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Childbirth Professionals: A Call to Advocacy

jpeICAN President Desirre Andrews and Advocacy Director Gretchen Humphries have recently published an article in the Journal of Perinatal Education. Desirre and Gretchen call for childbirth professionals to work together with advocates to promote change so that childbearing women can be empowered to seek the best care for themselves and their babies.

Tackling the topics of cesarean surgery and vaginal birth after cesarean (VBAC) is an increasing challenge  for  the  birth  professional  even  though  scientific   evidence   clearly   supports   reducing  the skyrocketing cesarean rate and increasing the support for and availability of VBACs for childbearing women. We need to ask why this is so…

Using  RCS  and  VBAC  as  an  example  of  the broader issues within the current maternity care system, we can identify some of the issues facing both the birth professional and the consumer. Looking at the published evidence about cesarean and VBAC is  both  heartening  and  disheartening:  heartening because the evidence is that, although cesareans are safer than ever before, they should be used in a judicious manner (not prophylactically), and VBAC is a safe, viable option for most women who have had a  previous  cesarean;  disheartening  because,  even with  tens  of  thousands  of  research dollars having been spent in the past two decades to define the risks and benefits of VBAC and RCS, the evidence has not translated into education and medical practice. We maintain that the failure to accurately communicate  the  risks  and  benefits  of  RCS  versus VBAC  is  a  stumbling  block  that  needs  to  be addressed in order to apply the gathered evidence to  good  practice.

Desirre and Gretchen suggest several ways that childbirth professionals can help overcome this stumbling block.

  • Childbirth educators:

Many   couples   attend   a   childbirth   preparation course.  Within  the  curriculum,  there  is  usually some  discussion  of  cesarean  surgery.  Research has shown that if a woman is told about the option of VBAC at the time of her cesarean, she is more likely to have a VBAC. A discussion of the realities of  post-cesarean  pregnancy  and  the  validity  of VBAC  as  a  choice  would  also  serve  this  purpose… Childbirth  educators  have  the  opportunity  and ethical  requirement  to  give  the  most  accurate and up-to-date information about birth practices, even when it does not reflect current practice on the labor and delivery floor.

  • Doulas:

Although  a  doula  cannot  speak  for  her  client,  she can be a force for best practice if she has adequately prepared her client for the realities of the labor and delivery floor and is not afraid to speak the truth when the client is buffeted by conflicting information. ‘‘Preserving the experience’’ is a false positive outcome when ultimately the experience has negative repercussions in the months and years to follow, no matter what the client may describe in the hours and  days  after  giving  birth.  ICAN  knows  that women appreciate honesty, even honesty that is difficult  to  hear.  This  is  truth  that  doulas  are  well equipped to speak.

  • Labor and delivery nurses:

A  supportive   nurse   can   make   the   difference   when a woman seeks a low-intervention labor or wavers in the face of the difficulties of labor. And there is no doubt that the nurse is also often caught in the middle of the conflict between the patient and the machinery   of   institutionalized   maternity   care…Nevertheless, nurses are called to advocate for their patients, and this is no less true on the labor and delivery floor than in the cardiac wing…A commitment to staying current with the evidence for best practice through continuing education and working as a profession to support best practice is required to effect any real change within the hospital system. To do anything less is to compromise the very principles of nursing.

To summarize, Desirre and Gretchen point to ICAN as an example for all childbirth professionals:

More often than not, ICAN is the only source   of   evidence-based   information   on   the risks  and  benefits  of  RCS  and  VBAC  and  the only  source  of  support  for  a  decision  to  choose VBAC. If we have any hope of derailing the juggernaut of worsening maternal and fetal outcomes in the United States, the wider worldwide childbirth community  must  begin  to  support  and  educate as ICAN does.