A Game-Changer: Toolkit To Support Vaginal Birth and Reduce Cesarean Delivery, Coming in Spring 2016

9 Jan

Unlike previous U.S. guidelines, consensus statements, position papers, and tool kits developed to reduce the high rate of cesareans, the Toolkit to Support Vaginal Birth and Reduce Primary Cesarean Delivery was developed by a multidisciplinary task force of over fifty expert writers and advisers representing physicians, midwives, nurses, lactation experts, childbirth educators, doulas, patient advocates, public health experts, policymakers, and health care purchasers. It is a comprehensive, evidence-based, how-to guide to support vaginal birth and reduce the first cesarean in low-risk mothers.

Developed by the California Maternal Quality Care Collaborative (CMQCC) of the Stanford School of Medicine, the Toolkit includes strategies to lower the odds for a cesarean during labor. The strategies can be implemented by women and clinicians as early as the first trimester. The Task Force acknowledged that most women do not have evidence-based information about labor and birth or about the potential risks of frequently used interventions that increase the risk for a cesarean. So it is critical that communications between providers and pregnant women be frank and comprehensive during prenatal care to help women make informed decisions about how they want to give birth.  365087516311

“ By identifying the major decision points that most impact the risk for cesarean delivery, “ the Task Force found that, “providers can markedly improve patient decision making and improve knowledge deficit.”

The underlying principles of the recommendations include respect for childbearing women’s values, choices, and cultural background. The Toolkit strongly recommends that women should be treated with dignity, respect, and cultural sensitivity throughout pregnancy, labor and birth, and postpartum.

The Task Force has included guidelines and recommendations for all stakeholders in maternity care from hospital administrations to healthcare insurance payers. The strategies that focus on hospital-based care encourage nursing skills which focus on promoting freedom of movement, fetal positioning, intermittent auscultation instead of continuous fetal monitoring, labor support techniques, and non-medical options of pain relief. Doulas are recommended as part of the collaborative healthcare team’s support for vaginal birth and reducing cesareans.

Although the main focus of the CMQCC Toolkit is on low-risk first births, nulliparous, at term, with a single fetus in a vertex position (NTSV), the philosophical principles and specific recommended strategies can be applied to all women giving birth.

While the Toolkit is meant to guide individual hospitals and provider level change in California it also includes guidance for state, county, and hospital system-level change. Hopefully, this game-changer Toolkit will eventually be adopted by maternity care stakeholders across the U.S.



For Doulas Who Support VBAC Clients: A Personal Perspective

9 Dec

By Jess Larsen Jukelevics, MA, CD(DONA)

VBAC families commonly come to birth with hopes or determination for a different experience, fear of repeating some part of their first birth, and sometimes unresolved feelings about giving birth again. In short, it can often feel (for every one) that the stakes are high.

We know that labor support is associated with better outcomes (Childbirth Connection, 2013), and a doula can go a long way to alleviate the fear and anxiety a VBAC mom may experience. But it’s also critical for doulas to be capable of supporting the emotional realities of VBAC women regardless of the clinical outcome of the VBAC attempt. VBAC For Educators

So how can a doula:

  1. Offer help that best supports a family’s chances of a successful VBAC?
  2. Hold the space for a family no matter the outcome in a productive and healthy way?

In prenatal work together with the family:

Depending on how the family is approaching this birth, it may be helpful to plan for more time prenatally than you might with other families. Before now, they may not have had an opportunity to digest what happened last time, their feelings about it, or to get clear on what they want this time (particularly if their first child is still young). Their time with you may be the most productive and helpful time they’ve had to do that. If they need more help than you can offer, refer them to a Birth Story Medicine® session[1] or local birth trauma workshop. These can be very healing experiences for parents.


Coping with the Pain of Labor

6 Nov

Many mothers considering a VBAC, especially if their prior cesarean was scheduled, are concerned about how they will cope with the pain of labor. Some fear that having an epidural will complicate labor and lead to additional interventions that will lower their odds for having a vaginal birth. The VBAC Education Project

Non-drug methods of pain relief including continuous emotional support from a doula are beneficial for mothers and babies and do not cause harm.

  • What options for pain relief are you considering?
  • Try to use non-drug methods of pain relief and comfort measures before using drugs for pain relief.
  • You may want to use music, aromatherapy, visualisation, rhythmic breathing and relaxation, yoga or hypnobirthing techniques.
  • Find out about touch therapy, massage, a water birth, acupressure or acupuncture, water injections, and TENS (electrical stimulation).

If you want an epidural:

  • Try to wait until your cervix is dilated to 4-5 centimeters before it is given to you.
  • To help the baby move through your pelvis and rotate for birth, try changing positions slowly while in bed every 20 to 30 minutes during labor. You may need some help.
  • When you are fully dilated, you may need to wait an hour or more before you feel you’re ready for active pushing.
  • You may want to rest or sleep until you feel rectal pressure strong enough to push on your own.
  • You may want to wait until the numbness of the epidural wears off before pushing. With an epidural you may need up to three hours to push your baby out.

Find out more about coping with the pain of labor from Module 7 of  Deciding if VBAC Is Right for You: A Parent’s Guide.

Additional Resources


National Health Service, UK

Choices In Childbirth


Birth Professionals Are Eager to Increase Awareness About VBAC

21 Sep

Maternity care professionals have many suggestions for increasing awareness about the safety of VBAC and supporting mothers who want to labor after a prior cesarean. They only need an opportunity to make that happen. Intro.key

On Saturday, September 19, I had the honor of speaking about VBAC and the VBAC Education Project to a room full of dedicated maternity care professionals at the Lamaze/ICEA Joint Conference in Las Vegas, Nevada. I spoke about the need to educate parents and professionals about bringing back the choice to labor for a VBAC which was widely available till the late nineties when nearly 1 in three U.S. mothers with a prior cesarean had a vaginal birth. I asked the audience if they could think of one strategy they could use to increase awareness of the safety of VBAC in their community or one change they could make in their hospital policies and procedures to help mothers who wanted to labor after a prior cesarean. I was inspired by the suggestions they made.