Shopping Cart
Your Cart is Empty
Quantity:
Subtotal
Taxes
Shipping
Total
There was an error with PayPalClick here to try again
CelebrateThank you for your business!You should be receiving an order confirmation from Paypal shortly.Exit Shopping Cart

Sweet Pea Births

Chandler, Arizona

Sweet Pea Births

...celebrating every swee​t pea their birth

Blog

VBAC Preparation: Ask the Midwife

Posted on April 29, 2015 at 7:16 PM Comments comments (409)
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:
  • 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.  


Q: What can I do to prepare my body for a VBAC?
A: There are a few things you can do
  • 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.

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
  • 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.

WHAT IF…
If your VBAC doesn’t work out, be easy on yourself. 
  • 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.
(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
  • If you feel inside that you can do it, then give it a go!
  • Have faith 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


Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson  Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.



VBAC: The BIG picture of the risks

Posted on April 24, 2015 at 9:58 AM Comments comments (0)
Uterine Rupture.   

If you have had a previous cesarean, this is THE “drop” word for many care providers when they have their “informed consent” talk with patients for consequent pregnancies.

Today I want to take a look at several other complications related to labor and delivery.  If your care provider is expecting you to be influenced by risk factors for uterine rupture, I think it is fair to look at all the other risk factors of pregnancy and labor in order to create a bigger picture and put things into perspective.

Pregnancy is generally considered a healthy time in a woman’s life.  In order to make life, the woman’s body has to be able to support that life.  In most cases, it is healthy women who become pregnant.  What do we have to be afraid of?  In most cases: nothing.  However, as with many if not all things in life, there is a certain level of risk, and yes, sometimes things go wrong.

So let’s start with the risk numbers for uterine rupture.  Read THIS blog post for an in depth look at the numbers.  Here is the summary of the incidence of uterine rupture, depending on what category you fall in:
 

  • 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) 


So what are your risks of other complications of labor?





True statisticians are going to take issue with this oversimplification of comparisons.  In recognition that a percentage is more than its face value, here are the ratios and the sources for my information:

Postpartum Hemorrhage:  1/5 – .2000 – 20%
Definition:  “Postpartum hemorrhage is traditionally defined as blood loss greater than 500 mL during a vaginal delivery or greater than 1,000 mL with a cesarean delivery. However, significant blood loss can be well tolerated by most young healthy females, and an uncomplicated delivery often results in blood loss of more than 500 mL without any compromise of the mother's condition.” Quoted from Medscape  
 
“The incidence of postpartum hemorrhage is about 1 in 5 pregnancies, but this figure varies widely due to differential definitions for postpartum hemorrhage.” 
Stat SOURCE

Preterm labor and preterm delivery: 1/9 – .1111 – 11.11%
Definition: Baby born before 37 weeks
Stat SOURCE

Post-Maturity: 3-6%
Definition:  pregnancy past 42 weeks in which the placenta cannot provide the nourishment to maintain a healthy fetus
“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.”
Stat & Quote SOURCE

Breech presentation: 3-4 % of all deliveries
Definitions of the types of breech:
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

Preterm Premature Rupture of Membranes before 37 weeks: 3%
3% of all pregnancies and occurs in approximately 150,000 pregnancies yearly in the United States 
Stat SOURCE

Preeclampsia:  2% to 6%
Definition:  a condition of pregnancy in which the mother’s blood pressure starts to rise to dangerously high levels, the indicator for possibility of more complications that are potentially fatal to mother and/or baby; 2% to 6% in healthy, nulliparous women (women who have never given birth yet) 
Stat SOURCE

Placenta Abruptio: 1.0%
Definition:  the placenta separates from the uterine wall before delivery of the baby
“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).”
Stat & Quote SOURCE

UTERINE RUPTURE STATS FALL HERE

Umbilical cord prolapse: 1/300 – .0033 – 0.33%
Definition: the umbilical cord precedes the baby in the birth canal
Stat SOURCE

Placenta Accreta: 1/533 – .0018 – 0.18%
Definition:  the placenta grows too deeply through the uterine wall 
July 2012 study publication
Stat SOURCE

What do you think now that you have seen a wide array of complications and risks?
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.

