Empowering Birth Blog

NIH VBAC Conference

I spent all day today at the NIH VBAC Conference.  You can catch the rest of the conference tomorrow on Webcast.  My head is aching from listening to fourteen presentations, breaking only for lunch.  It is also bursting with questions.  Here are a few:

Why do doctors continue to talk about whether or not we should "allow" certain women to VBAC rather then supporting a woman's right to choose by offering access to VBAC and information on real risks of attempting VBAC or a repeat cesarean delivery?

Why do we call repeat cesareans ERCDs or Elective Repeat Cesarean Delivery (when you have hospital VBAC bans or individual doctors who do not support VBAC, there certainly isn't much election involved)?

If successful VBACs are safer repeat cesareans and failed VBACs, then why aren't we talking about how to increase our rate of successful VBACs?

Why is it acceptable to talk about Obstetrical studies from other countries but not home birth studies from other countries?

Why can't we talk about the difference between VBAC rates based on birth setting (home, hospital or birth center)?  (Instead we talk about university hospitals vs. private hospitals, vs. community hospitals etc.)

Isn't the fact that access to a "trial of labor" would lead to 9/100,000 fewer death a good reason to support VBAC?  (From the presentation "Evidence-based Practice Center Presentation II: Maternal Benefits and Harms and Relevant Factors," Jeanne-Marie Guise, M.D., M.P.H)

Time for some ginger tea and honey.  More tomorrow.

It's 100% if it's your baby!

Anyone heard this comment before?  I heard it again today and it got me thinking.  I remember I heard that phrase frequently when anticipating my first VBAC, from friends as well as care providers (not my midwife).  The comment was in reference to the rate of uterine rupture and went something like this "the rate of uterine rupture may be less then 1% for most moms who VBAC but it is 100% for you if your uterus ruptures."  I wonder why no one ever says, to the mom opting for a repeat cesarean, "I know the rate of maternal death is at least two to four times that of women with vaginal births but if you are the one that dies, it is 100%." (For more info on the risks of cesarean, please see the International Cesarean Awareness Network's Cesarean Fact Sheet.)  I would just like to know why the only "scary" risks seem to be the risks associated with vaginal birth or with opting out of a particular medical test.

VBA2C, This Video Will Bring Tears!

I have a friend who is anticipating her VBAC after two cesareans.  I am going to send her this link but wanted to post it here too.  This video reminded me of the pain I still sometimes feel because I did not hold Khady in the first hour of her life and of the triumph I felt after my first VBAC.  Let's take back that hour! It belongs to us, and to our babies.  Thanks Alexandra for sharing your story!

Cesarean vs. VBAC: A Dramatic Difference from Alexandra Orchard on Vimeo.

Allison's VBAC!

Her Story...

I have attended a couple of ICAN (International Cesarean Awareness Network) meetings in the past 6 months and wanted to let you know that on March 27th my second child was born by VBAC. I delivered at Upper Chesapeake with the midwives from Susquehanna OB/Gyn.  I cannot say enough good things about UC and the Susquehanna practice.  The midwives who I delivered with were Metta and Karen (Metta is new to the practice and Karen supervised the later part of the delivery). The one visit with the OB was with the head of the practice, Jon Bellantoni - who is just terrific and very supportive of VBACs.

I think it's safe to say that the difference between this birth experience at UC as compared to my first unscheduled c-section delivery at Sinai was like night and day.  (My delivery at Sinai in short began with being almost immediately put in bed after one moderately high blood pressure, labored for 40 hours, put on pitocin half way through the labor, and then after not progressing beyond 8 cm and told that the baby wasn't descending, had a c-section).   At UC, I arrived at the hospital after laboring at home from 1:30am to ~9:30am at 6 cm dilated, labored until ~2pm and pushed for about another hour, and then Kate was born at 3:08pm.  No one ever suggested pitocin and I managed to labor through it all without meds (the midwife and l&d nurse were also very supportive of my pushing through without meds - I had made it clear at the outset and my birth plan that I hoped to avoid using meds).

