Choosing an experience: My journey to VBAC

Today's post is written by Pamela Candelaria who writes over at Natural Birth for Normal Women. 

I’m going to come right out and say it: The single biggest reason I wanted a VBAC was because I wanted the experience, magic-filled and complete with angelic music and ethereal light. Well, yes, I had romanticized it a bit, but I had a very clear vision of my ideal birth before my firstborn was a twinkle in his daddy’s eye.  I believe giving birth is a rite of passage, and the actual physical act of giving birth is the highest expression of feminine power.  I was shocked when I ended up having a c-section to deliver my first baby, and it was an enormous struggle for me to work through my feelings of failure. There was never a question that I would pursue VBAC when I had more children. Or at least, there was never a question until I got pregnant again. 

Then it started. I knew I had to be better informed this time, make better choices to have a better birth. My starting point for research was the internet, and it was absolutely filled with horror stories about VBACs gone wrong, catastrophic uterine ruptures that killed babies and left mothers hemorrhaging and facing hysterectomy. If only they’d chosen another c-section, their babies would be alive and they would be able to have more children. My conviction began to falter. I kept reading. I read the derision heaped on VBAC moms, the accusations that we were trying to get a “vag badge” or would rather have a vaginal birth than a healthy baby. I wondered if I was putting my own desire for an experience above the health of my baby. If that was the case, I needed to re-evaluate my priorities make peace with having c-sections for all my children.  

In the midst of my searching, something wonderful happened. I found an online support group full of women who not only knew absolutely everything about VBAC and repeat cesarean (RCS), but were able to direct me to the sources so I could learn it myself. I started reading studies- actual studies that looked at thousands of births. I could see the biases and flaws in the research, and I was able to critically evaluate how the conclusions of the studies were affected by those biases. I had support, I had encouragement, and I had resources- and this is what I learned:

VBAC is safe. Let me say that again: VBAC is safe. That is not to say it is without risk, but any pregnancy following a c-section carries greater risk than a pregnancy with an unscarred uterus. On the whole, VBAC provides better outcomes for mothers and babies than scheduled repeat cesarean.  VBAC babies have higher APGAR scores, lower rates of NICU admission, less need for supplemental oxygen, and shorter hospital stays than babies born by RCS. VBAC moms have less time in the hospital, too, and they also enjoy significantly lower rates of infection, hemorrhage, transfusion and hysterectomy. Repeat cesareans are 2-4 times more likely to result in maternal death than VBAC, but death related to uterine rupture in a VBAC attempt is unheard of. Because I wanted a large family, it was critical for me to learn that risks in future pregnancies dramatically decrease with multiple VBACs, but dramatically increase with multiple c-sections. Having this information renewed my confidence in my decision to VBAC, but it left me with questions, too. Why was the obstetric world so against VBAC? And why do only 10% of women choose VBAC? 

The answers to those questions are multifaceted. The factors influencing modern obstetric care in general, and VBAC specifically, are complex and interwoven to the extent that it’s nearly impossible to separate them. Medical malpractice suits are a huge part of the equation, and there are lawyers ready and waiting to vilify OBs who support VBACs. It’s estimated that 30% of OBs have stopped supporting VBACs solely because they fear malpractice liability, and another 29% have increased their c-section rate for the same reason. The ACOG issued guidelines requiring “immediate” availability of emergency c-section for VBAC moms, and as a result nearly 1/3 of hospitals stopped supporting VBAC labors. But with the majority of OBs and hospitals still allowing VBAC, I wondered, why do women choose RCS in droves? 

