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♥ The Facts on Having a VBAC ♥

 

In honor of VBAC Awareness Day, I want to share with you some statistics on VBAC.  I’m also including tips for planning a VBAC.

C-Section Facts Roughly 30% or babies born in the US are born via C-section. 10-15% [is] the WHO recommended C-section rate. Up to 80% of births could be vaginal. About 13% of births after C-section are vaginal. Vaginal birth is a safe and reasonable option for most births. Vaginal birth has innumerable benefits for both the baby and the one giving birth. If your provider doesn't support VBAC, you CAN switch at any time.

What is a VBAC?

VBAC stands for having a Vaginal Birth After Cesarean. It means to give birth vaginally after having had a cesarean, also known as a c-section.

C-section has become one of the most frequently performed major operations in the United States. Over 30% of births in the US (higher in some other countries) are c-sections. The World Health Organization recommends a rate closer to 10%. Some hospitals have begun to try to bring their rates down, but sadly, many continue to increase their rates steadily. In Brazil, 80-90% of births in private hospitals are c-sections. With numbers like this, it’s likely that many people will plan to have a VBAC one day.

 

Why Would Anyone Want to Have One?

Reasons differ from person to person. Some choose VBAC because they want to have the experience of vaginal birth. Others choose it because they know that vaginal birth is the best method for optimal seeding of the infant microbiome. Another reason is to avoid the risks that come with having another major surgery. Some choose it because they simply see no reason for another c-section. It is a very personal choice, in any case.

Each surgery performed causes more scar tissue, and impacts not only fertility, but the stability and safety of future pregnancies. Some providers simply refuse to attend a vaginal birth after more than two previous c-sections. For someone who wants to have multiple children, avoiding c-sections is essential to ensure the health and safety of future pregnancies. Not to mention the general lifelong health and wellbeing of the person undergoing them.

 

Why is it so Hard to Have One?

Many providers still have the outdated thought pattern of “once a c-section, always a c-section.” At one time, it was believed that a vaginal birth was never safe after having a c-section. We now know that one of the primary reasons for this belief, the increased risk of uterine rupture, is actually much smaller than once believed. It can also be reduced by simply not inducing, and allowing the body to go into labor on its own.

Other reasons, such as increased risk of stillbirth, have also come from low-quality studies in which there were poorly thought out selection processes. One example is including trials of labor, or TOL, in which a classical or T-inverted scar was present from a prior c-section, but excluding them from the elective c-section group because it was “an indication for repeat surgery”. 

Now that these studies have been scrutinized and the results questioned, we know that the reasons for denying VBACs by many providers and insitutions are invalid. But policy change takes time, as well as pressure from the community. Both from those who are having babies, and those who are delivering them. Unfortunately, many providers don’t want to question the status quo and potentially face repercussions from their place of practice or insurance for “making waves”. And fighting for policy change takes a lot of time and effort that most just can not muster during pregnancy, especially while taking care of their other children.

 

Who is a candidate?

According to ACOG, most people with one previous c-section with a low-transverse icut are candidates, and should be given the option to choose a VBAC. There are times when a VBAC would be contraindicated, however the majority of them are also situations where someone who has never had a c-section would also be recommended for a c-section. Even after two or more previous c-sections, as long as there are no other contraindications, VBAC is still a reasonable option.

 

Can You Have a VBAC at Home?

Yes!

In some states, you may find restrictions imposed upon midwives and their patients regarding insurance coverage and requirements for consulting an OB/GYN for VBAC. And some midwives just don’t want the hassle of the extra paperwork. But having a previous cesarean is not a reason you can’t have a homebirth.

I have met many women who have had amazingly peaceful and powerful homebirths after having a cesarean (or three). I, myself, had my youngest at home after having my first via c-section.

There are considerations, and in some situations, it may involve more risk, but only you can make the choice of how much risk you’re comfortable with, or whether it outweighs the risks associated with a hospital birth.

If a VBAC at home is what you want, be sure to research your options for providers in your area. In some places, there may be no legal options for an attended homebirth after c-section. In these cases, any provider that chooses to attend your birth may be putting themselves at risk for considerable legal repercussions. However, an unassisted home birth after c-section is not subject to these regulations. If you choose this route, like I did, ensure that you have done adequate research and be prepared with a good back-up plan. Unassisted birth is a viable option for many people, but it requires a lot of planning and education. It is definitely not for everyone. Nor is it for the faint of heart.

 

How Can You Have One?

