Empowering Birth Blog

VBAC Success Increases with Increasing Number of Prior VBACs

I find it interesting that moms who attempt VBAC (vaginal birth after cesarean) in our area seem to be treated the same whether or not they have had a prior vaginal delivery.  Once upon a time, I am told, VBACers with a prior vaginal delivery were "allowed" to deliver at a birth center, but that was several years ago.  I am hoping recent research will encourage doctors to be more supportive of moms who have had prior vaginal deliveries and would like to have a VBAC. A new study, Labor Outcomes with Increasing Number of Prior Vaginal Births  After Cesarean Delivery, had these results:1

 

Among 13,532 women meeting eligibility criteria, VBAC success increased with increasing number of prior VBACs: 63.3%, 87.6%, 90.9%, 90.6%, and 91.6% for those with 0, 1, 2, 3, and 4 or more prior VBACs, respectively (P<.001). The rate of uterine rupture decreased after the first successful VBAC and did not increase thereafter: 0.87%, 0.45%, 0.38%, 0.54%, 0.52% (P=.03). The risk of uterine dehiscence and other peripartum complications also declined statistically after the first successful VBAC. No increase in neonatal morbidities was seen with increasing VBAC number thereafter.

To repeat, after one prior VBAC, your chance of success jumps from 63.3%-87.6%!  That is no small increase.  I  can't help but suspect your chances for VBAC success might be greater with an HBAC (home birth after cesarean), assuming you feel safe at home.  Many women who VBAC in hospitals require continuous fetal monitoring and are subject to staff who are nervous about VBACers, not exactly the best environment in which to let go, trust your body, and open up.  I know the VBAC success rate of my midwife's VBACing clients is greater then 63.3% and she has attended quite a few VBACers in her day.

1 Brian M. Mercer, MD, "Labor Outcomes with Increasing Number of Prior Vaginal Births After Cesarean Delivery,"  Obstetrics and Gynecology 111 (2008):285-291.

Fen is Weaned...

My goal was to wean Fen as gently as I could.  Knowing that nursing is painful for me during pregnancy (I nursed Khady the first three months of my pregnancy with Fen and gave it up due to the discomfort), I started the process of weaning shortly after I became pregnant.  As I approached six months, I was successfully nursing Fen only every two or three days and hoping my milk would hurry up and dry up!  Last Tuesday (Feb. 12) Fen asked to nurse before bed.  I said, ok but I think the milk might be all gone.  Sure enough, he nursed on one side and said, "all done, other side?," and then nursed on the other side for about thirty seconds only to declare "all done too."  So the milk is all gone and the weaning process complete.  He asks every now and then but I remind him that he tried and the milk was all gone and then distract him, which works.  Six months pregnant with very sore nipples, I am happy that the nursing is over but even more content that I was able to wean him gradually and with very few complaints.  Though it does tear a bit at my heart strings to have to wean a two year old who, without mom's gentle but firm efforts to redirect, would not have stopped nursing so soon...

Scrubs Star's Wife has Home Waterbirth

Maybe the ACOG statement "Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre" was referring to the recent press on celebrities having home birth.  After Ricki Lake's home birth, I was strongly leaning towards following in her footsteps but now that the wife of Scrubs star John C. McGinley has had a home birth, I will definitely have one!  Just kidding.  I do appreciate the positive press for home birth though!

The Struggle Between Midwives and Doctors

I was out of town reading a fantastic novel, The Birth House, when ACOG decided to release its latest "Statement on Home Births."   Much of the book is about the battle between midwives (traditional wisdom) and doctors ("science").  In her Q and A at the end of the book Ami McKay, the author and journalist, writes: "When I began researching the history of midwifery in North America in the early 1900s, I was horrified to find how aggressive the obstetrical community had been in campaigning for the elimination of midwifery....Doctors actively went to women's organizations and club meetings, discrediting midwives and telling women they were bad mothers if they didn't choose a hospital birth with a physician."1

ACOG's statement made me realize that the campaign against midwives presented in The Birth House continues today.  ACOG notes: "Attempting a vaginal birth after cesarean (VBAC) at home is especially dangerous because if the uterus ruptures during labor, both the mother and baby face an emergency situation with potentially catastrophic consequences, including death."  This statement is no less of a fear-mongering tactic then those used by obstetricians in the time of The Birth House.  Midwifery Today offers a snapshot of one of these prominent obstetricians (c.1920):

