Positive Birth News

birth stories, news and articles to encourage and inspire


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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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Positive Birth Story – Finding My Voice: my journey to VBAC

Kush and her girls My wonderful VBAC starts with the terrifying caesarean I experienced bringing my precious three year old into the world.

I now know that fear and stress can stop labour progressing. If someone had told me there was nothing to be afraid of, Maitreya’s birth could have been very different.

My mum had six kids and she was told she couldn’t possibly birth naturally because of a rare condition where she has two wombs. My mother in law was full of stories about the horrors of birth and seemed to delight in telling me as many bad stories as possible. I had been led to believe birth was a terrible, dangerous thing. I didn’t know birth could be empowering, spiritual and an amazing natural process that my body was built for. I have one amazing book and an amazing doctor who helped me see this.

My First Birth
I really wanted a natural birth. I went to birth classes and read a few books like Kaz Cook’s Up the Duff and The Complete Book of Pregnancy and Childbirth by Sheila Kitzinger. I thought I was prepared but all I knew was the mechanics of labour, not the emotional and spiritual side of birth. I was really vague with my first birth plan. I thought that they would know best and I should leave it up to them.

When I went in to labour in the afternoon, I tried to stay at home like the midwives advised me, but the phone rang constantly. At first it was just a couple of casual calls and one of these was very welcome, as it was a friend telling me she was pregnant! I remember saying “Yay! I’m in labour, talk to you soon!” Then my partner’s family caught wind of what was happening and they seemed to call one after another to ask how long I had been in labour, when I was going to go hospital and lots of other questions.

We also had a few unexpected visitors and my partner, Josh, decided they should be invited in for a drink. I was embarrassed to have contractions in front of the visitors so I kept leaving the room when I had them. I wanted my partner to be there for me but he was so distracted by the phone and the guests that he didn’t even have time to ask me how I was going. He seemed to treat it as just another day.

I felt stressed and I wanted to go to the hospital to be away from all the intrusions. I asked Josh to call my mum and ask her to meet me at the hospital. He had to ask the last of the friends to leave so he could drive me in. It was about 7pm.

I thought it would be quiet in the hospital but my birth room seemed so busy. People were coming and going. The lights were bright and it was noisy. I started to feel scared. Everyone seemed to be talking around me and not to me.

I had tested positive for Group B Streptococcus so a cannula was put in straight away for antibiotics. It seemed like that was an excuse to give me everything they had. I agreed to it all in a haze. One of the midwives broke my waters with the crochet hook looking thing, then I had syntocinon a while after that. At dawn they gave me pethidine. I didn’t know what it was at the time. I remember being told “We are giving you this to help you get some rest” but it had the opposite effect. I started chatting away to a student nurse about a girl I knew at school who had the same name as her. I’m sure she thought I was crazy!

I felt this excruciating stinging pain between contractions, but a midwife told me that I wasn’t having contractions so I wasn’t in pain! My mum told her, “She is in pain! Something’s not right!” The pain went on for a long time. I was exhausted and worried.

After 20 hours of labour, I was being monitored constantly and I was told to stay on the bed. Finally, a midwife told me that I hadn’t progressed and I was actually going backwards due to the swelling of my cervix. I had only reached 5cm dilation and now I was back to 3cm. I was bleeding and my baby was distressed. They brought me the paper to sign for a caesarean. I was terrified of losing my baby and I agreed straight away. But I felt like I had failed.

My little girl, Maitreya May, had a rough start so we couldn’t be together for a few hours. She had a huge cone head because she was stuck for such a long time. I had a long recovery afterwards.

In quiet moments, I felt this huge regret. I believe that the trouble I had breastfeeding was because I didn’t see my girl for what seemed like forever after the birth. She had trouble latching on, but after almost two months of pain and perseverance we sorted it out and went on to breastfeed for two years. Maitreya always wants to be with me and as a bub she wouldn’t let anyone else hold her including her dad. I think her fear of separation comes from her traumatic birth. I felt like I had no voice when it came to people wanting to hold her, even when I knew she would scream. I didn’t have the confidence to say “I’d better take her back” when she was upset (which was pretty much every time someone else held her).

My Second Birth
The obstetrician who performed the caesarean was an older gentleman, and when he came to follow up and check my incision he said I should get my hips x-rayed if I wanted more children. He said my hips could be too small to birth naturally. That really worried me but I didn’t get an x-ray as I was breastfeeding Maitreya and then I was pregnant again!

I was now terrified of birth and what might happen, so I spent the first half of my second pregnancy trying not to think about it much. I had heard of VBACs from books but everyone I knew just said why bother. They said I would probably have another caesarean anyway so why not just book myself in for one and then I wouldn’t even have to go in to labour.

My doctor told me that a VBAC was possible but that the likelihood was slim and most women go on to have another caesarean. She was full of facts. She told me,“If you go overdue it’s a caesarean. If you labour for more than 12 hours – it’s a caesarean. If you don’t progress quickly – it’s a caesarean.” This didn’t help me prepare for a natural birth. And to top it off, one of my shared-care midwives told me a horror story about a lady’s scar splitting and bubs hand sticking out of the tear!

