The Path to VBAC

ICAN of Salem

2011-06-27T16:55:00.000-07:00

I am excited to announce that my friend and I are starting up an ICAN of Salem group to offer a safe place of support for those who have gone through having a c-section and who are interested in knowing more about VBACs. So if any of you are from the Salem, Oregon area and are interested in attending meetings we will be starting up in September and would love for you to come. I will announce more when it gets closer, we are only in the planning stages right now but we are so thrilled to be starting up this group. If you have ever been to an ICAN meeting I would love to hear what you thought too. Stay tuned for more announcements about this!

Get Off Your Back!

2011-05-03T13:12:00.001-07:00

What do you mean you had the baby on your side, standing up, squatting, on your hands and knees?

This picture might seem so weird to some people because all they have known or seen is a woman lying on her back, legs in the stirrups being told to push as someone else counts for 10. Isn't that the way birthing a baby is done? Sadly, it is a common picture however it is by far not the most effective or easiest way to give birth. I hope this post will change the way we picture ourselves giving birth and that women will get off their backs!

My picture for my first birth was me in the tub delivery my baby. Reality was that I was laying flat on my back in the OR being cut open and my baby pulled out of my stomach.

My second birth picture in my mind was again delivering in the tub. Reality was that I was lying on my side on the bed with one leg up resting on my midwifes shoulder.

None of my original pictures or the outcoming reality had me laying on my back with my legs in stirrups, and why not? Because I had read about, witnessed, and my midwives had discussed alternative and better birthing positions.

So what is wrong with being on your back and why is it mostly used in hospital deliveries?

I think the main reason it is the most common position for hospital deliveries is purely convenience for the doctor. It is the easiest position for them to see what is going on, and the easiest access. But I think who cares what is more convenient or easier on the doctor. Who is pushing this baby out, the doctor or the mom? This idea should be changed to what is easier, more comfortable, and more productive for the mom. It is amazing to see and hear stories about midwives and doctors who truely focus more on the mom than their own comfort. They are true contortionists and work around whatever position the mom has chosen is best.

When a woman is laying on her back, or in a c-shape where she is mostly resting on her tailbone with her body curved like a c, her pelvic outlet is up to 30% smaller. That doesn't even make sense to me to be in a position that would make the opening that the baby is moving through smaller in any way. We want positions that help open us up, making it easier for a baby to get through.

This position also puts more pressure on the perineum and other muscles that should be more relaxed not stressed, which can cause worse tearing, unnecessary episiotomies, forceps or vacuum deliveries.

Blood flow and oxygen to both the mom and the baby are reduced when laying on your back because it puts pressure on your vena cava, which is a large vein that returns blood from the lower half of the body to the heart.

Being on your back clearly works against gravity. I would want gravity to aid in birth not work against it so this is another reason to get off your back!

There are a lot of other positions that are better for birthing your baby. Again it is best to try them and see what works best for you in your immediate circumstance. Here are some good ones.

Sitting: This is a position that allows gravity to work with you and help bring the baby down. It can also be a relaxing position for many. This might not be a pretty mental picture but this can be done on the toilet or a birthing stool.

Standing: Again this uses the benefits of gravity to aid delivery. This position also helps get oxygen to the baby. It can also help create a pushing urge.

Squatting: This is the best position to help open up the pelvis and again uses the benefits of gravity working with you.

Hands and Knees: This position is especially helpful when birthing a large baby, back labor, or helping turn a posterior baby. Gravity isn't as effective in this position but it does allow the baby's head to emerge more gently which will lessen the chance of tearing.

Side-lying: This position can be more relaxing but again the aid of gravity is less effective when lying on your side. This position puts less strain on the perineum and helps get oxygen to the baby.

So I hope the vision most of us see when we think of birth will soon move away from the back laying position to one of the many alternatives. Stand with me and tell other women to "Get off your back!"

Andrea's Path to VBAC

2010-11-27T23:08:00.000-08:00

I asked one of my friends to share her VBAC story and here it is! Thank you Andrea!

My VBAC Journey

I suppose my story begins with my first pregnancy. It was a healthy and normal pregnancy. My husband and I took a childbirth class which spent one entire session discussing Cesarean Section. I spent most of this session thinking about what I needed at the grocery store. I tuned out because I wasn't going to have a Cesarean Section. I was going all-natural. My prenatal care was with a group of OB's with an outstanding reputation. Towards the end of my pregnancy, one of the doctors told me that I may run into problems with cephalopelvic disproportion. (which turned out not to be the case...) My water broke late at night and I was already tired. As soon as I arrived at the hospital, my OB ordered a Pitocin drip, even though I was in labor and having contractions. After several hours of increasing amounts of Pitocin, I felt like my spirit was broken and caved and had an epidural. My labor lasted into the next day. I was finally fully dilated after 21 hours and began pushing while laying on my back. I pushed with all my might for THREE HOURS. During this time many strangers came in to "observe" it was really humiliating. My doctor came in periodically to bully me. She reminded me that the hospital policy was to only allow a woman to labor for 24 hours after her water breaks. After that she "had to have" a C-Section. I remember during a previous appointment (when the doctor mentioned that I should be prepared for a C-Section) explaining that I didn't want a surgical delivery and he explained that occasionally they obtain court orders to require a woman to have a C-Section against their will. Nice, huh? The baby crowned over and over again. My doctor came in and determined that the baby's shoulder seemed to be caught on my pelvic bone. There was never any mention of changing position or other methods to remedy this. She tried the vacuum three times. When this was unsuccessful she pushed the baby back inside me. To say this was uncomfortable would be an understatement. Then she announced that I was going to have a C-Section and told me to remove my jewelry. They wheeled me in, I was so defeated and sad that I asked not to be awake for it. The anesthesiologist told me that he could do that as soon as the baby was out. He also told me that since I had an epidural, that I would have some dreams. Well, it turned out to be hallucinations, HORRIBLE hallucinations. Thankfully, the procedure went well and the baby was healthy. A few hours later I woke up to find my husband rocking her next to me. I was overjoyed. After the next few weeks I battled post-partum depression, undoubtedly exacerbated by grief over the delivery. I felt a sense of loss, as if I had failed, less of a woman, and missed out on a right of passage. My wound did not heal well. I wasn't able to do much for a couple of months. I had to be driven to the OB's office every week for 6 weeks for the wound to be drained. I remember one night after nursing my daughter, I leaned over to the side of my bed to put her back in her co-sleeper and I dropped her because the pain in my abdomen was too much to bare. I quickly learned that although Cesarean Section is the most common surgical procedure in American hospitals, it is not to be taken lightly. It is a major surgery that leaves physical and emotional scars. When I became pregnant with my second child, I knew I didn't want to have another C-Section. I had moved to a much smaller town, one with only one hospital. Turns out this hospital has a "VBAC Ban". Don't get me started on this! There have been several challenges to the legality of these bans, but I didn't have the time, money, or energy to fight it. I received prenatal care from an OBGYN in a nearby, ironically, smaller town. She was one of the few doctors in the area who would attend a VBAC 'attempt'. After the first half of my pregnancy, however, I left her practice as she didn't seem to have the same goals as I did. VBAC was very important to me, as this was to be my last child and only chance to experience a natural childbirth. She treated me as if the idea was a novelty and at one point told me I had a "38% chance of successful VBAC." I often wonder what scientific formula she used to calculate these statistics. I got in touch with the local ICAN chapter...( International Cesarean Awareness Network) . The woman that I talked to was very understanding of my situation and recommended another hospital in another (much bigger) city. I wasn't too excited about driving an hour each way for my prenatal appointments. I was also uneasy when she told me the group was midwives. I had a vision of a women delivering a baby on a kitchen table, Little House on the Prairie style. I was so wrong, these women were professional, educated, and very sincere. They practiced in a very beautiful hospital next to a group of OB's. The technology they used was modern I and received similar care to what I would expect from an OB. These women just had a different approach. The focus seemed to be on letting birth happen and minimizing interference during labor. I AM SO GLAD I found them. I met most of them over the course of the rest of my pregnancy. By the end of my pregnancy, I felt at peace that whichever midwife was at the hospital when I arrived in labor, I would be in very capable, supportive hands. I believed that my vision for the birth was indeed their vision for my birth. They actually REQUIRED me to have a birth plan.

