The “birth community” has a rather unfortunate reputation that precedes us. Some tend to come across as harsh and judgmental toward western medication, not unlike this childbirth educator in the 2008 comedy, Baby Mama.
We rather giggle about this interaction as Amy Poehler’s character makes it very clear where her decision lies. And yet, we all know that, especially when it comes to all aspects of childbirth, the media has a reputation for being woefully inaccurate. This includes the education and support personnel in the field of childbirth, namely birth doulas and childbirth educators.
As a doula who has attended all kinds of births, let’s clear the air about medical birth a bit.
When it comes to birth, women have many medical options. Some of these options are what we call “interventions” because they intervene in the normal birthing process. These can be natural interventions (such as natural induction) or pharmaceutical interventions (such as epidural anesthesia for labor and birth).
There is, fortunately, a lot of readily available information about the risks and benefits of interventions. Women have more knowledge available at their fingertips than ever before in history. It’s true that evidence shows that most of the time, interventions do carry more risks than they do benefits.
That does not make them bad. Or evil. Or unnecessary.
And it doesn’t invalidate the women who choose to have them for their birth. It simply says that there are risks associated with them.
But, there are also benefits.
So let’s talk about some benefits to interventions. The most obvious benefit is that some interventions can be life-saving. Birth is rarely complicated, but when it becomes so, western medicine is very good at handling acute care situations for both mothers and babies.
There are many interventions used in modern obstetric units, but for the sake of simplicity, we’ll stick to 3 of the most well known: Induction, Epidurals and Cesarean section.
Induction is a great benefit for when it’s really necessary. Evidence supports induction in 3 cases. 1: Preeclampsia. 2: When the waters have been broken for 18 hours and labor hasn’t started yet. 3. Being induced past 41 weeks is supported by evidence – not because going past 41 weeks is dangerous, but because induction is likely to be successful at this time.
When induction is successful (meaning that it leads to a vaginal birth), it keeps a mother from having to go through a cesarean. It can save a mother and baby who are headed toward toxemia which can be very dangerous. Waters being broken for extended periods without labor starting can cause infection. The benefits of induction are obvious in these cases.
Epidurals (pain relief that is injected into the dura part of the spine) are being hailed as either Heaven’s gift to women or the devil’s invention itself. Emotions and opinions aside, when is it useful? One of the side effects of an epidural is that it causes a drop in blood pressure. It’s so predictable for this, actually, that nurses are required to give women a bolus of fluid to prevent that drop. However, for a woman with out of control high blood pressure in labor, an epidural’s blood pressure lowering effect may be of tremendous benefit.
What about sexual abuse survivors? Sometimes their bodies can respond in a similar fashion to labor and birth that they did to their abuse: by closing up and pulling away from the situation. This is not helpful in childbirth since a baby needs to come down and out. This reaction can be subconscious and out of an abuse survivor’s control. An epidural’s numbing effect on that region can allow a woman to open her body for birth.
Epidurals are also popular because they are generally a very effective form of pain relief. This can be important to many women for many reasons that go beyond just not wanting to experience pain. The way that epidurals are given today, most women are numbed enough that they feel pain relief, but they are also left with enough sensation to push. Birth doulas as very helpful to mothers that have epidurals as well since they can help explain what is happening, keep the mom comfortable, and help aid in the laboring process to keep the baby moving down.
What about the exhausted mother who has a baby that is perhaps malpositioned and causing labor to go longer than the range of normal? Or the baby that simply caught the birthing mother in a completely exhausted state? An epidural can allow for some much-needed rest from what is surely the biggest physical job a woman will ever have.
It’s true that cesarean section is nothing to shake a stick at. It is major surgery and a mother should only go into a cesarean if the situation truly warrants it. But it does save lives. And the ones that have been saved by surgical birth are grateful for it.
Interventions are tools and nothing more. They are neither good nor bad. They simply carry risks and benefits. Which risks and benefits are important to a birthing mother are solely up to her. Sometimes the benefits outweigh the risks. In those situations, mothers, doulas, and providers are grateful to have them.
