May 8th, 2011

C-Section Birth Plan: By Dou-La-La

The lovely Anne Tegtmeier, also known as Dou-La-La submitted this post, as well as another to my wonderful blog carnival on positive c-sections. While they may not be birth stories, it is a lot of great information that the readers should take the time to check out!

Birth Plans. Normally, they’re a collection of things to do or not do in order to give birth the way you prefer, and a major component of that for most women is avoiding a c-section. Same goes for a doula, right? In addition to helping create a birth that is as close to your ideals as possible, moms choosing to birth in hospital settings hire doulas to get their best chance at avoiding a cesarean.

So why would you even want to think about cesareans during your pregnancy, when you’re focusing on visualizing your birth as positively as you can? And why would you bother with a birth plan if you know you’re having one? Once the plan changes to surgery, whether it’s in the heat of labor or in advance, isn’t the whole raison d’etre for birth plans and informed choices out the window? Isn’t it basically all the same?

Not at all. There are absolutely choices you can still make, choices that can make a huge difference in the experience for both your baby and yourself.

Hypothetical Reader: But I don’t have any indication for a scheduled c-section, and no reason to think that I will be more likely to have an emergency arise during labor than any other low-risk mom. I want a natural birth if possible, or at least a low-intervention one. Are you saying I should write a backup cesarean plan? And doesn’t thinking about this stuff risk manifesting it?

I remember all too well when I was facing the very real possibility of a cesarean, and a scheduled one at that – the very antithesis of the home birth that I had been planning and yearning for. Over the course of my pregnancy, my placenta moved from complete to partial to marginal, to finally, finally just over 2 centimeters (the minimum required to be in the clear for a vaginal exit) away from the os, at my 34 week ultrasound.

That whole story is a post unto itself, again, but I want to talk today about how I dealt with the possibility. Or rather, how I DIDN’T deal with it. Because I was intensely focused on doing visualization to help my placenta move upwards, I deliberately avoided reading anything at all about cesareans. I’m a pretty voracious reader, especially when it comes to this subject, and I read quite a few pregnancy books. But I confess to you all now, right here in virtual public, that I skipped right over everything that had to to with cesareans. I covered my ears and sang “Mary had a little lamb . . . (at home in her birth pooooool)”.

Yes, it’s true that I was able to dodge this bullet by the skin of my teeth, but in hindsight, I think this kind of willful denial was really not the best thing to do. Now, I’m not talking about turning it into a fixation that becomes a self-fulfilling prophecy, investing your energy into fear and anxiety. And as I said, I can relate. I understand not wanting to think about it too much. But I have read enough birth stories now where the mothers, in their admirable preparation for a natural or low-intervention birth, wind up heading into surgery for one reason or another, having absolutely no idea what was in store for them.

So to go back to our Hypothetical Reader, on the first question, “Are you saying I should write a formal backup cesarean plan?” No, not quite going this far (unless you have reason to schedule one, in which case, definitely yes; keep reading below), necessarily, but it is worth taking a deep breath, looking over some information on cesareans, and thinking about what your preferences would be if this were to arise. Perhaps write them down based on the examples to follow, if writing works for you. Take a few minutes to talk to your partner, doula, and anyone else on your birth team about these wishes. Confront it calmly, and then put it away. On the second question, “Doesn’t thinking about this stuff risk manifesting it?” Again, this isn’t about fixating on it and creating a self-fulfilling prophecy, this is acknowledging it and letting it go. Again, confronting it calmly, and then putting it away.

I want to share with you some really eye-opening and helpful information I’ve culled so far on the matter, most notably from Morgan of Adventures in Diapering and Beyond. (By the way, in case it’s not already clear, let’s assume for the purpose of this post that we’re talking about necessary cesareans, both scheduled and unscheduled. You all know how I feel about unnecessary ones, and there’s much to be said on them. But not today. Today we’re talking about the ones that really do save lives.) First, Morgan herself gives a great explanation for using a birth plan for a cesarean here. An excerpt:

Why bother with a birth plan if you’re having a c-section because you don’t really have any say in what happens, right? Wrong. Even when you are expecting a c-section, there are still choices that you can make during and/or after the birth. Knowing what your options are can help you feel more a part of the birth experience rather than just an observer. While researching your choices, you will become better informed on what your doctor and hospital’s expectations are and what you can/cannot do in a hospital setting.

Morgan provides a comprehensive collection of posts on c-section information, from questions to ask, what to pack, recovering from surgery, and a good visual guide for what to expect. She even shares a video of one of her own births. If yours needs to be scheduled, I would pore over every single link she provides. For those who aren’t planning a cesarean but want to take my advice re: confronting it briefly but thoughtfully, her example of a c-section birth plan is a must. I’m going to quote extensively here, to illustrate just how many choices there really are, but all credit goes to her:

During Surgery:

*Catheter put in AFTER spinal (this is standard procedure at many hospitals)
*Volume down on heart monitor beeping
*Husband will photograph c-section
*One of the staff members from my dr.’s office will video tape Baby’s birth

*I’m allergic to (x drug). Please make sure I am not given this drug.

*Warm blankets during surgery
*No sedatives after birth. I want to remember my Baby’s first day of life.
*Please reinforce my uterus and use dissolvable stitches for closing me up [Note from Dou-la-la: I would recommend making sure that your doctor uses a double suture, as this increases likelihood of a safe VBAC. There is also evidence supporting sutures over staples - this is important to discuss with your doctor as well.]

Baby:

*Please hold baby up for me to see as soon as Baby’s born
*Husband to announce Baby’s gender (or maybe not announce gender at all and allow me to see for myself)
*Keep cord long for Hubby to cut
*No Eye Gel, No Hep. B vaccine. I will sign the waiver ahead of time.
*Please bring Baby close to me during measuring & weighing.

*If Baby is doing well medically, please bring Baby to me as soon as she is suctioned, weighed, and measured. Please do not worry about cleaning her up much before bringing her to me.

*I would like to hold Baby while Baby is being foot printed, getting bracelets on, and while the paperwork is being filled out.

Recovery:

*Once back in our room to recover and been checked as stable, we would like to be alone with Baby to nurse.
*We would like to keep Baby with us at all times. If Baby must go to NICU due to medical reasons, my Husband will follow.
*If someone arrives to visit, please check with my husband or I as to whether we are up for company before allowing them in our room.
*Delay Baby’s bath until the evening after Baby is born rather than bathing Baby right after birth.
*I am willing to be up and walking as soon as possible so I can get leg compressors off sooner
*I would like my Catheter out early the morning after surgery
*Baby will sleep with me in the hospital bed. While I am sleeping, there will be another adult in the room with Baby and I.
*I will be nursing on demand and whenever Baby is fussy to help stimulate my milk to come in and to soothe Baby.

Excellent, right? I think she has done a wonderful thing in providing all this information. make sure to also check out her post on Things I Wish I Had Known Before My 1st C-Section. It has lots of firsthand information about possible side effects, descriptions of some of the strange sensations and hospital protocols you MUST be aware of if you want to avoid them (like taking baby to the nursery while you recover). Morgan, my hat is off to you.

