Fear of Rupture

I received a Facebook message from someone wanting to have a VBA2C, but dealing with a lot of fear.  I sent the message on to my go-to VBAC girl, Abbey Robinson.  Her response was so fabulous, I asked if I could post it here.  I hope you will find it helpful if you too are wanting a VBAC but dealing with the fear that is spoon-fed to our VBAC mamas.

First of all, congratulations on your pregnancy.  I, personally, had a VBA3C so I can definitely understand where you are coming from.  VBAC is a huge commitment and learning everything you can about the process is crucial to success.

I think that it’s normal to be fearful when you hear so many scary stories on the internet and through friends, family, and acquaintances.  From what I am hearing, your major concern is that you may not know/feel when/if you have a uterine rupture.  I will try to address this for you.

I never speak in absolutes regarding anything, so I’m not one of those people who will reassure you that there is no risk and everything will be fine.  Simply being pregnant and carrying a baby has risk.  Having a 3rd c/section places you at risk for many complications, much more than your 1st c/section would have been likely to cause.  Your risk of 

•    major complications is a whopping 7.5% (including but not limited to are listed as  uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.)

•    Placenta accreteta: 0.57%

•    Risk of hysterectomy: 0.9%

•    Risk of blood transfusion: 2.26%

•    Risk of dense adhesions: 32.2%  (can cause life long pain/bladder and bowel problems/back pain (from everything sticking together) and will heavily complicate any future c/sections)  If you want statistics on a 4th c/section (if you plan to have more children, let me know.  The risk goes up many more times for each complication)

   http://icanofomaha.webs.com/vbacorrepeatcesarean.htm

That leaves you with VBA2C and the risk of “uterine rupture”.

There was an Australian study of over 29,000 women who spontaneously went into labor where the risk of UR without augmentation (pitocin, prostaglandins, cytotec, etc.) with one prior incision was found to be a very low 0.15%  Once you introduce labor augmenting and induction drugs, the risk of uterine rupture increases to 1.91%.  HUGE difference.  From the studies that have been done on VBA2C or more, there isn’t much difference in the UR rates.  Cochrane reviews have identified true UR rates to be around 0.4% when no augmenting drugs were used.  Most of those cases were uneventful and mother and baby were healthy and fine.

SOOOOO, now that we’ve established that statistically, you have much better odds of having a VBAC with no uterine rupture than the risks of having a 3rd c/section, let’s talk about what you might feel and how to identify a UR.

Much of what we refer to as ‘uterine rupture’ is what is medically known as ‘dehiscence’ or a ‘uterine window’.  This is where the scar tissue begins to separate but a thin piece of tissue is left so the muscle doesn’t completely rupture but it’s so thin you might even be able to see through it.  Even though this ‘window’ is included in the statistics for ‘rupture’ when it is identified (usually when a mother is having a RCS either scheduled or after a trial of labor) It has mostly been found as harmless…usually no repair or special care is needed and it heals on it’s own.  There’s not enough information to know if it increases your risk of rupture for the next pregnancy or not.  But if you didn’t have it last time, there is no reason to believe you will this time.

Sometimes a rupture is painful.  Sometimes there is absolutely no doubt that you are having one, but as you have found out, it’s not always that way.

What WILL happen is your body will act differently.  If your uterus has a tear, it will not function like it did before.  It may become boggy and limp.  It may suddenly change shape.  You will probably have actual bleeding (bright red blood rather than normal bloody show).  As long as you are not medicated (don’t have an epidural or narcotics) you will feel that something is different. 

Much of the time, when a mother goes back for a section and there is a dehiscence, the OB will make a point to tell the mother that her uterus was rupturing, she is then terrified into scheduling a RCS for any future births.  The OB only knows what he has seen and the mother only knows what she is told and even though there was no negative outcome, both are scared of VBAC from then on.

As long as no harm was done, there is no reason to assume that it’s a dangerous situation.  The pregnant body is AMAZING, and if there is a problem with your uterus, most of the time it will send that signal to your body and labor may slow or even stop to protect itself.  Contractions may space out and be gentler on you than if you didn’t have a scar.  Embrace it and enjoy your labor.  Even when babies are stressed out, the body will get the message and contractions will not intensify, changing positions will get things going again, because baby is getting more oxygen and sending the signal to get going again.

NOW, catastrophic uterine rupture is what we are really afraid of.  It’s what we always *think when we hear the term “uterine rupture”.  This is when the baby literally breaks the uterus and is born into the abdominal wall.  You better believe that this will be painful and you will bleed and this is very scary and dangerous.  It accounts for a VERY VERY tiny percentage of the statistics.  It has most often been reported with labor induction and augmentation.  We hear a lot about this kind of rupture when we think of induction on a VBAC with cytotec.  

Find out if you have an anterior placenta (the placenta is on the front of your belly, near the old c/section scar).  An anterior placenta makes UR more dangerous and gives you only minutes to get to the operating room.

Do you have access to your OP reports from previous c/sections?  Do you know how you were sewn up?  Double sutures don’t matter quite as much as whether the OB took time and care sewing you up.

No one can promise you any specific outcome.  You have to be willing to be accountable for the risk of either VBAC or RCS.  No choice is 100% risk free…but statistically you are MUCH safer having a VBAC than you are having a 3rd c/section.

I will promise you that if you are not able to let go of the fear and apprehension, you will sabotage your ability to labor and give birth.  Please find a way to move past your fear.  I highly recommend a great childbirth class, yoga classes, stellar diet (to build strong, healthy muscle tissue), seeing a Webster-certified chiropractor (to make sure that everything is lined up correctly and prevent obstructed labor and decrease the risk of rupture) Make sure your chiropractor can come and adjust you during labor to help things move along or keep them going.  www.spinningbabies.com is the most amazing resource for getting and keeping baby in a good position so that you aren’t ‘stuck’ in labor.

Do everything within your power to have an uneventful labor and your risk of rupture goes down.  Belly breathing was HUGE for me in labor and I believe it made the difference between success and failure for me. 

Ultimately, you have to be willing to accept the risk of getting your baby out, one way or another.  Build yourself up and be positive if you go through with labor.  Read positive affirmations daily out loud. 

I'll leave out Abbey's phone number for the sake of this blog post, but she is a great resource for VBAC.  Her blog is a good read and full of helpful stuff for anyone wanting a VBAC, or just a plain-old good, informed, and empowered birth. There are several posts here about VBAC as well.  I hope you find them helpful on your journey to vaginal birth.

[Continue Reading]

VBAC vs. Repeat C-Section -- by Abbey Robinson

I hope you enjoyed Allison's HBA3C story from last week.  I asked another friend, Abbey, who has also had a VBA3C to write a post about the safety of VBAC versus Repeat C-Section (RCS). Abbey is a doula who writes a blog dealing with vaginal births after multiple cesareans and other interesting topics.  She recently started a Facebook page as well.  She's pretty opinionated too, but VBACs are her passion. 

I've always considered myself an advocate of all things 'natural'.  A bit of a hippie in high heels, well, wedges to be exact.  I've never wanted my children to be exposed to anything artificial or harmful and have always wanted to give them a gentle start to life.  Of course, all of that starts at pregnancy and birth, so naturally I expected and planned natural births and to breastfeed my babies. 

