What you need to know to “Just Say No”

What you need to know to “Just Say No” to medically unnecessary cesareans:

Ten important documents to have when planning a VBAC.

1. ACOG’s Statement on Maternal Decision Making, Ethics and the Law can be downloaded here. Now, why is the Committee on Ethics Opinion Statement from the American Congress (formerly College) of Obstetricians and Gynecologists (ACOG) from 2005 important in a world where women are regularly denied informed consent?  It’s more ammunition to fight back against care providers who are behaving UNethically.  While the entire document is worth reading to know where and how the committee came to its opinions, the opening abstract hits on the most important parts:

“ABSTRACT:  Recent legal actions and policies aimed at protecting the fetus as an entity separate from the woman have challenged the rights of pregnant women to make decisions about medical interventions and have criminalized maternal behavior that is believed to be associated with fetal harm or adverse perinatal outcomes.  This opinion summarizes recent, notable legal cases; reviews the underlying, established ethical principles relevant to the highlighted issues; and considers six objections to punitive and coercive legal approaches to maternal decision making.  These approaches 1) fail to recognize that pregnant women are entitled to informed consent and bodily integrity, 2) fail to recognize that medical knowledge and predictions of outcomes in obstetrics have limitations, 3) treat addiction and psychiatric illness as if they were moral failings, 4) threaten to dissuade women from prenatal care, 5) unjustly single out the most vulnerable women, and 6) create the potential for criminalization of otherwise legal maternal behavior.  Efforts to use the legal system to protect the fetus by constraining pregnant women’s decision making or punishing them erode a woman’s basic rights to privacy and bodily integrity and are not justified.” – ACOG Committee Opinion, November 2005.

While ACOG does not expect us to use this document against them, the reality is that in and of itself, ACOG expects its member providers to live within the bounds of these types of opinions.  If a provider follows the “immediately available” standard which is NOT law in any state, then it reasonably follows that you can show them this committee opinion and ask them to hold themselves to the same standard.  VBAC is not a procedure and this document would also apply to any hospital offering obstetric care and refusing to allow a woman to vaginally birth (VBAC) within their hospital.

2. The National Institutes of Health (NIH) Consensus Development Conference Statement and their recommendations regarding VBAC can be downloaded here.  This document is most useful for pointing out the research that backs up VBAC as a safe and reasonable choice for mothers to make and has comparative risks to a primipara (first-time) mother.  There is a problem with these documents being only recommendations, without force of law and/or protocol on obstetricians but it’s still a re-affirmation of the same information that we knew thirty years ago with the force of thirty more years of research to back it up.  If you don’t want to print the abstracts, then you can print only the conclusion.  Watching the actual consensus development process is worthwhile to understand the science that the panel was hearing and to further understand the true underlying causes of cesarean.

3. Federal Emergency Medical Treatment and Labor Act (EMTALA)

A good link to what is entailed in EMTALA is http://emtala.com/law/index.html.

Does EMTALA work to allow VBACs in hospitals that claim to have vbac bans? There is some dispute as to whether or not EMTALA would work in the case of a woman presenting in labor who wants a VBAC.  It’s a valuable document to have considering that a woman who is far enough along in labor does reserve the right to refuse treatment (cesarean) and right to refuse transfer if her birth is imminent but the hospital is still required to provide appropriate care under this law.

There is one section of a current recommendation that exists that may be somewhat helpful despite any debate over EMTALA’s total usefulness for VBAC moms:

“Individuals who present at these locations and request examination or treatment for a medical condition or have such a request made on their behalf must be screened under EMTALA and, if an emergency medical condition is determined to exist, provided necessary stabilizing treatment, because these locations are dedicated emergency departments.”

In the language of a normal mom, this could mean that a woman in labor with imminent delivery is expected to be treated with only stabilizing treatment and therefore, has the right to refuse a cesarean despite the hospital’s objections and without being told she must leave and find another care center.

