I hope to have another post out before Pessach but for now I will leave you with my links of the week
- Ellen at Love That Max is blogging all about toilet training her son Max this week and boy, can I relate. Read her account of her first weekend without diapers here and about her having to be ready to start the process of potty-training here.
-On the birth front Mama Birth talks about the importance of resting after birth- I am a big proponent of that!! If you do not give yourself time in the beginning, you will regret it in the long run.
-Henci Goer has a great piece about why VBAC is safer than a repeat c-section, despite a recent study that came out that seems to claim otherwise.
-Lastly, here is a recipe for Passover granola. It sounds really yummy and like a great breakfast option. If you google "Passover granola recipes" you will find many more variations but they are all pretty similar- matzah, nuts, dried fruit, honey and oil.
How is that for an eclectic mix of interests?? Let me know what you think
Showing posts with label VBAC. Show all posts
Showing posts with label VBAC. Show all posts
Wednesday, April 4, 2012
Links of the week
Tuesday, December 6, 2011
AY's birth story
My doula Leda came for a postpartum visit today and presented me with a lovely birth story. This inspired me to finally write down my own version. Note- if you do not like birth stories and do not want to read about mucous plugs, contractions and amniotic fluid, stop reading right now. Otherwise, consider yourself warned and read on:
During this pregnancy, I started having Braxton Hicks/ pre-labor contractions pretty early on, around 34 weeks. I was surprised, but my midwife Miriam reassured me that it was normal for symptoms to appear earlier in subsequent pregnancies. On November 7th, in my 36th week, I had a day of more intense contractions and all around weird sensations and I thought I may be in labor and that my water had broken (it had not). The sensations went away in the evening though and for the next few weeks, I went about my regular business, having some days with more contractions, others with less. I tried to rest up more, especially at nights. I always knew the contractions were not real labor because they did not hurt that much and because they stopped when I was lying down.
I saw my midwife Wednesday before Thanksgiving and she said everything looked great. We scheduled our next visit for Thursday, December 1st, my due date. My husband laughed and said there was no way we were still going to be seeing her pregnant that day.
Friday November 25th started out as a pretty regular day. The kids were all home so we spent time at the park in the morning and then the afternoon getting ready for shabbos. A little bit after candle-lighting, I noticed that I was having a lot of discharge, more than usual. This continued on for most of the evening so I asked my husband if I could call the midwife just to check in and see if it might be amniotic fluid. I told her what was going on and she told me she thought it was my mucous plug and not amniotic fluid. She also told me how to check to be sure, to go to bed early and call her if anything changes.
I went to bed early and had a pretty good night's sleep although I just felt something was going on. I was not having a lot of contractions, but something felt different. I also remember having a few contractions lying down and thinking it was weird, because I had never had contractions in bed.
Shabbos morning I woke up and soon after started having real contractions. They felt different than the Braxton- Hicks because they were stronger, although still not very painful. They were coming about every 15 to 20 minutes. I told my husband to go to shul but to make sure the janitor would pick up the phone in case I needed him. I was not sure if I should go to shul, but once I saw that the contractions were still irregular and not hard to deal with, I decided to take the kids. I figured it would distract me and also keep them busy. It is hard for them to be home all day so I wanted to take them out.
Shul was pretty uneventful. We only went around 10 45 and left about 12 so we were not there for that long. I was able to daven and interact with people at the kiddush after, while every 20 minutes or so taking 45 seconds to surreptitiously breathe through a contraction. Around 12 I decided it was probably best to head home. We then had a pretty normal shabbos lunch. I wanted to go about with my routine as much as possible until I felt like I could not anymore. So I served everyone lunch and I ate a good meal to make sure I was well nourished and hydrated for labor. We sang songs and talked about the parsha with the kids.
The contractions started feeling stronger and coming closer together. At some point my husband walked into the kitchen while I was leaning into the counter and breathing/swaying. He shook his head and said something like, "It's a good thing you know about this stuff and are calm."
By now I knew this baby was coming that day, it was just a question of when. We discussed dropping the kids off by friends but there were some teenage girls coming over to play with them around 3, so we decided to wait and see what was going on once the girls left. Maybe we could stall till bedtime or at least till shabbos was over when we could distract the kids with the iPad.
We finished lunch around 1 45 and I told my husband to go rest because I could not sleep with contractions anyway. I decided to read on the couch while the kids played. The contractions were closer together when I was actively moving around so I was trying to stall a bit by staying lying down. The contractions were more uncomfortable that way. The kids still had no idea anything was going on. They did not really notice me breathing through contractions and I wasn't doing anything else at this point.
When the girls arrived to watch the kids around 3, I excused myself to go lie down. I called Miriam to tell her what was going on. Because the contractions were still spaced out when resting, she thought I probably still had some time but told me she would be close by, awaiting my call. I was a bit disappointed because I thought she would come right over, but decided Miriam was probably right and there was still more time.
