• Formula: weight/2 = how many ounces of water you need
• If you want to find out how many glasses of water that is, divide it by 8 ounces in a cup

• Climate: is it humid or dry where you live? How much water are you perspiring?
• Energy: again, perspiration also how much is being used by your body in the activities in which you participate?

Source: http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/prenatal-care/art-20045660?pg=2

Sources:

~http://www.ncbi.nlm.nih.gov/pubmed/20159393

~http://www.ncbi.nlm.nih.gov/pubmed/20159393

• Cervical Dilation
•  Cervical Ripeness
• Cervical Effacement
•  Station of baby (position in relation to pelvis -5 to +5)
• Position of the baby (anterior vs. posterior)
• Position of the cervix
• May find cervical anomalies, like early dilation and effacement, so that appropriate changes can be made to the woman's care, including bedrest, hospitalization, tocolytics, etc.
• May stimulate the cervix so that a medical induction does not become "necessary"

Source: http://www.drmomma.org/2010/04/myth-of-vaginal-exam-in-pregnancy.html

• Increased risks of infection, even when done carefully and with sterile gloves
• Increased risk of rupturing the membranes
• May stimulate the cervix prematurely
• Information collected does not accurately predict when labor will begin and may excite or disappoint women unnecessarily 

Sources:

~http://www.pregnancy.org/article/are-vaginal-exams-pregnancy-necessary

~http://www.scienceandsensibility.org/?p=5673

Pelvic Exams Near Term: Benefit or Risk? Talking to Mothers About Informed Consent and Refusal

http://www.scienceandsensibility.org/?p=5673

Premature rupture of membranes at term. Retrospective study of 88 cases

http://www.ncbi.nlm.nih.gov/pubmed/7569588

Chorioamnionitis in the delivery room

http://www.ncbi.nlm.nih.gov/pubmed/21090085

Bacterial vaginosis and intraamniotic infection

http://www.ajog.org/article/S0002-9378(97)70568-4/abstract

Premature rupture of the membranes and ascending infection

http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.1982.tb05028.x/abstract

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.

"The natural cesarean, or family centered cesarean, is a procedure developed in the UK which takes a “woman centered” approach to the surgery that now accounts for one third of all births in America, a cesarean. This approach to a c-section incorporates many important aspects of a vaginal birth, parent participation for one."

• Mother watches the birth of her child by having the surgical screen lowered at the time of delivery
• Baby is delivered slowly so that they can get some benefit from uterine contractions to clear fluid from the lungs and nasal passages
• Immediate skin-to-skin contact between mother and baby
• Delayed cord clamping
• Breastfeeding soon after birth
• Continuous contact between mother and baby
• "Seeding" of the mother's microbiome - read more about that HERE and HERE.

There is a difference between the microbiome of a baby born vaginally compared to a baby born by c-section (Azad, et al. 2013; Penders et al. 2006; Prince et al. 2014). During a vaginal birth the baby is colonised by maternal vaginal and faecal bacteria. Initial human bacterial colonies resemble the maternal vaginal microbiota – predominately Lactobacillus, Prevotella and Sneathia. A baby born by c-section is colonised by the bacteria in the hospital environment and maternal skin – predominately Staphylocci and C difficile. They also have significantly lower levels of Bifidobacterium and lower bacterial diversity than vaginally born babies. These differences in the microbiome ‘seeding’ may be the reason for the long-term increased risk of particular diseases for babies born by c-section.

~Rachel Reed, Midwife Thinking

• In the event of a c-section, be proactive. Mamas, we know this recommendation is not without its “icky-factor," but WOW it makes perfect sense when you think about it, and some believe it will be a standard recommendation in the future. Here goes: if your baby is born via c-section, consider taking a swab of your vaginal secretions and rubbing it on your baby’s skin and in her/his mouth. I know, ick. But when babies traverse the birth canal, they are coated in and swallowing those secretions/bacteria in a health-promoting way, so all you’re doing is mimicking that exposure. Don’t be afraid to ask your midwife or OB to help you collect the vaginal swabs—or do it yourself, if you’re comfortable. You have all the available evidence on your side.
  ~Michelle Bennet, MD, mamaseeds blog

• Less traumatic birth experience
• Moms get to *see the birth* of their baby
• Greater sense of satisfaction in regards to their birth
• Establishment of the MotherBaby dyad immediately after the birth
• Better breastfeeding outcomes

• Someone who had an emergency cesarean with a previous child and does not feel comfortable with anything other than a repeat cesarean
• A family with a known complication who wants to allow labor to start on the day of baby's choosing, but knows they will have a cesarean delivery
• A family who planned a natural birth and had their course of labor  change before they were in an emergent situation

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®.

