Tag Archives: making informed decisions

In Honor of Cesarean Awareness Month: Introducing The VBAC Education Project

10 Apr

VBAC was deemed a reasonable and safe option to a routine repeat cesarean by the National Institutes of Health decades ago (1981). But, in recent years, misinformation about its safety and lack of clear national practice guidelines have succeeded in virtually eliminating VBACs in many hospitals. Intro.keyThousands of women are being denied medical care for VBAC and given no choice but to “consent” to a repeat operation they do not need or want. Mothers have the legal right to make their own health care decisions, but that right, more often than not, is not upheld. The  upcoming, evidence-based VBAC Education Project, endorsed by the International Childbirth Education Association and the International Cesarean Awareness Network was developed to answer the many questions parents have about VBAC and provide educators and maternity care professionals with the resources they need to support women who want to labor after a prior cesarean. This volunteer collaborative project will be available for download at no cost.

The VBAC Education Project consists of four sections:

  • žDeciding if A VBAC Is Right for You: A Parent’s Guide (slides)
  • žVBAC for Educators: A Teaching Guide
  • ž Resources for VBAC and Physiologic Birth
  • žEducational Handouts for Parents

For Parents

žIf you are a parent whose baby was born by cesarean section, VBAC_HandoutsForParentsthis evidence-based slide presentation (14 modules) provides comprehensive information on vaginal birth after a cesarean (VBAC), a safe option to a routine repeat cesarean. It will also help you to understand why you may have had a cesarean and how you can do things differently this time. The Resources will help expand your knowledge about VBAC and physiologic (normal) birth. The Educational Handouts for Parents will give you the tools you need to make informed decisions and help you to have a safe and satisfying birth.

žFor Educators and Group Leaders

VBAC For Educators: A Teaching Guide is a companion to Deciding if A VBAC Is Right for You. If you teach childbirth classes or lead a support group for women with a prior cesarean the supporting e-book, VBAC for Educators: A Teaching Guide will help you to present the material to your students. It includes background information for each of the 14 modules, sample class outlines, teaching tips, examples of hospital guidelines and informed consent forms for VBAC you can duplicate for your own educational use. VBAC_ForEducatorsFor mothers considering a birth-center or home VBAC the Teaching Guide also explores the relative safety of VBAC outcomes for low-risk women who begin labor on their own compared to outcomes for planned hospital VBACs.

For Maternity Care Professionals

žIf you are a labor and delivery nurse, office nurse, doula, community-based maternal-child health worker or birth activist, this visual guide provides the medical facts you need to understand the VBAC option, the psychological issues related to laboring for a VBAC after an unexpected prior cesarean, and the many ways you can support and empower mothers to make their own best decisions about how they want to give birth this time. The Resources and Educational Handouts for Parents will be useful for you and the mothers and families you work with.

žFor Physicians and Midwives

žIf you are a physician or a midwife, this visual guide can help provide expectant parents with evidence-based information about vaginal birth after a cesarean. It can also help them to clarify some of the issues they are most concerned about.VBAC_Resources Clinicians rarely have the time to provide parents with all the information they may need to make informed decisions for birth after a cesarean. This guide can help begin the prenatal conversations you will have with mothers to help them make an informed choice about how they want to give birth this time.

The VBAC Education Project will soon be available for free download from www.vbac.com and the International Childbirth Education Association. We hope it will help parents to find out more about the VBAC option and encourage maternity care professionals to safely support them.

Updated June 24, 2015.

A Professor of Psychology and VBAC Mom Explores How Women Make Birth Decisions After a Prior Cesarean and Shares Her Own Birth Stories

19 Jun

Yasmine L. Kalkstein, Ph.D. is Assistant Professor of Psychology at Mount Saint Mary College, in Newburgh, New York. She gave birth to her first child by cesarean. Her second birth was a VBAC. “Making the decision to VBAC was a scary one” the professor said. “I hated the idea of getting my hopes up and being all the more let down. Yet, I also knew that I’d feel an amazing sense of regret if I didn’t try.“  By talking with other mothers, she discovered that many women simply scheduled a repeat cesarean. Some by choice, others because they did not know about another alternative. The psychology professor realized that it was important to understand how women with a prior cesarean make a decision to give birth when they become pregnant again. Last summer Professor Kalkstein conducted the first phase of a research project to better understand this important issue.

