Chandler, Arizona
Sweet Pea ​Births
Sweet Pea ​Births
...celebrating every swee​t pea their birth
...celebrating every swee​t pea their birth
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VBAC Preparation: Ask the Midwife
Posted on April 29, 2015 at 7:16 PM |
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Our posts for Cesarean Awareness Month continue. With their permission, I am sharing notes today that I took at an
ICAN meeting presented by some Phoenix-area midwives in 2012. The main presenters and most of what you see below are the paraphrased words of Diane Ortega, CNM
and Belinda Hodder, CNM. They are midwives at Valley Women for Women, whose overall cesarean rate in 2014 was 7% in the midwife practice.* Also in
attendance and adding commentary to some of the answers was another CNM in the
area. While all three midwives believe
in and support the natural process, all of these women have had a cesarean
themselves. It seems to me that it lends them an
extra dose of vestment in their patient’s goals for a vaginal birth after
cesarean.
The format of this meeting was question and answer. Below is a paraphrase of the midwives’
answers to the questions posed by the women in attendance at the ICAN meeting
on October 24, 2012 in Tempe, AZ.
There is not a lot of opinion offered here.
It was a presentation of information so that a woman considering a vaginal birth after cesarean (VBAC) could consider
the information as she prepared for her next birth journey. This information is offered a starting
point for the previous cesarean birth woman to do her own research so that she could make the decision that
is right for her unique situation.
VBAC Planning and Preparation
Q: What are the best methods to prepare for a VBAC? A: There are several things you can do to prepare:
Q: What can I do to prepare my body for a VBAC?
A: There are a few things you can do
Q: Will the type of sutures I have determine whether or not I can have a VBAC?
A: Whether an obstetrician will do a
single-layer or a double-layer of sutures depending on how they are trained,
and sometimes it depends on what the uterus looks like. As long as you have a low, transverse scar,
or the status of your scar is “unknown” than you can have what is called a
“trail of labor”. If you have a vertical
scar, the standard is to have a repeat cesarean. Uterine Rupture
Q: Will my chance for a uterine rupture increase with the length of labor?
A: There is no evidence in the research that supports that. (At this point, ICAN leader Stephanie Stanley mentioned that a uterine rupture can happen at any time, with or without a previous cesarean – HERE is her research on that topic). Q: What are signs of uterine rupture? A: Pain that doesn’t go away after the contraction is over,
and a decrease in the baby’s movement an/or heart rate.
Q: How long does it take to heal from a uterine rupture? A: Like a cesarean; maybe there will be a little more bleeding.
Going Past 40 Weeks
Q: What is the concern about going postdate? A: ACOG guidelines are that babies should be born by 42 weeks gestation. While the literature does not show an increase of risk for uterine rupture, it does indicate that a baby does not tolerate a labor as well after 42 weeks. There are more issues with meconium, the umbilical cord and the placenta after the 42-week mark. You could find a care provider that is willing to let you go past 41 weeks as long as you are having ultra-sounds and non-stress tests done.
Q: What is the policy for induction if a
mother wants a trial of labor after multiple cesareans? A: That usually depends on the personal beliefs of your doctor(s). The use of prostaglandins or Cytotec is not indicated. In reality, there are no guidelines, only protocols to consider and to follow.
Q: How do I know if I am really “past” my estimated due date? A: The ultrasound at 9-10 weeks is considered to be the most accurate predictor of your estimated due date. If you know the history of your menstrual cycle (menses), or if you used an ovulation kit, you might have another data point for establishing your conception date, and thereby having another way to estimate your due date.
Q: What are strategies for inducing labor for a VBAC mom? A: Things that are done in office and then allow you to go home and labor there: a foley bulb (aka foley ball) or a stripping of the membranes. In the hospital and you stay at the hospital: foley ball, artificial rupture of membranes, and in some cases, you could use Pitocin.
About Labor
Q: What is the most common reason for a repeat cesarean after a trial of labor? A: A slow progress of labor with no real signposts that labor is going to progress. Keep in mind that if you come to the hospital early in labor, you start chipping away at your chances for a VBAC.
Q: Why do I have to be continually monitored? A: Our hands are tied by hospital policy – any VBAC patient has
to have continuous electronic fetal monitoring.
We work in a community that is frightened of litigation.
On the upside, if everyone looking in from the outside can “see” that mom and
baby are doing fine, this can buy you more time.
