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Cesarean Birth Trauma and then VBAC {2 Stories}

Cesarean Birth Trauma and then VBAC {2 Stories}

My first birth C-section and disrespect.

I never doubted my body’s ability to give birth. I guess that is why I didn’t think I needed to research my birth options. My mother gave birth vaginally, her mother, my other grandmother had 10 children vaginally, all the way back to my great great grandmother who had six sets of twins vaginally on a Cherokee reservation. My first pregnancy was stressful but I had a great doctor who assured me all would be ok.

Unfortunately, circumstances beyond our control, we had to a move 5 hours away at 32 weeks. That’s where any “birth plan” I had went out the window.  The only doctor I found who would see me obviously had no faith in me. I honestly believe when I walked in the door he saw a very petite woman and thought C-SECTION! The day before my 40 week appointment I had an ultrasound done and everything looked great.

However at my appointment the next day my doctor started scaring me by saying my placenta was depleting and becoming less safe for my baby and I needed to be induced the next day. My cervix was still hard and I wasn’t dilated. I asked if we could wait at least a week and was made to feel like I had just asked the stupidest question on earth “but your placenta is DEPLETING!” I reluctantly agreed after he assured me that if the cervadil didn’t soften me enough we’d wait or try another round.

I went to the hospital that night and they started the cervadil.

6 am the next morning the Doctor came in to check me and said that I was “a little softer, but only dilated to a one”. He then proceeded to BREAK MY WATER. Pitocin was started at some point I can’t quite remember if that happened before or right after my water was broken. The next few hours were hell. The doctor had the largest hands I’ve ever seen on any human and he HURT me so bad every time he came in to “check me” I asked tearfully several times to let the nurses do it. After several hours of the pitocin being increased and increased I asked for some pain meds and eventually an epidural.

When I requested these I was again made to feel stupid and incompetent as my doctor asked “why did you wait? You just wanted to know what pain feels like?” The epidural was terrible. I couldn’t move from the chest down and started having panic attacks. I was also almost given phenergan twice, which I am severely allergic to. I am so lucky my husband was so vigilant and asked what they were giving me every time they came in to give me anything.

Almost twelve hours in my doctor came in and started pushing for a c-section. I said I didn’t want one and that’s when he pulled out all the stops telling me “your baby will go into distress”, “fine don’t do one now but I’ll just be back in an hour or so rushing you in for an emergency c-section” and the real kicker “I have been doing this a long time and I know when a woman isn’t meant to give birth, you’re just too small”.

Feeling beat down and like my body was betraying me I agreed. Strapped down and feeling broken I welcomed my beautiful daughter into the world. They brought her over to see me for a brief second and my husband was able to hold her and go with her to the nursery. Laying there being stitched up I cried. Not the beautiful happy cry it should have been. I felt terrible. My child was beautiful but I didn’t get to hold her and bond. I was not happy like I should be I was angry. I felt like a failure.

In the recovery room it only got worse. My nurse said something along the lines of, “I hope you didn’t want a big family” I asked what she meant and she said “well they will only allow you to have one or two more c-sections”.  I told her I would attempt a VBAC next time and she said, “not in this city you won’t”. Again I felt like a failure.

When I finally got to hold my baby several hours later I felt horrible because although she was the most beautiful thing I’d ever seen I didn’t feel any bond. She immediately wanted to breastfeed and was a total champ at it although my milk wasn’t completely in. Thankfully the bond came quickly over the next week and I thank breastfeeding and plenty of skin to skin time for that.

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My beautiful birth center VBAC and hospital stay

Within months of my first daughter’s birth I started doing my research on VBACs and birth choices. I knew what happened to me was wrong, but I wasn’t prepared for how common it was. I was told to check out “The Business of Being Born” and was shocked! How could the state of birth be so awful in OUR country? It was then that I decided my next birth would be with a midwife.

When we found out we were expecting our second baby we started the search for a midwife. One of my husband’s co-worker’s wife had recently had a VBAC with a midwife named, Joi, and only had wonderful things to say about her. When we met with Joi, I instantly knew she was the one for us. She shared our faith, spoke confidently, and put any fears we had at ease. I told her my birth story and she was as mad as I was and even got teary eyed with me. Immediately I had a sense of comfort and a new found confidence in myself.

Over the next few months I had my share of doubters and was even called selfish for wanting a better birth experience. I had to come to realize that those who were negative and rude, just didn’t know what I knew and so I started trying to educate others on the risks and benefits of each birth option. My confidence grew over these few months as well. I was more educated than ever and had wonderful support.

Thanks to a wonderful friend I was even able to attend the Birth Without Fear conference where I was encouraged and my spirit was strengthened. My team at the birth center was amazing as well. Joi and her backup midwife were wonderful as well as the student midwife Meghan who was the person I felt most comfortable texting with random questions.  I had no doubt that my team was there for me and believed in me.

We had everything planned out so well. My husband was going to get a bonus at just the right time to help us pay off the midwife, my best friend who does photography was going to come and photograph the birth, and my mom was going to be there to watch my daughter. However in the last few weeks of my pregnancy everything seemed to fall apart. Three weeks before my due date (and six weeks before Christmas) my husband not only didn’t get his bonus, but also had to take a 30% salary cut. My best friend wouldn’t be able to make it and my mother had to go out of town. I was very upset and stressed out, but Joi held my hand and assured me that it was in God’s hands and that whoever was meant to be at my birth would be there.

At 40 weeks 6 days I started having regular contractions. They would start out ten minutes apart and get closer to 3-5 minutes apart, but then they would stop for several hours. This went on for two days before I asked Joi if I could come in and be checked. I went in Thursday afternoon December 12th and I was dilated to a 3 and about 80% effaced. After my first birth experience I was so overcome with emotion when I found out how beautifully my body had progressed on it’s own.

I felt confident in my body, but I asked to have my membranes stripped at this point. It was an “intervention” I felt confident in having as it was my choice on my terms. My husband and I must’ve walked five miles that afternoon stopping every five minutes to breath through a contraction. The contractions continued to get closer together and stronger. Around 9:30 I called Meghan and told her that I thought this was it and was ready to come in. We agreed to meet at the birth center in an hour.

When we got to the birth center I was checked, and I was somewhere between a 4 and 5 and still 80% effaced. I had the option of going home to labor a little longer but decided to stay and get in the tub for a little while. My contractions were strong and I did low moans through them. As I labored it was just my husband Ryan and I.

I couldn’t have asked for a better support than my husband was. I didn’t want to be touched or coddled I just wanted him to hold my hand through the contractions. It was such an intimate experience and I was glad that it was just us, no cameras, no nurses, just us. About 1:30am I was checked again this time I was 5cm and 90% effaced. I decided to get in the bed and try to rest some. Joi told me to try just breathing through the contractions and not moaning. My husband got in the bed with me and held my hand with each wave.

After a while of being in the bed I could feel a change during the contractions.  The only way I can describe it is it felt like my water was trying to break. I kept saying to myself “these contractions are not stronger than me because they ARE me.” I decided to get on the birthing ball for a little while. The contractions were more intense now and I had lots of pressure on my lower back. Joi came in and showed Ryan how to apply counter pressure. I kept thinking this hurts but not too bad, but it’s going to get worse.

About 30 minutes after I got on the birth ball Joi came in to check me again. She looked at me after a minute and said, “sweetie I think you’re complete.”  I thought she meant completely effaced and my thought was “ok big deal,” but then I looked at Meghan’s face and she was smiling and excited. I looked at her puzzled and said, “wait, completely what?”  “Completely DILATED,” she said excited. I realized that sensation I was feeling during contractions was the urge to push. With the next strong contraction I started pushing.

A few pushes in I moved from the bed to a birthing stool which made pushing so much easier and more productive. Having both Joi and Meghan there pushing me and encouraging me was amazing. My husband sat behind me and gave me strength by just holding me. My water finally broke but there wasn’t the huge gush of fluid I had expected. Shortly after my water broke, Joi told me to reach down and feel my baby’s head. It suddenly became so real, I’m DOING this. I am pushing a baby out! I felt a rush of strength and with the next two pushes my baby was born at 4:38 am, Friday December 13, and immediately placed on my chest.

All the pain and anger from my oldest daughter’s birth was forgotten and healed in an instant. I couldn’t believe how smoothly it went, I never had a moment where I felt it was too much or I couldn’t do it.  I was on cloud nine. I did it! At some point I looked up and said something to the effect of, “suck on that, Dr. O.” I can’t describe how amazing I felt in those moments after she was born. I proved to my doubters, and more importantly to myself, that I could do it. Joi cried tears of joy with me and Ryan. She thanked ME for letting her be a part of my birth. That amazed me. What a difference in care. What a blessing.

Unfortunately a few days later I got very ill. I went to the ER with 103.5 temperature, and when I got there my heart rate was 150. We eventually found out I had a rare blood infection group a strep. There was no way of knowing how or when I got it and I was told I most likely was a carrier of it on my skin and it entered through an open wound during delivery. I could write a book on my terrifying hospital stay, but what is important is my husband and I were informed.

We asked questions. We made the doctors take their time to explain things and refused unnecessary procedures. They tried to tell us to send my baby home, but when pressed for why we should they couldn’t give us an answer so she stayed. They tried to tell me I should never give birth outside the hospital again, but when asked if they could have prevented this or caught it earlier they said no. They tried to tell me I put myself at a “great risk” for uterine rupture by having a VBAC, but backed down when I threw actual statistics their way. I stood up for myself and I believe I showed my strength.