On our June 7, 2012 blog post we asked women who wanted to participate in Dr. Kalkstein’s research to take the survey she had designed.  Apparently, the posting encouraged hundreds of women to respond. The data from this first phase of her study is now complete. She is now conducting the second phase of her research project.396871_10150477635423717_1114115397_n Once again she is asking women whose first birth was by cesarean and are currently pregnant if they would like to take the current survey. The research team is especially interested in women whose pregnancy is 25 weeks or less. Doing this survey helps give mothers a voice. The results can also help careproviders better understand the perspective and values of the women they care for.

At our request, Prof. Kalstein was gracious enough to share the results of the first phase of her research study and her own birth stories. If you are a pregnant woman who is considering taking the second BIRTH DECISION SURVEY, please do so before going on to read the results of the first phase of Kalkstein’s research project and her birth stories.

Prof. Kalkstein-My Birth Stories

I gave birth to my first daughter in Minneapolis while a graduate student in Psychology. I remember literally “tuning out” the class on c-sections during my birth preparation class. I nudged my husband and said, “Everything is fine, the baby is in the right position, so I am not likely to have a cesarean.” And I daydreamed through whatever was being said.

My water broke a couple days after my due date. I had never felt a contraction and when my water broke in the middle of the night, I actually thought I wet the bed! My husband called the hospital and they told us to come in right away.I dawdled a little…first I wanted to shower. And to eat something! But my husband was nervous and emphasized that the doctor said we needed to come in immediately.

We called our doula from the car on the way to the hospital. We didn’t want to wake her up earlier than we had to. She said, “Wait, maybe you should stay at home!”  We thought it was best to follow our doctor’s advice. After a few hours had passed with not much progress, they told me we had to start Pitocin. They kept upping the Pitocin and I was in agony, feeling horrible back pain with each contraction which came every 60 seconds. My nurse and doula tried to help me as much as they could, but finally I said, “I have to know how far along I am.” Turns out I was only at 1 centimeter dilation.  At that moment, I realized I couldn’t have an unmedicated natural birth. I could not handle this. They tried to encourage me to wait before taking any medication, but I begged for an epidural. I was so happy when the epidural kicked in and I could just relax.

My doula went to grab a bite and my husband relaxed next to me. Then gradually, I began feeling pain in my back again.  I called for help.  I could barely move to get into any position to relieve the pressure I felt. It took the anesthesiologist nearly an hour to get to me. I was in agony, trying to hold for the doctor to redo the epidural. I only had 45 seconds of relief between contractions. I recall trying to fix my eyes on a beautiful sunset while I felt a sense of panic until the epidural took effect.

I had been experiencing induced labor for 12 hours when the doctor checked me and said I was 10 centimeters. I had just gone through transition without a working epidural. It was time to push. I didn’t feel a thing but tried to push. The nurse was great; the doctor was barely present. I spent three and a half hours of basically seeing the top of the baby’s head, but I couldn’t push the baby out. I started running a fever, my contractions were so weak they could barely tell me when to push, and I was rushed to have an emergency c-section. I threw up when I found out the news, but I was not allowed to drink to wash my mouth out because I was going into surgery.

I began crying. The staff threatened that if I didn’t calm down, they would put me under general anesthesia. When we got to the OR, the doc asked me, “Are you excited to see your baby?” I answered,  “I just want an ice pop” (and at that moment, I really meant it). It had been nearly 22 hours since my labor began and I had been unable to drink or eat anything other than ice chips. My husband had to “sneak” sips of juice when no one was looking, and even then, we were worried we were doing something wrong.

My baby girl thankfully was okay, and I begged to be unstrapped from the operating table so I could touch her. Shortly after, they rushed her off (no nursing) as she had to go on (preventative) antibiotics for 48 hours because I had developed a fever.

I was taken to some post-operative room, where it seemed some of the focus was on “pain control.” I kept asking when I could see my baby. It somehow became clear to me they didn’t want to release me until my pain went down. They asked me to identify the intensity of my pain on a scale of 0-10, 10 being the worst.  I finally said, “What number do you need to hear to let me go see my baby? I’m a 2. Okay? Is that good?”

