But Didn't You Have a Previous Cesarean?

But didn't you have a previous cesarean?  Yes, I did!  (You can read a little more about it on my birth stories page.)  Does that make a natural birth unsafe now?  I believe not.  I have had two natural births since then, one at home.  As far the cesarean goes, to this day, I cannot conclude whether or not it was necessary (an "unnecesarean" as they call it) or not because there are so many factors that play into the end result.  What I can say is that I definitely not as educated as I could have been to make choices about the things that I did have in my control.  Since then, I have been involved with a group called ICAN that has provided me with a sense of empowerment to pursue my desire for natural birth. 

Here is an article took part in writing for a local magazine regarding cesareans and VBAC that can give insight into the scope of the issue:

ICAN of Southeast Idaho – Education, Support, Advocacy.

The old adage of “once a cesarean, always a cesarean” is all too well accepted and is a myth that local women are trying to debunk…local women who participate in a group called ICAN.    

ICAN of South East Idaho is a local chapter of the International Cesarean Awareness Network, a non-profit organization whose mission is to “improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).”

Cesarean Sections

A cesarean can be lifesaving for mother and baby when medically necessary. However, for a cesarean that is not medically necessary, the risks outweigh the benefits and is a less-safe option. Many mothers are unaware of the risks of repeat cesarean births and the benefits of VBAC. In 2010 The American College of Obstetricians and Gynecologists released updated guidelines for Vaginal Birth After Cesarean (VBAC). The guidelines state that VBAC is a safe and reasonable option for most women, including women with multiple previous cesarean deliveries, twins, and unknown uterine scars.

Cesarean delivery is the most common surgery for women in North America. The World Health Organization recommends a country’s cesarean rate be no more than 10 – 15%.  According to the 2011 Health Statistics Idaho Annual Report, the U.S. had a 32.8% cesarean rate with Idaho having a 24.5% cesarean rate.  Of that 24.5%, 16.9% were a primary cesarean delivery and 83% were a repeat cesarean delivery.  Women who have a primary cesarean delivery are more likely to have a subsequent cesarean delivery. Only 7% of women with a prior cesarean delivered via VBAC, even though the ACOG approximates that up to 80% of women would be successful if VBAC was attempted. These reports are staggering for ICAN supporters who recognize that these statistics demonstrate unreasonable and unsafe practices for women and infants. 

So what is causing this high rate of cesarean-sections?  For initial c-sections, many women may not be educated about things that may lead to this undesirable outcome.  For example, induction via Pitocin, a widely used medical intervention is considered the “quickest route to the surgery room,” with the chances of having a c-section greatly increasing when this method is used.   Continuous fetal monitoring, artificial forms of pain management, and caregiver’s policies also serve as an influence.

Vaginal Birth After Cesarean (VBAC)

Risk of uterine rupture is the most well-known and overstated risk for women attempting a VBAC.  But the chances of 0.5% - 0.9% are very low, especially compared with the risks of major abdominal surgery. In addition to the already low risk, with each successful VBAC, the risk of uterine rupture decreases. Women who have cesarean sections may suffer from a variety of risk factors including severe bleeding, infections, blood clots, hysterectomy, longer recovery times, placenta problems in future pregnancies, limitation on family size, problems with bonding and breastfeeding their infant, just to name a few.  Infants also suffer from surgical deliveries, one of the most important being the deprivation of having fluid squeezed from the lungs by going through the birth canal which can lead to respiratory problems. 

The benefits of vaginal delivery are plentiful, including increased bonding between mother and baby, lower infection rates, and shorter recovery times.  It cannot be minimized how advantageous it is to have a vaginal birth over major surgery. 

Local Women Taking Ownership 

ICAN emphasizes the importance for women and couples to take ownership of their pregnancies and births and educate themselves about the best options. If you recognize that you are not receiving evidence-based care, don’t be afraid to go somewhere else. 

