ICAN of Somerset County, NJ

WWW.ICANOFNJ.COM

Thanks to a generous grant from ICAN of Morris County, NJ, we are excited to launch a new website to bring childbirth information to all women in NJ.  Please checkout the ICAN of New Jersey website.  It's still slightly under construction but there is lots of good information there!

WWW.ICANOFNJ.COM

C-sections on the Rise in New Jersey

On the anniversary of my c-section....  how fitting....

C-sections on the Rise in New Jersey

By Suzanne Koup-Larsen

   

   

When her doctor said it was time for a C-section, Jaime Rowlyk of Woolwich, mom of now-2-year-old Alden, tried to negotiate. “Can you give me five minutes to think about it?” she asked. The doctor gave her just one. After 12 hours of labor with virtually no dilation and soaring blood pressure, Jaime’s body was beginning to break down; there wasn’t time for back and forth. In retrospect, Jaime believes the C-section saved her life.

While cesareans obviously are useful in preventing potentially serious complications for mother and baby, the World Health Organization recommends they be performed in no more than 15 percent of all births.

But in 2006, the U.S. cesarean birth rate was 31.1 percent, according to the National Institute for Health Statistics. (It was 20.7 in 1996.) Delaware and Pennsylvania had numbers in line with the national rate, at 30.7 and 29.7 percent, respectively, but New Jersey led all 50 states with a C-section birth rate of 37.4 percent.

This disparity between the recommended and actual frequency of surgical births has people asking: why are so many C-sections done in the U.S., and why do the numbers continue to rise?

Risks and complications
There’s no doubt that a C-section is major abdominal surgery. It carries risks—such as bleeding and infection—and requires a longer recovery time than vaginal childbirth. There’s also a chance of injury to surrounding organs, such as the bowel or bladder. The risks increase with each successive C-section.

But the consequences are relatively small in comparison to complications that can arise during pregnancy and delivery. A first, or primary, C-section may be performed because of:

• Malpresentation of the fetus (if the baby faces any way but down);
• Fetal distress (if monitors indicate the baby isn’t tolerating labor);
• Failure to progress in labor (if dilation stops, or pushing is unproductive);
• Health conditions of the mother, such as diabetes or high blood pressure;
• The baby’s size (if he’s estimated to be too large to fit through the mother’s pelvis—generally more than 11 pounds).

An end-all cure-all?
Pam Udy, president of the International Cesarean Awareness Network (ICAN), an organization that aims to prevent unnecessary cesareans through education, says, “C-sections have become the end-all cure-all to every pregnancy complaint and labor complication.” She herself had a C-section after she got indigestion 38 weeks into her pregnancy. No other remedy was suggested.

Due to the high number of lawsuits from complications during vaginal births, doctors seem to order C-sections more quickly than they used to. They tend to err on the side of caution if fetal monitor tracings or anything else is abnormal during labor. Says Dr. Sindu Srinivas, a clinical fellow at the Hospital of the University of Pennsylvania and a member of the Committee for Professional Liability at the American College of Obstetricians and Gynecologists: “the liability issue definitely plays some role” in climbing C-section rates.

On the agenda
According to Dr. Gordon Ostrum, Jr., acting chair of the OB-GYN Department at the Christiana Care Health System in Delaware, “Repeat cesareans are the other large driving force,” in rising U.S. C-section rates.

Because research has shown a small but increased risk of uterine rupture during vaginal births after cesareans (VBACs), some moms and doctors avoid them for fear of potentially dangerous complications. Also, some moms are less receptive to going through labor if they’ve had a prior C-section. Today, most women who’ve had a C-section will likely have another for subsequent births.

While most physicians discourage purely elective C-sections, they are becoming more common. “Our society is very convenience oriented,” says Dr. Ostrum. “People wish to be delivered on a schedule.”

Since labor is unpredictable, making an appointment for surgery removes the guesswork about when a baby will be born. Both physicians and mothers have plans to make and agendas to keep; scheduling delivery offers the option of knowing an exact due date.

Still, an elective C-section remains controversial. Many say babies should simply arrive when they’re ready. Potential physical risks to the baby include low birth weight, prematurity, respiratory problems, and lacerations, according to the ICAN website. Potential risks to women include hemorrhage, placental abnormalities in future pregnancies, and an increased percentage of maternal death, says ICAN-online. In addition, the New York Times reported a finding in June that a history of a cesarean can mean higher health insurance premiums for a woman—even if she is in good health.

Pam Udy of ICAN suggests women ask their doctors: “What’s the medical justification for this procedure?” before agreeing to a C-section. If a C-section is recommended, Udy suggests asking for a second doctor’s opinion if there’s time.

---

Birth Info
International Cesarean Awareness Network: ican-online.net
KidsHealth: kidshealth.org/parent/pregnancy_newborn
WebMD: webmd.com
Hospital C-section rates in NJ: starledger.com/str/indexpage/default.htm (link from Health and Environment)

---

Suzanne Koup-Larsen is a freelance writer from Pennsylvania. Her second baby is due in September.

September 2008

Printed on September 9, 2008

http://www.njfamily.com/en/news/C_sections_on_the_Rise_in_New_Jersey.aspx?cat=26&news=698

C-section crisis in the Philadelphia/South Jersey area

Posted on Fri, Feb. 15, 2008

http://www.philly.com/philly/news/breaking/15661817.html

C-sections rise again around the region

By Josh Goldstein

INQUIRER STAFF WRITER

The number of cesarean section births in the Philadelphia region is continuing to rise, paralleling the national trend.