I tried to lie down and rest a bit, but I was too excited by all the happenings. Plus I could not stay lying down during the contractions which were now 7-8 minutes apart and getting stronger.
The turning point came at 3 45 when I went to the bathroom and all of a sudden, started having contractions every 2-3 minutes. I stayed in the bathroom for a bit because I felt more comfortable there but when I saw that they were not slowing down and also thought my water might have broken, I realized I needed to call Miriam back.
I called Miriam around 4 10 and told her I was ready for her to come ASAP. I also called my doula Leda who happened to be on her way to the West Side anyway. She said if I was calling her on Shabbos, something must really be going on. It was a little strange making all these calls on Shabbos, but I knew it was the right thing to do. If anything I probably should have called earlier!
From here, everything went really fast. My husband asked the girls to stay so he could daven mincha. He would watch the kids till the end of shabbos and then put on a video for them. There was only 45 minutes left till the end of Shabbos so that seemed to make sense.
He also brought me some water. Meanwhile I decided to get in the shower to cope with the contractions. By now they were really intense but thankfully they were very short, maybe 30 seconds or so. Maybe 45. I wasn't timing anything at this point, just trying to get through one at a time. The shower was incredibly helpful. I let the water run down my back while leaning into the wall and moaning.
I could have just stayed there. I did not really want to move but I realized I was close to pushing and decided to call Miriam again to make sure she was really coming! Just as I came out of the bathroom, Miriam walked in. It was 4 45 and I was so relieved to see her. I told her I thought I was almost ready to push and she took one look at me and agreed. She checked the baby's heartbeat and said it sounded great.
About two contractions later, Leda walked in and I started to feel a real urge to push. At 4 57, with one of my first pushes, my water broke. At first I was pushing standing up but then I decided to move onto my bed. This was my first time pushing self-directed rather than the counting way they do in the hospital. It felt better this way to push when I felt the need to, rather than when the doctor tells you to. I could feel the baby moving down, although I could not see anything because of the position I was in.
At this point, Leda asked if she should go get my husband and take over the kids. I was very much in the moment and did not want her to leave my side. I also was not sure how he could be in the room for modesty reasons. Looking back, I regret that decision. I did not realize how soon the baby was going to be born and I wish he could have been there. I was also just really focused on getting the baby OUT. Throughout my labor I had been pretty calm and in control, even through what must have been transition while I was in the shower. But now I was starting to lose it and just wanted it to be over. With every push I kept asking if the head was crowning yet. I actually only pushed for 10 minutes but it felt like forever at the time. Finally I felt the baby crowning and the head emerged. I was assuming that from that point on, he would slide right out like the others did, but instead I felt incredible pain as his shoulders and the rest of his body came out. It was the only time in my labor when I actually screamed really loud. I remember saying, "What's going on?" because I thought something was wrong.
But then the baby was here! Miriam and Leda helped me turn from my knees onto my back and handed me the baby. They covered us in towels so we would be warm and I got my first look at the baby. I checked the gender and announced "It's a boy". He was covered in vernix and cried right away. In fact, Miriam said he started making sounds before his whole body was even out. She also told me that the pain I had felt was him coming out straight with both shoulders, as opposed to rotating one shoulder at a time, so she had helped him along a bit. Even so, I only had a minor tear that did not need any repairs. The baby looked great. His APGARS were 9 and 10.
As soon as the baby was born and I was covered, Leda went to get my husband so he could meet our new baby. It was a very special moment. We were waiting to cut the cord until the placenta was out so I just lay there with the baby on me, getting to know him. I felt the cord pulsating, which was pretty cool. The baby cried a bit and at first he was not so interested in nursing but after 20-30 minutes, he latched on like a pro.
Soon after,I delivered the placenta and we cut the cord. The kids came in at some point to meet their new baby brother. They were very excited.
After about an hour, Miriam examined me to make sure my bleeding was normal (it was) and did a newborn exam on the baby. He measured 21 inches and weighed in at 8lbs 6 oz, although I think Miriam's scale might have been a bit off and he was probably more like 8 lbs 2 oz. He passed his newborn exam with flying colors- his color was good, all his reflexes were in order and, as a bonus, he was beautiful!
I could not believe how normal everything had felt. I also was feeling very good for just having given birth. When I told Miriam that my perineum felt a bit sore, she laughed and said, "Well you did just have a baby come out of there!" I got up to take a shower, while Leda and Miriam changed the sheets and cleaned up the room. The mess was pretty contained and it was easily done. I also got dressed so we could take some pictures with the baby.
Miriam left around 6 45 after making sure we were all settled and okay. She told me to call her anytime if I had any questions and that she was available to come back if I needed her. Leda stayed for a bit longer. She got some laundry started and brought me dinner- orange juice and cereal.
My husband put the kids to bed and called our parents to share the news. By 8 pm, everyone had left, the kids were sleeping and I was lying in bed with the baby. I marveled at him and at how smoothly things had gone. It's truly a miracle how one moment you are pregnant and then all of a sudden there is this little person. We felt incredibly blessed.
