Where are the mothers?

I live in a city with a hospital that has roughly 3,500 births every year.

Their cesarean rate is very hard to find (as are most hospitals'), but based upon information from some of the doctors and nurses that work there, it is estimated to be around 50% (some say closer to 60%). The rate is, in part, this high because the hospital doesn't "allow" VBACs. So, the many first-time mothers whose labor inductions fail (induction rate is very high in my area) or whose labor is taking too long that end up having a cesarean...with future babies, they are told that they must have a repeat cesarean. I have met many mothers in my city that have had 4 and 5 cesareans. It is criminal.

There is a hospital about 20 minutes away that allows providers to attend VBAC, though not every provider does.

Where are the mothers? I am a little surprised to see how very, very few women seek out the services of a midwife for an out of hospital VBAC. I would expect there would be such a demand that we would be needing more and more midwives to accommodate the demand. But, there isn't.

Of course, not every mother will decide that an HBAC is the right choice for her. But, it makes me wonder...where are the mothers? Ar they signing up for repeat cesareans? Are their doctors telling them that, although their hospital doesn't 'allow' VBACs, even the National Institute of Health came to the conclusion that a VBAC is a perfectly safe option and that perhaps they should look into different birth options? I seriously doubt that.

There are approximately 50-60 homebirths each year in my county. It would make me so happy to see that number sky-rocket in the coming years.

Clarification

Because I think there may be some confusion from my last blog entry, I wanted to clarify something.

The rule changes that are being proposed will not make breech, twins, VBACs and postdates 'illegal' or absolute risk factors for licensed midwives. They will still be 'allowed' to attend them out of hospital.

But, they are creating stringent criteria in each of those categories, proposing to dictate under what terms a VBAC, breech, twin, postdate birth would be considered safe enough to stay home (with a licensed midwife).

For example, if the baby is breech, is must be frank breech with an estimated fetal weight less than __gms. Or....once you hit 41 weeks, you must have a weekly biophysical profile and get a score of __ or better to continue with a homebirth. (AGAIN, THIS IS JUST AN EXAMPLE OF SOME OF WHAT I HAVE HEARD BEING PROPOSED. ITS STILL ALL IN PROCESS).

Oregon's current rules dictating what is an absolute risk factor for out of hospital birth with a licensed midwife are very BROAD with lots of grey area. They were originally written this way on purpose.

It should be up to each mother and each midwife individually to decide if they are comfortable proceeding with an out of hospital birth, not up to the licensing board. I think that the informed choice process is critical in this issue.

So, when writing those letters, please remember they are not (at this point) discussing making VBACs, twins, breeches, and postdates illegal...but are trying to put restrictions and set in stone guidelines around them. (Not good for birthing women!)

Come to the meetings if you can!!!

To all Oregon mothers!

(eta: See my post on clarification of this issue here)

We need EVERYONE in Oregon to write letters in support of keeping birth choices open for birthing families!

The Board of Direct Entry Midwifery is currently reevaluating our current rules and regulations, reconsidering what should be considered an 'absolute risk factor' and what should risk women out of the care of an licensed midwife/out-of-hospital birth. This is taking choice out of the consumer's (YOU) hands and they need to hear from you!

The things that they are focusing on are:

POSTDATES
TWINS
VBACs
BREECH

There are board meetings being held on each of these topics (some of which the dates have already passed). Upcoming meetings can be found here and are as follows:

June 2, 2010, 9am , topic: BREECH and TWINS
ODVA Auditorium, 700 Summer Street NE, First Floor, Salem, OR

June 16, 2010, 9am , topic: VBAC and POSTDATES
ODVA Auditorium, 700 Summer Street NE, First Floor, Salem, OR

August 5, 2010, 9am , topic: TBA
Rhoades Conference Room, 700 Summer Street NE, Third Floor

August 12, 2010, 9am , topic: TBA
Rhoades Conference Room, 700 Summer Street NE, Third Floor

These meetings are open to the public, but there won't be time for public comment. (Because why would they want public comment when they are working on rules to protect the public, right? ). Even so, your presence is needed! Please attend, and show your support for birthing choices in Oregon. (when you sign in, you can write "Support Birth Freedom!" or something similar). You don't have to stay for the entire meeting, and you don't have to be there right when it starts. Even if you can only come for one hour, please do!

Since there are no times for public comment, we need to FLOOD their mailboxes with letters in support of women having the choice to choose where and how they give birth. Email letters to samie.patnode@state.or.us or snail mail to Oregon Health Licensing Agency (OHLA), Attn. Samie Patnode, 700 Summer St. NE, Suite 320, Salem, Oregon 97301-1287

Speaking as a birthing woman, I am highly insulted the the state is trying to tell me what is safe and what is not safe when I give birth. A mother is of course still be able to stay home alone if her midwife has to risk her out and discontinue care, but no woman should choose unassisted birth because she is backed into a corner!!

Many of you are aware of the lovely law in Oregon that allows midwives to be unlicensed if they choose. However, our voluntary licensure law is ALSO at risk. While there are many who are under the false assumption that licensed midwifery is safer midwifery, this couldn't be further from the truth. What mandatory licensing does is LIMIT choice for families.

More than ever before, we need the state of Oregon to hear from the consumer of midwifery care (birthing families...YOU!!!) that you won't stand for your choices being limited and restricted!! Please write and come to the meetings!!

To summarize, here are the main points that your letters should include:

• keep our rules and protocols as they are!
• allow women to choose for themselves once they have been given informed choice! (women are smart enough!)
  
• support voluntary licensure!
  

If you have never had a breech baby, or aren't planning a VBAC, or never go past your due date, or have unassisted births and don't utilize midwives, please don't think that this won't affect you. It does. It will have far reaching effects for all women planning out-of-hospital births. Please act. Please make your voice heard and pass the word on!