Less Restrictive Guidelines for VBAC

With the cesarean section rate in our country reaching an alarming 31% The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines in hopes to allow greater access to vaginal birth after cesarean (VBAC). In a statement issued today, ACOG says:

"The current cesarean rate is undeniably high and absolutely concerns us as ob-gyns," said Richard N. Waldman, MD, president of The College. "These VBAC guidelines emphasize the need for thorough counseling of benefits and risks, shared patient-doctor decision making, and the importance of patient autonomy. Moving forward, we need to work collaboratively with our patients and our colleagues, hospitals, and insurers to swing the pendulum back to fewer cesareans and a more reasonable VBAC rate."

The World Health Organization (WHO) recommends that for the best maternal and fetal outcomes that cesarean rates in industrialized countries should be no more than 10-15%. ACOG's recommendation is a step in the right direction to allowing more women the choice of a VBAC. While it moves us forward, we still need to keep the doors of communication open between women and their doctors and fully support their childbirth options. You can find the full text of the press release from ACOG here.

Mother & Baby Friendly Cesarean

The United States cesarean section rate is rising at an alarming pace. While we need to educate ourselves about and discourage the use of unnecessary cesareans, the medical necessity of the procedure has allowed for healthy outcomes for countless mothers and babies. (me to be included!)

For those mothers and babies that medically require delivery by cesarean I argue that we should explore the option of a mother/baby friendly experience. The Natural Cesarean: A Woman-Centred Technique (pdf file) is an article published in the BJOG: An International Journal of Obstetrics and Gynaecology exploring the option of the parents being active participants in the birth of their baby.

What would a mother/baby friendly cesarean look like? According to the authors of the article:

• The drape would be lowered and the mother's headed elevated so that she may witness the birth.
• The partner would be allowed to observe as well
• Baby would be allowed to slowly emerge helping to expel liquid from its lungs as it would during a vaginal birth
• Rest of delivery is allowed to occur passively as the uterus continues to contract
• Clamping of the cord is done in front of both parents and the partner is permitted to cut if desired
• Baby is brought between the mother's breasts for immediate skin to skin contact and offered a chance to suckle
• Baby is allowed to remain on mother's chest until the surgery is complete. Procedures (labeling, Vitamin K, etc.) that can be completed in this position are.
• Once surgery is complete, partner accompanies baby for weighing and remaining procedures
• Upon completion of procedures, baby is immediately returned to mother for skin-to-skin contact

A cesarean section is major abdominal surgery. This birth experience is not suitable for all cesarean births, but I think, as suggested by the authors of the article, this option can be explored for non emergent situations. The International Cesarean Awareness Network has also written details about how to have a family centered cesarean.

If your medical situation dictates that a cesarean is the safest way to deliver your baby discuss your options with your doctor.

The NIH VBAC Conference Hits Close to Home

As a mother who had a vaginal birth for my first child, and due to umbilical cord entanglement, had a cesarean for my twins, I've been following the National Institutes of Health Consensus Development Conference on Vaginal Birth After Cesarean with great interest. It has recently hit me that if my husband and I decide to expand our family, that I cannot go to just any healthcare provider. Not all physicians in the Raleigh area would be supportive of my decision to attempt a vaginal birth. That idea is mind boggling! The thought that a doctor or hospital would not support my birth choice is something I never imagined that I would have to deal with.

The NIH conference earlier this week examined the availability and access to VBAC for pregnant women The panel reiterated what many evidence-based practitioners believe, that expectant mothers should have the option to pursue a vaginal birth after a having had prior cesarean. Seems like a no brainer, right?

Unfortunately, while 60% to 80% of women who attempt a VBAC have a successful vaginal birth, the reality is that there are hospitals and care providers that limit that option for mothers. Some facilities and doctors ban the procedure outright. The risk of uterine rupture, which is often stated as a reason not to pursue a VBAC, is less than 1%. Not to minimize that small percentage, but is the fear of litigation a reason to limit this birth option for millions of women? The panel recognizes the medical and legal issues surrounding VBAC, but urges all stakeholders to overcome the barriers to allow access for pregnant women.

You an read the panels draft report here. The conference was an excellent opportunity to shine a spotlight on the availability of VBAC, maternal care and birth options in our country. It is an important discussion that we as birth professionals, mothers and healthcare providers need to work together to move forward.

The Conference is available by webcast at the NIH website.

Birthing Choices and C-Sections - Why I Became a Doula

Doula-ing was born out of my desire to help educate and empower woman about their birthing choices. On the surface it appears very cut and dry. I peed on a stick, it came back positive, I go see my OB and nine months later my baby is born. Ok, maybe I’m over simplifying it a bit, but you get the point.

It’s not that cut and dry. From deciding which healthcare provider will care for you and your baby (obstetrician, certified nurses midwife, certified professional midwife) to where you will give birth (hospital, home, birth center) there are hundreds of decisions that aren’t so clearly defined that each woman should examine and decide which ones are best for her. As a doula, I want to provide as much information to help my clients make the best decisions for her and her family.

Blogger The Unnecesarean posted the map above showing the 2007 Cesarean Rates by state. It is important to note the the World Health Organization (WHO) recommends that for the best maternal and fetal outcomes that cesarean rates in industrialized countries should be no more than 10-15%. The map indicates that in 2007 the rate in my state of North Carolina was between 2.5 to 3 times what is recommended. According to the North Carolina State Center for Health Statistics, in 2008 the Wake County cesarean rate was 32%.

If Raleigh and Wake County’s rate is 3 times higher than is recommended for the healthiest outcomes for both mother and baby, shouldn’t we be asking questions? Shouldn’t we be asking why is the rate so high and by many accounts increasing? As an expectant mother, ask your healthcare provider what their rate of cesarean births are. Ask what their policy is regarding vaginal births after a cesarean (VBAC). Inquire about their rate of inductions and how many of those lead to c-sections. Educate yourself about your options. Ask questions. This is your pregnancy, your baby, and you are your best advocate.

Don’t misunderstand my questioning as a sign of not understanding the importance of a c-section. I am the mother of twin boys who very well might not be here if it was not for a c-section. My boys were in the same sac without a separating membrane. This rare twinning meant that their umbilical cords were in a knot and they were at risk of cord compression. Because of the knot, if they were not born via c-section, one or both of them may not be here. As a doula I have also attended necessary c-sections births.

C-sections are necessary medical procedures, but we as women and mothers need to educate ourselves about the medical situations that dictate the necessity and unnecessary interventions that can ultimately lead to a cesarean birth.

For additional resources visit The International Cesearn Awareness Network ICAN.