Friday, July 31, 2009

Sarasota to Host Maternal Health Care Panel

Sarasota, FL (July 31, 2009) -- On November 1, 2009, Sarasota will host a discussion entitled 'Maternal Health Care in the 21st Century: Sarasota and Beyond.' The program will feature a distinguished panel of internationally recognized speakers. The Sarasota-Manatee Chapter of the National Organization for Women (NOW) is sponsoring the event, along with co-sponsors Florida Friends of Midwives and the Sarasota Commission on the Status of Women. The discussion will take place at the Hyatt Regency Sarasota. The public is welcome to attend at no cost.

The panelists for this discussion are:
--Dr. Washington Hill, MD, FACOG, Labor and Delivery Medical Director and Maternal-Fetal Medicine Director at Sarasota Memorial Hospital;
--Ina May Gaskin, MA, CPM, Founder and Director of The Farm Midwifery Center;
--Jennifer Highland, MPH, Executive Director of the Healthy Start Coalition of Sarasota County; and
--Rep. Keith Fitzgerald, PhD, Florida House of Representatives, District 69.

The discussion will be moderated by Kelly Kirschner, Sarasota City Commissioner and Vice Mayor, and will last approximately an hour and a half. Time will be allotted for audience questions and answers as well as refreshments following the program.

This panel will review current trends in maternity care in Sarasota within the context of the U.S. and the world and target paths to improving maternity care locally and nationwide. Topics for discussion include:

* maternal mortality,
* obstetric intervention rates and risks,
* legislation,
* legal reform and malpractice concerns,
* community education and awareness,
* the midwifery model of care,
* informed consent and refusal,
* the availability of prenatal and postpartum care (including education, counseling, and doulas), and
* the upcoming expansion of Sarasota Memorial Hospital to include new labor and delivery rooms.

Hosting a panel discussion about maternal health care issues was the brainchild of Sonia Pressman Fuentes, co-founder of the National Organization for Women (NOW). “After spending a lifetime improving the legal status of women and fighting gender discrimination in the US and the world, it is exciting for me to be involved in a field new to me, that of improving maternal health care options for women in Sarasota, the US, and the world,” says Fuentes. Joining her in planning the event is Laura Gilkey, local childbirth advocate and board member of Florida Friends of Midwives. "With a panel representative of obstetrics, midwifery, legislature, and public health, perhaps Sarasota can begin a conversation that will pave the way toward becoming a national model of community healthcare reform through improved maternity care," says Gilkey.
About the National Organization for Women (NOW): The National Organization for Women (NOW) is the largest organization of feminist activists in the United States. NOW has 500,000 contributing members and 550 chapters in all 50 states and the District of Columbia. Since its founding in 1966, NOW's goal has been to take action to bring about equality for all women. NOW works to eliminate discrimination and harassment in the workplace, schools, the justice system, and all other sectors of society; secure reproductive rights for all women; end all forms of violence against women; eradicate racism, sexism and homophobia; and promote equality and justice in our society. The Sarasota-Manatee Chapter of NOW meets on the third Thursday of each month at the Selby Public Library. For more information on the Sarasota-Manatee chapter of NOW, please visit

About Florida Friends of Midwives (FFOM)
: Florida Friends of Midwives (FFOM) is a non-profit grassroots organization dedicated to promoting the Midwives Model of Care and supporting the practice of midwifery in Florida. Florida Friends of Midwives was formed to support midwives who offer safe, cost-effective, evidence based care to Florida's Families. FFOM members are consumers and birth advocates with a common goal: to preserve the legal protection afforded to Florida's midwives and birth centers. They are committed to organizing the community to support midwives and to assure the continued availability of midwifery care in the State of Florida. For more information, please visit

About the Sarasota Commission on the Status of Women (SCSW)
: The Sarasota Commission on the Status of Women (SCSW) was established in 1987 and became an independent nonprofit organization in 2007 to empower Sarasota County's women through education, research and advocacy. Their overview is Women and Violence and they work through committees on Domestic Violence, Women and Housing, Women and Homelessness, Sexual Content in the Media, Human Trafficking, Women and Politics. Their focus is local and they encourage the enhancement of the status of Sarasota's women through public policy changes by local, state, and national governmental entities by partnering with other organizations with similar goals. For more information, please visit


