The Empowering Cesarean

Empowerment - making one stronger and more confident, especially in controlling their life and claiming their rights.

Let's get one thing straight from the start - noone can empower another person when it comes to the humanistic experience of empowerment. Empowerment is, by definition, one finding ones own strength. So, I cannot empower you... but, you making a choice that feels good and resonates within you can be empowering to you. It is your power of making that choice that feels good. 

I am a huge advocate of low intervention, no pain medication birth. In healthy and low risk birth, less intervention (medications, tools, equipment, etc..) means less inherent risk. But just because I believe in that truth does not mean that it is going to be true for every birthing journey. Every birthing journey doesn't stay healthy and low risk, not every birthing journey couldn't benefit from weighing the pros and cons of an intervention and erring on the side of the intervention. So, that is where we start.

Women can have very empowering births in whatever way that they birth. My years as a birth worker have taught me that truth. The number one deciding factor that makes or breaks the case for a woman's fulfillment of a birth experience and decreases her chances of seeing it as a trauma is choice. When a woman is provided with choices, and is given the space to be a partner in her healthcare and birth planning, she is able to look forward to her birthing time with joy and not fear, fulfillment and not trauma.

If you find yourself planning for an upcoming cesarean, here are some options that are specific to you:

• Feminist Breeder 
• ICAN’s Family Centered Options 

• Sample Cesarean Plan 
• Medical Paper on Facilitating a ‘Natural Cesarean’ 
• Best Cesarean Care Plan – most information is for a planned cesarean

• Gentle Cesarean 

• Kangaroo Care after Cesarean 

• Family-Centered Cesarean

 In addition, you can talk with your provider about using a clear drape or a drape with a window in it, see if your hospital offers the TAP block for post-operative pain management, and talk with them about having a photographer in the OR with you to document those first moments.

Knowing your options, and finding a provider who will have an open dialog about these options, helps to ensure a happy and healthy mom in all birth experiences. 

A Risk Analysis' Review of Her Own Births

This is a mamas review of her own birth experiences, cesarean and two VBACs. Thanks for sharing mama C! 

To those whose c-sections were for "failure to descend" (stuck baby) who are seeking a VBAC but having doubts about your ability to push out a baby, I hope my story (and data) will encourage you.

My first OB said she'd support my first TOLAC but she didn't see why I bothered trying as I probably just have a "small/heart-shaped" pelvis and probably can't push out babies. Which is funny because she didn't even attend my first birth that ended in c/s (she had an ear infection). So how would she know anything about my pelvis? Luckily by then I had read enough to know the necessity for my c/s was probably caused by position (baby's and mine) and preparation (mine). So I fired her. Clearly not supportive. I interviewed 6 OBs and finally hired another, much more supportive, OB who delivered both of my VBAC babies.

Some data which may interest you, in order of birth (c/s, VBAC, VBAC):
Birth weight - 7 lbs 2.3 oz, 7 lbs 0.2 oz, 7 lbs 0.8 oz
Birth length - 20.5", 19.8", 20"
Head circumference - 32.5 cm, 34.5 cm, 33 cm
(So, clearly it wasn't a size issue...)

Baby's position - stubbornly OP and asynclitic, OA, OA
(Figured out first was OP due to 24 hrs back labor, slow dilation, contraction pattern, head shape post-partum, and ultimately OB had to reach in and turn her for a final pushing attempt - she then flipped back to OP prior to surgical delivery)

My position - flat on my back, seated squat, flat on my back
(Delivering my 3rd on my back was unplanned and probably only successful due to SPD during pregnancy and/or my pelvis having opened before and/or preparation (see below))

Preparation -

For my first delivery I took the hospital childbirth and child care class which taught Lamaze. I did not however practice the Lamaze on my own between classes or after the classes were complete. I assumed I had learned it, and would use it when the time came. I didn't understand that when your body is under stress the only response you can count on is one that is INGRAINED in your psyche, not one that is simply understood by your brain. So it didn't work when I went to try and remember it during my birthing time. In addition I didn't prepare well when it came to my birth team - I had my husband, who had no birth experience, and my 3 best friends, who had no birth experience. I have no local family, and we all tried real hard, but no one knew how to recognize poor baby positioning, no one could advise on how to reduce discomfort, no one had a clue about how to calm me down and get me to release and let my body do what it needed to. I saw 4 shifts of L&D nurses of varying quality, and the least helpful was unfortunately who I had at the most critical time. The OB wasn't there much at all but was very encouraging when she was (again this was not the OB I had prenatally but the on call I met when I was admitted).

For my second delivery I took Hypnobabies (HB) and I practiced between classes and practiced after the classes were over right up until delivery. I wasn't perfect, I didn't practice every day, but I did it enough because I made it through delivery using those tools. For me HB was essential in preventing panic, which is what locks me up, in response to discomfort. My husband took the class with me and became a great L&D coach, more confident in how to support me, how to help me get through it. And I hired a doula, (Cole), who supported me through both shifts of L&D nurses (yay for consistently great support no matter who's on shift!!), and also specifically used her tools to help move labor along and help move baby down, in addition to taking the time to learn all my HB cues to help me use it successfully. My second birth was a GENTLY induced VBAC - yes it can be done when medically necessary and still end with a vaginal delivery!!

My third birth I credit HB for allowing me to be in denial about being in my birthing time most of the day. I practiced HB from week 30 up until birth, most nights, just listening to my tracks and practicing finger-drop. The day I entered my birthing time I was just uncomfortable and felt crappy. So I took the opportunity to "practice" HB for some relief but never believed I was actually in my birthing time. Suddenly late that night I knew we had to go to the hospital. I gave birth 42 minutes after arriving at the hospital, using HB the whole time. Everything happened so fast that my OB didn't make it in time, but my doula (Cole) did and she and my husband again gave me exactly the support I needed. Even with birthing flat on my back I pushed her out in under 15 minutes.

My point with all of this, ladies, is that POSITION and PREPARATION are far more important than perceived body capability and baby size to achieve the birth you want. Body capability and pelvis size CANNOT be determined by an OB by any method of examination, just educated guess! Baby's size doesn't matter as much as you'd think because FAT SQUISHES! Baby's position on the other hand can be encouraged (see SpinningBabies), your own birthing position can be controlled (particularly if you have a trusting relationship built with your care provider), and your preparation is entirely in your control as well. Find a childbirth class/method that you can COMMIT to and PRACTICE, and build your birth team based on your birthing NEEDS, not necessarily the PEOPLE you simply love.

