When a woman learns she is expecting, she will often have a lot of expectations for her pregnancy and birth experience. Which is completely natural.
Finding a provider is always the first step in your birth plan. Making sure that your desires for your experience are going to be respected is like laying the ground work for not only your birth, but also for your pre natal care during your pregnancy. If you do not have someone who is friendly to patients “calling the shots” then you may run into some issues along your journey.
There are a lot of misunderstandings when it comes to birth plans. They are not a final blue print of the birth you will have because in some cases there are situations or emergencies that come up that we could never imagine planning for, but there are some things Moms can do to help avoid those emergencies arising as some of the commonly seen emergencies can and are caused by frequent intervention in the birth process.
But to get started on writing what you want, you should sit down with your partner, or by yourself, or maybe even with your doula to see what you have in mind for your birth experience. A couple questions you can start with to help lay your ground work are…
Where do you want to give birth?
Hospital
Home
Birth Center
During labor do you want to be mobile or remain in bed?
Do you want an IV in place during birth, or an alternative such as a heparin/saline lock or nothing at all.
Be sure to find out what your hospitals policy is about IV’s being in place during labor and birth. Many today require mom’s to have a line of access at all times. This also makes it easier for labor drugs such as pitocin to be used.
Do you want to wear your own clothes?
Would you like to use the shower, or even a bath tub while you are in labor?
Finding out what kind of luxuries your hospital labor and delivery rooms have available is also key. Many hospitals do NOT offer birthing tubs for laboring mothers.
Would you like to listen to music?
Then there are the more “medical” questions that you need to take into consideration.
How do you feel about labor induction?
What methods of pain relief are you comfortable with?
Epidural Anesthesia
IV Pain relief such as a narcotic
Acupressure
Massage
How do you feel about episiotomies?
Would you rather tear naturally than receive an episiotomy?
Are you planning on breastfeeding?
If you are planning to breast feed, it is a smart idea to put a sign or something small in the bassinet of the baby telling hospital staff the baby is breast fed only, and you do not wish for the baby to have any bottles or pacifiers.
Also, if you are planning on breastfeeding, you should look into the lactation consultant services at the specific hospital to help make your experience easier for you and your baby!
If you expect hospital staff, including your provider to discuss all procedures with you before doing them, make sure you include this in your plan.
If you would like to be able to eat, and drink during labor, be sure to discuss this with your provider prior to labor also.
Some mothers may need special attention due to conditions such as gestational diabetes or group B strep. If you are one of these mothers, be sure to include this in your birth plan so that hospital staff knows these things and provides you care accordingly.
Be sure to go over your wishes before entering the hospital for your birth. If your provider is already aware of your wishes, and has a copy of your birth plan in your medical chart it will make the experience easier on you, as well as the hospital staff.
In the case that your provider does not or will not go by what you would like for your birth plan, it may be a wise idea to look into switching providers. It is never too late to change during your pregnancy, and if you cannot agree with simple requests that may be important to you, it may only cause more harm than good in the long run.
Remember, this is your birth experience, you are the boss and you make the calls!
Recently I came across a great video on Youtube which features Dr. Stuart Fischbien speaking about the safety of Vaginal Birth after Cesarean which has turned into such a hot button topic in our society today since the VBAC rate took a nose dive in the past decade.
In 1996, the VBAC rate was upwards of 28.3%, the highest it ever has been. Now we are seeing VBAC rates in some states of 6% or less which is really sad.
Between misinformation given by word of mouth, and even some health care providers women are making the choice to have elective major surgery over attempting for a natural birth. Another problem is the amount of hospitals that are taking on unlawful bans on VBAC, which leaves many mothers with no choices other than birth at home, birth alone, or sign up for surgery. It is estimated that half of the Nations hospitals currently ban VBAC.
But what is the problem with the misinformation about this procedure? It is not only putting mothers at risk, but also their babies.
Many women are under the impression that having a repeat cesarean section is the safest option, but in reality for the vast majority of low risk mothers, that is not the case. The safest option would be a vaginal birth after cesarean section. But many factors sway women away from this choice.
One being the risk of uterine rupture, which in healthy, low risk women is less than 1%. What is not being told to these women that any time after you have a cesarean section, during a pregnancy you run the risk of uterine rupture, not just if you go into labor, or try to give birth.
But the risks of VBAC do not outweigh the risks of major surgery.
