New Website!

This blog is closed. Please click here to see our new public page on Facebook for the latest research and local information. You can also find resources on our website: http://www.ican-online.org/jacksonms/

As always, you can also contact our leadership team by email: jackson.ms@ican-online.org

April is Cesarean Awareness Month! Donate or join at a discounted rate this month.

ICAN does not require membership, but if you'd like to support our mission please consider either making a donation or joining. Donations can be made through PayPal to jackson.ms@ican-online.org or click here to join at the CAM discounted price:

http://www.ican-online.org/join/

Hire a Doula! (or two)

Research shows that having a doula by your side decreases your risk of having a cesarean and increases the likelihood of having appositive birth experience. http://evidencebasedbirth.com/the-evidence-for-doulas/

I was so glad to have had three doulas support my labor with my second child. They knew just what I needed and I never had to say a thing! The doulas I had on my team made sure to involve my husband in many ways and they helped to manage my older child if needed. They got me snacks and made sure I stayed hydrated, applied counter pressure, gave me massages, were always full of encouraging words, suggested different positions to facilitate my baby coming down, and so much more! Doulas are really an invaluable source of comfort and strength when you are at your most vulnerable place. Decisions that you have to make in labor are yours to make, but your doula knows your desires and will help to remind you of them if times get hairy.

ICAN recommends hiring a doula because every woman needs to be surrounded by true support in labor. If you feel this is an expense you cannot afford, please contact a doula anyway. Many doulas will work with you on payment, some even will barter services or they can point you to a doula in training who can support you for less. Having the support, knowledge and experience of a doula is really priceless! Click here to see a listing of doulas in Mississippi

Mississippi cesarean rate for 2013 with Jackson area hospital percentages

10 Things You Can Do To Lower Your Chance of Having an Unnecessary Cesarean

1. Be aware that your choices in pregnancy and labor can have a BIG impact on your chance of having a cesarean. 
   http://www.ahaparenting.com/ages-stages/pregnancy/how-to-avoid-a-caesarian- c-section-birth

2. Choose a care provider with a low cesarean rate and similar birth preferences to your's. 

3. Hire a doula. Studies show that this can lower your chance of a cesarean by up to 50%!
    http://www.msbirthcollective.com/birth-doulas-childbirth-assistants-and-postpartum-doulas.html

4. Choose positions in in pregnancy and labor that help your baby to get in the best position for an easier birth. http://spinningbabies.com/baby-positions

5. Read a lot of birth stories from woman with atypical labors to see how wide the range of normal is in labor.  http://inamay.com/books/

6. Trust your body to birth your baby; it's what you are designed for!

7. Switch to a new care provider if you feel you are being led toward unnecessary intervention or a scheduled cesarean. http://www.improvingbirth.org/2013/06/bigbaby/

8. Avoid common hospital procedures that increase your chances of a cesarean, like induction, epidurals, pitocin, or breaking the bag of waters. 
   http://www.improvingbirth.org/induction-c-section-vbac-facts/

9. Be informed. When faced with any (routine or emergency) procedure, ask:
    Why it is being done in my case?
    What are the short and long term effects on me and my baby?
    What are my other options?

10. Last but not least, contact your friendly ICAN of Jackson chapter for more information and       support! We hold free monthly support/educational meetings. Contact us for more     
      information.  icanofjacksonms@gmail.com

A glance at worldwide cesarean rates.

http://www.huffingtonpost.com/2014/04/16/c-section-rates_n_5161162.html?&ncid=tweetlnkushpmg00000041

I do hope we are successful at lowering our country's cesarean rate
as planned. It all really starts with
the individual woman preparing and being knowledgeable,
paving the way for a better birth environment for future generations!