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I Am Strong {Breastfeeding in a Modern World}

I Am Strong {Breastfeeding in a Modern World}

I am strong because at 39 weeks and 1 day my son, Brendon was born.

I am strong because I endured 24 hours of labor, and only dilated to 5cm and he still hasn’t dropped into the birthing canal.

I am strong because after knowing I refused to have a cesarean section, my doctor told me it was the only option.

I am strong because while in the operating room, we found out my son’s umbilical cord was wrapped around his neck.

I am strong because we heard his cry even before he was taken out of my body.

I am strong because I am still exclusively breastfeeding, despite how difficult the world makes it.

I am strong

Healing Home Waterbirth After Traumatic Cesarean and Miscarriage

Healing Home Waterbirth After Traumatic Cesarean and Miscarriage

“This is the story of my Home VBAC Water Birth after a traumatic cesarean birth and a miscarriage. My story really begins with the birth of my first son. It is fairly lengthy, so I didn’t want to repeat the whole thing here. Some of what I will share will make more sense if you do read it. It was written over a year after my son’s birth, and while I might not write it exactly the same today, it is very much how I felt at the time and a part of my journey. My son is now 3 1/2 and this birth was just as much for him as it was for me and our new baby!” – Melissa

I separated my cesarean birth experience from my son from the moment I met him. I knew I had to in order to be a mom to him. Those few days had torn my heart and made me question everything. I couldn’t have this beautiful new little being attached to such horrific event. He was here, he looked like my husband so he must be mine, and I was going to do everything I could to succeed at what was left for me to do – be a mom.

For months I didn’t dare think about what happened, I was holding on to my faith by a thread. When I did start to think about it I struggled with making sense of it. The only conclusions I could come to were either A – God wanted this to happen, in which case I was incredibly pissed at Him and didn’t want to talk to Him, or B – This was a test, as I had felt it had been, and I had failed in which case I was ashamed and didn’t want to talk to God. So I stopped. I wasn’t until our son was about 2 years old that I started to make any sense of the spiritual aspect of the events. I often get flack for saying this but it doesn’t change what I know. My first experience was a test, God tests His children with trials, and I failed. He asked me to trust Him and I didn’t. It’s taken a long time, but I have come to terms with that. The key is “His Children”, even though I failed, I am still His child and I have learned from my failure.

In March 2012, I found out I was pregnant again. We were both so happy! We wanted more children and hadn’t expected to take as long as it did to conceive again. I was in the middle of planning the first Bellies to Bambinos Expo. I knew I would have a lot of work to do to prepare for a VBAC but I was busy with the expo and figured I would have plenty of time after it was over. I did, however, come to the conclusion that there was a good chance that I could have another cesarean and that I needed to be at peace with that. My husband thought I was giving up on a VBAC like I had given up on my first birth. But I explained that I just needed to be able to be at peace with either outcome so that I wouldn’t be in fear the whole time. I knew that even if I had another cesarean there was no way that it would be like the first. One major reason for that is that I was educated this time and I was going to trust God. If I had another cesarean, it wouldn’t be because an inpatient OB bullied me into it, it would be because there was not other choice and it was truly needed. This was a bit of a revelation for me.

April 8, 2012 around 1am, I was up with my son, who had been woken up by our new noisy neighbours again, and I had a cramp and got dizzy. I thought it was odd and was a little worried but I as 10 weeks, I went back to bed. I woke up with bleeding. I called for Dave, in tears, and asked him to pray. Even thought it wouldn’t end up being over for 8 days, I knew in my heart that our baby was gone. I had cramping and bleeding all that Easter Sunday that peaked that night in about 6 hours of, what I can now say was transition like, labour but without the pressure. I had taken another shower as it had helped before, but it was too hot and I started to pass out. I had no intention of going to the hospital and I was fine by the time my husband was on the phone to 911, but I went anyway. They confirmed in what I knew in my heart. I was so sad, and scared, but I was trusting God. They had offered me a pill to speed things up, but even though I thought they were right, I knew they could be wrong and there was no way I could take control of this. I left it in God’s hands and our little “Sprout” came to us on April 16, just after I had attended a birth. It is still incredibly sad, but I am at peace with it. God loves me and knows best and this is what He chose.

The end of October 2012 and I was pregnant again! I was excited, but both me and my husband were a little hesitant to be too excited. He will admit that he had issues bonding with the baby even up to the birth. He had been hurt by the miscarriage and was afraid to get attached and lose another child. I knew either way, this was going to be hard. I was either going to face another miscarriage or have to fight for the VBAC I knew I wanted. With the planning of another Expo in the works, I went to some counseling with a doula friend of mine who is also a Christian. She asked some hard questions about my faith, as I had come to terms with my failure at my first birth but hadn’t really known how to move forward from there. How do I see myself? How does God see me? Who did He make me to be? In light of this, how should I live? Questions we should all ask. I didn’t get time to finish all the sessions before the birth, but even just having someone listen to me and not throw out the standard “Thank goodness for Drs, God made them too and they obviously saved you from yourself” and “you should be happy you have a healthy baby” was a load off of my shoulders.

I remained cautiously excited and did what I could to stay healthy and give myself the best shot I could at a successful VBAC. This included having midwives and choosing a home birth. I also wanted as close to an unassisted birth as I could get and still have the midwives there. I wanted to know that this was happening on my turf and I was calling the shots. My midwives were so supportive and respectful of my decisions all the way through pregnancy and the labour.

I had gained about 70lbs with my son, I believe mostly because I was allergic to wheat, diary and corn and didn’t know. This time I gained about 25lbs and attended belly dancing classes, to which I attribute the amazing core strength I had through out my pregnancy. I also took a few different vitamins and supplements, saw a naturopath and had a few acupuncture treatments. While for months I would jump at any little twinge or gush, in fear of another miscarriage, but the pregnancy was without any major complications. I was, and remained a good candidate for Home Birth and a VBAC.

I didn’t know it was possible, but I started having Braxton Hicks contractions from about 6 weeks pregnant, I had never had any the first time. The baby also dropped in to my pelvis and was quite low very early on. Everyone, even the midwives, speculated that I might go early! Since being post dates was the major instigator of everything that happened the first time, I really hoped they were right!

Week 40 came and went, I was now 40+5 and creeping closer and closer to the 41+4 that my son was taken from me at. I was still in good spirits but the worry was always there, quietly in the background and saying that the clock was ticking and I would have to fight. I had a plan, I would be 41+1 on Canada day and I have a fairly severe allergy to milk. My plan was to go to Dairy Queen and get a Blizzard if labour was no where in site! A BIG one! I knew that it would have about the same effects as castor oil on me and would taste far better. The midwives thought the plan was hilarious and even said they hoped it would work so they could write “induction via Blizzard”. My husband didn’t mind the idea either as he hadn’t had a Bilzzard in as many years as I had.

My midwives appointments were every Friday now. Thursday afternoon I lost my mucus plug! I was excited as I knew that meant change, but cautious as it was no guarantee anything was going to happen soon. My Braxton Hicks came back again, as they had stopped for a couple of weeks, but were different. I didn’t know for sure what it meant – early labour? Nothing? I was excited about both at my appointment and really didn’t have any desire to discuss induction at our Friday meeting. I really thought the baby might be here by Canada Day. My Midwife was optimistic, but was talking about what day the hospital did inductions. I think I started to tune out at this point. I am sure she knew I wasn’t going to agree to one, even if it meant being 42 weeks and having to deliver in the hospital, but it was on the check list for the appointment. I left still in good spirits but anxious to move things along.

I had been doing and taking everything I could over the last couple of days to get labour going, homeopathics, essential oils, sex, evening primrose oil, acupressure and letting my son nurse as much as he wanted (which was the only thing that seemed to do anything). Each evening feeling hopeful I would wake up to labour. When my husband got home that evening, we went out and got some groceries and went to the bank. At the bank I saw my naturopath and asked if she would be able to do a treatment on me, she said “Yes!” and came to our house later that evening. She put in about 25 needles, ALL the way. I think that was about my third or fourth treatment ever and I really wasn’t expecting the needles to disappear into me! My husband thought it was hilarious and just had to take a picture to commemorate the moment. I thought for sure I would wake up in labour this time!

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Saturday morning came, and I had slept the whole night. No only that, but I wasn’t even getting the mild contractions anymore that I had been. Letting my son nurse wasn’t working either. Everything had stopped. I was started to panic, to doubt, to play worst case scenarios over and over in my head and to think that I was NEVER going to go into labour on my own. At more that one appointment I had told my midwife that I was hoping and preparing for a pain free orgasmic birth, but really all I was worried about was actually getting into labour and whatever happened after that I could deal with as it came up. She thought this was a good plan, but so far it seemed like it wasn’t going to happen. Saturday came and went, my husband arranged for someone else to cover the sound board at church as he didn’t know if he would be there, but I was starting to get a pessimistic and wanted to just make plans for the rest of the week and forget everything that was going on.