The benefits of natural birth are far to strong to ignore...including but not limited to:

* Baby coming when ready (lower NICU rates, longer gestation means better brain development (ref 01)

* Immediate skin to skin contact (better bonding)

* Delayed cord clamping (increased levels of iron, lower risk of anemia, fewer transfusions, and fewer incidences of intraventricular hemorrhage) (ref 02)

* Immediate ability to breastfeed (ref 03)

* Faster, easier recovery

* No scarring on uterus, so no increased risk of uterine rupture or other effects on future pregnancies

For many of us, the desire to birth naturally is based largely on the emotional aspect of birth.  It's what WE as women want to be able to do.  There are FAR too many emotional benefits to natural birth to list.  The glorious hormones received after an uninterrupted birth have been talked about by advocates of natural birth for many years.  The famous French Obstetrician, Michel Odent says, "Oxytocin is the hormone of love, and to give birth without releasing this complex cocktail of love chemicals disturbs the first contact between the mother and the baby."  He says that any interruption of that process is damaging to the mother/baby bond including any induction or augmentation of labor.  Artificial oxytocin does not have the same effects as natural oxytocin.

Unfortunately my journey to birth took a very medical twist, despite having good information and support.  Fourteen years after my first pregnancy, my natural birth score card read 3 to 1.  That's right, 3 c-sections and 1 natural VBAC (Vaginal Birth After Cesarean -- I had a VBA3C).  Despite the odds, my bond with my babies was strong and I learned to advocate for my own health.  I have always thirsted for knowledge and continued researching risks/benefits of both VBAC and RCS (repeat cesarean section) since the birth of my first child in 1996.  I'm a bit of a sponge with statistics and numbers and love to share that information with others.  I want women to make truly informed decisions about the kind of birth they want, but they can only do that if they are given ALL the information.  I'm sorry if the numbers below make your head spin, but they are SO important...especially in these days where c-sections are treated like lollipops and being handed out to every woman who (thinks she) wants one.  Here's a little of what I've learned over the years.

The risks of VBAC carry the same risks as vaginal birth, but also the same benefits.  The major difference is the increased risk in uterine rupture.  Did you know that women who have never had a scarred uterus can have a uterine rupture?  According to a 12 years study in 1983, the uterine rupture rate in an unscarred uterus is 1 in 16,840 or about 0.006%.   (ref 1)  7 of the 10 cases of rupture were reported in women who either had used oxytocin or prostaglandins to augment or induce labor.

Finding the rupture rate for a scarred uterus is a little more complicated because there are so many variables that have to be considered that can increase risk of uterine rupture.

But let's keep it as simple as we can for now.  In an Australian study of over 29,000 women, the risk of uterine rupture in spontaneous labor without augmentation after one prior incision was 0.15%.  (ref 2)  Once you introduce labor augmenting and induction drugs, the risk of uterine rupture increases from 3-14 fold and jumps to 1.91%.

The conclusion of this study was NOT that women shouldn't VBAC, it was that "careful consideration should be given to the use of oxytocin for augmentation of labour or induction by any method for women with a previous caesarean" Because that's where the true risk lies.

In the summer of 2010, ACOG revised it's VBAC guidelines to say "VBAC is a safe and reasonable option for most women, including some women with multiple previous cesareans, twins and unknown uterine scars. ACOG also states that respect for patient autonomy requires that even if an institution does not offer trial of labor after cesarean (TOLAC), a cesarean cannot be forced nor can care be denied if a woman declines a repeat cesarean during labor." (ref 3)

I read a story the other day of a mother who was attempting a VBA2C.  Her OB seemed supportive up to 38 weeks and then he informed her that she would be having a RCS.  The mother printed the ACOG guidelines and when presented to her OB, he said he had never seen it.  The c-section appointment was cancelled and that mother was given more time.  I suspect there are MANY OBs, nurses, and other medical professionals who don't know about the ACOG statement... sad but true. We often hear about the risks of c-sections, and not many people I know really want to have a primary c-section but after they've had that first one, there is a belief in this area that a repeat c-section is safer than attempting a VBAC.  How true is this?

After you've had your first c-section, you have a choice to have a RCS or to VBAC.  If you are only going to have ONE more child, your risks during your second surgery still skyrocket, but after 2 c-sections, the risks are downright scary. 

Some of the risks of RCS include but are not limited to:

* Hysterectomy

* Blood transfusion

* Placenta accreta

* uterine rupture 

* additional surgery due to hemorrhage

* injury to the bladder or bowel

* thromboembolism

* excessive blood loss

* cystotomy

* bowel injury

* ureteral injury

* and ileus (bowel obstruction)

* the need for postoperative ventilation

* intensive care unit admission

* duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries (ref 5)

* lower breastfeeding rates

* immediate skin to skin more difficult

* delayed cord clamping much harder

* harder/longer recovery

* scheduled delivery means baby could be premature (higher incidences of NICU stays)

Some long term risks are:
* Scar tissue/adhesions (can cause any number of issues, pain, fertility problems, etc.)

* Endometriosis and Adenomyosis can be caused from scarring on the uterus resulting in surgery and hysterectomy years after c-section

The charts below are from ICAN.

1st C-section Risk of hysterectomy: 0.65%
Risk of blood transfusion: 4.05%
Risk of placenta accreta: 0.24%

2nd C-section	1st VBAC
Risk of major complications: 4.3%	Chance of successful VBAC: 63.3%
Risk of placenta accreta: 0.31%	Risk of uterine rupture: 0.87%
Risk of hysterectomy: 0.42%	Risk of hysterectomy: 0.23%
Risk of blood transfusion: 1.53%	Risk of blood transfusion: 1.89%
Risk of dense adhesions: 21.6%

3rd C-section	2nd VBAC
Risk of major complications: 7.5%	Chance of successful VBAC: 87.6%
Risk of placenta accreta: 0.57%	Risk of uterine rupture: 0.45%
Risk of hysterectomy: 0.9%	Risk of hysterectomy: 0.17%
Risk of blood transfusion: 2.26%	Risk of blood transfusion: 1.24%
Risk of dense adhesion's: 32.2%

4th C-section	3rd VBAC
Risk of major complications: 12.5%	Chance of successful VBAC: 90.9%
Risk of placenta accreta: 2.13%	Risk of uterine rupture: 0.38%
Risk of hysterectomy: 2.41%	Risk of hysterectomy: 0.06%
Risk of blood transfusion: 3.65%	Risk of blood transfusion: 0.99%
Risk of dense adhesion's: 42.2%

5th C-section: placenta accreta: 2.33%
hysterectomy 3.49%
in the women with previa, the risk for accreta was 61% (ref 5)

6th (or more) C-section:  placenta accreta: 6.74%,
hysterectomy 8.99%,
in the women with previa, the risk for accreta was 67% (ref 5)

Additionally, the risk of accreta for women who had previa was 3%, 11%, 40% for 1st, 2nd, and 3rd c/sections.  (ref 5)

NOTE: "Major complications" include one or more of the following: uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss. (ref 4)

There was a study done with over 30,000 women having their 1st c/section up to their 6th (or more) c-section over a 4-year period that concluded, "Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery." (ref 5)  This study alone should deter ANYONE from wanting to have multiple c-sections.