Here is what ACOG has to say about reducing cesarean deliveries: http://www.acog.org/About_ACOG/News_Room/News_Releases/2014/Nations_Ob-Gyns_Take_Aim_at_Preventing_Cesareans

Two Beautiful Births

My name is Melissa and I am the chapter leader for ICAN of Jackson, MS. I was honored recently to be a small part of the birth stories of two of the mamas in our group. Both mamas were VBA2C candidates. Both mamas gave their ALL and both gave birth to beautiful baby girls! The reason I wanted to share this story is because I think these ladies both are such strong women, both were very prepared and both amazed me and gave me hope for my future deliveries. Mama S labored for 41 hours, most of that all natural even on the max dose of pitocin! Her water broke early on and she stayed home laboring for several hours, using the birthing ball, dancing, hip rotations, walking…you name it, she tried it. Her doula couldn’t make it, so another one of our mama doulas in the group came to her aid and they seriously tried everything to get baby to come on down. I got to be there and help for a few hours before the doula came, and I was completely amazed at how calm she was breathing through each contraction after being awake for nearly two days! A few times we were all even laughing about the whole situation. Ultimately a cesarean was necessary. Mama A was in labor for nearly a week! At some point she decided to get checked, thinking she’d not be far enough along and would just go back home…she was 7cm! Shortly after getting to her room, she was 9cm! She had asked me to help support her along with her doula and take pictures. When I got there she was so peaceful and breathing beautifully through each contraction. There was no sign of transition until she was just about ready to push. I was once again amazed at how serene she was during back to back major contractions. Mama A delivered her baby vaginally on her own time without coached pushing. She did have a second degree tear that took a couple hours to repair. All this to say some things are just out of our hands. There comes a point in labor and delivery at which we meet the place where our desires end and birth takes over. Birth is beautiful even if it doesn’t end the way we planned. I think as long as we are prepared and knowledgeable and surround ourselves with love and support, we can achieve a positive outcome. Two days apart, two miracles were born, by two very strong mamas…one cesarean and one vaginal…both beautiful births that they both should be proud of…I know I am!

New ICAN T-shirts for sale!

In honor of Cesarean Awareness Month coming up in April, ICAN has a new T-shirt that you can buy to help raise awareness. Please check it out and consider making a donation as well. ICAN reaches women across the globe and empowers us all to know our rights and make informed decisions, money raised will help further spread that message.

https://www.booster.com/cesareanawarenessmonth2014

ICAN of Jackson, MS is pleased to announce our first two professional subscribers!

Mississippi Birth Collective
Email: msbirthcollective@gmail.com
Website: www.msbirthcollective.com
Services Provided: The MS Birth Collective strives to improve pregnancy, childbirth and the post partum period by creating a central database of Mississippi birth workers passionate about providing local birth related services.

Sunstone Birth Services - Susan Stonecypher
Phone: 769-232-9968
Email: sunstonebirth@icloud.com
Website: www.facebook.com/sunstonebirthservices
Services Provided: Professional birth doula and placenta encapsulation services in Central MS.
_______________________________________________________________________________
ICAN's Professional Subscriber Network includes doulas, CBEs, chiropractors, massage therapists, hypnobirth therapists, midwives...... Anyone who feels they have a service they can provide to pregnant women. To be eligible for this listing you must become a professional subscriber of ICAN. Please contact us if you wish to become a subscriber. You will be listed on our website as well as ICAN National's website, helping you reach more mothers.

ICAN's Professional Subscriber Network is a resource for consumers and for birth professionals.

The ICAN website gets between 4,000 - 5,000 hits per month, ranking high in browser searches for "cesarean" as well as "VBAC." Many of our initial contacts are from women seeking "VBAC-friendly" birth professionals. Our professional subscriber program connects women to birth professionals in their area that profess support for ICAN's mission. ICAN's Professional Subscriber Network also links to our searchable chapter feature further enhancing your exposure.


ICAN Professional Subscribers also receive:

•Discount to ICAN's conference

•10% discount at ICAN's bookstore

•Additional recognition in Clarion & Annual report

•Website Listing for one year


ICAN is a 501(c)(3) organization in the USA. Donations are tax deductible by most US taxpayers. Your subscription is tax-deductible to the extent allowed by law.

Disclaimer

ICAN's Professional Subscriber Network is intended as an informational resource for consumers. ICAN is pleased to pass along the names of professionals who have given us permission to release their names for referral. Please understand that ICAN is not a credentialing agency or a regulatory body. As such, we are not responsible for the competency of the professionals listed. Consumers are encouraged to take responsibility for their birth experience by informing themselves regarding the competency of those professionals that they retain. Asking questions, obtaining local references and understanding that you are responsible for your own choices by thorough reading and discussing care with other parents and care providers is essential and is your responsibility.

