International Cesarean Awareness Network...

the clarion winter 2015 | 1

CLARIONInternational Cesarean Awareness Network

WINTER 2015

HEALTH INSURANCE HASSLES

VBAC BANS

gina walker: HOPE FOR ACCRETA

2 | winter 2015 the clarion

ICAN’s BOARDPresidentLaQuitha [email protected]

Vice PresidentLindsey [email protected]

TreasurerMychel [email protected]

SecretaryMegan [email protected]

Member(s) at LargeChrista [email protected]

LaKeisha [email protected]

www.ican-online.orgInternational CesareanAwareness Network, Inc.PO BOX 573Glen Alpine, NC 28628

The information in this newsletter is intended for general consumer understanding and education and is not provided as a substitute for profes-sional advice. ICAN encourages women to discuss these issues with a trusted healthcare provider. Opinions expressed by the content and advertising in The Clarion are not necessarily the views of ICAN, Inc.

WINTER 2015

CONTRIBUTEsend your corrections, suggestions, ideas, and thoughts to:

[email protected]

Contents

letter from the President 3

overturning a Vbac Ban 4

Membership thanks 6

Featured chapter // ican of Phoenix 7

Volunteer of the Month october 11 november 12 December 13

Planning For the Unexpected 14

Birth Story // Brandy Firth 17

navigating insurance 19

coVer Photo

Heidi Mattson and her daughter, Lacy. Photo courtesy of Heidi Mattson Photography.


In this first letter to you as the new president of the ICAN Board of Directors, I would like to express my sincerest grati-tude at being given this opportunity to create further advance-ment for ICAN. Many of our volunteers can attest to the mul-titude of changes that have occurred over the past couple of years, many of them challenging at times. However, we press on towards our goal of fulfilling our mission as a cohesive and efficient organization; one that can have an even larger impact on the lives of the mothers we serve.

This year, we have a number of projects that we will be taking on as we work to collaborate with organizations that have mission objectives compatible with ours. We are so pleased to announce that Trial of Labor, a film by Elliot Berlin and Rob Humphreys, is slated for release in March of this year. ICAN has been a major supporter of this film since its inception, and it gives us great joy to see it brought to fruition. You can find an ad for this film on page 10, and we will have a special article on the film by Elliot Berlin in our next edition of the Clarion. Additionally, many of our chapters will be hosting local screenings of this film in April and beyond. Keep an eye out for updates coming soon.

Another project that we are collaborating with for the first time is the Hope for Accreta Blood Drive, which is hosted an-nually by Hope for Accreta Foundation. This will be the second year that this drive has taken place, and will occur globally

Dear ICAN Supporters,

laQuitha Glass // President

on April 3, 2015. The purpose of this drive is to raise aware-ness of the increasing incidence of placenta accreta, a serious medical condition in which the placenta becomes too deeply attached to the uterus. In the July 2012 Committee Opinion on Placenta Accreta issued by ACOG and reaffirmed in 2014, the incidence of placenta accreta is on the rise and seems to be rising in correlation with the cesarean rate. They state that “women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either an anterior or posterior placenta previa overlying the uterine scar” (ACOG, 2012). During the birthing process, it can cause hemorrhaging so severe that it requires blood transfusion and possible hysterectomy. The women af-flicted by this condition rely on the local blood banks to supply the life saving blood products they often require during birth. Gina Walker, founder of Hope for Accreta Foundation, shares with us how mothers facing accreta can prepare for their birth in “Planning for the Unexpected” on page 14. Be on the look-out for dates and locations of a blood drive near you.

Each April, ICAN celebrates Cesarean Awareness Month to bring attention to our nation’s cesarean rate. As of 2013, the cesarean rate in the U.S. was 32.7%, marking a .1% decrease from 2012. While we are pleased to see a downward trend, no matter how small, we are also aware that the cesarean rate when broken down by ethnicity tells a different story. In 2013, the cesarean rate among African American mothers was 35%, with no change from the year before. However, we know that African American women can and do seek to VBAC, and this February we are highlighting a different birth story each day on our main Facebook page in conjunction with Black Women Do VBAC, a birth blog created by long time ICAN volunteer Melek Speros.

As we continue to make strides towards change in how women are treated during pregnancy and birth, like our chapter ICAN of Southwestern PA who overturned a VBAC ban at a local hospital on page 4, we will require the ongoing support of our members. Consider renewing your membership when it ex-pires this year or maybe even share our mission and goals with a coworker or friend during Cesarean Awareness Month.

As always, thank you for your support as we support women and families.

In solidarity,

LaQuitha GlassICAN [email protected]


In late 2012, ICAN of Southwestern PA started getting calls and emails from women living in Mercer County, PA, about an hour northwest of Pittsburgh. Apparently, one of the hospitals there was instituting a VBAC ban! Some of the women contacting our chapter had already had success-ful VBACs in the city of Pittsburgh and had been looking forward to birthing closer to home, supported

in the local hospital by a CNM, for their next babies. For them, the VBAC ban was upsetting. How could they choose between co-erced surgery or driving an hour into the city for each prenatal appointment (with young kids in tow) and driv-ing while in labor?

