Category: VBAC Preparation

Coming Soon!

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Coming in February 2015!

The two and a half years since the birth of my son have been a journey full of emotions.  My recovery from Traumatic Birth has  been cathartic. I am a stronger and more empowered Mother, Wife, Woman and Soldier than I ever thought I would be.  Thank you all so much for coming with me on this journey!

I have been full of mixed emotions since finding out our exciting news.  I feel so blessed to have our family grow, but I am also nervous about what the next few months will bring as I strive to have a vaginal birth.  My doctors and midwives have already been so incredibly supportive!

So hang on to your hats as we embark upon our own VBAC journey!  I’m going to keep you all updated along the way, with the goal of helping other Mama’s who are hoping for a VBAC know that they are not alone on this road.

~Mama

CombatBootMama

7 Signs Your Provider is Not VBAC Supportive

As you start exploring providers for your VBAC, there are some things that providers might do that could tip you off that they aren’t supportive of your VBAC journey.  Including but not limited to:

  1. They put off the conversation about whether you are a VBAC candidate.  When you bring up your desire for a vaginal birth, they dismiss it and say that they will discuss it closer to your due date. This might include the phrase, “We will see how things go…”
  2. “We don’t do VBACs” Obviously, this is a big red flag.  If they aren’t even willing to entertain the idea of a VBAC, you should definitely find a new provider!
  3. “If you go into labor on your own by 40 weeks, then you can VBAC.” Babies come in their own time, not on a schedule.  Let your baby and your body decide your due date, not your obstetrician.  This can also be tied in with the phrase, “Let’s go ahead and schedule a repeat cesarean at 41 weeks, just in case.” 
  4. “Let me do my job”  Obstetricians have probably delivered hundreds of babies, and therefore they do have quite a bit of expertise.  However, that is no reason for them to dismiss your desire to birth the way that you want to.  It is extremely condescending to imply that you will have no say over what happens to your body during birth, and that they are to control you during that time. If they belittle the research that you have done regarding your birth plan, and are condescending regarding your birth plan approach with caution.
  5. Unsupportive staff.  If your primary provider appears supportive, but alternate providers and/or staff are unsupportive.  Birth is unpredictable, and if you happen to go into labor when the one OB in the practice that is adamantly against VBAC is on rotation, where will that put you?  It’s important that all providers are on the same page and supportive of you.
  6. High cesarean rate. If the hospital where they have permissions has a very high cesarean rate, or the practice itself has a high cesarean rate you should approach with caution.  There are several factors that go into CS rates including the percentage of patients that are high risk. However, this shouldn’t be ignored.
  7. You have big babies. “Your first baby was too big, and your second will be as well.  You might as well schedule a RCS.”  The size of one child does not automatically dictate the size of your subsequent children.  In fact, if your provider insists on an ultrasound during your third trimester to check for size, this is a major red flag.

In the end, remember that this is YOUR birth.  If you feel uncomfortable with your provide and you do not feel supported by them, please have the courage to find another provider – even if it is “late in the game!”  Your local ICAN chapter can help you find a VBAC supportive provider in your area.  Every woman deserves to have the birth that they desire!

 

On The Right Path, My Path

Sometimes, it’s hard to believe something that others have told you until you see it in black and white.

This is especially true if you weren’t ready to hear the truth before.

After more than a year and half, I finally requested copies of my surgical notes from my son’s Emergency Cesarean Section.  I wasn’t sure how I would react to seeing the medical documentation, but I want to be able to move forward with my recovery. Part of that is facing what happened, and seeing what caused it in order to try to have a different outcome in the future.  And what I found, was actually very validating.

You see, after my sons arrival, I was certain that my body had to have been broken.  I was convinced that there was something flawed with me that made it so that I couldn’t do the one thing that women are designed by the great Creator to do.  I felt like a failure, less of a woman, and on some days unworthy of being a mother.

Over the past year and a half, I have slowly but surely dragged myself out of that hole.  I have built myself back up piece by piece; literally step by step as I trained for my first marathon.  I felt like if I could just run further, and push harder, and do more – then surely next time I could birth my own child from my womb.

And as it turns out, my body was never broken.  I progressed to “complete effacement, complete dilation, and +1 station.  The patient pushed for greater than 90 minutes without a change in station. On assessment, [the OB] felt the fetal head to be asynclitic and ROP*.  Two attempts at manual rotation were unsuccessful.  The patient was counseled regarding the diagnosis of arrest of descent…”

After having been in active labor for more than 20 hours, my body had done everything that it could do to get my DS to come into this world on his own.  He just happens to be one stubborn boy.  I was exhausted, and he wasn’t budging.  As much as I had hoped and wished for a natural birth, it just didn’t happen for me.  And you know what?  I think I might be getting closer to the point where I’m okay with that.

