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Uterine Rupture: Assessing the Risks

Posted on April 26, 2016 at 10:18 AM Comments comments (49)
Uterine Rupture: Assessing the RisksThis was in posted April 2012 - updated April 2016
Uterine 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®.    

Bradley Method classes offered in Arizona: convenient to Chandler, Tempe, Mesa, Gilbert, Ahwatukee, Scottsdale, Phoenix and Payson, Arizona



In Their Own Words: Annika's Story

Posted on April 15, 2016 at 4:10 AM Comments comments (52)
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®.
 
 Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson


 

Q&A with SPB: Cesarean Support

Posted on April 21, 2015 at 3:18 AM Comments comments (48)
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:


ICAN Chapter Co-Leader -- Phoenix, AZ - cesarean birth prevention - recovery - advocacy


And here is my virtual interview with Jenni Fromment, one of the co-leaders of our local ICAN chapter in Phoenix, AZ.


Tell me about ICAN and the mission of the organization.
ICAN has focused our time and attention on improving maternal-child health by preventing unnecessary cesareans and promoting  a conversation around VBAC.  We do this through education, and by providing support to women that have gone through unnecessary cesareans and/or are planning future VBACs.  The idea was born between two women back in the 80s, Esther and Liz, whom both had cesareans and committed to never having one again.  We have chapters all around the world, and at least one chapter in almost all states in the US.
 
Can you tell me more about the ICAN community?
ICAN of Phoenix has such an amazing community, I am really proud of the dynamic of the group and the support we offer the women of Phoenix.  Our growth over the last couple years is really a testament to the impact we are making, and our greatest achievement so far has been getting ourselves integrated into conversations with birth professionals.  One of my personal agendas has been to build the relationship between ICAN moms and care providers that support the ICAN mission.  We do this buy building relationships with childbirth educators, doulas, midwives, and OBs.  We ask them to join our group, speak at our meetings and we talk about ICAN with them during our appointments.  We don't want it to be an "Us vs. Them" environment.  We want to work together to improve birth rights in Phoenix.

What have you seen as the benefits of peer-to-peer support?
This is my favorite part of the ICAN group.  This is probably the #1 reason I recommend that mothers join our group.  I can offer my perspective and experience, but I am only one person.  By joining the ICAN of Phoenix Facebook group, and coming to meetings, you get access to over 600 women in the Phoenix area that have had the same experiences, and walked the same journey as you.  It's so powerful to feel that sisterhood, and you can't put a price on the emotional impact of knowing that the women around you understand your feelings, and have been there with you.
 
Additionally, we have a lot of different channels that we can offer for women looking for support.  They can join our facebook group for a large pool of experience and sharing opportunity.  They can join our monthly meetings for a smaller, face-to-face audience for support.  And they can always email me directly if they are wanting to share privately.  I can be reached at [email protected].

What would you like to tell someone who has been thinking about coming to a meeting, and just hasn't gotten there yet?
You can find someone just like you.  We are such a diverse group of women.  There are working moms, stay at home moms, moms that believe in western medicine, moms that only use essential oils, moms that believe in hospital births, moms that believe in homebirths, etc.  I remember that when I went to my first ICAN meeting, I was so worried that I wouldn't fit in and when I got there I was so relieved.  It was just a bunch of women, some like me, some different, but all there with the common purpose of trying to find empowerment for our births.  There is such a fellowship, it's beautiful.  I also tell women not to worry about being forced to share their feelings, or tell their story if they are not ready.  Our meetings come planned with an ICAN-related topic, and then time for people to ask questions and share their stories if they want to.  No one has to share or speak if they don't feel comfortable doing so.

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/


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: 
Bradley Method® natural childbirth classes offered in Arizona: convenient to Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonThe material included in this video and blog 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®.

Wordless Wednesday: Cesarean Awareness Month

Posted on April 8, 2015 at 6:10 PM Comments comments (0)
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.  

*not an SPB student - they took a Birthing From Within Class as part of their VBAC journey


Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
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: What Your OB is Supposed To Know and Acknowledge

Posted on April 3, 2015 at 3:42 PM Comments comments (0)
Last year I wrote an article on evidence-based practice for The Clarion, the newsletter published by ICAN and sent to it’s subscribers (Spring 2014).  I read A LOT of documents and studies in preparation for that! 

Since it is Cesarean Awareness Month, I thought it fitting to share those with you.  The information shared below is accessible to all care providers who care for women in their childbearing years.  

If you would like a Trial of Labor with a subsequent pregnancy after a cesarean birth, then inform yourself about what the professionals are saying.  Examine your expectations, and find a care provider that supports your intentions for your next birth journey.

I have provided a brief summary, excerpt, and link to the complete document so that you can read that are meaningful to you in full.
 

