Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

With the Iowa legislative session beginning January 13, it is time for a rundown of important maternal health policies that should become priorities for state lawmakers in 2025.

Since I am focusing on access to midwifery care, it is worth noting that in October 2024 the World Health Organization issued a new position paper on “Transitioning to Midwifery Models of Care.” That paper offers an international definition by describing the guiding principles of midwifery models of care and reviewing the advantages of adopting them. 

According to the World Health Organization’s position paper, 

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

As the phrase “your body, my choice” has infiltrated social media in the days following the 2024 presidential election, Linda Crownover-Inch, the International Cesarean Awareness Network (ICAN) of Quad Cities chapter leader and a doula, posted the following on Facebook:

There is one place where this phrase has been accepted and normalized for decades and will not disappear until people rise up and face it head on. That place is in the medicalized maternity care setting.

In my experience as a seasoned doula, every one of the medical maternity care providers (OB’s and medicalized midwives) that provided labor and birth service for my client’s, have violated my clients right to bodily autonomy in ways that should be categorized as assault.

Sadly, US medicalized birth culture has normalized assault during labor and birth as “That’s just the way it happens” and “They need to do those things to me to make labor and birth safe”, or “I can’t tell them what to do”. Too often I’ve stood in circles of people retelling, All the while normalizing trauma and assault in their medicalized birth stories.

While I’m sure many will balk at applying this horrendous saying to standard maternity care in most of the United States, Linda’s post resonated with my experience as a maternal health advocate in Iowa. The current reality is that most women seeking prenatal, birth, and postpartum care in Iowa face inadequate care options and degrading experiences, all in the name of so-called health care. 

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa. This article originally appeared on the Des Moines Register’s website.

The Des Moines Register article “What Patients Should Know About Hospital Drug Testing” missed some key information that may help families disrupt the illegal maternal and newborn drug screening practices taking place at Iowa hospitals and clinics.

The U.S. Supreme Court made clear in 2001 (Ferguson v. Charleston) that prenatal drug testing without specific informed consent is unlawful. Nevertheless, some Iowa clinics and hospitals continue to conduct such tests, when urine is gathered for testing of urinary tract infections or to check urine glucose or protein levels. Such practices are not only unlawful, but also create mistrust of the medical system—putting the lives of moms and babies at risk. 

Photo provided by the author, showing maternal health advocates advocating for licensure of certified professional midwives during an Iowa House Ways and Means subcommittee meeting in February 2023.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

This time last year I wrote about five policies that would improve maternal health in Iowa. I’m updating the piece for the 2024 legislative session with a focus on three core priorities. 

Although access to abortion care and contraceptives are critical to maternal and infant health, I do not discuss those topics here. I want to highlight lesser-known aspects of maternal health specific to prenatal, birth, and postpartum care, which receive much less media coverage.

For the 2024 legislative session, I am focusing on three issues I raised last year, which have a strong chance to be enacted. These policies would improve maternal health in Iowa by expanding access to midwives and expanding prenatal care options. I wrote at length in 2021 about how midwives save lives, and it seems like every week a different study or article underscores how the midwifery model of care leads to better outcomes. If you’re interested in diving deeper, one of my favorite resources released in 2023 is this Issue Brief on Maternity Medicaid Strategies from the Maternal Health Hub.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa. This essay was originally published in the Des Moines Business Record’s Fearless publication.

While we see regular news coverage about challenges accessing maternal health care in Iowa and the related racial disparities, I rarely see the mention of higher cesarean rates as a relevant factor in those disparities.

April is Cesarean Awareness Month, and April 11-17 is Black Maternal Health Week. The overlap of these initiatives is relevant given the higher cesarean rate for Black people across the country and Iowa. 

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

The 2022 Iowa legislative session saw the most significant momentum in more than forty years of advocacy for the creation of a licensure of direct-entry midwives in Iowa. With the 2023 legislative session underway, I will review the pivotal moments in the 2022 legislative session and explain why the Iowa legislature and Governor Kim Reynolds should prioritize enacting a midwifery licensure bill.

While I have addressed the need to provide a licensure for Certified Professional Midwives (CPMs) in previous pieces, I will go more in-depth in providing background on why all Iowans should want and support CPMs practicing in our state.

