Posts Tagged ‘cesarean’

This week we are thrilled to feature Desirre Andrews (midwife assistant & ICAN President) of Preparing for Birth as she discusses how to say no to interventions after a previous experience with cesarean birth.

Let me begin by saying I am a VBAC and Cesarean mother of 4 boys. Officially I am designated as a 2VBA2C mother. I too, have walked this path out just like countless other women. Many VBAC hopeful mothers are in a club they did not ask to be a part of regardless of why or how the cesarean occurred.  The first or last birth leaves not only a uterine scar but different possibilities for any subsequent future pregnancy and birth. It can be a very sobering, shocking, even overwhelming realization that there may never be a vaginal birth in the future or again.  The option at birthing versus repeat surgical delivery can be determined by accessibility and cultural expectations, needs and desires.

Why would there be an issue of VBAC access by hospitals and providers? VBAC is not a procedure that requires specific training or skill, unlike surgery. In a nutshell, it is the usual extension of pregnancy and labor to push out a baby vaginally. In essence, it IS the biological norm and expectation. The uterus does have incredible resiliency in healing, like other muscles in the human body. It is also widely recognized by and large to be a safe, reasonable option for women and babies by the National Institute of Health  (NIH) and the American College of Obstetricians and Gynecologists (ACOG) as evidenced in 2010 statements all backed up by years of evidence.

Some issues in access availability are language in the previous practice guideline statements stating immediately available anesthesia is needed (this idea knocks out vast number of rural facilities from offering access), physician liability concerns (cost of liability insurance, thought of being sued), lack of true informed consent between mother and physician comparing repeat surgical risk and VBAC risk, physician fear and desire for making labor and birth a zero risk venture (life is not risk free, either is labor and birth and can never be), and overall physician/hospital culture (what pressures, protocols and practices are widespread in an area).

Yes even with all of these, some changes are being made toward more access, albeit very slowly in most area. Women are compelling providers and hospitals to offer access through determination, evidence, self-advocacy, exercising options, rights and open communication. It is possible. Another point to look at is women are more and more choosing alternate places to birth whether at free standing birth center or in the privacy of their own home (with a midwife or unattended) when access is declined in the hospital environment.  Women are increasingly saying no to those who refuse to give options and choice.

The culture in which a childbearing woman lives (family, friends, co-workers, faith community) affects decision making for the positive or negative. When some or all of those in these cultural areas are supportive of VBAC, she is more likely to choose going for it. When it is the opposite and she is told to just do the “easy” thing (for whom, surely not the one undergoing surgery), ask “Why would you WANT to labor? How lucky you are to be able to get out of it.” or “What does it matter anyway? All you want is an EXPERIENCE, A healthy baby is all that matter anyway….”  All of these negate the woman herself. It is more than okay to want the vaginal birth. It is good to look at what is the healthiest birth avenue. That goes a long way to seeing how the best experience is also the healthiest experience for both mom and baby.

I asked a recent VBAC mother, Katie Z. how her culture affected her decision to go for a VBAC. She stated “Friends and family were extremely supportive, especially after seeing what I went through with (my) cesarean and subsequent PTSD. The community (at large) most was surprised it was no longer once a cesarean, always a cesarean.”

She was able to more readily and easily pursue the desire and need to have a healthier experience because she was fully supported by those in her life. Conversely, some women are willing to buck the trend within their culture and have a VBAC. With lack of support, fear mongering and too often misguided advisement, it is much more a challenge to gestate peacefully and prepare for birth. It is possible, but much more difficult when those a woman cares most about are not be in her corner. I will share that with my fourth son; very few in my world shared my point of view. Thankfully my husband and certified nurse-midwife did. That was really all I needed. Frankly, it can be a dangerous thing to tell a determined woman “no”. She is very likely going to find a way.

Bottom line, there are options though to exercise them it may require much effort, research, relocation, financial planning, meeting with administrators, changing providers and more.

For more information on VBAC www.ican-online.org and www.prepforbirth.com

Desirre Andrews, CCCE, LCCE, CLD, CLE, Midwife Assistant & ICAN President. Preparing For Birth, LLC – http://www.prepforbirth.com.


