Labor Day has a new meaning, as maternal health advocates join others nationwide to inform women about the need to have a positive birth experience. The Rally to Improve Birth, as part of the national group Improving Birth, returns to Bergfeld Park from 10 a.m. to 1 p.m. Monday.
Maternal health advocates said having a baby shouldn’t be a fight. It’s a time to rejoice over a new life, but oftentimes, they said, women are stripped of the choices surrounding their pregnancy and birth.
This includes decisions about tests, procedures, birthing positions, induced labor or a cesarean section.
While there always will be some risk involved in delivery — whether it’s a surgical birth or a non-intervention birth — women still have the right to understand those risks, benefits of recommendations and to discuss alternatives.
“We’re not saying that (medical professionals) are doing these things maliciously,” said Katherine Stanglin, one of the event’s organizers. “We really don’t think they are. What we are saying though is women still have to say no. (Doctors) have the responsibility to say, ‘Here are all of your options.’”
Mrs. Stanglin, who is a local doula, said there are several factors that determine birthing decisions, including medical history, one’s religion and family.
She said Monday’s event offers information to help families make sound decisions before and during delivery.
“This is one way to reach out and connect with families, specifically, women hopefully, before they’re even pregnant,” she said. “What a great opportunity to plant seeds of knowing more about this before venturing down the pregnancy path.”
Improving Birth aims to work with communities to change the culture of maternal health care.
“It’s not enough for you to know,” said Jennifer Mallios, an organizer of the event. “You have to have a team to support you.”
VBACS, C-SECTION RATES & EVIDENCE-BASED CARE
At the center of the national push to have a more positive birth is the overwhelmingly high rates of cesareans and the few vaginal births after a previous C-section, or VBAC. About one-third of all births in the United States are done via a C-section. In Texas, that number is a little higher, at 35.1 percent. Local hospitals’ C-section rates are lower than the state and national figures.
Mother Frances Hospital in Tyler’s total C-section rate is estimated at 26.5 percent, according to figures compiled by the Texas Hospital Association. East Texas Medical Center in Tyler’s rate is 31.3 percent. Some of ETMC’s rural hospitals have higher rates, such as ETMC Jacksonville, at 38.4 percent. Its Athens, Crockett and Carthage hospitals have even higher rates, at 39.8, 40.4 and 46.7, respectively.
The World Health Organization has recommended that C-section rates stay within 10 to 15 percent.
Cesarean rates began rising in the 1990s but are now leveling off. There is no one reason as to why they climbed, but contributing factors include the fear of medical lawsuits and the trend to have scheduled births. However, in recent years, the medical community is moving away from elective early induction. The American College of Obstetricians and Gynecologists with the Society for Maternal-Fetal Medicine last year jointly recommended a new standard. They state that if the pregnancy is uncomplicated, labor induction should not occur before 39 weeks of gestation.
Historically, VBACS have not been encouraged. However, the risk of uterine rupture after one low transverse C-section is about .5 percent to 1 percent, according to a 2010 Agency for Healthcare Research and Quality report.
“It’s become a part of the conversation that you actually do evidence-based care,” Mrs. Mallios said.
Dr. Daren Yeager, an obstetrician at Trinity Clinic Obstetrics and Gynecology, said there hasn’t been much of a change in regard to VBACs.
“Even though we’ve had liability reform here in Texas, you’ve not really seen that pendulum swing back toward doing more VBAC births,” he said.
Yeager noted another reason C-section rates could have increased is because there had been a standard to perform cesarean on all breech babies following a 2001 study. In addition, mothers’ health concerns may prompt some doctors to recommend a surgical birth.
“We are seeing more patients who are getting pregnant later in life,” Yeager said. “They may be at more at risk for high blood pressure, diabetes. That may or may not be contributing to the increase in the cesarean rate.”
Yeager said doctors should fully discuss with their patients the risks of C-sections and their options.
“Some of the blame for the increase in C-section rates comes from the fact that we feel like cesarean deliveries are so safe nowadays,” he said. “The truth is, it’s a major surgery, and it is fairly safe, but there are risks associated with anesthesia and bleeding and a possibility of infection. All of those risks are greater than with a vaginal delivery.”
Monday’s rally and fair will include booths from a family practice physician, birth doulas, midwives, massage therapists, photographers and marriage and family counseling. Information about breastfeeding support, homeopathic medicine, acupuncture and chiropractic care will also be available.
The women said a struggle to change the culture of maternal health care in America may continue for a while, and progress starts with grassroots efforts. Rally to Improve Birth organizers said they want to connect with women in between rallies. They’ll distribute resource guides during the event Monday.
“It’s going to require legislation,” Mrs. Mallios said. “It’s going to require systemic changes in the hospitals and in the way insurance works.”