The Induction: Making an Informed Decision

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Hey all!  I’ve got another birth post for you today!  Being pregnant means I’ve obviously often got babies on the brain and since birth is the culmination (and finale!) of 9 months of growing a sweet baby, it’s probably what I think about the most often.

Today I want to talk inductions: the what, the why and the how!  Just like all the other birth interventions I’ve previously written about, inducing labor comes with benefits as well as some risks.   Hopefully this helps you, or someone you know, be as prepared as possible to choose (or refuse) an induction.

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The VBAC: Making An Informed Decision

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Hey all!  I’m excited to be back with another post in my series on birth!  I’ve previously written about epidurals and c-sections and today, we’re talking about VBACS.

The term “VBAC” stands for “Vaginal Birth After Cesarean” and as the rate of c-sections continues to climb in many countries, so does talk of VBACS.  Moms everywhere are asking things like, “Is a VBAC safe?”  “Is it necessary or desirable?”  “Am I eligible to have a vaginal birth after a c-section?” and “What are the risks?”

I hope this post can answer some of those questions and inspire anyone with a history of a cesarean to become more informed and ready to face future births!

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As discussed in my C-section post, we know that cesareans are an unnatural birth outcome and present risks to both baby and mother.  That being said, just because you’ve had a c-section before (or even multiple!) does NOT mean you necessarily have to have a repeat surgery in the future.  I remember grieving after Liam’s birth because I knew I wanted a large family, yet I couldn’t envision putting my body through 4 or more cesareans.  Luckily, I found some great resources regarding VBACS and have been able to find supportive providers who allowed me to try for the births I had hoped for.  I’ve since delivered 6 babies vaginally after that initial cesarean with no complications.

If it is a safe option for you, there’s a good chance you can have one!

While my cesarean was unexpected, emergent and traumatic, I understand that not all c-sections end up that way.  Some are planned, peaceful and wonderful experiences.  If you were lucky enough to have one of these, you might be wondering why anyone would choose a vaginal birth over a planned cesarean.  Barring any life-threatening need for a cesarean , vaginal births are desirable for a number of reasons:

  1.  No surgical risks such as blood loss, side effects from anesthesia, adhesions (cases where the scar tissue attaches itself to other organs), blood clots, extended recovery time, etc.
  2. Less traumatic on mother and baby: c-section babies often have fluid in their lungs, trouble breathing and other complications.
  3. If labor is allowed to begin naturally at the end of pregnancy, there’s no risk of accidentally delivering a pre-term baby.  The bodies of both mother and baby work in tandem to signal when baby is ready to be born; it’s not usually wise to forcefully extract a baby before labor begins.
  4. Lower medical costs and shorter hospital stay!IMG_4069

On the flip-side, some of you with previously negative c-section experiences might be wondering why anyone would WANT to undergo another surgery.  Your doctor might choose to surgically deliver your baby if your first cesarean was due to (or your current pregnancy includes):

  1. Eclampsia
  2. Serious medical problems with mother or baby
  3. Poorly positioned placenta or unusual bleeding
  4. Any other life-threatening emergency

As discussed in the c-section post, some less clear-cut reasons for an additional surgery include a baby estimated to be larger than usual, a breech baby or a mother with a small pelvis.  These DO NOT always necessitate an automatic cesarean.  Do some research, get a second (or third!) opinion, pray/meditate, and follow your gut to make the best decision for you and your baby.

There can be risks associate with a VBAC as well.  The most dangerous (and one you’ll probably hear about most often) is the risk of uterine rupture.  The strain on a uterine scar during labor can sometimes cause it to reopen, and this usually has very serious results for mom and/or baby.  Luckily however, uterine rupture is very rare and occurs in right around .5% of laboring women who have had a previous cesearean (check out this great article for more details).

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There are TONS of amazing resources online regarding VBACS and how to decide whether one is right for you.  The VBAC Education Project is a great place to start.  The International Cesearean Awareness Network (ICAN) is another great place to learn more.  It’s difficult to even scratch the surface of all the great information these websites hold – be sure to check them out!

Lastly, I wanted to touch on the subject of homebirths and VBACS.  While there are still restrictions in many states regarding the ability to give birth at home after a cesarean, other states have now lifted bans and allow certified, licensed midwives to assist women attempting a VBAC in their home.  Three of my births occurred at home (all 3 technically considered VBACS) and I’m so grateful for these experiences!  I researched and prayed and listened and we decided that this choice would be the safest and the most peaceful for me and each of these babies.

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I believe that each woman is the most qualified to make these crucial decisions regarding the birth of her baby.  Regardless of what your birthing choices look like, it’s important to remember that you HAVE choices!  It can be both scary and empowering to face such important decisions, but they are the first of many you’ll need to make for your baby throughout his or her life.

You can do it!!

If you have any other questions about VBACS or want to hear more about my experiences, feel free to email me!  (whiskem {at} gmail {dot} com) I love talking birth and encouraging women to make informed decisions.

 

**Note: As I am not a medical professional, nothing in this post should be considered medical advice.  Please consult a qualified OB or midwife for more information about VBACS and to decide if it is the right option for you.

The Epidural: Making an Informed Decision

 

Yay for a new year and getting back to the swing of things and regular schedules!  That is, after getting my family over all the yucky sicknesses making the round this winter…it’s been like Pukefest 5000 around here. 🙁

Now back to one of my favorite topics…birth!  And on to the second installment of my series on this wonderful topic.

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The C-Section: Making an informed decision

 

I’m so, SO excited for my first post in a blog series on birth!  I LOVE babies and I love talking about birth.

