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About Us
Mission Statement
The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization whose mission
is to improve maternal-child health by preventing unnecessary cesareans through education, providing
support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).
Statement of Beliefs
We, the International Cesarean Awareness Network, believe that:
1. The inappropriate over use of cesarean surgery is jeopardizing the lives of mothers and babies.
2. When a cesarean is necessary, it can be a lifesaving technique for both mother and baby, and worth
the risks involved.
3. Birth is a normal physiological process. Research shows that with emotional support, education, and
an honest opportunity, the vast majority of women can have a healthy vaginal birth.
4. A healthy birth incorporates emotional, physical, and spiritual well-being.
5. Research shows that VBAC is reasonable and safe for both mother and baby. A repeat cesarean
should never be considered routine– it is major abdominal surgery with many risks.
6. It is unethical and unenforceable for hospitals to institute VBAC bans. Women have the right to
refuse any procedure, including a cesarean.
7. Women have the right to true informed consent and refusal, which entails full knowledge of the risks
and benefits of all tests, drugs, and procedures.
8. It is incumbent upon every care provider and institution to facilitate the informed consent process.
9. Women must be allowed to express all their birth related feelings in a safe and
supportive environment. The emotions of a pregnant and birthing woman have profound effects on
the birth outcome and recovery.
10. It is unethical for a physician to recommend and/or perform non-medically indicated cesareans
(elective). Women are not being fully informed of the risks of this option in childbirth, and therefore
make decisions based on cultural myth and fear surrounding childbirth.
11. The trend of “elective cesareans” is being significantly overstated through distortion of research and
data.
12. We as women must now assume more responsibility for our own births.
13. It is critical that women’s choice of care provider and location of birth is respected.
The International Cesarean Awareness Network, Inc. (ICAN) is a nonprofit organization whose mission
is to improve maternal-child health by preventing unnecessary cesareans through education, providing
support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC). ICAN's focus is
on pregnancy, delivery, traumatic birth, recovery and newborn support as it relates to birth. We do not
take positions on issues outside of our mission statement. We encourage our families to educate
themselves and make decisions accordingly.
ICAN Chapter Guidelines/Rules
* Confidentiality is Paramount. To ensure the safety (emotional, professional and otherwise) of our
group members, what is said in group stays in group. Never disclose personal information. Unfortunate
breaches in confidence can result in dismissal from our group. This also applies to our online and email
forums.
* Meetings are a safe space. This means you are able to speak freely here and feel heard. This means
you will not be judged here. This means that chapter leaders will intervene if others are interrupting
members or dominating discussion so that every woman feels empowered to speak.
* We are all equally experts in our experiences. This is not a forum for expert advice, but a safe space
for listening and empowering women to make their own "next steps" and conduct their own research
* A Person's Birth Choices are Her Own. ICAN's mission is to educate families AND to provide
support for personal situations, including traumatic birth recovery. We do not pass judgment or provide
unsolicited advice to group members.
* Our goal is empathy and fostering empowerment. We hope to achieve this by providing accurate
information, promote healing and recovery through resources and peer support.
* We do not pressure women to share during group time. This is a safe space to speak and be heard or
to not speak if you choose.
* Listen actively. This means never interrupting a woman while she is speaking (the group leader will
facilitate if a problem arises) and saving questions for after a mother is done speaking.
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Ob Gyns Issue Less Restrictive VBAC Guidelines
July 21, 2010
Washington, DC -- Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice
for most women who have had a prior cesarean delivery, including for some women who have had two
previous cesareans, according to guidelines released today by The American College of Obstetricians
and Gynecologists.
The cesarean delivery rate in the US increased dramatically over the past four decades, from 5% in
1970 to over 31% in 2007. Before 1970, the standard practice was to perform a repeat cesarean after a
prior cesarean birth. During the 1970s, as women achieved successful VBACs, it became viewed as a
reasonable option for some women. Over time, the VBAC rate increased from just over 5% in 1985 to
28% by 1996, but then began a steady decline. By 2006, the VBAC rate fell to 8.5%, a decrease that
reflects the restrictions that some hospitals and insurers placed on trial of labor after cesarean (TOLAC)
as well as decisions by patients when presented with the risks and benefits.
