My hospital is currently not allowing VBAC and forcing me to have a cesarean. What are my options?
Contact ICAN with the name and city/state of the denying hospital, along with the name and contact information of the Nurse-Manager of the Labor & Delivery/Birthing unit that is forcing you to have surgery against your will. (For support in Los Angeles, email us.)
You may choose to present a signed VBAC Consent Form as proof of your understanding of the benefits and risks involved in childbirth.
State that you require more time to consider your decision. Ask to postpone the surgery until you have been given adequate time to research your decision thoroughly.
When labor begins spontaneously, some mothers feel more comfortable laboring in the comfort of their own homes for as long as possible. It may be possible to find a doula or monitrice for labor support.
It is never too late to change caregivers or birth location. Consider seeking another caregiver or birth location immediately.
Write a letter to your local television station and/or the editor of your local newspaper, telling them you are being forced to have a cesarean against your will.
During the month of October, ICAN will be focused on bringing awareness to the condition of placenta accreta, when the placenta attaches too deeply into the uterine wall. This condition carries a 7% mortality risk to the mom due to massive blood loss. Moms are normally made very aware of the risk of uterine rupture when attempting a VBAC, but very few moms are counseled on accreta when considering a repeat cesarean. Many women hear the word accreta for the first time when they are diagnosed with it. With the cases of accreta on the rise due to high cesarean rates, chances are that you will know someone in your lifetime that will face this scary diagnosis.
ACOG states that “The incidence of placenta accreta has increased and seems to parallel the increasing cesarean delivery rate. Women at greatest risk of placenta accreta are those who have myometrial damage caused by a previous cesarean delivery with either anterior or posterior placenta previa overlying the uterine scar. The authors of one study found that in the presence of a placenta previa, the risk of placenta accreta was 3%, 11%, 40%, 61%, and 67% for the first, second, third, fourth, and fifth or greater repeat cesarean deliveries.”
On October 15th we are going to take a day to remember and honor the moms and babies that we lost to accreta, a very real risk with this condition.
The Los Angeles Chapter of ICAN is now accepting professional subscribers for the 2016-17 year. Available in one-year or five-year installments, professional subscribers enjoy the following benefits, in addition to being our first point of referrals for local women seeking support.
ICAN newsletter, the Clarion
FREE admission to the ICAN Speaker Series online events
If you have a local or national business or service that supports women recovering from Cesareans, seeking VBAC resources or researching evidence-based birth practices, please consider supporting our local chapter!
There has been a lot of discussion at our recent meetings regarding continuous electronic fetal monitoring (cEFM) – which doctors/hospitals require it for VBAC, which don’t, and if there is access to telemetry. This post from ICAN of Atlanta was just shared with us showing several effective labor positions while on the monitors.
In most hospitals, continuous external fetal monitoring (cEFM) is part of the protocol for women having a VBAC. It can also be necessary for reasons such as induction or other medical concerns. One common misconception about cEFM is that you have to stay in bed in order to be monitored. This might be something the nurses tell you, or just something you think and the nurses don’t bother to correct you on. Either way, mobility and gravity are your best friends in labor. Though the monitors do limit you to a small radius where the cords will reach, there are many positions that can still be used for your comfort and to help labor progress. (Also, don’t forget frequent bathroom breaks!)
The amazing mothers of ICAN of Atlanta have submitted the following pictures of laboring on the monitors in different positions. While cEFM can certainly present challenges, it doesn’t have to prevent you from having the birth of your dreams.
We hope these pictures inspire you. Happy laboring!
Check out more photos of laboring on the monitors in different positions here!
Thank you to ICAN of Atlanta for allowing us to re-post this content.
My son celebrated his 18th month earth-side. Like most third kids, we celebrated by totally forgetting. Sorry kid. But for many, that 18th month mark offers the mom an opportunity to look back at a day that has been difficult to talk about. Today I want to tell you about the 18th month cry. Here is a woman that I’ve seen a dozen times.
