Cesarean Awareness: A Doula’s Humble Reflection

by Erin Stertz-Follett, CLD, LCCE, HBCE

 

My journey into birth began 10 years ago after the birth of my first nephew, Micah. I wouldn’t fully embrace birth as my calling until many years later, after the birth of my own two girls and the ‘birth’ of the passion inside me to bring services of meaning to pregnant women and their families.
I will never forget that moment. After an induction that lasted more than 24 hours, and “arrest of descent” of the baby during pushing, my sister was told that she would need a cesarean section. I watched as her face turned from determination, to disappointment, to resignation, and to sorrow. As my mom and I left the room while they began the surgical prep, I said to Mom, “That’s not what we wanted.” With tears trickling down her cheeks, she shook her head, “No.” The grief for what Sarah so badly wanted – a vaginal birth with minimal interventions – was palpable.

A few years later, as I was pregnant with my first child and wanting to learn as much as I could to avoid my own surgical birth, Sarah invited me to an ICAN (International Cesarean Awareness Network) meeting. At that time, the group was small and had just begun reforming here in the Twin Cities. I happened to attend on a night when a wise midwife named Gail Tully was on hand to provide information and practice in ‘optimal fetal positioning’ for birth. I didn’t know anything about birth halls or Rebozos, or the side-lying release. I just knew that it felt so good (and kind of funny!) as I was used as the ‘pregnant model’ for Rebozo belly sifting.

Two babies later, both of which included my sister’s attendance and support, I began the true path to birth work as a Lamaze Certified Childbirth Educator, doula, and HypnoBirthing Certified Educator. Again, my journey was largely inspired not only by Sarah’s first birth, but also by her successful HBAC (home birth after cesarean) her second time around.

To offer full disclosure, I dreaded as a doula the first time I would need to step into the surgical suite and witness a mama experience a cesarean birth. In some small way, I was traumatized by my sister’s experience. Now with several under my belt, I can say that my perspective has changed. Yes, it is still difficult. But, with my doula hat on, I enter the experience with an open heart and an open mind, with nothing but how I can best support that mama in that moment as my focus. It is at that time that we turn our trust over to the trained surgeon whose job now is to safely bring the baby forth from the mother’s womb. I offer a grounding hand on the forehead, an explanation of what to expect and what is happening, sounds and smells that calm the mother, words of reassurance to the partner, and pictures if mama desires.

I have seen mothers who view their surgical births in many different ways: From full-on acceptance (even requesting one at the end of a long, stalled labor); to complete devastation (offering my doula hands to wipe away tears); to somewhere in the middle (perhaps with resignation and a resolve to process the experience later).  I have seen cesareans that are completely medically necessary, and those that fall in a grey area.

Look, the cesarean rate in this country (32.8%) is too high. There’s no way around that. We can do better. For women, for babies, and for their families. It may feel daunting to tackle this subject on a grander scale and I know many of us birth workers often feel at a loss. But here is what we can do:

• Approach the subject with mamas (clients, patients, friends, family) with gentleness, understanding, an open heart; and, when needed, the statistics.
• Remember and value the fact that not all mamas view their cesarean as traumatic or unnecessary. Don’t assume that all mamas do and meet them where they are, especially as they plan a subsequent birth.
• Educate. Educate. Educate. Knowledge truly is power. Whether it is ways to more optimally position baby for birth, or methods for deep relaxation, or just knowing all options and all places of referral. Education is key. The ability to ask questions and have them honestly answered is tantamount.
• Refer to birth providers who offer options for mamas in pregnancy and labor; and who understand normal, physiologic birth… Those whose rates of cesarean birth are on the lower end (including out-of-hospital options if the mother desires).
• Refer mamas who have experienced cesarean birth, especially those that view their births as traumatic, to resources such as ICAN and Homebirth Cesarean groups.
• When a surgical birth becomes truly medically necessary either before the birth or during the laboring process, we can offer support and guidance for having a more family-centered experience.
• Put our time, our money, and our voices behind organizations that support mamas in having births with low interventions.

And finally, as doulas and as friends or family, we can hold hands. Wipe tears. Validate fears. Lift them up. Walk down to the lowest lows with them. Remind every mama how strong they are… that they brought their baby into the world; that they can do it again with love.

