Cesarean rates in MS increased 22.8% in ten years.

According to the 2012 Report on Hospitals - Licensed by Mississippi State Department of Health

Division of Health Facilities Licensure and Certification, the cesarean rate in Mississippi increased from 11,790 in 2002 to 14,478 in 2012.

http://msdh.ms.gov/msdhsite/_static/resources/5418.pdf

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The following is taken from http://www.ahaparenting.com/ages-stages/pregnancy/how-to-avoid-a-caesarian-c-section-birth by Dr. Laura Markham:

Avoiding a C-Section: What every pregnant woman needs to know. 
You can significantly reduce your chances of having a C-Section by informed choice of a caregiver and birth place.  Here's how:

1. Exercise moderately during pregnancy.  Sedentary women are 4x as likely to deliver via caesarean section as women who did aerobics during the first or second trimester.

2. Find a caregiver who has a low C-Section rate and is experienced with successful VBACs.  This is true even if you don't need a VBAC, because it means your caregiver doesn't default to caesareans.
3. Find a caregiver who will give you all the time you need, rather than rushing your delivery because of staffing issues.
4. Ask your caregiver what she does if your baby is in a breech position in late pregnancy.  You want to hear that she is experienced with turning babies and always tries that before scheduling a C-Section.
5. Check Hospital policies.  If you're considering a VBAC, be sure to use a hospital that allows VBACs.
6. Arrange continuous trained labor support, which studies show keeps labor moving.  If you aren't using a midwife, supplement your OB by hiring an experienced labor doula. A 2001 study in the journal of perinatal education showed a 56% reduction in the risk of caesarean in women receiving continuous one to one nursing/doula or midwifery care.
7. Be sure that your caregiver and birth venue encourage practices that support the normal process of labor and keep it moving:

• Arrange to stay upright and moving rather than lying down.
• Stay well-nourished and hydrated to give you energy 
• Avoid continuous electronic fetal monitoring
• Avoid hastening labor with pitocin, which increases the severity of contractions and makes other medical interventions much more likely.

Labor, Interrupted: Cesareans, “cascading interventions,” and finding a sense of balance

Article from Harvard Magazine
Written by Nell Lake
http://harvardmagazine.com/2012/11/labor-interrupted

"Ecker believes that obstetrics needs to move ever closer to “evidence-based medicine”—the study of risks and benefits, and the application of this knowledge to medical decisions, professional standards, and training. Doctors and institutions should help patients understand risks and the tests, during pregnancy and labor, that measure them. Whenever appropriate, he says, physicians and patients should avoid interventions and prevent that “cascade.” For example, he says, doctors and hospitals should encourage trials of labor after cesareans."

 

Six reasons the National cesarean section rate is so high.

1. Low priority of enhancing women's own abilities to give birth
2. Side effects of common labor interventions
3. Refusal to offer the informed choice of vaginal birth
4. Casual attitudes about surgery and variation in professional practice style
5. Limited awareness of harms that are more likely with cesarean section
6. Incentives to practice in a manner that is efficient for providers

"All of these factors contribute to a current national cesarean section rate of over 30%, despite evidence that a rate of 5% to 10% would be optimal."

This list and more information can be found on the Chilbirth Connection website:
http://www.childbirthconnection.org/article.asp?ck=10456

Baby number eight...VBAC!

In writing this birth story, I am hoping to not only record one of the most incredible evnets of my life, but also to give home to someone who may be wondering if it's possible to have a beautiful birth exerience after a less than great one. Many people think that I needed "healing" after the csection birth of my seventh child. Not true. The csection I believe was an act of mercy.. from Someone who knew I was not ready to deal with the intense fear
and emotion that came from the traumatic vaginal birth of my 6th child. That story is for another day.

When I found out I was pregnant again, I knew immediately I had decisions to make. As much as I liked my ob and the hospital I had delivered at, I could not have a vbac if I used them. I decided to use my daughter's ob... the one who allowed her to deliver her little girl vaginal breech. I knew if he could handle that without so much as breaking a sweat, he could handle an old mom who just wanted to avoid surgery. I have to say there is comfort in the familiar.. even if the familiar is bad for you. There were times I wondered if I should just go with the flow and stay with my former ob and have a repeat csection. I'm so glad I didn't.

