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Sweet Pea ​Births
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Uterine Rupture: Assessing the Risks
| Posted on April 26, 2016 at 10:18 AM |
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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®. |
In Their Own Words: Isla's Birth Story
| Posted on April 8, 2016 at 8:03 AM |
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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. 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®. |
To Eat or Not To Eat…
| Posted on November 5, 2015 at 8:07 AM |
comments (123)
|
 To eat or not to eat…That was the question for families planning a hospital birth. When you are laboring at home or a birth center, you have the freedom to eat as your appetite dictates. If you choose to have a hospital birth, you are at the mercy of your doctor’s orders and the nurse’s interpretation of the hospital protocol. We love it when science catches up to Dr. Bradley. Anecdotally, we could tell students that it was safer to eat before/during labor since anesthesia has changed from the days of "knock'em out, drag 'em out" birth, as Dr. Bradley called it. Women used to be under general anesthesia, which is administered differently than today's spinal or epidural blocks. We are so excited to update this post (and our class info!) with a press release from the American Society of Anesthesiologists (ASA):
Now...how long will it take for hospital protocols to change and reflect these recommendations from ASA? As we found out the hard way, sometimes the doctor approves something but if it is not in writing and signed off on the birth plan, it probably isn't going to happen in the hospital setting. The nurse will follow the hospital protocol or they may invent their own interpretation if none exists to cover their liability. If you are going to have a hospital birth, I have a strong opinion about getting your wish list signed so that the nursing staff has “permission” to “break the rules” if they feel that something you are requesting is out of the ordinary. Maybe you could ask for a copy of the ASA press release to be included in your chart that goes to the hospital. Dr. Bradley always advocated that a healthy mom should eat if she is hungry and drink if she is thirsty. As he said, “Birthing is like playing a full game of football without any substitutions.” He recognized that labor is an athletic event, and that a well-nourished athlete would perform better than a hungry one.
A Note About Hospitals and Nourishment If you are having a hospital birth, you need to find out how your care provider feels about nourishment during labor, even with this announcement by the ASA. If your care provider is on board with mom eating and drinking as her body directs, great! Get it into your birth plan, aka "wish list", that you have permission to eat and drink. If they restrict intake, you need to think about your options. You may question whether or not your care provider is truly supportive of your plans for a natural birth. You should also ask what the hospital policy is on food and drink during labor when you do your hospital tour. It helps to know what kind of potential situations you may be facing so you can avoid stress-inducing encounters during labor. The potential conflict between a laboring mother’s needs for nourishment and her care provider or hospital protocol comes from the days when general anesthesia was standard for hospital births. There was a very real danger of a mom “aspirating”, meaning that food or drink the mom had consumed before labor would be regurgitated and accidently enter the trachea and lungs, creating a life-threatening condition to mother and baby. [See reference 1]
Although very few women have births under general anesthesia nowadays, the practice of restricting food and drink still persists. You may hear it called “NPO”, which stands for the Latin, “non per os”, meaning nothing by mouth. With the press release from the ASA, we can keep our fingers crossed that hospitals will start to change their practice protocols. In the past, it was likely that you would only be allowed ice chips if you opted for an epidural. The chance of needing general anesthesia was within the realm of possibility since some moms and babies “crash” after the epidural dose is dispensed. As with all labor interventions, you don’t know how you will react until it’s administered. Although it’s a small percentage of women that have life-threatening complications, the prospect of the drugs dropping your heart rate, blood pressure or respiration to dangerously low levels exists once they are in your bloodstream. In the instance of a “crash”, you would need general anesthesia to perform an emergency cesarean to save your or your baby’s life, thus your nourishment options become limited to ice. Eating and Drinking During Labor Have your refrigerator stocked with your favorite healthful foods and/or meals as you near your estimated due date. Labor is a funny thing – you never know what your body is going to like. If you think you are in labor, you can go through Dr. Bradley’s list of things to do to see if you are in pre-labor (contractions slow down or stop) or actual labor (contractions continue at same pace or get closer and harder despite the change in position or activity). To "test" for labor, he suggests that a woman should eat, drink, go for a walk, shower and nap – in that order. When you start with the “eat” part of the list, it will be more satisfying to eat something you really enjoy. If you are not in labor, at least you ate something you like and you can move on with your day with a tummy-full of your particular “comfort food”. If you are in labor, then you have eaten something that is fueling your body for the labor. It will put you in a good frame of mind if you ate something that is a favorite and you create a positive emotional state. The best drink during labor is water. Water is a key to staying hydrated and avoiding the slippery slope of interventions. A hydrated body has the energy for the work of labor. Ample water also allows for effective hormone distribution throughout the body: the chemicals and hormones being made to stimulate and progress labor are able to circulate freely. If you have a longer labor, consider an electrolyte replacement: trace minerals added to the water you are drinking, Emergen-C makes a powder, or coconut milk is a "natural" version of sports drinks. Dehydration causes a spike in temperature and blood pressure, while at the same time depleting your energy by as much as 30%. Can you see that simple dehydration can also be interpreted as the mom being “in distress”? Your care team will not want to take a chance of making the wrong call, so they are likely to intervene or suggest drastic measures to “save” mom and baby. Whether you are laboring at home, a hospital or birth center, small-portioned, protein rich snacks are nice to have on hand. As your labor progresses, a laboring woman’s appetite will naturally decrease as the body shuts down other functions such as digestion to allow for full focus on the progression of labor and birth. Here are some foods that we and other students have found useful for quick energy boosts when mom doesn’t have the desire to eat a full meal. These snacks are also handy for the coach to get the energy boost he needs to be a great support person for mom. We don’t want hungry, cranky coaches during labor!!