Laura Lind, current leader of ICAN’s local chapter, was struggling with the idea of having a third cesarean. Her second cesarean had more complications than the first with the pain medication wearing off during the surgery to tearing out her sutures. Her baby has had many struggles with asthma (a side effect of cesarean delivery for infants).

“I was depressed at having to have another c-section. I did not want to face the pain associated with a cesarean including the recovery,” says Lind. She had been told by her provider to not have any more children because too many cesareans are dangerous, but she and her husband did not feel like their family was complete. “I didn’t know where to find evidence-based information about VBAC but the Lord eventually provided the people I needed to lead me to ICAN.” After seeking education, Lind switched to a supportive VBAC provider at 32 weeks and now has had two successful VBAC’s.

Lind says, “Now my greatest wish is to help women make their own informed decision on whether to have another cesarean or a VBAC.”

Education, support, and confidence are necessary for women seeking a VBAC because there is often a fight in store in order to achieve this goal.  On separate occasions, two local women of Pocatello planned to have VBAC’s, which their primary caregiver confirmed they were valid candidates for.  Each of them went into labor on weekends when a different doctor was on call that did not allow VBAC’s, according to his personal policy.  One of these women made the choice to drive to an Idaho Falls hospital while in labor in order to deliver vaginally.  The other individual was too far along in labor to make such a decision and was forced to comply with the on-call doctor’s policy and have an unnecessary cesarean, even though she had no other risk factors other than that she had had one prior cesarean.

Restrictive VBAC policies cause women to have to make difficult decisions like these.  Because each hospital has different VBAC policies and not all providers support VBAC, it is important for women to research local options.  ICAN of South East Idaho can also assist with finding a VBAC provider.

Get Education, Support, and Advocacy through ICAN

Our local chapter utilizes a Facebook page, blog, chapter meetings, and other events such as childbirth classes to provide support for local women and families.  ICAN is for those with a variety of circumstances, including those with prior cesareans who would like support for emotional and physical recovery, those who wish to find out how to avoid an unnecessary cesarean, those who would like more information on VBAC, and those who know they need to have a cesarean and would like support to know how to still make it a special and personal experience.

In addition to supporting women, ICAN strives to reach out to medical professionals and policy makers who would like to gain deeper insights about the way that birth shapes the family and also find ways to decrease the amount of unnecessary medical procedures to improve maternal and infant care. 

Facebook Page:  ICAN of Southeast Idaho

Local Chapter Blog:  www.ICANSEIdaho.blogspot.com

Website:  www.ICAN-online.com

Email: ICANSEIdaho@gmail.com

  

Sources:

1.     Ob Gyns Issue Less Restrictive VBAC Guidelines. July 2010.  The American College of Obstetricians and Gynecologists.  www.acog.com. 
2.  www.healthstatistics.dhw.idaho.gov

 

So the answer is, YES, you can have a vaginal birth after a cesarean with the right education and support.  For me, it has been an absolutely empowering pursuit.  I am regretful about the birth experience I did not get to have with my first son but I am not regretful about all the things I have learned, people I have met, and things I have been able to be a part of as a result of it.  I would likely not be writing this blog.
But the question is, how can we open women's eyes up to the risks of cesareans without having them experience it first?  Currently in America, one of three births are via cesarean.  Those are some high chances but I think most women were like me and skipped over the chapter in the book on cesarean section because they didn't think it will ever happen to them.  When the doctor came in a told me that he recommended, or rather informed me, that we were going to do a cesarean, it was a major wake up call!  It happened to me...and the main regret is not so much that it happened but that I was caught so off-guard by it.  Here are 14 Tips to Avoid a Cesarean.  If you have not had a cesarean yet, the more the reason to read this!

Interventions

Giving birth is an amazing process, designed perfectly by God.  When interfered with, the process doesn't quite unfold the same.

To be short, I think this video clip from The Business of Being Born gives a great overview of why someone would want to avoid interventions to birth as much as possibly.  The whole clip is great but you can start at 1:12 to see a visual of the "domino effect."

Emergencies: "But What if Something Happens?"

