The Human Face of Birth Trauma
To me, the subject of VBAC begins with cesarean prevention. Midwifery Today has a clinical series book on this subject, titled, The VBAC and Cesarean Prevention Handbook. Cesarean may be the most important issue around birth today because it is becoming a worldwide epidemic that does considerable damage to mothers and babies. The flip side of this is, of course, the damage that happens when necessary cesareans are unavailable. Regrettably, this lifesaving operation can be turned into a life-taking one through mismanagement.
How can we change the world? How can we make the people in the medical system care about the birth experience as well as the safety of it? The question of what the cesarean rate should be is controversial. Many of us believe it should be around 3–5%, but the World Health Organization says 10–15%. There is yet another issue—how do we help women become healthy? One-to-one midwifery care is one answer.
Another answer would be to put a human face onto this issue because every cesarean involves two or more lives. My friend, Sister MorningStar, pondered how we do statistics on cesareans. The statistic is counted per mother cut, but a stat should be counted on how many babies have been cut out of their mom and correctly represent when two or more babies are born per abdominal surgery. All of these mothers carry in their being trauma from birth rather than the miracle of birth. What might be the lasting effect on each of these babies? How do moms process this incredible trauma and why do they have to? Visit the International Cesarean Awareness Network Web site to find out answers to these questions and also to get help if you need it. There are so many questions here with very few answers, but I think if we could each put a human face on each statistic that would be a start. Midwifery Today magazine and the conferences we host provide opportunities for solutions to be discussed.
Birth stories shared by real women might be the most powerful way we can put a human face on this situation (see “Birth Q&A” below). One reader named Shasta Marine shares one of the joys she had from her VBAC, “I got to touch my baby first! My baby, my hands, my body! I reclaimed ownership.” A midwife, Susan DiNatale, shares her experience with VBAC moms, “They glow like something from another dimension must.” So let us all put a human face on cesareans and both prevent unnecessary ones from occurring and help sweet mommas and babies to heal from their cesarean experiences. Ask your doctor and nurse friends to “First, do no harm,” and let’s make sure we are doing the same.
— Jan Tritten, mother of Midwifery Today
Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.
Midwifery Today on Facebook: facebook.com/midwiferytoday
Jan on Facebook: facebook.com/JanTrittensBirthPage
International Alliance of Midwives on Facebook: facebook.com/IAMbirth
Birth Is a Human Rights Issue: facebook.com/birthisahumanrightsissue
Midwifery Education: Caring and Sharing: facebook.com/MidwiferyEducation
US Cesarean Rate Dips Slightly; Is There Hope for More VBACs?
The Centers for Disease Control and Prevention released a report on birth in 2010 in the United States. The data showed a 3% decrease in births from the year before and a 0.1% decrease in cesareans. This is the first decline in cesarean rates since 1996. However, 17 states and the District of Colombia showed an increase in cesarean rates.
Academics, health care quality groups, state lawmakers and the like have been voicing their concerns recently about reducing the number of maternal and newborn complications associated with cesareans, which will have the added bonus of reducing health care costs.
In the US, more than 4 out of 10 births are paid for by Medicaid. Because of shrinking state budgets, cesareans have been a main topic of discussion. In 2009, the average cost for a cesarean was between $13,000 and $20,000.
Repeat cesareans put mothers at an increased risk of death and early elective deliveries are linked with short- and long-term neonatal morbidities.
Dr. John T. Queenan, author of the article, “How to Stop the Relentless Rise in Cesarean Deliveries,” expects the US cesarean rate to reach 50% unless cesarean rates are reduced and access to VBAC is increased. Similarly, Dr. James R. Scott, author of the article “Vaginal Birth After Cesarean: A Common-Sense Approach,” promotes an ethical approach to caring for women with a previous cesarean, giving preference to VBACs over repeat cesareans despite fears of malpractice suits.
Hopefully the call for fewer cesareans and more VBACs will be a trend that continues in years to come. Perhaps a more significant dent than the current 0.1% decline in the cesarean rate will occur.