It is common (though inaccurate) knowledge that VBAC is safer for mothers and RCS is safer for babies, and there is a strong social expectation that we as mothers should be willing to sacrifice our own safety to ensure the safety of our babies. We fear we’ll be held responsible if a VBAC goes wrong, but choosing RCS makes the OB responsible for the safety of the baby during birth. Many OBs provide misleading information about the risks of VBAC, guiding women to “choose” RCS because it is falsely presented as risk-free.  Other OBs claim to be VBAC-supportive, but have a laundry list of criteria that virtually guarantee no one will ever achieve a trial of labor. VBAC is no longer a mainstream birth choice, and when faced with unsupportive providers, misinformation, scare tactics, and a constant need to be vigilant and advocate for ourselves to ensure we’re given an opportunity to birth the way we want- well, is it any surprise that most of us opt out? 

After all my hours of research, I felt vindicated. Not only was my desire for a birth experience okay, but going ahead and having that experience was going to be better for me and my baby and all my future babies too. I was also lucky; my OBs never questioned my decision to VBAC and they were supportive and encouraging throughout my pregnancies. I have now had three VBACs, and oddly enough, there wasn’t a single one marked by angelic music or ethereal light. I never had that ideal birth I’d envisioned. It was just me, birthing my babies, having that experience, doing a little part of God’s work. And I wouldn’t trade it for the world.  

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Pam is a mother of 4 who found a passion for birth through her cesarean and 3 VBAC journeys. She believes the best way to improve maternity care is to empower all women to make fully informed decisions, regardless of what type of birth they choose. She resides in Denver, Colorado. 

J Lo tells us the reason we should all get our pre-baby body back...

Recently, Jennifer Lopez was interviewed for  US magazine. Not the most intriguing of magazines, I know, but they do have (what I am assuming is) hundreds of thousands of subscribers, and many, many more pick it up while waiting in line at the grocery store. The cover screams, "MY BEST BODY EVER" and provides us with an eyeful of the celebrity looking happy and sultry. A look all of us mothers are apparently dying to achieve. (Insert eye roll). The article quotes Lopez as saying,"You get to the point where you're like, Where am I? What happened to me? I got to get myself together for my kids, you know? They need to know what I really look like."

Don't get me wrong; I love me some J Lo. Many times I've been running, listening to her music, shaking my butt, trying to tap into my inner Latina. But, Jesus H. Christ. "They need to know what I really look like" ?? What she really looks like? I can guarantee, that what she really looks like is not some perfectly lit, posed, professionally make-up'd, airbrushed and photoshopped celebrity. And what kind of message does this send to her children and to other mothers? Call me completely bananas-gone-crazy, but this is the message it sends to me as a mother: 

Mamas: If you've got a little or a lot of belly fat, perhaps some pesky cellulite on your thighs,

 some sag on your butt cheeks after having those babies, don't you think it's about time you show 

your kids what you looked like BEFORE you had them? So what if it's been several years and you're

 not 20 anymore. Do it for your KIDS! Get yourself together for your them. 

Clearly, I jest, and who really takes J Lo seriously anymore. But, this is nothing new. We see it and hear it daily. The "How I got my body back after baby" article is a pretty constant bombardment to us mothers. So how do we ignore it? How in the world do we squash just deal with the body image pressures after having babies? 

There are many things a woman can do about it, and it really depends on the severity of her issues. I will say a couple of things. First of all, remember this: When you decide to have a baby, your life will change permanently. Forever. For the rest of your natural life. So, count on the fact that it's pretty likely that your body will change too. For-ev-er. Am I happy about the fact that my body is different now after having 2 babies? No. By no means do I give myself a wink and a thumbs up in the mirror when my eyes fall on a part of my body that is different than it used to be. But, I'm learning to live with it. Sometimes I just sigh and have to say, "It is, what it is", then go chase my toddler or nurse my daughter (which by the way I'll take my not-so-perky-anymore breasts as a trade off for breastfeeding both of my children). Just try to keep it in perspective. We chose to have the attitudes we have about certain things. Body image is no different. We can choose to be in a place of "Oh-my-god-I-need-to-get-my-body-back-or-else-(insert worst possible fate)" or we can choose to just accept it for what it is.

