trying for a vbac Archives - Bare Feet on the Dashboard

Tag: trying for a vbac

08
Apr
2013

Trying for a VBAC: Our Birth Plan

categories: birth, pregnancy, trying for a vbac, vbac

Our second baby is due at the end of April, and we are hoping and trying for a VBAC (vaginal birth after cesarean section). This is one of a series of posts about Trying for a VBAC. There are many reasons why we are heading this direction and I hope to share them with y’all over the next few months. You can read the Bear’s full birth story here to see what our first child’s birth entailed. If you read that story you will get a little glimpse into why we are now on this journey to VBAC and a normal birth. This process has been all consuming for me and this blog is my space to express the way I feel about the whole situation. Many folks have strong opinions about VBAC vs. repeat cesarean, and I hope that whatever your opinion might be you will respect mine. VBAC is not the right decision for every c-mama, and it doesn’t always work out no matter how you prepare. Our hope and prayer is that we can have the best birth possible for our little girl.

Because we are trying for a VBAC and lots of people have lots of questions about what that entails, we’ll be live tweeting as much as we can during the birth. You can read my other pregnancy 2.0 updates here, and read all my pregnancy posts here. *UPDATE* We successful had a VBAC with our daughter, and you can read our full birth story here.

This week I’m sharing our birth plan with you. We worked out the details with the help of our doula, Erica Sosa. She has attended many VBACs and has worked with our OB on a number of occasions. We know that every birth is different and things rarely go according to plan. We still think it is best to have a plan and to share that plan with our birth team so that everyone is on the same page.

Birth Preferences for our VBAC Birth

Becca and Jed Eby

Due Date: 4/24/13

Before Labor Begins

– As long as my baby and I are healthy, I want to reach as close to 42 weeks as possible.

– If some induction method is needed, I prefer to try these first: natural induction methods

– If my water breaks before I go into labor, I want to wait as long as possible before coming in to allow labor to start on it’s own.

– I would like to labor at home as long as possible.

– I wish to have spontaneous rupture of membranes.

Upon Arrival / Admittance

– If I am less than four centimeters dilated, I would like the option of going home to continue laboring there.

– Upon arrival at the hospital, I prefer to have my husband Jed Eby and my doula, Erica Sosa with me at all times.

– As long as my baby and I are fine, I want my movement during my delivery and stay to be completely unrestricted.

– I want to remain IV free unless it becomes medically necessary to start one and am fine with a saline heplock.

– I prefer to limit vaginal exams unless I request one.

– I am aware that pain meds are available and will ask if I feel the need. PLEASE do NOT mention or ask otherwise.

– If a situation arises and we need to make a medical decision, please allow my husband and I time alone to discuss it.

– I may be wearing my own clothing to labor and birth in.

– I understand that upon arrival I need to be monitored, I ask that I be able to do this in the position that I am most comfortable in as I am wanting this birth to be unmedicated. Thank you.

– I would like as much intermittent monitoring as possible.

– I will use a heating pad, massage, and lavender essential oil aromatherapy as needed.

Delivery

– Please do not allow any other visitors into my room without my consent.

– I want to have my door closed, lights dimmed and I prefer for people entering the room to speak softly. I appreciate your cooperation in helping make this the birth experience we want.

– I want the freedom to use different positions and equipment during my labor such as: birthing ball, squat bar, shower etc.

– IF I request pain relief, I would appreciate some private time to think about which pain management technique or medication I would like to use.

– I would like to use a mirror when I am pushing and may touch my baby’s head when crowning.

– I would like to be in the position for delivery that is most comfortable to me at the time. I.E. Squatting or on my side

– I would like my Dr. to guide my breathing and pushing for slower crowning.

– I would like olive oil/coconut oil that I will provide, used and gentle perineal massage at crowning.

– Please allow the umbilical cord to pulsate 1.5 to 2 minutes before it is clamped.

– We will be taking our placenta with us.