This document from ACOG sets new goals for the obstetrical practice as a whole to re-evaluate their standard practices and make necessary changes to reduce the primary cesarean rate:
Safe Prevention of the Primary Cesarean Delivery
Excerpt:
Abstract: In 2011, one in three women who gave birth in the United States did so by cesarean delivery. Cesarean birth can be life-saving for the fetus, the mother, or both in certain cases. However, the rapid increase in cesarean birth rates from 1996 to 2011 without clear evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused. Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia. Safe reduction of the rate of primary cesarean deliveries will require different approaches for each of these, as well as other, indications. For example, it may be necessary to revisit the definition of labor dystocia because recent data show that contemporary labor progresses at a rate substantially slower than what was historically taught. Additionally, improved and standardized fetal heart rate interpretation and management may have an effect. Increasing women’s access to nonmedical interventions during labor, such as continuous labor and delivery support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation are other of several examples of interventions that can contribute to the safe lowering of the primary cesarean delivery rate.

ACOG http://bit.ly/1e5A2TW
 
This document from ACOG outlines the benefits and risks of a trial of labor after a cesarean (TOLAC), and help a doctor and a patient determine whether or not they are a candidate for TOLAC:Vaginal Birth After Previous Cesarean Delivery
Excerpt:
Trial of labor after previous cesarean delivery (TOLAC)* provides women who desire a vaginal delivery with the possibility of achieving that goal—a vaginal birth after cesarean delivery (VBAC)†. In addition to fulfilling a patient's preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. At a population level, VBAC also is associated with a decrease in the overall cesarean delivery rate (1, 2). Although TOLAC is appropriate for many women with a history of a cesarean delivery, several factors increase the likelihood of a failed trial of labor, which compared with VBAC, is associated with increased maternal and perinatal morbidity (3–5). Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. The purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and provide practical guidelines for managing and counseling patients who will give birth after a previous cesarean delivery. 

 
This article outlines some of the different changes that might be made in the way labor is managed – definitely talking points for ANY family to discuss with their care provider to ensure they are receiving evidence-based care:
Safe Prevention of the Primary Cesarean Delivery: ACOG and SMFM Change the Game

Excerpt:

The alarming and sustained increase in the cesarean rate in the United States has not improved either maternal or neonatal outcomes. In fact, data suggest that there is increased maternal mortality and morbidity associated with cesarean delivery. This statement describes the myriad of complications associated with cesarean and the increased risks associated with cesarean for mother and baby. The authors suggest that potentially modifiable factors, such as patient preferences and practice variation among hospitals, systems, and health care providers are likely to contribute to the escalating cesarean rates. There is a need to prevent overuse of cesarean, particularly the primary cesarean.
Science & Sensibility » http://bit.ly/1imlVdt
 
Prepared with the intention, “To provide health care providers, patients, and the general public with a responsible assessment of currently available data on vaginal birth after cesarean (VBAC).”
NIH Vaginal Birth After Cesarean (VBAC) Conference - Panel Statement
Excerpt:
Given the available evidence, trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision. The data reviewed in this report show that both trial of labor and elective repeat cesarean delivery for a pregnant woman with one prior transverse uterine incision have important risks and benefits and that these risks and benefits differ for the woman and her fetus. This poses a profound ethical dilemma for the woman as well as her caregivers, because benefit for the woman may come at the price of increased risk for the fetus and vice versa. This conundrum is worsened by the general paucity of high-level evidence about both medical and nonmedical factors, which prevents the precise quantification of risks and benefits that might help to make an informed decision about trial of labor compared with elective repeat cesarean delivery. We are mindful of these clinical and ethical uncertainties in making the following conclusions and recommendations.
 
One of our major goals is to support pregnant women with one prior transverse uterine incision to make informed decisions about trial of labor compared with elective repeat cesarean delivery. We recommend clinicians and other maternity care providers use the responses to the six questions, especially questions 3 and 4, to incorporate an evidence-based approach into the decision-making process. Information, including risk assessment, should be shared with the woman at a level and pace that she can understand. When trial of labor and elective repeat cesarean delivery are medically equivalent options, a shared decision-making process should be adopted and, whenever possible, the woman’s preference should be honored.
 
We are concerned about the barriers that women face in gaining access to clinicians and facilities that are able and willing to offer trial of labor. Given the low level of evidence for the requirement for “immediately available” surgical and anesthesia personnel in current guidelines, we recommend that the American College of Obstetricians and Gynecologists and the American Society of Anesthesiologists reassess this requirement with specific reference to other obstetric complications of comparable risk, risk stratification, and in light of limited physician and nursing resources. Health care organizations, physicians, and other clinicians should consider making public their trial of labor policies and VBAC rates, as well as their plans for responding to obstetric emergencies. We recommend that hospitals, maternity care providers, health care and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to trial of labor.
 
We are concerned that medical-legal considerations add to, and in many instances exacerbate, these barriers to trial of labor. Policymakers, providers, and other stakeholders must collaborate in developing and implementating appropriate strategies to mitigate the chilling effect the medical-legal environment has on access to care.
 