If you want more info on the risks and benefits of VBAC and RCS, www.ICAN-online.org is a fantastic place to start.  www.VBACfacts.com is good, factual information.  www.specialscars.org is for women who have had 'different' types of uterine scars, including classical, T, inverted T, J, myomectomy or other uterine scarring. 

http://www.ncbi.nlm.nih.gov/pubmed/21713130  (ref 01)
http://www.bellybelly.com.au/birth/cord-clamping-delaying-cord-clamping (ref 02)

http://www.llli.org/llleaderweb/lv/lvaprmay05p40.html (ref 03)

http://www.ncbi.nlm.nih.gov/pubmed/9166298  (ref 1)

http://www.ncbi.nlm.nih.gov/pubmed/20716251  (ref 2)

http://blog.ican-online.org/2010/07/21/ican-responds-to-new-acog-guidelines-on-vbac/ (ref 3)

http://icanofomaha.webs.com/vbacorrepeatcesarean.htm (ref 4)

http://journals.lww.com/greenjournal/Abstract/2006/06000/Maternal_Morbidity_Associated_With_Multiple_Repeat.4.aspx (ref 5)

[Continue Reading]

“I’m just a mama having a baby, I’m just a mama having a baby…” -- Allison's HBA3C Story

Here it is:  The much anticipated story from Allison who recently gave birth at home after 3 prior c-sections.  She told me she could give me a condensed version, but I wanted her to write out her entire story.  Grab your tissues.  It's a great read.  I am so happy for this mama.  She is a dear friend and it was a privilege to witness her get the birth of her dreams.

Two weeks ago my sweet little #4 came into my arms, and I have been blissfully enjoying newborn-land ever since. It has however come to my attention that I now have FOUR children, count them: one, two, three, four—and I still have to just laugh about the reality of me taking care of 4 kids by myself in another week or so. But that’s my next adventure. This story is about becoming that mother of four, who actually got to be “just a mama having a baby”—my first vaginal birth with my fourth baby. (Donna wants this to be the story of my journey to HBA3C, but that’s a lot of letters. For me, it’s the story of how I finally stopped trying to be smart and instead learned to trust my intuition, my body, and the Lord.)

Here’s the back story: in college, my first major was to become an RN, and my plan was to go back and become a Certified Nurse Midwife after I’d had my kids. I have a memory of being a naïve little 19 year old telling someone about my plans and about how crazy it is the way that docs and hospitals treat pregnancy like an illness. Fast forward eight years later—my husband is in grad school and we are buying private health insurance to cover me because we’re hoping to get pregnant soon. So exciting when that little stick comes up positive!! It’s still in the back of my mind that I want a CNM not an OB, but we find out after I’m already expecting that our insurance only covers one group of 6 OBs. We’re poor students and figure the big group of OBs seems to work for everyone else so we’ll try it, but we do decide to drive to a hospital across town for a “lamaze natural childbirth class” because I know I do not want an epidural and my mom did lamaze. The night we cover c-sections our teacher tells us that 1 in 6 births happen that way—I say, “You mean one out of the couples here will probably have a c-section?!” I had no idea cutting a mama wide open to get her baby out was that common. (and those are pretty nice numbers compared to what they are today…)

My water broke 3 days before 40 weeks. It was dinner time and I was pulling laundry out of the washer. We did just what they taught us at the hospital: don’t eat if you’re in labor! and come right in and get checked if you have a gush of fluid! Well, that left me very tired and hungry by the time contractions started kicking in 4-5 hours later. And then after a couple hours, the doctor said we needed to do pitocin to speed things up, so the nurse said she’d put it on low “since I wanted to go natural.” After an hour or so I was dilated to a 5 (that was good progress! What I wish we had known…), but pitocin contractions were hard to deal with (no endorphins), and we were already wearing out our breathing techniques. The hospital staff basically patted my hand and said, “Oh honey, you probably have another 12 hours of this, don’t you want an epidural?”

So I caved and got one, and immediately after insertion our room filled with nurses. Fetal distress. They slapped an oxygen mask on me and started flipping my numb body from side to side. (I remember thinking: “See, I knew epidurals weren’t good for my baby!”) They couldn’t get his heart rate back up from 90s so we were prepped and headed for an emergency c-section before we hardly knew what was going on. Baby was acynclinic with a slight brow presentation, nuchal chord wrapped around torso/neck, and my sweet baby boy was sucking on his cord when delivered. Nine on his apgar, 8 lbs. 13 oz. I begged for and got one glimpse of him before they wisked him away to check him out. He was screaming and a healthy bright pink curled in the nurse’s arms—I sent my husband with him and stayed to joke in the OR about the way they were stapling me back together (it really does sound very much the same as the stapler on your desk). My firstborn was delivered around 3:40 am, I didn’t get to see him again and hold him for the first time until after the nurse shift change at 6am. Those two hours seemed an eternity to me and I was upset—keeping me from my baby was probably more traumatizing than anything else.

With baby #2 on the way two years later, “I want a VBAC” was my cry. My OB told me I was a great candidate for a vaginal birth, but that when we moved I would have to look hard for a doctor that would support it. Well, we made it to TX when I was 3 months along and I asked around. Lots of women from church used a group of OBs that said they “allowed” VBACs. One of the doctors even told me that they were one of the few groups that did VBACs in the area, and I believed them. Every visit I told them that I wanted a vaginal birth, they in turn reminded me every visit of the risks of VBAC, and agreed that they would “let” me labor as long as it began before 40 weeks. I dutifully scheduled a date for surgery, just in case.
 
The day of the planned surgery arrived, I walked and walked that morning, already so depressed that labor hadn’t come. When the nurse (who smelled of cigarettes) prepped me, I was contracting. “Can you feel those?” she asked, “Yes. I want to VBAC, I need to talk to my doctor!” I said, but she replied, “If you are scheduled for a c-section, you are having a section, honey.” The doctor and assistant talked about garage sales over me in the OR like I was an old Buick, and my sweet little girl was born, 8lbs. 7oz. “She probably wouldn’t have fit through there anyway,” the doctor reassured me as she sewed my belly back together. I later had to yell at the nurses to get them to give me my baby so I could nurse her—they had a policy about
moms on morphine not being alone with a baby. Did I mention that I don’t like being separated from my baby?

Donna summed up baby #3’s story for me, you can read it here. It was wild and disappointing, and again, even when I asked them to stop, they took away and poked my baby, this time because he was “big” 9lbs. 6 oz. I’ve never felt more beaten down than I did as I watched them wheel my baby away from me, and it sunk in that I had just had my 3rd “unnecesarean.” But I did have an angel nurse later that same day, and her simple kindness helped me feel again what I have always known: I was made to be the mother of my children. My husband had gone home to get a shower, and I was lying in my crinkly hospital bed with my sweet baby boy starting to fuss over in the hospital bassinet, out of my reach. As the hopeless feeling of again being stuck in bed unable to care for my new little one was threatening to overwhelm me, my good nurse picked up my baby and said, “He just wants to be with his mama,” as she tucked him in beside me. It was a turning point for me, bless that nurse!

