• The Mangieri family welcomed their son via cesarean in March 2012, and went on to have a VBAC with their second child, a daughter, in December 2013.
• The Schlueter family welcomed their son via cesarean in July 2013.
  
  

Cesarean to VBAC Journey Getting induced with Taylor

Cesarean to VBAC Journey Trying to see Taylor after my cesarean section

Cesarean to VBAC Journey My doula and Taylor helping me with by breathing during contractions

Cesarean to VBAC Journey Scott holding Kaylee after catching her and cutting the cord

Cesarean to VBAC Journey Skin-to-skin after VBAC

Although many people commented how lucky I must feel that I didn't have to birth that big of a baby, I felt very defeated after and it took a long time to recover...not only physically, but emotionally. I suffered big time postpartum depression and had to seek counseling for a little while. I worked through grieving the loss of the birthing experience I had wanted.  Though it felt silly at first since I had a perfect, healthy, beautiful little baby...it was very healing to grieve the loss of what I had wanted. 

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®.

• Use midwives so you can have the one-to-one model of care.
• Stay at home until you are in established labor.
• Be supported
• Set yourself a mini-goal: what are my absolutes even if the VBAC doesn’t go as planned?
• Take a good childbirth education course
• Pain is associated with death, dying and injury.  You have to redirect that fear to the understanding that this pain, labor pain, is going to lead to life.  

• Be physically fit – strengthen your body.
• Eat well – eat foods that promote skin integrity and scar integrity (i.e., foods high in Vitamin C have collagen that is essential for building strong, stretchy tissues)
• Be mobile – do everything you can to stay active to get baby in a good position for labor.

• Take care in choosing your provider – do you trust them?  Do they follow evidence-based care?  Do their cesarean numbers bear that out?
• By picking your care provider carefully, you can ensure that you hire a person that truly supports your desire to VBAC and will give you the time to labor as long as mom and baby are doing well. 
• Choose a care provider with whom you can have an open dialogue.
• If your instincts are telling you that you are with the wrong provider, then change.
• Not only do you need to find out how your care provider feels about VBAC, you need to find out how their back-up doctor or other care providers in the practice feel about VBAC.  You do not want to do everything possible to prepare an then show up at your birthplace and realize that you won’t be able to have the birth you have prepared for.

• Ease that path by writing a cesarean birth plan – what do you want to do differently this time
• As long as things are not critical, you can opt for a “natural cesarean”, where some of the principles of natural birth can be honored.

• If you feel inside that you can do it, then give it a go!
• Have faith in yourself

Disclaimer: 

Uterine Rupture.   

• Unscarred Uterus: 0.0033% (primigravidas) to 0.0051% (multigravidas)
• 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) 

“The incidence of postdates ranges from 3 - 12% of all pregnancies. If the pregnancy is dated using ultrasound criteria, the incidence of post-dates is lower and ranges from 3 - 6%. Only 1 - 4% of all pregnancies continue to 43 weeks.”

Frank breech (50 – 70% of all breeches): In a frank breech, the baby's buttocks lead the way into the pelvis; the hips are flexed, the knee extended (pike position).

Complete breech (5 – 10% of all breech): In a complete breech, both knees and hips are flexed, and the baby's buttocks or feet may enter the birth canal first (cannonball position).

Footling breech (10 – 30% of all breech): one or both feet lead the way.

Stat SOURCE for frank, complete, and footling breech birth

Transverse lie. A few babies lie horizontally in the uterus, called a transverse lie, which usually means the baby's shoulder will lead the way into the birth canal rather than the head.  1/500 –  .0020 – 0.20%

Stat SOURCE

“The frequency of abruptio placentae in the United States is approximately 1%, and a severe abruption leading to fetal death occurs in 0.12% of pregnancies (1:830).”

http://emedicine.medscape.com/article/275854-overview

Understanding Labor and Delivery Complications – The Basics from WebMD
http://www.webmd.com/baby/understanding-labor-delivery-complications-basics

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.

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.

The 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®.

A little terminology for the uninitiated:

ICAN ~ International Cesarean Awareness Network

VBAC ~ Vaginal Birth After Cesarean

CBAC ~ Cesarean Birth After Cesarean

The material included in this blog and video is for informational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader and/or 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®.

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

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®.

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.

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. 

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.

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.

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.

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.

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.”

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