Your kids don't care if you have some belly fat. They don't care if you have some cellulite. But, they do care (and listen) about how you think and talk about your body. I vowed to do my best to heal my body image issues and to not pass them on to my children, especially my daughter. I do the best I can. Sometimes I feel like that clown at the circus who spins plates on both hands, one foot, his head and his nose. Some fall off, sometimes he looks silly, but, hey, at least he's trying, right? We have a lot to deal with as mothers. Let's not beat ourselves up by comparing our bodies now to what they looked like before we had babies.

Thanks anyway, J Lo. Please don't comment anymore about that. Just keep making great movies making music that we can shake our butts to. 

Things you shouldn't say to a pregnant lady...

...Or one that just had a baby

“Don’t be a hero, just get the epidural.” 

Plain and simple- Women who don’t get an epidural during childbirth are not trying to be a hero. They’re not trying to prove anything to anyone. They don't want a trophy, a medal, or a "congratulations". Their reasons may vary, but I can almost guarantee that they are completely annoyed by the “Don’t be a hero” statement. 

“Women that have natural child birth are crazy!”


We are trained to think that childbirth is hidiously painful and should be avoided at all costs. Childbirth is a right of passage and many women embrace it, pain and all. 

“VBAC is selfish. You should just do the safest thing for your baby and have another c-section”


This one makes my head spin. If anyone was truly educated on both the subject of multiple cesarean and VBAC, they would never say this ridiculous statement. I can only assume this would be said by someone that doesn't have a clue about both subjects or does not have a vagina. If someone does have the balls to say this, ask them where they got their medical degree. 
VBAC is not selfish. 

“Having a healthy baby is all that matters. It doesn’t matter how he’s born”

There is someone else involved in the birth and caring of that baby- and it’s his mother. Her physical health is important, but also her mental and emotional health. I am so tired of hearing this. It does matter how the baby is born! It goes without saying that the health of the baby is most important, but it's entirely unfair that the mother's feelings are simply pushed aside. 

“C-section is the way to go. No contractions, no pushing, you’re in, you’re out!” 

If you’ve never had a c-section and you say this to someone, shame on you. You have no right to impose this type of advice. If you’ve had a c-section and your experience was pleasant, I ask you to STOP telling pregnant women this. The process of labor and delivery is actually healthy for mother and baby. Most women grow up hearing nothing but horror stories about labor, so they learn to fear labor. I mean really FEAR labor. But women's bodies are made for labor. We're made to be able to take the pain and the contractions. 

“Well, it could always be worse”

I'd like to think that this statement is said when there is absolutely nothing else to say. Perhaps out of desperation to fill the silence or say anything to make the mother feel better. But, I urge, you...don't say this! Obviously, it could always be worse. But, someone who didn't have a great birth experience does not need their feelings to be made less. 

And lastly, I hesitated to write about this, but I wanted to make the point. (Another great post about this is here). If someone has had a traumatic c-section, or even a non-traumatic one but has ill feelings toward it, I think saying the following can be hurtful:

“Don’t worry, next time you can just have a VBAC!”

It can be negative for two reasons. First, she may not be a good candidate for a VBAC or she may attempt and not succeed (or she may be done having babies). Secondly, having a VBAC doesn’t automatically erase or “fix” the feelings of a previous traumatic birth experience. In some ways, I expected this to happen to me. Although my VBAC was great, and I encourage all women to try for one that desire to, I’m still sad that my son came into the world in a way that I feel was not the greatest. It’s out of my control, I’ve come a long way with the feelings assocaited with it, but like any traumatic experience, happier ones in the future don’t make it all better. 


Photo courtesy of Shutter Daddy

Caveat Emptor: The Real Risks of Cesarean Section

Today's post is written by Pamela Candelaria who writes over at Natural Birth for Normal Women. 