Dr. Washington Hill, M.D., FACOG
Labor and Delivery Medical Director / Maternal-Fetal Medicine Director, Sarasota Memorial Hospital
B.A., Rutgers University, College of South Jersey, Camden, New Jersey, 1961
M.D., Temple University School of Medicine, 1965
Obstetrics and Gynecology Residency, William Beaumont General Hospital, 1970
Post Graduate, Maternal-Fetal Medicine Fellowship, University of California, San Francisco, 1984
Board Certification, American Board of Obstetrics and Gynecology with Special Competence in Maternal-Fetal Medicine, 1989 with Recertification 1978, 1993 and 1998

Dr. Hill is the Past President of the Medical Staff and Chairman of the Department of Obstetrics and Gynecology at Sarasota Memorial Hospital, Sarasota, Florida. He is currently Director of Maternal-Fetal Medicine. He is also Clinical Professor Department of Obstetrics and Gynecology at University South Florida College of Medicine, Tampa, Florida and Clinical Professor Department of Clinical Sciences OB/GYN Clerkship Director-Sarasota Campus Florida State University College of Medicine, Tallahassee, Florida. Following completion of his fellowship in Maternal-Fetal Medicine, he has practiced this subspecialty for over 20 years first at the Sutter Perinatal Center and the University of California-Davis School of Medicine, Sacramento, California; and then at Creighton University, School of Medicine, Omaha, Nebraska; Meharry Medical College; and Vanderbilt University School of Medicine, Nashville, Tennessee. He served as Chairman of the Department of Obstetrics and Gynecology at Meharry Medical College, School of Medicine, until 1992, when he took his current position as Director of Maternal-Fetal Medicine and the Perinatal Center of Sarasota Memorial Hospital in Sarasota, Florida. Dr. Hill is the author of at least 60 articles in refereed journals and the book
Ambulatory Obstetrics.

Ina May Gaskin, M.A., C.P.M.
Founder / Director, The Farm Midwifery Center

State University of Iowa, Iowa City, Iowa, B.A., English, Summa cum laude, Highest honors
Northern Illinois University, DeKalb, Illinois, M.A., English
North American Registry of Midwives
Certified Professional Midwife
Tennessee Licensed Certified Professional Midwife

Ina May Gaskin, MA, CPM, is founder and director of the Farm Midwifery Center, located near Summertown, Tennessee. Founded in 1971, by 1996, the Farm Midwifery Center had handled more than 2200 births, with remarkably good outcomes. Ms. Gaskin herself has attended more than 1200 births. She is author of
Spiritual Midwifery, now in its fourth edition. For twenty-two years she published Birth Gazette, a quarterly covering health care, childbirth and midwifery issues. Her most recent book, Ina May’s Guide to Childbirth was released in 2003. She was President of Midwives' Alliance of North America from 1996 to 2002. The Gaskin maneuver, a low-interventive effective method for dealing with shoulder dystocia, is the first obstetrical procedure to be named for a midwife. Ms. Gaskin’s center is noted for its low rates of intervention, morbidity and mortality. Ms. Gaskin is the originator and coordinator of The Safe Motherhood Quilt Project, a national effort developed to draw public attention to the current U.S. maternal death rates. Her newest book, Ina May's Guide to Breastfeeding, will be released October 1st, 2009.

Jennifer Highland, M.P.H.
Executive Director, Healthy Start Coalition of Sarasota County
University of South Florida, M.P.H. Public Health, 1995

Jennifer’s passion for helping mothers and infants began with the birth of her children. Jennifer's early career was in Louisiana, Georgia and Texas, where she served as a registered nurse. After she moved to Florida and became a mother, Jennifer volunteered for the Breastfeeding Advocates of Sarasota County and completed her Master of Public Health Degree from USF, graduating in 1995. Jennifer was the Project Coordinator for the first and on-going national breastfeeding promotion campaign, “Loving Support Makes Breastfeeding Work,” through her employment with Best Start, Inc., in Tampa. She then became trained as a Childbirth Educator and taught at Sarasota Memorial Hospital. Her work at The Healthy Start Coalition of Sarasota County began in 2001 as the Contract/Quality Manager. Her role expanded to include professional education. In 2006 she became the Executive Director.