You CAN do this, and don't let anyone - including well-meaning family, friends, or care providers - tell you otherwise!!!

I am Brave

I'm Brave.
I ate all the right food
and didn't eat the bad
I worked out daily
did my Kegels
had a doula
found a midwife
cleared my negativity
healed my relationships
journaled
meditated
cat cowed
prepared
and
prepared
and
prepared

I loved my baby so much
And my baby
oh my baby
she was perfect
so perfect
but
my
body
said
no

It said no
to birthing
and
the doctor said I
needed to be cut

I'm brave

I'm brave
that
I loved my baby so much
when she
needed me
to give up my
dreams
my
expectations
my
hopes
my
body
to make her safe

I did

I loved my baby so much
I numbed my belly
laid down willingly
on the cold
table
cried
tears of frustration
and a little fear
and a lot of mourning
then breathed deep
and rallied

They cut

                              they suctioned

they cauterized

                                                                  they tugged
               they pulled

And then she cried
and I cried tears of joy

I loved my baby so much

But when I held her
when I held her
my doula kissed my forehead
and whispered, "well done, mama"
and my midwife gazed at my baby
and whispered, "you're so brave and courageous"
and the doctor put his hand
on my foot with tears in his eyes
honored me with his silence
and left me with a smile

I am brave
I loved my baby
so much
that I had a cesarean
I didn't birth her
through my vagina
I birthed her
through my heart

I am brave

Texas Cesarean Rates

Alright my lovely readers. I know that you know just how much I want to keep women away from unnecessary procedures and interventions during pregnancy and birth. To more clearly illustrate what we are up against, specifically here in Texas, I refer you to the State Comparison map.

This map has information from 2008. Unfortunately, we know that the cesarean rate has only gone up since then, so, most likely, Texas rates are even worse now.

This means that 1 in every 3 women will have a cesarean. These are not good rates. Take two of your closest friends, stand side by side, and draw straws... one of you will get the short stick.

What increases the chances a woman will have a cesarean? Here is a short list of just a few of the reasons:

• Induction
• Routine use of epidurals
• Routine use of augmentation (pitocin to speed up labor after labor has already started)
• Restricting the mother's movement during labor
• Late-term ultrasound
• Unsupportive birth team (spouse, care provider, hospital, or nurse)
• Lack of maternal education/information
• Heading into the hospital too soon after labor has started or water has broken
• Doctors impatience/time constraints
• Hospital policies/impatience/time constraints

---

	% of Births by Cesarean Delivery
United States	32.3%
Alabama	34.9%
Alaska	22.6%
Arizona	27.1%
Arkansas	34.6%
California	32.6%
Colorado	25.9%
Connecticut	35.1%
Delaware	33.2%
District of Columbia	31.4%
Florida	37.6%
Georgia	32.9%
Hawaii	26.8%
Idaho	24.4%
Illinois	30.9%
Indiana	30.0%
Iowa	29.3%
Kansas	30.1%
Kentucky	35.0%
Louisiana	38.0%
Maine	30.4%
Maryland	33.1%
Massachusetts	34.1%
Michigan	31.5%
Minnesota	26.4%
Mississippi	37.1%
Missouri	31.1%
Montana	29.2%
Nebraska	31.0%
Nevada	33.7%
New Hampshire	31.9%
New Jersey	38.7%
New Mexico	22.9%
New York	34.5%
North Carolina	30.8%
North Dakota	28.1%
Ohio	30.6%
Oklahoma	34.2%
Oregon	28.9%
Pennsylvania	30.9%
Rhode Island	33.3%
South Carolina	34.2%
South Dakota	26.6%
Tennessee	33.8%
Texas	34.5%
Utah	22.0%
Vermont	27.2%
Virginia	34.0%
Washington	29.4%
West Virginia	35.5%
Wisconsin	25.2%
Wyoming	27.0%
Guam	27.6%
Puerto Rico	48.5%
Virgin Islands	25.8%

Not surprisingly, our rate of preemie babies is just as high, as is our induction rates. Now, there are some things that you can do to decrease your chances of becoming one of those women. Some of these things include:

• Don't have a primary cesarean. Having a primary cesarean means that you will have to work harder for a VBAC.. including finding a VBAC friendly doctor, hospital, and birth plan.
• Get a Doula. I know, I seem biased. But doulas do truly reduce your chances of heading into that OR. How do we do it? We act as a catalyst for informed choice, full disclosure and informed consent, keeping mom up and active during labor, helping mom to have as few interventions as possible - all of which reduce her and babies risk, which, in turn, help reduce her chances of 'needing' a cesarean.
• Hire a mother-friendly practitioner. A mother-friendly practitioner is one who will listen to your desires and hopes and fully support them. They will not use language such as 'I am going to', 'I can't let you', 'we don't allow', or the like. They will treat you with autonomy and understand that you are the consumer who has hired them, not vice versa. This is a great post about how to talk openly with your practitioner and to look for more information regarding choosing a mother-friendly practitioner (see links).
• Go to a hospital with a low cesarean rate. This chart (pdf) has a breakdown of Texas hospitals and their cesarean rates. If there is no information for your hospital, it doesn't mean that their cesarean rates are stellar, it means that they refuse to disclose that information to the public. If you happen to live in the Houston area, the rumors are true: Women's has the highest cesarean rate in the area.

Be educated, be informed, and be prepared. Our rates are not good, and besting your chances for a vaginal birth through preparation and planning is your primary weapon against a primary, or repeat, cesarean.

Doulas Do It Anywhere, pt 5

Doulas help women give birth anywhere. We offer support in a home birth setting, hospital birth setting, birth center birth setting, medicated birth setting, and even cesareans.

Again, the definition of a doula:

A doula is not a midwife (unless, of course, she’s certified as both), in that she has no authority to make medical decisions, nor is she credentialed to deliver a baby. She’s not considered on the level of a nurse, either; doulas cannot administer or regulate medicine, operate monitoring devices, et cetera. In fact, a reputable doula will tell you that she doesn’t even have the authority to speak on behalf of the mother should a complication or other medical surprise surface.