Sometimes our toughest critic, and our hardest judge is ourselves. I feel a sense of relief after reading the surgical notes.. as if I’m cresting the top of the mountain and now I can see the path ahead of me clearly.  It’s looking pretty good from here.  Behind me is a tangle of self doubt and unrealistic expectations, ahead of me is the path to full recovery – body and spirit.

*asynclitic and ROP indicates that the head was tilted to the side rather than positioned correctly, and ROP stands for Right Occiput Posterior which means that the baby was “sunny side up” or was facing outward rather than facing back towards the mother.

Seeking Therapy for Birth Trauma in the Military

I have touched upon PTSD in previous posts, discussing how people can be on that path and some of the ways that they can seek treatment.  One way that helps many is therapy.  In the military, there can be many barriers to a Soldier seeking assistance with Behavioral Health.  These include Chain of Command conflicts, mission needs and availability of services.

Seeking assistance at the Behavioral Health Clinic on post can be as simple as calling to find out when their walk in hours are, and then going.  But sometimes it isn’t that simple.  The walk in hours are usually after the duty day has already started, and this can cause some Soldiers to avoid going because they must then speak with their First Line Leader about why they need to be gone.  Sometimes if you get lucky, you can go on a day after Staff Duty or manage to find a day when there’s nothing going on and just let them know that you’re running an errand or two and you’ll be back in about an hour.

So what happens during the walk in?  Well, you’ll most likely fill out a survey on the computer.  It asks questions about how you’re feeling, if you drink or smoke, if you have any conflicts with anyone, whether you’re thinking about hurting yourself, and other questions as well.  Once you complete the survey, you wait until a therapist comes and brings you back to their office.  Once there, you talk with them about why you are there, what else is going on in your life, and some general back ground questions.  Based on that, they will talk to you about making a followup appointment to speak with someone on a regular basis.

From there, you go to the front desk of the clinic to make your follow up appointment, and get an appointment slip.  Here’s where it gets tricky for some Soldiers.  In many units, it is customary for them to require you to bring your appointment slip in and then they write it on a calendar somewhere so they can help to decrease the number of “No Shows” that they have to medical appointments.  Here’s the thing, posting information about your appointments in a place that can be seen by anyone is a violation of your rights under the Health Insurance Portability and Accountability Act (HIPAA).  Frankly, it really isn’t anyones business if you’re going to BH or not.  But in the military, it can certainly be a tricky situation.

Your unit, mainly your Commander and your First Sergeant, are responsible for ensuring the health and welfare of all of their Soldiers.  As a part of this responsibility, they should permit you to seek the assistance that you desire and/or require to ensure that you recover both mentally and physically from a traumatic birth experience.  However, that doesn’t mean that they won’t want to speak with you regarding the situation as a whole to ensure that you are okay.  I personally don’t know all the regulations regarding this, and whether they can even ask questions or not.  My advice on this would be to confide in your First Line Leader first, and discuss with them whether you have to talk to the 1SG or Commander.  Best case scenario, you’ve kept your FLL in the loop so they know where you are at and you avoid an awkward conversation with anyone else.

If you are uncomfortable going to the BH clinic on post, there are other options that you can explore as well.  Calling Military One Source is a great way of finding out if there are counselors in your area to speak with, and sometimes they are able to get you in with them for several sessions for free.  It can be very helpful to be able to speak to a therapist regarding birth trauma, and make a plan of action to not only recover from your past but to move forward.

Traumatic Birth Recovery

Over the past few months, I have started on my journey to recover from my traumatic birth experience.  During this process I have often struggled on whether to categorize my journey as one of grieving the loss of my birth experience, or as a trauma recovery.  I grieve that I did not birth my son, hold him skin to skin, breathe in his scent, and nourish him in the precious moments after he entered the world. Those are moments that I will never have with him, and that makes me feel heartbroken.  But I also feel a nearly indescribable  and paralyzing array of negative emotions when I think of his cesarean birth, the loneliness of being on the operating table, the crushing intensity of my anxiety as I couldn’t feel my body, and the indifferent conversation of the surgeons as they dissected my body.  The overwhelming physical and emotional reaction to my memory of the cesarean leads me to focus trauma recovery rather than grieving.

Trauma recovery is a hot topic in the military.  Many soldiers experience trauma while in performance of their duties overseas, and are then prone to Post Traumatic Stress Disorder.  According to the United States Department of Veterans Affairs, Post Traumatic Stress Disorder, or PTSD, occurs after experiencing a traumatic event such as combat exposure, physical abuse, physical attack or serious accidents like a car wreck.  During the traumatic event you believe that your life or others’ lives are in danger, that you have no control over the situation.  Most people experience stress after a traumatic event, but if your reactions don’t go away over time and they disrupt your life, you may have PTSD.