Erin Stertz-Follett owns Flutterby Birth Services, located in Burnsville, MN. In addition to doula services, she offers HypnoBirthing, Lamaze, and Breastfeeding classes as well as other workshops and events. She is the mother to two lovely and lively little girls.

Editor’s Note: This post first appeared on the Flutterby Birth blog. Photos credited to Stephanie Ryan Photography.  All birth stories used with the permission of the mothers. 

Birth Story: “I did it! I did it!” – Katie and Carter’s HBAC

by Katie Champ

My journey to Carter’s homebirth after cesarean (HBAC) began when my daughter Kaylee was born on September 1, 2011.  I was induced at 38 weeks for pre-eclampsia with cytotec, pitocin, and an epidural which led to a cesarean section under general anesthesia.  After her birth, I was determined to do things differently the next time.  I needed to be the first person to see and hold my baby.  I joined the Twin Cities chapter of ICAN (International Cesarean Awareness Network) and learned that I was not alone.  That other women had traumatic births as well, but they went on to have beautiful vaginal births after their cesarean.  This is when we decided that when we had another child, they would be born at home.

 

We spent a lot of time doing our research on natural birth, homebirth, birthing classes, midwives, and more!  On October 31st, 2012, we found out we were expecting our second child.  We went on the hunt for the perfect homebirth midwife, doula, and childbirth class.  We quickly found our midwives and decided to use Hypnobabies for this birth.  We couldn’t attend in person classes due to scheduling conflicts, but we were able to do the home study course.  We went back and forth on hiring a doula.  One thing I really regretted in my daughter’s birth was not hiring a doula.  Even though I had 2 wonderful midwives attending my birth, I didn’t want to have any regrets this time, so we went ahead with finding a doula and are beyond thankful we did.

 

I spent my pregnancy preparing myself for this birth.  I needed to make sure I did not get pre-eclampsia and I needed to stay healthy.  I completely changed my outlook on pregnancy and birth.  I ate healthy, stayed active, went to prenatal yoga, received chiropractic care, bodywork, and massage, did my daily spinning babies, listened to my Hypnobabies tracks and practiced my Hypnobabies techniques, read more birth books, attended ICAN meetings (and joined the board), met more homebirth families, and really took an active roll in preparing for this birth.  I wasn’t going to let anything get in my way of having a successful HBAC!

 

Fast forward to July 2013.  My guess date was July 13th, 2013.  This day came and went with no baby.  So did 41 weeks and 42 weeks!  I was growing impatient, but my husband kept reassuring me that I would not be pregnant forever and that babies come when they are ready.  Thankfully, my doula had gone to 43 weeks herself and assured me that I would go into labor.  At 42 weeks we started trying all to old wives tales to get labor started.  This little guy must not have been ready, because none of them worked!  At 42 weeks 4 days, we went in for a biophysical profile (BPP).  This showed low fluid, but nothing my back up OB said was urgent.  He encouraged us to keep trying to get labor moving and come back in 2 days for a follow up BPP and we would go from there.  He was pretty confident that labor would happen soon and was not concerned that I was nearing 43 weeks.  We were very lucky to have fabulous, supportive midwives, and a wonderful back up OB!

 

I cried lots of tears that day wondering when my baby was going to decide to make his appearance, but also accepted that he would come when he was truly ready.  Earlier in the week, we tried some herbs with our midwives, but that did not encourage labor to begin.  We decided to try them again that night and see what would happen.  That night, we had a wonderful dinner and put our daughter to bed before the midwives arrived.  I must have had a gut feeling something was going to happen.  We read extra books and had lots of extra snuggles, hugs, and kisses before bed that night.  I think deep down, I knew this would be our last bedtime as a family of three.

 

The midwives arrived around 8:00.  I spent the next hour bouncing on my yoga ball, hanging out with our midwives, and trying the herbs.  Around 9:00, I started getting a little crampy and a few waves here and there.  By 10:00, waves had begun to get regular.  I started listening to my Hypnobabies Birthing Day Affirmations while bouncing on my yoga ball. I texted my doula to let her know that labor had possibly begun.  I told her that we may have a baby the next day and that the midwives were still at our house.  I honestly thought I wasn’t in real labor.  I thought the midwives would go home to rest and come back in the morning.  Being almost 43 weeks, I was in complete denial that labor was actually going to happen!