Two beating hearts...let's keep both healthy during pregnancy!

At February's monthly meeting we'll have a local Chiropractor joining us to field questions and discuss overall healthy in pregnancy, adjustments during pregnancy and the Webster technique used to help turn breech babies.

If you are interested in attending this meeting, please email: icanofjacksonms@gmail.com

Here's more information for keeping two hearts healthy during pregnancy:

Diet During Pregnancy: http://www.drbrewerpregnancydiet.com/id96.html

http://www.juiceplus.com/content/JuicePlus/en/clinical-research/expert-testimonials/pregnancy-nutrition--fruits-and-vegetables-for-a-healthy-pregnan.html#.Uv2hMGJdV8E

Exercise: http://www.birthdancing.com/

http://www.mayoclinic.org/prenatal-yoga/art-20047193

Webster Technique: http://birthwithoutfearblog.com/2012/07/10/how-the-webster-technique-can-help-you-birth-without-fear/

http://spinningbabies.com/baby-positions/breech-bottoms-up/305-body-work-for-breech

Birth Story/Cautionary Tale - first two births...Spoiler Alert: She had a VBA2C last month! (We'll post that story soon.)

My first birth story is not extraordinary. It's not unusual or unique. I don't say this to be self-deprecating. I say it to point out that, sadly, it's one of millions. It's happening every day. It's not a happy, exciting birth story and that's not because anyone did anything horrific or hateful or malicious. It happened because I didn't know that I needed to know more. I didn't know that when people say becoming a mother is like starting a new job and you need to prepare, they don't just mean for what in the heck you're supposed to do with the human they let you leave the hospital with. The job starts when the positive pregnancy test shows up. Well, I guess if you're really industrious you could start before that- but that's probably a whole other kind of blog post. Let's just say- you made a baby, now what are you going to do? How about you don't do what I did, very little. And maybe your birth story won't be the cautionary tale that mine is.

When I became pregnant with my first child, I didn't have a clue. I know most of us don't and this isn't a new theme but it is true. I spent 9 months planning the nursery, reading books about how to get my baby to sleep once it was here, and the obligatory What to Expect When You're Expecting. I signed up for updates from BabyCenter and enjoyed informing family and friends that my child was the size of a spaghetti squash that week. It wasn't that I thought I was above more research or that I was too lazy to do it. It's that I didn't know there was more to it than in the movies. I believed the stereotype of the woman's water breaking in the restaurant (I still REALLY, REALLY want my water to break in a restaurant, mall, grocery store- anywhere. I would settle for being with a friend when hers does,) the mad dash to the hospital while baby is about to crown, the screaming for an epidural and then the rapid delivery where everything ends in soft focus and a perfect baby. I took the childbirth classes at the hospital and learned a lot about how everything works at the hospital, if you fit a certain mold and follow a certain pattern. I basically tuned out during the cesarean section discussion because I didn't plan on having one. I even turned and whispered to my husband, "that will NOT be us." But I hadn't done anything to prevent that. In fact, the first decision I made regarding the birth of my child was made flippantly and with a laugh. I had been seeing an OB recommended by many who had delivered a friend's child with no problems. She was no longer delivering and I needed to pick a new doctor. When I got the positive pregnancy test we had been waiting on for 3 months, I called the OB's office and asked for the first appointment available. I didn't care who it was with- I just wanted confirmation of my pregnancy so we could tell our families. I figured we would decide who to go to later after I asked around. The first appointment was with Dr. P. He was funny in a sarcastic way. Very laid back and an incredibly dry sense of humor- it was almost as if he was bored. See how I typed that in red? Well, let's just call anything in red font a red flag. We joked a bit with him, told him we didn't plan to find out the sex and he said he really liked that because it was more fun for him too once the baby was born and it's rare that he gets to enjoy that these days. This made us like him, he was already telling us we were cool! We left the office and I said, "He is a big enough smart ass to be able to handle me when I'm in labor- let's stick with him." My husband agreed and we officially had a doctor.