The most important factor in planning a VBAC is having a supportive provider. Many providers are starting to recognize the many benefits of having a vaginal birth, and changing their policies to reflect that. Sadly, there are still many providers that do not support it, or they pretend to, but pull a bait-and-switch. Make sure you ask around for feedback from people in your local area that have had a VBAC. Find out how they were treated and talked to by their providers. Get stories from those who wanted a VBAC but did not have one, as well. You will often be able to identify many red flags to watch out for from specific providers after listening to the stories of others. And you will learn which ones to avoid completely.

The second most important factor when you are planning a VBAC is the actual planning of it. You need to prepare yourself for birth, and consider what you might need to do differently. Working to break up adhesions from scar tissue is something I highly recommend. The softer and more flexible the scar, the safer and easier your VBAC will be. Massage, acupuncture, and certain herbs can help with this. In addition, ensuring your baby is in an optimal position helps to give you the best chance at a smooth birth. Educating yourself on the risks and benefits of – as well as ways to prepare your body and your mind for – VBAC is the best thing that you can do for yourself when you are planning for to have one.

If you want to have a VBAC, get informed. Do your research, ask around, and talk with potential providers about their opinions. Make sure you choose a provider that is supportive and has experience with VBAC. Remember that not all providers are equal. And they are all human, therefore subject to their own biases.

 

Where Can You Learn More?

To learn more, please explore the site vbacfacts.com. It is run by the incredibly passionate Jen Kamel. She has spent decades, tirelessly working to bring awareness and education to birth professionals and parents. Her goal is to ensure everyone has access to and quality information about VBAC. Her website is full of amazing and insightful information, from the current ACOG guidelines, to common myths about VBAC, and much more. I highly recommend giving it a read!

 

Sources:

1. Flamm BL, Newman LA, Thomas SJ, Fallon D, Yoshida MM. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol. 1990 Nov;76(5 Pt 1):750-4. doi: 10.1097/00006250-199011000-00004. PMID: 2216218. https://pubmed.ncbi.nlm.nih.gov/2216218/
2. Bujold E, Gauthier RJ, Hamilton E. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. J Midwifery Womens Health. 2005 Sep-Oct;50(5):363-4. doi: 10.1016/j.jmwh.2005.06.001. PMID: 16154061.
https://pubmed.ncbi.nlm.nih.gov/16154061/
3. https://vbacfacts.com/2017/10/25/acog-2017-vbac-guidelines/
4. https://vbacfacts.com/
5. https://vbacfacts.com/2012/01/16/myth-risk-of-uterine-rupture-doesnt-change-much-after-a-cesarean/

 

♥ How Beautiful Relaxed Birth Can Be ♥

 “For some reason, I could not bring him into my pelvis with anything I was trying or doing, and I was working hard.”

 — statement from a mom’s homebirth story that ended in a transfer to the hospital, with baby coming out right as they got into a room. 

Photo credit: Melissa Butler

 

Maybe it was Because…

The clue here is that she was working hard. She was “doing” too much. Throughout the story, she mentioned how her baby was still too high, and wouldn’t come down. She felt him hitting her pubic bone, unable to get past it. And she kept trying to force him down. She never mentioned trying to help him go back UP to readjust. The thirty minute ride to the hospital, she spent upside down with her face pushed into the gurney. All her baby needed was the space to come back up and readjust himself, which she gave him on the ride to the hospital. Because she did that, he was finally able to come out on his own, without any help, or her “doing” anything.

This is a lesson I learned with my first birth. I “did” too much. I tried too hard to “help” her come out, only causing her more distress, and making my body stop labor every time it became productive. Sometimes, we need to just let go. We need to stop “doing” and just relax. This mom became anxious and panicked when her labor stopped itself.

 

A Better Way

My Experience

With my second birth, I stopped “doing” after I realized how silly it was to try to pressure my baby with homeopathics, essential oils, exercises, etc. This time, I didn’t want to stress myself and my baby out. I wanted to have a relaxed birth. By the end, I had practically forgotten I was pregnant.

At 42 weeks and 3 days, I had spent the day as though this were simply how my life had always been and would always be. Then, just as I was about to go to bed, labor began. I didn’t panic or worry or get anxious. Instead, I just thought “huh, I think I’m in labor… cool.” My husband prepared the birth pool while I went to the bathroom to allow my body to “clear out”. I spent a couple of hours laboring on the toilet (they call it the porcelain birthing stool for good reason!), which eased the pressure of the contractions. Then I got in the birth pool, leaned over the edge, and slept between contractions. I had my husband put on a couple of albums that facilitated my sense of inner peace and connection with myself.

I didn’t try to rush anything. Nor did I do anything to try to “speed up” the contractions. I simply relaxed, rested in between contractions, and waited for my body to do its thing. 

