Once a c-section, always a c-section RIGHT??

The following is an article written by Henci Goer. I found this at: http://parenting.ivillage.com/pregnancy/plabor/0,,bgjt-p,00.html

The facts about VBAC

After years of slowly moving in the direction of establishing VBAC as the norm, prominent obstetricians and the American College of Obstetricians and Gynecologists (ACOG) did an about-face in the mid 1990s and began promoting elective repeat cesarean. As a result, the VBAC rate, which had steadily risen since 1980, fell from a peak of 28 percent in 1996 to 21 percent in 2000, a decline of 27 percent (23). The anti-VBAC campaign has had two prongs: the claim that planned repeat cesarean is as safe or nearly as safe for the mother and safer for the baby and the institution of criteria in the name of safety that act as a barrier to VBACs. (1,16). What changed?

Obstetricians have openly admitted that one reason for the turn around is reducing liability stemming from the scar giving way during labor, a concern that arose from some successful malpractice suits involving VBACs (1,29). This self-confessed incentive provides a powerful motive for bias, conscious or unconscious, against VBAC and a cause for skepticism of statements and policies favoring elective cesareans.

I contend that nothing changed. It remains as true as it ever did that VBAC is as safe as planned cesarean for the baby, safer for the mother, and much safer for any future pregnancies. Here is the research that backs my contention. You decide who’s right.

When is a repeat cesarean not necessary?
Doctors may cite the following as reasons for planned cesarean, but none are true disqualifiers for VBAC. Obstetricians also give rationales that have no basis in the research. These include indications such as mother past her due date, cervix not ready for labor at the due date, baby’s head still high at full term (22):

-Hospital lacks the ability to perform emergency cesarean around the clock: The general hospital population has about the same potential for a labor emergency as the potential for the scar giving way. If the hospital isn’t safe for a VBAC labor, then it isn’t safe for any woman to labor there.
-Prior cesarean for poor progress -- also known as “failure to progress,” “labor dystocia,” “cephalopelvic disproportion”: Eighteen studies report the VBAC rate when the first cesarean was performed for one of these reasons (15). All but two found that half or more of the group gave birth vaginally. Half the studies report rates between 60 and 69 percent, so your odds of vaginal birth with a supportive practitioner should be roughly two out of three.
-Suspected large baby: Ultrasound scans predicting weights over 8 lbs. 13 oz. (4,000 grams) will be wrong one-third to one-half of the time (15). Even when babies weigh more than 4,000 grams, the VBAC rate is about two out of three (30).
-Type of uterine scar not known: Unless the prior cesarean was done in Latin America or certain other countries or for the reasons listed under When would a VBAC be inadvisable?, the odds are 99 to 1 the scar is transverse (10).
-Low vertical uterine scar: Doctors perform a low vertical incision for cesarean deliveries of premature babies because the lower part of the uterus isn’t well enough developed yet for a transverse incision. Data suggest this scar is as strong as a transverse scar (24,33).
-More than one prior cesarean: Two studies reported rates of less than 2 percent and less than 1 percent (3,25),. A third said merely that the rate did not differ from the rate with one uterine scar (9). Overall, the chances of vaginal birth were two out of three.
-Twins: We haven’t much data on twins, but VBAC doesn’t seem to pose excess risk (11,25,27,35).
-Breech: External cephalic version is a procedure in which the doctor turns the baby head down in late pregnancy by manipulating the woman’s belly. What little data we have suggests this procedure is safe in women with prior cesareans (8,19,32).
-Labor induction is indicated: Large studies show that straight oxytocin (Pitocin) induction increases the incidence of symptomatic scar separation only slightly from 4 to 5 per 1,000 to 7 to 8 per 1,000 (21,30). The risk comes when prostaglandins are used. Prostaglandin E2 (dinoprostone), the type found in Prepidil and Cervidil, increases the incidence of the scar giving way to 25 per 1,000 (21). Prostaglandin E1 (misoprostol), the type found in Cytotec, raises it even higher, possibly much higher (12). Some evidence suggests that long, unproductive oxytocin inductions may also be a problem (20).
In any case, induction should be reserved for those situations where the risks of awaiting labor outweigh the risks of inducing it. This occurs far less often than the typical obstetrician thinks it does. One of the common reasons for induction is questionable: induction at 41 weeks. Others aren’t supported by the research at all: convenience inductions, induction for suspected big baby, induction for gestational diabetes, induction before 24 hours in a woman at full term with ruptured membranes, no signs of infection, and who tests negative for Group B strep (15). What are the potential risks of a cesarean?