The federal Agency for Healthcare Research and Quality reported the number of c-section births rose to 1.3 million in 2005, up from 800,000 in 1995.

That's a 62 percent increase.

Locally, the percentage of c-sections rose to 31 percent of the 64,436 children born in the eight-county Philadelphia region in 2005, according to an Inquirer analysis of hospital billing records.

The numbers continued to increase in 2006. That year, 32 percent of the 65,820 children born in the region were delivered by c-section.

A decade earlier, just 20 percent, or 12,267, of the nearly 62,000 births in the eight counties were by cesarean section.

There were ongoing differences within the region: Cesareans accounted for 34 percent of all births at hospitals in New Jersey's Burlington, Camden and Gloucester Counties in 2006 compared with 31 percent in Pennsylvania's Bucks, Chester, Delaware, Montgomery and Philadelphia County hospitals.

The federal report noted that while C-sections at one time were performed primarily when a vaginal delivery would put the baby or mother at risk of death, the surgical procedure is increasingly performed in "births that would otherwise have been normal."

 

---

Contact staff writer Josh Goldstein at 215-854-4733 or jgoldstein@phillynews.com.

Follow up on NJ c-section deaths

The 2 NJ deaths are mentioned and give cause of deaths.  Just realized I never posted this although the article is several months old.

Associated Press
Experts: U.S. Childbirth Deaths on Rise
By MIKE STOBBE 08.24.07, 4:43 PM ET
ATLANTA -

U.S. women are dying from childbirth at the highest rate in decades, new
government figures show. Though the risk of death is very small, experts
believe increasing maternal obesity and a jump in Caesarean sections are
partly to blame.

Some numbers crunchers note that a change in how such deaths are reported
also may be a factor.

"Those of us who look at this a lot say it's probably a little bit of both,"
said Dr. Jeffrey King, an obstetrician who led a recent New York state
review of maternal deaths.

The U.S. maternal mortality rate rose to 13 deaths per 100,000 live births
in 2004, according to statistics released this week by the National Center
for Health Statistics.

The rate was 12 per 100,000 live births in 2003 - the first time the
maternal death rate rose above 10 since 1977.

To be sure, death from childbirth remains fairly rare in the United States.
The death of infants is much more common - the nation's infant mortality
rate was 679 per 100,000 live births in 2004.

Maternal deaths were a much more common tragedy long ago. Nearly one in
every 100 live births resulted in a mother's death as recently as 90 years
ago.

But the fact that maternal deaths are rising at all these days is shocking,
said Tim Davis, a Virginia man whose wife Elizabeth died after childbirth in
2000.

"The hardest thing to understand is how in this day and age, in a modern
hospital with doctors and nurses, that somebody can just die like that," he
said.

Some health statisticians note the total number of maternal deaths - still
fewer than 600 each year - is small. It's so small that 50 to 100 extra
deaths could raise the rate, said Donna Hoyert, a health scientist with the
National Center for Health Statistics. The rate is the number of deaths per
100,000 live births.

In 2003, there was a change in death certificate questions in the nation's
most populous state, California, as well as Montana and Idaho. That may have
resulted in more deaths being linked to childbirth - enough push up the 2003
rate, Hoyert said.

Some researchers point to the rising C-section rate, now 29 percent of all
births - far higher than what public health experts say is appropriate. Like
other surgeries, Caesareans come with risks related to anesthesia,
infections and blood clots.

"There's an inherent risk to C-sections," said Dr. Elliott Main, who
co-chairs a panel reviewing obstetrics care in California. "As you do
thousands and thousands of them, there's going to be a price."

Excessive bleeding is one of the leading causes of pregnancy-related death,
and women with several previous C-sections are at especially high risk,
according to a review of maternal deaths in New York. Blood vessel blockages
and infections are among the other leading causes.

Experts also say obesity may be a factor. Heavier women are more prone to
diabetes and other complications, and they may have excess tissue and larger
babies that make a vaginal delivery more problematic. That can lead to more
C-sections. "It becomes this sort of snowball effect," said King, who is now
medical director of maternal-fetal medicine at Riverside Methodist Hospital
in Columbus, Ohio.

The age of mothers could be a factor, too. More women are giving birth in
their late 30s and 40s, when complications risks are greater.

Other characteristics of the maternal mortality rate include:

_Race: Studies have found that the maternal death rate in black women is at
least three times greater than is it is for whites. Black women are more
susceptible to complications like high blood pressure and are more likely to
get inadequate prenatal care.

_Quality of care: Three different studies indicate at least 40 percent of
maternal deaths could have been prevented.

Sometimes, there is no clear explanation for a woman's death.

Valerie Scythes, a 35-year-old elementary schoolteacher, died in March at a
hospital in New Jersey - the state with the highest Caesarean section rate.
She had had a C-section, as did another teacher at the same school who died
after giving birth at the same hospital two weeks later.

However, Scythes died of a blocked blood vessel and the other woman died
from bleeding, said John Baldante, a Philadelphia attorney investigating the
death for Scythes' family.

"I'm not sure there was any connection between the two deaths," Baldante
said.

Also mysterious was the death of Tim Davis' 37-year-old wife, Elizabeth, who
died a day after a vaginal delivery at a Danville, Va., hospital in
September 2000.