 

Shortly after texting my doula, our midwives decided to time the waves.  They were already 2 minutes apart.  I kept moving on my yoga ball for awhile, then went to take a shower.  I went upstairs and by the time I got up there, I could barely move through a wave.  I asked my husband, Jon, to come help me.  I leaned on him during the waves while I was trying to move into the shower.  I listened to my Hypnobabies Deepening track and kept going between waves on the toilet and waves leaning on Jon.  I finally got in the shower.  The water felt great but standing was a challenge.  I got out and got on the toilet again.  I started getting vocal through the waves.  Deep moaning helped me make it through them.

 

I have no idea how far apart they were, but they felt very close.  I told Jon that I needed them to set the pool up because I needed to get in it now.  By this time, my midwives were setting everything up for the birth.  I texted my doula a little before 11:00 to come now.  She asked if the midwives were there and all I said was yes.  She asked if she should let the birth photographer know to come, and I said yes.  That was the last I looked at my phone.

 

My doula got to our house at about 11:45 and my photographer got there at about 12:00.  I was sitting on my yoga ball in our bedroom while everyone scrambled to get the birth pool set up.  My doula used the relax cue with her hand on my shoulder and said lots of wonderful, positive Hypnobabies birthing affirmations which kept me calm and relaxed.  The midwives and Jon were trying to get the pool filled fast.  The hose was not quick enough!  They brought up pots and pitchers of water from the kitchen to the nursery upstairs where we had the pool set up.  Shortly after, the pool was full and ready for me to get in. I climbed in the pool before another wave hit me.

 

The water felt amazing!  The only position I was comfortable in was kneeling and leaning over the edge of the pool.  Jon held my hand pretty much the entire time.  He was truly my rock through all of this.  My doula helped me with Hypnobabies affirmations, staying relaxed, and breathing my baby out.  My moaning got louder and deeper and the pressure waves more intense.  I can’t say it wasn’t painful, but I was able to keep my body relaxed and not tense up.  I thank Hypnobabies for being able to keep me calm and my body relaxed through this stage.  I spent awhile on my knees hanging over the edge letting my body push.  I never believed people when they said your body will start pushing when you are ready, but it is absolutely true!  As baby moved down, I needed to move to open my pelvis.  I alternated between one knee down and the other knee up in a lunge and then the same thing on the other side.  It was uncomfortable but its what baby and my body needed.  My midwives also wanted me to sit up so gravity would help bring baby down.  This was incredibly hard to do.  I certainly tried my best to stay upright, but I couldn’t do it every wave.

 

I said many times “this baby needs to come out!”  I was getting close to crowning when they brought my husband an elastic band with handles on it that he wrapped around his body and I held onto the handles to keep myself upright.  This is when the intense pushing began where I really gave it my all.  Shortly after, I remember saying it burned and they said that was good and to take it easy and his head was almost out.  A couple pushes later and his head was out.  His shoulder was a little sticky so my midwife helped loosen his shoulder and shortly after, the rest of his body slid out.  I remember hearing everyone tell me to reach down and pick up my baby.  I reached down and grabbed him into my arms and said “I did it!”.  I think a repeated “I did it” over and over again!  I was the first person to see and hold my baby!  Carter was born at 2:14 am.  He certainly waited until the last minute to be born, but once labor started, he was in a hurry!  His whole labor was about 4 hours long!  He was 9 pounds, 9 ounces and 22.5 inches long.

 

Carter’s birth was absolutely perfect and everything I dreamed of.  It was the healing birth I needed and it brought our beautiful baby boy into this world!

“Incredibly healing and an absolute gift”: An HBA2C birth story

by Joyce Geving

My first of three sons was born December 21st, 2004.  We labored for hours and I was given an epidural followed by Pitocin. His cord was wrapped around his forehead, so with each contraction his heart rate would fall. So I was rushed into the operating room. I remember feeling so scared and helpless.  I am not sure if a cesarean could have been avoided with his birth. Afterward, I really mourned not being pregnant any longer, and I think it was the safe feeling of my pregnancy that I missed. I no longer had my baby safe and warm in me but had this scary birth story. I also left feeling like my body had been violated in some way. All of these feelings I shared with others and my doctor but were dismissed or hardly acknowledged so I thought I just needed to get over it and move on.

My second, July 6th, 2007, was a scheduled repeat cesarean. The hospital had a no VBAC policy in place and my doctor convinced me that a cesarean would be the safest option, and I went along with it.  It wasn’t until a couple years later, after watching the “Business of Being Born” that I began questioning the necessity of my cesareans and how I and my babies missed out on the natural experience and all the benefits that happen with that.