But sometimes it’s the unnameable, intangible aspects of the conclusion of a pregnancy that require the most help and planning. And that’s where a doula is indispensable. In addition to the priceless knowledge and experience she brings to the laboring phase and to newborn-care assistance, she’s a wellspring of intimate emotional and physical support. A doula educates the family ahead of time; keeps the laboring mama focused and lucid; instinctively retrieves things she needs, like water or compresses; supports her body while walking through contractions; suggests different laboring positions; initiates massage and breathing patterns; reassures other labor partners; works alongside hospital staff; advocates for the mother; and, afterward, ensures that the new mommy is getting enough rest, is recovering well, and is bonding with the baby.  - Divine Caroline

That said, a doula is definitely a soothing presence in all birth settings, including PLANNED CESAREAN BIRTH.

During home visits, your doula can help you know what options you have for a cesarean birth, options to make your birth experience as mother- and baby-friendly as possible. Doulas also help women to talk with their provider about these options, which is an important step since many of these options are not common-place or commonly requested. In addition, we are helpful assurance during your birthing time:

• We labor with you: If you plan on waiting for baby to decide his/her birthday, we will do the early labor part with you at your home, earlier than we normally would.We will then move with you to the hospital. 
• We 'labor' with you: Even if you aren't planning on letting labor begin before your cesarean, we can meet with you at the hospital before surgery to do last minute emotional mapping, get all postpartum plans in order, and more.
• We can be there for...: Oftentimes, we can be in the OR if it has been cleared with the obstetrician and anesthesiologist. This can be such a benefit because, once baby is born, someone normally can go and be with baby (if it's in the nursery or on the other side of the room) while someone else can stay with mom during repairs.  We also have lots of doula-y tricks up our sleeves to make the experience very personalized and mother-centric.
• We can make memories: Or should I say lasting memories? Oftentimes the medications used during a cesarean can make it difficult for mom to remember all of the details of a cesarean birth. We can use a voice recorder, a video recorder, and/or a camera to take it all, or some of it (the parts you want us to), in. This can be an invaluable thumbprint for your memory of your baby's birth day. 
• We stay late: We wait until you are out of surgery, to help you to nurse, to answer any questions you have, and to help you make a 'be sure to ask later' list for when the medications wear off and you and baby have had some time to rest. If your baby has any extended nursery time, we will wait until you and your partner feel settled in and comfortable letting the 'extra pair of hands' go.
• We refer out: if you need a postpartum doula or a lactation consultant, two very helpful options for postpartum, we can definitely give our recommended and personal best to you.

Women still have many options and needs for a cesarean birth. Whether those needs are emotional or physical, a doula can help a cesarean to be as empowering and mother-centered as possible.

Doulas do it at planned cesarean births!

Induction Increases the Risk of C-Section and C-Section increases Newborn Infection

Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at Term, a recent study published with the American College of Obstetrics & Gynecology (July 2010 - Volume 116 - Issue 1 - pp 35-42) gave the following conclusion:

Labor induction is significantly associated with a cesarean delivery among nulliparous women at term for those with and without medical or obstetric complications. Reducing the use of elective labor induction may lead to decreased rates of cesarean delivery for a population.

This makes for even more worrisome fodder, as the study also includes this information:

Labor induction was used in 43.6% of cases, 39.9% of which were elective.

Inductions for 43.6% of cases?! How many inductions are too many?? And, based on the information given just previously, how many of those resulted in maternal or newborn risk?

Another study printed with the National Academy of Sciences researched what microbiota habitat a newborn at birth... depending on their mode of birth. The small study found that:

those born vaginally tended to get colonized by bacteria such as Lactobacillus from the mother's vaginal canal. C-section babies, however, got more Staphylococcus, a type of microbe usually found on the skin and one that sometimes causes nasty infections. - "Babies' First Germs Depend On Type Of Birth", Chao Deng, NPR

So, in conclusion, to lower cesarean rates and increased risk of newborn strep infections, we should stop inducing for mundane reasons. To lower strep infections, lower the risk for newborn death, respiratory distress, incidences of autism and other SENs, and modestly lowered IQ scores, we need to stop inducing so much.

This is only the tip of the iceberg, people. Oh, the tangled web we weave.

Cesarean Awareness Month

Yesterday was the first day of Cesarean Awareness Month! Coincidentally, this post was supposed to go out yesterday, but I was called away, mid-post, to a beautiful mamas birthing time (and again, coincidentally, she was working toward a VBAC). So, a day late for good reason!

Did you know that, in 2007, the last year that has been reported and released to the public, nearly 32% of births were via cesarean?

In honor of this month, I would like to point you in the direction of other blogs/posts on the internet:

Emjaybee writes on the Unnecesarean -

The most common thing I heard from everyone, doctors, nurses, midwives, friends and relatives, when I told them my awful c/section story, was, “Well, next time you can have a VBAC!”

Well, no actually. I’m not planning to have another child, and that probably won’t change.

And even if it did, what does it do to a woman to say this to her? It tells her “OK, well, you failed, but you can try again!”

And there are so many things wrong with that attitude I hardly know where to start.

This insightful post brings tears to my eyes as I had just recently visited with a woman who is still, years and years after her 2nd cesarean, trying to work through the grief and distrust, damage, and pain of her experiences. She feels trapped in a decision that is not so much a choice as a last resort to ensure that she has every chance possible to have a vaginal birth - and that still will not erase the damage already done.

The Feminist Breeder covers all of the VBACivism around the world.

Today marks the beginning of Cesarean Awareness Month. Over the next 30 days, let’s all take a moment to raise awareness of the cesarean epidemic, increase education about normal birth, and advocate for women’s reproductive rights.

April is sure to be filled with cesarean and VBACtivism all over the world. To start, the International Cesarean Awareness Network is hosting a radio show highlighting Mother’s Stories TODAY at 2 pm Eastern Time. If you are a Cesarean mom, a VBAC mom, or a CBAC mom, please call into the show to share your story. The ICAN blog will also be posting a new birth story every day of the month of April.

Definitely check out her post on web events!

Doula Ambitions talks about the correlation of Sexual Assault Awareness and Prevention Month and Cesarean Awareness Month.

