, they provide it in a personalized, woman-centered, family-centered, culturally competent, and individualized manner that is qualitatively different from the customary assembly-line postpartum care commonly experienced in U.S. hospitals.

For example, in a home birth setting, the midwife typically conducts the initial newborn exam in the presence of the mother and family, which does not disrupt the crucial process of mother-infant bonding and breastfeeding, and is focused on being instructive to the family. Midwives provide holistic care to the mother-baby dyad in concordance with World Health Organization’s Baby-Friendly best practices.

As a way of illustrating important differences in care practices, we can point to the recent Breastfeeding Report Card issued by the CDC (2012) that indicates only six percent of U.S. hospitals are offering care that aligns with the international best practices outlined by Healthy People 2020.   By contrast in a 2005 study, 95% of babies born at home under the care of Certified Professional Midwives were exclusively breastfeeding at six weeks of age (Johnson & Daviss, 2005). This is just one area where midwives are well-trained, skilled, and uniquely positioned to help families succeed.

An opportunity for collaboration and integrated care 

Physician conversations about home birth and midwife-led birth will be better informed and more useful to maternity care consumers if AAP is able to become more cognizant of important changes in the landscape of U.S. midwifery. 

The release of the AAP policy statement on care of newborns born at home is an opportunity to reinforce the need for professional and seamless collaboration with members of community health care teams. We view this statement’s release as an opportunity to align best practices for all parties who care for and support families choosing home birth.

The Midwives Alliance stands ready to work with other pediatric and maternity care providers to establish best practices in the postpartum period to not merely provide the basic level of care in the first hours, days and weeks of life for the newborn as outlined in the latest AAP statement, but to elevate that standard to include support for breastfeeding and the personal attention that can prevent infant death and improve maternal and child health.  Babies born in all settings deserve this kind of care.

About Geradine Simkins

Geradine Simkins, CNM, MSN is an activist, midwife and author. She began as a direct-entry home birth midwife in 1976 and became a nurse-midwife twenty years later. For over thirty years she has provided health care for women, infants and families in a variety of settings, including attendance at births in the home, a freestanding birth center, and hospitals. Geradine’s work with migrant farmworkers and American Indian tribes focuses on addressing health care disparities and engendering a more equitable maternity care system for all women and infants.  Geradine is currently the Executive Director of Midwives Alliance of North America, a professional organization that promotes excellence in midwifery and is dedicated to unifying and strengthening the profession, thereby increasing access to quality health care and improving outcomes for women, babies and their families. She is the editor of the recently published book entitled Into These Hands: Wisdom from Midwives, an anthology of the life stories of 25 remarkable women who have dedicated their lives and careers to the path of midwifery and social change.  More info about Geraldine Simkins can be found here.

Sharon Muza ACOG, American Academy of Pediatrics, Babies, Delayed Cord Clamping, Home Birth, informed Consent, Maternity Care, Midwifery, Transforming Maternity Care AAP, ACNM, ACOG, CNM, CPM, Geraldine Simkins, Home Birth, MANA, Midwifery Care, Midwives Alliance of North America, newborn

Press time update: Over the course of my research on Monday 4/22/13, I noticed that by the end of the day, Milkscreen’s main website no longer shows links to the Breastfeeding Assesment Calculator. The Facebook page for this product has also been removed.  An email received from the company confirms that the product has been removed from the website and retailers have been instructed to pull the product from the shelves. I can only speculate that this is due to pressure from social media. ~ Deena

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© Deena Blumenfeld

I recently became aware of a new product, the Milkscreen Breastfeeding Assessment Calculator by Upspring Baby, designed to help new breastfeeding mothers be more confident in their breastfeeding abilities. This product tells them whether their milk supply is “low, normal or high” and how they can correct problems.  

This product assumes that many mothers are worried about having a low milk supply and therefore this product will reassure mothers that they are normal. To use this product, a mother must pump her milk. Additionally, this product assumes that pumping breastmilk will yield the same quantity as when a baby nurses.  We know: what a mother pumps is not indicative of what she may be producing to feed her baby. 

From the product description: 

“The Milkscreen Assessment home test determines daily breast milk supply. It was created to address the common concern many moms have: how much breast milk do I make and is that enough for my baby? Milkscreen Assessment gives mom confidence to keep breastfeeding by telling her how much breast milk she makes and how that relates to baby’s growth, identifying possible breastfeeding issues and providing recommendations on how to overcome these issues.”

This description may play directly into a mother’s fear that she isn’t making enough breastmilk for her baby. 