4. ACOG’s Statement on VBAC (2010) which emphasizes that VBAC or Trial of Labor (TOL) is a reasonable choice for women who have had a cesarean under certain conditions. It should be noted, however, that these are simply guidelines by the obstetrical trade union and do not necessarily apply to other providers and/or their organizations. Many providers find that with informed consent, very FEW restrictions should be placed on VBAC and those reasons would almost all overlap with requirements for cesarean birth overall, such as a complete placenta previa.

5. Your state’s Patient’s Bill of Rights or Pregnant Patient’s Bill of Rights.

While not every state has one, if your state does, this could be a legal statute that binds providers to act ethically despite their personal wishes for care.  In some states, this document reiterates a woman’s right to informed consent and refusal, giving grounds to refuse the procedure of a non-medically indicated cesarean.  Check out our State By State page to see if your state has one listed.

6. A VBACFacts.com calling card or Quick Facts Sheet. These handy little cards describe your risks or non-risks in a quick, easy to produce form.  They are ideal for recalling what the studies break down to and include citations for those studies as well.  Not to mention, if you share…you will be helping other women break the cycle of myths about VBAC.

7. The “Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery” Study (Landon, et al NEJM 2004). If you are a mom who has had multiple cesareans, a copy of Landon’s study is a must.  This landmark study is the best ammunition for mothers of unknown/unusual scar types or multiple cesareans.  The study reaches conclusions about the relative safety or risk of uterine rupture that shows that even after multiple cesareans, VBAC is not an unreasonable choice for mothers.  The wording on this study is actually very medically inclined but for those who want to understand the real risks of cesarean and how it affects every labor thereafter (Uterine rupture is NOT a risk of vaginal birth, it’s a risk of prior cesarean.  VBAC is not to blame, the first cesarean is, which is why prevention is VITAL) should check out this study’s conclusion, excerpted here:

“Among 17,898 trials of labor and 124 ruptures, we found two neonatal deaths, for an overall rate of rupture-related perinatal death of 0.11 per 1000 trials of labor.  A recent review of 880 maternal uterine ruptures during a 20-year period showed 40 perinatal deaths in 91,039 trials of labor, for a rate of 0.4 per 1000.

8. The American Association of Family Physicians’ (AAFP) Statement on VBAC.  This particular document is interesting because it does not agree with the ACOG recommendations for VBAC.  Several family physicians went even further with editorials regarding the controversies here and another, additional document under the AAFP also shows that maternal and infant outcomes do not improve under ACOGs “immediately available” guideline.

9. The Northern New England Perinatal Quality Improvement Network document set.  This includes a sample consent form, VBAC guidelines and a patient education document.  While this document set does not clear all women with prior cesarean for VBAC, the guidelines are just that, they provide a framework for understanding relative risk and factors that may contribute to risk and to help a mother and provider choose appropriate care.  A favorite quote is the last paragraph:

“If our goal were to prevent all cases of fetal injury due to uterine rupture, approximately 7.5 million dollars would be spent for each case of fetal injury from rupture that was prevented.  This is based on a general risk of uterine rupture of 0.5%, a 10% incidence of significant fetal injury when rupture occurs, and the cost of cesarean delivery listed above.  In addition to the economic costs, substantially more children would be require intensive care services due to respiratory complications at birth, some of them severe.  The price of discontinuing VBAC services is thus substantial.”

10. The March of Dimes statement on “Why the Last Weeks of Pregnancy Count” (2009).  This page emphasizes NOT doing cesareans before 39 weeks unless absolutely necessary (in the case of a medically indicated cesarean) due to the increased morbidity (harm) and mortality (death) in these infants.  Another page on the March of Dimes site that is important is “Cesarean Birth By Request”.

I truly wish that any and/or all of these documents could protect women from an OB/GYN or hospital facility violating her rights to bodily integrity by trying to force her into a cesarean.  The only way this will truly be overcome is by women filing complaints, going to newspapers and other media outlets and presenting our cases to our state attorneys offices in the hope they will take up the case or filing private lawsuits.

In the case of Florida, the state attorney and the state insurance commissioner both stated, “We simply don’t get enough formal complaints about these subjects.”  And they don’t.  Many women are either still pregnant and search out other providers or simply cave to the planned cesarean or they are new mothers caring for an infant and a healing wound and possibly, other children at home.