The risks of planned repeat cesarean fall into three categories:

1. Risks of cesarean, compared with vaginal birth (14):
Cesarean section results in more pain, debility, and a longer recovery period. It substantially increases the risk of infection, injury to other organs, hemorrhage, and blood clots. These complications, in turn, increase the likelihood of prolonged hospitalization, hysterectomy, readmission to the hospital, and maternal death. Babies who were healthy before delivery are more likely to be born in poor condition or have breathing difficulties. In the long term, cesareans can lead to chronic pain or bowel problems, and they increase the risk of infertility, miscarriage, placental abruption (placenta detaching before the birth), and placenta previa (placenta overlaying the cervix).

2. Excess risks of planned cesarean versus labor:
Hysterectomy: In the Swiss study, three times as many women having planned cesareans required hysterectomies as women who labored (45 per 10,000 versus 16 per 10,000) (15,30). Among 29 other studies, comprising 18,500 planned cesareans and 38,700 labors after cesarean, hysterectomy rates were also tripled in the planned cesarean group (21 per 10,000 versus 7 per 10,000) (15).
Blood clot complications: In the Swiss study, planned cesarean doubled the risk of blood clot complications (43 per 10,000 versus 22 per 10,000) (30).

3. Risks that derive from accumulating cesareans. Some complications arise from the build-up of scar-tissue in the pelvic cavity. Some are likely due to accumulating uterine scars leaving bare patches in the uterine lining, the layer in which the placenta implants. Still others may be due to post surgical infection injuring delicate tissues such as the cilia lining the Fallopian tubes that link ovaries to uterus.
-Increased risk of injury to other organs during subsequent cesareans: Scar tissue makes successive cesareans more difficult technically to perform.
-Increased risk of chronic pain and bowel problems.
-Ectopic pregnancy -- embryo implants outside of the uterus: (Potentially life-threatening for mother, invariably fatal for the baby.) A study found no increase in ectopic pregnancy in women with one prior cesarean but half again the risk (3 percent versus 2 percent) in women with a history of more than one cesarean (18).
-Placental abruption -- placenta detaches before the birth: (Potentially life-threatening for mother and baby.) Two to four times the risk compared with an unscarred uterus depending on whether the woman’s first birth was a cesarean, or she has more than one prior birth and at least one cesarean (18).
-Placenta previa -- placenta overlays the cervix: (Potentially life-threatening for mother and baby.) More than four times the risk with one prior cesarean, seven times the risk with two to three, and forty-five times the risk with four (2).
-Placenta accreta or percreta -- placenta grows into or through the muscular wall of the uterus: (Particularly dangerous for mother and baby.) Eleven times the risk with multiple prior cesareans compared with one prior cesarean -- nearly 1 per 100 versus 1 per 1,000 (2). In a study of 109 cases of placenta percreta, 40 percent of women required transfusion of more than ten units of blood, nearly all had hysterectomies, and ten babies and eight mothers died (28).
Both placenta accreta and placenta previa: Eight out of ten women with both had prior cesareans (34). The risk for the combination was 35 times higher for women with a prior cesarean compared to women with unscarred uteruses.

How might care in VBAC labors differ?

VBAC labors shouldn’t be handled any differently from labors with an unscarred uterus with one possible exception. The most reliable symptom that the scar has opened and is causing problems is a sudden drop in the baby’s heart rate. For this reason, Dr. Bruce Flamm, preeminent VBAC researcher, recommends continuous electronic fetal monitoring (EFM). Others have argued that symptomatic scar separations happen no more often than other unpredictable obstetric emergencies (7). If women generally have not been shown to benefit, we should be cautious about subjecting women with prior cesareans to EFM’s disadvantages.