Note: I would not benefit directly in any way if this bill passed, as I am not a birthworker (doula, midwife, physician), and I do not plan on having any more children. Through my volunteer work with the International Cesarean Awareness Network, I have learned a lot about the different types of midwives and believe Iowans have been “dealt a bad hand” by not having knowledge or access to community birth options that are more readily available in other states and other high-income countries. Iowa families deserve to have all options available for safe and quality maternal health care.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

A 2022 report from March of Dimes shows that “36% of counties nationwide — largely in the Midwest and South — constitute ‘maternity care deserts,’ meaning they have no obstetric hospitals or birth centers and no obstetric providers.” While their report does not provide state rankings, you can see whether your county classifies as being a maternity care desert here. Additionally, a report from Stacker in June 2022 ranked Iowa eleventh on a list of “states where the most people live in maternal health care deserts.”

Even if your area has maternal health care providers (OBGYNs, family physicians, midwives), finding quality care is another challenge facing pregnant and postpartum individuals in both urban and rural areas. I’ve discussed some of those problems in previous articles for this website. 

The good news is relatively low-cost, evidence-based solutions are available to make maternal health care more accessible in Iowa, which would improve outcomes. I have identified and prioritized opportunities that should be bipartisan based on successes in other states.

Note: I am not including abortion access in these recommendations, since the procedure continues to be legal in Iowa, the media regularly cover this topic, and several organizations advocate on this issue. This article from Commonwealth Fund explains how states with restrictive abortion laws have worse maternal health outcomes.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

In August, I spoke to the Broadlawns Board of Trustees for the third time in the past four years.

You can read my comments from my first time speaking during their citizen comment period in July 2018 when I was five months pregnant and looking for VBAC supportive care for the birth of my second child. Unbeknownst to me at the time, this experience launched my maternal health advocacy.

Iowa’s health and human services budget for the coming fiscal year includes a $500,000 appropriation for a new “maternal health” initiative modeled on an ineffective, wasteful Texas program.

But the bill, negotiated by House and Senate Republicans and approved on party-line votes in both chambers May 23, does not extend postpartum coverage for Iowans on Medicaid, a documented way to reduce maternal mortality.

Bethany Gates is a Certified Professional Midwife from Vinton (Benton County), where she lives with her husband, Judah, and their 4 daughters.

Certified Professional Midwives are midwives who practice in an out-of-hospital setting. Iowa CPMs attend home births; in other states, CPMs attend home births and births in birth centers. 

Here in Iowa, CPMs are unregulated, and the Iowa Code does not have any section addressing their practice. While this may sound like freedom in theory, the reality is that midwives face many challenges as they strive to provide quality care, because Iowa does not license the profession.

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa.

I recently recounted how it took the Iowa Department of Public Health (IDPH) 170 days to respond to my request for information on the total births, primary cesareans, total cesareans, and vaginal births after cesareans (VBACs) at Iowa hospitals. I eventually received aggregated five-year totals (2016 through 2020) for each birthing hospital in Iowa.

The International Cesarean Awareness Network (ICAN) of Central Iowa, where I serve as a volunteer chapter leader, has made the data available on our website. You can see it in table form below as Appendix 1. 

While I would have preferred for IDPH to provide the figures for a single year, as I requested, the compiled data still tells us a lot about the overuse of cesareans at several Iowa hospitals and the lack of VBAC access across much of the state.

Rachel Bruns recounts the saga of trying to obtain records that the Iowa Department of Public Health could have provided promptly.

In an article I wrote for this website in January 2021, Provider practices in Iowa lead to more c-sections, complications, I mentioned that I had requested records from the Iowa Department of Public Health (IDPH) on the number of cesarean births and vaginal births after cesarean (VBACs) in Iowa hospitals.

A lot has happened related to my request since then. I’m summarizing my experience in case it can help other Iowans seeking what should be public information from a government entity.

Rachel Bruns continues a series of posts addressing the quality of maternal health care in Iowa. -promoted by Laura Belin

My first post here addressed a number of outdated and non evidence based practices that continue in Iowa. My second post addressed how expanding access to midwives could help improve access to quality care, reduce the incidence of cesareans, and save lives.

This post will continue on those themes addressing additional practices of concern surrounding cesareans and vaginal birth after cesarean (VBAC).