"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N.
Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough
counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient
autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues,
hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC
rate."
In keeping with past recommendations, most women with one previous cesarean delivery with a lowtransverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In
addition, "The College guidelines now clearly say that women with two previous low-transverse
cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are
considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts
General Hospital in Boston and immediate past vice chair of the Committee on Practice BulletinsObstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University
in Chicago.
VBAC Counseling on Benefits and Risks
"In making plans for delivery, physicians and patients should consider a woman's chance of a
successful VBAC as well as the risk of complications from a trial of labor, all viewed in the context of
her future reproductive plans," said Dr. Ecker. Approximately 60-80% of appropriate candidates who
attempt VBAC will be successful. A VBAC avoids major abdominal surgery, lowers a woman's risk of
hemorrhage and infection, and shortens postpartum recovery. It may also help women avoid the
possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury,
transfusion, infection, and abnormal placenta conditions (placenta previa and placenta accreta).
Both repeat cesarean and a TOLAC carry risks including maternal hemorrhage, infection, operative
injury, blood clots, hysterectomy, and death. Most maternal injury that occurs during a TOLAC
happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has
fewer complications than an elective repeat cesarean while a failed TOLAC has more complications
than an elective repeat cesarean.
Uterine Rupture
The risk of uterine rupture during a TOLAC is low—between 0.5% and 0.9%—but if it occurs, it is an
emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College
maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency
cesarean, but recognizes that such resources may not be universally available.
"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier
guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary
goal is to promote the safest environment for labor and delivery, not to restrict women's access to
VBAC."
Women and their physicians may still make a plan for a TOLAC in situations where there may not be
"immediately available" staff to handle emergencies, but it requires a thorough discussion of the local
health care system, the available resources, and the potential for incremental risk. "It is absolutely
critical that a woman and her physician discuss VBAC early in the prenatal care period so that
logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack
"immediately available" staff should develop a clear process for gathering them quickly and all
hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they
may occur, Dr. Grobman added.
The College says that restrictive VBAC policies should not be used to force women to undergo a repeat
cesarean delivery against their will if, for example, a woman in labor presents for care and declines a
repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during
prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to
refer her to another physician or center.
Practice Bulletin #115, "Vaginal Birth after Previous Cesarean Delivery," is published in the August
2010 issue of Obstetrics & Gynecology.
The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is
the nation's leading group of physicians providing health care for women. As a private, voluntary,
nonprofit membership organization of approximately 55,000 members, The College strongly advocates
for quality health care for women, maintains the highest standards of clinical practice and continuing
education of its members, promotes patient education, and increases awareness among its members
and the public of the changing issues facing women's health care. The American Congress of
Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.
www.acog.org
http://www.acog.org/About-ACOG/News-Room/News-Releases/2010/Ob-Gyns-Issue-LessRestrictive-VBAC-Guidelines
F.A.Q.
What does an ICAN meeting look like?
A typical ICAN meeting entails women coming together with women of similar experiences for peer to
peer support. Meetings are sometimes topic specific and sometimes general support. Often birth stories
are shared. There is often laughter, tears and a feeling of camaraderie. The feel of a particular meeting
can change based on who is there and what it being discussed. I like to remind newcomers that they
should always try a second meeting as they are all different. Sometimes meetings can be VBAC heavy
and other times they can be cesarean recovery heavy. It really depends on who shows up to the meeting
and who is driving the discussion.
Who is welcome? Mothers? Partners? Birth Professionals? Providers?
Some meetings are open for women/lap babies only and other meetings welcome children, dads,
husbands, partners, birth professionals and other community members who want to learn about
cesareans, VBAC and recovery. Each chapter may vary on how they do things, so check in with the
chapter leader if you have any questions.
What are some things that ICAN does that reinforces it’s mission statement?
We offer support to mothers through listening. We also help in educating them by providing evidence
based research to help them make the best possible birth choices for them or to cope/understand what
they have experienced. We recognize that both VBAC and cesareans carry risks. We help women
understand what those risks are with both choices, where typically many providers only provide the
VBAC risks.