Here are some unjustified ways that doctors may manage VBAC labors:
-Refusal to allow an epidural: At one time doctors thought an epidural might mask the pain of the scar separating, but pain has been shown not to be a reliable symptom, and experts have long since agreed that epidurals should be permitted (13). That being said, epidurals pose one problem peculiar to VBACs. Some babies will experience an episode of slowed heart rate, and a drop in the fetal heart rate is the most reliable symptom of the scar giving way (15).
-Routine IV: IVs cause pain, decrease mobility and can cause fluid overload. Fluid overload can lead to a host of physiologic problems, some minor, some major, in babies and mothers (15). If you feel uncomfortable refusing an IV, compromise on a heparin lock. With a heparin lock, the IV catheter is inserted, but it is only connected to a short piece of tubing that is taped to your hand or arm. It frees you from the IV pole, but an IV can be plugged in at any time.
-No oral intake: You should at least be allowed to drink clear liquids. Hunger and especially thirst increase discomfort. Dehydration and starvation can diminish contraction strength and may make the baby’s blood more acidic, a symptom of fetal distress (15).
-Intrauterine pressure monitor: The theory is that the scar giving way will decrease uterine contraction pressures. However, an analysis of 76 cases of symptomatic scar separation found that in no case did monitoring contraction pressures internally diagnose the problem (31). Another study simulated scar breakdown in twenty women by recording uterine pressures in laboring women before and after incising the uterus during cesarean section (5). The monitoring device failed to show pressure changes in any of the women. Internal contraction monitoring increases the risk of infection, and in rare cases, the catheter can injure the placenta, pierce the uterus, or become entangled with the umbilical cord.
-Manual exploration of the uterus after the birth: There seems to be little value in identifying symptomless scar windows because they don’t seem to pose a risk in subsequent pregnancies. On the downside, the internal examination is extremely painful. The procedure also could increase the risk of infection or convert a small, harmless gap into a problem. In the sole reported case of maternal death due to bleeding from a scar that gave way, the uterus had been explored after the birth, but the rupture was missed (6).

Will a VBAC affect your postpartum recovery?
If you have a vaginal birth, the days and weeks after the birth are likely to be much easier because you won’t be recovering from major surgery. This will be even more important than it was the first time because you already have another child or children at home. A VBAC that ends in a repeat cesarean can be disappointing, but even so, most women are glad they tried.

When would VBAC be inadvisable?
Doctors agree that planned cesarean is preferred when the mother has a vertical (also called “classical”), T-shaped, or J-shaped uterine incision. However, in most countries, the low transverse incision has been the norm for many years. Reasons for a vertical incision include the placenta is overlaying the cervix (placenta previa), some breech presentations (the baby is buttocks, knees, or feet down), and some emergency cesareans.

What are the potential risks of VBAC?
-Symptomatic scar separation: The main fear with labor after a cesarean is that the scar will open enough to cause bleeding or for the umbilical cord or the baby to pass through the opening. Among thirty studies totaling 56,300 VBACs, the rate of symptomatic scar separation was 4 per 1,000 (15,30). Even so, few instances where this occurs result in harm to the baby, which is the real issue. The perinatal mortality rate (stillbirths and newborn deaths together) from this cause was 3 per 10,000. This did not differ from the perinatal mortality rate of 2 per 10,000 in 29,900 planned cesareans. Nor does planning a cesarean eliminate the risk of the scar giving way. Several large studies reported scar separation rates ranging from 2 to 3 per 1,000 with repeat cesarean, not much less than the 4 to 6 per 1,000 reported in VBAC labors (17,21,30).
-More likelihood of complications if the labor ends in a cesarean: You are somewhat more likely to have complications such as infection with a cesarean after labor compared with a planned cesarean. Nonetheless, planned cesareans have substantially higher complication rates than vaginal births, and most properly managed labors after a cesarean should end in vaginal birth.

In summary, VBAC introduces a slightly greater risk of serious complications relating to the scar, but this is more than counterbalanced by a host of complications that occur more frequently with cesarean section.

What is a reasonable VBAC rate?
Among 34 studies of labor after a prior cesarean, totaling 38, 700 women, all but one reported VBAC rates above 60 percent (15). Half reported rates between 70 and 79 percent. An analysis of 17,600 labors after cesarean in Switzerland reported a 75 percent rate (30). Therefore, with a midwife or doctor committed to VBAC, your overall odds of VBAC should be three out of four, and you would be well advised to seek another practitioner if yours has a rate less than 70 percent.
The odds of VBAC also shift up or down depending on various factors. As you would expect, you are more likely to have a vaginal birth than the overall average if you have had a prior vaginal birth, less likely if your prior cesarean was for poor progress or this baby is big. You are also less likely to have a vaginal birth if you are induced. Nonetheless, the VBAC rates still fall around 66 percent, or two out of three with supportive caregivers (3,9,26,30).