Des Moines-based holistic doula and lactation counselor Olivia Samples first published this post on Kismet Doula Services’ blog. -promoted by Laura Belin

Rachel Bruns continues a series of posts addressing the quality of maternal health care in Iowa. -promoted by Laura Belin

This article is all about midwives. I will be using this space to expand on four different needs in our state to improve the access and quality of maternal-child health care in Iowa. All of them are interrelated. If Iowa accomplishes these four things, we will see an improvement in maternal-child health outcomes across all races, accessibility of care options in all geographies, and an overall increase in quality and satisfaction from patients. 

The four areas I will address are:

Rachel Bruns is a volunteer advocate for quality maternal health care in Iowa. -promoted by Laura Belin

As I plan to write several posts in the coming weeks related to maternal-child health in Iowa, I want to introduce myself to Bleeding Heartland readers. For this piece, I’m going to provide some high-level information on the landscape around maternal health in Iowa from my perspective as a maternal-child health advocate.

But first, some background on myself and how I became involved in this work.

Friends of Iowa Midwives has worked with legislators to present companion bills in the House and Senate that would allow for safe and legal access to Certified Professional Midwives (CPMs) in Iowa.  For 15 years Friends of Iowa Midwives has worked toward licensure for CPMs. In 1999 the Iowa Legislature conducted a scope of practice review, the result of which was a recommendation to the legislature that the CPMs should be licensed through the Iowa Department of Public Health.  The bills propose that a license be created for the already trained and nationally certified midwives who seek to provide quality and safe care to Iowa women.

Every year in Iowa, more than 500 women choose to give birth outside of the hospital.  This number is on the rise both in Iowa and nationally.  A study published last month in the Journal of Midwifery and Women’s Health again demonstrated that for low-risk women out-of-hospital birth with skilled providers is a safe option.  This study found that almost 94% of the nearly 17,000 participants had a spontaneous vaginal birth.  The cesarean rate for this study was 5.2%.  The national average cesarean rate is 33%.  The in-labor transfer rate for this study was between 8-23%.  The most common reason for a transfer of care was prolonged labor or what is commonly called failure to progress. This study was one of among several that have demonstrated that out-of-hospital birth is a safe option for low-risk women. 

The U.S. teen birth rate reached “a historic low in 2010,” according to data released by the U.S. Centers for Disease Control this week. Iowa was among 47 states where the birth rate for teenagers fell significantly from 2007 to 2010, and Iowa’s rate of 28.6 births per 1,000 teenagers was ranked 34th nationwide. More details are after the jump.

Megan Day Suhr announced this week that she is running for Iowa House district 28 in 2012. A map of the swing district and background on Suhr are after the jump.

The cesarean section rate in Iowa climbed again to 30.37 percent in 2010, and statistics compiled by the Iowa Department of Public Health showed huge disparities among hospitals in the percentage of live births done surgically.

As always, post a comment or send me an e-mail (desmoinesdem AT yahoo.com) if you know of an event I should add to this post.

Friday, February 13:

As part of the “POWERLINES to the Future” conference of the Midwest Regional Physicians for Social Responsibility, there will be a free film and discussion of “Scarred Lands and Wounded Lives” at 7:30 pm in the International Center, Old Capitol Town Center Mall, downtown Iowa City.

Get full information at:

www.iowa-psr.org/pl/pl_home.html

One Iowa urges supporters to “write a note on Facebook or Myspace with the 25 Reasons you support marriage equality. Then tag 25 of your closest friends on the note and add your 25 reasons as a comment to the One Iowa Facebook or Myspace page.” Also, One Iowa is hosting a Happy Hour from 5-7 PM at Azalea Restaurant, 400 Walnut St., Des Moines.

Friends of Iowa Midwives is having a “Red Envelope Party” (where people can write letters to policy-makers advocating for expanding birth options in Iowa) in Davenport from 3 pm to 5 pm at the Harrison Hilltop Theatre. Click here for more information:

http://www.friendsofiowamidwiv…

Saturday, February 14:

Physicians for Social Responsibility is holding a “POWERLINES to the Future” conference at the International Center, Old Capitol Town Center Mall, Iowa City. PSR hopes to encourage Iowans, especially those involved in the health professions, to become more informed and actively engaged in confronting the gravest health challenges of our time:

Conference 9:00 AM — 4:00 PM

Check-in and breakfast at 8:00 AM

The Saturday program addresses health, environmental, and economic consequences of:

Nuclear weapons

Nuclear power

Coal fired power generation

View full program at:  www.iowa-psr.org/pl/pl_home.html/#program

Intended audience: physicians, allied health professionals, public health officials, general public, and students.

