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Birth Story: Heather’s VBA2C

Heather's VBA2C birth storyHeather’s VBA2C Birth Story

(photo provided by Heather)

Birth story and photos shared by Heather M.

During my last few prenatal visits, my provider had been getting more and more negative about my vba2c [vaginal birth after 2 cesareans]. I would hear comments like, “Oh, you are not dilated at all so you have a crappy cervix and might as well have a section now” (at 38 weeks). And “you are just too old, people over thirty rarely have babies naturally, let’s just do a section” (I was 31).  So at my 39 week appointment when my fluid registered 5.8, I’m sure you can predict the comments… “your baby will die” and “you are a horrible and selfish mom.”

They never addressed the fact that I had been hospitalized for severe dehydration from stomach flu days prior. I elected to go receive fluids and tabled the cesarean discussion. The fluids did not bring my fluid levels up and I heard the same comments, despite a perfect score in every other way from the baby. They agreed to give me the weekend and let me be checked in three days. I decided then I was never going to be given a fair shake in the hospital and arranged for a monitrice to help me labor at home when it was time. She gave me suggestions to get my fluid up, which I followed all weekend. I went in on a Monday (at 40 weeks) and my fluid level was 8! The comments I then heard were, “well I still want to section you today, but now I guess I don’t have a reason.”

Monday came and went. Tuesday I tried an acupuncturist that had a 100% success rate of induction within 24 hours. Tuesday and Wednesday came and went. I would have contractions by the evening, but in my sleep they would all go away! As I showered Wednesday night I stayed in prayer for guidance. I was frustrated I hadn’t gone into labor and wasn’t sure I would. I was scared of the process and scared of failure. I suddenly began to sing a Casting Crowns song whose lyrics spoke to my soul, “The voice of truth tells me a different story, the voice of truth says do not be afraid, the voice of truth says this is for my glory, out of all the voices calling out to me, I will choose to listen and believe the voice of truth.” I know that was God answering my prayer and giving me reassurance in that moment that all would be well.

On Thursday I took a homeopathic remedy and went to the doctor. My fluid level was at 3. My doctor was in surgery but the nurse practitioner called her and she said I was to “rush” to the hospital. I knew if I went over there I would never get to leave. I knew if I had to labor there the whole time, I would fail. I proceeded to emotionally melt down in front of the nurse, telling her all the hurtful things that have been said to that point and asking how I was to trust a doctor that clearly has their own agenda? (A question I know so many of you have felt at one point or another also!) Losing hope I would ever start labor on my own, I begged her to please give me an honest agenda-free evaluation of my baby’s health and safety of waiting.

The nurse put me on the non-stress test (NST) and after a good half an hour said that the strip was still reactive, the other markers were good, and I was contracting. Her guess was that I was in early labor (I was only at 1.5-2 cm dilated and 50% effaced). She said if I didn’t have a baby by the next morning I needed to go in for monitoring. Fair enough!

I left the office and went to lunch with my husband and toddler. I felt the contractions picking up steam, enough to make me want to go home and sleep… enough to give me hope this might be it, 40 weeks and 3 days in. We all went home and I laid on the couch all afternoon with my son and we watched Thomas on TV. I ate dinner and nursed my toddler to bed.

At 8pm my doula came over and we walked. And walked. It felt amazing. The night air was perfect. Our air conditioner had broken hours before so I was contemplating just laboring in the front yard so I didn’t sweat to death.

We came home at 9pm and I took a second dose of my remedy. With that, the contractions got intense. I told my husband, “if this is false labor, I quit!” That was the last thing I clearly remember saying (most of my labor I remember with dimmed senses, no concept of time, almost looking at my body from the outside). I know I labored on a ball in the living room, in the tub, and on the bed. I threw up. A lot. I had a lot of back pain, thank goodness for my doula and her counter pressure work! I labored and labored and labored. They checked my progress and I was 3 centimeters dilated. All I kept saying was ‘God help me.’ My midwife would say, “He is.” And he was…

Then what seemed like ten minutes later, but was actually hours later they checked me again and I was 5 cm dilated and it was time to go to the hospital. My friend came over to watch the toddler and my neighbor was in the kitchen frantically scrubbing dishes to help, or maybe to drown out my screaming, haha. She would later tell me “women get amnesia hormones after birth to forget the pain… but what do the women that have to listen to the women get to forget the pain?” ;)

My labor got intense fast, much more intense than the previous five hours had been. I climbed in the back of our minivan and my husband drove like the wind. We passed a cop going well above the speed limit while running red lights, but I guess they assumed a minivan driving like that at 3 am can only be going one place!

When we got to the hospital they had the orderly waiting. Oh the poor orderly. He kept trying to push me and each contraction I would jump out of the chair. He would beg me to sit down and I would scream at him to let me stand. We finally reached an agreement that if he’d let me out of the chair to get through contractions, I promised I would not have the baby in the hallway. Haha. He was a young kid and I could tell he was terrified.

I got into the room around 3:30am, checked, and I was at 7cm. I was really dehydrated from throwing up all night and needed some fluids. The nurses tried and tried and tried. They finally got an IV in. While most people would beg for an epidural at this point, I begged for some Pepcid. My heartburn this pregnancy was brutal and at that moment my heartburn was slowly killing me far worse than a contraction ever could. I labored on the yoga ball for awhile until the doctor came in.

The doctor started pressuring me to get internal monitors. I said no way, because until that point the only person that had been watching the external ones were my monitrice and doula! I said I didn’t want my water broken and they kept telling me I only had 3cm to go so it wouldn’t matter and that it had most likely already broken anyway. I argued for what seemed like eternity, but was really minutes, that it hadn’t and that I wasn’t having it broken until it was good and ready.

Labor was very intense at this point. I remember looking at my husband and either saying or just thinking, “I’m dying, tell our son I love him.” With that, the doctor wanted to check me. I was at 9cm and 100% effaced. I sat up for a contraction, my water broke (told ya!), I threw up and her head hit the table I was sitting on. I screamed, “I have to push her out.” They laid me back and people flew into action. Lights came on. Tables of supplies appeared out of no where. We went from 2 nurses and a doctor to a room full of people. I have literally never seen so many things or people appear out of thin air in my life. I had been there just under an hour at that point and I don’t think anyone expected it to go that fast, except my monitrice and doula. I think they knew things were picking up when we left the house!

I laid back and we practiced pushing for a few contractions. I had no idea how to push, this was the first time I ever tried to labor! The doctor told me her head was right there and with one good push she would be out. I was so tired, I wanted to be done and wanted to meet my baby, so I gathered every ounce of energy I could find. I dug deep down in my spirit and fire in my belly and pushed with all I had. Out came her head.  One more push and out came my baby girl. They placed her directly to my chest and I saw her perfect little eyes looking at me.

VBA2C birth story

(photo provided by Heather)

To this day, a year later, when I look at her I still see her newborn eyes looking up at me for the first time. We have a connection that is unbelievably close and I know the natural birth has something to do with that.

I am so completely grateful for the opportunity to have had her naturally, to have had a healthy baby, and to have had so many people supporting the VBA2C along the way! I found ICAN through a local Facebook group. The community was a vital part of the process in supplying ideas on talking with providers about controversial things (my VBA2C was very controversial!) and with ideas on how to raise my fluid level at the end. It was also how I was connected to the monitrice I ended up using to labor at home with. Without this group I would have never known that this was a possibility and I don’t think I would have been successful in having an intervention free birth if I had labored at the hospital the whole time.