 - Honey sticks. According to honey.com, “Honey is also a rich source of carbohydrates, providing 17 grams per tablespoon, which makes it ideal for your working muscles since carbohydrates are the primary fuel the body uses for energy. Carbohydrates are necessary in the diet to help maintain muscle glycogen, also known as stored carbohydrates, which are the most important fuel source for athletes to help them keep going.” [2] - Trail mix. You get the nice variety of nuts, dried fruits and if you want, candy, in one bag. I found myself picking out my favorite nuts and fruits and snacking on them – literally one or two at a time – as we got into the active phase of first stage labor. - Protein bars or chews. Look for bars that are low in carbs and added sugars –the key is to provide an energy boost without an energy crash afterwards. We have had students that use the “PowerBar” brand Energy Bites, as well as Gel Blasts that are bite size energy foods.- Handful of nuts. If you have a favorite nut (besides your coach-lol), bring some with you. You can eat 1 or 10, whatever you are in the mood for. I like nuts because you get the energy boost in whatever quantity you are in the mood to chew and swallow. Trader Joe’s sells packages nuts in handy single serve packets. I usually eat 2 or 3 pieces, and Bruss would finish off the bag for his energy boost.  - Popsicles. While working hard in labor, a popsicle can be refreshing. To prevent an energy crash, look for a brand that uses natural fruit as a sweetener instead of added sugars. Added bonus: you can also push it against the top of your palate to stimulate oxytocin production. - Applesauce cups. Provide potassium along with a little protein. The nice thing about applesauce is that while some people prefer them cold, they don’t need to be refrigerated. Again, look for naturally rather than artificially sweetened sauces.- Banana. Another source of potassium that is portable and easy to eat. To prevent a sugar burst, pair this with a cheese stick to balance out the carbs.  - Soup or clear broth. Campbell’s came out with the “Soup at Hand Cups” that are single serve, portable and microwaveable. They were a God-send during our third birth. The nurse didn’t want me to eat “just in case”, but she was okay with me drinking – hence, I could drink my meal and stay nourished through our 34 hours at the hospital.- Single serve smoothies or juice drinks. I am thinking along the lines of Stonyfield Farm Smoothies or Drinkable Yogurts for a liquid protein boost, or the Odwalla line of Protein Beverages. It’s a little sip of something sweet with carbs that still offers a protein source for energy. As you noticed from the list, some of these foods need refrigeration or a heating source. These are considerations if you are having a hospital birth. It stands to reason that if you will not have access to a refrigerator or microwave, the items that won’t stay cool with an ice pack or the foods that need to be heated need to left out of the cooler. The bottom line: eat to appetite and drink to thirst for the best labor possible! I hope this list gives some ideas with which you can fill your refrigerator or cooler. What did you eat during your labor? Disclaimer: 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®. References: [1] http://en.wikipedia.org/wiki/Pulmonary_aspiration [2] http://www.honey.com/nhb/benefits/natural-energy/ |
Two Cesareans and A VBAC
| Posted on May 1, 2015 at 12:33 AM |
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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 |
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 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 |
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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®. |
Q&A with SPB: Cesarean Support
| Posted on April 21, 2015 at 3:18 AM |
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 April is Cesarean Awareness Month. Today I am bringing you a virtual interview with local Phoenix ICAN Chapter co-leader, Jenni Froment, as well as a VLOG with Stephanie Stanley, founder and instructor at Give-Birth.org.I interviewed Stephanie about her childbirth classes last week. She came back to sit down with me and talk about the mission of ICAN, and we talked a little about peer-to-peer support. Here is what she had to say about this amazing group:  And here is my virtual interview with Jenni Fromment, one of the co-leaders of our local ICAN chapter in Phoenix, AZ.