Our goal is to prepare families to have a natural birth by teaching a mom and her loving coach to labor together.  The reality is that even with the best preparation, birth is unique, fluid and unpredictable.  Our experience as natural childbirth educators is that even if your birth does not go according to your plan, a comprehensive education like The Bradley Method® will pave the way for you to have your best possible birth with a Healthy Mom, Healthy Baby outcome.

 Link to video: http://youtu.be/PmlPITHsFio

• They did their work throughout and after Class 7 when we talk about writing the Birth Plan. 
• They got great ideas, and then took it to their care provider and asked her, “Is everything realistic on here?”  She went through it line by line and said it was all in-line with what was possible in a hospital setting. 
• Care provider signed off on plan, put it in file, sent it to hospital to give the staff their a heads up on their desires for their birth. 
• When it was “go time”, they arrived at hospital with several copies of plan and 3 dozen cookies.
• Everyone who walked into the room was offered cookies and a birth plan

• “Going in, we knew there might be a possibility that things were not going to go to plan.”
• Came to terms with making an adjustment
• Once the bag of waters was broken, contractions completely changed and things progressed quickly
• Christine reasoned with herself, “This isn’t going to be how I planned it, but if I give up one thing, the birth can still happen unmedicated like I want it to”

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®.

In some cultures, food and drinks are consumed during labour for nourishment and comfort to help meet the demands of labour. However, in many birth settings, oral intake is restricted in response to work by Mendelson in the 1940s. Mendelson reported that during general anaesthesia, there was an increased risk of the stomach contents entering the lungs. The acid nature of the stomach liquid and the presence of food particles were particularly dangerous, and potentially could lead to severe lung disease or death. Since the 1940s, obstetrical anaesthesia has changed considerably, with better general anaesthetic techniques and a greater use of regional anaesthesia. These advances, and the reports by women that they found the restrictions unpleasant, have led to research looking at these restrictions. In addition, poor nutritional balance may be associated with longer and more painful labours, and fasting does not guarantee an empty stomach or less acidity. This review looked at any restriction of fluids and food in labour compared with women able to eat and drink. The review identified five studies involving 3130 women. Most studies had looked at specific foods being recommended, though one study let women choose what they wished to eat and drink. The review identified no benefits or harms of restricting foods and fluids during labour in women at low risk of needing anaesthesia. There were no studies identified on women at increased risk of needing anaesthesia. None of the studies looked at women's views of restricting fluids and foods during labour. Thus, given these findings, women should be free to eat and drink in labour, or not, as they wish.

"There should be no hospital policies which restrict fluids and foods in labor; nor should formal guidelines tell women to take specific foods, such as energy drinks," states one of the study's authors, Gillian ML Gyte, M.Phil, of the department of women and children's health at the University of Liverpool in the U.K.

She and her co-authors point out that prior research has shown that many women in labor do not feel like eating, but for others the notion of long hours without any food or drink can be anxiety provoking.” …

"Our study found no difference in the outcomes measured, in terms of the babies' wellbeing or the likelihood of a woman needing a C-section," said Gyte. "There is no evidence of any benefit to restricting what women eat and drink in labor." The researchers also emphasize the value of allowing women to make choices regarding these matters. 

Throughout much of the last century, eating and drinking during labour was considered dangerous and many maternity units operated "nil by mouth" policies or restricted what women in labour were allowed to eat and drink, regardless of women's preferences. This was largely due to concerns about possibly fatal damage to the lungs caused by "Mendelson's syndrome," where particles of regurgitated food are inhaled under general anaesthetic during Caesarean sections. Recently, however, attitudes have begun to change and in many maternity wards, particularly in the UK, women are now allowed to eat and drink what they want during labour…

"Since the evidence shows no benefits or harms, there is no justification for nil by mouth policies during labour, provided women are at low risk of complications," said lead researcher Mandisa Singata, who is based at the East London Hospital Complex in East London, South Africa. "Women should be able to make their own decisions about whether they want to eat or drink during labour, or not."…

"While it is important to try to prevent Mendelson's syndrome, it is very rare and not the best way to assess whether eating and drinking during labour is beneficial for the majority of patients. It might be better to look at ways of preventing regurgitation during anaesthesia for those patients who do require it," she said. 