From the product box:

“Problem: About 50% of moms stop breastfeeding because they are concerned they don’t make enough milk for their baby. Solution: Milkscreen Calculator”

How do we know that this percentage is accurate? 

The company does not cite a source for this statement. Moms cease to breastfeed for many reasons, including, but not limited to; going back to work, pain while breastfeeding and personal preference. 

The real data on low milk supply

 An estimated 5% to 15% of all mothers experience either primary or secondary lactogenesis failure, with the actual numbers being unknown. 

Hypoplasia or Insufficient Glandular Tissue is a rare condition that some women may have. and it needs a clinical diagnosis to confirm. Many women with this condition supplement with donated breastmilk or formula while continuing to breastfeed.

I believe that the Milkscreen Calculator doesn’t help to eliminate low production worries, as advertised. I believe that it promotes this fear! 

How does Milkscreen test the breastmilk?

After scouring their website, I am not able to find any information on what nutrients they are testing for or what testing procedures they use because they don’t actually test the breastmilk! A mother doesn’t send the breastmilk to their lab for testing. A mother fills out a questionnaire and enters the amount of milk pumped in three pumping sessions, one hour apart. Milkscreen looks at a mother’s production level as “low, normal, or high” and gives her results and recommendations as to what to do if she’s having a problem, and then makes suggestions as to their other products she might like to purchase. 

From Milkscreen’s FAQ: 

How accurate is this test?

Milkscreen Assessment is modeled after a scientific paper, published in a peer-reviewed journal, and interpretation and recommendations provided in report are based on published scientific literature found in our list of references. However, each woman will respond differently to pumping breast milk. If a woman gets a result that shows low production, it’s possible that pumping was not as efficient for her as feeding at the breast.  In this case, the report will suggest to explore this possibility with a Lactation Consultant.

When I took a look through their references list, I was unable to find the paper they referred to.. They do offer useful citations and background information, but nothing supports the need or usefulness of this product.

From the video with breastfeeding expert Dr. Landers:

“This test is based on data that are normative. Hundreds of mothers have had very special calculations of daily milk supply. Our test takes an estimated amount of breastmilk supply over a shorter period of time and lets a mother know if she’s low, normal or high. Milkscreen calculator is an estimate of the day’s milk production, but in a scientifically studied, peer reviewed paper it’s actually a good approximation….. This test is an accurate estimate of daily milk supply…. It is the growth of the baby that is the most important thing. Gives mom an idea of whether baby’s weight gain is low, normal or high. (Uses the WHO growth chart)”

If the growth of the baby is “the most important thing” why don’t we weigh and measure the baby. That would tell us if the breastmilk supply is adequate.

This product oversimplifies the issue of low milk supply. “Low, normal or high,” doesn’t give a mother any real data to go on.

How do others test* for nutritional quality of breastmilk?

The Mayo Clinic provides us with some insight as to how breastmilk is tested and what it is tested for. They use thin-layer chromatography (TLC)/colorimetry/spectrophotometry (SP)/other methodologies as appropriate. With their testing, they use samples that are 4-5ml of breastmilk.

From the Mayo Clinic:

“The nutritional content of breast milk changes considerably from day 1 to day 36 postpartum. Subsequent to that time the nutritional content is considered to be stable.

Measured nutritional components are glucose, lactose, triglyceride, and protein. Deficiency of any of the measured or calculated parameters is suggestive of decreased nutritional quality of human breast milk.”

Mayo Clinic, Breast Milk Nutritional Analysis

“Several different methods are used in the analysis of human breast milk. The sample is analyzed for triglycerides using an enzymatic method. One aliquot of breast milk is tested for total protein using biuret reagent and titration methodology and for measurement of glucose using a glucose oxidase method. A second aliquot of breast milk is pre-incubated with beta-galactosidase and glucose is measured. Lactose is calculated using results obtained by the methods listed above.”

*These tests are not FDA approved.

What is the rate of false positive / false negative results from the Milkscreen test?

An incorrect assessment can have a huge impact on the mother’s breastfeeding relationship. If a mother is led to believe falsely reassured that she is making enough milk, she may not seek appropriate help from a lactation consultant or other breastfeeding professional and her baby may suffer, Alternately, a mother may choose to supplement with formula when in fact, there was no issue or her supply could have been corrected with professional help.

