The Unnecesarean Birth Story: How It Might Have Been Prevented

Sweet mama Toki submitted her birth story for me to share, but when I read it, I felt the sadness amidst the joy of having a baby. I felt I needed to embrace Toki with much love, compassion, and support. And then came the outrage. I hear stories like these all too often, and every time I feel this way. I do not like to judge any provider or mama doing her best with what is known and faced at the time, unless I have been in their shoes...which is never. I know what happened was meant to happen, because it did; and I do believe it was a gift even though we do not always understand why, nor comprehend each of our soul's unique journey. Nevertheless, I told her I could only post her story if I could write how as a midwife, I would have dealt with a situation like hers, and she agreed I could add my editorial. My comments are based only what she reported. I am forever grateful to modern medicine when medical and surgical intervention are truly needed for serious illness or life threatening complications. But when they are used on healthy pregnant women having healthy babies, I speak up about avoiding unnecessary risky procedures and major abdominal surgery, I speak up about prevention, and I speak up to support mamas who have had such experiences. 

Mama said she was "tremendously scared about the entire pregnancy... It was my first and I was 38 years old. Everything was frightening to me including the tests, the OB visits, and the internal ultrasound! Mostly, I was afraid that something would happen to my baby. I was always in a state of worry. I worried about the heartbeat, if she was getting squished inside me... all those silly crazy things that we worry about!" When a mama has such anxiety and fears, it concerns me; they must be addressed comprehensively throughout the pregnancy, as they negatively impact labor, birth and life. Sometimes all that is needed is some education and calm reassurance; but in many cases, we need to take a look at lifestyle as a whole, ways to reduce stress and enhance a more relaxed inner world. I also draw upon many holistic modalities, depending on the needs of each individual.  I would definitely urge hiring a wonderful doula and taking my Love Your Birth online course!

But there are red flags here, that make me question the entire philosophy of maternity care that has become standard. Healthy women today over 35 are unnecessarily placed in a high risk category simply because of their age, and are scared into an array of testing to screen for problems. Looking for problems when there are none or there is a very low chance of having them, alone creates anxiety. Also aside from the prevalent horror stories of others who birthed in typical hospitals and the media hype and dramatization, many modern women have not been exposed to normal birth as women supported women during the process throughout history, before birth was moved to the hospital setting in the 1900s. There is much fear in the unknown. Another characterization of today's mom is disempowerment to a patriarchal system, placing full trust in technology and modern medicine rather than confidence in herself as a woman and the process of childbearing. That being said, we are a generation bereft of spiritual connection, with a false expectation of perfect outcome always, without tolerance or ability to cope with anything less.  

"Saturday morning, I wake up with this crazy urge. Pee. I get up, or rather I roll out of bed and head to the bathroom (I am on my 38th week of pregnancy). Everything goes as normal, so I head back to bed.

Check the time… it’s 3:30 am. I’m lying there WIDE awake at this point, just trying to flop around and get comfortable when I feel a small warm surge flow out of my “va-jay-jay”. Whoa... Felt like I went an extra tinkle, it happened before. No biggie. Then, this warm surge happens again and once more but on the latter, it was a wee bit more or a LOT more! I whack my partner on the bum and say, “I think my water broke!” Of course, I have no clue and I was freaking out. Normal, right?! I roll out of bed and the moment I stand up completely, a much larger surge flows out! Yet, I am still clueless and asking out loud if my water broke because, again, I am freaking out."

I do my part to prevent mamas in my practice from freaking out about a normal sign of labor, as I make sure they are well prepared about what to expect, and to embrace it with calm.  I want mamas to be empowered with the brilliant wisdom they possess within, so they are not clueless, so they do not become scared - but rather are excited about the adventure ahead. Also, at 3:30 am in the middle of the night, if the fluid is clear and all is well, mamas need to feel relaxed to go back to bed so they are well rested for the challenging work of labor.

"Could it be true? Is this really happening? I don’t know what to do, what to think and want dearly for this not to be happening. Back to the story, I went into the bathroom to see what this was and my bottoms were fairly soaked with a slimy type substance. And as I am standing there, more is coming out. By this time, my partner is up and waking my mom up because it’s time! I make the call to my OB office and they said for me to come in immediately."

To go the hospital immediately after suspected water breaking, without other signs of labor, is a set up for induction that often fails, resulting in a cesarean birth - which can usually be avoided if managed differently. That is what this mama was told by her obstetrician. Maybe the hospital or malpractice insurance has these policies. But this is not evidence based care. This is not in the best interest of mother or baby. Unless there is an emergency, something wrong or cause for concern, a reassuring phone call which includes basic assessment and guidance, would be all that is needed, with follow up in the morning after a night's sleep. I also like to make sure it was not simply the outer bag of fore waters that commonly breaks prelabor - which is often mistaken for the main sac of amniotic fluid.  Babies are double wrapped in the chorion and amniotic membranes. There can be up to 2 tablespoons of fluid between them, which can make a pancake size stain on mama's clothing, if the first outer sac breaks. If indeed it was the main inner bag of amniotic fluid that broke, there is usually a puddle, or as if you poured a few cups of water on your pad, panties, or surface beneath you; and that puts mama on the clock to birth before a certain time in which the risk of infection increases. But there is time to wait for mama to go into labor as most do, and natural remedies to try before rushing to medical treatment. There is time in the morning to discuss the pros and cons of watchful waiting versus induction in the hospital, for informed decision making.

