VBACs - making a come back

This month, the National Institutes of Health (NIH) held a conference to review new findings on Vaginal Birth after Cesareans (VBACs). An important conclusion from this conference was that - given the available evidence, Trial of Labor (TOL) is a reasonable option for many pregnant women with a prior low transverse uterine incision. This shift in medical thinking is a promising start to return to more evidence-based practices that can help women understand their options for birth.

Data on births in the US show that in the mid-nineties, there was a steady increase in women having access to VBACs. In 1996 VBAC rates peeked at 28.3% while the cesarean rates were at 20.7%. Most recent data from 2005 show that VBAC rates have dropped to 7.9% while cesarean rates have soared to over 30%. Today, one in three women in the US is giving birth via c-sections with fewer options to attempt a vaginal birth for future births. Unfortunately, reasons cited for VBAC plummeting by the late 1990s have more to do with the American College of Obstetricians and Gynecologists (ACOG) restrictive recommendations and guidelines on VBACs and increased malpractice insurance fees, than with evidence-based assessment of each woman’s unique birth experience and circumstance.

Consumer advocate groups like the International Cesarean Awareness Network (ICAN) and Coalition for Improving Maternal Services (CIMS) provide strong voices to educate parents to make informed decisions on birth choices and preparing for subsequent births after a Cesarean. Similar to many aspects of childbirth, we moms must continue to do our research and be our own best advocates. Good starting points include educating ourselves, finding community and support, and exploring options with our healthcare provider early in our pregnancy. Below are a few suggestions for getting started:

Educate ourselves:

Blossom Birth now offers a new VBAC Refresher class, an opportunity to explore the reasons for and feelings about your previous birth so that you can more easily move towards a successful trial of labor and VBAC. This class provides a comprehensive birth refresher class, including reminders of stages of labor, physical and emotional comfort techniques, questions to ask your care provider and helpful tips for partners.  

Find community:

ICAN San Jose Chapter holds free monthly meetings on the second Tuesday evening of every month at Blossom Birth. ICAN’s website also provides an online community and other educational resources.

Explore your options with your healthcare provider:

CIMS has recently published an updated factsheet on “The Risks of Cesarean Section” and “A Checklist for Expectant Mothers” to help expectant parents explore options with their healthcare provider. 


-Mora 

Preparing for Birth Beyond the Physical

With all the medical assessments in pregnancy- blood pressure, weight checks, ultrasounds, and more- it’s really easy to focus on the physical experience of pregnancy, labor, and birth.  But what about the emotional and spiritual sides?  As pregnant moms, we rarely get the opportunity to slow down, connect with the divine being growing inside of us, and consider our own emotional needs as we approach parenthood.  Nevertheless, it’s an extremely important part of pregnancy and unresolved issues can often create obstacles during labor.  (See Ina May Gaskin's books Ina May's Guide to Childbirth and Spiritual Midwifery, both available in Blossom's Lending Library.)

Recent scientific research supports the connection between mind and body.   When one stops to think about it, it’s really no surprise that emotional issues play a part in how labor unfolds.  Yet most women put much more emphasis on preparing physically for the event.  Chances are, most women just don’t even know where to begin to prepare emotionally.  Few health care providers draw attention to the importance of emotional health during pregnancy and friends and family may not know how to approach the issue either.  And while many birth classes will bring up the mind-body connection, it’s not usually the most appropriate forum to “do the work.”  

Prenatal yoga is an excellent starting place, with time to “go inward.”  Meditation techniques practiced in yoga class help the mom-to-be to notice what her mind tends to do and how it may affect her body.  And for many moms, it may be the only place where they can let everything else go and just BE pregnant.

Having already given birth and having years of supporting other moms through prenatal yoga and childbirth education under my belt, I wanted to do something special as I awaited the birth of my second child in 2008, but wasn’t sure what.  Most of the birth classes available to me, I was qualified to teach and I felt completely prepared on a physical level.  Fortunately, just before conceiving I met Elisabeth Manning, who expressed a desire to offer her services at Blossom.  By my sixth month, we had BabySpirit Meditation scheduled.  It was the best preparation I could have done during my second pregnancy, and I welcomed the opportunity to commit to connecting with my baby-to-be.  What I didn’t bargain for was how profoundly the experience would affect other areas of my life, particularly my challenging relationship with my first child. Through Elisabeth’s group, I was able to recognize our underlying issues, and find a new direction to repair the disconnection we had suffered in our relationship.

Currently, I am awaiting the birth of my third child due this July.   I have returned to BabySpirit with Elisabeth to take that special time to just be pregnant and connect with myself and my baby.  This time around, I am giving myself the gift of going even deeper and doing some private sessions with her as well.  I am amazed how much I learn about myself, my children, and our relationships with each other with Elisabeth’s amazingly intuitive guidance.  My birth experience with my son two years ago was incredible and I am confident that the work I am doing on a spiritual and emotional level will benefit my next birth experience as well. 

I encourage all moms to spend some time preparing for their birth beyond the physical realm.  Getting in touch with “old wounds,” spending the time to listen to your baby’s spirit, and considering the connection between all family members is so important during this transformative journey.  Pregnancy can be an amazing time of introspection and heightened intuitiveness- take advantage of this gift!  In addition to Prenatal Yoga and BabySpirit Meditation, Blossom’s Prenatal and Postpartum Moods and Challenges group is a safe place to find emotional support.  There are many providers on Blossom’s Provider List as well that can help- from Counselors to Coaches to Blessingway services (a ceremony to honor the transition into motherhood) and more.  And if you would like to explore this side of pregnancy, but you are not sure where to begin, don’t hesitate to give us a call- we can help point you to resources that will serve you best.  May your journey to parenthood be emotionally rewarding and full!
-Jeanna