Breastfeeding confidence 

In the video explaining the science behind Milkscreen, Dr. Landers states;  

“Anything we can do to help a new mom, especially a first time breastfeeding mom, to have confidence in her body’s ability to make milk and nourish her baby would be a huge, huge addition to our tools to help breastfeeding moms and babies. We know from clinical studies that moms stop breastfeeding because they think they don’t have enough breastmilk supply. It’s the mother’s perception of an inadequate supply and that she doesn’t know what she’s doing… Modern women don’t have confidence in that process (supply and demand). So one of the reasons this product is so important is that it is a huge confidence builder for the average mom.’

Phrases like  “they think they don’t have enough milk” and “mother’s perception of inadequate supply” or “doesn’t know what she is doing” reinforce the idea that women are not capable of being knowledgeable or confident about breastfeeding. 

© Deena Blumenfeld

Milkscreen Assessment also claims that if a mother has too much milk, she will likely have growth issues with her baby as well. They attribute this to the foremilk/hindmilk imbalance, including the problem of ‘loose stools’ with the infant.  Current research no longer supports the foremilk/hindmilk theory, and exclusively breastfed babies normally have loose, mustardy stool.  According to Kellymom.com, “Your breasts don’t “flip a switch” at some arbitrary point and start producing hindmilk instead of foremilk. Instead, think of the beginning of a nursing session as being like turning on a hot water faucet.” In other words, there is always fat in breastmilk but the quantity varies dependent upon how long baby nurses. Feeding from a relatively empty breast will yield a higher fat content in the milk. However, it’s the fat over the course of the day, not just in a single feeding which is important.

As educators and professionals, we know to refer a mother who is questioning her milk supply to seek help from a qualified lactation consultant or other breastfeeding professional.  Additionally, we can be sure that our breastfeeding and newborn care classes are evidence based, offer useful information and instill confidence in new mothers so they can start their breastfeeding relationship off on the right foot.  We also make sure that new mothers are aware of support groups and local resources that can help them if they run into problems and concerns. 

Lamaze’s Healthy Birth Practice #6: Keep Mother and Baby Together- It’s Best for Mother, Baby and Breastfeeding is a great resource for parents and includes a wonderful video for use in class. 

Resources and References:

 AAP Breastfeeding and the Use of Human Milk (2012) 

American Academy of Pediatrics, Adequacy of Milk Intake During Exclusive Breastfeeding: A Longitudinal Study, (2011)

Butte NF, Garza C, Smith EO, Nichols BL. Human milk intake and growth in exclusively breast-fed infants. J Pediatr. 1984 Feb;104(2):187-95.

Daly SEJ, DiRosso A, Owens RA, Hartmann PE. Degree of breast emptying explains changes in the fat content, but not fatty acid composition, of human milk. Exp Physiol 1993;78:741-55.

Highlights of, and thoughts regarding the AAP’s Policy Statement “Breastfeeding and the Use of Human Milk”

Hurst, N (2007) Recognizing and Treating Delayed or Failed Lactogenesis II, Journal of Midwifery & Women’s Health

“Hypoplasia/Insufficient Glandular Tissue.” KellyMom RSS. N.p., n.d. Web. 22 Apr. 2013.

 World Health Organization on Breastfeeding

Deena Blumenfeld Babies, Breastfeeding, Childbirth Education, Evidence Based Medicine, Guest Posts, Healthy Birth Practices, Healthy Care Practices, informed Consent, Newborns, Social Media breastfeeding, breastmilk, Childbirth Education, Deena Blumenfeld, guest post, Healthy Birth Practices, power of social media, Social Media

Taking the hospital tour is considered to be a right of passage for expectant parents choosing to birth in the hospital.  They gather together in a group, a bit nervous, a bit excited, following the tour guide, quietly tiptoeing through the labor and delivery unit, hearing and seeing women in labor, peeking into empty rooms, learning where to park and finding out about the amenities that the facility has to offer.  They smile slightly to themselves and begin to imagine themselves birthing in one of these very rooms in the not too distant future.

A few families may ask questions, inquiring about policies and what they are “allowed” to do once admitted.  In fact, some of these questions may come up in your classes or you may hear stories about what the students learned on their various tours.

Lamaze International is offering a Parent Webinar: Getting the Most out of Your Hospital Tour next Wednesday, April 24th. at 12 PM EST.  This one hour webinar is being presented by Allison Walsh, IBCLC, LCCE.  This engaging learning opportunity can help parents to prepare for their tour,  ask questions that count and really understand what they need to do to have an active, upright birth within the hospital setting.

http://flic.kr/p/6s15sQ

I encourage childbirth educators to inform their students about this webinar opportunity and suggest your CBE families register now.  The webinar will be made available in recorded form in a timely fashion after the live presentation is completed.  As an educator, I see lots of opportunities to bring this webinar into your classroom for discussion, watch snippets of it throughout your series, or ask your students to do a fun role play, incorporating what they learned from the webinar.