REFERENCES
ACOG. Vaginal birth after previous cesarean delivery. Practice Bulletin 1998, No 2.
Ananth CV, Smulian JC, and Vintzileos AM. The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 1997;177(5):1071-8.
Asakura H and Myers SA. More than one previous cesarean delivery: a 5-year experience with 435 patients. Obstet Gynecol 1995;85(6):924-9.
de Meeus JB, Ellia F, and Magnin G. External cephalic version after previous cesarean section: a series of 38 cases. Eur J Obstet Gynecol Reprod Biol 1998;81(1):65-8.
Devoe LD et al. The prediction of “controlled” uterine rupture by the use of intrauterine pressure catheters. Obstet Gynecol 1992;80(4):626-9.
Farmer RM et al. Uterine rupture during trial of labor after previous cesarean section. Am J Obstet Gynecol 1991;165(4):996-1001.
Flamm B, MacDonald D, Shearer E, Mahan CS. Roundtable discussion: should the electronic fetal monitor always be used for women in labor who are having a vaginal birth after a previous cesarean section? Birth 1992;19(1):31-35.
Flamm BL et al. External cephalic version after previous cesarean section. Am J Obstet Gynecol 1991;165(2):370-2.
Flamm BL et al. Vaginal birth after cesarean delivery: results of a 5-year multicenter collaborative study. Obstet Gynecol 1990;76(5 Pt 1):750-754.
Flamm BL. Vaginal birth after cesarean section. In Cesarean Section: Guidelines for Appropriate Utilization. Flamm BL and Quilligan EJ, eds. New York: Springer-Verlag, 1995.
Gilbert L, Saunders N, and Sharp F. The management of multiple pregnancy in women with a lower-segment caesarean scar. Is a repeat caesarean section really the “safe” option? Br J Obstet Gynaecol 1988;95:1312-16.
Goer H. Childbirth Forum in press.
Goer H. Obstetric Myths Versus Research Realities. New York: Bergin & Garvey, 1995.
Goer H. The case against elective cesarean section. J Perinat Neonat Nurs in press.
Goer H. The Thinking Woman’s Guide to a Better Birth. New York: Perigee Books, 1999.
Greene MF. Vaginal delivery after cesarean section--is the risk acceptable? N Eng J Med 2001;345:54-5.
Gregory KD et al. Vaginal birth after cesarean and uterine rupture rates in California. Obstet Gynecol 1999;94(6):985-9.
Hemminki E and Merilainen J. Long-term effects of cesarean sections: ectopic pregnancies and placental problems. Am J Obstet Gynecol 1996;174(5):1569-74.
Lau TK, Kit KW, Rogers M. Pregnancy outcome after external cephalic version for breech presentation at term. Am J Obstet Gynecol 1997;176(1 Pt 1):218-23.
Leung AS et al. Risk factors associated with uterine rupture during trial of labor after cesarean delivery: a case-control study. Am J Obstet Gynecol 1993;168(3):1358-63.
Lydon-Rochelle M et al. Risk of uterine rupture during labor among women with a prior cesarean delivery. N Engl J Med 2001;345(1):3-8.
Macara LM and Murphy KW. The contribution of dystocia to the cesarean section rate. Am J Obstet Gynecol 1994;171(1):71-7.
Martin JA, Hamilton BE, and Ventura SJ. Births: preliminary data for 2000. Nat Vital Stat Rep 2001;49(5):1-20.
Martin N et al. The case for trial of labor in the patient with a prior low-segment vertical cesarean incision. Am J Obstet Gynecol 1997;177(1):144-8.
Miller DA et al. Vaginal birth after cesarean section in twin gestation. Am J Obstet Gynecol 1996;175(1):194-8.
Miller DA, Diaz FG, and Paul RH. Vaginal birth after cesarean: a 10-year experience. Obstet Gynecol 1994;84(2):255-8.
Myles TD and Miranda R. Vaginal birth after cesarean delivery in the twin gestation. Obstet Gynecol 2000;95(Suppl 1):S65.
O’Brien JM, Barton JR, and Donaldson ES. The management of placenta percreta: conservative and operative strategies. Am J Obstet Gynecol 1996;175(6):1632-8.
Phelan JP. Rendering unto Caesar cesarean decisions. OBG Management 1996 Nov:6.
Rageth JC, Juzi C, and Grossenbacher H. Delivery after previous cesarean: a risk evaluation. Swiss Working Group of Obstetric and Gynecologic Institutions. Obstet Gynecol 1999;93(3):332-7.
Rodriguez MH et al. Uterine rupture: are intrauterine pressure catheters useful in the diagnosis? Am J Obstet Gynecol 1989;161(3):666-669.
M, Kogan S, and Blickstein I. External cephalic version after previous cesarean section--a clinical dilemma. Int J Gynaecolog Obstet 1994;45(1):17-20.
Shipp TD et al. Intrapartum uterine rupture and dehiscence in patients with prior lower uterine segment vertical and transverse incisions. Obstet Gynecol 1999;94(5 Pt 1):735-40.
To WW and Leung WC. Placenta previa and previous cesarean section. Int J Gynaecol Obstet 1995;51(1):25-31.
Wax JR et al. Twin birth after cesarean. Conn Med 2000;64(4):205-8.
Zelop CM et al. Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery. Am J Obstet Gynecol 1999;181(4):882-6.