Now I like to think that I’m educated about normal birth and rather loud and feisty to boot, and I fought hard, but fighting just doesn’t get you a peaceful birth. I did however learn much from my experience in getting baby #3 here. I learned that for me, labor stops in a hospital with bright lights and uncooperative staff. I learned that I can’t be smart enough and know enough to make people treat birth as healthy and normal when they are in the habit of doing things differently. And as I look back, there were key decisions that I made based on logic and convenience instead of what my intuition told me. I had heard of a very pro-VBAC doctor that I could have switched to, that was an hour drive from my home, but had ruled it out because it seemed too far away. My doctor who was supportive of VBAC had told me that there was only a 60-70% chance that he would actually be at my birth, that should have been a red flag, but it was more convenient to just stay with him. I also made the mistake of paying attention to my labor too soon and let myself be very discouraged by dilation numbers. And I allowed myself to fight against the very labor that I had hoped and prayed for when we had no care provider.

“Trust in the Lord with all thine heart; and lean not to thine own understanding. “In all thy ways acknowledge him, and he shall direct thy paths.” –Proverbs Ch. 3

When we realized that baby #4 was coming it was a bit of a surprise and it put me in a very humble place. What do I do? I believe with all my heart in normal natural childbirth, but I have been cut open 3 times already. Even Ina May herself would send me to the hospital to have this baby, but I know that my body shuts labor down in a hospital. And my good husband at this point would rather just skip the whole birth phenomenon and go straight to having a 2 month old—he doesn’t trust hospitals and doctors anymore than I do, and he just wants me safe. So I did what I thought I had done before, but with my whole soul this time, I put it in the Lord’s hands. I told God Almighty of my desires to birth my baby the way He designed me to, and before I could add that I’ll do a c-section if I need to and I’ll stop trying to be too smart about all of this, I felt the sweet peace that He was good with my desires and that it would all work out just fine. Wow. That same peace has been renewed again and again and carried me through to holding that sweet baby in my arms.
 
Love this quote from Hannah at Intuitive Mothering:
“The intuitive mind is a sacred gift and the rational mind is a faithful servant. We have created a society that has honored the servant and forgotten the gift.”  –Albert Einstein

I formed what I call “my bubble” around myself to protect that peace and rely on my intuition as I prepared to birth this child. A very important part of that bubble was choosing care providers who were in the habit of treating birth as a normal, natural event. I did drive the hour up to the amazing doctor I should have gone to with baby #3, and he was supportive of my VBAC plans and fine with me doing most of my prenatals with my midwife. My awesome midwife helped put my husband at ease, and I had that same peace about her, my intuition telling me simply “she will help you.” I actually saw my chiropractor before any other care provider, and she got my uterus back in alignment (it was tilted over on my right side) and provided great care throughout pregnancy.  I never worried about my scar (my husband let me know the other day that he did the worrying for me), and my awesome midwife reminded me early on that a chance of uterine rupture is very much the same during all the growing of pregnancy as it is during labor. Didn’t tell many people about our plans, if they did ask, I usually told them the back-up plan: we’ve hired a midwife to be our doula and have a doctor who is very supportive of me having a VBAC. As pregnancy continued, I grew sure that we wouldn’t actually need that doctor because this baby was going to be born at home. My husband was willing to ride on my faith, after plenty of discussion. He trusted our midwife—she had made it clear that if there was any indication of a problem for baby or me in labor that we would transfer to the local hospital less than 5 minutes away.

And so now it’s time to tell the labor story, but it’s just not super exciting because it was so normal, nothing very noteworthy besides maybe the magnitude of burping (!!) that escaped my mouth but didn’t wake the older kids. Early labor lasted all day, slowly contractions got stronger and closer, but I ignored them and took care of kids just like any other day. By the time we got the kids down for the night, it was on to active labor—this was really it! We had our midwife join us and I had earlier agreed that she could check dilation during labor, but I didn’t want to hear what it was. My plan was to labor until I felt like pushing and then push the baby out, I don’t need any numbers messing with my psyche. Turns out that I was at a 7, she silently let my husband know, and he called our “kid helpers” to come hang out and be ready. My birth ball was my friend and my favorite place to labor—I was sounding my way through contractions and using horsey lip sounds to help keep all those sphincters relaxed as well. I started to show signs of transition, but didn’t believe it because I wasn’t really in laborland, I was still talking to people during those lovely breaks between contractions. But the shaking and huge burping had to be something, right? With baby #3 I had shown signs of transition (contractions on top of each other, throwing up) from early to active labor and had been so discouraged to find out I was only dilated to 3, so I thought I might be repeating that. When she checked again, my midwife asked if there was a number that I would be okay hearing, and then let me know I was to a 9 and super stretchy! “Wahoo!!!” I yelled out—I have no idea how my 8, 6 and 2 year olds slept through all my noise that night!

My water broke while she was checking me, huge release for my huge belly. And then from here things get a little hazy for me—I got in the tub again for a little while and I think I began to feel the urge to push. I had figured that I would spend a lot of time squatting to help get my baby down and open up my pelvis, but squatting didn’t work for me for very long. I had a lip of cervix that needed to get out of the way, my midwife held it back though a few contractions and I was ready to push. Pushing is hard, I know some women like it better than first stage and I can see how they might, but I just wanted to be done. I was getting more and more tired and a bit confused about how to make the pushing effective, and I had strained an inner thigh tendon that was freaking out when I pushed. Being a “first-time mom” I had mentally tried to be ready for hours of pushing, but it was harder than I had imagined and I was so tired.

 Then I heard her say she could see dark hair, and then I reached down and could feel my sweet baby’s head! They tell me that I was kind of funny, giving myself pep-talks half way through a contraction if I started freaking out. That peace held me and carried me through and I pushed that baby with strength I didn’t know I had. “I want to hold my baby!” I told myself, and my midwife said if I gave her an ear, she could pull her out. It was amazing to me when they started saying, “little pushes, little pushes” because that means the baby’s head is crowning! Near that time they had woken up our 8 and 6 year olds to let them know the baby was being born. One of my sweetest memories is the smile of my 6yo daughter at the end of the bed as this baby is about to be born! So back to the little pushes, and the head is born and I’m waiting for that slippery release of the rest of the body…waiting…(this couldn’t have been more than a second) and then I’m told to push again, and then the release and my baby is on my belly. She’s really here, she’s here—well, we’re about to find out, boy or girl? I lift her up and declare “it’s a girl!” and her big sister is delighted (she had guessed she was getting a sister). Two year old brother is on the bed with us now too checking out his new little sister. So sweet.

We did it, she’s here! Sweet baby girl #4 is here!! And her big sister saw her birth. I don’t really know how to describe how good this has felt for me and for my family. I am whole and well, and able to enjoy this little one as I had never been able to with my older ones. Not a bit of the baby blues that hit me so hard after my previous 3 cesarean births. I do cry, but it’s when I think about the blessing of this new little one coming the way the Lord designed. And one of the best parts: my baby has been with me as much as I want! (I think I need to go snuggle her soft little head again right now…)


And speaking of her little head, my sweet little one was 9 lbs. 12 oz. and her chest was an inch bigger than her head. Her dad has called her our sumo baby. I had a 1st degree tear (sweet baby kept her hand up by her face too) that did need a few stitches, and felt better within several days. Recovery has been very different from major surgery. I feel so well, and my baby has been so alert, a great nurser and a really good sleeper.
 
