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Sweet Pea ​Births
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...celebrating every swee​t pea their birth
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Meet the Doula: Ashley Anders
| Posted on October 7, 2016 at 10:36 AM |
comments (931)
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 Welcome to this month's installment of "Meet the Doula". This month I have the pleasure of introducing you to one of the Valley's postpartum doulas, Ashley Anders. I had the pleasure of meeting Ashley at an ICAN meeting last year, and I am happy to say we have kept in touch. She is honored to serve her families, and as such, Ashley is dedicated to furthering her own education so that she can better serve her clients. I hope you enjoy our feature with our October 2016 doula: Ashley! When was the first
time you heard the word, “doula”? I first heard the word doula years ago when I was talking
with a friend about supporting women in childbirth. How did you decide
that becoming a doula was part of your journey? Since I was little I wanted to be a Labor and Delivery
nurse, I loved supporting women and their families through one of the most
intimate times of their life, and watching them bring new lives into this
world, but quickly realized I didn't like the idea of having to leave my
patients to go to another patient, or leaving a shift before a baby was
born after being there her entire labor, or having to do all of the clinical
things. That is when I started researching to see if there was this
dream job out there of giving non-judgmental support to women and their
families before, during and after childbirth, and I came across birth and
postpartum doula! Are you a birth
and/or a postpartum doula? I am both a birth and postpartum doula, breastfeeding counselor
and newborn care specialist. Focusing most of my time
currently postpartum, breastfeeding and newborn care. How long have you
been a doula? I have been a doula just about 3 years. I am trained with
Childbirth International for birth, breastfeeding. I have also received
postpartum training, and trained with Newborn Care Solutions for my newborn
care specialist certification. I have supported single moms, moms on bed
rest, families that have a scheduled cesarean birth, unplanned cesarean
birth, teens, high risk, expected stillbirth, prematurity, twins and
triplets. What do you enjoy the
most about being a doula? For birth, I love that I am invited into the lives of
families expecting a baby. I love that I can build confidence in women
and their partners. Help them feel safe, protected and informed about the
birth experience and provide non judgmental support throughout their journey
into parenthood. For postpartum, I find that we often focus so much time
on pregnancy, and childbirth and forget that there is in fact a 4th
trimester. I enjoy helping everyone in the family transition into having
a new baby at home, if its baby #1 or baby #3. An extra set of hands to
help siblings adjust, help mom get a shower or a nap in, breastfeeding/bottle
feeding assistance, meal prep, and helping with all of the "is this
normal" questions I often get. Newborn care, infant brain
development, feeding, bathing, sleep conditioning, etc., are all things I love
to give information on to help clients make the best decisions for their
family! How do you work with
and involve the Coach? I make sure that we are working as a team. My job is never
to take the place of a partner or coach. I like to show and guide the
partners on things that they can do throughout labor to assist in the comfort
of the laboring mom, but also make them feel comfortable enough that they can
take a break, take a quick nap or grab something to eat and she will be
supported and never be left alone. What is the toughest
situation you have ever dealt with? How did you handle it? I would have to say that supporting a family through an
expected stillbirth was the toughest. She still had to give birth just
like any other laboring mother, but unfortunately had to say goodbye shortly
after her baby was born. It was hard! I cried alongside with them,
made sure that they had everything they needed and was just there for
them. The hospital was wonderful and provided the family with photos and
a box to remember him with. I joined them on the annual walk for infant
loss and continue to keep in touch with them. They were blessed with
their rainbow baby a year ago and I was honored to be by their side through the
birth of their second son. What keeps you
working as a doula? My family and my clients! I have the best :).
Hearing that I have found my calling, and that it is obvious that I love my job
and what I do, is so great to hear. I couldn't do this if I didn't have
the continued support from my husband. From day one he has supported me,
and pushed me to fulfill my dreams and I cant thank him enough! What does your fee
cover – how many visits or hours? Is there a different charge for a
shorter labor or longer labor? My birth fee includes 2 prenatal appointments where we will
discuss birth plan options, discuss postpartum care/plans and go over early
labor comfort measures. Your labor and birth, and up to 2 hours after, to
get you settled into your postpartum room, get you your first meal and make
sure that baby has had his/her first feeding. I will also schedule a time
within the first week to come and do a postpartum visit to talk through your
birth and make sure that feeding is going well and to answer any additional
questions you may have. Since birth is unpredictable there is not a different
charge if your labor were to go long or if you were to have a shorter
labor. Postpartum/Newborn care fees are hourly and I do
daytime and overnight care. Each contract can be fit to each client and
their needs. Do you offer any
other services to your clients? I offer breastfeeding support, it is included in my doula
packages, but I offer it separate if needed. Just for fun, what do
you do when you are not doula-ing? When I'm not doula-ing I'm sleeping! haha! I'm
also spending time with my husband and 2 kiddos: our daughter Tyler (11)
and our son Bennett (4), plus our 2 dogs Maddie and Oddie. We enjoy riding
bikes; mornings at the park, watching our daughter ride her horse, and just
spending quality time together with family and friends.  Love what you read?? Would you like to contact Ashley? Read more about Ashley and schedule a visit via DoulaMatch Phone: 480-457-9151 Email: [email protected] Disclaimer: The material included in this video is for informational
purposes only. It is not intended nor implied to be a substitute for
professional medical advice. The viewer should always consult her or his
healthcare provider to determine the appropriateness of the information for
their own situation. Krystyna and Bruss
Bowman and Bowman House, LLC accept no liability for the content of this site,
or for the consequences of any actions taken on the basis of the information provided. This blog and video contain information about
our classes available in Chandler, AZ and Payson, AZ and is not the official
website of The Bradley Method®. The views contained in this video and on our
blog do not necessarily reflect those of The Bradley Method® or the American
Academy of Husband-Coached Childbirth®. Sweet Pea Births offers Birthing From Within and Bradley Method® natural childbirth
classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert,
Mesa, Scottsdale, Payson |
Uterine Rupture: Assessing the Risks
| Posted on April 26, 2016 at 10:18 AM |
comments (139)
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 This was in posted April 2012 - updated April 2016Uterine rupture is a topic that came up when I was pregnant with
Otter that I was not ready to allow into my consciousness until she was
safely in our arms. After enough time
had passed and we have proven to ourselves that homebirth can be a safe option
when a person is healthy and low risk, I am ready to write about it.
I gave Stephanie Stanley, former facilitator of the East Valley
ICAN group, byline credit for this because I am using her research from a
uterine rupture presentation she did at a meeting for my post today. ICAN, the International Cesarean Awareness
Network, is a non-profit organization that strives to improve maternal-child
health by preventing unnecessary cesareans through education, providing support
for cesarean recovery, as well as educate about Vaginal Birth After Cesarean
(VBAC) and options for what is called a "gentle cesarean" where the event is honored as a birth even though it's via a surgery. ICAN’s goal is to see a healthy
reduction of the cesarean rate that is patient-driven. By providing education and support, they hope
that more women making evidence based, risk appropriate childbirth decisions
will lead to an overall reduction in the rate of cesareans performed.
