VBAC Series: Vaginal Birth After Cesarean (VBAC) Resources

On a personal note, I had a cesarean section with my first child.  Two and a half years later I had a vaginal birth after cesarean, commonly shortened to VBAC.  During that time I searched the Internet tirelessly looking for resources, stories, anything that would lead me to remain hopeful or perhaps increase my chances of success. 

While there were a few solid resources, I wanted more!  My hunger for information could not be satisfied.  Now two years later, I was curious to see what was still out there and if there was anything new.

Here is my round up:

www.vbac.com

This website has become a wealth of knowledge.  I haven’t even scratched the surface of her new resources.  As far as I can tell, it all looks free.  I look forward to reviewing her new The VBAC Education Project. 

www.vbacfacts.com

I was hoping this website would be a little easier to navigate after a few years, but while it has been updated, I am not in love with the format.  There still seems to be a great deal of information on the website, just a little buried.   Jen Kamel (the creator) has workshops around the country, and they look well worth cost/time. 

American College of Obstetrics and Gynecology (ACOG)

ACOG has practice bulletins, which should guide obstetricians practicing in the United States.  They are in support of VBAC, and their guidelines are far less restrictive than how most obstetricians practice. 

NIH Consensus

Another position paper in support of VBAC

Childbirth Connection

Overall, this is a solid website that focuses on evidence based care.  There is a good deal of information about VBAC and repeat cesarean.  While I do think the information is good, I want to point out that the last time this section was updated was 2012. 

International Cesarean Awareness Network

A website dedicated to providing resources to women who have had a prior cesarean.  They also have local chapters where women who have had a cesarean can meet together. 

www.trialoflabor.com

This is a documentary that explores a women’s journey to VBAC.  Definitely worth the watch.

Ina May's Guide to Childbirth

This book is not specific to VBAC, but there are a few stories about VBAC in it.  The most important part of this book is the normalization of childbirth.  Ina May Gaskin is an amazing birth advocate, this is a must read.

 The Official Lamaze Guide: Giving Birth with Confidence

Another good read that normalizes birth.

Many websites have a page or two dedicated to VBAC, but these resources dig deeper, fully aware that knowledge is power when pursuing or deciding about a VBAC. Is there anything I missed, a resource you found particularly valuable to your journey?

Failure to Breastfeed, Who is to Blame?

In the obstetric world, the word failure is often used when the norm is not met or an intervention (regardless of its appropriateness) does not work. Some terms you may recognize include:

·      Failure to progress

·      Failure to descend

·      Failure to dilate

·      Failed induction of labor

·      Failed trial of labor

·      Failed attempted vaginal birth after a previous cesarean

·      Failed lactogenesis (not able to make breast milk)

The terms failed or failure are harsh, to say the least.  They are deeply personal to those who are the recipients of the diagnosis.  But when breastfeeding fails, is it the mother’s fault? 

In a recent issue of The Lancet breastfeeding has been highlighted as a health topic that needs more support, investment, and commitment.  The health benefits of breastfeeding are staggering, for both mom and baby.  In the response to overall low breastfeeding rates, the authors of Why invest, and what it will take to improve breastfeeding practices?*, suggests 6 points to improve breastfeeding rates around the world.  Guess how many of these points directly involve the mother?  None!  The call for support looks more broadly to the system, if the system is improved the breastfeeding rates should follow. 

In brief, here are their suggested interventions to improve breastfeeding rates.

1.     Disseminate the evidence of exclusive breastfeeding

2.     Foster positive societal attitudes towards breastfeeding

3.     Show political support

4.     Regulate formula companies

5.     Monitor trends and interventions in breastfeeding practices

6.     Political institutions to exercise their authority and remove structural and societal barriers to breastfeeding.

What do you think, will a systems approach improve breastfeeding rates?  What do you think was the biggest influence on your breastfeeding experience?

*The summary of the article is found here

Portable and Convenient Snacks

During pregnancy and breastfeeding when the hunger hits there is little time to spare.  The nausea, anger, or extreme tiredness is sure to follow.  Having a few snacks on hand or at least easy to put together are key in overcoming these desperate moments.  

In general, I think sticking with a limited number of snack ideas, for at least a week, is a good idea.  It makes grocery planning/shopping easier, and additionally there will probably be less waste.  Nothing is worse than throwing out expensive groceries that have passed their prime before you could get to them.

The other key to good snacking is having a balance of carbohydrates and protein.  If your snacks are carbohydrate heavy, you are at risk for feeling hungry soon after. 

So put down the candy and take a look at the following list of ideas.

·      Trail mix, ideally separated into snack size bags.  Don’t feel like making your own? Trader’s Joes carries individual sized trail mix bags. 

·      Hard boiled eggs

·      Banana or Apple with peanut butter.  Have a desk at work?  Store a jar of your favorite nut butter in a drawer

·      Handful of nuts

·      Popcorn and nuts

·      Carrots and hummus

·      Crackers with cheese.  Pre-slice cheese and keep in an airtight container or try some of the individually packaged cheese

·      Celery and peanut butter

·      Cottage cheese or yogurt with fruit

·      Roasted chickpeas

·      ½ peanut butter and jelly sandwich on whole grain bread

Have any go to snacks?  Would love to hear what you turn to when the hunger strikes!