"I change while my mom is getting ready and I am standing there chanting, “I can’t do this, please, why did I do this to myself, I don’t think I can do this!” Over and over… Side note: I was saying why did I do this to myself because I went through a IUI process to become pregnant. If you are interested, you can read my pre-pregnancy story here - https://www.rockthebabybump.com/intrauterine-insemination/ "

I do wish I was in mama's range here, to whisper repeatedly "Yes you absolutely CAN do this, like the billions of women who birthed before you. since the beginning of time," and remind her of her capacities when she doubted it.

"My mom, just listening to me, says, “Get in the car because I am not calling the wammbulance to come get you.” Yes, mom, real funny. Oddly enough, amongst all my chanting and on the drive, I was feeling NO pain. When I calmed down, I was still feeling nothing. The car ride was filled with even more chanting and just talking to myself about how I can’t believe this is happening. My mom, just smiling.

At The Hospital!

We get to the hospital and check in. At the hospital, everyone is being so nice. Too nice. I wasn’t expecting this kind of treatment. I actually didn’t know what to expect. All the nurses were just making sure I was as comfortable as possible. (Emerson Hospital in Concord, Ma. was where I had my baby girl.) My OB came in, did the ultrasound and tested my amniotic fluid. It’s a GO! Next I am being hooked up to all the many monitors to make sure the baby has a heart beat and mine hasn’t exploded! Next, they need to know how far along am I. Pelvic exam. Let me preface this by saying I am NOT a fan of pelvic exams. Who is? But for me, it’s just not a happy time for me. Painful."

The evidence does not support internal exams prior to labor, in a healthy women whose main bag of amniotic fluid has broken and the amniotic fluid has released. The word broken implies something is wrong that needs to be fixed, when it is all as right as can be. Internal exams increase the risk of infection, which is what we want to avoid or at least minimize. Especially when such a woman who is not having surges or waves of contractions looks this happy, I do not need to do a pelvic exam to determine what is going on.  She is not in labor.  Period. I do like to confirm that the main bag is intact or not and releasing clear amniotic fluid (this can often be done by history and assessing fluid on the pad), there is no sign of infection and check baby's heartbeat, but there is no need for ultrasound. Basic hand skills to assess the uterus and baby via mama's belly are sufficient...unless there is a concern.

"So when it came time to see where I was at in dilation, well it wasn’t pleasant. My OB attempted the exam and an epic deathly scream filled the air. Failure. My OB walked right out of the room saying only, “get the epidural!”. She stated I was NOT dilated past 1 cm. As a result, the nurses had me going through a 10 hour regime of walking, squatting, bouncing on a medicine ball, hugging that medicine ball and just trying everything under the sun to get my body to dilate. Not happening. After all was said and done, I never dilated."

I value talking to the moms in my care as human beings, and discussing my findings and possible options with them. And there is no failure in labor. Zero. I cringe at the word. I would not expect you to dilate when you are not having waves of contractions/expansions, and I would not expect you to go into labor under this stressful pressure. Animals in the wild do not labor well when afraid or stressed, nor do humans. The mind and body are intricately connected. And the facts speak for themselves. Here is an anxious first time mom whose main bag of amniotic fluid has released presumptively, and is not yet having other signs of labor. Normal findings. Go home (even if you are planning a hospital birth) and do what you can to relax, cuddle, have fun, eat, drink, stay active but make sure to rest, prevent and monitor for infection. Most mamas go into labor naturally within 24 hours, a small percent by 48 hours, rarely longer. This is what you can do to help bring it on. These are the risks and benefits of watchful waiting versus medical induction. And we stay in touch.  

"Leading up to getting myself and the epidural ready, I was being induced with Pitocin. (My water broke only but I was not in labor. If that is even possible?!). With being induced, I started to feel the twisting and straining of labor. Not bad until the dosage was being raised higher and higher and then the pain. I was then offered, laughing gas. Never heard of this and surely didn’t think this would ever work for the pain of labor. I had a myriad of questions about this but the main one, will this hurt my baby? They assured me that inhaling this does not hurt the baby but helps with the pain. I was given the mask and told to breathe it in very deeply. I remember taking 3 deep breaths in and on the third I felt my entire body just instantly relax."

Yes, mama, it is normal - sometimes your water breaks before labor. And now there is the medication Pitocin creating contractions that are more painful than natural ones. Natural oxytocin secreted in labor stimulates the top of the uterus to contract so the bottom part, known as the cervix, thins and opens for baby to be born; this also leads to the production of opiate like hormones, beta-endorphins, that naturally lessen pain and produce a high that is reported after natural childbirth. The natural hormonal balance within the bodies of mama and baby has been disrupted here. There are serious short and long term consequences to this disruption that are downplayed and even disregarded by many in the medical world. For a wonderful discussion about the hormones of labor and the importance of not disturbing them, check out this amazing book by physician Dr. Sarah Buckley. ->

"My hand holding the mask dropped and I began to literally laugh. Laugh in a tone I have never heard before. So loud that the nurses had to ask my mom if this was normal! It was not normal, I could not control this screeching high pitched laugh at all. I had NO control over my body. It struck me as so funny that I could not control a thing and felt so relaxed... I was just as fine as can be with no pain. All I could feel was extreme pressure.

By then 15 hours passed, exhaustion set in and I was asked that dreaded question (meaning I knew it was going to be a c-section), “Do you want to have this baby?” I replied, “Yes.” I was truly and utterly exhausted, though. So it began, the preparation for getting ready for the c-section. Just breath, the anesthesiologist said right before he slid the needle in my lower back. I didn’t jerk nor did I feel any pain. Just a prick. Felt like a rush of cold water flowing down my back but from the inside. Almost immediately my legs went limp and felt as if they weighed 100 pounds each! It was the oddest feeling to see my legs yet couldn’t move them or have control. While the team was prepping for the procedure, I started to regain feeling in my right leg. Not sure why but the anesthesiologist had said that my spine was twisted slightly in the middle of my back. So right before I was taken into the birthing room, I had ANOTHER epidural done. I was completely numb at this point. My legs felt like lead weights, made me laugh that I could not move them no matter how hard I tried."

