Positive Birth News

birth stories, news and articles to encourage and inspire


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VBAC – the Cinderella Birth 2

Suggestions for an Empowering Birth after Caesarean

The greatest challenges women face in achieving a VBAC are the emotional legacy of the previous birth and an absence of support and options for a safe, mother-baby centred VBAC. And it seems as though the closer women get to their baby’s birth month, the less support there is, almost as though previously supportive doctors, midwives and people are pulling the rug out from underneath them out of fear. Women are told they may have a trial of labour to VBAC, but only if they can jump through all the hoops. In The VBAC Dilemma DVD (Part 4 of More Business of Being Born), they call VBAC a ‘cindarella birth’ – finish the birth before the magic runs out at midnight!

A woman who wishes to have a VBAC has to become a researcher, an advocate, a communicator and negotiator. She needs to become comfortable with the safety of a VBAC and educated about the potential risks. And she often has to dig deeper and work harder than the first time mother to prepare emotionally and mentally for a vaginal birth, because now she has the legacy of her caesarean birth to come to terms with. While these challenges are enormous, they also are an invitation and opportunity to be transformed and empowered through the journey of birth after caesarean.

  • Understand the reasons for your caesarean birth and evaluate whether these are likely to be repeated and whether any factors are within your sphere of influence. If they are, then address each of these in your birth preparation. Include your chosen doctor or midwife in this discussion.
  • Choose doctors and midwives who support your choice to have a VBAC and who make you feel safe, respected and strong. If you find that your VBAC-friendly doctor is putting pressure on you or undermining your confidence, you have the right to change doctors, and it may be worth while doing so.

    Finding the right health professional to support your VBAC is like finding a fairy godmother – but be aware of conditions and limitations. Will the magic run out at midnight?

  • Choose a place of birth where you feel safe and will be safe. 11% of Australian women choosing a VBAC will choose to have a homebirth and a high percentage of these women will have a successful vaginal birth at home. Some of these women are choosing homebirth because they felt they had no other option. They were unable to negotiate the care and environment they needed for a successful VBAC in hospital or a birth centre and have accepted the risks of VBAC at home.
  • If you are having a hospital birth, find out what the policies are for VBAC and decide how these will impact on your ability to birth vaginally. Don’t ‘go with the flow’ in maternity care decisions without knowing that the flow is going to carry you towards the vaginal birth you are seeking. Think about conditions such as an IV on arrival in case you need surgery, a 12 hour time limit for labour, fluids only and no food in labour and continuous external foetal monitoring. These conditions are there to protect you from an undetected uterine rupture and to make emergency caesarean surgery quicker. They also come from a place of fear – fear of complications and fear of legal consequences.
  • On the other hand, women and researchers are in agreement that many of these conditions actually make it harder for women to birth vaginally and may end up contributing to a repeat caesarean. It may be helpful and important for you to meet with hospital staff and negotiate the care you want. Avoid, if possible, anything that increases the likelihood of a caesarean or a failure to progress.
  • Surround yourself with supportive people – a doula, an independent midwife, birth educators, a community of women online or in real life.

Your chances of having a vaginal birth are higher than those of a first time mother! The greatest threat to your VBAC is the impact of fear and being labelled ‘high risk’.

VBAC Journey – an opportunity to learn, grow and heal

We can reach a new perception of birth and feel confident, empowered and excited if we are open and willing to consider different possibilities. A crucial first step is knowing that your feelings about your past birth and future births are valid, no matter what they are.

Seek and read positive stories that speak to you and your experiences. Your feelings about birth may begin to change and then you will begin to consider how you can have a positive birth. If you decide that a repeat caesarean is the best path for you and your baby, you are in a far more powerful position to plan your baby’s positive and welcoming caesarean birth.

Consider the perspective that your previous caesarean birth gives you an opportunity to learn, grow, heal and transform yourself. Women who have had one or more births of any kind now have a wonderful source of information about themselves. The way they feel about birth and what they need for their next birth is held within their own birth story. Reflect, debrief, cry, rage, rant, talk, write and seek healing and lessons in your births. This self-knowledge will go a long way in empowering you for your next birth and for motherhood too.

