Search results: homebirth

Second Chance: A Mother’s Quest For A Natural Birth After a Cesarean- A Memoir by Thais Nye Derich

1 Aug

Thais Nye Derich’ book is a beautifully written, restorative journey of self-discovery, empowerment, and spiritual growth. It is also a testament to a maternity care system that has inadvertently failed many women. Managing the natural process of childbirth with routine protocols and multiple interventions geared more to an intensive care patient than a healthy woman giving birth. Multiple interventions used on a healthy woman often lead to an avoidable cesarean section.

The mother of two boys, Luke, born by cesarean and Mikko, born naturally at home with midwifery care, Thais tells us that she wrote this book to heal from the trauma of her unexpected cesarean and unresolved past trauma, untreated and buried. Her mother had abandoned her family when Thais was four. After Luke’s cesarean birth assisted by a vacuum extractor, her goal was to find a way to talk about Luke’s birth without crying.

This book is not a general guide to a VBAC, but a personal narrative that reflects the deep disappointment and disconnect that many mothers feel after an unexpected cesarean. It is also an example of the strength and resilience of mothers who take the difficult but rewarding journey to resolve their conflicted feelings about a cesarean birth they experienced as traumatic.

Thais’  cesarean was performed many hours after having been in labor with a typical “cascade of interventions.” A Pitocin augmentation, an IV, continuous fetal monitoring, restricted movement, fentanyl to mitigate the pain of the relentless contractions, and finally an epidural and a bladder catheter.

“ I am in a panic now,” she writes. “I have no idea how to handle my contractions. I am about to have a baby while hallucinating.” When she begins to push, still numb from the epidural, she writes, “My body isn’t with me, or I am not with it…My instincts are hidden from me…This is like swimming with a backpack full of rocks.”

Unable to make progress in the pushing phase within the expected time frame for a first birth, her physician was called in because she lived far from the hospital and it was nearing midnight. Neither Thais or her baby were at risk, but after examining her the physician said, “It’s time to get that baby out.” She wanted to “grab” the available OR before someone else did. Although Thais was treated kindly and agreed to the interventions, neither her physician nor her nurse took the time to explain her options nor the risks of a cesarean section on future pregnancies. Her physician made the recommendation and waited on Thais’ bed with a consent-for-surgery form that needed to be signed although Thais had no time to read it nor the mindset to understand it at the time.

Like many mothers who have had a cesarean, Thais struggled for years to understand what happened that led her to have a cesarean and why her psychological pain was so visceral. She looked for someone to listen to the story of Luke’s birth without thinking like she was “crazy.”

When she became pregnant with her second child, her search to find a caregiver she could trust and a safe place to give birth to her second child was not easy. Her path led her to a spiritual healing center, chiropractic care, yoga, visualization, meditation, an improved diet, a Blessing Way, and a woman’s circle where she found the reassurance and emotional support she needed.

Like many women who are focused on  laboring for a VBAC, the author’s decision alienated her from her partner at times. “ I realize that Jake and I are living two separate lives. He sees my struggle, but he doesn’t understand it. He doesn’t get me anymore.”

Laboring for a VBAC at home for a mother who has not had a prior vaginal birth has increased risks. But, Thais researched all she could on VBAC and made her decision with her eyes wide open. “…there is something about taking full responsibility for the birth of my child that leads me to the very real possibility of death. The glory of a beautiful and peaceful birth in my own home doesn’t come for free…Birth is not a fairy tale.”

When her midwife gave her the consent-for-treatment forms to sign, she did not mince words about the risks of a homebirth VBAC. “This form says you understand that there is an increased risk of maternal or neonatal death at home because there is not an operating room down the hall….in reality we could be dealing with some very hard scenarios at home that require guts and grit and trust in one another.”

Thais’ midwife had an agreement in place with a hospital four minutes away to care for her client in case of a home-birth transfer.  The collaborating physicians on staff did not support home birth,  but did respect  a woman’s ethical and legal right to make her own informed decisions. If Thais needed to be transferred to the hospital she would go directly to the labor and delivery unit and her medical record would be accessible to any member of the staff that needed to care for her. Her midwife had the right to accompany Thais, but not provide any medical care.