Keyboard Revolutionary writes "Come on In To The Cesarean Factory":

How is it that a woman can waltz in off the street, say she's pregnant and wants a Cesarean, and everyone leaps to her command....yet a woman who IS pregnant has to jump through hoops and fight tooth and nail just to give birth vaginally?

Are Cesareans really so common these days that you can easily get one whether you have an actual baby inside you or not? Are hospitals so happy to do one that they won't even make sure you're really pregnant? Or even full term?

Momotics talks about VBACtivism, her own personal journey:

With the growing cesarean birth rate nationwide it is so important that we take some time and realize that the 32% numbers we are seeing are not healthy, nor are they improving maternal or neonatal outcomes. In the past month we have seen several reports in large national news sources about this, and while bringing attention to this is great, it is not going to make the change that we need.

Cesarean Awareness is important to me because of the births of my two children, so different, but much alike.

She shares her birth video (below) as well as many links to great information, articles, and activism.

My Birth Journeys from Danielle Elwood on Vimeo.

Thoughtful Mama 'rants about her opinion' on VBAC bans and frustration surrounding it.

There is so much talk about VBAC floating around on the ‘nets lately! I was going to write a long article about all the medically sound reasons for VBAC and all of the lack of evidence for VBAC bans, etc, etc but honestly, that’s all been covered by far more qualified individuals than me. So I’m going to stick with what I’m good at: Standing on my soapbox ranting about My Opinion!

All the talk of VBAC these days is just dripping in terminology that turns my stomach...

Heart and Hands blogs, in Telling The Story, about the difficulty and healing - and the subsequent 'next chapter' - that occurred when she shared her birth story.

Today, ICAN (International Cesarean Awareness Network) had a radio show about cesarean and VBAC stories. They told women to call in and share their stories, to help themselves and other women.

I listen to a lot of blog talk radio shows. I love hearing the views of the blogs I read and feeling the connection.

I have never called in though. There have been a few times when I should have, but I always chickened out.

This time, the President of ICAN (who is one of my friends on twitter that I just LOVE) asked me if I was going to call in and share my story. I knew it was time, so I said yes, and as soon as I did, I broke down.

I expect to see many more bloggers add their thoughts in the coming days and, if you happen to blog about it, feel free to post your link the comments section.

I encourage everyone, this month, to look into how to support women who have experienced a cesarean or how to bring awareness to the unnecessarily high C-section rates in the U.S. (and how to minimize those rates) in your local community.

Together, with our voices raised as one, we can make an impact in our local communities and the U.S. at large - giving women options on how to make their birthing times the lease risky and most rewarding possible.

For additional information:
The First Cut Is The...
Cesarean Education in the News
Making Cesareans Mother-Friendly
Frozen Smiles
Natural Cesareans
Scarred for Life
Cesarean Art and Awareness
Cesarean Birth in a Culture of Fear
ICAN online
What Every Pregnant Woman Needs To Know About Cesarean Section

The First Cut is The....

Wow... I opened my inbox this morning and found a plethora of information on the results of the National Institutes of Health (NIH) Consensus Development Conference on Vaginal Birth After Cesarean: New Insights

The conclusions (per their draft statement) are shown below, although you can follow the above link and read the complete study, as well as additional information:

Given the available evidence, TOL is a reasonable option for many pregnant women with a prior low transverse uterine incision. The data reviewed in this report show that both TOL and ERCD for a pregnant woman with a 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 TOL versus ERCD. 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 a prior transverse uterine incision to make informed decisions about TOL versus ERCD. We urge clinicians and other maternity care providers to use the responses to the six questions, especially questions 3 and 4, to incorporate an evidence-based approach into the decisionmaking process. Information, including risk assessment, should be shared with the woman at a level and pace that she can understand. When both TOL and ERCD are medically equivalent options, a shared decisionmaking process should be adopted and, whenever possible, the woman’s preference should be honored.

We are concerned about the barriers that women face in accessing clinicians and facilities that are able and willing to offer TOL. Given the 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 relative to other obstetrical complications of comparable risk, risk stratification, and in light of limited physician and nursing resources. Healthcare organizations, physicians, and other clinicians should consider making public their TOL policy and VBAC rates, as well as their plans for responding to obstetric emergencies. We recommend that hospitals, maternity care providers, healthcare and professional liability insurers, consumers, and policymakers collaborate on the development of integrated services that could mitigate or even eliminate current barriers to TOL.

We are concerned that medico-legal considerations add to, as well as exacerbate, these barriers. Policymakers, providers, and other stakeholders must collaborate in the development and implementation of appropriate strategies to mitigate the chilling effect of the medico-legal environment 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 prioritized and appropriately funded, especially to characterize more precisely the short-term and long-term maternal, fetal, and neonatal outcomes of TOL and ERCD.

The LA Times reports on these findings as well in Panel urges more choice in birth after C-section.

A National Institutes of Health panel says vaginal birth after caesarean is reasonably safe and should be more widely available. Many hospitals ban the practice as a matter of policy or liability. Vaginal birth after caesarean, or VBAC, is reasonably safe and should be more widely available, a National Institutes of Health advisory panel concluded Wednesday.

Such deliveries once accounted for 25% of U.S. births among women with a previous caesarean delivery, but have now fallen to less than 9%. Many women would like to attempt a vaginal delivery, however, and the panel's consensus statement is expected to increase their access to the option.

Daniel DeNoon reports in NIH Panel: End Bans on Vaginal Birth After C-Section:

But women who might want to give labor a try very often don't get a chance. That's because of so-called "VBAC bans" -- hospital policies that forbid a vaginal birth after a cesarean (VBAC) unless fully equipped and staffed surgical and anesthesia services are readily available. These policies align with current guidelines set by gynecology and anesthesia professional societies.

Not all hospitals are able to comply with this standard, so many women who have had a C-section have no choice in the matter. In fact, 30% of hospitals stopped offering women this choice after the professional-society guidelines went into effect.

Denise Grady of the New York Times wrote on this subject in her article Panel Urges New Look At Cesarean Guidelines:

A panel of medical experts on Wednesday recommended steps to reverse a trend that has dismayed many pregnant women: the increasing difficulty of finding doctors and hospitals that will let a woman try to give birth normally if she has had a Caesarean section in the past.

