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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

 

Still Hearing Scary Stories About VBAC?

11 Nov

Despite the evidence from leading maternity care associations and birth advocacy groups that planning a VBAC (vaginal birth after a cesarean) is a safe option to a routine repeat cesarean, expectant mothers with a prior cesarean are still hearing from their own care providers that VBAC is too dangerous an option to consider.

Mothers who want to avoid a routine repeat cesarean, but are experiencing resistance from their caregivers, may want to begin a conversation during their prenatal visits based on these positive VBAC perspectives:

Download from http://www.vbac.com/the-vbac-education-project/

Download from http://www.vbac.com/the-vbac-education-project/

*Women who have a trial of labor, regardless of ultimate mode of delivery, are at decreased risk of maternal mortality compared to elective repeat cesarean delivery.  National Institutes of Health

*Women who attempt a TOLAC (trial of labor after a cesarean) are successful 60-80% of the time. Vaginal birth after cesarean reduces the likelihood of maternal morbidity associated with multiple cesarean deliveries. Women who desire large families and are candidates for a TOLAC should be encouraged to attempt VBAC.  American College of Nurse-Midwives

*Women who achieve VBAC avoid major abdominal surgery, resulting in lower rates of hemorrhage, infection, and a shorter recovery period… žFor those considering larger families, VBAC may avoid potential future maternal consequences of multiple cesarean deliveries such as bowel or bladder injury, blood transfusion, hysterectomy, infection, and abnormal placentation such as placenta previa and placenta accreta. American College of Obstetricians and Gynecologists, Vaginal Birth After Previous Cesarean Delivery (August 2010, Reaffirmed 2015)

*For babies, accumulating cesarean surgeries increase the likelihood of preterm birth and subsequent complications, breathing difficulties, and admission to a NICU (special care nursery).  H. Goer and A. Romano

*Although caesarean sections are safe, research is increasingly showing that vaginal birth and labour can protect against long term-risks such as impaired immune response, asthma, obesity and type 2 diabetes in the baby. Royal College of Midwives

*Planned vaginal birth is safer overall for you than a planned repeat C-section unless there is a clear and well-supported need for a C-section. With supportive care, 75 or so out of 100 women who plan VBAC do give birth vaginally. Childbirth Connection

*Labor after cesarean is safe and appropriate for most women with a history of one or two prior cesarean births. The American Academy of Family Physicians (AAFP) recommends that clinicians counsel, encourage and facilitate planned vaginal birth after cesarean so that women can make informed decisions. If planned vaginal birth after cesarean is not locally available, then women desiring it should be offered referral to a facility and/or clinician who can offer the service. American Academy of Family Physicians

*Provided there are no contraindications, a woman with 1 previous transverse low-segment caesarean section should be offered a trial of labour after caesarean with appropriate discussion of maternal and perinatal risks and benefits. Society of Obstetricians and Gynaecologists of Canada

*There is a consensus, endorsed by evidence-based systematic reviews and clinical guidelines, that planned VBAC is a safe and appropriate mode of delivery for the majority of pregnant women with a single lower segment caesarean delivery.  National Institute for Health and Care Excellence

*Most women with a prior cesarean will give birth vaginally, including women with the following conditions: more than one prior cesarean; having had a prior cesarean for dystocia (delay in progress), macrosomia, a baby weighing more than 4000g ( 8lb. 13oz); older age; high body mass index (BMI); and longer pregnancy duration.  H. Goer and A. Romano

*TOLAC is possible for women with a previous cesarean before 37 weeks, with 2 previous cesareans, with a uterine malformation, a low vertical incision or an unknown incision, with a myomectomy, postpartum fever, an interval of less than 6 months between the last cesarean delivery and the conception of the following pregnancy, if the obstetric conditions are favorable (professional consensus). French College of Obstetricians and Gynecologists

*Unfortunately, quite a few hospitals and doctors do not support VBAC, even though the best research and professional guidelines support it in most cases. There are a number of reasons, including fear of lawsuits, insurance company restrictions and convenience of scheduled deliveries, among others. Ultimately though, the effect is the same: if you wish to use their services, you must accept surgical delivery. Childbirth Connection

*Respect for patient autonomy also argues that even if a center does not offer TOLAC, such a policy cannot be used to force women to have cesarean delivery or to deny care to women in labor who decline to have a repeat cesarean delivery. American College of Obstetricians and Gynecologists,

* Professional liability carriers and hospital administrators should not prohibit maternity care providers or facilities with maternity services from providing care to women who are candidates for a TOLAC. American College of Nurse-Midwives

*Although 70 percent of women or more who plan a vaginal birth after cesarean (VBAC) can birth vaginally and avoid the complications of repeat cesarean surgeries, almost all women today have a repeat operation because most doctors and many hospitals refuse to allow VBAC…To reduce the risk of cesarean surgery, the Coalition for Improving Maternity Services (CIMS) encourages women to seek providers and hospitals with low cesarean rates (15% or less) and those that support VBAC.   CIMS The Risks of Cesarean Section

Resources

For free, evidence-based information on VBAC for mothers, nurses, midwives, physicians, educators and doulas, download the VBAC Education Project.

The VBAC Education Project

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Can I Have a VBAC After a Cesarean for Failure to Progress?

19 Oct

Yes! Failure to progress is one of the four main indications for a cesarean. Often, a woman in labor is restricted to bed and if she has reached full dilation she pushes her baby while on her back. The most painful and most difficult position for giving birth. A U.S. survey of childbearing women found that only 4 out of 10 women walked in labor once they were admitted to the hospital and regular contractions began. Nearly 7 out of 10 women pushed their baby out on their back (lithotomy position). Women who have had a cesarean for failure to progress very often go on to have a VBAC.                                                             1_page_08

A woman’s body changes during pregnancy to prepare her for birth. Connective tissues soften the joints. The pelvis expands to accommodate the baby during labor. The baby’s head molds as it moves through the mother’s pelvis. Having the freedom to move and knowing which positions are helpful during labor and birth reduces pain and helps labor progress.

  • Staying upright and walking during labor makes contractions more efficient, helps the cervix to dilate, moves the baby down, and decreases back pain.
  • Lying on your side helps with back pain, provides added oxygen for mom and baby, makes contractions more efficient, and can be used to give birth.1_page_12
  • Sitting on a rocking chair or sitting and leaning over the back of a chair helps with back pain, makes contractions more efficient, helps the cervix to dilate, and to move the baby down.
  • Squatting for birth widens the pelvis by 20% to 30%, relieves back pain and provides more oxygen for the baby.

Childbirth educators, doulas, midwives, and some nurses know how to help mothers stay upright and change positions during labor to minimize pain and help labor progress.

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For more information about helpful positions for labor and birth download Module 6 of Deciding If VBAC Is Right For You: A Parent’s Guide.