International Cesarean Awareness Network

Hi Pam! You know how much we care about mamas and babies, so we’re very excited and honored to chat with you. Can you give us a little insight into what ICAN does?

The International Cesarean Awareness Network is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting Vaginal Birth After Cesarean (VBAC).

Why should women be more educated about cesareans?

So many women get caught in a spiral of interventions and medical interference, which leads to cesareans. If you know what is likely to lead to a cesarean, it might be possible to prevent one. When a cesarean is necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. However, in the United States, a cesarean is done every thirty seconds. In many cases, the reasons are not medically indicated. Women are having cesareans because of carpal tunnel syndrome, indigestion, or because they already had one cesarean and their care provider doesn't do VBAC. The inappropriate overuse of cesarean surgery is jeopardizing the lives of mothers and babies.

Many women are scarred, emotionally and physically, when one out of every three births ends in a cesarean. Many of these women want a vaginal birth after their cesarean, but are told it is against hospital policy to VBAC, some are even told it is against the law. Some attempt to have a vaginal birth despite the medical “scare provider's” tactics to try and get them to schedule another cesarean. They show up at the hospital in labor and immediately face abuse. They are threatened with having their support people removed and having their babies taken away. If hospitals become a place of fear, threats and coercion, instead of a place of care, healing and treatment; what does that mean for our society? Surgical decisions rest with the woman. Why is that being taken away from women? What does that mean for all patients that come through hospital doors? If women are more educated, they know what to expect and when to advocate for themselves or ask their support person to intervene. Without education, women get caught in the process.

It sounds like this is not just about one type of birth over another, but a real gap in women's health education. How can we be better advocates about women's health issues in general? We believe strongly that women can be their own best advocates!

ICAN educates women about options, so they can make informed decisions during their pregnancy and birth. It is critical that women assume more responsibility for their own births. Birth is a normal physiological process. Research shows that with emotional support, education and an honest opportunity, the vast majority of women can have a healthy vaginal birth. A healthy birth incorporates emotional, physical, and spiritual well being.

By becoming informed and educated about pregnancy and birth, the expecting family knows their options and everyone is more comfortable with the process. This makes for a better experience for everyone in the family.

Can you give us some suggestions for real things women can do to be better educated?

1. Read Jennifer Block’s book Pushed: The Painful Truth about Childbirth and Modern Maternity Care.
2. Hire a doula.
3. Read The Thinking Woman's Guide to a Better Birth by Henci Goer.
4. Interview care providers.
5. Read Sit Up and Take Notice by Pauline Scott.
6. Ask questions.
7. Read Gentle Birth Choices by Barbara Harper.
8. Browse articles on Midwifery Today's website: http://midwiferytoday.com/articles/
9. Read The Birth Partner by Penny Simkin.
10. Visit Childbirth Connection http://www.childbirthconnection.org/

Here at EMAB we worry about the lack of after-care for mamas who have had a cesarean, that’s why we created our C-Section Healing Kit in the first place. Can you give us some tips and ideas for women who are planning a cesarean?

If your cesarean is planned, it is important that you have the opportunity to fully discuss with your care provider the reasons for your surgery. Knowing that this surgery is the best choice for you or your baby can create a less traumatic environment for you. If you desire a vaginal birth and feel that a cesarean surgery may be unwarranted for you, consider getting a second medical opinion

If you still feel a cesarean is necessary:

1. Write down your preferences for surgery and for postpartum care of you and your baby. Schedule an appointment with the anesthesiologist. Discuss options and effects of medications. Ask to have at least one, if not both, of your arms free. Discuss who can be in the operating room with you. Sometimes a doula can accompany you while your partner stays with baby.
2. Ask to have the staff refrain from extraneous conversation.
3. Request that a member of the medical team narrate for you exactly what is happening.
4. If you would like music playing, ask for it.
5. Ask about photographs or videotaping the surgery.
6. Discuss the option of seeing or taking home your placenta.
7. Many women have been asked on the operating table about tubal ligation, "since the doctor is there anyway" and have answered hastily only to regret it later. Make the decision before your surgery.

Cesareans carry the same risk as any surgery and administration of blood products may happen when there is excessive bleeding. Options may include banking your own blood or refusing blood products and building your own supply back to normal in the days following your birth.

Discuss whether the father of baby can cut the cord. If you would like to see the delivery, discuss lowering the screen or positioning a mirror. Discuss and thoroughly understand the separation of baby and mother. Will they place baby directly on your chest? In your line of vision? How long will you be in the recovery room and will baby be there as well? Can you have a support person there with you, either your spouse or a doula?

Have a well prepared plan for baby's care after delivery. Routine health checks using the APGAR assessment, vitamin K injection, eye ointment application, PKU test, weight and height measurements, a bath, and possibly Hepatitis B or other vaccinations. It is highly recommended you research each of these and make an informed decision on allowing, delaying, or not allowing these procedures. You can ask for any procedures to be done in your presence rather than in the nursery.

What about mamas who have a cesarean for emergency reasons?

Women tell me all the time that they skipped the section on cesareans in their pregnancy books. With more than one out of every three births ending in a cesarean, it is a good idea to read about cesareans. Most cesareans aren't for emergency reasons, they are simply unplanned for.

When you have had a cesarean, know that you need and deserve extra support during this time of recovery. A cesarean is major abdominal surgery.

To Relieve Pain and Assist Healing:

1. Take pain medication as needed for comfort.
2. Rest as much as possible and limit visitors.
3. Use pillows to support your abdomen when turning, standing, coughing and when feeding the baby.
4. Have several diapering stations so you can change your baby easily.
5. Keep baby near you at night so you do not have to get up.
6. Have a pitcher of water or juice and a plate of nutritious snacks near you. Eat and drink freely and well.
7. Get help with the other children.
8. Increase activity gradually.
9. The area around your scar will bruise. Talk to your healthcare provider about other things you might see or should not see and call with any questions right away.

Thank you, Pam, for all the great ideas. Mamas, daughters, grandmothers and mamas-to-be, let’s all stand together for a healthy, informed, spiritual and personal birth process. Our pregnancy and childbirth options are in our own hands; let’s make sure we support our rights and the rights of others, especially during such a vulnerable time.