For more reading:
Uterine Rupture in Pregnancy: Article dated July 31, 2012

The Risks of Cesarean Section
http://www.motherfriendly.org/Resources/Documents/TheRisksofCesareanSectionFebruary2010.pdf

Disclaimer: 
The material included on this site is for informational purposes only.
It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult her or his healthcare provider to determine the appropriateness of the information for their own situation.  Krystyna and Bruss Bowman and Bowman House, LLC accept no liability for the content of this site, or for the consequences of any actions taken on the basis of the information provided.  This blog contains information about our classes available in Chandler, AZ and Payson, AZ and is not the official website of The Bradley Method®. The views contained on this blog do not necessarily reflect those of The Bradley Method® or the American Academy of Husband-Coached Childbirth®.

Q&A with SPB: Cesarean Support

Posted on April 21, 2015 at 3:18 AM Comments comments (27)
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®.

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


Mommy Con: January from Birth Without Fear

Posted on October 10, 2013 at 6:33 AM Comments comments (0)
Cassandra and I were part of the "media" contingent at MommyCon LA Babywearing World Record Event on Sunday, October 6, 2013.  We had such a wonderful time walking the floor, meeting vendors and being inspired by the wonderful speakers as we looked and listened to bring all the happenings back to you.  See the bottom of this posts for links to more of the activity! 

At 2:00 pm, the third person to take the stage on Sunday was January Harshe, founder of Birth Without Fear, sponsored by Nüroo.  She started a facebook page with a simple message - that birth does not have to be scary, and that we have choices.  That message has resonated and grown into an incredible community that is active on-line 24/7.

Here are the notes I took as she delivered her message on Sunday:

You are judged for your choices no matter what you make.  Life is hard – we are all doing our best.  The last thing we need to do is judge others – be kind to one another.

Choices – you do have a choice when it comes to birth.

With her fourth child, she decided to have complete faith in her body.  We are indoctrinated with unrealistic images of birth in the media – either it’s completely zen calm and peaceful (my note: and in the middle of nowhere somewhere beautiful), or it’s a major emergency when mother and baby need to have a life-saving operation.

There is a choice not to cut – you can choose to birth via cesarean or vaginally – you can choose to breastfeed or pump or to give formula.

The days when the OB told a mom what to do and how it’s going to go – that is changing.  She's striving to make them numbered.

January wants to tell as many women as possible that they have a choice:
My body
It’s up to me how I birth

What is another mom going through?  How does she need to heal?  “This is my vagina – if I want to have a baby out of it – it’s my choice.”

If you can’t find someone to support your choice – do more than sit online and complain.  Start acting as a consumer – demand change.

I heard a paradigm shift in her presentation:
You hire your care provider to do a service.  Find someone to do the job you want them to do.  If they don’t listen, respect your choice, then you know it’s time to hire someone else.

The last thing you want is to go home with a new baby and the trauma from a bad birth experience.  Your care provider doesn’t have to live with your birth – you do.

If there were no moms birthing in the hospitals any more, they would be quick to change their policies!

We need to take the power back for ourselves – our daughters – our granddaughters.

The feeling of “I rocked this birth – I can do anything” should not be rare and exclusive.

We need to go into birth feeling supported and empowered.

How we birth affects our postpartum experience.

If you have postpartum depression, and you always feel like you are going to cry – Cry.  It’s okay – you are still a good mom. (melt – I love this woman’s message!!)

After a VBAC with her third child, within 15 minutes her care provider started tearing apart her birth and her choices and deflated her "VBAC high".  The care provider was callous and careless, and her postpartum experience left her questioning herself.

With her fourth child, she decided to get “in the zone”.  She and her husband made their choice about how they were going to birth.  If anyone came into “the zone” with negative energy, she punched them out (jabs at the air with a couple of side punches to the great delight of the audience) and went back into her “zone”.

She birthed her baby without any drama, complications, and she had her family around her after the baby was born.  They welcomed their new child together.  Her postpartum experience was very different – down to the breastfeeding relationship.

In talking with midwives at The Farm, they do not have any incidence of postpartum depression.  One of the midwives stated that she thinks PPD is a symptom of nuclear family living in isolation.  In communal living, women support and help each other; when they see a need, they take care of it.  In nuclear family living, women are isolated and alone.  It is seen as weakness to need help.

January believes that we need other women.  We need to cry and celebrate together, be okay with doing each other’s dishes, bringing meals, letting mamas take a shower.  We need to support each other with no judgement and help each other with love.

