Positive Birth News

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Positive Birth Story – A Gentle and Welcoming Caesarean Birth

Planning Our First Birth
We had planned a homebirth for the birth of our first child. At first my husband wasn’t terribly keen on the idea, but we spoke about the benefits for both of us to receive continuity of care and support by one midwife. I didn’t want to be ‘just another woman having a baby’ to the hospital staff, with my husband barely figuring in the equation.

Once we met our midwife Marie, there was no going back. When I knew I was pregnant, we spoke on the phone and we talked about the need to ‘own our births’. This was important to me, because I did not want to be controlled by hospital policy. I wanted to have my feelings and wishes respected. With an independent midwife, the emotional, mental and physical welfare of myself, my husband and our baby were considered with the utmost importance.

Giving birth in a hospital was not out of the question; there would be no hesitation if the need arose. But continuity of care with someone that knew us and truly cared about us was our priority and we couldn’t get the kind of care we wanted in the hospital. In the end this continuity of care is exactly what made the birth of our son a positive experience, even though his birth was everything I did not want.

Phe and baby Donald Phe and baby Donald[/caption]

I started reading Ina May Gaskin’s books Guide to Childbirth and Spiritual Midwifery before I was even pregnant and they got me so excited about being pregnant and giving birth. I just wanted it to happen NOW! They were so positive and made birth seem so normal, yet monumental and incredible at the same time. Thankfully I got pregnant very easily and it was a very breezy pregnancy. I had no morning sickness, although I was ridiculously tired for the first few months and fell asleep as soon as I got home from work every day.

I was fit and continued with Pilates twice a week up until the week before I was due. Watching my tummy grow was exciting and I felt great. We saw Marie every four weeks and then weekly as the due date approached. We only had one ultrasound at 20 weeks for curiosities sake, as we wanted a peak at the little person growing in there.

During Marie’s visits she felt my stomach to assess baby’s position and we would listen to the heartbeat and just chat over a cup of tea. We discussed fears, hopes and concerns about the labour and birth and how we could work together to ensure we felt supported by each other. Ultimately I was really looking forward to labour and just getting to experience it all.

Something Unusual
Each appointment when she looked at my stomach, Marie would shake her head in amazement at the strange shape my stomach made; it was so lopsided! As we knew I had a bicornuate uterus[1] uterus she suspected the baby just preferred being in one side rather than the other, but was still vertex. Indeed at 36 weeks baby was Left Occiput Anterior[2], textbook perfect.

However, at our 38 week appointment Marie was having trouble figuring out what position the baby was in. She decided that if we were still having trouble at the 39 week appointment we would have an ultrasound to ensure we were properly prepared.

So at 38 weeks and 6 days we had another appointment and baby was giving Marie a hard time again so an ultrasound was scheduled for that afternoon. During that scan we discovered the baby was transverse[3]. Spine down, head in the right horn and feet in the left. The ultrasound also showed an exceedingly long wall (septum) extending down the middle of my uterus.[4] It was a pretty upsetting result!

That evening, Marie reviewed the scans and the report and contacted Dr Ken at the Foetal Medicine Unit in our city. He arranged for us to see him the next day. Marie would come with us. At the appointment, we had an ultrasound that confirmed what we had seen the previous day. We then had a 4D diagnostic scan which showed that the septum was not as big as first suspected and it was decided to attempt an external cephalic version (ECV) to turn baby. It was quite quick and not too uncomfortable and baby’s head moved down with relative ease.

Ken arranged for us to come back and see him on the Friday to reassess. By Thursday however, I knew that baby had reverted back to transverse and at the next appointment this was confirmed. Another ECV was performed and baby again went head down with ease. But again within hours, I knew that baby had moved back!

Ken was such a lovely doctor. He truly empathised with us as the situation unfolded during the week leading up to the birth. He was softly spoken and gentle and always very respectful. Not only to Tim and myself, but also to Marie, as he recognised that she was our primary caregiver. He did not to try to ‘take over’ at any stage, but consulted with Marie and ourselves at every appointment.

We had another appointment on the following Monday and this time we discovered that baby was again transverse, this time with head on the left and feet on the right. I remember Ken just looking at Marie with a really sad expression and he left it to Marie as our caregiver to break the news of the need to perform a caesarean. As the due date was the Wednesday and the baby was in a very unstable lie, we decided to deliver the baby by caesarean the next day. I think all four of us, Ken, Marie, Tim and I felt pretty devastated.

