VBAC Series: Finding Support

Any woman planning a VBAC knows the support for her decision is of utmost importance.  Ideally this support would be found in her family and care provider.  However, this might not be the case for each woman planning a VBAC or she would simply like to connect with someone making the same decision.

There is little to no research about the supportive environment affecting the rate of VBAC, but for those who have been through the experience, support is one of the key factors of successful VBAC. 

In the day and age of social media, many women are turning to online communities to find the support they desire while planning a VBAC.  In a recent article from the Journal of Perinatal Education, a childbirth educator describes the online support she saw for a woman who attempted a VBAC and ultimately ended up with a tertiary cesarean section.  Strangers followed this woman’s story, and hundreds commented on her posts during labor. 

Another journal article analyzed a VBAC forum and pregnancy forum on babycenter.com.  The VBAC forum appeared more personal and supportive than the pregnancy forum based on their scoring criteria.  

You may want to consider the following when joining an online group:

1.     Size.  Are you looking for a more intimate group where members know each other well or a larger group that might have more activity.

2.     Moderation level.  Some groups may have a monitor that deletes inappropriate comments or off topic threads. 

3.     Privacy.  Is it a closed group or open to the public?  How are members approved?

4.     Types of questions asked.  This will probably be mixed in all groups, but overall are members looking for support, medical advice, or general information. 

5.     Usefulness in your own life.  Does the group bring you the support you are looking for, positiveness to your situation, or just a fun distraction?

There are no right or wrong answers to the considerations above.  It is all based on personal preference and determination of value in your own life.  If you are looking for extra support when pursuing a VBAC or want to hear from someone else going through the same situation, an online group may be a viable option. 

Listening to Mother's III

Have you heard about the Listening to Mother's surveys?  In 2013 the third report was published, where over 1000 women in the United States were interviewed about their childbirth experience.  This report gives a snapshot of the state of maternity care in the United States.  

Some of the results are mind blowing!  One of the most startling results was about women being told their baby would be "big" at the end of their pregnancy.  In the shared decision making section, 32% of women reported they were told their baby may be big.  The majority of these mother's said their practitioner brought up an induction (62%) and 44% reported a discussion about cesarean.  In the end, the average size of the baby's actual birth weight was 7lbs 13oz.

Another startling response was that 47% of first time moms reported being induced.  Almost half! 

In teaching childbirth classes, there is often this disconnect where you sometimes feel like you are teaching women to fight for their rights.  Many elements in this report underscore the importance of women learning to be advocates for their care.  But is that fair?  Should a woman in labor or at the end of her pregnancy be expected to stand her ground when it comes to unnecessary interventions, or rather should it be expected that she will be offered good quality care based on evidence and putting her first?

I encourage you to check out the results and consider the state of maternity care in the US.

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.