Over 1.3 million babies in the US were born by c-section in 2008, accounting for 32.3% of all births. The most common reason for cesarean delivery is having had one before, but the reasons for a cesarean can vary widely. Sometimes there are medical reasons for planning a c-section prior to labor, and emergencies during labor make other c-sections truly lifesaving. For a huge number of women, though, the picture is less clear. They are told they have small pelvises, or big babies, or their labors aren’t progressing fast enough. Many women are told cesareans are a safe way to avoid the risks of vaginal birth, and an increasing number of mothers are choosing c-sections with no medical indication at all. Whatever the reason for the c-section, though, one thing they almost always have in common is a lack of truly informed consent. Let’s look at the risks listed on a fairly typical consent form—what isn’t on the form may be surprising:

The consent form says:

Infection in the skin incision, usually this is controlled with antibiotics. Sometimes it can require you to be re-admitted to the hospital, but in most cases antibiotics are taken as an out-patient.

In reality, you are twice as likely to be re-hospitalized following a c-section, infection is almost five times more likely to occur, and infection can extend to the uterine incision. Taking antibiotics while breastfeeding contributes to thrush, adding another challenge when breastfeeding is already less likely to succeed following a cesarean. 

The consent form says:

Development of heavy bleeding at the time of surgery with the possibility of hemorrhage which could require a blood transfusion.

Transfusion is required in up to 6% of cesarean sections. If your c-section goes perfectly, you’ll lose over twice as much blood as you would during a normal vaginal birth- and even that number may be grossly underestimated. It is interesting to note that “normal” blood loss during a c-section would be considered a hemorrhage during a vaginal birth.  

The consent form says:

Injury to the bladder and/or bowel which could require surgical repair (this occurs in less than 1% of all Cesarean sections)

True- but mild bowel paralysis occurs following up to 20% of cesareans, and some women have bladder injuries that don’t require surgical correction but do require use of a catheter for weeks following delivery. Even if only 1% of women require further surgery to correct these injuries, that is almost 14,000 additional- and largely preventable- surgeries per year being performed on mothers who should be happily caring for their newborns.

The consent form says:

Injury to the ureter (a small tube which passes urine from the kidney to the bladder)

While this injury is unusual, occurring in just 0.1% to 0.25% of cesareans, it often goes undiagnosed until the mother returns to her doctor with symptoms including pain and fever. Another surgery is then required. 

The consent form says:

Developing a blood clot in the leg veins after delivery

This occurs in ½% to 2% of c-sections- somewhere between 6,900 and 27,000 women- and can be fatal; yet many women are never told what symptoms to look for or how to reduce their risk.  

The consent form says:

Risks for subsequent pregnancies include: placenta previa (where the placenta lies wholly or partly in the lower part of the uterus)

Shockingly, this consent form fails to list any other risks for future pregnancies. Reproductive consequences of a primary cesarean include a risk of uterine rupture that is 12 times higher than it would be with an unscarred uterus, even if a repeat cesarean is scheduled. A woman also faces increased risk of placenta previa, more severe placenta problems like abruption and accreta, miscarriage and unexplained stillbirth, unexplained secondary infertility, and dramatically increased risk of surgical complications in future c-sections. If that is not enough, the scar tissue and adhesions left by cesarean surgery can cause chronic pelvic pain and sexual dysfunction, and in rare cases can cause intestinal blockage that can be fatal.

The consent form says:

Cutting the baby during the incision into the uterus (this occurs rarely).

About 1-2% of babies are cut during c-sections- that could mean over 25,000 babies, every year, receiving anything from a nick to a severe laceration at the hands of the delivering OB. While the consent form ends here, a slippery scalpel is not the only risk babies face when delivered by cesarean. Babies born by elective cesarean are up to seven times more likely to have respiratory problems at birth, and are up to three times as likely to die in their first month of life.  C-section babies have lower APGAR scores, higher NICU admission rates, and they are more likely to have ongoing health problems like asthma. It’s important to note, these are low-risk babies, not babies who are delivered by emergency cesarean who may have been affected by complications of labor. No, these babies experience these issues as a direct result of the way they were born. 