PS: I know a lot of you are curious about the logistics of home birth. I plan to do a more comprehensive post about it in the next few weeks, including frequently asked questions, the safety of homebirth, etc. so stay tuned!
During this pregnancy, I started having Braxton Hicks/ pre-labor contractions pretty early on, around 34 weeks. I was surprised, but my midwife Miriam reassured me that it was normal for symptoms to appear earlier in subsequent pregnancies. On November 7th, in my 36th week, I had a day of more intense contractions and all around weird sensations and I thought I may be in labor and that my water had broken (it had not). The sensations went away in the evening though and for the next few weeks, I went about my regular business, having some days with more contractions, others with less. I tried to rest up more, especially at nights. I always knew the contractions were not real labor because they did not hurt that much and because they stopped when I was lying down.
I saw my midwife Wednesday before Thanksgiving and she said everything looked great. We scheduled our next visit for Thursday, December 1st, my due date. My husband laughed and said there was no way we were still going to be seeing her pregnant that day.
Friday November 25th started out as a pretty regular day. The kids were all home so we spent time at the park in the morning and then the afternoon getting ready for shabbos. A little bit after candle-lighting, I noticed that I was having a lot of discharge, more than usual. This continued on for most of the evening so I asked my husband if I could call the midwife just to check in and see if it might be amniotic fluid. I told her what was going on and she told me she thought it was my mucous plug and not amniotic fluid. She also told me how to check to be sure, to go to bed early and call her if anything changes.
I went to bed early and had a pretty good night's sleep although I just felt something was going on. I was not having a lot of contractions, but something felt different. I also remember having a few contractions lying down and thinking it was weird, because I had never had contractions in bed.
Shabbos morning I woke up and soon after started having real contractions. They felt different than the Braxton- Hicks because they were stronger, although still not very painful. They were coming about every 15 to 20 minutes. I told my husband to go to shul but to make sure the janitor would pick up the phone in case I needed him. I was not sure if I should go to shul, but once I saw that the contractions were still irregular and not hard to deal with, I decided to take the kids. I figured it would distract me and also keep them busy. It is hard for them to be home all day so I wanted to take them out.
Shul was pretty uneventful. We only went around 10 45 and left about 12 so we were not there for that long. I was able to daven and interact with people at the kiddush after, while every 20 minutes or so taking 45 seconds to surreptitiously breathe through a contraction. Around 12 I decided it was probably best to head home. We then had a pretty normal shabbos lunch. I wanted to go about with my routine as much as possible until I felt like I could not anymore. So I served everyone lunch and I ate a good meal to make sure I was well nourished and hydrated for labor. We sang songs and talked about the parsha with the kids.
The contractions started feeling stronger and coming closer together. At some point my husband walked into the kitchen while I was leaning into the counter and breathing/swaying. He shook his head and said something like, "It's a good thing you know about this stuff and are calm."
By now I knew this baby was coming that day, it was just a question of when. We discussed dropping the kids off by friends but there were some teenage girls coming over to play with them around 3, so we decided to wait and see what was going on once the girls left. Maybe we could stall till bedtime or at least till shabbos was over when we could distract the kids with the iPad.
We finished lunch around 1 45 and I told my husband to go rest because I could not sleep with contractions anyway. I decided to read on the couch while the kids played. The contractions were closer together when I was actively moving around so I was trying to stall a bit by staying lying down. The contractions were more uncomfortable that way. The kids still had no idea anything was going on. They did not really notice me breathing through contractions and I wasn't doing anything else at this point.
When the girls arrived to watch the kids around 3, I excused myself to go lie down. I called Miriam to tell her what was going on. Because the contractions were still spaced out when resting, she thought I probably still had some time but told me she would be close by, awaiting my call. I was a bit disappointed because I thought she would come right over, but decided Miriam was probably right and there was still more time.
I tried to lie down and rest a bit, but I was too excited by all the happenings. Plus I could not stay lying down during the contractions which were now 7-8 minutes apart and getting stronger.
The turning point came at 3 45 when I went to the bathroom and all of a sudden, started having contractions every 2-3 minutes. I stayed in the bathroom for a bit because I felt more comfortable there but when I saw that they were not slowing down and also thought my water might have broken, I realized I needed to call Miriam back.
I called Miriam around 4 10 and told her I was ready for her to come ASAP. I also called my doula Leda who happened to be on her way to the West Side anyway. She said if I was calling her on Shabbos, something must really be going on. It was a little strange making all these calls on Shabbos, but I knew it was the right thing to do. If anything I probably should have called earlier!
From here, everything went really fast. My husband asked the girls to stay so he could daven mincha. He would watch the kids till the end of shabbos and then put on a video for them. There was only 45 minutes left till the end of Shabbos so that seemed to make sense.