While I was monitored, I was mobile - out of the bed, using a birthing ball, sitting in a chair and squatting at times near the bed.  I barely noticed the monitor, and the nurse who attended our birth was fantastic - not only in her support and labor position suggestions - but no one seemed to insist that the monitor constantly trace the baby's heart beat.  At times when I was in between contractions she would hand position the monitor to get a tracing when the tracing had gotten lost.

My husband and I also hired a doula who was in your ICAN directory, MaryBeth Nance, and she too was fantastic.  She has attended many births at UC.

In closing, thank you to you and your members for planting the seed about Upper Chesapeake.  I know it's not easy to find a VBAC friendly practice.

Another VBAC Around the Corner!

I LOVE, LOVE, LOVE finding emails like this in my inbox!  So good to know there is another empowered mom out there, another VBAC around the corner.  You will be happy to know the below mom already has a meeting scheduled with a super VBAC friendly OB!

Hello! I took your yoga class in 2007, and had my first son summer 2007. I had a c-section because of a late term sonogram (i think I had them too often because of a fibroid) showed him to be 11lbs (riiiight), he came out at 9lbs 4 oz (big, but not 11lbs). Imagine my jealousy (is it alright to say that?) when my sis in law delivered, vaginally, a 9lb 6 oz baby about 2 months after my c section for a "big baby" that was smaller than her "big baby."

Anyway, I was uninformed and now am armed with correct info about big babies and vaginal birth. All that said, I am interested in switching obs to a more VBAC friendly practice, I just found out I am pregnant, have not even told family. 

So my question for you is, what is the protocol for switching docs? Do I go to my old doc and say thanks but no thanks, or go to the new doc and have them get my records?

VBAC Activism: We have a long way to go

I found the below email on a local list.  It was written by our tireless ICAN Baltimore leader.  We have a long way to go...

I recently re-surveyed all of Maryland's birthing hospitals to check on our state's VBAC ban situation and was distressed to learn that a ban went into place in Cecil County two years ago, that Garrett County now says they have had a ban in place since 2004 but which they had not informed me of during previous survey calls, and that Washington County's hospital is telling women that they don't have a VBAC ban in place but if you show up during labor and the operating room is already occupied then you will not be allowed to have your VBAC. Yes I know it is a strange policy considering the question of what they will then do with the laboring woman - stop her labor?

In addition, most of you are aware that that the hospital in Easton Maryland has had a ban in place since 2003. 

I used to be able to brag that due to our activism in Maryland (shutting down both Frederick's VBAC ban in 2006 as well as reversing Washington County's 7 a.m. to 3 p.m. VBAC policy in 2007) we have never had more than two active bans at anyone time. I am very concerned about these new developments and feel we need to stop these bans in their tracks lest we have a spread of bans across the state similar to what has happened in many other areas of the country.

For a comparision, ICAN volunteers across the country recently re-surveyed the rest of the US and there are some states that when you add together official bans along with "defacto bans" (no official policy but no doctor will do them) you reach ban numbers as high as 70%.

So please help me by posting on any email lists you are on in our state to help find women in Garrett, Cecil, and Washington Counties as well as Easton who have been affected by these bans in the past, are currently affected, or will be affected by them in the future. It is simply not possible to raise a rukus without even a small group of women in each area who are affected and willing to speak out and take a few actions against the ban. You are welcome to post my ICAN email address right into the emails for them to contact me directly ICANofBaltimore@comcast.net

-Barbara

Processing Your Birth

At the MANA 2006 conference, I won a free Birth Story workshop with a local CPM.  I wish I had taken this workshop shortly after Khady's birth (my cesarean birth), instead of three and a half years later (but it is NEVER to late to heal).  I received permission from Juji to post these questions on my blog.  I highly recommend answering these questions as part of a journaling session, particularly if you've have had a birth experience that you wish had gone differently.  They made me realize how much regret I still had from Khady's birth, regret that I wasn't close to her while they were sewing me up, regret that I let them take her out of the room for a bath, etc.  Some day, perhaps, I will write the answers to these questions on this blog.  I realize I have yet to post Khady's birth story on this blog, one day soon I must do that as well.