Sunday morning came, and once again I had slept the whole night. My husband went and did the setup and sound and took our son with him as he usually did. I slept in and made sure I went into church late. I didn’t want to talk to anyone, especially when most knew that I was due or post dates. I didn’t want the questions, the looks, the “You’re still here??” stare. I came in and sat at the back, with my husband at the sound table and avoided eye contact with everyone. Much to my pleasant surprise, one of the other moms came in a bit after me and walked right over and said “You look like you are going to have that baby any day!” It almost brought me to tears. I had carried very high and trim the whole pregnancy and most couldn’t believe I was full term because I looked to small this time. This instigated a lot of “You don’t look like you are having a baby any time soon” type comments, even when I was 40+ weeks. This was the first time anyone had said I looked ready. I needed that. One concerned friend came over with an almost frantic look on his face after church and said “Where is your baby??” His wife had been a part of the Blessing Way group and my Mom had told them on Friday that I was in early labour, I guess some had assumed that I would have had the baby by now. I relied pointing at my belly “In urtero.”

I came home from church tired and exhausted. I was getting scared, worried, frustrated and just plain fed up. I felt like I had done everything I could and my body was just saying “NO.” I didn’t feel like it would ever say “Yes.” My husband went took our boy outside with him and worked on the shed that we had been building, he had hoped to finish it before the baby got here so he was taking the opportunity while he had it. This left me some time to think. I often do my best thinking when I am journaling, something I haven’t done a whole lot of lately but I felt I needed to get it out. I wrote/prayed to God and wrote to my baby. I begged God, pleaded with Him to make me go into labour NOW! As I thought this I realized that this wasn’t His way. While I am all for doing things to prepare your body as best you can for labour, I had been attempting to take things from His hands, once again I wasn’t listening to Him or asking Him or trusting Him. The chief end of man is to glorify God and enjoy Him forever. If I “made” myself go into labour, who would be glorified? God doesn’t like to share His glory, and He clearly told me He wasn’t going to. I could either trust Him, or fend for myself. Well, I know how well that worked out for me last time. I chose to trust Him. I also wrote to my baby, I told it that I was sorry I was so sad and that it was safe to come out now, but if it waited to much longer, it might not be. Mostly I was scared to fail, scared to fail by baby and my son, who wanted to be at the birth so much. After my praying and journaling I felt more at peace, I had let go.

Once I had let go, I decided I needed to do something to keep busy and keep my mind off of things. Cleaning the bathroom has been my husband’s job for a long time. It started with the toilet when we got married. I said the two things I do not do are garbage and the toilet – that is a boy’s job. Since he was already there he kind of just took over the rest of the bathroom and it’s been that way for years. However, every woman knows that most men’s version of clean isn’t quite the same as ours and I would need to do a really through clean every once in a while to satisfy myself that it really was clean. I had found out I was pregnant right after moving into our house and had never had the energy to bother with a good scrubbing the whole time we had lived here. In the back of my mind I had known for weeks that the bathroom was going to get cleaned by me before the baby would come. Now was the time! I scrubbed my heart out and cleaned every inch. My husband came in at one point and tried to take over, being sweet and not wanting me to have to do it. I quickly bit his head off, tired of waiting for labour, and said “Just leave me alone! I have to do SOMETHING!” I just as quickly apologized and he left me to clean.

About 8pm Sunday I started to feel the surges again, but stronger. My heart was elated, I knew this was it! I kept it a secret as I wasn’t having to breath through them yet and didn’t want my husband to be too excited to sleep. I had a bath in our soaker tub with a small glass of wine and some cheese. I floated and swayed in the water, reveling in every surge and delighting in secret that only myself and my baby knew – we would soon meet. I went to bed but I didn’t feel I would wake in the morning.

About 4am Monday I had been awake for a bit off and on, the contractions were becoming stronger and I couldn’t sleep through them any longer. The birds were singing outside our window as they always were at this time. The sun was just beginning to make it assent into the sky. I had to get up and move. I put on my robe and paced and swayed. They were strong enough that I couldn’t ignore them but I didn’t have to breath through them yet. I hummed and sang to my baby, standing and swaying in the front door watching the sun rise. I sang the song from church the day before that’s lyrics were “Grace to you and peace, from God the Father and the Lord Jesus Christ.” It was new but words and the melody had been playing in my head since I had heard it. I enjoyed our time together, some of our last hours so close. I am in tears remembering the beauty of it as I write.

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About 6am my husband and son woke up. He had known that things were happening but had tried to get some more sleep. He got us breakfast then proceeded into a flurry of action that lasted the rest of the day. He was excited and nervous and I think he felt like completing tasks was the best way to “fix” the situation. Some of the things needed to be done, he went to the grocery store and got some food for everyone and kept our son busy and fed. But all I really wanted was for him to hold me, sit with me and for us to spend some time together as a family. The contractions had gotten stronger and I was having to breath through them by mid morning, but they were still irregular and anywhere from 5 to 10 minutes apart. I waiting until I thought everyone would be up on a holiday Monday and let them know what was happening. I called my doula, my midwife, my photographer and my Mom. I had at least 2 or 3 contractions when I was on the phone with each of them and always felt like a creep doing all that heaving breathing on the phone. I had a good laugh with each of them about it too. They all appreciated that I had waited until morning to call and were on standby if anything changed. Nothing really changed.

Canada Day continued that way all day. The contractions would get stronger and closer together and then they would space out, they didn’t get any weaker but every time they got stronger they got further apart again. Then they got closer and stronger then spaced out again. I walked, bathed, ate, drank and continued the day like that. Evening came and I paged my midwife about 8pm. I wanted to check in with her before bed time as I knew I wouldn’t be getting much sleep. She asked if I wanted her to come and assess me, I said my biggest fear was that I had laboured all day and she would check and I would be 2 cm. We decided that she would come and see where I was. When she got there I was on my knees and draped over the birth ball. I looked at her and said “It just occurred to me what actually molds the baby’s head – that’s not nice!” She checked me and sure enough, I was 2cm… She suggested that I try a Gravol shot and Tylenol. I have issues with Tylenol so she was going to just do the Gravol but discovered she was out. While she went to get some more, I heard the Canada Day fireworks and laid down in bed and slept! I had maybe 2 contractions in the time she was gone, which was about 2 hours. My body knew I needed a rest and it gave me one. I probably could have slept longer but when she came back I woke up, the contractions started again and she gave me the shot. It didn’t do a thing, and the silly part was that the injection site was hurting like crazy, was red, hot and swollen! It almost hurt more then the contractions at that point. She left us to go to a hotel and get some sleep. I, unfortunately, didn’t and the contractions picked up where they left off. By 2am Tuesday, I knew I needed some support and called in my Doula and paged the midwife to come back.

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When my doula and midwife arrived to stay, I felt like things were finally really happening! I was vocalizing through contractions and coping well. Up to this point I had been labouring on my own. My husband had been home for the most part, as well as our son, but mostly I was going doing my own thing without any support through the contractions. It was good to know I wasn’t alone and I didn’t have to troubleshoot things myself anymore. I could just let my mind go and let things happen.

My husband filled the birth tub in our living room while our son was still sleeping. I was in different positions and tried the tub. I was still eating, drinking, peeing and pooping – oh the pooping! I don’t think I have ever pooped so much in my life! The student midwife arrived and at 6am I was 3cm and 90% effaced. I didn’t want to hear that, I was tired and already felt like I had been in labour forever. It was progress, but it wasn’t as much as I had hoped. The midwife called this the start of active labour. I knew I wasn’t going to give up but I was discouraged that I had made what seemed like so little progress. I also knew that things could change quickly as my cervix had almost completely thinned. We called my friend, fellow doula and volunteer birth photographer to come when she was ready. I continued in and out of the tub and different positions, vocalizing eating, drinking – pooping! Around 10am they checked me again.

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I was 6cm, once again it was progress but labour was getting really hard and it seemed like it should be happening faster. I was in the thick of active labour and it hurt like hell. Nothing seemed to help. I was getting frustrated that nothing seemed to even be taking the edge off. At every birth I had attended there was always something that helped. I couldn’t understand it and I was starting to feel like no one was helping me. They were all there and supporting me but I didn’t feel like they were. I think everyone could tell I was hitting a wall and suggested I go out side for awhile, it was humid but a nice day. I really didn’t want to, but did it anyway.

As soon as I stepped out the door I had to drop to my preferred hands and knees position as this was how I had been labouring, that, and howling like a banshee! When it was over I made it about another 20 feet and was down again. I stayed down when it was over. My husband was with me and I could tell he was worried. I really wanted to say “I can’t do this” but I knew I couldn’t, I wouldn’t. I did say “I don’t know if I can do this” but that is because I didn’t know. It was so hard, nothing had prepared me for that. Not the books I had read or even the births I had attended. My husband was strong for me when I couldn’t be, he told me I could do it and that I there was no way I was going to give up.

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I made it back in side and sat on the birth ball. My midwife could see that I was still having a hard time, she talked to me about my head space. She suggested that maybe I was trying to have three labours at once – my first son’s, my miscarriage and this one. She later said I gave her a look of death and that is why she had backed off after, but it was just that I hadn’t had a conversation with anyone in a while and just wasn’t in the head space to think quickly. I took a few minutes and really thought about what she said. I came to the conclusion that I didn’t think that was the issue, or at least the biggest one, but I did realize that I was thinking too much about the future. I needed to deal with what was happening right then and there. I needed to take it one contraction at a time and the truth of the matter was that I WAS doing it and had been doing it already much longer then I ever thought I could have! That was the moment I dug deep and fully committed. This was happening, it was what I had wanted so desperately and I was going to see it through. I wasn’t alone, God was with me, friends and family where praying for me and I was joining every other woman throughout history that had every given birth.