There are options in monitoring. There
are waterproof monitors that can be used in water during labor, and there are
also some hospitals that use wireless monitors.
HERE is a great visual on all
the different positions you can labor in even if you are continuously
monitored.
In reality, the amount of monitoring is specific to the hospital. You have to decide how you feel about going
Against Medical Advice (AMA) if you feel strongly about not having a continuous
monitor.
Q: What are your thoughts on an epidural?
A: You want to try to get into labor on your own at the beginning since
epidurals tend to slow your labor down.
When we say “get into labor” we mean dilation to at least a 6 with a
good, established pattern of contractions.
Pain is one of the indicators that can tell you something is going wrong
right away. If a mom has an epidural,
bradycardia (slow heart rate) in the baby is the only indicator we have that
things are not staying low risk. The use
of Pitocin to augment a slowed labor can also increase your chance of uterine
rupture.
Q: How long can I go with ruptured
membranes (broken bag of waters)?
A: If you are GBS negative, you could wait up to 24 hours before coming
in. If you are GBS positive, then we
evaluate that on a case-by-case basis. (Krystyna’s note: the presence of GBS at the time of labor raises the
concern for mom/and or baby to develop an infection during labor since the bag
of waters in no longer intact and able to provide a barrier against infection.)
Q: What are ways to prevent tearing during the pushing phase?
A: Eat well – a good diet packed with fruits and vegetables. There is no evidence that shows that perineal
massage will prevent tearing. You could
avoid tearing by tuning into the natural “safety mechanism” known as the “Ring
of Fire”. By tuning into your body, you
will slowly ease the baby out. This is
another reason to consider going the natural route: you don’t feel the ring of fire
when you have an epidural. In closing, here are their "Words of Wisdom": CARE PROVIDER
WHAT IF…
If your VBAC doesn’t work out, be easy on yourself.
(Krystyna’s note:HERE is a family-centered cesarean on film.
What is a little startling about this is that one of the references is
dated 2008! At least we are doing our
part to bring awareness to this option.)
BELIEVE IN YOURSELF
*Rate for one baby, head down, for patients who wanted to have a vaginal birth was 7% in 2014. This marks the third year they have collected data and the rate has remained 8 % or below whilst their overall number of patients rises each year. What did you do to prepare for your VBAC/CBAC journey? What did you learn that you are willing to share? Please leave us a comment - it will be moderated and posted. *I think* that the amount of traffic you so generously generate has led to a lot of spam posting. In an effort to keep the spam to a minimum, I am taking the time to moderate comments now.
Link List Visual reference of labor positions during EFM http://www.icanofatlanta.com/?page_id=159 The Family-Centered Cesarean http://blog.ican-online.org/2012/04/14/the-family-centered-cesarean/ Video: The Family-Centered Cesarean http://www.youtube.com/watch?v=m5RIcaK98Yg
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®. |
Birth Story: Marathon Labor
Posted on January 23, 2015 at 9:45 AM |
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Christine & BJ Bollier Bradley Method© Birth Story This story is a great example of making your wishes known,
persevering through a long labor that stalled (The Bradley Method® calls “the stall”, aka
“failure to progress”, a “Natural Alignment Plateau” or "NAP"), and making decisions as the labor progressed for a Healthy Mom,
Healthy Baby birth experience. Even with
an intervention they did not initially want or anticipate, they were able to have the vaginal,
unmedicated birth they had prepared for. One of my favorite quotes from the video is Christine’s
statement, “I was tired, but I was never scared, because I knew what to
expect.”