But then, our chapter learned that this particular hospital served the local Amish population and that they were transferred to

this hospital for cesareans. Many of them felt safer birthing in the hospital for subsequent babies. This became an important fac-tor for many reasons: these women felt called to have many children, however it simply isn’t a safe plan for a woman to have 8 or more cesareans. These women also did not carry health insurance. They would have to pay out of pocket for hospital procedures. Coerced cesarean delivery

would mean tens of thou-sands of dollars per Amish family per child. Some Amish do not drive auto-mobiles, so even though the tertiary hospital in Pittsburgh, where VBAC was supported, was only an hour away by car, this was not a practical option for families whose primary means of transportation is a horse and buggy.

We immediately reached out to the ICAN board of

oVertUrninG a VBac BanBy // KaTy RaNK LEv aNd LaUREN MCaNaLLEN


directors for advice. While we waited to hear back, we started a letter writing campaign, addressing our letters of concern to the patient advocate at the hospital as well as the head of obstetrics. We found some letter templates in the chapter leader guide-book and tweaked them to fit our situation.Soon after, ICAN’s legal counsel got back to us. She felt that since Amish women in particular were being affected, this meant we had solid legal ground to approach the hospital administration persuasive-ly. She began to draft a legal letter to the administra-tors, outlining how and why a VBAC ban was discrimi-natory against this religious group.

Meanwhile, we needed to find mothers who were willing to speak up against the VBAC ban. We found a few women who spoke with legal counsel, gave their stories and talked about how the VBAC ban af-fected their family planning and their own autonomy. A big challenge for us was to find Amish women who would speak to ICAN’s lawyer since our chapter leaders were located in the city, over an hour away, and many of these women could not access Facebook.

Thankfully, a CNM working in the hospital was willing to risk her job to help the cause. She created surveys

and asked for community support and gave patients ICAN’s contact information so they could reach out to us for help. And, by winter, some Amish families did! Pregnant Amish women walked miles in the freezing cold to use a payphone and tell their story. One Amish woman pleaded with legal counsel, “My sister had a cesarean, and I saw [ev-erything]. Please don’t let them cut me open like my sister!”ICAN’s legal coun-sel developed the letter to be sent to the hospital administrators, which was about ten pages long, and called for an immediate lift of the ban. We were dismayed when they failed to respond.

At this point, ICAN’s legal counsel urged us to begin looking for an attorney who would take the case pro-bono (we certainly didn’t have the funds to pay for a lawyer) to sue the hos-pital system. Our chapter decided it was important to get an ICAN person on the ground, closer to the women being affected, and so one of the mothers who originally contacted us agreed to start a new chap-ter: ICAN of Western PA.

Lauren McAnallen found out the day after her daughter’s first birthday that the hospital where she was delivered had instituted a VBAC ban. She says, “I was devastated. I didn’t really know where

to start. At this point I was not an ICAN member; I had only attended one in person meeting and a handful of online webinar meetings, but this ban was hitting really close to home. Reaching out to ICAN was the first thought that came to mind.

“I got in contact with Katy and she soon put out a call to action for any mothers affected by the ban to write letters, spread the word, and to speak with ICAN’s legal counsel. Katy supplied some fantastic guidelines for writing my letter to the hospital’s patient advocate – simple but important things – keep it short, share how this directly affects you, quote current medical stance on the safety of trial of labor after cesarean, and encourage the hospital to reverse the decision. I quickly drafted my letter, dropped it in the mail and began to encourage my friends and family to do the same. I signed a peti-tion in one of the local care provider’s office and kept in contact with Katy and ICAN’s legal counsel as we waited to hear if our efforts were making any waves or if they were being heard by the hospital administration.

“It took a while for my let-ter to receive a response, and when it came I was shocked by their reply. It seemed to be a copy/paste letter that neither covered any of my concerns nor

was any bit empathetic to my personal experience or the impact of the ban on my family planning – they basically told me that there are other hospitals in the area that offer the services I want and that I can just go there. This was not the answer I had expected from a respected hospital and especially not the answer I expected after I put my heart and major concerns into writing a letter – I was furious to have not received a letter with even just the smallest bit of compassion. It was then I recognized how important it was for me to bring ICAN to my community and in March of 2013, I joined ICAN and took the steps to start a local chapter, ICAN of Western Pennsylvania.”

Over the next few months we continued to reach out to friends and family to write letters and did as much networking via social media as we could. The new chapter started hold-ing monthly meetings and hoped to get some local in-terest in ICAN and fighting the ban. Also during these months news came that a different hospital would be closing their maternity department entirely. Since this time, three other hospitals have closed their maternity departments, funneling birthing mothers to the tertiary hospital an hour away. Options seemed to be diminishing for families in the continUeD


5 year

Lifetime10 year

Alicea Acevedo Rachelle Ahmad Amanda Alford Esther Altman Mariya Amelicheva Ashley Anderson Dawn Baranski Rachel Borland Danielle Braden Janlaine Brady Ashley Brinkmeier Rachel Bruce Mallory Bundt Amber Bush Cristina Cage

Regina Campbell Megan Carter Lauren Cooper Danielle Craighead Sarah Curtis Brenda Dampier Sharon Drapeau Sarah Dulany-Wilhelmi Pauli Durrow Joyce Dykema Carolyn Ericson Naomi Fiddes Karin Finley Kelly Fischer Sara Healy

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Mary Sandvig Amanda Santo Bethanie Schultz Jordan Shaw Stephanie Shumaker Anna Siskind Anne Slack Barbara Stratton Michelle Sun Brandy Terry Somer Torres Karen Troy Lonika Utterback Dr. Heather Yost

