ICAN in the News

Cesarean Rate Jumps to Record High - Up 53% Since 1996

More Women Facing Surgical Delivery; All Ages and Ethnic Groups Affected

 

Redondo Beach, CA, March 23, 2010 – The National Center for Health Statistics reports that the cesarean rate in 2007 is the highest ever reported in the U.S., with a rate of 32 percent, up 53 percent from 1996.   The most significant increase is among women under 25, up 57% since 2000.

 

“This report confirms the alarming trend affecting all age and ethnic groups of childbearing women,” said Desirre Andrews, President of ICAN. “With every state showing an increase of cesarean deliveries, this concerns all women across the United States today.”

 

In light of the NIH Consensus Panel recommendation statement , the overuse of cesarean and dramatic underuse of vaginal birth after cesarean (VBAC) must be addressed. Currently, the VBAC rate is less than 8 percent, with evidence showing that 60%-80% or more of women having a VBAC trial of labor will be successful.   This decline is driven by the continually growing number of hospitals banning the VBAC option.    

 

ICAN’s VBAC Policy Survey, originally conducted in May 2005 and updated in January 2009, surveyed a total of 2878 hospitals. 1654 hospitals “allow” VBAC, 824 have an official ban, and 400 have a de facto ban in place.   Full results of the research can be seen at http://ican-online.org/vbac-ban-info.  Between formal and de facto bans, women are not able to access VBAC at over 40% of hospitals in the U.S.   

 

Research consistently shows VBAC is a reasonably safe choice for women with a prior cesarean, consistent with the recent NIH Consensus Panel findings.  While VBAC does carry risks associated with the possibility of uterine rupture, this event is rare. Cesarean surgery carries life-threatening short-term risks, as well as long term risks to future fertility and pregnancies. 

 

Women are often told it is safer, less painful and easier to have a cesarean, even though cesareans are generally shown to have greater risks and have longer recovery times than VBAC. The choice to have a non-medically indicated surgical procedure is based on a false representation of the risks and consequences of a scheduled repeat cesarean and an inflated representation of the risks and consequences of VBAC. 

 

“Women are subjected to a provider's lowered risk threshold for practice and do not receive complete informed consent regarding the risks of a cesarean delivery,” said Andrews. “Women and their babies are forced to take on increased medical risk during pregnancy and childbirth so that providers can feel they’ve decreased their own non-medical risks in practice.”

 

For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients.  This resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure.  The guide can be found at http://www.ican-online.org/vbac/your-right-refuse-what-do-if-your-hospital-has-banned-vbac-q.  

 

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit www.ican-online.org for more information.  In addition to more than 130 local chapters worldwide, the group hosts an active on-line discussion group that serves as a resource for mothers.    

 

About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved.  Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations.  Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death. www.ican-online.org/ican-white-papers

Mission statement: The International Cesarean Awareness Network (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.  There are over 130 ICAN chapters worldwide which hold educational and support meetings for people interested in cesarean prevention and recovery.  read more »

For Immediate Release

National Institutes of Health Releases Statement on VBAC

Access to VBAC is Limited by Non-Medical Factors and is Safe for Most Women

 

REDONDO BEACH, CA, March 11, 2010.  The National Institutes of Health (NIH) finished the Conference on Vaginal Birth After Cesarean (VBAC) March 8th-10th, 2010, evaluating issues surrounding VBAC and seeking to quantify why VBAC rates have plummeted in the U.S. over the last decade.  The final report will provide consumers, health care providers and the general public with data currently available on VBAC.  Audience members included members of birth, health, and women’s rights organizations, including ICAN President Desirre Andrews and numerous other ICAN representatives.

 

“The final statement from the NIH concludes that a VBAC is a reasonable option for most women.  Over 75% of women who attempt VBAC will be successful.” says Desirre Andrews, ICAN President. “Currently less than 10% of women who have had previous cesareans deliver vaginally in subsequent pregnancies, leading to significant and preventable illness and death.”

 

The NIH made clear that the major driving factors behind this are non-medical reasons including but not limited to perceived convenience, insurance and liability concerns.  Proper execution of the informed consent and refusal process is not routine, and would be one factor in addressing non-medical concerns.