So a big thank you Juji Woodring for letting me post these Birth Story Journaling questions!  Now mamas, find a quiet moment and grab a pen!

When you think about your previous birth, what is your favorite moment?

What moment do you try not to think about, or what moment still bothers you?

What was your most brilliant moment?

Who or what helped you most when you gave birth?

What was your first thought when you saw your baby?

If your baby could speak, what's the first thing it would thank you for?

How did the journey of birth change you?

What do you now know about yourself that you didn't know before?

Another VBAC Baby Born!

Amanda Arnold shares the story of the birth of her son.  Welcome little one!  Thanks for sharing mom!

I'd like to share the news of the birth of my baby boy as well! Shaymus Nathan Arnold is my VBA1C (VBAC after one cesarean) baby. He was born at home on September 4th/ 4:15am into the guiding hands of Karen Carr after just 5 hours of labor. My C-section had been done just 20 months prior in a military hospital after 6 hours of pushing at the end of an induced labor/premature rupture of membranes at 41 weeks. Karen helped to talk me through my fear of pushing I was carrying from my first son's birth, and after pushing side lying, I had a 8lb. 7oz. baby lying at my breast just 45 minutes after her arrival! Shaymus was 21" long and 14 and 1/8" head circumference. The experience was intimate, beautiful, and healing. I am proud of myself and all the women who educate themselves, listen to their bodies and hearts, and go on to experience the births they truly desire, Oh! And I guess I should mention, he was born with a "V" mark on his forehead--which I am sure as a boy he will never tire from hearing stands for Vaginal! ;)

Is Your Doctor REALLY Supportive of VBAC?

Here is a list of questions to help you find out.  Thanks to the NOVA Chapter of ICAN for passing them along.  They apply to midwives as well as doctors of course!

• Of the last 10 women that have come to you originally wanting VBAC, how many were able to have their VBAC? (kind of asking their VBAC success rate, but this number should represent better, as it will be lower if they tend to talk women out of it during their pregnancy)

• What do you think would prevent me from having a VBAC?

• What do you believe are my chances for having a VBAC?

• I have now read more information regarding my previous c-section, and I’m curious to know what your practice would do in the same situation to help me avoid a c-section, either prenatally or during labor?

• Would your practice allow me go to 42 weeks?  If not, how long will I be able to be pregnant?

• If I hit 42 weeks (or whatever gestation you require me to deliver by), would you consider induction, or just schedule a c-section?  If induction, what are my options (ROM*, pitocin – how much, etc.)?

• What circumstances, later in my pregnancy would contraindicate a VBAC and make you recommend a repeated cesarean section?

• If I do go past my due date, what testing requirements do you have (BPP, US, NST**), when will they begin, and how often will I need them?

• Will you recommend an ultrasound to estimate weight late in pregnancy (providers who are nervous about a "big baby" may recommend ultrasound)?

• How do you feel about VBACers birthing "big" babies?  What do you think is "big"?

• When in labor, what stipulations do you have for VBACing moms?  For example, do you require continuous monitoring?  Do you have a time limit for progression in labor (ie, I need to dilate 1cm each hour)?

• Do you require your VBACing moms to have an epidural?

• Where is my placenta located? Anterior, Posterior, lower uterine-segment, Fundus?

*ROM, Rupture of membranes

**BPP, Biophysical profile, US Ultrasound, NST Non-stress test (see biophysical profile)

VBA3C

I've posted this story about a vaginal birth after three cesareans before but I met the mom in the video (and the midwives!) and feel compelled to post again.  I think that sometimes, when we are VBACing, we can see videos like this and nagging doubts might cause us to ask, did it really happen?  Well I can vouch for this video! The mom gave a powerful talk at one of our sessions and I put two and two together and asked her afterwards if she was the mom in the video.  Watching her beautiful son run around all weekend and being a witness to the strength of this amazing woman was one of the highlights of the weekend midwifery retreat.  Growing up my heroes were almost always people I knew and this momma is certainly one of my heroines.  I have to remember to pass this video along to the mom who will be celebrating her own VBA3C in the next couple of months.
I have much to write about after an energizing, hope-filled, community-building weekend but first I need to finish unpacking.