My pregnancy progressed just fine. I am one of the lucky ones who doesn't have morning sickness and I was actually hard pressed to find some pregnancy symptoms to whine about for the entire first trimester. I WANTED something to complain about like everyone else who is pregnant so I made sure to lament my sore arches and introduction to what constipation is for the first time in my life. But other than that-nothing. I spent the rest of my pregnancy buying maternity clothes, gender neutral baby clothes, picking out suitable gender neutral baby bedding and nursery decor. I spent HOURS online one time in search of a light fixture, HOURS people! (I did finally find one that I loved so much- I made sure it was written into the contract when we sold out house that it would be moving with me, I still have it in my daughter's room today.) I assumed that the hospital childbirth classes would take care of all we needed to know and thought people who attempted natural birth were insane. Why would you do that if you didn't have to? I didn't think they were stupid or trying to one up everyone else, I just thought they must be scared of needles and didn't want to admit it.

I was due January 3. When my doctor told me my due date, I told him I had used ovulation predictor tests to conceive and knew for a fact that I didn't ovulate on day 14 the month we conceived. I ovulated on day 21, an entire week later so my due date should be January 10th. He said, "Well, my handy dandy little due date calculating wheel is based off of day 14 ovulation, don't make me argue with it. Due dates don't mean much anyway and first babies love to come late. You tell people you are due early January and call it a day." This kind of bothered me but I went with it. Ooooh how I wish I had made him change my due date in my chart.

Fast forward to my last month. My doctor was checking me and finding some effacement, no dilation, and the baby was high. I wasn't concerned-just ready.  The week between Christmas and New Years I had a sonogram at 38 weeks to determine baby's size and position. My baby was supposedly weighing 8 pounds 12 ounces already. I saw the nurse practitioner in their practice at that appointment and she declared me dilated to 1 cm. Yay! But then she started talking about how big the baby was and how I might want to start thinking about an induction or c-section. I told her flat out I wasn't having a section and that I would talk about an induction when my doctor was back in town. The next day I was getting my haircut when my cell phone rang with a call from my doctor's office. It was the scheduler calling to schedule my cesarean section, "What day would you prefer? Friday or Monday?" I was flabbergasted. I was barely coherent at first and then managed to get her to explain to me that the nurse practitioner had told her to call me to set it up. I said, "But I'm not having a c-section. I'm not even due yet! I never said I wanted a c-section." She was thrown a bit and just kept saying she was told to call and schedule it. I told her I had an appointment scheduled with my primary doctor for Friday and I would talk with him then and I would not be scheduling anything with her that day. I think I hung up on that poor woman who was just doing her job and following the directions of the doctors she works for. I started crying and called my husband. Full disclosure- I wasn't just getting a haircut. I was getting my hair highlighted. So I am wandering around the salon in a big black cape, over my big huge full term belly, with all my hair sprouting out of pieces of foil like a space alien. My stylist is trying to catch my eye to tell me I need to be shampooed now because my timer went off. I keep walking further away from her trying to get away from the hair dryers and sinks and noise to have these phone conversations- all the while my hair is chemically frying on my head! I have a quick conversation with my husband who talks me down off the ledge saying the nurse practitioner was confused and I don't have to do anything I don't want to and we will talk to my doctor in a few days and to chill out because it was just a scheduler doing her job- nobody was coming after me with a scalpel. I got my hair shampooed. It was not platinum white or breaking off from the extra long processing time. Thank you Lord for small mercies. It really looked pretty good actually.

I didn't tell anyone else about this phone call. I told my husband not to tell anyone else either. If the doctor's office thought I needed a section then I must have failed at this whole birthing thing and this was something I didn't want people to know. It was like being told, "You aren't going to get this right so let's cut our losses and get this over with. You can't do this." I know this is a gross overreaction to a call from a scheduler, which was made based on one person's directions after meeting me once when I wasn't even officially overdue yet- but I felt ashamed.