The new recommendations came at a conference held in Bethesda, Md., by the National Institutes of Health to examine why the rate of vaginal birth after Caesarean, or VBAC (pronounced VEE-back), has plummeted, to less than 10 percent from 28.3 percent in 1996. The repeat operations are feeding the nation’s overall Caesarean rate of 31.8 percent, which has been rising steadily for the last 11 years.

Lauran Neergaard, AP Medical Writer, covers that Women Need A Chance to Avoid Repeat C-Sections

Too many pregnant women who want to avoid a repeat cesarean delivery are being denied the chance, concludes a government panel that urged doctors to rethink litigation-spurred policies that have swung the pendulum back toward the days of "once a C-section, always a C-section."

Fifteen years ago, nearly 3 in 10 women who had a first C-section were able to deliver their next baby vaginally, a trend called VBAC for "vaginal birth after cesarean."

Now that rate has dropped to 1 in 10, in part because a third of hospitals and half of physicians ban women from attempting VBAC, a panel of specialists convened by the National Institutes of Health said Wednesday.

But VBAC remains a safe alternative for the right candidates, and when those women try labor, between 60 percent and 80 percent of the time they do give birth vaginally, the NIH panel concluded. It urged that doctors offer mothers-to-be an unbiased look at the pros and cons, so they can decide for themselves.

Lolita Carico writes, at Mama Gloss, in her article Why Are C-Sections on the Rise,

Cesarean sections are the #1 most performed surgeries in the United States, with 1 in 3 pregnant women giving birth via c-section. That figure is up significantly since 1996, when the rate was 1 in 5.... The debate rages on, but a new report being released today by the NIH (National Institute of Health), has determined that VBAC’s are just as safe as normal births. The findings could lead to a decline in c-sections.

MSNBC shares on Women Need the Chance To Avoid Second Cesarean:

Visit msnbc.com for breaking news, world news, and news about the economy

I have high hopes that this exposure will change (over time) the unethical ban of VBACs in hospitals across this nation (and two in my own area) and create an uproar by consumers over insurance companies dropping women seeking VBAC or even women who have had prior cesareans and find themselves pregnant again - and force change.

As the results of this conference snowball across the birth community news, blogs, Facebooks, and Tweets, I anticipate and joyfully expect more women to seek out alternatives, vocally so, and hospitals/practices to be urged to make changes to accommodate these options.

Additional Blogs of Note:

The Feminist Breeder (along with more coverage of the conference) concludes in Once a Cesarean, Rarely a Choice :

Time will only tell if the more positive points made by NIH consensus will have an impact on access in this country. From a birth activist’s point of view, the statements made by many of the conference speakers were a huge leap in the right direction. However, our cesarean and VBAC rates will not be reversed overnight, and in the interim, scores of women are left without a choice but to either fight the system for their VBAC, or submit to a surgical birth. To these women and their families, this is really no choice at all.

Science & Sensibility writes, in Do Women Really Need To Know The Uterine Rupture Rate To Make Informed Choices About VBAC:

The NIH press release about the VBAC Consensus Meeting includes only a single instance of the phrase “uterine rupture.” Having spent 2 1/2 days watching the streaming webcast of the event, my strong sense is that this was by design. During the expert testimony, we heard over and over again that uterine rupture is the most feared outcome of a VBAC. We heard in gripping detail what happens when a uterine scar ruptures in labor, and even saw photographs of the devastation. We heard about deaths and hysterectomies and hypoxic injury to newborns that occurred with uterine ruptures. But after all of that, we heard a rather consistent message that uterine rupture itself is not the issue.

Courtroom Mama ruminates, over at The Unnecesarean, NIH VBAC Consensus Development Conference: Gift Horse or Trojan Horse?

There are a lot of wonderful things to say about the recent NIH VBAC Consensus Development Conference. Hopefully it will expand access to VBAC by urging ACOG to reconsider the “immediately available” standard, and end the practice of banning VBAC rather than working to lessen the risks through physiological management of labor and other techniques. I’m happy to see that they are finally acknowledging that there is no way to reduce infant mortality to zero, and that the risks inherent in VBAC are no different from the risks of catastrophic outcome in any other delivery, making singling out of VBAC nonsensical. I applaud the panel for that.

But, as a law geek and a birth geek, I have to look a gift horse in the ass here.

When the draft statement first came out, I was a little bit troubled by the part that is now the end of page 14 and top of page 15.

Along these same lines, the 1999 ACOG guideline urged, “After thorough counseling that weighs the individual benefits and risks of VBAC, the ultimate decision to attempt this procedure or undergo a repeat caesarean delivery should be made by the woman and her physician.” Presentations at the conference suggested that this important recommended practice is not uniformly followed, but there are no strong data documenting the extent of this problem.

In my opinion, this portion of the recommendation didn’t strongly address some of the concerns raised in the prior two days about what happens to women who aren’t ideal VBAC candidates and who nevertheless don’t want to have surgery. Surely I wasn’t the only one worried…

Stand and Deliver posted a great review on her blog, along with much more linkie love on the whole event.

Doula-la talks about what Shrimp and the NIH Panel have in common.

Karen The Pittsburgh Doula covers a small blip and privies us to her 'shell shockedness' of the whole communication-sphere of the US going abuzz with the news.

Academic OB/Gyn writes about a possible solution through Micro Tort-Reform. Very good read.

VBAC in the News is covered by Your Best Birth.

Momotics talks about what wasn't covered at the conference.

And, to close, Refuse to Be A Womb Pod writes I know what you did last summer

I did something last summer.
Actually, I did it for the second time.
Most professionals think what I did is dangerous.
I was told I shouldn’t do it. Many institutions have banned it.
I meet women very often who have never even heard of what it is I did.
Sometimes women say they wish they could do what I did
but they aren’t allowed.
Or brave enough.
Or wide enough or thick enough.
Or, it’s just not convenient
enough.
Sometimes the very law itself doesn’t allow women to do what I did....

Go to her blog to read the rest.

Cesarean Education in the News

How important is nutrition in pregnancy? Very.