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To conclude our series on giving birth after sexual abuse, we’ve decided to share the story of Erica, a survivor who contributed to Mickey Sperlich’s advocacy. Erica shows the evolution experienced in her four births, and shares how each progressively moved her through the healing process, and to a place of true empowerment.

The atmosphere I grew up in was wide open and sexually supercharged. I don’t remember ever not knowing about sex, and based on my parents’ behaviors, it seemed to be the entire goal of adult life. My father was by far the most powerful person in our home, so for survival, I adopted his view of the world. I learned to see my body as my currency — it was what I had to surrender to be wanted. My mother taught me to be careful of the tender feelings of men, but no one taught me that I had the right to say no to sexual advances, or that I might actually want to. As a result, I began experimenting sexually when I was 10 years old. It began with pornography magazines my older brother gave me, and moved into partners who were boys and girls my age or a little older — usually my parents’ friends’ kids.

When I was 12, I was seduced by an older man — a med student who was the son of my parents’ friends. Years later, he nonchalantly shared with me vivid details about the experience, commenting on how none of his girlfriends ever “let” him do such things — though I don’t even remember all of these “things.” It was all very antiseptic, very calculated, and I had no frame of reference to know that it should be different. I had my first pregnancy scare when I was 13, and continued to live the only way I knew — seeking the attention of men.

The summer after my sophomore year in college, I became pregnant. I didn’t think I had any other choice but abortion. I believed that once I had given birth, I would no longer be desirable to men. So, I dutifully marched myself down to a clinic and aborted my baby. The unexpected outcome of having an abortion was that I stopped caring so much if a man wanted me. In fact, I stopped caring about pretty much everything. Given my mental state, it is not surprising that I didn’t give the next guy I met a lot of thought. Nor is it that difficult to understand why it took me years more of running to realize that he was the man I wanted to marry. Or that it took me a few more years after that, even into the marriage, to realize that I really did love him.

Almost immediately after marrying Bill, my desire to get pregnant became overwhelming. I wanted a baby so badly, but he wasn’t ready. When I finally did get accidentally pregnant, I was ecstatic. I thought I knew so much about pregnancy — I assumed that if I told my doctor I wanted natural childbirth, I would have a natural childbirth. I wanted to deliver my own baby more than anything, to finally feel like I was a real woman — to finally heal the wounds that had accumulated over the years.

Four weeks before the end of a healthy pregnancy, my doctor discovered that my baby had turned breech. A c-section was quickly scheduled. Once again, I climbed onto a table and let a doctor cut my child out of me. I came home with my baby and a frozen heart.

By the time I became pregnant with my second child, I had already embarked on the long, exhausting process of revisiting my past through counseling — I had let the tears out, and was set on planning the birth I had always dreamed of. Twenty hours of active labor and four hours of pushing would have in most cases earned me another trip to the surgical suite, but I was lucky to have wonderful, caring midwives who believed in me — and instead of another cesarean, I gave birth to my child naturally at home. As I held my sweet son, a surge of something came over me that I’d never felt before: true power. Power that came from having done something difficult and important, not the false power that I had experienced in the past as men used my body.

I believe that God used the birth of my first child (and the loss of a lifetime of dreams that came with it) to take down the walls that I built to survive my childhood. My second birth — it began the reconstruction process.

My third labor and birth was the sort that women would forfeit body parts to experience. I had learned something from the previous two births. I had learned to relax into it, so much so that I was able to doze between contractions. I essentially woke up ready to deliver, and the midwife didn’t even get her coat off before my daughter slid into the world. I was the first to notice she was the daughter I had longed for, that I had wondered if I was too unworthy as a woman to deserve. Again, fear too deep to name dogged me, but each birth restored a damaged part of me. I sat in my rocker for a month straight with my daughter, so incredibly delighted I didn’t want to move.