It is not clear why some people develop PTSD and others do not.  Many factors contribute to the possibility including whether or not you were injured, how close you were to the event, how much control you had over the event, how strong your reaction was, how much help and support you received after the event,  and how intense or long the event lasted for.  Some key markers that can indicate PTSD include reliving the event, avoiding situations that remind you of the event, negative changes in beliefs and feelings, and feeling “keyed up” in scenarios that remind you of the event itself.

There are very few resources regarding the recovery of the woman after a traumatic birth experience.  According to research done by  Kalina Christoff, Ph.D., Professor of Psychology at the University of British Columbia, Vancouver, around 30% of women are traumatized during the birth of their child and between 2% and 6% go on to develop Post-Traumatic Stress Disorder (PTSD) as a consequence. To put this in perspective, according to the same article, the rate of PTSD in the regular Canadian Forces is estimated to be 2.8% overall and 4.7% in soldiers with 3 or more deployments (Christoff).

A birth is defined as traumatic if the woman was or believed she or her baby was in danger of injury or death, and she felt helpless, out of control, or alone, and can occur at any point in labor and birth.  It is important to recognize that it is the woman’s perception that determines the diagnosis, whether or not clinical staff or caregivers agree.  Even though physical injury to mother or baby often occurs during a traumatic birth, a birth can still be traumatic without such physical injury. Unfortunately, clinical symptoms of full diagnosis of Posttraumatic Stress Disorder (PTSD) can occur for mothers andpartners following a traumatic birth, the effects of which impact attachment, parenting, and family wellness (Karraa).

Treatment options for birth trauma include trauma focused psychotherapy (counseling) and medication.  The two most effective forms of trauma focused psychotherapy are Cognitive-Behavioral Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR).  CBT includes cognitive therapy, exposure therapy and stress-inoculation therapy.  Ideally, this therapy allows the patient to confront your traumatic past without triggering PTSD symptoms.  EMDR is highly effective and considered a frontline treatment for PTSD.  In EMDR, you are told to think about your traumatic experience while moving your eyes back and forth following the therapist’s fingers as they briefly move across your field of vision (Kendall-Tackett).

There are also several medications that can be used during recovery from traumatic birth including antidepressants and antipsychotics.  These should be discussed with a medical provider to see if they are right for you.  Antidepressants have been viewed as a key part of treatment for PTSD and can compliment counseling treatment as well.

After gleaning all of this information, it is even more obvious to me that recovery is not just going to happen and that as a patient I must take an active role in my recovery.  If I do not confront my trauma, it could cause further problems with future birth experiences.

Have you pursued counseling or medication in your recovery from traumatic birth?  How has either helped you in your journey?

Sources:

“What is PTSD?” United States Department of Veterans Affairs, National Center for PTSD.   12 August 2013 <http://www.ptsd.va.gov/public/pages/what-is-ptsd.asp&gt;

Christoff, Kalina, Ph.D.,  “Vancouver Birth Trauma: connecting women who were traumatized during childbirth.” University of British Columbia, Vancouver.  12 August 2013 <http://www.vancouverbirthtrauma.ca/home.html&gt;

Karraa, Walker, MFA, MA, CD(DONA). “Traumatic Birth Prevention and Resource Guide,” 12 August 2013 <http://givingbirthwithconfidence.org/2-2/traumatic-birth-prevention-resource-guide/&gt;

Kendall-Tackett, Kathleen, Ph.D., IBCLC, FAPA. “Treatment Options for Trauma Survivors with PTSD,” 12 August 2013 <http://givingbirthwithconfidence.org/2-2/traumatic-birth-prevention-resource-guide/treatment-options-for-trauma-survivors-with-ptsd/&gt;

Finding a VBAC Provider

Finding the right VBAC provider is a daunting task for me.  As my husband and I start talking about trying for baby #2, this decision weighs on my mind a lot.  Even putting aside the fact that I am not currently stationed in the same area as we will be when we do start our second pregnancy, the enormity of the task is intense.  The more birth stories that I read, and the more resources that I find, a common thread is that it is absolutely positively essential to have a supportive team that you trust and can depend on to be there for you during your VBAC experience.

I usually try to be as impartial and methodical as possible when I pick our medical providers, but finding a VBAC supportive provider is so much more than that.  Of course, there are checklists that I can use and questions that I can ask like:

How many VBACs have you attended? What is the success rate? How many uterine ruptures have you seen?

What is your philosophy on going past 40 weeks? If I were to go post date, what options would you offer and at what time? 41 weeks? 42 weeks? 43 weeks?

Do you have any standard VBAC protocols that you follow that differ from non-VBAC birth?

What kind of pain management techniques do you encourage? Do you support water birth? Will you support a home birth?