I also want to address some possibilities that may be outside the realm of most OB’s experience, but if you have a really good one, they might very well be willing to try something new. If you poke around in the birth spheres on the internet as much as I do, you may have run across the term “gentle cesarean”. Dr. Nick Fisk in the UK has been a proponent of this approach, pointing out that “while couples having normal deliveries have been given more and more opportunities to be fully involved in childbirth, very little has been done to see how we could make the experience more meaningful for those having caesareans.”

The scent of lavender fills the air and classical music is playing quietly. On the bed, Jax Martin-Betts, 42, is calm, focused and in control. With the birth of her second child just minutes away, the midwife, Jenny Smith, is giving her a massage. Her husband, Teady McErlean, is whispering words of encouragement: just a tiny bit longer, and our baby will be in our arms!

It could be a natural birth at any maternity unit in Britain, but we are in an operating theatre at Queen Charlotte’s and Chelsea hospital in west London, and the birth we are about to witness sounds a contradiction in terms: a “natural” caesarean section.

Jax has been on the theatre table for half an hour, and the obstetrician, Professor Nick Fisk, has almost completed the incisions through her abdominal wall and into her uterus. “OK, the baby is about to be born,” he says. “Let’s prop you up so you can see him coming out.”

Smith removes the blue drape between Jax’s head and her belly, and the head of the bed is lifted to give Jax a clear view. Fisk cuts into the amniotic sac and a fountain of fluid rises into the air before he rummages around to locate the baby’s head. In a few seconds it comes into view, covered with the milky-white vernix that has protected it in the womb. For the next few moments, the atmosphere in the theatre is electric: Jax and Teady gasp in wonder at their new son, who is now looking around, although his lower body and legs are still inside his mother’s uterus.

The “gentle cesarean” tried to make the environment more soothing and slows the pace of the entire process down, making the baby’s entrance more gradual and thus, hopefully, more peaceful. It may even help in squeezing the lungs out, the way vaginal birth normally functions, and one of the distinct disadvantages of surgical birth for the newborn’s respiratory function. The parents can see the birth if they wish, rather than being walled off by drapes, and the baby is given immediately to the mother, instead of whisking him or her away just because of protocols/habits.

This may or may be your cup of English Breakfast, so the specifics are up to you and your doctor, but if a necessary elective cesarean is required, you could think about incorporating some or all of this into your birth. I encourage you read the whole article – you might want to consider printing it and bringing it in to your doctor to discuss it.

In a similar spirit, Radical Doula featured a story on what was termed an “assisted cesarean”, where the mother was able to catch her own baby! Check out this image:

A far cry from the usual image we see of someone holding the baby next to the face of the mom, who is strapped motionless to the table, unable to touch her baby. Radical Doula raises a very important point here, commenting, “But is this just an attempt to make an entirely medicalized process seem more mother-friendly? Luckily both the mother and doctor in this situation don’t want this procedure to encourage c-sections:”

But women should not consider assisted caesareans ahead of vaginal birth. “I still think a vaginal birth is the best way to birth your baby,” Ms Chapman says. “I don’t want women to choose to have a caesarean because of this,” [Dr. Gunnell] says. “We need to be very clear that this is not a good alternative to a vaginal birth; the caesarean section rate is very high . . . “But for those of us who don’t necessarily have that opportunity [for a vaginal birth], this is a way of making an intervention experience a better experience.”

The original article also acknowledges that this certainly isn’t going to appeal to everyone. Many women would shudder at the thought of seeing their own incision, for one thing. But if you look at the picture above and think this is a pretty amazing thing under the circumstances, why not at least ask your doctor? It’s worth a shot. Even if he doesn’t go for it, hey, maybe your other preferences won’t seem like such a big deal anymore, by comparison. A nice bargaining chip, at the very least.

One final thought from Dr. Michel Odent. He was asked for his thoughts on how to make the best of the situation if a cesarean is inevitable, and he makes a case for allowing labor to begin on its own (hey, one of the Healthy Birth Practices, even if the context is a bit different) even if the end result is known.

Q: We now find ourselves preparing for a cesarean birth. We are wondering what things would be helpful to keep in mind/plan for/request in order to have the gentlest birth possible considering the circumstances.

A: The best way to deviate as little as possible from the physiological model of birth would be that the medical team is comfortable with the principle of an elective in-labor cesarean. In other words, the medical team would accept to wait until the day when you are in labor to perform an “in-labor non-emergency cesarean.” This way it is a guarantee that the baby will have given a signal indicating that his or her lungs are mature. We know today that the baby participates in the initiation of labor. Furthermore, during labor contractions, the baby is exposed to hormones that make more complete the maturation of his or her lungs. This is why, as all pediatricians know, there is an increased risk of respiratory problems during the days following a cesarean performed before labor starts.

I think that’s a pretty strong case, whenever the situation allows for it. Logistics would have to be managed, especially in terms of making sure your own doctor is available, or that his or her partners are also on board with whatever your plans are, but the effort is likely to be well worth it.

All efforts to reduce cesarean rates aside (and you know I’m all about that), a cesarean birth is still a birth, and is worth all the TLC you can possibly give to it, for both mom and babe. It IS possible to make it a healthier, less traumatic, and gentler experience. They both deserve it.

Hypothetical Reader: Wait, isn’t one character glaringly absent from this whole picture? What about having . . . a doula?

Indeed, what ABOUT having a doula? This will be addressed in a future post – for which I am soliciting stories from readers who have had cesareans with doulas. Please tell me your story!

Top photo by Arif Tanju Korkmaz.

May 2nd, 2011

Announcing Addison Ann Elwood

Addison Ann Elwood aka Little Miss A was born
Saturday April 30th, at 4:26am
SURPRISE!
She weighed in at a whole 5 pounds and 12 ounces

She is an angel… an awesome baby, an amazing nurser who brought my milk in only 2 and a half days
post c-section, which is very surprising, and she has already started to gain weight back!

My boys came to visit Mommy and meet their little sister, and they are so amazingly in love with her. It is so
heartwarming, and beautiful to see how much they love her already…

I was unable to VBA2C after going into labor on my own after my water broke Friday night. After talking with my midwives
and the OB/GYN after the fact, and knowing she never made it anywhere close to engaged, it made me feel comfortable with the
fact that I was going to go ahead with a scheduled c-section because there was a true medical need for it.

Addison did in fact have intrauterine growth restriction which showed with her birth weight.
She was 38 weeks 5 days at birth, the same as my oldest son, and weighed in two pounds less than him,
as well as two pounds less than my oldest son.
Thankfully she is healthy, and happy, and gaining already, something else unusual for most babies
while in the hospital.
I get to go home on Wednesday, and I cannot wait. I miss my own bed, and my older children!

Who couldn’t miss those faces?

Thank you everyone for all the well wishes and comments, as well as support!