When I was 42 weeks pregnant with my fourth child, the midwife did a heavy-duty manual exam to see if we could get things going, and discovered that I was having another breech baby. We were living in Dallas at the time, had no back-up doctor, and not much time to make any decisions. We went through with the birth as planned, since we both thought this baby would be relatively small. I remember this labor as a time of song — I was overwhelmed with a supernatural peace. While it wasn’t quite as fast as my previous baby’s birth, the breech birth was in some ways less difficult. When it was all over and we weighed my “littlest” baby, she was a full pound heavier than my firstborn breech — the one who doctors said I could never have delivered myself. I laughed such a laugh of freedom, of pleasure, and yes — of power.

Each birth brought back a piece of me that had been distorted by the fear and shame that resulted from my turbulent sexual past and abuse. Each birth reaffirmed, in a way much deeper than just knowing so, that women are powerful — extremely powerful.

Erica’s story was repurposed with permission from Mickey Sperlich’s blog, Survivor Moms Speak Out.

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This week, Mother’s Advocate is proud to present well-known and respected childbirth educator and author, Nicette Jukelevics. Nicette is blogging on behalf of the Coalition of Improving Maternity Services (CIMS), and has given us a straightforward, detailed look at labor induction.

Although there is no evidence to show that non-medically indicated inductions improve outcomes for babies, inductions for non-medical reasons have been on the rise in the U.S. Increasingly, labors are being induced for psychosocial reasons and for medical convenience. What’s more, the majority of expectant mothers are not aware of the risks of elective induction when they request one or when their caregiver schedules it.

We are learning, however, that with a healthy pregnancy, not waiting until labor starts on its own may have far greater health consequences for babies than we knew. Research shows that when births are induced or cesarean sections are scheduled — especially before the 39th week of pregnancy — newborns may appear mature, but they are at greater risk for short- and long-term complications.

Labor Induction: Alarming Statistics

In 2005, 22.3 percent of all U.S. births were induced — a 50 percent increase since 1990. A national survey by Childbirth Connection showed that 21 percent of U.S. women who gave birth in 2005 tried to self-induce labor because they were tired of being pregnant. They wanted to induce to avoid a medical induction, to control the timing of their birth, or because their caregivers were concerned about the size of the baby.

Elective induction rates vary widely among hospitals (12 percent to 55 percent) and among individual physicians (3 percent to 76 percent). But more than four out of 10 mothers (41 percent) reported that their caregiver tried to induce labor. For some women, an elective induction can almost double the risk for a cesarean, depending on the individual physician’s practice style and medical specialty. And all of these statistics are even more frightening when compared to the World Health Organization’s recommendation that appropriate induction rates in any geographic region should not exceed 10 percent.

Labor Induction: The Risks

With an elective induction, babies are more likely to suffer from hypoglycemia, to be admitted to a special care nursery, and to need ventilator support. A recent study of a U.S. healthcare system showed that babies born at 37 weeks were 22.5 times more likely to need a ventilator at birth, and babies born at 38 weeks 7.5 times more likely, when compared to babies born at 39 weeks. Babies born too soon are also more likely to experience serious complications, including fever, infection, respiratory distress syndrome (RDS), and transient tachypnea of the newborn (TTN).

These babies may look normal, but have an increased risk of difficulties with vision and hearing, feeding and digesting their food, regulating their body temperature, and are more likely to need phototherapy to treat jaundice.

The newest research on babies born before term indicates the potential for neurological problems and learning difficulties that may not show up for years. The March of Dimes is educating healthcare professionals and mothers alike about the important brain growth and fetal neurological developments that take place in the very last weeks of pregnancy. At 35 weeks, a baby’s brain weighs two-thirds what it will weigh at 39-40 weeks. At 37 weeks, the brain weighs only 80 percent of its weight at 40 weeks. The cerebral cortex — the part of the brain that controls functions such as cognition, perception, reason and motor control — is the last to develop. Researchers have found that babies born pre-term are more likely to have learning difficulties at school age. It’s essential for baby’s brain development that the pregnancy goes to full-term.

