In new study by Dr. Jason Wright and colleagues of Columbia University in New York, it is found that of 717 common OB-GYN practice recommendations from ACOG (American College of Obstetricians and Gynecologists), just 30% are based on top-notch research. Another 38% are based on observational studies, and another 32% are just expert opinion.

The study is a call for better evidence and, as it relates to you, the consumer, can be an alert to the fact that the jury is still out on many of the common practices that are perceived as ‘the only way’ childbirth operations can work in the US. Here is the link to the full article from it’s original publisher.

I post what I see. I saw this, and found it to be an intriguing alternative to our traditional cesareans performed routinely. I particularly am intrigued by their description and execution of “a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother’s chest for early skin-to-skin.”

Is it possible to have this experience here in the States? I don’t know. I don’t know if they are able to perform this kind of surgery on every cesarean candidate or only certain candidates that meet certain criteria. I am not a medical professional. I DO know that there are some striking differences between these care provider’s practices and many of our local ones. My initial reactions are 1) the OB is performing the surgery, but it is the midwife’s responsibility for the overall well-being of baby and mum; 2) delayed cord clamping is compatible with cesarean birth!; 3) I love the slow delivery from the uterus to help force the fluid out of baby’s lungs.

Under more scrutiny, this video is from the UK’s leading midwife, Jenny Smith. Here is her website: jentlechildbirth.org

I was thrilled to have heard this on the radio news report yesterday! In the past year I have had more than a few clients asking me about it’s availability for their hospital births. Laughing gas takes the edge off of labor pain, can be self-administered, and is covered by insurance. It could take the middle ground between an epidural or nothing at all. Laughing gas is used commonly in the UK and Canada to help women cope with labor pains, but it is currently only in two hospitals in the US.

That’s about to change. Special recognition to Vanderbilt Nurse Midwife Michelle Collins for her quote in the article and undoubtedly the many hours of work she has logged getting this change to occur. Vanderbilt patients, it sounds like the road for laughing gas has been paved, and you could reap it’s benefits during your labor soon (purely my inference on reading the article).

So here’s the full article from abc news: Not Just for the Dentist: Nitrous Oxide Returning to Delivery Rooms .

Researchers recently published findings in the Journal of Cellular and Molecular Medicine that concluded that in normal birth, delayed cord clamping should be encouraged, as it amounts to “mankind’s first natural stem cell transplant.” MSNBC published an article about the research results.

This Monday, March 22, come to Bongo East for a very informative and well researched meeting about the biggest causes of cesareans. Any expectant mama or future expectant mama should make it a point to be here.

“Does (Birth) History Repeat Itself?

CPD (aka baby-too-big/mama-too-small) and Failure To Progress are some of the most common reasons for cesareans today. We’ll discuss how the CPD and FTP labels can be wrong, examine some extenuating circumstances that could lead to these diagnoses, look at some research, and discuss questions you can ask your provider about your case history. Come learn why a previous diagnosis of CPD/FTP should NOT preclude you from a VBAC attempt.

Cost: Free, though donations of any amount to our ICAN treasury are greatly appreciated. Better yet, become a subscriber at the meeting!

Who Should Come: Anyone interested in learning more about healthy pregnancy, birth, and recovery is welcome to attend. First-time moms are especially encouraged to come! While childcare is not provided, children with quiet toys and babes-in-arms are welcome.”

Monday, March 22, 2010
Time: 7:00pm – 8:30pm
Location: Bongo Java
Address: 2007 Belmont Blvd Nashville, TN

For more information: http://icanofnashville.webs.com/meetingsandactivities.htm

Finally, facts for women about the c-section rate at your local hospital. These numbers are from 2008, but are better than nothing, which is what we had before. Thank you, thank you, for compiling and posting. This is so so important. Would you find the best heart hospital if you had heart issues? What about cancer treatment? So why would you not find out what your hospital’s c-section rate is? Find it here: TN C-Section Rates.