In the video below, Dr. Stuart Fischbein, a California based OB/GYN who has been in practice for years talks about the safety of VBAC and common misconceptions in our society today.
Why is it so important in our society today to teach our children the lessons of tolerance? Well the actions of three cowardly men hiding their faces behind masks and nazi flags showed us why we need to teach our children to be accepting of all people this past Sunday night while a small group of families gathered on the Fairfield green to celebrate the third night of Hanukkah and light the menorah. In an attempt to intimidate the families peacefully celebrating their holiday, they did nothing but bring attention to themselves. Which is for sure what they were doing for.
But we have to step back and ask ourselves, what breeds this kind of ignorant hate? Nearly 70 years after the disgusting genocide of the Jewish in Nazi Germany, we still have people today, who were not even a thought during this mass murder, who are following the hate that was instilled in ignorance. Where do these people learn these lessons from, because babies are not born with hate in their hearts, it is something they are taught over time.
With the melting pot we call America, we need to step back and teach our children to be accepting and loving of all people from all walks of life, not just those who are like us, if we don’t, what kind of world will we create for our children? There is already enough hate, violence, and war, why teach more?
Lately I have taken a lot of time to sit down and look at some numbers for the past almost 40 years.
Maternity, cesarean section, Vaginal Birth After Cesarean (VBAC) and Maternal Mortality numbers, and I found some shocking patterns. While I am not statistics professor and I am clearly not a medical professional, the patterns that some of these numbers show us is alarming to say the least.
Because of lack of standardized reporting, many of the numbers before 1980 were not regulated or actually accurately kept, so this is all I was able to find through the CDC.
Starting around 1980, we see the maternal mortality rate start to decrease, while the number of cesarean sections increase, as well as the number of VBAC’s. Which is a good thing, anytime the maternal mortality rate decreases, it is good. Sadly we still lack behind the majority of other industrialized nations in the world when it comes to Maternal, as well as neo natal mortality rates.
During 1996 we see two things that stand out the most, the lowest maternal mortality rate, as well as the highest number of Vaginal Birth’s after cesarean sections, although the c-section rate is still too high according to the World Health Organization standards. But then once 1997 comes we not only see an increase in maternal mortality, but we start to see a decrease in VBAC’s which never recovers.
1998 till the represent numbers in 2003 how how not only the VBAC numbers suffered, dropping over 17% but also the maternal mortality rate started to increase again, but to an alarming 12.1 per 100,000 live births in the United States.
The decrease in VBAC’s as well as VBAC access is a controversial issue. Not only are hospitals decreasing access to VBAC, but they are doing it at drastic rates. Here are a couple alarming numbers for you.
Since 1996 the c-section rate in the United States has increased 50%.
8% of women who previously had c-sections had a VBAC in 2006.
28% of hospitals in the United States do not ALLOW VBAC.
0.7% of women rupture their uterus while attempting a VBAC.
The last number is something I want to focus on because this is the main risk that Doctors use in discouraging mothers to choose VBAC. They do not tell you that according to this statistic, you are more likely to get struck by lightening twice in your lifetime, or you are two more times likely to be murdered, or even twice as likely to have your car stolen in ONE year. But they are using this as a big scare tactic for discouraging women to sign up for surgery.
The problem is, the huge risks of repeat cesareans are being sugar coated. They are not discussing the risk of uterine rupture any time during pregnancy with these women. Uterine rupture can and does happen to women any time during pregnancy, not just while attempting to deliver vaginally. They do not tell you that you are more likely to be re-hospitalized in the following weeks after your surgery, suffer infection, increased risk of your uterus adhering to other organs such as your bladder, and the laundry list of problems that comes with abdominal surgery after abdominal surgery.
What else? Increases your risk of a blood transfusion, hysterectomy, Placenta accreta which is when the placenta actually grows into the walls of the uterus making a hysterectomy a common result. And these are also things we are seeing in increased numbers over the past 30 years.
In a recent blog, Michele Demont of BirthCut a website for post cesarean section mothers to express their feelings, blogged about ‘The Gift that Keeps on Giving” which details the amount of complications mothers are experiencing due to cesarean sections, but now we are just starting to see the long term effects because in the past 30 years, the cesarean section rate has drastically increased.
“Another article talks about one study where the rate of placenta accreta in women that had placenta previa with no prior cesareans was 5%, but if she had one prior cesarean it was 25%, 2 or more prior cesareans, the rate jumped to 50%.”
