Hi Everybody:
   I have obtained the loan of a manuscript entitle "Coming to
Term...Innovaions in Safely Reducing Cesarean Section Rates" The three major
areas of focus are "broadening physicain accountability, enlisting the
patient, and restaffing the hospital" This is a fabulous report and belongs in
the hands of doula organizations and childbirth educators. I believe LCs and
those of us working with breastfeeding will benefit from it as well, for this
report clearly states in many ways that there is a direct correlation between
epidural use (particularly when given early in labor) and cesarean section.
And breastfeeding workers sure have an uphill battle to get mother and baby
together well when there is either of these events.
   It can be obtained from the Medical Leadership Council, (FAX) 202-672-5700
or 1-800-673-1756. Ask for publication #MLC-000-001. It is intended for broad
dissemination among OBs, administrators and L&D unit staff members.  A number
of folks have reviewed this report, including Bruce Flamm, Penny Simkin, and
John Kennel.
The tables and charts and research are amazing...I can't post the whole thing,
although I'd love to. There is one pie-graph showing that 20% of cesareans are
influenced by patient demand: 9% from epidural-related dystocia, and 11% from
women refusing a trial of labor. It also shows how the jury is still out on
the Active Management of Labor...that recent research hasn't supported a
significant difference. (Is this because active management of labor in the US
leaves out the one factor determined by meta-analysis that makes the
difference, i.e. one-to-one support?) Whatever....I hope we can all get
copies. Warmly, Nikki