January 2, a Friday, I met with my doctor again. He said I was still not dilated at all. I asked how that could be since the nurse practitioner had said I was 1 cm? He said, "She has little skinny girl fingers, we are going by my fingers and my fingers say you might be almost 1/2 cm but no more." Then we discussed my sonogram. He was distracted, writing in my file and looking at his watch. My husband was with me at this appointment and we were both trying to get him to tell us something. He finally turned to us and said, "We are to the point of diminishing returns. You are not favorable to being induced because you aren't dilated much or effaced much, which increases your chances of a failed induction resulting in  c-section. But your baby is big and every day it stays in there it's getting bigger, which increases your chances of a c-section because you might not be able to push it out." And then I asked the question I wish I could take back with all of my heart. "So, what do you think we should do? What would you do if it was your baby?" He said he would schedule an induction.

We went in the night before for cervadil. Our families were all in town and more coming the next day. Everything was set. We even took my husband's laptop and the current season of Entourage on dvd to watch that night. We were so smart, we wouldn't be bored- so on top of this thing. The cervadil put me into back labor and upped the strength of the Braxton Hicks I was having enough to keep me from concentrating on the show. I didn't make it through one whole episode.

The night of discomfort only resulted in a 30% increase in effacement by the morning, bringing me to 1cm and 70% effacement. Between 6-7am my water was broken, painfully, (I was officially on the clock and needed to make progress that looked like I would deliver in 24 hours or less), and the pitocin was started. By 12:30pm I was contracting to the doctors satisfaction on the monitors, me and baby were picture perfect. I was feeling the contractions but could still totally function and pain relief was not on my mind yet. I didn't know any better than to just sit in bed waiting on things to happen. My OB came in and asked why I didn't have an epidural yet. I said I was fine and didn't want it to slow anything down. He checked me finding me dilated to 2/3, baby was still very high and not engaged at all. He said, "your contractions are pretty strong and you're not dilating enough, I think you're tensing up against them and you need your epidural to relax you and your cervix so you can dilate." I said I was thinking of going for a walk soon since I wasn't gushing fluid as badly anymore. He said no you need your epidural. So I got it. Now I am stuck in bed, with a baby still at a very high station and I can't do anything to help her move down. But I didn't know this- this was never covered in my hospital childbirth classes. I didn't know the combination of being induced, having my water broken, and being immobilized in bed with an epidural was the kiss of death to my vaginal delivery. Not. A. Clue.

At 2:30pm he came back to check me finding no change, not surprising since I was stuck in bed. He started talking section. My husband and I both asked if there was anything wrong with the baby? Baby's heart rate? My heart rate? Temp? Blood pressure? He said, "no y'all are both fine but you've been at this a while and the strength of those contractions means sooner or later one of you will get stressed and it's not going to be you." We went back and forth with him a bit more and I convinced him to give me an hour. But what can you hope to see change in an hour when you're stuck in bed and can't do anything to help the baby move down? Nothing. And he came back at 3:30 and found no change. My daughter was born at 4:16pm and my doctor was home for supper. I cried and cried and didn't want the section but didn't know anything else to do. I didn't know I had more options. I didn't know I could refuse. I just went along with it crying. So of course the anesthesiologists saw a crying woman and doped me to high heaven so I didn't freak out on the table. I had to fight to stay conscious. I had to fight to be present. I had to tell my husband I loved him but to please stop talking to me so I could focus and not throw up. I remember saying in my head "you are having a baby! Do not go to sleep! Do not miss this!" She was pulled out, my husband announced we had a girl and I cried more. They took her to the other side of the room to clean up and I gave myself permission to fade, to give in to the drugs making me so fuzzy. She didn't ever leave the OR and my husband held her while I drifted. She weighed 8lb 6oz, so unless she lost weight in the womb-the 38 week sonogram was very wrong. While being wheeled from the OR I said I needed to throw up and promptly did so into a kidney shaped basin pressed against my cheek. Ever wonder why those things are shaped like kidney beans? Because then they fit perfectly up against the face of someone laying flat on their back who can't get up to vomit. Maybe there's another reason for this but that was the one conscious thought that went through my head before they pushed more meds and I was out for the next hour. I woke up in recovery to see my husband standing over a bassinet and heat lamp talking to our baby. I said, "Well, if you're not going to hold her bring her to me!" He didn't know he could pick up his own daughter. I held her for the first time and she latched on but I was shaking so badly from all the drugs the nurse tried to take her from me. When I looked at her like I might hit her and said, "I am not going to drop my baby-we're fine," my husband said, "I'll hold her up to you, we've got it." And she backed away. It was the first time I stood up for myself and my child and have wished I'd done it hours before for years since.

