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A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations

September 7, 2010 By A Woman's Guide to VBAC 1 Comment

In June 2010, a National Institutes of Health (NIH) panel published a Consensus Development Conference Statement on vaginal birth after cesarean (VBAC).

In addition to examining the current evidence related to VBAC and offering recommendations for future research on this topic, the NIH panel concluded that VBAC was a “reasonable option” for most women with a previous cesarean section.

In the context of a current birth climate that can be somewhat hostile toward VBAC, this was an exciting moment for many birth advocates, maternity care providers, and mothers!

But even with all that is included in the NIH Statement on VBAC, it might be difficult for many of us to wade through the information in it and figure out what it means for us and our particular birth options and unique circumstances.

This is where the guide comes into play.

A group of maternity care experts and VBAC advocates came together to address the most common and pressing questions women may have about their birth choices in what could be called the “post-NIH-Consensus-Recommendations Era.” We hope this guide gives you the tools you need to empower yourself to advocate for you, your baby, and your birth choices!

 

The sections of A Woman’s Guide to VBAC

 

The Inspiration for this Project

The concept for this guide was borne out of many things: the timeliness of the NIH panel’s statement on VBAC, the importance of the statement itself, and our personal interest in advocating for women seeking vaginal birth after cesarean.

But we would be remiss if we didn’t acknowledge another source of my inspiration for this project: namely, the heartfelt and heartening consumer participation in the NIH Consensus Development Conference on Vaginal Birth After Cesarean.

As women who were lucky enough to attend the NIH Consensus Conference on VBAC in person (Kristen) or view the entire proceedings in real time by webcast (Amy), we can say with some certainty that consumers – that is, the mothers, doulas, midwives, nurses, doctors, and other birth advocates who traveled from near and far and volunteered their time to attend—played a big role in this conference!

We listened, we read, we talked with one another, we got the word out to women who couldn’t participate in the meeting, and we asked some of the most incisive questions of the entire conference proceedings.

Quite simply, we made a difference.

This guide is dedicated to those consumers—and to all of us who are maternity care consumers, whether we are currently pregnant, have been pregnant, or simply work and advocate on behalf of pregnant women.
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What exactly is a National Institutes of Health Consensus Development Statement?

This statement is the product of an NIH Consensus Development Conference. These two-and-a-half day conferences—which are free and open to the public—are organized by the NIH to address issues in medicine that are both controversial and pertinent to health care providers and the general public.

During the NIH Consensus Development Conference on VBAC, an independent panel listened to presentations given by invited expert speakers. The panel also heard input from members of the general public during Q&A sessions. Finally, drawing upon the conference proceedings and upon a systematic review of the evidence on VBAC, the panel drafted their statement on VBAC.

Like all Consensus Development Statements, the statement on VBAC is not legally binding. It does not create practice guidelines, nor does it establish any health policies. Nonetheless, it is still an exceedingly important document. In fact, because of the high-quality evidence that the NIH panel uses to create consensus development statements, the NIH claims that it is “reasonable to expect that the panel will be able to give clinical guidance” to care providers.

Filed Under A Woman's Guide to VBAC, Birth, Birth plans, Choosing a care provider, Featured Post, Pregnancy, Preparing for VBAC Tagged With A Woman's Guide to VBAC

A First Timer’s Experience with Childbirth Class

September 1, 2010 By Cara Terreri 2 Comments

Today’s post is a guest post interview with Ann Romero, a new mom and staff member at Lamaze International. She shares her experience with taking a Lamaze childbirth education class as a new mom-to-be.

Why did you decide to attend a childbirth education class?

As a first-time mom, I didn’t know what to expect. I wanted to take a class to help prepare my husband and myself. The last thing I wanted to feel was anxious or nervous – I just wanted to be focused on meeting my baby.

Why did you choose a Lamaze class?