Ideas for the Best Planned Cesarean Possible
By Penny Simkin
You may feel disappointed that you must plan a cesarean for your safety or your baby’s.
Here are some ideas for making the cesarean birth of your baby very special and personally satisfying for you,
your partner, and your baby.
Before the surgery:
Be sure you understand and agree with the reasons for the cesarean (i.e., malpresentation of the baby, or a
medical problem for you or the baby).
Learn about the procedure. Read about it in Pregnancy, Childbirth and the Newborn or the Birth Partner and
discuss it with your caregiver.
Learn about your anesthesia choices and how each is administered. General information is available in the
books mentioned above. If possible, however, meet and discuss medications with an anesthesiologist along with
any concerns you have. A spinal is the most common type of anesthesia when a cesarean is planned in advance,
but there are other possibilities. (See “Anesthesia and other medication issues" below).
Learn the layout of the operating room, particularly where the baby will be taken for initial care. Will she be
in the same room or an adjacent room? Will you be able to see her? Can your partner move back and forth
between your side and your baby’s?
Discuss the possibility of waiting until you go into labor and then going to the hospital to have the cesarean.
The advantage is that the timing for birth is more likely to be optimal for the baby. The disadvantages are that
you might not know the doctor on call who will do the surgery, and that you cannot plan ahead (which is
the same as with most vaginal births).
If you do not await the onset of labor, you will make your appointment for the surgery. Consider being the
first on the day's schedule for two reasons: there is less likely to be a delay (from earlier surgeries taking longer
than expected); and you will not be as hungry if you do not have to wait all day. You will probably have to avoid
eating from the night before.
During the surgery and repair:
For your personal comfort, consider these ideas:
-Ask if at least one arm can be left unrestrained.
-Have your partner put some pleasant-scented (lavender and bergamot are popular) lotion, massage oil, or
cologne on your cheeks. He can also put it on his wrist for you to sniff. This is soothing and may counteract the
“hospital smells.” Because some staff members may be allergic to some scents, you’d better ask if this is okay.
-Bring your own music to listen to during the surgery. Music that is familiar and that you love is most soothing.
Many operating rooms have CD players, or check whether you may use your own ear buds and music player.
-Plan to use relaxation techniques and rhythmic slow breathing (like sighing) during the surgery. Hold your
partner’s hand.
Ask them to lower the screen when the baby is lifted from your body so that you can see the birth.
Though not usually done, ask if they will delay clamping your baby's umbilical cord for one to three minutes
after birth to allow the baby's blood that is in the placenta to return to the baby. There are many advantages. (see
Pregnancy, Childbirth and the Newborn)
During the repair procedure, some doctors lift your uterus out of your abdomen to inspect it and then replace it
while others believe this is unnecessary and possibly problematic. This procedure may cause greater nausea, and
later gas pains than if the uterus is not lifted out. You might wish to discuss this with your doctor beforehand.
Ask about the advantages and the disadvantages.
Ask about picture taking during the surgery or afterwards. There sometimes are policies restricting picture
taking. With a digital camera you can see pictures of your baby within seconds.
Once your baby is born, it may be possible to have him or her placed on your chest, skin to skin. This practice
is becoming more popular for healthy babies.
If you don't get the baby right away, your partner may be able to bring the wrapped baby back to you for your
first contact. You can nuzzle, kiss and talk to your baby. Ask if you will be able to hold her or breastfeed until
you leave the operating room.
You and your partner might talk or sing to your baby. A familiar voice often calms the baby at this time, and
seeing the baby’s response is a poignant moment for you both. If you sing a special song (i.e., “You Are My
Sunshine”) aloud to the baby frequently before birth, it soothes the baby at birth and afterwards when hearing
your voices and the familiar song.
Anesthesia and other medication issues:
The spinal block has many advantages for a planned cesarean, which make it the usual choice. It is quick to
administer and to take effect. It usually involves only a single injection, and does not require a catheter in your
back. It causes numbness that lasts a few hours. You remain awake and aware. It hardly affects your baby.
