In Richmond, we have noticed that it is getting harder and harder to find VBAC care providers. There are many controversial issues that can interfere with women's natural ability to birth their babies. How big your baby is, if you go past your due date, if you have any health conditions like gestational diabetes or high blood preasure. Something that care providers may not share openly is their fear of liability. These issues are sometimes concerns of care providers that may influence their decision to let the natural birth process continue on its own. 

So with that in mind, it is very important to avoid that first cesarean. We have listed some tips below to help decrease your risk of a surgical birth. The most important being 1) having a care provider that believes in and practices the normal process of birth 2) optimal fetal positioning (the position of your baby can affect how long your labor is and how it progresses) and 3) staying at home until labor (contractions) become active (longer and closer together). You have less of a chance to be offered interventions if you come into the hospital with labor progressing well.

At ICAN, we encourage you to be fully informed of your options, be prepared to advocate for yourself and understand your rights to birth your baby.

Read Cesarean Birth in a Culture of Fear

This Mothering magazine article examines technological birth and the rising c-section rate in the United States. Reviews many facts and figures and underlying beliefs and practices. Features results from Childbirth Connection's national Listening to Mothers II survey. Excellent charts and illustrations of typical hospital birthing experience and surgical procedures.

 

Choosing your care provider is a very big decision. Take your time as you will only birth this baby once! Here are some great questions when interviewing your doctor or midwife.

Do you know what kind of care philosophy your provider practices? Learn the difference between the Expectant and Active type of care management. The Midwives Model of Care follows the Expectant style of care.

Cesarean Section: Myth versus Reality

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Out of concern for rising cesarean rates and reduced access to vaginal birth after cesarean (VBAC), Childbirth Connection carried out a systematic review of several hundred studies that compared harms of cesarean and vaginal birth. The evidence is clear: unless there is a compelling and well-supported reason for cesarean section, vaginal birth is the safest way for women to give birth and babies to be born. (See links below to learn more about review results.)

MYTH: The belief that cesarean section is safe.

REALITY: Vaginal birth is far safer overall for mothers and babies. Although cesarean section is safer now than in the past, it is major abdominal surgery and poses many extra risks for mothers and babies in comparison with vaginal birth.

MYTH: The belief that planned ("elective") cesarean is an optimal solution for mothers and babies.

REALITY: Although planned cesarean is very convenient for busy hospitals and caregivers, vaginal birth is far safer overall for mothers and babies.

MYTH: The belief that vaginal birth is harmful for mothers and babies.

REALITY: Vaginal birth is far safer overall for mothers and babies than cesarean section. Some common overused obstetric practices, such as making a cut to enlarge the vagina (episiotomy) or forceful staff-directed pushing, can harm women and should be avoided.

MYTH: The belief that a healthy woman who has a cesarean will avoid incontinence later in life

REALITY: Current research suggests that this will have no effect on later-life incontinence. Having an unneeded cesarean poses plenty of risks and no clear benefits. Women who wish to avoid or limit incontinence would be wise to take other steps, such as maintaining a healthy body weight, avoiding or quitting smoking, avoiding or quitting hormone therapy, and carrying out a rigorous program of pelvic floor muscle exercises ("Kegels").

BEFORE LABOR

 *Read and educate yourself.  Attend classes, groups and workshops inside and outside of the hospital environment.

 

* Research and prepare a birth plan.  Submit copies to your hospital or birth facility, doctor or midwife, and labor support persons.

 

* Interview more than one care provider.  Ask key questions, see what their responses are and how your probing influences their attitudes.  Are they defensive or are they pleased by your interest?

 

* Ask your care provider if there is a set time limit for labor and second stage pushing.  See what he/she feels can interfere with the normal process of labor.

 

* Tour more than one birth facility, note their differences, and ask about their cesarean rate, VBAC protocol, etc.  Become aware of your rights as a pregnant woman.