At one week past my due date, my water broke in the evening after dinner. We left for the hospital and arrived in the early hours of the night, it WAS a full moon, and everybody and their sister was in labor! They didn't have a labor room for me. I eventually got a better room. Progress was slow. My doula came and I got on the birth ball. Later in the afternoon, I got in the shower as the pain was intense and the only birthing tub was in use ...I never did get to get in the tub, even though that was the plan. The shower only helped for so long and it seemed as if there was no end in sight. I tried various positions and rocking in a rocking chair, but eventually decided to have an epidural. I wanted to see if I could go without, but it seemed obvious that I was in for another long labor. It was more important for me to have a VBAC than not to have an epidural...if that makes sense. Finally, at 1 a.m. the next morning, I was dilated and pushed for three hours. After this, they started some Pitocin to get labor to speed up. The OB's at this point came in and sort of threatened a C-Section due, which was stress I did not need. The midwives and my doula were taking care of me just fine, thank you very much....My midwife told me to "get really mad and push", which was easy to do. I tried lots of positions, but finally ended up reclined with my feet on the shoulders of my doula...poor thing had severely bruised shoulders at the end of it all! They could tell I was starting to lose steam and they pulled out the mirror, in which I could see my baby crowning and that was what I needed. I finally pushed out Fiona at 10:08. I can't really describe the feeling, but it certainly empowering. I felt so proud of myself. I had this internal dialog ever since my C-Section that I was somehow incapable of giving birth to my babies, and therefore, less of a woman and a mother. Now that I have been a mother for 5 years, I realize that mothering makes you a mother, not how the child came into the world. However, I am SO glad that I had this experience and wouldn't change a thing.

Andrea

Helpful Pain Managment When Saying No to Drugs

2010-08-24T22:03:00.000-07:00

I remember when pregnant with my first I often anxiously wondered how bad is this going to hurt. The thought of pain can be scary! No one can tell you exactly what it will feel like to give birth. It is different for every woman and even for every birth.

When I told people I was going the "natural" route with no drugs I definitely got different reactions. Obviously many not very encouraging with looks of disbelief as if it has never been done, to jokes about how I will change my mind once labor starts, a lot of "good luck with that," or how crazy I was to even try it. I was thankful for those who said "good for you!" Positive encouragement sure can go a long way!

Of course I wasn't going to go into it blindly. I was going to do research on "alternative" pain management. I knew having the right support from people around me would be key. I also knew I needed to learn techniques to help me relax. Being tense in labor will only make the pain more intense. I also decided to take a birthing class which would help me and my husband learn some of these techniques.

There are quite a few different types of birthing classes. These are not the generic birthing class that all hospitals offer. Sadly most of those focus more on how to be a good patient then on ways to actually help a women achieve a non-medicated birth. The most common classes are Bradley Method, Lamaze, and Hypnobirthing.

We decided to take a Bradley Method class. This style focuses more on the natural birthing process and involving active participation of the husband and is even also referred to as husband-coached childbirth. They teach you how a women's body works during labor and are taught how to work with your body to reduce pain and make labor more efficient. The class teaches relaxation techniques, and effective labor and birth positions and how the husband can really support the woman through it all. The classes offer relaxation practice and labor rehearsals. I remember at the time I felt pretty silly doing all that practice and role play but in the end I do think it helped a lot. Especially for my husband because when I was in real labor he remembered a lot of what we had practiced. These classes also cover everything else from nutrition, exercise, phases of labor and delivery, how to avoid episiotomies and c-sections but also covers what happens if you do need a c-section, circumcision, and breastfeeding.

I liked this method a lot because it really focused on how birth is a natural process and taught me how to trust my body. It helped me focus on working with the pain and learning relaxation instead of controlling the pain or ways to just distract from it. One thing I will always remember is how you look at the pain can really effect the way you handle it. If you think of it as pain like breaking your arm where it is just intense, continuous, with no reason or accomplishment it will be harder to work through it. But if you think of it as work, hard, intense, physical work that has a purpose, and a goal, and an awesome accomplishment and reward at the end, you will have a much easier time working through it. They even had us not call it "pain" because of all the negativity that surrounds that word, but rather "extremely hard work."

Besides taking a birthing class there are many ways to help manage the pain. I found it best in both my labors to use a variety.

Water is a great way to manage the pain. Using a shower helps a lot and you can also target the water on any specific areas of discomfort. To me a shower is just relaxing anyways. With my VBAC I spent plenty of time in the shower while sitting on a birth ball. My midwives gave me that excellent idea and it was very relaxing and helped with some discomfort. Along with the shower getting in the tub is another way to manage pain. What women doesn't find a bath relaxing anyway right? The water actually helps decrease the pressure on a woman's body, which helps eliminate pressure and discomfort and makes her more buoyant too.

With both my births I desired a water birth. I labored in a birth tub with my first child and I did really enjoy it. Unfortunately I never got my water birth since I ended up with a c-section. I again wanted a water birth with my VBAC but once again plans changed when right before getting in the tub while getting checked I all of a sudden felt the urge to push. So I never made it to the tub for that birth.

Another great technique that helps ease the pains is counter pressure. We learned about and practiced this a lot in our Bradley classes. It basically is just having another person using significant pressure against you in your specific area of discomfort. It feels especially good with back labor to have someone pushing pretty hard against the small of your back. I had a lot of pains in my upper thighs and hips and I needed someone to just push as hard as they could into my hips and legs.

Massage is also a great way to help with relaxation which in turn will help you cope through the work of labor. It might feel good to have someone massage your back, thighs, or hips. Make sure there is communication going on so the laboring mama is able to tell you where they need the massage and for how long and how hard.

Breathing and vocalizing techniques can help a women relax and focus on working through the labor. Breath through each contraction, don't hold your breath. Remember to use low sounds when vocalizing it once again helps your body to open up the way it needs to and not tense up. My midwives would remind me to keep my sounds low throughout my labor. I never thought I would really be very vocal in my labor but I found that making these low sounds actually did help me to work through the contractions.

Sometimes applying heat to areas of discomfort help ease the pains. A good thing to have on hand would be a rice bag or sock or even hot water bottle that can be placed on the areas of discomfort.

Don't forget to think about what type of environment would help you relax the most. Would it be helpful to dim the lights, have candles, aromatherapy, certain music, etc. For my first birth I spent time beforehand going through my CD's picking out the music I thought would be most relaxing. For me it really didn't make any difference. I actually didn't even realize they had turned on the music. But I'm sure these factors could be beneficial to many so it is something to think about.

Visualization is something else that can help prepare and help a women relax more in labor. We also did some visualization in our childbirth class. It can be helpful to visualize each stage of labor and how you will respond. I think it helps with the anxiety and fear of the unknown which when you get past those fears you are more likely to relax. I remember being encouraged to visualize my cervix opening, the baby moving down the birth canal, pushing the baby out and holding her in my arms.

A variety of birthing aids can be useful for labor pain management. These might include a birthing ball, squat bar, and of course effective birthing positions. I used a birthing ball with both of my labors and it really helped with the pain. I didn't have an actual squat bar but I used the end of a bed and a bed post to hang on to as I squatted. I hated squatting but at the same time it did help and I really did notice the benefits. Effective birthing positions are so important to help get you through labor and delivery. I found a variety of positions helpful and just movement in general was helpful to get through the pains. I will talk more about good birthing positions in another post. Women need to get off their back!

Red Raspberry Leaf Tea has been said to make labor quicker along with lessening the pain.

Acupuncture has been used by many who have said that this technique was helpful with the pain and increase relaxation during labor.

Saline shots are a good way to help with back labor. It is when an injection of saline is put into your lower back. This is also called a subcutaneous water block. It is supposed to last 90 minutes and can be repeated. My sister had extreme back labor with her first child and I remember watching her midwife inject the saline. She said it really did ease a lot of the back labor pain.

As you can see there are so many things you can try to help ease some of the pains with labor. Most likely you will need to try a variety of them and at different stages of labor as well. Also keep in might that what was helpful 5 minutes ago might not be helpful the next 5 minutes, and what you like will change over the course of labor too. The important thing is to listen to your body and be open to trying new techniques. Also remember that with each wave of painful contractions means you are that much closer to holding your precious baby in your arms!

I would love to hear from you what you tried during your labor and if you have any other good suggestions on pain management to share.

I'm back!

2010-06-07T22:03:00.000-07:00

Ok, again I apologize for the neglect. Life is just getting in the way! :)

I am still just as passionate about helping women who have a desire to learn more about VBACs. I want all women to be informed about the birthing process.

That is one thing that has changed me since having my VBAC is just really becoming more informed about everything. I grimmace when I hear of people who just accept everything the so called "professionals" tell them without even doing research or questioning. And when I hear a woman say "well, I have to have a c-section with this one" there is just so much I want to ask and inform her of.

I would love to hear from you what led you to desire a VBAC and how did you make an informed decision?

One Year Later

2009-12-11T22:45:00.000-08:00

I am so sorry I have been neglecting this blog and it feels like forever since I wrote on here. I meant to write on Oct. 23 since that was my little girl's first birthday and my anniversary of my VBAC. It is so weird that a year has gone by it seems like it was just yesterday that she was born and I was feeling the rush of ecstatic emotions of accomplishment after the succesful VBAC birth. Yet at the same time it seems like so long ago too....