Two weeks ago I got to be “just a mama having a baby” as we welcomed our sweet baby girl into our home and family. My intuition has always quietly told me that birth without unnecessary interventions would be best for me and for my baby and for our new relationship. I’m very grateful to have found people who believed in me and believed in natural normal birth. It has made all the difference for me. My body gave birth the way it was designed to, the same way thousands of mothers across the globe give birth every day. It was awesome. Not eventful at all, just plain old normal, and I loved it.

[Continue Reading]

An Oldie But Goodie: Sarah's Amazing VBAC

I have contemplated how I want to present this for weeks. Sarah herself joked about how much she had to say to about her very fast labor! In the end, I've decided, who am I to edit this amazing woman's birth story? I thoroughly enjoyed reading it, and I think you will too.

Why is this VBAC so special? I have chills as I write that question. About a year ago, I posted a picture of Sarah right after her c-section that took place 2 years ago. Without going through all the details, it was a nightmare. They had taken my class by DVD, and while I had met with Sarah a number of times, I had never met her husband, Kip, until that day on the phone. We spoke for about 30 minutes and it broke my heart. I could feel the love that he has for Sarah, and he had felt so helpless as their birth spiraled out of control, ending in a c-section. If you would like to read what she wrote about her previous experience, you can find it at the previous post titled "Ah, the Glorious C-Section."



Sarah and Kip, like so many couples, struggled with depression over the event and went through an intense healing process. Breastfeeding was such a struggle with the first baby, and when Sarah started the baby on formula, she went through tremendous guilt and more depression. Kip wasn't sure he ever wanted to go through this again, but Sarah knew her body could do this. When she found herself pregnant again, she hired a midwife at Gentle Beginnings Birth Center and planned for an out-of-hospital birth.

I love the look on Sarah's face and I have no doubt that she was saying a silent prayer of thank- fulness, healing, and amazing power. What a strong woman. Enjoy her story in her own words:


Jackson’s birth story
Born 8/29, 9 days past EDD by VBAC waterbirth

“I love you Lord,
And I lift my voice,
To worship you,
Oh my soul, rejoice.

Take joy my king,
In what you hear,
May it be a sweet, sweet sound
In your ears.”

This was my song during labor… it helped me to survive the hardest 4 ½ hours of my life! Compared to my first labor and eventual c-section w/ Kate, this was short and 100 miles an hour – less to tell (so why is it so long!) 9 days past EDD, my mantra of “Be still and know that I am God,” from Psalm 46 was starting to waver and I was starting to be anxious. After speaking w/ my midwife and starting Master Gland on 8/28, I went to bed grouchy w/ no contractions. My husband & his parents went to a high school football game & I stayed home w/ Kate.

I woke up at 4:30am and felt terrible, but assumed it was food related again since I had developed a sensitive tummy around 38 weeks to many different foods. By 5am I was starting to believe I was in labor, but not worried. I wasn’t experiencing contractions as I had expected them to feel, but still believed that things were starting to warm-up. (I never went into natural labor w/ Kate, but was induced due to high BP at 41 weeks.) I couldn’t go back to sleep, so I made myself a big bowl of rice krispies & strawberries since it was easy & sat down to relax & catch up on facebook and emails. I also found an online contraction timer, but the contractions I was experiencing were irregular and all over the place & impossible to chart well. I felt frustrated, and unsure if I was really in labor of wondering if something might just be wrong.

By 5:30am, I really needed to focus much more on my contractions instead of my computer work and started to feel much more uncomfortable. I so badly wanted to wake up Kip and call my doula, Camron, but decided that I should wait until 6am to wake them. It was a Saturday morning, and I figured that 6am was a ‘reasonable’ time to be awakened compared to 5:30. I also figured that since my last birth was more that 30 hours, they would probably need all the sleep they could get since I was sure I was going to have another marathon labor. By 6am I woke up Kip, and my contractions were getting painful at this time, to the point that it was difficult to talk. I remember specifically saying, “You need to get up, and you need to eat some breakfast. Like, right now.” I called Camron, and told her that I thought I was in labor, but that things were inconsistent. She told me she’d get ready and come over, and ordered me into the shower.

In the shower, though the pain was relieved due to the hot water, I could still feel the intensity building. “For out of the overflow of his heart his mouth speaks.” – Luke 6:45. Suddenly in the shower my heart was just swelling with a praise song (lyrics above) and I remember leaning on the wall of our shower and sort of muttering this praise song. Hadn’t heard it in a long time, and not one of my favorites or anything but it appeared on my tongue and I lifted it up to the Lord! I felt calmer instantly. Kip called Camron to tell her that I was getting serious, and that she should probably hurry.

I told Kip that he needed to call his mother to come get Kate. His response was “Aren’t we going to drop her off on the way to the birth center?” I quickly said ‘No way!!” to having enough time to do that because of the intensity of my contractions and his mother headed our way. At this point, Kate woke up which was really hard for me. She’s very sensitive to my physical feelings and I didn’t want to show her I was in pain. (She was 21 months old at the time.) I labored on my yoga ball on my hands and knees until Kate was picked up.

At this point, Kip and I began to argue and bicker. I still wasn’t positive that I was in labor, which in retrospect is just silly. I was experiencing strong contractions that I couldn’t speak through, and my train of thought was all over the place and I wasn’t making sense of finishing thoughts & sentences. Kip kept asking me questions, and my answers were mostly “I don’t know.” In hindsight, this should have clued him into the fact that I was really in labor and focused inwardly, unable to carry on a good conversation. Instead, it just really frustrated him because he thought I wasn’t communicating my needs well to him. Oh well – now we know better for next time!

Camron arrived at 7:35 to see me laboring on the side of the bed, w/ my contractions 2-4 minutes apart. She wasn’t sure what was going on w/ my irregular contractions; they were all over the place, and only lasting about 30-45 seconds, and a few minutes apart but super intense and I wasn’t able to speak during them. Camron started to think I was farther along than we had originally thought, and asked me to go to the bathroom and asked Kip to help me to try & relax. Relaxing and peeing was totally out of the question – I felt like I had to pee so badly but just couldn’t relax and this was really starting to bother me. At 8am I had a 1 minute 45 second contraction and Camron asked if I was pushing and I told her ‘no’, but in retrospect I think I might have been ‘trying’ and didn’t know it yet. At 8:02 Camron called our midwife Ann and they decided it was time to head to the birth center so we started collecting our things.

At 8:09 it was DEFINITELY time to go to the birth center, the waves of contractions were short and hard, almost angry feeling. I remember crying from the pain, thinking that I couldn’t be that far along and that if I was feeling so much pain how could I make it another 30 hours like my last labor? Camron and Kip just kept reassuring me, and she gave me a pad to wear in case my water broke in the car. The walk to our car was absolutely the longest and hardest walk of my life, and looking back at it I now absolutely see the benefit of homebirth and never having to leave your sanctuary when you are at that point in labor! By 8:15am we were standing outside, leaning on the car until the contraction was over to leave and I yelled at the 2 of them “JUST GO!” in the middle of the contraction. I knew it didn’t matter how bad it felt, we had to get moving before this baby came.