Another Mama’s Experience

Another mama I know didn’t push at all during one of her births. She labored in a cast iron tub and just relaxed and gave herself over to the process. Her body pushed her baby out without any effort from her (this is called the fetal ejection reflex, and it’s how babies can be born even when the mama is in a coma). She knew that birth happens, and it didn’t need any help from her.

This is How Birth Should Be

It doesn’t need to be a big production. It is life at its most basic. Relaxed birth is the most connected a person can be with the universe. When you relax and let it happen, it is the most beautiful thing you’ll ever experience.

 

How Can You Relax in a Society Filled with Fear?

1. Turn off the TV.

The news is full of tragedy and heartbreak. So-called “reality” shows only show you what’s dramatic, what will give you an adrenaline spike through fear or anger. The same goes for social media when your feed is full of panic-ridden taglines. Studies have shown that too much screen time can increase the risk of depression. It can also cause a lack of sleep and increase of anxiety, particularly during pregnancy.

2. Get more sleep.

As shown in the study above, getting more sleep can help decrease anxiety levels. It also gives your body more energy for growing that precious life inside you. Not to mention the boost your immune system gets, which helps you to avoid getting sick, and recover faster when you do get sick.

3. Avoid scary stories.

I know I have a habit of speaking out against the “good vibes only” mentality, but during pregnancy is the one exception. Many people, myself included, find that their intuition calls them to avoid negativity during pregnancy. And it’s for very good reason! Constantly hearing stories about what could go wrong, or what has gone wrong for others, during pregnancy can increase fear and anxiety. It sows seeds of doubt in ourselves and our bodies’ abilities. Therefore, protecting your mental health is just as important as protecting your physical health, and helps you to achieve that goal as well.

4. Surround yourself with positivity.

Read positive birth stories. Listen to podcasts that share positive birth stories. Ask your friends to share their positive stories of their own births. Envision yourself having a beautiful relaxed birth. Picture how you want the environment to look and feel. Listen to music that makes you feel happy and relaxed. Draw or print out affirmations and pictures to hang up around you that make you feel confident that you will have a relaxed birth.

5. Educate yourself.

I chose the name Baby Led Enlightenment in part because enlightening (educating) ourselves on topics that arise during pregnancy and beyond is one of our duties as parents. Not only that, but knowledge is the best cure for fear. If you find yourself afraid of any specific situation, research how to handle it. For instance, once you’ve learned how to treat an illness or condition, resolve a shoulder dystocia, or stop a hemorrhage, you’ll feel a lot more confident in your ability to move past these issues with ease instead of panic. It’s a lot easier to relax when you’re confident that you can handle anything that comes your way.

 

What if I don’t Want a Relaxed Birth?

That’s okay, too. Some mamas prefer to have a powerful birth experience. They want to feel like they could wrestle a bear while they’re in labor. And that’s totally cool! What’s important is that you align your process with your goal. If you want a relaxed birth, you have to learn to trust the process and let go. If you would rather have a powerful birth, take charge and go for it! We are actually simultaneously at our most powerful and most vulnerable during birth. Both experiences are beautiful in their own way.

♥ Black Birth Matters ♥

“According to the CDC, black mothers in the U.S. die at three to four times the rate of white mothers, one of the widest of all racial disparities in women’s health.” ¹

We Need Change

I am calling on my followers to learn more about the abysmal treatment of black women and transfolks in pregnancy, birth, and postpartum, and what you can do to help.

“There is much evidence to document the impact that generations of imperialism, colonialism, racism and white supremacy has had on African people in general—and on Black women in particular… Black mothers, children and families… are unseen and unheard in a health system driven by the remnants and realities of institutionalized racism.” ²

According to the most recent CDC data, more than half of maternal deaths occur in the postpartum period, and one-third happen seven or more days after delivery. The majority of initial postpartum appointments don’t happen until four-to-six weeks after birth. These are also frequently the only postpartum appointments that occur. Anyone that has had a c-section, pre-eclampsia, depression, or is taking anticoagulants needs to be seen sooner than four weeks after birth. Black women and transfolk are far more likely to experience all of these things, sometimes more than twice as likely as white women. In one study published in 2017, two-thirds of low-income black women never made it to their doctor visit.

The high risk of death surrounding black birth spans all income and education levels. It happened to Shalon Irving. It almost happened to Serena Williams. Their education and money did not change the way that their providers brushed off their concerns and ignored them. This shows that the problem does not stem from race, but from racism.



All of this was even before COVID-19 came along and highlighted the disparities even more.

 

What Can You Do?

