Wednesday, May 6, 2015

DRMC Unveils 'Simply Birth Suite' for Low Risk Mothers

Last week Dixie Regional Medical Center unveiled it's new 'Simply Birth Suite' for "no to low risk women". Women in the community have been excited about this new option, but there seems to be several misconceptions that I'd like to make people aware of.

First, the 'Simply Birth Suite", is a mere addition of two beautiful rooms inside of the hospital. Yes, they are stunning. Gone is the small, uncomfortable, adjustable bed and replaced with a queen sized bed. The rooms are large, and offer a beautiful tub in which you can labor. You may or may not notice the absence of the infant warmer, and may notice the addition of comfortable chairs and a more inviting atmosphere than the regular rooms.

But what are the medical differences from the regular rooms, and the similarities to home birth? Not much, I'm afraid.

You may decline to have an IV. You do not need to be continually monitored, beyond an initial 20 minute monitoring session when you are first admitted. You will be monitored via intermittent doppler. You may use different pushing positions, based on the discretion of your care provider. Baby will be with you, rather than taken to a warmer.

But that's really where the differences end.

You will need to submit an application. Your past and current medical history will be reviewed before you are either accepted or rejected. You are required to take a hypnobirthing class if you have not given birth without medication before. You are required to have dedicated support for your whole stay. You are still in the hospital, which has policies and procedures that must be followed if any (even minor) blip comes up. You will not be admitted to stay until you are at least 5cm (which is not a bad thing - just be aware). You will be unable to use one of the two rooms if they are full when you go into labor.

You are still not allowed to birth in the water.

Did I also mention that it's the same doctors and nurses who will be attending you? This seems to be the biggest confusion. Women have asked me if I will now be able to attend at the hospital. The answer is no. It is the same doctors and the same midwife (Katie Gubler - whom I have heard is fabulous!) who will be attending women, and the same nurses.

Women planning a VBAC are not allowed to utilize the birth suite rooms, even though they are inside of the hospital. Statistically, there is a 0.3-0.7% risk of uterine rupture with a vaginal birth after one prior cesarean, and less than 2% for up to four prior cesareans. This is less than the risk of cord prolapse and the need for immediate cesarean in any other woman. But, women planning a VBAC are not allowed.

I am awaiting news on how the actual delivery process goes. At DRMC, the routine protocol is lithotomy (on back/mostly reclined, knees pulled back) and directed pushing during each contraction while the nurse sweeps in and stretches the inside of the vaginal opening (which is unnecessary and often causes swelling). Does this still occur within the 'birthing suite' rooms? Is the newborn exam done on the bed with mom? Is mom allowed to really EAT while in labor, and not just ice or jello? I'm unsure. I will update if I ever learn the answers to these questions.

While these are wonderful steps taken by DRMC to offer women an additional option, it is not "just like home birth" as claimed. Especially when those who attend you have very likely never attended a home birth before. I would be curious to know how many have even witnessed a truly  (and purposeful) physiological birth without any interference during, or after. Obstetricians are trained surgeons who follow their own and the hospital's set of guidelines and protocols ... and we know from ACOG's own admission that only 1/3 of current obstetric protocol is based on empirical evidence.

Ask in depth questions before making a decision about where to birth - whether hospital or home. Ask what kind of philosophy your potential care provider has regarding birth. Is it normal? Natural? An emergency waiting to happen? Do they facilitate physiologic birth? Do they encourage autonomy and choice for the birthing mother? Do they follow evidence-based protocols? Are they up-to-date with research?

Vaginal Birth After Cesarean (VBAC)

It hit me just how long it has been since I have kept up-to-date with posting in this blog. I do apologize! I am still in practice in Southern Utah, and my clients keep me busy! 

We just wrapped up Cesarean Awareness Month last week. In case you don't follow me on Facebook, here are my posts to bring about awareness regarding both cesarean section and vaginal birth after cesarean: 

Did you know that approximately 1 in every 3 women in America who walk into the hospital to give birth, walk out healing from major abdominal surgery?