At 8:30am Kip picked up the speed and we hit 90mph down 820 towards the birth center. Praise God that the cops weren’t around! I remember telling Kip that either my water had just broken or that I had finally gone pee. (It was my water breaking, thanks for the help Camron – you saved our car!) I kind of went to another place mentally in the car – I had no concept of time or distance other than it was taking too long for my liking. I had one hand down on the middle console pushing my bottom up and the other hand pulling my whole body up from the handle bar attached in the ceiling. Kip asked me if I was pushing and I kept telling him that I didn’t think so, that I was trying not to, but I really had to go to the bathroom. Piece of advice – transition in the car stinks, so try to avoid it!!

At 8:48am we pulled up to the birth center, and Ann and Marsha (my midwife & her assistant) met me at my car door and unbuckled my seatbelt for me. They lovingly and swiftly escorted me into the back bedroom to check me. I remember walking past the sign they had put up front, “Ssshhh! Mother in labor.” I thought, “wow! That’s for me!” When we got there I was calm and seriously working hard, feeling like I was going to lose control soon. I told Ann I needed to push or go to the bathroom. She checked me and said, “Honey, you feel like you need to push because you are complete and +1, and this baby is ready to come! If you want to do this in the tub you need to go there NOW, or we can just do this right here on the bed!” I remember Kip asking if I had heard her, and hearing how encouraged he was at her words. Everyone suggested I get in the tub if I felt like it, and I really wanted some pain relief if possible. As I walked to the birth tub, I remember seeing the copy of my scriptures for labor laying on the table. I remember feeling so relieved that someone else had seen them, that the midwives and looked at them and prayed for me even before my arrival! I had a suitcase full of gear for labor and scriptures with lots of good intentions but my labor was going too fast to use any of it!

I walked to the bathtub and stopped to push really hard for the first time on the side of the tub. Then I got in, and pushed while sitting on my hands and knees. I remembered Donna (my birth instructor) suggesting this position in labor, and once I got into it I felt like I couldn’t get out! It just felt right, and even though I felt like I had a little less control since I couldn’t see what was going on I fully trusted my birth team who were literally right behind me! I remember Ann praying for me, Marsha coaching me, Camron keeping my hair out of my face, and Kip right above my head whispering encouraging words as I pushed. As I was pushing, Lynsey (the best birth photographer!) showed up just in time to capture Jackson’s arrival. He was born at 9:15am, less than 30 minutes after our arrival! Praise God! My midwives had to use suction to get some of the meconium-stained fluid out of his mouth but then I turned around in the water and took my baby boy! They gave him to me, and he was quiet for just a moment and then cried out to let us hear his voice. It was so wonderful to relax in the birth tub with him and hold him in my arms while the midwives helped me to deliver the placenta. Kip got to cut the cord. I remember being in total shock and disbelief about what I had just done. Only 4 hours before I wasn’t even sure I was in labor!

We got out of the tub for the midwives to check us over (no tearing!) & clean up the tub, and then we got back in for our herbal bath, which was just amazing and so relaxing. Jackson was quiet, opened his eyes so wide for us, and sucked his thumb sweetly in our candlelit bath. Ann told me that thumbsuckers are sweet babies and she was sooo right! Kip helped me to clean the little bit of vernix that he had in his hair, and we went back to the bedroom where we had breakfast in bed and I nursed him. Kip’s parents brought Kate down to meet her little brother, and Lynsey captured their first meeting in a sweet photograph. My birth team kept asking us if Kip and I wanted privacy w/ our new baby but I didn’t! I was so happy and proud that we had accomplished our vbac, and I felt SO GOOD that I was glad to be in the presence of everyone that had helped us to get there! I remember laughing quite a few times after he was born, knowing that I had been surrounded by successful VBAC’ers (Lynsey & Camron) and that I had just pushed my baby out! They took Jackson’s measurements, 10 lbs, 11 oz’s and 21 ½ inches long! I remember laughing at the look in Kip’s eyes when he held up the scale to weigh him – you could tell he was thinking “Am I reading this thing right?!”

It was so strange, just 3 ½ hours after his birth, being gently escorted by my midwives back to my vehicle. Hadn’t they just taken my seatbelt off?? Was I really done and going home with my baby? It just didn’t seem real! I can’t begin to describe how great I felt after his birth – physically, emotionally, spiritually. I’ve never felt so ALIVE as I did that afternoon (and hungry, too!)

The differences between my 2 birth experiences are night and day, especially in the care that we received as a family. Within 48 hours of Jackson being born, we had house calls from our midwife, our chiropractor, and our lactation consultant. I really had a team of people surrounding me with Christ’s love and support, helping me to figure out the ‘new mom thing’ with Jackson. The care that we received from these women was a true testimony to the rest of our family as to the reason we made our birth choices to a family that hadn’t been too confident in our choices to use a midwife & birth center.

Physically, recovery is so different w/ a VBAC than with a c-section. Ann warned me and was correct, you feel SO GOOD compared to your c-section that you have to be really careful not to overdo it & exhaust yourself. Breastfeeding has been so successful with Jackson, and I haven’t struggled with feeling blue like I did after my c-section. Jackson is a sweet-natured baby who slept so much during the first day or 2 that I worried about him! His gentle beginning has surely affected his temperament in a very agreeable way. Kate just turned 2 this week, and she is a firecracker that lights up our life with her vivacious spirit. She came into this world with a bang and is a spitfire for sure, and I look forward to see how Jackson’s personality develops and to see if his labor and birth experience shape his character. I can’t even begin to describe the healing that has taken place since my vbac, and I now feel so alive and encouraged about our family and look forward eagerly to see if God blesses our quiver with more arrows!

[Continue Reading]

ACOG's Bittersweet VBAC Statement Issued July 21, 2010

The American College of Obstetricians and Gynecologists (ACOG) issued a long-overdue statement this week regarding Vaginal Birth After Cesarean (VBAC):  "Attempting a vaginal birth after cesarean 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...  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...  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 patents and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate..."

OK.  My reaction after reading their statement should have been joy.  The natural birth community has waited a long time for this.  To be honest, my initial reaction was anger, followed by sadness.  My eyes even welled with tears thinking of all the millions of women who have been lied to for the last decade about how risky VBACs are and as a result had unnecessary surgery.  Babies suffered.  Mothers suffered.  Doctors benefited. 

We have a generation of doctors who now believe that VBACs are risky -- because ACOG said so for so many years-- and now they are being told that they are not dangerous and to go ahead and allow women a TOLAC (Trial of Labor After Cesarean).  I probably don't need to tell you that a trial of labor can easily make an OB look like he tried to allow a VBAC and (s)he may have no intention of allowing moms to VBAC.  If you are in this situation, ask your care provider what a "trial of labor" means to them.  Will you have time limits imposed on your labor?  Likely.  Do you require continuous monitoring?  Can you get up and walk around?  Are they going to treat you  like a "normal" woman in labor or like an accident waiting to happen -- IV fluids, restricting food and water, continuous monitoring, regular vaginal exams, etc. -- because attitude is everything when a woman is VBACing.  She requires a lot of emotional support.