Here is a quick summary of their labor: She started with contractions around 15 minutes
apart on a Thursday morning. They went
to their doctor’s appointment that afternoon and decided to go home and let their
labor progress. On Friday, they were timing contractions throughout the
day. When they got to five minutes apart,
they decided to go to the hospital because of the impending blizzard (they live
in Payson, AZ). By the time they were
all checked into their room, it was 2:30 am on Saturday. By Saturday evening at 6:00 pm, they hit a NAP
at around 8 cm dilation. They made the
decision to accept an amniotomy (breaking the bag of waters) at 10:00 pm. Their son was born on Sunday morning at 3:30
am. When the Bollier's time their labor, they call it 36 hours from the
contractions that were 6 minute apart on Friday afternoon to the time when he was born on Sunday morning. They both stayed awake for the whole of that time, save a few cat naps that happened between contractions when they were both exhausted. It is good to note that they did sleep on Thursday night when contractions were still in the "putsy-putsy" stage. I am so glad she talks about how she experienced contractions
– that’s a big question mark for first-time moms. Christine says she felt them as rhythmic and
internalized them – she says she could have painted you a picture of the
contractions. I love that perspective! HIGHLIGHTS Birth plan
Changing the Plan
Christine’s Insight: Q: What did BJ do as a Coach that helped you the most? A: He kept me from freaking out when it had gone on for so
long. As she explains, he kept her on track through the
exhaustion. BJ kept her calm with reassurance; he also pointed out the progress they had made. Loosely paraphrasing: [The hard part] wasn’t the pain – it was the exhaustion. I knew the pain was purposeful because
I was getting a baby. [Contractions] came in bursts and they were
not constant - it wasn’t miserable pain or constant pain from an injury that hurts all the time. Looking back a year later, [a contraction] was such a short period of time. BJ’s nuggets of wisdom Education & knowledge quell fear – having notes at
my fingertips kept me from getting scatterbrained while I was watching
(coaching) my wife through labor. Postpartum advice for the husbands: Don’t be proud – just say
yes. Don’t be too proud to accept help –
it’s a gift. On the lighter side, you’ll hear the inauguration of the
term “The Splash Zone” – now that we know our student’s perception of watching
all the birth videos from the first row of chairs, it’s what we call that front
line when we show birth videos in class - lol. QUESTIONS FROM THE CLASS: Q: Were you both awake the whole [36 hours of progressive
labor]? A: Yes…If I had it to do over again – we would rest throughout
labor. You’ll hear it in class that you
should rest. Seriously – REST. After the baby is born, you are playing
catch-up with sleep. Q: What can you tell us about breastfeeding a newborn? A: Get your hands on reading material, borrow books, have phone
numbers of support people you can call, have a good structure around you to
encourage, inspire, and inform you. Invest in good bras – wear a tank top with shirt underneath
at this age (son is about 11 months old in this video), after the infant stage
the nursing cover is not staying on! Did you have a long labor?
What labor management tips would you share with first-time parents? Please leave us a comment - it will be moderated and
posted. 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®. |
Birth News
Posted on January 10, 2014 at 6:31 PM |
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These are probably going to keep being evening editions - thank you for your patience as we ramp up posting again in the New Year. I am really placing a high value on being Peaceful Mama for my kiddos, which means that being on the computer is taking a back seat to homeschooling and teaching classes this season. I will be back in full swing soon - until then, please do not hesitate to contact me via email (krystyna{at}sweetpeabirths{dot}com) if you have any pressing questions about pregnancy, natural birth or breastfeeding! Birth News FERTILITY NOTE: Please read this with a grain of salt - we have had students have beautiful, term babies even though they used IVF to attain pregnancy. Simply shared as a tool for discussion with your care providers as you weigh the benefits and the risks. IVF Pregnancies Are More Likely To Result In Stillbirth, Preterm Birth, Low
Birthweight, Or Neonatal Death
Medical Daily http://bit.ly/19V24Sc PREGNANCY NOTE:I am by no means suggesting that you *should* go get a flu shot – again, I am simply offering this as information to discuss with your care provider. See what Dr. Sears has to say about the flu shot during pregnancy HERE and HERE Flu shots in pregnancy protect babies from being born too soon, Canadian studies show
Ottowa Citizen http://bit.ly/1gqKeoL BIRTH Premature 'Water Breaking' During Pregnancy Linked to Bacteria
WebMD http://bit.ly/1d31rF3 POSTPARTUM Is Placenta Encapsulation the Answer to Postpartum Depression?
Health24 http://bit.ly/1iWKgZG Doctors report uptick in number of babies with RSV, a respiratory virus, this flu season
abc13.com http://bit.ly/1gqJ8cC BREASTFEEDING Study Links Breastfeeding to Lower Risk of Rheumatoid Arthritis
Science World Report http://bit.ly/1iWMTKQ 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®. |
A New Chapter: Meet Cassandra
Posted on March 5, 2013 at 8:48 AM |
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Bruss and I would like to welcome Cassandra to the Sweet Pea Births Family. She will be a regular contributor to the blog and you will start seeing her around the internet on our other social media platforms. I am looking forward to sharing her areas of expertise with our students and readers. Bienvenidos, Cassandra! ~KRB I am wife to my wonderful husband, Eric, of four years, and
mother to our one-year-old son. I quit my career in telecommunications finance
at 34 weeks pregnant and have stayed home ever since. SAHM, wife, mother, all
roles I am still struggling to understand, identify, navigate, and balance a
year later.