Uterine rupture seems to be the leading reason why care providers are
hesitant to allow a mother to have a trial of labor (TOL) after a previous
cesarean. In Arizona, a licensed midwife or certified professional midwife can attend a homebirth
with a mom who is striving to have a VBAC only if the mother meets certain criteria. Arizonana for Birth Options is leading a grassroots efforts to change this so
that as per the ICAN vision, women living here can make evidence based and risk
appropriate decisions. They want all
options to be available: for a hospital birth if mom feels that is the best
option, or a homebirth if both mom and midwife agree that they are a good
candidate for VBAC.
Uterine rupture is defined as an anatomic separation of the
uterine muscle with or without symptoms.
What this means for baby is that the uterus ceases to function as a sealed protective container from the rest of the blood and organs surrounding the baby. The function of the placenta and umbilical
cord may also be compromised. Mom is
subject to blood loss and shock. A
decision also has to be made about repairing the uterus or performing a
hysterectomy.
Another term used when talking about uterine rupture is
“dehiscence”. A dehiscence is the
splitting or incomplete opening of the cesarean scar. It can happen without complication for mom or
baby and sometimes it is only discovered after the delivery. It is also called a “window” by some care
providers.
As it turns out, while uterine rupture is a consideration when you are preparing for a birth after a cesarean, it's not the only one your care provider should be having a conversation about. You can read THIS post to see where the risk for uterine rupture falls in comparison to other risks of pregnancy and labor. So what does the research say?
Here is the overarching conclusion: anyone can be at risk,
whether you have an unscarred or scarred uterus. At most, your risk rate is 2%. 2 percent!
Why then is it that this is such a big deal? I believe it lies with the potentially
devastating circumstance a family will find themselves in if the uterus does
rupture. While 98% of the population
may have a successful VBAC, the worst case scenario of a uterine rupture is
the loss of the baby and possibly a hysterectomy for mom which makes future
pregnancies impossible.
Another point to ponder is that the statistics listed below
are close to other statistics for labor emergencies, such as placenta accreta,
placental abruption, miscarriage; for a longer list click here.
Statistics for the risk of uterine rupture – see links at
the end of this post for references: VBAC: .5% - .7% VBA2C: 1.7% (vaginal
birth after 2 cesareans) VBAMC: 1.2% (vaginal
birth after multiple cesareans) Previous VBAC: .4% - .5%
(if you had a previous successful VBAC) VBAC + Augmented labor:
.9% (stats for first attempt) VBAC + Induced labor: 1%
(stats for first attempt)
Here is a link to the comparison of risk rates for VBAC,
CBAC (a cesarean birth after a trial of labor) and ERC (elective repeat
cesarean)
http://www.sciencedirect.com/science/article/pii/S0002937808004213
The risk factors when considering whether or not to do a
trial of labor after a cesarean are: The type of scar you have: the most favorable is a low
transverse scar. Classical T-shaped
scars, vertical scars or high uterine scars are said to have a higher risk of
rupture.
Induction of labor using cervical ripening agents, i.e., Cytotec,
Cervidil: the prostaglandins that soften the cervix may also soften the scar
tissue. In addition, ripening agents can
cause uterine hyperstimulation, meaning contractions that are much more intense
and frequent than the uterus is designed to withstand in the course of an unmedicated
labor.
More than one cesarean: as you can see from the statistics
above, there is a slight increase of risk.
Among factors that are disputed in medical literature are: - Age of mother: if a mother is over 30 she may be considered
at higher risk for uterine rupture. - Obese women - Size of baby: more than 8 pounds, 14 ounces - Post-term baby: 40+ weeks gestation from last menses To compare, here are the stats and risk factors for an
unscarred uterus: “The normal, unscarred uterus is least
susceptible to rupture. Grand multiparity, neglected labor, malpresentation,
breech extraction, and uterine instrumentation are all predisposing factors for
uterine rupture. A 10-year Irish study by Gardeil et al showed that the overall
rate of unscarred uterine rupture during pregnancy was 1 per 30,764 deliveries
(0.0033%). No cases of uterine rupture occurred among 21,998 primigravidas, and
only 2 (0.0051%) occurred among 39,529 multigravidas with no uterine scar. A meta-analysis
of 8 large, modern (1975-2009) studies from industrialized countries revealed
174 uterine ruptures among 1,467,534 deliveries. This finding suggested that
the modern rate of unscarred uterine rupture during pregnancy is 0.012% (1 of
8,434). This rate of spontaneous uterine rupture has not changed appreciably
over the last 40 years, and most of these events occur at term and during
labor. An 8-fold increased incidence of uterine rupture of 0.11% (1 in 920) has
been noted in developing countries. This increased incidence of uterine rupture
has been attributed to a higher-than-average incidence of neglected and
obstructed labor due to inadequate access to medical care. When one assesses
the risk of uterine rupture, this baseline rate of pregnancy-related uterine
rupture is a benchmark that must be used as a point of reference.” If you choose to have a VBAC, or realistically for any woman
in labor since the statistics show she has a slight risk, here are the signs that may
help you recognize that a uterine rupture is occurring or may have occurred: - Excessive vaginal bleeding - Extreme pain between contractions – these may or may not
be felt through an epidural block, though due to severity of pain it’s possible
they may be felt - Contractions that slow down or become less intense - Abdominal pain or tenderness - Baby’s head moves back up the birth canal - Bulge in the abdomen, bulge under the pubic bone, or
pressure on the bladder where the baby’s head may be coming through the tear in
the uterus - Sharp onset of pain at the site of the previous scar - Uterus becomes soft - Shoulder pain - Heart decelerations in the baby - Maternal tachycardia (rapid heart rate) and hypotension
(low blood pressure)
If you have a true uterine rupture, then an emergency
cesarean will be required. A Chandler
doctor told the ICAN group that the care provider has 5 – 7 minutes to get the
baby out safely, although in reading for this post I saw some estimates as 10 –
37 minutes. According to a 2010 National Institutes of Health study,
there have been no maternal deaths in the US due to uterine rupture. Overall,
14 – 33% will need a hysterectomy. 6% of
uterine ruptures result in perinatal death, and for term babies this risk was
put at less than 3%. **
If you do have a uterine rupture, it will have an effect on
your future pregnancies. Each cesarean a
mother has increases the risk for future complications of cesarean
surgery. If you have a hysterectomy, you
will not be able to carry any more children.
In today’s medical climate, a uterine rupture will most likely result in
all future pregnancies being delivered via repeat cesarean.
There are a lot of points to ponder as a new mom or as a mom
considering a VBAC. Our Bradley® mantra
is: Healthy Mom, Healthy Baby. We teach
that as long as you make all your decisions with those two goals in mind, you
are likely to make the choices that have a positive outcome for both Mom and
Baby. What are your thoughts on VBAC and/or uterine rupture?
**NOTE: Stephanie’s presentation called out these statistics
as inflated as the Landon study (2004) included women who had pre-labor
stillbirths included in the statistics.