I nursed my daughter and then I was wheeled down to my suite to thankfully sleep. Or so I thought. I’m not sure what was worse–the labor or the 48 hours afterwards.

My daughter and I were separated by two floors and I was expected to get in a wheelchair and go up to breastfeed her. That was so hard for me and it would take me 45 minutes to get up there and return and then, I would have to go up again. When we were finally together 48 hours later, I was relieved. The recovery was horrible, and I went through some post-traumatic stress, feeling that I was less of a woman, and wondering what I had done wrong. My doctor said that I was probably too small, but told me I could try to VBAC in the future if I wanted.

In the couple of years after my daughter’s birth, I saw a couple of different doctors. One told me that I had a 90% chance of having a repeat cesarean given the way it played out the first time. Another told me 50%. I had moved to New York, and when I got pregnant, I went to see a doctor I had heard was great. It was a male physician with a private practice. I had never seen a male obstetrician before, but I didn’t care…I wanted the best. I told him my story, and cried. He empathized and said he thought I should try for a VBAC. I asked him, “What are my odds?” He said, “I’m not going to give you a number. But, I think you should try.” Then I asked him, “Can I drink during labor?” (I was not going through another labor on ice chips.) He answered, “What? Like vodka?” I realized, as we laughed, that this physician was it.

One week away from delivery, he told me not to come to the hospital until I was “literally crawling.” My doula helped me deal with my fears, telling me over and over that natural labor is not as bad as “Pitocin labor.” My labor was very long, and I called the doctor up and told him, “I just want to get an epidural so I could sleep.” And, “Can I go to the hospital now?” He was very harsh and told me, “If you come, you’ll get an epidural and then possibly a c-section…is that what you want?” I couldn’t understand how my nice doctor could be so mean, but in retrospect, I realize his words kept me out of the hospital a few more hours and he was only trying to help. After more than three days of contractions and nearly 20 hours of labor where I needed support, I finally BEGGED to go to the hospital. My contractions weren’t getting closer together (never closer than 6 min), but I was so exhausted from not sleeping for 2 nights. My husband and doula (who were both amazing) stalled as much as they could, packing my things and offering me food.

Finally we drove to the hospital. When we arrived, I saw my doctor immediately (I was 4 cm) and he did recommend that I get an epidural (he said I was narrow and he thought it might help). We got an “epidural light” when I was at least 5 cm, where unlike the first time, I could feel my body. Unlike with my first birth, I also was served a tray of food and drinks. At 8 cm, they broke my water. When I was fully dilated, this time I knew it was time to push and begged to do so.

While I was pushing the doctor, nurse, and doula at a certain point could see something I couldn’t. They began to say, “It’s going to happen.” The doctor said, “I’m too tired to do a c-section today.”  My doula, who promised me never to say I was going to have a vaginal birth unless she saw the baby crowning  also joined in. “You are going to do it.” I looked at her angrily, “Don’t get my hopes up!” Then I saw my doctor scrub up. I asked, “Are we going to do the c-section here?” In my head, I honestly wasn’t sure this was going to happen. When I saw the surgical tools on the tray and my doctor scrubbed up, I thought I was going to have another cesarean.   However, this time I gave birth on my own. In short, I had a successful VBAC. It was unbelievable to nurse right away and not be separated from my baby immediately after birth. I credit my supportive husband, doula, and doctor for helping me achieve this.

How My Birth Experiences Led To My Research

A week before I gave birth to my second child, I went to a luncheon for mothers and their children. I did not know anyone. In our discussions, I told them I was trying for a VBAC and other moms began to talk about their own births. It seemed that most of them had had cesareans. “I just scheduled a cesarean…I didn’t even think about it,” said one mother and “I wanted it all planned,” said another.   I was shocked at how different my attitude was. I was terrified of having another c-section. I began to wonder what led to our completely different reactions? Was it their doctor and what he/she said about how best to give birth? Was it their memories of their first birth? Was it a personality difference?