VBA2C birth story

5 ways a cesarean impacts a new family and what we can do about it

“I hated him”. Sarah took a deep breath. “I know it’s not logical, there wasn’t anything he could do,
but that’s how I felt. I hated him for not protecting me.”
A Caesarean Section is both the most common and least necessary surgery conducted in the United
States. It is also the only surgical procedure that will be up-close-and-personally witnessed by an
intimate partner, and if unplanned, with little warning and no preparation at all.
The effects of this singular event on a couple’s relationship may not manifest until weeks or months
afterwards, with one researcher reporting more adverse psychological effects at seven to twelve
months later and another saying caesarean parents have “more difficulties and differences in the
postpartum period up to 7 years”.
Need for emotional support
Mothers often report feelings of shock, loss of control, loss of self-esteem, detachment, overwhelm,
guilt, violation, trauma, depression, anger, resentment, hostility and anguish. Fathers often report
feeling isolated, inadequate, fearful, worried, guilty, shocked, confused and helpless.
Both can feel “like a failure”: mothers like their bodies have let them down and fathers from failing
to perform “the supportive ‘coaching’ role often prepared for in childbirth classes”.
These are the emotions parents bundle up and carry home with them along with their new baby.
If there is no way to process these feelings they are likely to remain ‘boxed up’ and can undermine
new parenting confidence. Any emotion that sits deep within us is likely to be triggered by our
partner eventually. Parents who have been through a caesarean need the opportunity to explore
and express their emotions, to be heard and their experience validated.
Assertive communication
When our senses are overloaded it affects normal thought processes and the chaos of those first few
weeks means communication can be even more difficult. This environment breeds assumptions and
misunderstandings that cause feelings of isolation and create tension between a couple.
Talking about feelings often takes a back seat to preoccupation with physical needs as Caryl
experienced:
“Steven could see how distressed I was…he looked at my notes and helped me work out
when I would need to take pain killers again, he was so competent, some staff even asked
him if he was a medical professional, it was like he had found his role and something he
could do (after being a bystander at the labour)…but to be honest I would rather have
had his full attention, talking to me, letting me cry, saying he was sorry for what I’d gone
through”.
Steven was aware of it too:
“At the time I didn’t realise how damaging it was for Caryl – to me it was another thing I
could take some ownership of and control while Caryl was recovering. Once home, and over
the next week while I was off work, this practical focus continued. I put Caryl’s tearfulness
down to tiredness and tried to take over to give her the rest she needed to build up her
strength for when I got back to work.
When I did go back to work I just became a bit of a robot – trying to do again the practical
things and tiring myself, not really giving Caryl the emotional support she needed. Maybe I
didn’t want to deal with my own emotions”.
A new awareness of needs and a new assertiveness in communicating them may need to be
negotiated between a couple. Whereas previously, requests may have been hinted at and
resentment set in if a partner didn’t mind-read, a new directness can be beneficial: “can you please
hang out the washing” or “I need you to say nothing and just hold me”. This can feel uncomfortable
at first, but many partners find this new style of communication is actually a relief.
Awareness of Tension
Some women feel ‘duped’ into the operation, told the benefits but not all the costs. Some felt
controlled, manipulated or downright bullied. Many have the “dead baby” card played on them.
They are angry, of course, but not all are aware of the depth of their anger or where it should be
directed, particularly when caesareans are often trivialised or seen as routine. It’s not uncommon
for us to project the deeper, more unconscious layers of anger on to our partner. The lack of
understanding and empathy from medical providers, family, and friends can mean a woman needs
more empathy from her partner at the same time she may at some level be blaming him for the
situation, particularly if the c-section has been traumatic.
Anticipation of Risk for Postpartum Mood Disorders
Women who have undergone a caesarean are more prone to Postpartum Depression and those who
have experienced the birth as traumatic are 75% more at risk. Fifty percent of mothers with PPD,
will have a partner who also becomes depressed, which along with other implications for the whole
family, can mean she is more depressed and for longer. Perinatal screening for mood disorders, for
both mothers and fathers, both having the opportunity to debrief the birth if desired and links to
community and support organisations will, hopefully, eventually become standard practice.
Take time with Intimacy
What’s it like for a woman to see a scar, expected or not, so close to the most intimate part of her
body? What is it like for her partner? And for her to see her partner’s reaction? Having the lines of
communication open about these things allows couples to work through thoughts and feelings.
Nekole Shapiro of Embodied Birth says women can feel ‘pulling’ on their scar during intercourse and
for some anything related to sex can restimulate trauma. It takes couples who have been through
a caesarean longer to resume sex and both partners are naturally anxious. Some cope with this
by going back to the beginning of their relationship, as if they were dating for the first time, start
by holding hands and hugging, then slowly moving on to cuddling and kissing before beginning to
gradually explore each other’s bodies again. The more a partner knows about how a woman’s new
sensitivity, the more sensitive they can be. Her being direct “don’t touch me there, touch me here
instead” can take intimacy to a new level.
It’s obvious to say we need to prepare couples better for the possibility of an unexpected caesarean
birth but childbirth educators will tell you it’s common for expecting couples to ‘tune out’ caesarean
information in classes, expecting it won’t apply to them. Some educators get around this by
presenting the information as a “what if” scenario, playing a short YouTube clip, encourage couples
to discuss it and include a “just in case” section in their birth plan.
Where physical scars are obvious it can be easier to understand just how much support a recovering
mom and her partner will need. If they can be supported to heal psychologically and emotionally as
well, that’s a much better start for a new family.
Bio: Elly Taylor is an Emotionally Focused Couples Therapist, educator and columnist for Practical
Parenting magazine. She is passionate about including fathers (or partners) more in pregnancy, birth
and early parenthood to support the emotional health and bonding of the whole family. Elly lives
in a beach house in Sydney, Australia with her husband, their three children and a bunch of pets.
Becoming Us is her first book: http://www.amazon.com/Becoming-Us-Steps-Family-Thrives/dp/
0992385601/ref=sr_1_1?ie=UTF8&qid=1395975897&sr=8-1&keywords=Becoming+Us .

Guest Article by Elly Taylor

“I hated him.” Sarah took a deep breath. “I know it’s not logical, there wasn’t anything he could do, but that’s how I felt. I hated him for not protecting me.”

A Cesarean Section is both the most common and least necessary surgery conducted in the United States. It is also the only surgical procedure that will be up-close-and-personally witnessed by an intimate partner and, if unplanned, with little warning and no preparation at all.

The effects of this singular event on a couple’s relationship may not manifest until weeks or months afterwards, with one researcher reporting more adverse psychological effects at seven to twelve months later and another saying cesarean parents have “more difficulties and differences in the postpartum period up to 7 years.”

gift box

Need for emotional support

Mothers often report feelings of shock and being overwhelmed, loss of control, loss of self-esteem, detachment, guilt, violation, trauma, depression, anger, resentment, hostility, and anguish. Fathers often report feeling isolated, inadequate, fearful, worried, guilty, shocked, confused, and helpless.

Both can feel “like a failure:” mothers like their bodies have let them down and fathers for failing to perform the supportive ‘coaching’ role often prepared for in childbirth classes.

These are the emotions parents bundle up and carry home with them along with their new baby. If there is no way to process these feelings they are likely to remain ‘boxed up’ and can undermine new parenting confidence. Any emotion that sits deep within us is likely to be triggered by our partner eventually. Parents who have been through a cesarean need the opportunity to explore and express their emotions, to be heard, and to have their experience validated.

Assertive communication

When our senses are overloaded it affects normal thought processes and the chaos of those first few weeks means communication can be even more difficult. This environment breeds assumptions and misunderstandings that cause feelings of isolation and create tension between a couple.

Talking about feelings often takes a back seat to preoccupation with physical needs as Caryl experienced:

“Steven could see how distressed I was… he looked at my notes and helped me work out when I would need to take pain killers again, he was so competent, some staff even asked him if he was a medical professional, it was like he had found his role and something he could do (after being a bystander at the labor)… but to be honest I would rather have had his full attention, talking to me, letting me cry, saying he was sorry for what I’d gone through.”

Steven was aware of it, too:

“At the time I didn’t realize how damaging it was for Caryl – to me it was another thing I could take some ownership of and control while Caryl was recovering. Once home, and over the next week while I was off work, this practical focus continued. I put Caryl’s tearfulness down to tiredness and tried to take over to give her the rest she needed to build up her strength for when I got back to work.

When I did go back to work I just became a bit of a robot – trying, again, to do the practical things and tiring myself, not really giving Caryl the emotional support she needed. Maybe I didn’t want to deal with my own emotions.”