When I became pregnant with my third I knew I wanted to give birth, to do what my body was meant to do, even with a scar. I was so happy to hear the nearby hospital was doing VBACs again but was told it was not for me because I had had two previous cesareans and the risk was too high…so now what? I felt defeated.

I contacted the ICAN Minneapolis chapter and was informed of hospitals in the metro that would do VBA2C. I began making appointments and looking into a couple that were within reasonable driving distance. After each appointment I left feeling like they were setting me up for another cesarean, and more interested in adding my birth to their statistics – good or bad.  I began questioning what my birth was going to look like at the hospital with all their policies and protocols. 

Mean while, we had hired a doula because we had read the statistics supporting reduced risk of cesarean when doulas are present. I also knew I would need someone to help us make informed decisions in a hospital. Right from the start, we had a connection with our doula, Ashley; she gave us so much support and information that we needed. 

While doing my research online, home births always came up as an option or in success stories, but my husband and I were both really scared of the idea thinking, “what if something goes wrong” and “what would we do with the dogs and my dad during labor, how are we going to come up with the money?”

Our doula encouraged me to just meet with homebirth midwives to rule it out, if nothing else, and at 30 weeks my husband and I made an appointment to do so. After our first meeting, we knew this was our path and had a sigh of relief. We left feeling excited again and validated, instead of stressed about the birth and our plans. We could really enjoy the pregnancy and the preparing for our birth. 

My prenatal appointments were always at least 45 minutes long, usually longer. We talked about the importance of eating well and drinking water and my tea.  The care I experienced during our appointments was amazing, they always made me feel comfortable and that I could do this.  Nothing like what I experienced in any of my clinic visits.

On January 21st, my contractions began at 10:40 at night. I was so excited, we were up timing contractions all night and called our doula so excited at 4am. She convinced us to get some rest. I slept a couple hours and my water broke at 7:35the next morning. Then I called everyone, because I felt like now’s the real deal, but contractions were still steady and not increasing or getting stronger. I was in constant contact with our doula and midwives. One of the midwives came to check on our progress and things were moving so slow we were urged to get some rest that evening and labor would hopefully pick up after some sleep. Just as soon as I laid down, contractions really began – and we had just told our doula to take her time and come that night when she wanted. One of the midwives came and hurriedly called the other to come now after she said she could see his head and then reassured me that my body was doing what it was supposed to be doing.

That night, in our family room, I gave birth to our third son.  He came out and cried “momma” (sounded like that to me) and nursed like champ all while his cord was still attached to me. My husband was so comforting and amazing while supporting me. It was so calm, comfortable, and full of love and encouragement…it was a beautiful setting for our little guy to enter the world. 

My home birth experience was incredibly healing and an absolute gift.

Editorial Response to Minnesota C-Section Rate Article

The following editorial, written by Childbirth Collective president Judith Nylander, was written in response to this article that appeared in the Minneapolis Star Tribune in February 2013. We encourage you to read the article first and then read Judith’s thoughtful response. 

A recent article about the C-section rates for Minnesota clinics surely raises questions, but comes as no surprise to most folks working in the birth world.  And while these statistics do not appear to be “solely driven by medical necessity” they are, perhaps, driven by the medical model of childbirth widely practiced in nearly every hospital in Minnesota.  The medical/obstetrical model of birth includes a number of factors that would be worth questioning as we ponder the reason for the high number of first-time mothers who leave the hospital after major abdominal surgery, and with a newborn in their arms.

The cost alone is reason to question these high numbers. But as a birth doula, I think of the early days of a mama’s life, as she does the stressful, remarkable and unforgettable work of caring for a newborn who needs and deserves our complete attention while simultaneously recovering from major abdominal surgery.    Would asking some questions about the model of care really make a difference?

What would some these questions be?  If I was a first-time mother looking for prenatal care for my pregnancy I would ask: What is your rate of induction for first-time mothers? How you deal with mothers who might need 42 full weeks or more before their babies are ready to be born?   How do you understand informed consent and informed refusal?  How do you deal with a mother who wants, or needs, to give birth in a non-traditional position, say on hands & knees?  I would ask questions like this of an obstetrician, a family practice doctor, a certified nurse midwife and a homebirth midwife.  I think the answers would lead you to the care that is appropriate for you and that model of care is likely to be the midwifery model – as long as you are a healthy woman having a healthy pregnancy.

