Happy Cesarean Awareness Month

April is Cesarean Awareness Month!  I am here to talk about my experience today, and why cesarean awareness is such an important subject for women to get involved with, even if you have not had one!

When I was 22 I gave birth to my first child via an unnecessary cesarean because my my physician wanted to go home for the day.  I never knew how much that experience would impact my life not only as a woman, but as a mother, and my mothering skills. I look back often and know that had I taken the time to take a childbirth education class, it would have prevented that experience completely, and honestly I would have never stayed with the OB/GYN practice I was with at that time.

When I got pregnant with my second child, only 9 months postpartum from my first, I knew that it needed to be different and I set off to find a midwife for a VBAC.  After the experience and postpartum emotional toll my first surgical birth took on me, I knew it would be best for my family to not deal with the emotional and physical repercussions of a repeat cesarean.

My Birth Journeys from Danielle Elwood on Vimeo.

But after over 26 hours of a VBAC labor, doing everything right from staying in shape, exercising, preparing for birth, having a doula, and receiving regular Chiropractic care for the duration of my pregnancy, my second child was born via a medically necessary cesarean that saved not only his life, but my own.

It gave me a different perspective on being a birth activist, and cesarean awareness supporter. I went from angry, bitter, and sad insisting most of cesareans were unnecessary (which statistically most still are) to grateful for my experience the second time around knowing and giving me the understanding behind a medically necessary cesarean birth.  It still sucked big time, it was painful, my recovery was much worse than the first time around, and emotionally it was devastating because of the hard work and commitment I had to working towards a VBAC.

I am thankful for both of my experiences as it helps me to know I can help women on all sides of the cesarean spectrum because I have been there myself.

I hope everyone takes some time to get involved this April in some way!

A couple great events taking place this month :

ICAN will kick of Cesarean Awareness Month today with a Radio show about Cesarean Mothers Experiences

I Will also be on The Feminist Breeder’s radio show this coming Sunday Night at 10pm CST discussing the recent Cesarean Feelings Survey I worked on with the Healthy Baby Network.

The ICAN Blog will be having birth stories from Cesarean Mothers, and VBAC Mothers all month long, so take some time to check that out.

Thoughts on Informed Consent, Refusal and VBAC

If you’ve been listening to the news lately, you’ve probably heard a lot about vaginal birth after cesarean (VBAC). The NIH held a consensus meeting to decide what was appropriate in VBAC care. The general thought was that the overall VBAC rate should increase and that the rate of primary cesareans should decrease due to the risks of surgery to the baby and mother. The panel had several recommendations that can be boiled down into:

• ACOG and ASA should revise their guidelines on the “immediately available” guidelines.
• The decision to do a VBAC or a repeat c-section should be made between a woman and her practitioner, after an informed discussion.

The problem with the last statement is that true informed consent and discussion is very rare in obstetrical care. The closest that we tend to come is the woman who is choosing a VBAC. She is likely to spend the last several months of her prenatal care being told of the risks of VBAC and the parameters in which it will happen. In contrast, had that same woman chosen to have an elective repeat cesarean, she would simply be handed an appointment card for her scheduled surgery and then sign a sheet of paper that would have to suffice as informed consent, all done a few minutes before her surgery. Neither of these is truly informed consent.

So how can women get informed consent, particularly when it comes to a hot topic like VBAC? My advice is:

• Do independent research.
• Seek out information from neutral sources.
• Talk to other mothers who have had a VBAC.
• Talk to other mothers who have had a repeat c-section (planned and not).
• Prepare for your birth by childbirth class, doula support and emotional support.
• Consider alternatives including midwifery led care.
• Make a decision only after a lengthy discussion with many people, including your practitioner.

Providers have to consider multiple issues when recommending one mode of birth over another: health of mother and baby, liability for complications, availability of self and staff during uncomplicated and complicated births, personal beliefs, medical malpractice insurance (if they choose to carry it), what other practitioners will think of their choices, etc.

Women have their own issues to consider when deciding her mode of birth: health of baby and mother, likelihood of the success of VBAC, physical and emotional pain after the birth, personal beliefs, etc.

The final point is that of informed refusal. ACOG has a policy of informed consent and refusal. This states that they believe that a woman who has all the information, is allowed to make a decision to choose not to receive the recommended procedure or therapy that is being suggested by her doctor.

At the panel yesterday, when asked specifically about the policy of informed refusal as it included forced repeat c-section, either by practice policy or individual recommendation, they basically said that this was unclear. Some advocates took this to mean that the consensus panel was suggesting that women did not have the right to choose a VBAC if that wasn’t the recommendation of her doctor or that if she did, it was acceptable to coerce her with threatened legal action. In other words, a woman is free to make any decision she would like, unless it conflicts with what her practitioner decides.

That leaves us in a sticky spot. What’s a birth activist to do?

Related:

• Maternal Decision Making, Ethics and the Law
• Refusal of Care Based on Religious Beliefs
• Women Need a Chance to Avoid Repeat Surgery

VBAC is Vital

Vaginal birth after cesarean (VBAC) is a crucial option in maternity care today. I see VBAC as one of the key ways for us to attack the growing maternal mortality.