A new awareness of needs and a new assertiveness in communicating them may need to be negotiated between a couple. Whereas previously, requests may have been hinted at and resentment set in if a partner didn’t mind-read, a new directness can be beneficial: “can you please hang out the washing” or “I need you to say nothing and just hold me.” This can feel uncomfortable at first, but many partners find this new style of communication is actually a relief.

Awareness of tension

Some women feel ‘duped’ into the operation, told the benefits but not all the costs. Some feel controlled, manipulated or downright bullied. Many have the “dead baby” card played on them. They are angry, of course, but not all are aware of the depth of their anger or where it should be directed, particularly when cesareans are often trivialized or seen as routine. It’s not uncommon for us to project the deeper, more unconscious layers of anger on to our partner. The lack of understanding and empathy from medical providers, family, and friends can mean a woman needs more empathy from her partner at the same time she may at some level be blaming him for the situation, particularly if the c-section has been traumatic.

Anticipation of risk for postpartum mood disorders

Women who have undergone a cesarean are more prone to Postpartum Depression (PPD) and those who have experienced the birth as traumatic are 75% more at risk. Fifty percent of mothers with PPD will have a partner who also becomes depressed, which along with other implications for the whole family, can mean she is more depressed and for longer. Perinatal screening for mood disorders for both mothers and fathers to have the opportunity to debrief the birth, if desired, and links to community and support organisations will, hopefully, eventually become standard practice.

Take time with intimacy

What’s it like for a woman to see a scar, expected or not, so close to the most intimate part of her body? What is it like for her partner? And for her to see her partner’s reaction? Having the lines of communication open about these things allows couples to work through thoughts and feelings.

Nekole Shapiro of Embodied Birth says women can feel ‘pulling’ on their scar during intercourse and for some, anything related to sex can re-stimulate trauma. It takes couples who have been through a cesarean longer to resume sex and both partners are naturally anxious. Some cope with this by going back to the beginning of their relationship, as if they were dating for the first time. Start by holding hands and hugging, then slowly moving on to cuddling and kissing before beginning to gradually explore each other’s bodies again. The more a partner knows about a woman’s new sensitivity, the more sensitive they can be. Her being direct, “don’t touch me there, touch me here instead” can take intimacy to a new level.

It’s obvious to say we need to prepare couples better for the possibility of an unexpected cesarean but childbirth educators will tell you it’s common for expecting couples to ‘tune out’ cesarean information in classes, expecting it won’t apply to them. Some educators get around this by presenting the information as a “what if” scenario, playing a short YouTube clip, encouraging couples to discuss it and include a “just in case” section in their birth plan.

Where physical scars are obvious it can be easier to understand just how much support a recovering mom and her partner will need. If they can be supported to heal psychologically and emotionally as well, that’s a much better start for a new family.

Elly Taylor

Bio: Elly Taylor is an Emotionally Focused Couples Therapist, educator and columnist for Practical Parenting magazine. She is passionate about including fathers (or partners) more in pregnancy, birth and early parenthood to support the emotional health and bonding of the whole family. Elly lives in a beach house in Sydney, Australia with her husband, their three children and a bunch of pets. Becoming Us is her first book, find it here. You can also find her online at Parent Support Online.

ACOG’s New Labor Guidelines Fall in Step with ICAN’s Mission

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ACOG’s New Labor Guidelines Fall in Step with ICAN’s Mission

New, Breakthrough Guidelines Pave Way for Safer Labor and Birth

Release Highlights:

  • New study shows that labor takes longer than previously believed, and it is safer in most cases for a woman to labor longer than for providers to push for cesarean birth.
  • The emphasis throughout the report is on patience during labor, which is critical for the success of a vaginal birth.
  • Providers should be better trained—and maintain their knowledge and education—in the practice of operative vaginal delivery methods (including forceps and vacuum delivery).
  • The presence of labor support personnel, such as a doula, significantly reduces the incidence of cesarean.
  • These new guidelines support what ICAN has been advocating for all along: safer, healthy, natural birth experiences for women, and a reduction of the incidence of cesarean birth.

February 27, 2014 – Newly released guidelines compiled by the American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) are encouraging the medical community to rethink its approach to cesarean delivery, with a goal of reducing the number of primary cesareans. This is exciting news for the birthing community as a whole, and ICAN especially, as it could open up a new world of birthing opportunities for women who traditionally would be pushed toward cesarean by their provider.

The guidelines, which can be found on ACOG’s website, call for a drastic change in the way the medical community has typically addressed labor and birth. The standard practices have, up until now, been based on research conducted in the 1950s, including Friedman’s curve for deciphering standard dilation and labor progression. However, the new studies conducted by the ACOG and SMFM have proven that labor happens at a much slower pace than previously thought. Friedman’s research had determined that the cervix should dilate at roughly 1.2-1.5 cm/hour. However, the new research has found that dilation typically happens at a rate somewhere between 0.5-1.3 cm/hour, depending on how many previous pregnancies a woman has had (among other factors). This is a significant difference in the presumed rates of dilation and will have an obvious and immediate impact on how labor is handled in the future, promoting longer first stage labor with less intervention.

The study also states that it is nearly impossible to determine a “standard” length of time for the second stage of labor, as there are so many varying factors that can impact the duration of this stage. While some negative maternal outcomes have been associated with a longer second stage, the numbers are minimal, even in cases where the second stage lasts five hours or longer. Again, labor as a whole should be allowed to progress naturally, with minimal intervention.

“There has been a disconnect between what medical research says and the way that hospitals and providers have practiced medicine for a long time” said Christa Billings, ICAN President.  “These guidelines support what ICAN has been educating women on all along.  While this report is encouraging, it fails to address the nationwide problem of hospital and provider vaginal birth after cesarean (VBAC) bans.  With the primary cesarean rate at a high level, many women are seeking VBAC’s.  This important issue needs to be addressed by ACOG.”

Besides slowing down and allowing the process of birth to happen naturally, the report also recommends that providers should have more training in operative vaginal birth methods such as forceps- and vacuum-assisted vaginal deliveries. The study purports that the practice of such assistive methods has fallen sharply as the use of cesareans has risen, and that by better educating providers in the use of these methods, cesareans can be avoided more frequently.

The cesarean rate has also been shown to be significantly less among women who have continuous labor support, such as a doula. The report points out that there is nothing negative about a doula—no physical side effects to either the mother or the baby—but rather a doula can make the whole birth experience more positive overall, and so this is one option that is tremendously underutilized.

This new report from ACOG is very propitious. It paves the way for new standards in the handling of labor and birth in medical settings. The guidelines come at a time when the cesarean rate in the United States is approximately 31.3%. Despite the rates not increasing over the past several years, the fact remains that this number is too high. ICAN hopes that the newly released guidelines will elicit a positive response from labor and birth professionals around the country who will act in accordance with this new standard of care.

Part of ICAN’s stance, as outlined in their Statement of Beliefs, is that “It is unethical for a physician to recommend and/or perform non-medically indicated cesareans (elective). Women are not being fully informed of the risks of this option in childbirth, and therefore make decisions based on cultural myth and fear surrounding childbirth.” These new guidelines, as set forth by the ACOG and Society for Maternal-Fetal Medicine (SMFM), are on track to help make sure that “non-medically indicated cesareans” happen less frequently and that women are given more opportunities to experience the natural process of labor and birth.

Of course, these changes will take time, and these standards will need much support—both socially and legally—if they are to be implemented at the individual hospital level. ICAN will continue to advocate on behalf of birthing women everywhere to help ensure that the standards are effectively put into place and met with compliance.

If you would like to find out more about ICAN, join a local chapter, or volunteer, please visit http://www.ican-online.org for more information.

About Cesareans: ICAN recognizes that when a cesarean is medically necessary, it can be a lifesaving technique for both mother and baby, and worth the risks involved. Potential risks to babies include: low birth weight, prematurity, respiratory problems, and lacerations. Potential risks to women include: hemorrhage, infection, hysterectomy, surgical mistakes, re-hospitalization, dangerous placental abnormalities in future pregnancies, unexplained stillbirth in future pregnancies and increased percentage of maternal death.

Mission statement: ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery and promoting vaginal birth after cesarean.  There are over 110 ICAN Chapters across North America and abroad, which hold educational and support meetings for people interested in cesarean prevention and recovery.