In 2009 I began a whirlwind adventure into all things
nutrition, holistic healing, natural living, conscious consumerism, and
sustainability, not only for our earth but also for us! This led me to obtaining
a certificate in Holistic Nutrition from the Southwest Institute of Healing
Arts in 2010 and exploring the world of healthy pregnancy and natural home
birth before becoming pregnant in 2011. Now my days are filled with post
partum/nursing nutrition, toddler nutrition, gentle parenting, and being the
best facilitator to my son as he explores the world.
My pregnancy was filled with tons of herbs/herbal tea,
chiropractic care, yoga, massages, nutritious food, walking, weight training
(until my due date!). Everything progressed
very normally. At 43 weeks 4 days (according to the date *I* believed my
baby was conceived), I woke up around 9:00 am and while laying in bed felt some
slight cramps that were coming and going about every 5/6 minutes. I had no
signs of labor up until this point and I knew this could last for days or even
weeks so I just relaxed, read, and then got ready for the day. My husband was
taking me on an afternoon date to see The Lorax!
While I was getting ready they were coming a little stronger
and by the time I met my husband at 1:00 pm, I was stopping for a breath at each
one. I LOVED the movie but about an hour into it I just couldn't get
comfortable during the contractions and I asked if we could leave so I could
lie down (I still haven't seen the end of that movie!).
We got home about 4:00 pm and I tried laying on the couch
while my husband changed our bed sheets and made me something to eat. That
wasn't very comfortable and I settled in on the floor. Around 5:45 pm I called our doula. I knew it could still be a
very long time and didn’t want her to come prematurely but wanted to give her a
heads up so she could plan her night. She was on her way to teach a birth class
which was from 6:30-8:30 pm and I told her to just come after! She had to run
home and get her things and said it would probably take about an hour and I
figured I could definitely go on like this for three more hours and 9:30 pm would be perfect. The bed was now ready so I got in, surrounded myself with
pillows and tried to rest, but they were really coming now. I also had to get
up and pee a lot, which was no fun. I felt the best lying down, I needed to be
supported and just try and sink into the bed when a contraction would come. I
tried the birth ball for one and I just felt so unstable without the support of
the bed and pillows all around me. I would have some on the toilet though and
would brace myself against the door; the support of the door and the toilet
beneath was good too. Around 6:45 pm they were more intense and hard for me so I
started moaning through them, it actually really helped. I decided I needed to
call our doula back and have her come now. I also called our midwife then to
give her the heads up as I was definitely feeling this was the real thing and
hoping to have my baby with us sometime the next morning. Our doula arrived around 8:00 pm, and I was so happy to see her. I was still
in bed, surrounded by pillows and not opening my eyes – just moaning through
each contraction. She set up the birth tub and it was super noisy but I didn’t
mind at all, during my contractions I was in my own world and although I would
still have my eyes closed between contractions I could still hear and
understand everything going on around me. I am not sure what time it was when the first batch of hot
water was in the tub but that is when I got in, it wasn’t very deep but it was
actually perfect. The water felt good. I got on my knees and laid over the side
with my arms outside, I began to lose it a little in the pool. The contractions
were so strong and honestly I wish I could describe how they felt but I can’t,
I couldn’t really explain to my husband right after and by now I can’t remember
as vividly. They were HARD though, I got really scared that this was going to go
on for hours and hours and hours and I knew I wouldn’t be able to last that
long. I kept asking my doula if she thought I had a lot longer left and she
just kept telling me to focus on each contraction and not think about anything
except that one. She held my hands and repeated “think about being soft and
open in front of your baby” during the contractions and I did. I spread my legs
out wide during each and thought about my cervix as butter melting away.
Between contractions all I wanted to do was rest, I just wanted to lie down. I
started sitting back in the tub during the breaks just to try and find some
relief, even though it was more work to get back up as soon as I felt another
contraction coming. During this time I had a non-stop feeling that I had to pee.