May 1st, 2011

C-Section Birth Story #1 – Brandee

A Day Unlike Any Other

I will say one of the things I have failed at since having my daughter Everly is writing her birth story. I kept intending to, and it kept getting pushed aside. First of all, I had a brand new baby. Second of all, I have a brand new abdominal cut, and third of all, I just kept finding other more pressing issues I needed to write about. There were breastfeeding issues and diapers, sleeping and not sleeping, development and bonding. All the things that happen in that whirlwind of time that directly follows the arrival of a baby took over my brain, and at some point I felt like it had just been too long to write about it.

However, it sits fresh in my head every day. I remember the day Everly was born like it just happened this morning. I also remember the weeks leading up to her arrival vividly, and with both joy and sadness.

When I first decided it was time to try for a baby, I realized something about myself I had never known before – I was OBSESSED with the process. And not in a crazy, timing my egg and stalking my husband kind of way. No, I was obsessed with learning every last detail about how a baby was made. I learned so so much about my body in the 14 months it took to conceive Everly. Things I never knew a thing about. I had no idea that you could track ovulation by cervical mucus or even that there was a reason for the stuff. I didn’t know about basal body temperatures or the 3-5 day window. I knew nothing. And now? Well now I am everyone’s go to person for the stuff because I researched so much, and loved every minute.

When I finally did get pregnant, all of that attention shifted to birth. Apparently, there is a little birth junky living inside me. Suddenly I was faced with an entire new world of information to drink in, and I had never been more interested in something in my life. It was amazing. I was so completely excited about the birth of our baby I wasn’t even thinking about the pain or anxieties that often times come with it.

And I stayed that way, blissfully preparing, for almost 9 whole months.

I opted to go the midwife route. I just knew I wanted a more natural, holistic experience that focused on more than just getting my baby from the inside to the outside. I chose to supplement my care with the use of a doula, and began my search for one I felt would suit both me and my husband’s personalities. I found a woman I absolutely adored, and we were well on our way to having an incredible birthing experience.

We went to birthing class, and I made the decision to attempt a drug-free labour. I really had my heart set on this magical, wonderful experience that would bring my husband and I closer than we’d ever been. An experience that, while extremely intense and let’s be honest, likely painful, would allow me to bring our daughter into a world full of love and peace; a world where she felt happy and warm and secure, from the first moments of her life. My husband is more the medically minded type, but he respects me enough to let me lead the decision making for the birth of our child. Finding a midwife, doula and birthing class that allowed me to explore all the different options available, while satisfying his need to hear the scientific, evidence based risks associated with each option was important. I was very happy to be able to meet both our needs with the team we established.

We built a birth plan with the doula. We truly sat down and thought about what we wanted, how we wanted it to go and the realities that we may face, should something go awry. We planned to labour at home as long as possible, and head to the hospital for the big finale (I was open to the option of a home birth, but the husband was petrified so, this was an excellent compromise). We planned to use music and candles and water, we planned to keep the room as calm and quiet as we could. We planned to just let nature take its course and let my body lead the journey. We practiced a hundred techniques for pain management and for partner support, we listened to all the options available to assist us, and we felt content in the plan we made together. Well, he was content while being cautiously optimistic, I was beyond ecstatic.

As the weeks went on, things progressed beautifully. Everly was growing inside my belly at exactly the right rate. She was healthy and I felt AMAZING. I loved every last second of being pregnant, and I really truly thought it would be smooth and happy sailing right on through to the end.

I learned early on that children have their own agenda.

At exactly 36 weeks and 1 day, I was standing drinking a glass of water at my best friend’s house, where I have been every Thursday for over 6 years now. We were chatting about names and birth, while her little one slept in the other room and while mine snuggled deep in my womb. As I stood there, I got an extremely odd sensation in my legs, my body started to shake and my entire belly shifted. It was like Everly stood up in there, fluffed the amniotic sack, adjusted and got comfortable again. We both saw it. After it was over, I got an intense rush of warmth through my body, my cheeks flushed and I felt dizzy. I quickly left my friends place, because clearly I was about to go into labour and I needed to get home.

I went home, went to bed nervous that my baby might come this early but giddy with excitement that this could be the time. And when I woke up in the morning, not a cramp nor a big sticky wet spot to be seen, I laid confused.

I saw my midwife early the following week for our regular appointment. As usual I was excited to hear the heart beat and feel for her back. It was the best part of my week by far.

Only this appointment was different. This time, Everly’s position was unclear. And though she had been in a head down position for my entire pregnancy, and the thought of a breech baby had never entered my mind, it became clear that that is what had happened that Thursday night. My little bundle had flipped, head over butt, and was now resting comfortably with her head in my ribs.

I was sent for an urgent ultrasound, just to confirmed what I already knew. I sat and watched as Everly popped up on the screen, and the technician said “and here is her head” to the lump the rested just to the left of my left side ribs.

“And here is her head” the words still tear through me even now as I write them.

What does that mean? What will happen? How will we get her to turn around? My baby cannot be breech, SHE CANNOT, I mean, she’s has been head down ALL this time so why, why now? WHY? I have a plan, a birth I want to have, and it requires her to come out of my vagina, and not my abdomen. So seriously, what do we do WHAT DO WE DO?

I cried. I faked ok about it in the clinic and to my friend that was with me, I got in the car and took her and I back to work and I called my husband, and I cried.

And I cried and I cried and I cried. And then I got angry. Why am I facing a c-section when all I want it to do is labour? Why? This isn’t what I want, my birthing experience is RUINED, it’s going to be medical and scary and without feeling or emotion. It’s not going to be the same. All the things I’ve worked for are being taken away. I am one of the only people I know who WANTS to labour, so why? Why me? Why is it that someone who WANTS to try for a natural birth, who is borderline obsessed with the idea of experiencing it and all the good and bad about it, is in this position? Why not someone, like MOST of the people I know, who don’t care and just wants the baby out?

I can’t tell you how angry I still get when I hear expectant mothers say things like “well I am just going to try to schedule a c-section and do it the easy way”. Right, abdominal surgery is a total no brainer, and c-sections carry no risks or detriments to your unborn baby. Who cares about labour, it’s irrelevant right? There is nothing important about the process. It’s not like bringing a baby into the world is a big deal, so why should it be hugely intense?

I digress.

In any event, this was my new reality. I had to decide what I wanted to do to ensure this baby got out of my body in as healthy and happy a way as possible.

The hubs and I toiled with the idea of trying for a breech delivery. Well, I did. Once we were referred to a very talented and PRO vaginal breech delivery OB, and he discussed options with us, I got gung ho to give a vaginal breech delivery a try. And I tried very hard to convince my husband of this plan. However, after many many a discussion we realized that the risks – small as they might be, outweighed the benefits of having a vaginal delivery. For him, all he could hear were the words “potential cord prolapsed” and “brain damage” ringing in his ears. And for me, I knew I had to let go. My selfish desire to birth my daughter the way I wanted was not going to put her at risk. And I knew that the birth I wanted was already gone anyway, since my husband was going to be in NO shape to support me, while he was panicking about the potential complications.

We discussed labour options and while I was given the option to go into labour, and THEN have a planned (albeit non-emergent) c-section, I figured since I was having the c-section anyway, I might as well do it in the easiest and least complex manner possible. I might as well schedule it.