“My VBAC was the most amazing, fabulous and triumphant thing I’ve ever done! I loved it! And I would do it all again.” Jo’s VBAC story in Birth Journeys 

 


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VBAC – the Cinderella Birth

Emotions, opinions and fears run high when it comes to birth. If we are frightened of birth in the first place, then the thought of a VBAC going wrong is terrifying. Women’s VBAC stories show that health professionals often focus on uterine rupture, damage to the baby or mother, and the risk of death. No wonder health professionals are often discouraging of VBAC! Their fears and concerns may come through in the way they present information, the way they speak about VBAC and a woman’s birth history.

Women’s fears however are even more complex. Many women have had their confidence and belief in their ability to birth shaken by the experience of labour followed by an emergency caesarean. Many women report feelings of failure and having let their baby down. They may fear another vaginal birth ending in an emergency, they may fear another frightening or dehumanising caesarean birth, and they may fear feeling like they have failed again.

The risks of VBAC include separation of the uterine scar before or during labour and a higher risk of infant mortality compared to a caesarean birth. Professor of Midwifery, Hannah Dahlen, explains that the chance of infant death from a uterine rupture is 1 in 10, 000 babies and this is equal to the chance of a death of a baby in a first pregnancy.[2]

The risk of infant mortality in a VBAC is also equal to the chance of a perinatal death due to mid-trimester amniocentesis, or the risk of an infant death due to sudden infant death syndrome explains Catherine Spong in her review of the latest studies on VBAC risk[3]. Other rare complications like cord prolapse or shoulder dystocia are more likely in any labour than a uterine rupture occurring during a VBAC explains Midwife and academic Rachel Reed in Birth Journeys. Yet women are frightened and discouraged out of VBACs for levels of risk that are acceptable to most people in other circumstances.

Meanwhile the risks of caesareans have been downplayed. Immediate risks of a caesarean include heavy bleeding or haemorrhage for the mother, infection in the wound and blood clots. We are only just beginning to see some of the long-term risks to mothers of repeat caesareans. With each caesarean the risks of the placental abnormalities like placenta accreta and placenta previa increase, the risks of uterine rupture increase, and the risk of internal damage to mother or baby during the surgery increase. Adhesions to the scar tissue, chronic pain, future ectopic pregnancy and hysterectomy become more likely. Risks of maternal death increase. [2]

We know little about the long term impact of caesarean birth on the health of a baby. We know that babies born by caesarean are more likely to have respiratory problems, and now studies are finding an increased risk of asthma, allergies and type 1 diabetes. [2]

Each woman needs to be aware of her unique circumstances and explore her own risks for a vaginal birth and a caesarean birth. The length of time between pregnancies, reasons for the first caesarean, and many other individual factors are relevant – but also important is a woman’s emotional wellbeing and her reasons for desiring a VBAC. It is helpful to distinguish between fears and risks. While you (or a doctor) might be very frightened of a negative outcome from a birth, the likelihood of it happening to you remains slim – but still possible. This doesn’t mean your fears are invalid or the risks are unimportant, but it does mean you have the power to do something about your fears. You have the power (and the right) to prepare yourself for the most positive birth after caesarean on your terms.

VBAC for most women after one or two caesareans

Current research supports VBAC in hospital as a safe and reasonable option for most women after one or two caesareans. This research is starting to filter into obstetric guidelines for birth after caesarean around the world. However there is still a considerable gap between guidelines and what some women are experiencing at this time. Many women still share that they are limited in their options, refused a VBAC, unable to find a supportive doctor, or unable to negotiate their care plan to give them the best chance of a successful VBAC.

I hope we will see an increase in VBAC opportunities, VBAC support and VBAC rates. We also need to see a reduction in avoidable first caesareans so that 30+% of women will not have to face the choice of VBAC or another caesarean.

Read Part 2 of VBAC – the Cinderella Birth

[2] From Professor Hannah Dahlen’s presentation on VBAC at the Maternity Coalition’s Empowering Birth Stories, May 1013.

 [3] CY Spong, In PLoS Med. 2012;9(3):e1001191. doi: 10.1371/journal.pmed.1001191. Epub 2012 Mar 13.


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About Birth Journeys – positive birth stories to encourage and inspire

About Birth Journeys 

Birth Journeys – positive birth stories and encourage and inspire contains 29 birth stories and informative articles from Australian doctors, midwives and educators including Dr Sarah J Buckley, Prof Hannah Dahlen, Rachel Reed, David Vernon, Justine Caines OAM and the Maternity Coalition.

Birth Journeys is not a collection of ‘perfect’ birth stories. The stories in this book have been carefully selected to reflect different women, their unique journeys and their experiences of positive birth. The stories are diverse and they have been chosen to speak to different readers. Not every story will appeal to you – there may be some that you do not wish to read.