The main thing that attracts me to Lamaze is the Healthy Birth Practices; they are so simple and so natural. I did not want to go in to the hospital on birth day and follow blindly whatever a doctor or nurse said just because they are professionals — I wanted to be an informed woman. I have always been like that; my dad always told me that I started asking why to everything as soon as I could talk. To me, Lamaze was all about educating yourself to make the best decisions for you and your baby and that made me feel comfortable. I also did not want to have to learn a technique; I wanted something that would come naturally and relax me.

What was the format of your classes?

I took a class one evening a week for 2.5 hours for a period of 4-5 weeks. I took my class thru the DC chapter of Lamaze.

What were your impressions of the first class?

Our class only had four other couples, so it was very intimate. I didn’t know what to expect, but our instructor involved the dads first. She got them to talk about their fears and expectations. Listening to them talk made me and I’m sure the other moms feel more relaxed and free to voice our feelings as well. Being 7 months pregnant when we took the class, I really liked the relaxation exercises and massages we practiced too!  

Talk about some of the more notable details of your class.

The one thing I noticed is that we were all first time parents. One of the first questions the instructor asked was if anyone was planning to take advantage of the pain relief options at the hospital. She was not judgmental, but rather let the course information present itself to help women make their decision. All of the moms present at the beginning of the course were planning on getting an epidural because of their perception of childbirth. I remember one of our classes had to be rescheduled because our teacher was also a doula. She came to class the next week and told us about her client’s birthing experience. She told us the client was moving around during labor and trying different positions – several of the moms didn’t even know that was possible. At the end of the class, two of the moms decided to find a midwife instead of continuing to see their ob/gyn and one mom decided to find a hospital that would allow a water birth.

How have your emotions and thoughts and the way you feel about childbirth changed after taking the class?

For some reason, when people see that you’re pregnant, they decide to tell you about their labor experience and of course, they are all scary stories of people laboring for days with 4th degree tears! So naturally I was very nervous about giving birth, and I didn’t think I could do it. That fear is what drew me to take a childbirth education class.

During the class, the teacher made it seem like birth wasn’t so bad. That was the first time anyone described birth to me that way. She showed us a video where a woman was laboring at home but was sitting on the floor watching TV with her husband – she was so relaxed! Nothing like the movies! I was starting to feel like, “I can do this!” The class left me wanting to educate myself even more! I searched for more videos, blogs and articles on natural birth and the more I learned, the more natural it seemed. It seemed like the only way to go and made me wonder why people were not exploring this option more. I came across one woman’s blog who had her natural birth with her family and friends present and after the baby was born, they celebrated with champagne. She looked so happy in the pictures, even while she was pushing I didn’t see pain in her face, but rather determination. I knew that was the experience I wanted!

Filed Under Birth, Birth plans, Childbirth education, Choosing a care provider, Featured Post, Healthy Birth Practice, Pregnancy Tagged With childbirth class

Coming Soon on the Blog: A Woman’s Guide to VBAC

August 30, 2010 By Cara Terreri 4 Comments

Even with all of the information that is included in the recent National Institutes of Health (NIH) statement on VBAC, which says that VBAC is a “reasonable option” for most women with a previous cesarean section, it might be difficult for many of us to wade through the information and figure out what it means for us and our particular birth options and unique circumstances.

To address these concerns, Lamaze along with a team of midwives, obstetric research experts, mothers, doulas, lawyers, and healthy birth and maternity care advocates developed A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations. The Guide, which will launch next week right here on Giving Birth with Confidence, will cover: 

  • What all of the technical terms in the statement actually mean
  • How to analyze the risks and benefits of VBAC and repeat cesarean delivery
  • Putting the risk of uterine rupture into perspective
  • Contacting your local hospital to find out their VBAC rates and policies
  • Advice on how to discuss the NIH Statement and its recommendations with your care provider
  • Other questions about the NIH Statement on VBAC

A Woman’s Guide to VBAC may be just what you need to empower yourself to be an advocate for you, your baby, and your birth choices!

Filed Under A Woman's Guide to VBAC, Birth, Birth plans, Choosing a care provider, Pregnancy, Preparing for VBAC, Recent Posts Tagged With A Woman's Guide to VBAC, VBAC

Practices that Promote Healthy Birth – Get Upright & Follow Your Urge to Push

August 27, 2010 By Danielle Elwood 1 Comment

“Ok, ready to push? Bear down, hold your breath: One, Two, Three, Four, Five, Six, Seven, Eight, Nine, and Ten!”