IN other words, women whose babies had passed away before labor and
still delivered via VBAC rather than choosing a repeat cesarean were counted in
the perinatal death statistics. Please
read Henci Goer’s analysis for more information
For the resource list, click here. Disclaimer: The material included on this site is for informational
purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.  |
In Their Own Words: Daniella's Story
| Posted on April 22, 2016 at 12:14 AM |
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April is Cesarean Awareness Month. In order to expand the conversation around all the choices mothers have when preparing for a birth after a cesarean, we will share around cesarean birth journeys, and options that cesarean birth warriors have for subsequent pregnancies. If you would like to submit your story for our In Their Own Words series, please send your submission to krystyna{at}sweetpeabirths{dot}com.  Why I Chose to Have a Repeat Cesarean Birth After the initial excitement and shock I felt after I looked at the pregnancy test and saw two lines my first thought was: “How do I want to deliver this baby?” When my son was born I had to have an emergency c-section after being induced because of extremely high blood pressure. Even though now (four years later!) I can look back and see that it needed to be done to keep both of us safe, it wrecked me emotionally for quite some time after he was born. I felt like a failure and like I wasn’t a “real mom” because I didn’t actually give birth to him. Add to the fact that we had a really hard time breastfeeding and I was left feeling like a terrible person. I didn’t admit this to many people, but I spent the first few weeks of my leave crying all day because in my mind, I was a terrible mother. It took a long time for me to be at peace with having a cesarean birth and I swore that if we had another baby, I would be attempting a VBAC for sure. Fast forward to that day in March of 2014 when I got that positive, I didn’t know what I wanted to do. I remember talking to my husband and asking him what he wanted me to do. He told me, “I just want you to be safe. Healthy mom, healthy baby, you know?” When I met with my doctor for my first appointment I asked her if I was a good candidate for a VBAC. She told me I was and gave me some literature to read about VBACs and RCSs so I could make an informed decision. I didn’t have to choose until a few weeks before my due date so I had some time. I thought about it a lot. This was going to be our last baby so if I was going to try to a VBAC this would be my only chance. It was a lot of pressure! After doing a ton of research and talking to my husband, I decided to have a RCS. All I could think about was that dark and foggy time I had experienced after my son was born and it scared me so much. This time I wouldn’t be responsible for just one baby, it would be a pre-schooler and a baby. There was no guarantee that I would feel like that again, but it was such a huge worry to me. I remembered the anger and the doubt and replaying my labor over and over again and I didn’t want to do that to myself and again. I knew I was making an informed decision and I was at peace with it. My repeat cesarean birth ("RCS") was a complete 180 from my emergency cesarean birth. I got to prep for the surgery with my husband in the pre-op room which helped put me at ease. When I was taken into the operating room the doctors and nurses were joking around and talking about college football. There was classic rock playing on the radio and unlike my son’s birth there wasn’t a sense of urgency. When my daughter was born I was able to hold her almost immediately and they let me keep her while they stitched me back up. After I went to recovery they brought her to me so I could nurse her. I will be forever grateful for that, when my son was born I had to wait over two hours until I could see him. I know the major difference between my two births was that one was planned and the other was a true emergency. I think that knowing what was going to happen helped keep me calm and relaxed. Sometimes I think of the what-if’s: what if I could have had a successful VBAC? I should have at least tried. If it was successful I wouldn’t have had to deal with an incision that didn’t close for almost ten weeks… I can’t go back and think about that now. I have two beautiful healthy children. I know that I made the right decision for myself and for my family. Disclaimer: The material included in this video is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The viewer should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog and video contain information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained in this video and on our blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
What is ICAN?
| Posted on April 19, 2016 at 9:48 AM |
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 Did you know there is an international organization dedicated to cesarean advocacy? The International Cesarean Awareness Network, known as "ICAN", is dedicated to the prevention of unnecessary primary cesareans, recovery support, and advocacy for birthing families. Thanks to information sharing at ICAN meetings, families are aware of the evidence in regards to a trial of labor after a cesarean (TOLAC), vaginal births after cesarean (VBAC) births, and options in the event a family chooses a cesarean birth after a cesarean (CBAC). Here is an interview I did last year with ICAN of Phoenix founder Stephanie Stanley. Although she is no longer active with the group, it is due to her efforts that our area has an active chapter to begin with. Learn more about ICAN and their mission in this brief video: Want to learn more? Read more about ICAN in general and learn more about our local Phoenix group HERE. I was thrilled to see ICAN mentioned in THIS blog post written by an OB/GYN that talked about the importance of true collaborative care and the demand for it from mothers who want an optimal maternity experience. The fact that a younger hospital-based doctor has heard of ICAN and recognizes the collective power of informed consumers encourages me that there is hope for our maternal care system that is so clearly broken. I have never understood how we spend more on maternal health than any industrialized nation and rank so miserably far down below even third-world countries in our ability to keep mothers and babies alive after the birth experience.
