Why would we improve birth?

Birth is birth. It's perfect; without need of improvement. Right? Yes, of course. But, the care mothers and babies are receiving, here in the U.S., with our outrageous healthcare costs, during this beautiful part of life that sets the foundation for humanity, is in much need of improvement. Women deserve evidence-based care.

The mission behind the Rally to Improve Birth is not about convincing women to abandon the system. It’s not about hospital birth or home birth. It’s about bringing evidence-based care and humanity to childbirth – wherever that takes place.

There are some folks who refuse to be affected by the system; those who live off the grid and do choose their own path. Not everyone will birth their children unassisted, with no one else present. I understand the frustration with the system but the system isn’t all that it’s about – it’s about awareness. It’s about bringing the concept of evidence-based care to the average mother; the mother who might not realize she shouldn’t hire a surgeon for her normal, healthy, low-risk pregnancy; the mother who doesn’t know that 40 weeks is a guestimate and it’s common to go past; the mother who is told she is “not allowed” to have a vaginal birth.

As a vbac mom I know the frustration with the new statutesin Arizona and while I don’t agree with the changes in the system, it is at the very least something that has happened here; while they are nowhere near ideal, it has brought attention to the issue. Will I hire an LM under those regulations? I don’t know. Will I use our local birth center? I don’t know. Will I plan for an unassisted birth? I don’t know. Will I travel to Phoenix again, or Flagstaff? I don’t know. But look at that – I have options.

Every woman, in every situation has options. But so many don’t realize it. The Rally to Improve Birth, as it grows each year, is bringing attention to these very issues; the issues of induction and vbac and EFM and autonomy. It’s not just about wanting evidence-based care to be provided by health care providers but also about women understanding that there is such a thing as evidence-based care and that it is lacking in the U.S.

The theme this year, #breakthesilence is raising awareness to the birth trauma that happens every single day here! Women are #improvingbirthbecause they may have not received evidence-based care and they want now want to advocate for humanity in childbirth!

While some have thrown their arms up in the air and proclaimed their mission to be #abandonthesystem –not all women are going to do that and for those that don’t ImprovingBirth.org is sparking the change in providers, hospitals and consumers, which could bring evidence-based care and humanity in childbirth to the women who choose to remain part of the system.

Thank you for those who have shown your support and stand with the Rally to Improve Birth, bringing your wisdom and information to our rally attendees! I hope you'll join us for the first annual 5k Fun Run!!

In love and service,

Jennifer Valencia, CD(DONA)

Rally Coordinator, Improvingbirth.org

It's Not About You {Don't Hate, Let's Educate}

Dear mother who had a cesarean,

It's not about you

Dear mother who had a natural birth,

It's not about you

It's not about you and it's not about me; it's bigger than us! It's not about your birth choices or mine, or anyone else's. We each make choices that are best for our own unique situations with the information that is given to us. The information that is given to us is what's so important.

The United State's ranks 60th in Maternal Mortality Rate while flaunting some of the worlds highest World Health Organization's recommended cesarean section rate of no higher than 10-15%, with an astounding rate of 32.8% that can vary greatly even among neighboring hospitals. ACOG has released guideline after guideline after guideline in effort to reduce the climbing cesarean rate and encourage vaginal birth [after cesarean (pg 6)]. What makes all of this a greater challenge, isn't the system, it isn't even the doctors who aren't following ACOG guidelines, it's society, perpetuating lies and fear throughout your community. There are obviously a variety of complex reasons for the high cesarean rate but each woman holds the responsibility to create positive change for our sisters, for our daughters and generations to come by speaking out with facts and encouragement for those around us. Too often I see women perpetuating the fears and the lies that many have come to believe; especially in regards to VBAC. I encourage you to take a class on VBAC and understand the real risks and benefits of a trial of labor vs a planned cesarean delivery. You deserve the facts and evidence based care. An informed decision is not one driven by fear; it is one made from statistics and access to all of the information.

Women deserve access to the safe and appropriate choice of VBAC and banning vaginal births is not in the best interest of babies and families.

Please, join us at this year's 3rd National Rally to Improve birth!!

Introducing the first year of the Improving Birth Fun Run!!

I was recently confronted by a mother who felt attacked by the statistics; a mother who had chosen a RCS for the birth of her second child. I do not know her whole story but she was adamant that vaginal birth was very dangerous! [Perhaps she hadn't know the facts and was second guessing her decision or perhaps she just didn't like that I had personally made a decision that differed from hers or perhaps she was emotionally burdened because she felt that she didn't have a choice.] I don't know, but whatever the reason, this is bigger than her, this is bigger than me, this is bigger than you.

As a doula, I support any birth - I've supported natural births and medicated births, I've supported inductions, I've supported a planned cesarean section and emergency c-sections. I am well aware of the need for facts and evidence based information, especially in the face of our alarmingly high cesarean rate and climbing maternal mortality rate. Women need to be empowered and spreading false information or being denied all the of the information is damaging to society as a whole. The system isn't going to change, women need to be the change.
There is no room for spreading fears and falsehoods.
Each woman is tasked with the responsibility of taking charge of her health; making safe and appropriate choices that are right for their individual circumstances.

