Healthy People 2020 (HP2020) is a national initiative through the Centers for Disease Control (CDC) to improve the health of all Americans by creating targets for improving leading health indicators in a specified time frame. Increasing vaginal births after cesarean (VBAC) for low-risk women is one of those indicators.
There is no way to measure progress on these outcomes without data. Data is essential to any process to improve health. If we don’t know where we’re starting, we have no idea if our interventions are having the intended impact. For this reason, the Michigan Department of Health and Human Services (MDHHS) started collecting and sharing information by county on the percentage of women with a prior cesarean who have a repeat cesarean (to calculate the opposite, or percentage of women with a prior cesarean who did not have a repeat cesarean, subtract the percentage given from 100).
Not surprisingly, when compared to surrounding counties, Muskegon ranks last. In fact, in 2014, the most recent year for which data is available, only 16 women in Muskegon had a VBAC! This was not always the case. When women were encouraged to plan VBACs and deliver at local hospitals in 1999, this number was 83! VBAC bans make a difference.
Kent County leads West Michigan in the percentage of women having VBACS. When it comes to options, Kent County women can choose from three hospitals, Metro, Spectrum Health Butterworth and Mercy Health St. Mary’s. All of these hospitals allow VBACs.
Why does this matter? Why should women be concerned about their access to options for giving birth after a cesarean? The truth is that laboring and attempting a VBAC is less risky for most women than having major surgery. Family size also matters. The risks decrease with each successful VBAC and increase with each subsequent cesarean.
While many providers inform women of the risk of uterine rupture when attempting a VBAC, women are almost never informed of the risks of repeated cesarean surgeries. Every year in the month of October, the International Cesarean Awareness Network (ICAN) works to educate women about one of those risks: accreta. Accreta is a condition in which the placenta attaches too deeply into the uterine wall. According to their website, in the presence of placenta previa, the risk of accreta is 3% with the first repeat cesarean and increases to 67% for fifth or higher. Seven percent of women with placenta accreta will die from excess blood loss. Many women are encouraged to have a repeat cesarean without ever being informed of the risk of accreta. In fact, many women first learn about what accreta is when they are diagnosed with it!
When I speak with women in Muskegon about what influences their decision on how to birth after a cesarean, most tell me that the distance to travel to a hospital without a VBAC ban is just too far. They don’t want to travel for care or risk having a baby in their car. Some don’t have reliable transportation or gas money to make it to a hospital that allows VBAC. Most women want to give birth in their own community with the providers they know and trust. This is where their support system is and they don’t want to accept additional challenges by having a baby far from home.
One of the roles of doulas is educating the public on their options. If you are pregnant or planning a pregnancy after a prior cesarean, hiring a doula may be a first step in learning about your available options.
At Birth Quest, we’d like to hear from you! Are you a Muskegon woman who planned a VBAC? If you chose a repeat cesarean, what were the factors that influenced your decision? Your experiences may help another woman in a similar situation. Thanks for sharing!
Having a midwife attend your labor and birth increases the chance of having your baby naturally and without drugs!
In a prior blog, I wrote about how North Ottawa Community Hospital (NOCH) closed their midwifery practice in 2014. At that time, I contacted both federally qualified health centers (FQHCs) in Muskegon to ask them if they would be willing to have me interview them to help spread the word to expectant women in the area about their remaining options. Hackley Community Care (HCC) got back with me and we were able to videotape an interview with their collaborating physician, Dr. Danielle Koestner.
I have been at several births with the HCC midwives and have always been impressed by the way they respected and supported the wishes of my clients. The good relationship we had benefited our mutual clients because we were able to communicate concerns to better coordinate care.
When I learned that the HCC midwives were going to stop catching babies, my initial response was, “Not again!” Like others, I am still upset about losing the option of midwife-attended deliveries at NOCH. Still, I wanted to wait and find out more information. Earlier this week, I received the official letter from HCC, stating that the midwives were going to continue to provide pre- and post-natal care and that they were officially certified as a Centering Pregnancy site. Now, however, the obstetric laborist and residents at Mercy Health Hackley would be in charge of their pregnant patients’ labor and deliveries.