This of course did not stop me from trying EVERYTHING to flip that baby. I did acupuncture and moxibustion, I saw a chiropractor and did the Bradley method, I did 1000’s of cat/cow stretches; I hung upside down off my couch and my stairs for as many hours of the day as I could stand it. I did an ECV (external cephalic version – where the doctor tries to flip the baby from the outside…it was AWFUL), I did hypnosis with my doula, I sat with a heating pad on my lower abdomen and an ice pack on that bump I now knew to be my daughters head (the guilt of this technique and the ECV STILL haunts me). I spent 2 straight weeks visiting my friend and the pool in her apartment complex so I could cat/cow in the water and stand on my hands. I must have done 600 hand stands in that pool; 9 months pregnant, in my bikini, standing on my head and trying to get my baby to flip.

In the end, she remained head up and I remained on a list for a c-section appointment.

When the first one came up, I declined. The nurse and everyone I knew thought I was INSANE for not jumping on the chance to meet my sweet girl, but I was determined to give her as long as humanly possible to flip (and to keep her in there close to her due date). The next appointment came up a day before her due date, and I found myself at the hospital ready to have my baby.

In my true form, I use humor and sarcasm to deal with emotional pain. I continually told people I was having my child cut from me, or that I wasn’t having a baby, the doctors were having it for me. A little dramatic, but that is just how I felt.

However, I needed to get passed being so depressed about what I lost in the process, and start to accept what I was about to gain. I needed to get over myself and realize that a c-section didn’t have to mean a cold, impersonal experience that scarred me and my child for life. I needed to take back my birth, and make it what I wanted despite the circumstances I was in.

And so I did.

I met with my doula who, was completely on board with helping us through the process, even though the traditional doula role would no longer be required. She met with me and the hubs, and helped walk us through the experience. What it would be like, how we might feel, and what we could do to make a medical procedure joyful, while also being safe. We visualized the day, we talked to our baby, we made a plan to exude love and peace throughout the experience, despite our fears.

We took our birth back.

On March 23, 2010 we walked into the Women’s Hospital on a cool and somewhat drizzly morning. Our doula and midwife met us in admitting, and helped us through the exciting (albeit terrifying) process of getting all checked in. The 4 of us headed to the prep area, where they gave me that awesome gown and started taking me through the process. Our hospital is a research hospital, so I was asked to participate in a study and I accepted. I might as well help someone else while I’m at it.

I was hooked up to the monitors, Everly was checked for position JUST in case she flipped at the last moment, and the doula and midwife helped keep my husband calm. I laughed nervously at everything. I was a ball of emotions I couldn’t control. I was so incredible excited this day was finally here, I was still sad that I wasn’t going to experience labour and I was very nervous about both the surgery and the becoming a mother thing. It was intense. I think that’s part of the thing with a scheduled c-section, you have a long time to think about what is going on, and that can be overwhelming.

After all the checking of my stats was done and we were ready to go into the room, I had to leave the doula with my husband, and get my spinal. The doula wasn’t allowed in the operating room, which is funny since there were no less than 19 other people in there, but those are the rules. 1 support person and I was already bending that rule by also having the hubs and the midwife present. Lucky for me, the midwife and my OB were used to this arrangement and he allowed it no problem.

Walking into an operating room is a very strange experience. I don’t think most people walk in there awake and on their own two feet. It was scary and intense. The big metal table, all the tubes and machines, and the apparatus for checking my baby – all laid out there for me to see. Talk about impersonal, everything was cold, shiny and sterile.

As I was being prepped for the spinal I couldn’t help but shake. Nerves, excitement, fear of losing the feeling in my legs, it was all hitting me. The midwife stood by, held my hand, explained the process and ensured I felt safe. The nurses and anesthesiologist made jokes with me and I calmed down. Who cares what is going on around here, I am HAVING A BABY!!!!!!!!

Once the spinal took effect and they swung my now useless legs onto the table, things seemed to move at warp speed. My husband was brought back into the room, dressed in his scrubs, tears already staining his mask, and in came the doctor. Up went the sheet to block our view of my internal organs, a few tests to make sure I was as numb as required, and it was on.

The OB asked for everyone to be silent and calm, as a baby was about to be born and this was an incredibly important moment in all our lives. And while my husband held my hand and whispered all the nice, positive things the doula had reminded him to say into my ear, Everly Delilah was born.

It took less than 10 minutes from when the doctor told me we were getting started to when I heard that first cry. The midwife was snapping photos like the paparazzi, and suddenly this sticky little face popped up over the screen and she was here. I burst into tears, how could I not? They cut the cord, and let my husband take her to assessment. I could hear the cries and see my husband, and everything was right in the world. I wasn’t holding her yet but she was safely with daddy and that was good enough for me.

Within minutes she was placed across my chest, and I got to kiss her sweet face for the first time. Arms shaking, body rushing, I held her for as long as I could and then had to give her back to daddy. I just didn’t have full use of my body yet and I was afraid to drop her.

Once I was sewn up and clean, we were wheeled into recovery. I clutched her closely the entire time, and was pushed through the same hall I’d walked through a short while before, only this time I was a mother. She grunted and snuggled and my heart grew 10,000 time larger.

In recovery we immediately started skin to skin. Everly latched on and nursed for the first time, and the doula and midwife stood by, allowing us to bond as a family. We stayed there for a little over an hour, and then it was up to our room for the next 2 days.

I’m not going to lie, having abdominal surgery wasn’t easy. The recovery was painful and I never thought I would use the washroom without fear again. However, in the end Everly’s birth was perfect. She was healthy, I was healthy and we were in love.

There is so much hype about c-sections. I’ve heard the term birth rape and I know that for many people, a c-section is pushed on them in the throes of labour, and they feel robbed of their experience. That’s not how it went down for me. I made the decision to go this route because it was the best idea for our family, and while I still wish I could have experienced labour, I have confidence in our choices. Was it scary? Sure. I don’t think any kind of child birth could be without fear; it’s such an overwhelming time in your life. Was it bad? Not even a little bit. All of the concerns I had about not bonding with Everly, about a c-section creating breastfeeding challenged or about my being denied a positive birthing experience were unnecessary. I made peace with the situations and turned my energy towards making the birth what I wanted, despite the circumstances. The day was perfect. It was calm and happy, we had support from a great team, and most importantly, Everly was treated with love from the moment she entered the room. All of our wishes were met with enthusiasm and while I lost out on things like extended umbilical cord attachment and labouring at home, what I didn’t miss out on was a positive, blissful experience.

Everly Delilah was born, through an incredibly beautiful and peaceful c-section at 11:55am on Tuesday, March 23, 2010.

Thank you to Brandee for sharing her story!

April 17th, 2011

Week 15 – C-Section Essentials Bundle from Earth Mama Angel Baby

If you know that you are going to have to have a c-section, like I very well may be with this baby, although she has thrown us some more new curve balls in the last week… This is a complete must have for recovery.

Planning for my postpartum recovery has been hard, not only emotionally but also because I know what kind of process I will be going through after the fact.  Lets face it… c-section or any major surgery sucks.