  • If you are a black mother or a care provider, read this guide for how to acknowledge and address racism in prenatal and postnatal care.
  • If you are a care provider, pay attention to your unconscious biases that may arise when serving black women and transfolks. Work hard to be mindful and overcome them. Talk about them with others in your field, to help them give voice to their own unconscious biases, which is the first step to removing them.
  • Support the NAABB in their mission to “combat the effects of structural racism within maternal and infant health to advance black birth outcomes.”
  • Check out the resources offered by and support Black Women Birthing Justice.
  • Speak up and speak out. Raising awareness of black maternal mortality rates helps inspire policy changes, targeted funding, additional training for providers, and other solutions. Vote for candidates that support these solutions. Talk about these issues with your friends.
  • Share the IRTH app with your black birthing friends and acquaintances, so that they know about this resource for reading and sharing reviews of black care providers. This helps black birthing people make informed decisions when choosing their care providers.
  • Have a look at the anti-racist reading list and other black maternal health resources offered by Every Mother Counts, an organization working for equality in maternal health care around the world.
  • Support National Advocates for Pregnant Women, an organization working protect constitutional and human rights for women of all races, but primarily focused on black and low-income pregnant and parenting women. They provide legal defense and advocacy services.
  • If you are black and have a passion for helping pregnant women and babies, consider becoming an OB/GYN, midwife, pediatrician or other medical specialist, or doula. Currently, only 4% of doctors are POC. According to a review in 2019, the mortality rate is cut in half when black babies are cared for after their birth by doctors of the same race.

Remember to Share Positivity

It’s easy to share the scary articles and statistics surrounding black birthing women and transfolks. But sharing and celebrating the positive stories is just as important. There are lots of beautiful, peaceful, relaxed, and/or powerful black births that happen every day, and they deserve to be recognized, too. Black birthing people need to see the happy stories and know that they can have those kind of stories themselves. The media likes to share things to scare everyone into believing there is no happiness or joy in the world anymore. Even Google brings up only horror stories and dismal statistics when searching “black birth”. That means it’s up to us to prove them wrong.

 

  • You can tune into the podcast Birthright for inspirational black birth stories.
  • The podcast NATAL Stories also provides positive black birth stories alongside empowering ones that tell of overcoming the issues that black women face.
  • Homecoming Podcast is a podcast focused on black home birth, working to dispel the myths that hospital birth is safer than homebirth and that black people don’t birth at home.

 

sources:

1. https://www.npr.org/2017/12/07/568948782/black-mothers-keep-dying-after-giving-birth-shalon-irvings-story-explains-why
2. https://thenaabb.org/advocacy/

3. http://www.ajog.org/article/S0002-9378(17)30368-X/fulltext

4. https://theeverymom.com/black-mothers-are-dying-at-an-alarming-rate-how-to-be-an-ally/
5. https://www.nytimes.com/article/black-mothers-birth.html
6. https://thenaabb.org/
7. https://www.blackwomenbirthingjustice.com/
8. https://irthapp.com/
9. https://everymothercounts.org/anti-racist-reading/?gclid=Cj0KCQjw5auGBhDEARIsAFyNm9F3mczdvIMSeK4uWb5pb03WdxsoQfICIvx9Z5HLJPb0vLxEw2qtvpYaAuhTEALw_wcB
10. https://www.nationaladvocatesforpregnantwomen.org/
11. https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ugd/c11158_150b03cf5fbb484bbdf1a7e0aabc54fb.pdf
12. https://birthrightpodcast.com/
13. https://www.natalstories.com/
14. https://www.instagram.com/homecomingpodcast/

♥ My Homebirth Story — Freebirth ♥

 

Happy International Homebirth Day!

Since the restrictions of 2020 changed the experience of hospital birth so dramatically all over the world, many more women have turned to homebirth as their way of having the birth experience they want. Others have wanted to, but for one reason or another, not gotten that experience they so desire.

Some of you may know that I had a homebirth with my second. What you may not know is that I wanted one with my first, but thought I couldn’t have it because Medicaid didn’t cover homebirth midwives in Ohio, and my husband had been laid off for several months due to a natural disaster, so we had very little funds at the time. I probably could have found a way to make it happen if I’d had the support and knowledge then that I have now. I hear similar stories all the time, where the mama wanted to have a homebirth, but didn’t think she could afford it, or her insurance wouldn’t cover it.

If you want a homebirth, sometimes you have to work for it. It shouldn’t be this way in the US and other countries around the world, but it is. The important thing is that you know there are options, and if that is what you really want, you can have it. For instance, in Florida, homebirth midwives ARE covered by medicaid. There are still guidelines and restrictions put in place by governing bodies that limit the access to them for VBAC, plus size mamas, breech, twins, etc, nearly everywhere. But there are oftentimes ways around this as well. Sometimes, simply seeing an OB one time, regardless of what they tell you regarding their opinion on homebirth, is enough to satisfy the requirements. The red tape and hoops you may need to jump through can vary depending on your insurance, provider, and location. Seek out your local birth network and talk to birth activists in your area to find out more about ways you can advocate for your right to a homebirth.