High-quality research is needed in many areas. We have identified areas that need attention in response to question 6. Research in these areas should be given appropriate priority and should be adequately funded – especially studies that would help to characterize more precisely the short-term and long-term maternal, fetal, and neonatal outcomes of trial of labor and elective repeat cesarean delivery.
 
Perspective and summary of the revised recommendations issued by online news source, Medscape:
ACOG Issues Less Restrictive Guidelines for VBAC
Excerpt:
Trial of labor after previous cesarean delivery (TOLAC) is safe and appropriate for most women with previous cesarean delivery, including some women with 2 previous cesarean deliveries, according to less restrictive guidelines issued by the American College of Obstetricians and Gynecologists (ACOG). The revised recommendations for attempting vaginal birth after cesarean delivery (VBAC) are reported in a practice bulletin published in the August issue of Obstetrics & Gynecology.

 
A look at what evidence-based practice is – great place to empower you as a consumer and demand evidence-based care, and help evaluate the choice to change providers if you are not getting evidence-based care:
Introduction to Evidence-Based Practice
Excerpt:
The most common definition of Evidence-Based Practice (EBP) is from Dr. David Sackett. EBP is “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.” (Sackett D, 1996)

EBP is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal preferences and unique concerns, expectations, and values. The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)



The evidence, by itself, does not make the decision, but it can help support the patient care process. The full integration of these three components into clinical decisions enhances the opportunity for optimal clinical outcomes and quality of life. The practice of EBP is usually triggered by patient encounters which generate questions about the effects of therapy, the utility of diagnostic tests, the prognosis of diseases, and/or the etiology of disorders.

Evidence-Based Practice requires new skills of the clinician, including efficient literature searching, and the application of formal rules of evidence in evaluating the clinical literature.
 
LibGuides at Duke University Medical Center http://bit.ly/1e5zxcH
 
The jury is still out as to how this will affect mothers who birthed by cesarean who want a Trial of Labor with subsequent pregnancies.  Theoritically, it should allow for more time before a mother is considered "past due" and a care provider talks about induction.
Ob-Gyns Redefine Meaning of "Term Pregnancy"
Excerpt: 
Washington, DC -- The nation’s ob-gyns have redefined ‘term pregnancy’ to improve newborn outcomes and expand efforts to prevent nonmedically indicated deliveries before 39 weeks of gestation. In a joint Committee Opinion, The American College of Obstetricians and Gynecologists (The College) and the Society for Maternal-Fetal Medicine (SMFM) are discouraging use of the general label ‘term pregnancy’ and replacing it with a series of more specific labels: ‘early term,’ ‘full term,’ ‘late term,’ and ‘postterm.’  
 
The following represent the four new definitions of ‘term’ deliveries:
    • Early Term:  Between 37 weeks 0 days and 38 weeks 6 days
    • Full Term:    Between 39 weeks 0 days and 40 weeks 6 days
    • Late Term:   Between 41 weeks 0 days and 41 weeks 6 days
    • Postterm:     Between 42 weeks 0 days and beyond


“This terminology change makes it clear to both patients and doctors that newborn outcomes are not uniform even after 37 weeks,” said Jeffrey L. Ecker, MD, chair of The College’s Committee on Obstetric Practice. “Each week of gestation up to 39 weeks is important for a fetus to fully develop before delivery and have a healthy start.”


ACOG Publication http://bit.ly/1y5woWq

Any thoughts on cesareans or VBAC?
Please leave a comment – it will be moderated and posted.
 

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®.

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson


Monday Mantra: Your Best Birth

Posted on January 19, 2015 at 5:58 PM Comments comments (0)
If you follow us on social media, you probably know that Cassandra, our guest blogger and social media maven, is expecting her second Sweet Pea any day now.  As a matter of fact, she is 41 weeks today.
 
When we were corresponding last week, she sent a plea that most pregnant women in their last weeks of pregnancy send:
“I need something; grounding, reassurance; I’m not sure!”
 
I sent her some ideas to help pass the time until it’s “real McCoy” labor…she will be writing a post about that later in the week (maybe!).
 
I also sent her some words that she turned into a beautiful image for the lock screen on her phone: 

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
Art Piece by Alisha Vernon
Image credit: Cassandra Okamoto

 
While I hope they offer her (and anyone else they speak to) some reassurance, energy and courage, I offer them with love and caution.
 
After taking the first part of a training offered by Birthing From Within, I am painfully aware of the power of the words we use, especially around the topic of birth.  As Pam England calls them, these “bumper stickers” of the birthing world can be incredibly damaging.
 
These bumper stickers are ideas like, “Trust Birth”, “Empowered Birth”, “Birth Works” – you catch my drift.  If they hold true, they have the potential to encourage the mother throughout labor and motherhood.  On the other hand, say the birth has unforeseen or outcomes the mother/family did not prepare for or expect…then the woman might be left feeling powerless, helpless, something like a failure.
 