While we were in Ken’s office getting all the paperwork underway I asked him if he would be able to perform the operation. He told me that his shifts meant that he would not be able to. The upside that day was that we were able to arrange to have my aunty (a midwife) to be the supporting midwife in the operating theatre. Ken personally called Aunty Rozzie to tell her that I had asked for her and together they arranged for her to be in theatre as the assisting midwife. My mother also drove up to be with us for the two weeks after the birth to help. We knew that I would not be able to do much after the surgery for some time.

That afternoon Marie and Aunty Rozzie discussed how the caesarean could be made as calm, loving, and respectful as possible. They helped us put together a caesarean birth plan:
• Tim and Marie were to be with me for the entire procedure, including pre-op and recovery;
• No one was to announce the sex of the baby; we were to be able to discover for ourselves;
• Immediate skin to skin and breastfeed opportunity after the birth;
• The baby was not to be separated from me after the birth at any point;
• The placenta was to be retained so that we could see it afterwards and keep it if we so desired;
• The theatre was to be as quiet and lights as dim as possible for the moment of birth.

For the rest of the day and night I was angry and inconsolable. I sat for an hour in the bottom of the shower that night crying. I was broken hearted. Despite having a great pregnancy and positive attitude about birth, my chance to give birth naturally had been taken away. I was never to know what contractions or labour felt like.

Caesarean Birth
On Tuesday morning, Tim, Mum and I went to the hospital to meet Marie and our little baby. I was still angry and upset, and even refused to have Mum take a photo of me the day our baby was born, despite taking a photographic record of the entire pregnancy. When I had to change out of my clothes in triage into the surgery gown I broke down into tears in the change cubicle. After such a breezy nine months and feeling so prepared and excited to experience labour and birth, having to put on tie-up paper underwear for a caesarean section was like the ultimate smack in the face.

The triage nurse was so lovely and caring though. She hugged me and told me she understood how confusing and disappointing it all was. Tim and I hung out together waiting to go in to theatre while Marie and Rozzie were preparing together. We found out that Ken had changed his schedule around just so he could be there for me. That made me feel so cared for.

Once I was finally in theatre it was incredibly emotional. After the epidural was in, I found it difficult feeling so physically disconnected from the birth. I could feel my legs being manoeuvred and knew a catheter was being put it. I tried not to cry and Marie was with me, getting me to focus on her rather than the necessary unpleasantness. She was a physical, mental and emotional support the whole time.

Ken, Aunty Rozzie and the theatre staff told us what was happening and constantly checked to make sure I was feeling all right. Marie was able to photograph the entire birth so I also have an incredible record of how it unfolded.

Time was strange during the operation. I felt tugging and pulling. There was the buzz of all the staff in the operating theatre…and then quite suddenly a beautiful little boy was held up over the partition for us to see.

No one told us what he was; we got to discover for ourselves. No one whisked him away, but instead he was placed on my chest with his face against mine. There was so much encouragement and joy from the midwives. I blew gently in his face to help him take his first breaths. I remember smelling him for the first time and it was the most beautiful creamy scent I will never forget.

Aunty Rozzie then took him away to clean him up and Tim was able to cut the cord. Once he was brought back he was never taken from me again. He attached straight away and didn’t stop feeding for over two hours.

Looking at the incredible photos Marie took of Don’s birth while I write this still makes me want to cry. The operation itself is quite amazing to see and I can tell Ken is grinning like crazy behind his mask as he lifts my tiny baby up for me to see for the first time. I remember constantly being asked if I was OK or if I was uncomfortable. Everyone knew what our birth plans had been, so they made sure that despite our baby having to be born via caesarean, it was as good as a caesarean could be. The birth was as caring, gentle and respectful as possible. It was not rushed, it was not an ‘emergency’ and my husband, my baby and myself were looked after to very high standards. Ken came to visit me the night after Don was born to see how I was and to tell me “You can birth vaginally next time. You will do it”! He was a genuinely caring and gentle doctor.

Healing
For a long time afterwards, despite having a beautiful boy and a ‘good’ caesarean birth, I still felt like a failure. I felt like my body had let me down. I felt cheated and that I hadn’t really given birth as I did not feel a single sensation during his birth, or one contraction to let me know that my baby would soon be here. I felt let down by myself and just very confused.