Rep. Keith Fitzgerald, Ph.D.
Florida House of Representatives, District 69

University of Louisville, B.A., 1979
Indiana University, Ph.D., 1987

Representative Keith Fitzgerald was elected to represent State House District 69 in 2006, and re-elected in 2008. His district includes the northern part of Sarasota County and a small portion of Manatee County. Representative Fitzgerald has lived in Sarasota and taught political science at New College of Florida since 1994. He and his wife, Angela Baker, have nine-year-old twins. Representative Fitzgerald serves as the Democratic Ranking Member on the Policy Council and as a member of the Finance and Tax Council, Health and Family Services Policy Council, Select Policy Council on Strategic & Economic Planning and the Military and Local Affairs Policy Committee. Representative Fitzgerald also serves as Policy Chair for the House Democratic Caucus. His prior leadership positions include service on the Advisory Council of Faculty Senates, the Board of Trustees at New College of Florida and the Sarasota City Charter Review Board.

MODERATOR: Kelly Kirschner
Sarasota City Commission (District 3 Commissioner / Vice Mayor)

B.S. Foreign Service, Georgetown University
M.A. Latin American Studies, Georgetown University

Kelly is a lifelong Sarasotan. He has served the Sarasota community as President of the Alta Vista Neighborhood Association as well as having been an active member of the Coalition of City Neighborhood Associations. Believing strongly in public service, Kelly has worked for the White House Office of Public Liaison; served as a Peace Corps Volunteer; and led a USAID community conservation project in rural Guatemala. Kelly lives with his wife, Tracy, son, Bodhi, and daughter, Selby, in District 3.

EVENT SPONSOR: Sonia Pressman Fuentes
The Sarasota-Manatee Chapter, National Organization for Women (NOW)

B.A. Cornell University 1950
J.D. University of Miami School of Law 1957

Sonia Pressman Fuentes, who was born in Berlin, Germany, came to the U.S. with her immediate family in 1934 to escape the Holocaust. She was an attorney for the U.S. Department of Justice, the National Labor Relations Board, the Equal Employment Opportunity Commission (EEOC) (where she was the first woman attorney in its Office of the General Counsel), and the U.S. Department of Housing & Urban Development in Washington, D.C. and elsewhere. She was a co-founder of NOW, WEAL (the Women’s Equity Action League), and FEW (Federally Employed Women) and a charter member of VFA (Veteran Feminists of America). She was the longest-serving board member in the history of NWP (National Woman’s Party). In 1993, she retired from the federal government, thereafter wrote her memoir,
Eat First—You Don’t Know What They’ll Give You, The Adventures of an Immigrant Family and Their Feminist Daughter, and embarked on new careers as a writer and public speaker. For further information, please visit her website at

Florida Friends of Midwives (FFOM)

B.L.A. Landscape Architecture, University of Florida, 2000

Laura Gilkey serves on the Board of Directors for Florida Friends of Midwives, and is the Florida Coordinating Ambassador for The Birth Survey: The Transparency in Maternity Care Project. Laura is an endorser of The Mother-Friendly Childbirth Initiative and a member of the Coalition for Improving Maternity Care Services. She is a project coordinator and quilter for Ina May Gaskin's Safe Motherhood Quilt Project, intended to raise awareness about American maternal mortality. Laura has recently joined the Planning and Evaluation Committee for the Healthy Start Coalition of Sarasota County, whose mission is to improve the health and well-being of Sarasota's pregnant women, infants, and small children. Professionally, she is the marketing manager for Michael A. Gilkey, Inc., landscape architecture studio, and is the owner of Kangaroo Promotions, Inc., a creative marketing firm in Sarasota. For more information, please visit her website at

Thursday, July 23, 2009

BIRTH STORY: Worth Every Second

(by Lizz Pugh, about the birth of Haven Lea, born 12.24.07)

After a scary post-Thanksgiving hospital visit I decided to look into having a homebirth. I was 37 weeks pregnant when I interviewed Christina Holmes, LM. She had such a calming presence and charming personality that I decided to ask her to be my midwife.

My due date fell on a Sunday. Friday night everything happened very quickly. Contractions came very close together. I called both Christina and my best friend Allison. My cervix was dilating, I had "bloody show"; this was it!

Or not.

