Giving Birth After A Cesarean: It’s Your Decision

10 Jun

Many mothers, pregnant after a prior cesarean birth, feel pressured to schedule a routine repeat cesarean when they prefer to labor for a VBAC.

Care providers have an obligation to share information with you about your care. To present the risks and benefits of planning a VBAC or choosing a routine repeat cesarean. When you have received all the information you need to feel confident to make a decision, the choice is yours.  No provider should frighten or coerce you into having a routine repeat cesarean.The decision to have a repeat cesarean or labor for a VBAC is yours.

Prenatal visits give you the opportunity to have a frank discussion with your caregiver about your concerns and how you will be cared for. It is your right to participate in all decisions regarding your health and the health of your baby.

  • During your pregnancy you should have several discussions about the benefits and risks of VBAC and repeat cesarean.
  • Ask your caregiver about his/her VBAC rate, repeat cesarean rate, and VBAC success rate.
  • Discuss your personal medical condition with regard to VBAC and repeat cesarean. You may need to review your operative record (documentation of the surgery.)
  • Ask what safety measures are in place to respond to an obstetric emergency including a uterine rupture.
  • Try to get the hospital informed consent forms for procedures that you may need (for induction, an epidural, pain medications) during your pregnancy so that you have the time to read and understand them.
  • Make a list of the advantages and disadvantages of planning a VBAC or scheduling a repeat cesarean and discuss them with your partner.
  • Consider having a doula at your birth, a midwife as your primary caregiver, or giving birth in a birth center.

Giving birth is a transformative experience. Your caregivers should make you feel cared for, respected, and supported in your wishes and needs.

For more information about your rights in childbirth see the slides in Module 12 of the VBAC Education Project.

 

Nurses Play A Significant Role in Supporting VBAC Mothers

11 May

May 6-12, 2017 is National Nurses Week, a time to recognize, appreciate, and celebrate the important work that nurses do. In particular, maternity care nurses play a significant role in helping mothers who want to labor for a VBAC.

Women laboring for a VBAC may have some anxiety about their prior cesarean and may need additional support. They are grateful for the encouragement, validation, and labor progress suggestions that nurses can provide. Many times mothers have said, “My nurse was wonderful. Just when I wanted to quit and ask for another cesarean, she told me things were going just as they should be. I couldn’t have done it without her.”

Nurses, midwives, childbirth educators, and doulas who have  experience working with mothers who want a VBAC have learned that a mother with a prior cesarean may need additional support, time, and encouragement to have a rewarding and satisfying birth.  She needs to feel self-confident and strong. Here are some valuable suggestions that they have shared:

  • When meeting a mother for the first time, try to find out how she experienced her cesarean? Can you suggest how she can do things differently this time? Ask her how she wants to labor. What is important to her? Help her to create the birth environment she prefers so she can feel safe and supported.
  • Ask her partner or family how they feel about a VBAC? What concerns do they have?
  • Remind parents that 3 out of 4 women who labor for a VBAC have a safe birth.
  • Some mothers may have anxious moments and flashbacks of their prior birth. Disturbing memories of fetal distress or of laboring “for ever” and not getting anywhere. Help mothers to overcome these difficult moments and remind them that this is a different labor for a different baby and that they are strong enough to move through it.
  • Mothers who may have experienced a prior birth as traumatic  will especially need understanding, encouragement, and the freedom to give birth as she wishes.
  • Some mothers know when they have  gone as far as they can and that they will probably need to adjust to the idea of having a cesarean birth. Give a mother time, if circumstances allow it, to think about what she would like for this cesarean birth. Does she want her doula to be at her birth? Does she want her baby skin-to-skin after birth? Does she want her family to visit her in recovery? Does your hospital support a “gentle cesarean?” Let her know that your team wants her to have a good experience and will do their best to welcome her baby.

For additional information on how maternity care professionals can support mothers who want to labor for a VBACs see VBAC for Educators: A Teaching Guide. 

Maternity care professionals who are interested in establishing “skin-to-skin after a cesarean” clinical guidelines or developing mother-centered VBAC education guides can freely use the hospital-developed forms included in Hospital Policies that Support VBAC, Family-Centered Cesarean, and Informed Choice, both are part of the VBAC Education Project.

A nurse’s support, guidance, compassion, and respect for a mother’s individual birth preferences will give both, mother and baby their best start together.

 

 

 

 

Maternity Care Professionals Agree on How Best to Care for Women in Labor

5 Apr

Failure to progress, abnormal fetal heart rate, malposition, and “big” baby are the four main reasons for the first cesarean. These complications can often be avoided by the kind of care that women receive prenatally and during labor and birth.