Virginia Bobro Lisa Carguello Tina Carlson Pam EnglandDaisy Fulgham Eva Gavin Jean Greenberg

Amberle Heath Lisa Heffner Maureen F Hetrick Lisa Houchins Kristin Hultgren Birgit Kaneko Elizabeth Kooy Melissa McNulty

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Desirre Andrews Madeleine & David Arnow Dawn Ashbridge Carrie Ballek Janice Banther Lily Beck Laura Bentz Christa Billings Mark R. Bower Victoria L. Brown Mary Caellaigh Joyce Chernick

Scott Krista Cornish Christie Craigie-Carter Berna Diehl Donna Dietz Juli Duncan Bruce Flamm, MDJane Frank Anne Frye Sharon Graham Nichole Grawer Kathleen Gray FarthingJenny Griebenow

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ICAN recognizes and thanks all our five- and ten-year subscribing members. A special thanks goes out to all our lifetime subscribing members.We appreciate your support and commitment to ICAN.

MEMBERshIpThaNKs


5 year

Meet the leadersJenni Froment is the Chapter Leader for ICAN of Phoenix. She has had two cesareans, the second of which resulted in the hospitalization of her newborn due to premature birth. After that, she resolved to do things differ-ently with her third birth. Her research lead her to find out more about VBAC births and, ultimately, ICAN. After her first two births, she went on to have a VBA2C in December 2012 and a 2VBA2C this past September. She lives with her husband, and their five children. By day she works as a training specialist for a local telecommunica-tions company, but she spends her free time serving ICAN of Phoenix and mentoring pregnant women.

Jesse Franks joined ICAN of Phoenix in 2010 after battling postpartum depression following her cesarean.

She immediately connected with the women at local meetings and became an official co-leader the next year. She has only missed a handful of meetings in the past 4 years and loves helping women process and share their stories. In addition to her support of ICAN of Phoenix, she is also very involved in supporting ICAN nationally. She has just transitioned out of the Assistant Chapter Director position and will be starting as the New Chapter Ambas-sador. She has had two beautiful VBAC births since joining ICAN. Along with being a stay at home mom, she loves to crochet, paint and make jewelry. She also runs her own blog and etsy store, all VBAC related of course.

ICAN of Phoenix has several volun-teers that help keep their active group running smoothly. Elizabeth Morton, Natalie Johnson, and Anne-Marie Chun are all very supportive and have been

pivotal in managing the administrative duties, keeping the library updated and moderating our Facebook group; especially since Jenni and Jesse both had new babies within a month of each other this year.

In the CommunityWe are lucky to have a strong presence in the birth community in Phoenix. Many providers are familiar with our chapter, our mission to support women, and their autonomy to birth vaginally. We also have a solid network of doulas, midwives, chiropractors, lactation con-sultants, and therapists that support ICAN. This allows us to offer women a great community full of experience and resources from pregnancy to parenthood. Recently we participated in a Bradley Day event where we had a booth sharing pamphlets and info-graphics about recovering

FeaturedChapterICaN OF phOENIxBy // JENNI FROMENT

established May 2011

1-800-686-(ICAN) 4226 EXT 255

http://www.ican-online.org/phoenix/

[email protected]

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from cesarean births and planning VBACs. We held our first Mom Prom in April 2014, and before that had an ICAN Family Picnic in late 2013 to raise money and create community among our members. Next year we have plans to start reaching out to local hospi-tals and providers proactively, to help spread the message of ICAN.

Mother to Mother SupportICAN of Phoenix has a very active Face-book group, with more than 500 mem-bers that converse, ask questions and share stories on a daily basis. We hold monthly meetings at a local chiroprac-tic office with upwards of 20 women in attendance. We alternate our meetings schedules month by month so that we offer a mix of cesarean support and VBAC planning topics. In the last year,

we’ve seen an increase in women com-ing to us for VBAC planning in addition to emotional support allowing us the opportunity for a period of growth and opportunity for our chapter to share information with the women of Phoe-nix. Jenni and Jesse spend a lot of time moderating the Facebook group, with the help of the other volunteers. When the board seems quiet, the leaders will post topics for discussion that range from lighthearted to soul-searching. We ask questions like “what was the silliest pregnancy advice you’ve ever received?” Or “what is something that you learned from previous births, that has helped you plan your future births?” Our Facebook group has doubled in size over the last year, and is growing rapidly. It’s exciting to see our message spread so quickly in the Phoenix area!

FundraisersPlanning Mom Prom was new territory for both Jesse and I, but with the help of our volunteers I think we did a nice job pulling off our first one. We learned a lot about organizing sponsorships and how to divide up duties. We are excited to apply these skills to future Mom Proms. Finding people to donate professional services such as the DJ and photographer was helpful be-cause it allowed us to keep more of the proceeds within our chapter. We have sold t-shirts in the past and they were popular with the members of Facebook so we are planning for new t-shirts, in 2015 as well as holding another Family Picnic style event to coincide with their sale. We will continue to support and volunteer for local birth fairs when possible, because that’s continUeD

Top Left: ICAN of Phoenix meeting ICAN Bottom Left: ICAN of Phoenix Mom Prom

Top Right: Jenni Froment and Jesse Frank at Mom Prom Bottom Right: Sharing information about ICAN


an easy way to put ourselves right in the market of birth services and make our group known to mothers and care providers within one event. When I volunteered to lead ICAN of Phoenix, all I had was my own birth ex-perience and a deep desire to help oth-ers. One of the important philosophies I wanted to impart on the members of our group is that our experiences can be a gift; especially our most chal-lenging experiences. I encourage the women of our group to find what they can learn from their most difficult birth experiences, and to use that informa-tion to make a positive change in their futures. We like to dig deeper within the grief of our cesareans, and ask women to explore what feelings they

had that made the cesarean birth a negative experience for them. We want them to ask themselves, “How can I protect myself from that in the future?”

