Unnecesarean: The Blog

OBs, Midwives, Lies and I Have No Idea How to Title This Post

Jill — Fri, 18 May 2012 13:22:31 +0000

It’s been about four years since I embarked on this here journey to figure out what the hell the problem is with maternity care in the United States. I’ve been down a few roads and back, tried on a few frameworks and took them off in favor of cruising around the interwebs naked and now have my mind set on (read: am obsessed with) a different way of tackling the problem using research that’s been around for decades.

Here are a few things I have learned, and I have learned them in a pretty unique manner, mostly in the last year or two.

Video: Caesarean section at full term for contracted pelvis (1930)

Jill — Thu, 10 May 2012 16:25:26 +0000

My friend Grace hit the motherlode of videos for medical history junkies on the Wellcome Film YouTube channel.

This series of three silent British films from 1930 shows and describes (with language that reads like a standardization checklist) in detail the cesarean section.

Part 1:

Part 2:

Part 3:

Quick Hit: What to reject when you're expecting

Jill — Thu, 10 May 2012 16:01:17 +0000

Consumer Reports published an updated guide to overused procedures in maternity care, aptly and cleverly titled, “What to reject when you’re expecting.”

Hat tip to New Hampshire Patient Voices

New research shows...

Jill — Tue, 08 May 2012 19:57:39 +0000

Nice that there is research that shows that all of the time I have spent goofing around on the Internet has had a measurable effect and that continued photoshoppery has positive public health implications.

All I am going to say about this is that I walked past that blank bulletin board at the ACOG Annual Clinical Meeting and tried to tell myself not to do something this dorky. As usual, resistence was futile. This one is for the long-time readers.

Hopes of VBAC out the window?

Jill — Sat, 05 May 2012 13:37:51 +0000

This comment was left on one of our Facebook pages. I want all of you OB-GYNs who read this blog to take an extra second to think this one through and examine the contribution your refusal or resistance to attend VBACs is having on women’s health overall, please.

“I am on the waiting room, after seeing a “VBAC friendly” OB, turn against her patient. This is throwing my hopes of a VBAC for myself out the window. I guess I have to start thinking about HBAC.”

Is that what you want? More Home Birth after Cesarean?

Please work toward making VBAC available to more women. We all know it is a safe and appropriate choice for most women. Sure, you might have to make waves in your community. You’ll probably have to rally and do some outside-the-box thinking (no pun intended). The problem with the primary cesarean rate climbing is that the ol’ VBAC dilemma isn’t going to just go away… it’s going to snowball.

Thank you. See you at the ACM. I’ll be there wearing a moustache and a fedora and hiding in the back.

50% Off Webinar for the Human Rights in Childbirth Conference

Jill — Tue, 24 Apr 2012 05:20:06 +0000

Readers,

I have been confirmed as a panelist at the Human Rights in Childbirth Conference on May 31 - June 1, 2012 at The Hague University of Applied Sciences in the Netherlands.

If you attend, please take a few seconds to fill out the box on the form which asks how you learned about the conference with some variation of Unnecesarean, The Unnecesarean, Jill Arnold, CesareanRates.com or anything that will let them know that I referred you. Without the benefit of institutional support and without a spare $1500 in my pocket, I asked if they would be willing to help me get there and was relieved that I could help them by filling seats.

If you are in the Netherlands, then please ga naar de conferentie en vertel hen dat ik van je verzonden.

For those of you who want to stay put and attend the conference from home, you will want to get a group together and sign up for the webinar for half-off just for saying I referred you!

Please read more and reserve your spot today. My new Dutch friends can now mock me for using Google Translate to destroy their language. Het spijt me.

Jill

Human Rights in Childbirth Conference

Healthcare in childbirth is of great importance to society. This conference takes a unique, consumer perspective. It will focus on the legal and human rights issues arising at the intersection of childbirth and healthcare. The conference is being organized and hosted by affected groups, a legal research institute, and an international law program at The Hague University. Therefore, it creates a unique opportunity for a wide spectrum of stakeholders to share perspectives on the issues relating to birthing women and their families.

Doctors, midwives, lawyers, and parents agree on the general principle of client-centered care in childbirth. The conference will be a platform to explore the practical aspects of human rights in 21st century healthcare systems, and how those systems can both maximize safety and respect the dignity of the women they support.