My labor started petering out and by five in the morning had completely subsided. I was horribly disappointed. We had tried for almost three years before I was able to conceive. I had hated being pregnant. It was time to hold my precious baby girl! Now!

Allison and Christina headed home and I got some much needed sleep. I was very thankful that I had chosen a midwife. It is likely I would have been persuaded to take medicine to progress my labor.

Saturday and then Sunday (my due date) passed slowly.

The clock was just past midnight on Christmas Eve (Monday) when the worst pain of my life started. It was such a contrast to the earlier labor that I couldn't even breath. I screamed. It was so bad that I threw up several times. My husband called Christina and Allison. I was panicking. I head read that women often vomit during transition and I was convinced that the baby would come before my helpers could get here. Turns out that transition would be hours and hours away.

Christina came and helped me labor. The only thing that got me through each contraction was looking at pictures of babies. As long as I could focus on the fact that I'd be holding a baby in my arms--my baby--by "this time tomorrow" I could breath and get through it. I had a brief period of time when I was convinced that I couldn't do it. I wanted to go to the hospital. Christina and Jay talked me through it and I got through it. Breathing more openly helped and made things tolerable. I didn't use any of the breathing I had learned through the SMH classes. I also didn't want to be touched or held. I had Jay's hand in mind and focused on the baby and my breathing.

My hubby went ahead and filled up the pool in our living room. I wasn't allowed into it for a long time. It felt like forever, but was probably a half hour or so. I didn't want a water birth but purchased the supplies just in case I changed my mind. I am so glad I did! I'm also very glad I decided not to have my hubby in the pool with me. While I prepared for the pool I felt a wonderful pressure and knew that my water was going to break. I didn't expect to feel it before it happened. It gave me strength because I knew that no matter what she was going to be born that day. Labor wasn't going to peter out again.

I laid in the pool and stared at the outfit I knew my daughter would wear the next day. It was a green pj outfit with "Elf In Training" embroidered on the front. It was a gift from Allison when she came over for the first labor session. She hadn't called us back or shown up. We figured they had gone to bed and didn't hear the phone. The outfit was more effective than pictures of other babies.

Allison walked in the door just over seven in the morning, minutes after I started pushing. She was such a life saver. My back hurt after every push and Jay just couldn't find the right place to support. Allison had had back labor and knew exactly where to press. Pushing was horrible. I had to push; there was no choice. But man, it felt awful. I got through it, knowing that each push would bring her closer to coming out. Feeling her head really helped as well. Finally, after what felt like a million pushes, she crowned.

If pushing was horrible then crowning was hell on earth. I tore in three places. Minor tears. I can't imagine what some women go through with major tears. It was the worst pain I've ever experienced in my life. "Ring of fire" is an accurate description of what it felt like. I was terrified that my more sensitive parts were going to be torn apart and I'd never find pleasure in sex again. (Thankfully that was not the case!) Eventually the primal part of me took over and pushed through it. I pushed through the fear. I pushed through the pain. It was time for my baby to come out.

We had discussed my birth quite a few times and had decided that Jay would catch our daughter and welcome her into the world. She was placed almost immediately on my chest and I was lost in love. I know that most books tell mothers not to feel bad if they don't feel love at first sight. I was prepared to take a few days to get to know her. I didn't need it. I was head-over-heels in love with her from the moment I held her in my arms. The picture I'm sending with this shows my husband behind me. I didn't know he was there. I was completely unaware of anything but my amazing little bundle of joy.
I was moved into the bedroom and settled on the bed. I waited as long as I could to cut the cord. I had decided that I liked the symbolism of cutting the cord myself rather than having my husband do it. I wanted to welcome her into the world and acknowledge that she is an individual. Having the father cut the cord made it feel more like he was coming between us. It was so much thicker than I had expected.

I delivered the placenta and tried to breastfeed. At some point Haven was taken out of my arms to be weighed and have her hair washed and I had a chance to rest. One of the birth assistants let me look at my placenta. It was one of my favorite moments. It had a strong tree of life. I thanked it for taking such good care of my daughter and for helping her grow so big and strong.

Christina and her helpers stayed for a long while. I was surprised that they drained and sanitized the birthing pool and then scrubbed my bathtub. They cleaned up any blood spots off the floor. They made sure someone fed me and brought me lots of liquids.

