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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Many providers still have the outdated thought pattern of “once a c-section, always a c-section.”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/

♥ 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/

 

♥ Let’s Be Frank About Breech ♥

 

 

 

 

Breech is when the baby is in a number of positions that are head-up. There are many different breech positions and presentations. Some babies are breech until just a few weeks, days, or even hours before labor. Others are breech until sometime during labor. And a small percentage of babies are born breech. 

Many doctors will try to tell you that breech is an indication for c-section. This is simply not true. Breech is just a variation of normal. Midwives are much more likely to have experience with facilitating the birth of breech babies than obstetricians are, because obstetricians are surgeons. Obstetricians get paid more for performing surgery than they do for vaginal births. C-sections are also more convenient for them, as they don’t have to show up at the hospital at whatever random time a mom shows up in labor when they schedule the c-section in advance. They can plan their vacations and golf games easier this way. They can afford their fancy cars and private schools for their kids this way.

I recently had an extensive exchange with a mom who sounded terrified of having a c-section and all of the repercussions that came along with it. This was worsened by COVID-19 restrictions at her hospital and limited leave for her husband to be with her, leaving her to be alone for the majority of her hospital stay, and unsure of how to care for her infant and dog at home alone while her husband was forced to go back to work. However, her doctor never told her that she had any options beyond scheduling a c-section. She simply told her, at 35 weeks, that since her baby was still breech, she would schedule her for a c-section. She gave her no advice for encouraging the baby to turn, and never told her that vaginal breech birth was possible. Once I had informed her that she DOES have options, she seemed to be determined to avoid having a c-section. She went to her doctor the next day, ready to question what she had been told. Or so she thought. When I spoke with her a few hours later, she had again resigned herself to having a major surgery for no reason beyond the doctor’s convenience unless the baby magically turned on its own before the scheduled time (39 weeks, not even allowing the baby the chance of going to true full-term), with no effort on her part. 

She will likely end up having that c-section, feeling defeated and powerless. She will spend multiple days in the hospital, alone for most of it, unable to keep her baby in the room with her the entire time, not knowing what is being done with or to her baby while out of her sight. She will struggle to take the dog outside, possibly pulling a stitch or worse as she tries to. She will have difficulty caring for her baby on her own while she heals from major surgery. She may have issues with her supply and getting the baby to latch. She may have difficulty bonding with her baby and develop post-partum depression. If she manages to overcome her depression through counseling, drugs, and/or any number of mindset-shifting events, she may find the strength to forgive herself . Or she may not, and wrestle with depression for the rest of her life, borne of a self-hatred for not advocating for herself and her baby. She may not even realize these feelings, or where they stem from.

This happens far too often. Moms are pressured to ignore their instincts and accept many possible risks, including infection, injury to the baby, scar tissue, lengthened recovery time, excessive blood loss, increased risk of post-partum depression, difficulty breastfeeding, difficulty bonding with their baby, and many more, up to and including death. They are not informed of their options. They are brushed aside when they learn about their options and attempt to exercise their rights to choose them. They end up with severe complications and feel angry at themselves, regretting not standing up for themselves and their babies. They have a hard time processing the trauma of what they experience, and the feeling of powerlessness that goes along with it. 

It isn’t their fault. They have been groomed for this kind of mistreatment and disempowerment their entire lives. That is what our society does. Anyone who questions what they are told and seeks to educate themselves gets shamed, ridiculed, and laughed at. They are made to feel as though they know nothing, and pressured to trust that the given authority figure knows best, so they should simply accept whatever they tell them without question. The media teaches us to reinforce this, and seeks outliers to make examples of, encouraging others to judge and shame them for making choices different from those they would make for themselves.

We need to fight back. Question parents, question teachers, question doctors, question lawmakers, question the media. The United States is going through a massive upheaval right now. We are questioning the status quo. It’s time to stand up and speak out. No more lying down and taking the abuse that they give. Change begins within each and every one of us.

 

If your doctor tells you that you are going to have a c-section because your baby is breech, tell them you know your options and you will make the choice that is right for you. Educate yourself, listen to your intuition, and make your own choice. Knowledge is the best cure for fear, and fear is the most common ingredient in a recipe for disaster.

 

Here is a list of resources to learn more about breech presentations and your options if your baby is breech:

Home4Birth

Birth Without Fear

Informed Pregnancy

AIMS

BellyBelly

Spinning Babies

Evidence Based Birth

 

As always, do your own research and listen to your intuition, and do not allow anyone, regardless of the letters after their name, to pressure you into making a choice that you do not feel comfortable with.