Who is going to be involved in these changes?  It's not just about an OB and his patient.  It's about hospitals and insurance companies.  There are more than 800 hospitals across America that have banned VBACs over the last decade, the majority of those fairly recently.  Can we expect these changes to be immediate?  Unfortunately, probably not.  If you are a VBACing woman, be very familiar with this statement and fight for your right to a VBAC.  That is probably the first step.  Change is not going to occur immediately.  Women may even find themselves quoting this statement to their insurance companies.

I believe that what led to this statement was not evidence or the demand for VBAC by women.  The evidence against repeat cesareans is strong and always has been.  What led to this statement was another agency getting involved in the cesarean epidemic.  The National Institute of Health (NIH) held their conference in March and at the top of the list was addressing America's insanely outrageous c-section rate.  The number one reason for a cesarean is because a woman has already had a c-section.  If we could raise the VBAC rate, we'll automatically lower the cesarean rate, improving lives while saving money all at once.  A win-win. The statement had to come from ACOG.  The pressure was on.

According to the statement issued, 60-80% of women who attempt a VBAC will be successful.  I interviewed a group of CNMs in Albuquerque several years ago who loved doing VBACs, and as a result, their VBAC rate was 92.3%.  The care providers in the DFW area who support VBACs also boast 90%+ VBAC rates.  The Mother-Friendly guidelines state that the VBAC rate should be at least 60%.

I have written about the safety of VBACs in the past, so I wont rehash that here.  You know what I believe.  There are a couple more quotes I think are worth repeating here that appeared in the statement.

"Our primary goat is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."   However, in another paragraph, it says "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."  (Remember, the risk of uterine rupture is between 0.5% and 0.9%.)  A statement very similar to this is what led to the VBAC bans in so many hospitals.  Not crazy about it appearing in the statement.  I think we'll see doctors referring to it in defense of continuing with not allowing VBACs. 

The last paragraph says "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."  I could not help but think of Allison's story I wrote about last year.  How things would be different for her if this statement had been issued less than a year ago.  Honestly, it makes me feel sick, angry, and sad.  I called her tonight after rereading the statement.  She had read it this afternoon.  We had the what-might-have-been conversation.  It's a moot point.  But now she has 3 cesareans under her belt (pardon the pun -- really not trying to be funny here), but the statement doesn't address women with more than 2 c-sections.  But because she was literally forced into the third c-section solely because of a hospital policy, if they decide to have another baby, she is still going to have to fight for a VBAC. 

So, yes, I am glad that ACOG issued the statement.  The price was high.  Women, I believe, are still going to have to fight to make this a reality.  A friend of mine, former Bradley student turned Bradley teacher, Sarah Clark, aka Mama Birth, titled her post on this topic "ACOG Still Sucks."  And that about sums it up...

[Continue Reading]

So You Want to Have a VBAC...

Isn't pregnancy a miraculous time in a woman's life? To look down and see your belly grow, and grow, and grow! There are moments of panic when you look at your belly and think, "This has to come out of me!" We all do it. It can be frightening and overwhelming.

For the millionth time -- say it with me -- education and a supportive birth team are the keys to a successful, happy, unmedicated birth. Preparing your mind and your body for labor are crucial, but it does no good if you have a doctor who is determined that you need to be induced or are too weak to give birth without his/her assistance. Surrounding youself with positive energy is an absolute must. An unmedicated labor and birth are hard enough under the best circumstances, but nearly impossible with no education and support.

We've talked about American birth and the scenarios that lead to the majority of c-sections. They often begin with an induction, which leads to an epidural, which leads to pitocin to stimulate contractions, which leads to fetal distress and a mom who can't move around to help her baby out. The c-section "saves" the baby. There are lots of variations of this scenario. Maybe this sounds familiar to you.

Let's say this scenario ends in a c-section, which 50% of births do in North TX (33% nationwide), and most women begin that sentence somewhere along these lines: "I had to have a c-section because..." Let's face it -- had she not had the epidural and the cascading interventions that followed, she very likely would NOT have had to have a c-section. Harsh? Perhaps. I think it is crucial that women -- and men -- come to understand their role and their responsibilities when it comes to birthing their child(ren). They need to understand that by interfering with the natural process, they are (almost always) doing more harm than good.

But they can change their next birth.

Here's another harsh statement: If you want a different outcome, you have to do things differently! You have already been labeled by everyone as a VBACer. That previous c-section will follow you forever. Some providers care and others don't. You make most doctors nervous even though your chance of rupture is the same as a women who goes in for a -- in this day and age -- standard pitocin induction.

If the epidural led you down the road to a c-section the first time, why would you do it again? Maybe you aren't even aware that that is why you had the c-section. Think back to your labor. Often, everything is fine until pitocin or pain medication is introduced. If you were told that your hips were too small or or baby was too big, why would you just take that? Your body grew your baby. It is made to birth your baby. Get up. Walk. Give birth. Squat. Take an active role in your labor and your birth. You can do it. If your doctor says no way, he won't do a VBAC, I don't care if he's a "nice guy" (I hear this all the time!), change doctors! Find that supportive birth team. They are out there!

I routinely hear women ask if they can expect their labors to be like their mothers -- slow, fast, c-sections, etc. -- and most doctors will say there is no correlation. And yet, recently I heard of a women who was told that her mother had c-sections, so she probably needed them too. Her sisters have also all had c-sections. The power of suggestion is an amazing thing. How can the need for c-sections run in an entire family?!

One of my Bradley moms gave birth this past Friday (my birthday, too!) and the day before she had been at her chiropractor's office. This woman had been laboring on and off for a couple of days and was exhausted. Her chiropractor told her to talk to her body and her mind. "Tell your body to stop labor for a while so you can sleep." That night she did just that and she slept for a solid hour and woke up to her water breaking and hard labor. She gave birth about 7 hours later. The mind and body work together in labor. Modern medicine discounts this very important fact and only focuses on the body.

My point - the mind is so powerful. If you want a VBAC, go for it. But it will not just magically happen for you. And it is not about luck. It is about preparation and hiring the right care provider who believes in you! Prepare for an unmedicated birth if you really want that VBAC!

It cannot go unmentioned at this point that even if you hire a doctor who is pro-VBAC, it is vital that his/her hospital and OB group also support VBACs. If you read Allison's story a couple of months ago, we learned how important this aspect of your health-care is. Everyone must be on the same page. When I lived in Albuquerque, I was interviewing a group of midwives at one of the local hospitals and they were so proud of their VBAC rate -- an astounding 92.3%! But they all had the same goal. Supporting women. Encouraging them to push their babies out vaginally! If your OB or midwifery group says they support VBACs, ask them for their VBAC rate. According to CIMS' Mother-Friendly guidelines, that rate should not fall below 75%. That means that at least 3 out of every 4 women will achieve a vaginal birth after a cesarean.

Bottom line. You will birth this baby one time. No second chances. Don't let the American way of not "allowing" you to VBAC keep you from this experience. Make the commitment to yourself, your husband, and especially your baby, that you will not have medication to numb this experience. Embrace it. You and your baby deserve to experience labor and a vaginal birth.

[Continue Reading]

Scars

"Scars remind us where we've been, but don't have to dictate where we're going."
-Agent Rossey, Criminal Minds

OK, a bit strange to put a quote on here from Criminal Minds (my favorite show on television), but seems very applicable right about now. Stay tuned for a wonderful VBAC story...

