According to a study published in the June issue of Obstetrics and Gynecology, babies born via vaginal birth after a prior cesarean section (VBAC) have lower rates of respiratory morbidity and intensive care admissions compared with babies born by repeat cesarean section.
The retrospective cohort study was comprised of 672 women with one prior c-section in a singleton pregnancy at 37 weeks or more gestation, and compared both neonatal outcomes and monetary costs of the procedures.
Researchers found that babies born via repeat c-section had higher rates of intensive care admission and higher rates of oxygen supplementation for delivery room resuscitation than those babies born by VBAC. The highest rates of resuscitation, however, were in babies born by c-section after a failed VBAC.
And while a successful VBAC is definitely less expensive than a second c-section, the highest costs were associated with a cesarean after a failed VBAC.
The study's authors suggest that these results "[argue] for greater selectivity in performing a cesarean delivery in the first place, and certainly a greater need for counseling before a primary elective cesarean delivery."
— www.medscape.com/viewarticle/703773. Accessed 5 Nov 2009.
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Midwifery Care for the VBAC Woman
If the [VBAC] woman has dilated past five centimeters in the first birth, I plan for it to be fairly fast—like any second baby. If the woman has not gone into the birth process or not dilated past five the first time, that's all right, she'll still give birth vaginally, but we have extra midwives on call to bring fresh energy if the others get discouraged or tired. We plan for it to be like going to two births in a row. The point that the woman reached in her first birth is often a psychological hurdle for her. If she dilated to six centimeters the first time, the news that she is seven or eight will be a relief and a breakthrough. One of our clients, a minister's wife, said over and over again in her pregnancy: "I just want to feel what pushing is. If I only get to push, I'll be happy. I just want to know what other women mean when they say they had to push." She'd had a Bandl's ring in the first birth process and the cesarean was done at five centimeters. We were praying that the complication wouldn't repeat. She dilated smoothly and began to push. With each push she would exclaim "Thank you Jesus, thank you Jesus!" What a wonder it was to watch her push out the baby, a girl whom she named Faith.
All humans have a certain propensity to self-sabotage, and the VBAC woman must be on guard against her own defeating patterns. The midwife must be bold in pointing out ways that the woman is repeating dumb moves—there's no place for us being "nice" if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, we won't let her have extra people at her VBAC birth.
Privacy and quiet are a must, and we will be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because this woman's whole obstetrical future rides on its success.
We show the couple lots of videos of beautiful VBAC births because one video is worth a thousand words. If you don't have your own, I recommend Gentle Birth Choices by Barbara Harper, which includes footage of a beautiful VBAC birth. Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to, "Draw your birth cave," or, "Color your birth." When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.
I have longer appointments with VBAC women because they seem to need to obsess. I don't have solutions to many of their fears but it seems to help to just be able to talk to someone who cares and understands. I usually also ask them to "Tell me how you know that this time you're going to have a vaginal birth?" The answers always amaze me. One woman said, "Because this time I'm not depending on my doctor or my midwives—[I] and my husband are going to have this baby." I suggested that she give up depending on her husband, too. She looked terrified at that idea but I could see that she understood; she looked me in the eye and said, "Right!" That was the moment I knew she would do it. She's had three water homebirth VBACs since then, and after each birth her first words were, "I did it."
— Gloria Lemay
Excerpted from "Midwifery Care for the VBAC Woman," Midwifery Today, Issue 57
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Consider chiropractic care for safer, easier births.
Our doctors offer special care for pregnant women and infants. Specialties include the Webster technique for optimal fetal positioning and gentle cranial and spinal techniques for your baby. Visit www.icpa4kids.org.
Looking for a good appointment book for the new year?
||The With Woman Appointment and Resource Book is just what you need. This handy spiral bound book lets you record 15 months of appointments and is perfect for midwives, doulas, childbirth educators and lactation consultants. You'll appreciate the reference guides and resources, the place for listing client information and the handy pocket in the back that can hold business cards or a gestational wheel. If you're a student it can help you keep track of your prenatals, births and postpartum visits. Not a midwife? With Woman makes a great gift for someone who is. Now on sale: Just $12 plus shipping. (Regular price: $16) To Order|
Learn how you can have a safe, gentle birth.
Pregnancy & Childbirth Secrets is packed with information that will guide you throughout your pregnancy and during your first days as a mom. Mothers, childbirth professionals and researchers share their experience and knowledge, giving you the insight you need to have a birth that is safe and rewarding for both you and your baby. To Order
Discover The Power of Women!
When you read this new book by Sister MorningStar, you'll discover how healing words and empowering stories help women listen to their instincts during childbirth. Filled with inspiring, moving stories, The Power of Women will lift the veil from your eyes and let you view the world in a new way. Give it to the pregnant women you know. Help them see the power that resides within them.