For more information on the conference and for an overview of our esteemed panelists, please visit our website: www.humanrightsinchildbirth.com. (Facebook | Twitter)

About the Human Rights in Childbirth Webinar

This webinar provides a unique opportunity for professionals and parents around the world to be a part of the global discussion on human rights in childbirth. The Human Rights in Childbirth Conference will be LIVE streamed by a professional team, so you can watch live and join the discussion via twitter.

If you are unable to join live, you will be able to watch the conference panels at your leisure for 30 days following the conference, join the ongoing discussion via the Facebook page, and connect with the regional and international networks of professionals capable of protecting women’s fundamental right to authority and support in childbirth.

We want the conference to be accessible for your community, and we have negotiated a special price for you to join this important event!

Regular Price: €175/2 days inclusive the pre-conference publication. [Edit 5/8/2012- One day webinar option dropped]

Special Price for The Unnecesarean: $75/2 days pre-conference publication not included.

How to get this special price:

1. Go to the Registration Form: Registration Page

2. Fill in the registration form and select the webinar (you will see the regular prices but don’t worry you will get your discount!), in the field “How did you learn about the conference? *” fill in “Unnecesarean Discount”

3. Do not pay by clicking on the PAY PAL directly (then you will pay the regular price). You will receive a confirmation email from our office with the discounted price and you can pay either via PAY PAL or via a bank transfer. The details for this will be provided in the email confirmation (this is created by a human, it is not an automatic mail, so won’t be sent directly).

"Fracturing the Doctor-Patient Bond"

Jill — Thu, 19 Apr 2012 15:00:33 +0000

Canadian Government Releases Facility-Level Cesarean and VBAC Rates

Jill — Mon, 09 Apr 2012 22:32:22 +0000

Labor takes longer now. In other news, green hospital gowns cause colitis.

Jill — Mon, 02 Apr 2012 22:26:47 +0000

As a practicing obstetrician in a busy office, I am continually on the lookout for complications arising in my patients. That said I have read this study and, with complete surprise, said aloud, “The federal government funded this WHY?”

Sharing All of the Important Numbers

Jill — Tue, 27 Mar 2012 13:58:58 +0000

Just another corny post on The Unnecesarean.

ACLU Intervenes to Help Woman Get a Trial of Labor

Jill — Mon, 26 Mar 2012 20:14:53 +0000

The ACLU stepped into help a South Carolina woman avoid coerced surgery.

Everything's Bigger in Texas

Jill — Tue, 20 Mar 2012 19:55:41 +0000

Cesarean rates are no exception.

The Case for Not Using One Personal Anecdote as a Global Case

Jill — Sat, 17 Mar 2012 18:07:22 +0000

Massachusetts cesarean rate history and VBAC bans | Massachusetts cesarean rates by hospital, 2009

The Atlantic’s piece, The Case for Hospital Births, seems to be sending segments of the internet into a stir.

An Informal Poll on VBAC Access

Jill — Wed, 14 Mar 2012 18:56:13 +0000

Jill Arnold and Bianca Wooden Interviewed on SuperTalk Mississippi Radio

Jill — Sun, 04 Mar 2012 16:55:51 +0000

On February 29, 2012, Bianca Wooden of Mississippi Friends of Midwives and I did an interview with Paul Gallo of SuperTalk Mississippi. The 14 minute interview is here (credit to SuperTalk’s Paul Gallo Show). I was concerned about going on a conservative talk show radio, mostly because of that whole steel cage wrestling “two men enter, one man leaves” thing and I didn’t want to have to be the liberal emerging from the cage covered in blood. It ended up being a lovely interview broadcast to the entire state.

CesareanRates.com

Jill — Tue, 14 Feb 2012 17:13:52 +0000

Come on over to cesareanrates.com. The Unnecesarean will be updated weekly from this point on. May this post serve as an apology for the exceptionally weird and/or corny content in the past months while I got the new site ready. I am sure you have had your fill of photoshoppery and sarcasm.

A Victory for Activists™: Censoring the Glory of the Belly

Jill — Thu, 02 Feb 2012 16:57:43 +0000

I had planned to post something substantial today but this is so much better.

I re-posted (from here) this glorious photo series of bellies to the Facebook page. Bellies… they’re so beautiful. I revere them. You should, too.

Venn Diagram of Site Metrics: Readership of The Unnecesarean

Jill — Fri, 27 Jan 2012 17:23:05 +0000

How exactly would one describe our large, lurky readership? With science, of course.

