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

Good, no, great news for moms who have undergone a c section! ACOG has a new stance on trial of labor after c section and VBAC. ACOG’s new policy states that not only are women with low-transverse incisions with one previous c section potential candidates, but also mothers who have had two previous c sections, mothers carrying twins, and women with scar of unknown location. To read the press release from ACOG go here.

April is Cesarean Awareness Month, and an article I read recently stated that since VBAC’s (vaginal birth after cesarean) still have not completely caught on by the medical model (although research continues to show it is safer than a repeat cesarean, the way to begin to bring down our national cesarean rate (latest reported number is 32%) is to also educate first-time moms, to help them avoid a cesarean in the first place. Obviously, mother friendly care providers and most labor support professionals are very supportive of VBAC, but we are probably outnumbered by those that are not. We are working, working, working on this. Need help finding a VBAC supportive professional? Contact me.

So, as an expectant mother or a birth advocate, what can you do to avoid an unnecessary cesarean? A google search will bring you LOTS of information. Probably even this post. Here’s a short list, and for more visit ICAN.

• educate yourself! I always recommend “Ina May’s Guide to Childbirth” as a starting point to all my clients
• choose a mother and baby friendly care provider. What is this?
• take a comprehensive childbirth education class, that offers facts and evidence honestly (may not be a hospital offered course)
• eat healthfully during pregnancy and exercise
• write a birth plan
• hire a doula

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.

Scar tissue on your cervix can slow dilation during labor. A care provider massaging the scar tissue to break it up can be helpful, but taking evening primrose oil is something you can do at home to help soften the tissue. Remember, a slowly dilating cervix to medical staff is ‘failure to progress,’ which can result in a c-section. Being aware of scar tissue that may be present and alerting your care provider to it can help you have a vaginal birth.

Think of any possible procedure you may have done to your lady parts, and tell your doctor about your medical history and alert them to the presence of scar tissue and it’s affect on cervical dilation.

For example, cryo-surgery is a procedure that uses extreme cold (liquid nitrogen) to destroy abnormal tissue. Abnormal tissue is not cancerous, but thought to be pre-cancerous which is why it is destroyed. A widespread cause, though not the only cause, of abnormal tissues is HPV (human papilloma virus). At least 50% of sexually active men and women in the US may get HPV at some point in their lives. 1 in 2 people.

If you have been affected with HPV and had any procedure done to remove abnormal cells at your cervix, please be aware that the scar tissue left may affect the rate at which your cervix dilates. Using evening primrose oil orally throughout your entire pregnancy, and vaginally each night after 36 weeks can help break up the scar tissue during labor. Have your care provider, when checking you for dilation, also check for scar tissue. If they find any, they can massage it to help break it up.

Read this article written by a San Diego Birth Doula to hear her story: Cervical Scar Tissue- A Big Issue that no one is Talking About.

A very well-written and informed piece about nurse-midwifery. An excellent source of information for any woman, especially those within childbearing years, found here Rebirth of the Midwife.

From now on, when a woman tells me she is pregnant, or is planning on getting pregnant, my first question is, ‘how are you feeling?’ and my second question is ‘have you read “Your Best Birth?”‘  Ricki Lake and Abbi Epstein wrote this book as a response to their documentary, “The Business of Being Born.”  “Your Best Birth” is the perfect follow-up to the documentary that causes many women and their partners, after having watched it, to say “I could have a home birth.”  “Your Best Birth” undertakes all the emotions, questions, and frustrations with our culture’s maternity ward and puts them to good use.  It is a comprehensive, deep, yet not too in-depth, look at what your best birth could be and how to achieve it.  It is the perfect answer to the questions they prod out of you while watching “The Business of Being Born.”  Get it, read it, and call me when you have questions.

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.

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