She had a heart attack after a massive blood loss, Davis said. It's not
clearly known what caused the heavy bleeding. There was no autopsy, he said,
a decision he now regrets.

Two previous births had gone well.

"Nothing led us to believe anything was wrong with this pregnancy. She was
like a picture of health," he continued, noting she had been a YMCA fitness
instructor.

A lawsuit against the hospital ended in a settlement. Davis also sued the
obstetrician, but a jury ruled in the doctor's favor.

The child born that day, Ethan, starts second grade next week. "He's a happy
kid," Davis said. "He's just never had a mom."

National Center for Health Statistics 2004 deaths report:
Copyright 2007 Associated Press. All rights reserved. This material may not
be published broadcast, rewritten, or redistributed

DORIS HAIRE AWARD for excellence in maternity being presented Sunday 11/11/2007 to NJ Star Ledger!!

This Sunday, the Doris Haire Award is being presenting to the New Jersey Star Ledger newspaper for their "By the Numbers Website" which lists statistics for 68 New Jersey hospitals resulting in transparency of c-section rates and vbac rates.  This website allows women birthing in NJ to make better and more informed choices regarding childbirth.

************************************************************
The award will read:

Doris Haire Award
Recognizing Excellence
The Star-Ledger "New Jersey By The Numbers"
Best Maternity Data in NJ
Hospital C-Section & V-BAC Rates
As Per Governor Corzine's Proclamation 2007

http://www.nj.com/news/bythenumbers
The Rising C-Section Rate:  A Star-Ledger analysis has found that hospitals are performing Caesarean section deliveries at a ever-increasing rate, and are growing less likely to allow a woman who has had a previous C-Section to give birth vaginally, a procedure known as a VBAC.
On this page, you'll be able to view statistics the Star-Ledger obtained from state regulators covering birth methodologies at 68 New Jersey hospitals.

In addition, this year there will be three additional awards presented to 3 individual reporters for Excellence in Reporting & Investigating.

#1
CAROL ANN CAMPBELL
Star-Ledger Staff
After C-section, some mothers dare defy trend
July 1, 2007
no longer on their website but can be access here: http://romancathanachronism.typepad.com/ican_somerset/2007/07/vbac-in-nj-news.html

********************************
#2
Anne-Marie Green
CBS 3/ Philadelphia-
C-Section Rally Held After Deaths Of Two Mothers
May 17, 2007
http://cbs3.com/topstories/Valerie.Scythes.Melissa.2.309061.html

*********************************
#3
Marie McCullough
Inquirer Staff Writer
C is for caution: C-sections on the rise
June 10, 2007
http://www.philly.com/inquirer/front_page/7923767.html
************************************

Each award will say the following:

Doris Haire Award
Recognizing Excellence
Reporting & Investigating
As Per Governor Corzine's 2007 Proclamation

The Award will be etched Crystal with, Doris Haire's likeness,
Logos of the following: Cesarean Awareness Ribbon, Doulas of New Jersey, International Cesarean Awareness & NOW NJ,

A copy of the Governor's Proclamation will also be presented to each winner at the ceremony.

The award ceremony is taking place during the NJ NOW mini-conference 2007:

Sunday November 11, 2007

1-5p.m. at the Montclair Library,

50 South Fullerton Avenue,

Montclair, NJ  07042

Who is Doris Haire?

Doris Haire is a part time resident of NJ. A woman that is frequently given credit for women in the United States being allowed to have their babies with them in their room after giving birth. She was the force behind the Maternity Information Act being passed in NY in 1989, The Act is also detailed below.

Wife, mother, grandmother, and friend and mentor to birth professionals around the world, Doris Haire is admired and respected as a leading advocate for mothers, babies and families.

Doris Haire is the founder of the American Foundation for Maternal and Child Health, a past Chair of the National Women's Health Network, and a past President of the International Childbirth Education Association. Over the past 50 years, in her effort to gain an international perspective of obstetric care she has observed and interviewed professional providers of obstetric care in more than 72 countries. Today she continues her efforts to raise awareness of the need for more quality research to determine effects of common obstetric drugs and practices on maternal and infant health and child development. Her organization is Alliance for the Improvement of Maternity Services (AIMS) and can be found at http://www.aimsusa.org

She is the author of the renowned book, The Cultural Warping of Childbirth, published in 1972, and Implementing Family-Centered Maternity Care with a Central Nursery, the book that helped foster changes in state regulations in the 1980's resulting in babies "rooming-in" with their mothers after hospital birth.

Doris Haire was responsible for getting the Maternity Information Act passed in NY in 1989. As evident in our current state of Maternal distress in the US there still is a need to get similar legislation passed in all 50 states in the US. The Maternity Information Act was enacted in the State of New York in 1989 to provide expectant parents and the public with information relative to the hospitals they are considering for the birth of their babies. The Act directs the New York State Commissioner of Health to require that every hospital distribute a maternity information pamphlet directly to each prospective maternity patient at the time of pre-admission and, upon request, to the general public. The format of pamphlet is prescribed by the Commissioner and contains state reviewed information giving the rate that various maternity related procedures are performed at each respective hospital and such other information as is deemed appropriate by the Commissioner. She was able to document that this information was already being collected by the State Dept. of Health but had not previously been available to the public.