So when you read the mantra and absorb the message, hear all of what I am trying to convey:
 
Your body and your baby are functioning within a cycle of birth that is timeless. There is sacredness and beauty in the process of pregnancy, labor and birth. 
 
The reality is that even with the best preparation, birth is unique, fluid and unpredictable. I feel like the words I sent Cassandra give any birthing family the “permission” to embrace even an “imperfect” birth, for *that* journey was what *that* body and *that* baby needed for a Healthy Mom, Healthy Baby outcome.
 
I encourage you to adjust your lens: instead of focusing on the outcome, embrace the journey.  What are you meant to learn from this journey through pregnancy, labor and birthing?  By maintaining a realistic outlook that sometimes interventions are necessary and desirable for a Healthy Mom, Healthy Baby outcome, you can mentally prepare for the outliers and then celebrate the baby instead of the process.
 
So please embrace all of it – whatever happens, your body and your baby know what kind of birth they need for both of you to be well after the journey.  Sometimes Mother Nature needs no help at all, or sometimes a little encouragement.  At the other extreme, sometimes it takes all of the available medical technology to have a Healthy Mom, Healthy Baby outcome.  Embrace it, accept it, own it, learn from it.  It is your unique birth journey into motherhood, waiting just for you to uncover all the lessons and treasures hidden as unexpected forks in the road.


Do you have a favorite affirmation? What encouraged you?
Please leave us a comment - it will be moderated and posted. 
 

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, PaysonDisclaimer: 
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®.

Labor Support: Meet the Monitrice

Posted on March 22, 2013 at 11:33 AM Comments comments (0)
I am so excited to announce a monitrice service for couples that want to have a natural birth outcome in a hospital setting.  Jennifer Hoeprich, LM, is now extending her skill set to families who want to stay home as long as possible before heading to a hospital for their birth.


What is a monitrice?
A monitrice is a professional, medically trained, labor support person, who provides clinical monitoring within the home environment, including cervical dilation exams, auscultation of fetal heart tones, and monitoring of general well-being of mother and baby, during labor. The monitrice helps couples to assess their progress in labor, to determine the best time to leave for the hospital, where the birth is to take place.


How does a monitrice differ from a doula?
The focus of a monitrice is to provide clinical and educational support, while the focus of a doula is to provide emotional, mental, and physical support. Our monitrice service only provides services within the home environment. She only accompanies the couple to the hospital if complications arise, whereas a doula remains with the client during their transition from home to hospital.

How is a monitrice different than a midwife?
In the role of monitrice, the practitioner does not provide services at the actual birth. She does not "catch" the baby, or provide immediate postpartum services. A midwife provides all prenatal care, all labor and birth care, and all postpartum care.

Who would find monitrice services beneficial?
Couples who have chosen to birth in a hospital with an obstetrician, but who wish to labor at home for an extended period of time would benefit greatly from monitrice services.  They might want to stay at home in order to avoid unnecessary hospital interventions (such as movement restrictions, food restrictions, Pitocin augmentation, breaking the water prematurely, epidural, etc.).  Although they are choosing to wait longer before "going in", they can have that feeling of "safety" with consistent, professional monitoring, 

How do you envision a couple utilizing monitrice care?
A couple would interview the monitrice at her office and determine that the services are in line with their birth plan. They would then have two prenatal visits to get to know each other, and for the monitrice to assess baseline vitals and good health in the pregnancy.

The monitrice would be on call for the couple, starting at 36 weeks. When the couple believes labor has begun, they would contact the monitrice to give her a head's up. They may request her services at that point, to help determine if this is the "real thing" or may wait to call her over, once a labor pattern is clearly established.

Once the monitrice has arrived at the couple's home, she will assess maternal blood pressure, pulse, signs of infection, and hydration level. She will also asses fetal heart tones, and upon request from the couple, the mother's cervical dilation. The monitrice may make recommendations as to positions that would be helpful, encourage eating and drinking, and may provide herbal, homeopathic, or flower essence remedies, as appropriate, and as desired.

She will perform clinical monitoring every 30 minutes or every hour, depending on the stage of labor and the client's wishes. She performs monitoring respectfully, and can monitor the woman in any position the woman’s choosing, including in the shower, or in the labor tub. Once the couple determines that they are ready to leave for the hospital, the monitrice wishes them well and departs.

The couple will have a follow-up visit, including assessment of mother's vital signs, stitches (if applicable), a check for any signs of infection, breastfeeding support, and baby weight.  These visits occur at 1 week postpartum and 3 weeks postpartum, as most obstetricians only provide one postpartum visit at 6 weeks.

In the rare event that a complication should arise during labor, the monitrice will accompany the couple to the hospital.  Once they arrive at the hospital, the monitrice will provide a report and labor records to the staff. 