Home Births in the United States, 1990-2009

Jill — Thu, 26 Jan 2012 17:52:39 +0000

CDC National Center for Health Statistics released a new data brief today on home birth in the United States.

Key findings include:

After a decline from 1990 to 2004, the percentage of U.S. births that occurred at home increased by 29%, from 0.56% of births in 2004 to 0.72% in 2009.

For non-Hispanic white women, home births increased by 36%, from 0.80% in 2004 to 1.09% in 2009. About 1 in every 90 births for non-Hispanic white women is now a home birth. Home births are less common among women of other racial or ethnic groups.

Home births are more common among women aged 35 and over, and among women with several previous children.

Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births.

The percentage of home births in 2009 varied from a low of 0.2% of births in Louisiana and the District of Columbia, to a high of 2.0% in Oregon and 2.6% in Montana.

NCHS Data Brief No. 84: Home Births in the United States, 1990–2009

Down Home Gynecology

Jill — Tue, 24 Jan 2012 16:04:31 +0000

A friend just inquired as to whether I wrote this. The answer is yes. Of course I did. And I posed for the rendering that also appears on mudflaps which you can pick up for $27.99 at your nearest NAPA Auto Parts. Incidentally, you can also pick up a lot of the down home gyno supplies recommended in my book at NAPA, so bring your checkbook.

Why It's Difficult to Calculate Provider-Level Cesarean Rates

Jill — Wed, 18 Jan 2012 14:45:00 +0000

Guest post by Jill’s Friend, MD

I was asked my cesarean rate recently and gave my stock answer of “I do not know. I have never calculated the percentage because it is as low as possible, so why bother with the number?”

This.

Was.

The.

Wrong.

Answer.

Iowa Cesarean Rates by Hospital, 2010

Jill — Wed, 11 Jan 2012 16:27:03 +0000

SOURCE: Iowa Department of Public Health, Bureau of Health Statistics

"Non C-Section Deliveries"

Jill — Fri, 06 Jan 2012 20:39:53 +0000

Aw, c’mon now. Really?

Twin Birth Rate in the U.S. Rose 76 Percent in Two Decades

Jill — Wed, 04 Jan 2012 17:01:00 +0000

CDC NCHS released a new data brief this morning on twin births in the United States from 1980 to 2009. Here are the key findings from the report:

Working to Ban VBAC at Your Hospital? Then Stop Griping About Home Birth

Jill — Thu, 22 Dec 2011 14:51:52 +0000

I posted this prompt over yonder on the Facebook page:

Here is question posted here by Nicole: “So what are you supposed to do when the hospital closest to you has a VBAC ban? Show up when ready to push?” What did you do? Stories?

Responses are pasted below.

Minnesota Cesarean Rates by Hospital, 2010

Jill — Tue, 13 Dec 2011 13:54:44 +0000

SOURCE: Minnesota Hospital Assocation

Massachusetts Ten Highest Total Cesarean Rates, 2008 and 2009

Jill — Sat, 10 Dec 2011 17:45:00 +0000

Almost as fun as The Late Show Top Ten List, but not.

Perinatal Quality Collaborative of North Carolina Receives $1M in Support

Jill — Tue, 06 Dec 2011 15:30:00 +0000

I have kept tabs on the Perinatal Quality Collaborative of North Carolina since they produced the following video, Maverick, in which a mom talks about the repercussions of an early induction of her baby. PQCNC has managed to get more than half of North Carolina’s 91 hospitals that deliver babies to participate in their initiatives, which focus on quality improvement and cost reduction.

Illinois Cesarean Rates by Hospital, 2010

Jill — Sun, 04 Dec 2011 13:00:00 +0000

The above data for the calendar year 2010 can be found on the Illinois Health Facilities and Services Review Board site, which falls under the auspices of the Illinois Department of Public Health. The report that lists both live births by hospital and number of cesareans performed at each hospital is called the Annual Hospital Quality Data Spreadsheet, which was last revised on November 29, 2011.

The Nativity Story: 2011

Jill — Mon, 28 Nov 2011 14:00:00 +0000

By Lauren Plante, MD

A couple thousand years ago, a nice Jewish girl has a baby in a stable. Rejoicing ensues. And so it should: the astonishing event of birth resonates with us at a primal level. It’s an everyday occurrence…