We’ve seen this a million times in movies and on TV. A woman lies on her back in a hospital L&D ward in the pushing stage of labor and is bearing down, chin-to-chest and being directed to push for 10 seconds while her partner or care provider (or both) coach her through the process. Well, I’m hear to tell you that it doesn’t — and SHOULDN’T — be that way!

Throughout pregnancy, most women are told not to lie on their backs, but yet, that is the first thing most hospitals do when a woman shows up in labor! On the back is one of the worst positions for labor and birth. The position drastically decreases the size and opening of the pelvis and causes women to work against gravity.

Want to understand more about healthy practices for the pushing stage? See here:

 

 

Great video isn’t it?  When you are laying down on your back and pushing, it is like you are pushing up hill. It makes pushing and birth harder, and in many cases longer for mothers. Getting up and allowing gravity to assist in the pushing phase is a huge benefit to mothers. Not only is it more comfortable, but it utilizes

Some hospitals offer a "squat bar" that can be attached to the bed.

gravity to help during this phase. Babies are also more likely to show signs of distress if you are laboring on your back, which is one of the reasons health professionals encourage you to stay off of your back during pregnancy!

Some of the benefits to upright pushing include :

  • Lessened pain
  • Shorter second stage of labor
  • Less damage to the vagina and perineum
  • Reduction in use of or need for a vacuum assisted delivery
  • Lower number of episiotomies

The second piece to this healthy birth practice is following your urge to push, also known as spontaneous pushing. Pushing when your body tells you that you need to push and following that urge to push is what your body needs to do to birth your baby! By following commands from others on when, how, and how long to push, you will be more likely to tire out faster, as this practice puts undue stress on you and your body.

Some of the benefits associated with spontaneous pushing include :

  • Less abnormal fetal heart rate changes
  • Less damage to the perineum
  • Stronger pelvic floor muscles in the months following birth

For the experienced moms out there, what positions worked best for you? What was least effective during the pushing stage?

Filed Under Birth, Birth plans, Healthy Birth Practice, Recent Posts

Have You Taken The Birth Survey?

August 25, 2010 By Cara Terreri Leave a Comment

Have you heard about The Birth Survey? It’s an ongoing, online maternity care survey that provides a place for women to give feedback about their birth experiences with specific doctors, midwives, hospitals and birth centers. The feedback is then made available in a searchable online database that provides resources to help other women and families to make more informed choices when choosing maternity care providers and birth settings.

 

The main goal behind The Birth Survey is to provide access to information that will help women of childbearing age choose maternity care providers and institutions that are most compatible with their own philosophies and needs. The survey was created by the non-profit organization, the Coalition for Improving Maternity Services (CIMS), a coalition of individuals and national organizations with concern for the care and well-being of mothers, babies, and families. The CIMS mission is to promote a model of maternity care that will improve birth outcomes and substantially reduce costs.

 How great would it be to have access to feedback and information on all of the hospitals, OBs, midwives and otherwise through just a few clicks? The Birth Survey is currently in the building process with its database, which means YOU need to go and take the survey to help make it complete! The survey takes about 30 minutes to complete, and you have the option to save and come back to it later.

Here’s what else you’ll find at The Birth Survey:

  • Survey results in the way of ratings for doctors, midwives, hospitals and birth centers
  • Intervention rates by state for hospitals and birth centers
  • State by State links to info on the health of mothers and babies and access to VBACs
Filed Under Birth, Birth Center, Birth plans, Choosing a care provider, Health and well-being, Healthy Birth Practice, Pregnancy, Recent Posts, Working with a midwife Tagged With The Birth Survey