Did you know that a cesarean for "big baby" is actually not a valid medical reason, and is advised against by the American College of Obstetrics and Gynecology, based on empirical research?
Did you know that according to research, most complications during labor that lead to a cesarean are iatrogenic (physician or procedure caused)? This includes cord prolapse, cesarean for nuchal cord (cord around the neck), fetal distress, hemorrhage, and more

Did you know that not only is Vaginal Birth After Cesarean (VBAC) possible, but that it's statistically low risk? The main concern with a VBAC is uterine rupture, which has a likelihood of 0.3-0.7%. This means that you are 99.3-99.7% likely to NOT rupture.
Being in a birth setting which is conducive to complete support and facilitation of VBAC is the most important aspect, beyond researching the ins and outs of it all. Unfortunately, many care providers and hospitals have policies and procedures which reduce your likelihood of a successful VBAC. Not because it can't be done, but because of the "rules" that often come with VBAC. Sadly, many care providers are not up to date with research in this area, and have restrictive rules surrounding VBAC labor.

Did you know that a VBAC after more than one cesarean is not only possible, but still considered relatively low risk? I have attended women who have had 2 cesareans, and have a current client who has had 3.
The largest research conducted on vaginal birth after multiple cesareans showed a uterine rupture rate of between 1-1.7%. The American College of Obstetrics and Gynecology position statement on VBAMC say that women who have had 2 cesareans with low-transverse incisions should not be discouraged from planning a vaginal birth.

Did you know that your chances for a successful VBAC lie with the rules your care provider might have for VBAC labor/birth, rather than your inherent ability to give birth vaginally?
Restrictive (and non-evidence based) rules such as scoring "well" on a trial of labor success scoresheet (where they take into consideration your age, weight, reason for previous cesarean, whether you've had a vaginal birth, etc), going into labor prior to 40 weeks, needing to dilate at the rateof approximately 1cm per hour, consistent monitoring, epidural (some require this), and the type of closure you had during your last cesarean.The American College of Obstetrics and Gynecology does not limit their recommendations for encouraging VBAC in women with 1-2 prior cesareans to these things, yet Obstetricians and Midwives (even home birth midwives!) restrict to these things. Make sure you know your care provider's beliefs about VBAC, and what rules they may have in labor and birth. How do they feel about VBAC? Are they hesitant, worried, even afraid? Do they know what the research says about VBAC risk and benefit? Find someone who knows these things thoroughly, and who is experienced and comfortable with VBAC.

Did you know that not being dilated or effaced by your due date is NOT an indication that you are not likely to have a successful VBAC? Though this is often said as a stipulation to "allow" (gotta stop allowing people to "allow" you in birth, ladies!) you to have a trial of labor, it is not evidence based. Dilation only tells you what your cervix is doing at that moment. That's it. Normal gestation length (38-42 weeks) applies to VBAC moms as well, and some may need longer.
Waiting does not increase your risk of rupture.

Christine Fiscer is a Traditional Midwife in Southern Utah who has been entrenched in VBAC research for over ten years. She has been attending VBAC and VBAmC (vaginal birth after multiple cesareans) at home for eight years. 

Saturday, December 15, 2012

Midwife Arrested in CA After 22 Years of Faithful Service

By now some of you may have already seen the story of Brenda Capps, a Traditional and Christian Domiciliary Midwife who was arrested in CA last month. She has served families there for 22 years, and has a better safety record than just about any physician that I have ever known of (even when you break it down to only low-risk women!). She was not arrested because a mom or baby died. She was not arrested because a family reported her. She was arrested after being named in another case, even though she had nothing to do with said case.

There are many who are shaking their heads, saying that she knew better and should have just been licensed. Many more disagree with this sentiment. You see, Brenda has served the women in California that other, Licensed Midwives, would not and/or could not. She has served the women who have found themselves carrying twins or a breech baby that would not turn. She has served the women who have had multiple cesareans.

She served me. She was my Midwife, seven years ago. After every other single Midwife had turned me down due to multiple factors, she believed in my body's ability, and wasn't bound by state regulations that were put together by Physicians. Without Brenda, I would have ended up in the operating room again. She believed in me and supported me through the birth of my posterior, 10lb 10oz baby girl. My triumphant HBAC.

There is a desperate need for Midwives who serve families, and not the state. We need more, not less of women like Brenda.

Technically, Brenda didn't even do anything wrong according to the law. According to the Licensed Midwife Practice Act of 1993 (CA), it is only unlawful to represent oneself as a Licensed Midwife when one is not. Brenda NEVER did this. Each and every one of the families she served knew with full disclosure, from Brenda, that she was not licensed. Each family signed her religious exemption clause. Families chose Brenda BECAUSE of her status, not in spite of it.

