Vaginal Birth After Cesarean or VBAC has been a highly controversial topic for the past few years. But not any longer.
World-wide studies are showing that not only is vaginal birth after a cesarean safe, but successful. A study released in summer 2013 from King Abdullah University Hospital in Jordan, reported among 207 women, 117 or 57% achieved a successful VBAC. Parity of ≥ 2 was significantly associated with increased odds of success (OR = 2.7, 95% CI: 1.2, 6.2). Compared with women who had no previous VBAC, those with previous VBAC had higher odds of success (OR = 3.8 (95% CI: 1.5, 9.5). We concluded that women with a previous cesarean section who achieved a cervical dilatation of ≥ 7 cm before caesarean, had a previous history of successful VBAC and had parity of ≥ 2, have the greatest likelihood of successful VBAC. (Journal of Obstetrics & Gynaecology 2013 July 33(5):474-8.)
Another study, this one from New Zealand, showed a 73% VBAC rate between 2008-2009. Increasing parity increased the chances of another vaginal delivery. Variables that lead to a failed VBAC included BMI=25 in women of single parity, labor augmentation and epidural anesthesia. (New Zealand Medical Journal 2013 Sept 27; 126(1383): 49-57).
Most recently (November 2013), a study from the UK shows of 143,970 women in the cohort, just over half of the women with a primary cesarean who were eligible for a TOLAC attempted a VBAC. Of those, almost 66% achieved a successful vaginal delivery. (British Journal of Obstetrics/Gynecology doi: 10.1111/1471-0528.12508).
How can women wisely choose VBAC? First and foremost, women need to choose both a careprovider and hospital who will support them in their VBAC. The International Cesarean Awareness Network has identified hospitals who do not offer VBAC. To identify whether or not a provider or hospital supports VBAC, call that hospital and then ask for the names of at least three providers. More information about selecting providers and hospitals can be found at the website VBAC.com. On that website, author and VBAC researcher Nicette Jukelevics also gives an extensive list of resources for those wanting additional information on VBAC. You may also utilize the VBAC Finder here
What does all of this say? It says that the research is there. The evidence is speaking. Expectant mothers need to have this education available to them in whatever source of media they use – childbirth education classes, online : blogs and websites, and social media.
Are you aware of the new video set for 2015 release about VBAC? View the trailer below and then be sure to visit www.themamasherpas.com for additional information!
Monday, December 02, 2013
Friday, November 29, 2013
I mean – cruise to exotic places, live on a floating posh ocean liner for 5 days and equally as important – hear amazing speakers such as Penny Simkin, Elizabeth Smith and Mickey Scott Jones! It truly doesn’t get much better than that.
The amazing ICEA Convention Cruise 2013 opened on Saturday November 9, shortly after boarding Royal Caribbean’s Liberty of the Sea.
Monday, we were tendered to Belize City, Belize where there were many excursions to explore this amazing and beautiful Central American country. My husband, who accompanied me on this convention cruise, and I chose the Baymen City Tour excursion. This tour took us via air conditioned trolley through the entire city of Belize and was hosted by “real” Caribbean pirates! We stopped at a rum factory and a nursery where the owner/nurse spoke to us about the use of herbs in Belize rather than pharmaceuticals.
|Nurse describing herbal remedies|
A brief over-night journey landed us at the dock of Cozumel – another absolutely amazing Caribbean location – complete with gracious people, balmy breezy weather and plenty of fun. This time, my Husband and I went on a coral exploration! Boarding a semi-submersed boat, we were able to view the second largest coral reef in the world. The number of fish and coral and other sea life was phenomenal! After the excursion, we “docked” at Margaritaville....for quite some time!
|Nancy and Penny|
Perhaps the highlight of the cruise was the celebration of Penny Simkin's 45th year as a childbirth educator! Penny was presented with many memorable items and we all celebrated with her. A wonderful video interview of Penny by Nancy Lantz, ICEA president opened the festivities.
Below are some additional photos from the Convention Cruise! I hope you enjoy the convention cruise through my eyes. Next year, I invite you to Asheville NC for a convention through YOUR eyes!
|Humor in Belize!|
Wednesday, November 06, 2013
Thursday, October 31, 2013
If you have never heard Dr. Nils Bergman speak in person, you need to make every effort to do so. This mild-mannered physician who was born in Sweden and raised in Zimbabwe works as a Senior Medical Superintendent of Mowbray Maternity Hospital in Cape Town – overseeing 18,000 births per year.