So what is a couple to do when the hospital has a policy that restricts food and drink during labor?  Do you feel confident in your choice to eat and drink?  Do you want to circumvent the system by bringing in “Coach’s Food”?

That is a very individual choice.  You can labor at home as long as possible and follow your own cues if you want to prolong going to the hospital where your intake is going to be restricted.  You can pack some “Coach’s Food” and circumvent the system by snacking out of the coach’s cooler.  You can do neither and go with the system.  You can also talk to your care provider, bring in the scientific literature, and see if they will sign off on a birth plan that allows you to eat and drink in the hospital in spite of the policy.  Their hands may be tied, and it may not be a possibility, however as the saying goes, you won’t know unless you try.

Did your birth place have a policy that restricted food and drink?  What did you do; how did you handle it?
Please leave us a comment – it will be moderated and posted.

[1] Singata M, Tranmer J, Gyte GML. Restricting oral fluid and food intake during labour. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD003930. DOI: 10.1002/14651858.CD003930.pub3.

[2] Health Behavior News Service, part of the Center for Advancing Health (2013, August 22). Restricting food and fluids during labor is unwarranted, study suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2013/08/130822141954.htm

[3] Wiley-Blackwell (2010, January 22). Eating and drinking during labor: Let women decide, review suggests. ScienceDaily. Retrieved September 10, 2013, from http://www.sciencedaily.com/releases/2010/01/100119213043.htm

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®.

Did you know that there is a national organization advocating evidence-based care and humanity in childbirth? 

I first became aware of ImprovingBirth.org when they held their first rally last year.  In order to bring awareness to the maternity health care crisis in our country, the organizers chose the date of Labor Day for the national event.  This year, they are truly nation-wide – there is at least one rally planned in all 50 states, and as of today, it looks like they are up to eight international locations.

What maternity health care crisis in the United States, you ask?  Here is a look at the numbers.  In the world:

• We are 34th in maternal mortality rates:  33 countries have lower maternal mortality than we do.
• We are 38th in neonatal mortality rates: 37 countries have lower neonatal mortality rates than we do.
• We are 41st in infant mortality rates: 40 countries do a better job at keeping newborns alive than we do.
• We are 66th in birth weight: 65 countries do better than us when it comes to birthing babies at healthy birth weights.
• We are 33rd in the breastfeeding: 32 countries had higher rates of exclusively breastfeeding at six months.

-International Comparisons from Childbirth Connection

“ Despite the poor international ranking, the International Federation of Health Plans recently reported that average U.S. payments for vaginal birth were far higher than all other countries reported, including Canada, France, and Australia (7).”

Quote from Childbirth Connection 

“It’s about women being capable of making safer, more informed decisions about their care and that of their babies, when they are given full and accurate information about their care options, including the potential harms, benefits, and alternatives.  It’s about respect for women and their decisions in childbirth, including how, where, and with whom they give birth; and the right to be treated with dignity and compassion.”

-Rally To Improve Birth

• Lower the C-Section Rate
• Respectful Maternity Care 
• Question Your Induction
• Informed Consent is My Right 
• Evidence-Based Birth

Donate HERE to the national organization:

http://bit.ly/19BXZ4u

Donate HERE to the local Phoenix Rally:
http://rallytoimprovebirth.causevox.com/phoenix

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®.

Cervidil is contraindicated in:

"- Patients with known hypersensitivity to prostaglandins.

- Patients in whom there is clinical suspicion or definite evidence of fetal distress where delivery is not imminent.

- Patients with unexplained vaginal bleeding during this pregnancy.

- Patients in whom there is evidence or strong suspicion of marked cephalopelvic disproportion.

- Patients in whom oxytocic drugs are contraindicated or when prolonged contraction of the uterus may be detrimental to fetal safety or uterine integrity, such as previous cesarean section or major uterine surgery (see PRECAUTIONS and ADVERSE REACTIONS).

- Patients already receiving intravenous oxytocic drugs.

