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Many providers still have the outdated thought pattern of “once a c-section, always a c-section.”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

♥ 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

 

♥ 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.