Since starting this blog I have enjoyed having friends go on to have successful VBACs and I have also enjoyed sharing my story with other women who have wanted to learn more about their options. It amazes me how many women don't even know that a VBAC is an option!

I hope to continue to offer encouragement, and knowledge to women who are wanting to have a VBAC. I also am looking forward to having other women share their own birth stories on here so we can celebrate with them.

I really want to get back into posting on here. If there are any questions anyone has feel free to post a comment or if anyone has specific topics they want me to discuss I would love to hear from you. I have been mentioning I will talk about pain management techniques, as well as twin and breech VBAC so that is next on my list of topics. My goal is to finish those soon!

Twin HBAC Video

2009-12-11T22:38:00.000-08:00

Here is another great video a friend found that is showing a wonderful HBAC (homebirth after cesarean) of twins!
http://www.youtube.com/watch?v=xi37qJ-mIoU

Is your hospital on the list?

2009-09-23T22:01:00.000-07:00

Even though I decided to have my VBAC in a freestanding birth center, I know many people feel more comfortable in an actual hospital. In my town my hospital does not do VBACs so I would've needed to travel to find one that allowed them.

Here is a great resource for you if you are trying to find a hospital that allows VBACs. It is taken from the ican website, which I mentioned earlier has some wonderful information. The list shows each state and all the hospitals and then tells whether VBACs are allowed, banned, or defacto. Defacto bans are hospitals that do not have an official ban, but do not have any doctors that do VBACs, or are hospitals that allow VBACs but have not had more than 2 in the last 6 months.

I would still encourage you to ask lots of questions of the hospital that says they allow them, to get a feel how friendly towards VBACs they really are.

http://ican-online.org/vbac-ban-map?filter0[]=**ALL**&op1=5&filter1=

Natural Births and VBACs with Twins and Triplets

2009-09-21T08:38:00.000-07:00

Here is another video a friend sent me about women who had natural births with twins and triplets. I will do some research on this subject and write more on the topic later. It is nice to know that there are options with multiple births. It is important to have a careprovider who has had a lot of experience with natural multiple births and breech births. One thing that stood out to me while watching this video was the actual week of delivery. So many were into the 39th-40th+ week. If they had a c-section that most likely would've been preformed around 38 weeks or before and obviously these babies were not ready to be born then. What a wonderful gift to let the babies continue to grow and develop and enter this world when they were ready and in a natural way!

http://www.youtube.com/watch?v=7E-wULAaD50&feature=related

Peaceful Birth

2009-09-19T11:57:00.000-07:00

This was shared to me by a friend studying to become a midwife. Even though it doesn't show the actual birth you can tell this baby was brought gently into the world. I wasn't as focused and peaceful at 10 cm as this woman but it shows how beautiful and natural birth is.

http://www.youtube.com/watch?v=r-eW2miJN7U

Good Articles and Other Links

2009-09-08T22:15:00.001-07:00

I just came across this great quiz that was on the Consumer Reports website. It has great information. Take the quiz and see how informed you are!
http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/maternity-care-quiz/maternity-care-quiz.htm

Another great article found at Consumer Reports:
http://www.consumerreports.org/health/medical-conditions-treatments/pregnancy-childbirth/maternity-care/overview/maternity-care.htm

Overcoming Fear and Trusting your Decision

2009-08-31T22:24:00.000-07:00

With a VBAC the fear of the unknown can sometimes get the best of someone. It is like being a first time mom again and all the fears that went with labor and not knowing what to expect. The same is true with a VBAC. For me even though I knew what to expect more with the actual labor since I had gone through that before I had no idea about the pushing part and was really nervous for that. The fear of the unknown. Unfortunately sometimes that fear can actually cause someone to just have a repeat c-section because they are at least familiar with that and know what to expect.

So what can you do if you have a fear of repeating another hard labor? How do you overcome that fear if it seems to be holding you back from considering a VBAC? Take the time to look back on your birth that ended in a c-section and try to identify those fears and ways to avoid repeating those same problems if possible.

Maybe you realize now you didn't have good, supportive care whether it was with your doctor/midwife, or the birth setting. If that is the case you should look into other caregivers, and/or birth settings. You also might want to look into hiring a doula or have a close friend or relative with you this time who you know would give you the support you need.

Maybe you realize you didn't have enough knowledge of what to expect or knowledge of procedures or things you could do to help yourself in labor. In that case there are great books, websites, etc. that can help you gain knowledge. Some of these are listed in my resource post. Also a good birthing class, such as a Bradley Birth class, would be beneficial. You can also look for a VBAC support group in your area to gain insights from other women who have experienced what you are going through.

If your anxiety is towards having another long, non-productive labor or hours of pushing remember all births are different and this one most likely will proceed in its own way. Also keep in mind the first is usually the longest. However since you haven't given birth vaginally before it is like a first time birth. Again gain knowledge about ways to help labor progress and learn about what can also interfere with labor.

If your fears are related to the pain of labor learn ways to help you work through the pain. As I mentioned before it is best if you can avoid epidurals. I will have a post soon on some pain management techniques. Just remember that once the baby is born all that pain is quickly forgotten. :)

If you are still having a hard time dealing with your fears it would be a good idea to talk to someone. Seek a trained counselor who also is knowledgeable about maternity issues.

If you seem to be questioning your decision to have a VBAC here are some good questions to ask yourself and think about how you would truly feel:

If you tried to have a VBAC and it wasn't successful and you ended up with another c-section, would you feel better for having tried or worse because you went through all of that just to have another c-section? As I mentioned before I knew that I wanted to at least try and if I did end up with a c-section I would then know it was completely necessary.

If you just scheduled a cesarean, would you feel relieved that you wouldn't have to go through labor again or upset because now you would never know what would have happened if you had chosen a VBAC? As for me, like I said before, I knew that I wanted to at least try and I knew I would always wonder if I could've been successful if I had tried.

If you planned a VBAC and were successful, what would that mean to you? After my baby was born the sense of accomplishment and empowerment was amazing! I was truly blessed!

I hope you take time to ask yourself these questions and really be honest with yourself about your answers and feelings. You will realize if trying for a VBAC is really something that is important to you and that will help you overcome your doubts and fears!

Paige's VBAC Story

2009-08-04T11:25:00.000-07:00

Again I want to thank Paige for sharing her VBAC story with us!

Paige's VBAC Story:

"Despite all my gentle attempts to naturally induce myself I was not going into labor. I had to really fight to get to 42 weeks, especially after I agreed to the US to check the baby's size and they estimated him at +9lbs. They scheduled a c-section for the day I hit 42 weeks. That was a Sunday. Here's the rest of the story...
Saturday morning at 6am I woke up and felt my first real contraction. It felt nothing like anything I'd felt before so I thought it was the real thing, but was afraid to get my hopes up again. They continued regularly every five minutes for over an hour so I knew something was really happening. I took a shower and they started coming one on top of the other so I called my doula. While she was on her way they evened back out a bit. My mom came and got DD and I settled in to what I thought would be a pretty quick labor- since they were already so close together and lasting about 45 seconds. Over the next few hours they got to every 2 minutes and stayed there. All. day. long. I should have tried to do other things to take my mind off of labor, but I was so afraid that if I stopped concentrating on the contractions they'd stop coming and I'd end up on that OR table the next day.

Around 6:30PM that night I called the oncall MW because my doula was afraid I was going to get too worn out and she wanted me to try to speed things up. I'm so glad I called the MW because she assured me that the surgery was definitely off since I was in labor. I didn't realize I'd been worrying about that all day- like i was trying to labor on a time clock. She told me to relax, make myself comfy, take a warm bath and let labor take its own course without trying to speed things up. I felt so much better. I sent my doula home- that was actually a big relief. She was starting to stress me with suggestions of how to speed things up and I was tired of being stared at.

So i took a hot bath, relaxed, laid down in bed, tried to watch SNL and dozed between contractions for a while. DH was so sweet and comforting. After a few more hours the contractions weren't getting closer together but they were getting harder to deal with and more intense so I decided to head to the hospital. I'd been in labor about 18 hours at that point, though I lied to the MW when I got there and said the contractions had started early afternoon sometime. I really didn't want to be on their clock.