- Multipara with 6 or more previous term pregnancies."

"Warnings

Women aged 30 years or older, those with complications during pregnancy and those with a gestational age over 40 weeks have been shown to have an increased risk of postpartum disseminated intravascular coagulation. In addition, these factors may further increase the risk associated with labor induction (See ADVERSE REACTIONS, Post-marketing surveillance). Therefore, in these women, use of dinoprostone should be undertaken with caution. Measures should be applied to detect as soon as possible an evolving fibrinolysis in the immediate post-partum period.

The Clinician should be alert that use of dinoprostone may result in inadvertent disruption and subsequent embolization of antigenic tissue causing in rare circumstances the development of Anaphylactoid Syndrome of Pregnancy (Amniotic Fluid Embolism)."

"Precautions

General: Since prostaglandins potentiate the effect of oxytocin, Cervidil must be removed before oxytocin administration is initiated and the patient's uterine activity carefully monitored for uterine hyperstimulation. If uterine hyperstimulation is encountered or if labor commences, the vaginal insert should be removed. Cervidil should also be removed prior to amniotomy.

Cervidil is contraindicated when prolonged contraction of the uterus may be detrimental to fetal safety and uterine integrity. Therefore, Cervidil should not be administered to patients with a history of previous cesarean section or uterine surgery given the potential risk for uterine rupture and associated obstetrical complications, including the need for hysterectomy and the occurrence of fetal or neonatal death.

2. Drug Interactions: Cervidil may augment the activity of oxytocic agents and their concomitant use is not recommended. A dosing interval of at least 30 minutes is recommended for the sequential use of oxytocin following the removal of the dinoprostone vaginal insert. No other drug interactions have been identified."

"Post-marketing surveillance:

Immune System Disorders: Hypersensitivity

Blood and lymphatic system disorders: Disseminated Intravascular Coagulation (See WarningsSection)

Reproductive system: Reports of uterine rupture have been reported in association with use of Cervidil some required a hysterectomy and some resulted in subsequent fetal or neonatal death.

Vascular Disorders: Hypotension

Pregnancy, Puerperium and Perinatal Conditions: Amniotic fluid embolism"

"Contraindications:

Hypersensitivity to dinoprostone, prostaglandins, or any components of the product; patients in whom oxytocic drugs are contraindicated or when prolonged contractions of uterus are considered inappropriate; ruptured membranes; placenta previa; unexplained vaginal bleeding during current pregnancy; when vaginal delivery is not indicated; acute pelvic inflammatory disease; active cardiac, pulmonary, renal, or hepatic disease (suppository only)."

"General advice:

Carefully examine vagina to determine degree of effacement and appropriate length of endocervical catheter to be used for application of gel (10 mm if 50% effaced, 20 mm if no effacement).

Patient should be in dorsal position for administration and remain supine for 15 to 30 min after administration of cervical gel.

Following administration of vaginal suppository, the patient should remain in the supine position for 10 min.

Following administration of the vaginal insert, the patient should remain in a recumbent position for 2 h.

Inserts do not require warming prior to administration.

Suppositories and gel must be brought to room temperature. Do not use external sources of heat (eg, hot water bath, microwave oven) to decrease warming time.

Wait at least 6 to 12 h after administration of gel before using IV oxytocin; a dosing interval of at least 30 min is recommended after removal of insert.

Do not use dinoprostone vaginal suppository for extemporaneous preparation of any other dosage forms or for cervical ripening or other indications in the patient with term pregnancy."

"May augment effect of other oxytocic agents; avoid concomitant use. For the sequential use of oxytocin following dinoprostone cervical gel administration, a dosing interval of 6 to 12 h is recommended. A dosing interval of at least 30 min is recommended for the sequential use of oxytocin following the removal of the dinoprostone vaginal insert."

"Pregnancy Category C. Contraindicated if fetus in utero has reached viability stage except when cervical ripening is indicated."

"Lactation: Undetermined."

"Special Risk Patients

Use with caution in patients with asthma, glaucoma, or raised IOP, hypotension or hypertension, CV or renal or hepatic impairment, anemia, jaundice, diabetes, epilepsy, compromised uterus, infected endocervical lesions, acute vaginitis, in patients with cases of non-vertex or non-singleton presentation, and in patients with a history of previous uterine hypertony.