The Secret to a Beautiful Birth

I wanted to share the secret with all of you. It's an amazing concept that few seem to think about. The secret, besides having an AMAZING doula is....

Pick the right provider. Honestly... if you pick a provider that routinely does birth the way you want your birth to be... you are almost guaranteed to get what you want! :o)

Benefits of Continuous Labor Support from lamaze.org

In times past, women learned about childbirth from their mothers and sisters. Birth took place in the familiar comfort of home. Family rituals and traditions ensured that women were confident in their ability to give birth. Throughout labor and birth, family members and wise women surrounded the laboring woman and gave her constant support and encouragement. Community midwives attended almost all births.

As birth moved into the hospital early in the 20th century, women lost the valuable support and encouragement of women from their communities. Nurses gave support, but often they were responsible for several laboring women and could not stay continuously with one woman.

During the 1960s, Lamaze International and other childbirth organizations advocated successfully to allow fathers into the labor room. Fathers provide special emotional support to laboring women and deserve to be present for the birth of their child. This was an important step in preventing women from having to labor alone.

Now, in the 21st century, women are again discovering the value of additional support from women knowledgeable about birth. Women often assume that a nurse, midwife, or doctor will stay with them throughout their labor. In some birth settings, midwives and nurses are able to give continuous support to the laboring woman and her family. However, the reality is that other responsibilities often keep doctors, midwives, and nurses from being with one woman continuously. Even when a midwife is caring for only one woman in labor, it can be helpful for another experienced woman to provide emotional and physical support.

Before your baby’s birth, you should decide who could offer you continuous labor support. You might choose a friend or relative who is experienced with childbirth, or perhaps you will decide to hire a doula, a labor support professional.

Why Is Continuous Support Important? Labor may surprise you (and your partner) with its power. Having a woman experienced with birth there to reassure you and your partner that your labor is progressing normally will help you both to cope. A woman experienced with childbirth will also know how to give comforting touch such as massage and suggest positions that will help the progress and comfort of your labor.

The Role of a Doula According to The Doula Book, a doula is “an experienced labor companion who provides the woman and her husband or partner both emotional and physical support throughout the entire labor and delivery, and to some extent, afterward” (p. 4).3 A doula will remain with you and your partner throughout labor and birth, providing physical, emotional, and informational support. Your doula will never be away from you for more than a few minutes, unless you request time alone with your partner. She will work with you and your partner to help you have the kind of birth you want. She may help you into a warm tub or shower, walk with you and your partner, and massage your back, hands, or feet. She will support you in your decisions about pain medication. If you tell your doula that you want to give birth without medication, she will help you do this. After the birth, a doula usually stays with you for 1 to 2 hours to help you with breastfeeding.

Doulas are not trained to perform any medical or nursing tasks and should never offer medical advice. However, they should help you understand medical events. They also can encourage you to communicate your preferences to the hospital staff. If your labor takes a different path than expected, a doula can help you make clear your feelings and review your options.

One of the most important roles of the doula is to help you to have positive memories of your birth experience. After the birth, you will remember together the positive aspects of the birth, and she will answer any questions you may have. If the birth does not go as you planned, your doula will be there to listen to you and to offer you support.

What Research Tells Us The research regarding the benefits of continuous support by doulas during labor is impressive. A review of the research by the Cochrane Pregnancy and Childbirth Group, a respected international organization that defines best practices based on research, shows that continuous support for women during labor and childbirth is clearly beneficial.2 According to the review, compared with women who do not have continuous labor support, women with continuous, one-to-one support are less likely to:
have a cesarean section;
give birth with vacuum or forceps;
have regional analgesia (e.g., an epidural);
have any analgesia (pain medication); and
report negative feelings about their childbirth experience.2
Two other reviews of the research on continuous support had similar findings.4,5

The authors of all three reviews found that continuous support is more effective when the person providing it is not part of the hospital staff than when it is provided by staff members such as nurses or midwives.2,4,5 In one review, better results were found when the support started earlier in labor.2 Another review showed that support was most helpful for low-income women who would have labored alone if they had not had a doula present.5

The Doula and the Labor Partner Most partners want to participate in the birth of their children and to provide support for their significant others. However, most men and some women have little if any experience with childbirth. As your contractions become more intense and you struggle with pain, your partner may become frightened. Your partner may not have the experience to know whether your labor is proceeding exactly as it should. As labor progresses, it may become more and more difficult for your partner to reassure you. Most partners breathe huge sighs of relief when an experienced childbirth professional is there to assure them that labor is going just fine.