Some people kept telling me that I needed to “Get over it” as I was fine and Don was fine and “If you were in Africa you’d both be dead”. But Marie completely supported me in my feelings of disappointment and grief for what I didn’t get to have. She did not allow me to wallow, but she never once made me feel that my hurt was unwarranted. She let me vent and be angry and upset, but she helped me relinquish those negative feelings as well.

As time moved on and I was able to talk things over with Marie, my sister who has had two caesareans and two VBACs, and other friends, I saw that it was a positive experience and one to be cherished. Even now I wish I could go back and do it again, just so I could take more of it in and see my little boy being born all over again. It was positive because I had the best care in my midwife. I know that if I had gone though the public system, or even through a private obstetrician, I would not have received the same level of support or respect that I received from her. Terms would have been dictated and I would have had little to no control over events. She was as sad and disappointed as I was that things didn’t eventuate the way we had originally planned, but she also had a positive attitude that I definitely needed as well.

Despite being born by caesarean birth in hospital, Don’s birth was an amazing day that I wish I could experience all over again. We were cared for, loved, respected and consulted. He was delivered by people who loved him before he was even born; people who couldn’t wait to meet this crazy little personality that had refused to head in the right direction! His first moments were shared with our wonderful midwife Marie and his Great Aunty Rozzie. Sadly Rozzie died less than two years later, and just three days before the birth of my second child. I am forever thankful for sharing something so precious with someone so special to me.

Ultimately Don’s birth paved the way for an amazing achievement: the breech HVBAC (a vaginal breech birth after a caesarean – at home) of my little girl 20 months later with Marie as my midwife. Adwen is now three months old and her big brother loves her to pieces. If Don’s birth hadn’t been what it was, her birth would have also probably been very different.

Donald was born 6 September 2011, 3:19 pm, measuring 7lb 2oz (3.2 kg) and 49cm in length.

Phe lives in Canberra with her husband Tim, two children Donald and Adwen, and two puppies, Oberon and Hermione. Her days are mostly spent at home looking after all four little ones, and trying to make sure Donnie doesn’t terrorise the puppies too much! She loves gardening and cross stitching and as many catch ups and coffees with friends as possible.

Glossary
[1] A bicornuate uterus is has a heart shape with a deep indentation in the top middle, making two horns. It is possible to have a normal pregnancy and labour with a bicornuate uterus, however it is also common for the baby to settle in an unusual position such as bottom down (breech) or transverse. In some of these cases the safest option may be to have a caesarean birth. http://pinterest.com/pin/371617406723121402/

[2] LOA or Left Occiput Anterior is considered to be the most favourable position for babies to be in for birth. LOA means baby is on your left side with the back of their head facing towards your belly, their back is aligned with your belly. Occiput means head (specifically the back part of the head), anterior means front (your belly).

[3] Transverse babies lie across the mother’s belly. Unless the baby turns a caesarean is considered the safest birth in this situation. http://spinningbabies.com/baby-positions/all-positions/sideways

[4] A septum is a muscular or fibrous wall extending down the middle of the uterus http://pinterest.com/pin/371617406723121454/

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A Positive Caesarean Birth

If you wish to emerge from your baby’s caesarean birth feeling positive then it is wise to take ownership over your baby’s birth. This means speaking up for what you want and do not want and placing yourself in the hands of people you trust and feel safe with.

Consider what your wishes would be for a caesarean birth when you are doing your birth preparation and planning. Then you will have the opportunity to communicate your most important desires for a caesarean birth with your place of birth and carers ahead of time. This doesn’t mean dwelling on the possibility of a caesarean, it just means considering and documenting what would make this type of birth as positive as possible for you, your partner and your baby.

Most of us like to avoid conflict. We are used to being told what we should or shouldn’t do by health professionals and we are in the habit of giving over our power and ownership to others in medical situations. Although it may be very challenging for you (it is for me!), your baby’s birth is an opportunity to begin advocating for yourself and for your unborn child. Through your experience of birth you can set the scene for future interactions with doctors, dentists, health nurses and teachers where you are a strong advocate and an expert in your needs and the needs of your children.

There are options for a caesarean birth that may not be offered to you as they are not standard care in most hospitals. Although a caesarean is surgery, it is also the birth of a baby, a mother and a father. Even in an emergency, this surgery can be performed with gentle and respectful intentions, with consciousness that this is a birth and it is a special day.

Based on many women’s stories and the work of retired US obstetrician, Robert Oliver, MD, board of directors of APPPAH, the Association for Pre and Perinatal Psychology and Health, these are my suggestions for turning a necessary caesarean into a positive and beautiful birth.