My pregnancy was considerably uneventful for someone who had so many "risk factors" . Overweight, many children, a big "AMA" stamped across my forehead, and high bloodpressure. Dr. W was awesome about making me feel "normal" for once.. He never acted like I was a ticking timebomb of liability or a malpractice
suit waiting to happen. It was nice to see him each visit.. even though he picked on me and called me "grandma" (he did deliver my granddaughter after all) I actually looked forward to my doctor visits.

There was a certain amount of disconnect during my pregnancy. I dreaded the birth. I didn't want to be in a situation where I had no control. I was afraid of not having the support of the ones from whom I needed it most. The days and weeks flew by. At 20 weeks we found out we were having a boy. I was shocked.. after three
girls in a row it didn't seem possible. It felt real. I started allowing myself to get a little excited and to love this little boy growing as fast as he could inside me.

My due date was May 16th. I was quite sure I would likely go a little early. During my 37th week I began having bouts of frustratingly strong contractions. Several times I got my hopes up only to become exhausted and let down. I was tired.

On May 5th, my second daughter's 8th birthday, I woke up feeling strangely rested. I wasn't having those annoying contractions, and felt more energy than I had in weeks. I left the other kids with daddy while I took my birthday girl out for some one on one time. We shopped, ate at Olive Garden...stopped for ice cream...It was a good day. It was also the calm before the storm.

That night I was up a couple times with a bit of tummy trouble. I wasn't ready to blame early labor yet, considering I did eat some crazy amounts of Italian food and ice cream the day before. Later that morning, however my suspicions were heightened with the return of contractions and now, bloody show. Was it time?

I tried not to get excited. My sweet daughter, (who was also my doula) offered to come over. If nothing else, her company and playing with my grandbaby would be a welcome distraction. We visited, I bounced on the birth ball. Contractions kept coming, but never really intensifying.. they were "beyond braxton hicks" but never became more than around 20 minutes apart. I did this all afternoon. Dinner time came and nothing seemed to be changing, so she went home to take care of her family. I had already prepared our dinner, as the boys had scouts that night, so I decided to lay down and rest. I didn't want to encourage labor at this point, because one of my biggest fears was dealing with a painful labor with no sleep.. btdt. Hubby came home, asked me if it was safe to go ahead and take the boys. I told him to go ahead, nothing had changed. Or maybe I was in serious denial. I had a contraction, then just a few minutes later had another. This raised the attention of my husband who decided he was not about to take the boys considering I began having contractions less than 10 minutes apart. He got a quick shower, so did I...
the contractions continued. Since I was group b strep positive I knew we had a window of opportunity to get there and get the antibiotics. I still wasn't "completely" sure I was in labor, but was ready to at least go find out for sure. I texted my daughter...come over.

We gathered our stuff headed out the door. I hugged and kissed my babies.. for some reason leaving for a birth is always a bit emotional for me. I'm not so nieve as to think bad things never happen. I said a silent prayer for my children, and the safety of the birth.

We arrived at the hospital about 7:45 or so that night. The first contraction in the parking lot was quite intense.. I leaned on the truck for support. The sunset was stunning. Once at the labor and delivery floor, we were shown to our room.. My daughter left our granddaughter with us while she ran to her car to get something.. what a sight we were carrying a baby and me being hugely pregnant and obviously in labor. ha! The nurses were quick to confirm that I was indeed in labor, contracting every few minutes and 4-5 cm dilated. I appreciated their swiftness, it allowed me to at least get one dose of antibiotics. I was also told as soon as the meds ran in my iv, I could be unhooked with only a heplock. yay!!! No swelling from being pumped full of fluids!

My sister called and asked if she should come.. I was sure we were in for a long night, and told her we would likely just be sitting there for a while. I felt bad but she did have to work the next day and I didn't want her to sit with me all night only to not be there for the birth.. and be sleep deprived the next day. Boy was I wrong about how
the evening's events would transpire..

