MoonDragon's Women's Health Pregnancy Information
VAGINAL BIRTH AFTER CESAREAN
VBAC Information & Links
VBAC - WOMEN RECLAIMING THEIR BODIES & BIRTH RIGHTS
As midwives, we believe that women should be able to reclaim their bodies and their birthing rights after they have had a cesarean delivery. Due to the great emotional and physical trauma which often occurs and is associated with a cesarean delivery, women opting for a VBAC may need minimal to substantial support from the birthing team. With extra labor support, it has been shown that a majority of women who have had previous cesarean deliveries are able to birth their babies vaginally, with safe and healthy (not to mention emotionally healing) outcomes for both the mother and baby.
On the average, babies born by cesarean and induction have lower birth weights, have more breathing problems and other issues, and have fewer weeks gestation than are babies born vaginally without induction. This suggests that cesareans and inductions are occurring before the mother's body is ready (ripe) and the baby has reached full maturity. At the other end of the spectrum, inductions and cesareans occur when the health care practitioner fears the baby may be post dates and becoming too large (greater than 4000 grams or 8 lbs 13 oz). Determination of baby size is very inaccurate whether by ultrasound or by palpation by an inexperienced health care provider. The babies that have been born by cesarean or induced without initiation of labor account for the majority of admissions to high-risk nurseries. Although some of these infants were born by cesarean or induced because of medical emergencies that may threaten the life of the infant or the mother, a majority of them are miscalculated due dates, fear of large baby size, convenience scheduling, or misdiagnosed fetal-maternal distress.
Midwives assist women with natural, holistic childbirth at home and in family oriented birth centers.
Midwives are available and with the laboring mother from the beginning of labor to several hours after the baby is born, especially in a home setting where there are no shift and staff changes. This allows continuous care, careful monitoring of both the mother and the unborn baby, emotional and physical support for both her and her partner (who often times can be more nervous than the mother and may have unresolved feelings left from the previous cesarean experience resulting in an unempowered-helpless-fearful emotional state of being). Midwives work with the mother and baby as whole beings, and not just a uterus giving birth to a fetus, offering natural means of assisting labor. These may include upright walking, position changes, water laboring in warm tub or shower, adequate nutritional and hydration, massage, encouragement, various relaxation techniques.
GETTING LABOR STARTED
RELEASE OF BIRTH HORMONES
Babies born vaginally are usually born when they are ready, rather than prematurely by surgery.
Studies have shown that the babies are the initiators of labor by releasing hormones (such as a small amount of oxytocin) to the mother's blood stream which then sets off her own hormonal release, which initiates and continues labor. Although science has does not completely understand this process yet, one theory has been that the baby induces labor when the mother's body is unable to satisfy his-her nutritional needs any longer. In other words, they become hungry and are looking for nutrition beyond the capabilities of the mother's blood-nutrient levels.
Midwives do not induce labors using pitocin or PGE2 in a homebirth setting. (Note: These methods may possibly be used in a birth center where there may be a physician-on-standby or on-call.)
Pitocin and prostaglandin (PGE2) inductions are shown to contribute to severely painful labor conditions, higher incidence of fetal distress and injury, uterine rupture and repeat cesarean deliveries. Although these induction drugs have a higher incidence of complications, all of these conditions can also occur without induction and outside of a medical facility, but much, much less often. When a woman reaches her 42nd week of gestation and she has not began labor yet, some of the holistic (home remedies) which may be used by the woman and her midwife include the following suggestions.
SEXUAL INTERCOURSE & ORGASM
A sexual orgasm causes the uterus to contract and oxytocin to be released in the blood stream (Pitocin is a synthetic version of oxytocin). Orgasm may be with a partner or with self-pleasuring (masturbation) by the pregnant woman herself. Orgasm causes waves of contractions throughout the uterus, stimulating hormone production and contractions. In addition, semen is a rich source of prostaglandins (the principle ingredient in the PGE2 gel used in hospitals to induce labor). It has even been suggested during a midwife's discussion group that oral intake of semen is highly effective in assimilation of the prostaglandins (not to mention that it helps to relax a nervous partner!) and may actually work faster than the cervical application of semen. I personally cannot vouch for the oral connection... but it never hurts to give it a try if you are postdates.