Earth Mama Angel Baby is one of my favorite companies out there, and since having children I truly learned how important their products are, not just because they are organic, but because of the skin reactions not only I have, but my children have had to typical shampoo, and body wash products like Johnson & Johnson. I had a very similar experience to Gina (The Feminist Breeder) when it came to my children and sensitive skin.

I am grateful that there are products on the market like this, not just for my children, but also for myself.  Heck, without the Happy Mama Spray I would not have survived my first trimester.

But today, I am going to be giving away this awesome kit for c-section moms. In the next two weeks I am going to start featuring a series of positive, and medically necessary c-section stories for my readers. Not because I am super excited about the circumstances I find the birth of my third child in… but because I think that the fact that there are positive and medically necessary c-sections on occasion is greatly over shadowed about the negative we hear. (I am still accepting submissions)

How can you enter to win?   Well, its pretty typical to all of my giveaways thus far!

Each of the below is ONE entry!

April 4th, 2011

Call for Submissions!

With Little Miss A joining us in less than 30 days, I wanted to put out a call for post submissions for a mini blog carnival I am going to hold in hopes of keeping my site going while in the last days of pregnancy, in recovery at the hospital, and in the weeks after at home.

I must admit, I was completely inspired by the Letter To My Daughter series that The Feminist Breeder is running. I often wondered how blogging Mom’s maintained their website around the end of pregnancy, and birth, and it is a purely genius idea!

Given the circumstances of my birth this time around, and having a scheduled c-section instead of going into labor on my own, and all of the options I had looked at before deciding with the help of friends, family, birth professionals close to me, and of course my providers that this would be the best option… I have not only struggled with this decision, but I have also been struggling and striving over the last couple months to make the best of this experience, and do everything in my power to make this a positive cesarean experience.

Of course we all know how I feel about this, and I am certainly disappointed this is the route that I need to take, but dwelling on the bad is not healthy, and it is not going to make the experience positive by any means.

So I am putting out a call for positive stories of medically necessary c-sections. Whether you were in labor on your own, and needed to have a c-section for some reason, maybe a medical condition that truly made a c-section your only option, etc.

I also want to put it out that I am not going to post all of the stories I get. I would like to read them over, talk with the moms, and choose carefully those to feature. Not only for my readers, but for my own personal emotional well being. I truly hope that the moms out there understand why I plan on doing that.

I know there are a lot of mothers out there affiliated with ICAN that have had to have medically necessary c-sections, and I have been blessed to read some of their tales, and I would appreciate if you could take the time to submit your story, and even a picture to help show the positive side of medically necessary c-sections during this difficult time for me.

Mothers supporting mothers!

To submit your post please e-mail me at Danielle.Elwood@gmail.com with the subject title “Positive Cesarean Submission”
Be sure to include your name, and Blog URL if applicable…
(If you would like to remain anonymous please let me know)

Thank you for taking the time to consider being part of this project that will hopefully become a very touching project for mothers, and helpful in the healing process of many women!

January 26th, 2011

Venting about My Pending C-Section

If you have been following my journey of this pregnancy, you would know one of my initial plans was to talk to our local home birth midwife, and plan a HBA2C (Home Birth after 2 C-sections) because of the lack of access to a real trial of labor with two previous surgical births. With my oldest son, while he never dropped into my pelvis, I was sure that my OB/GYN’s interest in going home for the day was the reason the induction was called off, and the OR was the place my son came into the world.  He was born at 4:37pm, around the peak c-section time of the day… 5pm.

When it came to my VBAC attempt with Benjamin, I labored forever. 26 hours, and was always under the impression that he got stuck because he came down in a face presentation, but after reading over my records, and learning more about m surgery not only from the surgical report, but also talking with the resident who was in the OR since the OB/GYN who was on call that day had since retired.  Benjamin was just OP… sunny side up… hence the back labor I had… Nothing special… And when he tried to make it down into my pelvis, he got stuck. Poor little guy had a nice bruise when he finally made it out. And apparently, there were some dense adhesions from my first surgery. Bang up job by my first OB.

Needless to say, learning all that made my decision making process much more difficult than I thought it would be. And had I not truly researched and learned all of that, I probably would be well on my way to a home birth as we speak. Which would most likely end in a hospital transfer because of the true CPD I have in my pelvis. Something I have not talked about until now because I know how many in the natural childbirth community (which I am an active part of) do not believe in CPD, and I didn’t feel like defending why I think, and my midwife thinks I have a true CPD.

It has been hard for me to come to terms with the fact that I will have a third c-section. I have heard so many beautiful VBAC stories of mothers who have had two or three c-sections, and I always had envy of their experiences, and I know that it is not something in the cards for me. It is hurtful.

I wrote earlier in the week on the Babble Being Pregnant blog I participate in about it too… The post was called I Don’t Want Your Pity… I Want Your Support…

I don’t want people saying they feel sorry for me anymore. This is a choice I made, and was not forced into by providers, or bad information. Nor am I a hypocrite for being a VBAC activist, and not trying for a VBAC this time around, like some idiotic and uneducated internet trolls have accused. Being an activist, especially for VBAC is about being educated, and making informed decisions. It would be one thing if this was my second child, and I was opting for an elective c-section, not a medically necessary surgical procedure.  I am sure there are some out there who simply do not respect that at all, and would rather I put myself, and my child in danger to please them… unfortunately for them, they don’t mean much to me.  They can run their mouth all they want, but they will continue to look like the uneducated assholes that they are!

I interviewed four providers. One OB/GYN who is famous in my area for supporting VBA2C (vaginal birth after 2 cesareans), one home birth midwife, one hospital birth midwife practice, and a high risk Perinatologist I was referred to. None of who I felt comfortable with. Comfort was a big factor.

I continued to tote my medical records, surgical reports and my emotions all over the state, and ultimately, I went back to my midwife I trusted with my care during my last pregnancy and delivery. After hours of discussion, questions on her professional opinion, which I take very seriously as she has been doing this for 30 years in various settings including home birth, and birth centers, I knew that the best option for myself, and our third child would not be a trial of labor, or an attempt at a VBA2C.

It sucks, but one thing I am sick of hearing is how sorry people are about this birth. I don’t want your pity!!  I want your support and resources that can help make this the best experience I can possibly have given the circumstances!

I think sometimes people really fail to see when they are being negative or pessimistic, and today I just really wanted people to see how it comes off sometimes. Leave your judgment at the door, and provide your amazing resources for helping someone who needs a medically necessary c-section.

I want to have an empowered delivery, a delivery I know that I made the choice to have, and can be in control of. I am going to be empowered by this birth, and I am going to show women everywhere that you CAN be empowered by a c-section on your own terms!

January 3rd, 2011

Creating a Cesarean Birth Plan

Since yesterday marked my 22 week pregnancy mark, and knowing I have roughly 17 weeks left, I started to put thought into working on my birth plan for my upcoming c-section. Both cesarean’s with my boys turned into unplanned or “emergency” c-sections making the planning virtually impossible. I am sure with my VBAC attempt I could have done some planning before hand, but I didn’t want to think about the negative “what if” at the time.