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Less then an hour later I was on the toilet, again, and started feeling a little “pushy.” My contractions actually stopped for a little while too, and my whole demeanor changed. I “woke up” and looked around, I was smiling at people and greeting them, as I didn’t remember doing it when they came in. It crossed the back of my mind that this could be my “rest and be thankful” stage before pushing! I asked to be checked. About 1:30pm I was 8cm with a thick lip at the front, they told me not to push. Once again I was feeling somewhat defeated, happy that I had made progress but really expecting to be closer to fully dilated. Now I was in transition, wanting to push, feeling like my pelvis was going to break into a million pieces and I couldn’t do the one thing that had brought me any relief – push. I got into some forward leaning positions to try and put pressure on the the front of my cervix, it was so hard, but there was only one way out – quite literally! And that was for things to progress. At some point my husband had started breathing with me as I had totally lost control of my breath at the peak of the contractions, he said “Breathe innnn and ouuuut.” This became my ritual, my breaths were me saying/yelling “IIINNNNN – OOOOWWWWTTTT!” And, yes, “Out” just so happens to start with “Ow!”

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Just after 2pm I was into the tub again and that is where I stayed! I was actually sleeping in between contractions and my body was starting to push all on it’s own! About an hour later they checked me again and I still had a cervical lip at the front, so they said not to add anything to the pushing my body was doing. My body might push through the lip but they didn’t want me to cause anything to swell. The student had checked me and she also said that I could likely reach the head if I wanted to feel – did I ever! It was the most amazing thing to feel my baby’s head while it was still inside me. I could also feel what my body was doing and boy was it doing something! I had moved into a squatting position in the tub and thought I might as well try and do a bit of pushing with a contraction to try and get the feel for it.


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I had my finger on my baby’s head and it moved a little when I pushed, but right after I stopped, my contraction peaked and my body pushed – it moved about a 1/4″! WAY more effective than anything I was doing. My contractions spaced out a bit at this point, likely to catch up to the movement of my baby down the birth canal, and I slept in between them. I felt my baby through every one, I even let my husband feel too.

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The second midwife was there and keeping our son occupied as official “Pooper Scooper” and got him involved in checking the tub temperature too. It wasn’t too many contractions before I started to feel a bit of the “ring of fire” and everyone said they were starting in be able to see hair! I hadn’t been freaked out or worried up until then. This was the part that I had been a little worried about – crowning – I didn’t want to tear and I heard it burned like hell. I had to take my hand away for a bit so I could gather myself. I put my hand back and my baby’s head was right there! It was slipping back a bit in between contractions so I did a little bearing down in between so that I wouldn’t loose any progress. A couple more contractions and it’s head was out! They knew I wanted to be the one to pick the baby up so all they did was check for a cord around it’s neck. It had a tight one they couldn’t get off, so I pushed out the shoulders. My baby was born! I picked it up and brought it into my arms. As a family, my husband, my son and myself – we welcomed our new son!

At 5:49pm on July 2, 2013. Our family was reborn. As a family we welcomed our new son and brother, Levi, into this world, into our home, without drugs, without interventions, without fear and in God’s own timing. Levi means “joined together” or “joined with him”. That day our family was joined together and so was my heart, it was healed.

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Photos © 2013 Nicole Marozzo & Melissa Van Dam
A Cesarean for Breech Baby, Jaundice and PND

A Cesarean for Breech Baby, Jaundice and PND

At our 19 week scan, the sonographer found that our son, J’s, nuchal fold was more prominent than it should be. She also found the left brain ventricle to be larger than the other. These, we discovered, were soft markers for some chromosomal abnormalities, such as Down syndrome, and it may have indicated J having fluid on the brain.

I remember I picked up the scans on a Friday afternoon. My next appointment with my GP/ob was not until Monday and I had to work Saturday morning. The first thing I did when I got home with the scans was read the report (of course!). It had a lot of big words that I didn’t understand, and I did the worst thing possible. I turned to Doctor Google. I was in tears when Tobi came home. He said I was being silly, and there was no point in panicking and dwelling on this until we had heard it in laymen’s terms from the Doctor. I went into work Saturday morning, determined not to think about those horrible long words in the report. I stepped into the office, where the boss was sitting, to grab my keys and name tag, and the boss asked me (completely innocently) how I was. I took a deep breath and burst into tears! He took one look at me and sent me home. He is the biggest softy when he wants to be.

We were booked for another scan at the Women’s and Children’s Hospital in Adelaide at 22wks, just to double check the measurements. It was at this point it was highly recommended to have an amniocentesis to confirm whether J had any chromosomal abnormalities. Tobi was adamant it was not a risk worth taking. I needed a little more convincing, but with a 1 in 200 chance of miscarrying, it was not something I wanted to risk. We also agreed, that whatever the outcome, we would still want J, regardless. The doctor we saw also told us that a termination was still an option, right up until 26-ish wks, when “it would start to become a little difficult.” NO! NOT an option!

I felt devastated. I hated being in limbo, not knowing whether our baby was healthy, whether he would be ‘normal,’ or whether he would even survive. Tobi was my stronghold. He never wavered in front of me. He knew nothing was wrong and that we would have our perfect baby with us. I should have trusted him. I later found out from a family friend that he wasn’t ok, and had gone to him and completely broken down. I had no idea! He is so brave for being strong for me. He doesn’t need to be, but it is nice to have a rock to lean on.

For 10 weeks we continued on. I still worked, the world kept revolving. We headed back to Adelaide at about 32 weeks for another scan to check the measurements again and to see whether I could birth our baby back home, or whether (because of the possibility of fluid on the brain) I had to be in the city. There would still be the possibility of a chromosomal abnormality, but our local hospital would be more than capable of ‘handling’ that. The scan took forever. Two different people did the ultrasound. We then waited for the results.

They came back all clear!

There seemed to be no fluid on the brain. It was just a random thing that happened every now and then. The possibility of having a Downs baby, or some other abnormality flew out of my mind. I was just ecstatic that I was allowed to stay home and try for the birth I was so desperate for. Oh, and it was also at this scan that we found out baby was measuring nearly 5wks ahead of dates at 36+ wks!

A bit of history – my first son was posterior. I had always had in my head that I wanted a natural birth. I envisioned walking around, laying in the bath, nice warm showers, not birthing on my back… but after 3hours labour at home, I was crying to Tobi to take me to hospital. Within an hour of being there, I had screamed for the gas. NO, the pethidine. NO an EPIDURAL! I had just got the epidural in when the midwife leant down on the bed and said, “ah… I’ve just read your birth plan… ummm…” to which I replied “I don’t care, it doesn’t matter!” while still waiting for the epidural to kick in! Anyway, 18 hours later, and about 1 hour of pushing (and third degree tearing), we welcomed L into the world.

I was determined that I was going to have my natural birth one day, or that I’d at the very least, better myself. I research and educated myself on natural birth, and found myself a student midwife to help support me. From about half way through, J decided breech was the best position, and stayed there until birth. So I also researched (extensively) about vaginal breech births and had spoken about this with my midwife and OB. My OB was all for trying a vaginal breech birth, but wasn’t confident, and was recommending I see another OB as well to discuss options. I was to make an appointment with him at about 37 weeks. In the mean time I was spending a lot of time inverted or on my hands and knees to try and get him to turn. It must have been hilarious watching me!

On a Wednesday night, at 36 weeks and 2 days, I finished work with MAJOR cankles! It was hot, I know I hadn’t drank a lot of water and I had been on my feet at work for 9 hours that day. I took myself up to the maternity ward as I had never had an issue with swelling before, and it was starting to feel really uncomfortable all over. I was monitored and had my blood pressure taken, but all seemed normal, so was sent home and told to put my feet up. I was planning on finishing work that Friday, and was really looking forward to a week or two off before baby made his entrance. Later that night I thought I noticed some fluid leaking. But I wasn’t sure. I had no pelvic floor muscles left by that point and baby seemed to be sitting right on my bladder for the last 4 weeks, so I assumed it was just wee.

Friday, as I’ve finished work, I’ve noticed my pad is pretty soaked, so again, I trot myself up to maternity to get myself checked out. With my first son, my waters broke after the epidural was in, half way through the day, so I didn’t know what to expect. Tobi came up with me and we sat around for a while, while I was being monitored again. The midwives check the fluids, and yes, it was amniotic fluid. My pelvic floor muscles were better than I gave them credit for! Coincidentally my OB was on the roster that night and she came in to see me. She explained that yes it was my waters. They hadn’t broken, it was just my hind waters. As I had no contractions in the 2 hours I’d been laying there, the (more senior) OB might do an ECV if asked. This was one of my options, as a breech vaginal delivery was NOT a favorable option to most of the hospital staff.

Unfortunately, the OB who was on call, was not one of the local guys. He was an OB from Adelaide and he was driving down (5hours) and still ½ an hour away. He was not aware of my birth plans and didn’t seem to want to hear them.