A Birth Story: Lauren & Baby Naomi

August 23, 2010 By Cara Terreri Leave a Comment

On Monday, June 14, I went to work just to do patient phone calls and desk work. The nurses I work with hadn’t let me hardly touch a patient for days so I knew I could get a few hours at work and not over exert myself. I worked about a half day and then went to the chiropractor for a routine visit. My midwife recommended chiropractic care to help with the baby’s positioning and also for my pelvic/hip alignment. On the way home I felt the urge to do a major grocery shopping trip, so off to Giant I went to stock up on essentials. Over an hour later, I finally got home, only to commence a kitchen overhaul…cleaning out the fridge and reorganizing the cabinets. After my nesting cravings had been satiated I was able to relax with my husband, Adam, until about 10:30 pm when I started to have some Braxton Hicks contractions. Hoping to sleep through these minor contractions, I was asleep by 11:30 pm, but then was up at 2 am due to the discomfort that was coming with each contraction. At this point, it felt mostly like moderate to severe menstrual cramps, not so bad. I was excited and hoping that maybe this was “it” so I started tracking the frequency of each surge. All night my contractions came with some regularity, but they were too inconsistent. On Tuesday morning around 8 am I spoke with my midwife who suggested I try to rest and keep my appointment for that afternoon.

On the birth ball, with Adam supporting my back.

At my appointment around 2 pm, I found out that I was only 1cm dilated which was a little discouraging at the time. Megan (the midwife) was really concerned that I was so exhausted and suggested I try to get some sleep that night because true labor could be weeks away. At her suggestion, I accepted some prescription sleeping pills, knowing that I needed the rest. Unfortunately I had a reaction to the sleeping pills which caused me to be incoherent and in and out of sleep all night. I found myself in the tub around 5:30 am, listening to my iPod and breathing through each surge.

On Wednesday morning, I didn’t feel rested and the contractions were getting stronger. I spoke with my hypnobirthing instructor on the phone and made another appointment with the chiropractor in hopes that she could help “get things moving.” I also made an appointment with an acupuncturist, hoping that maybe stimulating the right pressure points could help get me into active labor. While at home, I just sat on my exercise ball, bouncing around or trying to relax in the tub. I found that my surges were increasing in intensity but I was still able to breathe through each one and stay very relaxed, calm and positive. I’ll take a moment to note that as prepartion for birth, I listened to relaxation exercises and birth affirmations as part of my hypnobirthing class. Because of this, I was able to quickly go into a deep state of relaxation and allow my body to respond to uterine surges with ease. Around 2 pm I checked back in with my midwife requesting to be assessed prior to my acupuncture appointment; my contractions were about every 5 minutes and I was just plain curious to see if things were progressing. 

Meeting Naomi for the first time.

At the birth center, the midwife told me I would not be making my appointment for acupuncture because I was 7 cm dilated and she wanted to admit me! I was relieved to know I really was in labor and excited to have the baby! Adam and I went upstairs and chose our birthing room, a large room with private jacuzzi tub and comfy queen size bed. Adam unpacked the car and brought my exercise ball in for me to use. After a little while I asked my nurse, Ann to get the tub ready so I could relax in there for a bit. I labored in the tub for a couple hours, Adam rubbing my shoulders and my mom massaging my low back during each contraction. My ipod speakers were set up with some relaxing music and the recording of birth affirmations previously mentioned. I was allowed to eat and drink as I wanted and was encouraged to take fluid by mouth since I did not have an IV like at a hospital.

 Around 7 pm, I was presented with the option to have my membranes ruptured. I was really exhausted from not sleeping for 2 nights and really wanted to get things moving so Adam and I decided to go ahead and do it. Afterward, the contractions became increasingly intense and I changed position from the tub to birthing stool. After pushing for about an hour I moved onto the bed so that I could be better supported. At 9:50 pm, Naomi Christine was born after about 1.5 hours of pushing.  My labor was calm and relaxed until I had to push. While I wouldn’t say that it was painful, pushing required every ounce of my being because I had been sleep deprived and unfortunately had not eaten enough that day.

Our first family photo.