Labor Induction: Consider This

An induction of labor is a complex process that often requires additional medical interventions to keep the mother and baby safe from successive potential complications. Inducing labor with pitocin when the cervix is unripe (long and closed) sometimes causes the mother to labor for long hours with little progress. Subsequently, confining the mother to bed, using continuous fetal monitoring and IVs, and administering an epidural for pain are commonplace with an induction. Shoulder dystocia (when the baby’s shoulders cannot fit through the pelvis), and the use of forceps or a vacuum extractor are also increased with induction. All of these interventions and complications can lead to higher risk of cesarean section — failed inductions are not uncommon.

Labor Induction: When it’s Helpful

Regardless of all the risks, there are several medical indications for inducing labor — when the mother or the baby’s health would benefit more from the induction than from continuing the pregnancy. These may include diabetes, pre-eclampsia (high blood pressure), or a uterine infection in the mother. Or when a baby in utero is not growing at a normal rate (small for gestational age) or the pregnancy is post-term (more than 42 weeks). Induction may also be favorable when the bag of waters breaks prematurely (also known as PROM, premature rupture of the membranes).

Labor Induction: Questions to Ask Your Provider if it’s Suggested

  • Why are you scheduling an induction of labor?
  • What are the risks of inducing my labor?
  • I know that my due date is only an estimate. What precautions will you take to make sure my baby is not born too early?
  • How do you plan to induce my labor?
  • How will an induction affect my labor and the health of my baby?
  • I know that compared to waiting for labor to begin on its own, an induction is more likely to lead to a cesarean section. What measures would you take to reduce my odds for a cesarean?

If both you and your baby are healthy and stable, don’t hesitate to take time to consider your caregiver’s recommendations and explanations. Feel free to leave the appointment, with a follow-up scheduled — or to get a second opinion. After all, this is your birth.

The last week or two of pregnancy may be difficult. Priorities at work, or scheduling maternity leave to accommodate childcare or family needs may be a priority. However, waiting for labor to begin on its own is safer for you and your baby — and safety is of the utmost importance!

Nicette Jukelevics, MA, ICCE is a childbirth educator, researcher and author of “Understanding the Dangers of Cesarean Birth: Making Informed Decisions.” She is also the founder and publisher of VBAC.com. Nicette is past-chair of CIMS, and now serves as chair of the CIMS Coalition Building Committee. She has also served on the Board of the International Childbirth Education Association and DONA International. For more than 25 years, Nicette had the privilege of helping thousands of expectant families prepare for childbirth, VBAC and early parenting. She has presented on cesarean and VBAC issues at national conferences, and for advanced doula trainings across the U.S. With co-author, Henci Goer, Nicette recently published “The Risks of Cesarean Section & Expectant Mother’s Checklist,” a Coalition For Improving Maternity Services (CIMS) Fact Sheet.

Other resources: California Maternal Quality Care Collaborative

Tell us about your labor. Did (or will you let) your labor begin naturally? Was (or are you planning on having) your labor induced? We’re looking forward to hearing about your experiences!

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This week, we are thrilled to feature the voice of a leading birth advocate, Ricki Lake. The below interview features Ricki and her producer and coauthor, Abby Epstein, as they speak to their film, The Business of Being Born, their book, “Your Best Birth,” and the inspiration behind their mighty movement.

How have women responded to The Business of Being Born?

Ricki Lake: The reaction has been really incredible. Everyday I meet people who have been affected by it, and it’s not just women, it’s everyone. Even people who do not think they have an interest in the subject matter are suddenly interested in the story — are sucked in to the personal tales and the statistics that we reveal, and realize what an important issue this really is.

Abby Epstein: I love the stories that we hear. Someone saw the film, and then at 35 weeks dropped her OB and went to a birth center and a midwife. We also hear stories about those women who didn’t necessarily change providers or birth locations, but were able to advocate for themselves and talk their way out of a C-section. I love those stories, because I think that is the message of the film. It is not that everyone should have a home birth, that everyone should be at a birth center, or that everyone should use a midwife — at all. It’s really about education. Knowing your choices, being a really informed consumer, and not falling prey to the fear that so many women feel that makes them consent to things they may not have, had they known differently.

So you are actually changing people’s lives.

Abby: They tell us we are!