[Continue Reading]

Twins born via VBAC!

I have to share some wonderful news about a friend/former student that just gave birth to twins. Her first birth was a C-section, followed by a VBAC with an epidural. By the time she took my Bradley class, she was on baby number 3. She gave birth, unmedicated, to a baby weighing in at 10 pounds. (The hospital nurses told her she wouldn't be able to make enough milk to feed a baby that big. She took her baby, AMA, out of the hospital because they were insisting on feeding the baby formula. She knew that her body would be able to feed her baby. And so it did!)

She went on to have another unmedicated VBAC. And then she found out she was pregnant with twins! She had a fight on her hands to give birth to her babies, especially since she'd had a previous C-section. Nevermind that she'd had 3 VBACs since then. But, really, how often do we hear of women giving birth to twins vaginally? Never. They just schedule a C-section.

There are a couple of issues that play a role here: positioning of the babies -- particularly baby A (preferably head down), and the medical staff wanting the mom to have medication in her system in case she "needs" a C-section. I am so proud of this mom for sticking to her guns. What a wonderful example she is to this hospital staff. Next time, maybe, they'll think twice about scheduling an unnecessary C-section. Look at the size of those babies! She must have eaten great protein! Congratulations Rebekah. Isn't it amazing what we can do when we set our mind to it and don't let others make decisions for us?

"I had my twins! Andrew was born VBAC at 6lbs 13oz 21inches long and Ammon was born
at 6lbs 15 oz at 20 in long. It was a struggle with my medical staff to get them here VBACbut I made my wishes known and miraculously there were no complications. I will email
the story later, the twins are hungry. (This makes 4 children birthed VBAC
and unmedicated...yipee!!)"

[Continue Reading]

The VBAC Debate

In response to Sarah's request on VBACs...

I have already started writing this once, but saved it under a c-section title. I am having a hard time writing about VBACs (Vaginal Birth After Cesarean) without writing about the reasons for all the c-sections in the first place.

So many women are having c-sections, as we already know. Some women are requesting them, and some don't care if they have one or not. The majority of doctors are very comfortable with them, so it's become very commonplace. Every now and then, a woman truly feels "ripped off" by not giving birth vaginally. If you have had a c-section, I would recommend getting in touch with the ICAN support group.

I am a member of the International Childbirth Education Association (ICEA), who publishes the International Journal of Childbirth Education. There were some fantastic articles in the journal this month. One woman was commenting on the stress of having a c-section and the after effects (it didn't give a reason for the c-section): "My baby was next to me but I didn't want to touch him or look at him. I was mourning the loss of a child who never came through me. I was unable to give birth. He was stripped from me." There is a strong link between postpartum depression and cesarean birth and also with epidural birth. Typically, women who experience childbirth and breastfeed their babies do not experience depression.

I hear people say this all the time: "Well, at least the baby is healthy," or "It doesn't really matter how the baby got here, as long as it's healthy." Does this mean that if you have an unhealthy baby, you don't want it? Likely, women just want their baby, whether it's healthy or not. And it does matter how they get here. No woman would choose a good birth over a healthy baby. Accusing women of doing so is a way of dismissing their valid requests for good health care and respectful, positive births. Whatever the case, and whatever the reason a c-section was performed, during the next pregnancy, she should find a provider who does VBACs and believes in their safety.

This is what happened: VBACs were on the rise in the 90's, until Cytotec appeared on the scene in the late 1990s. Cytotec is a drug that is FDA approved to treat people with stomach problems, such as ulcers. A side effect is that is causes the uterus to contract. Women were receiving this drug as an induction drug who had previously had a c-section, and as a result, many lives were lost -- both mothers and babies. The makers of Cytotec have requested that it not be used to induce labor, but let me assure you, it is alive and well. In fact, one of my students received it just last week.

Your OBGYN will tell you how dangerous it is to have a VBAC -- that your uterus could rupture. Did you know that you have less than a 1% chance of that actually happening? Did you also know that a woman who has never had a c-section can also have her uterus rupture from the use of induction drugs? I have never heard of a woman being told that when they are scheduling an induction.

I was talking with a woman several months ago and asked her what month (not what day!) her baby was due. She said she was having her baby on such-and-such date. She had scheduled another c-section. She wasn't even sure why she had had the first one! I told her that there were doctors and midwives in this area who would do a VBAC, but she said that she liked her doctor and she was "really nice." This is not a reason to let your doctor surgically remove your baby from your body! This is not good health care! A repeat c-section carries far more risk than a vaginal birth after a c-section! The evidence backs this statement over and over. You need to truly understand why you had the first c-section. What are your chances of having the same "complication"?

So, first of all, if you want to have a VBAC, you will not be induced. You need to seek out a birth attendant who is supportive of VBACs. They should have a VBAC rate of at least 75%. In Albuquerque, when I was doing my Bradley certification, (5 1/2 years ago), I was interviewing a group of midwives at one of the hospitals, and they were very proud of their 92% VBAC rate. ACOG has gotten very strict with the allowance of VBACs now, which is completely absurd. What has changed in womens' bodies to all-of-a-sudden make a VBAC dangerous? It doesn't make any sense.

When you find a birth attendant that does VBACs, they will request your medical records from your previous birth. They will examine the records of the surgery and determine if you are a candidate for a VBAC. It has become popular, because of the recent denial of VBACs by OBs, to perform a single suture instead of a double suture when sewing the uterus back together. They know that you'll be having another c-section with subsequent babies, so why bother securing it for a VBAC? Be sure that you are double-stitched if you have a c-section! Also, if you have a vertical incision (more common in other countries), you will likely not be having a VBAC.

When you introduce any medications or interventions you are more likely to have another c-section. To really understand this concept, you need to understand how the body works in labor and birth. You need to know how medications work and why you are 4 times as likely to have a c-section with an epidural than without one. The bottom line is this: Prepare yourself -- mind and body -- to give birth without drugs.

What I have seen over the years is that women who have had a c-section become so focused on having a vaginal birth, they don't even contemplate not having an epidural (probably because they assume them to be completely safe). I would like to share the 4 factors that research has found to make the greatest contribution to a woman's degree of satisfaction with her birth experience. I thought these could easily be said of a VBAC:  
1) Having good support from caregivers (who support VBACs); 
2) Having a high quality relationship with caregivers (who likewise respect you and your body's abilities to give birth vaginally);
3) Being involved with decision making about care (even if this means another c-section); 
4) Having better than expected experiences (or having high expectations). "The best predictor of a woman's experience of labor pain is her degree of confidence in her ability to cope with labor." Confidence in yourself is everything.

So, this is the bottom line: If you are planning a VBAC, don't make your focus the previous c-section. A few months ago, I was on the phone with a woman in labor, having a VBAC, and everything kept coming back to the c-section. I finally said, "Let's just forget the c-section and that this is a VBAC. It's getting in the way of this labor. You are just a woman having a normal labor." Use the experience to learn and grow from. If you know where things "derailed" last time, do what you can to not have it happen again. Your chances of rupture are about the same as a woman having an induction who has never had a c-section.

You are simply a woman who is going to give birth.

[Continue Reading]