Two years later I asked my new OB (we'd moved), about a vbac and he said it was against practice policy but IF I went into labor on my own, and IF he was on call (because he couldn't speak for the other doctors in his practice,) and IF everything went ok he would let me have a trial of labor. I didn't do anything else to encourage the success of a vbac. I just hoped it would happen, a lot. Again, I didn't know I should know any better. It was obviously a little 'out there' to even be asking for a vbac- so I didn't want to rock the boat too much... I just waited and hoped.

I reached 40+3 weeks and no dilation, little effacement, and baby very high-he said we could schedule a section for a few days later or my next appointment. I had no faith I would go into labor. I had no clue my baby was posterior and needed me to help her spin to be able to drop onto my cervix. I decided my body would never do what it was supposed to do, and I gave up. I scheduled my section for 3 days later-as a last ditch effort to give me a little more time but I didn't believe anything would happen. And it didn't. My second c-section was much better after a 'come to Jesus' talk with the anesthesiologist about how I didn't need any 'don't let this mama freak out on us' drugs or anything to relax me. I wasn't scared or nervous. I just wanted to be present and not loopy. He stood by his word and I was totally coherent the entire time. The whole experience was much better than my first, but I still grieved the loss of my vaginal birth, because NOBODY tries to have a vaginal birth after two cesareans-unless they are crazy or stupid. Or so I believed at the time.

Two more years later, I've switched doctors to an OB known for supporting vbac, who believes in it and in me and I'm planning a vba2c in December. I don't know how to fully explain what happened in those two years but I guess it could best be described as water on stone. I read a lot of natural birth blogs. I'll admit, I started reading them for the curiosity factor. Who are these people? Why do they do this to themselves? Whatever the initial attraction, it drew me. Slowly and surely, it started to make more sense. I was reading and believing 

Anyone who knows me could look at this picture and know I'm faking it. I'm fighting to stay awake, to pretend I'm happy- I'm about to have a baby! Of course I'm happy, right? When I see this picture I see a woman who has resigned herself to her failure and is trying desperately to fake it until she makes it. To put a smile on for the future days when she will look back at this picture with her daughter and tell her about the day she was born and needs to have something to show her it was a wonderful day! I still don't know how that conversation will go, but she will know she was welcomed with joy and love regardless of the mode of her entrance. I do know that by the time she is old enough to be planning the births of her children that she will know the mistakes I made and that I have done something in the years between to help change the atmosphere surrounding birth-and that I did it for her.

ICAN of Jackson, MS Meetings

We meet once a month in Flowood, MS.

Please email icanofjacksonms@gmail.com if you are interested in attending a meeting.

If you are unable to attend a meeting and would like more information, please email also. We have brochures we can mail and can provide further assistance specific to you.

Happy New Year!

If you would like to know where the ACOG stands on VBAC/TOLAC, please check out this post from Birth Without Fear: http://birthwithoutfearblog.com/2014/01/02/vbac-what-acog-really-says/

The article above includes the following:
Risks/Benefits of a Trial of Labor after Cesarean (TOLAC)
Success Rates
Who is a candidate for TOLAC
Management of Labor
and more...

If your provider doesn't "allow" patients to VBAC, find another provider. Don't believe the blanket statement, once a cesarean always a cesarean. Do your research, ask questions and be prepared to move on.

Movie Night

We had a movie night for our August meeting. If you haven't seen Organic Birth, you should! It is a very inspirational movie for anyone planning to have a baby. Please join us for our next meeting on September 26, 2013 at 6:00pm. We will have a special guest to field our questions reguarding VBAC and CBAC. Email icanofjacksonms@gmail.com for more information.

Be prepared. Ask questions.