Not all of these are going to be possible for a mid-labour emergency caesarean or in every individual situation, but they are possible and achievable. Reading positive caesarean stories and asking questions of other women will help you to discover that the smallest things can make all the difference to your baby’s birth.

Robert Oliver MD writes about his experience with positive caesarean births: “It is our intention to maintain the mother’s control of the events. She must at all times feel she is important to and guiding the birthing, regardless of the emergency and the operative procedure.This also goes for the baby in a spiritual and metaphysical sense. Ideally the obstetrician and labor room personnel will honor these two people most strongly.”

Preparing for Caesarean Birth
It is OK to feel disappointed, sad, or angry before and after your baby’s birth. Seek an empathetic listener (eg, your doula or midwife) who will not dismiss your feelings, ‘jolly’ you along, or diagnose you with depression before you even have time to grieve the birth and meeting with your baby that you had hoped to experience.

If you feel ready and you have time to prepare for your caesarean birth, read positive caesarean birth stories so that you are familiar with what will happen and what the birth may feel like. These stories will also give you confidence to ask for what you want. Talking to other women will also help you to find out what products there are that may make your recovery easier. (There are three positive caesarean stories in the Birth Journeys book.)

Meet the surgeon and anaesthetist beforehand with your midwife and/or doula to discuss your birth plans and hopes.

Ask that your baby be placed on your chest before weighing, cleaning and paediatric assessment, unless absolutely necessary. Weighing and cleaning are not emergency procedures that have to happen the moment your baby is born – they can wait – but we tend to accept that they take place immediately after birth. There are many possibilities like this that are not widely discussed or offered.

Ask for delayed cord clamping so that your baby receives all the cord blood and oxygen from the placenta while they adapt to life outside the womb. A recent review of studies showed that delayed cord clamping provides longer term health benefits for your baby as well as supporting them as they begin to breathe. A lotus birth is possible with a caesarean birth and it ensures that your baby is not taken away (although baby may be held rather than placed on your chest) before the placenta is birthed.

Ask for the lights to be dimmed and the surgery to be a little warmer than usual for your baby’s birth. This is achievable and it will make your baby’s first moments in the world easier and the birth environment more pleasant for you too.

Ask for talking to be quiet and gentle with attention focused on you, your baby, your partner and this birth. One common complaint couples have after experiencing a caesarean birth is that medical staff carried on with their own conversations ignoring the presence and the feelings of the key people in this important event. Perhaps some surgeons and theatre staff have this habit because other ‘patients’ would not be listening in and they may not be aware of how it makes many couples feel.

Discuss your intentions for breastfeeding and how you will be supported after the caesarean birth. Identify how will you be helped to breastfeed, especially if there is a reason why you are unable to breastfeed your baby for the first few hours. Remember that skin to skin contact and allowing your baby to explore and find your nipple by themselves is a wonderful way to initiate breastfeeding and reconnect with your baby after a separation.

Caesarean births are sometimes linked to difficulties in establishing breastfeeding so consider finding the supportive friends and professionals now before your baby is born. It is easier to reach for support if you have already made contact before the birth.

You may wish to discover your baby’s sex for yourselves. You may like the doctors to welcome your baby by name. Ensure you make your wishes clear so that this special moment meets your wishes.

Use honey not vinegar to get what you want. If you are worried about dealing with potential conflict, try words like these: “It is important to us that… How can we work together to…” Eg, if you are concerned about your baby being taken away immediately after birth you could try words similar to “It is important to us that our baby is not separated from us. How can we do things so we have our baby in our arms straight after the birth?”

This may seem to be giving the power to find a solution to the doctors, but you are actually telling them what your concern is and what outcome you want. I’ve not had to use this method in maternity care, but I have used it in the operating theatre and recovery ward with my children to get what I knew they needed and it really works! Honest and respectful communication with the right person goes a long way.

On The Day
Have your partner place their hands on your belly or speak to your baby in the time before the caesarean birth begins. Your baby knows their daddy’s voice and this can help your partner to feel involved and connected with your baby and the birth.

Before the birth begins, ask to take a moment to welcome your baby and give thanks for their life and the wonderful care and the gentle hands of everyone in the room that will receive your baby into the world. If you would normally pray or say a few words before something momentous takes place then surely the caesarean birth of a baby fits this category. I believe your wish will be respected if you frame it as a need to give thanks, say a prayer or a blessing before your baby’s birth.