 

* Find a labor support person.  Interview more than one, look for someone who has attended several births and has background experience with normal, non-interventive birth.  A recent medical journal article showed that female labor support can significantly reduce the need for a cesarean.

 

* Help ensure a healthy baby and mother by eating a well-balanced diet.  Eating foods rich in protein, vitamins and minerals can prevent complications in pregnancy, labor and delivery.  Salt restriction is not recommended during pregnancy.  Salt food to taste.

 

* If your baby is breech, ask your care provider about "tilt-position" exercises, external version (turning the baby) and vaginal breech delivery.  You may want to seek a second opinion.

 

* If you have had a prior cesarean, seriously consider and explore the option of vaginal birth after cesarean (VBAC).  According to the October 1988 VBAC guidelines from the American College of Obstetricians and Gynecologists, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of woman with prior cesarean sections can go on to delivery their subsequent babies vaginally.

 

 

 DURING LABOR

 

* Stay at home as long as possible.  Walk and change positions frequently.  Labor in the position most comfortable to you.  Remember squatting can help.  Do not  labor or birth flat on your back as the weight of the baby on the vena cava (a major blood vessel in the mother's abdomen) can decrease the blood supply and oxygen to your baby.

 

* Continue to eat and drink lightly, especially during early labor.  The uterus is a muscle, and like all muscles, it must be nourished to work effectively.

 

* Avoid pitocin augmentation for a slow labor.  If your labor is progressing slowly, you may want to try nipple stimulation.  Nipple stimulation and loving caresses may also get your labor going when you are past your due date.  Remember, delivering past your due date and/or a slow labor may be normal for you.

 

* If your bag of water breaks, don't let anyone do a vaginal examination (to avoid the risk of infection), unless medically indicated for a specific reason.  Discuss with your care provider about how to monitor for signs of infection.

 

* Recent studies have shown that the routine use of continual electronic fetal monitoring contributes to an increase in cesareans without related improvements in fetal outcome. Request the use of a fetoscope or perhaps just an initial monitoring strip upon admission to your birthing facility.

 

* Epidurals and other anesthesia can slow down labor and can cause complications for the mother and baby.  If you do have an epidural and are having trouble pushing effectively, let the epidural wear off and then resume pushing.

 

* Do not arrive at the hospital too early.  If you are still in the early stages of labor when you get to the birthing facility, instead of being admitted, walk around the hospital or go home and rest.

 

* Find out the risks and benefits of routine and emergency procedures before you are faced with them.  When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on your baby, and what are your other options.

 

* Remember, nothing is absolute.  If you have doubts, trust your instincts.  Do not be afraid to assert yourself.  Accept responsibility for your requests and decisions.

 

 

 

 

                                                                                                                                                                    

Facility Labor and Birth Charges by Site and Mode of Birth,
United States, 2003-2004

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Childbirth charges vary by the type of birth you have (vaginal or cesarean birth) and the facility in which you give birth (birth center, hospital, or home birth). Charges of giving birth are also affected if there are complications during childbirth, be it vaginal or c-section. As you can see from the chart below, the charge for giving birth in a birth center is the lowest, as compared with giving birth by c-section in a hospital, which increases with complications.

Notes:

Figures in graph do not include the following charges: additional anesthesia services charge for all cesarean and most vaginal births in hospitals additional newborn care charge for all births in hospitals additional maternity provider charge for all births. Payments of third-party payers typically reflect a discounting of charges. Birth center data are not available for 2004.

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Resources

U.S. Agency for Healthcare Research and Quality, HCUPnet, Healthcare Cost and Utilization Project. Rockville, MD: AHRQ. Available at: http://hcupnet.ahrq.gov/ [DRGs 370-373.]

National Association of Childbearing Centers, National Association of Childbearing Centers Survey Report of Birth Center Experience 2003. National Association of Childbearing Centers, 2004. [Figure is average charge reported by 86 out-of-hospital birth centers. New name of organization is American Association of Birth Centers.]