The law requires hospitals with obstetric services in the New York State to make public via a State designed brochure their annual rates of:

• cesarean sections, primary and repeat
• women with previous cesarean sections who have had a subsequent successful vaginal birth
• deliveries in birthing rooms
• deliveries by certified nurse-midwives
• fetal monitoring listed on the basis of auscultation, external and internal.
• births utilizing forceps, listed on the basis of low forceps and mid forceps delivery
• births utilizing breech vaginal delivery
• vaginal births utilizing analgesia
• vaginal births utilizing anesthesia including general, spinals, epidural and paracervical
• births utilizing induction of labor
• births utilizing augmentation of labor
• births utilizing episiotomies; and
• mothers breast feeding upon discharge

Doris is one of the most famous NJ activists for Pregnant Women's Rights that we have in the US. She divides her time and activism between NYC, Denville, NJ and North Carolina.The goal of her organization is to bring about a reduction of birth injury and trauma in newborns and their mothers through the sharing of scientific information and public information.

Infant mortality in the U.S. is the highest of all industrialized countries -- and can not be explained away merely by lifestyles. Her organization advocates for the following:

• Maternity care could be made safer and more humane for babies and their mothers,
• FDA's 1974 guidelines for evaluating the safety of obstetric drugs need to be updated,
• The FDA should require a follow-up of children exposed in utero to obstetric related drugs to determine the behavioral and cognitive effects of the drugs,
• A pregnant woman should be told, prior to giving birth, of the risks, as well as the benefits, of the drugs and procedures frequently used in maternity care,
• A pregnant woman and her baby should not be used as teaching or research "material" without the woman's informed consent,
• Hospitals should be required, as in the State of New York, to provide prospective maternity patients with a brochure that clearly states that respective hospital's rate of cesarean section, induced or augmented labor, epidural anesthesia, analgesia, forceps extraction, episiotomy, midwife deliveries, etc.,
• The mother should be given a copy of her baby's hospital/medical records,
• Women consumers, knowledgeable in the area of maternity care, should be included in any city, state or federal body authorized to determine or evaluate maternity services,
• HMOs should be required to reimburse for midwifery services by state licensed midwives for women who wish it,
• A hospital which refuses to provide admitting privileges to state licensed midwives must submit their position to the state department of health for arbitration and settlement.

A strike against NJ midwives and natural birth in NJ

I have to admit that I was disappointed by a recent TLC "A Baby Story" episode where a woman had a VBAC with Lonnie Morris and the midwives at the Childbirth Center.  Maybe it was the portrayal by A Baby Story but the woman hit 42 weeks and Lonnie pushed for induction.  The woman did go into labor on her own but was augmented with pitocin which really is NOT safe for a vbac.  The woman DID have a VBAC which was great.  I just wish it could have been a more "natural" experience. 

That being said, I'm disappointed to hear of the closure of Pascack Valley and the Childbirth Center there.  Choices for women in Northern NJ are going to be more limited. 

This is a printer friendly version of an article from the The Journal News.
To print this article open the file menu and choose Print.

---

Expectant moms, midwives scramble for new hospital

By JANE LERNER
THE JOURNAL NEWS
(Original Publication: October 21, 2007)

WESTWOOD, N.J.

Tara Martinez had her first child, Arianna, 3 1/2 years ago via cesarean section, an experience she was determined not to repeat when she gave birth again.

The Nanuet woman's second child, Isabella, was delivered 18 months ago without drugs or intense medical intervention, after 17 hours of labor - part of which Martinez spent relaxing in a bathtub at Pascack Valley Hospital.

"It was an amazing experience," she recalled. "So much better than the first time."

Now pregnant with a third child, Martinez looked forward to giving birth again with the help of a midwife in the private maternity suites at the New Jersey hospital.

But now she and many other Rockland women are scrambling to make other plans, because Pascack Valley Hospital has declared bankruptcy and announced plans to close by the end of the year.

The hospital says it plans to stop accepting obstetrical patients by Nov. 30.

Martinez is due Dec. 26, but she expects her third child - like her first two - to arrive several weeks early.

"I can't believe this is happening," she said. "You can't imagine how upset I am - I don't know where this baby is going to be born."

Many Rockland women who have had or planned to have their babies at Pascack Valley did so because, they said, that hospital gave them more options.

"The philosophy of Pascack Valley and the nursing staff was very open - very progressive," said Pauline Nardella, a Blauvelt nurse and childbirth instructor. "Women would switch services just to go to that hospital."

And Pascack is the only hospital in the area to provide bathtubs to women in labor who use a water method to relax and ease the pain of delivery, Nardella said.

That was one of the reasons Haverstraw resident Sonia Serrano chose to have her baby there.

"I really wanted a water birth," she said.

But her baby had other plans.

Her labor didn't go as Serrano expected, and she was never able to use the tubs. Janet Sophia Alessi was delivered Oct. 13 by cesarean section.

"It wasn't the way I planned it," Serrano said. "But the hospital was wonderful - the nurses were great. I was so glad I was there."

Many women chose Pascack Valley because a number of midwives are on staff there.

Lonnie Morris, an Englewood, N.J., midwife, has practiced for years at Pascack Valley, and her patients include many Rockland residents.

"It's a huge loss to see Pascack Valley go," Morris said. "It's a brand-new unit, beautiful, and women got the birth experience of their choice."

Morris is talking to other area hospitals about switching her patients, but she has not yet come up with a plan.

