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

How Caregivers Can Support Mothers Who Want A VBAC

16 Jan

For a mother who has had a prior cesarean birth, understanding the medical pros and cons of laboring for a VBAC is essential, but not enough. She is also likely to need psychological support, guidance for maximizing her chances for a vaginal birth, and access to community resources. It’s important to take the time to discuss her options and to find out what her needs are during prenatal visits.

Refer her to evidence-based educational resources for additional information and VBAC classes in her community.

Provide her with hospital informed consent/refusal forms for each procedure  that you would require her to sign-off on during her prenatal visits to give her the time to discuss them with her partner and make a thoughtful decision. This will also give her time to consider them and to give her the feeling of safety and sense of control she may not have had with her cesarean birth. Some caregivers have developed a check-list to complete during pregnancy.

Provide her with a list of birth doulas.  Having a doula at her birth will increase her odds for a vaginal birth.

Respect the mother’s birth plan. Women who have had a negative cesarean birth and plan to labor for a VBAC will usually seek ways to make sure that this birth will take place in an emotionally safe environment. They will need to re-establish trust in their caregivers and place of birth. Reviewing her birth plan during a prenatal visit will increase her confidence in her ability to have a vaginal birth.

Involve her in making all the decisions about her care. Mothers  look for caregivers who are sympathetic and supportive of their needs. Often, caregivers misinterpret this need for psychological safety as being a woman’s irrational need to be “in control”. Or a mother may be seen as having a “demanding birth plan.” Mothers who are involved in their own care have a more satisfying birth.

If a request is not possible to comply with, it may help to ask the mother more about it. Why it’s important to her and if she would consider other options that you can offer her.

Some mothers suffer from post-traumatic stress as a result of an unexpected cesarean. Because a newborn demands so much care and attention mothers often do not have the time to process these feelings and they can linger for a long time. Sometimes these feeling surface only when a woman becomes pregnant again and begins to think about the coming birth. Provide mothers with a list of psychotherapists who focus on birth-related trauma issues.

Some mothers feel isolated and may be haunted by the “crazy” thoughts they have about their cesarean. Some feel they are “bad” mothers for having negative feelings and for not loving their baby as much as they think they should. A support group would give them a safe place to discuss their feelings without being judged. Contact the International Cesarean Awareness Network (ICAN) to find out about chapters in your community or to learn how to begin one.

Many caregivers and hospitals who provide care for VBAC have found a way to develop policies which provide safe care for VBAC and also honor a woman’s right to choose how she wants to give birth. You can find samples of these in Deciding If a VBAC Is Right for You: Hospital Policies that Support VBAC, Family-Centered Cesarean, and Informed Choice.

Healing From A Traumatic Cesarean

8 Dec

Women’s emotional reactions and adjustment to cesarean birth vary widely. Although some women recover fairly quickly and accept the surgical birth as a necessary step to a healthy baby and to becoming a mother, others experience various degrees of sadness, disappointment, anger, violation, loss of self-esteem, guilt, depression, and sometimes post-traumatic stress disorder (PTSD).

Some women experience their birth as a traumatic event. Often they are not aware of how the trauma has impacted their life, their sense of self and their feelings about mothering. Because a newborn demands so much care and attention mothers often do not have the time to process these feelings and they can linger for a long time. It is normal for a mother to appreciate the fact that her birth by cesarean resulted in a healthy baby while still feeling sad, confused, or angry about the experience itself. Friends, family, and even partners of mothers who have had an emotionally difficult cesarean often do not understand why mothers don’t just “move on,” or why they “obsess” about their birth experience.

concept for love, family, and harmony. mother hugging baby tenderly in monochrome

The effects of trauma after childbirth include flashbacks of the birth, nightmares, avoiding and feeling stressed by reminders of the birth, feeling edgy, and experiencing panic attacks. Often these symptoms are confused with postpartum depression by mothers, doctors and mental health providers.

It is normal for a mother to appreciate the fact that her birth by cesarean resulted in a healthy baby while still feeling sad, confused, or angry about the experience itself. Mothers who have an unexpected cesarean, have general anesthesia, or are separated from their infants are especially vulnerable. A mother’s satisfaction with her birth experience depends on whether or not she was included in the decisions made on her behalf, if she was treated kindly and with respect by her caregivers, if she received medical interventions she feels were unnecessary, and/or if she felt she was “in control” of her birth.

Friends, family, and even partners of mothers who have had an emotionally difficult cesarean often do not understand why mothers don’t just “move on” or why they “obsess” about their birth experience. It is important that, whenever you are ready, you find the right time, a safe place, and a person you trust to resolve some of these feelings. It might be weeks, months, or years after your cesarean, or even during a subsequent pregnancy, before you will be able to talk about your traumatic birth.

If you are planning to have another baby and plan to labor for a VBAC, you will feel better about that pregnancy and birth if you first process your feelings about the difficult cesarean you’ve already experienced. Find out how you might be able to avoid the recurrence of those events. You can find out more about healing from a traumatic cesarean from the websites listed below.

 Resources

PATTCH, Prevention and Treatment of Traumatic Childbirth
The Birth Trauma Association of the UK
Trauma and Birth Stress New Zealand (TABS)
Solace for Mothers
Birth Trauma Association of Canada