Whether in love play or a hospital room, the gentle stimulation of one or both nipples also releases oxytocin, helping labor to either start or keep going. Some suggestions have been to have the mother stimulate her own breasts or have her partner stimulate the nipple by hand or by oral (sucking). If an breastfeeding infant is available, having a baby nurse at the breast is helpful. I have even heard of midwives, themselves, stimulating the mothers breasts... but some women and midwives may find this encounter a bit uncomfortable (intimately speaking). In one study, 84 percent of VBAC mothers who tried this technique managed to get their labors started with nipple stimulation.
Although there is little public research available on the use of herbs for labor, many midwives report that Evening Primrose Oil, Black Cohosh, Blue Cohosh, Ginger Root, Bethroot (Birthroot) and Red Raspberry leaf tea are sometimes effective in either getting labor started or keeping it going.
Among the most popular homeopathic remedies for late or slow labor are Caulophyllum (Blue Cohosh), Cimicifuga (Black Cohosh), and Pulsatilla (Windflower). If you want to try these remedies, talk with a homeopathic practitioner or get a copy of Homeopathic Medicine for Pregnancy and Childbirth, by R. Moskowitz(North Atlantic Books, Berkley CA, 1992).
CASTOR OIL COCKTAIL
Made from the bean of the castor plant, Castor Oil has a laxative effect, much like an enema. If the cervix is ripe already, castor oil can stimulate contractions. It apparently works best with women having their first labors. The usual dose is 2 ounces, and it ordinarily takes effect in two to six hours. Some midwives recommend an "induction mix" or a "labor cocktail" of 2 ounces each castor oil, orange juice, and vodka (vodka optional). The best time to swallow castor oil is very early in the morning, so that you are not kept up all night with diarrhea (it will definitely clean out the colon, which can be beneficial with women having constipation problems that may inhibit the baby's head from engaging well in the pelvis or slow labor progression because of a full colon). The orange juice helps it to be easier to swallow. Sometimes a second dose may be needed.
FOR MORE INFORMATION
Labor & Delivery Introduction
Labor Initiation - Suggestions For Starting A Labor When Due
Labor - Stage 1 - Early & Mid-Labor - Dilation & Effacement
Labor - Stage 2 - Pushing Stage
Labor - Stage 3 - Delivery of the Placenta
Labor - Stage 4 - Immediate Postpartum Period After Delivery
LABOR & PAIN RELIEF
Midwives do not use pain medications during labor (for homebirths and most birthing center births).
Labor drugs (epidurals and other medications are often used in medical settings. In the United States, more than 90 percent of women in some hospitals use the epidural anesthesia. When done correctly, some women have found this method to be an excellent pain relief, especially for the exhausted laboring woman. The use of labor drugs is not frowned upon by midwives, but we feel they should be only used in special situations and not with the average healthy women having a normal healthy labor and birth. It is always better and healthier to deliver your baby without drugs in your system and in your baby's system.
BE AWARE: No drug administered during labor has been found to be totally safe for the baby. ALL drugs cross the placental barrier to the baby during labor. There are potential side effects, some serious, for the mother and the baby.
The most common effects of an epidural on a baby during labor is a fluctuating heart rate. Labor drugs, in general, can have greater potential for fetal distress, resulting in hypoxia (low oxygen), possible brain damage and fetal death. After birth, a depressed respiratory system and other neonatal complications are common. Apgar scores generally are lower in medically managed births with a higher incidence of babies being placed in neonatal intensive care units.