Dr. Joseph DeLee, author of the most frequently used obstetric textbook of the time, argued that childbirth is a pathologic process from which few escape "damage." He proposed a program of active control over labor and delivery, attempting to prevent problems through a routine of interventions. DeLee proposed a sequence of medical interventions designed to save women from the "evils" that are "natural to labor." Specialist obstetricians should sedate women at the onset of labor, allow the cervix to dilate, give ether during the second stage of labor, cut an episiotomy, deliver the baby with forceps, extract the placenta, give medications for the uterus to contract and repair the episiotomy. His article was published in the first issue of the American Journal of Obstetrics and Gynecology. All of the interventions that DeLee prescribed did become routine.2

There have been some fantastic responses to ACOG's misguided release.  Check out  ICAN's response (The International Cesarean Awareness Network).  The Big Push for Midwives Campaign tells it like it is: "ACOG: Out of Touch with Needs of Childbearing Families Trade Union claims out-of-hospital birth is “trendy;” tries to play the “bad mother” card."  And for a fabulous blog response, check out House of Harris.

Instead of struggling, perhaps midwives and doctors could work together!  Check out this joint statement on home birth from The Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists.

1 Ami McKay, The Birth House (New York: Harper Perennial, 2006) p. 5 of the QandA.
2 Adrian E. Feldhusen, The History of Midwifery and Childbirth in America: A Time Line (Midwifery Today, 2000) http://www.midwiferytoday.com/articles/timeline.asp.

It's Been a Year Since My HBAC

Thanks to Tami for sharing the beautiful story of her HBAC (Home Birth After Cearean)!

Emma, yesterday for the first time in your life you stood up without any assistance and walked to me.  You had a gigantic grin on your face, showing me all six of your teeth, and you laughed as you took each step, so proud of yourself.  It amazes me that it's been a whole year, and that a year ago today you were engaged in the first great journey of your life.

Your daddy and I had found out around Mother's Day that we were expecting another baby and we were so excited!  I immediately started searching for a midwife who would help me have my baby safely at home.  After several interviews I chose Peggy Franklin and I felt very comfortable and peaceful about the idea of having my baby at home.  Your brothers' births each presented their own challenges because of the hospitals and doctors, and I wanted to have a peaceful birth experience this time, and to give you the best chance of having a gentle birth.  We expected that you would be born around January 20th.  As that day came and went, I grew a little discouraged.  Finally we decided that we would wait until Valentine's Day if we needed to (as if we had much of a choice in the matter).

The morning of February 1, I woke up at 4:30 and went to the bathroom.  I felt fine, nothing unusual.  I sat down at the computer to check my email and do some work before the rest of the family got up.  Within a few minutes I started feeling contractions.  I stayed at the computer for nearly an hour while the contractions got stronger and more frequent.  By 5:30 I knew it was time to call the midwife and wake up your daddy.  Daddy got to work getting the pool ready--he had a hose that he had planned to use to fill the pool, but it was frozen, so he drove to Home Depot to get a new one.  I called Peggy, who had just left another birth, and we decided she should come right away.  I set out towels and a washcloth for her so she could take a shower when she arrived at my house (since she had been at another birth all night).  My instructions from Peggy had been to make up the bed for birth as soon as I knew I was in labor, and since I still wasn't completely decided about whether to actually have the baby in the pool or in the bed, I got to work on making up the bed.  It took me about 45 minutes to make the bed!  I would get a sheet on one corner, have a contraction, start to walk to the next corner of the bed, have to stop about halfway down the bed for another contraction, then get to the corner and have another contraction... I think I set a world record for the longest time to make a bed.  Once the bed was made I put on my "birth clothes," a bathing suit top and sweatpants, and went downstairs to the living room and sat on my birth ball.  Your daddy was home by then and turned on a HypnoBabies CD for me to listen to.  My favorite blanket was a soft fuzzy blue blanket, so I wrapped that around my shoulders and just rocked on the birth ball.  I threw up once or twice.

At about 6:30 Peggy arrived.  She said I was making good sounds and went up to the bedroom to organize all the supplies that we had piled in a box.  I continued to rock on the birth ball and threw up a couple more times.  Peggy came downstairs and rubbed my back through a few contractions, then she offered to check to see if these contractions were causing any progress.  I figured she would tell me I was at 2-3 centimeters, since it had only been a couple of hours.  I was shocked to hear her say I was at almost 10 and the bag of waters was bulging.  She suggested that I get in the pool if I wanted to labor in the pool at all.