Leading ICAN of Phoenix has been a deeply meaningful way to contribute my time and passion for birth in my community. It has been such an enlight-ening journey for me over the past 3 years. I began being painfully ignorant about birth to now being fired up about birth rights as a certified birth activist. People frequently ask me how I juggle leading ICAN of Phoenix with a family of 7 and a full-time job, and the only answer I have is that it’s my soul-work. I enjoy doing it, and it gives me a great sense of accomplishment and fulfill-ment to help women in such an impor-

tant part of their lives. I have found such a sweet sense of community with the women of ICAN of Phoenix, women that share my values and have become some of my very best friends.

I believe that helping women achieve empowering births can change their lives. Birth is the beginning of our motherhood, and what better way to kick off a mother’s confidence than through a positive and empowering birth experience? I am humbled by the opportunity to educate, support and advocate for the women of Phoenix in this way, and I plan on serving in this role for years to come.

area – until August 2013 when the almost miracu-lous news came in that the VBAC ban had been lifted. There was little word about the ban before it was re-versed. Things were really quiet for months before the news came through. It seems that the Amish community did most of the fighting. Two women came to the hospital in labor and quietly but powerfully declined repeat cesar-eans. They were treated respectfully by all staff, and both had successful VBACs attended by their midwife with the support of an attending physician. Soon after those births, the ban was lifted. Providers, anesthesia and nursing finally worked together to ensure the safest coverage for those desiring VBAC, advocating the lift of the ban at every staff meeting.

Our local ICAN chapters took all the steps we could to bring attention to the ban and did our best to get the community involved, and in the end it worked.

Keeping the ball rolling was the difficult part and ICAN’s board of directors and legal counsel provided the Amish mothers a voice and informed them of their options, because it really appears that they were the ones who fought the hardest.

Because of that fight the women in Western Penn-sylvania have their option to birth their babies safely in a supported hospital environment. Although some women were caught unfairly in that painful period, and there’s no good excuse for that, finally com-mon sense and autonomy prevailed!

VBac Ban continUeD

Amy had a successful VBAC with her second child and would have faced a coerced cesarean for her

third delivery. She said she is so thankful ICAN helped to get the ban lifted—she had a vaginal deliv-

ery with Lydia, supported in the hospital by CNMs.

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volunteer of the Month: October 2014

TaBaTha dIdOMENICOTabatha DiDomenico, chapter leader of ICAN of East Central Florida, has served ICAN in various ways by stand-ing in the gap to assist with major tasks that needed to be accomplished. One such task was the complete overhaul of the ICAN main website. Tabatha generously donated her time to help us complete the site when we ran across technical difficulties with its comple-tion. She also stepped up to take over as Publication Coordinator of our quarterly newsletter, The Clarion, as well as the leader of our IT team.

Locally, Tabatha played an integral role in the success of the first Central Florida Mom Prom in Orlando, Florida. This fundraiser helped to elevate the level of awareness in her local area about cesarean issues while simulta-neously giving women a reason to cut loose and have a great time.

how long have you been an ican member?I have attended meetings and partic-ipated in ICAN of Orlando’s Yahoo! Group since September 2008.

How did you first find ICAN?I found ICAN while searching online for information for local providers for VBACs.

as a volunteer, what motivates you?After the support I received from ICAN of Orlando after my unneces-sary cesarean, I saw a need for the same support closer to home. I am motivated to continue every time I

learn of a woman that felt supported by our chapter. Also, I get to hold babies at meetings.

Do you have a profession or any other passions outside of ican?I am employed full time as an In-ternet Marketing Manager for an eCommerce company. I am a tech-nologist, designer, and activist. My passions include reproductive and birth rights, increasing opportunities for informed decision making, and leveraging technology and design to improve social problems. What was your proudest moment as an ican volunteer? What about your hardest?My proudest moment was abso-lutely the success of the first Cen-tral Florida Mom Prom. Scanning the room that night and seeing the crowded dance floor, laughing faces, and happy women in attendance made the previous months of hard work worth it. It was particularly special for me to plan this event with the ICAN members that have supported me and so many other women in our area.

The hardest moment as a volunteer came after a mother in our chapter met cruel, punitive care as a home birth transfer at a local hospital. While being heartbroken for her, in the weeks and months following her birth it was difficult to see how we could make any positive change in our local birth climate.

Scanning the room that night and seeing the crowded dance floor, laughing faces, and happy women in atten-dance made the previous months of hard work worth it

“


volunteer of the Month: November 2014

ERIN FLaGEErin Flage is currently the chapter leader of ICAN of Northeast Iowa. During her time as a volunteer with this chapter, she has helped to increase the effectiveness of her chapter by implementing the use of technology to increase their reach. Additionally, she has helped with a number of local fundraisers and contributed to the rec-ognition of the chapter by the governor of Iowa.

how long have you been an ican member?I have been an ICAN member since 2012.