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Now on DVD—Normalizing the Breech Delivery
If you attend pregnant women, you need basic knowledge of the breech delivery. In this DVD, Midwives Valerie El Halta and Rahima Baldwin Dancy share their expertise in a clear, detailed manner. You'll learn a Breech Scoring System to help evaluate risk, various positions for the mother in delivering a breech baby, the key points for diagnosing and delivering a frank breech and more. Perfect for midwifery training programs and self-study by both student and experienced midwives, Normalizing the Breech Delivery is a must-have for every birth library. Order the video.
Expectant moms need good birth information.
|Having a Baby Today newsletter is perfect for new or expectant parents. It includes positive information about staying healthy through pregnancy and birth, advice on caring for a newborn and information needed to make informed choices and avoid complications. Give all 10 issues to someone you know—it's just $25 for the package. Order the Pack.
Web Site Update
The complete program for the Strasbourg, France, conference this fall is now online! You may view it online or download a PDF. Sign up for your first choice of classes before they fill up!
You may check out the table of contents for the newest issue of Midwifery Today print magazine (Winter 2009/2010).
Read this editorial by Jan Tritten from the brand-new issue of Midwifery Today, Issue 92, Winter 2009/2010:
- Birth Is a Human Rights Issue
“In June of this year, the United Nations Human Rights Council adopted a landmark resolution acknowledging maternal mortality and morbidity as a human rights issue. The adoption of this resolution prods governments to ‘change the way they view maternal death—that is, as a human rights issue no less serious than executions, arbitrary detentions, or torture.’”
Read this review from Midwifery Today newly posted to our Web site:
- Understanding the Dangers of Cesarean Birth—by Nicette Jukelevics, reviewed by Cheryl K. Smith
“This book should be read not only by people who plan to have babies, but by policymakers and providers as well, so that we can all work to change the system to one that values human beings and their informed choices, is humane and is cost-effective.”
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Question of the Week
Q: I'm curious as to how well the uterus heals after three c-sections. I've been told that the uterus heals very well—better than the scar on the outer part of the body. I'm considering a VBAC.
I've spoken to a few midwives: the nurse-midwives won't even talk to me once I tell them that I've had three c-sections. They've actually been abrupt and wouldn't even give me the time of day. The traditional midwives took the time to answer my questions and it seemed like they really love what they do and care about women and their concerns. I felt that the traditional midwives were caring and considerate whereas the others were just going by the book to cover themselves like the medical doctors.
SEND YOUR RESPONSE to firstname.lastname@example.org with "Question of the Week" in the subject line. Please indicate the topic of discussion *and the E-News issue number* in the message.
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Question of the Week Responses
Q: What is your best tip for shoulder dystocia?
— Midwifery Today E-News staff
A: With shoulder dystocia one shoulder is locked above the pelvic brim; it is noteworthy that the pelvic inlet can be widened by stretching the hip joints like [what] happens in a standing position. Even some over-stretching, like bending over backward, may be needed. The labouring woman often feels instinctively which position will be beneficial, provided she happens to be on her feet in the first place. This often enables her psychologically to adopt this remarkable instinctive behaviour. In my broad experience with vertical labours, the shoulders will rotate quickly and come down that way merely by gravity force. A small Chinese primi gravida just needed a very lightly applied little push behind her pubic bone, against the baby's shoulder, while she was in standing position and I had gone [to] my knees a little. She gave birth to a sturdy eight-pounder. In my view, starting the second stage in a standing position can be seen as a preventive measure against the occurrence of shoulder dystocia. If it does occur, it can be easily corrected without having to perform all sorts of heroic manoeuvres.
— Gre Keijzer, Dutch Midwife
Responses to any Question of the Week may be sent to E-News at any time. Write to email@example.com. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Think about It
Soy as a "health food" may not be all it's cracked up to be. Cultures where soy has been traditionally included in the diet have also traditionally eaten it in small amounts and in a fermented form—making it more digestible and providing probiotics. Now, with soy appearing in almost every packaged food we eat, we are learning more about its potential deleterious effects on our health.
One problem might be soy's high levels of isoflavones. Author Robyn O'Brien, as quoted in "The War on Soy: Why the 'Miracle Food' May Be a Health Risk and Environmental Nightmare," by Tara Lohan, states: "[I]soflavones' very ability to boost estrogen production can also pose hazards to our health. For example, the FDA scientists point out, during pregnancy, isoflavones could boost estrogen levels even higher, 'which could be a risk factor for abnormal brain and reproductive tract development.'"
These developments may be of particular concern to vegetarian mamas, many of whom rely heavily on soy foods to supply necessary protein.
Read the full article at: www.alternet.org/water/144074/the_war_on_soy:_why_the_'miracle_food'_may_be_a_health_risk_and_environmental_nightmare?