These are the questions that could impact the statistics in the article.  The World Health Organization  states that a C-section rate over 15% is unacceptable.  Let’s ask some questions.

Judith Nylander, CD(DONA)

President, Childbirth Collective

Ask a Doula: How can a doula assist my family during a planned, medically necessary C-Section?

A doula assists a birthing family in the OR at Abbott Northwestern.

We are excited for our first “Ask a Doula” post to have responses from not one, but two of our Collective doulas! On the heels of April’s International Cesarean Awareness Month, a mama on our Facebook page asked, “How can a doula assist my family during a planned, medically necessary C-section?”   Women having a necessary surgical birth still have choices for this important day! If you know you’ll be having a surgical birth, interview several providers and find one who can help you have the cesarean birth experience you want.  If you’re interested in learning more, check out this video on the  Natural or Family-Centered Cesarean movement being implemented in the UK. 

Our first doula response comes from Karrie Nesbit CD(DONA), CLC, HCHD: 

When considering a planned surgical birth, getting the information you need to make informed decisions is critical.  A doula will ensure you understand all of your options, and because a doula is not accountable to your provider, she will provide you with unbiased information to help you make the decisions that are best for your family.  With such a wide variety of birthing options available nowadays, it can be comforting to speak with a doula about her experiences with different birth techniques, providers, and birth places.  In short, if you are not completely comfortable with the options you are getting from your provider, a doula can help you find more of what you are looking for with other providers or birth places.

Once the decision to have a surgical birth has been made, your doula will prepare you for what you are going to see, hear, smell, and feel during the birth.  I find that for most families, just knowing what to expect takes away a lot of the anxiety.  Sometimes the  hospital staff forget to explain the details, or they explain them in a way that is not calming or easily understood.

In the operating room, your doula will explain procedures as they happen to reassure, comfort and calm everyone throughout the process. She will help you understand the circumstances immediately following the baby’s birth. If the partner needs to leave the operating room with baby, the doula will remain with momma. Whether in the operating room or recovery room, your doula can help facilitate skin to skin and breastfeeding.

Above all, doulas encourage and help you to speak up for what you need and want for your baby’s birth.  No matter how your baby comes into the world, the presence of a doula will help you to look back on your baby’s birth as a positive and empowering experience.

Our next response comes from Gina Picht with Partners in Birth: 

Sometimes when a family finds out they need or chooses a planned Cesarean birth, they stop thinking of it as a birth.  It becomes a procedure, a “section”.  Something that the doctors do to them, not them birthing their baby.  A doula’s role becomes the keeper of the birth, bringing the focus back to the family and how they can best work with their circumstances to welcome their baby is a gentle, interactive way.

Your doula will likely meet with you before the day of surgery to review options, which some families are surprised to learn they still have!  Cesarean birth is more and more viewed as an experience that can be tailored to a family’s wishes.  Hospitals and even doctors themselves handle the surgical experience in their own unique way.  It is worthwhile to ask questions beforehand to better understand what options may be available to you.  Your doula can arrive early with you and help keep you relaxed through the preparation process, giving massage, using scented oils, dimming lights, and offering guided visualizations, just as in labor.  As questions are asked of the family by the medical staff, the doula can help give context for those questions, and help get more information when needed.

When the mother goes into the OR to get anesthesia, the partner is usually left alone outside the room.  Your doula will stay with your partner during this time and can be a calming presence in an unfamiliar time and environment.  Most often, the doula is allowed to join the family in the OR where she continues her support, using massage, her calming voice, and maybe a scented oil to mask any surgical odors.  If desired, the doula can narrate the procedure to some extent, letting the family know at what stage the surgery is and when the birth is close.  The time it takes to get to the baby can seem incredibly short, and the doula helps the family participate emotionally in the process, anticipating that moment when the baby is born.  She can encourage the screen to be lowered so the family can see the baby when it’s born, and advocate for the mother’s hands to be unstrapped so she can touch and hold her baby.