She has submitted an application for staff privileges to Nyack Hospital. She has not applied for privileges at Good Samaritan Hospital in Suffern, which also has nurse-midwives on staff.

"Nyack would be a stopgap for me," Morris said. "They don't have the tubs, they don't have all private rooms, and they can't compare with what Pascack has."

Maureen Kirk, chief nursing officer and vice president of patient care services at Nyack Hospital, said that Morris' application to become a member of the staff is under consideration.

"We'd love to welcome Lonnie here," said Kirk, who knew Morris when she worked as an administrator at Pascack Valley.

Other midwives who practice as part of an obstetrical group are already on staff at Nyack, Kirk said.

Morris said she wants to continue to practice as an independent provider.

Kirk said that while Nyack Hospital does not currently have bathtubs on its labor and delivery ward, administrators would consider getting them.

Nyack's obstetrical department was renovated in 2005, she said

"The water option was very popular at Pascack Valley," Kirk said. "If that's something that women in Rockland County desire, it's not a problem for us to get that."

Women will be able to continue to use Pascack Valley until Nov, 30, said hospital spokeswoman Heather Wolff. The hospital's closing plan has not yet been approved by New Jersey state officials.

Other New Jersey hospitals have expressed interest in keeping parts of Pascack Valley open, including the emergency department.

But there has been little discussion of anyone else taking over the obstetrical unit.

"We are asking women to talk to their obstetricians about making alternative plans," Wolff said.

For women such as Martinez, that leaves a difficult choice.

She had an appointment with Morris, her midwife, last week. Morris told her that she thinks she will be able to start delivering babies at Nyack Hospital.

"It really wasn't my first choice," said Martinez, whose first child was born at Nyack. "But as long as my midwife is there, I guess I'll be OK. There's nothing I can do about it if Pascack closes."

NJ Courier News publishes my response to their inaccurate article on the NJ c-section rate!

A Northern NJ ICAN chapter leader and I didn't get anywhere attempting to set the record straight with the reporter who wrote the inaccurate article on the NJ c-section rate.  I finally spoke to the managing editor who claimed he saw the state report used by the writer and everything was quoted correctly.  He went on to mention that they didn't have the resources to look into the facts further (even though I emailed them links to the true stats!).  He invited me to write an opinion piece which was published today in the "Local Voices" section of the NJ Courier News:

http://www.c-n.com/apps/pbcs.dll/article?AID=/20071004/OPINION02/710040366/1010

****************************************************************************************************************

Too many women urged to have Caesarean births

Several weeks ago, an article ran about the Caesarean section rate in New Jersey hospitals. The report cited in the article, issued by the Department of Health and Senior Services, contained numerous inaccuracies.

In 2005, the Caesarean rate was 36.3 percent, as reported to the CDC (www.cdc.gov/nchs/pressroom/data/state_pro). file_NJ.htm

However, that statistic was calculated by taking the average of rounded C-sections rates from each hospital. An examination of the raw data -- i.e. the true number of C-sections divided by the true number of total births in the state -- shows that the average is 37 percent, which is the highest in the nation. The 2005 average Caesarean rate across the U.S. was a record high of 30.2 percent. (www.cdc.gov/nchs/products/pubs/pubd/hestats/pre). limbirths05/prelimbirths05.htm

According to the World Health Organization, a Caesarean rate above 10-15 percent puts women at risk.

The hospitals mentioned in the article also have much higher Caesarean rates than reported. In 2005, Hunterdon Medical Center and Somerset Medical Center had Caesarean rates of 34 percent and 36 percent respectively. Muhlenberg was at 20 percent. St. Peter's, one of the largest maternity hospitals in the state, had a C-section rate of 38 percent. Complete information on New Jersey hospital stats, which are maintained by the Center for Health Statistics and sourced through the New Jersey Electronic Birth Certificate (EBC) file, are available online at www.nj.com/news/bythenum. Caesarean rates at all hospitals have risen in 2006. Incredibly, there are hospitals in New Jersey with Caesarean rates approaching or exceeding 50 percent. bers/

New Jersey is experiencing a Caesarean pandemic. Women in New Jersey are being coerced into Caesarean deliveries for such questionable reasons as: prolonged labor, suspected macrosomia (large baby) as estimated by ultra-sound (which can be off by up to 2 pounds), advanced maternal age, multiple gestations and breech presentation.

Although any of these reasons may ultimately result in Caesarean being the safer mode of delivery, it is not necessarily so, and we should question the number of C-sections based on these reasons.

In addition, once a woman has had a C-section, she is often told that a repeat C-section is her only or best option. Doctors and hospitals in New Jersey are increasingly denying women the opportunity to have a vaginal birth after Caesarean (VBAC). Most will claim that VBAC is too risky, when the true risks of VBAC are very low. A Caesarean section is major abdominal surgery and carries numerous risks which most women are seldom made aware of. Women in New Jersey need accurate information to make informed decisions regarding their births.

When a Caesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. According to the International Cesarean Awareness Network (www.ican-online.org), legitimate medical reasons for a C-section include placenta previa, baby in the transverse position at the time of delivery, prolapsed cord, abrupted placenta, eclampsia or severe pre-eclampsia with failed induction, true fetal distress and uterine rupture. However, Caesarean surgery is grossly overused in New Jersey, putting the lives and health of women and babies in danger.
**********************************************************************************

Falling C-section Rate in NJ??? I don't think so!!!