The drive to the hospital sucked, but we got there Sunday morning at 1am. We got lost trying to get in to the maternity ward but a friendly security guard helped us out and let us in the door that was locked after hours. The nurses recognized my name from the surgery roll for the next morning and were really excited for me that I was in labor. I was 5 cm when I checked in and incredibly happy to hear it. I had a heplock for ABX (I was GBS+) and was on continuous monitoring because I was VBAC, but generally comfortable and able to move around. I decided not to worry about whether they were getting good monitor readings and that made things easier. I used my yoga ball to sit on, lean on, drape myself over. I squatted into contractions some, I laid on my side for a while. Basically I tried every position in the book and just tried to generally stay mobile.
By 4am I was 8 cm and 100%effaced. I heard that and cried with happiness. Then my body decided that it was done for a little while and I stopped progressing. It was probably good cause I was able to sleep a little bit, but after a few hours they started talking about internal monitors and pitocin so my body kicked back into gear. In another hour or so I got to 10cm with a cervical lip that just wouldn't go away. I was getting frustrated at that point because I felt like no one was telling me what to do to make it progress. The doula was useless at this point (im sure she was worn out) and I was getting so tired and just frustrated. The pain really wasn't much of an issue for me, I was just exhausted from lack of sleep and a long labor and just READY FOR THE BABY TO COME OUT.
Then shifts changed and this angel of a nurse came in and started quietly making suggestions about how to stand, where to put my feet, how to curl my back forward instead of backward to get the baby around my pelvis. I got to the point where they said i could try pushing past the lip but the baby kept slipping back. The midwife (the same one I had talked to the night before on the phone) assured me that at this point I WAS going to have a vaginal birth, but they thought a "whiff of pit" would strenghten my contractions and make them consistent enough to actually push the baby out. I was still falling asleep between them at this point. I didn't even notice the pitocin, but once they gave it to me it took about 45 minutes of pushing before the head came out (at 11:13am after 29 hours of labor). I was laboring on my back at this point holding my feet and pushing against my own hands with some help from my aunt on one side and the nurse on the other with my mom holding my head and helping me curl into a shrimp position. DH was waiting to catch the baby and my sister was watching over his shoulder. My eyes were mostly closed but I have a few mental images of seeing their faces as the baby was coming out. I thought it would be embarrassing but it was encouraging because they both looked so amazed and impressed. Then the head popped out and everyone cheered.

The amniotic sac was still intact and she had to burst it by poking her finger in his mouth. Then they told me to stop pushing because his shoulders were stuck. DH was not able to deliver him because the midwife had to manuever him a bit, which caused a pretty good tear, but when I felt his body slither out everyone in the room cheered. They put him up on my belly and I reached down and felt that he was a boy. They had to take him away pretty quick because he was in a little bit of shock from getting stuck, but they assured me that he was just fine and they kept him in the room to check him over. I delivered the placenta (that thing was huge!!!) and then they stitched me up. The stitching was the first time I said the word "epidural" the whole time I was in labor. OMG that was the worst part of the whole experience. I tried to hold the baby to distract myself, but I was yelling so loud I had to give him to DHuntil they were done. It took forever, but they finally finished and gave my baby back to me. I offered him my nipple and he immediately latched on and went to town. Like he'd been doing it forever. It was wonderful. It was the most healing, amazing experience of my life and I hope every woman can experience something like it."

Paige's Cesarean Story

2009-08-04T11:15:00.000-07:00

I am part of a site called Circle of Moms where I came across Paige's birth stories. She was kind enough for me to repost her experiences on my blog.

Paige's Cesarean Story:
"I know when I was pregnant the second time I was desperate to read about other women's VBAC stories no matter what the outcome was. I want to share my stories because if my experiences can help another mother out there then I want to do it.

Here's my c-section story:

I went in on a Friday to see my midwife. I was a little more than a week overdue at that point so they strapped me to the monitor to check things. Everything looked fine except the baby wasn't moving as much as they wanted. My midwife said just to be safe to go to the hopital for a NST. She told me that if I wanted to, just tell them I'm ready to have the baby and they'd induce me. That should have been my first clue that things might not go the way I was hoping.

So I went to the hospital and they decided that I was low on fluid. Fortunately the midwife oncall at the hospital was really understanding about me NOT WANTING an induction. Despite the doctor's recommendation (and my mother, and my aunt, and my grandmother) that I induce, the midwife suggested I go home over the weekend, drink tons of water and come back for another NST on Monday. I was very relieved to have another option.

I showed up at the hospital Monday afternoon and had another NST. While my fluid had not gone down, it hadn't come up either so the doctor, midwife, nurses, and my entire family told me to just get the induction. I still felt like it was the wrong thing to do, but everyone else was telling me to do what the doctor said and they kept insinuating that by NOT doing that I was endangering my baby's life. So I agreed.

You have to be 4cm to start pitocin and I was nowhere close (about 1 cm) so they used a Foley bulb to dilate me further. It was painful, uncomfortable, and invasive. They basically insert a balloon inside your cervix, inflate it to 4 cm, and it puts pressure on your cervix. When your cervix dilates to 4cm it falls out. The thing is connected to a tube that runs down your leg, which is taped there to hold it in place. They did this later in the evening and told me to sleep with it in. Yeah. Right.

By this time everyone had gone home because it was clear I wouldn't be in labor any time soon. There was no bed for Jason to sleep in so he asked if he could go home too. I wanted to say no because I was so scared to be there by myself, but I knew that if I did go into labor the next day I'd need him to be well-rested so I said that if he wanted to go he could. I don't think I actually believed he would leave me there alone, but he did. I've never been so lonely and scared in my entire life and I just lay there crying for a while. I felt abandoned and then guilty for begrudging him sleep. To my surprise I actually fell asleep.

I woke up a couple of hours later and had to pee so I went to the bathroom. While I was there the bulb fell out of me. There was a lot of blood and it was sort of frightening. I called the nurse and she just told me over the intercom to leave it in the bathroom. I was disappointed she didn't come in because I was still feeling lonely and wanted to actually talk to someone. I fell back to sleep, much more comfortable now that I didn't have a contraption inside me.

The next day my family showed back up cheerful and well-rested. I was feeling a bit grumpy myself, but tried to be excited that I was going to have a baby today. I thought. I asked the midwife if I could go walk around outside for a while before they strapped me to all the IVs and monitors because at that point I'd been in that hospital room for almost 24 hours. So I got my last breath of fresh air for a while and walked around outside the hospital. It was a beautiful day.

I went back in feeling much better and settled in for a long wait. They started the pitocin and an IV antibiotic (that burned when it flowed in! I could feel it all the way up my arm and into my chest). The first anesthesiologist came in and offered me an epidural. That pissed me off because it specifically said in my birth plan NOT to offer me medications. I wasn't even in labor yet for crying out loud! It would have been waaaaay too soon for an epi even if I'd wanted one. I just said, "No. I'm not using medications." He laughed and said, "I bet I'll see you later" and walked out the door. I was pretty pissed off, but my mom and Jason said "oh he was just kidding, you're making too big a deal out of it" so I tried to let it go.

After that it's a long, boring blur. Every few hours or so a new anesthesiologist would come in and ask if I was ready for an epi yet. I got irritated…then I thought it was funny. Especially since I still showed no signs of labor. They kept cranking up the pitocin, but nothing was happening. I dilated to about 6cm by early evening, the monitor showed regular contractions, but I felt nothing. The baby was perfectly happy and showed zero signs of distress. I laid there on my back and got up from the bed only to go use the bathroom. I started lying about needing to pee just so I could get up.

Sometime in the evening a nurse offered me a rocking chair. I was surprised. I asked if it was ok for me to get out of the bed and she said of course. Geez, I wish someone had told me that earlier!! I'd have been up moving around, squatting, rocking, kneeling on all fours, all the things I knew would help the baby move down. At that point I don't think I sat down again. I stayed on my feet except when they checked me for dilation.

I don't know what time it was when the midwives changed shift, maybe 8ish, but the new MW came in and it seemed like right away she decided she needed to know how strong my contractions were since I hadn't dilated past 6. She put an internal monitor on my cervix, which meant the end of my standing. I had to lay on my back and try not to move at all. It wasn't long before I felt the water trickling out. I let her know my water had broken and she removed the monitor. I’ve since learned that the water has to break when they use an internal monitor, but the midwife didn’t tell me that part when she said she was going to put it in.

But I got excited once my water broke because suddenly I could actually feel the contractions. I thought what I'd been waiting for for two days was finally happening- I was in labor!! I was thrilled.

Then the midwife came back. She said the monitor showed that I was having really strong contractions and that because I wasn't dilating despite the contractions she thought it was time to do a c-section. I felt like someone had literally punched me in the stomach and knocked the wind out of me. I started crying and said, "but I can feel the contractions now, I'm in labor." She told me I'd been in labor for a while and it wasn't progressing anything. I asked her if we could please just wait a little while to see if anything happened and she said she would give me one hour. If I hadn't dilated by then I had to have a c-section.

She put me in the "Pretzel"position, which apparently is supposed to encourage dilation (again, no one could have suggested that earlier??) but unfortunately makes the fetal monitor hard to keep in place. I spent the entire hour crying to myself, listening to my mother and Jason tell me it was for the best, and trying to ignore the friggin nurse who would not leave me alone and kept messing with the stupid monitor. I wanted to scream at her that surely after 13 hours of lying there with the damned monitor strapped to me and the baby had never once shown any signs of distress, surely it would be ok for the next hour. But of course I didn't. I just kept trying to help her get the monitor situated. She didn't try to hide her frustration and impatience with me at all. She clearly thought I should just go do the surgery and get it over with.