Even if you don't fully agree with what Brenda has done over 22 years, can't you agree that the rights of women to choose their birth attendants (even if that means no one at all!) are at stake here? If you do, please sign a petition that was put together on behalf of Brenda, and women's rights. We are hoping to see the petition hit over 2,000 signatures. We want the medical board to know that women and men are SPEAKING UP about their choices being limited to what the Medical Board thinks is appropriate.

Please sign it. Share it. This is such a vital issue.

Wednesday, April 18, 2012

Cesarean Awareness Month

I am so late with this, but I am hoping to keep in mind that late is better than never, right?

April is Cesarean Awareness Month. Did you know that? Have you come up with any ways to help spread awareness? If so, please list them! I'd love more ideas for next year. This year I got caught up with clients, school, and exams to do the legwork ahead of time. I am hoping to still put together a VBAC Q&A community event, but I am waiting to hear back from contacts about location.  I'll keep you all updated!

No onto some of the things that I have posted on Facebook so far. I was thinking of doing them individually, but I decided to just list them all in this one post in case I don't get back here before April is over. ;)


Did you know that our current national Cesarean Rate is 32.9%? That means that roughly 1 out of every 3 women who walk into a hospital to give birth, walk out recovering from major abdominal surgery. The World Health Organization, the Coalition for Improving Maternity Services, and other health organizations recommend a safe cesarean rate NO HIGHER than 10-15%, which means that approximately 1/2 - 2/3 of the cesareans done are unnecessary or were avoidable.

Concerns Over Rising Cesarean Rates


Cesarean Awareness Month Fact: 

Did you know that your OB is NOT supposed to recommend induction of labor for a baby who "seems to be large" at term? This is not only NOT evidence based, but it also leads to higher rates of cesarean section. Baby's weight plateaus at term, with adding only ounces per week. Half a pound or so is *not* going to make a difference between a birthable baby, and a baby who is "too big" for your pelvis. Fat squishes, and baby's skeletal size does not increase at term.

From ACOG: "Suspected fetal macrosomia is not an indication for induction of labor, because induction does not improve maternal or fetal outcomes." 


Did you know that in 2006 it was found that a cesarean delivery comes with a 3x higher risk of newborn death, than a vaginal delivery? The rates were found: .62 per 1000 deaths among vaginal births versus 1.77 per 1000 infant deaths among cesarean babies.


Did you know that a VBAC is possible, even after THREE Cesareans? 


Did you know that the majority of women who were diagnosed with CPD (Pelvis too small for baby) had other things going on, and that true CPD is extremely rare and occurs mainly when you've had a pelvic injury, or have had rickets?

Induction of labor, malpositioned baby, epidural, forced pushing, and pushing on your back (which decreases pelvic size by up to 20%) all increase the risk of "baby not fitting" - or baby not being allowed to come as he would without these interventions. Almost never does a woman *actually* have a pelvis that is too small to birth her babies ... and many moms with a label of "CPD" have gone on to not only give birth vaginally, but a good number of them have given birth to *larger* babies. ;) 


Did you know that being overweight puts you at higher risk for a cesarean? But it isn't for the reason you think. Many health care providers (of all kinds - not just OBs!) hold the belief that an overweight women cannot be healthy. Overweight women are often labeled with "Gestational Diabetes", even if their numbers are fine, and one higher blood pressure reading at term can have talk of induction begin. Women have been told that their vagina was "too fat" to give birth, that their baby would be huge because they were huge, or that they simply would not be able to push their baby out due to their size.

Having a cesarean if you are obese increases your risks dramatically. Obese women are at much higher risks of infection, issues with anesthesia, and blood clots. Taking steps to avoid one is key. 

Wednesday, January 11, 2012

FREE Waterbirth Information Night - Cedar City

Back by popular demand:

FREE Waterbirth Information Night!
Saturday, February 25th at 6:00pm
Braun Books - 25 N. Main St. Cedar City, Utah

Come to find out WHY and HOW birthing in water can help to Reduce Pain, Give Your Baby the Most Gentle Birth, Reduce the Risk of Tearing, and Reduce the Length of Labor.

