The birth world is all a twitter right now.  One of our roles as a doula is to provide evidence-based information to our clients when they have questions or concerns.  We (at least all the ones I have come in contact with) believe a woman’s body was made to birth a baby and only under special circumstances is a cesarean surgery needed.  Most of the time, the surgery is preformed because of lack of information to the pregnant mama.  If she knows the risk and benefits of her options, she is more likely to have a vaginal birth.  There are so many benefits to mama and baby after a vaginal birth versus a cesarean surgery.

ACOG (American College of Obstetricians and Gynecologists) just released an update on their stance about VBAC’s (vaginal birth after cesarean).  They now say “Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans…“.  Now the leading source of information doctors trust is on board with what studies have proven.  This is certainly a step in the right direction back to what birth should be, an empowering, joyous, natural experience.  Here is the full press release if you would like to read it.

The one aspect that has always concerned doctors is uterine rupture at the previous incision site.  While the risk is there, it is low.  Henci Goer (a leader in the birthing world) wrote a great article posted on iVillage about the facts of a VBAC from an evidence based view point.  This is what she had to say about uterine rupture:

Symptomatic scar separation: The main fear with labor after a cesarean is that the scar will open enough to cause bleeding or for the umbilical cord or the baby to pass through the opening. Among thirty studies totaling 56,300 VBACs, the rate of symptomatic scar separation was 4 per 1,000 (15,30). Even so, few instances where this occurs result in harm to the baby, which is the real issue. The perinatal mortality rate (stillbirths and newborn deaths together) from this cause was 3 per 10,000. This did not differ from the perinatal mortality rate of 2 per 10,000 in 29,900 planned cesareans. Nor does planning a cesarean eliminate the risk of the scar giving way. Several large studies reported scar separation rates ranging from 2 to 3 per 1,000 with repeat cesarean, not much less than the 4 to 6 per 1,000 reported in VBAC labors (17,21,30).

Now, the next step is preventing the need for a VBAC in the first place.  The more we speak up and are informed, the quicker we can create change.  Birth is natural and normal, not a condition to be treated.

Here is a copy of an email I received from a colleague.  I believe we must use evidence based care and not just believe what people tell us (yes, even doctors).  She tried to find studies and couldn’t so she is conducting her own.  She is looking for Muslim women who are breastfeeding to help with a study…..if that’s you or someone you know, keep reading:

Anyone interested in joining a study on nursing while fasting please

keep reading….!!!

I saw the topic of fasting while nursing came up and when I was
approaching my first Ramadan as a nursing mommy, I (coming from a
science/medical background) decided to see if there were any research
studies on the topic. I found just one study looking at Muslim women
and it only studied, I think, 12 women. Anyhow, every year the topic
comes up and mommies look to other mommies for advice and it usually
goes both ways….some mommies saying it makes milk supply go down,
others saying they were able to do it just fine. So this year I am
working on studying the topic myself. I am still working out the
details of the study but I just realized how quickly Ramadan is
approaching so I need to get the word out ASAP so that I can get as
many people to participate as possible. The study will be looking at
a number of different factors and try to see which, if any, help to
determine which women will be able to fast while nursing and which
women will have troubles with milk supply or not be able to fast for
other reasons.

At this point, the minimum I need is anyone that is breastfeeding that
is willing to try fasting and do some record-keeping (ie food eaten
each day, # of ounces of fluid taken each day). I may also need a pre
and post-Ramadan baby weight check. So if anyone is interested (and
please please pass this around to all women, all around the world
even) please email me at saadiap@gmail.com

At this point, I would like to exclude women who are also pregnant,
and women who are already experiencing milk supply problems, and
women who are increasingly using formula (since the milk supply may
already be going down due to formula use). Once I get an interest
list, I will email out the specifics.

Please make dua that this is a successful study and helps us to answer
the age old question of whether fasting while nursinng will decrease
milk supply!

And again…please pass this on to every nursing mommy you know!

Jazak’Allahu khayran,

Saadia

Another reason to seek the services of a birth doula to help avoid an epidural and why I am an aspiring herbalist.  One of the speakers at the Autism One Conference, Elaine DeLack, RN spoke on her hypothesis of the originating cause of autism.  One of the causes she believes is an epidural with pitocen during childbirth.  She theorizes this causes a change in the baby’s brain chemistry which later manifests itself during the natural changes of the child’s brain.  Here is an article explaining this more in depth.

Here is the synopsis of her lecture from the Autism One website:

“This presentation will explain how the metabolic imbalances, gastric problems, and core symptoms of autism may be the result of a malfunction of the mitochondrial enzyme, MAO-A. The presentation will discuss how stress, genetics, epidurals with Pitocin (oxytocin) augmentation during childbirth, toxins such as mercury, aluminum, high copper and cadmium are possible risk factors contributing to the overall symptoms resulting from the MAO-A deficiency. This science provides the rationale unifying the benefits seen from various therapies such as the gluten-free and casein-free diet, hyperbaric oxygen, methylcobalamin and Respen-A.”

I find this very fascinating and hope to see more concrete research in the near future.  Maybe this is the breakthrough that is needed to really understand this mysterious diagnosis and help families before their child starts showing signs.