The cascade of interventions had already begun when admitted to the hospital. I am not surprised about the cesarean. Mama was not given much of a chance, even to have a vaginal birth. Of course she was exhausted. She had been up since 3:30 am and scared. 15 hours in the hospital under this duress probably seemed like forever. I totally get why mamas in this position just want it over with. 

"Into the operating room I went with only my partner. Upsettingly, my mom was not allowed in the room. It was a small room with white walls and 1 door in and out. I had one hand on my OB, the entire time. I was scared and felt so alone…I was also administered a spinal tap at this point. I was so out of it by now that I didn’t question why I even needed that… as well as why I needed morphine."

I am a huge advocate of what is termed the gentle cesarean, in which humanity is restored to the operating room. More and more providers are doing it. Mama can have her so needed support with her, and in this case, would include her mom as well as her partner. No mama should feel scared and alone, especially during a surgical birth. The drapes are lowered so mama is involved and can see her birth, baby is supported in gently emerging on its own from the incision (to simulate passage through the birth canal), into mama's hands and skin to skin bonding. Baby is allowed to receive the cord blood via delayed optimal clamping, and early breastfeeding is encouraged.   

"What I Was Feeling?

I felt so drugged up and my mind was just so distant. I felt alone and so very nauseated. I was throwing up the entire time. Especially during the c-section. The only things I was feeling physically were the shaving, the harsh pushing (she was pushing hard on my chest for a while, knocking the air our me moments at a time) and a vacuum of sorts (for the blood I am guessing).

What Was I Hearing?

The first words I heard from my OB was, “Look at all that hair!”. Yes, she had a full head of hair. Then moments later, I hear my daughter's first sounds… her cry. The most beautiful sound I heard and I just lost it. I started asking for her and crying uncontrollably. I couldn’t see anything but my blue tarp! Then she came around the side and was brought right to my face to kiss, feel and just love. I almost don’t remember after this. I also never got skin to skin right away either. I felt so sad because they took her away and I didn’t see her for almost 45 minutes later. I was also so exhausted that I think I was sleeping most of that time, I was in and out. Granted, post birth, the doctors had to stitch me back up, make sure I was ok and clean up but I figured I would get some time with her right away. I felt a bit of a disconnect. Is that normal?"

Yes, sweet mama. It is totally normal and expected to feel this way, given what you went through. Aside from the powerful obvious effects of the medications, the delicate natural hormonal balance within your body, responsible for bonding and attachment has been disturbed. When you are given the medication Pitocin, it suppresses your own production of oxytocin, the love, bonding and attachment hormone. You can certainly compensate with breastfeeding and skin to skin bonding time as much as possible postpartum. But this explains why you felt disconnected at the time. Pediatrician Dr Sears gives some helpful suggestions here.  You CAN heal... which may take some time and lots of support. But there is no place for shame and negative self judgement. You ROCKED your birth like a rockstar, despite being challenged to the max, and this is something to be immensely proud of. You have the strength of a warrior, strength YOU possess and can draw on forever. 

"Overall, after all was said and done my little girl was healthy and well, just wanted to sleep. The next 5 days were of recovery and just learning the ropes of motherhood. I am sure that the mommy reading this knows all the highs as well as the lows. For having a c-section, I couldn’t get out of bed for the first couple days, so thankfully my mom was a huge help with feeding, changing and caring for my baby…I also got extremely nauseated and had vomiting for the first day post birth as well.. I couldn’t eat anything. Just drink water. BUT loved all those nurses, all hours of the night, who brought my pain meds every 4 hours because healing from this was extremely painful. But amongst all that pain, I had no feeling in my legs for a long while but I noticed they were put into a compression device, constantly being massaged to keep blood flowing for a good 24 hours post birth. It did feel good and after the feeling came back into my legs I was instructed to begin walking around… noting that my feet would most likely begin to swell. It was a double edge sword here because when I would walk, my feet became so swollen that it merged with the width of my calf! Then they told me to put my feet up but yet I was supposed to be walking as much as possible. That double edge sword.

Home

After this week at the hospital was over, I headed home with my new baby girl and began a life changing feat that I just absolutely love. Well, sometimes.

Anani Pearl 7 lbs. 9 oz. 20 inches long

My name is Toki, mommy of Anani. Thank you for being a part of my little story… for me mothering will always involve long hours, heavy physical work and the type of worry that could bring down an elephant if put into a dart gun. I'm here to cultivate a sense of inner support to calm our mini little storms. You can read more about me and my family here: www.rockthebabybump.com ."

Toki, you are one amazing woman! Thank you for sharing your story and for allowing me to use it to raise awareness, empower and support other mamas, and do my part in helping to lower our country's soaring rates of cesarean births, especially those that could be prevented. Rather than creating more fear, I want to create more voices, who speak up respectfully in knowledgebale support of themselves, their babies and their families. Thank you for creating a blog to support other mamas.  

Let Me Help You Create The Happiest Birth Experience Of Your Life...

Whether you're a first time or experienced momma, planning a VBAC

Or a midwife, doula, or birth professional guiding mommas..

Regardless if you are intending to birth at home, a hospital, a birth center or need a cesarean section, or if you are taking another childbirth education class…

You Really Can Create The Delivery Of Your Dreams, ROCK your VBAC

And have a blissful birth wherever you are.