I had studied decision-making in the context of my doctoral program in psychology, and I realized this would be a fascinating topic to research. And so for the past eighteen months I have been researching why women choose to try for a VBAC or choose to repeat a cesarean. As a scientist, I am approaching my data analysis without interjecting my own biases. Trying a VBAC was right for me, but it’s not my job or my agenda to tell women what’s right for them. I want to learn how different variables may influence a woman’s choice.

Results of the First Phase of Our Research Study (Pilot Study)

Data we collected last summer revealed some interesting trends. We consider it a pilot study and now are limiting our sample to women who are pregnant (not only planning on being pregnant) and are in the early phase of their pregnancy (where they do not know their baby’s position yet). We are also asking more questions related to personality and gathering more information on what women know about VBAC before making their decision (e.g., odds of uterine rupture).

In our pilot study, we analyzed women who were pregnant (N = 166) or planning on being pregnant (N = 117). 215 were planning to VBAC, 20 were planning an elective repeat cesarean delivery and 48 were undecided. In an online survey, we asked the women questions about perception of risk, previous delivery, locus of control, and sources of influence.

Here are some of our results:

-Not surprisingly, women who plan on having a VBAC perceive VBAC as less risky than a cesarean section whereas women planning on having a repeat cesarean perceive VBAC as more risky than a repeat cesarean.

-Women who are less satisfied with their first birth are more likely to try for a VBAC.

-Women who are trying for a VBAC more strongly endorse these items:

•In my first birth I had no control and my situation determined the outcome.
•I felt like my body had failed in some way.
•I felt like my health providers or hospital staff had failed me in some way.

-Women perceive childbirth differently. Some women believe the doctor/nurse is in control. Others believe they themselves control the success or failure of their birth. Some mothers consider “luck” to play more of a factor. Psychologists call this personality variable “locus of control.”

A scale was developed to measure locus of control for childbirth (Stevens, Hamilton, & Wallston, 2011). We found that women who are choosing a VBAC have a stronger internal locus of control. This means women choosing a VBAC more strongly believe that they have control over their outcomes, and endorse items like, “I am directly responsible for my labor and delivery going well or poorly.” They also have less of a powerful-others locus of control and are less likely to endorse items like, “Following doctor’s orders to the letter is the best way to keep my labor and delivery from going poorly.”

-Women who are choosing to VBAC seem to be obtaining more of their information from and are being influenced by sources other than their healthcare provider.

15% of women choosing a VBAC listed online information as the primary influence on their birth plan.

22% choosing a VBAC listed their healthcare provider as the primary influence vs. 45% of women electing a repeat cesarean.

Why women want to plan a trial of labor after a cesarean (TOLAC): The majority of women who plan a Trial of Labor After a Cesarean (TOLAC) want to experience a vaginal birth, suggesting there is definitely an emotional component to this decision. Beyond that, other common reasons include a shorter hospital stay, avoiding surgery, believing it’s the healthier option, and being able to bond/breastfeed.

What I learned from women’s responses is that many women experience the same feelings I felt and that have been reported in previous studies:

Coping with fear of failure/loss of confidence (McGrath et al., 2010)

Wanting to experience natural childbirth (Kaimal & Kupperman, 2012)

Feeling unsupported by health professionals when they want to have a vaginal birth (Lundgren et al., 2012)

Here are a few comments from the women in our study who were choosing to have a VBAC that reflect some of the above sentiments:

  • “I felt like less of a woman after my c-section. I want to be able to say that I gave birth to my children, I want to endure the pain that is natural… I know this isn’t true but a small part of me believes that natural birth is almost a right of passage to becoming a mom. I know that isn’t the case, but that’s how I feel.”
  • “I am always so jealous of those who have had vaginal births. I really feel like a failure.  If I don’t at least try this second time around, I think I may regret it.”
  • “I’m also becoming afraid of the risks of VBAC as they were presented by one of my doctors.”
  • “ I’m trying to discuss with friends who’ve tried for a VBAC. They seem to be the only people who understand.”
  • “ I feel deeply in my core that my body is capable of delivering this baby vaginally, and I want to have that experience.”
  •  “I had already made my decision long before I became pregnant again, but seeing recent a photo of a college friend who was leaving the hospital after delivering vaginally, smiling broadly while sitting in a wheelchair, with the caption, ‘It’s embarrassing, but they make you go out in a wheelchair,’ made me tear up. When I was leaving the hospital after my c-section, I needed that wheel chair. And the pain and feeling of helplessness at not being able to walk at least sort of normally sticks with me today.”
  • “[I] just want the ‘normal’ experience.”
  •  “I barely remember my daughter’s first day of life. I was in pain for several weeks. I would prefer a day of pain versus several weeks of it. Additionally, I now have a toddler and would like to recover more quickly to try and keep things as normal as possible for her. I think people only see the convenience of the scheduled C-sec and don’t grasp that it is abdominal surgery-which is a big deal!”