When Dr. W came it I was very relieved to see him. One of my fears was that he wouldn't be on call. He checked me.. and announced "Hmm.. we have a hand" WHAT???? Before I could really process what was happening, he attempted to get baby to move his hand off his head by pinching his fingers. That didn't work. There was no time for me to become afraid.. he asked the nurse to aply fundal pressure while he slowly broke my water and repositioned his hand. This was the most painful part of my labor.

I thought I closed my eyes. I was told I didn't, and had a frightfully spaced out look on my face. I remember the intense pressure, the feeling of fluid flowing out.. but I was strangely calm. I trusted him. Within what seemed like seconds it was over.. Baby's hand was back out of the way, and only his little head on the cervix. Now all we had to do was just wait for appearance. My sister did come.. I'm so glad she did. We missed so much growing up I was thankful she would be with me for the birth. My sweet grandbaby fussed herself to sleep. My daughter was concerned it was bothering me.. nope. She was a sweet distraction.

Now off the monitor and iv, I was free to move.. I stayed in bed sitting up.. astonished at the powerful contractions that still were not very painful despite my ruptured membranes. I talked and laughed through them.. until that moment things suddenly got REAL. I felt a shift in the intensity and knew I had to get out of that bed.
I stood, walked, went to the bathroom.. never stopped by the nurses. They were great. At some point in all this, Dr. W asked my daughter if she would like to "catch" AWESOME. Of course she would!!! He asked for another gown and gloves to be brought for her. By this time I was 8ish cm.. I did begin to let those scary thoughts
enter my mind.. what if it gets too intense? It was like I was waiting for the worst. I leaned on the birth ball. I rocked. I walked. I mumbled prayers.. God please give me strength to handle this.. I knew the pain was going to be much much worse.. I was waiting for it. Checked again, still 8. how much longer? My daughter told me I was
doing so good.. I remember her speaking to me.. though I can't remembre everything she said. Just her voice. Her sweet soft voice was soothing. It kept me grounded. My husband was there. Calm. Just there.. just what I needed.

The urge to push. It was almost time.. not quite. I stood through a couple more contractions. Back on the bed to check... 9 cm.. The sweet nurse thinks I can push past it. She's right. Dr W and my daughter suit up. Time to meet baby.

The first few pushes felt ineffective.. then I could feel him come down and they felt so much more purposeful. I listened to Dr. W guide my daughter in easing her baby brother earthside.. I reached for my husband.. he was there. Silent support. I didn't let him go. Pushing. Couple more... I felt his head emerge... deep breath, one final push..

warm, heavy, vernix covered baby boy. oh my God.. He was pink, but wasn't crying.. no worries. I rubbed him, he was breathing well, just wasn't too very upset about things. One more push for the placenta. I pulled him closer once the cord was cut. (not sure why his cord was so short??)

He cries a bit.. still warm on my chest...oh that feeling. I wish I could bottle it up and experience it again and again..

After a while I handed him off for a quick assesment by the nurse (there was a tiny bit of meconium in the fluid) he was then placed back skin to skin where he belonged. I thought I would cuddle him and wait for him to show signs of being ready to eat.. nope.. he began rooting immediately. No effort what so ever to get this boy latched..
He did it all by himself! Little man was born ready to eat and nursed for almost an hour.

I still get teary thinking about what an incredible experience his birth was. Oh, and that horrible pain I kept waiting for? It never came. I am so blessed by the whole experience. Did a healing take place? Yes. And with it came such a precious gift.

Madison's VBAC - Thanks for sharing your story!

Loralai's speedy arrival VBAC

June 4th I went into my 40 week checkup (according to my LMP... 39 & 4 according to my dating ultrasound). My doctor stripped my membranes for the second time at about 11 am. I wasn't very hopeful since it hadn't worked the previous week. I was 4 cm dilated at 70-80% effaced. I was 2-3cm dilated the previous week. The rest of the day Caleb, Cormac and I enjoyed play dates with friends! I felt good and completely normal. As the afternoon continued, I noticed (or thought I was trying to notice) very light crampy feeling in my uterus. I also had lots of what thought were Braxton hicks contractions, but that was a normal occurrence for me. The later the day went, the closer the contractions got but they were painless so my hopes weren't up!