She is new to the ICAN meeting. She comes alone. Her purse, which could double as a diaper bag, is a tell-tale signs that she has an active toddler at home. When the introduction circle comes to her, we smile politely and wait to see what brought her here.
“I haven’t really discussed this much, after all, it’s been a year and a half, but I just wanted to see what this meeting is about,” she begins. Tears well up. And she shares her story. My heart drops. Her pain is palpable. I feel like every few meetings we have a woman come in for her 18th month cry. Sometimes it coincides with a second pregnancy. But more often than not, it is just the space that a woman needs to process.
When she speaks, she doesn’t talk about the surgery itself. She talks about the mis-information she was given beforehand. The doctor who left on vacation two days after her birth. The unnecessary choice between a cesarean or induction at 39 weeks. The insulting scare tactics directed at her partner designed to pressure her into a cesarean. The inaccurate assertion that post-dates begin at 40 weeks (they begin at 42). The description of a vaginal delivery akin to a cesarean without anesthetic. The weekly ultrasounds that, for months, predicted an HUGE baby that would NEVER fit… only to surgically birth a 7 pounder. The hospital that would not “let” her move around while in labor. The doctor that painfully stripped her membranes or broke her bag of waters without her concent. Condescending comments about what a doctor would tell his sister to do (wouldn’t the sister get to make up her own mind?)–instead of offering concrete information to base a real decision on.
The humiliation of reading on her birth chart that the cesarean was deemed “Elective” and preformed at “Maternal Request”.
As a member of the community she sought out for support, I feel like a failure. There is no amount of pro-active training or advice I can give. There is no band-aid for her wounds. It’s like hearing a rape story. She second guesses her choice of doctors, her choice of hospital, the advice she accepted from friends and family. She mourns the loss of her expected post-partum gentle introduction into parenthood where she gets to fall in love with her child after a birth. She describes her struggles of adjusting to new parenthood while recuperating from a surgical evisceration.
She is proud of what she was able to do with what she was dealt, but she has a sneaky suspicion that it didn’t have to be that way. With information about the doctor’s vacation, she could have met and interviewed his back-up team. If she had heeded the advice of an old high school friend, maybe she would have chosen a different hospital. Maybe she should have hired a doula, hired a different doula, or not hired a doula. If she had seen the Business of Being Born earlier, maybe she would have felt empowered to interview midwives. If she had read that one book… If she had stood up for herself… If she had asked for more statistics… If only… Should’a…. Could’a…
But in the end, it’s not her fault. At every step along the way, she believed that her medical team was acting in good faith. She believed that best birth practices, not CYA legalese, would dictate her care.
I have yet to see a woman who felt that her cesarean was an empowered choice that she made during an unexpected birth come to our regular meeting. Cesarean moms who were treated honestly and respectfully during their birth process only come to the meetings to prepare for a VBAC or as guests when the topic is “Mom-powered cesareans.” Empowered women don’t show up for the 18th month cry.
What makes the 18 month cry so powerful is that it is mourning the ultimate betrayal. She has acknowledged that she was lied to. And that dishonesty has dramatically affected her life. Perhaps that is another step in healing process.
Vaginal Delivery Recommended Over Maternal-Request Cesarean
March 21, 2013
Washington, DC — The nation’s largest ob-gyn organization recommends that pregnant women plan for vaginal birth unless there is a medical reason for a cesarean. In new guidelines issued today, The American College of Obstetricians and Gynecologists (The College) says maternal-request cesareans are especially not recommended for women planning to have several children, nor should they be performed before 39 completed weeks of pregnancy.
In the Committee Opinion, The College addresses the controversial issue of “maternal-request cesareans.” Cesarean deliveries done at the request of the mother without a medical indication represent an estimated 2.5% of all US births. Some women request cesareans because they fear childbirth pain, while others believe a cesarean will prevent urinary incontinence or preserve sexual functioning.