He also brought me some water. Meanwhile I decided to get in the shower to cope with the contractions. By now they were really intense but thankfully they were very short, maybe 30 seconds or so. Maybe 45. I wasn't timing anything at this point, just trying to get through one at a time. The shower was incredibly helpful. I let the water run down my back while leaning into the wall and moaning.
I could have just stayed there. I did not really want to move but I realized I was close to pushing and decided to call Miriam again to make sure she was really coming! Just as I came out of the bathroom, Miriam walked in. It was 4 45 and I was so relieved to see her. I told her I thought I was almost ready to push and she took one look at me and agreed. She checked the baby's heartbeat and said it sounded great.
About two contractions later, Leda walked in and I started to feel a real urge to push. At 4 57, with one of my first pushes, my water broke. At first I was pushing standing up but then I decided to move onto my bed. This was my first time pushing self-directed rather than the counting way they do in the hospital. It felt better this way to push when I felt the need to, rather than when the doctor tells you to. I could feel the baby moving down, although I could not see anything because of the position I was in.
At this point, Leda asked if she should go get my husband and take over the kids. I was very much in the moment and did not want her to leave my side. I also was not sure how he could be in the room for modesty reasons. Looking back, I regret that decision. I did not realize how soon the baby was going to be born and I wish he could have been there. I was also just really focused on getting the baby OUT. Throughout my labor I had been pretty calm and in control, even through what must have been transition while I was in the shower. But now I was starting to lose it and just wanted it to be over. With every push I kept asking if the head was crowning yet. I actually only pushed for 10 minutes but it felt like forever at the time. Finally I felt the baby crowning and the head emerged. I was assuming that from that point on, he would slide right out like the others did, but instead I felt incredible pain as his shoulders and the rest of his body came out. It was the only time in my labor when I actually screamed really loud. I remember saying, "What's going on?" because I thought something was wrong.
But then the baby was here! Miriam and Leda helped me turn from my knees onto my back and handed me the baby. They covered us in towels so we would be warm and I got my first look at the baby. I checked the gender and announced "It's a boy". He was covered in vernix and cried right away. In fact, Miriam said he started making sounds before his whole body was even out. She also told me that the pain I had felt was him coming out straight with both shoulders, as opposed to rotating one shoulder at a time, so she had helped him along a bit. Even so, I only had a minor tear that did not need any repairs. The baby looked great. His APGARS were 9 and 10.
As soon as the baby was born and I was covered, Leda went to get my husband so he could meet our new baby. It was a very special moment. We were waiting to cut the cord until the placenta was out so I just lay there with the baby on me, getting to know him. I felt the cord pulsating, which was pretty cool. The baby cried a bit and at first he was not so interested in nursing but after 20-30 minutes, he latched on like a pro.
Soon after,I delivered the placenta and we cut the cord. The kids came in at some point to meet their new baby brother. They were very excited.
After about an hour, Miriam examined me to make sure my bleeding was normal (it was) and did a newborn exam on the baby. He measured 21 inches and weighed in at 8lbs 6 oz, although I think Miriam's scale might have been a bit off and he was probably more like 8 lbs 2 oz. He passed his newborn exam with flying colors- his color was good, all his reflexes were in order and, as a bonus, he was beautiful!
I could not believe how normal everything had felt. I also was feeling very good for just having given birth. When I told Miriam that my perineum felt a bit sore, she laughed and said, "Well you did just have a baby come out of there!" I got up to take a shower, while Leda and Miriam changed the sheets and cleaned up the room. The mess was pretty contained and it was easily done. I also got dressed so we could take some pictures with the baby.
Miriam left around 6 45 after making sure we were all settled and okay. She told me to call her anytime if I had any questions and that she was available to come back if I needed her. Leda stayed for a bit longer. She got some laundry started and brought me dinner- orange juice and cereal.
My husband put the kids to bed and called our parents to share the news. By 8 pm, everyone had left, the kids were sleeping and I was lying in bed with the baby. I marveled at him and at how smoothly things had gone. It's truly a miracle how one moment you are pregnant and then all of a sudden there is this little person. We felt incredibly blessed.
PS: I know a lot of you are curious about the logistics of home birth. I plan to do a more comprehensive post about it in the next few weeks, including frequently asked questions, the safety of homebirth, etc. so stay tuned!
Tuesday, October 18, 2011
Gilad, Special Needs and Birth- a bit of a hodgepodge
When it rains, it pours. Somehow over the last few days, I have accumulated quite a few topics to write about and with yomtov around the corner, I wanted to get them all off my chest :)
First of all- Gilad Shalit. What an amazing miracle. No matter how you feel about the release of prisoner, who can not rejoice with the Shalits and all of Israel. I am so moved and have been thinking about it all day. Gilad was kidnapped about a month or two before A. was born and so whenever I thought of the length of time he spent imprisoned, I would think of A. I would marvel at how big she was getting, how 5 years is an eternity, my child's entire life up until this point. It just made the insanity of the situation more real to me. And now I can finally stop using A's milestones as a measure of his length of imprisonment.