Women with a vitamin D deficiency were almost 4 times more likely to have a cesarean than those with [normal] vitamin D levels," says senior study author Anne Merewood, an assistant pediatrics professor at Boston University School of Medicine. "Vitamin D is definitely involved in muscle strength…. contractions of the uterus [which is made of smooth muscle] may not be performing as well as they could be," making it difficult for the woman to help push the baby out herself. - Vitamin D deficiency ups risk of C-section deliveries, study says

It reminds me again of how nutrition does not just affect our and our babies health, but our reproductive and birthing health - and in more ways than we currently know!

It is thought that these genetic changes, which differ from normal vaginal deliveries, could explain why people delivered by C-section are more susceptible to immunological diseases such as diabetes and asthma in later life, when those genetic changes combine with environmental triggers.

Blood was sampled from the umbilical cords of 37 newborn infants just after delivery and then three to five days after the birth. It was analysed to see the degree of DNA-methylation in the white blood cells - a vital part of the immune system.

This showed that the 16 babies born by C-section exhibited higher DNA-methylation rates immediately after delivery than the 21 born by vaginal delivery. Three to five days after birth, DNA-methylation levels had dropped in infants delivered by C-section so that there were no longer significant differences between the two groups.

“Delivery by C-section has been associated with increased allergy, diabetes and leukaemia risks” says Professor Mikael Norman, who specialises in paediatrics at the Karolinska Institutet in Stockholm, Sweden. “Although the underlying cause is unknown, our theory is that altered birth conditions could cause a genetic imprint in the immune cells that could play a role later in life. - C-section births cause genetic changes that may increase odds for developing diseases in later life

Very interesting article. It makes me think that more follow up studies should be done on cesarean born babies as they mature to childhood and adulthood, especially comparatively to their non-cesarean born siblings.

And, some somewhat related oddity, a shark has an accidental cesarean.

Delivery Method Affects Brain Response to Baby's Cry

This article came to me quite timely after find it on Karen's blog:
Delivery Method Affects Brain Response to Baby’s Cry

When my own daughter was born by Caesarean section delivery, I was surprised how uninvolved I was in the process. My body was numb, and my view of the surgery was blocked by a sheet. When I finally heard a baby cry, it took a minute for me to realize that the sound belonged to my own baby.

Karen reports something similar...

I know that from my personal experience, I felt very detached in my mothering with my first child, who was born via c-section, when she would cry. With my second child, who was born via vbac, I couldn't tolerate hearing him cry. I would act immediately (well, most the time). I have chalked this up to the toll the difficult labor and recovery with the c-section, that it just took a lot out of me, emotionally and physically; whereas with my second, I felt victorious and energized, and I had energy to spend mothering my child.

I say this was timely, because I had just spoken with a wonderful woman who had an epidural with her two previous children and was now seeking a natural birth. Now I know that this particular article is talking directly about vaginal vs. cesarean births, but I would like to see vaginal unmedicated vs vaginal medicated vs cesarean as the conversation with this woman raised some interesting dialog.

One of her previous experiences, in particular, she had gotten the epidural, had her little girl, and then, after being given her baby, kept thinking 'how long until I can give her back'.

She felt bad that she was, for lack of a better explanation, not that interested in her babe at first site. As she said, it was like a dream. Only after her epidural wore off, and when her babe was brought to her a second time, did she really feel like she was meeting her little girl for the first time.

Sarah J Buckley, whom I have referenced before, has two great articles called Pain in Labor: Your hormones are your helpers and Ecstatic Birth.

In them, she talks about how a woman's body creates this marvelous cocktail of hormones that help her throughout labor, postpartum, and with newborn immediate bonding. When epidurals, synthetic induction hormones, or cesareans are performed/introduced to the laboring woman, these hormones production are stunted.

Oxytocin is the hormone that causes the uterus to contract during labor. Levels of oxytocin gradually increase throughout labor, and are highest around the time of birth, when it contributes to the euphoria and receptiveness to her baby that a mother usually feels after an unmedicated birth. This peak, which is triggered by sensations of stretching of the birth canal as the baby is born, does not occur when an epidural is in place. Administration of an epidural has been found to interfere with bonding between ewes and their newborn lambs.

Synthetic oxytocin is often given by drip- that is, directly into the bloodstream- when labor contractions are inefficient. Oxytocin given in this way does not enter the brain, and so does not contribute to the post-birth “high”, and in fact can lead to desensitization to the mothers own oxytocin production.

... Again we must ask: What are the psychological effects for mother and baby of laboring and birthing without peak levels of these hormones of pleasure and co-dependency?

Epidural pain relief has major effects on all of the above-mentioned hormones of labor. Epidurals inhibit beta-endorphin production,15 and therefore also inhibit the shift in consciousness that is part of a normal labor. This may be one reason why epidurals are so acceptable to hospital birth attendants, who are not prepared or trained to deal with the irrationality, directness, and physicality of a woman laboring on her own terms.

When an epidural is in place, the oxytocin peak that occurs at birth is also inhibited because the stretch receptors of a birthing woman’s lower vagina, which trigger this peak, are numbed. This effect probably persists even when the epidural has worn off and sensation has returned, because the nerve fibers involved are smaller than the sensory nerves and therefore more sensitive to drug effects.

... Another indication of the effects of epidurals on mother and baby comes from French researchers who gave epidurals to laboring sheep. The ewes failed to display their normal mothering behavior; this effect was especially marked for the ewes in their first lambing that were given epidurals early in labor. Seven out of eight of these mothers showed no interest in their offspring for at least 30 minutes.

There is good indication, from the article on cesarean vs vaginal bonding, as well as the articles by Dr. Buckley, that we are starting to make good strides to understanding the endocrine, psychological, mental, and emotional repercussions of our medicalization of childbearing women and processes.

Good information to, hopefully, cause us to pause and reconsider our birthing practices and what we optimally want out of our birthing time. Because, as I have said before, it is not 'just about the process' - the journey, the process, is for the health of the baby/mom (not just physically), and just happens to include the experience?

Making Cesareans Mother-Friendly

Cesareans. The frozen smile, the marks of a mama-warrior. There are so many emotions caught up in this quickly-coming routine surgery. Dear close friends have had their hearts broken and their bellies scarred. Others have elected to have this operation with no medical reason.

I am so glad for the life-saving advances we have made in medicine that comes in the form of cesarean surgery - when it is indicated.

When this is the safest course of action for mom and baby (pelvic nuances, placental previa, fetal malformations, iatrogenic complications, etc..), there are some great resources that I would like to share with you, so that you can share with others.