A good doula takes her cues from the labor partner. If your partner is sitting close to you, holding your hand, and providing eye-to-eye contact and supportive words, the doula will not interfere in the intimate relationship between the two of you. Instead, she supports and encourages both you and your partner. However, if you need more support than your partner can give, the doula will work along with your partner. She might give you a back or foot massage while your partner provides the eye-to-eye contact and reassuring words. Or the she may suggest a change of activity, a new position, or a comfort measure you and your partner had not tried. The doula can show your partner how to give effective counter pressure or massage. She can also offer support while your partner takes a much needed bathroom or meal break.

Planning for Continuous Support A friend or family member experienced with childbirth may be able to provide continuous support for you and your partner. These women do not need to have formal training as doulas, as long as they have confidence in your ability to birth your baby and are willing to stay with you continuously during labor.

However, many women find that hiring a doula is the best way to be sure that they have continuous emotional and physical support throughout labor and birth. You can ask for referrals from your childbirth educator, your health-care provider, DONA International, or another doula organization. After you have decided whom you want with you, plan at least one visit with her to talk about the type of birth that you and your partner hope to have. Share with her the comfort measures that are important to you, including medications.

Some hospitals or birth centers may offer free or low-cost doula services. If there is a language barrier between a laboring woman and the doula, both usually find that eye-to-eye contact and gentle touch overcome the lack of a common language. Some hospitals also provide a translator, if needed.

Some health plans will reimburse you for the cost of doula services. You can call in advance to see if services will be paid for, and advocate for doula coverage if they are not. Insurance companies and health plans may not know that, by providing continuous support, doulas decrease health-care costs from interventions such as cesarean surgeries. Doulas charge varying amounts, and some may even offer barter (trade) options or provide free services in order to get their certification.

Recommendations from Lamaze International Lamaze International joins with the World Health Organization in recognizing the value of continuous labor support as a key element in normal birth.1 Lamaze believes that all women should have access to continuous labor support, without financial or cultural barriers. Lamaze encourages you to plan for a supportive birthing environment that includes continuous emotional, physical, and informational support.

A supportive woman experienced with childbirth can make a valuable contribution to your care during labor and birth because of her commitment to staying continuously with you and your family, her knowledge of both physical and emotional comfort measures, and her confidence in your ability to birth your baby.

Doulas and Personal Trainers

I have recently started a fitness study that gives me a FREE personal trainer for 9 visits. (It's a 21-day study). Now a personal trainer is a luxury I would NEVER have thought to give myself because I have a hard time spending money on myself and really could never justify the extra expense. Interestingly enough... my passion for doula work has helped me understand how important a trainer is. Here's my comparison:

As a doula I do not look at my clients and say; "well... I'm not sure if you can do this but we'll try!" I really KNOW that they can succeed, that any obstacles can be dealt with. I give support and encouragement and really good information and believe in the body and it's ability to birth babies. I think this is why having a doula is so effective. Just having someone supporting you that knows that you can do it and reminds you of your goals makes a huge difference.

My trainer looks at me the exact same way I look at my clients. He doesn't look at me and think... "Hmm... there is no way this woman is ever going to run a 5k" he actually KNOWS that I can do it. Now of course he understands that I am the only person standing in my way (short of an injury) and he also understands the importance of having good support. He would never look at me and say... "yup you can't do it... better quit!" or "jeez are you okay, you look like you are dieing!" He pushes me and reminds me of my goals all the while KNOWING that I am capable. He believes in the body and it's ability to be fit!

The moral of the story? Mastering your goals is always easier when you have support from an amazing person who KNOWS how achievable your goals really are... even if you aren't so sure yourself.

Picnic in the Park!!

After the Labor Day Picnic
A gathering of doulas and the families who have used their birth services.

PLACE: Sugarhouse Park-Terrace Central
2100 S. 1300 E.
DATE: Saturday September 13th
TIME: 11 a.m. - 2 p.m.

-Please bring a picnic lunch for your family.

-The Utah Doulas association will be providing drinks and dessert.

