VBAC

May 06, 2009

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.

March 17, 2009

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?

March 12, 2009

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

November 21, 2008

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?

October 06, 2008

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! ;)
Shaymus

October 02, 2008

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.

  • 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)

September 15, 2008

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.

September 10, 2008

Birth, As Safe As Life Gets

Prenatal day!  Oh how I love my Wednesday prenatal days.  We've had a lot of VBAC'ing moms lately and so I thought I would quote a bit from Jennifer Block's book Pushed today.  (Have I mentioned how I LOVE this book?)  I think Block does a great job of demystifying the whole uterine rupture fear-mongering that VBACers are subjected to.  Here are two snippets from the chapter that covers the ins and outs of VBACs (I should add, and Block does as well, that a lot of the VBAC studies involve managed care so the rate of rupture, when birth is allowed to proceed physiologically, may be lower then one in 200.)


the rate of uterine rupture kept coming up the same in the literature: roughly 1 in 200, even in women with multiple cesarean scars, and the rate of neonatal brain damage or death among VBAC attempts was consistently about 1 in 2000.  Those are excellent odds-the risk of a U.S. baby not surviving labor in a low-risk pregnancy is about 1 in 1000.1


The risk-benefit analysis of VBAC versus repeat cesarean breaks down something like this: If you are a woman attempting a VBAC, you have around a 75% chance of delivering vaginally and avoiding another major surgery and at least a 99.5% chance of not suffering a uterine rupture.  If you choose a repeat cesarean , you have a 99.8% chance of not suffering a uterine rupture (it can still happen) and a 100% chance of having another major surgery, with all the risks and drawbacks that entails.2


When doctors discuss VBAC with their clients, do they discuss the above research with their clients?  Do they carefully go over the possible physical effects of a cesarean on mom (longer hospital stay, higher risk of infection, organ damage, adhesions, hysterectomy, to name a few)? In my experience, Doctors seem to like to repeat something along the lines of, "well, they say the rate of rupture isn't high but it certainly seems high when its your baby."  Well isn't that true about everything we do? Riding a car seems pretty safe until we are in a major car accident but does that stop us from getting into a car every day?  Recently, I can't remember where, I saw the quote that sums up the whole VBAC/home birth safety debate pretty neatly:

 
"Birth, As Safe As Life Gets."



1 Jennifer Block,  Pushed The Painful Truth About Childbirth and Modern Maternity Care (Philadelphia: Da Capo Press, 2007), 88.
2  Jennifer Block,  Pushed The Painful Truth About Childbirth and Modern Maternity Care (Philadelphia: Da Capo Press, 2007), 20.

May 26, 2008

Antoinette's Birth Day!