-Anaphylactoid syndrome of pregnancy Intracervical placement of dinoprostone may result in inadvertent disruption and subsequent embolization of antigenic tissue, and rarely leads to development of anaphylactoid syndrome of pregnancy (amniotic fluid embolism).

- Incomplete pregnancy termination If dinoprostone pregnancy termination is incomplete, take other measures to ensure complete abortion.

- Postpartum disseminated intravascular coagulation An increased risk has been described in patients whose labor was induced by physiologic means. Women who are 30 y and older, those with complications during pregnancy, and those with gestational age more than 40 wk are at risk.

- Pyrexia Transient pyrexia (temperature elevations in excess of 2°F), possibly due to the dinoprostone effect on hypothalamic regulation, was observed in 50% of patients receiving suppositories at the recommended dosage. Temperature returned to normal on discontinuation of therapy.

- Ruptured membranes Exercise caution when administering dinoprostone cervical gel or vaginal insert to patients with ruptured membranes.

- Uterine hyperstimulation Placement of dinoprostone cervical gel into the extra-amniotic space has been associated with uterine hyperstimulation. When using the vaginal insert, if uterine hyperstimulation is encountered or if labor starts, the vaginal insert should be removed."

"Generic Name: misoprostol (MYE-soe-PROST-ol) Brand Name: Cytotec Do not take Cytotec to reduce the risk of stomach ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) if you are pregnant. Cytotec may cause abortion, premature birth, or birth defects if taken during pregnancy. Life-threatening..."

(My note: yes - this is just how it appears - with the ellipsis there)

"Misoprostol has been assigned to pregnancy category X by the FDA. Animal studies have failed to reveal evidence of fetotoxicity and teratogenicity. In studies of women undergoing elective first trimester abortion, the administration of misoprostol 400 mcg for two doses caused increased uterine contractions and bleeding in 41% of cases, and partial or complete expulsion of uterine contents in 11% of cases." 

"Breastfeeding Warnings

Misoprostol is rapidly metabolized in the mother to misoprostol acid which is biologically active and is excreted in human breast milk. There are no published reports of adverse effects of misoprostol in breast-feeding infants of mothers taking misoprostol. The manufacturer recommends that caution should be exercised when misoprostol is administered to a nursing woman."

"What should I discuss with my healthcare provider before receiving Pitocin (oxytocin)?

You should not receive this medication if you have ever had an allergic reaction to oxytocin."

"To make sure oxytocin is safe for you, tell your doctor if you have:

genital herpes;

diabetes;

• high blood pressure;
• a heart rhythm disorder;
• a history of cervical cancer;
• a history of severe infection in your uterus;
• a history of difficult labor because you have a small pelvis;
• if you have ever had surgery on your cervix or uterus (including a prior C-section);
• if your pregnancy is less than 37 weeks; or
• if you have had 5 or more pregnancies.’’

"Tell your caregivers at once if you have a serious side effect such as:

fast, slow, or uneven heart rate;

excessive bleeding long after childbirth;

headache, confusion, slurred speech, hallucinations, severe vomiting, severe weakness, muscle cramps, loss of coordination, feeling unsteady, seizure (convulsions), fainting, shallow breathing or breathing that stops; or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure)."

"Less serious side effects may include:

• nausea, vomiting;
• runny nose, sinus pain or irritation;
• memory problems; or
• more intense or more frequent contractions (this is an expected effect of oxytocin)."

"For Health Professionals

Hepatic side effects have included neonatal jaundice."

Read more at HERE 

"Genitourinary

Genitourinary side effects have included pelvic hematoma. Excessive doses have produced pelvic fracture, uterine hypertonicity, spasm, tetanic contraction and rupture."

"Hematologic

Hematologic side effects have included postpartum hemorrhage and fatal afibrinogenemia."

Read more HERE 

"General side effects have include low Apgar scores at 5 minutes. Fetal death has been reported."

Read more HERE 

• Is Mom okay?
• Is Baby okay?
• What are the benefits of using this drug?
• What are the risks of using this drug? (You have the right to read the drug insert for yourself in the care facility)
• What else is going to happen if we say yes? (Additional procedures, time in bed, time being monitored, position for mom, etc.)
• What are the expected results?  What if we don’t see them? 
• What are the alternatives if we choose not to do this?
• What does our intuition tell us?
• What happens if we choose to do nothing?