Joanna Moorehead watched the cesarean birth of one baby. In Every Bit as Magical, the British doctor who headed this procedure up, understands more than most OBs how very important it is to preserve "birth", no matter what the setting. I would love to have this Obstetrician teach doctors in the U.S. a new way of cesarean delivery. Not to make it more acceptable of a practice, but to make it a better transition for mom and baby, should it occur.

"Whatever your view on caesareans, for some women it's always going to be the safest choice," he explains. "And while couples having normal deliveries have been given more and more opportunities to be fully involved in childbirth, very little has been done to see how we could make the experience more meaningful for those having caesareans...

What I realised was that caesareans were done a certain way because they've always been done a certain way, but in fact they can be done differently - and in a way that parents love," says Fisk. Other doctors are sometimes shocked when they hear what he is doing. "They say, but surely you have to get the baby out fast so she can get oxygen straight away? And I say, when the baby is being born she's still attached to the umbilical cord and is still getting oxygen from the placenta. Caesarean birth can be gentle, just as vaginal birth can be gentle.

Obstetricians are too hung up on getting from the point of incision to the birth of the baby as quickly as possible: that's been the benchmark of a skilled surgeon. But I'm challenging that because, from the baby's and from the parents' point of view, it's not very helpful."

Paula Beckton is another individual who, with her birth team, has changed the face of cesareans for those willing to fight for something better.

For many women the thought of having a caesarean is terrifying, the knowledge that after viewing your newborn child, you may be unable to hold or even see your baby for at least an hour (sometimes longer), can be devastating. Paula Beckton experienced a ground breaking caesarean, where she helped assist in the birth of her second child Oliver and not only was he not whisked away immediately, but was placed on her chest for cuddles and mother/baby bonding. This is her story...

Although I don't know as she had to have another cesarean, the point is how she made her own choices regarding how it would occur and how she would be more involved in the process. Her story is an amazing, nearly unbelievable, triumph of a woman taking control of her birthing time. Again, though I might not agree with everything about her reasons for a re-C, my point is not whether she needed one, but how she became proactive in her health care, making policy changes and overcame the very stubborn status quo of surgical delivery.

And finally, Humanizing Cesarean Birth... This, The Ideal Cesarean, is a wonderfully insightful article written by a doctor by the name of Robert Oliver. Not only is it eutopian, something we can only hope for when these instances are of the nessessity, but it is beautiful to read his heart.

Now, I will never hope that any woman will go 'under the knife' if it can be helped, but these more recent events, I hope, can inspire us, and U.S. mothers, to demand more, better, healthier, and safer practices that not only benefit our physical bodies, but our emotional, spiritual, and mental health as well - which can, in turn, only better our familial health as well.

Hi, My Name Is Nicole and I am a Conspiracy Theorist

I have been called a conspiracy theorist for touting that women's options are actually disappearing the more liberal we get with our birth practices.

With recent articles like Choosy Mom's Choose Cesareans, and responses from myself and others, it sounds like we are just hot under the collar and making up dark images of a 'right to choose'.

But are we?

Emotionally and physically, women are hurt, and their options are forever limited or made to be seemingly insurmountable uphill battles. Cesareans are becoming so prevalent and rates are increasing because of 'choice', policies, and iatrogenic complications, that we made an awareness month about it to promote more public education regarding this major abdominal surgery.

ICAN has a great resource on hospitals and VBAC bans... check it out for yourself BEFORE you go into labor or choose a cesarean... you will have a better idea of if you will be 'allowed' a VBAC next time around. That is one battle that many of us were already aware of...

But the battle just got bigger.

Now, after a cesarean, women with abdominal scars could very possibly find themselves without insurance. Some insurance companies are beginning to refuse women coverage if they have had a previous cesarean or give them higher insurance costs.... Unless they are sterilized or infertile!

“Obstetricians are rendering large numbers of women uninsurable by overusing this surgery,” said Pamela Udy, president of the International Cesarean Awareness Network, a group whose mission is to prevent unnecessary Cesareans.

Not only are women feeling pressure to have Cesareans that they do not want and may not need, but they may also be denied coverage for the surgery.

“You have women just caught in the middle of this huge triangle of hospitals, insurance companies and doctors pointing the finger at each other,” Ms. Udy said.

ugh! This is not how I, or any other professional in my field, wanted to be vindicated. I would rather be considered a conspiracy theorist than to see our healthcare and the lives of children and moms be affected in such a profound and inhumanitarian way.

• A Doula Too blogs about the horrible realization that our public is coming to: our cesarean rates are out of control, hurting our healthcare options, and hurting our babies.
  
• Karen The PA Doula is outraged and incensed - wanting to find a way to fix this mess.
  
• Navelgazing Midwife positively lights on the fact that this might make VBAC more possible and sought after and make cesarean a 'less achievable' OPTION for women when not medically necessary - will women start making more informed and mother-friendly, newborn-friendly healthcare choices?
• Pushed Birth reminds us that, with cesarean rates on the rise, it is a horribly unfair and hard place for families to be: coerced into unwanted cesareans either by default or by iatrogenic complications, and then refused basic care and health coverage - limiting their choices for care even more.
  
• Crunchy Domestic Goddess gives a great post on how others are responding to this article and have foreshadowed this day previous to it.
  

What next peeps? What do we have to do and be put through to get the information in between those plates of bones resting on top of your spine? Those of you in white lab coats - is it worth it to be home in time for dinner?Oi. I am going to the pool to cool off.

Frozen Smiles

I have been surfing the blog-space for a few weeks now and I find myself bombarded by tales of sadness, fear, heartache, hurt, angst, anger, and frusteration - these are the stories I am hearing from women with frozen smiles... women who, on the outside, you may barely notice their abdominal scar, but inside, the scars run much deeper.

Cesareans hurt.

I feel under qualified, I have not had one myself. But, enough friends, would-be clients, and family members have that I am accustomed to seeing the frozen smiles - seeming that all is well, but a haunted vacancy where there used to be light. Yes, the corners of their mouths turn up at the right times, but their hearts are broken, their bodies are put in risks way, and, forever, their birth choices are limited. They may not even be able to acknowledge this splintering, this robbed process, this destination with no journey... But I only pray I am there when they do.