Read on for more of my personal homebirth story:

 

Planning Makes it Possible

I planned to have an unassisted homebirth with my second daughter. I knew, even before I got pregnant with her, that it was the birth experience I wanted to have. I got involved in my local birth network, studied numerous books, took a course on homeopathy, attended a workshop for birth professionals, and just generally soaked in as much information about birth as I could. When I finally saw that second line, I knew I could do this.

 

Preparations

A few weeks before my guess date, a doula and student midwife friend of mine lent me her birth pool. We cleared a space in our living room for it, behind our couch. It was a cozy corner, where I hung up red Christmas lights and a double-heart light. My friend hosted a mother’s blessing for me, and I had brought home several beautiful drawings and quotes from friends, which I hung on the walls. I also put up a family photo with my husband, my oldest daughter, and myself, as well as a photo of my grandma from when she was younger, which we had displayed at her funeral just days before I found out I was pregnant. She was my rock, and I wished I could have had her there for my birth, but this was the next best thing.

Pardon the fuzzy photo, this was the only one I managed to salvage after issues with my camera. 

I’m in labor!

The night I went into labor, I had been sitting on the couch watching TV with my husband, and we were about to go to bed. I had been having contractions off and on all night, the same as I had for the past 3 months. Suddenly, I realized one of them made me sit up straighter than usual. After 2 more, I felt the urge to go to the bathroom, and knew that it was time. I spent the next 2 hours laboring on the toilet, which brought me considerable relief (They don’t call it the porcelain birthing stool for nothing!).

I called my friend around 2AM, who I had planned to have there as my doula. She told me to call her back when I wanted her there. I had no idea when I “should” have her there, but I wanted her there then. Since she clearly didn’t want to come right then, and I felt bad about it being 2AM, I just said ok and we hung up.

I went straight from the toilet to the birth pool. I just draped myself over the side of it without any water for an hour or two. Once I started feeling the need to vocalize through contractions, I had my husband begin filling the pool. We only filled it halfway for the first couple of hours. The contractions were easier to handle when the water was over my lumbar. My baby’s spine was facing mine, so I felt significant pressure in my back. I tried to hold off on filling the pool, so that the water wouldn’t get too cold too soon. I had my husband put on some music to help me relax in the meantime.

My friend called around the time we got the pool filled, and reminded me to have my husband bring me food and drink. I had been sleeping in between contractions, and he had too. He made me some scrambled eggs and brought me some chocolate coconut water, which took me a good hour to fully consume.

 

It’s Time to Push!

About 10 hours after that first contraction that made me sit up straight, my vocalizations became much louder and more frequent. My mom, who lived with us, came out of her bedroom because she could tell something had changed. Our daughter woke up and came out of her bedroom. We told her that her sister was coming. She stayed until the next contraction, but said that my vocalizations were too loud, and retreated to her room again. I began to feel the urge to push. About forty-five minutes later, she began to crown. My husband saw her forehead, but saw her pulling back in a bit in between each contraction. I went slower and panted through a few contractions as her eyebrows began to emerge. My husband told me to push, and I told him to shut up. I was listening to my body, and it was telling me that it needed time to stretch as we reached “the ring of fire”. A few minutes later, her head was free, and my husband worried about her trying to breathe under the water as he saw her mouth opening and closing. I assured him that she was fine, and she would not try to breathe yet, and she was still getting her oxygen from the umbilical cord.

 

I did it!

At almost exactly one hour from the first push, she was free. I had spent the entire labor on my knees, hanging over the side of the pool because my body wouldn’t allow me any other position. I was so relieved to finally be able to sit down properly. My husband helped me bring her to my chest. She was covered in vernix. He brought us a blanket to put over her to keep her warm against my chest, as the water had gotten colder than I had realized. This was when I finally decided to call my friend and tell her to come over. We spent a few more minutes in the pool, giving me a chance to rest. Once I had delivered the placenta, we placed it in a bowl, still attached to our baby, and moved to the couch, where we laid on chux pads together, with the bowl near my head.

My favorite photo ever. I feel it truly embodies the tranquility and connection felt after a homebirth. 

(yes, I wore a Wonder Woman camisole as my birthing gown)

Breastfeeding Begins

I placed her on my belly and allowed her to do “the breast crawl”. It only took her a few minutes to find the breast, but she needed a lot of help with latching. My first had needed help, and I just thought it was similar, her mouth was too tiny and my breast was so big that it was hard for her. I later found out she had tongue and lip ties. But with a little help from me, she was able to get enough colostrum to fill her tummy and she drifted off to sleep peacefully on my chest.