Finding the right care provider is important with any pregnancy, but especially if you want to have a VBAC.  You need a provider who is experienced and knowledgeable and is truly supportive of your desires. Here are 18 questions to get you started (via vbacfacts.com):

What is their philosophy on going past 40 weeks? ACOG’s latest VBAC Guidelines, Practice Bulletin No. 115, (which from here on out I will refer to as “PB115″) states that going overdue should not prevent a woman from planning a VBAC.

What is their philosophy on “big babies?” PB115 states that suspecting a big baby should not prevent a woman from planning a VBAC.  Further, ACOG Practice Bulletin No. 22, which appeared in the November 2000 issue of Obstetrics and Gynecology, found no value in inducing for “big baby” since it simply doubles the CS rate and does not prevent shoulder dystocia or reduce newborn morbidity.  Nor do they support cesarean section for suspected “big babies:”

While the risk of birth trauma with vaginal delivery is higher with increased birth weight, cesarean delivery reduces, but does not eliminate, this risk. In addition, randomized clinical trial results have not shown the clinical effectiveness of prophylactic cesarean delivery when any specific estimated fetal weight is unknown. Results from large cohort and case-control studies reveal that it is safe to allow a trial of labor for estimated fetal weight of more than 4,000 g. Nonetheless, the results of these reports, along with published cost-effectiveness data, do not support prophylactic cesarean delivery for suspected fetal macrosomia with estimated weights of less than 5,000 g (11 lb), although some authors agree that cesarean delivery in these situations should be considered.

How many VBACs have they attended? Word spreads fast on pro-VBAC OBs.

Of the last 10 women seeking VBAC from them, how many had a VBAC? If it’s less than 7 or 8, I would ask what happened in those 2-3 labors that ended in a cesarean.  This would give you a great idea of how they manage labors.

Do they attend VBACs with an unknown or low vertical scar? PB115 states that an unknown or low vertical scar should not prevent a woman from planning a VBAC.

Do they have any standard VBAC protocols that differ from a non-VBAC mom? If so, ask what they are.  Compromises almost always have to be made in order to birth in a hospital.  If your care provider requires an intrauterine pressure catheter, you can read more about those here.

Under what circumstances would they induce a VBAC?  It is a myth that a VBAC mom should never be induced.  Inducing a VBAC mom increases the risk of uterine rupture which should be weighted against the reason for the induction.  “Big baby” (less than 11lbs) and “over due” (meaning you are 40 weeks, 1 day) are not legitimate, medical reasons.

However, if a medical reason for induction is present, women should be given that option rather than required to have another cesarean.  As Dr. Stuart Fischbein, a breech & VBAC supportive Southern California OB, recently shared on my FB page,

According to ACOG, prior low transverse c/section is not a contraindication to induction (other than the use of misoprostol [Cytotec]) so a foley balloon or pitocin may be used safely in these women. The problem arises when a practitioner does not believe in doing inductions on women with prior c/section. Despite the evidence and the ACOG clinical guideline the reality is that many doctors will just not want to deal with it.

If I was overdue and my care provider was concerned about the baby, I personally would request a biophysical profile to check on baby and as long as baby and I are fine, I would request to wait for labor to start instead of inducing or scheduling a repeat cesarean.

However, if my provider was unwilling to wait for spontaneous labor, or if there was a medical reason for the baby to born, and it was the difference between a VBAC and a repeat cesarean, and I had a favorable Bishop’s score (download the app), I would consent to a foley catheter or low-dose Pitocin induction (not Cytotec or Cervidil).  If I was induced with Pitocin, I would be comfortable with continuous external fetal monitoring (preferably telemetry – call the hospital beforehand to confirm that it’s not lost in a closet.)

What methods do they use? PB115 states “Misoprostol [Cytotec] should not be used for third trimester cervical ripening or labor induction in patients who have had a cesarean delivery or major uterine surgery.”