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Arguably one of the most controversial of all topics related to birth, VBAC seems to be in the spotlight again. VBAC stands for Vaginal Birth After Cesarean. In spite of overwhelming evidence that supports VBAC as the safest option for the majority of birthing women with a previous cesarean, most care providers are hesitant to support and perform them.
Women who desire a VBAC often feel like they are fighting an uphill battle just to have a normal vaginal birth. Birth doulas work hard to support and equip women to have the birth that they want. Since so few providers support it and insurance companies discourage it, women usually need to do extra careful preparation and planning as they look at their options for birth.
Care Provider – The most important thing to do when planning a VBAC is to find a supportive care provider. This may sound easier than it usually is. Many times a doctor will say they are supportive of VBAC but their stance changes once labor begins. A provider is supportive of VBAC if their statistics say so. Interview your provider carefully. Do your research. Ask to see their VBAC success rates and ask them direct questions that require more than a “yes” or “no” answer. Is their approach to birth the same as yours? Would they support alternative care, such as chiropractic care, if that is important to you? A woman can have all the support in place for a VBAC, but if her care provider is not fully on board, she will likely not have one.
Also, it is NEVER too late to change your care provider. Just because you’ve been with one for a long time doesn’t mean you need to stay with them. A more supportive provider is going to be just as qualified to be in charge of your care as the one you are struggling with. If you suspect that your provider is not on board with your desire for a VBAC, it’s ok to interview and find another one. Hiring a new provider is preferable to try to talk your current care provider into supporting your choices.Your doctor is hired by you – make sure you hire the right one.
Gestation length – Though we calculate due dates at 40 weeks, 42 weeks is clinically considered the full term, and evidence says that risks to mother and baby do not become statistically significant until then. This is no different for a woman desiring a VBAC. Waiting until the baby is ready will give the mother’s body its best chance of having a successful VBAC.
Avoid induction – The risks associated with VBAC are almost all centered around uterine rupture, which is when the uterus tears. Many times this is an emergency situation requiring an immediate cesarean, but the incidence of rupture is small – even with a VBAC. Uterine rupture can be encouraged and brought on by unnaturally strong contractions. Drugs that imitate oxytocin may cause the body to contract in unpredictable ways which can cause a rupture to occur. This is why preparing the body as much as possible for a more natural labor is so imperative.
Avoid birth interventions – Many interventions necessitate the use of artificial oxytocin to make the labor progress. Choosing one may inadvertently sabotage your VBAC. Avoid interventions, or wait as long as possible in labor to use them. The best way to avoid interventions is to hire a birth doula.
Hire a birth doula – Doulas are trained in VBAC. They can help you with everything from finding a supportive doctor or midwife to hands on support for your labor. Doulas do not have clinical skills and they do not provide medical care, but evidence shows that the presence of a doula reduces the likelihood of a woman having a cesarean – including a repeat one.
Consult with alternative care. Your birth doula can help you connect with alternative support care providers that can assist you as you prepare for birth. For example, a chiropractor can help you make sure your body and baby are optimally aligned and positioned for birth. Acupuncturists are experts in providing the body with balance so that hormones can function at their peak. Herbalists can help you make sure your body is absorbing all the proper nutrition you need. Nutritionists know what a pregnant body needs, and they can consult you to make sure you have optimal fuel for your hard working body. In each of these professions, it is imperative that you seek out a practitioner that is trained in pregnancy, and as with any treatment, always consult your care provider.
Optimal Fetal Positioning is an often overlooked essential when preparing for birth. Of course, it’s important that the baby is head down, but that is not the only important positioning factor to consider. Check out Spinning Babies to learn more about optimal fetal positioning. Birth doulas are well versed in optimal fetal positioning as well and we are available to discuss it with any client that wishes.
Consider home birth. A home birth midwife will not accept you as a client if she is not confident she can safely manage your birth. A midwife will likely incorporate all of the above-mentioned factors into your midwifery care as well. Many women safely birth vaginally at home after a previous cesarean.
VBAC is a safe option for the majority of women. When planning for a VBAC, mothers need to be selective and deliberate. With a little extra careful planning and support, a mother can achieve the birth she desires.