What kind of care is included in your fee?
The fee is $625. This includes two prenatal visits in the office, four hours of labor monitoring, and two postpartum visits in the office. Labor monitoring above four hours falls to an hourly rate of $50.  I am happy to offer a discount of $200 to any students of The Bradley Method®; their fee for service is $425.

As an added service to our clients, our monitrice service also rents, which includes set up and take down, the Birth Pool in a Box  labor tub, for $200. 

For more information about Moxie Monitrice Services, please visit 
www.moxiemidwifery.com or call to set up a free consultation.  You can also search for "Moxie Midwifery" on Facebook and @moxiemidwifery on Twitter. 

More about Jennifer:
Jennifer Hoeprich is a licensed midwife and monitrice, who provides services in Phoenix, Chandler, Mesa, Gilbert, Queen Creek, Maricopa, and Casa Grande.  She attended her first birth at age six, when her dog Cinnamon had puppies. She was the only attendant and knew then that she had found her calling. In 2001, Jennifer obtained her Bachelor's Degree, Minoring in Women's Studies. She experienced a natural birth with her son, in 2004 and began her journey into midwifery, shortly after. In 2005, she became a certified doula, and in 2008, a certified childbirth educator. She then obtained her midwifery license in 2011, and began the practice, "Moxie Midwifery." In her spare time, Jennifer enjoys being with her family, playing guitar, crocheting, and doing yoga. 

What do you think?  Would you use a monitrice service?  Why or why not?
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.

Disclaimer:
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson 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®.

Mental Relaxation

Posted on March 31, 2012 at 4:55 PM Comments comments (115)

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleCoaches Corner
Today's post is from Bruss' perspective.  He led class on Monday and told a story he had never shared in a class setting before...here it is along with an introduction that shares the line of thinking that went along with the story...

An important part of The Bradley Method® (some say the most important) is relaxation.

The superficial view I had of relaxation going into our first Bradley class and subsequent birth was that of *physical* relaxation. Krystyna and I were/are regular Yoga practitioners and my mental picture of relaxation was the final Yoga posture where one lays prone on the floor after a hard workout where the only option is total physical relaxation. In my own mind I thought that getting Krystyna to the physical state of relaxation was the goal/benefit to her in pregnancy and labor.

The Bradley Method® instructs various methods of physical relaxation to the couples and encourages them to explore others that are meaningful to them. Among the methods are message, stroking, hot showers etc.

Combined with physical relaxation, The Bradley Method® teaches the importance of emotional and mental relaxation. Initially I considered these relaxation themes of less importance than physical relaxation. My thought process was if I can help get Krystyna to relax *physically* than the other relaxation components would take care of themselves. 

I have come to find out through our Birth experiences as well as the dozens of students that we have help teach/mentor that my initial approach to relaxation in pregnancy and birth was exactly backwards.

Physical relaxation is the *end* result and dependent on emotional and mental relaxation, Mom needs to be in a good emotional state, accepting of the baby and ready (as possible) to take on her labor, ready to be a Mother, has effectively dealt with any family dynamic issues *prior* to going into labor or any other *emotional* issues that may impact Mom's readiness for labor and beyond. 

As a strong compliment to emotional relaxation, Mom's ability to focus her mental energies effectively in pregnancy and labor can dramatically effect the outcomes for better or worse. I think of mental relaxation is the ability of Mom to affect her state of mind positively to overcome any externalities such as physical discomfort, emotional and environmental challenges.

What I have found through experience is that if Mom is not relaxed emotionally and is not able to focus her mental energies positively then *physical* relaxation is all but impossible. Conversely, by concentrating on emotional relaxation and positive mental focus then physical relaxation seemingly just happened and labor was able to progress more effectively.

.....

So what does all that mean?

For me as a husband and labor coach, what this means is that I have to (1) understand the importance/impact of emotional and mental relaxation to pregnancy and labor and (2) be ready, willing and able to effectively work/communicate with Krystyna on these components of relaxation during pregnancy, labor and beyond.

......

I'll end the post with a story from our first labor.

In our first labor Krystyna's water broke and labor contractions started soon thereafter. We went to the hospital after 6-8 hours and labored there for another dozen plus hours. While we were out walking the halls attempting to get labor to progress, Krystyna visibly became chilled and shaky. I reached up to her forehead and, sure enough, she was warm and very likely running a low grade fever. Krystyna told me, adamantly, 'do not tell the nurses/doctor that I have a fever or they're going to give us a C-section'.

OK, here I am as first time father, birth coach, with little or no experience, what to do?

Here's what went through my mind at the time.

1. Fever is sign of infection and potentially very dangerous to Krystyna and baby (we didn't know boy or girl yet)

2. Krystyna is *very* mentally strong and her mind is completely set on an intervention *free* labor and delivery.

3. Krystyna is *very* emotionally invested in this labor being natural and intervention free.

4. My last thought before coming up with a plan was I need to be careful how I handle this. Krystyna is very tired after 20+ hours of labor and on edge. If I don't handle this correctly there's a chance that she will just give up and then we're highly likely to be getting a C-section.