I just came across this article published in the NJ Courier News on Friday, August 31, 2007:

C-section rate falls at 2 local hospitals
By MARTIN C. BRICKETTO
Staff Writer

While Caesarean sections performed during births continue to increase in New Jersey, two Central Jersey hospitals fell below the statewide average for what's been characterized as an overused procedure, according to a new state report issued Thursday.

The "Inpatient Quality Indicators" report from the state Department of Health and Senior Services compared 84 New Jersey hospitals using 32 measures of care.

Using statistical numbers adjusted to account for patient risk, the study found 28.9 C-sections for every 100 births statewide in 2005, an 8.3-percent increase compared to 2002. Nationwide, use of the procedure increased through the 1970s and 1980s, climbing again in the past decade.

Caesarean sections can be necessary to preserve the health of a mother or baby, but some health activists have said the procedure can subject women to risks of bleeding, infection and blood clots and potential long-term complications.

The American College of Obstetricians and Gynecologists has reported a greater risk of pregnancy-related death associated with Caesarean deliveries than with vaginal births.

In 2005, Muhlenberg Regional Medical Center in Plainfield had a statistical Caesarean rate of 15.9 percent of births, while the Hunterdon Medical Center in Raritan Township had 25.3 percent. Both were described as significantly below the state average.

"We traditionally had one of the lower C-section rates in the state," said Dr. Robert Bayly, vice president of medical affairs at Muhlenberg. "That is something our physicians, nurses and midwives have keep a close eye on and worked hard to keep that rate low."

"In general, if you can deliver naturally, I think it's preferable," Bayly said.

The Somerset Medical Center was just below the state average for Caesarean sections with 28.3 percent, according to the report.

The state's medical and surgical death rates are largely in line with or better than the national average, according to the department, and mortality rates for conditions such as pneumonia and heart attacks declined between 2002 and 2005.

Muhlenberg's mortality rate for heart attacks was 10.4 percent, just above the state average of 8 percent, the report stated.

While the report doesn't deem that rate statistically significant against the state numbers, Bayly said Muhlenberg and other hospitals have been focused on treating heart attack patients and getting them the appropriate drugs quickly.

"Regardless of what the number is, it's something we'd be looking to decrease," Bayly said.

The mortality rate for hip replacement surgery at the Somerset Medical Center -- 3.4 percent -- was listed as significantly higher than the statewide rate of 0.3 percent in 2005.

Dr. Richard Paris, the Somerset hospital's chief medical officer, said the rate was an anomaly and dependent on the number of procedures, which he said are difficult surgeries but almost always have positive outcomes.

"We did 87 for the year. If we had done 180, our rate would probably be much lower and be within the statistical norm," Paris said. "I would not say it's a pattern or a problem we're having with the care of patients, but it's something that's important to note and follow up on."

The hospital's rate of laparoscopic cholecystectomy procedures -- minimally invasive gallbladder surgery -- was also high compared to the statewide rate, which is considered a plus in the report.

http://www.c-n.com/apps/pbcs.dll/article?AID=/20070831/NEWS/708310317

********************************************************************************************************************

I am seriously appalled that this state is issuing such inaccurate information.  The c-section rate in NJ in 2005 was NOT 28.9% but 37%!!!!  It is actually reported as 36.3% to the CDC and also published on the ICAN main website .  However, that figure uses the average of rounded hospital c-section rates.  If you actually look at the number of c-sections in the state divided by the number of total births, the c-section rate is 37.0%.

I wish Hunterdon Medical Center had a c-section rate of 25.3%.  2003 was the last year they could brag about that.  Overall, Hunterdon is a very natural birth friendly hospital (with huge beautiful rooms I might add!) but their c-section rate has skyrocketed to 35% in 2006.  Unfortunately, they have at least 1 practice delivering there with a crazy high (well above 50%) c-section rate.  Luckily, there are still practices that promote natural birth and vbac.  Somerset Medical Center hasn't had a c-section rate of 28% since 2001.  They were also at 35% in 2006.

I just emailed the reporter.  Hopefully he will clear up this information!  Stay tuned....

For more information on NJ hospital's c-section and vbac rates, check out:  http://www.nj.com/news/bythenumbers/ and click on "rising c-section rates."

Reflections on the NJ rallies in ICAN's Clarion newsletter

Here is the article that I submitted to ICAN's The Clarion newsletter:

On May 17, 2007, a rally was held at Underwood Hospital in Woodbury, NJ and the State House in Trenton, demanding justice for women birthing in the state. When I heard about the rally, just days before, I knew that I had to be there no matter what. Though I've never had trouble expressing an opinion, I had never been this public with my views. But I felt called to be there for this event. Sadly, this rally was called after the deaths of 2 women at that hospital, teachers in the same Southern NJ elementary school, who died just 15 days apart following their cesarean sections.

 

I made the 1.5 hour trip that morning down to the hospital. I typically feel a sense of anxiety as I approach any hospital; however, this time it was different. Walking up to the hospital, I remember feeling chills and being somewhat shaken knowing that 2 women entered that hospital, happy and eager to bring their children into this world but left to die at other institutions (Underwood Hospital sent each woman out to another hospital for post op care once complications set in). I couldn't help thinking that I was in their positions just 2.5 years ago. But I was lucky. Neither my daughter nor I suffered long term effects of the cesarean. Feeling those emotions gave me strength to stand up and look people in the eye - whether it was the media or passers-by.

