ICAN, VBAC Friendly Hospitals, Midwives, Childbirth Educators: Speaking with Elaine Diegman, CNM, Ph.D

We wrap up Cesarean Awareness Month and acknowledge the week of International Midwifery Day with a post about an initiative to  create a VBAC Friendly Hospital, led by midwives.

ln honor of Cesarean Awareness Month, Lakeisha Dennis, the Chapter Leader of International Cesarean Awareness Network (ICAN) of Greater Essex County, New Jersey, invited Elaine Diegman, CNM, Ph.D, to speak about Worst to First, a talk about how to modify New Jersey’s high cesarean rate. Professor Diegman is head of the University of Medicine and Dentistry of New Jersey’s (UMDNJ) School of Nursing’s Midwifery Program.

Nationwide, the cesarean section rate is about 33%; in other words, one in three women in the United States give birth by surgical cesarean section. The cesarean section rate has risen about 50% in 15 years. According to the World Health Organization, a cesarean section rate of about 5 – 10% is the target for overall optimal maternal – baby outcome.

The state of New Jersey has a cesarean section rate of about 39%. New Jersey consistently places in the top two states for the highest cesarean section rate, sharing this distinction at the moment with the state of Louisiana.

Despite the National Institute of Health’s recommendation about vaginal brith after cesarean (VBAC) being safe under certain circumstances, there is a ourtright ban on vaginal birth after cesarean (VBAC) in many hospitals across the nation and the birth educators and doulas at this meeting said they noticed some ob-gyn practices have a quiet bait and switch tactic in place around this issue.

Professor Diegman has a long and distinguished career. She started out by telling us she’s actually the oldest practicing midwife in New Jersey (and maybe in the American College of Nurse Midwives). She gave us some history about the profession of midwifery. She reminded us midwifery is mentioned in the Bible and all the past royal houses of Europe used midwives for their births. She added she attended so many births in her career, she stopped counting after 3000.

Professor Diegman wanted to talk to us about pro-active change regarding lowering the cesarean section rate. UMDNJK has spearheaded a new initiative at Newark Beth Israel Hospital. UMDNJ has worked to become an official Vaginal Birth After Cesarean (VBAC) Center, keeping with the guidelines developed by the National Institutes of Health and the New Jersey Hospital Association. Dr. Diegman and Mary Markowsky, CNM, who heads the midwifery area of Newark Beth Israel, were instrumental in helping the hospital gain this distinction.

The empowering role of the childbirth educator

Professor Diegman stressed it is crucial we educate women about the normalcy of birth. She is passionate about the midwifery model of birthing. She wants to spread the word about how pain in childbirth is not like pain in illness, and emphasizes women do have the ability to rise to the experience of childbirth.

She emphasized the crucial role of education in preserving a woman-baby-centered birth culture. Professor Diegman said healthcare providers don’t normalize birth for women and don’t introduce women to nonpharmacological techniques to manage their birth.

Women only learn these techniques in independent childbirth education classes. So, the role of the childbirth educator is crucial in helping women understand what birth really can be and in getting our women back. The childbirth educator has a unique role to educate and empower women.

Dr. Diegman said the media and our constant exposure to technology has eroded women’s confidence in their ability to give birth. She wants to bring our women back. When Oprah, a powerful media presence, comes out positively about epidurals, that hugely influences our society’s views of birth. Dr. Diegman went on to say Oprah’s not the only one; there’s a constant flow of negative media stereotypes about birth. In addition, she said our constant reliance on technology has eroded our confidence in our bodies. She said “We need to be warriors and get our women back!”

Sonora Davis, community doula with the Hudson Perinatal Consortium, says “….women don’t seem to be taking the time to acknowledge their pregnancy or bond with their babies in utero.” She said she’s noticed this leads to a lack of focus on the birth. The other doulas, childbirth educators and midwives in the room echoed this concern, saying the disconnect during pregnancy sets up a disconnect to the experience in the birth room.

Childbirth educators play a crucial role in helping women know what their options are for birth, showing them what normal physiological birth looks like, and helping them focus on their pregnancy and the miracle of becoming a mother.

It is indeed good news that there appears to be a small upswing in one corner of the world back to women-baby-centered birth. As childbirth educators we can help women learn their options for women-baby-centered birth.

We need to keep asking, as Beverly Chalmers did in her editorial in Birth (2002):

How Often Must We Ask for Sensitive Care Before We Get It? 


Chalmers, B. (2002).How often must we ask for sensitive care before we get it? Birth, 29(2), 79-82.

 I wish to acknowledge Jill Wodnick, MS, in helping collate the information in this article.

Cesarean Birth, Childbirth Education, Uncategorized, Vaginal Birth After Cesarean (VBAC) , ,

  1. | #1

    Great piece. Thanks for the info and update. As a childbirth educator, I share all of that and so much more in my classes. Unfortunately, only about a third of pregnant moms even take a childbirth class these days, so 70% are either completely uneducated about the birth process, rely mostly on their caregivers for their information, and/or receive their information from online sources only. The real work is getting women to understand that they NEED a class so they can be informed and empowered to make personal choices about their birth experience. Too many leave their choices up to people who have no real interest in the short and long term effects of what could be, in most cases, one of the most precious moments in a woman’s and baby’s life.

