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.