This book reveals to us that birth is a transformational experience. It is also about compassion, dignity, autonomy, trust, emotional support, and empowerment.

As Maria Iorillo, LM, CPM, former Vice President of the Midwives Alliance of North America and Chairwoman of the California Association of Midwives writes in the Forward, “How we as a family and community care for women in this fragile state (of giving birth) can mean the difference between suffering and empowerment.”

Every mother who begins the difficult journey to resolve her feelings about her unexpected cesarean will find her own safe way to give birth in her subsequent pregnancy. This safe place may be a birth center. Or the hospital with an OR down the hall, but with caregivers who respect her wishes for non-drug pain relief, freedom of movement, and doula care. Failing to find supportive caregivers, a good birth may also be an elective “gentle” repeat cesarean. Second Chance is inspiring for any mother making this journey.

Derich’s memoir is also  an important contribution to the current international debate about human rights in childbirth and  the critical role of respectful maternity care. In today’s world it is no longer acceptable to move ahead with or simply recommend a procedure or a course of care. It is women themselves who get to decide what they are willing to consent to and what to refuse.

Without respect for autonomy and women’s ability to make their own informed decisions about how they want to give birth it will be difficult for caregivers to gain the trust of the women they serve.

For more information about Thais Derich, see http://www.thaisderich.com/

 

Home Birth Is Safe Despite Medical Opinions

27 Jan

Last week the American College of Obstetricians and Gynecologists (ACOG) issued a press release announcing the publication of  Committee Opinion Number 476, Planned Home Birth questioning the safety of home birth based on a discredited and highly criticized study by lead author  J.R. Wax. The Opinion states that babies are two-to-three times more likely to die when women give birth at home. This is not the first time that ACOG has attempted to discredit the safety of home birth without supporting evidence.

“Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth,” states ACOG, “it respects the right of a woman to make a medically informed decision about delivery. Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.”

ACOG’s opinion is based on a faulty study not “recent evidence.”  Even more egregious, ACOG  is recommending to its members to spread this misinformation to their own patients.

In a commentary on the Wax study written for the Birth Journal Marc J.N.C. Keirse, MD,  a member of the editorial team responsible for preparing Effective Care in Pregnancy and Childbirth notes,

“Home birth has attracted a great deal of attention of late, culminating in a meta-analysis to assess its risks for mother and baby. Mothers were estimated to be 2.6 times more likely to die and babies 3 times more likely to die from a planned home birth than from a planned hospital birth. The actual data on which these estimates were based demonstrate that meta-analysis can be developed into an art that suits whatever purpose its authors hope to achieve. Combining studies of home versus hospital, without differentiating what is inside them, where they are, and what is around them, is akin to producing a fruit salad with potatoes, pineapples, and celery.”

ACOG states that hospitals are the safest place to give birth for all women. However, according to the Centers for Disease Control and Prevention (NVSS Vol.58, Number 11, March 3, 2010) low risk women who plan a home birth have fewer  preterm and low birthweight babies. For low-risk women who gave birth between 1990 and 2006 the low birthweight (less than 2,500 grams)  rate was 5.2% for planned home births compared with 8.3% for hospital births. For preterm (less than 37 weeks of gestation) births the rate was 7.2% for home births compared to 12.9% for hospital births.

Home Birth is Safe When Four Important Criteria are Met

Planned home birth is as at least as safe as planned hospital birth for similar groups of women when four important criteria are in place.

1. Pregnant women are low risk.

2. Home was chosen as the intended place for birth.

3. The primary care provider is qualified according to professional licensing standards and trained to assist at home births.

4. A collaborative relationship with consulting physicians and a medical center exists with clear guidelines for continuity of care should a complication arise where the mother or baby would benefit from the transfer.

Based on a review of 16 years of scientific studies on home birth the Coalition for Improving Maternity Services Expert Work Group found that compared to low risk women who plan a hospital birth, low risk women who plan a home birth have similar or better outcomes with fewer medical interventions and fewer cesareans.  The researchers found several health advantages to giving birth at home for both mothers and their infants.