  2. | #2


    I agree with your references about the need to remind us all that many women are capable of rising to the experience of childbirth. It often seems like there is a complicated balancing act between encouraging women to embrace their own strength and respecting their wishes. Thanks for your continuing efforts to clarify this balancing act.


  3. avatar
    | #3

    Great post. So important to take an independent childbirth education class instead of a hospital-run class. Also important to watch realistic, positive depictions of real birth rather than dramatized birth shows (Special Delivery, etc.) or fictionalized ones (ER). A few more thoughts:

    “When Oprah, a powerful media presence, comes out positively about epidurals, that hugely influences our society’s views of birth … there’s a constant flow of negative media stereotypes about birth …our constant reliance on technology has eroded our confidence in our bodies. She said ‘We need to be warriors and get our women back!'”

    I am a doula and a natural birth advocate, but I would like to respectfully point out that birth is not always a simple matter of “being a warrior” or “rising to the experience.” Some births are complicated and difficult, even under the most empowering of circumstances. There is nothing wrong with taking advantage of medical pain management when a woman feels that that is what she needs to have a successful birth. In my mind, the problem comes when women are afraid of the birth process and uneducated about their choices (medical AND nonmedical). My philosophy is: learn the risks and benefits of interventions, learn about nonmedical support options, have confidence in your body’s ability to give birth, but stay flexible and be open to medical support if you need it. All women who have given birth have “risen to the experience” of it, just in different ways.

  4. | #4

    @June Connell
    Hi June – I agree that our culture is very resistant to the midwifery-based model of birth. The media is saturated with doctor – hospital – hysterical births. The generation of homebirth women is basically gone. As Mary Ann Kerwin, one of the founders of LaLaeche League said, in 1956, when she started nursing her child, bf was just about a lost art in the US. Look at LLL now….it feels like something like that needs to happen in birth – woman led counseling!

  5. | #5

    @Ann Becker-Schutte, Ph.D.
    Hi Ann – I want to say the same thing I said to June…The media is saturated with dr-hospital-hysterical births and we have lost a generation of homebirth women. There are no portrayals of the midwifery model, which is the norm in Europe. La Leche League founder, when I interviewed her, said nursing was almost a lostt art in 1956 when she started LLL with 6 other women. So it can be done!

  6. | #6

    Hi Heather – TY for your comments. I dont think Elaine Diegman, head of midwifery at UMDNJ, was thinking that women should not take advantage of modern technology when needed. I think in some ways birth no win the US is like breastfeeding in the US in the 1950’s. I met Mary Ann Kershwin,one of the founders of La Leche League, she said bf was a lost art in the ’50s, when she & 6 other women formed LLL. LLL is now an international influence. LLL is a highly respected intervention in the Us now, a powerful social force. I think Dr. Diegman was referring to women taking back the arena of birth from the techno-medico establishment. The midwifery model of birth is not well depicted in the media, birth is a dr-hospital-techno scenario on most TV shows. As you said, most women don’t even realize they could use a childbirth education class to learn about birth, to learn there is another way. But there is a disconnect there, if there is not a midwifery model of birth.

  7. | #7

    Hi Kathy,
    Another great article. I think the idea of women not bonding with their baby in utero is so sad. It seems to speak to a lack of connection with one’s body in general. And it makes sense then that women would not think of birth as an experience that they could be taught to manage. That is a loss. Thanks for the work you are promoting.

  8. | #8

    Another great post, Kathy. Personally, I got a lot from attending prenatal yoga classes with a woman who is also a doula and a social worker. She really helped us mommies-to-be feel strong and capable.

  9. | #9

    Perfect case in point. If La Leche League could do it, so can the midwifery model of birthing. Actually, that one observation has given me new hope. We aren’t talking rocket science here. We are talking about the most normal, natural event, that of creation itself. The less we try to manage and manipulate, the better the outcome.

  10. | #10

    Hi Teresa – Thanks for the positive feedback! Yes, if LLL could become a force and bring bf back to the US, then so can midwifery !

  11. | #11

    @Rachelle Norman
    Hi Rachelle – I think that complementary therapies are empowering and also social support is a beautiful thing!

  12. | #12

    @Carolyn Stone
    Hi Carolyn – I enjoyed interviewing these birth women so much! They had such interesting points of view! Women do seem to be so busy that they almost ignore their pregnancies sometimes…a sad situation, and then there is emotional and psychological catching up to do after the birth.

  13. avatar
    Jess Groves
    | #13

    Can you please always post a photo with your blog posts or have a Science & Sensibility logo photo that is on each blog post page so that when we link your article on Facebook it has something to attach to? Articles with photos get read and opened more often than those that do not.

    Thanks for considering!

  1. | #1

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