Was the art of independence lost in the shuffle? Or forced out in labor and delivery rooms?

By Jennifer Antonik
Our daughter is in that lovely stage of life where everything has to be a struggle or it isn’t worth her time
it seems. She’ll be three soon. (I can see many of you emphatically nodding your heads in empathetic
understanding.) Truly, I love that age though. It’s magical.
She is quite the independent little princess. I say princess because I told her she was beautiful the other
day and her response was: “No, Mommy. I’m not beautiful. I’m a Princess!” Well okay then!
I couldn’t imagine having children who were not independent thinkers and free spirited. We try to
embrace and help foster their (we have two right now) spirits and independence as much as possible.
But sometimes, it just gets in the way of what us grown and somewhat boring adults decide is best.
You know, like the moment you have to go to a very important meeting, and you decide you need to
leave RIGHT NOW. But the child needs a(nother) round of toothpaste RIGHT NOW, and then decides
(after you’ve put the toothpaste on) that she doesn’t want toothpaste after all. Just to change her mind
again, after you remove said toothpaste. So much for being on time! And all you can do is lean your
head back and groan; and think of some crazy excuse as to why you were late. Possibly again.
I hear stories like this a lot in terms of maternity care, too often. Mom sees her care provider, but care
provider decides mom isn’t doing something just how he or she desires. Now, instead of reacting with
respect and compassion, he or she reacts with an entirely different beast called perinatal violence which
can include physically forcing a mom to cooperate, emotionally forcing her to do so through coercion,
impeding early bonding and/or breastfeeding or a host of other scenarios.
Perinatal violence and informed consent issues are becoming commonplace which, to be honest,
boggles my mind. We expect our children to grow up as independent thinkers, but as soon as they
become “old enough” to do so, we shut them out and tell them to sit down and take it? “You must
follow society’s ways,” we hear.
When I gave birth to our resident Princess, the doctor didn’t respect my independence, my informed
refusal of a procedure. It wasn’t a life or death situation, there was no emergency. Yet, he decided he
needed to give me an exam anyways, right then and there, against my wishes. Literally moments later,
after arguing with this doctor while his fingers were inside of me, I pushed out our daughter.
I suffered from PTSD for a long time after her birth. I used to say “Boy, I can’t wait to go to his
disciplinary hearing through the medical board and hold a sign which reads, ‘I think about you when
I have sex with my husband. Was that your intention?’” Probably two signs, one right after another. I
couldn’t step foot in a doctor’s office without triggering a PTSD episode and had to make two attempts
at removing my IUD. My husband and I struggled as a couple because of her birth in many ways.
The point, though, is that along with informed consent comes the right to informed refusal. My
daughter makes the decision of informed refusal nearly every night when it’s bedtime. Before you judge
my parenting, know that she takes a nap most days while her brother does not. So usually, brother goes
to bed at a decent time, Princess stays up until she passes out somewhere and we carry her to bed.
Because it’s either that or tantrums for hours. We choose sanity. But she does that because she’s telling
us she’s just not ready for bed yet. So, we try to help her get ready, of course. Lights down low, stories,
songs, etc. But ultimately, we can’t force her. She has to make the choice to go to sleep, or refuse sleep.
Just like we are the ones who have to make the choices, or refusals, during our births. Care providers
need to understand and respect those two aspects of care, or else it really isn’t good care. When a care
provider doesn’t respect informed consent and informed refusal, it becomes that beast all over again.
Coercion. Violence. Something that maternity care should never become.
When did we lose our focus and independence? Autonomy, Independence, a principle we should be
able to agree is a fundamental human right, is lost in so many of our birth communities, labor and
delivery rooms and OR’s. Just gone. Where did it go? Why is it that some activists think it’s one way or
the highway? My decision to birth at home this time around (yes, we’re pregnant, again!), is just that.
MY decision. My belly bump friend down the street has decided to birth in a hospital. And that’s just as
valid of a choice! Why is there stigma surrounding either choice?
Why is ACOG only *just now* finally acknowledging that women’s bodies are not just one size fits all?
Yes, of *course* some women labor longer than others! Is this really news? Do we really need a giant
labor organization to tell us that some women labor differently and deserve the same respect as those
who labor right on par with “standards?”
I’m not sure I understand the lack of independence or informed consent and refusal in today’s world.
Because there’s no way you can spin that argument to make it sound like a person should lose their
autonomy. What I do know is that we need more bodies standing up for the rights of childbearing
women and their babies. I began my fight after I found out just how non-evidence based maternity care
could be through our first born. Then with our second, I discovered just how nasty it can be in terms of
violence and lacking in the areas of informed choices and refusal.
I know after a traumatic birth it takes a little while to get to that point where you’re ready to rock and
roll and change the world! Some never get there, and that’s okay, too. Some want to help, but quietly.
Our movement needs people at all stages and all levels of commitment to continue making strides
towards better care and independence in all settings.
Jennifer Antonik is a mom to two surprises with another on the way. After her own traumatic
births, she founded the Momma Trauma Blog & Community which continues to thrive as a blog
and on multiple social media platforms. She recently also founded the Birth Advocacy Coalition of
Delaware and is currently working on legislative efforts to increase access to midwifery care and
safer, healthier birth options in all settings. Visit both efforts at www.MommaTraumaBlog.com and
www.BirthAdvocacyDelaware.com; both can also be found on Facebook and Twitter.

By Jennifer Antonik                  MOMMA TRAUMA logo

Our daughter is in that lovely stage of life where everything has to be a struggle or it isn’t worth her time it seems. She’ll be three soon. (I can see many of you emphatically nodding your heads in empathetic understanding.) Truly, I love that age though. It’s magical.

She is quite the independent little princess. I say princess because I told her she was beautiful the other day and her response was: “No, Mommy. I’m not beautiful. I’m a Princess!” Well okay then!

I couldn’t imagine having children who were not independent thinkers and free spirited. We try to embrace and help foster their (we have two right now) spirits and independence as much as possible. But sometimes, it just gets in the way of what us grown and somewhat boring adults decide is best.

You know, like the moment you have to go to a very important meeting, and you decide you need to leave RIGHT NOW. But the child needs a(nother) round of toothpaste RIGHT NOW, and then decides (after you’ve put the toothpaste on) that she doesn’t want toothpaste after all. Just to change her mind again, after you remove said toothpaste. So much for being on time! And all you can do is lean your head back and groan; and think of some crazy excuse as to why you were late. Possibly again.

I hear stories like this a lot in terms of maternity care, too often. Mom sees her care provider, but care provider decides mom isn’t doing something just how he or she desires. Now, instead of reacting with respect and compassion, he or she reacts with an entirely different beast called perinatal violence which can include physically forcing a mom to cooperate, emotionally forcing her to do so through coercion, impeding early bonding and/or breastfeeding or a host of other scenarios.

Perinatal violence and informed consent issues are becoming commonplace which, to be honest, boggles my mind. We expect our children to grow up as independent thinkers, but as soon as they become “old enough” to do so, we shut them out and tell them to sit down and take it? “You must follow society’s ways,” we hear.

When I gave birth to our resident Princess, the doctor didn’t respect my independence, my informed refusal of a procedure. It wasn’t a life or death situation, there was no emergency. Yet, he decided he needed to give me an exam anyways, right then and there, against my wishes. Literally moments later, after arguing with this doctor while his fingers were inside of me, I pushed out our daughter.

I suffered from PTSD for a long time after her birth. I used to say “Boy, I can’t wait to go to his disciplinary hearing through the medical board and hold a sign which reads, ‘I think about you when I have sex with my husband. Was that your intention?’” Probably two signs, one right after another. I couldn’t step foot in a doctor’s office without triggering a PTSD episode and had to make two attempts at removing my IUD. My husband and I struggled as a couple because of her birth in many ways.

The point, though, is that along with informed consent comes the right to informed refusal. My daughter makes the decision of informed refusal nearly every night when it’s bedtime. Before you judge my parenting, know that she takes a nap most days while her brother does not. So usually, brother goes to bed at a decent time, Princess stays up until she passes out somewhere and we carry her to bed.  Because it’s either that or tantrums for hours. We choose sanity. But she does that because she’s telling us she’s just not ready for bed yet. So, we try to help her get ready, of course. Lights down low, stories, songs, etc. But ultimately, we can’t force her. She has to make the choice to go to sleep, or refuse sleep.