Your choice doesn't have to be the same as mine or any one else's. What's important is that your choice is made from fact, not fear; aka making an informed decision.  I further encourage you to give the women surrounding you the same courtesy of informed choice by stopping the wild fire of misinformation and sharing facts.

Had a cesarean? Don't freak. Know the facts.
If you're local to Phoenix of Tucson Give Birth offers a VBAC Workshop
If you're local to Cottonwood, Prescott, Flagstaff or other surrounding areas, yours truly of Guiding Angels Birth Services also presents a VBAC Workshop for Northern AZ. And be sure to check out these helpful links!

More Than A Scar

       Crisis [krahy-sis]

Noun

1.       A stage in a sequence of events at which the trend of all future events, especially for better or for worse, is determined; turning point.

2.       A condition of instability or danger, as in social, economic, political, or international affairs, leading to a decisive change.

3.       A dramatic emotional or circumstantial upheaval in a person’s life.

I was 37 weeks pregnant, sitting on the white, crunchy paper of a doctor’s office table, when my obstetrician informed me that I was very tiny and the fetus I was carrying was measuring large; “we should just schedule a c-section” he said. Something in me knew that was not the appropriate response and I declined, requesting I be allowed to try and birth my child naturally. Reluctantly, this man I entrusted with my care agreed as long as I “progressed fast enough.”

I was 40 weeks pregnant, sitting on the white, crunchy paper of a doctor’s office table, when my obstetrician reminded me that I was very tiny and the fetus I was carrying was measuring large. At this point, I scheduled my induction. Little did I know, ACOG does not support induction or routine cesarean section for a suspected big baby.

I was 40+3 weeks pregnant in a hospital bed, receiving Cervadil. A few hours later it was apparent that either my child was ready for his birthday or the Cervadil was all I was going to need. It was around 2am, Feb 6, 2007 and my labor had begun. I slept through most of early labor and a nurse came in at 7am because “it was time” for the Pitocin drip to begin. I didn’t want it, I was beginning labor on my own but “I had to” have it. It was started and then quickly stopped due to decels in fetal heart tones. I labored naturally on my own, frequently interrupted by “required” vaginal exams to ensure I was “progressing fast enough.”

It was Feb 6, 2007 at 2 o’clock in the afternoon, I was 7 centimeters dilated, my water had spontaneously ruptured about an hour ago, fetal heart tones were reading great, maternal blood pressure was spot on but twelve hours was long enough according to the obstetrician I had entrusted with my care. A cesarean section was ordered for “failure to progress” and approximately 1.5 hours later, my child was cut out of my body. I gave my child a kiss and we were separated, the rest of the operation details don’t matter much. He was 7lbs, 2oz, 20 in long and his head was 14 ¾ in diameter.  At my late ultrasounds, the doctor had estimated my baby to be around ten pounds but “Wow, what a big head. He wouldn’t have fit anyway,” was the explanation without apology from my obstetrician.

A mother seeking a TOLAC, (trial of labor after cesarean), in a rural town is very limited. At the hhosptal in my town an RCS, or routine cesarean section, is scheduled for mothers with prior cesareans. For my second birth I sought care from a group of midwives in the city and planned my birth place to be a hospital; not my first choice but one of the few options I had because of my prior cesarean. I was 37 weeks pregnant, moderately dissatisfied with my choice of care providers, sitting on the white, crunchy paper of a doctor’s office table. My midwife informed me my fetus was breech, I would “have to” have a cesarean. I found a new care provider. My crisis taught me that this is my body, my baby and my birth.

My crisis taught me that I shouldn’t trust another with my care; I had to be responsible for the decisions made. My crisis taught me to follow my heart. My crisis taught me that what one person says is not always correct. Little did I know how profound that statement was to become.

I was 41+6 weeks pregnant, it was a little after midnight and fear overwhelmed me; fear that if I didn’t “push fast enough” this opportunity, this right, and this birth, would be taken away from me. Three pushes later, my son was born, measuring in at 8lbs, 6oz, 19 in long with a head that was 14 ¾ in diameter. My prenatal challenges shaped who I was becoming as a mother but these numbers impacted the realization of my crisis on a deeply emotional level; realizing how much I had been lied to during my first pregnancy. The cut of my first birth may have been the actual event of a crisis but it was at this moment that it became such.  It was at this moment my life changed.

As the weeks unfolded I bonded with my VBAC baby like I have never done with my first child. It was during these moments I began to feel the emotional impact and realize my first birth experience was a crisis. It had always angered me, it had been a frustration during my second pregnancy but now, it hurt me. The cut of my cesarean cut more than just my body, it cut my soul.

-- Anonymous  

The cesarean rate in America is 32%. The World Health Organization recommends less than 15% to be appropriate.  With these numbers in mind, it's no surprise that so many mothers have suffered from birth trauma from a cesarean. If this is you, I encourage you to process your past birth experience(s). Find a local ICAN Chapter, take a birth after cesarean workshop, attend a group counseling session where you can share your experience(s), hopes and fears, and be showered with love, compassion and support. Some mothers may benefit from seeking a therapist trained in EMDR, (eye movement desensitization and reprocessing). All mothers will likely benefit from a doula.