Empower birth.
Support the postpartum period.

My note…even more kudos to this woman for being there for the mamas at Mommy Con.  She has her own conference coming up this weekend – not even a mention or a peep about it when she had the perfect platform for self-promotion.  Truly she is a woman who is changing the world, one interaction at a time.

Want more Mommy Con scoop??
HEREare my notes from Dr. Robert Sears - He talked about vaccinations during pregnancy, postpartum, and for infants.
 
HERE are the notes from Jessica Martin-Weber of The Leaky [email protected]@b - Her talk was about parenting and being confident in our choices.
 
HERE are the notes from Abby Theuring of The Badass Breastfeeder - Her talk was about empowering breastfeeding as a society

HERE is a link to our tour of the convention floor.

HERE is a link to the Babywearing Fashion Show.

HERE is a link to pictures of the Babywearing World Record.

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®.


Meet the Doula: Jennifer

Posted on October 3, 2013 at 9:41 AM Comments comments (28)
This month's featured doula is Jennifer Valencia.  She is a doula that serves Central and Northern Arizona.  She believes that birth is a sacred time and every mother should be nurtured and respected as she brings her baby earth side.

When was the first time you heard the word, “doula”?
The first time I heard the word doula was probably in 2006, some time before my first baby’s birth. I didn’t really understand the full scope of benefits of a doula until the birth of my second child when I experienced a DONA certified doula.

How did you decide that becoming a doula was part of your journey?
I had a friend who was having her baby a few months before my first son was born and she was made to labor alone because “only the father” was allowed into the hospital after hours, per their policy. I knew this kind of treatment was not right and I advocated to make a difference before my son’s birth. Besides the role of advocacy, I knew I wanted to make a positive difference in the lives of mothers, babies and families at this very significant time in their lives.

Are you a birth and/or a postpartum doula?
I am a birth doula.

How long have you been a doula?
I have supported friends and family in their birth experiences prior to becoming a doula but began to take a much more active role in my training in 2012 and providing support to my community with local birth circles. I have completed my requirements to become a CD(DONA) and my certification is pending. I am also educated in the Social and Human Services field and am in the process of obtaining my MSW. I have taken advanced doula training- certified in TENS support for labor. I love to bring essential oils into the birthing room.

What do you enjoy the most about being a doula?
I enjoy providing women with evidence based knowledge surrounding prenatal care, pregnancy, birth and their newborn so that families can be empowered in their birth experiences. I am honored to hold a sacred space for women and their partners, allowing them to have a more intimate birth experience with confidence. I love seeing her joy as she meets and bonds with her newborn for the first time.

What is your philosophy when you go to a birth space?
I believe that birth is a sacred time and every mother should be nurtured and respected as she brings her baby earth side. As a doula, I hold that sacred space and strive to build confidence in childbirth and the ability of a woman’s amazing body. I believe that birth is a normal life event. I believe that birth matters; it is a transformational time, shaping the kind of mother and person a woman is.

How do you work with and involve the Coach?
I strive to create an intimate space, not just for the mother, but for the family. I provide perspective and support for a woman’s partner to participate at their comfort level to enhance the support they provide. Prenatally, we talk about “what to expect” and I focus on building confidence and trust in birth as a natural process that is different for every woman and every birth. A partner or other loved one brings compassion and intimate knowledge of you, while a doula brings knowledge, confidence and experience to the birthing room. Together, a doula and your coach make a strong support system. When the partner is desired as the primary support person, I work behind the scenes; I quietly offer ideas for the coach to support the mother and keep both of their basic needs met. I consider myself having “successfully” supported an intimate birth when mom remembers me as a nice person in the room and dad felt confident in his ability to support her. When the coach prefers to be in the moment and enjoy the birth experience but not be the main pillar of support, I am sure to include the coach’s presence so that the mother is very connected with him but I support her physical and emotional labor needs.

What is the toughest situation you have ever dealt with?  How did you handle it?
I have been in a birth where hospital staff does not listen to the mother’s desires for her baby or take the time to listen to her views of a situation. There wasn’t much I could do against the “policy” but I could still support the mother- I took the time to listen and validate her feelings and advocate for her within my scope of practice as a doula. I helped her feel more empowered and overcome a situation where she felt disregarded.