I’ve talked with hundreds of women about their cesarean births, both online and in real life. There is a pervasive belief that c-sections transfer the inherent risks of birth to the mother, providing babies a safer and lower-risk entrance into the world than they’d have with a vaginal birth. Many OBs perpetuate this myth, but it’s clear they aren’t telling us the whole story. I don’t think I’ve met one woman- not one single mother- who was told up front that in some respects her c-section put her baby at greater risk than vaginal birth would have. Even though many women seem comfortable with the increased maternal risks of c-sections, few are truly aware of exactly what those risks are, how much they are increased, or how they can be reduced. OBs are selling c-sections as a safe and easy way to deliver a baby- and women are buying. 

Buyer beware.

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Pam is a mother of 4 who found a passion for birth through her cesarean and 3 VBAC journeys. She believes the best way to improve maternity care is to empower all women to make fully informed decisions, regardless of what type of birth they choose. She resides in Denver, Colorado. 

Sources:

2008 Birth Data

http://www.cdc.gov/nchs/data/nvsr/nvsr58/nvsr58_16.pdf

Cesarean Section Consent Form

http://www.awomansplaceobgyn.com/PDF/CONSENT-FOR-CESAREAN-SECTION.pdf

Risk of selected postpartum infections after cesarean section compared with vaginal birth: A five-year cohort study of 32,468 women

http://www.informaworld.com/smpp/content~db=all~content=a913514882

Cesarean Fact Sheet

http://www.vbac.com/pdfs/CesareanFactSheet.pdf

Neonatal Morbidity and Mortality After Elective Cesarean Delivery

Caroline Signore, MD, MPH^a and Mark Klebanoff, MD, MPH^b

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2475575/

Thrush in Breastfeeding Moms

http://www.babycenter.com/0_thrush-in-breastfeeding-moms_8486.bc

Cesarean Childbirth

http://www.emedicinehealth.com/cesarean_childbirth/page9_em.htm 

Estimates of cesarean-related blood loss shown to be too low

http://findarticles.com/p/articles/mi_m0CYD/is_13_38/ai_105514154/  

Urologic Injury at the Time of Cesarean Delivery

http://www.femalepatient.com/html/arc/sig/obsF/articles/034_08_023.asp

Uterine Rupture in Pregnancy

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

Deadly Delivery Summary

http://www.amnestyusa.org/dignity/pdf/DeadlyDeliverySummary.pdf

Fetal Injury Associated with Cesarean Delivery

http://www.ncbi.nlm.nih.gov/pubmed/17012450

The Easter Bunny meets Cesarean Awareness

April is my favorite month. Probably because it's my birthday, Spring, Easter and Cesarean Awareness Month. So guess what this post is about? Yes, another topic that gets my panties in a wad: Cesarean section and VBAC.

Fighting for my own VBAC has changed my life. I don't use that term very often, only when I truly mean it. It opened my eyes up to the world of American obstetrics, and how far we've come away from birth as a natural process. In my opinion, we've shoved a big, fat middle finger in Mother Nature's face.

So, why do I care? Isn't it none of my business how another woman gives birth? What she chooses to do is her perogative, isn't that why we're so lucky to live in America? So, shouldn't I just sit back and not judge? Well, yes and no. Yes, I shouldn't judge, but realistically, we're all human and we do it every day. And no, this is my blog and I feel it in my bones to speak out about this. So, if you don't want to hear me rant about birth, unnecessary cesarean and VBAC, you are welcome to stop reading now and for the remainder of the month of April.

Congratulations if you're still reading, you might get your mind changed, help someone else change their mind, or just plain hate me later. I'm okay with any or all of those.