— Jukelevics, Nicette. “US Cesarean Rate Dips Slightly; Is There Hope for More VBACS?” vbac.com. November 19, 2011. http://www.vbac.com/2011/11/u-s-cesarean-rate-dips-slightly-is-there-hope-for-more-vbacs/
VBAC and Choice
Recently, I received an e-mail from a VBAC client. “When I agreed to have a cesarean, was I really making a choice?” she asked. “First of all, I, the chooser, was not truly informed; second, my doctor lied to me. Third, my insurance company limited my choices in many ways. Many of us women are so acculturated as to be unable to think outside the box, so if our insurance doesn’t pay for midwives or cover homebirth, we think we can’t choose it. Fourth, my family and friends were also ill-informed and thus played into the hands of the doctor; and in fact, I didn’t even have the doctor I chose—I ended up with the one who happened to be on call that evening.”
She went on: “[M]any women just like me end up having the primary c-section because of the ‘choices’ they made, even though, again, many of those choices were false and ill informed! Then, they are really stuck when trying to plan a VBAC in this climate and culture. The truth as I see it, Nancy, is that the choices are false, the lies are rampant and the truth (some c-sections are needed; some babies will die) is simply hard for people to face.”
Each baby has only one opportunity to be born, there are no second chances; so whenever possible, the experience ought to be safe, wonderful, natural, empowering and amazing. I have a sincere passion to assist women in having the best births possible. VBAC feels like my baby. Having had my own VBAC in the early seventies and having coined the term, I’ve spent my adult years researching the subject—teaching it, talking about it, thinking about it and writing about it. Along with many other midwives and childbirth educators, I’ve done my best to bring the subject of VBAC to light and to assist women who choose to birth normally after having been surgically delivered. My heart still drops into my toes every time I learn about a woman who received a c-section and leaps with delight when I either hear from, or am able to assist, a woman who has had a VBAC.
When Barbara birthed her 9 lb 4 oz son (vaginal birth after two cesareans—VBA2C) out of her supposedly contracted pelvis, in the privacy of her own bedroom, five hours after I walked through the door, and when I saw the look of relief-accomplishment-ecstasy on her face, I was happier for her than I could express. Ditto for Laura’s 11 lb VBAC daughter, who slipped out of her body one crisp winter night. In one capacity or another, I’ve assisted thousands of women who have chosen to have a VBAC; many have had births that exceeded their wildest expectations. Sadly, some of the women who have sought my help didn’t have the births they were hoping for, and some have had a repeat c-section.
We have learned in newspapers across the country this month that the cesarean rate has been consistently increasing. It is well documented that the rate has increased at least 48% in the last nine years—one in three women are now having c-sections. Before that I remember someone telling me that the rate was “barely 20%.”
Barely? Many of us remember back to the days when the c-section rate was approaching 15% and the headlines all over the country stated that the cesarean epidemic was indeed upon us and something had to be done! We were told that, conservatively, at least three-quarters of the one million cesareans that were being done were preventable and that this major abdominal surgery was far more dangerous than vaginal delivery.
Was anybody listening?
— Nancy Wainer
Excerpted from “VBAC and Choice,” Midwifery Today, Issue 86
View table of contents / Order the back issue
Learn about being a midwife’s assistant
The 2-DVD set, Midwife’s Assistant Orientation for the Student Midwife, features a combination of live workshops and demonstrations that will help you prepare for clinical site training and experience. It also includes detailed instructions for many emergencies, as well as role-play of various scenarios such as waterbirth procedures and neonatal resuscitation. If you’re a student midwife or know someone who is, this DVD is a must-have!
Are you ready for birth emergencies?
As a home or birth center midwife, you may rarely encounter emergencies, but when they do happen, you need to know what to do. Birth Emergency Skills Training: Manual for Out-of-Hospital Midwives gives you the information you need. It takes you from the initial steps of intervention though definitive care, balancing a friendly tone and visual appeal with authoritative and clinically useful information. This book belongs on the shelf of every practicing midwife. To Order
|Learn what’s going on during a shoulder dystocia|
The Resolving Shoulder Dystocia DVD shows you five types of shoulder dystocia and the techniques that solve them. A one-hour studio class includes slideshows, birth clips and demos, while the second hour shows systematic and clear demonstrations of techniques using a doll and pelvis. This is an important resource for your birth library.
Placenta rituals, remedies and recipes…
…are what you’ll find in Placenta: The Gift of Life. Read this book to discover the various ways placentas have been used by people around the world and throughout the ages. You’ll also find 15 recipes that will show you how to use the placenta in ointments, essences and other remedies for a variety of ailments. Placenta: The Gift of Life is a book from Motherbaby Press, an imprint of Midwifery Today.