– As long as my baby and I are healthy, I want to maintain skin-to-skin contact until after my baby has successfully breastfed on both breasts. (at least 2 hours and all routine procedures done ON me)

– If a tear occurs and repair is needed, please use local anesthetic for repair.

Postpartum

– As long as my baby and I are healthy, I want to maintain skin-to-skin contact and do not wish to have baby removed from me unless medically necessary.

– AFTER 2 hours has passed I DO consent to all routine newborn procedures such as weighing etc. I wish to waive the Hepatitis B vaccine.

– I would like a pulse ox screening after for our baby girl when she is 24 hours old to rule out congenital heart defects.

– If my baby’s health is in jeopardy, I want to be present with our baby at all times, breastfeed or express my milk for my baby and have as much bodily contact with my baby as soon as possible.

– My baby is to be exclusively breastfed; please do not offer my baby any formula, pacifiers etc without my consent.

– I am aware that there is guidance available for nursing and would like to consult with a lactation consultant to ensure there are no breastfeeding issues.

– I prefer that my baby’s first bath be done at my bedside and I may want to help with her bath.

– I want the shortest hospital stay possible.

What was/will be most important to you during the birthing process? How did you communicate your desires to your birth team?

13
Mar
2013

Trying for a VBAC: Preparing

categories: baby, birth, medical, pregnancy, vbac

This week I’m sharing what we’ve done to prepare so far for a VBAC. I’m not an expert by any means, but I’d love for others who are on this path to one example of how to prepare.

1) Do your research. Read, read, and read some more. Talk to your OB. Talk to another OB. Talk to the ladies in your local ICAN chapter or online. Talk to your partner and get on the same page. Watch The Business of Being Born together. If you come to the conclusion that you want to try for a VBAC, go for it! The American College of Obstetrics and Gynecology has come out recently in favor of most c-section moms having a trial of labor after cesarean. If your doctor says anything to the contrary they are going against their own governing body. That being said, there is a small percentage of women who do not qualify for VBAC. If you have found a doctor who is known for supporting trial of labor after cesarean (TOLAC) and she says you are not a candidate for a particular reason, that is important.

2) Find a supportive OB or Midwife. My former OB is awesome and I love her as a person, but she just doesn’t do VBACs. She told me that I was a good candidate but that she just didn’t do them. I started looking for a new doctor soon after that appointment, long before I was even pregnant again. My first choice was a midwife run birth center, but the one I like only does 2VBACs, not first time VBACs. They recommended my new OB, as did my ICAN chapter. The first time I met her I knew she was a great fit. She loves natural labor and backs up the birth center I researched. She read through my records and told me I should have at least an 80% chance of successful VBAC and she would be happy to support my birth choices. Such a relief. She doesn’t induce without medical reason, and won’t talk about induction for a VBAC mama until I hit almost 42 weeks. Yay! She even recommended I hire a doula, and gave me several cards of doulas she likes to work with. This is not normal for OBs, but is sure does rock.

3) Hire a Doula. A doula is a birth assistant. They don’t take the place of your partner or your OB/midwife, but they can help coach you through labor and achieve your birthing goals. Rates of VBAC drastically increase when a doula is part of a birth team. Doulas cost anywhere from $250-over $1000, depending on the experience of the doula and the rates in your area. I interviewed several doulas until I found the right one. She will meet with us to create our birth plan and also work with us to teach us natural child birth techniques.

4) Take a Natural Child Birth Class. We took the natural childbirth class offered by our former hospital, and it was a joke. This time I’ve taken some classes online, read several books, listened to Hypnobabies cds, and will have a private refresher course with our doula. There are Lamaze, Bradley, Hypnobabies and Hypnobirthing classes in most metro areas. If you live far outside a city, get yourself on Amazon and order some books.