Here is a link to a great blogpost about Gilad, posted by a blogger appropriately named A Soldier's Mother.
And a video of Gilad's first moments back in Israel, reuniting with his father that made me cry.
Enough said...
On a totally unrelated topic, The NY Times had a great op-ed in the Sunday edition entitled Notes from a Dragon Mom. Emily Rapp writes about raising her 18-month old son Ronan who has Tay-Sachs and will most likely die before age three. She writes how knowing her son's days are numbered makes her appreciate every day with him and focus on the present. She can let go of all her goals and expectations of a Mini-Einstein learning to read at age two and getting into Harvard on full scholarship; and just be with him. And while it is obviously very painful, it is also liberating to live in the now instead of constantly being future oriented as most parents are.
Although raising a child with special needs is very different than raising a child with a terminal disease, there is a similarity in the sense of letting go of expectations. While we do hope for a long and successful future for Y and for all our children, we have redefined what that success means. It is about being happy, being a good and kind person who is interested in helping others, rather than academic achievement and landing the biggest job. This reality check of what really matters is incredibly valuable.
Lastly, some news on the topic of birth, a topic I have been neglecting on this blog for quite a while. Being six weeks away from my due date, it is obviously on my mind. Just in time, Ricki Lake and Abby Epstein, the makers of the film "The Business of Being Born" have come out with the uninspiredly titled sequel "More Business of Being Born". Or, more accurately, four sequels. They felt that there were many issues surrounding childbirth that were not addressed in their first film and so they decided to explore as many as possible in their follow-up.
Here is the trailer
In Part 1, Ricki and Abby visit Ina May Gaskin, often called the mother of modern midwifery on her famous Farm. In Part 2, they interview celebrities about birth and their choices. Part 3 is called Exploring Options, giving more information on doulas, birthing centers and c-sections.
I haven't watched any of these yet, but last night while cooking yet again, I downloaded and watched Part 4- The VBAC Dilemma. As many of you know, VBAC (Vaginal Birth After Cesarean) is a topic close to my heart.
That is because Y. was born via c-section in 2005 and since then I have had 2 wonderful, uncomplicated VBACs and am gearing up for another one soon.
It frustrates me that the VBAC-rate in the US is so abysmal. Many doctors will refuse to even consider them or often tell patients things like: "Yes, you can try for a VBAC but just be aware that your uterus can explode any minute and you and your baby might die!" While uterine rupture is a very serious complication that I am not trying to downplay at all, the truth is that the likelihood of rupture is somewhere between .3 and .7%, less than 1 in 100. And that means any kind of tear in the uterus. The likelihood of a catastrophic and life-threatening rupture is 1 in 2000. As one of the doctors in the movie points out, the likelihood of miscarriage from an amniocentesis is 1 in 200, yet many women are comfortable taking that chance.
I have to admit that having done my research already, I did not learn a lot of new things about VBAC from the movie. Still, I think it was well done and for someone just at the beginning of their journey, trying to find out more information, this is a great resource. It offers a lot of facts and statistics, as well as some personal stories about VBAC. It explains both sides of the issue, trying to separate real health concerns from ones that are inflated and dramatized. It also talks about the risks of repeat cesarean, that doctors often do not share with their patients.
Part 4 of the movie can be watched for a small fee on the Business of Being Born website. You can also get more info on the other parts of the movie as well as the planned dates of screening. Surprisingly, there do not seem to be any screenings scheduled for New York at the moment.
That brings me to the end of my long and slightly rambling post. Wishing everyone a Chag Sameach and see you on the other end of yet another 3 day yomtov marathon :)
First of all- Gilad Shalit. What an amazing miracle. No matter how you feel about the release of prisoner, who can not rejoice with the Shalits and all of Israel. I am so moved and have been thinking about it all day. Gilad was kidnapped about a month or two before A. was born and so whenever I thought of the length of time he spent imprisoned, I would think of A. I would marvel at how big she was getting, how 5 years is an eternity, my child's entire life up until this point. It just made the insanity of the situation more real to me. And now I can finally stop using A's milestones as a measure of his length of imprisonment.
Here is a link to a great blogpost about Gilad, posted by a blogger appropriately named A Soldier's Mother.
And a video of Gilad's first moments back in Israel, reuniting with his father that made me cry.
Enough said...
On a totally unrelated topic, The NY Times had a great op-ed in the Sunday edition entitled Notes from a Dragon Mom. Emily Rapp writes about raising her 18-month old son Ronan who has Tay-Sachs and will most likely die before age three. She writes how knowing her son's days are numbered makes her appreciate every day with him and focus on the present. She can let go of all her goals and expectations of a Mini-Einstein learning to read at age two and getting into Harvard on full scholarship; and just be with him. And while it is obviously very painful, it is also liberating to live in the now instead of constantly being future oriented as most parents are.