Registration includes breakfast and lunch on Saturday.

Pre-registration by Wednesday February 11, 2009 is required to be ensured food!

Sliding-scale conference registration fee.

Register online or download a printable registration form at:

www.iowa-psr.org/pl/pl_home.html/#registration

Friends of Iowa Midwives is having a “Red Envelope Party” at the Urbandale Public Library from 10 am to 12 pm, and at the Iowa City Public Library from 1 pm to 3 pm. For more information:

http://www.friendsofiowamidwiv…

Monday, February 16:

Big event on climate change co-sponsored by lots of good organizations:

The University of Iowa Center for Global and Regional Environmental Research and a variety of co-sponsoring organizations invite you to a climate change briefing and discussion to highlight the recent report of the Iowa Climate Change Advisory Council.

The briefing and discussion will take place on Monday, February 16, 6:00-7:30 pm at the Iowa State Historical Building Auditorium, 600 East Locust in Des Moines.

The meeting will be an opportunity to learn more about climate change science its potential impacts on Iowa, as well as learn about the recent options detailed in the work of the Iowa Climate Change Advisory Council report and participate in an informal discussion about climate change and next steps.

Iowa Climate Change Briefing and Discussion

Monday, February 16, 6:00-7:30 pm

Iowa State Historical Building, Auditorium

AGENDA

Welcome – Des Moines Mayor Frank Cownie

Richard Leopold, Director, Iowa Department of Natural Resources

Climate Science and Assessment of Climate Change for Iowa- Eugene S. Takle, Director, Climate Change Initiative, Professor of Atmospheric Science, Professor of Agricultural Meteorology, Department of Agronomy, Iowa State University

Brief overview of the Iowa Climate Change Advisory Council’s Report –  Jerry Schnoor – Co-director, University of Iowa Center for Global and Regional Environmental Research and Chairman, Iowa Climate Change Advisory Council

What are our next steps? Interactive discussion with key legislators, ICCAC members and the audience

Adjourn for light refreshments

Climate Change Briefing and Discussion Co-Sponsors

Iowa State University Climate Science Initiative

UNI Center for Energy and Environmental Education

Iowa State University Extension

Iowa Department of Economic Development

Iowa Office of Energy Independence

Iowa Department of Natural Resources

Iowa Department of Public Health

Iowa Office of Consumer Advocate

Iowa Association of Municipal Utilities

Iowa State Association of Counties

Iowa League of Cities

Iowa Natural Heritage Foundation

Leopold Center for Sustainable Agriculture

Iowa Environmental Council

Iowa Interfaith Power & Light

Iowa Policy Project

Trees Forever

For more information or questions contact Joe Bolkcom, Outreach and Community Education Director, UI Center for Global and Regional Environmental Research at joe-bolkcom@uiowa.edu or 319-353-2681.

One Iowa is organizing this event:

February 16, 5:30 PM

“Transgender Medicine 101”

featuring Dr. Christine McGinn

FREE and open to the public

Dinner at 5:30, lecture at 6:00

Des Moines University Student Education Center Auditorium

3200 Grand Avenue, Des Moines

Go to www.oneiow.org for more information

Tuesday, February 17:

It’s the registration deadline for the Interfaith Alliance of Iowa’s Crossroads lunch on February 20 (see below for more information). Call 515-279-8715 to make a reservation.

The Women Food and Agriculture Network is holding “Women Caring for the Land” meetings on February 17, 18 and 19, for women landowners in Johnson, Jones and Linn Counties. These are free educational programs on conservation programming for women who are farm partners, owner-operators, or inheritors who own farmland. Laura Krouse will hold meetings in each county, followed by spring field days and a follow-up meeting. Please call her at 319-895-6924 to find out where and when the meeting will be held in each county.

Wednesday, February 18:

One Iowa and Lambda Legal are holding a “Let My Parents Marry” forum at 6:30 pm in the Coralville Public Library, Meeting Room A, 1401 5th St., Coralville.

Friends of Iowa Midwives is holding its third Annual Conscious Birth Summit from 3 pm to 8 pm in the Iowa City Public Library, Meeting Room A, Featuring screenings of The Business of Being Born and Orgasmic Birth.