If saying something aloud is all too much, then ask for a everyone to share a moment’s silence to give thanks. Taking this small but very personal action will send a very clear message about the way you want this birth to be – respectful, gentle and calm. I have not read of this in any birth stories so you may be pioneers if you try this – be sure to let me know what happens!

Focus on your baby and visualise sending them reassurance and love. Let your baby know that it is safe for them to be born this way and that you are in control of what is happening. Talk or sing to your baby in your head or quietly – keep focused on them and their wellbeing and imagine them coming out into the light and the air. This will help you to feel involved and in control of the birth of your baby. By keeping calm, you support the wellbeing of both yourself and your baby. If this is not for you, use other methods such as counting backwards to help you keep calm.

Have a doula or familiar midwife in the theatre focused on your care and wellbeing. You’ll benefit from having someone there for you and your partner.

If you prepared for birth with hypnosis or meditation methods you may find these are still very useful during the birth. If you have prepared using breathing techniques or counting methods these amy also be helpful for you. (See the links below for hypnobirthing specifically for caesarean birth.)

If you are unable to hold your baby post-birth, your partner can hold your baby against his bare chest with a blanket over them both, or even inside his shirt. Your baby will be kept warm and will love this close contact with daddy.

Remember it is your birth and your baby’s birth not just an operation. Every aspect of this birth may be performed with an intention to help, to care and to show respect for you, your baby and your partner. You deserve this.

Some links you may find helpful before and after a caesarean birth:
Caesarean birth plan: http://www.birthtalk.org/PlanaPosCS.hhtml
Hypnobirthing for caesarean birth: http://www.hypnobirthingaustralia.com.au/preparation-for-caesarean-birth-cesarean-c-section/
What a caesarean is like: http://www.birthingfromwithin.com/cesarean
Birth Rites on positive caesareans: http://www.birthrites.org/caesarean.html
Love letter to mothers who have birthed by caesarean: http://thestir.cafemom.com/baby/131563/a_love_letter_to_csection
Words that heal – why language matters: http://www.huffingtonpost.com/brandy-ferner/words-that-heal-cesarean-birth_b_3722185.html

20130826-213350.jpg No matter how you birth or how your baby needs to be born, you deserve this treatment.


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Failure to Progress or Failure to Wait?

Failure to Progress and Preparing for a VBAC

For most mammals birth seems to be fairly straightforward. They seek a safe and private place to birth in the middle of the night. Some choose to birth alone and others have ‘midwife mammals’ by their side. If there is danger they either have a speedy birth or stall labour until there is another safe opportunity.

For humans, it seems far more challenging. We have to feel safe in our environment, safe with the people around us, and safe with the physical and emotional process that is taking us over. We have learnt to fear birth with our minds and hearts, yet nature requires us to feel safe in order to give birth. Sometimes ‘failure to progress’ is the result of this struggle.

‘Failure to progress’ is one of the common reasons given for a caesarean during labour. This label is a blanket term for times where contractions have slowed or paused, dilation has gone backwards, or contractions are continuing but the baby is making no further progress towards birth. Women’s stories suggest that the label ‘failure to progress’ is often used when their labour has taken several days, or simply longer than expected or allowed by policy.

There are many variations in labour and doctors and midwives face the task of judging when medical assistance is needed and when all that is needed is patience. No one wants an adverse outcome, however in the rush to keep birth safe, some mothers and babies are hurried into treatment for an emergency that just does not exist. Some caesarean births due to failure to progress are actually caesareans due to impatience and failure to wait.

“After 50 hours of intense labour, I had a caesarean.

I haemorrhaged and my uterus collapsed requiring manual internal manipulation to contract it back down again. I had to have the caesarean under general anaesthetic because of my previous spinal surgery – I was unconscious for the birth of my baby.

My husband was allowed into surgery to be with our baby. I’m glad of that, because I wasn’t ‘there’.

The last thing I remember was being pregnant. Next thing I knew, at least a couple of hours later, I was being wheeled up a corridor past a baby in a clear plastic crib and someone was saying, “That’s your daughter.”

It was a very surreal and disjointed experience. To this day, I still feel a gap. I don’t feel like I birthed my daughter, yet she’s gorgeous and I love her like I’ve never loved anyone or anything before.