So teeny tiny in comparison!
Drifting off after a nice meal ♥

 

A Happy Ending

About two hours later, my friend and my midwife showed up and worked together to get me cleaned up and baby checked out. My friend brought a cord burning box and some candles. Around 10PM, my husband and I decided it was time to go ahead and burn the cord. We tied it off with some string left from the anklets I made for myself and my daughters at my mother’s blessing, then we got it situated in the box and began to burn through it. It took a lot longer than we expected, and dripped a lot, so we were glad we had the box to support the candles and catch the dripping.

A sacred family moment

 

The Less-Pretty Details (TMI WARNING!!!)

There were a few things I didn’t include in the actual story itself. I feel these need to be mentioned, however, to show that even the most beautiful experience can include trying times.

 

My Tailbone Broke

After about half an hour of pushing, I felt and heard my tailbone break. My mom asked me what happened, and I told her my tailbone just broke, and she told me that there was no way it broke. I began to lose my patience with everyone after that, and used some colorful language when telling both my mother and my husband that I was doing things my way and they needed to stop trying to tell me what to do. After a few weeks of postpartum agony, my chiropractor did an x-ray and proved that my tailbone had indeed broken, and it was due to a deformity caused by a childhood injury. This felt very vindicating.

 

I hemorrhaged 

After delivery, my friend showed up before my midwife, and urged me to get up and go to the bathroom. I had tons of chux pads ready so that I wouldn’t need to worry about this. I didn’t feel I had the strength to get up, and she had to support most of my weight when I finally relented and went. As soon as I sat down on the toilet, I dropped two big clots, and started to fall asleep. My mom panicked and started to call 911. Thankfully, my friend was able to wake me and get me up and back to the couch and hydrated, and my mom told them it was a false alarm. I drank copious amounts of coconut water over the next hour and took several doses of homeopathic remedies. This helped me regain my strength and begin to rebuild my blood volume. I personally think I should not have gotten up when I did, and could have avoided such trouble if I had listened to my body telling me to wait a little longer, rather than my friend urging me to get up, but there is no way to be sure of what was actually the best thing to do in that moment, or if the hemmoraging could have been entirely avoided either way. Had the coconut water and homeopathics not shown effective, the next step would have been to cut a small piece of my placenta off and stick it in my cheek. The placenta contains hormones that signal the uterus to contract, which would have helped to stop the hemmorage as well.

 

The Afterpains

One thing no one seems to mention when preparing for birth is the afterpains. The contractions after delivery felt so much stronger to me because I had nothing to push against them anymore. They lasted for nearly an entire day, with the worst of them happening over the first six hours or so. Taking homeopathic Sabina helped greatly, but the pain was still pretty intense. My midwife did a massage on my uterus to try to help it contract (part of the reasoning behind the “breast crawl” as well), and it HURT. I was not prepared for that at all. Clearly, I had missed a few things in my research!

 

If you would like to learn more about your options for homebirth, with or without assistance, here are a few great resources to check out:

American Pregnancy Association

Birthing Better

Midwives Alliance North America

The Unassisted Baby

♥ SPD – Symphysis Pubis Dysfunction ♥

This is something important for all women to know about. It is a lot more common than you might think, despite the fact that most doctors in the US don’t know about it, or don’t believe it exists. Don’t ever let your doctor tell you that excruciating pain is “normal” or tell you to “just deal with it”. If you are experiencing a large amount of pain, you have every right to adequate treatment of the cause, not just of the pain! If you suspect you may have SPD, and your doctor refuses to refer you to a specialist, find another doctor. SPD can cause permanent, sometimes debilitatingly severe damage if not handled properly. Please see the warning about labor and delivery near the end of this post for more information on this.

 

 

What is SPD?

 

SPD stands for Symphysis Pubis Dysfunction. It is also sometimes referred to as pelvic girdle pain, or PGP. It affects pregnant women, but can persist beyond pregnancy in a rare few very unlucky ladies. In simple terms, SPD is a misalignment of your pelvic bones, caused by your body producing too much of a hormone called relaxin during pregnancy. Relaxin is what helps your spine realign to make room for Baby, your hips to expand, and your pelvic bones to separate to allow Baby to be born. It’s a good thing — in proper amounts. When your body produces too much of it, the joints in your body become extra flexible, and much more prone to misalignment. In some women, this doesn’t become a problem unless they have some kind of trauma occur, such as a car accident or a fall. We don’t exactly have the best of balance when we’re carrying an extra 20+ pounds in front of us and our joints are soft, do we? When we fall, especially if we land on our hands and knees (which of course is much better than our bellies) the pelvis can easily become misaligned. In my case, my right hip became tilted backward. The body does not naturally realign itself without proper guidance, so the misalignment, if not corrected, can cause excruciating pain that lasts for a very long time, and only gets worse. In some women, however, SPD can occur without any kind of trauma. The hypermobility in the joints caused by the excess hormone can make it easy for the symphysis pubis to work itself into misalignment over time.