Thursday, February 19:

From the Iowa Environmental Council newsletter:

Growing Sustainable Communities Conference

Join us Thursday, February 19, 10:00 a.m. – 1:00 p.m., at the Grand River Center, 500 Bell Street in Dubuque. Cost is $20 per person, which includes a lunch. Limited number of student scholarships available. Our conference theme is “Promoting Historic Preservation as Part of the Climate Solution.” Insights will be offered on creating local and regional policies to promote sustainability through historic preservation. Keynote speakers for the event are Richard Moe, president of the National Trust for Historic Preservation, and Roya Stanley, director of the Iowa Office for Energy Independence. Deadline for registration is Feb 11 [from desmoinesdem: I know it’s late, but if you’re interested try calling anyway]. A limited number of student scholarships are available. Online registration and payment, as well as additional information, are available at www.sustainabledubuque.org or by calling 563.589.4110 during business hours. The mission of the conference is to educate the public on the issues that impact the long-term health and sustainability of our region and to create an opportunity for policy decision-makers from the tri-state area to come together to discuss ways in which they can enact the most effective change at the local level.

Also from the IEC bulletin:

Iowa Whitewater Coalition Annual Dinner Meeting

February 19, Des Moines

The IWC ‘Reconnecting the Rivers’ Annual Dinner Meeting will take place on Thursday, February 19th, with a social hour beginning at 6 pm and dinner at 7 pm. Following the meal special guest Adam Brooks, who has paddled the entire Mississippi and Missouri Rivers, will be sharing stories from his adventure on the Pacific Crest Trail and his plans for paddling 2300 miles of the Yukon River in Alaska starting in June. The meeting will be held at the House of Thai, located at 3017 100th Street in Des Moines. There will be a wonderful selection of dishes served banquet style, beverages and a cash bar for those interested. Tickets may be purchased for $25 per individual or $45 per couple. Proceeds from the event directly benefit the non-profit activities of the IWC and its Reconnecting the Rivers Campaign. For more information and to purchase tickets, go to: http://www.iowawhitewater.org/…

One Iowa and Lambda Legal are holding a “Let My Parents Marry” forum at 6:30 pm in the Des Moines Public Library, Meeting Room 1, 1000 Grand Ave. in Des Moines.

Friday, February 20:

The Interfaith Alliance of Iowa is holding a Crossroads luncheon:

Guest Speaker:    Nate Monson

Project Coordinator, Iowa Safe Schools

Subject:                Safe Schools for All

Sexual orientation and gender identity are two controversial topics in our communities and in our schools. Are our schools safe for LGBT youth? Learn about, discuss, and experience the effects of bias and harassment on students who identify and students who are perceived to be gay, lesbian, bisexual and/or transgender and learn about laws dealing with the GLBT community.

Date:                    Friday, February 20

o       Time:        11:45 – 1 p.m.

o       Location: Plymouth Congregational Church, Des Moines (42nd Street & Ingersoll Avenue )

o       Cost:         $9.00

Reservations are required for Crossroads.  Please call or email TIA Iowa by Tuesday, February 17.

Office: 515-279-8715

Friends of Iowa Midwives is having a Red Envelope Party from noon to 1 pm at the Marion Public Library.

Saturday, February 21:

From the IEC bulletin:

Hunter Angler Summit

Please join other outdoor enthusiasts on Feb 21, at Johnson County Conservation Education Center at F.W. Kent Park, just west of Tiffin, for a one-day summit to learn about threats to Iowa wetlands, rivers and streams, and help the National and Iowa Wildlife Federation to launch a state campaign to fight back after the rulings by the U.S. Supreme Court and administrative fiats that have left over half of Iowa streams and over 70 percent of Iowa’s prairie pothole wetlands vulnerable to losing Clean Water Act protections. Whether you are an angler who enjoys casting in your favorite stream or a hunter who counts on mallards and northern pintails, these decisions threaten the places you love. Policy experts and scientists will share the current efforts to eliminate protections in Iowa and the serious impacts they have for Iowa fish and wildlife. We will work together to design a statewide plan for hunters and anglers to stop the rollback of clean water protections for Iowa waters.  Hunters, anglers and outdoor enthusiasts who care about clean water and wildlife should attend. Please RSVP: Email Pam Goddard, goddardp@nwf.org or call at 301-741-6606.