So here's what I did.

I told her that she was doing such a great job and was laboring really, really well. I also reminded her that she worked so hard in preparing for the birth with nutrition and education and I was *proud* of everything that she had done for our child. She was/is the absolutely the best and that I love her.

Next I looked at her and told her that she/we had done all these things to have the best outcome possible and the end goal of all this work was ultimately for her and the baby to be healthy and happy.

Then and only then did I tell her that the fever was dangerous. It was dangerous to her and the baby. And that we were not going to *hide* the fever from the birth team because that would go against our primary goal of having her and the baby be healthy.

Then I said that I was there for her and that we were going to do this *together* regardless of what labor interventions we might be faced with even if that meant we were looking at a C-section.

After that conversation we walked back to the room and told the nurse that we likely had a fever and started to discuss the options. The option we chose was to start a penicillin drip to take care of any infection. Several hours later (and 2 more interventions) Krystyna delivered Ysabella vaginally. Mom and Ysabella were healthy and Krystyna and I were *very* happy.

So my role as a coach in this birth was to help Krystyna deal with the emotional and mental challenges in being faced with medical interventions in labor despite her *very* strong emotional and mental investment in a natural, *intervention* free birth. In my opinion the emotional and mental aspects of this birth were the primary challenges that we had to get past *together* so that Krystyna could relax physically, let go and deliver Ysabella into this world. 

In the moment and in retrospect it was one of our very best days as husband/wife and new *parents*.

Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale
Disclaimer:  
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, ScottsdaleThe 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®.


Guess who?

Posted on February 7, 2012 at 5:32 PM Comments comments (49)
Our students are coming down the home stretch in their pregnancies!!  We invited some alumni from our last class to come share their birth story tonight so that our students could hear from the parents fresh from the birth experience. 
 
Their story brought up an interesting point that was echoed by some of our current students.  What do you do when uninvited guests show up at your birth?  How do you keep them from coming in the first place?
 
This is a touchy subject – how do you tell your loving family or your devoted friend that this is not the time when you want to see them?  What do you do when a well-meaning person arrives at your birthplace and all you want to do is have them leave?
 
The direct way...
The direct way...
The nice way...
The nice way...
You can tell people to leave either way. How you say it will definitely make a difference in the long run.
Among the topics we encourage our couples to discuss before labor starts is who they want at their birth.  There is definitely an emotional component to labor that will allow or hinder progress if mother is not feeling safe, ready or supported.  Who will be there that will encourage the couple and support their birth choices?  With whom will they feel comfortable sharing an intimate and vulnerable experience?
 
Things to consider:
  - Will you be okay if they see you using the bathroom?
  - Will you feel okay if they see you naked?
  - How will they react if you are impatient or rude to them?
  - How will they react when they see you uncomfortable and/or in pain? 
     Will they be okay with it?
  - Do they support your choices for a natural birth and your birth wishes?
 
If you answered no to any of these questions, then think twice about having the person/people you are considering to be present at your birth.  Mom and Coach need to clarify their list of people who are a yes and then communicate their wishes to their family and friends.
 
Belinda Hodder, CNM, who is at Valley Women For Women, has a great suggestion about breaking the news to everyone.  She suggests having your birth plan ready in time for your baby shower.  Bring several copies to the event and have “Sharing the Birth Plan” be one of the activities.  This way the announcement of your wishes is public and clear.  If you are asking people to wait to see you until a certain point, you have the opportunity to tell everyone together.  Hopefully no one will feel like they are being singled out since they are not the only ones being told not to come until you are ready for them.
 
Mothers and Mothers-In-Law are an interesting set of people in relation to labor.  I have seen a midwife’s site that explicitly states if a mother wants either of those people at her birth, she will refer them to a midwife that is comfortable with that scenario.  She does not take clients who want soon-to-be grandmothers present since her experience is that they negatively impact labor.  On the other hand, we have had several students whose mothers were present at their birth.  It all turned out okay – they all had their babies with their mother in the birth setting, and many of them said that they couldn’t have done it without them taking on the role of assistant coach.
 
If you like the idea of a mother-figure being with you and yet you think you don’t want your mother attending the birth, you can hire a doula who has the personality traits plus the know-how you want in an assistant coach.  Interview several doulas until you find the right balance of personality and experience that fits your comfort zone.
 
If your family members are not going to be asked or welcomed in your birth place and you are going to have a doula or other assistant coach there, stating the facts without emotion is the best suggestion I can offer.  Instead of saying, “You stress me out” or “I don’t think you can handle it” or “You have not been there for me why would I want you there now” or any variety of other reasons why you would carry negative emotion towards someone, stick to the facts.  “We have asked/chosen this person to attend our birth because they have the training to be an assistant coach.” 