Are you a student midwife attending school or on a self-study course?
|If you are, the Birthsong Midwifery Workbook is just what you need! Are you an experienced midwife preparing for an exam? Use this book as a refresher guide to help you study. The sixth edition has 13 chapters that cover the basics of normal birth and midwifery. To Order|
What’s black and white…
|…read by birth professionals around the world, filled with informative articles and inspiring birth stories, and shows up in your postal mailbox four times a year? Subscribe.
Advertise at Midwifery Today’s Harrisburg, Pennsylvania, Conference
Reach a targeted, enthusiastic market by advertising at Midwifery Today’s conference in Harrisburg, PA. By advertising at “Midwifery: Skill, Wisdom, Culture, Love” you will reach an audience passionate about birth. Space is limited so learn more here or by contacting our ad director.
Education Opportunities Page
Reach prospective students online with our Education Opportunities Page. It is the solution for promoting your midwifery education programs and CE courses. [ Learn More ]
Contact our Advertising Director at: email@example.com
View more advertising options at: http://www.midwiferytoday.com/ads/
Q: What part of your VBAC did you enjoy experiencing the most compared with your previous cesarean?
— Midwifery Today
A: After my first VBAC I looked at my husband and said, “I don’t feel like I just had a baby. I’m coherent and everything!
— Ashley Klemm
A: The power I felt was amazing. The fact that I was needed for my birth was healing. With my c-section I felt like the only reason I got to go was because my uterus happened to be connected to the rest of my body. With my home VBACs (3 of them), I didn’t feel like someone else knew more about my body than I did. The simple act of me setting up my own birth supplies was empowering.
— Natalie Hessell
A: I had a section with my twins (babies number 4 and 5). It took a long time to establish nursing and bonding with them. I didn’t even realize how cheated and violated I felt by the whole thing until I read Silent Knife. I had the next baby at home—it was such a wonderful and healing experience. It felt like something was restored to me. (I went on to have five more babies at home, BTW!)
— Vicki Davis
A: I haven’t had my VBAC yet (I’m 39 weeks right now), but what I can say about this journey already is that is has been one of fear, sometimes anger, determination, emotion, and most importantly healing. I’ve learned to stop blaming myself, and to trust in my body again. I am not broken. I have educated myself and surrounded myself with a team of supportive caregivers, family and friends and have done everything possible to create circumstances for a successful VBAC. No one can know until it happens what the outcome will be, but I can tell you that no matter what it is, a VBAC is about so much more than a single birth. It’s a journey of healing, forgiveness, enlightenment, empowerment, and faith.
— April Murphy
Responses to any Birth Q&A question may be sent to E-News at any time. Write to firstname.lastname@example.org. Please indicate the topic of discussion *and the E-News issue number* in the subject line or in the message.
Bring resources about homebirth and midwifery to your community.
Does your library have relevant natural birth and midwifery resources? Did you know that as a patron of the library, you can make requests for specific books, magazines and DVDs? If these resources are not available for mothers to find, how will they make educated decisions? Making requests is easy. Go here to learn how.
Quite interestingly, the highest rate of VBAC is in women who have experienced both vaginal and cesarean births and given the choice, decide to deliver vaginally.
— American Pregnancy Association, promoting pregnancy wellness
A VBAC candidate who has had a previous vaginal delivery has an 89% success rate for a VBAC and fewer complications as opposed to a woman who has never had a vaginal delivery. It is therefore not appropriate to ask women who’ve had successful vaginal deliveries to have repeat c-sections based on “hospital policy.”
— Dr. Linda Burke-Galloway, author, physician, public speaker, medical malpractice reviewer
Planning cesarean surgery exposes women to the serious potential harms of major surgery. The best way of determining whether the baby is too big to come out is to go through labor and see. Take home message: don’t plan surgery.
— Henci Goer, obstetrical expert
If you’d like to share a bit of wisdom from the Web, please send a 4–5 sentence excerpt, accompanied by a link, to email@example.com.
Learn about midwifery education!
Are you an aspiring midwife who’s looking for the right school? Are you a practicing midwife who would like to learn more? Visit our Education Opportunities page to discover ways to start or continue your education.