Episiotomy or Not?

Episiotomy use in the United States has decreased dramatically in the last few decades.  In the year 2000, about 30% of women still underwent an episiotomy during delivery.  Currently the recommendation is that episiotomy should not exceed 5-8% of use during vaginal deliveries.

So what is an episiotomy?  Essentially it is a cut made is the delivering woman’s vaginal opening while she is pushing out the baby.  Historically, there were thought to be multiple benefits to this procedure.  Most, if not all, have not been supported by research.  In fact, woman who have an episiotomy tend to have more pain after delivery (and during the procedure!), further risk of tearing, and increased risk of pelvic floor dysfunction to name a few disadvantages to the procedure.

In 2006, yes 10 years ago, the American College of Obstetrics and Gynecology recommended against the routine use of episiotomies.  However, what we in the obstetric world know is this varies greatly by physician practice.  In fact, some research has found that private practitioners (as opposed to residents or hospital based physicians) have the highest rates of use.   

There are very few acceptable reasons for an episiotomy and even those aren’t always concrete.  I think most practitioners would agree that if a baby is in distress and the episiotomy will expedite the delivery, then yes an episiotomy is appropriate.  However, another reason often considered acceptable, is to prevent severe maternal perineal tearing.  This benefit would be difficult to prove.  How does the physician know how severely the woman will tear?  I haven’t heard or read a good prediction of tearing yet.

It is important to ask your practitioner what their episiotomy rate is.  They should know the answer to this question.  And if they claim they don’t, ask “50%? 33%? Less than 10%?”  Then I think the next question is, when would you do an episiotomy?  They should speak to expediting delivery when the baby is in trouble.  If you hear, “easier to repair, protect the pelvic floor, or every first time mom needs one” this should raise some red flags. 

Feel like you need more information about episiotomies? This is a summary of the ACOG recommendation.

Choices in Childbirth has more information about the procedure itself and how to potentially avoid the procedure. 

Conquering Diaper Rash

Need some tips to overcome diaper rash?  Nursing for Women’s Health Journal recently published an article* with some great tips to prevent and cure diaper rash.  This post will cover non-infectious diaper rash, also known as irritant or chaffing dermatitis.  If your baby has diaper rash that will not go away, there is skin breakdown, or you would use words like crusty or vesicles to describe the diaper rash, it is best to seek medical treatment.

This article suggests an ABCDE approach. 

Air – let your baby air out when possible.  After baths or diaper changes letting the diaper area dry before putting back on a diaper is a great time to expose your baby’s skin to the air.  If your baby isn’t yet a mover, you could try laying them on an absorbent diaper changing mat to hang out for a bit, just in case they do let loose!

Barrier – If your baby has frequent rashes you may want to consider diaper rash cream to be part of your diaper routine.  The best creams contain zinc and petroleum for protection.  Though you are welcome to try alternatives.  The key to a barrier is to lay it on thick, covering much of the diaper area or at least where the rash typically appears.  The cream should NOT be removed during diaper changes, but simply wiped as you would normally.  No scrubbing.  This may be a little more difficult to do when poop is present, and a very wet wipe may help in this case.  If your baby currently has a rash, you would follow the same tips as the preventative method, taking much care to cover the rash areas thickly with cream.

Cleansing – Always be gentle during a diaper change, avoiding scrubbing to remove diaper contents.  If you have a particularly messy diaper, a soak in the tub might be your best option, especially if baby frequently suffers from diaper rash.  If commercial wipes are used, it is best to avoid perfumes.  If made at home wipes are used, choosing a soft clothe is best.  

Diapering – There is not enough evidence to recommend cloth vs disposable diapers, but what is known is, frequent diaper changes are important.  Diapers should be changed every 1 to 3 hours during the day.  Crazy talk, I know.  Let’s say your child does not have a rash, and you change their diaper every 3 hours, really that is only 4-5 times during the day.  Not terrible.  What if you are in prevention mode?  Aiming for every 2 hours is certainly reasonable.  And if you are trying to cure, I would change the baby’s diaper each time it seems wet.  The types of diaper rashes we are talking about here should clear up in about 3 days.  Easy?  No.  Doable?  Probably yes.  A few other tips would be to change the diaper once in the middle of the night if you are clearing a rash, but certainly immediately before bed and upon waking.  And always change a poop as soon as it is detected!

Education- The E stands for educating parents, and is written from a health care providers standpoint, so for “E” I thought I would add a few more educational that came from the article and a few of my own.

-       Wash hands before and after diaper changes, this is particularly important if there is any skin breakdown

-       Try changing diaper brand, type (cloth vs disposable), or size if your baby is having recurrent rashes

-       Try changing wipes brand or type of wipes.  Look for ones without alcohol (huggies and pampers both have alcohol free versions, seventh generation seems to be completely alcohol free)

-       Wipe front to back (in both genders)

-       Pat the diaper area dry before replacing the diaper

Anything you have found particularly helpful in clearing up a diaper rash?