Although raising a child with special needs is very different than raising a child with a terminal disease, there is a similarity in the sense of letting go of expectations. While we do hope for a long and successful future for Y and for all our children, we have redefined what that success means. It is about being happy, being a good and kind person who is interested in helping others, rather than academic achievement and landing the biggest job. This reality check of what really matters is incredibly valuable.
Lastly, some news on the topic of birth, a topic I have been neglecting on this blog for quite a while. Being six weeks away from my due date, it is obviously on my mind. Just in time, Ricki Lake and Abby Epstein, the makers of the film "The Business of Being Born" have come out with the uninspiredly titled sequel "More Business of Being Born". Or, more accurately, four sequels. They felt that there were many issues surrounding childbirth that were not addressed in their first film and so they decided to explore as many as possible in their follow-up.
Here is the trailer
In Part 1, Ricki and Abby visit Ina May Gaskin, often called the mother of modern midwifery on her famous Farm. In Part 2, they interview celebrities about birth and their choices. Part 3 is called Exploring Options, giving more information on doulas, birthing centers and c-sections.
I haven't watched any of these yet, but last night while cooking yet again, I downloaded and watched Part 4- The VBAC Dilemma. As many of you know, VBAC (Vaginal Birth After Cesarean) is a topic close to my heart.
That is because Y. was born via c-section in 2005 and since then I have had 2 wonderful, uncomplicated VBACs and am gearing up for another one soon.
It frustrates me that the VBAC-rate in the US is so abysmal. Many doctors will refuse to even consider them or often tell patients things like: "Yes, you can try for a VBAC but just be aware that your uterus can explode any minute and you and your baby might die!" While uterine rupture is a very serious complication that I am not trying to downplay at all, the truth is that the likelihood of rupture is somewhere between .3 and .7%, less than 1 in 100. And that means any kind of tear in the uterus. The likelihood of a catastrophic and life-threatening rupture is 1 in 2000. As one of the doctors in the movie points out, the likelihood of miscarriage from an amniocentesis is 1 in 200, yet many women are comfortable taking that chance.
I have to admit that having done my research already, I did not learn a lot of new things about VBAC from the movie. Still, I think it was well done and for someone just at the beginning of their journey, trying to find out more information, this is a great resource. It offers a lot of facts and statistics, as well as some personal stories about VBAC. It explains both sides of the issue, trying to separate real health concerns from ones that are inflated and dramatized. It also talks about the risks of repeat cesarean, that doctors often do not share with their patients.
Part 4 of the movie can be watched for a small fee on the Business of Being Born website. You can also get more info on the other parts of the movie as well as the planned dates of screening. Surprisingly, there do not seem to be any screenings scheduled for New York at the moment.
That brings me to the end of my long and slightly rambling post. Wishing everyone a Chag Sameach and see you on the other end of yet another 3 day yomtov marathon :)
Wednesday, July 28, 2010
New VBAC guidelines
I have been so busy enjoying my vacation that I almost forgot to blog about some significant changes regarding childbirth in the US. Right on the heels of the Midwifery Modernization Act, ACOG- The American College of Obstetricians and Gynocologists have put out new guidelines and recommendations for VBAC- Vaginal Birth after Cesarean.
A quote from their press release states: "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."
Furthermore, they say :"In addition to providing an option for those who want the experience of a vaginal birth, VBAC has several potential health advantages for women. Women who achieve VBAC avoid major abdominal surgery, resulting in lower rates of hemorrhage, infection, and a shorter recovery period compared with elective repeat cesarean delivery. Additionally, for those considering larger families, VBAC may avoid potential future maternal consequences of multiple cesarean deliveries such as hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as placenta previa and placenta accreta."
Basically, doctors are admitting what the research has shown all along; that VBAC is a safe option for most women. What remains to be seen is if this statement will actually change the standards of practice of most OBs. Is it still possible to change the high rate of repeat cesareans and to allow more woman a trial of labor? I guess we will have to wait and see. To see the full press release, just click here.
A quote from their press release states: "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."
Furthermore, they say :"In addition to providing an option for those who want the experience of a vaginal birth, VBAC has several potential health advantages for women. Women who achieve VBAC avoid major abdominal surgery, resulting in lower rates of hemorrhage, infection, and a shorter recovery period compared with elective repeat cesarean delivery. Additionally, for those considering larger families, VBAC may avoid potential future maternal consequences of multiple cesarean deliveries such as hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as placenta previa and placenta accreta."
Basically, doctors are admitting what the research has shown all along; that VBAC is a safe option for most women. What remains to be seen is if this statement will actually change the standards of practice of most OBs. Is it still possible to change the high rate of repeat cesareans and to allow more woman a trial of labor? I guess we will have to wait and see. To see the full press release, just click here.
Monday, June 21, 2010
Once a VBAC, always a VBAC?