Women who gave birth at home had the same or lower rates of induction and augmentation of labor. They were less likely to need IV fluids, to have an amniotomy (intentional breaking of the bag of waters), or to have continuous electronic fetal monitoring. (Routine continuous electronic monitoring and amniotomy are associated with an increased risk for cesarean section.) At home women had more freedom of movement and more choice of positions for labor and birth. Ultimately the home birth group had fewer cesareans and more VBACs, less or similar incidents of maternal infection requiring antibiotics after birth, and less need for a blood transfusion.

Perinatal outcomes from the planned home births were similar to planned hospital births. Similar rates of newborns were admitted to the intensive care unit and similar or fewer numbers of newborns suffered from birth traumas. The number of babies who died in the first twenty-weight days (perinatal mortality) was similar in the home birth and hospital birth groups. Overall 85 % of women who first gave birth in a hospital and went on to have a home birth preferred their experience of birth at home. Nine out of ten women who planned to have other children said they would have another home birth.

Evidence supporting the safety of home birth is freely available on several websites including  the American College of Nurse Midwives, the Midwives Alliance of North America and  The Big Push for Midwives.

Undoubtedly, this unfounded opinion on the dangers of home birth is likely to cause some alarm. However, given that expectant mothers actively search the internet for information on pregnancy and birth women can be trusted to access the accurate information they need to make an informed choice about home birth.

Support Groups

30 Aug

Cesarean/VBAC support groups are listed on VBAC.com for the valuable social and psychological support they provide: sharing birth stories, expressing personal views in an open and safe forum, and exchanging information and resources. No responsibility however is assumed for the accuracy of the information provided, medical advice given or suggested on the sites, content from the links provided, nor any email lists or chat groups that may originate from the websites.

International Cesarean Awareness Network, Inc., USA

ICAN is a non profit organization which provides information and support to women and men who want to be actively involved in experiencing and planning birth.

Local ICAN chapters and members across the United States and other countries provide the opportunity to express childbirth-related feelings, information to help plan future births and VBAC (Vaginal Birth After Cesarean) and information to avoid unnecessary cesarean sections. Chapters may hold monthly meetings with speakers, videos and discussions addressing various childbirth related topics. The national newsletter, The Clarion, includes informative articles and inspiring birth stories.

Solace for Mothers

Solace for Mothers provides healing after traumatic childbirth through support. Support—in the form of a free telephone call with a trained peer counselor, in-person facilitated meetings to listen to and share birth-related stories in a safe and confidential setting, as well as referrals to community resources.

Postpartum Progress

Postpartum Progress offers the latest research and an unflinching look at what it is truly like to experience postpartum depression, postpartum anxiety, postpartum OCD, postpartum psychosis, and antenatal depression & anxiety. It features daily news and stigma-busting commentary, as well as a continuously-updated list of support groups around the country, personal stories from moms, photos of survivors, and links to major support organizations and top treatment programs

Birthrites, Australia

Healing After Caesarean aims to provide a worldwide support network for women who have had a previous c/section and to increase the awareness of these women’s needs to their health-carers within the medical profession.

Trauma and Birth Stress, New Zealand – PTSD After Childbirth

Some women who give birth by cesarean experience Post-Traumatic Stress Disorder symptoms (PTSD). Mental health professionals as well as medical providers have identifyed the experience as “Birth Trauma.” Birth Trauma is also experienced by some women who have natural births.

Birthcut

A mother who had her first child by cesarean writes, “Many women think that the feelings they have after a cesarean are wrong and they are afraid to share them with others, even loved ones. It has inspired me to create a place where these women can vent, share poetry, artwork, cesarean and VBAC birth stories and anything else that helps them through those painful feelings.”

CARES SA – Caesarean, Awareness, Recovery, Education, Support, South Australia

We aim to provide balanced, respectful and up-to-date information in regards to Caesarean Birth and Vaginal Birth After Caesarean. Our focus is on women healing from a previous traumatic or upsetting birth experience by caesarean, and helping women to achieve an empowering birth experience for their future births.