If you have been wanting to come to a meeting and just haven't had the courage to get yourself to a meeting, please trust that you will not be sorry. This group is one of the most supportive, empathetic places you can go to share your cesarean birth story and begin your journey to healing any emotional trauma you may have (or may not even realize you have, as mentioned in the cesarean birth story one of our readers shared last week). If you are local to the Phoenix area, please join the group this month. Meetings are almost always the fourth Wednesday of the month. HERE is the information for the meeting - I hope to see you there! Disclaimer: The material included in this video is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The viewer should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog and video contain information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained in this video and on our blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
In Their Own Words: Annika's Story
| Posted on April 15, 2016 at 4:10 AM |
comments (493)
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April is Cesarean Awareness Month. As such, the blog topics this month will focus around cesarean birth journeys, and options that cesarean birth warriors have for subsequent pregnancies. If you would like to submit your story for our In Their Own Words series, please send your submission to krystyna{at}sweetpeabirths{dot}com.  Here is Annika's story of her primary cesarean, and her VBAC journey with her second child: When you are pregnant with
your first child you have all these wonderful naive concepts about birth…well,
at least I did. Not to say I had a traumatic birth with my first child, but I
would say it definitely was a sobering lesson for my husband and I. Our plan was to have Landan
in a birthing center with minimal intervention and in a birthing tub. The
entire idea of a water birth and a welcoming atmosphere to me was literally heaven
and I would dream about it almost daily. At our 39 week check up our midwife
seemed a bit puzzled when she was examining my belly and feeling around for
Landan's position and promptly concluded after a ultrasound that he was in fact
breech and very comfortably nesting in my right rib cage. So with a referral in
hand and a last minute appointment with Dr. Medchill we made our way to his
office for another ultrasound to determine if I was a good candidate for an
external cephalic eversion (aka, external flipping or rotating of the baby). Much to our delight, Dr
Medchill concluded that there was sufficient fluid surrounding Landan and the
umbilical cord was not wrapped around his neck. So off we were to the OB Triage
at St Joe's to attempt flipping Landan with our bags packed "just in
case." While the idea of externally having my baby flipped was not
appealing, I really didn't have a whole lot of time to really understand the
gravity of what I was about to experience, nor do I think I would have cared to
be honest. I had my mind made up that
this was going to work and I was going to get my beautiful peaceful water birth
I had been dreaming about for 9 months. With my husband sitting at my head, Dr
Medchill on my right side pushing Landan's head and upper body, and a head
resident pushing Landan's legs and butt, they attempted 4 times to flip Landan
with no avail. My son was perfectly comfortable where he was at, and no one was
going to convince him to move otherwise. At this point, my husband and I had
been dealing with this ordeal all day and both of us were so incredibly burned
out. I was shaking thanks to the muscle relaxers they gave me so they could
perform the procedure and I didn't even want to dare to think about how sore my
belly was going to be once the pain medication wore off. So, seeing our
exhaustion, Dr Medchill offered to perform a cesarean birth within the hour. Looking back on it now, I am
actually very grateful for his willingness to help us in the midst of our
exhaustion. Let me be clear, he was not pushy by any means and if you have ever
encountered Dr. Medchill he is the most kind, but honest, human being on this
planet. In his professional opinion especially since I had showed no sign of
labor, my cervix was completely shut, minimal effacement, and Landan was
definitely not going anywhere from his comfy spot, the chances of my body
kicking into natural labor and Landan flipping and descending through the birth
canal was really minimal. Since I had never had a
vaginal birth to begin with, I also had what the medical community deems as an
"untried pelvis," which essentially means no baby has ever passed
through. Which can diminish your chances of having a successful natural breech
birth even farther. So, my husband and I decided
to go for the compromise and I was prepped for surgery before the ink was dry
on the consent papers. Looking back on it now, I'm actually incredibly grateful
for how quickly they moved as my husband and I weren't really given the chance
to think too much about what was going on. The cesarean birth, from what I
remember, was rather uneventful. I remember being extraordinarily cold, and
feeling very alienated being so exposed on the table, but the staff was really
pleasant and made me feel comfortable. Once Landan was born he was
quickly cleaned, weighed, and swaddled, and brought over to me where we
snuggled our heads together for a fleeting moment. My husband was allowed to
take him from there to the OB Triage area to have skin-to-skin contact while I
was being put back together. Granted, I would have loved to have that contact
with Landan myself, but stepping back from that, it really was a special time
for Danial and Landan. They definitely formed an unbreakable bond and for that
I am absolutely thankful for. That was such a special gift that Danial was able
to have with Landan and I wouldn't take that away from him ever. Fast forward 5 months and we
were a busy family with a new(Ish) baby still taking over our house. Since
having Landan I hadn't really thought much about his delivery or the ordeal
much as I was happy to have my son earthside safely. It was when I found out I
was pregnant with our second child that month that my feelings and emotions
about Landan's delivery and my upcoming delivery would soon start to bring to
the surface all sorts of emotions. Luckily for us, we decided to
stay with Dr. Medchill and continue care through him as he was most familiar
with us, and our previous experience with him was really outstanding. He didn't
hesitate when I asked if I had the option of attempting a normal VBAC and said
that I was a really good candidate and that he actually would encourage me to
at least try. Let me tell you, that was
music to my ears! But at the same time, the question in my head was "what
exactly am I going to expect?" I couldn't have the water birth that I had
fantasized about during Landan's pregnancy, and I was definitely not going to
get a very birth center like atmosphere in the hospital, so what exactly COULD
I expect? That's where getting involved
with the ICAN chapter in Phoenix really helped me wrap my head around my
options but also internally deal with some unresolved feelings from Landan's
delivery that I didn't even know I had. Also, getting involved with ICAN really
gave me confidence to ask questions that I didn't even know were subjects I
could ask! For example, I had no idea
that I could ask to have intermittent monitoring which would allow me to get in
and out of the shower along with walking freely without being attached to a
machine all the time. So armed with information, my husband and I navigated the
months leading up to Adaline's birth with optimism and trust in our care
provider that we could have a fair trial of labor. I'm not going to lie, while
we had an amazing support group around us from our care provider, to our doula,
to our family, there was some SERIOUS fear in me of the entire process. No
matter how you look at it, the incision is always going to be there. It doesn't
go away and that doubt of whether or not that area will be able to withstand
labor and birth is constantly lingering no matter how many statistics you look
at of the success of VBACs. I can say with confidence
that there were MANY times where I just wanted to schedule a cesarean birth and go
with what I knew and could expect. That is so much less scary then embarking on
the marathon of labor and delivery where you have no idea what to expect. But,
there was a really large part of me that just really wanted to experience the
beauty of labor and be able to say that I could do it on my own. So, I stuck to my guns and
kept drawing from my support group of my husband, my doula, and my care
provider. Much to my delight, on October 1, 2014 my water broke (which is
definitely not a glamorous experience like Hollywood claims it is!!) and labor
started with gusto about an hour later. My husband, doula and I made our quick
exit to the hospital as my contractions were coming on with force and
relatively quickly. After a marathon of 17 1/2
hours of hard, active labor, my daughter was born on October 2, 2014 and was
the most beautiful VBAC baby I could ever ask for. She absolutely made me work
for my VBAC and I truly couldn't have done it without my doula and my husband, who stayed up with me the entire night going between the shower, birthing ball,
holding the puke bin between contractions, making sure I drank water, and
listening to me when I was so tired that I could feel my body giving in after
15 hours and asking for an epidural simply so I could take a 30 min power nap. I have clients that ask me
all the time how I was able to get through that VBAC and it’s really plain and
simple to me. There is no part of me that hesitates when I say that I
absolutely drew from the strength of my husband and my doula the entire time.
Having my support group really helped me get through the toughest parts of that
labor and then also being at peace with getting an epidural and taking a nap.