This time around, the situation has taken a different turn, and while I still am not fully comfortable about my choice, I do feel as though I have made the most responsible, and safe choice for myself and baby given our set of circumstances.

One of my first resources has been ICAN’s Family Centered Cesarean, with a couple of my own wants/needs mixed in. Some of which I have already talked to my midwife about, and some of which I plan to bring to the table when I meet with the backup OB/GYN and my midwife in February.

I know I must have an ipod to listen to my favorite and most relaxing music. The sounds of the operating room make me anxious. I am sure I can deal with the noises while I have my baby with me in my arms, and welcoming her with my husband. But when it comes time to putting everything back together, and heading into the recovery room, I will need something to block out all the beeps, pings, and the machine that goes DING!

I also know I would rather have an epidural than a spinal block. I am going to have to set up a meeting to meet with someone from the anesthesia department at the hospital to speak about it though.  I have had 2 epidurals with the boys, and I know what to expect from it. It is my comfort level.

I know I obviously want the baby with me as much as possible in the hours after birth. I was able to successfully be kept with Ben in my postpartum hours also until he needed to be brought to the NICU for blood sugar issues. But that is a whole story in itself.

But this is where I need my readers to chime in and help me. I need other tips, and help that everyone else used to help them get through their c-section experiences. Planned or unplanned, all the tricks we have used are worth their weight in gold to others facing the same fate.

Leave a comment, and help me out!

October 19th, 2010

No, I am NOT a Hypocrite…

I found out we were expecting our third child almost two full months ago. During this time I have put an insane amount of thought into our options for birth. I searched high and low for a provider who would even accept me as a patient for a VBA2C… I dug through surgical reports, research, had awesome ladies like Amy Romano, and Kristen from Birthing Beautiful Ideas help me write letters to the backup OB/GYN’s of the midwives I love so much.

It has been stressful, and I have had up after down, after down, and then up again. I have been confused, worried about judgment, felt attacked and unsupported, and loved all at the same time. I took my thoughts about having a VBA2C vs. a repeat cesarean out of the public spotlight and started to discuss it with two people that I trust the most.

1. My husband
2. My midwife who attended my VBAC attempt in May 2009.

The two people I knew would ….

1. Not pull any punches with me
2. Tell me like it is
3. Support me in my choice.

They did when I was in labor with Benjamin, they did during the surgery, and they did in my postpartum period.

After looking at surgical reports, taking my last labor and birth into consideration, and all the factors in between, I have made the very educated and hard decision to opt for a scheduled cesarean this time around. I think one of the biggest statements, and ideas that has remained in my head through all of this was my midwifes speculation on my pelvis. And the more I think about Camden, and Ben’s births, the more I think that there very well may be a malformation that doesn’t allow my babies to get down into the pelvis. Neither ever made it, and there is little hope this one would either.

With the damage done by the two surgeries, one NICU stay, two emotional recoveries, and serious lack of support after my first son, I know that I can make things different this time around. Do I want to have another cesarean?  No. Not at all, I never wanted to have one, or even two… it was just the cards that I was dealt. Do I want to plan to have a scheduled delivery after bitching about other people doing it for years?  No. But the difference at this point is… and this is also where the title of this post comes from… the vast majority of scheduled cesareans in this country taking place have no medical reason.  This situation I am facing has a number of medical reasons.  And if I felt like there wasn’t going to be hundreds of people picking the reasons apart, I would certainly share them more openly. Unfortunately in recent weeks, it seems like internet harassment over medical choices that peaked, and it is something I am not going to deal with.

Especially over a choice that hurts me to come to terms with myself.

I have opted to go to the backup OB/GYN’s that my personal midwives I used last time around have. And my midwife from Benjamin has signed on to be with me for my surgery, and postpartum time in the hospital as my doula, which means the world to me since I lost Karen (My doula) a year ago unexpectedly.  It makes me know my experience will be more comfortable, and I will have not only my husband, but her with me, two people I trust very much to help my experience.

I will be writing a positive cesarean birth plan over the next couple months in a real attempt to make this not only a Family Centered Cesarean, but a positive experience for all of us.

Am I dreading the recovery?  Yes, I am scared to death.

After my first c-section, I had a newborn I was able to lay and rest with all day. Breastfeed in my bed, and change his diaper right there also.

With my second c-section, my husband was home and able to help me through my recovery. I laid in bed for weeks, not only in pain, but an emotional wreck from a failed VBAC.

This time around, I will have a 3 year old, a 2 year old, and a newborn to take care of after the surgery with little help. It is scary!

October 18th, 2010

History of C-Sections

I want to thank my awesome guest poster for this today!

The Birth of the Cesarean

Mandi Hardy

According to records, the first successful cesarean delivery took place at a Boston hospital in 1894. Undoubtedly, for the time period it was a very exciting obstetrical advance. Prior to the cesarean delivery if labor was obstructed, and forceps were not able to free the infant from the birth canal, the infant may have been killed to save the mother, or both mother and baby may have died. Now, keep in mind that the rates of this happening (obstructed labor) during this time, much like today, were low. Although the “invent” of the cesarean certainly had many benefits, and unquestionably has saved many lives, this is not the part of the story that I find most interesting. There are two social and historical aspects of the cesarean, which I find worthy of further thought and reflection: (a) how the procedure was perfected and (b) how issues surrounding the procedure have changed over the past 100+ years (or not).

Before going further there are also a few other key social, historical, and cultural understandings that need to be established. At the time of the first cesarean, most births (95%+) were still taking place at home and maternity hospitals were free-standing charity hospitals. Although the establishment of maternity hospitals seems like an altruistic endeavor, in reality they were more likely obstetrical experimental laboratories. New instruments and/or procedures needed to be tested, perfected, and improved upon. Therefore, clinical (observable and treatable) subjects needed to be readily available – the maternity (charity) hospital provided this steady flow of women subjects. It also seems worthy to note that from a cultural perspective unwed and/or poor women who were pregnant were generally believed to be of lesser moral character and therefore of lower social standing. These were the very women in need of the services the maternity hospitals were alleged to provide. What this means is that the way in which the charity patients were treated experimented on, was considered acceptable because it was to the benefit (allegedly) of more worthy and proper women patients. In summary, the women laboring in maternity hospitals were likely often not viewed as such (women), but rather as research and experimental subjects – in the name of medical advancement.

By 1913, the director of the Sloane Hospital in New York had preformed 112 successful cesarean deliveries. One can only speculate how many failed and unnecessary cesareans were preformed in order to accomplish this – to hone his performance skills. What is most interesting to note, is that this director is the doctor cited with stating “once a cesarean always a cesarean.” Words spoken nearly 100 years ago still heeded today as hallowed fact.