Recently, I finally had my long overdue annual exam at my Ob-gyn. Always a "fun" experience as I am sure many will agree.
I took this opportunity to ask my doctor if I am still considered a VBAC and therefor more high-risk, even after already having 2 successful VBACs. I find it frustrating to be limited in my choices. For example, most Birthing Centers will not accept VBACs. Some doctors (not mine, thank goodness, although one of his partners does) insist on continuous monitoring for VBACs. This even though the evidence shows that there is no difference in outcomes between intermittent and continuous monitoring.
In case you are wondering, I am not pregnant, but as a doula, I can't help thinking about these things a lot, especially because I discuss them frequently with my clients.
My doctor's answer was pretty much "yes and no." On the one hand, my two successful VBACS clearly prove that I can give birth vaginally and that I should have no problem doing so in the future. On the other hand, a uterine scar is still a uterine scar and is something that needs to be taken into account. That may mean no birth center birth but that does not mean that I cannot have a low intervention, normal childbirth experience elsewhere. I just need to advocate for myself, choose the right care provider and make it happen.
I was thinking that very few people have a picture perfect pregnancy. Someone may have high blood pressure, gestational diabetes or some other minor kink. Even if they do not, something may come up unexpectedly in labor. Like my previous cesarean, these issues should obviously be taken into account but they do not need to totally dictate a woman's experience. Basically, you make the accomodations you need to make, and you move on. Changing one thing does not mean having to change everything.
It was an interesting thought. Don't think about the things you can not have, rather work with what you do have. And that is usually plenty.
I took this opportunity to ask my doctor if I am still considered a VBAC and therefor more high-risk, even after already having 2 successful VBACs. I find it frustrating to be limited in my choices. For example, most Birthing Centers will not accept VBACs. Some doctors (not mine, thank goodness, although one of his partners does) insist on continuous monitoring for VBACs. This even though the evidence shows that there is no difference in outcomes between intermittent and continuous monitoring.
In case you are wondering, I am not pregnant, but as a doula, I can't help thinking about these things a lot, especially because I discuss them frequently with my clients.
My doctor's answer was pretty much "yes and no." On the one hand, my two successful VBACS clearly prove that I can give birth vaginally and that I should have no problem doing so in the future. On the other hand, a uterine scar is still a uterine scar and is something that needs to be taken into account. That may mean no birth center birth but that does not mean that I cannot have a low intervention, normal childbirth experience elsewhere. I just need to advocate for myself, choose the right care provider and make it happen.
I was thinking that very few people have a picture perfect pregnancy. Someone may have high blood pressure, gestational diabetes or some other minor kink. Even if they do not, something may come up unexpectedly in labor. Like my previous cesarean, these issues should obviously be taken into account but they do not need to totally dictate a woman's experience. Basically, you make the accomodations you need to make, and you move on. Changing one thing does not mean having to change everything.
It was an interesting thought. Don't think about the things you can not have, rather work with what you do have. And that is usually plenty.
Thursday, March 4, 2010
VBAC- a vital option
In anticipation of the National Institue of Health's policy conference on VBAC next week and ICAN's blog carnival on this topic, I wanted to share some thoughts on VBAC.
For the uninitiated, VBAC stands for Vaginal Birth After Caserean. It is a subject that is near and dear to my heart, not just because I am a doula but because I have had two successful VBACs myself.
The question posed is, why is VBAC a vital option. To my mind, the more important question may be- how can VBAC not be an option for so many women? How can we be limiting women in the size of their families, subjecting them to major abdominal surgery and depriving them of the life-changing opportunity to find their own inner strength? All this is done in the name of safety although it is not so clear that a Cesarean is a safer option than a VBAC.
Let's start at the beginning. The main risk to VBACs is that of uterine rupture. Although there are differing numbers, the risk is usually thought to be 1 in 100. That may seem like a high risk for someone to take, but consider these factors and risks associated with cesarean sections- higher rates of infant and maternal mortality, risks of infection, double the bloodloss of a vaginal birth, complications such as adhesions to scar tissue as well as the life threatening complications of placenta previa, accreta or percreta in following pregnancies.
Not to mention that the baby is subjected to drugs during the surgery, there is a delay in mother-infant bonding, and cesareans are associated with greater difficulties establishing breastfeeding. Additionally, the more difficult recovery can affect the mother's ability to care for her newborn.
I was fortunate to have had my first VBAC in Israel, a country where doctors are more open to VBACs in general. The large orthodox Jewish population who aspire to big families has motivated doctors to shy away from automatic repeat cesareans. While he did insist on the protocol of continuous monitoring, I felt confident that my care provider was committed to my VBAC and I indeed had a wonderful experience.