Frightening numbers that women are not being informed about up front when signing up for their cesarean sections, or repeat cesarean sections.
The problem we are seeing is defensive medicine, not evidence based medicine being practiced and sadly the women of childbearing age are becoming the victims of this system. Another article that I came across in the past couple weeks is from Jill who writes her own blog called The Unnecessarean. She discussed Multiple Cesarean Sections and the Long Term problems. In the piece, Jill discusses an e-mail she got from a reader regarding their mothers health after having two cesarean sections almost 40 years ago.
“Twenty or so years later, I had to rush my mother to the emergency room, and then consent to surgery (she was already comatose) to address what turned out to be a direct result of her two C-sections. The scar had opened up on the inside and her small intestine got tangled into the incision, causing a blockage severe enough that she nearly died.
A year later, it happened again with a different part of the incision. At that point, the surgeon elected to go ahead and open the entire incision back up and then re-sew it with a reinforcing plastic-type mesh to prevent it from opening again.
So my mother’s two major surgeries for having children ultimately resulted in two *more* major surgeries, when she was twenty years older and thus less able to bounce back. It was the beginning of a downhill spiral in her overall health.”
Shared the reader who chose to share this situation with Jill. Still we are not seeing this at large enough number for concern YET because we look back to the 1970′s and c-sections were not nearly as wide spread as they are today. 5.5% in 1970 compared to 31.8% in 2007 is a huge difference. What are we going to see over the next two decades in Maternal Health?
Last I just want to address VBAC Vs. Elective Repeat Cesarean Section. No matter how many studies, reports, information, or even just internet websites, they all say the same thing, VBAC is safer than repeat surgery. There are cases in which mothers have specific health issues, or results from their previous cesarean section that make VBAC a riskier choice, and a repeat cesarean may be warranted, but in Connecticut, only 6% of women in 2007 chose a VBAC over having a repeat cesarean section.
That may have to do with the strict rules local hospitals have put in place, or the hospitals such as Charolette Hungerford, St. Vincent’s Medical Center, Day Kimball Hospital, and Johnson Memorial Hospital. All of which do not allow women to make informed choices about their own maternity care, instead they are forced into a repeat cesarean section if they would like to birth there.
Sometimes, as much as I hate to even think about it, you need to let a baby cry. I hate this and I never thought in a million years I would be a “cry it out” parent. With my oldest I never let him cry, and he has turned out fine, not spoiled, no issues. But it seems as though this time around we need to allow our youngest to cry. Nap time, bed time, really any time he is tired it has turned into a screaming fit until he falls asleep. Not by my choice, but by his own.
I never thought a almost 7 month old would be able to make his own decisions about things, but he certainly has picked his own route and that is to cry till he falls asleep.
He could be in his swing, being held, rocked, in the bouncer, or anyplace, he just wants to scream until he finally falls asleep.
It breaks my heart to hear him cry, like a crying baby should do to any parent, but sometimes we just have no other choice as parents. Hence picking your battles.
I hate hearing him cry, but sometimes it just what HE needs and I need to tell myself that, just like any parent needs to tell themselves.
We all will have these moments like I have had dealing with this the past couple days. Moments where we feel like bad parents, it happens. No one is perfect and no matter what we do as parents, we are not going to be the worlds best parent, but we are certainly all the best that we can be for our children, and that is what should matter at the end of the day.
Moral of the story, sometimes the kids win the battle.
I never thought a day in my life, that even when I had children, I would have a difficult time balancing a social life on top of being a mother, and I think a lot of mothers have this same mind set. And then we become parents and realize how little time there really is to be mom, and still continue the active social life that we once had. Even with a super involved husband like I have, I find it hard to get out alone to meet with friends, or even just go to get a manicure or pedicure which are some essentials as a woman. (Haha)
Last night was a girls night out that I had been planning for nearly two months with a couple associates of mine, and last Friday we had a loss in our family. I found myself starting to make excuses not to attend the much needed Girls Night Out/Christmas Party because of all the added stress I had going on, and then when it finally came down to it, one of the women attending, and my husband made me go. I realized then that I need to do that at least once a month, whether it is dinner with the girls, or just going to the mall for some retail therapy alone.
It made me start to think about all the women who are in the same position as myself, and how important it is for us to make time for ourselves. We were women, friends, independent, and people before we were mothers. We had our own identities, and our own things we enjoyed to do, and just because you become a mother does not mean you are ONLY a mother.
Take some time ladies!