When it boils down to it, that's what my body needed and having my support
group there allowed me to listen to my body. There is nothing I regret from
Adaline's birth and in a way it was so healing for me and resolved so much self
doubt from Landan's birth that I didn't even know existed in me until I was
faced with the option of having a normal VBAC. Now we are weeks away from meeting #3 and my husband and I feel so comfortable and armed with such confidence that we do know our options and are going into this second vaginal birth. I know, and for the first time, feel absolutely confident in my body; that it knows what to do and I also know how to listen to it as well. We have moved to a different state so having to switch providers was nerve racking until my husband and I really sat down and realized that we were completely confident with the criteria that we wanted and were setting for ourselves and also that we would find a care provider who was just as amazing as Dr Medchill was. Luckily for us, we did find
an amazing care provider and he is definitely on the same page as we are with
this delivery. My hope and prayer for every single mother going through her
VBAC whether it be after one or multiple cesarean births is that you really
find your voice and find your support. I know that's what helped me navigate
this incredible journey that I've been on the past 3 1/2 years and I only can
hope that every single mother finds that strength as well.  Photographer Name: Allie Hannah Photography Henna: Pheobe Sinclair Disclaimer: The material included in this video is for informational
purposes only. It is not intended nor implied to be a substitute for
professional medical advice. The viewer should always consult her or his
healthcare provider to determine the appropriateness of the information for
their own situation. Krystyna and Bruss
Bowman and Bowman House, LLC accept no liability for the content of this site,
or for the consequences of any actions taken on the basis of the information provided. This blog and video contain information about
our classes available in Chandler, AZ and Payson, AZ and is not the official
website of The Bradley Method®. The views contained in this video and on our
blog do not necessarily reflect those of The Bradley Method® or the American
Academy of Husband-Coached Childbirth®. |
In Their Own Words: Isla's Birth Story
| Posted on April 8, 2016 at 8:03 AM |
comments (0)
|
April is Cesarean Awareness Month. As such, the blog topics this month will focus around cesarean birth journeys, and options that cesarean birth warriors have for subsequent pregnancies. I am pleased to open this month's In Their Own Words series with a share from a friend of ours from Texas. Her story is shared with permission from her blog, The Carey Haus, Here is the story of their second daughter's birth.  Isla's birth story Upon finding out we were expecting, I had a tough decision to make. Since I had a [cesarean birth] with Sadie, I had to decide if I wanted to try for a VBAC (vaginal birth after cesarean) or to opt for a repeat [cesarean birth]. I went back and forth for a good 8 months before finally deciding that I was more comfortable with a repeat [cesarean birth]. Yes, it is major surgery, but I liked knowing there would be less variables and I could have a little more control. (Can you say type A???) This turned out to be a good decision because my blood pressure started to creep up around the 35-36 week mark. We knew going into it that this would be a possibility, as I had severe pregnancy induced hypertension with Sadie. We had originally scheduled a repeat [cesarean birth] for my EDD, which was 11-25. When the blood pressure started rising we moved it to 11-18. This was not good as Adam was in the midst of a crazy school schedule. We tried to move it to Friday the 20, but the Dr could not find anyone to operate with her. We wound up moving it to Tuesday the 24 and agreed to keep a very close eye on my blood pressure. The 16 the Dr went ahead and put me off work to keep me lying around the house. Thursday my friend Dory came in to hang out for a couple days before the baby would arrive. Well, my blood pressure started getting really high on my readings at home and the Dr had said I needed to call her if it was not going down. Friday morning the 20 I went in for them to check it. I was 39 weeks and 2 days at this point, so already 9 days further than when I delivered Sadie. The Dr decided that based on the reading we would be moving the delivery to the following day, Saturday, November 21. It was a very surreal feeling being told that the next day I would be having a baby. We knew all along that was a very real possibility, but hearing the words made it that much more real. It took me right back to the moment when my Dr with Sadie told us we would be having a baby later that day. My Dr told me to be at the hospital at 7am and we would plan on going into the OR at 9:15. I left and called Adam to let him know that the next day we would have a baby. The rest of Friday I had to lay low to keep my blood pressure from skyrocketing so Dory and I watched movies until it was time to get Sadie from school. I had promised Sadie that before her sister arrived we would go get a pedicure, so when Dory and I picked her up from school we went straight to do that. She was so excited that she would be meeting her sister the next day! That night I finished packing our bags and went to bed around 10. I slept well, surprisingly. We got up and got everything loaded in the car. It worked out so well that Dory wound up being there still since she was able to watch Sadie while we had the baby. Dory and Sadie followed to the hospital so they could see where to go and get the stickers that would allow them in the room to visit me later on. I had asked my photographer friend, Cally, to be there to photograph the birth. She met us in the lobby and took some very sweet photos of Sadie hugging on my belly and kissing me goodbye. I should have them from her in the next few days. What sweet moments to have captured! We said bye to Dory and Sadie and headed up to labor and delivery. EEK! We got to labor and delivery and I changed into my hospital gown. They then allowed Adam and Cally to come in. They went through 50 million questions and started my I.V. The I.V. was probably the worst part, as the first attempt did not take and she kept digging around. It was awful. The other nurse came and got one started in my other arm. I had a couple bags of fluid, which made me sooo cold! They gave me some blankets and I tried to just relax. The Dr came in and said hello and we calmly chatted. She has the most relaxed personality ever, which is nice when you are about to be cut open! Soon after, the anesthesiologist came in to chat as well. I was very hopeful that they would allow me to have my husband AND Cally in the OR, but that was a no go. They did however agree to allow them to swap places halfway through-yay! Cally set my camera up for a nurse and showed her how to use it so that we could have some photos before they allowed her in. The photos actually came out great! Anyway, right around 9:15 they had me climb in a wheelchair and we made our way to the OR. Let me tell you, it is the most surreal feeling walking into a freezing cold operating room knowing you are about to have surgery, let alone have a BABY! It really hit me that we were having a baby when I walked in there and saw all the equipment to take care of her. I told the CRNA [Certified Registered Nurse Anesthetist] that I wanted to change my mind and not do it! Ha! He was very sweet and reassuring that all would be ok. I got situated on the table and the CRNA had me lean over a pillow into a nurse while he started my spinal block. It did not hurt when I had it with Sadie, but this time it hurt for a few seconds on the right side of my back, but went away pretty quickly. They got me situated on the table and then the rest of the surgery team started coming in. Luckily there is something in the spinal that relaxes you and warms you up, because I began to feel a little calmer. Everyone got prepped and they did a little test to make sure I was numb. I was, so they got started. It seemed like it took FOREVER for them to get to the baby. I kept asking Adam if they were close. Finally they said it was time and I would feel a lot of pulling and pressure. Boy did I! It was intense. It was not long and she was out! At 10:00am on the dot she was here! She cried right away, which is the best feeling ever. The Dr lifted her up over the curtain for me to see and the nurse captured some great photos of that moment! I feel like the image shows that a c-section is just as beautiful as a natural birth. The smile on my face is priceless.  