I was extremely nervous and scared for my first two births but since then I have learned and experienced so much that it is now my favorite part of pregnancy…and not simply because I get to meet my sweet baby! (and sleep on my back and stomach, and go longer than 30 seconds without peeing, and fit into tight spaces… you catch my drift)

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I’m grateful that my birth experiences have been extremely varied.  Because of that, I am very empathetic to all mothers and their births, both those that go as planned and those that don’t.  My first baby was delivered by emergency c-section after Liam’s heart rate kept dipping dangerously low.  I fought like crazy to get a vaginal birth the second time around and I succeeded; Toby was a VBAC (vaginal birth after cesarean) in the hospital, induced with Pitocin and I was given an epidural.  Juliet and Finn, my 3rd and 6th births, were water births at home, and 4th & 5th births, the twins, were natural and vaginal in the hospital (and also my biggest triumphs!).

The thought to write a series on birth popped into my head one day but I wasn’t sure what direction it would take.  Then the idea to write specifically about c-sections literally woke me up one night.  I couldn’t get back to sleep, thinking about all the women who face this decision and how scary it can be.

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This photo is of my little sister in the throes of labor with her first baby.  This was taken at a birth center but she ended up transferring to a hospital and delivering by cesarean.

No one can tell you what birth is best for you and your baby…or what unanticipated twist might occur to change your best laid plans.  But it IS important to plan.  If you read and research and become as informed as possible, then, if life does throw some crazy curve ball at you (twins anyone??), you will be prepared to change plans with minimal stress and still end up with an amazing and beautiful birth!

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This priceless photo was taken just seconds after I caught my 6th baby, Finn, who was born at home, in the water.

The reason I named this blog series “Making an Informed Decision” is because YOU get to decide how to birth your baby.  Yes, even if it ends in a cesarean.  Be very wary of any medical provider who tries to make every decision for you.  In some situations you will weigh the information given to you and it will be very clear that a c-section is the best choice.  In other situations, perhaps not.  But don’t forget that YOU have the last say!

Another important thing to understand about c-sections is that they are not a normal birth outcome.  A cesarean section is major abdominal surgery and has major ramifications for both baby and mother (both in the present and future).  In other words, it is not a decision to be taken lightly.  That being said, let’s all recognize what a miracle these life-saving surgeries are! Millions of women and babies would have very different, possibly catastrophic, birth outcomes without this amazing intervention.  C-sections have saved the lives of many babies and mothers.

Interestingly, the rate of c-sections has been on the rise for the past decade.  It’s currently close to 30% in the US (and 40% in the Arizona county where I live).  While there are lots of arguments regarding an “ideal” rate of c-section, it is widely believed that this surgery is often done unnecessarily.  See some great sources at the end of this post if you’d like to read more.  A cesarean can result in some scary stuff: placenta accreta, infection, blood loss or uterine rupture.  In short, it’s not a procedure you want to elect for if there’s a way around it!

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All the twin pictures in this post are of Vivian and Kira.  I love these shots so much!  Our girls were born vaginally but most of the doctors I interviewed preferred to deliver multiples surgically.

So the question is, why so many c-sections?

There are definitely some clear-cut medical reasons to get that baby out fast.  Some of these include eclampsia (dangerously high blood pressure in mom), problems with the placenta, and other serious medical conditions.

But there are also situations where the decision is less clear and it’s up to both the mother’s discretion and doctor’s opinion.  Some of these include a baby deemed larger than average, a breech or other poorly positioned baby, and previous c-sections*.

In these situations. it’s crucial to be informed and aware of your options.  Below are some great questions to ask your doctor if you’re facing either a planned or emergency cesarean (CS).

Why do I need a CS?
What are the risks of getting a CS?
What are the risks of delivering vaginally?
What happens if we wait and see (i.e. attempt a vaginal birth first)?

By the way, these questions are also a good thing to remember when facing any intervention (induction, epidural, episiotomy, etc).  A “cascade of interventions” is often blamed for leading to an emergency cesarean (i.e. too much “stuff” done to mom and baby).  Experts also blame changes in medical malpractice insurance and hospital policies for the rising rate of these surgeries.

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My last piece of advice is this: don’t be afraid to get a second opinion!  If your doc is telling you something that just doesn’t sit well with you, see another OB or midwife for his/her opinion.  For some reason we often hesitate to second-guess our doctors, but getting another opinion just means you want the very best for yourself and baby.  There are a lot of forces at play in America’s maternity system and sadly, not all providers make decisions that are in the mother’s best interest.  YOU are your own best advocate.

When we trust our bodies and our babies and assume they will do their jobs just fine on their own, chances are good that they will!  If for some reason something goes wrong, be educated enough to ask the right questions and have a birth advocate help you (if you’ve never considered a doula, look into it!  They can be wonderful).  Lastly, if a c-section is necessary, we can be grateful that we live in a country that offers access to this life-saving surgery.

Birth is an amazing, miraculous, spiritual journey and I hope you enjoy it!!

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*I am a huge advocate of VBACs, and I’ve fought tooth and nail for every one of mine (5!).  If you’ve already had one or more c-sections and are interested in learning more about having a vaginal birth, check out ICAN online or email me! I’d love to share what I’ve learned.

Sources:
International Cesarean Awareness Network
Brazil isn’t the only country with high c-section rates
Why is the US c-section rate so high?
C-section by choice

You can find all my posts in the series on birth HERE!

Note, this post is not meant as a substitute for medical advice.  Please consult with a qualified midwife or obstetrician in regards to your prenatal and birth care.