I have come to realize that birth is hands down the most natural, beautiful, organic process in the entire world. It's been happening for billions of years. And it's changing for the worse. We are backpedaling when it comes to nature. Once we figured out we were destroying our planet, we all jumped on the bandwagon to fix it, right? And when we realized how many hazardous chemicals are in our foods and  household products we try to make changes to keep ourselves and families safe, correct? But, here we are, destroying the one thing we all have in common: Birth, and year after year it continues to get worse. In the U.S. the maternal death rate has nearly tripled in the last decade and the cesarean rate has continued to rise for the last 11 years, and if the trend keeps going, it may reach 50% by the time my daughter is ready to have babies. There are many reasons for this sharp rise, but that's not what this post is about.

I feel if I sit back and say nothing, I perpetuate the problem. What has me so upset, is the lack of information women have when they are pregnant and give birth.  When pregnant with my first, I was one of them! I sat back, let my doctor talk at me and hardly questioned him. My instincts told me to do something, anything, ask questions, go against his word, call his bluff. But, I didn't. Years and years of wiring were engrained in me. Things like: Doctors know everything. Doctors always have your best interests at heart. Hospitals are the best and safest place to have babies. Birth is scary, painful and dangerous. These are all things I thought were true, never trying to find out if any of it was factual or not. Guess what? It's all bullshit.

(Note: Not all doctors are bad. There are some great obstetricians, ones that support VBAC and will even wait it out on a long labor. But, this post is not about that either. Moving on!)

So, what is this post about? Basically what I stated before: I feel that many women lack important information when they are pregnant and giving birth. Some patients rights include:

• Women can refuse to be examined or treated by anyone.
• Pregnant women have a right to refuse any medical treatment or drug, including a cesarean section, episiotomy, anesthesia, and pain medication.
• A woman has a right to change her mind about any decision made before or during labor or childbirth.

Those are just a few. For a full list and other great information, click here. I hear story after story of women who are pregnant that didn't know they could refuse treatment, cesarean deliveries, vaginal exams or other interventions. It's up to us to know our rights and be able to ask or question our medical professionals. 

One of my favorite birth bloggers, Barbara Herrera, wrote a post entitled, "When you buy the hospital ticket...you go for the Hospital Ride." She says, "If you want control, why go where egotistical birth is the norm? If you want autonomy, why go where lawsuits and defensive medicine are the rule?" I'll be honest. I was scared shitless that my baby might be in danger during labor. Why? Because I was fed the absolute worst possible scenarios at each and every one of my OB appointments. If you know me and/or read my blog you know that I encourage and teach people to listen to their intuition, their gut instincts. Mine was telling me everything was fine, myself and my daughter were healthy and safe and that I should trust my body. But, as mothers, as incubators of these precious creatures it's very difficult to ignore modern medicine and not place our utmost trust in our superhero medical birthing system. After all, hospitals save babies. They save mothers birthing babies. In very, very rare instances they do this. But, you have to wonder: Is a hospital the safest place to birth? Is it the best place to bond with our babies? Are we just too scared and maybe uninformed to do it anywhere else? Do women really think they can't or don't know how to birth? Is it just a coincidence that as maternal mortality is rising so is the rate of cesarean sections?

The month of April will continue with birth and Cesarean related posts. Here are some references if you are pregnant, wanting a VBAC, or thinking about either one. Or if you know someone who may learn something about birth, these would make an excellent gift. Birth is the first major event your child experiences. Inform yourself to be able to make the best choices for yourself and your baby. Empower yourself to take control of your body and your birth.

"Ina May's Guide to Child Birth" by Ina May Gaskin
"The Thinking Womans Guide to a Better Birth" by Henci Goer (this one is great if you like scientific research to back up all the things you're reading).

"Your Best Birth: Know All Your Options, Discover the Natural Choices, and Take Back the Birth Experience" by Ricki Lake and Abbi Epstein.
Also, visit the International Cesarean Awareness Network, VBAC Facts and The Unnecesarean websites.

Photo courtesy of Thomas van Ardenne