Labor has no clock and it is impossible to know when you are going to have a baby.  Liz had called me earlier in the evening to ask if she should go out dancing or if I was going to have a baby (since I had proclaimed it was coming Wednesday night).   I thought by morning, but....  And later I had no idea when to call Karen.  When Karen Carr, my midwife, asked me to call her back once contractions were under 8 minutes a part, I had no idea if that would be in 10 minutes, an hour, more?  I don't like to call too early because I like to labor by myself as long as possible.  I ended up being surprised by how quickly labor rolled along and pulled me into its vortex. By midnight, less then thirty minutes after calling Karen, contractions were regularly 4-5 minutes apart and sometimes less.  I waited a good 30 minutes to confirm I had reached the point of no return and then called Karen the second time.  I love Karen's voice.  It is calm, and confident and full of trust in birth.  I am on my way!  I called Liz and Corbin to report Karen was on her way and then called my sister who had the shortest distance to travel.  As the phone was ringing, I passed it to Matt.  There would be no more talking on the phone for me, I had a baby that was ready to be born.  I continued to labor standing up, feeling more comfortable upright, even between contractions.
My mom lay on the futon in our office/guest bed room as I labored, not asleep, she labored with my in the middle of the night as well.
Labor land.  The doorbell rang, and rang again, and there were knocks and footsteps.  Someone was in the hall, where was my sister?  Matt said Liz or Luz (I wasn't sure whose name he spoke) was here and wanted to come in, of course.  I was very restless but was in transition and shaky on my feet so decided I should move to a squatting position to conserve energy.  And through it all my music played, carrying me through the pain.
I glimpsed Corbin setting up camera equipment outside and felt Luz and later Liz and Karen enter the room. By 1:30am, everyone who had been called was at the birth.  Karen asked if I wanted to be checked and I said yes though I needed some time to negotiate putting my body in a position that would make a vaginal exam possible.  I decided upon a semi side-lying position and Karen speedily checked me so that I could return to a more comfortable position.  I was nine centimeters at 1:55am with a bulging bag of water.  I wasn't surprised by the bulging bag, I sensed something was in the way and had an overwhelming desire for my water to break.
I labored on, all fours, supporting my upper body by draping it over Matt's shoulder.  Matt reminded me that I had been in a similar position, on our first night out together (the perfect thing to say at the time).  He had given me a piggyback ride home, my head buried in his hair. 
Shortly after 2am I felt pushy but wasn't sure what position I needed to be in to really start pushing.  I had a few contractions where I was just hanging out, hoping my body would be inspired to find a new position sooner rather then later, I felt a lull.
I looked around as if someone in the room might offer a solution and for one brief moment thought "won't someone break my water?," before remembering this was my job.  Maybe it was because there were so many people in the room (while I sensed their loving energy and support, I never fully noticed they were there until the lull before pushing) but all of the sudden I said to myself, I'm going to go to the bathroom, announced that I had to pee and walked out of the room.  Karen later remarked that at births with many attendants, the mom usually heads off to the bathroom to have her baby.
Ah, the bathroom, I couldn't have made a better choice!  When we first bought this house I dreamed of having a baby in the claw foot tub that we would restore.  I was a bit off, I didn't have the baby in the tub, but the tub and sink provided the perfect squatting bar, with the toilet for back-up if my legs gave out.  I dangled my self, supported by tub on the left and sink on the right, and let my pelvis open, making full use of gravity.  In this self-supported upright squat, I found the strength to give a huge push and my waters blissfully released (2:25am).   As soon as my bag broke, I felt Nettie's head move down to my perineum and I eagerly began pushing.  I would have forcefully pushed Nettie out, impatient to have my baby in my arms, but Karen and I had talked about my need to have someone slow me down while pushing and she gently encouraged me to stop pushing and just breath her out.  Since I didn't have to focus on pushing, I had a heightened awareness of Nettie's descent from my body, it was wild!  At some point I stopped dangling, supported my weight with my legs, and reached over to hold onto her as she reaching the end of her journey into this world.  I pulled her up to my body (2:30am) and collapsed exhausted onto the toilet seat, letting the waves of exquisite birthing hormones roll over and through our bodies.
I felt for a moment that I was about to push the placenta out into the toilet and someone asked if I wanted to move back to my bed and slowly we made our way back down the long hallway to our bedroom.  Nettie latched on immediately, a nursing pro minutes after birth, and I caught my breath as I waited to birth the placenta.
So that is our story.  I promise to add pictures soon.  As with all spiritual, awesome events, words try to capture the essence of the story, but slip.  Perhaps when I am better rested and have a thesaurus at hand, I will rewrite.  Many thanks to my amazing midwife, Karen Carr, and her two beautiful assistants who were at the birth (I feel blessed to have discovered midwifery in this corner of the world, with so many strong and loving women on the journey and with such a dedicated guide), to my mom and sister, the closest women in my life, to Corbin who took beautiful photos and to my strongly loving and supporting other half, Matt.
Oh, I forgot to mention that my "BIG" week and 1/2 "late" baby was a mere 7 pounds and 3 ounces.  Smaller than her brother who was born two days "early."

March 14, 2008

Author of "Birth: The Surprising History of How We Are Born" has VBAC at Home!

It took a comment from my last post to remind me to check on Tina Cassidy's blog.  I am sure this is old news to everyone but she had her VBAC at home in January!  Check out her blog to read the story.  Congrats Tina!

And while we are on the subject of VBACs, Amy at Hospital to Home had hers too!