PB115 also said, “Induction of labor for maternal or fetal indications remains an option in women undergoing TOLAC [trial of labor after cesarean.]“

Landon (2004) reviews how uterine rupture rates vary by drug: 1.4% (N = 13) with any prostaglandins [such as Cytotec or Cervidil] (with or without oxytocin), 0% with prostaglandins alone, 0.9% (n = 15) with no prostaglandins (includes mechanical dilation with or without oxytocin), and 1.1% (N = 20) with oxytocin alone.  Women who were not induced or augmented had a rupture rate of 0.4%.  Overall, they found 0.7% of women experienced a true uterine rupture with an additional 0.7% experiencing a dehiscence.

Do they attend vaginal breech births? 3% of babies are breech at term, so it’s good to know what would happen if you were in that 3%.  Some hospitals do support vaginal breech birth.

Do they attend vaginal twin VBACs? PB115 states that suspecting twins should not prevent a woman from planning a VBAC.  Read stores of twin/multiples VBAC births.

How many uterine ruptures have they witnessed? This can be an indicator of their induction rates or simply how many VBACs they have attended.  It’s a numbers game.  The more births you attend, the more complications you see.

What kind of monitoring do they require? PB115 states, “Most authorities recommend continuous electronic fetal monitoring.  No data suggest that intrauterine pressure catheters or fetal scalp electrodes are superior to external forms of monitoring…”

CIMS asserts in Mother-Friendly Childbirth: Highlights of the Evidence,

Routine continuous electronic fetal monitoring (EFM), compared with intermittent auscultation, increased the likelihood of instrumental vaginal delivery and cesarean section and failed to reduce rates of low Apgar scores, stillbirth and newborn death rates, admissions to special care nursery, or the incidence of cerebral palsy.

In June 2009, ACOG released new heart rate monitoring guidelines where they affirmed,

“Since 1980, the use of EFM has grown dramatically, from being used on 45% of pregnant women in labor to 85% in 2002,” says George A. Macones, MD, who headed the development of the ACOG document. “Although EFM is the most common obstetric procedure today, unfortunately it hasn’t reduced perinatal mortality or the risk of cerebral palsy. In fact, the rate of cerebral palsy has essentially remained the same since World War II despite fetal monitoring and all of our advancements in treatments and interventions.”

What is their CS rate? This seemingly simple statistic is actually quite complicated. If they are a perinatologist who specializes in high risk births, then a higher CS rate would make sense, but for your average OB, going above WHO’s recommendation of a 15% cesarean rate could be a red flag.

As the 2009 edition of WHO’s “Monitoring Emergency Obstetric Care: A Handbook” states, “It should be noted that the proposed upper limit of 15% is not a target to be achieved, but rather a threshold not to be exceeded.”

Do they perform an automatic CS if waters have been broken for more than 24 hours, even if there is no evidence of infection and mom and baby are fine? If they say yes, this could be a red flag.

Do they have a time-limit on how long your labor can be before they c-section you? Generally, as long as mom and baby are fine, labor should be permitted to continue.

Do they require epidurals for VBAC? PB115 states that pain medication “for labor may be used as part of TOLAC, and adequate pain relief may encourage more women to choose TOLAC.”  One reason that some OBs require epidurals is because if they deem a cesarean necessary, you are already numb.

Do they require an IV or heplock? IVs can restrict your movement. A heplock means they put a line in your arm, but it isn’t connected to a bag.  Heplocks & IVs can be annoying and get you into the “patient” rather than “healthy, birthing mom” mindset.

Are you permitted to move and deliver in your position of choice? Laying on your back or the “on the edge of the bed with your knees by your ears” are great for their viewing, but may not be the most effective positions for you. It’s always nice to have options other than the standard birthing position, such as those demonstrated in this chart or using items like a birth/squat bar or a birth stool (which has the same concept as the bar, but you can sit) for delivery.

You might have to interview several providers until you find one who is truly supportive of VBAC. If you do find such a provider, refer all your friends, VBAC or not, to this provider so that they can reap the benefit of someone who supports non-interventive birth! I really think that true change won’t occur in the medical community in terms of supporting natural non-interventive birth and VBAC until the OBs and hospitals see their revenue decrease. For this reason, we all need to support OBs, midwives, and hospitals that support VBAC.

http://vbacfacts.com/2009/06/06/interviewing-care-providers-questions-to-ask/

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.