I'm very glad I made the choice to birth at home. I felt empowered and surrounded by love and support. I never had to deal with a stranger coming in or being treated as a number. I didn't have to worry about doing things on anyone else's schedule but my daughter's. And while it was the hardest and most painful thing I've ever experienced, I did get through it. And seeing how active and alert my daughter was made it completely worth it. If I had to do it again I'd choose home birth. No questions.

Monday, July 20, 2009

Sarasota Public Hospital Board Meeting, and Maternal Request Cesareans

At today's monthly Sarasota Public Hospital Board meeting, I requested an address with the board during the public commentary section of their agenda. As Sarasota Memorial is a tax-funded hospital, this is a right that anyone in our community has. I was given five minutes to speak. Five minutes was not enough, and there was much I wasn't able to say--but I left each board member with 146 pages of evidence to digest, and I hope that they do. The following is the agenda I used to quickly try and paint the broad picture.

What is the problem?
  • I represent a body of consumers that is concerned with the notably high c-section rates at Sarasota Memorial Hospital.
  • SMH's c-section rates are between 41.3-44%, depending on research vs. consumer data.
  • Best evidence (WHO) supports rates of 15% or less. I understand ACOG's viewpoint that this is an arbitrary number, and agree that hospitals should take a patient-centered approach rather than striving for a certain rate; however, it remains true that as c-section rates rise, so do maternal mortality and preterm birth rates, NICU admissions and health care costs.
How does Sarasota Memorial Hospital compare?
  • Sarasota County has the 4th highest rate in Florida.
  • Florida has the 2nd highest rate in the United States.
  • SMH has a real opportunity to implement protocols that will reduce these numbers and prove tremendous cost savings and improved outcomes.
Why is this a problem?
  • Evidence (included in binder) consistently shows that maternal / fetal / infant risks far outweigh benefits at this rate.
  • My biggest concern is the risk to future pregnancies / placental issues, as this directly correlates to the VBAC access problem.
  • Cost to taxpayers--C-sections cost twice as much as vaginal births; in Sarasota, taxpayers are hurt doubly - by paying for medicaid funded c-sections, and because SMH is a tax-funded hospital.
  • Cost to hospital--1/3 of c-sections are repeat c-sections, and repeat c-section babies are twice as likely to go to the NICU, at a high overhead to SMH; 1/2 of these babies are covered by medicaid, increased stay and risk of infection reduces reimbursement to hospital
  • Cost to patients--Insurance companies are beginning to refuse coverage to those with prior sections; if patients can't get coverage for repeat sections, AND can't get VBAC access, they find themselves in a true health crisis.
How can we improve?
  • Revise induction protocols. 44% of first time moms who are induced wind up with c-sections, as opposed to 8% of moms who go into spontaneous labor. Verify cervical ripening prior to induction. No induction prior to 39 weeks. Revise oxytocin infusion protocol to reduce intensity and frequency of inductions.
  • Require mandatory prenatal counseling on risks of elective c-sections (including benefits of full-term babies and natural hormone release).
  • Implement voluntary audit system / commitment of OB community (launch 1-5 year initiative, etc.).
  • Support TOLAC / VBAC wherever and whenever possible (i.e. w/ OB hospitalist to remain with laboring patients, careful attention to effects of pitocin on VBAC patients, etc.).
  • Reduce patient to nurse ratio for improved continuity of care.
  • It has been done: the Institute for Healthcare Improvement Strategic Partners Program trains hospitals to implement guidelines regarding induction and elective c-section prior to 39 weeks. 60 hospitals have joined. One such hospital reduced NICU admission by 46% in just three months.
What are the benefits of improvement?
  • SMH has the opportunity to be a model community at the forefront of evidence-based maternity care.
  • With the new bldg, allow for induction-free / drug-free labor support, including intermittent fetal monitoring, freedom of movement, increased continuity of care, and doula programs.
  • By allowing and encouraging spontaneous labor, you will send a message that you support the natural process of hormonal release that stimulates bonding and increases the rate of and the chance for successful breastfeeding.
  • If you implement these protocols and reduce c-section rates, you will see tremendous cost savings to the hospital, the taxpayer, and the patient.
  • A mother-friendly hospital is an attraction for potential new families.
  • Reducing c-section rates will result in fewer pre-term babies.
  • Reducing c-section rates will result in better birth outcomes, more satisfied mothers, support of initial bonding, and, I would argue, a reduction in postpartum depression.
When I was finished sharing this information with the board, Dr. Washington Hill, M.D., FACOG, the Director of Maternal-Fetal Medicine at SMH, presented an overview entitled Sarasota Memorial Hospital Births: Cesarean Delivery, Vaginal Birth after Cesarean Delivery, and Induction of Labor. His presentation was thorough and explanatory, defining commonly used terms, showing trends in c-section and VBAC rates, and siting tort reform as a necessary component to reversing this trend. On his list of 'Maternal Factors Responsible for the Increased Cesarean Delivery Rate,' Dr. Hill includes 'increased number of women choosing primary elective cesarean delivery and/or induction of labor (maternal request).' He and his colleagues have made a conscious decision to offer patients the choice of an induction or cesarean section, though he maintains that they are not performed unnecessarily prior to 39 weeks.

