VBAC

Mamas on Bedrest: It’s okay to have a C-section

August 10th, 2012

Whaaaaat?????

Yes, you are reading correctly, I am saying that it’s okay to have a c-section.

I realize that much of my platform here is about normal birth and allowing mamas (and babies) to come into and move into this world naturally.

Yet, I have had 2 C-sections.

Yup, 2 C-sections!

So how come I am such a proponent of “normal birth?”

I’ve often berated myself for not “trying harder” to deliver vaginally. I should have at least tried, shouldn’t I? These feelings welled up once again as I was about to pen another post about the virtues of normal, vaginal birth, this time about how normal birth is now associated with important positive brain proteins in babies. Then just when I was about to get started, I looked over at my 2 sleeping children (I’m writing this in a hotel on my way back to Austin from Summer vacation) when I had to stop myself and ask, “Are my children somehow brain deprived because they were delivered via c-section? Are they in anyway developmentally impaired or otherwise “less than” because they were c-section deliveries?” My children are beautiful and as healthy and cunning as they come!  

I also know that without c-sections, neither of my children (or myself for that matter) may be here. My daughter’s birth, my first c-section delivery was emergent, traumatic and both of us are lucky to be alive! I don’t remember all the details of her “coming out” but according to my husband, she was in distress, blue and the neonatologists worked on her for a bit before she cried. I was vomiting profusely from the pregnancy (I had all day sickness all 9 months!) and the anesthesia only made things worse. Added to that, my uterus was lacking in tone, so once my daughter was born, it didn’t contract but was kind of like a stretched out balloon. And I bled. I’m not talking a little sputter, I’m talking this side of hemorrhage! Everything started to move more quickly, there was a lot of clatter as more instruments were opened and soon I was given something in my IV to “calm me down” (translation-make me out of it so that I’d stop trying to see what was going on and getting more agitated in the process.) I watched my OB’s eyes over her mask; they were set, focused and soon you could hear a pin drop in that OR suite. I knew that things were not good.

But I lived to tell about it and I am thankful that I and my almost 10 year old sassy girl are just fine. And I can tell you, there is no brain deficit in this one! In fact, that smart mouth is about to drive me crazy!

Same with my son. My darling boy was born at 39 weeks via c-section. While his birth was much calmer, my uterus was again an overused balloon, lacking in tone and contractility. This time, my baby was put to my breast and with a bit of pitocin, I was stitched up, good as new (sort of!).

I know that I may not be here to write this blog or to critique and share the various articles that I read had I not had 2 c-sections. I would not have the 2 children that I adore beyond words without my 2 c-sections.

 “So how are my words affecting mamas who may have had a C-section or are about to have, a truly medically necessary, a C-section?”

I hope that my words will give you some solace. Sometimes you have to do what is right for you, and if a C-section is what is needed for you to have a healthy baby-and to survive yourself, then by all means, go for it! Yes, C-section rates in the United States have reached unacceptable rate. They are also often performed for “unnecessary” reasons. And there is no denying that c-sections carry with them risk. So if you can avoid having one, I prayerfully ask that you do. There really are benefits to having a normal vaginal birth for both mamas and babies. I look at it this way: If this is the way in which Mother Nature designed us to have our young, it must be good because she’s not been wrong so far!

But I am also very thankful for medical science and technology for evolving and developing such that I was able to have my children and live to tell about it! Without seeming mellow dramatic, I am quite convinced that I would be dead otherwise.

We do need to curtail the number of c-sections performed in the United States. I do believe that health care providers need to meticulously scrutinize each situation to evaluate if a proposed c-section is truly necessary. But if a health care provider, after careful analysis of the situation deems it in you and your baby’s best health interest to have a c-section, it (you) will be okay!

Mamas on Bedrest: Cesarean Awareness Month

April 25th, 2012

April is Cesarean Awareness Month.

I have really mixed feelings about cesarean sections. Having had 2 cesarean deliveries and knowing that at least in the case of my first one, it pretty much saved my life and the life of my daughter, I can’t be entirely “anti-cesarean section”. But in the United States thousands of women have cesarean sections for bogus reasons and that is what this movement and month of awareness is really all about.

So what are the facts about cesarean sections?

  • Cesarean deliveries are one of the most commonly performed surgeries in all of medicine. The other most commonly performed surgery is a hysterectomy.
  • Cesarean deliveries currently account for some 32% of all deliveries in the United States annually.
  • Originally, Cesarean deliveries were intended to birth a fetus when the mother was dead or dying. It has since evolved to be indicated for “large babies”, uterine/placental/vaginal issues, fetal distress or shoulder dystocia
  • According to MedScape, The leading indications for cesarean delivery are previous cesarean delivery, breech presentation, dystocia, and fetal distress. These indications are responsible for 85% of all cesarean deliveries.

I think that most of us would agree that in a healthy mother and baby, a vaginal birth is the way to go. However, in an effort to “control the situation and avoid complications” or to “avoid the pain” or “avoid going into labor at an inconvenient time”, mothers and doctors often schedule a cesarean section “to be on the safe side”. This is the impetus behind the International Cesarean Awareness Network (ICAN) and its supporters.  ICAN and other organizations hope to raise awareness amongst women that cesarean sections are to be the exception to vaginal birth when it is unsafe for mother and baby to undergo vaginal delivery. And while most of us agree with that statement, thousands upon thousands of women often mistakenly believe that delivering vaginally will be unsafe or them and their babies and opt for the cesarean delivery.