Some CBEs and L&D nurses may be the tour guide at the hospital, and this webinar can help them to offer an effective and evidence based tour that thoroughly meets the need of participants.

Tweet about this opportunity, post it on Facebook and share with students and your community of pregnant families, encouraging them to register now!  By attending this free webinar, families will become more informed maternity care consumers and in a better position to “Push for Their Baby.”

The Lamaze Parent blog, Giving Birth With Confidence highlighted this webinar in a comprehensive blog post yesterday that you may also want to share with your families.

To learn more about the Parent Webinar: “Getting the Most out of Your Hospital Tour” and to register, please click here.  See you at the webinar!

Sharon Muza Childbirth Education, Continuing Education, Evidence Based Medicine, Giving Birth with Confidence, Healthy Birth Practices, Healthy Care Practices, informed Consent, Maternity Care, Patient Advocacy, Push for Your Baby, Social Media, Webinars Allison Walsh, CBE, Childbirth Education, Giving Birth With Confidence, Lamaze webinars, maternity care continuing education, Sharon Muza

In recognition of Cesarean Awareness Month, I want to share an interview with Christa Billings, the president of International Cesarean Awareness Network (ICAN).  For over 30 years, ICAN has had an international presence and through peer to peer support and many volunteer hours, has worked tirelessly to prevent unneeded cesareans, help women recover emotionally from a cesarean and advocated for VBAC as a safe and appropriate choice for many women when they plan their future births.

I have been the chapter co-leader of ICAN Seattle for several years, and have been honored to walk alongside the women who make up our chapter as they have discovered their own strength and power and learned how to seek information and evaluate evidence and research.  There are many chapter leaders just like myself, working hard in our own communities, to help women both before and after a cesarean birth. ICAN has partnered with many other maternal health organizations and maternity leaders to help improve the state of maternity care for many women.  Learn more about this organization and be sure to share this organization (and its resources) with your students, clients and patients.

Sharon Muza: Can you tell me a bit about the history of ICAN?

Christa Billings: The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization that was founded by Esther Booth Zorn and many other motivated women in 1982. ICAN originated as “Cesarean Prevention Movement,” later changing its name to ICAN in 1992 to reflect a more positive statement. ICAN has now grown to over 180 chapters throughout the United States and worldwide over the past 30 years. ICAN’s mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).

SM: How many chapters does ICAN have nationally and internationally?

CB: ICAN has 181 chapters, 145 in the USA, and another 36 internationally.   

SM: What does an ICAN meeting look like?

CB: A typical ICAN meeting entails women coming together with women of similar experiences for peer to peer support. Meetings are sometimes topic specific and sometimes general support. Often birth stories are shared. There is often laughter, tears and a feeling of camaraderie. The feel of a particular meeting can change based on who is there and what it being discussed. I like to remind newcomers that they should always try a second meeting as they are all different. Sometimes meetings can be VBAC heavy and other times they can be cesarean recovery heavy. It really depends on who shows up to the meeting and who is driving the discussion.

SM: Who is welcome? Mothers? Partners? Birth Professionals? Providers?

CB: Some meetings are open for women/lap babies only and other meetings welcome children, dads, husbands, partners, birth professionals and other community members who want to learn about cesareans, VBAC and recovery. Each chapter may vary on how they do things, so check in with the chapter leader if you have any questions.

SM: What are some things that ICAN does that reinforces it’s mission statement?

CB: We offer support to mothers through listening. We also help in educating them by providing evidence based research to help them make the best possible birth choices for them or to cope/understand what they have experienced. We recognize that both VBAC and cesareans carry risks. We help women understand what those risks are with both choices, where typically many providers only provide the VBAC risks.

SM: I know that ICAN periodically holds conferences; can you tell me about them? Are there continuing ed hours available from them?

CB: The ICAN conferences are a time to spend quality face to face, talking with women who support VBAC and are interested in reducing the cesarean rate. This conference isn’t just for VBAC and cesarean mothers; it’s for anyone who supports birth. There are many great speakers and public discussion on various birth topics.  We do offer continuing education hours.

SM: How did you get involved in ICAN yourself? How did you find yourself in the president’s position?