More Precious Than A Wedding...A Birth Should Be A Celebration!

Let me show you how to…

Image by Megan Hancock Photography

• Understand the sensations of your body and connect your intuition with how your body is communicating and leading you towards what to do during labor

• Tap into your inner calm to deeply relax yourself,letting go of busy, stressful and fearful thoughts on demand for the health of baby

• Speak your truth from your heart in a way that deepens your relationships, sets clear boundaries, and has people listen to you and support you before, during and after pregnancy

• Trust yourself, connect with your body wisdom andcommunicate with baby in belly

• Connect with natural time and sync your body and mind up with your unique biological clock for ease from pregnancy to postpartum

• Reprogram negative patterns, stories, and beliefs that undermine your confidence, strength and self trust so you can rock your birth

Physicians and midwives around the world recommend my teachings to their pregnant clients and many Doulas across the country learn the secrets of blissful birthing from me to supplement their Doula Training & Certification process!

To learn more, visit:  LOVE YOUR BIRTH Online Childbirth Course!

It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy. 

 

Get a 10% discount on your Sleepod purchases at askrembla.com

-use the code SWEETHOME to get your discount. 

I am passionate about changing lives. This 44-day course is changing lives. Vital Mind Reset is a program that will hold your hand and help you heal your life without a prescription. It will also introduce you to a community of people just like you – all working to transform their lives and revive their power and joy. Be a part of this community. Be a part of something greater and get yourself back! This course is a must, by renowned holistic psychiatrist Dr. Kelly Brogan, author of NY Times best seller 'A Mind Of Your Own', a dear friend and trusted colleague I can vouch for personally and support whole heartedly.

The Homebirth Midwifery Model of Care

           As a certified nurse-midwife with a full-scope group homebirth midwifery practice,  I am often asked what the homebirth midwifery model of care actually is.  I can speak for my philosophies, which are shared in general by many of my colleagues. We provide prenatal, labor, delivery, postpartum and newborn care, as well as breastfeeding support for healthy low risk families planning to give birth at home; we also provide gynecological and some primary care services to well women. We offer a unique, comprehensive model of maternity care that provides an exceptional level of holistic support and services to achieve optimum health. We believe there are several ingredients that contribute to a deeply positive and healthful pregnancy, homebirth and postpartum experience, in addition to our midwifery care. These include wholesome nutrition, whole food supplements and healthy joyful living, relevant health education with books, movies and childbirth classes, connection with a supportive community, regular exercise as well as an ongoing practice of yoga and meditation and other such methods to reduce inner stress and increase inner calm; we often draw on the expertise of additional professionals, such as doulas, childbirth educators, lactation consultants, acupuncturists, massage therapists, chiropractors or osteopaths, and mind/body medicine practitioners to name just a few. We also encourage each woman and partner to take advantage of the many classes and support groups we recommend  – from prenatal yoga, yoga for labor workshop, and postpartum mommy and me yoga classes, positive birth story pregnancy circles, community new mother blessing ceremonies, annual family reunion, postpartum mom circles, pregnancy retreats and a variety of other educational, supportive, and fun events, classes, and ways to connect with other likeminded people and build community – in an effort to bring back the needed village it takes to raise a new baby, and new parents.

           While we continue to expand in our academic, clinical and intuitive knowledge and wisdom, we are also growing in understanding, appreciation and awe of the sanctity of life and its many facets, transitions and phases. Most women are candidates for midwifery care and homebirth; over 92% of pregnant women in our practice will have a homebirth, and we maintain a cesarean section birth rate of less than 5%.  Ongoing individualized care determines the needs of each childbearing family. We have developed practice guidelines in conjunction with other homebirth midwives, evidence based research and the current midwifery literature; they reflect our philosophies and professional standards for practice, and they are reviewed and evaluated periodically as needed. We follow these practice guidelines to protect the health and safety of each individual in our care; and we try our absolute best, within our human capacity, to give our utmost attention and care with integrity, honesty, and heartfelt commitment and dedication.

Photo by Niki Torres

            We firmly believe that pregnancy and childbirth are normal natural bodily functions, profoundly spiritual, truly inspiring and an empowering rite of passage for women and their families. We also believe that childbearing families are best served by caregivers who promote and encourage a loving, respectful, supportive, family-centered environment, and maintain trust and calm confidence in the normalcy of the process, until proven otherwise. We have taken and will continue to take every reasonable precaution to ensure safety, comfort, and deep satisfaction, which are our top priorities. A safe and wonderfully positive birth experience requires the joint cooperative efforts of both the expectant family and health care providers, with a relationship based upon good open communication, mutual respect, and shared responsibility. Education of women and their families is an integral part of our services, so that women are able to assume this responsibility for health maintenance and effective utilization of health care. Opportunity is offered to our clients to participate in the planning and implementation of their care, as emphasis is placed on an outcome that satisfies emotional, educational, family and spiritual concerns beyond the obvious physical needs. 

           We feel that every individual has the right to safe and satisfying health care by the provider of their choice, given with respect for personal preferences and cultural variations. We believe that normal, healthy women have the right to birth at home if they choose to do so, and as licensed practitioners, feel an obligation to make birth as safe and satisfying as possible for them. For the overwhelming majority of families, the childbearing experience is one of health rather than illness, and there is a need for preventative and loving supportive care that is not only safe, but also sensitive, compassionate and empowering. We believe in enhancing the normal processes of the female reproductive cycle, pregnancy and birth through education, physical and emotional support, and involvement of significant others according to the choices of each expectant mom and those she chooses and wants to be involved.