Then the MW came and checked my cervix again. Still 6 cm, so she said. I have my doubts about whether she would have actually told me if I had dilated, but maybe I'm just paranoid.

So that obnoxious nurse came in, much more cheerful now, and shaved the top few inches of my pubic hair. Someone came in and gave me a shot of something "to calm me down." I requested they wait to give me a catheter until after I'd been numbed and they said yes. It was the best decision I made all day, I think, but the nurse seemed to think it was weird.

They rolled me to the OR, which looked like a supply closet. They said Jason would join me in a minute. The anesthesiologist just happened to be the same one who'd been there 12 hours earlier. He said, "I told you I'd see you later." All I can say is that it was a damn good thing that they gave me that shot to calm me down because I remember being angry but just not caring. That stupid nurse who'd been badgering me for the last hour was there as well. While they are getting things ready they were gossiping about some guy who was "totally looking at" one of the nurses. I didn't understand how they could not realize that I was laying there having one of the worst moments of my life. I wanted to scream at them that I knew they probably did this everyday, but I didn't and it was really scary and emotional for me, but again that shot saved them from my wrath.

DH still hadn't shown up, but it was time for my spinal block. The thing I'd feared most throughout pregnancy- the reason I never wanted an epidural- a needle in my spine. I thanked the shot again. I leaned on the MW. Suddenly I thought someone had splattered boiling water down my left leg. I jumped and looked to see who'd dropped a cup but the MW just told me not to move. It was just the needle hitting a nerve. I laid back and they raised the curtain. I zoned out. The part of my brain not "calmed" by the shot wondered where Jason was.

Finally he came in. He seemed surprised they'd already started. Apparently he'd gone to get a cup of coffee and they couldn't find him.

It's all a blur from there until at 1 am I heard the doctor say, "Oh, what a beautiful baby." I remember wondering whether he said that about all the babies. I tried to look and see but the curtain was in the way. By the time they brought her to us she was clean and swaddled and had a little cap on, but she was the most beautiful thing I'd ever seen. Her face was so pink and her eyes were closed and she looked so peaceful. They handed her to Jason and I reached up and touched her cheek and said hello. I laid there with my hand on her cheek for god knows how long. It seemed like ages.

I started to realize that I felt a vague burning sensation in my abdomen. I told the anesthesiologist that I felt something. He asked me what it felt like and I thought for a second and said, "it feels like fingers in my belly." He said, "Let's get you a shot of morphine." They don't tell you this, but morphine makes you itch. It was terrible, it started in my nose, then my face...neck...chest. I was trying to focus on the baby but I was so itchy and I'd been laying there for so long.

Finally they finished and I was able to hold my baby for the first time as they rolled me back to my room. For a few moments all was right with the world. It wasn't so bad. My baby was healthy and I was OK. As soon as they parked my bed I put Nora to my breast and she latched right on. I was so happy. I slept with her all night in my bed with me, nursing and snuggling.

The next day I was in the bathroom when I heard my usual midwife come in my room. It was the first time I'd seen her since that Friday she'd sent me for the NST. I sat there in the bathroom afraid to come out and started crying. I couldn't face her. The last time I'd seen her I was pregnant and happy and confident and now I'd failed. She was going to be disappointed in me and I was scared to look her in the eye. I tried to clean off my face and look like I wasn't crying and walked out to see her. That was the first time I pretended like it didn't matter but it definitely wasn't the last."

Finding the Right Practitioner

2009-06-18T23:06:00.000-07:00

If you are hoping to attempt a VBAC it is crucial to find a caregiver who is supportive, encouraging, and trusting of VBAC's. They should also be knowledgeable and experienced in VBAC deliveries. It is important that your caregiver be comfortable and confident in order for you to feel safe and trusting in them and their judgement. Unfortunately it is becoming more difficult to find a caregiver who will offer the choice of a VBAC. I feel this is because of the fear of lawsuits and the high cost of insurance doctors and hospitals have to pay if they are doing VBAC's, not to mention the money they make by preforming surgery instead of allowing VBAC. I of course personally prefer midwives but there are good VBAC doctors out there as well. I suggest taking the time to interview a few different practitioners to compare their responses and attitudes to really have a better feeling as to which one is really going to help you the best to achieve the birth you desire.. Discuss with them your desire to have a VBAC, your goals and preferences and find out their philosophies, experience, success rates, and how they will work with you to have the birth you desire. If their responses don't satisfy you, or they don't seem like they would be supportive of your decision, if they have too many protocols to follow, etc..I would suggest finding someone who is a better fit. Also if you have different hospital choices or birth centers I encourage you to visit them and find a place you would be most comfortable in.

Sometimes doctors seem supportive but as time goes on they change their tune. I have heard many stories of this happening. Hopefully if you get that feeling you will be able to change and find someone who truly is supportive. I had a friend who did that in her last trimester and was so grateful she did. So how do you go about finding one who is truly pro-vbac? Here are some things to keep in mind when first meeting your caregiver:

They should believe that women should labor unless there is a medical reason not to, and talk about the benefits of labor for the mom and baby.

They should respect the woman's right to make the ultimate decisions about their birth.

They should view pregnancy and birth as a natural process, not treated or viewed as a medical condition.

They do not have policies that discourage VBAC such as having a "big baby", gestational diabetes, pregnancy going past 40 weeks.

They should have a high success VBAC rate of 70%.

They should show acceptance of your choice to have a doula present if that is what you want.

They should not routinely use interventions during labor.

To understand their views on the above subjects here are some good interview questions to ask:
I got most of these off of the ICAN website.

What are your beliefs about birth and prenatal care in general?
What are your beliefs about VBAC births and prenatal care?
How do you feel about VBAC delivery? Do you support VBAC?
Do you feel a VBAC is a safe option for women?
Approximately how many VBACs have you attended?
Of those patients in your practice who wanted a VBAC, how many were successful?
What do you think my chances are of a VBAC success, given my childbirth history?
What is your rate of cesarean sections and under what circumstances do you usually advise them?
Are VBAC patients treated any differently than patients who have never had a c section?
Who is your back-up? Is he/she VBAC friendly? Would he/she support my birth plan?
What hospital(s) do you have privileges at? (Which would you recommend for a VBAC?) (Natural birth?)
What book(s) would you recommend that I read?
Are you familiar with ICAN?
What prenatal tests/procedures do you usually require? Recommend?
What do you think of Birth Plans/ Preferences?
How do you usually manage a postdate pregnancy? Or a suspected Cephalopelvic Disproportion (CPD)?
Do you have a vacation scheduled near my estimated due date?

Questions regarding Labor & Delivery

What’s a reasonable length of time for a VBAC labor if I’m healthy and my baby appears to be healthy?
Do you know any kind of restriction I should expect from the hospital on a VBAC? (Who do I need to have policy exceptions approved through?)
How many people can I have with me during the labor and birth?
How do you feel about doulas?
What is your usual recommendation for IVs? Pitocin? Confinement to bed?
What’s your approach if the bag of waters has broken at full term but the mothers feels no contractions?
How often do women in your care give birth un-medicated? How many with minimal medication? In what percentage of your patients do you induce labor?
Approximately how many of your patients have un-medicated births?
Do you do breech deliveries?
What would you suggest if I had another breech baby? (Before labor? During?)
At what point do you arrive at the hospital during labor/delivery?
What labor positions do you recommend to your patients? Do you encourage movement during labor?
How much fetal monitoring do you routinely use during labor? Intermittent?
Do you allow light eating/ drinking during labor? Does the hospital?
Are you OK with No IV – but a Hep Lock?

Increase your VBAC chance--Decrease Cesareans

2009-06-18T22:58:00.000-07:00

Even though about 80% of women have successful VBACs I think it is important to be proactive to help increase your chance for VBAC and decrease your chance for a repeat c-section. We shouldn't just sit back and hope for the best, but seek out ways to improve our chances and be prepared.

I think the most important way to increase your chance for a successful VBAC is to find a doctor or midwife that 100% supports and encourages your decision. They should be offering advice on how to be successful and not focus on what would cause you to not be successful. Some doctors might be tolerant of your decision or say "well, you can try" while others help you realize that you can do it! Those that are "tolerant" are usually either looking for reasons/excuses to end up with a c-section or if anything seems at all "abnormal" might just end up saying you need to have the c-section. I have even heard of some that seem supportive, only in the last couple weeks of pregnancy totally change their tune and recommend a c-section. When that happens many women feel it is too late to change doctors so end up with the c-section they were trying to avoid and often times was not necessary. It is important to take the time to interview a few different people and to ask the right questions so you can really see what their philosophy is. Don't just end up with someone because you used them before or your sister/friend uses them and says they are good, or they are the closest, etc. To increase your chances it is necessary to find just the right person. I highly recommend midwives but also know there are some great very pro-VBAC doctors as well. You might even consider hiring a doula to help and support you through your delivery.