How did you first find ICAN?I first found ICAN online when I was planning a VBAC in 2008, but there was no local chapter. After my local chapter was started, I was encouraged to attend from a fellow mom.

as a volunteer, what motivates you?My biggest motivation as a vol-unteer is finding new ways to use my gifts and talents to help create positive change in the world. Do you have a profession or any other passions outside of ican?I work remotely for Kaplan Uni-versity as an instructional designer building online courses and instruc-tional multimedia.

In addition to working with ICAN, I am also a long time member and State Vice President for the Iowa

Junior Chamber, and serve on the state committee for Iowa Phi Beta Lambda, a business student organi-zation for college students.

What was your proudest moment as an ican volunteer? What about your hardest?I think my proudest moment was last April when we were deliver-ing cookies to our local L&D units and prenatal clinics for Cesarean Awareness Month. As we were dropping off cookies at one of the local hospitals, the Assistant Nurse Manager proudly shared with us their primary cesarean rate (9%!) and informed us that it was the lowest in their hospital system. That encourages me that we are having an impact and that change is happening!

the assistant nurse Manager proudly shared with us their pri-mary cesarean rate (9%!) and informed us that it was the lowest in their hospital system.

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volunteer of the Month: december 2014

BRaNdy FIRThBrandy Firth is the chapter leader for ICAN of Hagerstown and Frederick as well as the Northeast Regional Coor-dinator. Brandy has been invaluable in helping to increase the awareness of placenta accreta, a potentially life-threatening complication of multiple cesareans, throughout our organiza-tion.

After suffering from and surviving placenta accreta herself, Brandy is passionate about reaching mothers with the information to help them make informed birth choices and also making a difference for mothers cur-rently suffering from accretas through her work with the Red Cross. With her help, ICAN will be participating in the Hope for Accreta Blood Drive in honor of mothers with accretas on April 3, 2015.

how long have you been an ican member?I have been a member of ICAN since 2012.

How did you first find ICAN?I first found ICAN when I became pregnant after my 3rd cesarean. I began doing a lot of research and was relieved to find ICAN. The support and the knowledge that I received through ICAN helped me to make the best evidence-based decision for me and my baby.

as a volunteer, what motivates you?What motivates me as a volunteer is seeing the amazing strength that a mom has when she is given support and respect when it comes to having a voice in her birth choices. I want all moms to be given that. Do you have a profession or any other passions outside of ican?My passions outside of ICAN are: home schooling my little ones, work-ing with the Red Cross on blood drives and bringing awareness to the possible life-threatening compli-cations that unnecessary cesareans cause.

What was your proudest moment as an ican volunteer? What about your hardest?I have so many proud moments as an ICAN volunteer, it is impossible to just name one! I am so proud to be a part of ICAN every time I hear a mom say that ICAN helped her to heal from a traumatic birth experience or helped her to have an empowered birth. I also am not able to name just one moment that is hard. It is always hard when I see a mom have to fight to find a support-ive provider that will truly give her evidence-based care.

the amazing strength that a mom has when she is given sup-port and respect when it comes to having a voice in her birth choices. i want all moms to be given that.

“


In July of 2012, the American College of Obstetricians and Gynecologists issued a committee opinion on placenta accreta. It stated that “the incidence of pla-centa accreta has increased and seems to parallel the increasing cesarean delivery rate.” Additionally, they also stated that “women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either anterior or posterior placenta previa overlying the uterine scar. The authors of one study found that in the presence of a placenta previa, the risk of placenta accreta was 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth, and fifth or greater repeat cesarean deliveries, respectively (1).” In light of this information, it is more important than ever that women be made fully aware of the risks of cesarean, and that they are given the resources to plan for the unexpected should they occur.

Placenta accreta is an obstetric complication that oc-curs when the placenta embeds into the uterine wall. Accounting for 75% of all cases, the placenta does not penetrate the uterine muscle but does become deeply attached (2). This makes the expulsion of the placenta after delivery nearly impossible and dangerous to at-tempt without surgical intervention. When placenta accreta occurs, the blood vessels that have attached themselves to the uterus must be surgically discon-nected which can cause severe hemorrhaging. In a normal pregnancy, the healthy placenta detaches from the uterus after the baby is born with relative ease.

Minimal invasion of the placenta, or focal accreta, af-fects a small area of the uterus and is typically treated with a more conservative approach. This may include manually removing the placenta or treatment with methotrexate, a chemotherapy drug, to shrink and dispel the placenta as it allows the mother to retain her uterus and fertility.

When the placenta penetrates through the uterine wall and invades the muscle of the uterus the diagnosis is then called increta. This condition accounts for approxi-mately 18% of these cases (2).

The most severe form of accreta is called percreta and accounts for 7% of accreta cases (2). Placenta percreta occurs when the placenta has completely penetrated the uterine wall and most likely will attach itself to other organs looking for a blood supply. Organs that can be affected include the bladder and bowel, but are not limited to just these organs.

The risk of a massive hemorrhage, or losing large amounts of blood, goes up substantially with the sever-ity of the accreta. If the mother begins to hemorrhage and the bleeding can not be controlled, the physicians will need to perform a hysterectomy in an attempt to save the mother’s life.

Placenta AccretapLaNNING FOR ThE UNExpECTEdBy // GINa WaLKER

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Image Source: Reitman 2011, Anesthesiology


Planning ahead

If you have received a placenta accreta diagnosis, as-sess your situation, plan for the unexpected, and begin educating yourself of your specific condition. Speak with your birth care provider to get recommendations for a specialist, typically someone who specializes in Maternal Fetal Medicine. Research your options for specialists as they will attend the remainder of your pregnancy.