I overheard my OB was on the phone to the visiting OB explaining my ‘situation’ and, bless her; she was such an advocate for me to have this baby preferably breech, or at least try an ECV. She came back in to see Tobi and I with a sullen look on her face. She reiterated that the other OB did not want to try and ECV, and it was far too dangerous to try a vaginal breech delivery. He had said to book an operating room immediately and prep me for a cesarean.

For the second time this pregnancy my heart dropped. Having a C/S was so far from my mind. For me it was a very last resort. I was devastated. I wanted SO bad to try a natural birth and this person I had never met had just stripped it away from under me. When he finally waltzed in, he sat on the bed and would not listen to a word my OB and I were saying to him. He would not do an ECV as my waters had broken and there was not enough cushioning for the baby. It was far too dangerous to have a breech delivery, it is safer to have a cesarean, especially at 36+4wks. I just wanted the option. I wanted to try. I wasn’t even in labor for God’s sake! The visiting OB stated his reasons, said “hmff” and put the consent forms on the bed. Through tears, I signed the consent for to be prepped for the operating room. To this day, hubby still doesn’t seem to understand why that was so hard for me. Why a cesarean was such a bad thing. For me, I think, it was more the lack of choice. This doctor who didn’t know me from a bar of soap, strode in, told me what to do and expected it. I did not like that one bit.

At some point I was moved from the delivery room I was in to the maternity ward across the hall. Tobi and I debriefed a little and let it sink in that we were going to meet our ‘troublesome’ baby finally! I then did a little panic because we hadn’t chosen a name! It was literally on the way to operating room when we finally agreed on the baby’s name. We didn’t bother thinking about girl’s names as we were almost positive that this baby would be another boy.

So I was prepped for the most relaxed ‘emergency cesarean’ they’ve had for a long time and I got wheeled away. The anesthetic seemed to take forever to work. I swear I could feel them pricking me with something the whole time they were testing. They ran ice over my belly (apparently) and then they were ready to start. Funnily enough, as they cut into me a massive gush of fluid came out all over the Ob saturating his shoes. That made me feel a little better (no fluid or cushioning left, really?). It felt so weird to be tugged and pulled at. My Ob explained everything as it was happening and Tobi took photos over the curtain. It’s cool looking back at the photos, I must admit! I had to have a longer cut than normal as J was footling breech and had his feet were well engaged. Finally they pulled him out and showed him to us. He was perfect. Jackson Eli was born!

breech c-section photo

breech c-section photo

They whisked him away to be checked and I started shivering. Tobi freaked out a little me shivering, but the anesthetist assured him it was normal. It wasn’t long before I was stitched up and moved across to a bed. Still in the operating room, I was given Jackson and we had some skin on skin time and (tried to) breastfeed in recovery.  I think he was born about 9:30pm (that sound horrible doesn’t it, that I can’t remember, without looking at his book!). We got back to the room and J was weighed at 8lb 15oz, or 4.04kg (I think!). The question was floated as to whether we thought our dates were right, but after a couple of days, the nurses all agreed, because of his mannerisms, that J was definitely early.

We had a rough few days. J ended up becoming jaundiced and was under lights. Thankfully he was able to stay the room with me the whole time. Because of his jaundice, he was tired and he struggled to attach properly. I was pumping and expressing like mad and using a syringe to drop colostrum into the side of his mouth while he sucked on my finger. I was determined for him not to have a nasal-gastric tube and he was not having formula. We continued like this for about 3 weeks before he finally seemed to get his latch right.

On day two, the visiting OB came in to see me. He looked at our chart and saw I had been expressing and syringe feeding J. He told me that it babies don’t in fact need colostrum, it’s pointless really. People in such and such a country don’t give it, that’s why milk can take up to a week to come in. So don’t expect your milk to come in until next weekend. My milk came in that afternoon, before 48 hours were up. Just let me mother my baby! Just to add to that, not long after he left the (horrible) midwife on duty told me that J had lost too much weight and needed a formula top up and nasal-gastric tube. I asked why? My milk hadn’t come in, it was less than 48 hours after birth, give us a break! She begrudgingly left saying well, if things don’t improve, we’ll need to do it by the next morning.

I don’t remember when, but somehow J ended up with a tube thing “just in case.” Tobi wasn’t around when they did it and he wasn’t happy when he came in and saw it. He was just about ready to rip it out himself. I was already doubting myself and would’ve agreed for the midwives to give him top ups if it weren’t for Tobi and my friend. Kylie came in that day, and had the same reaction as Tobi. Kylie was an ABA counselor in training and was just about finished her nursing degree. She checked our chart and my colostrum supply in the fridge and said that J didn’t need that tube in. That settled it for Tobi – he marched J down the hall to the nurses and demanded that the tube be taken out. Tobi isn’t one to be messed with. He’s 6ft+ tall and built solid. You wouldn’t want to say ‘no’ to him! J came back without the tube in.

breech c-section first feed

A week after J was born, with his jaundice levels going down, we decided to leave the hospital. I was going mad, and the midwives and my OB told us his jaundice wouldn’t necessarily improve any faster in hospital, than at home. But they kept telling us, ‘just one more day, just one more day.’ By the Friday, we’d had enough, we discharged ourselves against medical advice and lo and behold, J was fine!

breech c-section

I was diagnosed with mild PND just before J’s first birthday. I think a lot of it has to do with his birth and the lack of choice I had. We are now talking about trying to conceive baby #3 and I am arming myself with even more research and knowledge. My OB and I are more confident and although I have still been recommended to see a senior OB, she and I seem to be on the same page more often than not and is more than happy to support a VBAC this time.

Giving Birth is a Journey

Giving Birth is a Journey

Three years ago I had my first baby girl naturally at 35 weeks pregnant, she was breech a week before but due to a small car accident the shock turned her, she was not harmed and neither was I, but apparently she couldn’t wait any longer. During delivery I suffered a 3rd degree tear that needed to be stitched in theatre, but I refused as I did not want to leave my baby. Luckily enough I had an excellent doctor who agreed to do the repair work in the birth suite.

Shortly after Isabella was born she was sent to the hospitals special care nursery to receive antibiotics, it was there they discovered she had high levels of jaundice requiring phototherapy within a humidicrib, she also had feeding troubles so a nasogastric tube was inserted to help her to feed. After over a month in special care we finally got to take her home. I was terrified about having another baby thinking the same thing would happen, but through the support of my partner we decided to go for another.

Isabella

Around 20weeks into my 2nd pregnancy we found out our baby was breech, we tried everything to turn her but she wouldn’t budge so I booked a C-section on a week that my partner would be home from work, as he worked away for a week at a time. Two weeks before my booked date, I knew I had gone into labour but I didn’t want to do it alone. So I held out and stayed home through increasing pain with Isabella (who was now 18 months old) until morning came as my partner would be flying home that day. I spoke to him and he told me to go to the hospital and he would try get an early flight home.

He arrived as I was being wheeled into theatre to welcome our new baby girl; I couldn’t be happier. Aria was born via emergency C-section at 38weeks and we got to take her home 3 days later; however, I knew there was something off about her. On day 6 I requested a doctor come to our home 30 minutes out of town, as my partner had gone back to work and I couldn’t yet drive.

Aria

She was readmitted to hospital that afternoon into the special care nursery as she, too, had high levels of jaundice. Hers, however, were at a critical level due to a urinary tract infection we weren’t aware she had. Blood was flown up from our states capital and triple phototherapy (the first time it had ever been attempted at our hospital) was commenced in the meantime to try starve off the jaundice to avoid brain damage. 1 month later we got to take her home again free and clear with no signs of any side effects.

Thirteen weeks ago I gave birth again to another baby girl, I prayed for a VBAC. When we found out she was breech also, we once again went through all the motions to try and turn her to no avail. I was booked for C-section at 40 weeks; 2 days before my due date. However, at 38 weeks pregnant, late at night, on the day of my step daughters 4th birthday, I knew I was going into labour.

I made all the calls and we arrived at the hospital at 3am, Jan 17th the day, after her birthday. Within half an hour I was in for my emergency C-section. Once again, I was terrified of my baby being ill; however, everyone was confident we would have a healthy baby girl. This time my C-section was calm and peaceful. My partner and I joked and lots of photos were taken of the whole process including her delivery by our midwife.

Moments later things started to get tense and I knew something was wrong. Harper was taken to be checked over while the surgeon battled with a bleed I was having. When they brought her back they told us not to be alarmed, but as soon as my bleeding was controlled they would need to take her into the special care nursery as some things weren’t “right” about her.

They let me hold her as they fixed me up and off we went. While in special care, I found out she had some “abnormalities” as they called them, and they weren’t 100% sure she was a girl, tests came back clear, she has no chromosomal abnormalities and we were sent back to the ward.

Harper

The next day things started going downhill, while I was up and about she was very lethargic and starting to yellow, so on my insistence they called a specialist. She was readmitted to special care nursery on day 2 with high levels of jaundice just like her sisters; however, they also found she had a heart condition and a torticollis in her neck, causing her head to pull to the side and develop a little wonky. After 2 weeks we took her home only to have her readmitted a week later with chronic heart failure.

She was placed on heart medication, antibiotics for an unknown urinary tract infection, and oxygen to help her breath as well as a feeding tube, that night they rang to tell us she had been moved to the NICU. After 4 days in the NICU, and another 2 weeks in special care, we got to bring her home again. She has an ASD, VSD, duplex urinary system, bilateral reflux of urinary system, and torticollis of the neck, low muscle tone, and failure to thrive.