There are always choices, and using Hibiclens instead of routine antibiotics during labor is proven as effective as antibiotic use. Here is the regimen that US midwives use, patterned after European nations Hibiclens standard. Hibiclens is available over-the-counter. You can also use Hibiclens before a GBS swab to test negative. Learn more about the use of Hibiclens: Chlorhexidine (Hibiclens) Protocol for Labor Among GBS Positive Women. As always, discuss the use of Hibiclens with your care provider as your alternative to antibiotics. To learn more about GBS, this is a well researched article from the same blog: Treating GBS (Group B Strep): Are Antibiotics Necessary?

Unless you were in utter news isolation during Christmas, you probably heard tale of the birth of a baby and recovery of it’s mother after complete cardiac and respiratory arrest during labor. When I first heard the news, I was thankful that this mother and baby  in question survived such a tragic experience, but also wondered at what the entire story may be, the part that doctors were not sharing and media was not telling. Science & Sensibility, a blog from Lamaze International published a transcript of an interview and questions what many are afraid to. Every pregnant woman must make choices, and gathering facts is important in making informed choices. Read the article from Science & Sensibility: Her Survival was a “Christmas Miracle,” but the Disaster was Man-Made.

At a recent birth I was greatly encouraged and impressed by the beautiful work done by a Certified Nurse Midwife at one of our local hospitals.  My client’s midwife was in tune with the birthing mother and allowed the mother to do what she needed to do, without asking her to have medical intervention.  The mother arrived at the hospital, unknowingly nearly complete in dilation, did not want to be checked for dilation, and thus was not checked until she felt it was time to push, just minutes before the birth.  The baby was nearly born into it’s mother’s arms with the mother able to squat while birthing.  The baby was not separated from it’s parents arms until it was absolutely necessary for him to regain his temperature.  The mother always reported feeling greatly cared for by the group of CNM’s she was being seen by.  They would hug her when she came in for appointments and encourage her in her up and coming motherhood.  This level of care is affirmed by the Midwives Model of Care statement.

The Midwives Model of Care is based on the fact that pregnancy and birth are normal life processes.

The Midwives Model of Care includes:

• Monitoring the physical, psychological, and social well-being of the mother throughout the childbearing cycle
• Providing the mother with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
• Minimizing technological interventions
• Identifying and referring women who require obstetrical attention

The application of this woman-centered model of care has been proven to reduce the incidence of birth injury, trauma, and cesarean section.

Copyright (c) 1996-2008, Midwifery Task Force, Inc., All Rights Reserved.

In encouraging women who are considering planning a VBAC, I recommend ICAN (Internation Cesarean Awareness Network: http://ican-online.org).  In exploring their pages further I found this fantastic list of the best way to prepare for a VBAC.  I love that they also identify that although you can plan, we can’t predict what will actually happen.  Some mother’s planned VBAC will become a CBAC.  And this ok.  I especially love the parts in the following about following The Brewer Diet, educating yourself through books and a preparation course, using a doula:), and relying on more non-medical methods to aid in labor.  Here’s their list:

Vaginal Birth After Cesarean Checklist

Read good pregnancy and Vaginal Birth After Cesarean books. Two suggestions are: “The VBAC Companion” by Diana Korte and “Open Season” by Nancy Wainer Cohen.

Focus on good nutrition and exercise. Make a daily checklist to ensure you are getting essential nutrients. Engage in daily exercise such as swim, walk, yoga, prenatal fitness class- whatever feels good. For information on diet throughout pregnancy, we recommend reading, “What Every Pregnant Woman Should Know” by Dr. Tom Brewer and Gail Sforza Brewer or The Brewer Diet.

Register for VBAC, refresher or another quality, independent prenatal program. Even though you may have taken classes in a previous pregnancy, an evening out together with your partner will help to prepare you both, promoting discussion, giving you ideas on coping with labor and bringing a focus to this baby and its birth.

Enlist the encouragement of a supportive care provider. Find a caregiver/hospital who ALREADY provide the options you want. Find someone who believes in VBACs, has a VBAC success rate over 75% and a cesarean rate that is lower than the community average. Consider having a midwife as your primary caregiver. Midwives have a very low rate of cesarean birth. If you are unsure about anything, get a second opinion. Trust your inner strength and knowledge.