Cesareans involve risks and require longer hospital stays than uncomplicated vaginal births. Women face the risk of bladder and bowel injuries during cesarean surgery, as well as serious complications in future pregnancies. Placental problems, uterine rupture, and emergency hysterectomy are all risks that increase with each subsequent cesarean. Compared with vaginal births, planned cesareans have a lower risk of excessive bleeding during birth and the need for blood transfusions.
Benefits of vaginal births for women include shorter hospital stays, lower infection rates, and quicker recovery. Babies born vaginally have a lower risk of respiratory problems. Continue reading →
“Walked that baby right out” – Goldie’s VBAC Story
Aura – 5 days old
[I requested my hospital records and added details in brackets to my story from those records]
My first born son, Rafi, was born via c section after 36 hours of back labor and 3 hours of pushing in August of 2009. Rafi was in the occiput transverse position (facing my hip) when they pulled him out, and the reasons for the c-section were given as cephalopelvic disproportion, failure to descend, and arrest of labor. In the months and years following his birth I wavered between feeling like the c-section was justified and being very disappointed. I was planning and hoping for a drug free, completely natural hospital birth with my highly recommended CNM, but things didn’t go as planned. The recovery was long and hard (a full 3 months!), and I never wanted to do be in the position of caring for a newborn while recovering from major abdominal surgery again.
With my second pregnancy I knew I was going to do everything in my power to try for a VBAC. I was also determined to have my pregnancy and birth be as intervention free as possible, including avoiding routine ultrasounds. From a financial standpoint, I preferred a hospital birth (covered by insurance), but I could not find a doctor or hospital midwife who I felt was fully supportive of what I was looking for in my birth. More so, I knew that if I wanted my VBAC, my best shot would be to “stay home as long as possible,” and it just seemed more secure to plan on giving birth at home and having a midwife labor with me at home from active labor, as opposed to being without a care provider until very close to birth. The biggest fear doctors seem to scare VBAC moms with is uterine rupture, and after reviewing the numbers and considering the slim chance that rupture were to occur, chances are, it would more likely to happen before I got to the hospital (since my plan was to go in during transition or later).
My local ICAN chapter meetings gradually helped me feel entirely comfortable with the concept home birth from a medical standpoint. But it took almost my entire pregnancy to really get comfortable with the financial cost of the home birth I envisioned (homebirth was not something we could really afford). Continue reading →
Disclaimer: This newsletter is devoted to Dr. Ben-Yehuda’s areas of interest that coincide with topics recently raised by my patients. This general information should not replace a personalized consultation with your physician.
June 2011: VBAC (Vaginal Birth After Cesarean Section)
In March 2010 the National Institutes of Health (NIH) published a report titled “Vaginal Birth After Cesarean: New Insights.” I will summarize some of their findings below. First, some general statistics.
In 1996, the total C/Section rate in this country was 21%. In 2007, it was 32% (the highest ever recorded). In 1996 the VBAC rate was 28% (about 1 in 4 women who had a C/Section and attempting another delivery, were trying to deliver vaginally). By 2007, the VBAC rate was about 10%. Given these significant trends, the NIH wanted to find out why things changed so rapidly in 10 years. The following questions and answers mirror the discussions I have with my patients who are considering a VBAC.
Q: In women who attempt VBAC, what is the rate of vaginal delivery? What factors influence that rate?
A: 74% of women who try VBAC succeed. Factors that INCREASE the likelihood of success include: Being “thinner” (BMI <30Kg/m2), having had a previous vaginal delivery, and if the prior C/Section was due to malpresentation (breech – a baby born buttocks first). Factors associated with a DECREASED chance of delivering vaginally include: Presence of maternal disease (hypertension, diabetes, heart disease, etc.), if the prior C/Section was done for failure of progression of labor (baby too big to fit), being currently past the due date, and being induced with the current pregnancy.
There are some statistics that will be presented below. Please keep in mind that statistics can be interpreted in two different ways: relative risk, and absolute risk. I will highlight the difference while using the NIH’s own numbers and try to make sense of it all in the end. Continue reading →