I still wanted a natural birth despite all the pressure so I made sure I was fit and healthy. I did yoga because I wanted to be able to move, walk, pace around and have an active birth. I told quite a few people that I didn’t want to hear any negative birth stories.

Birth-Journeys-Cover-Large

During my third trimester, the book Birth Journeys came into my life and I realised ‘I can decide what happens to me during birth. I can be excited and positive about my birth. It’s my birth. I will be informed and make choices and not just let myself be told what to do. I will listen to my body and my instincts.’ I learnt that I could speak up and ask for what I want starting at home and working my way up to telling the doctors. I told Josh that he could either be supportive of me or not be there at all this time! He was pretty sorry and would be very attentive this time.

In my final month I decided I wanted a more supportive doctor. Dr Patty was another one of the doctors at my clinic. I had seen her once or twice in the waiting room and once she said “Ooooo… look at that lovely round belly” in such a motherly way that I immediately warmed to her. I had found out that she was an obstetrician about half way through my pregnancy, so now I picked up the courage and asked to see her instead of my normal doctor (Patty is now my regular doctor too).

Dr Patty is such an amazing woman. She is originally from San Francisco and she goes back every year for Christmas. While she is there she spends a few weeks volunteering in a women’s clinic in Mexico. She told me how poor the clinic is. They have hardly any equipment so there is very little intervention there! She is more at home with natural births and has had to learn lots of ‘old midwife tricks’. I can tell she cares so much about the babies she births. One wall in her office is covered with pictures of babies she helped into the world and now my little Xaani is up there too.

Patty asked me what I wanted to do and I said I would like to birth as naturally as possible. I told her about my first birth and my regrets. She said that I would be fine to have a VBAC, but there would be more monitoring this time round just to make sure I was progressing and that the baby was okay. She said I could move as much as I liked with the fetal monitor on, I just had to try not to get tangled!

While Patty told me the statistics on uterine rupture, she also asked me if I wanted to have a big family. She told me that statistically the risk of uterine rupture would go up with each caesarean I had, but it would actually go down with each VBAC. I have always wanted a lot of kids because I love being from a big family, so this made me even more determined to go natural.

I asked Patty if there was anyway to tell if my hips were too small and she said not to worry. In the 18th and 19th centuries poor nutrition, rickets and illnesses such as polio caused pelvic anomalies. As the obstetrician who performed the caesarean was from the older generation and older style of doctoring, he would think that a caesarean was because the mother was unable to birth rather than blame a failure in the medical system to provide a safe environment so labour could progress naturally. She kept saying that my body was fine and there was no reason that this birth would be like the last. She encouraged me and made me feel in charge of my birth – she made me feel confident.

I had learnt that I’m a very private person and I don’t like to feel as though I have an audience. The one thing I really wanted was to have the minimum number of people in my birthing room. Dr Patty agreed that I could have just one midwife with me. I felt very supported by the hospital and midwives, especially by Hannah, the midwife who attended my birth.

When I went in to labour I made sure my home felt safe; no phones, no visitors, just my mum, my partner and my little girl, Maitreya. My mum stayed with Maitreya and I chose when to go into the hospital. I felt happy, safe and in control this time. There was just one midwife and my partner present and the lights were down very low.

I started doing my birth dance, walking round in circles and occasionally squatting with support from Josh. I thought it was going to take a long time as I didn’t feel overwhelmed by the contractions yet, so I had a shower. The contractions were nothing like I remembered. They swept in like a wave and then faded away. I didn’t feel like I was out of my depth and drowning like I did the first time. I remembered to breath into the pain, not vocalise it but use the energy to help my body do what it needed to. I came out of the shower and sat on the birth ball.

I remembered a few mums from Birth Journeys talking about visualisation and how it helped them, so I visualised opening and my baby traveling down. It was working! I was progressing well and I knew this baby wouldn’t get stuck.

I did have one surprise visit this time, but it was a welcome one! Patty said she had asked the hospital to let her know when I came in. This was her night off and I was in a public hospital so she was in no way obliged to be there. She said she hadn’t birthed a baby for a while and she didn’t feel right if she hadn’t ‘caught a baby’ for a long time. She made me feel special. She wanted to be there for me and my baby and her joy was lovely to see. Every birth was a special moment for her, not just another day at work. I wasn’t just another birthing mum, and my birth mattered.

The final stage was tiring and my legs were shaking through most of it. Josh and Patty were both so encouraging, they were saying things like “You’re almost there”, “You’re doing great”. They really made me feel like superwoman!

After only three hours of full labour, my beautiful baby girl arrived. Patty caught Xanni Lily and handed her to me for skin-to-skin contact. Xanni latched on, her eyes opened and she looked at me. Contented, elated, proud and in awe of my baby and myself – this is exactly the birth I had dreamed about!

Kush is a 35 year old mother of two amazing girls, Maitreya and Xaani. Kush started making modern cloth nappies for her first bub and loved making these and other baby gear so much that she just couldn’t stop and had to start selling them! She now runs a business called Kushy Komfort (http://kushykomfort.com.au) selling her modern cloth nappies and other environmentally responsible products for mums and bubs. Kush lives in rural NSW with her partner of 18 years, a cat, dog, fish, chickens and a pet spotted python called Monty.


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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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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.