What keeps you working as a doula?
I keep working as a doula because I long for every mother to have a safe and satisfying birth experience. I have seen the difference a doula makes and am eager to bring awareness about evidence based birth into my community by providing opportunities for mothers to connect and support one another in the birth circles. Not to mention I love these adorable babies and empowered mamas!

What does your fee cover – how many visits or hours?  Is there a different charge for a shorter labor or longer labor?
My basic birth doula service includes a minimum of two prenatal appointments, on-call availability 24/7, access to my lending library and at least one postpartum appointment. Prenatal appointments generally last about 1.5hrs, include basic childbirth education and are for getting to know each other and how I can help you achieve the birth you desire. I will provide continuous emotional and physical support for the mother and her partner throughout labor, birth and up to four hours after. Postpartum appointments vary in length and are for talking about your birth experience; I also provide basic breastfeeding counseling and referrals as needed. My basic birth doula services are $500, however, I believe in a doula for every woman who wants one; if money is a concern when hiring a doula, my basic services are offered for a donation. I have packages that include more extensive childbirth education, belly casts, birth stories, massages, yoga and more, starting at $550.  My fee does not vary based on the length of labor.

Do you offer any other services to your clients?
I offer belly casting and placenta encapsulation, tinctures and more.

Just for fun, what do you do when you are not doula-ing?
I enjoy rock climbing, hiking and spending time with my husband and children.

About our doula:  I am Jennifer Valencia.  I have two beautiful children and a wonderful, supportive husband. I have been drawn to the field of birth work since 2006 and am now obtaining my certification through DONA International. Because I have had a VBAC, mothers seeking a vaginal birth after cesarean have a special place in my heart. I feel honored to walk along side families in Arizona during this very beautiful time. As a birth doula, I support women of Yavapai County, Flagstaff and Phoenix. I attend birth in any setting- hospital, home or birth center.  Find me online at www.guidingangelsbirthservices.com, via email at
[email protected], or call me at 928.300.1337.


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

Rights For Homebirth - May 2013 Update

Posted on May 17, 2013 at 8:56 AM Comments comments (0)

The final Midwifery Scope of Practice Meeting was held on Wednesday, May 15, 2013.  It is now time for the families of Arizona, and anyone else who believes that compassionate care is a human right’s issue for the mother and the baby to take a stand.

You can click on the links below to read a copy of the current draft rules and to see Wednesday’s proceedings:
Most Recent Draft: http://1.usa.gov/YZw4Xt
Most Recent Meeting: http://bit.ly/104ZtKT

Here is my statement on the Arizona Department of Health Services Website:
In addition to agreeing wholeheartedly with Allyson Fernstrom's statement below, I want to direct the committee to THIS brief article with references if they want to dig deeper:
 
As the article and study succinctly show, "FTP" and "CPD" in the 21st century are mostly iatrogenic.  "Watchful waiting" IS the midwifery model of care in the hospital, in the birth center and in the home setting.  Many midwives have less than a 15% cesarean rate (defined as an "acceptable" rate by the WHO) in their practices because they do not intervene until necessary.  This does not mean emergency; read: most of these are non-emergent and appropriate.
 
At this point in our history, 99% of births are still occurring in the hospital setting (read more HERE), and a vast majority of those women are still under the OB model of care: the "do something to help this along" model.  A 32.8% cesarean rate calls into question the common practices that are being forced on women.  It should not surprise us that some of these women are demanding a different model of care with subsequent pregnancies.
 
It is unreasonable to essentially punish women who are seeking compassionate care after feeling abused in the traditional care system by doctors who subscribe to a different philosophy about birth.  By including FTP and CPD in the final version of the rules and regulations, you are essentially providing a VBAC option on paper without providing a VBAC option that will be a choice for the majority of the consumers who are now faced with choosing unassisted births instead of facing the trauma they faced in a previous birth.
 
Before a final draft is approved, I implore Dir. Humble to attend a home birth.  See what it is we are talking about.  Really understand why we are so passionate about this cause, and why we believe that birth is a fundamental human right and a woman's rights issue.  We are not asking for the sun, the moon and the stars.  We simply want you to understand the power of birth, and why we want our care providers to have all the tools they need at their disposal if we choose a home birth setting. 
 
