VBAC & VBA2C

Zoe's Delivery by Mwesigwa

VBAC (Vaginal Birth After Cesarean), or lack of it, is one of the major reasons for America's steadily (or should I say, alarmingly) rising Cesarean rate - currently a whopping 32.8% of all Amercan births end with an incision. Recently Richard Waldman MD, the president of the powerhouse medical organization, the American College of Obstetricians and Gynecologists, made a powerful statement concerning his colleagues quick jump to surgery. This year, at their annual conference he said:

"In 2008 the cesarean delivery rate reached another record high—32.8% of all births. There is a community not far from my home in which 45% of the newborns are delivered via an abdominal incision. [...] Liability dampens our spirits but unfortunately, it is also starting to define our specialty. [...] Let us recommit to do everything in our power to perform surgery only when necessary. Let us recommit to induce only when indicated and let us vow to never electively induce or perform an elective cesarean prior to 39 weeks. Any time we are tempted to take the safe path but not the righteous path, we should all say, “not on my shift."

It is a refreshing statement, one I hope holds up to the testing grounds of hectic and busy maternity wards. In our modern world it often seems that Cesarean is the only "choice" women have in the hospital to keep them and their babies safe. But our bodies have not changed since 1975 when the US Cesarean rate was 10.4%, obstetric training and practice has. Midwives have always been on the side of women and their bodies, learning and studying normal physiological birth in order to safely deliver women, and even now are often the only option for women who desire a chance at vaginal birth.

VBA2C refers to Vaginal Birth After 2 Cesareans. It is an unfortunate fact of life that many women now are in the situation of having had more than one Cesarean, but still long for a vaginal birth with a subsequent pregnancy. ACOG has in its guidelines on VBAC, allowed for a trial of labor with 2 or more Cesareans if a woman has had a vaginal birth before. Now a recent study has shown that even if a woman has not delivered vaginally before, she should still be allowed a trial of labor, even if she's had 2 prior surgical deliveries. In their findings VBAC in these cases, was successful 71.1% of the time. Uterine rupture, of course the sole reason for not allowing for VBACs, increased to 1.36%, which is roughly double what it would be in a woman who has had one prior surgery. But the tone of the researchers was encouraging and prompted practitioners to also caution their patients about the risks of a third repeat cesarean, in the light of these findings. Now that's informed consent.

This is great news for many women. Check out the video below to truly see the joy a successful VBAC can bring to a mother's face. If you want more information on VBACs in general check out this enlightening Cesarean fact sheet.

A Noisy Postpartum

crying-baby by bbuanach



After I had my daughter, my midwife checked both of us out, and satisfied with the health of me and my girl, tucked us snuggly into bed to rest. She then walked down to our local coffee shop and picked everyone up a latte. I got freshly picked wildflowers in lieu of the caffeine. We then proceeded to snack on fresh berries, cheese and crackers while chatting. There was a soft morning breeze blowing through my window and I could hear the pigeons cooing.

That was after my home birth. If I had had a hospital birth, it would've not only looked different, but it would have sounded different. My labor would have been accompanied by at the very least, the thumping rhythm of the fetal monitor, the beep of aforementioned monitor when the paper ran out, and the constant introductions of nurses, doctors, and pediatricians. My postpartum room most likely would have been shared with another mother, who may or may not have had a slew of visitors, and who may or may not have had a penchant for television watching. And again, there would be a new face and name introducing itself, at least every 12 hours or so. The coffee would have been terrible, and the flowers an elevator's ride away.

That's to mention nothing of the cries of not only my baby, but possibly my roommates baby too. Recent findings are now claiming that the noise of the hospital can be detrimental to health, not to mention recovery from birth. Take a look at this brilliant study and analysis of the decibel level of labor and delivery, and postpartum units in American hospitals. I love her idea of a postpartum lounge for new mothers to congregate in after they birth their babies. Although, I think even this might be a bit much for new mothers - it takes a considerable amount of energy to interact with strangers, especially in the precious moments after one has a baby. Still, I think that her nod towards other postpartum cultural practices, and their strict emphasis on calm, quiet, and rest for the new mother and baby, is an important and lacking one here in America. For most women here, it's back to 'normal' at about seven days postpartum. In contrast look at these practices from around the world.

• In Sudan mothers are treated to 40 days of rest, and beautification, treatment very similar to what a new bride in Sudan receives. They are served a fenugreek pudding, believed to encourage breast milk production and make one fat, something desired in Sudan! The treatment is thought to allow them to exit their 40 days feeling beautiful and rested.
• In Indonesia, the mother does not enter the kitchen or wash until the umbilical cord has shriveled and fallen. This ensures rest for her. The husband does not sleep for three days as he must guard the mother and baby. How about that for a taste of sleep deprivation for the partner!
• In India trained women come to the house and perform warm oil massages for mother and baby. It is believed to reduce colic in infants and preserve a woman's life long health. They also believe in resting for 40 days. Their are many special foods associated with the postpartum period.
• It is Holland I believe, who takes the cake for postpartum care. There a women receives a kraamverpleegsters, a postpartum nurse, who comes to the house all day long for eight days. This is paid for by the government. She helps with everything from breastfeeding, advising on infant care, to laundry and cooking! She even manages the flow of visitors.