Over at Daily Kos, nyceve put up another shocking diary about the practices of for-profit insurance companies in the U.S.

Today she links to this article from the New York Times about women facing higher insurance premiums, or even being denied insurance coverage, after giving birth by cesarean:

Insurers’ rules on prior Caesareans vary by company and also by state, since the states regulate insurers, said Susan Pisano of America’s Health Insurance Plans, a trade group. Some companies ignore the surgery, she said, but others treat it like a pre-existing condition.

“Sometimes the coverage will come with a rider saying that coverage for a Caesarean delivery is excluded for a period of time,” Ms. Pisano said. Sometimes, she said, applicants with prior Caesareans are charged higher premiums or deductibles.

This problem could affect millions of American women:

In 2006, more than 1.2 million Caesareans were performed in the United States, and researchers estimate that each year, half a million women giving birth have had previous Caesareans.

“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Caesarean Awareness Network, a group whose mission is to prevent unnecessary Caesareans.

Although many women who have had a Caesarean can safely have a normal birth later, something that Ms. Udy’s group advocates, in recent years many doctors and hospitals have refused to allow such births, because they carry a small risk of a potentially fatal complication, uterine rupture. Now, Ms. Udy says, insurers are adding insult to injury. Not only are women feeling pressure to have Caesareans that they do not want and may not need, but they may also be denied coverage for the surgery.

The New York Times piece also mentions one woman who was rejected for coverage by the Golden Rule Insurance Company:

She was turned down because she had given birth by Caesarean section. Having the operation once increases the odds that it will be performed again, and if she became pregnant and needed another Caesarean, Golden Rule did not want to pay for it. A letter from the company explained that if she had been sterilized after the Caesarean, or if she were over 40 and had given birth two or more years before applying, she might have qualified.

Great news–all she has to do to get health insurance coverage is be sterilized!

Seriously, we need a national health care policy that prohibits insurance companies from refusing to cover people with pre-existing conditions.

Until that happens, women would be advised to do whatever they can to reduce their risk of having a c-section.

Some surgical births are unavoidable, and in those cases it is a lifesaving procedure. However, there are ways to reduce the risk of having an unnecessary cesarean.

I advise women who are pregnant or planning to become pregnant to strongly consider using a midwife for your prenatal care, labor and delivery. Most midwives have a far lower cesarean rate in their practices than obstetricians.

One New Jersey hospital that has a thriving midwifery program has the second-lowest rate of c-sections in that state, “despite serving a low-income urban patient population that is more likely to have high-risk pregnancies.”

Hiring a certified doula to help the mother during labor and delivery has been shown to reduce the rate of cesarean births as well. You can have a doula assist you whether you are under the care of a midwife, an obstetrician or a family doctor, whether you give birth in a hospital, a birth center or at home.

You should also seek information about the c-section rates of the hospitals and birth centers in your area, if you have a choice. As I mentioned  in this post on cesarean births in Iowa, the percentage of babies born by c-section can vary widely from hospital to hospital.

For more information on cesarean births and the benefits of having a doula, click here.

Not long ago I posted about a poorly-researched and poorly-written article by the Associated Press on the rising rate of cesarean births in Iowa.

Lisa Houchins, a mom in Des Moines who is also education director for the International Cesarean Awareness Network, responded to the same article with this letter to the editor that the Register published earlier this week:

Regarding, “More U.S. Women Delivering Babies by Caesarean Section” (March 29): According to the World Health Organization, more than half of all Caesareans in the United States could be avoided. When used properly, a Caesarean can be a life-saving procedure. When used indiscriminately, C-sections introduce unnecessary risks to mothers and infants.

Women who deliver by Caesarean are more likely to have complications, including increased pain and recovery time, infection or death. Babies delivered by Caesarean are also more likely to suffer complications.

Women with Caesareans are at increased risk for miscarriage, infertility and complications in later pregnancies. Also, their future birthing choices can be severely limited. Some hospitals (including many in Iowa) and doctors are attempting to ban vaginal births after Caesareans.

Caesareans may be safer than they were 20 years ago, but that does not make them safer than a vaginal birth. C-sections are major surgery, and they should be reserved for times when there is a true medical indication. I encourage all pregnant women to educate themselves on how to avoid a Caesarean and how to have the safest and most satisfying birth possible.