While I received some sutures, Adam took off his shirt and held Naomi ”skin-to-skin” with him. Then, she went right to my chest and stayed there for 2 hours. She had absolutely no problems with jaundice, having passed two meconium stools in the first 4 hours of life, and my milk was in at 48 hours. I attribute these things to the uninterrupted skin-to-skin time of bonding and nursing in those first hours of life. I’m thankful that my first birthing experience was what I envisioned. I felt empowered, in control, and had minimal medical interventions.

Filed Under Birth, Birth Center, Birth stories, Coping with pain, Healthy Birth Practice, Labor, Pregnancy, Recent Posts, Working with a midwife Tagged With birth story

Great Expectations: Liz @ 18 Weeks

August 20, 2010 By Liz Abbene 4 Comments

“Feels like a foot!” It’s amazing how four little words can totally change things. Up until a few days ago, I spent a portion of every day worrying about the well-being of this little nugget and fearing that we would lose our baby once again.  As much as I didn’t want to, I couldn’t help it, and it was starting to weigh on my mind. As I’m nearing the half-way point of my pregnancy, I realized that this worry has interfered with me truly being able to enjoy this little one.

Then, at my prenatal visit the other day with my midwife, she was palpating my belly to feel the baby’s position, and said, very casually, “Feels like a foot!” At that moment, I felt like this dark cloud that has been following me for the last several months lifted. I was amazed at the fact that our little nugget is now big enough for her to distinguish body parts–that he or she is growing and thriving inside me, despite my worry, making me realize that I need to fully trust my body and my baby.

We heard the baby’s heartbeat again (no trucker interference this time), strong and clear.  My children continue to relish in the fact that my belly is getting bigger all the time, making it a prime target for hugs and kisses. I called up the photographer who took maternity photos for me with my previous pregnancies (including the one we lost) and had her come over to take the first pictures in what will become a series, ending with new baby shots. All these things, along with the feeling of those tiny little feet squirming around inside me, have given me a whole new outlook on my pregnancy.

Filed Under Great Expectations, Health and well-being, Pregnancy, Recent Posts Tagged With Great Expectations

Lamaze Blogger Attends BlogHer 2010

August 19, 2010 By Danielle Elwood Leave a Comment

Me with Gina from The Feminist Breeder

Thanks to the help of a few gracious sponsors, I was fortunate enough to attend BlogHer 2010. While the event encompassed a variety of experiences related to blogging, there were a couple of great moments that really focused on healthy birth. As a blogger ambassador for Lamaze, I provided a couple of pregnant bloggers with Lamaze Mom-to-Be Skin Care sets and talked about why I work with Lamaze, which was especially exciting after my Passion for Birth training the weekend before!

I also rubbed elbows and exchanged thoughts with some other amazing healthy birth and pregancy bloggers out there, including Gina from The Feminist Breeder and Jenn from Baby Makin(g) Machine.

The one experience I had that really focused on birth was my lunch chat on Saturday, day two of the event. I sat down at a table speaking with two women, neither of whom have children, and the movie Crisis in the Crib came up in the conversation. In overhearing our conversation, another woman who is currently 5 months pregnant sat down and proclaimed, “I don’t know crap about pregnancy, can you help me?” I was floored and excited at the same time! It was a great feeling to know that women looked to me as a resource on healthy birth! The more we spoke, the more I knew that she actually did have a clue as she had already enlisted a midwife for care and was considering a birth doula. She was on the right track! I would have loved to connect with more women on a deeper level — especially those who seemed to be uncomfortable talking about pregnancy or birth. But there’s only so much time!

Overall, BlogHer 2010 was an awesome experience, and I am eternally grateful to Lamaze to providing me with a great foundation for educating women.

Filed Under Birth, Pregnancy, Recent Posts Tagged With BlogHer10, Momotics

Week of Giveaway Winners!

August 16, 2010 By Cara Terreri 6 Comments

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Thank you to everyone who participated in Giving Birth with Confidence’s first-ever Week of Giveaways! And thanks even more to our generous giveaways sponsors:

Learning Curve, Belle Baby Carriers, Maternitique and Ecopiggy!
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Without further adoe, I present to your our lucky winners:

Baby Toys & Teether Bundle from Learning Curve by Lamaze

 Ashley S: “i love these toys – i would like Octotunes.”