Ricki: We are definitely helping to make birth a better experience overall, and that feels really good.

What stories are you hearing from midwives? How are you changing their lives?

Ricki: Their practices are definitely doing better than before the movie. In many cases, we are hearing that their practices have doubled, that they’ve had to take on more midwives — it has definitely helped their businesses. And it has helped to change the perception of them.

How has the movie changed your own life?

Ricki: It is so hard to put into words. I always felt like my life had a lot of meaning — I am a mom and feel really fulfilled in that role, and I love the work that I do — but I have now given back in a way that is bigger than I had ever hoped. I feel that given my former career as a talk show host, I now have some legitimacy. I have something to say, and people want to hear it. It is just a really good feeling to have done a project that I believed in so whole-heartedly — a project that is from a really good place and is having this kind of positive effect.

What about the difficulties? What challenges have you encountered as a result of the movie?

Ricki: Day to day, I don’t really come up against a lot of opposition to the film. I am sure there are obstetricians out there that still don’t believe in our message, but I don’t know how you can argue with the message of women having choices. That is ultimately what it comes down to. I don’t feel that women walk away from the film feeling judged by the birth that they ultimately ended up having, or are going to have.

Abby: I agree, and one thing that worked in our favor was including the outcome of my birth in the film. I won’t spoil it, but because you see a birth that required intervention, you see a really lovely transfer from home to hospital, from midwife to OB, and the system working in the way that it could. I think including my birth in the film really mollifies the medical community in terms of saying, “Of course, there is a place for the hospital. Of course, there is a place for surgeons and technology when it is needed.” So I think that has really helped us balance the film and receive more respect from the medical community. Even though a lot of people really don’t agree with a lot of the points we make in the film, on some level they do embrace the message.

What do you think The Business of Being Born is accomplishing?

Ricki: It is definitely raising awareness; it is educating people and getting them to fight for their own choices.

What are your next steps?

Ricki: I am continuing to put myself out there and advocate for choice in birthing. I hope to make the system better and safer, to give women access to the information for their decisions, and to hopefully lower both the C-section rate and the maternal death rate. We want all of it. We want better maternity care, and for women to have as amazing, empowered experiences as possible.

How has this movie or being a childbirth activist changed your mothering style?

Abby: This whole idea of awareness, of being fully conscious to all the levels of motherhood. Ricki has a quote in the film that her peers just seem to want to “get this baby, acquire this baby, get this baby out,” and oftentimes, that is where motherhood starts. I think it is really a shame that a lot of women are not approaching birth and motherhood prepared, not doing their homework, not getting access to the right information. That many are having birth experiences that are disempowering and depressing, or that they are separated from their babies at birth — all things that can be very deeply wounding.

Do you want to tell us anything about your book?

Abby: It is called “Your Best Birth,” and it is meant to be a very practical guide to navigating your choices in the current maternity system that we are in. It is not a pregnancy guide, or a “What to Expect When You Are Expecting,” that tells you what your baby is doing at 34 weeks. It is totally about how to pick your provider, how to build your birth team, whether you should hire a doula or not, whether you want a midwife, explaining the different types of midwives and how they work, what you should be looking for in an OB, what a typical hospital experience is like, things you should ask on the hospital tour, things you should ask on a birth center tour. It’s a very practical, handholding guide aimed at women who may want totally different types of births. It’s definitely not just for women who want natural birth. But for women who want a more empowered, more personal birth experience.

This interview, conducted by Maria Iorillo, was repurposed with permission from Mindful Mama.

Maria Iorillo, CPM, has been a practicing midwife serving the San Francisco Bay area since 1986. Maria co-produced It’s My Body, My Baby, My Birth, an educational childbirth film that tells the story of seven mothers in their emotional journeys to natural childbirth.

Have you seen “The Business of Being Born,” or read “My Best Birth?” How did these tools inspire or empower your birth?

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Mother’s Advocate Mondays begin today with extraordinary birth advocate, Danielle Elwood. Danielle’s passion for safe, healthy birth has led her to become a postpartum doula, seek certification as a Lamaze childbirth educator, begin a blog dedicated to empowering mothers, and actively join the International Cesarean Awareness Network. Through her two birth experiences, she has found the importance of trusting your body and baby to guide you safely through the process — and shared with us a few tips for along the way.