Through the help of our team of specialists, she is on various medication as well as growth formula and physiotherapy, and is on the road to recovery. At 13 weeks old she still only weighs 5kg, but she is getting there.  I couldn’t have done it without the help and support of my friends, family, partner and our team of doctors who have looked after all my babies and gotten them home with us.

I have attached photos of my girls in special care/NICU as well as my body post my miracles. People ask if I’d do it again, and I’ve always said yes. But since Harper was born I have changed my mind. Reading the stories on this site have helped me to see that even though it’s been a difficult road, I wouldn’t change it for the world and I would definitely do it all over again if I could.

Mom

Maternal Death and the United States {Birth Without Fear}

Maternal Death and the United States {Birth Without Fear}

Maternal Death – the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. (WHO)

This is a subject no one really wants to talk about. Mothers die. Mothers die in pregnancy and childbirth and just after birth. The weight of that reality is just so heavy and heart breaking. In our current birth culture, fear reigns. However, fear reigns without reason or knowledge of what really needs fear. And of course – all of us hope to Birth Without Fear. And so, I approach this subject with a heavy heart but hope as well.

Samantha's Birth

Where Does It Happen?

In short, it happens everywhere. However, some areas are more prone than others. This can be due to lack of care – think of sub-Saharan Africa or rural villages in some undeveloped countries. Maternal death in those areas is an unfortunate fact of life (though organizations are striving to change this).

But apart from the “obvious” places, where do you suppose it happens? Perhaps war-stricken places, or those places without advanced medical facilities? Would it surprise you to know that the United States has one of the highest maternal mortality rates in the developed world?

Yes – you read that right. Our current maternal mortality rate is 21 deaths per 100,000 live births as of 2010 (WHO). This rate went up from 2005 (18/100,000). The 2010 “Healthy People” Goal for the United States was set at 4.3/100,000 – we grievously missed that by a large margin. The 2020 goal is 11.4/100,000, which would only be a 10% decrease from what the US considers to be its current statistic (the 12.7/100,000). I find it interesting that the government decided after they missed the 2010 goal that maybe they should try less to save mothers, since their efforts before had no effect and saw a rise in deaths.

The WHO number is adjusted from the number reported by the CDC (12.7/100,000) – this is because the United States does not have a universal system of reporting maternal deaths and the CDC admits that our numbers are drastically under reported due to this lack of uniformity in reporting (See this CDC publication, specifically page 20). Currently, only 25 states make it mandatory to state that a death was pregnancy related on the death certificate – and even this method is questionable due to lack of doctor training in filling out certificates and the great fear of litigation in the medical system. Ina May Gaskin writes about the lack of reporting here.

Other countries have much better standards of reporting. The “gold standard” is considered to the be reporting system in place in the United Kingdom. The UK ensures that not only is every death reported, but they also compile the deaths and reasons for them in a report every three years. This report is available to the public and the locations and names of the deaths remain confidential. This allows the nation and the nation’s health workers to look at the issues without fear of litigation – meaning they have no reason to hide maternal deaths.

To provide some perspective, here are the rates of some other countries:

  • Australia: 7/100,000
  • Brazil: 56/100,000
  • Denmark: 12/100,000
  • Germany: 7/100,000
  • Israel: 7/100,000
  • Japan: 5/100,000
  • Netherlands: 6/100,000 – note that about 30% of all births here are at home.
  • United Kingdom: 12/100,000

As you can see, we are rather behind many other countries – and don’t worry, I am going to come back to Brazil and why I included that statistic which is very high for an industrialized country (as is the USA’s number).

Why Are Mothers Dying?

This question is hard to answer since as mentioned above the reporting methods are varied and not always followed. We do know that some deaths are simply not preventable, this is just a fact of life. However, looking at the much lower numbers in other comparable nations we know that unpreventable deaths are not the reason for the very high numbers in the United States.

We know that it is not from lack of care in general – reports show that over 99% of all women in the United States receive prenatal care. However, we have to look at the level of care women are receiving. We have to ask, does a 5 minute rushed visit with your actual doctor count as adequate care? Does more diagnostic testing equal better care? Does spending more money equal quality care? (The numbers say no – we spend more than any other country in the world on birth).

We see a HUGE disparity in death rates in regards to ethnicity. An African-American woman is 3.3 times more likely to die in childbirth than a white woman. This is simply not acceptable in a country as advanced as ours, and one that is supposedly equal. Midwives such as Jennie Joseph are helping to implement ways to combat this disparity – her creation of The JJ Way is an example of how we can work to correct this travesty.

A big question that needs to be asked in the United States has to do with who is providing this care – care that is obviously not saving as many mothers as it should. In the United States women overwhelmingly see Obstetricians. While Obstetricians are amazing for complicated and high-risk pregnancies, they don’t have much training in plain old boring pregnancy and birth.

A majority of the time pregnancy will proceed in a normal fashion, and birth will follow in the normal fashion. When we use care providers who are trained to search for problems there tends to be a trend of finding problems whether they exist or not, or whether they are actually emergencies or not. As the saying goes, “Give a boy a hammer and he will find something which needs to be hammered.”

We can see that in countries were the majority of care is given by midwives (or that country’s equivalent care provider) the maternal mortality rate is lower (and the infant mortality rate is lower as well). The United Kingdom is a great example of this. They are comparable to us in many ways (general health and population structure), and yet consistently have better maternal outcomes. And they use the midwife model of care in which all women start with midwives and only transfer if problems arise. (Note that a woman can opt for an OB to start with, however most do not).

Now for the elephant in the room: the United States cesarean rate. Our current cesarean rate is 32.8% (CDC). Yes – basically 1/3 of all babies in the US are born through cesarean. So are 1/3 of all US women somehow “broken”? Unable to birth? Producing massive or stubborn babies? NO – of course not. If 1/3 of all women in the US were “broken” then those numbers would be reflected all over the world, and the statistics show this is not the case. In the same vein, we are not producing massive babies either – in fact the average birth weight has gone down as the cesarean rates have gone up (and is independent of that rise or that of induction).

Remember when I said I would come back to why I included Brazil? Brazil has a rather good medical system and is considered a developed country, so why the massive maternal death rate (56/100,000)? Take a look at their cesarean rate – 52.3%. Yes – over 50%. Brazil is an interesting case since most of these surgeries are elective, even for the first time mothers. The fear of childbirth is so deeply engrained in Brazilian culture that women jump at the opportunity to have a cesarean and avoid labor totally. A vaginal birth is seen, culturally, as something only poor women do because they can not afford a cesarean.

That mortality rate could be the United States’ future. We see a fear of birth in the US, and a huge cultural love of telling horror stories about labor and birth. We see more interest in elective cesareans (though elective first time cesareans are not significantly altering the rates). As VBACs are “allowed” in fewer and fewer places and malpractice issues continue to rise we see more and more women forced into surgeries they do not want or need. Our rates are heading right up to that of Brazil’s, and our maternal mortality rates will be sure to follow. A Cesarean increases the risk of death significantly in comparison to vaginal birth.

In comparison, the rate of cesarean in the UK is 25%, the Netherlands has a rate of 14%. As I stated before, the UK has 12/100,000 rate and the Netherlands 6/100,000 – rather interesting that as the rate of cesarean is almost half in the Netherlands and their rate of maternal death is also half that of the UK. While in some countries a higher cesarean rate does not correlate to a significantly higher mortality rate, those countries with very high rates of cesarean typically have higher (or rising) mortality rates.

We also cannot forget postnatal care. The postpartum period is one that needs care just as much as the prenatal time period. In the US, typically a woman is seen in the day or two after birth, at two weeks or so, and then at six weeks…and that is about it. This is simply not enough during this time of life when hormones are changing, the body is attempting to heal from creating another life, and things like retained placenta or clots can cause major issues. A much better plan of postpartum care must be put in place.

What Can We Do?

Be Educated. That is the number one thing you can do to not only help yourself have a safe pregnancy and birth, but also to help the women around you as well. When you learn, share the information. Break down the myths that pervade this culture – break down the assumption that VBACs are dangerous, or that “big babies” need surgical birth. Share the studies and articles you read.

Be Fearless. Help to eradicate fear of birth. Can birth end in tragedy? Yes. Unfortunately is does happen. But with proper and evidence-based care we give ourselves and our babies the best chance. Share the positive birth stories you hear. Share your positive birth. How does this help? It helps women to not fall into a fear based decision that increases her risks of complications – namely induction and cesarean. When a woman can start her pregnancy and birth journey from a positive place it gives her more space for growth and research. Absence of fear is not ignorance of risks – it is not being beholden to the fear of risk.

Those two things hand-in-hand – education and fearlessness – can go a long way towards helping this mortality rate go down. An educated woman is better able to avoid situations or care providers that increase her risks, and a fearless woman is better able to stand up for herself and decipher what is really in need of intervention and what is not without cultural fears clouding her view. Lets do our part to save mothers.

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VBAC: What ACOG Really Says {Birth Without Fear}

VBAC: What ACOG Really Says {Birth Without Fear}

VBAC – Vaginal Birth After Cesarean.