Our results suggest that previous experience, risk perception, personality, and informational sources may influence women to make different decisions. I thank all the mothers who have helped by taking our survey and I look forward to researching this more in the next phase of our study. My research is, without question, personal.  Not only has my own experience led me to be passionate about this line of research, but learning about the issue from an academic point of view has also helped me heal.

Evidence suggests that VBAC is often a safe option, yet so many women aren’t choosing it. We need to understand why this is. Today, we have more of a role in directing our healthcare (patient-centered decision making); thus the exploration of psychological variables on medical decision making is an important area of research.

For additional information about this project, you can contact Dr. Kalkstein  at yasmine.kalkstein@msmc.edu.



Cesareans Rise For Twelfth Consecutive Year Increasing Risks in Future Pregnancies

13 Dec

Birth data for 2008 recently published by the U.S. Centers for Disease Control (CDC) and National Center for Health Statistics show that the U.S. cesarean rate rose for the 12th consecutive year. Cesarean section, the most common major surgical procedure performed in the U.S., accounted for 32.2 percent of all births in 2008. Despite concerns about the health risks of cesareans for mothers and infants physicians performed 2 percent more cesareans in 2008 than in 2007. The cesarean rate increased 56 percent since 1996 when the rate was 20.7 percent.

According to the CDC the rise in the total cesarean delivery rate since the mid 1990s has been driven by increases in primary cesareans and decreases in vaginal births after cesarean delivery (VBAC) . The increase in primary cesareans and decline in VBACs may have been influenced by shifts in demographics, maternal choice and other nonclinical factors, as well as VBAC guidelines from the American College of Obstetricians and Gynecologists (ACOG) and increased medico-legal pressure.

Hospital charges for a cesarean delivery are almost double those for a vaginal birth, adding significant cost to childbearing families. In 2007-2008, the average cost of a hospital vaginal delivery without complications was $ 8,919 compared to $14,894 for a cesarean without complications.

Earlier this year the CDC confirmed that a cesarean is major abdominal surgery and is associated with higher rates of surgical complications and maternal rehospitalization, as well as with complications requiring admission to a neonatal intensive care unit. (NCHS Data Brief ■ No. 35 ■ March 2010)

When the number of cesareans increase so does the risk for serious complications in a subsequent pregnancy including placenta previa (placenta covers the internal os) and  placenta accreta (placenta abnormally attaches to the uterine wall). With a placenta accreta mothers are at increased risk for hemorrhage and blood transfusion. Mothers are more likely to develop life threatening blood clots, have a hysterectomy, and more likely to die in childbirth. With a prior cesarean the odds of having placenta accreta increase with each additional repeat cesarean

According to the California Maternal Quality Care Collaborative (CMQCC) the rising incidence of placenta accreta is due to the rapidly rising numbers of primary and repeat cesarean births.

This chart, developed by the CMQCC  shows the increased risk for placental problems when women have a repeat cesarean.

Infants are also affected. With a planned primary non-medically indicated cesarean  there is a 69 percent higher risk of neonatal mortality than with a planned vaginal birth.

Despite efforts to reduce cesarean rates and increase access to VBAC some states surpassed the national average for the number of cesareans performed.  State cesarean rates varied widely ranging from 22.0 percent in Utah to 38.7 percent in New Jersey. Louisiana (38.0 percent) and Florida (37.6 percent) had the second and third highest cesarean rate. Alaska (22.6 percent) and New Mexico (22.9) had the second and third lowest. The highest number of cesareans were performed in Puerto Rico, where 48.5% percent of women gave birth by major surgery.