 

“NIH took the American Congress of Obstetricians and Gynecologists (ACOG) and anesthesiologists to task, calling on them to change the language in their official recommendations on VBAC.  ICAN has understood for years that this language plays a large role in the lack of access to VBAC in the U.S.” continues Ms. Andrews. “We hope ACOG rises to the challenge and also hope they will finally be willing to work with ICAN and other advocacy organizations to improve maternal and fetal safety.”

 

A survey conducted by ICAN in 2009 showed approximately 45% of hospitals in the United States formally ban VBACs either explicitly or through unsupportive policies and procedures.   Many women are never counseled that they are good candidates for VBAC and thus undergo more risky and expensive repeat cesareans.  The NIH report acknowledges that this represents a serious breach of medical ethics.  ICAN supports every woman’s right to select the care provider, birth setting and birth plan of her choice.

 

Lacking in the NIH statement is support for a woman’s right to refuse a cesarean section as this was felt to be beyond the scope of the current mandate.  It was acknowledged, however, by many expert presenters that forcing a pregnant woman to undergo an unwanted surgery is medically indefensible, unethical and immoral.  ACOG’s own statement on ethics states that a woman should neither be coerced nor punished for not following a recommendation.  Further exploration of the issue of patient autonomy in the pregnant woman will require vigilance by all concerned parties to make sure the discussion is an informed one.

 

ICAN encourages health organizations, care providers and consumers to continue to work towards improving the model of maternity care in our country to better reflect evidence-based practices and respect towards consumer rights of informed consent and refusal.  The NIH VBAC statement is available at http://consensus.nih.gov/2010/vbacstatement.htm

 

The International Cesarean Awareness Network (ICAN) is a non-profit 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).  read more »

Mother Provides Testimony on Capitol Hill Discriminatory Insurance Practices Investigated by Senate HELP Committee

For Immediate Release



ICAN Mother Provides Testimony on Capitol Hill Discriminatory Insurance Practices Investigated by Senate HELP Committee  read more »

Cesarean Rate Jumps to Record High

Cesarean Rate Jumps to Record High
More Women Forced into Surgery; Few Mothers Recognize They Can Reduce Their Risk of Surgery



Redondo Beach, CA, March 18, 2009 – The National Center for Health Statistics has reported that the cesarean rate hit an all-time high in 2007, with a rate of 31.8 percent, up two percent from 2006.  

“Every pregnant woman in the U.S. should be alarmed by this rate,” said Pam Udy, president of the International Cesarean Awareness Network (ICAN). “Half or more of cesareans are avoidable and over-using major surgery on otherwise healthy women and babies is taking a toll.”

A major driver of cesarean overuse is underuse of vaginal birth after cesarean (VBAC).  The VBAC rate currently hovers around 8 percent, far lower than the Healthy People 2010 goal of 37 percent.   Driving this decline is the growing practice of hospitals banning VBAC.  

In February, ICAN released the results of a new survey showing a startling increase in the number of hospitals banning VBAC.  The survey showed a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC.  In 2004, banning hospitals numbered 300.  The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with “de facto” bans (1).    Full results of the research can be seen at the VBAC Policy DatabaseBetween formal and de facto bans, women are not able to access VBAC in 50% of hospitals in the U.S.  

Research has consistently shown that VBAC is a reasonably safe choice for women with a prior cesarean.   According to an analysis of medical research conducted by Childbirth Connection, a well-respected, independent maternity focused non-profit, in the absence of a clear medical need, VBAC is safer for mothers in the current pregnancy, and far safer for mothers and babies in future pregnancies (2).   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,” said Udy.  

Studies from the National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network, one most recently published in the February 2008 issue of the Journal of Obstetrics and Gynecology, demonstrate that repeated cesareans can actually put mothers and babies at greater clinical risk than repeated VBACs (3).   


In October 2008, Childbirth Connection released a report called “Evidence-Based Maternity Care: What It Is and What It Can Achieve ,” (4) showing that the state of maternity care in the U.S. is worrisome, driven largely by a failure of care providers to heed evidence-based care practices.  For most women in the U.S., care practices that have been proven to make childbirth easier and safer are underused, and interventions that may increase risks to mothers and babies are routinely overused.  The authors of the report point to the “perinatal paradox” of doing more, but accomplishing less.    