*article reference: Clinicians Discuss Diaper Dermatitis. (2015). Nursing for Women's Health, 19(5), 422-429.

A little pause

While there has been a little pause in the the blog/business.  We are ready to roll.  We look forward to further creating a resource for parents in this journey called life!

Pregnancy and Infant Loss Remembrance Day

Pregnancy and infant loss affects more families than is probably realized.  It is the grief, especially in pregnancy, that often goes unnoticed or perhaps ignored.  Today we remember.  We remember those who may never have had a breath, a heartbeat or a voice, whose lives ended far too soon. 

And to the families who lost their babies, their hopes and dreams, we are so sorry.  We know the words we say will never change your situation or make it all better.  We can only hope you may rest in the comfort of a community who supports you and acknowledges your great loss. 

Today October 15th, we pause on Pregnancy and Infant Loss Remembrance Day, and we remember. 

Can Pregnant and Breastfeeding Women Eat Honey? Yes!

Finding the reason why it is ok for pregnant and breastfeeding women came from an understanding of why infants should not eat honey.  Let me lead you through what I found.  It was hard to find a single scholarly source of the risks to infants under 12 months, and it took reading a few to have a complete understanding.  This online resource from Kid's Health had the best overview based on all the reading I did. 

All honey carries the risk of being contaminated with spores from a bacteria that causes the illness infant botulism.  The digestive tract of a baby under one year old is immature in several ways.  Infants do not have all the normal flora (healthy bacteria) of an older child or adult to compete with the bacteria spores that cause botulism.  The spores are then able to set up shop in the infant’s digestive tract.  Additionally, the pH and decreased mobility of the infant’s bowel may also place a role in their susceptibility.  

Adult botulism from food ingestion is extremely rare.  The digestive tract of adults and child older than 12 months is able to move the spores out before they can cause harm.  Thus honey is considered safe for pregnant and breastfeeding women. 

While the number of cases of infant botulism remains low, less than 100 per year, avoiding honey is a smart tip to protecting your little one.  Infants do not need honey and avoiding is generally easy.  However, it is good to note that cooking or baking the honey will most likely not destroy the spores (need to boil for 20-30 minutes). 

In addition, after all of my reading, I would probably avoid feeding a baby under 12 months home canned vegetables for the first year of life.  This is not something we routinely eat, so avoiding would be easy for me.  If you do consume home canned vegetables, make sure the cook is following proper canning techniques and it may be best to boil before consuming.  This resource has more details

http://goo.gl/UkSJY6

Pregnant or breastfeeding?  Eat your honey!  Under the age of one?  Steer clear!  If you do find out your little one consumed honey, don’t panic.  While the risk is low, I would keep my eye out for any concerning symptoms mentioned in the first link, as it could take up to one month for symptoms to present. 

Pregnant and Breastfeeding: Is it Safe?

Pregnant?  Still breastfeeding?  You may be getting a lot of mixed messages about what is best for you, your child, and your growing baby.  The Italian Society of Perinatal Medicine Working Group on Breastfeeding thought this topic was of enough interest/importance to dedicate a workshop to it during their national conference in 2013.  Their review can be found here. 

Their basic conclusion was breastfeeding during pregnancy could be promoted, especially during the 1st and 2nd trimesters.   Many of the so-called “risks” of breastfeeding during pregnancy were not supported by research.  There is little, if any risk of miscarriage, preterm labor or growth restriction in the general population of developed countries.  Interestingly, it is noted that only developed countries seem to be concerned with the nourishment of the nursing child (older than 6 months) during this time. 

So, what’s a gal to do?  Essentially, keep breastfeeding!  It's safe!  Additionally, though it seems like there is little to worry over, it might not be a bad idea to keep a closer eye on your diet and hydration.  Babies, both nursing and in utero, will take what they need, so stay fueled mama, that you aren’t left in deficit. 

Many moms use pregnancy as a time to wean their older child.  Beyond concerns for supply, many moms find breastfeeding uncomfortable during pregnancy.  Did you experience breastfeeding while pregnant?  Did pregnancy make you anxious to wean your older child?  I am sure other women in similar situations would love to hear your experience. 

Welcome to Birth Avenue

Welcome to Birth Avenue!  We have had the wonderful opportunity of working with pregnant women, new moms and their families throughout our nursing careers.  During this time, we have seen a huge need, common amongst pregnant women a desire to be part of their care. However, they often feel their only option is to trust the medical system.  On the flip side, women can become easily overwhelmed with information during their pregnancy, but struggle to know what is the “right” answer.

After too many conversations that ended with, “I wish I had a way to let women know...” Birth Avenue was born.  We want to provide current information that is based in research to help you make the best decisions for you and your family.  We also know that parenting can be intense, and hope to lighten the mood with a blend of more lighthearted posts. 

So journey with us down Birth Avenue, as we work to be a guide during your parenting years!