Midwives have the ability, the training, and the knowledge to bring babies safely into the world without compromising the health of the mother.  They believe that mothers care about the life they carry within them, and will do their research when it comes time to choose or decline procedures.  Midwives also know how to recognize non-reassuring patterns and when it is time to safely transfer to a different birth setting in the rare cases that complications do arise.
 
I advocate for midwives to be free to choose the clients that they feel they have the training to care for, be that VBAC, breech, or mothers of multiples.  As an informed consumer, I ask for the state to certify that the women who offer this care are educated in the care and management of those labors.  Along with this, I trust that midwives will have the opportunity to continue their education so that they can assist at VBAC, breech and multiples births once they have completed training in those areas.  I am glad to see that there is a review process to keep midwives accountable for their decisions, none of which will be made lightly because at midwives care deeply about the women and the children that they serve. 
 
Dir. Humble, you have the opportunity to lead here and set a new standard for the great state of Arizona.  Please take it.
 
Respectfully,
Krystyna Robles-Bowman
Mother of 4
Chandler, AZ
 
Statement from Allyson Fernstrom:
"I am extremely grateful to see that VBAC is still included in the drafts. I believe this is a huge step in the right direction. It shows that the department is listening to the concerns of the consumers. I appreciate that more options are being opened up to the growing number of women who desire to achieve a VBAC. However, I have GREAT concern with some of the conditions suggested. It currently reads that a midwife can not attend a VBAC if their was a diagnosis of "failure to dilate" or cephalopelvic insufficiency". I heard in the last meeting that it is supposed to read "failure to progress". That does not make the problem better. Failure to progress, failure to dilate and cephalopelvic insufficiency/disproportion are ALL unacceptable. There is NO literature to support this rule. Listen to the members of the committee, including those from the medical community, who have mentioned may times that FTP is over diagnosed. FTP only tells you that a mother did not progress. It did not tell you WHY she did not progress. What if there was failed induction? What if it is an emotional issue that stalled labor? What if the baby was in a poor positioning? Maybe the care provider followed the Friedman's Curve, which does NOT allow the typical mother enough time to labor to full dilation? There are too many variables in play. A woman should not be excluded from attempting a VBAC because she had a failed induction, an emotional block, a baby in a poor position, an impatient care provider, etc. Because the diagnosis of FTP does NOT explain WHY the woman had a cesarean section, it should NOT be used to determine whether or not she is capable of vaginal delivery. CPD is also highly disputed in the literature. It is difficult to ever give a TRUE diagnosis of CPD. The testing is unreliable. FTP and CPD are subjective, over diagnosed and would be completely inappropriate in the rules. Director Humble mentioned that if he allows VBAC, he does not want to make it so restrictive that no one can do it. Leaving in FTP and CPD would essentially make it impossible for most VBAC clients to qualify for a homebirth VBAC. Consumers and members of the committee have been asking from the beginning that this be removed from the rules. Listen to these important stakeholders!"

Do you want to get involved?  Please do!!

There is a peaceful Rights For Birth rally being planned for today and Monday in the Phoenix area – click HERE for all the details.

Do you want to submit your own comment?
Click HERE for to make a direct public comment.

Let me be clear that I do not believe that OB's are bad people.  I simply disagree with the birth paradigm under which many of them practice.  I am forever grateful for their skill set as surgeons when it is an appropriate and needed use of their considerable skill in the operating theater.

Do you believe birth is a human right and/or a woman's rights issue?  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®.


 

Planning a VBAC – Dad’s Count, Too

Posted on April 24, 2013 at 11:50 AM Comments comments (0)
When it comes to pregnancy, labor and birth, the vast majority of the writing and expectation for preparation is geared at the mother.  One of the reason’s we chose The Bradley Method® is because it recognizes that the father may also want to play a role in the birth of the child and Bradley™ prepares the couple for labor to welcome their child, not just the mother.

The same holds true when planning a Vaginal Birth After Cesarean (VBAC).  If the partner was present for the first birth, they also experienced varying degrees of stress: watching their loved one undergo major surgery, the physical recovery period, and the emotional recovery period, which might have been longer than the physical recovery.  They may have watched their partner struggle with breastfeeding, if that was the choice for their family.  In any case, it may be a good idea for a mother to consider her partner’s feelings if she wants complete support in her choice for a VBAC.

Jenni Froment, ICAN Phoenix co-leader, shared some insights at last month’s ICAN “For Dads” meeting.  I have added to them from our experience with VBAC couples and from the knowledge I have learned from attending ICAN meetings. 