I felt a pop at 7:45 but nothing came out so I wasn't sure it was my water. I did think it was a possibility though and I later found out it actually was my water breaking.  A little while later I had semi painful contraction. I walked outside to watch Caleb and Cormac  play outside and mentioned casually (almost jokingly) that I may be having real contractions because I almost felt like I needed to stop walking when I had one. I walked back inside and felt a little wetness so I went to the restroom. I was hit with the urge to go number two and list my mucus plug. This was about 8:00. I excitedly told Caleb I lost my plug and we joked that maybe this baby would come by tomorrow. I later down and had a few more slightly painful contractions so I decided to call my parents and tell them to be on standby for delivery. They were in no rush because with my last I labored 20 hours before having a csection.

I had Caleb give Cormac a bath and get him ready for bed because my contractions were getting closer and stronger. I took a super quick bath and then started freaking out because my contractions started getting so close and strong. Caleb packed the car and I really started feeling stressed. We left Cormac with my Aunt and rushed to the hospital.

I didn't think we would make it to the hospital because I was feeling pressure. I told Caleb while we were driving that I wanted an epidural as soon as we got there, even though my plan was to labor drug free. This should have been my first clue as to how far I was! Self doubt was strong!!

9:00pm: The ob receiving nurse was ssssoooo slow taking my weight/questions/blood pressure etc. I kept stressing to her that I felt pressure during contractions to try to move her along quicker. She hooked me up to the monitors and i told her i needed an epidural! I was moaning during contractions at this point and was very uncomfortable having to lay in a bed. The doctor finally came to check my cervix and I once again expressed to her I wanted an epidural.   I was 7cm when the on call doctor checked and she said I'm probably not getting an epidural. I almost lost it but Caleb was there to reassure me that I could do it and that's what I wanted anyways. I was overwhelmingly scared because my contractions were really intense at this point. I would calm down and be like yea I did want a drug free delivery between contractions. But the crazy would return with each hard contraction!! Haha

9:30: I was rolled to a delivery room as soon as I was checked. I got my iv and a nurse took bloodwork. She assured me she would try and get the blood work in as fast as she could so I could possibly get that epidural. Transition went quickly. Within about 30 minutes I had a strong urge to push. I still had a "lip", which the nurse said she could try and get the babies head over if I really wanted to push.. Which I did. The nurse set up the bed and got the foot pedals and handle bars out and I began pushing a little after 10pm. I pushed for several contractions before I was able to figure out how to get a good push. I was never able to really figure out how to push without straining in my face ( I will have to work on this more for next time).  The nurse was great, she stretched me every time I pushed. After a while she told me she saw hair, so we got the mirror out so I could watch. At this point I had some real motivation during pushes because I could see the progress. I was amazing and surprisingly was not painful like I thought it would be. I could feel pressure against my c section scar, which scared me. The nurse did not seem worried when i kept telling her i could feel pressure on my scar though. A few more pushes and it was time to call a doctor in! I got the senior resident, which did a great job. I remember starting to feel a little burning as baby started to crown. When she started really coming out, I felt like I was tearing up toward my urethral (which I did a little) and then she was out at 11:10 pm! I got skin to skin immediately with her and breast fed for the first time within about 5 minutes.

The doctor started trying to get the placenta to deliver... Which was really unpleasant. She pressed on my belly for about 30 minutes before I was able to push it out. I had a second degree tear and a urethral tear that the doctor sewed up after that. I did not feel the perineal tear happen.

I got up and went to the bathroom about a hour later. Recovery has been much easier with a vaginal delivery so far. Right now (2 days ppd)  I just feel really bruised. I have not needed any medication other than ibuprofen for slight after cramping and general achy-ness.