Just like we are the ones who have to make the choices, or refusals, during our births. Care providers need to understand and respect those two aspects of care, or else it really isn’t good care. When a care provider doesn’t respect informed consent and informed refusal, it becomes that beast all over again.  Coercion. Violence. Something that maternity care should never become.

When did we lose our focus and independence? Autonomy, Independence, a principle we should be able to agree is a fundamental human right, is lost in so many of our birth communities, labor and delivery rooms and OR’s. Just gone. Where did it go? Why is it that some activists think it’s one way or the highway? My decision to birth at home this time around (yes, we’re pregnant, again!), is just that. MY decision. My belly bump friend down the street has decided to birth in a hospital. And that’s just as valid of a choice! Why is there stigma surrounding either choice?

Why is ACOG only *just now* finally acknowledging that women’s bodies are not just one size fits all?  Yes, of *course* some women labor longer than others! Is this really news? Do we really need a giant labor organization to tell us that some women labor differently and deserve the same respect as those who labor right on par with “standards?”

I’m not sure I understand the lack of independence or informed consent and refusal in today’s world.  Because there’s no way you can spin that argument to make it sound like a person should lose their autonomy. What I do know is that we need more bodies standing up for the rights of childbearing women and their babies. I began my fight after I found out just how non-evidence based maternity care could be through our first born. Then with our second, I discovered just how nasty it can be in terms of violence and lacking in the areas of informed choices and refusal.

I know after a traumatic birth it takes a little while to get to that point where you’re ready to rock and roll and change the world! Some never get there, and that’s okay, too. Some want to help, but quietly. Our movement needs people at all stages and all levels of commitment to continue making strides towards better care and independence in all settings.

Jennifer Antonik is a mom to two surprises with another on the way. After her own traumatic births, she founded the Momma Trauma Blog & Community which continues to thrive as a blog and on multiple social media platforms. She recently also founded the Birth Advocacy Coalition of Delaware and is currently working on legislative efforts to increase access to midwifery care and safer, healthier birth options in all settings.  Visit both efforts at www.MommaTraumaBlog.com and www.BirthAdvocacyDelaware.com; both can also be found on Facebook and Twitter.

New Survey Shows High Success Rate for VBAC’s at Home

ICAN-Studio412Imagery

by Karen Troy, PhD

The Midwives Alliance of North America (MANA) recently published data from a large and well-tracked series of planned home births, the result of a home birth registry program that was initiated in 2004 (1).  The data set included nearly 17,000 planned home births attended by a mix of midwives including CPMs (79%), CNMs (15%), and other unlicensed midwives.  Within this cohort were 1054 women with a history of cesarean section who were planning a vaginal birth after cesarean – VBAC – at home. (This is also referred to within the birth community as “HBAC” – home birth after cesarean).   Within this subgroup, 87% had successful vaginal births, with 94% of those births occurring at home and the remaining 6% occurring after a transfer to a local hospital.  This success rate is substantially higher than the 60-80% success rate reported across other large hospital-based cohorts (2) and likely reflects the high level of commitment to and support of natural birth, both from the mothers and their care providers.

The primary risk for women undergoing a trial of labor after a cesarean (TOLAC) compared to women with no history of a cesarean is uterine rupture, which can result in morbidity and mortality to mother and baby.  The American College of Obstetrics and Gynecologists estimates the overall risk of uterine rupture in women with a single low transverse cesarean scar to be approximately 0.7% (3) based on large hospital-based studies. For this reason, ACOG recommends that operating facilities be “immediately available” during TOLAC, a policy that has limited access to VBAC within smaller hospitals, and prevents many women with a history of a cesarean from choosing an out of hospital birth.  In the cohort reported by MANA, the intrapartum fetal death rate was significantly higher for women with prior cesarean compared to those without a history of cesarean (2.85/1000 versus 0.66/1000). For comparison, neonatal death rates for repeat cesarean and hospital VBAC were 1.03/1000 and 0.84/1000, respectively in one recent large series of low-risk births (4), and others have reported mortality rates of 1.77/1000 for primary cesarean births (5).

We at the International Cesarean Awareness Network (ICAN) find these statistics encouraging and applaud the Midwives Alliance of North America for collecting and presenting this data.  The data show that low-risk women who plan a VBAC at home have a high rate of success and a low rate of complications.  We believe all women have a right to choose their location of birth, and out of hospital birth can be safe for many women with a prior cesarean.  The data presented here give mothers important information that can help them understand the risks of HBAC so that they can make informed decisions in partnership with their care providers.  ICAN strongly encourages all women with a prior cesarean to educate themselves about birth options.  We believe that a more well-integrated and established continuity of care system that facilitated home to hospital transfers would improve home birth, and especially HBAC, safety.

The full study can be found here:

http://media.wix.com/ugd/7a9bd8_dccd61656b3346ca9647db9252cf389a.pdf

(1)  Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. (2014) Outcomes of care for 16,924 planned home births in the United States: The Midwives Alliance of North America Statistics Project, 2004-2009. J Midwifery and Women’s Health 00:1-11 doi:10.1111/jmwh.12172

(2) National Institutes of Health Concensus Development conference statement: vaginal birth after cesarean: new insights March 8-10, 2010

(3)  ACOG Practice Bulletin No 115, August 2010 “Vaginal Birth after Previous Cesarean”  Obstetrics and Gynecology Vol 116 No. 2 Part 1

(4) Menacker F, MacDorman MF, Declercq E. (2010)  Neonatal mortality risk for repeat cesarean compared to vaginal birth after cesarean (VBAC) deliveries in the United States, 1998-2002 birth cohorts.  Matern Child Health J 14:147-154

(5) MacDorman, M. F., Declercq, E., Menacker, F., & Malloy, M. H. (2006). Infant and neonatal mortality for primary cesarean and vaginal births to women with ‘‘no indicated risk’’, United States, 1998–2001 birth cohorts. Birth, 333, 175–182.

Failure to Progress in Labor

Many women that are told they need a cesarean for “failure to progress” may not realize that the doctor is likely looking at their labor and dilation and comparing it to research called Friedman’s Curve. This research was completed with 500 women more than 60 years ago.  A woman may be told that her doctor feels that she is not dilating quickly enough and she may feel pressure to follow the doctor’s recommendation for a cesarean; because, after all, the doctor is the one with the medical degree, right? The reality is, Friedman’s Curve no longer applies to the modern woman and yet, women are undergoing major surgery purely on the basis of this study.

In 2010, researchers studied records of 62,000 women from hospitals across the country and found that “mothers did not rapidly dilate starting at 3 cm like Dr. Friedman saw back in 1955.” (EvidenceBasedBirth.com) This new research shows that, for most modern women, 6 cm is when active labor begins. If active labor begins at 6 cm, then why are moms being taken to the operating room well before they have even reached active labor?

Further, it is common knowledge that there often comes a point in labor when everything seems to slow down. This is known as resting labor or slowed labor and it is a natural part of many births. As long as baby and mom are both weathering this change in pace, there is no reason to intervene. In most cases, this is a time for mom and baby to get a little rest before labor kicks back into full gear. What is needed in this case is patience and good humor. But, what many women get is a care provider that is overly anxious because the woman’s progress is not following Friedman’s Curve.

While it would be great if doctors and hospitals across the country would take notice of new information and change their policies and procedures, we know that these sorts of changes take time. Instead of waiting for change to take place,  couples can take ownership of their birth. Couples can ask questions and come to their birth with a sense of curiosity and patience. If a medical “need” arises, there is usually plenty of time to ask questions and understand the medical need for a suggested procedure. If there is no serious emergent circumstance, there is often ample time to discuss options and evaluate a decision, without feeling pressure to act rashly.

I feel that it is a mistaken belief that a woman’s cervix needs to open on some sort of timeline or on a regulated pattern or time frame. Time and time again, women prove that when they step back and allow a birth to unfold in its own time, the outcomes are better than expected.