This is a fun time for doulas to get together with previous clients. It's also an opportune time for anyone interested in doula work or the services provided by doulas to meet a great group of women who believe in the beauty of birth. Can't wait to see you all there. :o)

Your provider- The key to a beautiful birth.

One of my favorite CNM's Danielle Demeter said.... "I don't care where you choose to birth but with WHOM you choose to birth." This statement could not be more true.

It seems that many women fall into the "oh he is so nice!" trap. I admit being lured to such a trap but somehow managed to switch providers before my birth became a repeat of my recommending friend. (Who after telling me about the pitocin, episitomy and forcep delivery won me over by telling me how incredibly kind her doc was throughout the procedure.)

My first official doula client chose her provider based on the "niceness" factor. As it turned out... her very kind Dr. turned out to be nicknamed "the vacuum doc" (as he vacuum extracts all first babies) and was NOT nice once told "NO!" In fact, he resorted to name calling and threats when my client begged him to just let her tear and not cut an episiotomy and his tantrum worked. She walked away with a HORRIBLE birth story and realized that he wasn't so nice after all.
I am bringing this up because in my experience as a doula I have found many potential clients who don't seem to realize how important the provider really is. These care providers are creatures of habit. Some routinely cut episiotomies. Some insist all women birth with epidurals. Some even discourage women from taking childbirth classes or having doulas so they can be their clients ONLY source of information.

If you choose a provider her is a creature of such habits you are very likely to be subjected to these things regardless of what your birth plan states, or what you have previously discussed, so how do you know when you have chosen such a provider? ASK QUESTIONS and don't be afraid to switch providers.

First of all, when looking for a provider lean to people who support or have experienced the type of birth you are seeking. If you are seeking a non intervened unmedicated birth start with natural birth friendly people. Doula's are a great source of information regarding providers who are supportive (or unsupportive) of such births and you can find many local doulas who are willing to just chat and let you know @ www.utahdoulas.org. (If you are not in Utah you can start with www.dona.org (Doulas of North America).)

If you have already picked a provider and want to make sure they are on board with natural birth ask them questions such as: "How often do you feel it is necessary to cut an episiotomy on a first time mom?" or "How many of the mom's who tell you they want to birth without an epidural actually achieve their goal?" If you provider is unable (or unwilling) to give you a direct answer... RUN. If his answer to the first question is a high number, you are incredibly likely to have an episiotomy.
Two doulas I LOVE have both been heard numerous times saying: "YOU CAN'T GET PIZZA AT A CHINESE RESTAURANT!!" If you choose a provider who loves to cure women of their pregnancies he will most certainly cure you! But pregnant women are NOT SICK and we certainly don't need to be cured, or treated like every other pregnant woman. Our needs are unique and our own birthing desires CAN BE unique as well.

Another trap we fall into is the "it's too late to switch" trap. This is never the case! Please don't ever settle or sacrifice your birth experience because you are nervous about switching providers. If you don't get an answer you like from your chosen provider, find someone who gives you the correct answer. I promise your baby has no emotional attachment to the first person you chose. Switching to the right provider at 38 weeks is better than staying with the wrong one and getting a less than ideal birth experience because of unnecessary interventions.

Birth at..... HOME?!!?!?!

I have been asked by a few people to post by birth story. I am thrilled to announce that my 4th son was born on Wednesday June 4th in my home. It was an AMAZING experience and I will try to do it justice here. Before I begin I want to point out that it was my desire to have a better birth experience that led me to the world of doulas and I did not begin to get involved in anything doula until this pregnancy was already established! ;o)

Last summer I knew that I was going to be taking out my IUD very soon. I was not sure what I would do for a provider/hospital. I have had 3 VERY different birth experiences with the providers I have used in the past. With the first 2 I used the same group of midwives. They are an incredible group but I really HATED the hospital where they attended births. I knew that I didn't want to have my baby there so I picked a different midwife practice based on the hospital they delivered at (which has a good reputation). It also was NOT a good experience as the midwives themselves proved to be very interventional and impersonal... not what I expected at all. I also realized that no matter what hospital you are at they are all similar in the way they handle infants, which is my biggest erk with the hospital system. I hate that they TAKE your baby. They "DELIVER" your baby (as if you didn't do all the work), they PERMIT you to LOOK at him/her, and then they take them away to stare at them under the light. No one asks permission to hand your baby back and forth or stick their finger in your little guys mouth. They take them for a "quick test" and bring them back when I'm finally calling out because I'm having an anxiety attack. Needless to say, I hate when they take my baby away from me for any period of time and I've always thought that there has got to be a better alternative but I've never found it.