Russia maintained its unique traditional culture of parenting and midwifery until the early 20th century, when it was almost completely destroyed by the Soviet system. The Soviet Union needed women to be workers, not mothers. Immediately after giving birth to a child the mother went to work, passing the baby to a day care, then a kindergarten, and then to school. And the circle was repeated. The art and culture of parenting and mothering was ousted by pacifiers, strollers and breast milk substitutes, and an intimate family event turned into a bureaucratic affair.
In the 1970s Russia saw the beginning of a strong movement of parents who did not want to birth their children in "prison" (the birth clinics in Russia still look more like a prison than a place for comfortable and natural birth), and a movement of midwives who did not want to work in the public system of obstetric care.
Out of this movement, Moscow's Healthy Family Club was born, founded by Alexandra Gurevich. Working actively with researcher Igor Charkovsky, several families and their children got together and played group games: running, winter swimming in the pond, walking barefoot in the snow and winter skiing. In the summer they would go to the sea. Some of these children were the first to be born in the sea. It was a powerful advance in understanding the impulse of the soul, and a revival of the traditions of the national midwifery and parenting culture.
This movement that began 40 years ago continues to exist today. Babies are born at home with midwives, who are themselves third-generation homebirths. But the activity of homebirth midwives in Russia still happens outside of the law. In order to change this situation, we must change the views of our society. We've created our magazine, Home Child, to work for this change.
The idea for the magazine was born together with Masha, our second child, who was born at home in a close and loving group of people. Our first son, Michael, had already opened huge new worlds for us, worlds called "natural parenting" and "attachment parenting."
In the Soviet Union information about natural parenting had been closed, like secret knowledge. Today, there is more than enough information available about natural childbirth, breastfeeding, using a sling, natural medicine, natural health, alternative education and a healthy lifestyle, but putting the pieces together requires an incredible amount of time and effort. At the same time, separating fact from opinion and scientific evidence from mythmaking is not as easy as it seems. This is what we offer in Home Child magazine.
We are grateful to everyone who has supported the idea of a natural lifestyle, gentle loving birth and traditional midwifery. These are the people who have made the birth of Home Child magazine possible.
We are proud to partner with Midwifery Today in bringing the “Birthing in Love: Everyone's Right” conference to Russia. We believe that this meeting will be the beginning of a spirit revolution in the Russian natural parenting and traditional midwifery movements.
— Katerina Perkhova, editor of Home Child magazine
[Editor's Note: Please visit the page on our site about the upcoming conference in Moscow, Russia.]
Luna Maya Birth Camp is a one-week intensive workshop for birth workers to explore traditional Mexican midwifery techniques and tradition as applied to modern practice. These weeks are a personalized opportunity to renew your commitment to our shared wisdom and skills for working with birth.
In 2010 the Birth Camp will be carried out from February 1 to 6, and is set in the Highlands of Chiapas, a place where traditional and contemporary healing merge into daily life. Housing is available starting the night before the program begins and through the night the program ends. Morning sessions will be held from 9:30 am – 2:00 pm and afternoon sessions will be held from 4:00 pm – 7:00 pm.
Suggested donation to cover the cost of the workshop is $900.00, but we are now offering "pay what you can." This is to honor women's capacity to participate regardless of their financial situation. We know that some women will be able to donate more and other women will be able to donate less; what is important is that we are able to come together through an intense and transformative experience and also support Luna Maya while doing so.
Come and learn from other women as well as native healers; nourish your soul; expand your consciousness.
For more information please visit our Web site at www.lunamaya.org or e-mail us directly at firstname.lastname@example.org.
— Cristina Alonso, Luna Maya
The Mid-Atlantic Conference on Birth and Primal Health
Las Palmas de Gran Canaria, February 26–28, 2010
What is the future of a world born by caesarean? This is the question we need to ask now that, thanks in particular to the work of Michael Stark, the c-section has become easier, faster, and safer than ever before. In this conference we will not only focus on technical advances, though…. We will also constantly make reference to recent scientific advances which suggest we should apply new criteria in order to evaluate practices within midwifery and obstetrics. For example, thanks to a large amount of data provided by developing disciplines as diverse as ethology, bacteriology, epidemiology and hormonology, it has recently been possible to confirm scientifically that…a human newborn baby needs his or her mother. After thousands of years of beliefs and rituals which have disturbed or prevented first mother-newborn interaction, modern science now has the power to reverse our deep-rooted conditioning.
We welcome all of you, participants from the five continents. We want to thank Prof. Garcia Hernandez and our friends in Las Palmas for suggesting the Canary Islands Convention Centre as a venue for this conference held under the auspices of the Goddess of Love…the Goddess born from the foam of the waves.
— Dr. Michel Odent, President, and Heloisa Lessa, Executive Secretary
For more information and to register: http://www.wombecology.com/conference
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