We would love to hear your comments and experiences with a diagnosis of “failure to progress.”

Smiles,

Jennika Cook, ICAN Blogger

References:
Rebecca Dekker, Friedman’s Curve and Failure to Progress: A Leading Cause of Unplanned C-sections, EvidenceBasedBirth.com.

http://evidencebasedbirth.com/friedmans-curve-and-failure-to-progress-a-leading-cause-of-unplanned-c-sections/

Can Inducing Labor Lead to Cesarean?

A labor induction uses medication, like Pitocin, or other techniques to bring on (induce) contractions in a pregnant woman. Induction occurs in more than 23% of births (Census.gov) in the United States every year. That is, one in five women will have their labor induced. Studies show that there is increased risk for cesarean as well as neonatal ICU for baby when an elective induction is done. One study found that elective induction was associated with 67% increase in cesarean risk as well as 64% increased risk of baby requiring neonatal ICU treatment. (wiley.com)

There are a variety of reasons that women are induced, some elective, some not. The elective reasons for induction include wanting baby to be born before a care provider goes on vacation, mom getting eager to be done being pregnant, desire to birth by or on a particular date, etc. Some other reasons are twins, maternal illness such as gestational diabetes or high blood pressure, suspecting a big baby, going past due date, small pelvis, low amniotic fluid, etc. The list could go on.

There is an important distinction to be made here regarding induction: I am concerned about elective induction or non medically-indicated induction. If your care provider suggests that you be induced, you owe it to yourself and your baby to really understand why the induction is being recommended. You deserve to have informed consent—to know and understand the facts, implications, and future consequences of your decision. You may choose to go forward with the induction, to commence a natural induction, or to buy some time and reassess at a later date. When a care provider suggests induction, they often present it as a medical need; but, under direct scrutiny, you may discover that what your provider considers to be a medical indication might not be in line with your ideas about birth.

Bishop’s Score and Induction

One tool that is often used to assess the possible outcome of an induction is the Bishop’s Score. Bishop’s Score is a chart that can be considered before a woman is in labor to determine the likelihood that an induction would be successful. Bishop’s Score looks at the baby’s position and station as well as the consistency, effacement, and dilation of a woman’s cervix and a number is applied to each position. If a total score of 8 or 9 is achieved, this indicates that an induction is likely to be successful.

If your care provider suggests induction, you may want to ask them what is your Bishop’s Score? If you feel that your score is not in a range your are comfortable with, you may want to discuss the risks involved with waiting until your body goes into labor on its own or your Bishop’s Score becomes more favorable. You can also discuss the options available to you for induction and talk about maybe using some natural induction techniques.

Talking to Your Doctor About Induction

If you feel that your Bishop’s Score is not sufficient enough to warrant an induction or you just want to wait until your body goes into labor on its own, here are some suggestions for how to talk to your doctor:
• Is something wrong with with momma or baby that requires an induction?
• What is happening with this pregnancy that has you concerned?
• Do you have any literature that explains our situation?
• Can you explain what the effects of doing the induction may be? What is the worst case scenario in doing it?
• Is there a true medical indication for the induction?
• What harm is there in waiting and giving  my body time to go into labor on its own?
• Are there other options that we could attempt before doing a medicated induction?

Natural Means to Induce Labor

There are lots of methods—some wives’ tales, some tried and true—for initiating labor. They include: hot and spicy foods, making love, nipple stimulation, acupressure, acupuncture, warm baths, walking, relaxation, castor oil, primrose oil, etc. Any of these methods can be successfully used to bring about labor when mom is already showing signs of readiness.

Yes, inducing labor can lead to a cesarean. Any intervention that changes the course that labor might naturally take can lead you down a path that requires more and more intervention to keep things going. When mom and baby are both healthy and there is no well-documented reason for an induction, I believe that it is better to give baby time to come on their own. If mom and dad are both on the same page and trusting in their birth, they can remain relaxed and calm and take each challenge on their journey in stride with plenty of patience and lots of love.

We would love to hear your stories about successful or unsuccessful induction. Did you know about your Bishop’s Score and do you feel that your score helped or hindered your induction?

Smiles,

Jennika Cook, ICAN Blogger

References:
http://www.census.gov/compendia/statab/2012/tables/12s0088.pdf

http://en.wikipedia.org/wiki/Bishop_score

http://www.wiley.com/WileyCDA/PressRelease/pressReleaseId-102740.html

Mongan, Marie F. HypnoBirthing, The Mongan Method. Florida: Health Communications, Inc. 2005. Print.

Eric is Born: Our Peaceful, Extraordinary VBAC-Homebirth-Waterbirth

Wednesday, January 18, 10:30 p.m. The boys were dreaming peacefully in their bedroom.  Tim lay beside me, his breath quiet and even with the pace of an already deep sleep.

ContractionMaster.com was opened up on the phone in front of me.  (And yes, a Chipotle burrito was digesting inside of me.  OF COURSE labor began after I consumed my signature gigantic black bean burrito…)

Ten minutes and fifty-five seconds apart, fifty-nine seconds long.

Ten minutes and thirty-seven seconds apart, fifty-two seconds long.

Ten minutes and twelve seconds apart, fifty-seven seconds long.

Was it the way I arched my hips, pressing down on the right one with my hand as each ache took hold of my back?

Was it the way I cursed like a sailor through each surge, unable to focus on the games of solitaire and Words with Friends that distracted me during my ten-to-eleven minute breaks?

Was it the way I knew to begin playing my carefully crafted collection of songs as soon as I lay down to time my contractions?

I had little doubt that I was in labor.  Even with the contractions spread out over the span of ten minutes–a distance that often signals early labor, even very early labor–I had a feeling that I would be welcoming my baby soon.

In these first few quiet moments, I cried.  Not because the contractions hurt so much (even though they did–how does anyone labor lying down in a hospital bed without begging for pain medication?!) but because I needed a moment to mourn the passing of my pregnancy–my last pregnancy, in all likelihood.

For the first time ever, I had enjoyed and even savored being pregnant.  Weeks 35 to 39 were downright blissful.  And so with the knowledge that I was probably mere hours away from never being pregnant again, I felt awash with a bittersweet sadness.  I touched my belly.  I closed my eyes.  I breathed in those minutes.  And I cried.

I just needed a moment.

And then a few minutes before midnight, I stood up.

Uncertain over whether I was truly in labor, I’d made a plan to call my mom and ask her to listen to me through a contraction.  I figured that she could help me to discern if this was really it.  (The third trimester had turned me into the queen of prodromal labor after all.)  And I suppose that somewhere deep inside, I knew that my mom should be heading my way soon.

“Mom?”

“Yeah?”

“I think that I might be in early labor.  Just…listen…to me…through this…ugh…contraction.”

She packed up her car and left the house right after we said goodbye.

My phone call, as it turns out, came none too early, for as soon as I stood up my contractions started surging every four minutes.

So I woke up Tim.  I called my sisters.  I called my doula and one of my midwives.  I leaned my hands against the wall and swayed my hips every few minutes.  I crept into the boys’ rooms and kissed them on the cheeks.

The start to this labor–its mood and tone–was already so much different from my early labor with Alec.  There was no frantic excitement.  No nervous energy.

I was calm.  Focused.  Giddy, yes.  Even silly, yes.  But also peaceful.  Ready.

After I finished my round of phone calls–after I changed into my wrap skirt and my swimsuit top and took a few deep breaths–I made my way downstairs to see what and how Tim was doing.

Oh, my sweet husband.

The birth pool was already inflated.  He was filling it with warm water.  And, just as I had always imagined for this birth, he had lit both of our Christmas trees and prepared the fire place for a warm and cozy fire.  I didn’t care that we were already deep into January.  Those trees provided a most lovely ambience for Eric’s birth.

(Have I ever mentioned how much I love this man?  I mean, when I read the Homebirth Ryan Gosling tumblr I can’t help but think, “Oh yeah, Tim is actually like that.”  I thank my lucky stars that with each of our children’s births, I’ve fallen more in love with him.)