They started getting Isla all cleaned up and Adam swapped places with Cally. They brought Isla over to me to see and cuddle, but it is hard to hold a baby when you are laying down flat, even with a nurse helping. I told them to go ahead and take her out to my husband. Cally followed them out and I am sure got some great photos of that time. The CRNA told me he was giving me something in my IV to relax me and that it might make me sleepy. It did relax me and I was a tad sleepy, but too excited to go to sleep. I talked to the Dr while she put me back together. It was a very relaxed environment. Once they finished stitching me up, they wheeled me into the recovery room where I immediately got to do skin to skin and start nursing Isla. This was SUCH a different experience from Sadie, as I was not stable enough to be with her in recovery. Isla took to nursing right away and it made being in the recovery room so great. I shook quite a bit in recovery, but I don’t think nearly as much as with Sadie. The spinal started to wear off so I asked for some pain meds. Whatever they gave me did not work great, but I was ok since I had the distraction of a new baby! After about an hour or so they cleared us to go to my room. We called Dory and told her to head on up to the hospital with Sadie. We got to the room, which was so pretty and spa like for a hospital! Sadie and Dory arrived right after we got settled. It was so sweet introducing Sadie to her new sister. She did not want to hold her right away, but was certainly in awe. I think it was an hour or so later that she asked to hold her. They hung out for a bit and then Dory took Sadie home. Adam and I relaxed with Isla for an hour or two and then Adam headed home to get Sadie ready to spend the night at her friend Molly’s house. Isla and I enjoyed skin to skin for the rest of the day. It was the sweetest time ever. Adam got Sadie situated at Molly’s house and then came back so he could spend the first night with me. Isla and I stayed in the hospital for 3 nights. It was the best time, believe it or not. I never once turned the tv on. I just enjoyed the peace and quiet. It was such special bonding time with my baby. It was also very healing for me to have a better recovery this go round. I finally was discharged Tuesday and sent home on blood pressure medicine. It seemed like I would escape the post partum hypertension this time, but it started going up while I was still in the hospital. I was glad we caught it before going home, and am confident that it will correct itself in time. The time at home has been tiring, but wonderful. We kindly asked for some time before we were ready for visitors and I am thankful for that. It has been the most wonderful time to bond and establish nursing privately. I can honestly say that this time has been the best experience. We are so in love with sweet Isla and cannot imagine our family without her.  Thank you, Marissa, for sharing your family's birth story. It so important to honor all birth journeys, for they transform us into the mothers and fathers that we are. If you would like to share your birth story this month, please email it to me, along with a statement that I have permission to share your story on social media. You can email it to me at krystyna{at}sweetpeabirths{dot}com. Disclaimer: The material included in this video is for informational
purposes only. It is not intended nor implied to be a substitute for
professional medical advice. The viewer should always consult her or his
healthcare provider to determine the appropriateness of the information for
their own situation. Krystyna and Bruss
Bowman and Bowman House, LLC accept no liability for the content of this site,
or for the consequences of any actions taken on the basis of the information provided. This blog and video contain information about
our classes available in Chandler, AZ and Payson, AZ and is not the official
website of The Bradley Method®. The views contained in this video and on our
blog do not necessarily reflect those of The Bradley Method® or the American
Academy of Husband-Coached Childbirth®. |
Patient Rights
| Posted on September 25, 2015 at 9:39 AM |
comments (349)
|
 Thank you to one of my colleagues, Rachel Davis, for
suggesting this topic. I originally shared this after one of our couples had an unplanned unassisted birth couple encountered in the
hospital, and they were not treated very kindly upon arriving or throughout their hospital stay. Most people would not expect their baby to be born at 35
weeks. In addition, they had not counted
on dealing with hospital protocols since they had planned a homebirth. The other situation they hadn’t planned on
was giving birth away from their community. They were familiar with their local hospital in northern Arizona - it was beyond their imagination that they would spend their first week of their child's life having to deal with a major hospital in central Phoenix.  Their situation underscores the importance of having a
well-thought out and written birth plan no matter what kind of birthplace you
have chosen. Wherever you are
planning to give birth, Bruss and I suggest that you think about writing two birth
plans. Write one for a normal, uncomplicated birth at your chosen birth place. Also consider writing one that has your wishes written down in the event of complications, and that
factors in hospital care if you are planning to birth at home or birth center.. Once you have
talked these out between yourselves and your care providers, write them down and have a copy handy at all times.You just never know how the birth journey will unfold…in the event of
unforeseen circumstances, your birth plan can act as a compass for your
decisions. It can also remind you of the
decisions you made when you took the time to research your options and when you
were not under pressure. You can then
evaluate the current situation with a little less emotion and a little more
reason. There are two sections to this post. First, I highlight the main points of your rights as a patient in the hospital. I encourage you to remember that you are the CONSUMER of health care, not a helpless being at the mercy of the staff. The second section reviews some basics of informed consent so that you have an idea of how to receive the right care for you after asking questions that other people have found helpful to gather complete information before accepting or declining treatment. PATIENT RIGHTS For a full Pregnant Patient and Obstetric Patient Bill of
Rights, I am going to refer you to a link on Doris Haire’s Alliance for the
Improvement of Maternity Services (AIMS): http://www.aimsusa.org/ppbr.htm One of the reasons so many of us feel pressured to make choices
against our instinct or desire for as natural experience as possible is that
sometimes information is relayed in such a way that implies that you are a bad
parent if you deny treatment to your child, or they imply that by not choosing
something you could harm your child. How
many parents are strong enough to follow their instinct with pressures like
time, fatigue and shock also factoring into the situation? Whether you are planning to give birth at home, in a birth
center, or a hospital, I encourage all pregnant mothers and their coaches to
become familiar with the AIMS Pregnant Patient Bill of Rights in the event that
you end up in a hospital for whatever reason.
I suggest that you print out the American Hospital Association's
"Patient's Bill of Rights," (http://www.patienttalk.info/AHA-Patient_Bill_of_Rights.htm) as well as the AIMS Pregnant Patient Bill
of Rights and bring them both with you in the event of a hospital visit during
your pregnancy and labor. I will summarize some of the points here and encourage
parents everywhere, that pregnant or not, if you are in a hospital, there is very little that you can be forced to do or take for yourself or your child. You have every right to ask and be told the
benefits and the risk of EVERYTHING they recommend as treatment, and you have
the right to refuse. These are what I chose to pull our from both of the Bill of Rights documents as your rights as a pregnant and an obstetric patient:
INFORMED CONSENT What is informed consent?
According to Doris Haire: "Most courts consider that the patient is
'informed' if the following information is given:
You can ascertain this information by asking questions. For a more comprehensive look at positive
communications and informed consent, refer to page 55 of The Bradley Method®
Student Workbook. I suggest that you start with questions that establish how
the mother and the baby are doing.
Always use names to remind the care providers that they are making
recommendations for another human being, not an ambiguous test case:
If both are well enough and there is time, then you can
continue with questions such as:
If the care provider agrees that Mother and Baby are well
enough to let labor proceed and let nature take her course, continue to trust
that Mother and Baby are working together and that you will be meeting your
baby in due course. You can address
other probable causes – is mom hydrated?
Is she emotionally ready and relaxed enough to accept her labor? Are you using the best positions in the
appropriate stage of labor to allow gravity and physiology to move things
along? If after asking this series of questions Mother and Coach
decide that further action is worth exploring, then you can continue with these
questions:
One of the reasons it is so important to take care when
choosing your care providers and medical facilities is that sometimes there
isn’t time to ask all these questions.
If Mother and Baby are already compromised and there is no time to ask
questions, you must trust that the care providers and the birthplace will do
the best for your family. Do you have
this level of trust with your care provider?
Do you have this level or trust with the birthplace? If you answered “no” to either of these
questions, it’s time to seriously consider making a change. Although true complications are rare, if you
are part of the small percentage, you want to ensure that you have the best chance
for a good outcome despite any complications that may arise. You have a couple of
options in a hospital setting in the event that you want to choose differently than your care
providers are recommending and/or if you feel like your concerns are not being
heard by your care provider.