Hire a doula/labor assistant/support person. It is worth every penny to be reassured during labor by someone who believes birth is a natural function. This person will have supportive non-medical skills to help you through labor for the birth you want. This person will assist you from your first contractions at home right through postpartum. A labor assistant, or doula, takes the pressure off fathers and family members so that the whole family can be supported.

Throughout pregnancy practice relaxation and visualization with exercises, tapes, massage, affirmations and touch. Use affirmations such as “Each contraction strengthens my baby and me.” Or “I will birth my baby vaginally, naturally, and joyfully.”

Write a birth plan. Discuss everything that is important to you with your care provider, putting it all into your birth plan. Make extra copies to be put in your chart. Know your hospital’s VBAC policies and negotiate well before the birth for anything different. Things to consider when writing your birth plan are:

• Establish a safe, supportive birth environment to encourage labor.
• Try a variety of positions. Instead of lying down, try standing or walking. Squatting to push can be most effective. Try the birth ball. Try walking the halls. Try ‘dancing’ with your partner.
• Continue your calorie and fluid intake. Labor is work and takes energy. Far from eliminating the risk of aspiration with general anesthesia, total fasting (NPO) may increase the risk by raising the acidity of the stomach contents.
• Avoid medical intervention whenever possible. Continuous electronic fetal monitoring may restrict your movement. Ask for noninvasive options. Ask what will be done with the results.
• Artificial induction should be avoided, if possible. Medical induction is linked with high rupture rates and many interventions.
• Ask for time to try non-medical methods to stimulate labor if your labor is not progressing. These include change of position, walking, nipple stimulation, aromatherapy, acupressure. Every labor is different. Unless you dilated to five or six centimeters during a previous labor, consider this one your first labor.
• Avoiding an epidural may increase your chance for a vaginal birth. An epidural interferes with the baby being optimally lined up and will reduce your ability to push effectively. Try natural pain relief measures, such as: hot/cold compresses, bath/shower (once labor is established), tenns unit, massage, relaxation, guided imagery, birth ball. If you start to think you really need an epidural, give yourself a few more contractions, or request that you be checked one more time. You may be moving quickly into transition without realizing it.

Having a birth plan cannot guarantee that your wishes will be followed. Working with a careprovider who believes in birth is easier than fighting one who does not. No amount of demanding or asking nicely will get you the birth you want.

Many cesareans are done due to posterior or asynclitic presentation. Avoiding reclining positions prenatally. Read Val el Halta’s “Posterior Presentation – A Pain in the Back” article and “Understanding and Teaching Optimal Fetal Positioning” by Jean Sutton and Pauline Scott.

Believe in yourself and the process of birth. Repeat affirmations to yourself constantly. Encourage yourself to believe that you are capable of delivering your baby vaginally. Get in touch with your inner self; your resources and abilities. Forget about your scar and focus on the positive aspects of your pregnancy.

Work on leftover negative emotions (guilt, disappointment, anger) from previous cesarean birth(s). Two wonderful books for this are Lynn Madsen’s “Rebounding From Childbirth”, and “Ended Beginnings” by Claudia Panuthos.

Learn to trust, cooperate with and listen to your body and baby. Listen to your own unique labor pattern.

Feel good about yourself and your relationship as a couple and keep a positive outlook.

Enlist the support of family and friends. Remember that according to medical studies VBAC is usually safer for both you and your baby than a repeat cesarean. Don’t be afraid to let your family know how much you need their unconditional emotional support.

Attend VBAC support meetings and join national organizations. Through meetings and newsletters, you will hear from others who have been there, sharing their VBAC experiences. Read “The VBAC Experience” by Lynn Baptisti Richards, a collection of VBAC stories.

Having a VBAC is worth it! You can do it. Not everything is within our control — however, it is within all of us to prepare ourselves as best we can to maximize the chance of VBAC.

This may be copied and distributed with retained copyright.
© International Cesarean Awareness Network, Inc. All Rights Reserved.