These points are meant to initiate a conversation with your partner if you have not already covered them.  You may have talked through some of these after your cesarean birth, and they may bear revisiting as you move forward with future pregnancies.

What is going on in your partner’s head?
Partners have concerns, feelings about your birth(s), and they can get anxious, too.  
  • What is their first reaction when you tell them that you want to prepare for a VBAC?  
  • What is their biggest concern?

How do you involve your partner in the decision of whether or not to VBAC?
  • Have them express their feelings about the previous cesarean, and then talk about how they feel about a VBAC now that they have had time to hear why you want to prepare for one.
  • What are your partner’s priorities?
  • How do they envision their role in the planning process? 

Wouldn’t just be easier to have a repeat cesarean?
It is not generally a life-threatening since it is a surgery with a specific procedure and protocol after years of execution.  It is, however, a major abdominal surgery.  As Dr. Victor Berman explained to us at our Bradley Method® training, if your body underwent this kind of trauma outside of the operating room, very few people would survive.  Beyond the physical trauma to the human body, there is a risk for infections, an emergency hysterectomy, an admission to the ICU.  There is the introduction of narcotic drugs to the mother and baby, and the incredible physical ordeal of recovery.  There is nothing “easy” about a cesarean. 

Isn’t the VBAC going to be a lot of work?
 Yes, it might be.  Most mothers experience a sense of loss when they have a cesarean.  Planning can take the power back.  The analogy was shared that you spend months planning for the single event of your wedding day.  The day of your child’s birth merits at least that kind of attention, if not more.  Planning can alleviate stress in the labor and delivery space if the couple already knows their options and how they want to use them for their labor.  In a healthy, low-risk mother, a vaginal birth is best for both mom and baby.  Even if you should have a repeat cesarean, the prepared approach can empower a couple who can know in their heart of hearts that they did everything possible to prepare for a different outcome and their best choice for a Healthy Mom, Healthy Baby outcome was a repeat cesarean.

What is the benefit of letting the baby choose their birthday instead of just scheduling their birthday so we can plan?
 A healthy baby is the best-informed individual when it come to choosing the day of their birth.  A baby that is ready for life outside of the womb will have lungs that are fully developed and ready to breathe without the help of a machine.  The breastfeeding relationship has a better chance if the baby is healthy and can have skin-to-skin contact immediately after their birth (yes, even if it is another CESAREAN).

What are the risks of a VBAC?  Is it a safe choice?
 Uterine rupture is “the” drop word when it comes to VBAC.  You can refer to last Friday’s post to see what the numbers really look like (find it HERE).  The bottom line is that there are several other complications that can happen, whether or not you have had a previous cesarean.  Pregnancy is generally a healthy time in a woman’s life, and with a comprehensive childbirth preparation course, a family can prepare for a VBAC by keeping the pregnancy as healthy and low-risk as possible.  Bradley Method® students also get 12 weeks of nutrition education to help them build a strong, healthy mama and baby.

 The other thing to note in regards to uterine rupture is that there are two known factors that increase the stats:  the induction and the augmentation of labor.  If you want to lower your risk of uterine rupture, find a care provider who is willing to do “watchful waiting” as long as there is a Healthy Mom and a Healthy Baby.

 Lastly, the American College of Obstetrics and Gynecology just posted a position in support of vaginal deliveries.  You can read the position statement here:
Vaginal Delivery Recommended over Maternal-Request Cesarean

...and this one in case you are bring pressured to induce for suspected large-baby (macrosomia) or anything else that is not a medically necessary:
Early Deliveries Without Medical Indications

Communication Exercises
In the interest of moving forward together, you will need to communicate your needs to each other.  Let your partner know if any of these are important to you:
  • Tell them how you want to be supported
  • Have them listen to your feelings about your previous cesarean, and why exploring VBAC together is important to you
  • Go to appointments with you so that together you can asses whether or not providers are right for you
  • Can he be an advocate for you if people are questioning your decisions?
  • If your priorities are his/her priorities, could they verbalize and affirm your choices to encourage you?

So you and your partner have talked.  Are you both open to the idea of exploring a VBAC?  HERE is a guideline to planning a VBAC from ICAN Phoenix leader Jesse Franks, and HERE is the advice from midwives in our area.  