Some questions to ask while interviewing are: • How many cases of accreta have you attended? • What was the severity of those accretas that you

helped to manage? • With what hospital are you affiliated? • Do you offer more conservative approaches to pre-

serving the uterus, or is a hysterectomy the favored approach?

SupportA support network is crucial in a healthy pregnancy, and during a high risk pregnancy that support is even more important. Seek out the support of your friends, family, neighbors, church, and accreta support groups. Create a chart listing those available to help, what they can help with, and their contact information. Save or display it someplace that you can quickly and easily get to. You may want to consider educating your support network on placenta accreta and the severity of your accreta. The more informed that they are, the better they will be able to help you. You may not need the extra help, but knowing that help is there can alleviate some stress.

ChildcareIf you have children in school, contact the administra-tors to clarify backup arrangements and provide them with emergency contact information. • Do you have someone available to watch other chil-

dren for an extended period of time and get them to and from school?

• In an emergency situation would someone in your support network be able to get you to the hospital?

Finances and InsuranceWith the number of interventions necessary during a high risk pregnancy and delivery, it is important that you be aware of how your treatments will affect your hospital bill.• What happens if you end up in the hospital the

entire pregnancy?• Will your maternity benefits cover your absence

from work?• Will your health coverage carry the cost of a

lengthy hospital stay?• What additional expenses need to be budgeted?• Are there any treatments that aren’t covered?

Birth and PostpartumDuring the birth and the postpartum period, it is impor-tant to consider the following:• What should you expect during delivery?• Does the anesthesia department prefer you to be

asleep or will they let you stay awake?• Do the surgeons prefer to prep the OR with blood

or will they rely on a cell saver?• Will they give the baby steroid injections prior to

delivery to help with lung development and at what gestational age do they plan on delivering?

• What should you expect during recovery?• What happens if the baby needs assistance?• How long might you be required to stay in the ICU?• How long before you may be able to see the baby?• Does the hospital have appopriate NICU care?• If it is necessary for your newborn to be trans-

ferred, will you be able to be transferred there as well or do they have campus housing/lodging as-sistance to help lessen the burden of traveling back and forth?

• What is the average discharge time frame?

Always plan ahead for the worst case scenario that way all bases can be covered. If you do not require a hys-terectomy, plan for the normal pains and discomforts associated with a cesarean. Don’t forget to utilize your support network to help with meals, laundry, travel to and from doctors appointments or any other daily activities that may be deemed too strenuous for the first few weeks. Having a viable plan in place will help ensure peace of mind and can aid in recovery.

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16 | winter 2015 the clarion the clarion winter 2015 | 16

Help Yourself While Helping OthersOne last way you can help to prepare for your accreta is personally making sure your local blood banks are full. Set up a blood drive in your honor asking friends and family to donate in your name. Hopefully you won’t need it, but the peace of mind knowing it is there is priceless.

The Hope for Accreta Annual Blood Drive and Awareness event will take place globally, April 3rd, 2015. You can find more information at www.hopeforaccreta.org resources:1. American College of Obstetricians and Gynecologists. (2012, July). Placenta accreta. Committee Opin-ion No. 529. Obstet Gynecol, 201-11. 2. Miller D, Chollet JA, Goodwin TM. Clinical risk factors for placenta previa–placenta accreta. Am J Obstet Gynecol 1997; 177:210–214.

Gina Walker is the CEO of Hope for Accreta Foundation. She founded the organization after developing placenta percreta while pregnant with her daughter.

Hope for Accreta Annual Blood Drive: April 3, 2015The International Cesarean Awareness Network is excited to be participating in the 2015 Hope for Accreta Blood Drive hosted by the Hope for Accreta Foundation and the American Red Cross. The purpose of the Hope for Accreta Blood Drive is to raise awareness of placenta accreta, which is also a risk of repeat cesarean in which mothers often require emergency blood transfusions.

This year’s blood drive will be held globally on April 3rd. Be on the lookout for details on chapters near you who will be participating.

For more information: contact Brandy Firth [email protected].


in 2011, i gave birth to my eleven pound four ounce son at home, after having three previous cesar-eans. Over a year after his birth, and some months after establish-ing ICAN chapter Hagerstown and Frederick, I was excited to learn that I was pregnant. I began plan-ning my second home birth after three cesareans (HBA3C). Unfor-tunately, I began having complica-tions very early in the pregnancy. At eleven weeks, I was diagnosed with a complete placenta previa, a complication in which the placenta grows in the lowest part of the uterus covering some or all of the opening to the cervix.

Placenta previa is seen more com-mon with women that have had prior c-sections. I remained hopeful that the placenta would move up as my pregnancy progressed, but by twenty-four weeks the placenta had not moved. The perinatologist

started to suspect placenta accreta because of my previous cesareans and an abnormally vascular uterus.

The MRI at twenty-eight weeks confirmed that I had increta. My care was transferred to a the bigger city hospital with a larger blood bank then the local hospital. A team of surgeons began planning my delivery for thirty-six weeks via cesarean section, immediately fol-lowed by a hysterectomy.