5) Practice Relaxation Techniques and Positioning Exercises. If you want to use a certain technique for labor, practice it now. I’ve been working on my breathing, relaxing tense muscles, and repeating my positive birth affirmations (cheesy, I know, but people swear by them). Bear was in a poor birthing position, so I’ve been practicing the exercises from Spinning Babies and using my birth ball instead of slumping on the couch. I prepared a DIY heating pad using rice and a sock, and scented with lavender essential oil for calming and relaxation.

6) Create a Birth Plan and Share It with Your Team. I’ve worked on mine and have it narrowed down to what I want and don’t want for the most part. I’ll flesh it out with Jed and my doula next week, then discuss it with my OB. Last time I had a birth plan but I’m pretty sure none of the doctors or nurses ever looked at it. I was so wishy-washy about what I wanted that I ended up with none of it. This time around it may still go off course, but at least I will have made informed choices about my preferences. I think this step would be especially important if your mom or other family members will be in the room. They may get totally thrown off by delayed cord clamping or the squatting bar. You can read our complete birth plan here.

7) Make Sure Your Birth Location Lines Up with Your Plan. If you plan to birth at home, this one is a little easier. Most birthing centers and hospitals have policies in place that aren’t flexible. You need to know what those are before you are there in labor. Can you move around during labor? Will you have access to a shower or birth tub? Are birth balls provided? Can you eat or drink? Can you wear your own clothes? Can your baby stay with you for several hours after birth? Whatever it is that is important to you, make sure you have peace of mind about it long before labor starts. We were so relieved after our hospital tour because so many of the things we thought we might have to fight for are normal practice there. Yay!

8) Trust Your Body and Your Instincts. Your body was MADE by your Creator to do this. You were given all the instincts you need to birth without assistance. Technology is great, but it can also convince us that we are helpless without it. You are not helpless. You are an amazing woman who is carrying a life inside her and trying to do what is best for that baby and your own body. Trust that.

More on Resources for VBAC Preparation:

From Growing Slower

Hiring a Doula

Find a Doula in Your Area

Find a Lamaze Class

Birth Boot Camp Classes

Spinning Babies

Click here to read all of my Trying for a VBAC Series.

Looking for resources and information about VBAC and cesarean recovery? Try these:

International Cesarean Awareness Network

How did you prepare for birth (of any kind)?

12
Feb
2013

Trying for a VBAC: Risks vs Benefits

categories: baby, birth, medical, pregnancy, vbac

Today I’m addressing the most common question about our quest for a VBAC: What are the risks and benefits of a VBAC vs a repeat cesarean? A little about this series: Our second baby is due at the end of April, and we are hoping and trying for a VBAC (vaginal birth after cesarean section). There are many reasons why we are heading this direction and I hope to share them with y’all over the next few months. You can read the other posts in my Trying for a VBAC series here. You can read the Bear’s full birth story here to see what our first child’s birth entailed. If you read that story you will get a little glimpse into why we are now on this journey to VBAC and a normal birth. This process has been all consuming for me and this blog is my space to express the way I feel about the whole situation. Many folks have strong opinions about VBAC vs. repeat cesarean, and I hope that whatever your opinion might be you will respect mine. VBAC is not the right decision for every c-mama, and it doesn’t always work out no matter how you prepare. Our hope and prayer is that we can have the best birth possible for our little girl. I am not in any way a medical professional, just a mama who loves nerding out over research.

Risks VS Benefits of a VBAC or Elective Repeat Cesarean Section

First lets look at the risks of both, lined up together. I’ll start with what I like to call the “Big Scaries”.

Big Scary #1: Risk of Baby Dying

VBAC – 0.2% vs C-Section (ERCS) – 0.1%

Both rates are very low, but slightly higher for VBAC.

Big Scary #2: Risk of Uterine Rupture

VBAC – 0.4% vs C-Section (ERCS) – 0.2%

Did you know you could have a rupture with an ERCS? I didn’t either. The next facts really shocked me. Let’s look at the risk of uterine rupture for 1st time moms in natural births vs those induced and augmented with pitocin and/or prostoglandins.