Training can mean that they have completed or are working through a certification process; maybe they are reading your birth books with you (see the bottom of this page for our suggested reading list); or maybe they have attended your Bradley Method® classes with you.  Any or all of these things will prepare a person to be the assistant coach you need them to be as long as they are willing to support your birth choices and are committed to helping you have a Healthy Mom, Healthy Baby outcome.
 
A person’s presence in the birth space can very much affect the progress of labor – someone with negative energy can hinder labor; someone with positive energy can help it progress.  If the people you are asking to refrain from attending your labor press you for answers, stick to the facts.  Be a team together, insist that, “We made this choice” and avoid pointing fingers, “Mom (or Coach) doesn’t want you there because…”
 
If people do show up at your birth space even when you believe you have made your wishes clear, designate someone to be the messenger, or write them a note that someone else can deliver.  You can phrase it kindly – “Hi, (Person).  Thank you so much for expressing your support.  We are focused on bringing baby earthside and regret not being able to come out to see you.  We could really use your help after baby comes.  Would you be kind enough to come back and see us after baby arrives?  If anything comes up, we will let you know if we need you sooner.”
 
You may also find that the amount of people you have in the birth space is too much or too few.  If you find that all the people you said yes to is stressing you out, you have permission to ask them to clear out so you can focus on your birth.  If you initially decided you were going to go it alone and you find that you really could use an extra pair of hands, or you need a fresh energy after a trial of labor, bring a list of assistant coaches you can call in to support you.
 
It is your body, your baby and your birth.  The people in your birth space can potentially hinder or help your labor’s progress.  Set yourself up for success and clarify your “guest list” before labor starts.  Although it’s a tiny detail in the grand scheme of preparations you are making, you will be glad you did.
 
What influenced your decision to invite or exclude people from your birth?
 
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®.
 
We are now enrolling for our Spring Series
March 5, 2012 to May 21, 2012
 
For more information or to register, please call us at 602-684-6567 or email us at [email protected]
 

Healthy Mom, Healthy Baby

Posted on January 27, 2012 at 7:15 PM Comments comments (601)
Bradley Method® Fall 2011 Series Chandler, AZBradley Method® Fall 2011 Series Chandler, AZ





I finally got approval from all the families to post the Healthy Mom, Healthy Baby pictures.  Here is a brief synopsis of their outcomes along with a birth story from one of the moms.
 
All of these are babies from our Fall 2011 Bradley Method® series.  Angelika got to be one of these babies, too!  The families enrolled in our classes with the intention of having natural births.  However, all of them took to heart our entreaty to evaluate all their decision points with the Healthy Mom, Healthy Baby filter.  Most of them deviated from their birth plan, and definitely from what their expectation were…each birth is unique.  The beautiful element of these photographs is that these babies are all healthy, and so are their mammas.
 
I am going to number the babies from left to right.  Baby 1 is our longest labor (so far) for this class.  This family labored for 51 hours!  Mom and Dad labored at home, they went to the hospital and found out they were only 3 centimeters so they followed Berman’s law (go home if your are less than 5 cm dilated and not showing any physical or emotional signs of late labor) and went home.  Mom rested, ate, labored and the couple had the support of a wonderful doula.  They rested that night and labored at home most of the day.  When they went back to the hospital on day 2, mom had not progressed as much as they had hoped but they were past a five so they stayed in the hospital.  When they had marked the 48 hour of labor, they opted to have the bag of waters broken to see if that would speed labor.  Guess what – the on-call doctor did not want to come in to the hospital so he told the nurse to start a Pitocin drip instead.  Mom and Dad evaluated their choices and their wise doula gave them invaluable advice, “Let’s redefine our birth plan and make the adjustment we need to keep the vaginal birth.”  Knowing that mom was exhausted physically, and that she had been dilated to 8 cm with no progress for several hours, the parents evaluated their situation and opted for an epidural so that the strong Pitocin-induced contractions wouldn’t sap what was left of mom’s energy.  Three hours later they welcomed their son via vaginal birth.  He was ready to nurse – Healthy Mom, Healthy Baby.
 
Baby 2 is our Angélika.  Most of the hospital to homebirth stories we heard from families testified to the fact that their home births were significantly faster than their hospital births.  No transfer, no poking, no prodding, no weird or distracting noises.  So here we are, going into our home birth so excited that we are not going to have to move to the hospital since that had always stalled our labor in the past.  Labor starts and it is a completely different pattern than we have ever had before…the water broke at the midway point instead of at the beginning, walking slowed or stopped labor and laying on my side made things move along.  By the middle of day 2, I gave up on having the faster homebirth and resigned myself to be the mom that went to sleep and woke up ready to push.  You can read the long version here, suffice it to say Angélika was born about five hours after I surrendered and went to bed!
 