The American College of Obstetricians and Gynecologists (ACOG), the American College of Nurse-Midwives (ACNM), and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) agree, “Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor…Rather than label a woman as low-risk or high-risk, the goal is…to ensure that the obstetrician-gynecologist or other obstetric care provider carefully selects and tailors labor interventions to the requirements and the preferences of the woman in labor.”                                            

The following evidence-based, recommendations from Approaches to Limit Interventions During Labor and Birth ACOG’s Committee Opinion (Number 687, February 2017) will help to facilitate physiologic birth (normal progress of labor), avoid unnecessary interventions that can complicate labor, and respect women’s own preferences for how they want to give birth.

  • During pregnancy, learn all you can about labor and birth and write down your preferences for how you would like to be cared for in labor and birth.
  • Consider having one-to-one labor support such as a doula.
  • Consider taking a childbirth class where you can learn about how to spend you time at home in early labor, different comfort measures, and positions to make you more comfortable for active labor birth.
  • Stay home until you are in active labor (about 6cm dilation).
  • Ask about being monitored intermittently with a hand-held device such as a doppler instead of an electronic fetal monitor.
  • Drink clear liquids to keep up your energy rather than using an IV.
  • Consider using non-drug methods of pain relief. There are many options for you.
  • Stay upright and use different positions for labor such as walking, kneeling on hands and knees, lying on your side, and resting on a birth ball.
  • Avoid an amniotomy (artificially breaking the bag of waters).
  • When you reach full dilation (10 cm) you many not feel the urge to push. Your baby will move down as you are resting, so wait for the urge to bear down.
  • Push using an upright position or on your hands and knees, whatever makes you comfortable at the time.
  • Ask to have your baby skin-to-skin after birth it will help you to begin breastfeeding, and ask your caregivers about delaying the cutting of your baby’s umbilical cord.
  • Let your caregivers know what you need and how they can help you to have a safe and satisfying birth.

Although these midwifery-led recommendations have been known to many caregivers and women prefer them to routine interventions, it will now be much easier to get the support you need form all maternity care providers.

Resources

To find out more about these recommendations and why they are important for a safe birth link to Childbirth Connection’s Fact Sheet on limiting interventions in labor and birth.

To find out more about avoiding labor complications that can lead to a cesarean,  non-drug options for pain relief, and different positions for labor and birth download Modules 4, 5, and 6 of the VBAC Education Project.

 

 

 

VBAC Rights

26 Jan

The evidence for the safety of VBAC is clear. Guidelines exist for physicians and hospitals to provide care for women who choose to labor for a VBAC. About 70% of women who labor for a VBAC give birth safely. Yet, there seems to be a lack of will to change current practice and support women’s choice for VBAC. Many hospitals  in the U.S. choose not to provide care for women who want to labor for a VBAC. In 2014 only 12% of U.S. women had a VBAC.

The downstream effects of repeat cesareans put mothers and babies at increased risk for complications. Support for VBAC minimizes these harms. 

Women have a right to receive high-quality, evidence-based, respectful care in their childbearing year.

Women have a right to complete and accurate information to help them make an informed decision about how they want to give birth.

Women have a right to give birth without major surgery.

Women have a right to give birth without being put at risk for uterine rupture.

Women have a right to give birth without being put at increased risk for postpartum infection.

Women have a right to give birth without being put at increased risk for placental complications: placenta previa,  placenta accreta, increta, and percreta.

Women have a right to give birth without being put at higher risk for hemorrhage and blood transfusion.

Women have a right to give birth without being put at increased risk for a hysterectomy.ž

Women have a right to give birth without being put at increased risk for needing admission to an intensive care unit.

Women have a right to give birth without being put at risk for bowel obstruction.

Women have a right to give birth without being put at risk for a blood clot in the legs or lungs that can be life-threatening.

Women have a right to give birth without being put at risk for surgical injuries to internal organs and adhesions (internal scar tissue that forms between tissues and organs).

Women have a right to give birth without being put at increased risk for cesarean scar ectopic pregnancy, fetal malformations, miscarriage, low-birth-weight, premature birth, and still birth in a future pregnancy.

Women have a right to give birth without being put at increased risk for psychological stress, anxiety, and post-traumatic stress disorder.

Women have a right to give birth without putting their baby at increased risk for surgical injury, respiratory complications, and the need for admission to a neonatal intensive care unit (NICU).

Women have a right to give birth so that their babies experience labor and are primed to receive beneficial microorganisms from their mothers which play a key role in the development of their immune system.

Women have a right to benefit from a healthy birth and the innate birth hormones which prepare mother and baby for skin-to-skin after birth, mother-infant attachment, and successful breastfeeding.

Women have a right to give birth without the added financial burden of a 30% increase for the cost of a cesarean.

Women have a right to give birth without medical malpractice companies pressuring hospitals and administrators to close their VBAC services.

Women have a right to give birth without liability insurers imposing a surcharge on physicians who want to support VBAC.

Women have a right to labor for a VBAC and to reduce their own and their infant’s exposure to short- and long-term complications associated with routine repeat cesareans.

Resources

For sample VBAC-friendly hospital policies, birth options, and informed-decision documents with permission to reprint download Hospital Policies that Support VBAC, Family-Centered Cesarean, and Informed Choice