Free information packets, Free Food, and Free Giveaways!

For more information please email:
or visit the Facebook Event page at: Waterbirth Info Cedar

Saturday, November 12, 2011


Yesterday was 11/11/11. A big thing in numerology, I'm told. Lucky numbers. Matching numbers. What did some parents-to-be do on this date? They scheduled their child's birth to fall on it. :(

It happens every year. Last year I even heard of women who were planning home births, inducing at home in order to give birth on the "lucky" date. This is a travesty. Babies are literally forced out of their mother's womb before they are ready for life on the outside, because their parents want them to have a "cool" birth date.

There is even an Obstetrician in Des Moines who offered monetary compensation for families who scheduled their delivery yesterday. I wonder how many of those babies ended up in the NICU.

Do the doctors who encourage or allow elective inductions and cesareans for a "lucky" date, caution about the risks involved in doing so? Do they mention the risk of NICU admission due to their baby not being ready for life on the outside? I know that when I was being scared into my first cesarean, 7 1/2 years ago, the OB not ONCE mentioned that it was a risk. He was too busy coercing us into agreeing. My son spent 9 days in the NICU, and I was flabbergasted when the neonatologist assigned to my son, told us that respiratory distress is *the* most common risk of elective cesarean section.

Today I was told that six babies were admitted into our tiny, local NICU yesterday. I am waiting to hear if we will be able to find out how many were due to induction or cesarean for yesterday's date. This is inexcusable, and it is heartbreaking.

Wednesday, November 9, 2011

Caution: Choose Carefully

A woman thought she had chosen her care provider carefully. One whom she thought would facilitate the peaceful, calm, beautiful birth that she envisioned for her first baby. She was comfortable with her care provider, confident that she would have the type of birth that she was dreaming about.

Then, at the end of pregnancy she is bombarded with stress from her care provider. Pressure to undergo tests that weren't based on evidence of anything going awry. A strict dietary change, which she needed to report to her care provider. When her water breaks and there is no labor yet, her care provider is unable to follow evidence based research, and have patience as long as mother and baby are doing well. Care provider talks heavily and often of intervention. Begins forcing induction techniques on the mother. The care provider's nervousness exudes from every action, in turn causing stress on the family. Soon the mother is able to force-start her labor, even though her intuition tells her that everything was fine. Her care provider ordered the birthing woman's mother to get out. When it came to pushing, she wasn't given an option of birthing anywhere but on her back. Her care provider instructed people to hold and pull her legs all the way back, while roughly hooking fingers into the mother's vagina to stretch and pull. Stretch and pull. Mom kicks at her care provider's hands, and says, “This hurts. Please stop.” Her care provider continues, saying that if mom doesn't want to tear, this is what needs to occur. Baby is born. Yet, it isn't the calm and beautiful meeting that either parent had hoped for. Within minutes, the care provider was pulling roughly on the umbilical cord, even though the mother said it hurt. Pulling tore the placenta off of the uterine wall, and heavy bleeding began. Before the family knew it, the care provider was gone, citing fatigue. The husband was left to worry about his wife's bleeding, and his child's breathing, without the professional that they had paid for.

For those of you who know the difference between home and hospital birth, this sounds like a hospital birth. It wasn't. This was birth at home. With a Midwife. Unfortunately, just hiring a Midwife to attend a home birth does not guarantee you a peaceful, safe, calm birthing experience. And there are things you can look for in the interview, and in the prenatal process. The problem for most families is that they blindly trust in their care provider. They don't question, and they don't do independent research. And the Midwives that I know of that have caused these kinds of birthing scenarios are extremely smooth with how they present things. It is almost a grooming technique. They tell you exactly what you want to hear. If you question things, they have a well-thought-out reason for why they will intervene in an otherwise healthy pregnancy, labor, or birth.

Red Flags in a Midwife:

*She has strict requirements for what you can and cannot do for your own birth. For example, she has the rule that you cannot birth on your own bed. You must birth in water (if she “lets” you actually birth in water – does not pull you out when you start pushing), or on the floor. This is controlling, not evidence based, and quite frankly – disturbing. There is nothing evidence based about not allowing a woman to birth in her own bed. A birthing woman should be able to birth wherever and however she chooses. Period.