Here’s the checklist from Jenni's meeting:
  1. Find a supportive care provider.  If possible find out their primary cesarean rate and their VBAC stats.  Those should be a good indication of whether or not they subscribe to “watchful waiting”.
  2. Hire a doula.  Doulas are proven to reduce the amount of interventions a mother receives, the fewer the interventions, the more likely it will be for labor to progress towards a healthy, low-risk vaginal birth.
  3. Take a comprehensive childbirth class.  A good class will prepare you by teaching what to expect from pregnancy, labor and birth.  It will also fill your toolbox with coping mechanisms for the work of labor.  
  4. Research the protocols at your birth place and know your patient rights.
  5. Have faith in your intuition – let your instincts guide you.
  6. Plan your birth team well in advance of your estimated due date.  Everyone is on board with your vision and supports your choices, from you and your partner to your care provider, doula, and family.  Knowing who is not on board also helps you avoid “toxic” people who want to change your mind.

Do you have any ideas to share and add to the conversation?
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.   

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


Meet the Doula: Kimberly

Posted on April 5, 2013 at 9:23 AM Comments comments (28)
I am so pleased to introduce our students and readers to Kimberly Flake in this month’s Meet The Doula feature.  Kimberly has been a doula for a few of our students, all of whom have had great experiences with her.  I wanted to feature her in April, Cesarean Awareness Month, since she, herself, is a VBAC mama, and she specializes in VBAC support.

When was the first time you heard the word, “doula”?
The first time I heard the word doula was when I read about it just weeks before I sat in a class to become one.

How did you decide that becoming a doula was part of your journey?
A dear friend of mine and I walked the path together as we became doula sisters. Her road was short as she learned that she was there to heal from her cesarean births. I realized that the doula path was where I was truly meant to be. I had always considered becoming a midwife and this was my first step in the process. My first few births were amazing as I was a doula for a doula, attended the birth to a woman whose husband was not present, and my own sister-in-law. All three births were amazing natural births, where I learned, shared tears of joy and truly loved these special women as they came into their own strength of motherhood. I was incredibly privileged to share in the most intimate moments in a family's life. This was where I was meant to be without question.

Are you a birth and/or a postpartum doula?
I am a birth doula and monitrice.

How long have you been a doula?
11 wonderful years this month- April 2013.  As a doula, I apply my skill sets as a registered nurse, licensed massage therapist, and doula to support a family through their pregnancy and childbirth journey.  I specialize in VBAC support and natural childbirth.

What do you enjoy the most about being a doula?
There is a moment of complete joy as women and their partners realize their goal, give birth to their baby and experience a source of empowerment that she will carry with her for the rest of her life. This brief moment in time is without question the best thing about assisting couples through the process of pregnancy, labor and childbirth.

What is your philosophy when you go to a birth space?
Keep the birth space sacred so the birthing couple can have a bonding and positive birth experience.

How do you work with and involve the Coach?
Pregnancy, labor and childbirth are a shared experience between the woman and her coach. I work with the couple prenatally to learn what management tools for labor will be most effective for them as a couple or team. As she begins labor I act as an example of techniques to support the woman facilitating a positive experience for the coach to be present and supportive however he or she wants to be. I encourage coaches to remain in the role of support to the woman in front of her, so she can look into her partners eyes and be strengthened emotionally and physically by their bond.

What is the toughest situation you have ever dealt with? How did you handle it?
The most challenging situations have been those when a family experiences the loss of their baby. Each family is individual in how they need support, but I remain with them as their doula and sister. Helping them to cope and heal is a longer process than that of a living birth, and I spend many postpartum hours with them. I have had the honor of being asked to read a mother’s remembrance of her lost son who she knew and held for only hours outside the womb. I read her words at his memorial service and will carry her sentiments with me forever.

What keeps you working as a doula?
My love for helping couples through the process of pregnancy, labor, birth, and postpartum.

What does your fee cover – how many visits or hours? Is there a different charge for a shorter labor or longer labor?
My fee is a package fee that includes the following and does not change with the length of a labor.
  • Prenatal appointments (at least two but as many as you need) 
  • 1 hour prenatal massage 
  • Prenatal education for management of labor 
  • Assistance in developing birth plan if desired to have one
  • Labor and birth support (includes support at home in early labor and hospital) Use of labor pool at home
  • Breastfeeding support
  • Postpartum visit
  • Birth story

Do you offer any other services to your clients?
Placenta encapsulation for an extra fee.