Tax Day VBAC Baby 2013

Thankfully, this was an uneventful pregnancy - if you consider being a tax accountant who is uber pregnant during tax season, having a young toddler, and having a husband who is going to school full-time and preparing for finals, playing Army, and doing odd jobs in between all those duties “uneventful.”  It was hard to relax without having time to nest; thus, I felt very unprepared for birth and bringing a new baby home.  Luckily, some of my best, most wonderful, awesomest friends gifted me a housekeeper to help clean up one day.  I also got all projects done at work that I wanted to get done before maternity leave on that same day.  I started having contractions the next day.  Coincidence?  (I think not.)  This was about ten days before my EDD.

Nevertheless, my due date came and went.  While visiting at my parents’ after church that day my three year old nephew said, “Your tummy is big!”  I laughed and cringed at the same time.  A friend who had given birth a couple months ago had gone ten days past her due date – I did NOT want that to happen!  Thankfully, I started having regular contractions around 1:30 am.  I was able to get up and doze in our recliner in between contractions while listening to Hypnobabies in the background for a few hours.  Finally around 5:30 am I got up and started piddling around since I couldn’t sleep.  About 30 minutes later they were consistently 2-3 minutes apart, so I woke up my husband and said, “Um, we better get our daughter to daycare – I’m having contractions.”  On the way to dropping her off, they slowed down, so we went to my parents’ house so I could relax in their whirlpool tub.  Then they really slowed down so I got dressed and walked around outside.  The contractions picked up and got really intense, so around noon (I think) I decided it was time to head to the hospital. 

When we got there I was three to four centimeters dilated – not bad, but not as far as I would have liked.  My doula arrived and immediately got to work.  Around the room she pinned up affirmations I shared with her that I had gleaned from Hypnobabies.  I started off laboring on all fours on the bed with the head of the bed elevated while my sweet doula put hot and cold compresses on my neck in between contractions.  I tried several other positions, but that felt best.  However, the nurse kept making me get on my back to get a good fetal monitor reading.  Every time I moved I would have an intense contraction, so I eventually gave up moving.  I’m not sure when that happened (sometime after seven centimeters).  I wish I hadn’t, though.  In hindsight, I wish I had pushed to be more mobile and especially to walk around, but the contractions were so intense I was having trouble concentrating.  The intensity through me off guard.  When meeting with my doula one time, she asked me how she could help me relax.  I said I was a laid back person and felt pretty relaxed during my first birthing by just walking.  (I chose to be induced and ended up with a section, but that’s another story.)  Everyone says pitocin contractions are awful, but I felt like these were waaaay more intense than with my first, so I was thrown for a loop.  Around seven centimeters I started getting really tired and wondering what the heck I was doing trying a natural birth.  But, my husband and doula wouldn’t let me give up.  After all, I had made it this far they said; I could make it through one more, then one more, then one more….  At one point my water broke while I was laboring standing up.  Then again, I felt something gush and fall from in between my legs while I was on all fours.  No one else seemed to have noticed so I said, “Is that my baby?!”  Haha, super wishful thinking.  I was so ready to get this over with. 

Finally I got to “that point” and my vocalizations were much louder (I’m not a loud person, so that’s how I knew I was getting ready to have this baby).  The on-call doctor came in and said my doctor was on her way and asked if I could hold on another thirty minutes.  “I’ll try,” I responded, and immediately let out another loud vocalization while pushing.  I guess I wasn’t very convincing.  “I think I better suit up just in case,” she replied.  My doctor did make it.  I was told I pushed for about forty-five minutes.  It felt like longer, though.  The baby’s heart rate dropped and they gave me oxygen.  I knew I had to stay centered – I did NOT want another section after all this.  I talked to my baby through my body telling her it was OK and we were going to do this together.  I watched the reflection in my doctor’s mask as I pushed and soon I saw the head!  A couple more pushes and by 7:30 pm she was out!  I’m generally not a curser, but, “Holy shit!  I did it!” was my reaction.  Then they put this beautiful baby on my chest and I was very surprised to see a head full of dark hair.  Whaaaa??  My side of the family is fair skinned with light hair.  I still joke that if I hadn’t seen her come out myself I’d say she wasn’t mine.  And I’m so glad she is mine!

Oh yeah, and she was born on April 15, Tax Day.  J  This is one tax deadline I will never forget.