In my research I found these other tips to also better your chances of having a successful VBAC.

Wait at least 9 months before trying to conceive again, even longer is better: I think I was actually told wait a year before trying to get pregnant again while others say even 18 months. I know the longer you wait allows your scar to heal better and become stronger, which is what you want to help decrease any chances for problems with the scar that could lead to complications and a c-section.
Avoid induction of labor, whenever possible: My research said that induction agents can increase the risk of uterine rupture. Along with that though is that inductions significantly increase the likelihood that you will end up with a c-section---this is true in any vaginal birth, not just VBAC. Because you don't want to be induced you need to find someone who will not pressure you to be induced due to being "overdue" or for having a "big baby". If for some necessary medical reason you need to have labor induced you should avoid the cervical ripening agents such as prostaglandin found in Prepidil, Cervidil, Cytotec.
Avoid use of synthetic oxytocin (Pitocin or "Pit") early in labor:
Avoid interventions: Some of these were listed above but the more interventions that happen during any birth have greater likelihood for ending up with a c-section.
Wait until your cervix is beginning to open to be admitted: You are less likely to have a VBAC if you are admitted before your contractions are well-established. If you go to the hospital before labor is under way the more interventions are usually pushed on you as well. Also some hospitals have time limits for how long they allow VBACers to labor.
Avoid epidurals and spinals: A common side effect of these pain relievers is that they slow down the baby's heart rate. This is also a symptom of uterine rupture so even though it most likely would be the side effect of the drug most doctors would push for a c-section whenever the heart rate drops even when they are unsure of the cause. I had my baby naturally and there are many techniques, positions, etc. that can ease the pain. I will talk more about these in another post.
Work on a healthy diet and exercise: The stronger our body is will help during the hard work of delivery. I already talked about the diet changes my midwives suggested but I will list them again: going off sugar, limiting wheat and carbs, no milk, lots of protein, taking magnesium.
Healthy mental well-being: Take the time to process and work through whatever emotions you went through after your c-section. Don't ignore or suppress them. Visualize the whole labor, pushing, and delivery with the beautiful outcome of a precious baby and a successful VBAC. Positive outlook can do wonders for the mind and body.

VBAC risks

2009-06-05T21:34:00.000-07:00

Of course the main risk everyone hears about is the risk of uterine rupture. This is what most doctors bring attention to, unfortunately sometimes too much. Yes, this is a real and serious risk but as I have said before the risk is less than 1%. Since I want us all to be informed this is an important topic to discuss.

So what is uterine rupture anyways? There are different degrees of rupture. The least likely is a complete rupture. A complete uterine rupture is a tear through the full thickness of the uterine wall, usually at the sight of the previous c-section scar. A minor rupture is also known as a dehiscence or window. This is when the opening is very small or does not go through all the layers of the uterus.

If this occurs it is serious and potentially, though rarely, life threatening to the mother or the baby and needs to be taken care of right away. The rupture can take place during labor or even before. A rupture can also happen in women who have never had a previous c-section.

Usually there are warning signs before a rupture occurs but not always. Some warning signs include: vaginal bleeding; sharp pain between contractions; contractions that slow down, become less intense, or stop; abdominal or uterine pain; bulging under the pubic bone; sharp pain at sight of scar; low blood pressure; fetal distress; fundus may feel "boggy" or seem to be expanding; the baby can be clearly felt in the abdomen; woman in shock; extreme maternal heart beat.

Some of these warning signs occur anyways during birth but it is something to pay attention to and to be aware of. Also women might experience some, all, or none of these warning signs.

Though rare it can be serious and cause minor to major complications. When medical response is quick usually mother and baby do well. It is wise to have surgery available within 30 min for the best outcomes. In minor dehiscences there is usually no risk to the mother or the baby. For ruptures, they can happen in the lower segment of the uterus, the upper segment or where the two join. A rupture in the upper segment is the rarest but also the most serious because the baby could leave the uterus and move into the abdominal cavity and it has the most blood supply so the mother would lose the most blood and the baby would be deprived of oxygen. More likely the rupture would be in the lower segment where the baby still stays in the uterus and the mother loses less blood. Both of these would require an emergency c-section.

Fortunately if a rupture occurs mother and baby are usually fine. If a rupture occurs with excessive bleeding a clamp of an artery is needed and in some serious cases the woman might need a hysterectomy. In extreme cases when the bleeding can't be stopped a woman can go into cardiac arrest and death can occur. For the baby due to loss of oxygen brain damage can occur along with the rare risk of death.

Remember there are risks in any birth, c-section or vaginal. Although rare, death and serious complications can also happen during any birth. I found a website that put it all in perspective for me. The website is http://www.birthrites.org/uterinerupt.html. Here are some statistics from that site.
Risk of mother dying due to uterine rupture during VBAC---.0095%
Risk of mother dying in any vaginal birth---.0098%
Risk of mother dying during c-section---.0409%
Risk of mother dying during repeat c-section---.0184%
Risk of baby dying due to rupture during VBAC---.095%
Risk of baby dying during any VBAC---.2%
Risk of baby dying during any type of birth---.12%

So as you can see the likelihood of a fatal outcome of a uterine rupture is no higher than in any normal birth and actually a lot less than in c-sections. This is important to realize in case your doctor or anyone else stresses on the risks of uterine rupture in VBACs.

***Most of this info was taken from http://www.birthrites.org/uterinerupt.html

http://www.obgyn.net/displayarticle.asp?page=/pb/articles/uterine_scar_rup

http://www.drspock.com/article/0,1510,5926,00.html

Why not just schedule a C-section?

2009-06-01T15:22:00.000-07:00

I realize this is a very personal choice and there are risks with both but after doing my research and learning about how there are more risks with a c-section I personally would never just schedule one. I explained before too that the only way for me to know if I could do it was to try.

Most women will be successful with the VBAC---80%. Even though my midwives never used a scoring system with me, I read that some doctors use a scoring system to try to figure out the likelihood of the patient ending up with a vaginal birth. The scoring goes from 0 (least likely) to 10 (most likely). This might be helpful but again I would be careful because of course it isn't always correct. Just because a doctor gives you a low likelihood score does not mean you can't succeed. The studies found that half the group that scored 0-2 still were able to have a VBAC.

So if the high success rate doesn't encourage you to try for a VBAC instead of just scheduling surgery there are a lot of other reasons I personally would not want a repeat c-section. Here is what the research shows:

There are increased physical problems for mothers: Compared to a vaginal birth, c-sections have increased risks for many physical problems from mild to severe. These problems include hemorrhage (severe bleeding), need for transfusion, blood clots, injury to other organs, bowel obstruction (due to scarring and adhesions from the surgery), anesthesia complications, scar tissue, longer-lasting and more severe pain, infection, increased risk of hysterectomy, psychological complications and maternal mortality 2-4x greater than vaginal birth.

Longer Hospital stays: Usually women need to stay longer in the hospital after a c-section and takes a lot longer to recover as well.

More expensive: C-sections cost a lot more even with having insurance. Average cost is twice the amount of a vaginal birth.

Issues with emotional well-being: I already mentioned how this can take a toll on your overall mental health and how after a c-section women are more likely to experience depression and even post traumatic disorder. She is also more likely to rate a birth experience poorer than a woman who has had a vaginal birth.

Mother-baby relationship: You usually don't get the chance to hold your baby until quite a while after surgery as compared to usually immediately after a vaginal birth. Even though I never experienced this many women have a harder time bonding with their baby.

Breastfeeding: Many times the recovery from surgery can cause challenges with breastfeeding and delays immediate breastfeeding along with having your milk come in later. I remember being in so much pain it was difficult to even find a position that was bearable.

Effects on babies: Studies have shown that many c-section babies experience added difficulties as well. Such as having breathing difficulties, greater chance of developing asthma and also being cut during the surgery, though usually mild. Also there is more chance that the baby is not ready to come out out yet when a c-section is done early and has issues concerning prematurity.

Impact on any future pregnancies: Some research suggests babies born after multiple c-sections are more likely to be preterm, have low birth weight, along with more serious and deadly complications. With each surgery there is more scar tissue which makes things more difficult as well. There is also higher rates of infertility, miscarriages and ectopic pregnancy.