The term and action is wrought with political and emotional meaning in the birth world. Can  you have a VBAC? Does your doctor or hospital “allow” a VBAC? Under what conditions can you have a VBAC? Should it be called a TOLAC (trial of labor after cesarean)? What sort of prior birth history is preferred? Once I have one successful VBAC, will I still have to jump through hoops in subsequent pregnancies?

All these questions and more come up when we start to discuss the mine field that is VBAC in today’s world. But I wanted to know what ACOG really says. I am not talking about the public statements – which you can read HERE. I want to know what ACOG is saying to the doctors, what they put out in their practice guidelines.

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The document I found is HERE. I encourage you to not only look at the document for yourself, but to also follow the many links I have scattered throughout this article.

At the opening of the document, ACOG has this to say:

Trial of labor after previous cesarean delivery (TOLAC)* provides women who desire a vaginal delivery with the possibility of achieving that goal––a vaginal birth after cesarean delivery (VBAC). In addition to fulfilling a patient’s preference for vaginal delivery, at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies. At a population level, VBAC also is associated with a decrease in the overall cesarean delivery rate (1, 2). Although TOLAC is appropriate for many women with a history of a cesarean delivery, several factors increase the likelihood of a failed trial of labor, which compared with VBAC, is associated with increased maternal and perinatal morbidity (3–5). Assessment of individual risks and the likelihood of VBAC is, therefore, important in determining who are appropriate candidates for TOLAC. The purpose of this document is to review the risks and benefits of TOLAC in various clinical situations and provide practical guidelines for managing and counseling patients who will give birth after a previous cesarean delivery.

Lets start with noticing that ACOG automatically terms all VBACs as TOLACs first. If you complete the trial with a vaginal birth, then it is a VBAC. The issue with this sort of wording (and thought process) is that it sets women up with doubt and it sets the doctor on the defense against the failure of the trial. I will use the term interchangeably only because the document that I am citing uses the term so often. But moving past this unfortunate wording we do see that they know VBACs are beneficial. They state that VBACs lower the maternal morbidity rate and risk of complications in future pregnancies and that as a whole they lower the cesarean rate. They do also point out that there are certain factors that make a TOLAC less likely to succeed, and that when they do “fail” you are more likely to have morbidity (which makes sense, as a major surgery is considered a morbidity to begin with).

In the “Background” section at the start of the Practice Bulletin we see several points that seem to be denied in the general obstetric community. First they state that the cesarean rate has increased rapidly since the 1970s, from 5% to more than 31% in 2007. They blame this increase on the introduction of electronic fetal monitoring, and the decrease in breech births and forceps births. I put emphasis on the EFM use, since we are often told that it is needed for a safe birth, even though research proves that it does not lower fetal morbidity or mortality. Again and again, research also shows that it increases the chances of a cesarean, which in turn increases the risks to mother and baby. Yet, ACOG still insists on the use of EFM as standard care.

They also state in this section that after the 1970’s VBACs gained popularity. By the mid 1990’s the rates of VBAC (28.3%) were such that it was actually reversing the cesarean rates. However, this increase in VBACs seemed to come with an increase in uterine rupture – though the literature does not state what sort of uterine scars were common (since certain types are known to have more risk, such as classical), whether induction was used, or what type of rupture occurred (most ruptures are not catastrophic but are instead considered a “dehiscence”). Due to this increase in ruptures, the case for VBACs was again set back to “once a cesarean, always a cesarean” in many practices. They finish this section by stating that it is known that liability is a large part of why VBAC is not offered to many women who are actually good candidates.

Now we get into the nitty-gritty of what they say about VBAC. I am going to take questions and statements from the document to break this down. All noted pages are from the Practice Bulletin unless otherwise stated or linked.

  • What are the risks and benefits associated with TOLAC? (p2)
    • Neither an Elective Repeat Cesarean (ERC) or a TOLAC are without risks.
    • Most maternal morbidity that occurs during TOLAC is related to a failed attempt when a cesarean becomes necessary.
    • VBAC is associated with fewer complications than an ERC.
    • Thus, the risk of a VBAC really comes down to whether it is achieved. If it is a “failed” TOLAC it has more risk than an ERC, but if it succeeds, it has lower risk than a ERC.
    • The main risk of TOLAC/VBAC is a uterine rupture. However, as stated in the background, some studies do not give background information about what type of ruptures are occurring nor on what type of prior incision or induction methods.
    • They include a chart of maternal risk in this section and it is interesting to note that maternal death risk can be almost double (0.2%-0.4%) with a ERC compared to a TOLAC after one prior cesarean (0.2%), and that TOLAC with more than one prior cesarean had no death risk within those studies. It is also noted that a ERC also comes with the risk of uterine rupture (0.4%-0.5%).
    • It is noted that for families wanting several children a successful VBAC takes away the risks of multiple surgeries which includes hysterectomy, bowel or bladder injury, transfusion, infection, and abnormal placentation such as previa and accreta.
    • They include a chart of neonatal risk factors when comparing ERC to TOLAC. It should be noted that there is no significant increase in neonatal death or neonatal admission (NICU admission). We see a much higher rate of respiratory distress (1%-5% vs. 0.1%-1.8%), transient tachypnea (too much fluid in the lungs which causes breathing issues) (6.2% vs. 3.5%) and hyperbillirubinemia (jaundice) (5.8% vs. 2.2%) in babies who go through an ERC.
  • What is the vaginal delivery rate of women who have a TOLAC? (p3)
    • Most studies show a 60-80% success rate.
    • Studies show a decrease in success if the same circumstances happen again, such as stalled labor, which lead to the first cesarean  (however, I will note that the definition of “stalled labor” is more likely the issue than anything else).
    • The chances of success are increased if the mother has spontaneous labor with no augmentation.
    • One VERY interesting note is that being “non-white ethnicity” lowers your chances of success. This speaks to the huge disparity in maternity care in ethnic groups in this country. Simply taking one look at the maternal mortality rate in non-whites gives a clear and horrible picture of this undercurrent in our maternity care system.
  • Who is a candidate for VBAC? (p4)
    • The best candidate is one in whom the risks and benefits balance out in a way acceptable to the client and care provider, this may be different for each woman and there is no specific “formula” to come to this answer.
    • Decisions about the first VBAC should be considered with future pregnancies in mind. This is due to each subsequent cesarean increasing the risk for future pregnancies, and the inability in some areas to find care providers to attend a VBAC after multiple cesareans.
    • For most women with one prior cesarean and a low transverse incision VBAC is a good option and they should be counseled and offered a TOLAC. Women with other incisions (T-incision or classical) or with prior ruptures and surgeries of other sorts to the uterus should be evaluated more.
    • Individual factors should be considered in all cases (i.e. – no hard and fast decisions to ruling mothers out of VBAC), and in the case of women presenting in labor, VBAC should be strongly considered as spontaneous labor increases the success rate of a TOLAC.
    • More than One Prior Cesarean:
      • Studies addressing TOLAC in women with more than one prior cesarean find rupture rates ranging from o.9% to 3.7% – again, without specifying the type of prior incision or level of rupture. They also have not consistently compared these findings directly to women with only one prior cesarean.
      • One large study in particular found no significant increase in rupture between VBAC and VBAMC (vaginal birth after multiple cesarean) – o.7% vs. 0.9%. A second large study only found a slight increase – 0.9% vs. 1.8%. They also found no significant increase in morbidity.
      • The chances of success are similar to that of a VBAC after only one cesarean.
    • Macrosomia (Big Baby):
      • Some studies show a decreased chance of success with a baby larger than 4,000g, and posibily higher rupture rates. However, these studies are based on actual birth weights, and not the estimates given before birth. This is significant given the inability to accurately predict birth weight before the birth.
      • Suspected macrosomia alone should not rule out TOLAC.
    • Gestation of more than 40 weeks, according to the largest study done which looked at this factor, does not increase risk. There is evidence that after 40 weeks chances of success decrease but we must consider that induction of some sort may be common at that point (given current practice trends) and that lowers the chance of VBAC in general. Gestation of more than 40 weeks should not rule out TOLAC.
    • Previous Low Vertical Incision:
      • Studies show similar rates of success compared to low transverse incisions (the most common).
      • Studies do not show increased risk of rupture or morbidity for mother or baby.
      • Studies are limited, but a low vertical incision should not rule out VBAC given the current information.
    • “Unknown” previous uterine incision should not rule out VBAC. The two large studies done at large tertiary hospitals show that there is no increase in rupture rates or morbidity, and success rates are similar. Unless there is a high clinical suspicion of a complicated previous uterine incision TOLAC should not be ruled out.
    • Twins Gestation:
      • In all studies available it is shown that in women with a previous low transverse incision there is no increase in risk to VBAC a twin gestation.
      • Success rates are similar to those of singleton mothers. Twin gestation should not rule out TOLAC.
  • How does management of labor differ in a VBAC? (p5)
    • Induction of labor for maternal or fetal factors remains an option for TOLAC. However, the increased risk of rupture that comes with any induction and the decrease in success rates should be discussed.
    • One large study of over 20,000 women found that rupture rates increased slightly with induction. Spontaneous labor had a 0.52% rupture rate, non-prostaglandins induction with a 0.77% rate, and with prostaglandins a rate of 2.24%. However, again the types of rupture were not specified and the context of the inductions are not known (unfavorable cervix, need for multiple induction methods, etc).
    • Another study of over 33,000 women found a slight increase in rupture (o.4% for spontaneous labor, 0.9% for augmented labor, 1.1% for oxytocin alone, and 1.4% with the use of prostaglandins). An analysis of this same study noted an increase in rupture rates when the highest levels of pitocin were reached, however no upper level of dosing has been decided for VBACs.
    • Studies done on the risks of misoprostol (cytotec) show an increase risk of rupture and should not be used for TOLAC. (Actually, it increases risk of rupture in ANY mother so it should not be used for induction, period.)
    • Due to the small absolute risk found in several studies, ACOG notes that use of pitocin for labor augmentation is not ruled out for VBAC.
    • Mechanical cervical ripening (such as the foley bulb) are also considered acceptable for labor augmentation/induction in VBAC.
    • ECV (External Cephalic Version), such as to turn a breech baby, are not contraindicated in a woman who wishes to VBAC.
    • Epidural/Analgesia use is not contraindicated and studies show it does not effect success rates. However, epidural use in general is shown to increase the chances of cesarean in all mothers. (to view that study, right click and select “copy link location” and input into google)
    • Electronic Fetal Monitoring is suggested since the main sign of uterine rupture is abnormal fetal heart rate (up to 70% of cases). It is noted that internal monitoring does not help in diagnosing ruptures.
  • How should future pregnancies be managed after uterine ruptures? (p7)
    • If the rupture is in the lower segment of the uterus, the chance of another rupture is 6%. In the upper sections of the uterus it is around 32%.
    • ACOG suggests an elective cesarean for births after a rupture.
  • How should women be counseled about TOLAC/VBAC?
    • Each woman will weight the risks and benefits differently. Therefore, the options should be discussed at length and documented.
    • Counseling should always consider the future plans for more children and discuss the risks of multiple uterine surgeries. Women should also consider that family plans can change or there may be unexpected pregnancies.
    • After counseling the ultimate decision should be made by the client. Global mandates (aka – hospital wide) should not be made as they do not consider the individual factors and wishes of each client.
  • What resources should be available at a facility where a woman will VBAC?
    • The previous suggestion of ACOG was that VBAC should only be offered in facilities with “immediate” access to surgical facilities and staff. However, this severely limits the locations where women could VBAC.
    • ACOG now suggests that care providers and clients consider the facilities available, their individual risk factors, and the availability of other locations where more resources are available.
    • Health care providers and insurance companies should do all they can to facilitate women in achieving VBAC through transfer of care or co-management of care.
    • If there is no way to transfer care, a woman’s autonomy should be respected. If a woman wishes to VBAC in a hospital without immediate access to surgical facilities steps should be taken early in care to develop a plan of action in case of rupture.
    • It should be noted that coercion into a repeat cesarean is not appropriate. A policy of not allowing TOLAC at a facility should not be used to deny care or force a woman into a repeat cesarean. If appropriate, transfer of care should be arranged to a facility and care provider who is better able to support TOLAC.