Many people do not think about the cesarean rate as a two-part issue. There is the primary cesarean rate, the number of women having their first cesarean. There is also the secondary or repeat cesarean rate. Currently, both numbers are growing.

The primary cesarean rate is growing for many reasons. Some of these reasons women can help control, like choosing practitioners who have faith in the process and only intervene when truly necessary. A good example of an intervention that can increase the cesarean rate and isn’t truly needed would be non-medical inductions.

But the secondary cesarean rate is where VBAC comes in. This rate is growing as well, largely because women are not being offered the ability to give birth vaginally after a previous cesarean. The growing body of research is showing that VBAC is safe and successful for more women who try it. Many women want to try it but are turned away by their doctors or midwives – leaving them the option of a repeat cesarean or fighting for a VBAC.

More and more women are choosing to fight for the VBAC. The question becomes – why should women have to fight for something that is likely to be safer for her and her baby?

This is part of the ICAN Blog Carnival.

But Why is VBAC so Important?

I am sure that I am not the only person to ask myself this with the announcement of the National Institute of Health VBAC Conference announcement.  But unlike most, I know more than my fair share about VBAC after having a cesarean with my first child it became more than a healthy obsession to me. But sadly the more I learned, the more sad I became about the access to VBAC nationally.

In a 2009 survey from The International Cesarean Awareness Network, it was found that nearly 50% of all hospitals in The United States has some sort of a VBAC Ban in place. Whether it be a formal policy written by hospital administrators, or a de facto ban, meaning there simply are no providers who will take on a patient who wishes to have a Vaginal Birth after Cesarean.

But what does this mean for women nationally? For the women who have had cesarean sections, whether medically necessary, or unnecessary?  It means that once they have experienced once cesarean birth, they have no choices regarding future pregnancies or deliveries. Essentially leaving them with no real informed consent.  To me, as a huge activist, that is not only a violation of a patients rights, but it is a major human rights and bodily anatomy violation.

Right now, 90% of women who have had one cesarean section will go on to deliver all of their children through multiple major abdominal surgeries, the next more risky than the last. When the safe and relatively low risk  option of a VBAC is not available.  But lets look at the numbers regarding the risks of VBAC as opposed to repeat cesarean sections.
The major risk associated with a Vaginal Birth after a Cesarean section is something most near the most not knowing the risk is so low. Uterine Rupture.  Not something we should discount or not worry about, but when we look at the statistics, the average healthy woman who has had one previous cesarean section has a 0.6% chance of experiencing a uterine rupture.

When I went through the process of filling out and signing my VBAC consent form for my second pregnancy, there was paragraph after paragraph panting VBAC in a scary pictre, then a small paragraph with the minor risks of a repeat cesarean, almost like the practice of Obstetricians backing my midwives wanted me to change my mind and run in fear.
This form was not informed consent by any means, it was skewed, biased, and provided misinformation, but sadly this is what we are seeing Nationwide today.

But I can hope with the NIH VBAC conference we can start to see a change in the way that VBAC is handled nationally.
Women have the right to real informed consent, and give birth vaginally if that is what they choose for their own birth.

For more information on Cesarean Awareness, and Advocacy, check out The International Cesarean Awareness Network.

Cesarean Recovery

With the number of cesarean sections increasing in our country annually, many women do not really understand or know that recovering from a cesarean section is much different from a vaginal delivery. After my first cesarean section I learned this the hard way and wish I had a couple tips on making recovery more bearable.  But we often forget that the recovery after a cesarean birth is not just physical, but it is also emotional for a large portion of cesarean section mothers.

The different types of healing to be considered are in the hospital, long term, when you return home with your new baby, and also things you should be aware of such as when to call your health care provider post cesarean. (I also want to thank ICAN and their Recovering from a Cesarean White Paper in aiding to my post today)

While in the hospital :

• Get as much help as you can from family members, your partner, nurses, and other hospital staff. That is what they are there for and during the hours, and days immediately after your surgery, you will need it even if you do not want it.
• Stay hydrated and eat. You may not want to eat, but working on eating a well balanced and healthy diet, as well as staying hydrated (stay away from sugary drinks such as fruit juice and soda) will help to make you start to feel semi human again.
• If private rooms are available opt for one so someone (family member or friend) can stay with you to help you during this time.
• Use a pillow between your legs, and/or on your side to help sleep to be more comfortable. In the days, and even weeks following your cesarean it will not be easy to get comfortable. This is completely normal.  It took me almost a full 2 months to even get comfortable in my own bed at home after my second c-section.
• Take pain medication that is being offered if you are in pain. With my first child, I was breastfeeding and was overly concerned about any of the medications being transfused though my milk so I opted for over the counter pain medication such as motrin instead. But it certainly made my recovery longer, and made taking care of my son harder. (As ICAN recommends, ask your provider about a stool softener, as narcotic pain medication can cause constipation.)
• Get up and walk around.  It may hurt like hell, but it will help to get you back on your feet sooner rather than later. The longer you wait, the more painful it will get up, and the harder it will be.
• The use of a pillow to protect your stomach while coughing, standing up, nursing or moving around in bed is a smart idea.
• Do not hesitate to ask for a lactation consultant in the hospital. Breastfeeding after a cesarean section is more difficult not just for mom because of her incision, but also for baby. Check out the ICAN white paper on Breastfeeding After a Cesarean.