My passion for birth advocacy began two short months after my first child was born by cesarean section. It wasn’t until after I watched Ricki Lake and Abby Epstein’s “The Business of Being Born” that I realized the experience surrounding his birth truly bothered me. (I was persuaded by my obstetrician to be induced, which made labor difficult, which pushed me to an epidural … and then, cesarean.) When my oldest was 8 months old, I learned that I was pregnant with our second child. I automatically knew — without any question in my mind — that this baby would be delivered vaginally (VBAC). This time, I was going to do everything in my power to avoid a second surgical birth.

It wasn’t until I started to research VBAC (and birth in general) that I found so many ways that women can prevent a c-section from happening, even before labor begins. Doing simple things and taking little steps during pregnancy can greatly lower a woman’s risk for a c-section. I developed a list of easy ways to help lower that risk, which helped me work towards my goal of a VBAC.

Take a Childbirth Education Class

Lamaze, Hypnobirth, CAPPA, Bradley Method — I know — there are so many different kinds to choose from! Whatever your choice, the important thing is to simply take one! Skip the one day birth classes that hospitals typically offer, as most of them teach you about hospital policy, procedures, and how to be a good patient under their care, instead of about the birth process or about natural childbirth.

Interview Providers

Interview a number of different providers before choosing who will provide your prenatal care and delivery. Ask them the tough questions — what you really want to know about someone who could potentially be delivering your child, or helping “call the shots” when it comes to medical choices. This will prevent issues with your provider from arising later in pregnancy, or worse, during labor and delivery.

Hire a Doula

Many women don’t have a doula for their birth, for either the lack of available finances, or the fear that having a birth coach will take the spot of their partner or husband. There are a lot of benefits to having a doula at your birth, and having skilled, professional support is always helpful (your partner is probably just as nervous and new to this as you are!). As for the money hang up: There are a lot of doulas who are working towards their certification, and will take clients on for free, or a very low fee. Another option is to ask friends and family to chip in for a doula, instead of buying some of those baby shower gifts many of us will never use!

Read, Read, Read!

Skip “What to Expect while Expecting,” and the books that flood you with cute, antidotal-type jokes. Read about real birth, natural childbirth and the birthing process. There are a lot of great childbirth books out there, and The International Cesarean Awareness Network (ICAN) has an excellent list of reading material. Of course, it is unrealistic to think a pregnant woman will be able to read all of those books before her baby comes, so some of my personal favorites are:

  • “The Thinking Woman’s Guide to a Better Birth” by Henci Goer
  • “Birthing From Within” by Pam England
  • “Gentle Birth Choices” by Barbara Harper
  • “Creating Your Birth Plan” by Marsden Wagner
  • “Ina May’s Guide to Childbirth” by Ina May Gaskin

Avoid Elective Labor Inductions

We are all uncomfortable towards the end of our pregnancies, and sometimes I wonder why women get pregnant again — after baby feet in the ribs, pelvic aches, and never-ending heartburn. (We all know why we do it again!) Elective labor inductions mean not for a medical reason. More than 40 percent of all labor inductions end in a cesarean section, either because the baby is not ready to be born, or the mother’s body is not ready to birth her baby. Remember, a normal pregnancy can last up to 42 weeks gestation. Due dates are not an expiration date.

Avoid Being Restricted to Bed During Labor

Moving around is key for helping your baby to be born. For thousands of years, women have been giving birth in “alternative” positions, which are easier for mom and baby. It wasn’t until recent years that women have been put flat on their backs in bed because it is easiest for the person delivering or catching the baby. What women aren’t being told about this position is it decreases your pelvic size, and doesn’t allow gravity to help your baby come down. Get off of your back and move around as much as you can!

Avoid a Cesarean Section for Breech Presentation

There are many ways to help your baby get into the optimal position for birth before an external version or cesarean delivery may be necessary.