The injection may also contain some long-acting narcotic such as morphine that provides good postpartum pain
relief without grogginess for up to 24 hours after the surgery. If you have been in labor and already have an
epidural, they will likely add medicine to the epidural for a cesarean to increase the numbing effect. There
are some concerns about spinal and epidural blocks that might be disturbing or frightening:
-It is not uncommon to have a period during which you feel breathless or as if you cannot breathe. It can be
scary. It happens because the anesthetic may numb the nerves that let you feel your breathing, while the nerves
to the muscles that make you breathe are not blocked. In other words, you are breathing, but cannot feel it.
-What to do: Say that you cannot breathe. The anesthesiologist, who is at your head, will check and reassure you.
Your partner should coach you with every breath, watching closely and saying, “Take a long breath in -- yes you
are doing it, and now breathe out. Good.” Your partner might also hold your hand in front of your mouth so you
can feel your breath, and reassure you, “You are breathing, even though it doesn't feel like it.” This feeling does
not last for the entire surgery.
-On very rare occasions, the level of anesthesia rises high enough to involve the muscles of breathing, so that
you really are not breathing. You cannot talk either. The anesthesiologist, who is watching the monitors closely,
discovers this and takes measures to assist your breathing. You and your partner should also have a signal. If you
can’t breathe and can’t talk, blink your eyes many times. That means, “I can’t breathe!” Your partner should be
watching you, and if you blink in that way, says, “I think she can’t breathe!” This may alert the anesthesiologist
a few seconds before he would pick up the problem.
-On other rare occasions, the anesthesia is not adequate, and you feel the surgery. This is very scary. The doctors
will probably want to make sure your reaction is not an anxiety reaction to the surgery, and may seem not to
believe you at first. If you are feeling the surgery, tell them to stop. Your partner must help you with this. Make
them give you better anesthesia before proceeding. This might mean repeating your block or giving you a
general anesthetic.
During the repair, you may feel nauseated and shaky for a period of time. These are normal reactions to major
surgery and vary from feelings of queasiness to vomiting, and from trembling to shaking and teeth chattering.
There are medications to ease these symptoms. They are often put into your IV without you knowing, which may
be okay with you. They may, however, cause amnesia (e.g., Versed), or make you very sleepy. They can keep
you from being able to nurse your baby (or to remember that you did), and to remember the first hours of your
baby’s life. If you want to stay awake for this time, discuss this with your anesthesiologist ahead of time. You
might ask the anesthesiologist not to give you anything for nausea or trembling unless you ask. You may very
well be able to tolerate these temporary symptoms, but if you cannot, then you can ask for the medication.
Post-operative pain medications are available to help you during the days and weeks after the birth. Some
women try to avoid using them due to worries about possible effects on the baby. However, since very small
amounts reach the baby, the effects seem to be minimal. The baby nurses and remains awake and alert for
periods of time. The downside of avoiding pain medications is extreme pain, which greatly reduces your ability
to move about and to care for, nurse, and enjoy your baby. With adequate pain relief, you can have more normal
interactions with your baby.
The first few days:
Most hospitals have a bed available for the partner so he or she can remain in the hospital with you. This is
lovely for many reasons. You are together as a family. Your partner can share in baby care. If your partner stays,
your baby can probably room in with you the entire time. If not, you will need help from the nurse to change the
baby’s diapers, move him from one breast to the other, and carrying him, even for short distances. In some
hospitals, the baby spends more time in the nursery if the partner is not there.
Breastfeeding is definitely possible, but presents some challenges after a cesarean. Nursing positions such as
sidelying, and the “football” or clutch hold avoid painful pressure on your incision. Using a pillow over the
incision also reduces pain while holding your baby on your lap. Ask for help from the hospital’s lactation
consultant in getting started with nursing.
Rolling over in bed can be very painful, if you don’t know how to do it. The least painful way uses
“bridging.” To roll from back to side, first draw up your legs, one at a time so that your feet are flat on the bed.
Then “bridge,” that is, lift your hips off the bed, by pressing your feet into the bed. While your hips are raised,
turn hips, legs, and shoulders over to one side. This avoids strain on your incision.