April is Cesarean Awareness Month, and the ICAN website notes:

What is Cesarean Awareness Month? An internationally recognized month of awareness about the impact of cesarean sections on mothers, babies, and families worldwide. It’s about educating yourself to the pros and cons of major abdominal surgery and the possibilities for healthy birth afterwards as well as educating yourself for prevention of cesarean section.

Cesarean awareness is for mothers who are expecting or who might choose to be in the future. It’s for daughters who don’t realize what choices are being taken away from them. It’s for scientists studying the effects of cesareans and how birth impacts our lives. It’s for grandmothers who won’t be having more children but are questioning the abdominal pains and adhesions causing damage 30 years after their cesareans.

CESAREANS are serious. There is no need for a ‘catchy phrase’ to tell us that this is a mainstream problem. It affects everyone. One in three American women every year have surgery to bring their babies into the world. These women have lifelong health effects, impacting the families that are helping them in their healing, impacting other families through healthcare costs and policies, and bringing back those same lifelong health effects to the children they bring into this world.

Be aware. Read. Learn. Ask questions. Get informed consent. Be your own advocate for the information you need to know.

There is lots of information on the ICAN website, so if you or your partner or your friend is pregnant, I encourage you to check it out. C-sections can be lifesaving procedures, but it makes sense to take reasonable steps to avoid having unnecessary surgery.

The ICAN of Central Iowa website has statistics comparing c-section rates in the largest Iowa counties and hospitals.

If you want to avoid a cesarean birth unless it is medically necessary, ask about c-section rates when you are choosing a provider.

Don’t induce labor without medical need (for instance, because you hit your due date, or because you don’t want to go into labor over a weekend), because trying to induce a cervix that isn’t ripe is more likely to lead to “failure to progress” and a resulting c-section.

Consider getting a certified doula to help with childbirth education during pregnancy and to support the mother during labor. The website of Doulas of North America explains the benefits of having a doula:

Women have complex needs during childbirth and the weeks that follow. In addition to medical care and the love and companionship provided by their partners, women need consistent, continuous reassurance, comfort, encouragement and respect. They need individualized care based on their circumstances and preferences.

DONA International doulas are educated and experienced in childbirth and the postpartum period. We are prepared to provide physical (non-medical), emotional and informational support to women and their partners during labor and birth, as well as to families in the weeks following childbirth. We offer a loving touch, positioning and comfort measures that make childbearing women and families feel nurtured and cared for.

Numerous clinical studies have found that a doula’s presence at birth

   * tends to result in shorter labors with fewer complications

   * reduces negative feelings about one’s childbirth experience

   * reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and cesareans

   * reduces the mother’s request for pain medication and/or epidurals

Research shows parents who receive support can:

   * Feel more secure and cared for

   * Are more successful in adapting to new family dynamics

   * Have greater success with breastfeeding

   * Have greater self-confidence

   * Have less postpartum depression

   * Have lower incidence of abuse

Click through to find links to some research. Dads, don’t worry about the doula trying to take your place during labor. My husband is a huge advocate for doulas. She doesn’t do your job–she just helps the mother with practical advice based on training and the experience of attending many births. She will not freak out to see the mother in pain, and she will be able to reassure both parents if panic sets in while labor is progressing normally.

I know women who would have ended up with c-sections if not for their doulas. In one case, the baby was presenting with the cheek rather than with the crown of the head. The medical staff were convinced a c-section was the only way to get that baby out, but the doula encouraged the mother to try leaning and squatting in some different positions during and between contractions. After a few tries, the baby shifted, and the rest of the labor was over in less than 20 minutes.

When I was in college nearly 20 years ago, I remember reading an article in the Des Moines Register about the rising rate of births by cesarian-sections in Iowa. At some rural hospitals, the rate was approaching 25 percent, and that was alarming to some doctors.

Now almost a third of all births in Iowa are by c-section, and in some counties that figure is above 40 percent.

During the past week, the Des Moines Register, Cedar Rapids Gazette and several other newspapers  published this piece from the Associated Press about the rising rate of cesarean births, which quotes several women in Linn County and Johnson County.

Unfortunately, the article does a poor job of assessing the causes of the this trend and ignores the most significant problems associated with unnecessary c-sections. I explain why after the jump.