Go out and shop, get your nails or hair done, have dinner with your girlfriends you feel like you haven’t seen in ages…
Just get out!
Believe me, it will make a world of difference and it will help re-charge the mom in you until the next time you can get out and do you for a little while.
Thank you to ICAN for making this amazing brochure to help women all across the world. For those who are unable or have not seen the brochure at this point, I took the time to type out most of the information on it.
Make an informed choice about the risks of repeat cesareans Vs. VBAC.
Cesarean sections are major abdominal surgery, and like all surgery, carry the risks of complications. These can include dense adhesion’s, excessive scar tissue growth that connects the uterus to surrounding tissues and organs. Adhesion’s can increase the risk of longer operation times and injury to adjacent organs. The risk of hysterectomy, or the surgical removal of the uterus, also rises. Undergoing repeated cesareans make it more likely a woman will experience placenta accreta, in which the placenta grows into the middle layer of the uterus, possibly causing hemorrhage and requiring a hysterectomy.
A woman who has repeat cesareans can also be more likely to experience thromboebolisms (blood clots that break lose and block vessels), or experience blood loss. And while uterine rupture (a rare but potentially catastrophic event during pregnancy or childbirth in which the uterine wall splits open) remains a concern after one or more cesareans, the risk of uterine rupture is small, and it decreases further with each additional VBAC.
Lets Look at the numbers….
1st Cesarean
Risk of Hysterectomy : 0.65% (1 in 154)
Risk of Blood Transfusion : 4.05% (1 in 25)
Risk of Placenta Accreta : 0.24% (1 in 417)
1st VBAC
Chance of Successful VBAC : 63.3% (2 in 3)
Risk of Uterine Rupture : 0.87% (1 in 115)
Risk of Hysterectomy : 0.23% (1 in 435)
Risk of Blood Transfusion : 1.89% (1 in 53)
2nd Cesarean
Risk of Hysterectomy : 0.42% (1 in 238)
Risk of Blood Transfusion : 1.53% (1 in 65)
Risk of Placenta Accreta : 0.31% (1 in 325)
Risk of Major Complications : 4.3% (1 in 23)
Risk of Dense Adhesion’s : 21.6% (1 in 5)
2nd VBAC
Chance of Successful VBAC : 87.6% (9 in 10)
Risk of Uterine Rupture : 0.45% (1 in 222)
Risk of Hysterectomy : 0.17% (1 in 588)
Risk of Blood Transfusion : 1.24% (1 in 81)
3rd Cesarean
Risk of Hysterectomy : 0.9% (1 in 111)
Risk of Blood Transfusion : 2.26% (1 in 44)
Risk of Placenta Accreta : 0.57% (1 in 165)
Risk of Major Complications : 7.5% (1 in 13)
Risk of Dense Adhesion’s : 32.2% (1 in 3)
3rd VBAC
Chance of Successful VBAC : 90.9% (9 in 10)
Risk of Uterine Rupture : 0.38% (1 in 263)
Risk of Hysterectomy : 0.06% (1 in 1667)
Risk of Blood Transfusion : 0.99% (1 in 101)
4th Cesarean
Risk of Hysterectomy : 2.41% (1 in 41)
Risk of Blood Transfusion : 3.65% (1 in 27)
Risk of Placenta Accreta : 2.13% (1 in 47)
Risk of Major Complications : 12.5% (1 in
Risk of Dense Adhesion’s : 42.2% (2 in 5)
Note : “Major complications” include one of more of the following : uterine rupture, hysterectomy, additional surgery due to hemorrhage, injury to the bladder or bowel, thromboembolism, and/or excessive blood loss.
Sources : Mercer, B. M., & Gilbert, S. et al. Labor Outcomes with increasing number or prior vaginal births after a cesarean delivery. Obstetrics & Gynocology 2008; 111: 285-291.
Silver, R.M, & Landom M. B., et al. Maternal morbidity associated with multiple repeat cesarean deliveres. Obstetrics & Gynocology. 2006; 107: 1226-1232.
All VBAC statistics for this are taken from the Mercer & Gilbert study in which includes induced and augmented labors. Additional studies have shown lower uterine rupture rates (especially with spontaneous labors) and higher VBAC success rates.
Remember that tonight, on the biggest drinking nights of the year.
There are people out and about with their families and children traveling to their destinations for their Holiday tomorrow.
If you are going to go out and drink, do the right thing and have a designated driver or call a cab.