While I do not have specific physician diagnosis breakdowns for the c-sections performed at Sarasota Memorial Hospital, in Florida as a whole, maternal request was not listed among the top ten diagnoses for c-sections (AHCA 2006). If women are the ones driving up the c-section rates, their 'choice' is not being given as the reason for surgery.

Among physician diagnoses, there is a difference between the designation 'Elective Primary Cesarean Section' (EPCS) and 'Cesarean Delivery on Maternal Request' (CDMR):

Elective Primary Cesarean Section (EPCS): A planned first or “primary” cesarean section in a healthy woman for the birth of a baby when there is no medical, fetal, or obstetric reason for the surgery. May be influenced by non-medical issues, such as physicians’ personal beliefs (not facts) about safety, liability, insurance coverage, liability fears, hospital economics, efficiency, convenience, and reimbursement rates, as well as other factors not listed. (American College of Nurse-Midwives, Position Statement: Elective Primary Cesarean Section & Citizens for Midwifery, News Release: “Patient Choice” Cesareans Almost Non-Existent)

Maternal Request Cesarean Section / Cesarean Delivery on Maternal Request (CDMR): A subcategory of elective primary cesarean sections. A planned (before labor begins) first or “primary” cesarean initiated by the mother with the understanding that there is no medical, obstetrical, or fetal indication requiring cesarean delivery, and after a through review of the risks and benefits of cesarean delivery vs. vaginal birth by the obstetrician, the woman’s decision is to have a planned cesarean section. The primary decision maker for a CDMR is the woman. (National Institute of Health (NIH) Cesarean Conference definition, March 2006 & Childbirth Connection, Listening to Mothers II Survey)

Necessary Criteria for Maternal Request Cesarean Section:
1 : The request for the cesarean and the scheduling of the cesarean must have been made prior to the onset of labor.
2 : The request for the cesarean must have been initiated by the mother.
3 : The mother must have the understanding that there is NO medical, obstetrical, or fetal indication requiring a cesarean delivery.
4 : The obstetrician must personally review and assure the mother’s understanding of the risks and benefits of elective cesarean surgery vs. planned vaginal birth.
5 : The woman is the primary decision maker.

In national data compiled by The Childbirth Connection's Listening to Mothers Survey, 98% of women who gave birth by c-section believed there was a medically necessary reason for doing so.

As the Hospital Board meeting adjourned, Dr. Hill and his staff informed me of a new policy they are adopting involving elective induction and augmentation 'bundles.' The Insitute for Healthcare Improvement defines 'bundles' as groups of evidence-based interventions related to a disease or care process that, when executed together, result in better outcomes than when implemented individually. Components of the bundle, or elements that must be considered when administering oxytocin, include ensuring that gestational age is at least 39 weeks, monitoring fetal heart rate, pelvic assessment and monitoring and management of hyperstimulation.

I am hopeful that careful consideration of this and other protocol revisions aimed at lowering cesarean section rates at Sarasota Memorial Hospital are successful. In every clinical study I've read where rates have improved, the common denominator was voluntary commitment on the part of the obstetric community. Our obstetricians must be united in a desire to show the will and leadership necessary to reduce induction and c-section rates, thereby improving outcomes and saving our taxpayers, our hospitals, and our patients money.