There is no decision, big or small, that you will regret
making as long as you keep in mind Dr. Bradley’s ultimate outcome: Healthy Mom,
Healthy Baby. As long as your decisions
are made with the best results for these two people in mind, then you can find
peace of mind that you are making the right decision for you and your family. The
material included on this site is for informational purposes only. It is not intended nor implied to be a substitute for professional medical
advice. The reader should always consult her or his healthcare provider to
determine the appropriateness of the information for their own situation. This blog contains information about our classes available in
Chandler, AZ and Payson, AZ and is not the official website of The Bradley
Method®. The views contained on this blog do not
necessarily reflect those of The Bradley Method® or the American Academy of
Husband-Coached Childbirth®. |
Two Cesareans and A VBAC
| Posted on May 1, 2015 at 12:33 AM |
comments (30)
|
Here is our final post for Cesarean {Birth} Awareness Month. (I missed by a day when I was planning posts :/ Oops!) Today I am sharing two cesarean birth stories from SPB alumni families. Both beautifully illustrate the gift of a cesarean when they are medically necessary.
And to round off the stories, here is the Bland Family story. They were classmates with the Schlueter family, and joined us as part of their journey as they prepared for a Trial of Labor After Cesarean (TOLAC). They were able to have a VBAC - here is how it happened for them: My C-section and VBAC journey by Tanya Bland With my first pregnancy I planned an all natural birth. I went to midwives, took baby classes, the whole nine yards. 40 weeks came and went. When I hit 41 weeks the ultrasound showed that my daughter was measuring very large. They said she was weighing about 9 lbs, 15 oz. I was told all the concerns with a large baby and being "overdue". Unfortunately in hind sight I feel I didn't have enough knowledge or the confidence to ask more questions. I became scared by the "big baby" issues and decided to schedule an induction. We decided to go with a round of prostaglandin gels. My husband and I checked in to the hospital around 2pm and had to lay down in the bed for 6hrs then I went home. Nothing happened the next day. The following day I went back to the hospital for another round of gels. They admitted me and proceeded with more inductions. I went back and forth between prostaglandin gels and cervadil for 4 days. When I finally got to 3cm they started pitocin. The contractions started to intensify for a few hours but then I fell asleep. I slept for about 3 hrs and when I woke up all my progress had come to a halt. At that point my midwife told me about the risks if I were to continue of possible shoulder dystocia. Not knowing the stats or real risks of shoulder dystocia my husband and I became very scared. We decided to go with the option for a c-section. Even during the c-section they had to use a vacuum to get Taylor out. I feel that she truly wasn't ready to come despite how big she was. She was born at 10 lbs, 5 oz.
I attended some ICAN meetings and did more research and by the time I was pregnant again I was determined for a VBAC. With my second child I decided to attend Bradley™ classes to gain even more knowledge, along with hiring a doula. I believe that having Krystyna and Bruss, along with my doula in my corner to ask questions whenever I was unsure of things, not only made me feel more at ease but also helped with my successful VBAC. I made a plan ahead of time and knew that I would be "overdue". At 41 weeks the doctors wanted me to have a repeat c-section. Thankfully, with the knowledge I had learned I knew that as long as I was healthy and my baby was healthy that I could continue to wait until baby was ready to come. My midwives were very wonderful in supporting me with waiting and dealt with the doctors for me. The day before I hit 42 weeks I went in for my check up. My midwife said she supported me completely but needed to express the risks for continuing to wait. She offered to start an induction using the Foley Bulb. This time I felt more prepared. I called Krystyna and my doula, Diane Acuna and was able to research the positives and negatives. I made the choice to continue to wait because I was healthy and so was baby. I felt at peace with whatever was going to happen, whether it be VBAC or repeat C-section because I felt like I had done all I could and research all I could. Thankfully Kaylee decided to make her grand entrance at exactly 42 weeks and I got to have my completely natural VBAC. If anyone is open to advice, this is what I would tell them: take the Bradley™ classes and hire a doula! What a difference having all that knowledge and extra support in my corner did for my peace of mind and outlook. The material included on this site is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
The Family-Centered Cesarean
| Posted on April 30, 2015 at 9:40 AM |
comments (83)
|
 For today...another one from the archives, originally published in April 9, 2013. Updated April 30, 2014 to include information about microbiome seeding; and a gentle cesarean checklist of options to review with your provider and prepare for a cesarean birth journey.A "Family-Centered" cesarean? A "gentle" cesarean? A procedure that is Woman and MotherBaby-centered? What? Did you just read that correctly? Yes, you did. There is a "new" trend in cesareans that is hitting the mainstream consciousness here in the United States. While a lot of the focus during Cesarean Awareness Month tends to center on Vaginal Birth After Cesarean (VBAC), I also want to acknowledge that a VBAC is not the choice that all mothers want to make. Here is an option for mothers who know they want, or are considering, a repeat cesaran birth. It is also an option if a healthy, low-risk labor starts to change it's course and there is time for non-emergent cesarean. I have linked to THIS post about a "natural" cesaran more than once in previous posts, and today I want to be a little more specific about what a "natural" cesarean is and why a family might opt for this. To quote the article:
A family-centered, or natural cesarean strives to capture these components of a vaginal birth:
The idea of "seeding the microbiome" is a new concept. Here is a quote from THIS article:
And one from THIS article:
So while your initial reaction might be one of surprise and disgust, think about it. Please take a minute to read both of the excerpted articles and have a discussion with your partner and your care provider before you make up your mind one way or another. Here are some of the benefits that are causing mothers to request this kind of cesarean option:
If you would like to have a conversation with your care provider about planning for a gentle cesaean as your birth plan or "just in case" plan, HERE is a list of options for you to discuss with them, provided by ICAN of Phoenix chapter leader Jenni Froment. I also want to mention: these are evidence-based recommendations. If your care provider scoffs at you and laughs you out of the room, thank them very much for their time and go have a conversation with another provider in your area. Your local ICAN chapter or ICAN international are great resources for respectful, family-centered providers. What do you think? Please leave us a comment - it will be moderated and posted. *I think* that the amount of traffic you so generously generate has led to a lot of spam posting. In an effort to keep the spam to a minimum, I am taking the time to moderate comments now. Link List: http://www.youtube.com/watch?v=m5RIcaK98Yg ARTICLES ICAN http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/ MIDWIFE THINKING http://midwifethinking.com/2014/01/15/the-human-microbiome-considerations-for-pregnancy-birth-and-early-mothering/ MAMASEEDS http://mamaseeds.com/blog/antibiotics/how-seed-your-baby-healthy-microbiome-last-lifetime/  Disclaimer: The material included on this site is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided. This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®. |
VBAC Preparation: Ask the Midwife
| Posted on April 29, 2015 at 7:16 PM |
comments (688)
|
Our posts for Cesarean Awareness Month continue. With their permission, I am sharing notes today that I took at an
ICAN meeting presented by some Phoenix-area midwives in 2012. The main presenters and most of what you see below are the paraphrased words of Diane Ortega, CNM
and Belinda Hodder, CNM. They are midwives at Valley Women for Women, whose overall cesarean rate in 2014 was 7% in the midwife practice.* Also in
attendance and adding commentary to some of the answers was another CNM in the
area. While all three midwives believe
in and support the natural process, all of these women have had a cesarean
themselves. It seems to me that it lends them an
extra dose of vestment in their patient’s goals for a vaginal birth after
cesarean.