In certain cases the mother will feel ready to attempt nursing while the surgery is being finished.  If not, the doula can assist with this in the recovery room.  If the baby needs to leave the OR for any reason, the partner usually goes with the baby so the doula will stay with the mother.  She can help the mother process the experience, and go to get updates on the baby’s condition, maybe bringing back photos to help the mother stay connected.  Of course as soon as possible, the doula will encourage the mother and baby to reunite, facilitating skin-to-skin contact and breastfeeding.  And lots of photos!

A Cesarean section is still a birth.  In the end, a family is born, and a doula can help bring the focus back to that family.

Karrie Nesbit is a doula and lactation counselor who recently relocated to sunny Southern California. Find out more about Karrie at Birth, Etc.

Gina Picht has been a birth doula since 2001 after the birth of her second (and last) child. She is Treasurer of The Childbirth Collective and lives in Eden Prairie.  She believes all women already know how to birth.  www.partnersinbirth.com

The VBAC of John Gabriel

by Kalli Huehn

Before I get into the birth story of my second, I should say that my first child, my daughter, was born via c-section. She was presenting face-first, and according to our midwife it was against hospital protocol to deliver a baby face-first vaginally. Even though we desired a natural birth, we pretty much got the exact opposite of that, but in the end we still got a beautiful, healthy, plump little girl and everyone recovered wonderfully.

In preparation for our second birth, we really wanted to have the all natural, drug-free VBAC we’ve been dreaming of, so we ditched the hospital idea and decided to go with a birthing center. We surrounded ourselves with a team of extremely supportive, encouraging, all-natural believing midwives, a doula, and family members to aid us in our pregnancy and delivery.

Labor started early on Sunday morning when my water broke at 2:00am. We got excited with the possibility that we would be having a baby soon! But the story goes on and on….  We spent all day Sunday being active: walking in malls, eating good food, walking around the neighborhood. We went in for a check-up at the birth center, but nothing had changed. Contractions were like they’ve been for the past couple of weeks, 10 minutes or more apart, slow and putzy.

Monday we went in for another appointment at the birth center and started an herbal induction. I got checked and I was about 70% effaced and 1 cm dilated, so that was good news! The herbal induction was a remedy of castor oil, an herbal liquid and two different kinds of pills. All the while we tried to stay as active as possible, lots of walking, eating good foods, trying to stay positive! All the while contractions stayed the same, about 10 minutes apart and not too intense.

Monday night we had a home visit from our doula Rochelle and midwife. Our midwife had started getting plans in place for a hospital visit since it was over 24 hours since my water broke and no baby.  My husband was pretty scared; he did NOT want to go to a hospital since we worked so hard to have a VBAC all natural. But we all agreed to go one more night and, if nothing much happened, we would go to the hospital for an induction.

Well, that night we did go into labor!!  I woke up around 1:00am because I couldn’t sleep anymore through the contractions. We called Rochelle over and labored all night long. We thought we were making good progress, but still the contractions were just not picking up and getting stronger. They were about 5 minutes apart, but not lasting very long and not getting terribly strong.  The midwife decided to transfer us to the hospital. Reluctantly we did, but it was pretty obvious that my body was just not going into labor on its own.

We checked into the hospital around 11:00am and by 12:00 my AMAZING birthing team had assembled including Rochelle, my sister, and midwife apprentice from the birth center and the midwife from the hospital. We ran into some trouble with hospital politics when we first arrived. Even though our midwives had called and spoken to hospital staff about our situation and got the “all clear” to be admitted as a midwife patient, the OB resident was nervous because of my previous Cesarean and wanted me under his care, not the midwives. After speaking with him about our desires for delivery and our concerns (and going back and forth on the phone with our midwives and the hospital staff), the OB decided to keep us under midwifery care, but he would check on us.

Finally I got started on pitocin. Labor progressed still fairly slowly but it was definitely happening. We labored all day and into the night. Again we were able to stay active, walked all around the hospital, and used the birthing ball. I rarely sat down or laid in bed during contractions; it just felt much better to be active. I was disappointed to see midnight arrive and STILL no baby. Around 1:00 or 2:00am labor was pretty intense and I got checked. I was only about a 5. That was it for me. I was so distraught and discouraged, and I kept thinking “I can’t keep doing this I can’t keep doing this.”  Thankfully my birth team was SO SUPPORTIVE and encouraging; we tried a couple more positions and used the rebozo to move the baby around. Then we decided to get in the water. Still by this point I kept thinking “I can’t do this anymore.” Contractions were SO INTENSE by the time I got in the water it wasn’t even relaxing, I was vocalizing and grunting. I started getting the feeling I needed to push soon after getting in the tub. Everyone was so patient and calm I remember the midwife saying “If you need to push, then push and I did! I remember feeling him descend through my pelvis. Because I was on pitocin the whole time I remember E.V.E.R.Y.T.H.I.N.G. — every feeling, every conversation around me, every everything.