I open today's post with the reminder that April is Cesarean Awareness Month. The World Health Organization and evidence-based practice only supports a cesarean rate of 15% or less.

While a cesarean birth can be life saving and necessary, and we are so grateful for the technology when our students need this intervention, we encourage you to know the difference between a variation and complication. Is Mom okay? Is Baby okay? If yes to both questions, asking for time can spare both Mom and Baby from an "unnecesarean". 

The current cesarean rate in the US is around 32-33%, so our wish at Sweet Pea Births is that by raising awareness, only the necessary cesareans are performed, and that over time we see our national cesarean rate back down to at or under 15%.

If a VBAC is not an option you want to explore, I encourage you to explore the ideas and additional readings HERE to learn more about a family-centered cesarean that may be a gentler experience for both mother and baby.  With time and planning with your care provider, these are possible and a beautiful option for families that want and/or need a repeat cesarean.

On to the topic:  Where do you begin if you want to plan for a Vaginal Birth After Cesarean?  

These notes are from an ICAN meeting presented by ICAN of Phoenix chapter leaders Stephanie Stanley and Jessica Franks on January 23, 2013, hence they get the author by-line on this one.  Thank you, ladies, for your constant support of the cesarean community in the Phoenix area.  Here are the steps that Stephanie and Jessica identified in hindsight of their VBAC journeys.

Step 1:  Find a supportive care provider
Your options for finding a supportive care provider in Arizona include an obstetrician in a hospital setting, a Certified Nurse-Midwife in a hospital setting, and Naturopathic Doctor who also holds a Certified Professional Midwife license in a home setting.  In addition, you an interview at Women’s Birth and Wellness Center in Mesa, Arizona, to see if you are a candidate for a VBAC at their birth center.  If you are in the Phoenix area, you can check the ICAN Phoenix provider list HERE to see which care providers have been supportive as per first-hand experience from VBAC mothers.

Step 2: How do I know if someone is truly supportive?
The only way to really know if a care provider is going to go along with your choice for a trial of labor that you hope is going to lead to a vaginal birth is the interview them.  Schedule an appointment with them and meet them face-to-face.  Here are some questions you can ask – you want to keep them open-ended so that you hear their spontaneous answer.

• How do you feel about letting a VBAC mom go to forty-two (42) weeks gestation?
• How do you feel about natural birth?
• What are specific protocols and what is the timeline you follow with a VBAC mother?
• Which pushing position do you support when a mom is attempting a VBAC?
• How do you feel about doulas in the labor and delivery space?
• What are my options if I should need a repeat cesarean?

• Work through any fears you had going into your last birth, or that have arisen as a result of your previous birth.
• Strive to reduce stress and tension in your daily life.
• Surround yourself with supportive, positive, and helpful people.
• Be honest with yourself and with your partner – you need to address how both of you are feeling in regards to your past birth and the preparations for a VBAC.
• Identify what your needs are, and what needs to be addressed.  Do the same for your partner.
• Evaluate your mindset: are you going to go along with what your doctor tells you to do, or are you going to educate yourselves as a team so that you can make informed decisions?
  
  

• Birthing From Within
• The Bradley Method®
• Hypnobirthing: might work better if you have a yoga background
• Hypnobabies: some consider it a more “user-friendly” version of Hypnobirthing
• Private Comprehensive Class taught by a doula or independent childbirth educator

• Educate your family – invite them to come along to a cesarean support group meeting, such as ICAN.
• Honestly express why this is important and what led you to this decision.
• Understand that if something or someone is not helpful, supportive or positive, then it or they do not need to be a part of your birth.

• Read, read, read.
• Read positive VBAC birth stories
• Talk with your care provider – know their VBAC numbers
• Ask questions and research the information you are finding

• Write your VBAC plan
• Consider writing your cesarean birth plan
• Talk with your care provider about your birth plan.  If your care provider is not on board, talk with them to explore if there is a way to make it workable.  What are your absolutes, and are your communicating them effectively?

LINK LIST
Family-centered Cesarean
http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/

ICAN of Phoenix Provider List
http://icanofphoenix.weebly.com/valley-resources.html    

Bradley Method Course Outline
http://www.bradleybirth.com/krystynabowman?Page=5

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®.