 

There were several reporters and news cameras hovering in the crowd that was still gathering in front of the hospital. I have to admit that I was expecting more hostility from the media or the hospital but it seemed like everyone was genuinely interested in what we were saying. I think it helped that we weren't trying to specifically call attention to the deaths of these 2 teachers; rather we were talking about how the 37% c-section rate in NJ is unacceptable and we need to create a better birthing environment for women. The fact is that we don't know why these women had their c-sections and we wanted to make that clear but we were not challenged on that issue. We were calling for an investigation apart from the hospital's internal investigation. We wantedeveryone to know that the c-section rate in NJ is much too high and we are endangering women as a result.

I do think that our message did get through. The media really wanted to focus on the high c-section rate and the general feeling that birth is a natural process. I was rather surprised to learn that I was mostly in the company of homebirthing mothers, doulas, childbirth educators and midwives. I was one of the few scarred women there, which is the reason one of the Philadelphia news channels had asked to interview me. They wanted the opinion of a woman who had been through a cesarean section. Specifically they asked if I knew the risks ahead of time which I did not. No one took the time to explain them to me even though my c-section was not emergent. I actually began introducing myself as a "statistic" to the other rally goers. I am someone personally affected by the c-section rate and I want to change things. I feel personally shaken by the deaths of these women after their c-sections and I was proud to be in the company of women who know the beauty of natural birth and who supported me in efforts to reduce the cesarean rate in NJ.

 

The spokesperson for Underwood was cordial and receptive to our rally. Several NJ papers including the state-wide Star Ledger, and the local Gloucester County Times ran articles about the rally. In addition, the Gloucester  County times ran an editorial in support the maternity information act which would provide mothers with facts about hospitals and providers regarding all aspects of maternity care, allowing them to make informed choices.

We had a section of Ina May's quilt there dedicated to mothers who lost their lives in childbirth. I couldn't help staring at it and reading each of the squares with the names of a mother and child. I sincerely hope that sent a message of love and remembrance. I didn't know those women and there is really nothing I can do to bring peace or comfort to their families. But I can show that they did not die in vain and that they will be remembered. More than that, we will do everything we can to call attention to the cesarean epidemic in the state of NJ and prevent more women from dying, more fathers from leaving the hospital without their wives, and more babies from growing up without their mothers. As the Gloucester County times wrote in their editorial: "The finest memorial to the 2 young mothers would be to enact sound state legislation to improve maternal health care and increase knowledge about options."

VBAC in NJ newspaper article

The NJ Star Ledger addressed the difficulty in finding providers for vbac in NJ:

After C-section, some mothers dare defy trend

Sunday, July 01, 2007

 

BY CAROL ANN CAMPBELL

Star-Ledger Staff 

Weeks after her Caesarean section, Dana Roberts could not bend over because she hurt too much. She could not laugh, and even with narcotic painkillers it felt as if her stomach was being scratched with sandpaper.  They said, 'We'll do a 'C' to get the baby out.' They made it sound so easy," the Manville resident said. "But they didn't tell me I would watch everyone else take care of my baby. That I couldn't count her toes. That for weeks it would feel like my stomach was exploding."

Roberts, 32, is pregnant again and desperately wants to avoid a surgical delivery for her second child. But her desire to give birth vaginally this time pushes against a trend in New Jersey. Over the past decade, the number of women having a vaginal birth after a Caesarean -- a VBAC -- has plummeted, a Star-Ledger analysis of state health data found.

Some doctors refuse to perform VBACs. A handful of hospitals refuse, too.

A decade ago, 34 percent of New Jersey women who had Caesarean sections delivered another child vaginally, the analysis shows. Last year the figure had shrunk by three-quarters to 8.5 percent. At many hospitals, just 2 percent to 4 percent of women with previous Caesarean sections deliver babies without surgery.

To supporters of VBACs, the dramatic shift signifies a sharp increase in the medical management of birth, and a lack of choices for women. To many doctors, though, avoiding VBACs is simply safer because otherwise, on rare occasions, the mother's uterus can rupture at the site of the previous incision -- a potentially catastrophic complication for mother and child.

These doctors say the rise of VBACs in the 1990s was fueled by health insurers seeking to save money on surgeries, not by medical evidence, and that anything less than a perfect birth outcome today could result in multimillion-dollar lawsuit against the physician.

Louis A. Schwarz, an obstetrician in Hackensack said he will not do VBACs. When the uterus breaks, the doctor likely gets sued," he said, "but that's not why I don't do them. I've seen bad results from VBACs, and if you've seen those bad results you don't want to go back. Why would I double the risk of complication for my patient?"

Schwarz cited an influential 1996 New England Journal of Medicine study that found the risk of major complications doubled for prior-Caesarean mothers who went through labor, compared with those who underwent a scheduled repeat C-section. In the study of 6,138 women with prior Caesareans, 3,249 women tried to give birth vaginally. Ten women in the group experienced uterine rupture and two of the babies died because of the rupture. No mother in either group died.

UNWELCOME 

Some hospitals turn away women who want VBACs.

Hackettstown Community Hospital tells women upfront that it no longer delivers VBAC babies.

"We feel this is a high-risk delivery better performed in a tertiary (high-level) facility," a statement from the hospital said.

Proponents of VBACs argue that the risk is slight and the rupture often can be managed. They note that Caesarean section is major abdominal surgery that carries its own risks to the mother, such as infection, blood clots and hemorrhage. In addition, they say a vaginal birth allows women to immediately bond with and care for their new baby.