About 7:30 I got in the water.  It felt good, but I didn't spend much time just enjoying the water.  Within a few minutes I sat straight up, leaning forwards slightly.  I had my eyes closed so I lost track of time.  At some point I heard the voice of Aimee, the birth assistant, and I felt relieved that she was there.  Peggy and Aimee both rubbed by back through contractions.  Meanwhile, the boys were waking up, and Daddy got them dressed and gave them breakfast. They came in the kitchen for a few minutes, then went to watch cartoons.  We had planned for a friend to come and entertain the boys while I was in labor, but we couldn't reach her.  Or the other 2 people who had offered to be backups.  I heard Daddy on the phone telling my mother that Emma was on the way.  I heard Peggy on her phone saying things like "how far apart are they?  How strong are they?"--she had a third client in labor at the moment as well.  About 8:15 I started lifting my body off the floor of the pool because I need to push!  Peggy helped me move onto my knees, and then she felt like you needed more room to get out, so she helped me move one leg out of the way.  I was leaning on the side of the pool and we discovered that the valve on the top ring of the pool hadn't been closed tightly, and it collapsed a little--water went all over the floor.  But at that point we were all more focused on getting you out safely!  I was pushing as hard as I possibly could and Peggy and Aimee were saying things like "that's right, millimeter by millimeter, do it slowly."  In my head I was thinking, "that was just a millimeter?"  At 8:29 the bag of waters broke and your head popped out.  Suddenly I felt no more urge to push, and no more ability either.  It felt like an hour but was actually only a minute, with Peggy and Aimee both telling me I had to push harder to get the rest of your body out.

Finally you were born!  Somebody scooped you out of the water and I sat down to hold you.  You didn't cry, you just sat in my arms breathing quietly.  Since you hadn't taken a deep breath, Peggy gave you oxygen for a few minutes.  You looked tired, but after a couple of minutes you woke up and were very alert.  I delivered the placenta in the water and then got up to move to the couch.  My back went into spasms and it was very hard for me to walk, but Daddy carried you, and Peggy and Aimee supported me, and we made it to the couch.  Once we were there and I was comfortable, Peggy weighed you--10 lbs 10 oz!  Daddy said "She's a perfect 10!"  At 9:00 a friend showed up to take the boys for a pre-scheduled play date, which was perfect.  She was the first person outside of the birth team to see you and she cried because you were so beautiful.

Eventually we went upstairs and took to the bed that had been so carefully made up earlier.  I sent out an email message in the morning: "

Emma Jean Conklin was born at home this morning at 8:30 am.  12 days past her due date.  4 hours of labor, a good water birth, no problems or complications.  10 lbs 10 ounces, 21 3/8 inches long.  14 inch head circumference, 15 3/4 inch chest circumference.  She's a big girl, considerably larger than her brothers!  So far the hair looks red, blue eyes, a dimple in her left cheek.  She's gorgeous and doing great.  I'm doing pretty well too--tired and sore, but starting to feel like myself already.  We had a fabulous midwife who did a wonderful job in the last few months helping us prepare for Miss Emma's arrival.  We were the second in a string of back-to-back births she gets to help with today!"

And then we got down to the business of loving you and helping you grow up.  It's still amazing how much you've learned and grown in 12 short months.  We've had some challenges this year.  Your Oompa got sick a few days after you were born and died when you were only 2 months old.  But he did see you and hold you, and he loves you very much.  You got to meet many of your relatives because of Oompa's illness and death, and every one of them raved about what a beautiful and sweet girl you are.  Your brothers have been in love with you since the moment you were born.  Sometimes it's been a challenge to keep you safe from their "love," but you're a strong girl and can handle anything that comes your way.  Daddy and I love you.  Happy Birthday Emma!

Coming Full Circle

At almost six months pregnant, I've started to think more about this upcoming birth.  Khady will be present at the birth and I feel that her presence will complete the journey of healing that I have been on since her birth.  Since the birth of Fenimore, Khady's favorite roles (besides being a princess) are midwife, doctor or pregnant mom. Sometimes her babies are born in the hospital "because the babies are sick of course" but usually her babies are born at home.  She is currently going to be a "nice doctor" when she grows up because we need more "doctors that will be nice to babies."  When we read Richard Scarry's What People Do All Day, she asks why the baby bunny is in the nursery and not with her mom.  Khady proudly announces to all interested that she is big enough to be at this baby's birth.  There was never a question in my mind of whether or not Khady would be at this birth. I've thought a lot about what her presence means to me. I cannot give her a vaginal birth but I can let her be a part of the awesome power of normal birth.  I can help grow the seeds of trust in birth that were planted as she joined me for home prenatals when I was pregnant with Fenimore and watched birth videos together ("play that again" she would shout) on my bed when I was feeling too pregnant to be on my feet.  It feels good to have her share in the excitement of birth as well as the anticipation of having a baby/new sibling to play with and love.  And I know her presence at the birth will help me open my heart even wider while we wait for our newest family member to join us.