If you have heard about an ICAN chapter in your area, and you still haven't made it to a meeting, I encourage you to take the first step and get to a meeting this month. You may feel all alone...as Stephanie mentioned, find your courage and come out to a meeting. You are not alone. There is more to birth than,"at least you have a healthy baby". This support group knows it and is available to walk your postpartum journey with you. ICAN Infernational: http://www.ican-online.org/ ICAN of Phoenix: http://www.ican-online.org/phoenix/ Have you had help along your postpartum journey? What worked for you? Feel free to give a shout-out to your local ICAN group or your ICAN leaders in the comments. Comments will be moderated and posted. BUT WAIT - THERE'S MORE: Here are some specials for the month of April from ICAN and Give-Birth... ICAN: Membership Sale - www.ican-online.org/join  Give-Birth: In honor of Cesarean Awareness Month Stephanie will be offering her 6 Week Class Series for $100! If you're not due for a while you can still take advantage of this offer. Contact her for details. Disclaimer: |
Q&A with SPB: Childbirth Classes for VBAC or CBAC
| Posted on April 14, 2015 at 10:57 AM |
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We are honored to share an amazing childbirth educator and Cesarean Birth Advocate with you today. We got to sit down with Stephanie Stanley, founder of Give-Birth.org, and in today's VLOG we bring you a short interview with her: GiveBirth Workshops: Want to learn more about what VBAC is, why it matters, and why it's not standard practice for most care providers? The GiveBirth VBAC workshop will go in depth to answer all these questions and we don't stop there. In this 4 hour educational and interactive workshop you and your partner (and doula too, if you want to bring her!) will learn all about your options for VBAC, how to find the information and resources you need to make birth choices that are right for you, and how to release your previous expectations (or limitations) of birth and move forward open to a new experience. We also include 9 practical tips to prepare for your VBAC. Cesarean Awareness Month Special: In honor of Cesarean Awareness Month I will be offering my 6 Week Class Series for $100! If you are not due for a while you can still take advantage of this offer. Contact me for details. Upcoming Classes Preparing for Birth After Cesarean - 6 Week Series Wednesday evenings, May 6th - June 10th GiveBirth: VBAC Workshop Saturday May 23rd (time TBA) About GiveBirth GiveBirth is an idea born of a desire to help new parents discover and enjoy the experience of birth, regardless of how their birth unfolds. Birth is a transition for both the baby and the parents, as individuals and as a family. The way we welcome our children into this world, into our lives, begins at birth and our experience impacts bonding and growth through that transition. Our goal with GiveBirth is to create an organization committed to educating, supporting, inspiring and empowering parents as they prepare to Give Birth.  Disclaimer: |
Wordless Wednesday: Cesarean Awareness Month
| Posted on April 8, 2015 at 6:10 PM |
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There are no mommy wars on this page. Every birth is acknowledged, as our tag line is, "Celebrating every Sweet Pea and their birth." However your child enters the world, it is the day of their birth, as well as the birth of a Mother and Father. If you need help processing your birth, please email me at krystyna{at}sweetpeabirths{dot}com and I would be happy to send you a resource list. Cesareans:   This Coach still got to cut the cord - you can preserve some elements of your birth plan, even if it plays out differently than you prepared for.   Vaginal Birth After Cesarean (VBAC):  SPB students working through VBAC labor  ICAN of Phoenix leader and baby*  ICAN of Phoenix leader, husband and VBAC baby* We celebrate ALL births at Sweet Pea Births - ALL Birth-Days are the first day of your family's life. That is not to say there is not grief or sorrow for a birth that doesn't go as expected - we hope and pray that with time, glimmers of joy can be gleaned from your birth experience. If you had a cesarean birth, we invite you to find an ICAN support group in your area, and then prepare for a VBAC if that is a choice that works for your family. Thank you to our students and friends who sent pictures to share today...there is so much to say about cesareans...we'll leave these pictures with you today and share words and thoughts throughout the month.
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®. |