VBAC is an incredibly political topic in the birth world.  Doctors in the United States are telling women who have previously had ceasarean section births that baby number two will have to be born the same way.  The driving factor in this situation is medical  malpractice insurance companies, who are faced with a growing number of  lawsuits from people claiming that an emergency ceasarean was not available quickly enough.

  One of the effects of the rise in malpractice suits, is that these insurance companies are targeting a procedure that research shows is reasonable and safe.  Many insurance companies are instituting strict standards of procedure for planned VBAC births, which can cost hospitals thousands more dollars to provide.  Many companies are excluding coverage altogether for doctors to allow women with a history of C-Section to attempt a Trial of Labor (TOL). If the doctors and hospital have no insurance coverage, they will not allow the procedure.

What are the risks of a ceasarean section?

Risks of this major abdominal surgery include hemorrhage, bowel obstruction, pain, infection, and tissue scarring and adhesions.  Bonding and nursing are challenged, and babies are more likely to be cut, born early, have breathing problems or weigh less.

What are the risks of VBAC?

Research shows that less than 1% of VBAC births result in uterine rupture  (1.6 per thousand.)  These studies have  included women whose labors were induced.  Pitocin and cytotec, labor induction and augmentation drugs,  create artificially strong contractions, so it is likely that  a study done with women experiencing spontaneous labor would have even lower chances of uterine rupture occuring.   Cytotec is not used any longer in cases of previous ceasarean, and pitocin is monitered closely to keep the dose under control. The risks  of the scar giving way were also greater when incisions were made vertically and higher, but the way the incision is made now, low and vertical, has much better results. 

Vaginal birth itself has a greater risk of continuing perineal pain or incontinence, and a greater risk of baby suffering nerve damage in the shoulder area.

This is a topic that women need to continue doing their research about, as doctors may just tell them that a repeat ceasarean is the best option.  Ceasarean section can be a life saving operation, if necessary, but the c-section rate in America is almost 30%.   Many healthy women are facing unnecessary risks from this major abdominal surgery.  90% of women who have had previous ceasareans are having repeat surgeries.  It is clear that ceasarean section has complications and risks, and the research leans toward those risks outweighing the risk of VBAC.

more online resources:

http://childbirthconnection.org/article.asp?ck=10166#systematic
VBAC research statistics

http://pregnancychildbirth.suite101.com/article.cfm/vbac_controversy
risks of c-section

http://www.mayoclinic.com/health/vbac/VB99999/PAGE=VB00009
The Mayo Clinic reports that VBAC is safer

http://findarticles.com/p/articles/mi_m0CYD/is_3_40/ai_n11832004/
insurance companies set standards for VBAC procedures

http://pregnancy.about.com/od/vbac/a/deniedvbac.htm
What to do if you are denied access to medical care for a VBAC

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ERGO  

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Bjorn   

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      At the Ashland Community Hospital's Birth Center, doula care is provided for any laboring woman who requests support, and the service is at no extra cost.  A doula is a woman, experienced with birth, who provides constant physical and emotional support for a laboring woman.   She can be there as a main support person, if the woman has no family or partner with her, or she can be there to assist the husband or mother.   She will make suggestions about position changes, offer massage, and share her knowledge of the birthing process. She is there as a guide, and her main purpose is to help the woman feel safe and relaxed, so that her body can drop into a rhythm and give birth.   The nurses at the Ashland Hospital provide excellent labor support, but are also responsible for taking blood pressure, checking cervical dilation, keeping records, and caring for other patients.   Since they  cannot always provide constant support,  they have  hired a team of skilled and compassionate women to stay present with their patients.  It is an incredible gift to women, and unique for a hospital to provide this service.

     This Oregon hospital's progressive program began in 1995, as a way to support Spanish speaking women.  Originally, the doulas were fluent Spanish speakers and were there to translate, in addition to offering labor support.  A couple of years ago, the program expanded to include support for all women, and now there are doulas on call 24 hours a day, seven days a week.   Many of the current doulas speak Spanish, but not all are fluent. 

      Having a doula present greatly reduces the need for medical interventions and greatly increases the chances of a woman remembering her birth as a life transforming accomplishment.   You can see photos and read a little about the doulas, including myself,  on the Ashland Community Hospital website: http://www.ashlandhospital.org/Page.asp?NavID=175    

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   Pregnancy is a time to relax into your body and learn to truly care for yourself.  Regular massage therapy is an excellent way to tune in to your body and allow yourself to be nurtured, but it can be expensive to receive consistant bodywork.   That's why we've started a pregnancy massage clinic at Harmony Healing Arts.  For six hours a week we offer 60 minute massage sessions for pregnant women by donation.  Nobody is turned away.   This time in your life is unique and brief, and a time when there are endless shifts and changes physically and emotionally.  Massage can help relieve stress, soothe sore muscles, and fulfill our deep need to be taken care of. 

Going into labor and motherhood feeling relaxed and deeply connected with your body is ideal for a smooth transition through birth and into caring for your newborn.  This is an offering to our community of mothers, and we hope you'll take us up on the offer!

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     There are incredibly confusing and conflicted feelings that come along with your second baby.  How could you possibly love someone as much as the little one you have already?  You will. How will you share yourself, and how can you possibly give any more?  You can. What can you do to help big brother or big sister through this transition without feeling resentful or neglected?  Love and patience are the keys.

     My children are twenty three months apart, and it has been an incredible journey.  Right now they are 4 and 6, and love each other immensely, but certainly have moments of hatred too.  My younger daughter is extremely expressive and steals the show, while my 6 year old boy tends to quietly or sneakily express his emotions, especially his frustrations.   Their relationship is a fiery one, and it takes diligence on my part to help them learn to communicate with each other.  

    He was there when she was born, and loved to hold her on the couch and smell her sweet little head.  I packed her around in a sling or ERGO Carrier so I could keep up with him, and bounced her to sleep while reading him stories.  She slept in the bike trailer when he wanted to go on adventures.  I know he was impatient sometimes when we had to pull the car over because she was screaming her head off, or he didn't get to snuggle with me before sleep because she was still awake.  My feelings of guilt still linger, but I know that having each other is an incredible gift to them, so my gratefulness immensely outweighs my guilt. 

   They resent each other sometimes. They compete for my affection, or try to get each other in trouble, or fight over who gets to sit in my lap, and its exhausting.  Then I see him across the field climbing down from a tree to help her get up, or I experience the joy on her face when her big brother walks in the door.   There is nothing like the joy that a mother feels when her children take care of each other.  Their relationship is not perfect, but they love each other so much.  They fight with each other, as do myself and my husband.  We all can use some help learning to communicate, share, forgive, and look beyond our own desires to take care of our loved ones.   We learn from them, and they learn from us. 

      I don't think there is a solution to "sibling rivalry," although there are wonderful resources and ideas to help us navigate.  "Siblings Without Rivalry," by Adele Faber and Elaine Mazlish is one book many parents have praised on the subject.  This book encourages us to let children work their issues out with minimal adult intervention.    Sometimes this works for my family.     I think the true answer is to keep working on ourselves.  Modeling patience, clear communication, and expression of our frustration in healthy ways is the best way to teach our children.  I am still working on all of this, and so I cannot expect my children to have it down already.  These are life's lessons, and when our children see us working on them, they have less judgement of their own shortcomings and more inspiration to grow.

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