CB: I found ICAN five years ago when I first stepped foot into an ICAN meeting during Cesarean Awareness Month. I was just a mom looking for support as I planned a VBAC. I quickly found great support. My second birth ultimately ended in another cesarean, even though I attempted a VBAC. If I couldn’t have a vaginal birth I wanted to make sure others had the support and education to ensure the best advantage in planning for their births. I wanted to give back to the organization that helped shape my birth journey. I decided to join my local ICAN chapter’s board & accepted a position as the Northwest Regional Coordinator. Later in 2010, I went on to VBAC my 3rd daughter at home after 2 cesareans. After attending the 2011 ICAN conference I really felt pulled to do more. The conference was very inspiring and it touched me deeply.  It was a thrill to meet all the women I had been communicating with over the years. These mothers were no longer just a name in an email. Putting names & faces to it gave the journey to VBAC a whole new meaning to my life. In 2012 I joined the Board of Directors as Chapter Director. As we reshaped the board be a bit smaller and focused, I moved into the role of Vice President. The previous President stepped down and in October 2012 and I became the new President of ICAN. I never envisioned my life taking this path, but here I am and I’m proud to be the voice of the mothers for an organization so dear to my heart. ICAN has forever changed my life.

SM: What challenges do we face in lowering the cesarean rate? Do you think the tide has turned?

CB: While research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean, there is an alarming disconnect between what evidence based research shows is good for women and babies, and the way that hospitals and providers practice. Mothers need to start demanding research based care. The challenges we still face are getting care providers to work with us to improve birth outcomes by providing evidence based care and to stop practicing by provider preference, convenience, legal liability concerns and to perform cesareans only when the research clearly indicates it is needed.

I would like to think that the tide is starting to turn, but I am not ready to say it’s turned quite yet. Mothers are joining together to recognize they have a voice and choices in their maternity care and are starting to demand evidence based care. The recent statements from ACOG give us a little hope that people are opening up their eyes to see how out of control the cesarean rates are in many places.

SM: Are you optimistic with recent statements from ACOG about who should VBAC and how to handle maternal request cesareans?

CB: I’m not sure optimistic is the right word, I would say hopeful. I think it is great that ACOG is finally acknowledging that primary cesareans will affect future births and that in the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended to patients. These births are a very small percentage of the births, as often primary cesareans are not being performed based on maternal request, but rather being performed by provider preference, convenience, legal liability concerns and many other reasons. I will be optimistic when providers and hospital administration acknowledge that birth is a human right, that the consumer has the right to decide whether they accept the choices presented to her and start providing true informed consent and stop using scare tactics to influence women’s decisions. 

SM: What do you want childbirth educators to know and share with students about ICAN and cesarean awareness?

CB: That ICAN is a non-profit advocacy and support group whose mission is to improve maternal and child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting vaginal birth. We offer support and information to thousands of women through our main office, local chapters, website, forums, email support groups and various social networks. We provide evidence-based information, using research that is accessible for women and their care providers.  It’s important that women understand the effects a primary cesarean can have on them and on all future births.  It would be great if childbirth educators included ICAN as a resource for the families in their classes who may end up with a cesarean.

SM:What do you want health care providers to know?

CB: We are a support network for women healing from past birth experiences and for those preparing for future births. Our vision is to reduce the cesarean rate driven by women making evidence-based and risk appropriate childbirth decisions. We are not anti-cesarean. ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life-threatening risks as well. The choice between VBAC and elective repeat cesareans isn’t between risk versus no risk. It’s a choice between which set of risks you want to take on. We are here to help educate mothers on all risks to help them make the best choices for their birth.

SM: If someone was interested in adding a chapter, what would the first step?

CB: If someone wanted to start a chapter in their city or town, they would need to contact the regional coordinator for their area. Their regional coordinator will walk them through the steps & requirements to open a chapter.

SM: What can people do if they want to volunteer in other ways besides being a chapter?

CB: They can contact our volunteer coordinator for more information on how they can help. Please let our volunteer coordinator know what your special skills are that you have to offer and she will match you up with the right position suited to your skills. We have many positions or tasks within ICAN that are not chapter specific. As an all volunteer organization. we are always looking for help.

SM: I want to thank you, Christa for all the information you have provided and for your time in doing this interview.  I hope that more people will share the resources that ICAN offers with the birthing families that are affected by cesarean birth.

Sharon Muza ACOG, Cesarean Birth, Childbirth Education, Evidence Based Medicine, informed Consent, Maternity Care, Patient Advocacy Cesarean Awareness Month, Childbirth Education, Christa Billings, Evidence Based Medicine, ICAN, International Cesarean Awareness Network, Sharon Muza