The format of this meeting was question and answer. Below is a paraphrase of the midwives’
answers to the questions posed by the women in attendance at the ICAN meeting
on October 24, 2012 in Tempe, AZ.
There is not a lot of opinion offered here.
It was a presentation of information so that a woman considering a vaginal birth after cesarean (VBAC) could consider
the information as she prepared for her next birth journey. This information is offered a starting
point for the previous cesarean birth woman to do her own research so that she could make the decision that
is right for her unique situation.
VBAC Planning and Preparation
Q: What are the best methods to prepare for a VBAC? A: There are several things you can do to prepare:
 Q: What can I do to prepare my body for a VBAC?
A: There are a few things you can do
Q: Will the type of sutures I have determine whether or not I can have a VBAC?
A: Whether an obstetrician will do a
single-layer or a double-layer of sutures depending on how they are trained,
and sometimes it depends on what the uterus looks like. As long as you have a low, transverse scar,
or the status of your scar is “unknown” than you can have what is called a
“trail of labor”. If you have a vertical
scar, the standard is to have a repeat cesarean. Uterine Rupture
Q: Will my chance for a uterine rupture increase with the length of labor?
A: There is no evidence in the research that supports that. (At this point, ICAN leader Stephanie Stanley mentioned that a uterine rupture can happen at any time, with or without a previous cesarean – HERE is her research on that topic). Q: What are signs of uterine rupture? A: Pain that doesn’t go away after the contraction is over,
and a decrease in the baby’s movement an/or heart rate.
Q: How long does it take to heal from a uterine rupture? A: Like a cesarean; maybe there will be a little more bleeding.
Going Past 40 Weeks
Q: What is the concern about going postdate? A: ACOG guidelines are that babies should be born by 42 weeks gestation. While the literature does not show an increase of risk for uterine rupture, it does indicate that a baby does not tolerate a labor as well after 42 weeks. There are more issues with meconium, the umbilical cord and the placenta after the 42-week mark. You could find a care provider that is willing to let you go past 41 weeks as long as you are having ultra-sounds and non-stress tests done.
Q: What is the policy for induction if a
mother wants a trial of labor after multiple cesareans? A: That usually depends on the personal beliefs of your doctor(s). The use of prostaglandins or Cytotec is not indicated. In reality, there are no guidelines, only protocols to consider and to follow.
Q: How do I know if I am really “past” my estimated due date? A: The ultrasound at 9-10 weeks is considered to be the most accurate predictor of your estimated due date. If you know the history of your menstrual cycle (menses), or if you used an ovulation kit, you might have another data point for establishing your conception date, and thereby having another way to estimate your due date.
Q: What are strategies for inducing labor for a VBAC mom? A: Things that are done in office and then allow you to go home and labor there: a foley bulb (aka foley ball) or a stripping of the membranes. In the hospital and you stay at the hospital: foley ball, artificial rupture of membranes, and in some cases, you could use Pitocin.
About Labor
Q: What is the most common reason for a repeat cesarean after a trial of labor? A: A slow progress of labor with no real signposts that labor is going to progress. Keep in mind that if you come to the hospital early in labor, you start chipping away at your chances for a VBAC.
Q: Why do I have to be continually monitored? A: Our hands are tied by hospital policy – any VBAC patient has
to have continuous electronic fetal monitoring.
We work in a community that is frightened of litigation.
On the upside, if everyone looking in from the outside can “see” that mom and
baby are doing fine, this can buy you more time.
There are options in monitoring. There
are waterproof monitors that can be used in water during labor, and there are
also some hospitals that use wireless monitors.
HERE is a great visual on all
the different positions you can labor in even if you are continuously
monitored.
In reality, the amount of monitoring is specific to the hospital. You have to decide how you feel about going
Against Medical Advice (AMA) if you feel strongly about not having a continuous
monitor.
Q: What are your thoughts on an epidural?
A: You want to try to get into labor on your own at the beginning since
epidurals tend to slow your labor down.
When we say “get into labor” we mean dilation to at least a 6 with a
good, established pattern of contractions.
Pain is one of the indicators that can tell you something is going wrong
right away. If a mom has an epidural,
bradycardia (slow heart rate) in the baby is the only indicator we have that
things are not staying low risk. The use
of Pitocin to augment a slowed labor can also increase your chance of uterine
rupture.
Q: How long can I go with ruptured
membranes (broken bag of waters)?
A: If you are GBS negative, you could wait up to 24 hours before coming
in. If you are GBS positive, then we
evaluate that on a case-by-case basis. (Krystyna’s note: the presence of GBS at the time of labor raises the
concern for mom/and or baby to develop an infection during labor since the bag
of waters in no longer intact and able to provide a barrier against infection.)
Q: What are ways to prevent tearing during the pushing phase?
A: Eat well – a good diet packed with fruits and vegetables. There is no evidence that shows that perineal
massage will prevent tearing. You could
avoid tearing by tuning into the natural “safety mechanism” known as the “Ring
of Fire”. By tuning into your body, you
will slowly ease the baby out. This is
another reason to consider going the natural route: you don’t feel the ring of fire
when you have an epidural. In closing, here are their "Words of Wisdom": CARE PROVIDER
WHAT IF…
If your VBAC doesn’t work out, be easy on yourself.
(Krystyna’s note:HERE is a family-centered cesarean on film.
What is a little startling about this is that one of the references is
dated 2008! At least we are doing our
part to bring awareness to this option.)
BELIEVE IN YOURSELF
*Rate for one baby, head down, for patients who wanted to have a vaginal birth was 7% in 2014. This marks the third year they have collected data and the rate has remained 8 % or below whilst their overall number of patients rises each year. What did you do to prepare for your VBAC/CBAC journey? What did you learn that you are willing to share? Please leave us a comment - it will be moderated and posted. *I think* that the amount of traffic you so generously generate has led to a lot of spam posting. In an effort to keep the spam to a minimum, I am taking the time to moderate comments now.
Link List Visual reference of labor positions during EFM http://www.icanofatlanta.com/?page_id=159 The Family-Centered Cesarean http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/ Video: The Family-Centered Cesarean http://www.youtube.com/watch?v=m5RIcaK98Yg Disclaimer:
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical
advice. The reader should always consult her or his healthcare provider to
determine the appropriateness of the information for their own situation. Krystyna and Bruss Bowman and Bowman House,
LLC accept no liability for the content of this site, or for the consequences
of any actions taken on the basis of the information provided. This blog contains
information about our classes available in Chandler, AZ and Payson, AZ and is
not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or
the American Academy of Husband-Coached Childbirth®. |