            Our responsibilities include review of each woman’s complete health history, physical examination findings, and lab results to determine her eligibility for continued midwifery care and homebirth, as well as ongoing evaluation and guidance throughout pregnancy, labor, birth and postpartum with attention to signs of normalcy and/or signs of complications.  All findings are discussed openly; and there will be no routine procedures or interventions unless medically necessary and mutually agreed upon. While childbearing is a healthy, normal and natural process for the vast majority of women and babies, problems can infrequently occur, and need to be recognized and attended to. Although many complications can be prevented or handled simply within our practice, some do require consultation with a collaborative physician or transfer to medical and hospital care to increase the likelihood of a safe outcome.  It is our philosophy that decisions regarding each woman’s care are informed and collaborative, and ultimately hers to make; however, rare emergent situations may arise in which the professional judgment of the midwife and/ or consulting physician must be relied on exclusively for the safety of mother and baby. We are grateful for life saving hospital medical and surgical care when there are serious complications and illness; and it is my hope that the homebirth midwifery model of care can be applied as much as possible in all birth settings, including the operating room, if surgical birth is needed.            

           There is an overwhelming cultural belief in the United States that hospitals are the safest place to give birth, regardless of the extensive scientific data that planned homebirths with skilled midwives suggest otherwise. Numerous studies around the world have documented the safety of planned homebirth by trained professional midwives, with outcomes at least as good, if not better than those occurring in a hospital.  This is especially true of women who have delivered vaginally before. The total slight increase newborn mortality risk of home birth is estimated to be 10 per 10,000 babies born at home, and that 1 in 1000 babies born at home may be adversely effected by the extra transport time in reaching advanced care in the hospital; the absolute risk is small however. Despite spending the most money on obstetric care, the United States ranks among the lowest of industrialized countries around the world in neonatal mortality and morbidity, and ranks quite low in maternal mortality and morbidity as well. Countries that consistently demonstrate the best maternal and newborn outcomes have a large percentage of midwife led maternity care for healthy women experiencing normal pregnancies - which constitutes the vast majority - a higher percentage of homebirth midwifery care with supportive hospital/medical transfer arrangements when needed, while the obstetricians attend to the women with high risk complications and serious illnesses, which is how they are educated as surgeons and medical doctors.  When midwives and obstetricians work together as a team, both using their unique skills, knowledge, expertise and training, the outcomes for moms and babies are far superior. Midwives are trained in guarding the normalcy of pregnancy, birth and postpartum, not disturbing it when all is well, knowing when to compassionately observe with loving support, and when and how to use holistic remedies, or medical intervention only when necessary as a last resort; they are also educated in prevention, assessment and treatment of complications, which most times can be managed simply and naturally, but sometimes involves consultation or referral to an obstetrician. Although unforeseen events and emergencies can occur in any birth setting, some of which can be best handled in a high risk hospital, a low risk healthy woman entering the typical U.S. hospital expecting a normal vaginal birth is subjected to a routine barrage of procedures and interventions that dramatically increase the risk of complications and problems, with potentially longstanding physical and emotional ramifications for both mother and baby. 

            There are many other benefits of homebirth midwifery care, in addition to safety, which provides an alternative to the impersonal, fear based, law suit prevention oriented medical and hospital care that has become prevalent in our society. These benefits include but are not limited to the power of the human touch and presence, of being surrounded by supportive people of a family’s own choosing, security in birthing in a familiar and comfortable environment of home, feeling less inhibited in expressing unique responses to labor (such as making sounds, moving freely, adopting positions of comfort, being intimate with her partner, nursing a toddler, eating and drinking as needed and desired, expressing or practicing individual cultural, value and faith based rituals that enhance coping) -- all of which can lead to easier labors and births, not having to make a decision about when to go to the hospital during labor (going too early can slow progress and increase use of the cascade of risky interventions, while going too late can be intensely uncomfortable or even lead to a risky unplanned birth en route), being able to choose how and when to include children (who are making their own adjustments and are less challenged by a lengthy absence of their parents and excessive interruptions of family routines), enabling uninterrupted family boding and breastfeeding, huge cost savings for insurance companies and those without insurance, and increasing the likelihood of having a deeply empowering and profoundly positive, life changing pregnancy and birth experience. Getting holistic prenatal through postpartum care and birthing in one’s own home attended by a skilled midwife, is a refuge for those who want to protect the normalcy and sanctity of pregnancy and birth. But focusing on the normal does not mean that problems go unrecognized or unattended; rather they are viewed as imbalances that need to be righted, not expected or feared. 

           That being said, certain hazards do exist however, in all settings, whether childbirth occurs in or out of the hospital; and there are risks unique to each setting.  Some of these risks will never be eradicated no matter what our state of technology or medical advancement. The safety of home birth is well documented, but childbirth by its nature is a threshold passage for the mom, and the baby.  Some babies are born with defects and injuries despite all the technology, tests, and skills of the attendants.  In spite of the fact that that hospitalization of birth has failed to eliminate fetal or neonatal death, there is a cultural expectation that doctors and hospitals can guarantee a “perfect baby” every time. This is a pervasive myth. It is impossible for any provider to guarantee much of anything. Birth defects may or may not be detectable by prenatal testing. The practice of midwifery, nursing and medicine are not exact sciences and no assurances can be made regarding the results of examinations, diagnostic tests, treatments, procedures, or interventions. It is impossible for any provider to guarantee a normal healthy birth, mother or baby. Part of the wonder of the miracle of birth is the inherent lack of guarantees in life and birth, and the surrender to a power far bigger than ourselves. Part of life is death, and we often do not know why a person lives or dies. We do have a spiritual perspective, and believe that while we can do our best to do what is humanly possible, most of life, birth and death are ultimately not in our control; we do believe that everything that happens is meant to happen, because it did, and that it happened for our benefit, even if beyond our understanding, as we are souls temporarily residing in bodies, and know that G-d/Spirit of our own understanding is only good. Conception is the beginning of life, yet every life must end sometime.  Part of pregnancy is the excitement of new life and the fear of its loss. This is normal human reality and is in part why pregnancy deepens and matures a woman and man spiritually and emotionally.