Placenta accreta was the scariest thing I have ever had to face. It was difficult to believe that this was happening to me. I had to trust the same surgeons and surgery that contributed to the accreta to now save my life and the life of my baby. During each pregnancy that re-sulted in an unnecessary cesarean the risks of a VBAC were stressed. However, the risks associated with repeat cesareans, including placen-

ta accreta, were never mentioned. When I asked my OB after my third cesarean if I would be able to have more children, I was told that I had minimal scarring and was “good to have more kids.”

My scheduled surgery date came without further complication. Say-ing goodbye to my children was difficult. It was horrible to think that while they meet their new brother the next day, they may also lose their mother. My little guy was born on October 3rd 2013, healthy and weighing seven pounds and two and half ounces. Sadly, I did need to have a hysterectomy. During the surgery, I lost over two gallons of blood and received thirteen units of life-saving donor blood.

After my diagnosis with accreta, I felt it best to step down as an ICAN chapter leader. I posted updates in the ICAN Facebook group

BirthstoryBRaNdy FIRTh

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and I will carry the support and love that I received with me for the rest of my life. After delivery, I decided I could not let the chapter become defunct. I had to share my story so all women could be informed of the risks for both repeat cesarean and VBAC.

Women need to have this informa-tion in to make a truly informed decision on how they want to birth their baby.I want to see the day that providers convey all the risks of VBAC and major abdominal surgery in the same conversation. ICAN’s mission aims to prevent women from facing what I did, and I have to

be a part of that.I met Gina Walker, founder and CEO of the Hope for Accreta Foundation, a few weeks after the delivery of my son. At the time, she was planning the first annual Hope for Accreta Blood Drive. With lots of love and encouragement from Gina, I sponsored two blood drives. The first was in my local area and the other at the large city hospital where I delivered my son. The 2014 Hope for Accreta Blood Drive was a huge success, over 2500 units of blood was collected, and the 2015 drive is shaping up to be even bigger.

ICAN is a proud supporter of the 2015 Hope for Accreta Blood Drive. As a mother of 6, ICAN chapter leader, supporter of the Hope for Accreta Foundation, and a blood recipient I ask you to please con-sider donating blood or sponsoring a drive. Blood donations do save lives. I was at a excellent hospital with gifted surgeons, but without blood donations I would not be here today.

Brandy Firth and her family after her high risk birth with placenta accreta.


NavigatingInsurance

BY // MelinDa DoYle


PPo or Preferred Provider organization - A PPO will have both in-network and out of network coverage. If you choose alternative forms of health care or live in a remote area, this is generally your best choice. This type of plan is more flexible than others and offer more provider options. A PPO plan usually has higher premi-ums than an HMO. hMo or health Maintenance organization - An HMO requires you to use only in-network providers that are in your geographic area (meaning within a specified region). Out of network providers or facilities will not be covered without prior authorization, except in emer-gencies. This type of plan limits the providers you can use. However, the premiums and out of pocket expens-es are typically lower than with a PPO. ePo or exclusive Provider organization - This is simi-lar to an HMO in that you must use in-network provid-ers. However, there is no geographic restriction. If you frequently travel, an EPO has significant benefits over an HMO. in-network Providers - These providers are contract-ed with the insurance company and offer discounted rates to their members. Typically, your out of pocket ex-penses are what insurance applies to your deductible, copay, and coinsurance. Out of pocket expenses may be lower when using an in-network provider. Be careful though, just because the hospital or birthing center is in-network does not necessarily mean the provider is, and vice-versa. It is always best to ask if both the facil-ity and the provider are in-network. out of network Providers - These providers do not have a contract with your insurance company. Out of pocket expenses may be higher when using an out of network provider. In addition, you may be responsible for the difference between the allowed amount and the

amount billed by insurance. However, there are times when there are no in-network providers near you that offer the service you require.

Additionally, insurance companies do not always con-tract with certain specialties. Having out of network coverage can be very beneficial, especially if you prefer alternative forms of healthcare such as chiropractic care, massage therapy, acupuncture, nutritionists, doula services, homebirth, etc. out of Pocket expense - The amount of your bill that insurance requires you to pay towards your medical expenses. These expenses include your deductible, coinsurance, and copay amounts. Deductible - This is the amount that you must pay to-wards your medical care before insurance will pay out. coinsurance - A percentage of your bill that the insur-ance requires you to pay. copay - A fixed amount that you pay per visit, typically between $20 and $45 depending on the type of visit/provider. out of Pocket Max/coinsurance Max - This is the amount you must pay during a policy period (generally one year) before your insurance pays 100% for covered services. This amount does not include your premium amounts. Some policies include deductible, coinsur-ance, and copays in this amount, and some only include coinsurance. It is important to clarify when choosing a policy or planning your budget.

in network exception – Also called a Gap Exception, In for Out, PPO Waiver, etc. This exception is a writ-ten agreement where the insurance company agrees to process claims for services rendered by

Congratulations! You just found out that you are expecting. Now what? Being an expectant mother comes with countless questions, options, and choices to make. It can seem overwhelming, especially to first-time moms. One of the first questions that usually comes up is how to pay for your maternity care. Will you pay out of pocket? Perhaps you have insurance but don’t know exactly what it covers. Navigating the insurance landscape can be es-pecially tricky. With all the different types of insurance policies available in the United States, it can be difficult to figure out which one is just right for you and your child. While we can’t address every option in this article, we can help to make your insurance and coverage decisions a little easier. Let’s start with the basics. The most important thing, when looking at insurance, is knowing the proper terms. If you don’t use the right term or understand the terms used, you may not get the correct information and that can result in a higher cost to you.