Before anyone else arrived at the house, Tim and I took this picture of ourselves:

I like how tired/calm/happy we look.  I love how normal we look.  And truly, it all felt so normal.  Even the inflated birth tub in the center of our living room, the Christmas trees in mid-January, the contractions coming in between my efforts to tidy up a bit before the house was full of people–everything felt normal and unstrange.

Catie, my doula and dear friend, arrived at the house first.  I was thrilled to see her smiling face.  Comforted to hear her talk me through my contractions, reminding me to breathe slowly and deliberately.  Happy to know that I could still share the same laughter as always with her, even as I was bringing my baby into the world.

Miles even made a brief appearance, creeping downstairs a little after midnight “just to give Mommy a hug” before he scampered back upstairs.  Oh, my sweet boy!

Not yet ready to get into the tub, I spent most of this time in our kitchen.  I rocked and swayed and squatted.  I held a heated rice sock against my back.  (I felt best doing it myself.  I think I liked how it gave my arms something to do besides just dangling in front of me.)  I even joked and giggled with everyone there (which now included Amy, one of my midwives, and Ali, a friend offering support and taking pictures).

No, seriously, I joked and giggled.

When I wanted a heated rice sock on my back and an ice-cold washcloth on my neck?  I joked that it was “A BIRTH MULLET!  You know, like ‘party in the back, business in the front.’  I have heat on the bottom, cold on the top!  WAIT, YOU MEAN YOU’VE NEVER HEARD ANYONE SAY THAT ABOUT A MULLET BEFORE?!”

When we boiled water in order to warm up the birth tub?  I insisted on getting a picture with the water because “IT’S CLASSIC!  We’re actually boiling water at a birth!”

All of this silliness occurred within two to three hours of Eric’s birth.  This is what I looked like, and how I acted, two to three hours before birthing a baby.

How was this possible?  How is it that, while intense and not exactly comfortable, my contractions were not oppressively painful and were entirely manageable?  How is it that I could still laugh and joke in between contractions?

For one, I felt comfortable in my own home, in my own clothes, surrounded by people that I knew and cared for and who cared about me.  I wasn’t scared.  I felt confident in the skills and abilities of my midwives.  And I felt confident in my own ability to birth my baby.

What’s more, I felt so loved.  Eric was born into a home just bursting with love and support and generosity.  (And, at times, the house was literally bursting with people, for by the time he arrived earthside, there was a total of thirteen people in our house.)

All told, I was lucky.  My labor was progressing smoothly, Eric had a healthy heart beat, and I felt comfortable and loved.  And this all gave me the opportunity to remain myself–my silly, goofy self–throughout my labor.  I look back now, and the gratitude that I feel for this opportunity just slays me.  I’m so lucky.  So lucky to have had access to skilled home birth care providers.  So lucky to have been surrounded by so much love.  So lucky to have been able to labor confidently and powerfully and even enthusiastically.  So very lucky.

Sometime around 1 a.m., I thought that my water might be ready to break.

“You guys, I feel like a giant water balloon is about to come shooting out of me.”  [squat, sway]  “I think we need some towels.”  [ugh, deep breath]  “I’m totally not walking on the carpet until my water breaks.”  [contraction, contraction]

Sure enough, around 1:20 a.m. my membranes ruptured.  Or rather, they began trickling.  (Can I get an AMEN for not having to deal with a Niagara Falls of amniotic fluid?!)

Clear fluid?  Check.

Contractions starting to pick up?  Check.

Excitement abounding?  Check.

Soon afterward, Amy asked me if I was ready to get into the tub.

“No, not really.”

And soon after that, she again asked me if I was ready to get into the tub.

“But I’m worried that I will get in too early and make labor slow down,” I responded.

“Kristen, I don’t think it’s going to be too early.”

“Really?”

“Really, Kristen.  And know that I can check your cervix if you want.  We don’t have to, but it’s up to you.”

“No, no.  I’ll get so discouraged if I’m only, like, one centimeter dilated.”

“Kristen.  You are not.  One centimeter.  Dilated.”

“Yeah, but we don’t know that.”

“Kristen.  Kristen.  My guess is that you’re more like seven or eight centimeters dilated.”

“Yeah right.”

Through the fog of my laborland memory, I vaguely remember Amy smirking at me.  Maybe even rolling her eyes at me.  But in those moments, I really, truly believed that I was still in early-ish labor, still many, many hours away from transition and from having that overwhelming urge to push.

Nonetheless, I decided to humor my beloved midwife.  So I got in the tub.  I sank into the warm water and let my body simply float.

And the jokes just kept coming.

For as soon as my youngest sister, Kinsey, walked through the door, I began splashing and swaying in the tub and singing, “Look, Kinsey!  I swim like a little fishy in the sea!”

She smiled.  She raised her eyebrow.  She shook her head.

And she posted an update about it all on Facebook.  (She and my sister Kellie were in charge of updating all the good folks in internet-land following Eric’s birth.  And truly, there were many good folks following Eric’s birth, and I am still heartened and overwhelmed by how much love was sent my way as I brought my baby into the world.  Love from people I’ve met, from people who I “know” on the internet, and love from people who are, for all intents and purposes, complete strangers.  Just amazing.)

Very soon after, my mom and my sister Kellie arrived.

I smiled.  I waved.  I took my moment to close my eyes and breathe through my contractions.  And then I smiled some more.

And soon after that, my midwife Nina and my apprentice midwife Rachel arrived.  (I realize that referring to them as “my midwives” makes me seem very possessive of them.  And in some ways, I am!  Or rather, I feel very deeply connected to them.  And I will feel forever connected to them.  They supported and loved me–and my entire family–as we welcomed our baby boy into the world, after all!)

Their entrance marked the moment in which everyone on my birth team who could be there was actually there.  And in a turn of events both uncanny and magical, as soon as that entire team was assembled, I relinquished the silliness and turned inward, became serious.

This was not a conscious move on my part.  I did not decide to become serious.  Instead, I think that some deep-seated part of me “knew” that everyone I wanted and needed was present.  Some part of me knew that  it was safe to go forward: to embrace the most difficult challenges of labor, to give myself over entirely to this birth.

And give myself over entirely, I did.  For within minutes, I noticed that I was pushing at the end of my contractions.  Small pushes.  Miniscule pushes, even.  But definite pushes.

I leaned into the side of the tub.  I buried my face in a cold washcloth.  I held people’s hands–Catie’s, my mom’s, Tim’s, so many hands that I never quite knew whose hands I was holding, just that someone I loved was anchoring me to the earth, keeping me grounded as I floated off into the depths and heights of labor.

What transpired as those contractions continued still shocks me.  Astounds me.  For as I pushed through my contractions–as that urge to push grew stronger and bolder–I felt relief.  Pushing felt good.  It wasn’t horribly painful and overwhelming like it was when I gave birth to Alec.  It was physical and primal and intense, yes.  But it was…nice.

Yet did I speak a word of this to anyone?  Did I correct Catie when she reminded me that even though this was my least favorite part of labor (this time, it was my favorite!), I was so close to welcoming my baby?  Did I say anything about how good pushing felt?

No.  For I was also struck by the irrational fear that if I announced how good pushing felt, the goodness would melt away into terrible pain.

And so I kept this as my little labor secret.

It turns out that I had to keep this secret for quite a long time.  Much longer than any of us expected.  And as I pushed…and pushed…and pushed, I had a sneaking suspicion as towhy pushing was exceeding the 35 minutes that it took for me to bring Alec into the world.

Eric was posterior.  Sunny-side up.  Turned with his face to my front and his back to my back.

And this is where I needed to cull up grace and flexibility: two tools that I had worked hard to hone and sharpen for this labor.

For I needed help.  I needed some coaching.  Me, the woman who was always adamantabout being left alone to push.  Me, who adored being left alone during the second stage of labor.

I needed help.  And I needed not to be left alone.

And so Amy ever-so-gently asked if she could check and see where Eric was.  (He was at +2 station.  I had done something.)  She ever-so-kindly asked if I might try leaning back into Tim’s arms and to push.  (I would be in a semi-sitting, “floating” position.  Most likely to help get Eric under my pubic bone.)  She ever-so-sweetly asked if I might try pushing while squatting.  (To bring the baby down.  To coax him into rotating as I changed positions.)