Even during the early days of the cesarean heated debates over the necessity and indications for the use of the procedure were frequent. Interestingly, a common justification for such invasive procedures, and the increased apparent necessity for other types of instrumental deliveries, was frequently attributed to the woman’s moral character. A review of a Boston maternity hospital in the 1890s cited “patients as too lazy or too stupid to deliver by themselves, ¹” hence requiring the use of various interventions. Several social childbirth historians have noted that the use of instrumentation and other interventions were often employed as an, “expressions of impatience” on the part of the doctors. Of course, there were many occasions when interventions were, in fact, humanitarian and necessary. However, it appears that it was as difficult then as it is today to determine what indications are appropriate to warrant the use of intervention.

Certainly, few would question that the success and safety of this particular procedure has certainly improved since this time, specifically following the invention of antibiotics; however, many raise concern over the justification for its use in the first place. Many have argued that as the procedure became safer it also became an easier intervention – the ultimate intervention – to rely on. In the U.S. the cesarean rate in the 1960s was approximately 3% of all births, in 1970 it was 5.5%, 24% in 1988 and in 2007 the rate was the highest ever reported 32% (a 53% increase from 1996).^{2, 3} It leads one to questions if women’s bodies are evolving (or de-evolving) in their ability to birth or if there are other factors influencing these rates. I happen to believe it is not the women’s bodies, which are to “blame,” but rather a complex web of other explanatory factors interactions.

Sources:

1. Wertz, R., & Wertz, D. (1989). Lying-In: A History of childbirth in America. New Haven: Yale University.

1. Menacker, F., & Hamilton, B.E. (2010) Recent trends in cesarean delivery in the United States.

NCHS data brief, no 35. Hyattsville, MD: National Center for Health Statistics.

1. Tew, M. (1998). Safer childbirth? A critical history of maternity care (3^rd Ed.). New York: Free Association.

Mandi Hardy has a master’s degree in psychological counseling and worked as a mental health professional for a number of years before returning to school to seek a doctoral degree in human development and family studies.  She is currently a doctoral candidate at Iowa State University working her dissertation research, which will be a feminist study on childbirth experiences in the American maternity care system.  Mandi is a certified doula through DONA International and currently working on her ICEA childbirth education certification.  Married for over 4 years with one child.

September 16th, 2010

Update on the VBA2C Front…

I am going to write this post, then unplug for a couple hours, because I have too much on my mind. I have two beautiful son’s I am going to enjoy the day with, and a mother to share this time with. I am only sitting down to write this out in my confused state because I know so many here have been asking in the last couple days about this consult.

I had a great consult this morning with a warm, friendly, and informative provider. He, is a perinatologist, and even though I was speaking to someone with so much education, he was able to talk to me one-on-one like an educated mother. We discussed the new ACOG recommendations, the likelihood of a successful vaginal delivery with my history, and what they found during my second cesarean, which is what brings me the most confusion.

The positive is obviously that this Doctor will give me the green light as a patient, and even allow me to see the Midwives that everyone loves if they will take me as a patient, but the downside is, I am not sure of which choice to make at this point.

What was found during my second c-section, I was never told in full. From serious adhesions and damage, to issues with my bladder, and despite requesting a double layer closure, I was only given a single layer closer. I know this sounds Greek to most, but more and more evidence says that double layer closures for c-sections are really the safest option.  I know this, which is why I requested the closure I did, but apparently did not get.

Now here is the tough decision. I can opt to go into labor on my own, and have a trial of labor, and if something does go wrong, the time for them not only to get the baby delivered, but not seriously injure me, may cause damage in the event of an emergency. Unlike in a first time mother, opening them up, with no bladder damage, adhesions, bowel damage or adhesions, and deliver the baby is a piece of cake. With someone who has a history of dense adhesions, and the above problems, it could be a longer process, and more dangerous for myself especially.

While we truly aren’t planning anymore children, I am not comfortable with the idea of a hysterectomy, or any other major surgery as the result of these complications.

Downside? To avoid all that, I would have to opt for an elective c-section. I don’t see it as truly elective because of the nature of the surgical report from my second son, and the condition my uterus, bladder, and bowel were in at that point. They most certainly will be worse off this time around after going through two prior uterine surgeries.

I am scared, and I have a lot of thinking to do over the next 7-8ish months. I do not know what I am going to do at this point, but I know I am going to explore the option of the midwives for my prenatal care at the least, and then go from there.

I appreciate respect, and kind supportive words during this period of time. As usual all comments will be screened, and if I don’t like that you have to say, or it is negative, I will be throwing it into the trash can.  This is a very difficult time for myself, and my husband as we talk about our options.

June 17th, 2010

Birth By Numbers (Part 1)

I have wanted to share the Lamaze Birth by Number’s video for a while. It features Eugene Declercq one of my favorite Silver fox’s discussing the numbers surrounding maternity care in our country, where we rank in the world and the issues our care system presents. I have tried to find a way to get the video embedded here on my page, but I was unsuccessful in that mission. But the link for the video is :  Birth By Numbers and I highly suggest taking the 25+ minutes to watch this.  Whether you are a first time mother, childbirth educator, veteran mother, or just someone interested in the childbirth community, it is a must watch.,

4,138,349 – The number of births in the United States in 2005, the year this video’s information focuses on. The numbers are still similar, although they have increased and decreased in years since then.
18, 884 – The number of Neonatal Deaths in the United States in 2005. Meaning, the number of babies that died in the first 4 weeks of their lives.
1,248,815 – The number of Cesarean Sections that took place in the United States in 2005. And that number has increased every year since then.
4.6 – 4.6 neonatal deaths per 1000 babies born in the United States in 2005.

42 This is the number that the United States ranks in terms of our neonatal mortality rate. Meaning?  41 other countries have lower neonatal mortality rates than the United States and all of our magical medical technology.  Below is a list of the countries who rank better than we do, which is surprising.

There are several countries on this list that cannot realistically be compared to the United States because of the small number of births they have annually, but if you were to take all the countries that have at least 100,000 live births per year, The United States still falls behind.

Take these 15 countries, and The United States has the 2nd worst rate, only behind France. Still horrible in terms of concern for health in our mothers and babies.  When the numbers are broken down into countries that have at least 300,000 births per year, we are still in bad shape. 8th out of 9 countries with only France worse off than us again.

Now we move onto Maternal Mortality which is even more grim.

Now when we take countries with at least 300,000 births, The United States ranks last. We lose the most women around the time of birth than any other country who have somewhat the same amount of births.
What is most troubling about it all is that the numbers are getting worse, not better as the years go on.

While other countries are decreasing, this shows that we continue to increase or stay the same. A scary statistic for women who are having babies in the United States today.

Back to our mothers again. See that increase? EEK!

But why are we seeing a huge change like this? What has happened over the past 10 years that is aiding this problem?  One thing!  The increase in use of a sometimes valuable medical intervention…. The Cesarean section.

Now, if you know me, or have been reading my blog for a while, you know that I preach religiously about the over use of the cesarean section rate, and how it is causing more harm than good in our country. This next graph shows the issue with this, and why we as a country should truly be concerned by the number of surgical births taking place.

Since the 1990′s the cesarean birth rates have steadily increased, along with the maternal death rates.  Also with the preterm birth rates, and other complications that this video does not go into detail on. How do I know?  Because this is now something I have spent over two years of my life looking at, researching, and learning about.