I had heard about "crazy" women who dared to have their babies at home. I thought they were all insane and irresponsible. I'm not sure what prompted me to research it. Maybe it was the feeling that there was no better alternative. I went into my research very skeptical; wondering just how many women and infants were dieing from their own stupidity. What I found was incredible. It was exactly what I was looking for. Proof that birth is beautiful, natural and unflawed. Statistically, home birth is incredibly safe. For someone like me (who's history of child bearing is very simple) it actually looked like home birth was a safer alternative then birthing in the hospital. Home birth takes out the interventional aspect of birth that has become routine in the United States and gives birth back to nature. The statistics were proof enough to me that my body really does know how to have babies and that birth, when left to it's own accord, will happen smoothly and without complication. And so began my quest to attain my ideal birth.



I admit I was becoming increasingly frustrated as my due date came and went. I have never been "overdue" before and I became more and more nervous with each day that passed. What if my body DIDN'T know what to do? Maybe this whole "letting nature happen" thing was a bad idea. My midwife had complete faith in my body even though I was skeptical and at 12:05 a.m. on June 4th (the dawn of my 41st week) I woke to some very intense contractions and just enough blood to let me know that my body was serious. I have a history of fairly fast labors but have never been left to labor without my water being broken. I was excited to labor without intervention but nervous that with my membranes intact, labor would be long. Luckily for me, that was not the case.



My sister (AKA my doula) arrived around 12:30 and knew instantly that we were rockin' and rollin'. I had called my midwife (who lives 35 minutes away) shortly after I woke up and she arrived around 1:20. Labor was very intense from the time my sister arrived and when my midwife arrived I had already been in and out of the birthing tub.

The water had felt so good at first but I had begun to overheat as the contractions got more intense. It was her suggestion that we add cold water that allowed me to get back into the tub, where I remained until little Colton was born at 3:20 into the hands of his daddy.

The labor itself was incredibly intense from start to finish. My midwife, her apprentice, my sister and my husband were my constant support. They took turns pushing on my hips and applying sacral pressure. They also encouraged me and reminded me of the incredible miracle that is labor and birth. No one told me when to push or rushed to check dilation before pushing was "permitted" nor did anyone insist that I push on "their" time or in a position that was most convenient for them. It was amazing to feel the "urge" to push and to go with my body as I knelt in the water. The midwife was frequently checking fetal heart tones and it was when the baby was all the way to the perineum, waiting to be pushed free that I heard the heart tones and knew that the baby needed to come then. As the midwife calmly and quickly moved to get oxygen for me, I made the decision to push past all the burning and pressure that crowning presents for me and his head emerged into the water along with a small loop of chord (which explains the low heart tones as his chord was being compressed). Shortly after, I pushed his little shoulders free and he was lifted out of the water by his dad. It was so incredible.

The fact that he didn't cry right away was not terrifying and did not bring any panic to the environment. My midwife very peacefully lifted his little face to hers and puffed into his tiny mouth/nose. A small exhale/grunt was heard and she repeated the process until about 5 breaths later, when a loud cry echoed through the house. This entire process took about 20 seconds. I was at ease the entire time. And with that cry, the baby was handed to me and we were left to bond in the tub as hot water was added and the midwife poured warm water over his tiny body.

The birth and everything to follow was exactly what I wanted, what I knew birth should be. I was thrilled to avoid the audience of strangers staring at my bulging bottom as I pushed. (At my third birth which was intended for just me and my husband, there were at least 5 other "health care workers" besides my midwife in the room while I pushed.) I was also so excited to have my baby with me and my family. I loved being the one who provided my son with all that he needed and also that I was in control of who touched him, who held him, when they last washed their hands, whether or not they were sticking their fingers in his mouth and that NO ONE was going to take him away from me. I also was happy to avoid the interventions the hospital does without any form of consent and without your knowledge like erythromycin ointment (intended to avoid the transfer of gonorrhea and chlamydia from mom to babies eyes) and vitamin K injection. Really truly, it was perfect and beautiful. I had been seeking this, I just had no idea that I would find exactly what I was looking for right here in my own home.

Now I don't want anyone to assume that I believe that having a home birth is something that every woman should do. I truly believe that women should birth their babies in the environment where they feel safest. It would be impossible to enjoy your birth in any environment if you are uncomfortable or feel unsafe in that place. As a doula my goal is to help women achieve a birthing experience that is as close to their ideal as possible. Just wanted to share with all of you my beautiful birth.