Baby number 3 was born to an experienced birth mom.  She has two older boys and this was her third child, dad’s first.  She made the decision to switch care providers at 39 weeks!  Although she had been with her OB for several years and had even followed her when she went into independent practice, she started to get red flags in her third trimester.  They couldn’t agree on her birth plan; and then the doctor wanted to strip her membranes a week before her estimated due date.  Mom made the decision to switch providers and moved to an OB recommended by another classmate that still allowed them to deliver at the same hospital.  Guess what?  This baby was ten days past his due date!  Had mom stayed with her first OB, who knows when he would have been born?  By changing providers, baby was allowed the time he needed to start labor.  This couple opted for a cesarean section to ensure a Healthy Mom, Healthy Baby outcome.  Two factors led to their decision: three hours of pushing with no change in station, plus amniotic fluid that was stained with meconium. “Trust birth” as the saying goes…this young man was born with his cord wrapped not once or twice, but several times around his neck.
 
Baby 4 was an average length labor with a painful complication.  As labor progressed, she had a ring of pain that radiated from her uterus down to her upper thighs.  The lower baby dropped and engaged in the pelvis, the more sensation mom lost in her legs!  This mom and dad endured 18 hours of posterior labor – I award them the title of “Rock Stars” for staying drug-free for so long. It is truly a testament to her commitment and his coaching.  Her midwives recommended an epidural since she was not dilating past an eight.  Their baby was born an hour later!
 
Baby 5 was born to another multipara.  This mom was induced with her first baby…and she wrote her story out to share with you:
 
"Our birth choices were all made with a Healthy Mom, Healthy Baby outcome in mind.  Our first big decision was choosing a care provider we were comfortable with.  We ended up with a wonderful group of midwives who totally supported our birth preferences and were obviously in favor of our choice to have a natural birth.  We had started with a group of midwives in Brooklyn, then went to an OB in Phoenix for a couple of months while we waited for our AZ insurance to kick in.  This OB was definitely NOT on the same page as we were (he wanted to induce before the new year so we could get a tax break...) so we switched as soon as possible.
 
When it came to our labor, we chose to hire a doula and labor at home as long as we could so we could avoid any potential pressure from the hospital for interventions.  As it turned out, my labor was so short that was pretty easy to do!  When we got to the hospital I was already 9 cm, so it was a matter of a little time, then onto pushing, and within the hour Amelia was born.  We chose to skip the Hep B vaccine in the hospital, and waived the vitamin K and eye ointment.  We know my STD status, so we knew she was at no risk, and we wanted her to be able to see the world as best she could with her newborn eyes!  As far as the Vitamin K shot was concerned, we did some research and decided it wasn’t necessary unless she experienced trauma at birth, which she didn’t.  We also chose not to bathe her so the vernix could do its job and she wouldn’t experience crazy changes in her body temperature.  We have yet to bathe her, and won’t for a while longer.  
 
We also decided to encapsulate my placenta this time around.  It was an option presented by our Bradley® instructors, and we were encouraged to do so by our midwife and our doula.  We went home from the hospital the day after our birth because Amelia and I were both doing well.  I wanted to see my 3 year old, and felt like I would be happier resting and enjoying my family in our own home.  
 
It was a different experience from our first birth.  I felt like we were much more informed and able to make more decisions that were Healthy Mom, Healthy Baby outcome-minded.  That said, I was induced with my first because of high blood pressure, and while it wasn’t my ideal birth plan, it was a Healthy Mom, Healthy Baby based decision.  I also got an epidural after nearly 12 hours of a Pitocin induced labor, and I was able to progress quickly after that and go on to have a vaginal delivery.  I truly believe that I would have been too exhausted to push had I not gotten the epidural, so again, I don’t regret that decision.  An epidural was much more favorable to me than a C section!  We did have a doula with our first as well, and she was instrumental in keeping us calm and grounded through uncharted territories!  
 
With our firstborn Max, though, we hadn’t researched the vitamin K shot or the eye ointment, so we did both of those.  We also were not informed about the benefits of placenta encapsulation, so it wasn’t even on our radar the first time around.  I stayed in the hospital with Max for two nights, and felt like I needed that amount of time!
 
I definitely liked working with midwives the second time around rather than an OBGYN like we did with Max.  I liked my OB with Max, but I was definitely more comfortable with the midwives and felt like we saw eye to eye on our birth choices.  If we do have another, we will probably consider a home birth since Amelia’s birth was so fast and relatively easy.  That will be a whole new territory to explore, but we’re definitely interested!"
 
I hope these stories demonstrate the importance of a care provider you trust and have a rapport with, as well as the importance of making the choices to have a Healthy Mom, Healthy Baby outcome.  Happy New Year to all these babies and their families – ours has been wonderful so far.  Angélika started laughing today – pure joy!
 
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®.
 
We are now enrolling for our Spring Series
March 5, 2012 to May 21, 2012
 
For more information or to register, please call us at 602-684-6567 or email us at [email protected]