So many times women are told how dangerous VBACs are and are encouraged to just have another c-section making it seem like there are not risks involved. As you can see there are many risks concerning c-sections and I think all doctors should carefully go over these with their patients.
***Most of this information was found on the ican-online.org and vbac.com websites

Necessary C-sections

2009-06-01T15:01:00.000-07:00

There are only a few medical reasons when a c-section would be medically necessary. These are having a prolapsed umbilical cord or placenta previa, the mother has an outbreak of genital herpes or the baby is lying in a transverse position.

According to childbirthconnection.org, almost all care providers, including those who usually encourage VBAC, would strongly recommend planned cesarean in the following situations:

certain uterine scars from a cesarean that aren't the usual horizontal cut made at the bottom of the uterus (low transverse scar): In these rare situations, the concern is that the scar on the uterus may be weaker and more likely to give way (rupture) and cause serious problems than the usual cesarean scar.
- a high cesarean scar that runs up-and-down (vertical or "classical" uterine incision): a vertical incision may have been used if you had a placenta that grew over the opening to your uterus (placenta previa), for some urgent cesareans, or in some cases previous baby was in a buttocks- or feet-first (breech) position. (It is possible to have a low horizontal scar on your skin but a vertical cut on your uterus.)
- inverted T- or J-shaped incision
mother had previous uterine surgery for gynecologic problems, such as for removal of fibroid tumors
uterine scar opened and caused problems in a prior labor: The key point here is that the scar has caused problems before. Many times, scar openings are small, harmless "windows" (dehiscences). These windows are not thought to have any ill effects in future labors.
uterus does not have the usual pear shape: Examples of this are a heart-shaped (bi-cornate) uterus or a uterus that is partly divided down the middle (septate uterus).
ultrasound in late pregnancy finds that the area of the scarred uterus is unusually thin: There may be a concern if the scar is 2.5 millimeters thick (about the height of 2 stacked dimes) or less.

Birth Story

2009-05-19T14:44:00.000-07:00

I love hearing everyone's birth story and I am finally getting around to writing about my successful VBAC. I hope after reading mine you will also take the time to share your birth story with us.

My due date for my baby girl was Oct. 16. I didn't dwell on that too much knowing my first baby was almost 3 weeks late. Although I was definitely hoping not to go that far over this time. My midwives suggested stimulating the cervix in hopes to not go so far past my due date this time. So at each appointment from the end of September she would do that. While at my 38 week appointment I asked her about checking me also and she said I was 50% effaced and about 3 cm. dilated and that the baby's head was very low. That was pretty exciting news even though I knew some people can be that dilated for a long time before giving birth. It just made me feel good to know progress was happening.

Oct. 16 came and went. I was feeling a lot of Braxton-hicks contractions and baby continued to be very active. I was actually pretty sick for about a week before the due date and a week after so it was a good thing I didn't go into labor. I think my body knew I didn't have the strength or energy to get through labor at that point. I was blessed to have grandma come over on Oct. 22 to watch Isaiah while I was able to stay in bed and rest all day, which was a good thing because that night I couldn't sleep well. I had heartburn a lot and then started to feel crampy. I thought maybe things were starting to happen and I might go into labor that next day. Around 3 am I started to feel more contractions and they seemed to be more regular so I started to time them and they were between 4-6 min. apart. I decided to get up and go downstairs and see if they continued. I started cleaning the kitchen (nesting instincts I guess) and the contractions started to come quicker and more intense anywhere between 2-6 min apart and between 45 seconds and 1 minute long. Since they seemed to be picking up we decided to make the phone calls. When I called my midwife she suggested getting in the tub for awhile and see how things were and check back with her in about an hour. When I checked back in and reported the contractions staying regular she told us to head to the birth center.

We left home about 6:30 and drove to Bella Vie and got there about 7:00. It was a beautiful morning with the sun coming out and the mountains in the background with all the farm land around...it was a gorgeous sight.

The wonderful assistant Caroline greeted us and led us to our room and brought us some breakfast, took vitals and brought me a ball to sit on to help open my pelvis. Everything was going well. After a while we decided to go outside and walk along the path outside our room. We would walk a few steps then stop and work through the contraction then walk a little more. The contractions continued to pick up and become more intense.

Around 9:00 they checked me and said I was between an 8-9. That was exciting news! As labor progressed I continued changing positions from sitting on the toilet, to squatting while holding on to the bed post, to sitting on the ball while being in the shower. I really encourage all that movement, it really helps. During it all they kept reminding me to keep my noises low and deep. Everyone from my husband, sister, and midwives were there giving me support, helping me any way they could, taking care of me, rubbing my legs and my back...they were all wonderful.

Just before 12:00 pm they asked if I wanted to get in the tub---I'd been waiting for that! I was really looking forward to having a water birth. Before getting me in the tub they had me lie on my side on the bed and checked me again. They said I was about 9 1/2 cm! Soon after I had the urge to push and began pushing. It came on so suddenly I didn't get the chance to get to the tub and just stayed on my side on the bed. After about an hour of pushing my baby girl was here! It was an amazing and wonderful birth.

My baby girl, Kylah, was born on Oct. 23 at 1:06 pm. She was 20" long and weighed 8 lbs. 7 oz. The birth was definitely intense but so beautiful at the same time. It was so empowering to be able to have an all natural vaginal delivery. It was an awesome experience, and a beautiful baby girl. I was truly blessed!

Advice From Midwives

2009-05-17T22:49:00.000-07:00

Along with researching on my own, my midwives also had some advice for me to better my chances of a successful VBAC.

One thing they had me take was magnesium. It has to be the Magnesium aspartate or Orotate because any other form of magnesium is not helpful. They have done their own informal "studies" that showed this type of magnesium helped women have a better and shorter labor. I was all for that after 30 hours with my first one!

As for my diet, they of course wanted me to eat healthy, but they really wanted me to go off sugar, milk, and wheat. The sugar wasn't too bad---I wish I still had the will power to be off of it entirely now. :) The milk I substituted unsweetened Almond milk, which I didn't mind at all. I prefer the Blue Diamond Brand though. For the wheat, I didn't totally eliminate, but I did cut down. Some of the reasons they asked me to make these changes were, for one, they are healthier but also to not have my baby's growth on these empty calories that could tend to grow a bigger baby. Not to say you can't give birth naturally to a big baby but to just help me in maybe having a little bit of a smaller baby this time. They also suggested eating lots of protein to keep muscle integrity as strong as possible. Also to cut carbs as much as I could, suggested goat protein powder, spiralina, lots of good veggies, and drinking kefir.

They of course wanted me to keep my body strong and ready for labor so encouraged exercises like walking, pelvic tilts, squatting and being on my hands and knees.

So I don't know if all these things really did help, but as for the shorter labor I went from 30 hours to 10 hours. I gained a lot less weight from 40 pounds to 17 pounds, and my baby was smaller from 9 lbs. 6 oz. to 8 lbs. 7 oz. Who knows if these things had any contributing factors to any of these outcomes, but I was wanting to try anything that might potentially help increase my success in having the VBAC I wanted, so I thought I would pass it along to you in case you might benefit from these changes as well.

Resources

2009-05-13T15:15:00.000-07:00

I wanted to list some books, movies, websites, midwives, etc... that I found helpful or have had recommended to me. If you have any other recommendations please leave a comment.

Books
The Birth Book--Dr. William Sear
Pushed--Jennifer Block
Silent Knife: Cesarean Prevention and VBAC--Nancy Wainer Cohen

Movies
Business of Being Born

Websites
www.vbac.com
www.ican-online.org
www.childbirthconnection.org
www.childbirth.org/section/VBACFAQ.html
http://nursingbirth.wordpress.com
www.pushedbirth.com
http://yourbirthright.info
www.mothering.com

Midwives (Oregon--Willamette Valley)
Bella Vie Birth Center---www.gentlebirthcenter.com

Blessed With Support

2009-05-12T15:00:00.000-07:00

As I said before I was well informed about VBAC. The number one thing I can tell you helped besides my supportive family and faith was having wonderful midwives who were 100% supportive and encouraging of my decision and who really believed I could do it. I have heard of many who had a doctor who said they could try but you knew deep down they weren't supportive and any chance they got to go ahead with another c-section they would. I encourage you to find another doctor/midwife if you feel they aren't supportive 100%. They should be telling you they believe you can do this instead of giving you excuses as to why you won't be successful. That will make a huge impact on the success of the VBAC.

So as my pregnancy went on I was getting more and more excited. I was still nervous and anxious at times but I was able to deal with those emotions and overpower them with positive ones. I realized it was best for me to deal with these emotions instead of just try to ignore them. My midwife asked me one day what would be the worst thing about having to be transferred and told me to think that over but then to realize that if by chance that were to happen it wouldn't be the worse thing because I would know 100% that I had done everything to try to have a VBAC and I would know it was completely necessary.