Probably the most common reason for cesarean birth is repeat cesarean delivery. There used to be a saying, “Once a cesarean always a cesarean.” Thankfully this is no longer the case. Because of the risks associated with cesarean sections, more and more practitioners are beginning to look at VBAC (vaginal birth after cesarean section) as an option. One has to understand, a cesarean delivery involves cutting the abdominal and uterine walls, creating defects or weaknesses at the sites of the cuts and places for scar tissue to develop. The greatest concern is that in a VBAC, these areas won’t hold and the uterus will rupture causing hemorrhage and risking the lives of both mother and fetus. However, data is showing that this risk of uterine rupture is not as great as previously thought and that women who have repeat cesarean sectioins are at even greater risks. Additionally, in very healthy women having uncomplicated pregnancies and birthing with a skilled practitioner, VBAC’s are quite safe.

Another common reason for cesarean delivery is “large baby”. This is probably the most disputed reason for cesarean delivery and the most controversial. Who hasn’t heard stories of the 5 foot woman delivering an 11lb baby vaginally, or the 5ft 10 inch woman who had difficulty delivering a 5lb baby and required a cesarean section? Size of the baby is rarely the issue, but more aptly the position of the baby in the pelvis, the shape of a mama’s pelvis and how well mama and baby are faring during the delivery process.

Cesarean sections are also more common during labor inductions.  When labor is allowed to start and proceed spontaneously, babies have time to adapt and progress along the birth canal. Normal birth proponents continually state that when a baby is not ready to be born and labor is induced, the baby is rarely in the correct position in the birth canal, the baby often becomes distressed as a result of the uterine contractions, the labor fails to progress and then a cesarean section is performed.

So how does a mama decide whether or not a cesarean delivery is best for her?

  • Do your research. Know the indications for cesarean delivery
  • Talk with your health care provider. Know (as much as possible) the position of your baby in the uterus, consider the gestational age of the baby
  • Consider your obstetrical history. If you have certain complications, you may be more likely to require a cesarean delivery. Talk with your health care provider to assess your risks.

It’s a really tough decision. Even today, some six years after my last cesarean section, I often wonder if I should have tried to deliver my son. (my second child). But I had a list of obstetrical complications that would have made a VBAC quite risky. For women without my dicey history who are considering a VBAC vs. a cesarean delivery, I say, do your research, “be aware”. Only once you’ve fully informed yourself and spoken with your health care provider can you make an informed decision about whether or not to have a cesarean delivery.

Resources

The International Cesarean Awareness Network (ICAN)

MedScape

NIH Consensus Development Conference on Vaginal Birth after Cesarean: New Insights

The American Pregnancy Association

American Congress of Obstetricians and Gynecologists

About.com

Giving Birth With Confidence

Unnecesarean

My daughter at birth

Mamas on Bedrest: HHS offers $40M in grants to reduce preterm births!

February 10th, 2012

“To help reduce the increasing number of preterm births in America and ensure more babies are born healthy, HHS Secretary Kathleen Sebelius announced more than $40 million in grants to test ways to reverse that trend, as well as a public campaign to reduce early elective deliveries.”

Thus begins the February 8, 2012 press release issued by the US Department of Health and Human Services announcing the $40Million grant program, The Strong Start Initiative.  Strong Start is a joint collaboration between Centers for Medicare & Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), the Administration on Children and Families (ACF), and outside groups devoted to the health of mothers and newborns. (i.e. The March of Dimes, the American College of Obstetricians and Gynecologists (ACOG), the National Partnership for Women and Families, the Society for Maternal and Fetal Medicine, American College of Nurse Midwives, Childbirth Connection, Leapfrog Group, and the National Priorities Partnership convened by the National Quality Forum and others.)

The mission of  The Strong Start Initiative is two-fold:

  1. A test of a nationwide public-private partnership and awareness campaign to spread the adoption of best practices that can reduce the rate of early elective deliveries prior to 39 weeks for all populations; and
  2. An initiative to reduce the rate of preterm births for women who are at-risk for preterm birth and covered by Medicaid through testing enhanced prenatal care models.

According to the HHS press release,

“More than half a million infants are born prematurely in America each year, a trend that has skyrocketed by 36 percent over the last 20 years.  Children born preterm require additional medical attention and often require early intervention services, special education and have conditions that may affect their productivity as adults.

The funds will be awarded to organizations and providers that serve women on Medicaid and will be used to test and implement treatments and protocols that will reduce preterm birth and improve outcomes amongst this population. This is great news for such organizations as Centering Healthcare, CommonSense Childbirth, The International Center for Traditional Childbearing and The Indian Health Services and others which serve large populations of women on Medicaid. These organizations, with their proven methods of prenatal care and lower incidences of complications and preterm births are poised to teach the rest of the health care industry how to provide care to women in a compassionate and culturally sensitive manner all the while improving outcomes.

In addition to preventable preterm births, the Strong Start initiative will also focus on reducing early elective deliveries, which can lead to a variety of health problems for mothers and infants.  Up to 10 percent of all deliveries are scheduled as induced or surgical deliveries before 39 weeks that are not medically indicated. It has been well established that elective delivery before 39 weeks gestation is asssociated with increased complications to both mother and baby in the immediate intrapartum and for many years post partum.  The Strong Start Initiative seeks to significantly reduce the incidence of elective preterm birth and its associated morbidities in mothers and infants.

Finally, The Strong Start Initiative is poised to save money for the health care system. It is estimated that medical care in the first year of life for preterm babies covered by the Medicaid program averages $20,000 compared to $2,100 for full-term infants.  Medicaid pays for slightly less than half of the nation’s births each year.  Even a 10 percent reduction in deliveries occurring prior to 39 weeks would generate over $75 million in annual Medicaid savings. Such savings could be poured back into the Medicaid program to further the health of its recipients and reduce the ever escalating costs of health care in the Medicaid population.

References

The US Department of Health and Human Services

The Center for Medicare and Medicaid Innovation