Gail Tully in Harrisburg
I am so thrilled that Gail Tully of “Spinning Babies” is joining us at the Harrisburg 2012 conference in April. She will be a registrant, but we will engage her with her amazing knowledge at the “Tricks of the Trade Circle” and in other ways. She is so sweet and humble; I am sure she will be willing to answer your questions throughout the conference. There are so many reasons this is going to be an inspiring conference!
A couple of weeks ago I was blessed to attend Gail’s “Spinning Babies” and “Shoulder Dystocia” workshops when she came to our hometown, Eugene, Oregon! We had the events at my friend Anita Rojas’ birth center with the lovely hospitality of Anita and the midwives there.
I learned so very much from Gail. She is a fountain of information which she presents well with models and videos to help us understand what we cannot see within a mother’s body. She spices her presentation with birth stories to illustrate the points. We learned how the baby makes her way down and out and how it involves the mom’s bones, muscles and ligaments. There are dystocias that can happen just from the round ligament! The mom’s body and this process are so amazing. God is brilliant!
Besides these marvelous events, Gail and I got to get Vietnamese food together. If you come to town that is where we will go to lunch! Gail and I talked about our calling, how we got into this amazing field and our journey while in it, along with our birth plans for the future. Much to my joy, these future plans involve us working together. We talked about our families and life, philosophies, ideas and ideals. You know how it is when two midwives get together? We could have talked until midnight! Come join us in Harrisburg where we will have the chance to talk until midnight!
— Jan Tritten
I attended a twin homebirth (also waterbirth) of a first time mom. Another midwife helped birth the placenta. There was no bleeding but we could tell by looking at her uterus that it was descending into the opening of the cervix. The midwife gently supported the cord with gauze, and when the mom pushed, the placenta flew out and hit the assisting midwife in the stomach. The placentas had grown together and needed a forceful push to come out. The midwife was soaked in blood from head to toe and had to strip down in a nearby bathroom putting on a much smaller person’s clothes. We all got a good laugh at her expense.
— DyAnna Williams Gordon
Only letters sent to the E-News official e-mail address,
will be considered for inclusion. Letters sent to ANY OTHER e-mail addresses will
not be considered.
WomanCraft Midwifery Education Program: a strong foundation of academics and hands-on skills for aspiring midwives. Course includes Doula and CBE Certification. Begins March 10, 2012, Amherst, MA. http://www.womancraft.org
Global health professionals: look here for hard-to-find technologies and tools for midwifery and obstetrics. http://maternova.net/products
Tell our readers about your business. Just $37/issue ($135 for four) gives you 30 words to promote your products or services. http://www.midwiferytoday.com/ads/enews.asp or firstname.lastname@example.org
Remember to share this newsletter
You may forward it to as many friends and colleagues as you wish—it’s free!
Want to stop receiving E-News or change your e-mail address? Or would you like to subscribe? Then please visit our easy-to-use subscription management page.
On this page you will be able to:
- start receiving any of our e-mail newsletters
- stop receiving any of our e-mail newsletters
- change the version (text or HTML) that you receive
- change the e-mail address to which newsletters are delivered
If you have difficulty, please send a complete description of the problem, including any
error messages, to our newsletter.
Learn even more about birth!
Midwifery Today Magazine—mention code 940 when you subscribe.
| ||1-Year Subscription||2-Year Subscription|
|All other countries||$75||$145|
E-mail email@example.com or call 1-800-743-0974 to learn how to order.
Or subscribe online.
How to order our products mentioned in this issue:
Secure online shopping
We accept Visa and MasterCard at the Midwifery Today Storefront.
Order by postal mail
We accept Visa; MasterCard; and check or money order in U.S. funds.
Midwifery Today, Inc.
PO Box 2672
Eugene, OR 97402, USA
Order by phone or fax
We accept Visa and MasterCard.
Phone (U.S. and Canada; orders only): 1-800-743-0974
Phone (worldwide): +1 541-344-7438
Fax: +1 541-344-1422
E-News subscription questions or problems
Editorial submissions, questions or comments for E-News
Editorial for print magazine
For all other matters
All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today Web site.
Midwifery Today E-News is published electronically every other Wednesday. We invite your
questions, comments and submissions. We’d love to hear from you! Write to us at:
firstname.lastname@example.org. Please send submissions in the body of your message and not
This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.
Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.
The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.
© 2012 Midwifery Today, Inc. All Rights Reserved.
Midwifery Today: Each One Teach One!