Probably the most common comments I get when I tell people I am going to have a home birth is, "Wow, you are brave!" and "What about if something happens?"  For the first comment...yes I am, but not for the same reasons they are implying.  I feel that they are saying that I am brave because I am willing to take the risk of no pain medication and the risk of having no doctor on site in case of an emergency.  I, on the contrary, feel that I am brave because I have faith that my body knows what to do and I am willing to "let go" and let it do its thing without interventions.  I prefer the word "courage" over "brave."  

Pain: Its Purpose in Childbirth

“The point...is not birthing without pain. The point is to birth with LOVE and CONFIDENCE, without FEAR, without unnecessary INTERVENTION, and with a supportive team who shares your birth vision. The wonderful side-effect of this type of gentle, mother-centered, empowered birth is more pleasure and less pain.” – Lauralyn Curtis HBCE

I have always believed in natural childbirth.  At one point, I found myself not being able to articulate why though when friends and others would ask me why I don't just go for the epidural...seems like a simple decision right?  Pain or no pain?

Hormones in Labor

My husband uses pregnancy hormones to explain my crying spells :) but I want to talk about hormones in a more positive way and how they contribute to the amazing birth process.  I feel this is important because you cannot "trick" hormones.  They will be produced in the body by real feelings and emotions.  That is why when people say that a woman desiring the "comfort" of a home birth as an unrealistic reason, I question their understanding about the process of birth because it's success is very much based on the comfort, relaxation, and support and love felt by the mother.  I am not saying that a mother cannot have these things in a hospital birth, but based on personal experience, it is not easy to feel relaxed in calm in a cold and uptight environment. 

Care Provider

When I was pregnant with our first baby, I spent hours reading reviews on carseats, cribs, and strollers...wanting to make sure I got the best!  When it came to a care provider though, I have to admit that I choose the first one I went to based off an ad I saw in the school newspaper.  I thought, "Oh...this is a women's clinic, they specialize in working with women...this must be good."  How shallow I was!  This played a key role in how my birth eventually turned out (cesarean).  My childbirth educator explained it this way:  If you go to a Mexican restaurant and expect to get Italian food, it probably isn't going to happen.  If you want Italian food, go where they make Italian food.  If you want a natural birth, go where they do natural birth.  I had always known that I wanted natural childbirth, but I hadn't realize that I was going to a doctor who was trained to approach childbirth in a technological way.  And you can't blame a doctor for being that way...they go to school to know exactly how to deal with medical emergencies, (which we are grateful for).  But that is usually all they go to school for.  Most doctors have never actually seen a fully natural childbirth.  They are not trained and experienced in the natural course that a woman's body takes during the laboring and birth process.  Naturally...for them...when things are not looking like "the average," there is some sort of intervention put in place make things go "more smoothly."  The truth is that all women's bodies are different.  There are averages for length of labor, size of baby, heart rates of mother and baby, positioning of baby, etc, etc,...but more than likely no one is "average" in every way.  Make sure that you know what the philosophies about childbirth that your care provider has are and make sure they match your own.  If you tell your doctor that you do not want an episiotomy but he believes in episiotomies, then you will most likely get one even if he says you don't have to have one "unless he feels you really need one" because in the heat of moment, he will do what he believes in and feels most comfortable with.  Don't be fooled. 

Is homebirth selfish?

As I have explored the option of home birth, I have had to shift through different opinions.  As human beings, we can be susceptible to the words of others  until be develop our own strong opinions based on knowledge and experience.  One prominent opinion of others that intially bothered me and made me continue to question what the right decision for me was the accusation that women who choose home birth are "selfish" for putting their baby at risk in any way by not having emergency sources readily available.  Of course as a mom, I only want the best for my baby, and so this one set heavy for a bit. Part of the process of choosing home birth is figuring out what fears or reservations you might have and then researching until you are able to resolve these fears, one way or another.  This is an important thing to do because if you go into childbirth with unresolved fears, they can hinder the natural process. I found these two articles that really resonated with me when addressing my personal question of "Is it selfish of me to choose homebirth?"