Talking to others really helped. I even found two others from my mom's group at church who were trying for VBAC's as well. It was great getting to know them and be able to share with others who were going through the same thing and feeling many of the same emotions. That is partially why I wanted to start this blog because for me having the support of someone who had gone through it too was really a blessing. I hope sharing my story will be a blessing, support and encouragement to you.

Being Informed

2009-04-29T16:04:00.000-07:00

I wanted to be someone who took the time to be informed on the subject of VBAC. Of course I had heard different ideas and I wanted to have the knowledge so when I heard inaccurate information I would know the truth.

I had done plenty of research along the way and was knowledgable and informed about VBACs. I was so thankful to have supportive midwives. I know of so many doctors that use scare tactics to discourage a women from considering a VBAC. Our countries cesarean rate is outrageous and I am saddened that so many women are not allowed to have a natural birth. Doctors are so quick to stress the risks of having a VBAC but don't mention the risks of a c-section. Did you know there are more risks in having a repeat c-section than there are in having a VBAC?

I am going to list some of the ideas I had heard and what I learned through research. I'm sure many of you have heard these same things so hopefully what I learned will help you too but of course I also encourage you to do your own research too.

#1 "Once you have a c-section you always have to have a c-section"---this of course is not true. Chances are you will be able to deliver your next baby vaginally. According to childbirth.org more than 80% of women will have successful VBACs.

#2 "They tell me the baby is too big or my pelvis is too small"---True Cephalopelvic disproportion or CPD---where the baby is thought to be too big to fit through the pelvis--is very uncommon. According to Dr. Sears, "in most cases the births could just as easily been labeled failure to progress." Better positions such as being more upright, and squatting can enlarge the pelvis making it easier for the baby to find a way out. Many experts believe a true diagnosis can only be made after laboring for awhile any ways. To go along with this I have heard many stories of women who were told their baby is too big and had a c-section only to have a VBAC with the next child and delivery a much bigger baby. Also doctors may rely on ultrasounds and say the baby is too big when ultrasounds are not very accurate and can be a pound or more off. Since they are so inaccurate you should not be told you need a c-section because of the size of your baby.

#3 "Your uterus will rupture"---Most incisions now are made low and transverse (horizontal) and are very unlikely to rupture. It is now estimated uterine rupture occurs in less than 0.2%. Even though the term sounds scary, it does not mean your uterus suddenly explodes. What can happen is the previous scar gradually pulls apart. There are signs if this is happening and it can be detected by electronic fetal monitoring. This risk is so small, having a VBAC is still less risky than having a c-section.

#4 "It is safer to have a C-section, VBACs are dangerous"---According to the Birth Book by Dr. Sears "researchers studying the medical literature on VBAC over the last 40 years found not a single mother died from uterine rupture but mothers have died due to complications of repeat c-sections. The estimated risk of death from c-section is around one in one thousand, which is two to four times that of vaginal births."

These are just some of the reasons you might hear as people try to misinform you with reasons to not do a VBAC. If you have experienced any of these or other misguided information that you have heard or overcome please share your story so others won't be misguided. As I said before I encourage you to do your own research that way you too can be informed.

U-Turn

2009-04-24T15:46:00.000-07:00

As my pregnancy progressed I found myself revisiting the events and feelings of my first birth. I desperately wanted a totally different birth experience. I had fears of having a repeat c-section. I had confidence that I would have a successful VBAC but at the same time little thoughts of doubt would enter. I never was worried about the actual VBAC, I was worried about another birth happening in a different way than I had hoped and planned for.

Some doubts caused me to think what if I end up needing another c-section? I thought of the money it would cost because I would be paying for the midwives and then the hospital. I thought of my mental well being if I had to go through it all again. Those doubts would come and go throughout the beginning of my pregnancy.

So how did I overcome it? During my research I found out that even if I ended up with another c-section going through the labor was definitely beneficial to me and the baby. Also knowing that the baby was ready to be born rather than automatically scheduling a c-section when the baby might not be ready. I also realized that if I tried for a VBAC and for some reason it didn't work I would know that the c-section was absolutly necessary. I knew if I didn't try than I would always wonder if I could've done it. So there was no doubt in my mind that I wanted to try.

Wonderful News

2009-04-21T16:43:00.000-07:00

In February of 2008 I found out I was pregnant! We were so excited and couldn't wait to bring our new baby into this world. Now I had to figure out how and where I wanted this delivery to happen. I was still considering the idea of another homebirth but also decided to look into hospitals or birth centers that did VBACs. I found out that if I wanted a hospital birth I would need to travel outside my area. I briefly considered that but quickly realized I didn't want a hospital birth.

One day I decided to just look up midwives in my phone book and came across a name of a birth center. I was intrigued because I knew there were no birth centers in my area when my son was born. So I quickly looked them up on the internet and was so excited. I made an appointment to go visit Bella Vie Birth Center.

My husband and I were amazed when we took our visit and met with the midwives. It was a gorgeous place and the midwives were great. We both knew instantly that was the place we were going to have our baby!

Similar Emotions

2009-04-21T16:12:00.000-07:00

Whatever emotions you may have after your c-section are perfectly fine, and don't let others tell you otherwise or make you think you shouldn't have those feelings. Take the time to process, grieve or as some say mourn the birth. In my research I found many websites and books that talked about the mental effect c-sections can have on women and it was comforting to know I was not alone. "Many women recover fully physically and emotionally from a cesarean birth, others do not."--Nicette Jukelevics, MA, ICCE.

One great website is www.ican-online.org. This quote I read seems to sum up how I was feeling. "Realize that there is more to birth than a "healthy baby" and that even the healthiest of babies can come through a traumatic event to the mother. You have the right to mourn your birth and your trauma while celebrating your child. These are two different events in your life, even if they are happening simultaneously."

So you can see how you can have different emotions from overwhelming happiness in having a precious baby but at the same time a sadness of how the birth happened.

On the website http://www.vbac.com/emotionalscars.html they even show how women who have c-sections are more likely to have postpartum depression and even Post-traumatic stress disorder.

So as I said before let your emotions come out and if you need to talk to someone to help you through it I encourage you to do that. If you have gone through similar emotions I would love for you to share. Hearing that these feelings are ok and normal can help another person tremendously. It took me awhile to sort through my own feelings but as time went on I healed. However a few years later all of that came flooding back to me and I again had to take time to process.

Road to Recovery

2009-04-20T15:57:00.000-07:00

So I was so delighted and blessed to have a healthy baby. The physical recovery from the c-section was extremely hard but the mental recovery took the longest. Some people might not understand, they say you had the baby why did it matter how he came? Yes, the outcome of having a beautiful, healthy baby was the same but the road getting there took such a drastic turn that I had to process it all...and that took some time. Thankfully with a loving family, supportive friends, and my faith I accepted that for unknown reason's that was God's plan for me. I know I have talked to others who have gone through a similar experience and since I started this blog as a a place to support one another and a resource for some, I would love it if you would share your story on here as well.

A Look Back

2009-04-18T16:12:00.000-07:00

In 2006 I was blessed with my first baby. How happy I was with having a new baby but I was having a hard time getting past how my birth experience had gone down a totally different path than what I hoped and planned for. I never thought I would ever have a homebirth but after some events that changed my mind I had decided to go in the direction of having just that.

I was going to have a natural childbirth and hopefully a water birth too. I had taken the Bradley childbirth class and felt more prepared to have my baby naturally. I was nervous just like any first time mom is, but of course couldn't wait to meet my precious baby.

So the due date came and went. Then days, weeks passed by. Finally almost three weeks past the due date I went into labor. It was strong, hard, exhausting labor that was just not progressing. After 20 hours and only at a 7 dilation we made the decision to go to the hospital. I couldn't believe I was going to the hospital but I was so exhausted I decided to have an epidural in hopes to be able to rest and renew my strength. I was also given pitocin to hopefully make some progress. Those decision did not help. After another 10 hours and some drops in the babies heart rate I was informed I needed to have an emergency c-section. I remember being in shock, and crying uncontrollably and wondering how this had gone down such a completely different path than what I desired. That was hard to accept and come to terms with. So many different emotions, thoughts, and fears enveloped me as I was wheeled in for that emergency c-section. Then joy and an abundance of love thankfully overshadowed those earlier emotions as my beautiful baby came into this world!

Beginning the Path

2009-04-18T15:47:00.000-07:00

For the past few days this idea just kept coming to me to find a way to start supporting and encouraging other people who are considering a VBAC. I thought if sharing my journey could help someone else than I wanted to do it. I am not an expert but I have done a lot of research and believe that being informed is the first and most important step. So I wanted to share some of the information I found out in hopes to give others knowledge and the desire to continue with their own research. I also wanted to share my story and let others share their stories. I wanted a place where questions could be asked, feelings expressed, encouragement given and joys shared. I want to share my passion with others and hope to help someone along the way who is thinking about journeying down the same path. The path to VBAC!