Sunday, March 7, 2010


ICAN stands for International Cesarean Awareness Network. It's for any mom who has had a cesarean and wants a vaginal birth, wants to avoid a cesarean, had a traumatic cesarean, or a cesarean that involved postpartum issues such as baby blues, insensitivity from others, depression, anxiety, further complications, etc.

I went to my first meeting on Saturday, and plan to continue to go through out my pregnancy and then be involved with this amazing community for the rest of my career. They meet the first Saturday of every month at the Carver Library in Central Austin. Our Doula happens to be the Austin spokesperson for ICAN locally. You can contact her through, or through ICAN is an outstanding resource for all moms and moms to be. Go to the ICAN website, and watch the video of their mission statement.

Basically, it's raising awareness of the over use of cesarean sections, and why that is dangerous, much more dangerous than vaginal births and how "elective" cesareans should be given with FULL INFORMED consent. Also, how a VBAC is substantially safer than repeat cesareans, especially if you have had more than one cesarean.

Here is some interesting stats for those curious of the difference for the maternal side:

VBAC (pronounced VEE-back)
success rate..................63.2% (2 in 3)
Risk of uterine rupture.......0.87% (1 in 115)
Risk of hysterectomy..........0.23% (1 in 435)
Risk of blood transfusion.....1.89% (1 in 53)

These stats are for a 1st VBAC, all subsequent VBACs the risks lower, and the success rates go up by about 10-20%. The risk of rupture is lower without the use of induction and augmentation, but sadly, there are no studies out there with this number, so if you avoid induction and augmentation, your risk is lower than that stated.

Now, let's compare that to a repeat cesarean: (definitions below)

2nd Cesarean
Risk of hysterectomy........0.42% (1 in 238)
Risk of blood transfusion...1.53% (1 in 65)
Risk of placenta accreta....0.31% (1 in 323)
Risk of major complications..4.3% (1 in 23)
Risk of dense adhesions.......21.6% (1 in 5)

3rd Cesarean
Risk of hysterectomy........0.9% (1 in 111)
Risk of blood transfusion..2.26% (1 in 44)
Risk of placenta accreta...0.57% (1 in 175)
Risk of major complications.7.5% (1 in 13)
Risk of dense adhesions....32.2% (1 in 3)

4th Cesarean
Risk of hysterectomy..........2.41% (1 in 41)
Risk of blood transfusion.....3.65% (1 in 27)
Risk of placenta accreta......2.13% (1 in 47)
Risk of major complications...12.5% (1 in 8)
Risk of dense adhesions.......42.2% (2 in 5)

Hysterectomy-The need and removal of the uterus
Blood transfusion-The need and procedure of giving the mother blood through IV after a hemmorhage
Placenta Accreta-when the placenta grows into the middle layer of the uterus, and removal become more dangerous usually leading to hemmorhage and need of blood transfusion.
Major complications-These include uterine rupture, hysterectomy, additional surgery due to hemmorrhage, injury to the bladder or bowel, thromboembolism (serious, life threatening blood clot), and/or excessive blood loss.
Dense Adhesions-When scar tissue forms and binds two layers of the body together that should remain separate, such as the uterus and the abdominal wall.

Not to mention, the increase in infection, postpartum mood disorders, cost, and longer recovery, etc.

That's not touching on the risks that increase for the baby, ESPECIALLY when a baby is born by cesarean section, before labor starts on it's own.

The lack of VBAC moms is arguably the main reason the cesarean section rate is too high. In a country with a cesarean rate now reaching 31.8% and a city with a rate nearing 40%, we need to be concerned that so many babies are being born through MAJOR abdominal surgery. The recommendation is for low risk moms to be around 10% and high risk around 15%. Yeah, we are WAY off. Regardless of what anyone may say, a cesarean is not "just another way for a baby to be born". IT'S NOT A ZIPPER!

Sadly, in Austin, the hospitals with the worst rates are the ones most used. These include Seton NW and St. David's South. One of the "better" hospitals to go to is North Austin Medical Center. This is mainly due to it being the only hospital in Austin that Midwives can assist in deliveries instead of OBs. Midwives statistically have lower CS, induction, episiotomy, augmentation, etc rates, as well as higher VBAC rates. But it all depends on your provider. You can have an OB who is better than some MW and/or a MW who is worse than some OBs. It's very important to INTERVIEW your care provider to make sure that their birth philosophy agrees with yours and their rates are where they are supposed to be. If your OB has a CS rate of more than 20%, induction more than 10% or offers induction when you don't have pre-ecclampsia or serious gestational diabetes or other health issues, switch providers.

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