As soon as I could start feeling his head I forgot about “I can’t do it” and thought “I am doing this!” During pushing I asked to see his head in the mirror and got to feel him. I have never felt such joyous bliss, what an unreal moment that was. After about two hours of pushing, I caught my son; at 3:59am; 72 hours after my water broke and 26 hours after laboring, John Gabriel came into the world a whopping 8 lbs, 10 oz! He is a dark, handsome little lad, he has a PROUD big sister, mother and father.
—
Rochelle Matos, AAHCC, CD(DONA) is a member of the Childbirth Collective

Cesarean Prevention is for EVERY birthing mother….

by Chandra Fischer

“I never paid any attention to cesareans.”  “I ignored the part about cesareans in our childbirth class because I was planning a natural birth.”  “My care provider told me that he only does a cesarean when the baby is in trouble.”  “I was shocked when I had to have a cesarean.”  “I had no idea that an induction or epidural would increase my chance of cesarean.” “Isn’t a cesarean a better choice if I want to protect my pelvic floor?”

Sound familiar?  That’s the echo of thousands of pregnant women bypassing an issue that will, in effect, impact at least 1 in 3 pregnant women in the United States.  Yep.  You heard right.  One in every three women in this country will have a surgical birth.  Some of those will be life-saving.  Some of them will be necessary.  A great majority of them are entirely preventable, with higher risks to you and your baby.[i]  Because, let’s face it, an intervention that is unnecessary has NO benefit.  It’s all risk.

With that in mind, here are a few important things you can do to avoid an unnecessary cesarean:

• Read.  Learn about what a cesarean surgery entails.  Learn about the times when it *is* truly necessary.  Educate yourself about the risks, benefits and alternatives.  One fantastic, evidence-based, resource is “What Every Pregnant Woman Needs to Know About Cesarean Section” — downloadable booklet located at http://www.childbirthconnection.org.  Another is the International Cesarean Awareness Network’s (ICAN) website http://www.ican-online.org, and your local ICAN chapter at http://www.icantwincities.org.

• Hire a Doula! Research fully and repeatedly backs up the importance of trained labor support in the reduction and prevention of a variety of interventions, including cesarean section.[ii]

• Stay active and mobile during your labor.  Gravity and freedom of movement are a birthing mother’s best friend.  The ability to change your position allows you to respond to your baby’s spiraling movements and descent down the birth canal, opens up your pelvis and helps your baby to be born gently and easily.  This mobility can help prevent your baby from getting stuck in a less advantageous position, and, if your baby is already malpositioned, it can enhance your baby’s chances of moving into a better position for birth.  If your movement is limited or if you are confined to bed, ask your doula to help you change your position every 30 minutes.  [iii]

• Avoid induction of labor unless there is a true medical reason to do so.  Simply put, induction of labor, especially in first time mothers, increases your chances of a cesarean by 50%.  [iv]

The work of parenthood begins in pregnancy.  Advocating for the healthiest birth possible is just the beginning.  So, cesarean prevention isn’t for the other women.  It’s for you.  It’s for your baby.  It’s for this pregnancy.  This labor.  This birth.

-Chandra Fischer, Birth Doula

Prajna Birth Services

http://www.prajnabirth.com

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[i] http://www.motherfriendly.org/Resources/Documents/TheRisksofCesareanSectionFebruary2010.pdf

[ii] Cochrane Database of Systematic Reviews, Hodnett ED, Gates S, Hofmeyer GJ, Sakala C, Weston J. “Continuous Support for Women During Childbirth” 2011, Issue 2

[iii] http://www.lamaze.org/ChildbirthEducators/ResourcesforEducators/CarePracticePapers/FreedomofMovement/tabid/484/Default.aspx

[iv] Labor Induction and the Risk of a Cesarean Delivery Among Nulliparous Women at TermEhrenthal, Deborah B.; Jiang, Xiaozhang; Strobino, Donna M.Obstetrics & Gynecology. 116(1):35-42, July 2010.