As women we have fought for choice, we have fought for options with our lives, and we have fought for our voice to be heard.  What happened with childbirth?  It seems we have gone backwards.  We accept what the doctor says without exploring all our options, we suffer good patient syndrome,  and we lay on our backs to push because that’s what everyone else does.  It is time we take back our power over childbirth.  We are women of strength, and we are amazing! We need to give ourselves more credit! You really CAN do it with no epidural, I promise.

It saddens me that our c-section rate is going up and women don’t get that amazing pride of pushing out their baby. We have fought for the right to choice.  We so easily give up that choice to our care provider.  We have fought for options, however, we don’t explore them when it comes to having a baby.  If you are pregnant, research all of your options.   If your doctor tells you something and it doesn’t make sense, ask why.  If the doctor is concerned about something, go home,  do some research about it (unless of course it is life threatening to you or your baby), and find other women who have had the same experience.

For birth, the easiest way is to hire a doula.  If you can’t or don’t want to, do some research on different positions to labor and push in. The Birth Partner by Penny Simkin is well worth the investment!  If there is one book to get for pregnancy, find this one.  It’s a great conversation starter for your partner to help prepare him too. When you are in the midst of labor, you are more emotional and less analytical. Make sure you have a simple birth plan so the staff knows your wishes. Discuss your wishes with those who will be in the birthing room so they can speak up for you if need be and if there is a complication, they can rationally help you think through it.

Here is a post I did awhile back about advocating for yourself

Remember, if you choose a natural birth, when you start asking for drugs, you are in transition and pushing will commence shortly so hold on because you are almost there.

SIDS has decreased greatly over the past decade or so because of safetyprecaution awareness, however, for every family effected, statistics don’t matter.  They have lost their baby.  Hannah Kinney, MD, a professor of pathology at Harvard Medical School and a neuropathologist at Children’s Hospital Boston has recently published a study she conducted concerning the cause of SIDS.  We are now a step closer to eliminating this tragic occurence.  Her study narrowed down where the problem may lie.  It may come from the brain stem and could have to do with serotonin levels.  Here is a great article about this study.  Certainly one step closer to overcoming the number one cause of death in children newborn to one year old.  This is such great hope for such an elusive killer!

As I sit here in the waiting room waiting to rejoin my client who’s VBAC ended with a c-section, I am reminded how much of fertility, pregnancy, and childbirth is waiting.  As the saying goes “hurry up and wait”.  We wait for each time of ovulation  to hopefully get pregnant this cycle.  We wait for the next doctor appointment to see how we are doing and when we get there, we wait some more.  We wait those last few weeks when we feel like a house and are ready to meet our little one, we wait for birthing day.  Once labor pains begin, we wait on our bodies to tell us when to push.  Once our baby has been born, we wait to get the “all clear” to go back to our full schedules.  Perhaps all of this waiting is preparing us for the immense amount of love, patience, and nuturing we need to care for a child.  We mothers must be good at waiting right?  Maybe for some of us, it’s in our DNA.  I know for some (myself included), waiting can be as challenging as those labor pains.  I think a perfect balance of hurry up waiting and savoring the moment is within our reach.  Savor the moments that make us feel alive,  those moments our children steal our hearts yet again (yes, you know those moments, when you feel you could burst because of the love for them).  There are so many lessons our children are waiting to teach us, we just need to slow down and notice.  You can hurry up and wait when they are teenagers and you find yourself on the couch because curfew is soon approaching.  While they are small and even not yet born, savor the moments.  I know it’s a trite phrase, but it is so true “they grow up so fast”.  Even if you don’t have the pleasure of being surrounded by children, stop and remember the amazingness children bring to our lives, the lessons they teach, the love they so freely give, the laughter that is never far from their tongue, and their awesome curiosity.  If a child is near you, hug them and let them know how much they are loved.

One of the silly games I play with my kids……

“Why do I love you?” I ask

“Because I’m __________ (fill in the name).” they answer

One of those never ending debates among women…how far apart?  I come across numerous pregnant women and new mommies who ask this question.  Should they be close together or further apart?  How many years is best?  How long does it take for my body to recover from pregnancy and childbirth?

A report was published last December about the biological aspect.  Here is an article going over the results of that study.  It concluded that the first 6 months postpartum are vital for the mommy’s body to heal itself.  Waiting 11 months to conceive is recommended.  The article discusses the risk factors and statistics if you are interested in reading that aspect.

Some of the other details of child spacing that need to be considered are; Are both parents mentally and emotionally ready to add more responsibility?  What are the pros and cons of the sibling relationship if they are close in age or further apart?   Thinking ahead to when the kids graduate high school, how old do you want to be?  Is there a cut off age the mommy wants for being pregnant?

There is no exact, magic number.  It is a decision that each couple needs to make taking their lifestyle, opinions, and expectations into consideration.  If you are pondering this for your own life, take out a piece of paper, consider the questions, and write down your answers (there is something about writing them down).  Then, for the next few days just let your mind simmer.  After a few days revisit your answers.  Have they changed?  Are they still the same?  If they have changed, write down the new answers, again letting your mind simmer for a few days.  Keep doing this process until your answers remain the same.

Hopefully the questions prompted your mind to consider more questions to answer.  Leave a comment and let me know the questions you came up with.  Also, if you are one considering this for your own life, I would love to hear your thoughts!