Filing complaints is something BirthAction is trying to make easier on our State By State and Advocacy pages.  There are also templates on the site for approaching insurance companies or other interested parties.  If you are confronted by an unfriendly provider who refuses to allow VBAC or who refuses to acknowledge your right to refuse a cesarean, we suggest you do something about it.  We do not have to remain victims of this system, we can learn and grow and fight back for our births and our babies.  Birth IS Action.  Arm yourself.

Can I have a Respectful Cesarean?

Lately, there has been increasing discussion regarding cesareans made more mother-friendly. The concept came out of some videos in the UK and is now being popularized and sold in the US as the answer to helping women cope with the trauma of cesarean.

There is a basic flaw with the sales of this because every birth should be respectful. Providers shouldn’t have to sell skin to skin contact as if they are the only provider in the US that does it. Mothers shouldn’t have to beg to touch their babies before hours in recovery. This shouldn’t be an issue because it should be standard of practice.

The reason I chose to write about this is another simple reminder that moms shouldn’t have to sell their births to get a respectful cesarean either. Every birth should be respectful. Every birth should be as gentle as it can be made to be. Women shouldn’t have to agree to surgery to be treated well and this should not be advertising to convince women out of options like vaginal breech birth. If your provider uses this as a selling point, then consider the question, “will my choices be respectfully treated if I do not choose this elective procedure” if the answer is no, is this really who you want to be helping you transition into motherhood?

My Doctor Might Drop Me!

Yes, he might. She might. It’s a good threat and some providers even go so far as to write letters stating they have terminated you.

Your midwife might, as well.

However, it’s not in their ethical best interests and sometimes, they can be liable for it legally. BirthAction.org will be posting state-by-state regulations regarding patient care termination but here’s the American Medical Association’s take on it:

Opinion 8.115 – Termination of the Physician-Patient Relationship

Physicians have an obligation to support continuity of care for their patients. While physicians have the option of withdrawing from a case, they cannot do so without giving notice to the patient, the relatives, or responsible friends sufficiently long in advance of withdrawal to permit another medical attendant to be secured. (I, VI)

Issued June 1996 (formerly included in Opinion 8.11).

(Accessed by BirthAfterCesarean.com at http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion8115.page on 1/21/2013)

The Texas Medical Association states: (http://rightnow.texmed.org/ci/fattach/get/18682/) states:

Q: May a physician lawfully terminate his or her relationship with a patient at any


A: Abandonment of a patient may result in civil liability for the physician. Abandonment is

usually defined as “the unilateral severance of the professional relationship without

reasonable notice at a time when there is still the necessity of continuing medical attention.”


Proof of actionable abandonment requires a showing that the physician failed to provide “an

adequate medical attendant” and also failed to give adequate notice.

2 Finally, as in any

negligence action, the plaintiff must prove that this breach of duty was the cause of his or her

injuries or damages.


(Thank you to Felicia for her help in searching for these documents!)

Looking for California’s Cesarean Rates?

There are various ways to find cesarean rates in every state, some are easier than others. Www.Cesareanrates.com is currently compiling statistics for each state but sometimes, we tumble to freebie links where someone else has conveniently posted the information.


http://www.sacbee.com/2012/11/21/5002674/see-c-section-rates-at-every-california.html posted the following chart:


Hospital County C-Sections (2011) Rate Per 100 Births
Los Angeles Community Hospital Los Angeles 108 64
East Valley Hospital Medical Center Los Angeles 108 55
Bellflower Medical Center Los Angeles 755 55
East Los Angeles Doctors Hospital Los Angeles 410 52
Pacifica Hospital of the Valley Los Angeles 248 46
Citrus Valley Medical Center – Queen of the Valley Campus Los Angeles 1763 46
El Centro Regional Medical Center Imperial 487 44
Monterey Park Hospital Los Angeles 642 44
Verdugo Hills Hospital Los Angeles 258 44
Colusa Regional Medical Center Colusa 67 43
Torrance Memorial Medical Center Los Angeles 1223 43
Coastal Communities Hospital Orange 558 42
Community Hospital of San Bernardino San Bernardino 890 42
Palo Verde Hospital Riverside 64 42
Memorial Hospital of Gardena Los Angeles 465 41
Beverly Hospital Los Angeles 322 40
Hemet Valley Medical Center Riverside 355 39
Montclair Hospital Medical Center San Bernardino 325 39
Garfield Medical Center Los Angeles 1152 39
Glendale Adventist Medical Center – Wilson Terrace Los Angeles 819 39
Central Valley General Hospital Kings 663 39
Lodi Memorial Hospital San Joaquin 396 39
Hi-Desert Medical Center San Bernardino 137 39
Glendale Memorial Hospital and Medical Center Los Angeles 713 39
Garden Grove Hospital and Medical Center Orange 684 39
Sharp Memorial Hospital San Diego 2745 38
Valley Presbyterian Hospital Los Angeles 1367 38
Plumas District Hospital Plumas 24 38
Greater El Monte Community Hospital Los Angeles 164 38
Santa Monica – UCLA Medical Center and Orthopedic Hospital Los Angeles 418 37
Foothill Presbyterian Hospital – Johnston Memorial Los Angeles 321 37
San Ramon Regional Medical Center Contra Costa 231 37
Ridgecrest Regional Hospital Kern 191 37
West Hills Hospital and Medical Center Los Angeles 272 37
Huntington Memorial Hospital Los Angeles 1003 37
San Antonio Community Hospital San Bernardino 742 37
Hollywood Presbyterian Medical Center Los Angeles 1331 37
San Gabriel Valley Medical Center Los Angeles 692 37
Good Samaritan Hospital – San Jose Santa Clara 1001 36
Northridge Hospital Medical Center Los Angeles 695 36
Providence Tarzana Medical Center Los Angeles 701 36
Clovis Community Medical Center Fresno 1099 36
Centinela Hospital Medical Center Los Angeles 358 36
Victor Valley Community Hospital San Bernardino 491 36
Memorial Hospital Medical Center – Modesto Stanislaus 648 36
Scripps Memorial Hospital – La Jolla San Diego 1219 35
Western Medical Center – Santa Ana Orange 721 35
Sierra Kings District Hospital Fresno 347 35
Providence Little Company of Mary Medical Center – Torrance Los Angeles 761 35
Sharp Chula Vista Medical Center San Diego 888 35
Pacific Hospital of Long Beach Los Angeles 265 35
Kaweah Delta Medical Center Tulare 1270 35
Los Angeles County/Harbor – UCLA Medical Center Los Angeles 245 35
Pacific Alliance Medical Center, Inc. Los Angeles 649 34
Los Robles Hospital and Medical Center Ventura 527 34
Hoag Memorial Hospital Presbyterian Orange 1788 34
Saint Francis Medical Center Los Angeles 1598 34
Providence Saint Joseph Medical Center Los Angeles 765 34
Saint Joseph Hospital – Orange Orange 1469 34
Los Angeles County/University of Southern California Medical Center Los Angeles 289 34
Fairchild Medical Center Siskiyou 69 34
Saint John’s Health Center Los Angeles 448 34
Los Angeles County/Olive View – UCLA Medical Center Los Angeles 175 34
Sutter Tracy Community Hospital San Joaquin 199 34
Valleycare Medical Center Alameda 389 33
Cedars Sinai Medical Center Los Angeles 1917 33
Sonora Regional Medical Center – Greenley Tuolumne 147 33
Saint Agnes Medical Center Fresno 1207 33
Whittier Hospital Medical Center Los Angeles 642 33
Hazel Hawkins Memorial Hospital San Benito 135 33
Henry Mayo Newhall Memorial Hospital Los Angeles 353 33
White Memorial Medical Center Los Angeles 1139 33
Oak Valley District Hospital Stanislaus 82 33
San Gorgonio Memorial Hospital Riverside 139 33
Parkview Community Hospital Medical Center Riverside 574 32
Tulare Regional Medical Center Tulare 366 32
Antelope Valley Hospital Los Angeles 1551 32
Sierra Vista Regional Medical Center San Luis Obispo 348 32
Earl and Lorraine Miller Children’s Hospital Los Angeles 1409 32