It should not have happened this way. It was an unnecessary caesarean performed due to medical impatience with my long posterior labour. Neither my precious daughter nor myself were at risk during labour except when they intervened.”

From Jo’s VBAC story “Triumphant Birth”, in Birth Journeys – positive birth stories to encourage and inspire

The alternative response to a labour that seems to be failing to progress is to ask what obstacles are there to this birth. If a mother feels frightened, threatened, nervous, embarrassed, angry, unsupported, alone, disempowered, violated, exposed, worried, overwhelmed or any other negative feeling then this can slow her labour down and even stop her labour from progressing.

Women’s birth stories show that there are many ways to help a birthing mother to move through or let go of thoughts or influences that have made her feel unsafe or threatened if this is the cause of a slowed or stalled labour:
– a change in environment (can she leave the room, open or close the curtains, change the atmosphere if not location)
– a change in activity and pace (get moving if she has been still, be still if she has been moving)
– a challenging question (eg, what is it you are frightened of? What are you avoiding? Is she intentionally avoiding the intensity of labour mentally or physically by avoiding certain movements or positions that make her contractions more intense and more effective?)
– the removal of an unwelcome person in the room (is there an uninvited or irritating presence in the room? If it is a midwife or nurse, can you ask for a different one or buffer her from this person’s impact)
– or the inclusion of a loved and longed for person (is she missing someone special?)
a few simple encouraging words (you are made to do this, you are bringing your baby into the world, positive affirmations)
– a description of what her body is doing or needs to do (open up and let your baby come down)
– a cry (release the built up stress so she can feel ready to birth her baby)
– a reminder of the skills she has learnt and the strength she has to give birth and to be a mother (has she forgotten the birth skills she has learnt? Or is she worried that she doesn’t have the ability to be a mother to this baby?)
– some time alone (maybe she needs some quiet space to reflect and gather herself. A trip to the toilet seems to work well according to women’s experiences!)

Preparing for your next birth

It is important to understand the factors that contributed to the path of your last birth and to consider the possible impact your feelings (whether you felt safe or unsafe) had on your labour. It is wise to discuss your previous birth in detail with your chosen doctor/midwife for a birth after caesarean. Pay attention to the way your chosen carers talk about your past birth as this will tell you what you can expect from them.

If your doctor seems to blame you and your body for a failure to progress, then be wary of both the doctor and the truth of what they are saying. Keep in mind that a very, very tiny percentage of women actually have a physical reason why they cannot labour and birth vaginally and statistically you are unlikely to be this woman.

If you hear words like “Your pelvis is too small and your baby got stuck. Luckily we saved your baby’s life just in time. You’ll never be able to have a vaginal birth of course” then you can thank this carer and start looking for another! They have just revealed that they are unaware of or insensitive to the emotional issues around birth and they already believe you and your body ‘failed’. You could enquire about the evidence for their verdict or you could simply put this energy into finding a more supportive and respectful doctor first. There are ways to discuss a ‘failure to progress’ that would be more supportive, caring and respectful.

One doctor or midwife’s ‘failure to progress’ will be another’s call to action: how can I help you to feel safe enough to give birth?


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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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Birth Story – a journey from traumatic caesarean to healing

The following powerful story published on the Improving Birth website takes us from that place of hurt and betrayal from an unplanned caesarean birth, through a beautiful journey of learning and healing.

First and foremost, I needed to value myself as a woman and mother. If I had no self-worth, how could I expect that the experience of birth would offer me any more value than I already had for myself? What my second birth taught me is that when one values herself even just a little bit, her confidence prompts others to treat her with respect. I needed to take that sense of self-worth further, and rise up out of victimhood and into empowerment.

Read the full story on the Improving Birth website where they are celebrating April as Caesarean Awareness month.


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Birth Story – a family centred caesarean

Published on the Improving Birth website, this is a wonderful read for women who need or choose to have a caesarean birth and are seeking to be empowered and at peace with this choice and this experience of birth.

“So, what happens if you are completely committed to “going natural” and things don’t work out? How do you deal with being told, “This baby is at risk. We need to deliver via cesarean”?  All that matters is a healthy baby  – you just need to get over it…right?”

Get over it? Just like that?

Of course the ultimate goal is a healthy baby, and of course you are going to agree to the cesarean for the well-being of your child. But that doesn’t mean it’s going to be easy to let go of the experience you’ve been envisioning for nine months, and it doesn’t mean you don’t have the right to grieve that loss.”


Read the whole story here on the Improving Birth website.