Some things to try before signing up for a scheduled cesarean for breech presentation:

Avoid Routine Third Trimester Ultrasounds for Size

These ultrasounds are notorious for being up to 20 percent or 2 full pounds wrong in either direction, and could label you as having a big baby, which makes most providers push for an early induction or cesarean.

Stay Active During Early Labor

Walk, do light housework, eat — do what you would normally do during the day! This helps both you and baby progress through labor naturally. Have faith in the process of labor and birth!

After all of the preparation for my second child, I ended up laboring for more than 26 hours with several issues. My VBAC dreams turned into a CBAC reality. The difference between this and my first cesarean — this cesarean had to be done for my and my baby’s well-being, so I am at peace with it — and feel like I have the best of both worlds due to my intentions to prevent it.

Danielle Elwood’s birth advocacy began in 2007, with the cesarean birth of her first child that very well could have been prevented. Because of her experience, she became heavily involved with The International Cesarean Awareness Network (ICAN), and began writing in hopes of educating other women in her position. She started her work in the childbirth community as a postpartum doula, and is currently working on her certification to become a Lamaze Certified Childbirth Educator. Danielle is a dedicated mother of two small boys, Camden and Benjamin, and the wife of a veteran marine and fire fighter. For more, visit her blog, Momotics.com.

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Inspired to achieve a natural, vaginal birth after her first child was born by an unexpected cesarean section (she did!), Tina Cassidy set out to educate society about the history of birth, and how it’s influenced by different cultures and time periods —  through her book, “Birth: The Surprising History of how we are Born.” During our interview with her, she shared where exactly her inspiration for birth advocacy comes from — along with some excellent words of wisdom and encouragement for expectant mothers.

What inspired “Birth: The Surprising History of how we are Born?” What do you hope readers take from the book?

I was inspired by the birth of my 6-year-old, George. I had an unexpected c-section after a perfectly healthy pregnancy, and afterward, my husband asked what would have happened in this situation 500 yrs ago. The answer they gave was horrific — and sparked my interest in how birth has evolved over time. It’s fascinating hearing the women in my family speak about their births throughout different time periods and cultures.

I hope readers question birth more. I hope they understand that just because this is how we do it now doesn’t mean that this is how it’s always been done, that other countries do it this way, or that it’s the best way. Its just they way we do it. Other countries actually have better birth outcomes and spend less money achieving them. Many countries have lower infant and maternal mortality, and higher maternal happiness after birth than the U.S.

What went into the decision to deliver your second child VBAC?

It’s funny because when I ended my book, I wasn’t even sure I was going to have another baby. I wasn’t planning on it, but lo and behold, I found myself pregnant. Over the years, it has become harder for women to have VBAC in hospitals — some flat-out refuse, and others watch and monitor very, very carefully.

This was no way for me to labor and have my baby. It’s scary. It’s stressful. Since my chances of having a VBAC in a hospital were slim — not because it wasn’t safe — but because they were going to be over-precautionary, I decided to give birth at home. I wanted to enjoy having this baby, and I knew from all of the research that a VBAC was a safe option for a low-risk woman like myself. I made the choice to deliver VBAC at home for me and my family, but didn’t take the decision lightly. It turned out to be the most amazing experience I’ve ever had, and I’m so glad I did it. I’m by no means a radical person, and understand and respect that for some, it’s a wild idea. My first birth was (I believe) unnecessarily intervened by c-section, and I didn’t want it to happen again. My second birth was amazing.

How can women progress labor and manage pain naturally?

I am a real believer in the concept that we’re mammals, and believe we behave like animals in birth. It’s not an accident that when we enter a hospital to give birth, and are surrounded by strangers, we don’t feel safe or protected — we feel scared. The best thing to do is surround yourself with people you know and trust — whether that be a doula, midwife, friends or parents. Your partner is great support, but you need more — because they’re scared, too! Also, make sure you’re in the right frame of mind. Labor can be painful, but if you’re focused on getting it done, its less painful. I had a water birth, and it helped me manage the pain a lot. Being weightless helped me be in an otherwise uncomfortable position for a long time.