Doctors Medical Center Stanislaus 1074 32
Mission Hospital Regional Medical Center Orange 844 32
Fountain Valley Regional Hospital and Medical Center – Euclid Orange 895 32
Pioneers Memorial Hospital Imperial 530 32
Grossmont Hospital San Diego 1007 32
Washington Hospital – Fremont Alameda 553 32
Oroville Hospital Butte 124 32
Doctors Hospital of Manteca San Joaquin 221 32
Providence Holy Cross Medical Center Los Angeles 728 31
Sequoia Hospital San Mateo 424 31
Pomona Valley Hospital Medical Center Los Angeles 1926 31
John F. Kennedy Memorial Hospital Riverside 661 31
Sutter Amador Hospital Amador 92 31
Sierra View District Hospital Tulare 557 31
Kaiser Foundation Hospital – Riverside Riverside 906 31
Sutter Memorial Hospital Sacramento 1417 31
Kaiser Foundation Hospital – San Diego San Diego 1113 31
Barstow Community Hospital San Bernardino 64 31
Sutter Auburn Faith Hospital Placer 55 31
Mercy Medical Center – Merced Merced 754 31
Adventist Medical Center Kings 304 31
Marian Medical Center Santa Barbara 747 30
Presbyterian Intercommunity Hospital Los Angeles 856 30
Orange Coast Memorial Medical Center Orange 448 30
UC San Diego Medical Center San Diego 619 30
Madera Community Hospital Madera 476 30
Palomar Medical Center San Diego 968 30
Pomerado Hospital San Diego 319 30
Saint Mary Medical Center Los Angeles 819 30
Scripps Memorial Hospital – Encinitas San Diego 405 30
Dameron Hospital San Joaquin 343 30
Banner Lassen Medical Center Lassen 75 30
Saddleback Memorial Medical Center Orange 642 30
Saint John’s Regional Medical Center Ventura 644 30
Kaiser Foundation Hospital – Moreno Valley Riverside 314 30
Riverside Community Hospital Riverside 1013 29
Community Memorial Hospital – San Buenaventura Ventura 652 29
San Joaquin General Hospital San Joaquin 539 29
Tri-City Medical Center – Oceanside San Diego 750 29
Community Regional Medical Center – Fresno Fresno 1522 29
Mercy Medical Center – Redding Shasta 490 29
Scripps Mercy Hospital San Diego 1058 29
Loma Linda University Medical Center San Bernardino 595 29
Paradise Valley Hospital San Diego 299 29
Santa Rosa Memorial Hospital – Montgomery Sonoma 248 29
Peninsula Medical Center San Mateo 471 29
Eden Medical Center Alameda 297 29
Watsonville Community Hospital Santa Cruz 398 29
Providence Little Company of Mary Medical Center – San Pedro Los Angeles 187 29
Riverside County Regional Medical Center Riverside 594 29
Memorial Hospital Los Banos Merced 196 29
Kaiser Foundation Hospital – Sunset Los Angeles 559 28
Desert Regional Medical Center Riverside 826 28
Good Samaritan Hospital – Los Angeles Los Angeles 1154 28
Methodist Hospital of Southern California Los Angeles 418 28
Simi Valley Hospital and Healthcare Services – Sycamore Ventura 172 28
California Hospital Medical Center – Los Angeles Los Angeles 1079 28
San Dimas Community Hospital Los Angeles 110 28
Marshall Medical Center El Dorado 138 28
UC Irvine Medical Center Orange 259 28
George L. Mee Memorial Hospital Monterey 137 28
Kaiser Foundation Hospital – Downey Los Angeles 845 28
Kaiser Foundation Hospital – Fresno Fresno 285 28
Downey Regional Medical Center Los Angeles 328 28
Kaiser Foundation Hospital – Hayward Alameda 602 28
Arrowhead Regional Medical Center San Bernardino 713 28
Ronald Reagan UCLA Medical Center Los Angeles 541 28
Queen of the Valley Hospital – Napa Napa 221 28
Rideout Memorial Hospital Yuba 538 28
North Bay Medical Center Solano 343 27
Mercy General Hospital Sacramento 751 27
O’Connor Hospital – San Jose Santa Clara 810 27
Saint Jude Medical Center Orange 502 27
Corona Regional Medical Center – Main Riverside 381 27
Santa Barbara Cottage Hospital Santa Barbara 569 27
Western Medical Center – Anaheim Orange 448 27
Redlands Community Hospital San Bernardino 625 27
Desert Valley Hospital San Bernardino 127 27
Kaiser Foundation Hospital – Anaheim Orange 1184 27
Seton Medical Center San Mateo 154 27
Fallbrook Hospital District San Diego 113 27
Sutter Lakeside Hospital Lake 70 27
Salinas Valley Memorial Hospital Monterey 417 26
El Camino Hospital Santa Clara 1128 26
Natividad Medical Center Monterey 664 26
Southwest Healthcare System – Murrieta Riverside 900 26
Kaiser Foundation Hospital – San Francisco San Francisco 590 26