The laborist comes with a wealth of knowledge and experience. While many women include avoiding residents in their birth plans, I have found them to be on top of the latest research, open to patient preferences and supportive of evidence-based care. For some women, this will be an acceptable option. During their prenatal care, they will benefit from an evidence-based group prenatal care model, the individualized care characteristic of midwives and access to a host of other services offered on-site. However, for women specifically looking to benefit from the better outcomes research shows continuous care from a midwife during labor and delivery offers, this change will be unacceptable. The research shows that interventions are lower and outcomes improve when midwives provide care throughout the pregnancy, labor and delivery.
For women who seek a midwife to provide their prenatal care and attend their birth, Muskegon Family Care (MFC), Muskegon’s other FQHC with a midwifery program, recently hired new midwives and are now fully staffed. In July, I had the pleasure of meeting with one of them, Katie Van Heck, CNM, to discuss how to improve their services by increasing their patients’ access to doulas. I now have a couple of clients who are seeing the midwives there for care and I am excited to work more with this practice in the future!
If you live along the West Michigan lakeshore and you wish to deliver in a hospital, with a Certified Nurse Midwife (CNM), the only midwives who can practice in Michigan hospitals at this time, these are some of your remaining options:
- Muskegon Family Care – With three midwives on staff, this practice is located in a federally qualified health center in Muskegon Heights. This means they primarily serve low-income people, but they can serve anyone.
- Midwifery Services at Advanced Women’s Ob/Gyn – If Muskegon-area women are willing to travel to Spectrum Health Butterworth in Grand Rapids to deliver, this private midwifery practice has an 6% c-section rate, which speaks for itself.
What will be the next news for midwifery options along the lakeshore? Hopefully, something positive, like a new private practice or free-standing birth center opening up!
Did you have your baby with a midwife in a hospital? Please share your experiences in the comments!
Sandall, Jane, et al. “Midwife‐led continuity models versus other models of care for childbearing women.” The Cochrane Library (2016).
Private childbirth education classes in Muskegon – be prepared!
The hardest part about teaching classes has been finding appropriate, inclusive, affordable locations. I did a series of mini-classes last summer at the Muskegon Area Career Tech Center, but was unable to charge the participants. I did a vaginal birth after cesarean (VBAC) class at On the Path Yoga studio in Spring Lake, but they are a busy studio with lots of other things going on. That’s why I was delighted to receive permission to hold classes at The Center, a welcoming location conveniently located in the four corners in North Muskegon. Earlier this month, I learned that they were moving and going through other internal organizational changes. I immediately thought of the lovely Red Lotus art gallery, located in downtown Muskegon in the basement of the Century Club building and was pleased to find out how accommodating they are to a small business like mine. An artist myself (I sell buttons at the gallery), I’m looking forward to teaching surrounded by unique families and beautiful art!
For more information on individual summer 2016 childbirth classes, please see the events on my Facebook page or my calendar. Thank you and hope to see you at an upcoming class!
As a doula, two of the most important people in my life are my sitter and my back-up doula! Through the Lakeshore Doula Network, I have been fortunate to have had several area doulas willing to support my clients in the rare event that back-up is needed.
One time, I had two clients due the same week. Beth Singleton was my back-up doula. When they both went into labor at the same time, she was there for me. I cannot tell you what a relief it was to know my client was in good hands!
Beth and I have met to talk about working together since then. After making lists of our strengths and weaknesses, we identified ways that we are similar as well as ways we can mentor and support each other as we continue to develop our businesses. We recently signed a formal agreement outlining our commitment to provide back-up for each other.
Let me introduce to you, Beth Singelton, Birth Doula!
Hello! My name is Beth Singleton. I have lived in Muskegon my entire life and graduated from Reeths Puffer High School in 2000. I am the proud mother of 4 awesome kids and have been married to my husband for almost 14 years. I have given birth in both a hospital setting and at home. In 2014 while pregnant with my 4th child, I completed my DONA training and am currently working towards my certification. Aside from my life as a wife, mother, and birth doula, I have spent many years working as a floral designer and I LOVE writing poetry (I have self published two poetry collections so far!). Free time with my family is best spent in nature, preferably by the river or in the woods, with my camera in hand. I am also a huge fan of watching the sun rise.