Birth interventions and cesarean sections are on the rise. Why do you think this is?

Hospitals have forgotten that birth is a natural, physiological process, and just because we have technology, we use it.

In the midst of these interventions, how can women achieve the happy, healthy births they desire?

Expectant mothers have to stand up for themselves long before the birth day arrives. Be sure to make the right choices about your caregivers, support network, and the right place to give birth — whether it’s a birth center, a hospital or at home — you have to arm yourself with enough information about the best place for your birth, and the best people to be there for support.

Tina Cassidy was a reporter and editor at the Boston Globe for more than a decade, covering everything from business to politics to fashion — the very things, she would learn, that have influenced birth for centuries. She went on maternity leave in 2004, which morphed into a book leave, which became permanent in late 2005. “Birth: The Surprising History of How We Are Born” is her first book. For more from Tina, visit her blog.

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Women shouldn’t be denied the opportunity to have a natural childbirth simply because they’ve had a cesarean previously. Kristen Oganowski, mother, doula and blogging birth advocate, is working to provide women the tools they need to push for natural birth through recent research and findings. We think it’s a powerful, remarkable cause — and a necessary one, too.

Sometimes even I can’t believe that I really had a non-medicated, in-hospital, water birth VBAC. This experience had been a dream of mine for so long that I often have to remind myself that the actual experience of a natural birth was not a dream. But it was real, and it was empowering, and it was a dream come true. I had to fight (hard) for my VBAC, and would like to help other women avoid the struggles that I, myself faced.

Just last month, the National Institutes of Health (NIH) held a Consensus Development Conference on VBAC (vaginal birth after cesarean). It was refreshing to hear from the NIH panel that VBAC is a “reasonable option for many pregnant women.”  This is a very significant finding in the current birth climate in which:

  • Nearly one-third of babies are delivered by cesarean section.
  • The VBAC rate decreased dramatically from approximately 23 percent in 1996 to just 8.5 percent in 2007.
  • Many OB/GYNs and midwives often refuse to attend VBACs because of medico-legal concerns.
  • Approximately 30 percent of hospitals have written policies banning VBACs.

After attending the conference and fully absorbing the gravity of this consensus, I asked myself, What could I do to help facilitate self-advocacy? I was sure that the NIH statement could be just the tool that women seeking a VBAC in the U.S. have been looking for — to fight a local VBAC ban, discuss their natural birthing options with care providers, or even simply decide for themselves between a VBAC and a repeat cesarean section. Thus, the “NIH Consensus Statement Primer” emerged.

I am now partnering with Amy Romano (certified nurse-midwife and blogger for Lamaze International’s Science and Sensibility) and some other amazing birth organizations, advocates and bloggers, and the work for this primer is well underway! We hope for it to be accessible, informative and empowering — a real tool that women can use to help advocate for themselves, their babies and their birthing choices. The panel has yet to release its final statement on VBAC.  (The current consensus statement is only a draft version.) After the final statement is released in late April or early May, we hope to have an online version of the primer available four to six weeks later.

Our primer will include:

  • Risks and benefits of VBAC and elective repeat cesarean
  • An analysis of the “critical gaps” that the NIH panel found in the research on VBAC
  • Ideas for pushing care providers and hospitals to publicize their VBAC rates
  • Tips for discussing VBAC and the consensus statement with care providers.

What do you think about VBACs and the current resistance of the medical community to provide them? Do hospitals in your area do VBACs? Have you heard of any VBAC success stories?  Do you think that this primer could help you or another birthing mama you know?

We’d love to hear from you. Please share your feedback, questions and ideas in the “comment” field below!

Kristen is a feminist mother. A doula and future lactation educator who’s working on a PhD in philosophy. She’s a birth and breastfeeding advocate, a lover of good food and wine, an obsessive fan of various books and television shows, and the wife of a wonderful man who happens to be an attorney.

Finding a care provider who supports your decision to have a VBAC is essential for success. Check out these PDFs for helpful tips on choosing and changing your care provider:

Choosing a Care Provider

Changing Your Care Provider

Also, watch this video on avoiding unnecessary birth interventions:


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