Once I moved to the US, a different picture started to emerge. Because of my husband's pastoral involvements, I was privileged to be part of many life cycle events, particularly celebrations of births. Over and over I would hear the same stories- primary cesareans for failure to progress, botched inductions and twins. Repeat cesareans because the doctor convinced the woman that the risks of VBACs were just too great, whereas the risks of cesarean where virtually non-existent (untruth #1). Additionally, they would often question a woman's ability to birth vaginally, thereby destroying any confidence she may have had in her body (untruth #2).
Women who had already scheduled their sections were told to come to the hospital if by chance they went into labor because their uterus may burst any minute (untruth #3).
If, for whatever reason a woman was allowed a trial of labor, she often did not get very far before a cesarean was recommended. During these surgeries, the doctors would often say how fortunate it was that a c-section was performed because they could see that the uterus would not have withstood the "stress" of labor and delivery. How doctors could make such claims I still do not know (untruth #4).
When I was expecting my third child I was determined to find a care provider who supported my desire for a VBAC. I was not interested in becoming another statistic.
I had a wonderful experience and I felt greatful and empowered. I was also aware that my positive birth experiences are a product of the choices I made- to educate myself, to know my options and advocate for myself.
That is part of what is missing in our maternity care- women don't know what their options are. They do not know what questions to ask and although they consent to procedures performed on them, it is not informed consent because they often do not understand the risks involved and do not know that there are alternatives.
It is unfortunate that there are many places where a woman cannot try for a VBAC because the hospital policy does not allow for it. The fear of litigations and the constraints of malpractice insurance have created some difficult scenarios for careproviders and pregnant women alike.
I am curious to hear what the outcome of the NIH conference will be. VBAC is a vital option because it is a viable option for the vast majority of women, if we would only believe in them and give them the tools to succeed.
For the uninitiated, VBAC stands for Vaginal Birth After Caserean. It is a subject that is near and dear to my heart, not just because I am a doula but because I have had two successful VBACs myself.
The question posed is, why is VBAC a vital option. To my mind, the more important question may be- how can VBAC not be an option for so many women? How can we be limiting women in the size of their families, subjecting them to major abdominal surgery and depriving them of the life-changing opportunity to find their own inner strength? All this is done in the name of safety although it is not so clear that a Cesarean is a safer option than a VBAC.
Let's start at the beginning. The main risk to VBACs is that of uterine rupture. Although there are differing numbers, the risk is usually thought to be 1 in 100. That may seem like a high risk for someone to take, but consider these factors and risks associated with cesarean sections- higher rates of infant and maternal mortality, risks of infection, double the bloodloss of a vaginal birth, complications such as adhesions to scar tissue as well as the life threatening complications of placenta previa, accreta or percreta in following pregnancies.
Not to mention that the baby is subjected to drugs during the surgery, there is a delay in mother-infant bonding, and cesareans are associated with greater difficulties establishing breastfeeding. Additionally, the more difficult recovery can affect the mother's ability to care for her newborn.
I was fortunate to have had my first VBAC in Israel, a country where doctors are more open to VBACs in general. The large orthodox Jewish population who aspire to big families has motivated doctors to shy away from automatic repeat cesareans. While he did insist on the protocol of continuous monitoring, I felt confident that my care provider was committed to my VBAC and I indeed had a wonderful experience.
Once I moved to the US, a different picture started to emerge. Because of my husband's pastoral involvements, I was privileged to be part of many life cycle events, particularly celebrations of births. Over and over I would hear the same stories- primary cesareans for failure to progress, botched inductions and twins. Repeat cesareans because the doctor convinced the woman that the risks of VBACs were just too great, whereas the risks of cesarean where virtually non-existent (untruth #1). Additionally, they would often question a woman's ability to birth vaginally, thereby destroying any confidence she may have had in her body (untruth #2).
Women who had already scheduled their sections were told to come to the hospital if by chance they went into labor because their uterus may burst any minute (untruth #3).
If, for whatever reason a woman was allowed a trial of labor, she often did not get very far before a cesarean was recommended. During these surgeries, the doctors would often say how fortunate it was that a c-section was performed because they could see that the uterus would not have withstood the "stress" of labor and delivery. How doctors could make such claims I still do not know (untruth #4).
When I was expecting my third child I was determined to find a care provider who supported my desire for a VBAC. I was not interested in becoming another statistic.
I had a wonderful experience and I felt greatful and empowered. I was also aware that my positive birth experiences are a product of the choices I made- to educate myself, to know my options and advocate for myself.
That is part of what is missing in our maternity care- women don't know what their options are. They do not know what questions to ask and although they consent to procedures performed on them, it is not informed consent because they often do not understand the risks involved and do not know that there are alternatives.
It is unfortunate that there are many places where a woman cannot try for a VBAC because the hospital policy does not allow for it. The fear of litigations and the constraints of malpractice insurance have created some difficult scenarios for careproviders and pregnant women alike.
I am curious to hear what the outcome of the NIH conference will be. VBAC is a vital option because it is a viable option for the vast majority of women, if we would only believe in them and give them the tools to succeed.
Subscribe to:
Posts (Atom)