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an out of network provider at your in-network ben-efit levels. Typically this type of authorization is only possible if there are no in-network providers within a certain distance from your home that offer the service you require. open enrollment - The time span during which you can make changes to your policy. While not traditional insurance plans, a Healthcare Sav-ings Account (HSA) or Flexible Spending Account (FSA) are medical savings accounts with tax benefits that are available to some individuals. An HSA or FSA typically are associated with a High Deductible Health Plan or HDHP. Monies deposited into these accounts can be used to pay for your out of pocket medical expenses such as deductibles, copays, and coinsurance. Terms and conditions of these accounts can vary, so it is im-portant to review the policies closely. Another option available in the United States is the Medical Share Program. These programs, sometimes offered through religious entities, allow their members to share their medical expenses. Many of these share programs qualify you as having insurance under the ACA (Affordable Care Act), although they are very different than traditional insurance. Covered benefits are subject to the religious convictions of your cho-sen program, meaning that some services will not be covered. Examples of such excluded benefits include genetic testing and birth control options. However, monthly premiums are significantly lower than stan-dard insurance policies, and the out of pocket expenses are typically much lower as well. You may be required to attest to your religious faith and pledge to their life-style guidelines. In addition to your premiums, you are asked to donate towards paying medical bills for other members. Once you’ve got the vocabulary down, it is also impor-tant to find out the specifics of what your particular policy covers. Even policies offered by the same insur-ance company can have widely varying guidelines and covered services. Here are some key questions to ask your insurance company in regards to your maternity coverage:

is my provider in or out of network? This should always be your first question, as it will af-fect the responses for the rest of your conversation.

If your provider is out of network, do you have out of network maternity coverage? Is an in-network excep-tion possible on your plan, and what are the guidelines? is maternity care subject to my deductible?Although most policies are now ACA compliant, the ACA does not require labor/delivery care (provider or facility) to be covered at 100% with no deductible, only prenatal care. It is important to ask your insurance company specifically what they cover regarding prena-tal, delivery, facility, postpartum, and newborn care. It is also important to ask for those benefits for both in and out of network coverage, depending on your provider’s status. What percentage will be covered for prenatal, de-livery, post-partum, and facility fees? It is important that you ask your insurance company prior to delivery to break down each of these items in order to avoid unpleasant surprise billing after you deliver. Many poli-cies will cover prenatal services at 100%, but then only cover the facility (hospital or birthing center) fees at a lower percent, which can result in large out of pocket expenses for you. Is this a fiscal year or a calendar year policy? When planning your finances, it is important to know when your out of pocket accumulations will go back to zero. Most policies are calendar year, meaning your accumu-lations return to zero on January 1. However, some are fiscal year policies, and your accumulations will return to zero at some other point during the year. If you are using an out of network provider, ask if your in and out of network amounts cross accumulate. Frequently, amounts applied to your out of network deductible, coinsurance, and copay will also be applied to your in-network out of pocket accumulations. This can benefit you later in the year for services rendered by in-network providers, as you will be closer to meet-ing your yearly accumulations. is your chosen provider type covered? There are many types of maternity care providers in the United States. It is important to specify what type of provider you are getting coverage information for. Examples are OB (Obstetrician), CNM (Certified Nurse Midwife), LM (Licensed Midwife), CPM (Certified Professional Midwife), Lay Midwife, Doula, Lactation Consultant, and so on. continUeD


are birthing classes, lactation classes, or doula services covered? These are examples of “extras” that may be covered under your policy. is a breast pump or birthing pool covered? Be sure to ask specific questions, such as where you need to purchase and/or rent item from, are there any restrictions on the type of pump/pool you are allowed to get, etc. When must baby be added to the policy? There are guidelines when it comes to how long you have after baby is born to add them to your policy. These can range from 3 days to 60 days in most cases. If you do not add your baby within those guide-lines, you may not be able to add him/her until the next open enrollment period.

is your chosen birth location covered? Whether you are plan-ning on delivering in your home, a birth center or a hospital, it is important to ask if that specific location is covered. There are some policies that will only cover your maternity care if you deliver in a hospital unless you get prior authorization for your chosen place of service. is this a self-funded policy? If you purchase your insurance through your employer, it may be a self-funded policy. If your policy is self-funded, and you are not satisfied with the answers to any of your benefits questions, you have the right to speak to the Human Relations (HR) representative at your employer to file a complaint or grievance. The HR representative should be able to address any of your concerns that the insurance company could not. Insurance can be a difficult maze to maneuver, but if you ask the right questions, it can be much less stressful. Don’t hesi-tate to ask your provider any and all questions you have. Most providers have at least one person who handles their insurance claims and can answer any specific questions you may have.

MelinDa DoYle is the mother of four children and the owner of Doyle Billing, LLC - a medical insurance billing company specializing in the needs of both home-birth and birth center midwifery practices. She has significant successful experience fighting insurance companies for excep-tions and securing pre-authorization and payments on previously denied midwifery coverage and claims.

WEBINaRs

ICAN Is pLEAsED TO OffER both live and recorded webinars as a benefit of membership with our organization.

StaY tUneD The ICAN Professionals Series is coming soon! These informative webinars will be geared towards our professional membership. Webinar schedules are sent via email on a monthly basis.

QUeStionS?

contact [email protected]

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