Saturday, July 18, 2009

The Healthy Start Coaltion of Sarasota County

I was honored recently to be invited to participate on the Planning and Evaluation Committee of the Healthy Start Coalition of Sarasota County, in their efforts to produce a Service and Delivery Plan for 2010-2015. This will be a comprehensive plan outlining what conditions must be present in Sarasota County to promote healthy pregnant women and babies.

I have attended two meetings so far and have learned so much. This collective of people from groups countywide is committed to providing accurate data and using it effectively to create better conditions in our community. It has really opened my eyes to look behind the scenes at this group; my only prior knowledge of them was obtained during my own pregnancies, and I was most impressed.

During my initial prenatal screening, my midwife presented me with a Healthy Start risk assessment, a consent form allowing contact from a Healthy Start Care Coordinator, and information about the services they provide. The Care Coordinator called shortly thereafter. She was very supportive and knowledgeable, and offered me a myriad of services and information, including car seat safety, breastfeeding info, and free Infant CPR classes. Healthy Start is truly committed to getting their comprehensive prenatal and infant care information to every family who needs it, regardless of income or demographic.

Healthy Start services include care coordination and referrals for wraparound services for pregnant women and parents of children up to the age of three, such as pre/interconception education, psychosocial counseling, smoking cessation programs, childbirth education, breastfeeding education and support, nutrition counseling, and parenting education. Referrals are also made to appropriate agencies for food, clothing, baby items, etc.

If you are pregnant, please consent to being contacted by Healthy Start. When more people consent to being contacted, Healthy Start receives more funding to give support where it is truly needed.
ABOUT THE HEALTHY START COALITION OF SARASOTA COUNTY, INC.: The mission and goal of the Healthy Start Coalition of Sarasota County, Inc. is to improve the health and wellbeing of pregnant women, infants and younger children. Pregnancy and childbirth are major life events. Parenting during early childhood is very important. A physically and emotionally healthy course is needed for the rest of life. Healthy Start is driven by this precious and fragile life event. Our staff, members, service providers, and friends want to help assure that pregnant women, families, and infants in Sarasota County get needed care and services.

Please visit the Healthy Start Coalition of Sarasota County, Inc. if you would like to donate or volunteer. A wide range of opportunities is available.

Monday, July 6, 2009

Reduce Inductions, Reduce C-Section Rates

In a recent report presented to the American College of Obstetricians and Gynecologists, Dr. Gary Ventolini revealed that the emergency cesarean section rate at his large community hospital was reduced in half over a three-year period. Ventolini's hospital achieved this drastic improvement simply by modifying their oxytocin infusion protocol. An appropriate reduction in the amount and frequency of artificial oxytocin (or Pitocin) injection for induction or augmentation of labor directly resulted in decreasing emergency c-sections.

I will be strongly suggesting a similar protocol modification to the Sarasota County Public Hospital Board in the coming weeks. SMH's current Nursing Department Policy on Induction or Augmentation of Labor states that the specific rate and ration of infusion must be given in the physician's orders. Should the physicians' preferred rates of induction be reduced--for example, from 2 by 2 units every 20 minutes to 1 by 1 unit every 30 minutes, as was the case in Ventolini's hospital--I expect we would begin to see similar results here in Sarasota.

There are several medical reasons that warrant appropriate induction or augmentation of labor by artificial oxytocin. These include chronic maternal medical conditions (diabetes, hypertension, renal disease), fetal compromise (IUGR, alloimmunization, abnormal fetal testing), gestational hypertension or preeclampsia, post-term pregnancy, premature rupture of membranes or preterm premature rupture of membranes, placental abruption, chorioamnionitis, and fetal demise. Taking these indications into consideration, the World Health Organization states that no geographic region should have labor induction rates exceeding 10%. Current induction rates in America over 40% tell us that many women are being induced for non-medically indicated reasons.

Induction carries with it many risks. Induced patients are twice as likely to give birth via c-section (evidenced by the indication that induction requires a physician with c-section privileges on premises). Should they give birth vaginally, they are more likely to have vacuum or forceps assisted deliveries. With all labor inductions, uterine hyperstimulation is a major risk, leading to a large increase in the need for pain medication, potential fetal distress and further obstetric interventions.

Here are ten ways to avoid labor induction, from Lamaze International's Institute for Normal Birth.