Help at home is essential to a rapid recovery. If possible, someone (relative, friend, or postpartum doula) in
addition to your partner should help keep the household running smoothly. If that person knows about newborn
care and feeding, all the better. All three (or more) of you need nurturing and help during the first days and
weeks to ease and speed your recovery and help you establish yourselves as a happy family.
As you can see, there are many possible options for a cesarean birth. Some are personal touches and personal
self-care measures that will improve your satisfaction and self-confidence. Others are measures that involve the
support of the hospital staff. Think about your own preferences, prepare a birth plan, review it with your
caregiver, and bring it to the hospital for the nurses to read.
I hope these suggestions will help you have the best cesarean ever!
History of ICAN
The International Cesarean Awareness Network can be traced back to June 1982 when Esther Booth Zorn
conceived the Cesarean Prevention Movement (CPM) at her dining room table with Liz Belden Handler. Zorn is
credited for bringing the issue to national prominence--and for successfully challenging the long-held “once a
cesarean, always a cesarean” dictum that for years had been regarded as gospel. With Esther and Liz working
together, ICAN (then CPM) was born on Esther’s dining room table after they spent all night putting together
the first ICAN newsletter, The Clarion. Within a month of mailing out the first 500 copies, there were so many
inquiries Esther had to reprint more Clarions. Esther’s words struck a chord with women in this country.
Just two years after founding CPM, the American College of Obstetricians and Gynecologists (ACOG) issued
guidelines promoting vaginal births after previous cesareans. Four years later, ACOG issued another set of
guidelines aimed at dismantling the old “once a cesarean, always a cesarean” rule.
In 1992, the Cesarean Prevention Movement changed its name to International Cesarean Awareness Network,
Inc. (ICAN) and was incorporated as a not-for-profit corporation in the state of New York in the USA.
Today, the organization is credited with sparking a successful movement during the 1990s to lower the overall
cesarean rate by increasing the number of vaginal births after cesareans (VBACs). After VBAC gained
acceptance in the mid-1990s, the need for ICAN seemed to be gone and the organization entered a period of
decline, going from over 80 chapters in 1990 to 22 in 2000.
The pendulum has swung back since 1999. In July of that year, ACOG revised their VBAC guidelines in
response to medico-legal concerns in a manner, which has put a chill on VBAC across the United States and, by
example, the world. As we embark on 2010, the overall cesarean rate is the highest in United States history, and
the option of hospital VBAC is seriously threatened as hundreds of facilities in the United States have closed
their doors to VBAC entirely. Thousands of women are left with no options in childbirth. Since the change in
VBAC guidelines, ICAN’s subscriber base has increased from 47 in December of 1999 to 453 at the end of
2003, representing an almost ten-fold increase in a relatively short amount of time. In the summer of 2003, for
the first time in a decade, ICAN had in place a full Board of Directors and was ready to plan for the future. At
the close of 2009, ICAN had over 630 subscribers and over 120 chapters. ICAN has been involved in many
great events, including reversing some VBAC bans, mentions in national media, and a hearing on Capitol Hill.
Our Chapters, Regional Coordinators, and Board members have been providing support and facilitating great
changes throughout the United States and all over the world.
At its core, ICAN is a grass-roots organization made up of local chapters all over the United States and Canada
that provide mother-to-mother support and education about cesarean prevention and VBAC. All chapter leaders,
Board subscribers and officers are volunteers. There is no paid staff. An Advisory Board comprised of
recognized experts in the maternal-child health field supports the International Board. International interest in
ICAN’s mission is growing and new chapters are being started all over the world. The Board expects to see
more International Chapters within the next several years.
The International Board of Directors sets policy for local chapters and provides them with support, as well as
directing international public relations and collaborations with other organizations involved in maternal-child
health. Since its inception, ICAN has published a quarterly newsletter, The Clarion, available to current
subscribers as a way to connect the chapters, as well as furthering our educational mission. With the growing
popularity of the internet, ICAN has flourished with an award winning educational website, as well as an e-mail
support list, webinars, support forums, and biweekly E-news.