When you take a minute to look at the cesarean section rates by state (below) it shows that it is not evidence based medicine being practiced across the board, it is more of a cultural impact in certain areas that impacts the overall cesarean birth rate.

What stands out to me personally, areas like Utah, Nevada, Arizona, New Mexico, Colorado, which have a couple trends to me have these low cesarean rates.  One is a strong religious or Christian population. The other is a strong immigrant population. Although California has the same immigration rates with a much higher cesarean rate.

Some argue that the mothers are driving these rates up with Maternal Request Cesarean sections, but in fact that is not the issue at all. Check out this information and quote from the Listening to Mothers Survey :

I am not sure what world she lives in. No pain?  No hassle?  LOL!  This must have been BEFORE she actually had the c-section!
But all in all, blaming the 50% increase in cesarean births on women choosing them is ridiculous because women are not signing up.

I want to keep my post to a minimum toady before it gets way too long I am going to stop here, and pick up in a couple days on the second half of this video. Considering it is almost 25 minutes long, putting it all into one post would be overkill, and slightly foolish.

May 27th, 2010

Is Vaginal Birth after Multiple Cesareans an Option?

Many women think Vaginal Birth after Cesarean, better known as VBAC is only an option in women who have had one previous cesarean birth. Although the climate surrounding VBAC is not the best, a new published study has shown that VBAMC or Vaginal Birth after Multiple Cesarean’s is a safe option for women who do desire a trial of labor after more than one surgical birth.

Earlier in the year, MSNBC covered the study with an article they published online. The study suggests that :

Women who attempt vaginal childbirth after having several babies by cesarean section may not have a greater risk of complications than women who’ve had only one prior C-section.

Which is something most of the childbirth community has been working to prove for several years now. Personally I know several mothers who have had a VBA2C or even a HBA2C or more, which stands for Home Birth after 2 Cesareans. Amazingly, this study brought the infamous ACOG out of their cave to talk about the findings. ACOG says they do not suggest a VBAC or TOL (Trial of Labor) for a woman who has had 3 or more cesareans, but most of their providers still do not allow any options other than a scheduled cesarean after one previous cesarean section.

More information from the article, which talks about the study on VBAMC includes :

In the new study, however, researchers found that women with at least three prior C-sections showed no increased risk of uterine rupture during vaginal delivery.

In fact, none of the 89 women who opted to try vaginal childbirth had the complication, according to findings published in the British obstetrics journal BJOG.

While a study of 89 women is not a large scale study by any means, it is a huge step forward in research and more acceptance for VBAMC.

This information will help to show that women with 2, 3, or sometimes 4 previous cesarean sections can safely give birth vaginally if that it the path that they choose after having a previous cesarean birth.

Women today are not being given accurate information regarding the risks of elective repeat cesarean deliveries and the complications that can come, or increase with each subsequent cesarean birth, just a couple of the statistics include :

1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)

2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion’s : 21.6% (1 in 5)

3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion’s : 32.2% (1 in 3)

4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in
Risk of Dense Adhesion’s : 42.2% (2 in 5)

May 17th, 2010

Happy First Birthday Benjamin!

Well, this time a year ago, I was getting set up for an epidural. I had been awake for 30 hours, my labor wasn’t progressing, and we were all really at a loss. I needed sleep, and everyone, except for my husband really agreed the epidural may be most helpful. I think Will disagreed with it so much because I had told him and basically drilled it into his head for 9 months that I would not be having one this time around, but none of us anticipated a back labor that would span over 26 hours either.

Complication after complication started when I woke up a little before noon. My cervix was starting to swell, and Ben just wouldn’t come down past -1 station. We tried everything to get him to budge, and he wouldn’t move.  At this point I think the giant elephant in the room became more and more apparent to everyone. It took me about an hour to come to terms that the only way Benjamin was safely coming into this would was by a second cesarean section, which I worked so hard through my entire pregnancy to avoid.

Benjamin Emil Elwood was born at 1:59 pm via cesarean section weighing in at 7 pounds, and 3 ounces. Smaller than my oldest, even though I was diagnosed with gestational diabetes with my pregnancy. The moment I saw him, right after they removed him from the incision in my abdomen, I could see a giant bruise on his forehead. It took the on call OB, and the Resident on staff for the day to get him out. He was JAMMED in there.  No way he would have descended anymore than he had.  I think that made me feel slightly better than I originally felt with the decision to consent to the second cesarean.

I know looking back at all that happened with his birth, there is nothing that I could have done differently to change the outcome of my birth experience. I think that is what has helped me be more accepting of his birth than my first. Had I not consented and continued to labor, I not only could have hurt myself, but I could have hurt myself.  I desperately wanted a VBAC, but I am not a martyr, and I would not do it at the expense of anyone’s safety.  Contrary to what some seem to think.

Looking back, there is nothing that I would have changed. Not getting pregnant when Camden was only 8 months old, not choosing the midwives I did, nothing. I loved every moment of my pregnancy with Benjamin, while I may not feel the same about his delivery, I was blessed with such a unique, bright, and beautiful little boy who was always meant to be part of our family.

I certainly do not feel that our family is complete, but for the time being, it certainly is. I think after Ben’s birth, both my husband and I are certainly scared to have anymore children any time soon. The two cesareans have been emotionally trying on both of us, and certainly physically trying on me. It took me nearly 3 weeks to actually feel human after Ben was born, and to remove myself from my dark bedroom and join the rest of the world.

There is so much my little Jo Jo (one of Ben’s many nicknames) has taught me. One being that no matter what we do as parents, sometimes our children have other plans for us.  Ben was exclusively breastfed for the first 5 weeks of his life, during that time, we couldn’t figure out why he was so colicy but in reality, it was a reaction to my milk. We tried everything from dietary changed, to a variety of formulas before we finally found something that would work for him. It was the longest 8 weeks of my life. Cap that off with 3 surgeries (for me) starting when Ben was only 5 weeks old… I think that seriously aided to the stress in the house.

He is the light of all of our lives, including his big brother Camden. I thought there would be some jealousy issues in the house between the two children, but I couldn’t have been more wrong. Camden has been the most attentive big brother. Loving, teaching, and overall infatuated with his little brother. I really could not have asked for a better big brother.

The process of transitioning from a mother of one, to a mother of two would have made me insane if I didn’t have the help of my husband. The day we brought Ben home from the hospital, our oldest got his first flu of his life. Such timing!

There are some days I am sure I am going to lose my mind before my husband gets home from work, but I somehow manage to keep it together till he walks through the door and the kids clamor to him like they haven’t seen him in a year.

Wow!  I just can’t believe that it has been a year already!  Where does the time go?  It feels like yesterday he was born and I was cradling him in my arms in my hospital bed waiting for one of the nurses to come in and yell at me for co-sleeping!

Benjamin Emil, you have changed my life in so many ways. Given me and understanding of difficult parenting, and children. Taught me the feelings and emotions that go with a medically necessary cesarean section, which has enabled to me help mothers on a whole new level.  You are the light of my life and Mommy loves you so much!

Happy first birthday Ben!