But I think the biggest factor in picking my VBAC provider will be how well we “click” together.  This is why I am nervous.  During my first pregnancy, I participated in a new program offered at my hospital called “Centering Pregnancy” where appointments were held in a group setting (aside from the height and weight check, checking the fetal heartbeat and fundal height). During these appointments, I felt relatively comfortable.  The same midwife, OB and nurse were there each month as well as four other couples participating in the program.  We discussed different topics each month, and while I felt like I learned a lot during these appointments, I didn’t establish a good enough relationship with the Midwife.  She did happen to be the one on duty during the second half of my labor, and she wasn’t as supportive or present as I thought she was going to be.  In fact, I can only remember for sure seeing her twice during my labor and in both instances she was insisting that my baby was too big but I could “go ahead and try to push.” Followed by her walking out of the room.

So, I worry that my ability to pick a supportive provider might be weak.  Fortunately, there are a few organizations available to help find supportive providers for mothers who are seeking VBAC.  The first one that I learned about is called the International Cesarean Awareness Network or ICAN.  ICAN is a nonprofit organization whose mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).  There are ICAN chapters all over the world, and each one has mothers that have experienced VBAC and can provide recommendations of midwives and obstetricians in the area. Connecting to a local chapter on Facebook, I have been able to interact with other moms from that area.  I’ve learned more about the providers, what their quirks are, who they work with well, who they don’t work with well, what hospitals are more supportive than others and much more.  

What did you look for in your provider? What resources did you use to find a provider?

Fear and Perspective

After experiencing my Cesarean Birth I started to question myself, my body, and everything that I thought I knew about birth. I had done tons of research during my pregnancy to prepare for a natural birth.  I spent hundreds of hours on the internet collecting information, reading birth stories, talking to other moms for tips and advice.  I spent so much time, that my husband had to tell me (more than once) that he thought that I was scaring myself, that I was worrying about it too much, and that it [birth] wasn’t such a big deal. To which I would grumble about him not being the one to squeeze a watermelon out of his bum or something to that effect.

It is so interesting to me that two people, husband and wife, would have such different views of birth.  I grew up never hearing about birth; learning just the minimal amount that was taught in the public school system in the 90’s.  My mother had three children, one vaginally and two (including me) via cesarean section in the early 80’s.  I was never told the details of her birth stories, or how she really felt about her births.  Several women in my life had had children while I was growing up, my Nanny as well as my aunts, but I wasn’t there for any of the births nor did I learn the birth stories.  Looking back, it just wasn’t a topic that was ever deemed appropriate or important to discuss and it certainly wasn’t common around me.  So when we fell pregnant, I felt like I didn’t know anything about what birth was going to be like.  I felt scared by my own lack of knowledge, so I immersed myself in the cerebral aspects of birth, learning all that I could about mechanics of birth.

In contrast, my husband is the second oldest of five children.  He and his older brother were born in the hospital, but his younger siblings were planned unassisted home births! He remembers his parents preparing for the births, he was there in the house for them, he remembers the process and how natural it was.  With the exception of his younger brother, they were all uncomplicated births that went as planned at home.  His younger brother had meconium in the amniotic fluid, so they went to the hospital in that case. No one had to explain to him what birth was like, he had been there for it.  He knew what a natural process it was and that it wasn’t something to fear.

There is an overwhelming amount of negative information regarding birth available to expectant mothers.  For many in American culture, it has turned into a mysterious and dangerous thing that has to be controlled and monitored through medicine.  Young women aren’t exposed to birth in a normal and natural way like they were in generations past, when babies where born at home with the assistance of other women in the family.  It is no wonder that so many women are terrified of giving birth!

But what if it goes even deeper than that?  The extremely harsh culture that judges a girl from birth on her ability to be pretty, to be skinny, to be exactly what the mainstream says creates a self deprecating habit.  As girls, and women, we judge ourselves so harshly based upon the perception that we have to perform a certain way.  The images that we see of birth are of two extremes: a highly chaotic and dangerous birth that requires every intervention and danger we could imagine, versus a calm and serene woman who gently births her baby with her hair and makeup still intact.  How unrealistic!  We scare ourselves by seeing the chaos, and hope for the serenity, just to feel inadequate when we can’t lay there and take it!

When these fears are slowly formed over a lifetime, how do we possibly set them aside?  Without setting them aside, they continue to lurk, and the body can feel the fear even if the mind denies that it is there.  During labor, these fears can slow contractions, keep the cervix closed and high, and delay delivery.  So it turns into a self fulfilling prophesy: fear of complications begets complications, which begets self deprecation, which begets more fears, etcetera.

Until we can normalize birth within ourselves, and trust our bodies more than we trust our culture, we will continue to birth with fear.

Tell me about how you’ve overcome a fear. How has this helped you in your goals?