Art by Spirit Y Sol

Photo by Megan Hancock Photography

           We try our hardest to give the best care that we possibly can, pray we make the right decisions and that our hands are blessed. But we are all only human.  Midwifery and obstetrics are such humbling professions. And I would choose no other. 

Let Me Help You Create The Happiest Birth Experience Of Your Life...

Whether you're a first time or experienced momma,

Or a midwife, doula, or birth professional guiding mommas..

Regardless if you are planning a birth at home, a hospital, a birth center or need a cesarean section, or if you are taking another childbirth education class…

You Really Can Create The Delivery Of Your Dreams.

And have a blissful birth wherever you are.

More Precious Than A Wedding...A Birth Should Be A Celebration!

Let me show you how to…

• Understand the sensations of your body and connect your intuition with how your body is communicating and leading you towards what to do during labor

• Tap into your inner calm to deeply relax yourself,letting go of busy, stressful and fearful thoughts on demand for the health of baby

• Speak your truth from your heart in a way that deepens your relationships, sets clear boundaries, and has people listen to you and support you before, during and after pregnancy

• Trust yourself, connect with your body wisdom andcommunicate with baby in belly

• Connect with natural time and sync your body and mind up with your unique biological clock for ease from pregnancy to postpartum

• Reprogram negative patterns, stories, and beliefs that undermine your confidence, strength and self trust so you can rock your birth

Physicians and midwives around the world recommend my teachings to their pregnant clients and many Doulas across the country learn the secrets of blissful birthing from me to supplement their Doula Training & Certification process!

To learn more, visit:  LOVE YOUR BIRTH Online Childbirth Course!

It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy. 

Amazon Block

Search for an Amazon product to display. Learn more

VBAC - A Hot Topic

PHOTO CREDIT - THE UNISON PHOTO CNM

Correction - ACOG is the American College of Obstetricians and Gynecologists; ICAN is the International Cesarean Awareness Network

VIDEO IS NOW HOSTED ON MY LOVE YOUR BIRTH ONLINE COURSE

What is a VBAC?

A VBAC is a vaginal birth after cesarean.

If a woman has had a cesarean and wants to plan a vaginal birth for her next, it would be considered a VBAC.

Cesarean Surgery

Cesarean section is major abdominal surgery that involves serious potential risks for both a mother and her baby.

When medically necessary, it can be life-saving. I am very grateful for this. And it is still of course a birth to celebrate.

Unfortunately, cesareans have become so routine. I believe women are not given the opportunity to explore all their options and are not offered education and empowerment to have a vaginal delivery after a previous cesarean, other than a repeat cesarean birth, if that is their choice.

Statistically, the United States ranks among the highest in the world among cesarean rates. It’s approximately 30% and rising.

It’s as high as 40-50% in some areas near to where I live, and this is absolutely unacceptable.

Benefits of a VBAC

There are many benefits to a VBAC. These are physical, emotional, mental, and spiritual.

These are only a few important benefits on the long list:

• No risks from major abdominal surgery. This is huge.  Unfortunately, a cesarean can lead to trauma to the internal organs or reproductive tract, risk of hemorrhage, complications with scar tissue, long term post operative pain, wound infection, blood clots, stroke, and possible respiratory problems for the baby. High rates of cesarean section contribute to high rates ofmorbidity and mortality – and this is occurring in modern countries such as the US, which ranks among the bottom of them in terms of outcome stats.

• Easier postpartum healing and recovery.

• Baby receives needed bacteria for optimal health, from mother when passing through the vaginal birth canal.

• Breastfeeding may be more successful

• No potential harm to future fertility.

• Feeling more positive about the birth experience

• Increased sense of empowerment.

• More involvement of family and support people.

• Less risk of postpartum depression and emotional birth trauma.

Image by midwife @lindseymeehleis after mama's triumphant and healing VBAC.

Major Health Care Regulators and Advisory Organization Support VBACS

Most major health care regulators and advisory organizations like the World Health Organization encourage VBACS.

“The World Health Organization recommends that the caesarean section rate should not be higher than 10% to 15%. According to the Society of Obstetricians and Gynecologists of Canada (SOGC), vaginal delivery represents the safest route for the fetus and newborn in the first and subsequent pregnancies” – World Health Organization website, http://www.who.int/bulletin/volumes/85/10/06-039289/en/ This is generous, as when cesarean section was originally implemented, it was intended to serve 5% of the birthing population – those with serious complications who really needed surgical intervention.

Also encouraging of VBACS are the American College of Obstetricians and Gynecologists (ACOG) (link to their website: http://www.acog.org/ , The National Guideline Clearinghouse https://www.guideline.gov/  ,  Agency for Healthcare Research and Quality, and the American College of Nurse Midwives

No words can describe this amazing mama's feelings after her VBAC, captured by @skyla_walton

“The AAFP strongly recommends that clinicians inform women who have had a prior vaginal birth, either before or after a prior cesarean birth, that they have a high likelihood of VBAC. Unless there are specific contraindications to a vaginal birth, these women should be encouraged to plan a labor and VBAC and should be offered referral to clinicians and facilities capable of providing this service, if it is not available locally. (Quality of Evidence: High)” – Source: The National Guidelines Clearinghouse website https://www.guideline.gov/summaries/summary/49115/clinical-practice-guideline-planning-for-labor-and-vaginal-birth-after-cesarean?q=vbacs

In most cases, a VBAC is a safe option.