According to 2008 birth data non-Hispanic black women were more likely to deliver by cesarean (34.5 percent) than non-Hispanic white (32.4 percent) and Hispanic (31.0 percent) women. Although the rise in cesarean rate has slowed in recent years among many states, in 2008, 22 states had higher cesarean delivery rates than in 2007, an average increase of 2.5 percent.

Healthy People 2020 Goals for Reducing Cesareans

The increasing cesarean rate runs contrary to the Healthy People 2020 national health goals to reduce primary and repeat cesareans and the rate of maternal mortality.

To improve maternal and child health the U.S. Department of Health and Human Services Healthy People 2020 goals are to reduce the number of cesareans for low-risk (full-term, singleton, vertex presentation) women giving birth for the first time from 26.5 percent in 2007 to 23.9 percent. To increase the number of low risk women who have repeat cesareans from 90.8 percent in 2007 to 81.7 percent and to reduce maternal deaths.

The maternal mortality rate in 2007 was 12.7 per 100,000 the goal is to reduce the rate to 11.4 by 2020, all goals target a 10 percent improvement. Researchers found that healthy women who plan a cesarean are at increased risk of death compared to healthy women who plan a vaginal birth. Maternal deaths were due to complications of anesthesia, birth-related infection, and venous thromboembolism (blood clots).

To help an expectant mother understand the health implications of cesarean section for herself and her baby, the Coalition for Improving Maternity Services developed a checklist for mothers to read during pregnancy and discuss with her care provider. Reviewing this checklist can help mothers make an informed decision about planning a non-medically indicated cesarean.

Coalition For Improving Maternity Services

About The Risks of  Cesarean Section

A Checklist For Mothers To Read During Pregnancy

Birth is a normal, natural, process and the vast majority of women can have safe, normal, vaginal births. There are health conditions where a cesarean birth is necessary for the well being of the mother or her baby. However, more and more mothers these days are giving birth by cesarean section for non-medical reasons. A cesarean poses risks as well as benefits for mother and baby, and should not be undertaken lightly. This educational material is provided by the Coalition for Improving Maternity Services (CIMS) to help all expectant parents become better informed about the risks of cesarean section.

To give the expectant mother time to reflect on this information and consider the impact of cesarean surgery on her health and the health of her baby, care providers are encouraged to introduce and discuss this evidence-based information throughout pregnancy and no later than at 32-34 weeks.  The expectant mother is encouraged to take the form home, read and initial the statements, discuss the information with her partner, and raise any questions or concerns she may have with her care provider. The form may then be placed in her chart.

Expectant Mother’s Name: ____________

Care provider’s Name: _______________

A cesarean section is an operation by which a baby is born by making a cut in the mother’s lower abdominal wall (abdominal incision) and a cut in her uterus (uterine incision). I understand that a cesarean operation may be more dangerous than a vaginal birth for my baby and me.


1. _____I am more likely to have more blood loss and a longer recovery time.

2._____ I am more likely to have accidental surgical cuts to my bladder, bowel, or gastrointestinal tract.

3._____ I am more likely to have a serious infection in my incision, uterus, or bladder.

4. ____ I am more likely to have  thick scarring (adhesions) inside my abdomen that may cause chronic pain years after my cesarean.  This scarring can make any future abdominal operation I may need more difficult.

5.____ I may have uncontrolled bleeding and need an emergency hysterectomy (removal of the uterus) if the bleeding cannot be stopped.

6.____ I am more likely to have complications from anesthesia.

7. ____ I am more likely to develop serious and life-threatening blood clots that can travel to my lungs (pulmonary embolism) or my brain (stroke).

8.____ I am more likely to be admitted to intensive care.

9.____ I am more likely to need to return to the hospital for complications from the cesarean operation.

10.____ I am more likely to feel pain and/or numbness at the site of the operation for several months after my surgery.

11.____ I am less likely to breastfeed successfully. I may lose out on the health benefits of breastfeeding for myself, including: weight loss, reduced risks of cancers, heart disease, diabetes, and osteoporosis.

12.____ I am less likely to have a satisfactory birth experience. I am more likely to have emotional problems such as post-partum depression and post-traumatic stress. Many women experience  a profound sense of happiness  after a normal birth that flows naturally into bonding with the baby and breastfeeding.