How is SPD Diagnosed?

It cannot be 100% diagnosed “officially” until pregnancy is over, by doing an x-ray to see if the symphysis pubis is misaligned. It’s not that difficult for a good chiropractor to recognize it, though. For one thing, most people that have SPD have one leg slightly longer than the other, due to the misalignment of the pelvis. 

How Can You Tell if You Have SPD?

 

A tearing feeling in the middle of your pubic bone and/or perineum is a pretty strong clue. I’m not talking about the odd twinge here and there caused by stretching during pregnancy. This tearing feeling is different. It feels like you are being ripped in half. While the pain may subside quickly in the beginning, over time (if left untreated), it becomes more constant, and spikes with every movement, rather than just walking. It may hurt when rolling over in bed, or when sitting in a bad position. The pain usually subsides for the most part when sitting or lying down, at least until the condition progresses very far. Taking long strides when walking, going up and down stairs, and standing or walking for very long also cause great pain. This pain can also be felt in the hips, usually one side more than the other, or only on one side. The pain can be in different areas for different women, and may feel a bit different because everyone perceives pain differently, and the misalignment can go in various directions and affect different places. 
Clicking, cracking, and popping noises and feelings in the pelvic region and hips are also very common when you have SPD. Sometimes they can be so loud that others hear them, and sometimes they just feel like they are. Sometimes these pops can bring relief, other times they can make the pain worse. It just depends on whether or not your body is adjusting itself in the right direction.

How is SPD Treated?

There is no one-size-fits-all treatment. A combination of stabilization exercises, ice, positioning, and manual therapy is the most effective. Stabilization exercises reduce stress on the joint and improve stability. Stabilization exercises include strengthening the abdominals, pelvic floor, gluteals, latissimus dorsi and hip adductors. Chiropractic care is the most highly recommended component of treatment by those that have tried it. It is certainly what I recommend over anything else. Physical therapy is common in the UK, and sometimes attempted in the US, as well. Swimming is a good option, especially in conjunction with aquatic therapy if you can find a therapist trained in treating SPD. 
Many doctors will simply tell women to take acetaminophen (also known as Tylenol or paracetamol), and if the pain gets bad enough, give them crutches, or in rare cases, a wheelchair. This isn’t really treating the problem, however, only the symptoms. There are also a couple of different types of surgery that can be performed to try to repair it if it persists after delivery, but they have very low success rates, and sometimes can actually make the pain worse. One type involves fusing the pubis together with a metal plate. Another involves binding it with something else, like thread or ligaments from a donor (like a pig) or another part of your body. These surgeries also make future pregnancies highly inadvisable, since they immobilize the pubis, and make future vaginal delivery impossible. They can also come undone if you do become pregnant again because it will try to separate anyway to make room for Baby. I do not personally recommend these procedures at all, based on their outcomes, unless everything else has failed and you are desperate enough to risk it.

What Can You do to Minimize the Pain of SPD?

If you have SPD, or think you might have SPD, always be mindful of the following:
♥ When getting in and out of a car or getting up from a chair or bed, keep your knees together.
♥ Do NOT do extreme stretches, especially one-sided ones. DON’T do lunges or squats. These kinds of stretches have the ability to cause irreparable damage to the symphysis pubis that simple chiropractic care or physical therapy cannot fix, and then your only hope left would be the dismal chance of successful surgery. It is important that any stretching you do be symmetrical, to avoid exacerbating the misalignment, and that it be done while sitting or lying down, to avoid pressure on the pubis. 
♥ Sleeping with a pillow between your knees helps to stabilize the pubis at night.
♥ Sleep with your knees in a symmetrical position. Do not sleep with one knee drawn upward and the other leg straight, as this can worsen the misalignment and cause you much more pain, despite potentially being comfier for sleeping. It might take some getting used to and a lot of training yourself to be able to sleep in a different position, but it is well worth it. 
♥ Sit down to put on socks, shoes, underwear, and pants. 
♥ Take stairs one step at a time if you cannot avoid them altogether. A good phrase to remember is “up with the good foot, down with the bad foot,” meaning that you lead with your least painful side when going up steps, and your most painful when going down. 
♥ Take small strides when walking, trying to keep your knees as close together as possible, and don’t walk for too long at a time. 
♥ Rest frequently. 
♥ Do not cross your legs while sitting.
♥ Limping actually makes the misalignment, and thus the pain, worse, so try to avoid it if at all possible. 
♥ Keep your knees together when rolling over in bed, or with the pillow still between them. 
♥ Try sitting in a tall chair if you do the dishes or cook. 
♥ Anything you can do to take pressure off of your pelvis will help. 
♥ Change positions and shift your weight frequently when standing. Try not to favor one side when doing this, as this helps further the misalignment.

