Stand and Deliver: April 2016

Friday, April 22, 2016

Update on homebirth VBAC ban in Colorado

The Colorado legislature recently included a VBAC ban into pending midwifery regulations. Thanks to consumer activism, the Senate has now rescinded the VBAC ban. Here's an update from Emily Thompson:

APR 22, 2016 — Yesterday, by unanimous vote, the Senate Health Committee removed the VBAC ban amendment from HB 1360 which will continue to keep midwifery legal in Colorado. Many midwives, mothers, advocates and their supporters testified in support of both the safety and the right of mothers to choose VBAC at home.

The signatures on this petition and the many comments definitely swayed the opinions of the Senators, and the strong testimony yesterday sealed the deal.

The bill still must be heard in the full Senate, and there is the possibility of amendments being added. We're asking Colorado residents to contact their State Senator and ask them to vote YES on HB1360 as it is presented to them from the committee.

Thank you again to everyone who signed, shared, and supported this grass-roots movement!

Gratefully,
Emily

If you're wondering why preserving women's ability to have a VBAC at home is an important issue, consider this: around 50% of all US hospitals ban VBACs, either formally (hospital policy) or informally (no doctors at that hospital will attend VBACs). In those situations, a woman's only remaining choice for VBAC is an out-of-hospital birth. Banning CO midwives from attending VBACs forces those women into having unnecessary, unwanted surgeries or from having to give birth unassisted.

Wednesday, April 13, 2016

Human rights in childbirth: VBAC bans

A few human rights in childbirth cases in the news:

Low-income women in Oregon forced to have cesareans:

If you are have a previous c-section, you might end up in Laura Blevins' shoes: no hospital providers in her area attended VBACs, yet Oregon Health Plan would not cover out-of-hospital VBACs. Laura had to pay out-of-pocket for birth center care in order to avoid an unnecessary cesarean and is now filing an appeal with the Oregon Health Plan. Read her full story on her blog or listen to this NPR piece. She started a GoFundMe campaign to raise funds for her legal expenses.

Laura Blevins

Colorado Legislation would ban VBAC at home:

This last-minute legislation would ban home birth midwives from attending VBACs. With around 50% of US hospitals already banning VBACs, this is a pressing human rights issue. Please sign the petition and, if you live in CO, contact your legislators!

Wednesday, April 06, 2016

Two must-read pieces on physiology and "pronurturance"

Understanding and promoting physiology in childbirth has been an interest of mine since my graduate school years. See, for example, my one of my comprehensive exams that asked me to reflect on the intersection of childbirth and environmentalism, in which I explored biodynamic approaches to both our natural and our maternal environments.

I want to share two fascinating pieces that make a case for respecting and facilitating the hormonal physiology of childbirth, with the end goal of healthier mother-baby pairs:

The first is the article "Hormonal Physiology of Childbearing, an Essential Framework for Maternal–Newborn Nursing" by Carol Sakala, Amy M. Romano, and Sarah J. Buckley (JOGNN 45.2 264-275). From the abstract:

Knowledge of the hormonal physiology of childbearing is foundational for all who care for childbearing women and newborns. When promoted, supported, and protected, innate, hormonally driven processes optimize labor and birth, maternal and newborn transitions, breastfeeding, and mother–infant attachment. Many common perinatal interventions can interfere with or limit hormonal processes and have other unintended effects. Such interventions should only be used when clearly indicated. High-quality care incorporates salutogenic nursing practices that support physiologic processes and maternal–newborn health.

The second is a PhD thesis by Florence Anne Saxton of Southern Cross University: Pronurturance at birth and risk of postpartum haemorrhage: biology, theory and new evidence. (PDF here) From the abstract:

Background: In spite of the almost universal adoption of the active management of the 3rd stage of labour, postpartum haemorrhage (PPH) rates continue to rise; reaching 19% or more in some obstetric units. Conversely, there is emerging evidence that women who experience continuity of midwifery care have lower rates of PPH. Continuity of midwifery care normally includes immediate skin-to-skin contact and early breastfeeding in the 3rd and 4th stages of labour to optimise release of endogenous oxytocin. The objective was to determine if skin-to-skin contact and breastfeeding at birth affected the rate of early PPH in a group of mixed risk Australian women.
Method: De-identified birth records (N=11,219) for the calendar years 2009 and 2010 were extracted from the electronic ObstetriX database which records public sector births in New South Wales, Australia. Excluded (n = 3,671) were all cases where skin-to-skin and breastfeeding immediately after birth was not possible leaving 7,548 cases for analysis. The outcome measure was PPH of 500 ml or more; the independent variables were ‘skin-to-skin contact’ and ‘breastfeeding’ at birth (the combination of these two variables I ultimately termed pronurturance). Analyses were conducted to determine the risk of PPH for women who experienced skin-to-skin contact and breastfeeding at birth in the 3rd and 4th stages of labour compared with those women who did not (regardless of the woman’s risk status or mode of birth).
Results: Women who experienced skin-to-skin contact and breastfeeding at birth had an almost fourfold decrease in risk of PPH, (OR 0.26, 95% CI 0.20-0.33, p < 0.001). After adjustment for covariates women who experienced skin-to-skin contact and breastfeeding at birth were again less likely to have a PPH (OR 0.55, 95% CI 0.41-0.72, p < 0.001). This protective effect of ‘pronurturance’ on PPH held true in sub-analyses for both women at ‘lower’ risk (OR 0.22, 95% CI 0.17-0.30, p < 0.001) and ‘higher’ risk (OR 0.37, 95% CI 0.24-0.57, p < 0.001) of PPH.
Conclusion: These results suggest that skin-to-skin contact and breastfeeding in 3rd and 4th stages of labour was effective in reducing the risk of PPH in a group of mixed risk Australian women. The explanation of this finding is that skin-to-skin contact and breastfeeding promote optimal endogenous oxytocin release. Skin-to-skin contact and breastfeeding at birth has shown no known negative effects and should be encouraged for all women during 3rd and 4th stage labour care.

Here are some core elements of a physiological labor & birth

Mother moves freely & chooses her positions during labor