With all of this care, I'd be surprised if a baby ever cried in these countries! I hope that hospital administrators and anyone involved with postpartum mothers, would look at the above examples for inspiration and guidance on how mothers should be valued. Ask any mother what she wants, and I hedge that a good portion of them would say, "Some peace and quiet". Wishing that for you and yours!

Spirituality and Childbirth

Gold Dome Masjid by TeeJe

The Prophet Muhammad is reported to have said that Paradise lies at the feet of your mother.

Much of a woman's allure, is not in the color of her eyes, or coquettish smile, but rather, lies in the layers of tissue, muscle and fat which conceive, nourish and birth her children. It has been written about and allegorized since pen was put to paper, probably even before. Women themselves ponder its meaning and symbol. Rightly so, for it is hard to find a greater sign on this earth of something more powerful, more majestic, more intelligent, than a mother's growing girth and the subsequent perfection of her rose mouthed babe.

Many women find themselves in a more reflective state while gestating their young. Who will this little one look like? Boy or girl? When will the labor begin? How long will it be? Will I be able to breastfeed with success? With so many unknowns it is no wonder that many women turn to a Higher Power to make sense of it all. It is calming and reassuring knowing that with all the uncertainty and upheaval that this new life has brought, that it is the same Power who called its soul forth and into your womb, the One who will bring the contractions, who long ago rendered the gender of your baby, and who has brought many, many women to the other side of this childbearing experience. What a glory to participate in a child's creation!

And now modern science has proven it. A study was recently published in the Journal of Perinatal Education which showed a connection between childbirth and a woman's spirituality. They looked at data collected from 250 culturally diverse women over the past 20 years and concluded that many women experience a richer spiritual experience during the childbearing and mothering experience. Among other things they found:

• Childbirth as a time to grow closer to God.
• The use of religious beliefs and rituals as powerful coping mechanisms
• Childbirth as a time to make religiosity more meaningful
• The significance of a Higher Power in influencing birth outcomes
• Childbirth as a spiritually transforming experience

Based upon their findings, the researchers are recommending that health care practitioners ask their patients, "Do you have any spiritual beliefs that will help us better care for you?" There is no time like the birth of a child to ask that question. I hope that all of the above come true for you dear readers!!

Ina May's Guide to Breastfeeding

I realize that there have been a few breastfeeding posts in a row, but seeing as I'm spending much of my days and nights doing just that, I guess it's on the brain. Recently, I read Ina May's Guide to Breastfeeding. Ina May is a woman's woman. Reading her is like having a chat with your auntie about breastfeeding. She peppers her writing with illuminating anecdotes and funny asides.

Ina May's Guide to Childbirth is famous for its birth stories and one of the best aspects of this book, is it's breastfeeding stories. There are breastfeeding triumphs and losses, long unheard of stories of wet nursing, nursing multiples tales, and more. These are stories that allow women to see that breastfeeding is above all, simple and accessible. It is almost like reading about a different time and place, but these stories all take place in the here and now. Ina May is a student of cultures, and the stories, or "forgotten lore" as she calls them, are no accident. For, it is from lack of these stories in our lives, that Americans have lost so much knowledge of breastfeeding.

The highlight of the book is a chapter entitled "Nipplephobia". It is a brilliant and humorous analysis of why Americans, unlike other cultures, are so uptight about a woman's breasts being used for anything other than sex. This prudishness gives way to a dislike of breastfeeding in general. Nipplephobia is defined, identified, and cured in this chapter. She looks at other cultures and their examples to lead the way towards healing America's nipplephobia. I am especially fond (and I guess somewhat flattered), that towards the end of the chapter she cites examples from Muslim cultures where women who are covered head to toe, still have no trouble breastfeeding their baby, when their baby is hungry. One such example is from a male friend of hers who lived with a group of Bedouins during the '60's. Here is his experience in a culture where women covered head to toe:

"...but what really had an effect on me was the time when one of these Bedouin women raised her robes, exposing her breasts to me as she fed her baby. She acted as if everything were perfectly all right. It was only I who was taken by surprise. I realized that in cultures in which women breastfeed their babies, everyone in that culture grows up seeing breasts being used as they are meant to be. They have a natural attitude toward them. It's only in cultures like ours, where you almost never see a woman breastfeeding, that breasts become the object for something else, usually something to lust after."


She also cites Norway's example of moving towards a pro-breastfeeding culture, and gives reasons why they were able to do so while we weren't. It is a thought provoking chapter. The book as a whole is great with lots of information and tips about breastfeeding in the early days to weaning. The last two chapters, "Shared Nursing, Wet Nursing and Forgotten Lore" and the previously mentioned "Nipplephobia", are what makes this book so unique and memorable.