Not all mothers feel traumatized by their cesarean but most view it as a crisis that challenges them to this day. Use this challenge to support those around you; use it to improve birth. Because when you know better, you do better. Find evidence based information; know and understand your options and make informed decisions, encouraging those around you to do the same. 

If a mother feels empowered in her birth experience, no matter the type of birth it is, she is less likely to suffer emotionally. Birth shapes the type of mothers we become, the relationships we have with our partners, our children and those around us.  A cesarean affects a mother emotionally, physically and medically for the rest of her life.

Rally to Improve Birth

Where will you stand this labor day?  <--Click the link to find a rally near you

September 2, 2013

10:00 AM - 12:00 PM

ImprovingBirth.org Brings you the Rally to Improve Birth. I'm sure you know someone, or perhaps you are someone, who has felt taken advantage of during birth. It is becoming far too common in our culture for women to be uninformed or misinformed. Far too often, care providers are not offering evidence based care. We can fix that! Agnes Sallet Von Tannenberg said, 

If we are to heal the planet, we must begin by healing birth.

That statement could not be more true; birth matters! 

Every mother should be nurtured and respected as she brings her baby earth side. The way her birth experience makes her feel will have lasting impact on her life, shaping the kind of mother, lover, friend and person she is. This is the start of the Journey of Life and babies also deserve the best start; that begins with a healthy pregnancy in which a woman takes an active role in the decisions surrounding her pregnancy and birth. That begins with a birth that evolves around a woman's individual choices; informed choices that are derived from full and accurate information about her care options, including the potential harm, benefits, and alternatives.

VBAC

So you've had a cesarean - does that mean your other births must be a cesarean?  No! In fact, a VBAC (vaginal birth after cesarean) may be a safer option for you and your baby. What about 'once a cesarean, always a cesarean'? -Evidence shows otherwise; surround yourself with support and encouragement, educate yourself, hire a doula, choose your birth place and care provider carefully and avoid induction to improve your chances for a successful VBAC.

What are the benefits of a vbac?

An official statement by ACOG says

a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans

See the full article.

 

Bonding

Labor is an intricate dance of hormones; the most important of these- the "hormone of love" -oxytocin. This is not to say that you can't bond with your baby if they are born via cesarean but this very important hormone that enhances the bonding experience is lost in an [elective] cesarean section.  A cesarean section is major abdominal surgery and can be painful to recover from.  This associated pain can inhibit the bonding you experience during breastfeeding and can make breastfeeding more difficult. When a baby is born via c-section milk may take a few extra days to come in- don't let this discourage you.

 

The Big Squeeze

When a baby is born vaginally, fluid is expelled from the lungs when the baby is 'squeezed' through the birth canal. When a baby is born via cesarean section this factor is lost and can result in faster, shallower breathing; this is usually resolved within 24-48 hours. Another benefit lost to cesarean section would be delayed cord clamping.

 

What about a uterine rupture?

According to a recent UK study, the risk of uterine rupture is .2%; the study goes on to say

For women with a previous cesarean section, risk of uterine rupture increases with number of previous cesarean deliveries, a short interval since the last cesarean section, and labour induction and/or augmentation.

The fear of uterine rupture is the most common concern I hear in regards to a VBAC; according to the NIH consensus, 99.5% will remain intact. [This blog shares the evidence for decreased risks after multiple VBAC's.] There are risks associated with both an RCS (repeat cesarean section) and a TOLAC (trial of labor after cesarean)- the problem lies in that most women who are considering a VBAC are told of the risks associated with a trial of labor but not the risks associated with a cesarean section.

 

Risks of Cesarean

Risks for Mother	Risks for Baby
·         Infection ·         Longer hospital stay ·         Hematoma ·         Return to hospital ·         Extended recovery time ·         Injury to organs ·         Ongoing pain (6-12months post delivery) ·         Chronic pelvic pain ·         Hemorrhage ·         Mortality ·         Negative emotional reactions	·         Respiratory problems ·         Pulmonary hypertension ·         Difficulty breastfeeding ·         Premature birth (in a planned cesarean) ·         Fetal Injury ·         Lower APGAR scores
Risks for future pregnancies
Risks are greater after 2 or more cesareans. It is recommended to have a minimum of 18 months before a TOLAC.       ·         Placenta previa       ·         Placenta accreta       ·         Placental abruption ·         Uterine rupture

The fact of the matter

VBAC Support

Cesareans don't just require physical healing, they impact us emotionally and socially as well.  Both mothers and babies benefit from a successful VBAC with fewer complications, easier breastfeeding and a more positive outlook of the birth experience. There are many factors that go into achieving your VBAC, the most important of which is support.  Finding a care provider who will support you and a birth place where you are comfortable are critical components. You will probably find doula support to be indispensable -- a doula will support you prenatally as well as offer emotional [and physical]comfort during labor, which may be a central component to your VBAC. For online resources and to find support in your area, visit my helpful links tab.

Above all, be empowered in your birth by making an informed choice on this Journey of Life. I hope this blog post can help support that decision and would love for you to share your VBAC story here!