Saint Louise Regional Hospital Santa Clara 163 26
Kaiser Foundation Hospital – Fontana San Bernardino 1014 26
Kaiser Foundation Hospital – Oakland Campus Alameda 494 26
Community Hospital Monterey Peninsula Monterey 294 26
Lompoc Valley Medical Center Santa Barbara 111 26
Petaluma Valley Hospital Sonoma 104 26
Kaiser Foundation Hospital – Baldwin Park Los Angeles 667 26
Ventura County Medical Center Ventura 521 26
Kaiser Foundation Hospital – Woodland Hills Los Angeles 352 26
Sutter Solano Medical Center Solano 183 26
Ukiah Valley Medical Center Mendocino 201 26
Los Alamitos Medical Center Orange 368 25
Kaiser Foundation Hospital – Harbor City Los Angeles 448 25
Kaiser Foundation Hospital – Panorama City Los Angeles 405 25
Kaiser Foundation Hospital – Santa Rosa Sonoma 440 25
UC Davis Medical Center Sacramento 412 25
Kaiser Foundation Hospital – West Los Angeles Los Angeles 364 25
Sutter Roseville Medical Center Placer 663 25
California Pacific Medical Center – Pacific Campus San Francisco 1174 25
Delano Regional Medical Center Kern 182 25
Mercy Hospital – Bakersfield Kern 532 25
Mercy San Juan Hospital Sacramento 534 25
Kaiser Foundation Hospital – Rehabilitation Center Vallejo Solano 497 25
Sutter Coast Hospital Del Norte 81 25
Saint Helena Hospital Napa 54 24
Northern Inyo Hospital Inyo 44 24
Barton Memorial Hospital El Dorado 88 24
Kaiser Foundation Hospital – Walnut Creek Contra Costa 687 24
Mercy Hospital – Folsom Sacramento 206 24
Lucile Salter Packard Children’s Hospital at Stanford Santa Clara 847 24
Saint Rose Hospital Alameda 240 24
Enloe Medical Center – Esplanade Campus Butte 285 24
John Muir Medical Center – Walnut Creek Campus Contra Costa 548 24
AHMC Anaheim Regional Medical Center Orange 399 24
Kern Medical Center Kern 732 24
Marin General Hospital Marin 294 24
Saint Elizabeth Community Hospital Tehama 150 24
Tahoe Forest Hospital Nevada 77 24
Santa Clara Valley Medical Center Santa Clara 883 24
Regional Medical of San Jose Santa Clara 75 23
Mammoth Hospital Mono 25 23
Saint Joseph Hospital – Eureka Humboldt 123 23
Saint Joseph’s Medical Center of Stockton San Joaquin 523 23
Kaiser Foundation Hospital – Manteca San Joaquin 479 23
Methodist Hospital of Sacramento Sacramento 234 23
Kaiser Foundation Hospital – Santa Clara Santa Clara 815 23
Dominican Hospital – Santa Cruz/Soquel Santa Cruz 171 23
Saint John’s Pleasant Valley Hospital Ventura 49 23
Sutter Delta Medical Center Contra Costa 200 23
Alameda County Medical Center – Highland Campus Alameda 226 23
Mendocino Coast District Hospital Mendocino 35 22
Twin Cities Community Hospital San Luis Obispo 154 22
Feather River Hospital Butte 198 22
Kaiser Foundation Hospital – Sacramento** Sacramento 954 22
Alta Bates Summit Medical Center – Alta Bates Campus Alameda 1384 22
Sutter Maternity and Surgery Center of Santa Cruz Santa Cruz 196 22
Saint Bernadine Medical Center San Bernardino 407 22
Kaiser Foundation Hospital – Roseville** Placer 954 22
Bakersfield Memorial Hospital Kern 672 21
Emanuel Medical Center, Inc. Stanislaus 262 21
Kaiser Foundation Hospital – Antioch Contra Costa 275 21
Kaiser Foundation Hospital – San Jose Santa Clara 366 21
Mad River Community Hospital Humboldt 90 21
Contra Costa Regional Medical Center Contra Costa 403 21
Sonoma Valley Hospital Sonoma 38 21
Saint Mary Regional Medical Center San Bernardino 499 21
French Hospital Medical Center San Luis Obispo 145 21
Saint Helena Hospital – Clearlake Lake 39 21
Sutter Medical Center of Santa Rosa Sonoma 289 20
California Pacific Medical Center – St. Luke’s Campus San Francisco 166 20
San Joaquin Community Hospital Kern 500 20
Mercy Medical Center Mt. Shasta Siskiyou 26 19
UC San Francisco Medical Center San Francisco 277 19
Redwood Memorial Hospital Humboldt 59 19
Woodland Memorial Hospital Yolo 114 18
Sierra Nevada Memorial Hospital Nevada 76 18
San Francisco General Hospital San Francisco 179 17
Kaiser Foundation Hospital – South Sacramento Sacramento 351 16
Kaiser Foundation Hospital – Redwood City San Mateo 187 16
Sutter Davis Hospital Yolo 184 16
La Palma Intercommunity Hospital Orange 27 15
Loma Linda University Medical Center – Murrieta Riverside 12 15