13_____ I am more likely to die.


14.____ I am more likely to have trouble becoming pregnant again.

15.____ I am more likely to have complications in a future pregnancy due to the scar in my uterus. If the new placenta attaches over my previous scar, it is more likely to cause serious problems, including: serious bleeding, placenta coming in front of the baby (placenta previa), placenta growing into or even through the wall of the womb (placenta accreta), miscarriage, or pre-term birth.

16 .____ I am more likely to have a baby with a congenital malformation, central nervous system injury, or low birth weight due to problems with the placenta.

17. ____ I am more likely to have a stillbirth.

18. ____ I am more likely to require major surgery to remove cells from the lining of my uterus that may grow outside my womb (endometriosis).

19. ____ Since it is difficult to find a physician or hospital supportive of a vaginal birth after a cesarean (VBAC), I am more likely to have a repeat cesarean  for the birth of all my future children, although a vaginal birth after a cesarean birth is usually safe. Each additional operation I have increases the odds for complications.

20.____ Research shows that having a cesarean will not protect me from urine, gas, or stool incontinence in the future, or from future sexual problems.

21.____ I may not be able to get healthcare coverage since some insurance providers consider a cesarean to be a pre-existing condition.


1. ____ My baby is more likely to be born prematurely if the cesarean surgery is performed anytime before labor begins. A premature baby is more likely to experience the following:

-admission to the intensive care nursery

-trouble breastfeeding, digesting food, and regulating body temperature

-developing jaundice

-brain development problems and difficulties in learning in school

2.____ My baby is more likely to face complications from anesthesia and postpartum pain medication.

3.____ My baby is more likely to be accidentally cut during surgery.

4.____ My baby is more likely to have breathing difficulties since labor contractions clear the lungs.

5. ___ If I agree to a scheduled cesarean, it is normally best to wait for labor to begin before performing the operation.

6 .____ My baby is more likely to have difficulty breastfeeding. My baby is less likely to benefit from skin-to-skin contact with me and is less likely to get the health benefits from breastfeeding including: reduced risk for asthma, allergies, respiratory infections, type 1 diabetes, childhood leukemia, and SIDS (sudden infant death syndrome). If I do have a cesarean, I can request special care to help me and my baby breastfeed successfully before I am discharged from the hospital.

I have read and discussed this information with my care provider.

Expectant Mother’s Signature____________ Date_____________

Care provider’s signature_______________ Date____________

This information is provided for expectant mothers and their care providers by the Coalition for Improving Maternity Services (CIMS). CIMS strongly recommends that cesarean surgery be reserved for situations when potential health benefits clearly outweigh the risks. Please see The Risks of Cesarean Section, a CIMS Fact Sheet for the references that support this form, available as a free download from http://www.motherfriendly.org/downloads/php

The Power To Push Campaign Has It Right When It Comes To VBAC

5 Oct

The Power to Push Campain was created in 2010 by the British Columbia Women’s Hospital and Health Center to  reduce cesarean rates and help women make informed decisions about VBAC, elective primary or repeat cesareans.

Based on the latest evidence and respect for women’s ability to make their own decisions about how best to give birth, the Power To Push project has developed  well balanced, easy to understand consumer education booklets that tell it like it is. Resources in five different languages include brochures on VBAC, vaginal breech birth, and ECV, external cephalic version, a safe method of turning a breech around the 37th week of pregnancy. Their website also includes videos featuring real women sharing their personal birth stories and wisdom. Theresa’s VBAC story is honest, encouraging, and unusual given that her OB encouraged her to consider a VBAC. Women can also take the Birthing Misconception Quiz to increase their knowledge about cesarean and VBAC.

At the hospital’s Best Birth Clinic, women can be referred to the Choices in Childbirth Counselling Service where women can meet with a Registered Clinical Counsellor to discuss their concerns, and receive current, evidence-based information on the risks and benefits of cesarean birth.

Everyone involved in the Power To Push Campaign is committed to supporting women’s choices and helping them have the best birth possible. The U.S. can certainly benefit from this exemplary model of care aimed at reducing cesareans and increasing access to VBAC.