I have always had a passion for pregnancy and birth and am very grateful to the women in my life that have allowed me to be present during the birth of their children. What I’ve witnessed while watching other women labor and experienced during my own is that having support is vital to a positive birth experience yet, it is something so many women do not have. Giving birth is one of the most challenging and life changing experiences a woman can go through and how she experiences it can have a lasting effect on how she feels about herself, her baby, and the bonding experience. I know the importance of achieving the desired labor and birth and it is my hope to provide women with the information and support needed to do this. There is no crystal ball that can predict how labor will go. That is why I think it is so important for a woman to have support.
During pregnancy, I believe it is pertinent for women to educate themselves and build a good support team. It is also the perfect time for a woman to learn about self care and begin implementing this into her daily life if not already doing so. As your doula, I will be there for you during your pregnancy to answer questions, provide moral support, go over the importance of self care, help you with a birth plan if you’d like one and go over what you ideally think you will need from me. When you are in labor, it is my goal to be there for you and do all that I can to make sure you feel in control and empowered, providing you with the support you need to be a better advocate for yourself. Whether it is simply my presence that is needed, encouraging words, a shoulder to cry on, or hands on support like massage, I will be there for you. In the instance that complications do arise, I will remain with you and support you through those challenges as well. I believe all women have an inherent sense within them that guides them instinctively through labor and childbirth. My hope is that in all I do, I am able to hold that space for you, allowing you as an individual to experience labor and birth in whatever way you so desire. After birth I will visit with you, talk about the birth, talk about how you are feeling, and I can provide some help with breastfeeding if you need it.
I view birth as something sacred and a laboring woman as someone to be respected and held in the highest regard. There is a transformation that takes place whether a woman is having her first baby or her fifteenth and I consider my being allowed to bear witness and provide support during that transformation an honor. I also believe that a doula’s support is meant to complement and enhance the care that is already being provided by those who are giving clinical support and by loved ones who are also present to help. In birth (as in most of life), there are no do-overs. That is why I feel it is imperative that a woman who will be giving birth is surrounded by people who understand and are sensitive to the significance of the moment.
Recently, The Guardian broke the story of five pregnant women who were denied emergency care at Mercy Health Partners because religious directives at the Michigan hospital system ruled over best medical practice.
The report that the article refers to is actually a claim that I wrote from my experiences as an employee of Public Health – Muskegon County. I decided to come forward and share my name and story because the harm and suffering these poor women went through was wholly unnecessary and something must be done to ensure people are aware that is a growing crisis that needs to be stopped.
Mercy Health Hackley Campus is more than a hospital to me – it’s a home away from home. My first experience there was emerging from my mother’s womb over 40 years ago. Since then, I’ve attended meetings there, participated in and organized trainings, and completed case abstractions as the Fetal Infant Mortality Review Coordinator (FIMR).
In 2009, when I suffered complications from an incomplete miscarriage, Dr. David cared for me, performed surgery with sensitivity to my emotional needs and helped me have a healing experience.
As a doula, I’ve provided support for more deliveries occurring at Mercy Health Hackley than any other location. I have been impressed by the adherence to certain obstetric practices, such as immediate skin-to-skin and delayed cord clamping, which have been challenging to implement elsewhere.
In 2007, Hackley Hospital merged with Mercy, leaving Muskegon with a sole Catholic healthcare institution under Trinity Health. Despite many positive experiences with the dedicated staff there, a grave reality slowly started to sink in as many of them shared with me the struggles of healthcare that is dictated from afar by a group of Bishops, none of whom are doctors or will ever become pregnant, and prescribed religious directives.
The Tamesha Means lawsuit against the US Conference of Catholic Bishops and the EMTALA complaint outline substandard care to patients. What’s also at stake is how the Ethical and Religious Directives impact thousands of Trinity health employees and their families every day. Mercy Health is the largest employer in Muskegon County, with more than 3,500 employees. None of these employees, their spouses or their dependents up to the age of 26 have insurance coverage for birth control to prevent pregnancy under the insurance coverage that Mercy Health provides.
I stand in solidarity with the staff of Mercy Health in outrage of their and their patients’ denial of the basic human right of complete access to comprehensive reproductive healthcare services.
If you live in the State of Michigan and are being denied birth control coverage by your employer or know someone who was denied services at a religious-affiliated hospital, you can learn more information about your legal rights by contacting the ACLU of Michigan at (313) 578-6823.