Thursday, January 7, 2010

New boost for HBAC!!

Ok, so as you know, we are planning a home birth after cesarean (HBAC). Yeah, I had my doubt, even though the studies were all in my favor. Even in a hospital, a woman has a 60-70% chance of success, and that's without a Doula. At home, based on one study, her chances go up to about 90%. Which for most moms, even without a previous cesarean, a midwife sometimes has around a 10% cesarean rate anyway, so it's pretty much the same.

We picked our midwife, and I spoke with a Doula today that we are most likely going to use. She does a lot of work here in Austin with ICAN (International Cesarean Awareness Network), and she also does home birth doulaing. She is wonderful and has TONS of experiences with HBAC. She said the last one she went to was a mom who birthed a 10lb baby after a previous cesarean, AND SHE WAS ONLY 4'11''!!!! Yeah, me, I'm 5'10'', and I'm built to grow them big. I'm not worried about size.

The other thing that totally shot up my hopes was after talking to my dad. If you don't know, my mom tried for a natural birth with Orion, by oldest brother, the first born. After a long labor, with no progression, she had a cesarean. Her Dr. told her that her pelvis was too small. Much like most moms are told today when they labor with little progression. So, to me, I pictured my mom pushing and pushing, different positions, a bunch of nurses and people there cheering her on, and then finally out of exhaustion, she goes in for a c section. it turns out, that was not the case AT ALL. I asked him, as I have many times, tell me everything you remember. After much probing his memory (as this was 30 years ago) this is what I came up with. My mom went into labor on her own, good sign. Her water broke on it's own. She never pushed, only got to about 7, of what he could remember, and then didn't progress. That could mean a lot of things. I asked what maneuvers they did, and he said a lot of walking. Of course, most moms do a lot of walking. Orion was over 8lbs, not too much bigger than the average baby (despite what anyone tells you, the average weight of newborn at birth is 7-8lb). Most babies turn once upon reaching the pelvis to get a good fit, and then once again one on the perineum, this is what they do to make their way into the world. Some babies that are on the larger than average size, especially with an average woman (mom was about 5'6'' or so) on that first turn, get "stuck". This is usually called acynclitic. The head gets turned funny when trying to rotate and get's stuck in that position. Her water had already broken, so this took away the cushion for him to turn better. They didn't do any lunging, pelvic opening, probably not much hands and knees either, but that was probably the more used of if they did change positions a lot. This is also back in 1980, when Lamaze was used, and not used the way it was designed, so a lot of moms had trouble coping. She didn't do any hydrotherapy, which is the Cadillac of natural pain relief.

Also, to top it off, she was augmented with Pitocin!!! That changes everything!!! He said she started to become preeclamptic (high blood pressure) and the baby started to show signs of distress. Now, let me inform you if you don't know. These are common side effects of Pitocin, let alone, you factor in they were doing this in 1980 when this drug just got out on the market and didn't have all the regulations that it has today. So if a mom is preeclamptic and the baby is in distress, of course you need a cesarean, birth has now become too dangerous to carry on.

With her second, Rayne, she wanted to VBAC, but this was now 1984, when VBAC was NOT done. It was highly discouraged, and "once a cesarean, always a cesarean" was still the loud sounding recommendation. It wasn't till 1990 that this went away and ACOG (American College of Obstetrics and Gynecology) started to say, hey, this is safer, we need to VBAC, not repeat!!! By then, my mom was either on, or had just given birth to her 5th cesarean. I doubt she would even be considered a candidate that early in the VBAC campaign, and with that many cesareans. Also, her Dr. said her pelvis was too small to birth a baby over 5lb. Much what A LOT of women are told, but go on to birth babies vaginally up to 1 lb bigger than the cesarean baby.

So I have tons of hope. We are not going to be induced or augmented. We are going to have a midwife and a Doula, and my knowledge, of identifying and rotating a funky positioned baby. We have multiple maneuvers we will use, including belly dancing maneuvers that are proven to help and help quickly. We are going to rent a huge tub for a water birth, and have our garden tub, and two showers in the house, one with a detachable head for direct relief.

I really did struggle a lot with not knowing what went on, and thinking that I may be doomed to further cesareans but just in denial about it. But that's not it. Looking back, our birth team did the best they could with the knowledge they had. This time, I'm going to have a birth team with much better knowledge and much better support.

I can't wait!!!


  1. so whats the difference between a midwife and a doula? Aside from that a doula doesnt deliver babies?

  2. I asked the same question Allison - Ruth has all the knowledge!! I am SO thankful for her!

  3. In short for anyone who reads this, a midwife does what any OB would do as far as care, prenatals, testing, monitoring mom and baby at birth etc. A Doula is there solely to support the mom in an emotional, physical, physiological, and every other way in birth. A role of a Doula and a Midwife compliment each other very well, but if you have to go through an OB, a Doula is a great benefit, and can bring the midwifery type, intimate, personal care to your pregnancy, birth and postpartum.