In recognition of Cesarean Awareness Month, I want to share an interview with Christa Billings, the president of International Cesarean Awareness Network (ICAN). For over 30 years, ICAN has had an international presence and through peer to peer support and many volunteer hours, has worked tirelessly to prevent unneeded cesareans, help women recover emotionally from a cesarean and advocated for VBAC as a safe and appropriate choice for many women when they plan their future births.

I have been the chapter co-leader of ICAN Seattle for several years, and have been honored to walk alongside the women who make up our chapter as they have discovered their own strength and power and learned how to seek information and evaluate evidence and research. There are many chapter leaders just like myself, working hard in our own communities, to help women both before and after a cesarean birth. ICAN has partnered with many other maternal health organizations and maternity leaders to help improve the state of maternity care for many women. Learn more about this organization and be sure to share this organization (and its resources) with your students, clients and patients.

Sharon Muza: Can you tell me a bit about the history of ICAN?

Christa Billings: The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization that was founded by Esther Booth Zorn and many other motivated women in 1982. ICAN originated as "Cesarean Prevention Movement," later changing its name to ICAN in 1992 to reflect a more positive statement. ICAN has now grown to over 180 chapters throughout the United States and worldwide over the past 30 years. ICAN's mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).

SM: How many chapters does ICAN have nationally and internationally?

CB: ICAN has 181 chapters, 145 in the USA, and another 36 internationally.

Mission Statement of International Cesarean Awareness Network

The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).

SM: What does an ICAN meeting look like?

CB: A typical ICAN meeting entails women coming together with women of similar experiences for peer to peer support. Meetings are sometimes topic specific and sometimes general support. Often birth stories are shared. There is often laughter, tears and a feeling of camaraderie. The feel of a particular meeting can change based on who is there and what it being discussed. I like to remind newcomers that they should always try a second meeting as they are all different. Sometimes meetings can be VBAC heavy and other times they can be cesarean recovery heavy. It really depends on who shows up to the meeting and who is driving the discussion.

SM: Who is welcome? Mothers? Partners? Birth Professionals? Providers?

CB: Some meetings are open for women/lap babies only and other meetings welcome children, dads, husbands, partners, birth professionals and other community members who want to learn about cesareans, VBAC and recovery. Each chapter may vary on how they do things, so check in with the chapter leader if you have any questions.

SM: What are some things that ICAN does that reinforces it's mission statement?

CB: We offer support to mothers through listening. We also help in educating them by providing evidence based research to help them make the best possible birth choices for them or to cope/understand what they have experienced. We recognize that both VBAC and cesareans carry risks. We help women understand what those risks are with both choices, where typically many providers only provide the VBAC risks.

SM: I know that ICAN periodically holds conferences; can you tell me about them? Are there continuing ed hours available from them?

CB: The ICAN conferences are a time to spend quality face to face, talking with women who support VBAC and are interested in reducing the cesarean rate. This conference isn't just for VBAC and cesarean mothers; it's for anyone who supports birth. There are many great speakers and public discussion on various birth topics. We do offer continuing education hours.

SM: How did you get involved in ICAN yourself? How did you find yourself in the president's position?

CB: I found ICAN five years ago when I first stepped foot into an ICAN meeting during Cesarean Awareness Month. I was just a mom looking for support as I planned a VBAC. I quickly found great support. My second birth ultimately ended in another cesarean, even though I attempted a VBAC. If I couldn't have a vaginal birth I wanted to make sure others had the support and education to ensure the best advantage in planning for their births. I wanted to give back to the organization that helped shape my birth journey. I decided to join my local ICAN chapter's board & accepted a position as the Northwest Regional Coordinator. Later in 2010, I went on to VBAC my 3rd daughter at home after 2 cesareans. After attending the 2011 ICAN conference I really felt pulled to do more. The conference was very inspiring and it touched me deeply. It was a thrill to meet all the women I had been communicating with over the years. These mothers were no longer just a name in an email. Putting names & faces to it gave the journey to VBAC a whole new meaning to my life. In 2012 I joined the Board of Directors as Chapter Director. As we reshaped the board be a bit smaller and focused, I moved into the role of Vice President. The previous President stepped down and in October 2012 and I became the new President of ICAN. I never envisioned my life taking this path, but here I am and I'm proud to be the voice of the mothers for an organization so dear to my heart. ICAN has forever changed my life.

SM: What challenges do we face in lowering the cesarean rate? Do you think the tide has turned?

CB: While research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean, there is an alarming disconnect between what evidence based research shows is good for women and babies, and the way that hospitals and providers practice. Mothers need to start demanding research based care. The challenges we still face are getting care providers to work with us to improve birth outcomes by providing evidence based care and to stop practicing by provider preference, convenience, legal liability concerns and to perform cesareans only when the research clearly indicates it is needed.

I would like to think that the tide is starting to turn, but I am not ready to say it's turned quite yet. Mothers are joining together to recognize they have a voice and choices in their maternity care and are starting to demand evidence based care. The recent statements from ACOG give us a little hope that people are opening up their eyes to see how out of control the cesarean rates are in many places.

SM: Are you optimistic with recent statements from ACOG about who should VBAC and how to handle maternal request cesareans?

CB: I'm not sure optimistic is the right word, I would say hopeful. I think it is great that ACOG is finally acknowledging that primary cesareans will affect future births and that in the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended to patients. These births are a very small percentage of the births, as often primary cesareans are not being performed based on maternal request, but rather being performed by provider preference, convenience, legal liability concerns and many other reasons. I will be optimistic when providers and hospital administration acknowledge that birth is a human right, that the consumer has the right to decide whether they accept the choices presented to her and start providing true informed consent and stop using scare tactics to influence women's decisions.

SM: What do you want childbirth educators to know and share with students about ICAN and cesarean awareness?

CB: That ICAN is a non-profit advocacy and support group whose mission is to improve maternal and child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting vaginal birth. We offer support and information to thousands of women through our main office, local chapters, website, forums, email support groups and various social networks. We provide evidence-based information, using research that is accessible for women and their care providers. It's important that women understand the effects a primary cesarean can have on them and on all future births. It would be great if childbirth educators included ICAN as a resource for the families in their classes who may end up with a cesarean.

SM:What do you want health care providers to know?

CB: We are a support network for women healing from past birth experiences and for those preparing for future births. Our vision is to reduce the cesarean rate driven by women making evidence-based and risk appropriate childbirth decisions. We are not anti-cesarean. ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. While VBAC does carry risks associated with the possibility of uterine rupture, cesarean surgery carries life-threatening risks as well. The choice between VBAC and elective repeat cesareans isn't between risk versus no risk. It's a choice between which set of risks you want to take on. We are here to help educate mothers on all risks to help them make the best choices for their birth.

SM: If someone was interested in adding a chapter, what would the first step?

CB: If someone wanted to start a chapter in their city or town, they would need to contact the regional coordinator for their area. Their regional coordinator will walk them through the steps & requirements to open a chapter.

SM: What can people do if they want to volunteer in other ways besides being a chapter?

CB: They can contact our volunteer coordinator for more information on how they can help. Please let our volunteer coordinator know what your special skills are that you have to offer and she will match you up with the right position suited to your skills. We have many positions or tasks within ICAN that are not chapter specific. As an all volunteer organization. we are always looking for help.

SM: I want to thank you, Christa for all the information you have provided and for your time in doing this interview. I hope that more people will share the resources that ICAN offers with the birthing families that are affected by cesarean birth.

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