I share the opinion of many concerned with improving maternity care and reducing our rising rates of maternal and newborn death and serious health consequences from the interventions in childbirth, that a woman should not be forced to have a major surgery against her will, rather provided research and empowered to make her own decision, considering she is having a healthy pregnancy.

AAOG removed the previous unreasonable restriction requiring immediate availability of a surgical staff for an emergency cesarean, as most hospitals around the country, let alone free standing birth centers and home settings, do not meet this criteria. Most hospitals are not able to have a surgical staff at all times and cannot perform an emergency cesarean in under 30 minutes.

Despite this, research is showing that far too many obstetricians do not offer VBACS. They routinely recommend repeat cesareans because they may fear law suits, succumb to scheduling pressures, have restrictive hospital or malpractice insurance policies, and/or feel pressured to uphold certain standards among their colleagues who are not supportive of VBAC. The hands of a midwife whose collaborative obstetrician and hospital do not support VBAC can often be unnecessarily tied as well for these reasons. Most repeat cesareans are not actually medically necessary, and are commonly recommended due to various non-medical reasons. This is very concerning.

What also concerns me is that the risks of a VBAC are magnified in conversation with women, while the risks of a repeat cesarean are downplayed, so women may feel forced, afraid and powerless.

I want women to feel like they have a voice.

Some women who want to VBAC have limited options and local doctors in the area are only offering cesareans. Some feel they have no option other than having an unattended homebirth, or labor alone at home until the last minute without any monitoring, or not be truthful with their providers about their previous cesarean birth – all of which can increase the risks for her and her baby.

A trained and experienced midwife who is continuously with the woman in active labor, can detect concerning signs and symptoms before they can become a crisis, and she be transferred and treated in time to save her and her baby’s life and heath.  A midwife wears many hats, one of which is protecting the space so the natural process of birth can proceed with ease and grace, and another is a lifeguard – to know when and how to intervene to prevent problems or manage emergencies.  There are many wonderful obstetricians supportive of VBAC who have this training and style of practice as well; they are just harder to find.

What are the chances of having a successful VBAC and who is a good candidate for a VBAC?

The stats range that 60-80% of women, who have had previous cesareans, are candidates for a successful VBAC. In actuality, most healthy pregnant women carrying healthy babies are candidates.

The chances of a successful VBAC are higher if a woman is using a midwife, even higher in free standing birthing centers and home settings.

Above photos of rockstar mama's VBAC are by @karinariveraphotographer

Going to a hospital and working with an OB/GYN with high cesarean rates, will increase the likelihood that a woman will have another cesarean.

In some hospitals, there are a lot of restrictive procedures, like continuous electronic fetal monitoring, confining a laboring woman to lay in bed, not allowing her to eat or drink, routine IVs and time limits, which increase the risk of a cesarean.

What is the main risk of a VBAC?

The risk of separation of the prior uterine scar is approximately 2 in 1000 VBACs, but often it is a mild superficial dehiscence (slight separation of some layers of the surgical wound) that has no clinical significance and does not impact the health of mom or baby. The risk of severe life-threatening emergency from a partial or complete uterine rupture of all the scar layers is significantly lower – a highly unlikely occurrence, significantly less than 1 %.  The main risk is of a VBAC is this rare catastrophic rupture of the previous uterine incision. This rare total disruption of the uterine scar risks both the mother and her baby, and can lead to catastrophic outcomes. It cannot be ignored and must be monitored for appropriately; but it cannot be exaggerated or make the risk of repeat cesarean less alarming.

Although every decision has risks, a VBAC is a reasonable, appropriate and safe option. If a woman panning a VBAC decides to give birth at home, I highly recommend working with a well trained and experienced midwife and consider the distance to a hospital (30 minutes or less driving time is ideal).

There are risks and benefits to every kind of birth and in every setting. I provide women with evidence based information, encourage each family to dig deep and look at the pros and cons to having a VBAC in a hospital setting, free standing birthing center or home, vs a routine cesarean and have informed consent for her birth.

Are there benefits to a cesarean?

A planned cesarean is in a controlled environment, and some women find great comfort in that knowing. Perhaps a woman has had a previous traumatic, long labor the first time and they just don’t want to go through that experience again. Some women are very anxious about that and they just feel safer knowing they will have another cesarean.

I take that seriously, because she won’t labor well if she doesn’t feel safe.

Like I mentioned before, the serious risks for a VBAC can be often prevented, treated or transferred to surgical care in time, with a skilled midwife or obstetrician who is attending to the laboring women, aware and mindful of the symptoms that lead up to that.

Thankfully some hospitals are now at least allowing more time for baby to get the cord blood from the placenta, skin to skin bonding, and her partner or main support person in the operating room. Some hospitals and providers are performing “gentle cesareans” – cesareans that are family and woman centered, and try to provide the environment of a natural birth as much as possible. This is a wonderful attempt to restore humanity to birthing in the operating room.

Last tips:

If a woman knows she wants to have another baby, I would start with research and education. Ask yourself: “What do I want and why?”