What Should You Do if You Think you Might Have SPD?

If your insurance will cover it, or you can afford it, don’t wait for the pain to become unbearable. Get an adjustment from a knowledgeable chiropractor at the first sign of trouble and see a physical therapist to instruct you in stabilization if at all possible. This makes it much easier to treat, and increases your chances of a full recovery.The longer you wait, the worse the damage becomes.Many chiropractors have a self-pay option for $25-50 per visit, and some give discounts for those on Medicaid or who are uninsured or have low or no income. Reach out in your local community and ask for help. If you are in the US, call 211 to ask for referrals to resources that may be able to help. Start a GoFundMe. Do whatever you can to take care of yourself. Don’t let yourself suffer.

 

What is Good to Keep in Mind During Delivery if you have SPD?

 
The best position for delivery if you have SPD (and one of the best for everyone during labor in general) is on all fours. It is the most natural, and allows more room for the pelvis to expand, while actually taking pressure off of the pubis. In this position, the tailbone has room to move to make more space in the birth canal. It is much more comfortable during contractions for most women, as well.
Squatting has been recommended by some providers. I have not heard any accounts from people that have SPD that have delivered in this position, though, and since it still puts so much pressure on the pelvis, and stretches it so much, I would personally be a bit hesitant to try it, but I would definitely try it before the lithotomy position if I needed an alternative to being on all fours. A supported squat using a birthing stool or sitting on the toilet may help decrease the chances of injury with squatting.
Waterbirth is also a really good choice. This is when you actually deliver Baby in a pool or tub of water. It helps to decrease tearing of the perineum, and decreases the pain of contractions, as well. This is not always possible, but is becoming an increasingly more available option across the world. It is most common in birthing centers, but some hospitals do offer it. Homebirth with a midwife or freebirth (without any medical professional in attendance) also make this possible. 

What is the Most Important Thing to Know About Having SPD?

 

You have to be careful during delivery when you have SPD. If Baby is in a funny position, such as with their arm up by their head, during delivery, most doctors/nurses will forcefully grab your legs and push them up to your shoulders. This is one of the absolute worst things that can be done to someone with SPD, and almost always results in irreparable damage to the symphysis pubis, which can cause extreme pain for the rest of their life. Like with the stretching I warned against, this can actually cause severe tearing of the ligaments and in some cases, the muscles around the pubis. 

The lithotomy position (lying on your back on a bed or table during delivery) is the worst possible position for anyone to give birth in. Not just anyone with SPD, but anyone at all. The World Health Organization cautions against this position. Despite the fact that the US uses this position almost exclusively, it has been banned in many countries. It compresses the birth canal and slows labor. It also increases the chances and degree of tearing that may occur during birth. It may even increase the chances of needing an emergency C-section and the use of other interventions, such as forceps or venthouse. The common use of stirrups in this position is one of the dangers to people that have SPD, as it can also cause tearing of the ligaments in the pubis.
Having an epidural or spinal block also increases your chances of permanent damage due to SPD. Because it numbs you, your body can’t tell you when you are in a position that is putting too much stress on the pubis. You won’t be able to feel if your ligaments or muscles do begin to tear. If you can’t feel it, you can’t stop it.
It is very important that you make sure the doctor/nurses/midwife present at your delivery know that you have SPD, and know not to force your legs apart or to put you in stirrups. Some doctors will try to tell you that you cannot have a vaginal delivery if you have SPD. This is simply untrue. While there may be more risks to the pubis with a vaginal delivery than with a C-section, there are still more risks in general with a C-section, so it is still no more advisable over a vaginal delivery for someone with SPD than someone without it, unless there are other issues present that make a C-section a safer option.
Again, don’t ever let a doctor blow you off if you are having extreme pain. Trust your body. If something doesn’t feel right, then it probably isn’t. You know your body better than anyone else. Doctors may have lots of knowledge about lots of things, but they are not omniscient. They do not know everything. The best doctor can admit that sometimes the patient does know better than they do. If your doctor is unwilling to listen to your complaints, or is refusing to investigate your symptoms, please don’t hesitate to find another doctor that will listen to you and CARE. Many doctors think of patients as just numbers — money in their pocketbook. A truly good doctor will actually care about you as a person.

Where Can You Find More Information on Treating SPD?

You can find further information on:

 
 But the best information by far that I have come across in my research came from