The stories in this book include: births in hospitals, birth centres and at home; vaginal births after caesarean (VBAC); a twin birth; and emergency and elective caesareans. There are: first births, second births and even fifth births; water births; and an unassisted birth. There are stories that give an insight into the experience of pregnancy and birth from a man’s perspective. The stories also show that there are many different experiences of labour: a strenuous challenge; a strong, determined fight; calm and deeply focused; a wild instinctive ride or a joyful and ecstatic trance.

In Birth Journeys, you will meet women who felt nurtured by carers, partners, family and friends during pregnancy and birth. They were celebrated and honoured. These women share the excitement and joy they felt as they anticipated their baby’s birth.

Some women carefully chose their place of birth based on their need to feel safe, private and comfortable. These women describe how important it was for them to find a carer who shared their values and beliefs about birth. Some deliberated over their choice, and others felt an immediate connection and just knew they had the right carer. Other women demonstrated open and respectful communication with carers.

There are women who spent considerable time reading and researching to educate themselves about labour and birth. They reflected on their beliefs and their past experiences. They filled their minds with affirmations and visualisations to become confident in their ability to have a positive birth.

Some women share a disappointing or traumatic first birth followed by a healing later birth. Many came from a place of fear, while a few entered pregnancy with feelings of ease and confidence. They had not been exposed to the culture of fear or a family history of birth ‘gone wrong’. For them, birth was a normal part of life.

There are women who stood firmly by their beliefs, intuition and wisdom in the face of challenges, and others who learnt the value of being flexible and willing to change. These women were graceful as their dream birth slipped away.

The stories are honest and real. They reveal the unique, deeply personal experiences of ‘everyday’ people. These women (and men) have generously shared their choices, feelings, beliefs and learnings. They have entrusted us with their precious memories.

(this is an excerpt from the Introduction to Birth Journeys)

Visit www.birthjourneys.com.au for more information or to buy your copy. We ship internationally to US, UK, NZ and Canada and Birth Journeys is also available as an ebook.

Birth Journeys is available at wholesale rates to retailers as well as other individuals and groups who would like to sell the book or include it in a package to clients or customers. These include: midwives, doulas, birth educators, birth photographers, yoga teachers, massage therapists, meditation and relaxation teachers, chiropractors, acupuncturists, wellness clinics and fundraising groups, playgroups, and friends who decide to buy together and take advantage of the wholesale price. Fill in the form to make an enquiry.


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Don’t Underestimate the Importance of How You Feel

Don’t underestimated the importance of how you feel – in birth and in the months or years after. Although the moment of birth occurs on one day (perhaps after many days of labouring) it is not just another day of no significance. It impacts a mother deeply, whether she is conscious of this or not. It influences the way she views her baby and herself as a mother. It influences the way she engages with health professionals and the support services provided for mothers and families. It influences how she feels about another baby and giving birth again.

If you (or someone important to you) is unconvinced, approach your mother, aunty, grandmother, or friend who is one or two generations older than you and ask if they remember their births and would be willing to share their story. Ask them to tell you how it was when they gave birth. And be ready with a cup of tea, a hug and plenty of empathy – no judgement.

Don't Underestimate the Importance of How You Feel


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Once a Caesarean Always a Caesarean?

If you are planning a VBAC (vaginal birth after caesarean) or you have had a caesarean birth, you have more than likely heard this truism before from all sorts of people: once a caesarean, always a caesarean.

When caesarean surgery was first performed several hundred years ago, it was reserved for times when there was nothing else left to try and if a mother or baby survived it was quite miraculous. In the late 1800s and early 1900s, a caesarean was an intrusive, risky procedure used when a woman had a distorted ‘contracted’ pelvis due to malnutrition or illness. This physical condition would remain a problem in future births, so the advice ‘once a caesarean always a caesarean’, given by Dr Edwin Cragin in 1916, was true at the time.[1]

Fast forward many decades and now caesareans are much safer than they once were. Almost all caesareans are a lateral incision through the lower segment of the uterus, creating a stronger scar than the vertical caesareans used in the past. Caesareans are also more common. The caesarean rate in the US was only around 1% in the early 1900s but it has climbed significantly, up to 30% and above in Australia and the US. This is much higher than the WHO recommended rate of 10-15%. The majority of caesarean births today are clearly not for a misshapen pelvis, so using Dr Cragin’s statement (in its original meaning) for caesarean births today is questionable.