Natural, spontaneous labor – 0.012%

Spontaneous labor augmented (prostoglandins, pitocin, etc) – 0.9%

Induced Labor – 1% (WHAT???)

When I read those numbers from multiple scientific studies, I was seriously angry at my previous OB who mentioned none of the risks of induction. If you were induced or had augmentation during labor, did your OB mention the more than doubled risk of uterine rupture? I’d really like to know. I’ve asked a lot of mamas and across the board I’ve not heard of anyone being told this by their OB. Not cool.

Big Scary #3: Risk of Mom Dying

VBAC – 0.02% vs C-Section (ERCS) – 0.04%

Both rates are very low, but slightly higher for c-section. The problem is that this rate increases greatly with each repeat c-section, limiting the potential of family by putting mom at risk.

The other risks of VBAC are the same as normal first time birth, but many other risks increase greatly with a repeat c-section and continue to increase even more with a 3rd, 4th, etc c-section. I’ve found that most women are told the risks of VBAC I mentioned above but not the risks of repeat c-section. Why is this? Many birth professionals believe it because of 2 things: 1)the bad rap VBACs got during the 1990s when it was common to use drugs like Cytotec to induce labor, greatly increasing the risk of uterine rupture and 2)because a c-section is easier to control for the physician, takes less time, and makes more money. A VBAC or other vaginal birth costs around $3-5000 while a c-section costs upwards of $25,000 for the patient. I support every woman’s right to choose the birth that she feels is best for her baby and herself, but I believe we also have the right to know the risks and benefits of each choice.

Risks to Baby that Increase with Repeat C-Section:

being cut during the surgery

premature birth (and all the risks that come with that)

respiratory problems at birth and lifelong

readmission to hospital or NICU time

risk of death in first month of life

allergies

asthma

Type 1 Diabetes

problems breastfeeding

Risks to Mom that Increase with Repeat C-Section:

unintended cuts or damage during the surgery

major infection

emergency hysterectomy

blood clots

stroke

ICU time

complications from anesthesia

endometriosis

appendicitis

gallstones

depression and other negative psychological issues

infertility

problems breastfeeding

future pregnancy issues including placenta previa, stillbirth, low birth weight, and ectopic pregnancy

There are plenty of benefits to both choices. Let’s take a look at them.

Benefits of Repeat C-Section:

scheduled birth – easier to have support network and preparations in place

controlled situation

time to prepare a support network for post op

much faster method for emergencies that threaten the life of baby or mom

less liability for the doctor and hospital

Benefits of VBAC:

faster recovery

better immediate bonding with baby (lack of drugs, etc)

better breastfeeding results

avoid major abdominal surgery and all the risks that entails

birth the way God created our bodies to function

much less expensive

less hospital time

fewer complications for mom and baby

Every mama has to weigh these risks and benefits and come to a decision with their partner and an OB they trust. My former OB told me I was a great candidate for VBAC but that she didn’t do them, so I looked to my local ICAN chapter to find recommendations for VBAC friendly OBs in my area. I found an awesome doctor and am so happy with the prenatal care I’ve received. The information that helped me make my decision to try for a VBAC is the American College of Obstetrics and Gynecology’s (governing body of OB/GYN) recent statement on VBAC. The most important quote is below and you can find a link to the full statement under the resource links at the bottom of the post.

“The American College of Obstetricians and Gynecologists (ACOG) and the Royal College of Obstetricians and Gynaecologists (RCOG) agree that that most women with a history of one or two uncomplicated low transverse caesarean sections, in an otherwise uncomplicated pregnancy at term and with no contraindications to vaginal birth, are candidates for and should be counseled about VBAC.”

If your OB tells you differently, they are going against the policy of their own governing body and you should probably question their motives.

Looking for resources and information about birth, VBAC, and cesarean recovery? Try these:

ACOG Statement about VBAC vs ERCS

International Cesarean Awareness Network