I would get out of the tub and go to the toilet but during contractions it
started feeling so much better if I pushed like I was peeing. Our doula put a
chux pad outside of the pool and I spent a couple contractions coming back from
the bathroom leaning on the outside of the pool and pee would dribble out each
time. She said a little bit of pee in the pool was fine and I was SO happy
because it seriously felt so much better when I could do that during the
contractions. Somewhere in here I was asked if I wanted the student
midwives to come hang out in the other room but I said no, surprisingly (for my
worrisome nature) I didn’t feel like anything was wrong and the only thing I
was worried about was that labor was going to go on forever and I wouldn’t be able
to make it through. I started feeling some spasms on the right side of my belly
during three contractions and then at 9:55 pm my water broke! It was the wildest
feeling ever, I really had NO idea what it was – it felt like a big gush and
then bubbles coming out. I don’t know if I made a weird face or something but
my doula immediately asked if my water broke and then I knew what it was! The very next contraction was a pushing contraction – it was
the craziest thing I have ever felt. It was like my stomach was literally
ejecting my baby out. It would happen about three times each contraction. It
wasn’t as “painful” as the other contractions but VERY overwhelming and
honestly scary to me because it was SO strong and so involuntary – my body was
doing it all without me and it was nuts! I don’t think I actually pushed with
the contractions for awhile, I didn’t feel like I was doing anything – it felt
like my body all on it’s own. My doula told me to reach down and see if I could
feel my baby and I could! His head was about half a finger inside. After a few contractions his head was closer, and then I
would feel it come down and go back up. It then started coming down and staying
down, but during the break between contractions would go back up.
My husband replaced my doula in front of me holding my hands
during these contractions while she went behind me and put counter pressure on
my back. It felt amazing, I didn’t really feel that much pressure in my
back/bum and I think it was because she was doing that. The beginning of a
couple came without her ready and they were SO MUCH WORSE. Our midwives arrived around 10:40 pm. They checked my baby’s
heart rate and it sounded good and I was relieved. I hadn’t felt any movement
from him and a couple of times it crossed my mind that maybe he wasn’t ok or
alive (I know that is awful but it was in my thoughts). Pretty soon I started
feeling burning on the inside, then a couple more contractions later and I was
feeling a terrible burning on the outside – I could reach down and feel my
son’s head RIGHT there. I had felt something slimy sticking out of me earlier and my
doula had checked me with a flashlight and mirror and saw that it was just part
of my bag of waters. Our midwife noticed the same thing at this point and wanted
to make sure she knew what it was, she couldn’t get a good look with the
flashlight so she told me I needed to stand up. I thought there was no possible
way in the world that I could stand up even if I tried but somehow everyone
helped me up, a contraction hit and my baby just shot/tumbled/fell right out,
it was 11:20pm on March 7th, 2012.
Later this week I will be sharing Part 2 so watch for
it on Friday! In the mean time I would love to hear from you in the comments: where did
you birth your baby(ies)? Was it what you expected or planned, 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. ~KRB Disclaimer: It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. 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®. |
Rupture of Membranes
Posted on October 16, 2012 at 5:06 PM |
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The set up: We were
reviewing information from the previous class on vaginal exams, and reminding
students that *anything* going upstream once the membranes have ruptured has the
potential to introduce infection. We
were also reviewing what the pros and cons were to having an amniotomy
(artificial rupture of membranes) performed. The question: How long is too long to have your membranes
ruptured? The answer: Our
answer was to remind our students that once the membranes rupture, care
providers do not want patients putting anything in the vagina and discourage augmenting labor with intercourse (what!?). In addition, we have the privilege of having a pediatrician
in attendance in our classes (she is going to be the assistant coach for one of
our students), and I was happy to have her input. She said that there are several studies that
cite 48 hours as the time when the risk of infection rises. So I set out to find these studies and I did not find them. I did find that the medical term for one of the infections is chorioamnionitis, and this has been tied to risk associated with the number of vaginal exams in labor: "Chorioamnionitis is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor. The risk of developing chorioamnionitis increases with each vaginal examination that is performed in the final month of pregnancy, including during labor." From Wikipedia Here is a link
that explains the risk of infection and the signs to look for that might
indicate that the mother is developing an infection:
Here some additional links that you might also like to
review:
In conclusion, we want all of our students and readers to
remember that it is up to them to educate themselves – what are the benefits
and risks to any of the procedures or protocols of pregnancy, labor and birth? It is up to you to read up on the variations
and complications of labor. Once you are
informed, then you can decide what course of action you may want to take in
regards to your own situation and use that as a starting point for discussion
with your care provider. Disclaimer: It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation. 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®. |
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