Amber: “My favorite is the ‘my first toolbox.’”

Lisa L: “I like the cute Pull & Play Puppy.”

WWillow6: “I love the Elephantunes! What a cute musical toy!”

Organic Baby Carrier by Belle Baby Carriers

Amy Van Gundy: “I love the sugar plum pattern!”

$25 Gift Certificate to Maternitique

Diana: “I really like the Convertible Maternity Wrap, as well. I’m not sure if I’d go for pink or brown, but the style is really nice.” 

Discover the Sea Carousel Crib Soother/Baby Toy from Learning Curve by Lamaze

Trixx: “My favorite is Twinkle Twinkle Little Star, namely because it’s the only lullaby where I don’t make up my own lyrics.”

Lisa L: “My fave is Lullaby & Goodnight.”

Mom-to-Be Skin Care Gift Set from Learning Curve by Lamaze

Jena: “Of all of the items I actually like the Mom-to-be gift set best (I already have the books and have already entered to win the Lamaze brand baby toys). That cooling leg and foot cream sounds heavenly.”

Brianna B: “I deffinetly am in need of nursing bras so the Lamaze Seamless Padded, Strapless Nursing and Maternity Bra is on my ‘much needed list!’”

Julie L: “Lamaze Cooling Leg and Foot Cream.”

Alicia F: “I love the baby toys the best–my kids love them! Especially the moose and giraffe.”

Michelle: “Lamaze Lightly Padded Underwire Nursing Bra with Lace Detail. This bra actually looks like one I would have worn before pregnancy. It’s great to find something that looks great and is functional. I would definitely have to have this-probably in several colors!”

$25 Gift Certificate & RiNGLEY Natural Teether from Ecopiggy

MamaGames: “I like the Ringley Junior teether… Thanks!”

Alicia F: “I’d definitely get a few of the pura Kiki zippy cups! Love those.”

Filed Under Giveaway, Recent Posts Tagged With Week of Giveaways

Week of Giveaways: $25 Gift Card & Teether from Ecopiggy

August 14, 2010 By Cara Terreri 12 Comments

This giveaway is now closed.

Welcome to day six — the final day of the Giving Birth with Confidence Week of Giveaways. If you’re just joining us, visit Monday, Tuesday, Wednesday, Thursday and Friday’s posts for more chances to win great items!

For our final giveaway, we are giving away two $25 gift cards + a RiNGLEY Natural Teether (an additional $16 value) from Ecopiggy, a national distributor of natural children’s products, from reusable lunch bags, to organic teethers, to wellness products.

Who is Ecopiggy? Find out, direct from the owners:

“All children deserve to have the wonderful experience of super-soft organic cotton against their skin and nontoxic products near their sweet little mouths, and Ecopiggy is dedicated to creating a business form that gives more than it takes… just like a loving parent.

In fact, we don’t see ourselves as a business, but a family of devoted community members, seeking a healthier future for our children. Words can only do so much, though, and so we dedicate ourselves to making a difference through the actions we take.”
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Two Giving Birth with Confidence readers will win a $25 gift card and a RiNGLEY Teether from Ecopiggy!

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Here’s How to Enter

Everyone has three chances to win — choose one or all three!

1. Visit Ecopiggy then come back here and leave a comment to tell us about what you would buy with your $25 gift card.

2. Create a login and become a member of the Giving Birth with Confidence online community. It’s FREE and easy. Leave a second comment on this post to let us know that you’re a new member or if you are already a member.

3. Tweet about this giveaway with the following text: Enter to win today’s #giveaway week: $25 Gift Card! To enter, post a comment at www.givingbirthwithconfidence.org & RT this message! Be sure to come back here and leave a third comment to tell us that you tweeted.

This giveaway is open to anyone, worldwide. It will end this Sunday, August 15 at 11:59 p.m. EST. Winners will be announced on Monday, August 16. Good luck!

Filed Under Gear, Giveaway, Parenting, Recent Posts Tagged With Week of Giveaways
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