"Birth has become more medically managed today than even a decade ago, and maternal and neonatal outcomes have not improved," said Billee Wolff, a nurse and childbirth educator in Bergen County.

Wolff said some women are seeking out VBAC-friendly doctors and midwives. "Some doctors say they do VBACs -- but if the baby hiccups during labor, the mother is off to the O.R.," she said.

For Dana Roberts, finding a practitioner who supports VBACs meant driving an hour from home. She sought out Midwifery Care Associates in Pennington, which says it has assisted in 44 VBAC attempts, 42 of them successful, in the past 17 years. The practice's overall Caesarean rate is just 5 percent.

"We've seen an increase in the past year of women who can't get VBACs near their home, so they are coming to us," said Louise Aucott, a certified nurse midwife with the practice. The midwifery practice does many home births but will assist with VBACs only at the Capital Health System Mercer Campus, in Trenton

.

"This should be a choice that women make after considering all their options," said Aucott. She said Roberts has an "excellent" chance of delivering her baby without surgery.

Roberts, a food scientist, said she is looking forward to a more natural approach. She wants to hold her baby right after birth -- something she could not do after her Caesarean. "I've learned what I can do to make a difference this time," she said.

SCAR PRESSURE 

Meanwhile, the statewide Caesarean rate -- the highest in the nation -- continues to rise. More than 37 percent of women who gave birth in New Jersey last year did so surgically, according to state health statistics. At some hospitals, nearly half of all births are surgical.

The American College of Obstetrics and Gynecology continues to support a woman's right to choose a VBAC under the right circumstances, said Paul Stumpf, the group's New Jersey representative and the vice chairman of Ob-Gyn at Newark Beth Israel Medical Center. In the 1960s and 1970s almost no physicians did VBACs, he said.

"During a Caesarean, you cut the mother's abdominal wall and uterus. You cut through muscle. You can sew the muscle back together, but the scar is never as strong as intact muscle," he said. During a subsequent pregnancy and labor, the scar is under tension.

"But we found in the 1980s that you could monitor patients and there was a very low risk of bad things happening," he said.

Stumpf said the national VBAC rate reached 27.5 percent in 1995. But some women had ruptures, and publicity over these disastrous outcomes chilled enthusiasm for VBACs. The national rate is now 9.2 percent, he said.

Merely being pregnant puts pressure on the Caesarean scar. Stumpf said data from the college of obstetrics say the risk of rupture is 1.6 for every 1,000 women who have elective repeat Caesareans; 5.2 for every 1,000 women who go into spontaneous labor; and 7.7 for every 1,000 women whose labor is induced with medication.

"The chance of rupture is very small, but it can be very bad for the baby," Stumpf said. "Most people think the risk of losing a baby, even a tiny risk, is not acceptable. ... But there are risks to C-section, too. There is no perfect choice."

Joseph Ramieri, chairman of obstetrics and gynecology for Atlantic Health System, which operates Morristown Memorial Hospital, said he has seen a rise in women who need hysterectomies because of repeat Caesareans.

"It's okay to do one or two C-sections, but when you get into three or four, it's another issue," he said.

He said the overall increase in Caesareans partly stems from a lack of training among today's physicians in rotational maneuvers and forceps.

"When I was a resident we had a 5 percent C-section rate," he said.

Many physicians who perform VBACs ask women to sign a consent form that outlines the possibility of death or brain damage to the baby. Despite the fear of liability, few of the physicians interviewed for this story knew of specific VBAC lawsuits.

John Blume, an attorney with Blume Goldfaden Berkowitz Donnelly Fried & Forte, the state's largest medical malpractice law firm, did not know of any VBAC-related lawsuits filed by his firm. He said lawsuits are not driving the decline in VBACs.

"There is increased risk with VBACs," he said.

BACK TO THE NATURAL 

Some women who are trying to reverse the trend are lobbying in Trenton for legislation to require practitioners to release their VBAC and C-section rates to potential patients.

"We advise women to seek out practitioners with a 10 to 15 percent C-section rate," said Stacey Gregg, a childbirth educator and spokeswoman for the International Cesarean Awareness Network-New Jersey. On its Web site, the group calls VBAC safer than repeat Caesarean for both mother and baby -- and says modern obstetrical practice is forcing women to have unnecessary surgery.

One practice in Lakewood is bucking the trend. Women's Health Associates has a Caesarean rate of 4 percent, according to Christian Hoffman, one of four obstetricians in the group, which includes a perinatologist (a specialist in maternal and fetal health) and five midwives.

The practice has delivered 317 VBAC babies, with a success rate of 86 percent, he said.

Hoffman said the practice had one rupture, which was handled well, and mother and baby "did great."

He said inappropriate use of Pitocin, a drug to induce labor, and epidurals, or spinal anesthesia, can inhibit the natural process of labor and lead to Caesarean sections.

"We try to be as natural as possible," he said.

The practice primarily sees Orthodox Jewish women, Hoffman said, and they often are motivated to give birth vaginally so they can have large families.

TheLakewood practice reflects how culture and physician practices can affect birthing methods.

"Their bodies are no different than anyone else's," Hoffman said. "Many of our patients very much want VBACs, and we don't have a problem with that."

For 10 years of hospital-by-hospital data, go online to www.nj.com/news/bythenumbers/