*She becomes visibly nervous over things that are within normal or normal variation. A professional, experienced, and competent Midwife will make the family feel at ease, even if she internally feels nervous about something. This is the time for her to do research, collaborate with a peer, and then make a calm recommendation if evidence shows a reason to step in.

*She starts doing or wanting to do vaginal exams in the end of your pregnancy. Whatever reason she may give you, this is NOT evidence based. It holds no purpose whatsoever. It will not tell you when you will give birth, how well your labor will progress, or how baby is doing.

*You begin to feel like less of a peer with your Midwife, and more of a submissive party. You view your Midwife as an absolute authority figure who shouldn't be questioned, or one who will “disallow” you to do something. Your Midwife is your SUPPORT during a physiologic event in your life. Not your authority.

*She begins to come up with reasons why the things you may desire, or have planned for your birth, are not going to work out. For example – birthing in water. If she mentions that she “may have to pull you out” of the water for pushing, HUGE red flag. If she mentions that your partner or the person whom you have chosen to catch your baby can do so only with her help, huge red flag. There is nothing special about a Midwife's hands. She can sit back and carefully watch, and step in if there are any issues. Otherwise, she doesn't need to be involved.

*She answers, “We'll have to see how things are going...” in response to your desires for your birth.

And finally, for those of you who may be questioning what the heck happened during your birth...if your Midwife:

*Had you begin techniques to soften and prepare your cervix.

*Pressured you to begin intervention in your otherwise normal, healthy pregnancy.

*Began induction techniques because your waters released and labor didn't start yet, even though you and baby were not showing any signs or symptoms of infection.

*Was nervous during your labor – didn't seem like she was confident with what was occurring.

*Didn't allow you to birth anywhere but on the floor.

*Discouraged waterbirth, birth on your bed, or someone else from catching your baby. (including YOU!)

*Did multiple vaginal exams either without you asking, or because she had convinced you that they were necessary to assess progress and safety.

*Had you push before you felt the urge – your body will undeniably begin pushing on its own without any effort from you.

*Kept asking if you felt like pushing. A Midwife worth her salt knows that if you have to ask, mom definitely does not feel like pushing. Then mom wonders why she doesn't have to push yet. Is something wrong? When will I feel like pushing?

*Roughly applied perineal massage and stretching. If she told you that this is how to keep from tearing. If she told you that this was necessary. If she wouldn't stop when you mentioned how it hurt, was uncomfortable, or you didn't like it. Doing perineal stretching and massage is not evidence based. Research has shown that it does not reduce the risk of tearing, especially since the position that mom is in for this, is the LEAST optimal position for birth.

*Spoke to you in a controlling way. “Give me that baby!”, “You can either get down to business and REALLY push, and have this baby soon. Or you can keep going like this for hours.”

*Pulled on your placenta instead of waiting for the third stage to complete physiologically. By doing so, she put you at high risk for uterine and cervical prolapse, not to mention hemorrhage.

*Left shortly after your birth. A Midwife should remain in your home for a MINIMUM of two to three hours after birth. The first hour after birth is VITAL to mother-baby bonding, and should not be disrupted by newborn examination, birth certificate worksheets, or anything else if all has gone well. The time after birth is to assure that mom and baby are doing well, that they are snuggled into bed, that baby is nursing well, mom has eaten, and everything is cleaned up.

If she did any of the above, she did not practice in a safe, evidence based manner.

Overall, your Midwife should practice in a way that supports evidence based research and protocols. Not fear based, and definitely not control based. Women are perfectly capable of birthing out in the middle of the forest without anyone else around. They definitely do not need an overbearing, controlling Midwife to step in and make things unsafe.

Ask for the contact information of her last 3 clients. Ask them questions about their birth. Ask them about the demeanor of the Midwife during pregnancy, labor, birth, and postpartum. Ask about her transfer rate. Does she end up taking a lot of her clients in to the hospital? Call the hospital. Talk to the nurses. What is the reputation of the Midwife there?

If you have seen any of these red flags and feel it is too late to switch, it's not. Call around. Explain your situation. Make other arrangements for your birth, instead of continuing with these red flags, and possibly putting yourself, your baby, and your birth experience at risk.

Be careful with your choice in care provider. There are no do-overs in birth, and you will always remember the way that you were made to feel during your birthing process. Always remember that YOU are the one in charge of your birth. You hire your care provider – they work for you....not the other way around.