We wrap up Cesarean Awareness Month and acknowledge the week of International Midwifery Day with a post about an initiative to create a VBAC Friendly Hospital, led by midwives.

ln honor of Cesarean Awareness Month, Lakeisha Dennis, the Chapter Leader of International Cesarean Awareness Network (ICAN) of Greater Essex County, New Jersey, invited Elaine Diegman, CNM, Ph.D, to speak about Worst to First, a talk about how to modify New Jersey's high cesarean rate. Professor Diegman is head of the University of Medicine and Dentistry of New Jersey's (UMDNJ) School of Nursing's Midwifery Program.

Nationwide, the cesarean section rate is about 33%; in other words, one in three women in the United States give birth by surgical cesarean section. The cesarean section rate has risen about 50% in 15 years. According to the World Health Organization, a cesarean section rate of about 5 - 10% is the target for overall optimal maternal - baby outcome.

The state of New Jersey has a cesarean section rate of about 39%. New Jersey consistently places in the top two states for the highest cesarean section rate, sharing this distinction at the moment with the state of Louisiana.

Despite the National Institute of Health's recommendation about vaginal brith after cesarean (VBAC) being safe under certain circumstances, there is a ourtright ban on vaginal birth after cesarean (VBAC) in many hospitals across the nation and the birth educators and doulas at this meeting said they noticed some ob-gyn practices have a quiet bait and switch tactic in place around this issue.

Professor Diegman has a long and distinguished career. She started out by telling us she's actually the oldest practicing midwife in New Jersey (and maybe in the American College of Nurse Midwives). She gave us some history about the profession of midwifery. She reminded us midwifery is mentioned in the Bible and all the past royal houses of Europe used midwives for their births. She added she attended so many births in her career, she stopped counting after 3000.

Professor Diegman wanted to talk to us about pro-active change regarding lowering the cesarean section rate. UMDNJK has spearheaded a new initiative at Newark Beth Israel Hospital. UMDNJ has worked to become an official Vaginal Birth After Cesarean (VBAC) Center, keeping with the guidelines developed by the National Institutes of Health and the New Jersey Hospital Association. Dr. Diegman and Mary Markowsky, CNM, who heads the midwifery area of Newark Beth Israel, were instrumental in helping the hospital gain this distinction.

The empowering role of the childbirth educator

Professor Diegman stressed it is crucial we educate women about the normalcy of birth. She is passionate about the midwifery model of birthing. She wants to spread the word about how pain in childbirth is not like pain in illness, and emphasizes women do have the ability to rise to the experience of childbirth.

She emphasized the crucial role of education in preserving a woman-baby-centered birth culture. Professor Diegman said healthcare providers don't normalize birth for women and don't introduce women to nonpharmacological techniques to manage their birth.

Women only learn these techniques in independent childbirth education classes. So, the role of the childbirth educator is crucial in helping women understand what birth really can be and in getting our women back. The childbirth educator has a unique role to educate and empower women.

Dr. Diegman said the media and our constant exposure to technology has eroded women's confidence in their ability to give birth. She wants to bring our women back. When Oprah, a powerful media presence, comes out positively about epidurals, that hugely influences our society's views of birth. Dr. Diegman went on to say Oprah's not the only one; there's a constant flow of negative media stereotypes about birth. In addition, she said our constant reliance on technology has eroded our confidence in our bodies. She said 'We need to be warriors and get our women back!'

Sonora Davis, community doula with the Hudson Perinatal Consortium, says '...women don't seem to be taking the time to acknowledge their pregnancy or bond with their babies in utero.' She said she's noticed this leads to a lack of focus on the birth. The other doulas, childbirth educators and midwives in the room echoed this concern, saying the disconnect during pregnancy sets up a disconnect to the experience in the birth room.

Childbirth educators play a crucial role in helping women know what their options are for birth, showing them what normal physiological birth looks like, and helping them focus on their pregnancy and the miracle of becoming a mother.

It is indeed good news that there appears to be a small upswing in one corner of the world back to women-baby-centered birth. As childbirth educators we can help women learn their options for women-baby-centered birth.

We need to keep asking, as Beverly Chalmers did in her editorial in Birth (2002):

How Often Must We Ask for Sensitive Care Before We Get It?

References

Chalmers, B. (2002).How often must we ask for sensitive care before we get it? Birth, 29(2), 79-82.

I wish to acknowledge Jill Wodnick, MS, in helping collate the information in this article.

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