They had a one in three chance of C-section just by choosing hospital birth in the United States.
But 1 to 3 is 100% if you happen to be the ones sectioned.
Its not like my daughter-in-law was only 33% sectioned.

- Better Birth

"What does the Scar stop me from doing? Why does it bear any relevance in my life? Because I have this scar I cannot give birth in a birth center. Because I have this scar, many midwives are legally not allowed to attend my births. Because I have this scar, there is a very large number of hospitals around this country that will not “allow” me to give birth as I was created to. Because of this scar, there is a dwindling number of doctors who would attend my subsequent vaginal births. Because of this scar, I will be forced to drive long distances to find a willing care provider. Because of this scar, I have to hear comments from ignorant strangers and family members, “but aren’t you afraid your uterus will explode?!”"

I would like to share with you a quote from War of the Worlds (watched it on tv last night!)

A child is talking with her father about a painful splinter in her hand. The father insists it must be removed right away lest it become infected. The child says, "no, when it's ready my body will push it out".

- VBACwarrior

and here...

I’ve come to notice the shuffled hunched look most post birth cesarean mamas have. I sadly can almost tell from photo albums too… I see it with [my] biggest boys infancy photos. It makes me sad. I’ve been there.

-HBACmama

and here...

They didn't tell me when they would start, I just remember both doctors chatting away as if I wasn't even there. It was as if I was a corpse, I might as well have been, and they were performing an autopsy on me, totally desensitized to the process. I was laying there paralyzed, scared, and about to give "birth" my son, and they acted like it was just another day at the office, chatting as if on a lunch break.

- Michelle DeMont

And so many more. One of the most thoughtful posts I have read in my wanderings is here. Read with caution, read with a stress ball in one hand and a kleenex in the other. She breaks the ACOG train of thought that it is JUST about the process... Again, don't they understand that the journey, the process, is for the health of the baby (and mom), and happens to include the experience.

Interesting stats on cesareans and why I can't just 'leave it lie' when a woman says she is planning on a cesarean for an unnecessary reason (unnecessarian?):

• 80% of women report incision pain
• 31% had bowel problems
• 17% reported incontinence issues
• women who give birth by C are in 'significantly worse physical healthy
• many women end up with permanent overhangs of skin, fat, and scar tissue
• many women end up with permanently sensitive scar tissue that causes irritation for years afterward
• 500mL of blood loss is considered a hemmorrhage, in the average C, the average blood loss is 1000mL
• 19% of women report infection
• 91% of women with primary Cs end up with repeat Cs... not for lack of WANT but lack of "ALLOW"
• Placenta previa risk increases by 50% with subsequent pregnancies after Cs
• Placenta accreta was reported as 1 in 533 births for subsequent pregnancies after Cs
• Necrotizing Fasciitis occurs in about 1.8 per 1000 surgeries
• MRSA is becoming more and more common in all hospital patients and more-so in C patients
• A woman giving birth by cesarean is 4 TIMES more likely to die than a woman giving birth vaginally

And that is just a handful.

These are not small risks - not when you consider it might be your friend, your sister, your cousin, Daycare provider, child's teacher - YOU.

Why am I adamant that education is NECESSARY? It is LIFESAVING? Because, when giving this list to a group of women the other day, I omitted Cesarean in all of these facts... and women thought it was simply a paper on childbirth stats...

Women believe, by and large, that CHILDBIRTH itself is a risky event and that, in managing birth, we can decrease risk. In fact, the opposite is holding true - the more we manage, the less safe it becomes.

I don't care if you label me a trumpet, a granola-eating, moon-gazing, hippy who imposes her beliefs on others - I would rather you not like me than you not be around to not like me because I didn't give you true and accurate information so that you could make more TRUTHFUL, INFORMED, and EDUCATED choices about your health and that of your child.

ACOG, put that in your pipe and smoke it - I don't believe that you are so ignorant as to believe that women are choosing home birth simply for the 'process'... some of us simply cannot accept the 1 in 3 risk of being the next shuffling woman in Cosco with a frozen smile on her face, a stapled smile on her belly, and a haunted look in her eyes. Some of us simply cannot accept that we may be an unnecessary addition to Safe Motherhood Quilt Project.

My heart breaks, my fists clench, and I know why I am willing to cry over a woman who is too proud, to afraid, or too hurt to cry over herself. I will stand up against any lab coat who attempts, for no valid reason, to cut the women that have put their trust in me to protect them during their most vulnerable time. I am a doula, I love, I am an educator, I empower, I am a woman, I band together, I am a mother, I offer support. I am a woman.

Cesarean Education

Cesarean Birth in a Culture of Fear
Childbirth Connection and Cesarean Section
VBAC
ICAN

Natural Cesarean?

I believe that, what they are doing, can be a good thing... But then it raises a question:

If the cesarean is ACTUALLY a TRUE emergency C, getting baby out would be tantamount. No time for 'gentle birthing'

But...

1) in the incidence of placental previa, I can see how this would be a GREAT option.
2) in the incidence of TRUE CPD, this would be a great option

Any other thoughts? Any drawbacks or questions that this raises?

Scarred For Life

This is a great educational video on the increased risks attributed to repeat cesareans. Scarred For Life: Cesareans Head To Danger Level. Spread the word, finally, a good advocacy piece on WHY you should do everything in your power to avoid a first cesarean and WHY you should fight with everything in you for a VBAC.

Controversial?

I have been called a conspiracy theorist, an alarmist, an NCB Nazi and worse.

Why would I put up with these labels?



That's why.

Check out VBACWarrior's Blog for more information.

Journey of a Monkey Momma

Let me encourage you all to visit THIS blog and show this beautiful momma some support. She has experienced an unneccessary cesarean and is now seeking to heal and VBAC. Her video is beautiful a encouraging. And, if you feel led, I am sure she would love you to post her information on YOUR blog to help surround her with loving support from other mommas.

CPD - an American Error-ridden Epidemic

OK - I stumbled upon this video and have to say that it is definitely one of my new favorites.

This video shows how very faulty and error filled diagnosis' of CPD are in obstetrical circles. women have been led to believe, over and over, that evolution or diet or lifestyle has made humankind grow bigger babies and smaller pelvis'. When it is simply not true. Enjoy!