Just for fun, what do you do when you are not doula-ing?
Currently I spend most of my not doula-ing time studying to become a certified nurse midwife, with my family, and watching my kids sports and activities. When I do have some spare time I love to read, take photographs, skydive and swim.

If you are interested in interviewing Kimberly to be your doula, here is her contact information:
Tel:  (480) 216-1837

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®.

Planning Your VBAC – Where to Begin

Posted on April 2, 2013 at 4:02 PM Comments comments (0)
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?
  It is important to get out of the mindset that the obstetrician or care provider as the authority over you.  You are the consumer.  You are hiring a person to care for you and your baby.  A big red flag warning is the statement, “Well, we’ll deal with that when we come to that.”  That usually means that, “When we get there, we are doing it my way,” so consider it a sign that it may be time to move on to the next person on your list.
Step 3: Be Healthy, Starting Now
Your nutrition is vital to your health, your pregnancy, your baby and your birth.  Maintain a healthy diet and exercise on a regular basis.

Krystyna’s note:  A comprehensive childbirth education class, like The Bradley Method®, prepares mothers over the course of the twelve week series to eat well to build a strong body and a strong baby, and we have a pregnancy exercise program that builds stamina as well as the three major muscle groups that support pregnancy and labor: Back, Belly, and Bottom.

Step 4: Mental Health
Your mental health plays a significant role in your pregnancy and birth.
A childbirth preparation course can educate you on the course of labor so that there are *less* surprises – all labors have an unknown factor and you can’t be “completely” prepared.
  • 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?

Step 5: Take A Childbirth Education ClassThere are several options for birthing families these days.  Here are some of the classes mentioned in the meeting:
  • 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

Krystyna's Note:  The Bradley Method® is fabulous as a comprehensive preparation course. You can click HERE to see what is taught through the  course of the 12-week series.  However, we do not do anything in-depth to address any past birth trauma or fears that you may be bringing to the birth space.  If you are interested in The Bradley Method®, please contact me to discuss some additional resources I recommend for VBAC couples enrolled in our course.

Step 6:  Plan To Hire A Doula
Doulas are an essential part of your birth plan.  A doula is a woman whose only role is to support a family through their labor, birth and the choices they want for their birth.  They may offer ideas for labor positions, moral support and hands-on help, among other things.  Typically people hire their doula between 24-30 weeks.  There is no “right time” to hire a doula, so even if you are earlier or later than this window, you can make phone calls and find the right person to support you and your partner through your birth experience.  Some insurance companies cover the doula fee, so call them and ask!
Step 7:  Get Family Support
The support of the people closet in regards to your decision to VBAC is very important. 
  • 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.

Krystyna’s Note: My favorite line of conversation I have heard at an ICAN meeting, and that I know share with our students in regards to birth choices is this: 
“I have taken the time to educate myself and make the right choice for our family.  Do you really think that I would make a choice to intentionally harm myself, or our child?  If we cannot come to an understanding, or at least agree to disagree, this topic is off the table and no longer up for discussion.”


Step 8: Educate Yourself
Knowing the facts about VBAC will give you more confidence in your decision, as well as prepare you to educate those who may question the safety of your decision.
  • 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

 Step 9:  From a Birth Plan
A birth plan is a great way to organize and prepare your goals.  It is a tool to help you articulate the vision you have for this birth.  Birth plans are typically written around 30 weeks, but there is no “right time” to write a birth plan.
  • 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?
If you are absolutely confident that other care providers have supported the choices you are making, then it may be time to interview other care providers.

Step 10:  Breathe
It will be okay!  Your body knows how to have babies.  In the swirl of activity, remind yourself to relax and enjoy your pregnancy!   
Krystyna’s Note:  However this birth is going to go, your body is still in the midst of the miracle of creating an entirely new human being over the course of the pregnancy.  You are an amazing, creative goddess – enjoy the glow and revel in your growing baby bump!
 
Are you planning/have you had a VBAC?  What is/was been important to you?
 
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
Bradley Method® natural childbirth classes offered in Arizona: Chandler, Tempe, Ahwatukee, Gilbert, Mesa, Scottsdale, Payson
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®.


0