I flipped.  I moved.  I changed positions.  Amy checked me and asked me to push into her fingers.  She let me know which pushes were making progress, which ones I needed to replicate to birth my baby.

I.  Needed.  Some.  Help.

And I welcomed it.  I embraced it.  Instead of clinging hopelessly to what I expected I would want for my labor, I opened myself up to what I needed for my labor.  And what I needed was help.

Throughout all of this, the songs on my playlist continued to drift in and out of my consciousness.

Iggy and the Stooges’ “Search and Destroy” (which my team thought would surely annoy me, even though I loved it).

The first song from Miles Davis’s Sketches of Spain (which I adored).

The Crash Kings’ “You Got Me” (which did annoy me with its fuzzy reverb start).

And Regina Spektor’s “Eet.”  Which Amy said would be “a sweet song to be born to.”  Which I thought was an awful thing to say, because I surely wasn’t even remotely close to birthing a baby, because it didn’t hurt yet.

And then Greg Laswell’s cover of “This Woman’s Work.”  Which I loved.  Which I relished.

And then Ani DiFranco’s “Everest.”  Which I also loved.  And relished.

And then Amy said something about the “ring of fire,” which I thought was a strange thing to say, because surely his head wasn’t there yet, because it didn’t hurt yet.

And then?  Then Kenny Rogers’s “The Gambler” began to play.

And then  I was birthing my baby.

There were two main thoughts going through my head at this point:

1. Huh.  So this is the song that he is going to be born to.  Alrighty then.

2. Something serious is going on.  I need to make room for my baby.

It turns out that Eric’s umbilical cord was wrapped very tightly once around his neck: so tightly, in fact, that it could not be slipped over his head as he was born.

(Here is where I must pause to give thanks to grace and flexibility once again.  For Eric had remained in the Right Occiput Anterior [ROA] position for the vast majority of my pregnancy.  Knowing that babies often rotate clockwise, I feared that I would need to do a lot of work during labor to keep him from remaining in a persistently posterior position.  But during one of my prenatal appointments, Nina mentioned that he must have a reason–Eric must have had a reason for choosing and staying in this position.  And now I wonder–if he would have rotated and stayed in the Left Occiupt Anterior position [thought by some to be the optimal position for birth] would this have compromised his cord even further?  Would this have made for a very difficult delivery?  For he was born ROA.  Just as he had been for most of his time inside of me.)

My midwives, in their skill and wisdom, worked to “somersault” him out of me.  I lifted up one of my legs into a lunge (or, as I like to call it, the “Captain Morgan stance”) to make more room for him.  And no one panicked.  Amy and Nina were serious, but they were also calm and confident.

Their calm and confidence grounded me as I brought Eric up from the water and into my arms.



Thursday, January 19, 4:45 a.m.: that 4 a.m. to 5 a.m. hour that had often marked my hour of insomnia throughout most of this pregnancy.  My boys were still dreaming peacefully in their beds.  Tim was beside me, alert and awake and amazingly supportive.

Just six hours after I wondered if this could be it, I was holding my baby boy in my arms, surrounded by and  immersed in nothing but love and joy and wonder.

I couldn’t have asked for a more peaceful and extraordinary birth.

Kristen is a member of ICAN.  Thanks, Kristen, for inspiring us with your beautiful VBAC story!

In Conversation with Rebecca Dekker

Who: ICAN members

What: A discussion with Rebecca Dekker around cesareans and cesarean prevention

Where: Online Video and Voice

When: Tuesday, September 17, 2013

Register: Email speakerhost (at) ican-online (dot) org to receive an email with the link and password to join the conversation.

Join this Online Event September 17th, 2013 at 5pm PST/7pm CT. You’ll need to register with the speaker series host first. Please email Thais at speakerhost (at) ican-online (dot) org with your first and last name to receive the password and link to enter the meeting.

The speaker series is FREE for members. If you aren’t a member, please join ICAN to hear Rebecca Dekker speak and support a great organization all year long for just $30. You can become a member HERE and support ICAN’s mission to improve maternal and child health.

Rebecca Dekker, PhD, RN, APRN, is a nurse researcher and founder of www.evidencebasedbirth.com. Rebecca was inspired to share research evidence with moms after her 2 very different birth experiences. During the birth of her first child, she received care that was based on “that’s the way we do things.” Three years later, she sought out and found someone who would provide evidence-based care at her second child’s birth. Rebecca blogs so that she can get birth evidence out into the hands of moms and families. She is also Secretary of ImprovingBirth.org and has been working on this year’s Labor Day Rally to Improve Birth. In addition to blogging and being a mom, Rebecca works full-time as a nursing professor at a research-intensive university. She teaches pathophysiology and pharmacology to BSN nursing students, and she also conducts research on using cognitive behavior therapy to treat depression and anxiety in people who are at risk for heart disease, including pregnant women.

Looking forward to seeing you there!

Ever Wonder About the Cesarean Rate for a Hospital Near You?

When I was pregnant with my first child, I did very little research. I mean, people have babies every day, right? My mom birthed all of her children naturally, so I just assumed that all I had to do was pack a bag and show up. But, being true to my type A personality, I did just a bit of research. I went online and found a “10 things to ask your provider” checklist. Armed with my handy dandy notebook and the naiveté of some first time moms, I scheduled my first appointment with my OB. I asked my doctor what her cesarean rate was and when she replied 50%, I really didn’t even know what that meant. I didn’t know that her personal rate of surgery could/would impact my outcome. And, in the wee hours of the morning, Mother’s Day 2007, just before my doc’s shift was up, I was informed that baby wasn’t progressing and it was time for a cesarean. I didn’t know what the numbers meant back then but now I do. And, I’d like to share it with you.


Cesarean rates differ from hospital to hospital with some as low as 7% and others closer to 75%, some even a whopping 100%! The national cesarean average is a little over 30% (http://www.cdc.gov/nchs/data/databriefs/db124.htm) and, while the statistics show that the numbers may not be increasing at the same rate as they have in the past 10 years, this national average is still alarmingly high. If you talk with your care provider and discover that their cesarean rate is at or higher than the national average, you have to stop and ask yourself, “Is this provider offering the kind of care I’m looking for?” I look back on my 50/50 chances of having my baby vaginally and I see that the odds were against me. I didn’t think it could happen to me just like you didn’t think it would happen to you. There is no shame in not knowing but there is power in education. You may find it useful to check out this compiled list of hospitals in your state and just see what kind of rates the hospital near you is reporting. Just click on the link for your state then click on the image at the bottom to go to the full pdf.

http://www.cesareanrates.com/hospital-level-cesarean-rates/


The cesarean rate for the hospital I gave birth in for my first child is 38% and the rate for the hospital where I had my Vaginal Birth After Cesarean (VBAC) is 41%. These numbers are not surprising given my experiences with these hospitals. I would love to hear your comments about the cesarean rate of your local hospital and your thoughts on the subject.


And, while we are on the subject of hospitals and cesareans, let’s talk a bit about hospitals and VBAC. Did you know that ICAN is the only organization to have compiled a list of hospitals and their VBAC policies? Our team of amazing volunteers called hospitals in every state across the country and surveyed Labor and Delivery wards to find out which hospitals had VBAC bans. This survey found that approximately 30% of hospitals in America have official policies banning VBACs.  You can see the entire database of information collected here:

http://ican-online.org/vbac-ban-info


As with cesarean rates for your doctor and hospital, it is really important to know your own hospital’s VBAC policy, before you go into labor. You may have a doctor that says they are supportive of your VBAC only to discover that what you consider “support” may not be the same idea of “support” that your doctor had in mind. Sometimes, a frank discussion can help clear up any misunderstandings and sometimes, a change in care provider might be in order. All in all, trust your instincts, and if you feel that your provider is not on board, find one that is. Your reproductive health is more important than any discomfort caused by changing care providers.

Have any of you had experience with a care provider paying lip service to your desire to VBAC but not actually supporting you when the time came? How about providers that went above and beyond to help you reach your goals?


Smiles,

Jennika Cook, ICAN blogger