VBAC Hope

VBAC Hope is a Christian list offering support and hope for women facing all aspects of Cesarean and VBAC, including HBAC (home birth after cesarean). This list is open to all, but it is a distinctly Christian list, and we expect that the tenets of the faith will be respected. So many of us believe that we went through the traumas of a section to be able to help others avoid an initial section and/or a repeat.

Caesarean Birth and VBAC Information, Great Britain

We offer research-based information and support on all aspects of Caesarean and vaginal birth following Caesarean sections. We are able to sympathetically support a wide range of women’s needs around Caesarean issues. We are used to dealing with those wishing to opt for and elective Caesarean section to those who wish to avoid a Caesarean even when an operative delivery may appear to be an obvious choice. We can offer one-to-one telephone support and written information including a comprehensive reading list, a wide range of articles and research papers.

Birth Crisis Network, Great Britain

The Birth Crisis Network is a help line that women can ring if they want to talk about a traumatic birth. …Many women who are suffering from having been disempowered in birth are treated by GPs with anti-depressant drugs, when what they really need is to be able to talk with someone who understands, who does not try to explain or justify the treatment they received, or to criticise them and the way they feel about what happened to them, and who knows how to listen reflectively.

Birthtalk, Australia

Birthtalk was officially born in 2002, with the banding together of Debby Gould, Karen Hoffman and Melissa Bruijn – three women passionate about birth, each with a different area of interest. Debby, as a midwife and mum, had seen how amazing birth could be, and how this impacted upon women’s entry into motherhood, and wanted to educate women before they were in labour, to increase their chances of a positive experience. Karen had experienced a caesarean followed by a homebirth VBAC (vaginal birth after caesarean), and wanted women to hear those positive stories of birth that are rarely heard, but which can encourage a woman’s belief & understanding that her body is made for this job. And Melissa had experienced a traumatic emergency caesarean, then found herself isolated, unheard and unable to find support, and knew there needed to be a place for women to receive support and validation, without anyone saying “At least you have a healthy baby”.

Birth Trauma Association, U.K.

The Birth Trauma Association (BTA) was established in 2004 to support women suffering from Post Natal Post Traumatic Stress Disorder (PTSD) or birth trauma. We are not trained counsellors or therapists or medical professionals. We are mothers who wish to support other women who have suffered difficult births and we aim to offer advice and support to all women who are finding it hard to cope with their childbirth experience.

C-Section Support, U.K.

C-Section Support’s aim is to serve as a place of support for women and their families who have suffered trauma as a result of a caesarean section delivery. Many women feel an overwhelming sense of sadness after a c-section.  It is common to have feelings of grief for a ‘natural’ delivery and to feel that you have somehow failed at womanhood.  In a number of cases women feel unsupported by health professionals and this can leave them feeling very distressed and isolated.  As a result, women can go on to develop Post Natal Post Traumatic Stress Disorder, and in some cases Post Natal Depression. This site has been set up to offer women a place of comfort and understanding.  Somewhere to share your thoughts and experiences with others that fully understand how you are feeling.

Vancouver Birth Trauma, Canada

This website is dedicated to the survivors of birth trauma.  It offers information and a way for women from the Vancouver area to connect with each other in order to recover from their trauma and to seek ways to change the political, societal and health care systems that caused their trauma in the first place.

Prevention and Treatment of Traumatic Childbirth

PATTCh is a collective of birth and mental health experts dedicated to the prevention and treatment of traumatic childbirth.

What is Traumatic Childbirth?

If a woman experiences or perceives that she and/or her baby were in danger of injury or death to during childbirth, her birth is defined as traumatic –psychologically, physically, or both. Usually, she experiences extreme sense of helplessness, isolation, lack of care, fear, and anxiety (Beck, 2004a). Traumatic childbirth occurs in as many as 25 – 34 per cent of all births. Approximately one-third of those women may develop Posttraumatic Stress Disorder (PTSD).