“All pregnant women are faced with important choices in their pregnancies.  It is critical for women to understand what their choices are, and learn to spot the red flags that can lead to an unnecessary or avoidable cesarean,” said Udy.  

Women who are seeking information about how to avoid a cesarean, have a VBAC, or are recovering from a cesarean can visit ican-online.org for more information.  In addition to more than 110 local chapters nationwide, the group hosts an active on-line discussion group that serves as a resource for mothers.  

For women who encounter VBAC bans, ICAN has developed a guide to help them understand their rights as patients.  The resource discusses the principles of informed consent and the right of every patient to refuse an unwanted medical procedure.  The guide can be found here.


About Cesareans: When a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved.  Potential risks to babies from cesareans include: low birth weight, prematurity, respiratory problems, and lacerations.  Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: 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.  There are 94 ICAN Chapters across North America, which hold educational and support meetings for people interested in cesarean prevention and recovery.

   read more »

February 20, 2009 ICAN Press Release

See the TIME magazine article: The Trouble with Repeat Cesareans

For Immedate Release:

 

New Survey Shows Shrinking Options for Women with Prior Cesarean

Bans on Vaginal Birth Force Women into Unnecessary Surgery

 

 

Redondo Beach, CA, February 20, 2009 – The International Cesarean Awareness Network (ICAN) has released the results of a new survey showing an alarming increase in the number of hospitals banning vaginal birth after cesarean (VBAC). The survey shows a near triple increase (174%) from November 2004, when ICAN conducted the first count of hospitals forbidding women from having a VBAC. In 2004, banning hospitals numbered 300. The latest survey, conducted in January 2009, counted 821 hospitals formally banning VBAC and 612 with "de facto" ban. (1)  Full results of the research can be seen in the VBAC Ban Database  read more »

Home Made: Inside Baltimore's Home-Birth Underground


Like any 8-day-old baby, Jimmy Gaffney spends most of his time either nursing or sleeping. Peacefully alternating between the two while cradled in his mother's arms in the family's sun-dappled Hamilton backyard, the robust newborn looks like a promotional photograph for parenthood. And yet, so far as the state and city of his birth are concerned, this baby does not officially exist.  read more »

Santa Barbara Families Protest Hospital Ban on Vaginal Birth After Cesarean (VBAC)

Santa Barbara Families Protest Hospital Ban on Vaginal Birth After Cesarean (VBAC)

June 23rd Rally Highlights Plight of Cesarean Mothers

Santa Barbara, CA, June 23, 2008 – Dozens of parents and concerned community members, supported by the Birth Action Coalition and the International Cesarean Awareness Network (ICAN), will rally outside Cottage Hospital in Santa Barbara on June 23rd at 11a.m. against the hospital's refusal to allow them a natural birth. Women in Santa Barbara County who have previously given birth by cesarean section have been banned since 2003 from choosing a vaginal birth at Cottage Hospital. This policy is part of a growing national trend. The International Cesarean Awareness Network (ICAN) has documented vaginal birth after cesarean (VBAC) bans at 280 hospitals nationwide. Rally supporters will gather to raise awareness about the VBAC ban and to request that it be reversed.

The Birth Action Coalition's goal is to "work to create supportive birth environments in the Ventura and Santa Barbara areas.  read more »

June 1, 2008 ICAN Press Release

 For Immediate Release

Insurance Companies Rejecting Women with History of Cesarean

Some Companies Require Surgical Sterilization for Coverage;

Trend Gives New Imperative to Learn Ways to Avoid Unnecessary Cesarean

 

Redondo Beach, CA, June 1, 2008As reported in today’s New York Times, ICAN has begun tracking an alarming new trend of insurance companies refusing to provide health insurance for women with a history of cesarean surgery. In some cases, women are being rejected for coverage outright and in other case they are being charged significantly higher rates to obtain the same coverage as women without a history of cesarean. With over a million women each year undergoing this surgery, this practice has the potential to render large numbers of women uninsurable.  read more »

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