A woman should get the support she needs. Most women who have had a prior cesarean have issues they need to discuss. There are therapists who specialize in this.  One of my dedications and areas of expertise is creating space so a mom can debrief, process and heal from her previous upsetting or traumatic birth experience, as well as plan for a better one next time around. Schedule a consult with me here. http://homesweethomebirth.com/chat-with-anne/.

I tell mamas to do what they can to educate and empower themselves, and know they do have a voice, build their circle of support, and include in their birth team advocates to speak for them when they are in the heat of labor. I tell them to prepare for a vaginal birth. The mind, body, heart and spirit can prepare for a vaginal birth - and a deeply positive, beautiful and empowering one. This is one of my passions and main focus of my online childbirth course.

PHOTO CREDIT – THE UNISON PHOTO

A woman is more likely to have a vaginal birth if she has a natural birth. Although this is not in all cases, a woman who is educated, empowered and prepared for a natural birth has a greater chance for having one.

Things a woman can do to prepare for a vaginal birth:

• Take an excellent childbirth course! My online LOVE YOUR BIRTH course is available here. 

• Check out www.vbacfinder.com to find VBAC rates for local hospitals.

• Check out ICAN (http://www.ican-online.org) for more information; seek out VBAC groups in your community, on Instagram and on Facebook, to connect with other women who have had successful VBACS.

• Watch movies of women who have had VBACS… inspiring stories of healing, beauty and empowerment.

• Create your tribe, in your pregnancy, of like minded women who have gone through what you’re going through.

• Interview providers, and choose one that aligns with you the most – one that has high rates of VBAC and low rates of repeat cesarean. It is very important to ask them their rates, and if you are planning a hospital birth, research the hospital rates here (link to http://www.cesareanrates.org/2015/01/what-is-my-hospitals-cesarean-rate.html

   Most midwives, especially those who practice out of hospital settings, have the highest rates of VBAC and the lowest rate of repeat cesarean, but plenty of hospital midwives and obstetricians have similar stats – they just may take some work on your part to seek them out.

I also recommend hiring an awesome doula, as those who have a doula are less likely to have a cesarean.

A doula is amazing because they offer the mothering comfort and support that our ancestors had.  When women would give birth in their tribe or village, and they were surrounded by mothers, aunts, sisters, grandmothers, and the other women of their community, they received that mothering support by women who were comfortable with birth and relaxed around it. Fear has no place in birth, and a doula provides needed calm and loving support.

Lastly, I recommend drawing and journaling , mediation and visualization – which tap more deeply into her intuitive self. A woman can imagine how she’d do it differently or what she wants for herself. And she can face her fears head on, which often lessens them, or she can be with them and plow forward with courage in spite of them.

Remember, In the end it’s not in our control, and we let go and surrender,

If you do all of these things and end up having a cesarean, it’s not a failure. There is no failure in birth. It is a birth, a belly birth, and it’s the birth of your baby and you as a mother. It is the birth of your family and your partner as a parent. Stay present, stay involved and keep a positive mindset. Focus on the blessing, that you did all that you could, and thankful for modern medicine, which saved you and your baby’s life and preserved health. Also, you can ask for a gentle cesarean, which restores humanity to the operating room by doing such things as allowing your support people in with you, enabling baby to emerge from the incision simulating as much as possible a vaginal birth to help baby clear his/her own lungs, enabling you to participate by lowering the drapes so you can see your birth, giving you sterile gloves to receive your baby, delaying the umbilical cord clamping so baby can benefit from the cord blood, encouraging immediate skin to skin bonding and early breastfeeding.  

Image by angiebeehotz

Healing can occur afterwards, and may take time and lots of support. But there is no place for shame and negative self judgement here.

Image by Megan Hancock Photography

Let Me Help You Create The Happiest Birth Experience Of Your Life...

Whether you're a first time or experienced momma, planning a VBAC

Or a midwife, doula, or birth professional guiding mommas..

Regardless if you are intending to birth at home, a hospital, a birth center or need a cesarean section, or if you are taking another childbirth education class…

You Really Can Create The Delivery Of Your Dreams, ROCK your VBAC

And have a blissful birth wherever you are.

More Precious Than A Wedding...A Birth Should Be A Celebration!

Let me show you how to…

• Understand the sensations of your body and connect your intuition with how your body is communicating and leading you towards what to do during labor

• Tap into your inner calm to deeply relax yourself,letting go of busy, stressful and fearful thoughts on demand for the health of baby

• Speak your truth from your heart in a way that deepens your relationships, sets clear boundaries, and has people listen to you and support you before, during and after pregnancy

• Trust yourself, connect with your body wisdom andcommunicate with baby in belly

• Connect with natural time and sync your body and mind up with your unique biological clock for ease from pregnancy to postpartum

• Reprogram negative patterns, stories, and beliefs that undermine your confidence, strength and self trust so you can rock your birth

Physicians and midwives around the world recommend my teachings to their pregnant clients and many Doulas across the country learn the secrets of blissful birthing from me to supplement their Doula Training & Certification process!

To learn more, visit:  LOVE YOUR BIRTH Online Childbirth Course!

It is based on my years of experience, as a midwife and yoga teacher, helping thousands of women tap into their calm and live and birth from a place of grounded relaxation and joy. 

Some other resources:

• Home birth cesarean resource (http://homebirthcesarean.org/) “This website provides support, resources, and awareness around planned out-of-hospital births that end in cesareans, referred to as Homebirth Cesareans (HBC).”

• www.Vbacfacts.com

• www.Vbac.com

• Books on my website, www.homesweethomebirth.com

In the end, how a woman births is her personal decision and the more informed she is and empowered to play a large role, the greater the likelihood is she will have a positive birth experience.