Data:Office of Statewide Health Planning and Development
Powered by Daemon Fusion, under an MIT license. NOTES: Excludes hospitals with fewer than 20 births in 2011. 


© Copyright The Sacramento Bee. All rights reserved.

Read more here: http://www.sacbee.com/2012/11/21/5002674/see-c-section-rates-at-every-california.html#storylink=cpy

Looking for Florida’s Cesarean Rates?

2013-01-21_0042_Lee_County_Cesareans 2013-01-21_0043_Lee_County_Vaginal_Deliveries

There are several ways to get to see Florida’s Cesarean and Vaginal Birth Rates, these examples come from following a how-to link at http://tampa.ican-online.org/csrates.htm explaining one way to get these numbers. You’ll notice that above, the Vaginal Birth rate at Cape Coral is nearly the same as the Cesarean Rate, almost 50% cesareans.

You can also go through the Florida CHARTS system or go to www.cesareanrates.com where the information is compiled for you.




We Are ALL Activists.

What kind of activist are you?

Some of us are born mothers. We activate others to make better mothering choices simply by our being good mothers and an example.

Others are born to write about activism and educate the masses or the minor support groups of a particular need Both are important.

Some of us are icily strong in the face of danger, standing up to those who must be stopped. Others are fire, burning everyone in their path who opposes them.

Some moms write letters, some forward emails and Facebook statuses. Some mothers go on to be in government, stand up to government, change government.

Some speak to the spiritual, some to the literal, some to the mainstream and some to the far edges. We each have a voice we are activating.

Every one of us has been an example to someone else in some way of the action we wish others would be.

Find what your action is, know what it is, build it stronger. BE the change you want in the world.

So, babe, what’s your activism all about today?

Infertility: The Other Side of Pregnancy

For every mother out there having a baby, there are others who are struggling through varying degrees of inability to conceive. They are also trapped in the obstetric world, dealing with the same issues that pregnant women deal with every day.