Dr. Bergman was in my community recently. I did hear him speak. And here is part of what I learned:
During pregnancy, a baby begins to get to know the mother. Her voice, her smell. And immediately after birth, putting a baby skin-to-skin….mother to baby with no interference from hats, blankets orany other clothing…babies will begin to establish the external womb, a safe and inviting place in which to thrive. Blood sugar, respirations, blood pressure, and neuromuscular control stabilizes because the baby knows that he is safe. Skin to skin contact immediately between mother and baby allows the baby to be colonized by the same bacteria as the mother.
When other mammals are studied, those babies who are taken out of their natural habitat – the external womb – show all of the physiologic signs of being under significant stress. Cortisol rises (a stress hormone) and thwarts the baby’s system, decreasing stabilization. Additionally, normal baby behaviors such as rooting and searching the breast, breathing normally, staying warm…all of these behaviors take a tragic turn for the worse.
There is no reason why most babies cannot spend a significant amount of time in skin-to-skin contact with the mother – even cesarean born babies. And what better to help the mother and father relax and establish this amazing environment that with the presence of a doula.
Unfortunately, Dr. Bergman’s highly praising comments regarding doulas were met with “crickets”.
This amazing and safe environment allows the baby to begin its life outside the womb with a feeling of calm and safety. Yes, there is a lot of emphasis on safety. Early experiences establish brain function and the loving mother is key for neurodevelopment. Studies show that what happens in early life may facilitate a risk for developing severe psychopathologies at later states in life. Therefore, separation of the mother/baby dyad by required stays in a nursery or the baby taken away for “tests” interrupts needed neural process and becomes opposite of skin-to-skin. Basically, maternal absence to a baby is considered toxic stress.
For the mother, when oxytocin is released in the brain, its effects are to reduce fearfulness and initiate “mothering” behaviors but also enhances a tendency toward aggression and protective force toward anyone bothering the baby.
These tremendous links between behavior and hormones are called neuro-endocrine behaviors.
Therefore, it truly matters how we are born and also how we are nurtured after the birth. We are defined by our relationships early on. And separation of mother and baby is a violation of an innate agenda.
To add to my notes and thoughts of hearing Dr. Bergman, the following is excerpted from Dr. Bergman’s website www.kangaroomothercare.com ~
One of the most basic abilities, and that appears early in development, is to determine whether a sensation (or even constellation of such) is safe, dangerous or life threatening. This is seen in early fetal life, and is fully competent from 28 weeks. All the sensations in the uterus tell the fetus it is SAFE. At birth the baby is highly stressed, and this birthing stress is necessary to activate the systems that make for breathing air and coping with “life outside”. But once outside, the need for being SAFE is primary, and essentially it is only mother’s presence providing familiar sensations that achieve this. The chest of the mother is to the newborn its PLACE of care. Care means the three basic biological needs are met: mother skin-to-skin contact ensures warmth, her breasts provide nutrition, and her arms cover baby for protection. The baby is wired to respond to this place in many different ways, the two we can easily see we call self-attachment and breastfeeding. After feeding, sleep cycling is essential to establish the pathways that were fired.
When mother is absent, the newborn brain feels unsafe, it perceives danger and threat to life, and its basic needs are not provided. The brain kicks in a powerful defence reaction, which first makes a short burst of crying before shutting that down and lowering heart rate and temperature, and then shuts down all activity, reverting to the immobilization defence, similar to that of frogs and reptiles. This looks like sleep! But it is not, and it is maintained by high levels of cortisol, which make the “wear and tear” which is the primary first cause of all subsequent problems preterm infants suffer from. This is not actually sleep, so the pathways are not established. Instead, when stress is prolonged, the cortisol disrupts brain architecture, unless there is “buffering protection of adult support”.
All of our routines that are just that….routines, and not evidence-based…do more harm to our society’s future than we realize.
Tuesday, October 29, 2013
I love Ted Talks and I especially love this one. Ina May made this during the summer of 2013. Ina May Gaskin, MA, CPM, PhD (Hon), is founder and director of the Farm Midwifery Center in Tennessee. The 41-year-old midwifery service is noted for its women-centered care.
Thursday, October 24, 2013
In Part 5 of our 5 part video series on Delayed Cord Clamping, author and childbirth educator Penny Simkin offers this great visual explanation............