Now I would like to take a moment to talk about the notion of only “allowing” VBACs in facilities with immediate access to surgical teams and facilities. Lets compare the risk of rupture, 0.7% in most studies, which is not always catastrophic, to the risk of other obstetric emergencies. Cord prolapse, a very dangerous situation in which the cord proceeds the baby down the birth canal and gets pinched, occurs in about 0.28% of births. This situation requires immediate access to a cesarean in most cases. Placental abruption, another very serious complication, occurs in about 0.7% of pregnancies. This also requires immediate access to cesarean in almost all cases. Notice that the risk of abruption and the risk of rupture are the same. The rate of shoulder dystocia, which is considered an emergency that may necessitate a cesarean (or an instrumental birth) is around 1.29% though some studies report it at higher rates in the current birth climate.

Now looking at the rates of these complications, which are on par with the risk level of rupture, we have to wonder why ALL hospitals offering birth services are not required to have immediate access to a cesarean. After all, placental abruption happens with the same frequency and can happen in any pregnancy and ACOG does not seem to be concerned that EVERY pregnant mother does not have access to immediate surgical care. At the end of the day, the risk/benefit analysis needs to be decided by the mother and what she feels comfortable with since the rate of rupture is comparable to the risks of any pregnancy and birth.

The point of this article is not to suggest any particular course of action for every mother. This is about giving you the facts to make your own decision. This is about looking at what ACOG really says about VBAC/TOLAC and not just what your doctor tells you they suggest. Arm yourself with information and consider your own personal factors and Birth Without Fear, no matter how you choose to birth.

Loving My Body {One Scar at a Time}

Loving My Body {One Scar at a Time}

c-section

My fourth baby, an attempted VBA2C, left  me with my final scar of childbirth. After 3 premature deliveries, progesterone shots allowed me to carry to 38 weeks 6 days. Labour began on its own and after a stalled labour, forehead presentation and Bandels Ring I delivered by a calm and quiet c-section, the final chapter in my family’s growth.

I didn’t fail having a VBA2C, I tried and that’s all that I can ask for. Two emergency c-sections and one successful VBAC with premature babies were stressful. This babe was big enough to come home with us and we are breastfeeding exclusively 7 weeks in. That in my eyes is success.

Loving my body, one scar at a time. Your blog gave me hope and confidence… and for that I thank you!

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A Cesarean for Breech Birth with Video

A Cesarean for Breech Birth with Video

In the early days of my pregnancy, back when I was an un-crunchy as could be, my husband told me I wasn’t going to get an epidural. Told me. He was on the other side of the world serving the last couple months of his tour in Iraq and I was in sunny Hawaii, where we were stationed at the time, stunned at his words. My friends scoffed at the idea, “Forget him, you’ll get an epidural if you want one! They’re heavenly!” I believed them.

When he came home I was 15 weeks pregnant. Around that time, I watched a show where the woman giving birth was doing so at home using techniques she learned in a Bradley Method class. The idea of natural birth always intrigued me. My mom had done it several times and when I looked up what the Bradley Method had to offer, I started to change my mind. Maybe I wouldn’t get an epidural after all. Maybe I wanted an all-natural birth.

Fast forward a few months and we were taking our Bradley class. By that time I was fully convinced I was going to have a drug-free, low-intervention, hospital birth. I wrote out a beautiful birth plan. We were ready to tackle everything. Except one thing: A breech baby.

My family has a history of breech births. My mom and aunt were both breech. I was breech until the very end; my little sister was the same. But my baby was head down, at least at my 36 week appointment, so when I walked in for my 38 week appointment ready to be checked to see how far I was dilated (I wanted to know if I should start any natural measures to get things going), I wasn’t ready for the midwife to find something wrong. She brought the ultrasound machine over, waved it over my belly, and showed us. She was butt down, her head wedged in my right rib.

From there, began the most frantic and stressful two weeks of my life. They sent me upstairs for a non-stress test, which I passed fine, and a chat with an OB about scheduling a cesarean or doing an external version. No way, we said, we aren’t scheduling anything. We would think about the version, if it came to that. They sent us home with instructions to return in a couple days for another NST.

At home, we decided we weren’t comfortable with doing an external version, but we were try everything else to flip that baby around. Chiropractor, acupuncture, inversion table, music, hot & cold packs, music & recordings of our voices, handstands in the pool… everything. Nothing. She wasn’t moving.

At my 39 week appointment, the kind OB and midwife sat us down to talk about our wishes. We told them we didn’t want to schedule anything, that I wanted to go into labor naturally to give her every chance she had. They accepted it. And then again, at my 40 week appointment, we said the same thing.

That ultrasound, though, showed that she had one foot up and one foot down. The OB warned that if my water broke, there was a high chance the cord could prolapse and cause an emergency situation. He still was fine with me going into labor naturally, but urged me to consider scheduling a cesarean by 41 weeks if she hadn’t showed. He said it was up to me, of course.

The next day, while dealing with some awesome Braxton Hicks, I decided if she had showed up by the next day (a Friday) I would schedule something for the next Wednesday, 41 weeks. However, as the day progressed I noticed my BH coming regularly, about 6-10 minutes apart. By dinner time, I knew something was up, and even though I had wanted to labor at home for as long as possible, I was worried about the risk of cord prolapse. The hospital had us come in that night.

Our daughter was born via cesarean at 1:05am on December 16, 2011. She was 6 lbs 12 oz and 18 inches long. We named her Penelope “Penny” Ann.

The cesarean was an interesting experience, but so unlike what I was expecting. I received a spinal and requested anxiety medication as well, because I was feeling a panic attack coming. I didn’t feel a thing except some rocking, like I was on a boat. After the baby was born, my husband went to recovery to do skin-to-skin and I chatted with the anesthesiologist for 45 min while they stitched me up. In recovery, after nursing our desperately hungry baby, I vomited from the medicine. The next few days in the hospital were painful, and the recovery took several weeks before I could walk normal or feel an ounce like myself. I never wish a cesarean on anyone who doesn’t absolutely need it.

I don’t feel guilty about doing it, though. There were no doctors or midwives on the island who would deliver a breech baby. Giving her position, I wasn’t going to risk doing it by myself. In the head, we weighed our options and felt fairly in control of the whole process. Still, I feel some disappointment in missing out of the experience that I was envisioning, though I hope with our next baby we can have a home birth after cesarean.

You can find the video here through this link:  http://youtu.be/Ouf4BywpbRA

breech c-section

breech c-section

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