Today, most caesareans are for circumstances that are unique to a particular birth and the path the pregnancy or labour has taken: baby’s presentation (eg, breech or transverse), premature rupture of the membranes, an abnormality of the placenta like placenta previa, illness in the mother or baby such as pre eclampsia, a ‘failure to progress’, multiple births, a ‘large’ baby, disproportion between mother and baby, an ‘overdue’ baby, or evidence that the baby is at risk before or during labour. The same factors may not be present in future births.

If the causes of a caesarean are not repeated, then why repeat the caesarean? Is it because caesarean is perceived as being safer (safer for who – mother, baby or doctor) or because it is less frightening (for who, mother, baby or doctor)?

Discussions of risks often focus on the horror of having a VBAC with a devastating outcome rather than communicating the slim chance of this occurring and also evaluating the immediate and the long term risks of a repeat caesarean which are likely to affect many women.

For women approaching a birth after caesarean, there may be fear of birth, fear of caesarean and fear of VBAC – that’s a lot of fear! It is very hard to make any decision when you feel afraid of every option and no one can give you any guarantees.

So you might prefer to turn it around and ask different questions: would a repeat caesarean or a VBAC (with all the preparation you would wish to do for either of these births) have the potential to make the most positive contribution to your health and wellbeing as a woman and mother?
And what if the journey to each birth is equally important, offering you the opportunity to transform yourself? No one can answer these questions but you.

[1] Birth – the surprising history of how we are born, (2006) Cassidy, Tina, Atlantic Monthly Press. (please note – I do not suggest reading this book if you are pregnant or feeling vulnerable or very sensitive. It is fascinating but also quite gruesome in places!)

PS I’ll be posting more a detailed discussion on the factors causing our rising caesarean rate in particular “failure to progress”, putting the risks of VBAC in perspective, and women’s VBAC wisdom in the future.


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Don’t Miss Out!

StoriesHave you signed up to my free monthly newsletter Positive Birth News?

Positive Birth News for June is all about VBAC and it will contain a fresh new birth story, an article “Once a caesarean always a caesarean?” and links to helpful resources for recovering from caesarean and preparing for birth after caesarean, including the guidelines from the obstetric colleges in Australia, US and UK (and these are really interesting to compare!)

The birth story shares Kush’s empowering journey to a straightforward and beautiful VBAC, but more than that, how she found the confidence to speak up for herself and her needs. I have been working with Kush to explore her story in the same way that I did with the stories in the Birth Journeys book (only in a week instead of a year so I know her story could go even deeper – it’s amazing what a few questions reveal!). So, this is more than a raw account of a birth – like the stories in the Birth Journeys book, it is a story with wisdom and positive messages for you to learn from.

I am trying something a little different this month and the newsletter content will not be up on the blog straight away! I want women who sign up for the free newsletter to receive something special, something that is worth signing up for – in addition to the content on the blog. It’s also important to me that when you read the newsletter, you don’t have to keep clicking on the blog links to finish reading! Each newsletter will now have a theme with a birth story, one in depth article and links to support you in your journey to birth or in your role supporting pregnant women.

I will continue to post articles, women’s stories, inspiring quotes and links to the blog and put the newsletter content up later on.

The July issue will be all about doulas and the August issue will be about having an empowering caesarean birth.

The Positive Birth Newsletter will be emailed out by the end of this weekend, so sign up now so you don’t miss out!

Birth is Not Therapy is a wise piece by Chloe Bayfield and every woman contemplating a VBAC or any birth after a previously hurtful, disappointing or traumatic birth should read her story.

Chloe is absolutely correct. We should not expect a particular birth, like a natural birth, a drug-free birth, or an ecstatic pain-free joyous birth to be the answer or to heal our hurts and make us whole.

My second birth was joyful, pain-free, empowering and inspiring! I did feel like a goddess! Yet it doesn’t erase the impact of my first birth. Birth can truly be wonderful, empowering and awe inspiring – but only a woman can do her healing for herself. It is her own emotional work, her own reflection and learning, her own story to process and integrate… and it can be like peeling back layers of an onion.

Each time I revisit my first birth story, I discover more – more grief, more tears, a little more anger, and more lessons for me. Strangely, I now also find inspiration and a greater understanding of myself. And this somehow makes meaning out of a birth that while not outwardly traumatic – left its mark on me.

It is each woman’s journey that changes her and makes her feel strong, wise and whole again and this journey goes well beyond birth.