The first couple days in the hospital may feel like you are dying, I know because I have been there, but in most cases, you will only get better. When you get home, there are some more great tips for healing, although your housework may suffer for the first couple weeks, I am sure no one will mind too much.

When you get home :

• Focus on yourself, and your baby. You just had major surgery and your baby needs you.
• Have your partner help/do the household chores. Laundry, dishes, cooking, or anything else that needs to be done. Don’t worry, you can put off the dusting, cleaning the bathroom, mopping, and all the big chores for a couple weeks, your house won’t be mad at you!
• Do not lift anything that is heavier than your baby for at least 4-6 weeks. Those infant carriers/carseats are tempting to pick up, especially when going to an appointment for you or your baby, but stay away from it. You do not want to hurt yourself, or have an extended recovery.
• Ask others for help. If you have older children it may be helpful for your partner to take some time off from work, or have an available family member come over to help you. During the first weeks after my second cesarean section my toddler not only got the flu, but I was the only person he wanted making it difficult on me because I could not pick him up.
• Take it slow!  Get back into your normal household routine over a long period of time. You do not want to over do it because you will certainly pay for it later on.
• Have access to baby stuff such as diapers, bottles, burp cloths, wipes, or whatever you and your baby need for a couple hours in several places around the house. If your bed is the only place you are comfortable, make sure you can set yourself up to be able to hang out with baby, change diapers, and everything else you need right there.
• Co-Sleep!  Room in with your baby, so when it comes time for midnight feedings, you do not need to get up or go far to take care of your little one.
• If you have school age children, have others help to prepare their lunches, lay out clothes for the next day and anything else that needs to be done. To spend quality time, sit on the couch, or someplace comfortable and assist them with their home work, or read a book. Find ways to spend time other than anything that may put a physical strain on you.
• Considering hiring a post partum doula. They can really be heaven sent in a post cesarean situation!
• Don’t push yourself. If you want to take a shower and get dressed for the day, make that your only goal for the day.
• Pajamas are your best friend. They are comfortable, and help to remind others you are still recovering from major surgery.
• Remember how important it is to continue to remain well hydrated, and eating healthy.

Many do not think of the long term or emotional recovery of a cesarean section. I personally did not even encounter the emotional recovery until my cesarean baby was 3 months old. Be gentle on yourself, you aren’t the first to go through this, but many people around you may treat your feelings like nothing because cesarean sections have become so common. I can’t tell you how the phrase “a healthy baby is all that matters” feels to me still today.  Do not let others discount your feelings on your experience.

For your long term recovery…

• Contact your local ICAN (International Cesarean Awareness Network) chapter. These are women who have been there, and done that and know how you feel and what you are going through. They are an excellent support system internationally and are such a huge blessing for many mothers. I know they were to me!
• Write out a birth story, express your feelings on paper, or on a blog, get it out. Keeping your feelings inside may be harder in the long run.
• Keep your baby as close to you as possible for as long as you can.

If you experience any of the following symtoms or problems, you should contact your care provider immediately.

• Any type of bleeding from your incision.
• Leaking, redness, or any type of fluids coming from your incision.
• If your pain does not decrease over time.
• Symptoms of post partum depression such as anxiety, fear, problems sleeping, depression, or anything else you may equate with something more than just the baby blues.
• Cramping or pain in your arms or legs that will not go away.
• Continuous headaches, migraines, or backaches.

Over all, be gentle on yourself.
You just went through major surgery!

What is ICAN?

Check out ICAN’s latest video: What is ICAN?

Do you think that places like YouTube and videos make spreading birth activism easier?

Cesarean Awareness Month

So we told you last month that the cesarean rate for the nation was up for the 11th straight year.? The number, an astonishing 31.8%.? That was a timely announcement for the CDC because this month, April, is National Cesarean Awareness Month.

During this month it is a time to educate women on cesarean section uses, the benefits and the risks.? It is also a time to promote education and and activism, no matter how small. Our local ICAN chapter celebrated it’s second birth this month.? While there we brainstormed some ways to spread the word, including:

• Sharing pages and information on facebook.
• Joining ICAN and other birth related groups.
• Taking the Birth Survey.
• Talking to other mothers about cesarean and VBACs.

What is on your list?? How will you advocate for women this month?? What is your personal activism?

Cesarean Advocacy Help Wanted

ICAN has a new advocacy director looking for “people to be on my committee — to discuss, refine and make recommendations to the Board and then follow through on those recommendations. Many hands make for light work so the more people who are willing to do a little bit, there less we each have to do and the more we get done.”

advocacy @ican-online.org