Maternal complications can include a drop in maternal blood pressure. Women having medications are usually confined to their beds during labor, attached to electronic fetal monitors (EFMs) and a IV drip. This can make labors longer. Another effect that an epidural can have in a first-time labor - which is what the woman may be having if she did not have a previous vaginal birth, is a slowed or stopped labor. If an epidural is performed early in labor at 2 centimeter dilation, there is a 50 percent chance of another cesarean. At 3 centimeters, there is a 33 percent chance, and at 5 centimeters dilation, an epidural will put you at little or no chance of a cesarean. Some women develop fevers 100.4° or greater after having epidurals. This can effect their babies. About one-third of babies born to feverish mothers are taken to NICU for further testing for sepsis (infection), sometime with very painful test procedures such as a spinal tap (lumbar puncture in which spinal fluid is drawn out for testing). Women having epidurals often time have problems with second stage labor and have difficulty in pushing out their babies. Episiotomies are common place and always used with forceps or vacuum extraction usage for these medicated births. Both of these can be traumatic for the baby and can result in serious injury for the baby and the mother.
VBAC FOR HOMEBIRTH OR BIRTH CENTER CLIENTS
Making the choice to have a VBAC birth can be difficult when trying to find a midwife to attend your birth. Many midwives are not comfortable with accepting a VBAC mother as a client. Some are accepted as a "wait and see how it goes" client with the client arranging medical backup for "just in case" situations that may require a medical transfer to a hospital setting. The decision by a midwife will depend strongly on previous birth history, health of the mother, health of the fetus, nutritional status, reasons why a cesarean was performed, type of incision and other factors including the emotional and mental stability and well-being of the mother, her partner and her support system for her choices. VBACs can be a much more involved client-midwife relationship requiring more emotional and physical support, with increased potential risks, and time requirements... sometimes more than the midwife may want to invest in any particular client. Because of this, many homebirth midwives simply will not accept a VBAC client.
However, many other midwives continue to accept healthy, low-risk VBACs as clients for a homebirth setting as long as they fit within their practice guidelines. Many local hospital-based birthing centers refuse to accept VBACs and refer them to the hospital delivery wards to birth their babies. Their success rates are low and their intervention rates are high with substantial lack of emotionally-based birth support for their moms and babies and a low VBAC success rate. If you are considering having a VBAC, do your research before making a decision about where you plan on giving birth and who you will have attending you. It may be the deciding factor on whether or not your VBAC will be a successful experience or not. We support those midwives who continue to provide an alternative service to VBAC moms not wanting a standard hospital birth with a high possibility of a repeat cesarean.
CESAREAN & VBAC RELATED LINKS
MoonDragon's Womens Health Procedures: Cesarean Section
MoonDragon's Pregnancy Information: Cesarean Section Pictorial
Homebirth.org: HomeBirth After Cesarean
Childbirth.org: VBAC Index by Childbirth.org
Childbirth.org: VBAC Information
Childbirth.org: International Cesarean Awareness Network's Homepage - ICAN information from Childbirth.org.
Childbirth.org: Cesarean Fact Sheet - Some facts about cesarean sections from the ICEA Cesarean Options committee.
Childbirth.org: Cesarean Section Information - Internet resources for cesarean section.
Cesarean Section FAQ - The most commonly asked questions about cesareans.
PREGNANCY RELATED LINKS
MoonDragon's Pregnancy Information: Prenatal Vitamins
MoonDragon's Nutrition Information: Pregnancy Diet
MoonDragon's Nutritional Guidelines & Recommendations
MoonDragon's Pregnancy Information Index
MoonDragon's Womens Health Pregnancy Information Index
MoonDragon's Birth Concerns Index
MoonDragon's Articles Index
MoonDragon's Alternative Health Index
MoonDragon's Professional Guidelines Index
MoonDragon's Birth Index
MoonDragon's Pregnancy Information & Survival Tips
MoonDragon's Gestational Diabetes Index
MoonDragon's Breastfeeding Problems
MoonDragon's Pediatric Information Index
MoonDragon's Parenting Information Index
MoonDragon's Nutrition Basics Information Index
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Using Essential Oils
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