-Informed Consent
-Full Information
-Procedures without Understanding
-Provider Trust Issues

Most days, I’m not sure how to help mainstream pregnant women become more aware of these issues or how to react to them in order to receive proper respectful care and treatment and here I am including the even more broad environment of fertility issues.

Women, we are not broken as people even when our bodies betray us, we are not stupid and we deserve information, answers, consent and more than simple vacillation from our care providers who expect us to do as told in order to walk away with a healthy baby. There are more routes to birthing and parenting than compliance.

Arm yourself with information, empower yourself with the knowledge that gives you the rights to say no and make choices based on health, safety and instinct, not convenience. Anything less could easily be a shirking of responsibility.

Making Decisions: Bring your Brain to Work

Women and childbirth educators often talk about how to make decisions while under the influence of care providers or while standing in their offices. We all know it’s intimidating to sit there, half-naked in a paper sheet. Often, we need a non-confrontational way to think about the choices in front of us. Here’s some helpful standard acronyms for making good choices:


  • B – benefits
  • R – risks
  • A – alternatives
  • N – what happens if we do nothing
  • D – decision/delay/decide later (What if we wait? Respect your intuition! Ask for a few minutes to evaluate.)


  • B = benefits
  • R = Risks
  • A = Alternatives
  • N = do Nothing (What happens if we decide to do nothing?)
  • D = Decision


  • I = Intuition
  • N = Now What?

Or you can download this pdf from Lucina Birth Services.

Types of Care Providers for VBAC Moms

Choices in Birth Care Providers for VBAC Mothers

A mother who has had a prior cesarean does not always have an easy time finding someone to attend her birth, either in the professional care provider role or even for as something as simple as support.  Many times, mothers find avenues closed to them when they say they want a vaginal birth after cesarean (VBAC).  Since choices are often limited, BirthAction wants to outline what choices a mother does have when giving birth after cesarean and looking for care.

Obstetrician (OB) –

Obviously, the most mainstream and common of choices, some OBs do still attend VBAC births in hospitals around the country.  This usually takes a fair amount of research to find one locally and they may have qualifying protocols which a mother needs to be careful to ask questions about and use her best judgment.  There are also concerns about whether or not an OB truly supports VBAC mothers or is simply giving lip service until the mom gets so far along in her pregnancy.  There are some OBs that give all the rest a fantastic name and not only support VBAC but also do VBAC with twins and breeches or VBAmC (vaginal birth after multiple cesareans) based on a mother’s individual risks, knowledge and care.

Certified Nurse Midwife (CNM) –

Second to the OB in the number of VBACs done, CNMs are also a more common choice, often practicing within an OB practice or birth center.  While CNMs typically have some obvious drawbacks in being more medically-minded or using protocols that are required by law to be approved by OBs, CNMs are still a choice that many women make in trying to compromise between having a less-interventive but still vaginal birth and an elective cesarean.

Other Midwives (DEM, LM, CPM, “lay”) –

While often thought to be the same thing, different types of midwives also have different types of training while having one thing in common in helping women to have homebirths.  VBACs are frequently done at home in many states in the US, often due both to the decline in availability in hospital providers of VBAC but also in concerns for the safety of the mother and baby and prevention of a repeat surgery due to interventions from the care providers that practice in-hospital.  Women should be careful to do research about their midwife, her training and her philosophies about births, including handling an emergency situation.  While concerns are often raised about the immediate available of cesarean in case of uterine rupture, homebirth has not been shown to dramatically increase the rate of rupture or of catastrophic outcomes.  There is some question of the legality of midwifery in some states but many women choose to birth at home with a midwifery attendant anyway due to the same concerns of safety and realistic support of VBAC.  “Traveling midwives” would fall under this category as well.

Unassisted –

Some mothers also choose to have an unassisted or unattended birth.  This does not usually mean the mother is birthing alone, without a support person, but it does usually mean that she does so without a medically-trained provider.  The reasons for this are numerous, from religious and privacy concerns to an inability to find a supportive provider.  Unassisted mothers are typically very educated women who research and trust in the birthing process being normal.