Some of these situations we cover are  not necessarily dangerous for the mom or baby, they just change the options that are given to the couple.  Being post-date or going past the due date is one of these.  Depending on your caregiver’s policy induction may highly encouraged anywhere from 39 weeks 6 days to 41 weeks 6 days.  That is a BIG difference.  And if both mom and baby are fine, then they have a lot of options including refusing an unnecessary induction at 40 weeks on the dot.

Another option-changer is breech position of the baby.  While there is a movement in Canada to encourage vaginal delivery of breech babies, the recommended route here in the US right now is surgical.  And since many OB’s do not have the proper training or experience with vaginal breech deliver, I am not comfortable advising moms to ask for vaginal breech delivery with inexperienced caregivers.  So, for parents who find out before the onset of labor, there are many things they can do to encourage the baby to turn: lots of positions for mom to try, chiropractic adjustments, acupuncture, etc can be effective at turning many babies.

So when preparing for these discussions tonight, I came across Dr. Onyeije’s presentation on avoiding a Cesarean.  It mirrors so many of the things I try to stress in class, the  most important being finding a caregiver who shares your perspective on birthing.

That one thing can pave the way to avoiding so many difficult situations for a pregnant couple.  If you are wanting a natural childbirth and go to a practice with a high rate of intervention, then you will probably be very discouraged.  If you want every bit of technology used on you and your baby from the first twinge and you are with a more laid back practice, you will be so frustrated when they send you home from the hospital when you are at 3cm and still in early labor. It makes SUCH a difference.  I they to encourage couples that statistically they will not be the exception.  Exceptions are out there, but you can’t expect to be the exception for the particular practice you are using.

So here it is: 

Pregnant the second time, Jennifer was determined not to repeat her first experience.  Her first order of business was to find a supportive caregiver.  She had two litmus tests for each doctor she interviewed: “Do you support VBAC?” and  “Do you encourage repeat cesarean  for women who haven’t gone into labor by 41 weeks?”  Both of these were deal-breakers for Jennifer.    Coming from a family who has a history of babies being born between 41 and 43 weeks, she was not going to settle for a practice who routinely induced at 41 weeks.  It was imperative that she be given the opportunity to let labor begin on its own.  Committed to putting herself on a different path for this second birth, if she didn’t like the answers to either of those two questions,  she scheduled another interview with yet another doctor.

After several interviews with several practices she finally found an OB who was more than nominally supportive of VBAC and who looked at the big picture before encouraging induction.  Then as she educated herself about the various interventions, she decided that this time around she wanted to avoid an epidural for as long as possible as she was convinced that this had significantly slowed things down last time.

As her due date came and went,  she was sent in every 3-4 days for a biophysical profile.   She made sure to stay very hydrated so that she had the best chance at her amniotic fluid not appearing too low.  She also made sure to eat something before the visits so that her baby would be awake and energetic during the tests.  She stayed calm and did not stress out as 41 weeks passed.  41 weeks 2 days.  . . 41 weeks 4 days. . .

Her due date was just around the corner and still there were few signs that labor would be commencing any time soon.  Stripping the membranes wasn’t an option as she wasn’t dilated enough for the doctor to perform the procedure.   Her OB finally gave her a deadline of 42 weeks 3 days.  If her body hadn’t done something by then, medical interventions were going to be pursued.  The clock was ticking, but Jennifer stayed calm.

Of course Jennifer did not wind up becoming the first eternally pregnant woman.  At about 11pm on the eve of 42 weeks past her due date labor began.   Throughout this labor she and her husband  made many decisions to help make sure she stayed on a path that had the best chance of ending in a vaginal birth.

The first nurse assigned to care for her did not want her out of her bed when hooked up to the fetal monitor.  Jennifer immediately knew this was not a good fit.  She requested a new nurse from the charge nurse and was presently assigned a nurse who was studying midwifery.  Much better!

Later when her blood pressure was showing high readings, she labored on her left side even though this made dealing with the contractions much more difficult.    Jennifer knew that if her blood pressure didn’t come down, she wouldn’t even have the option of dealing with contractions as she would soon be having another surgical birth.   Laboring on her side was super effective at keeping her blood pressure in the normal range.

When the doctor on call (not the same doc who had cared for her during the pregnancy) lectured her on the risks of VBAC while she was in active labor, and later the risks of shoulder dystocia as this baby looked large, Jennifer kept her cool.  She had educated herself on these things before the birth and was more comfortable with VBAC  and birthing a large baby than she was with the risks associated with major abdominal surgery.

Lastly, she changed positions every 4 or 5 contractions while pushing to effectively use gravity and lots of movement to bring her baby down.   It so amazing when  Jennifer finally eased the baby out. Not quite two hours since she had begun, Jennifer pushed out all on her own body’s power, a 9lb 5 oz.  baby boy.  It was so amazing to see.  He slipped right out and was placed right on her chest to hold and cuddle and nurse.

VBAC moms always impress me.  Not only becasue they face the normal challenges of labor and birth (which are significant!) but they have the added challenge of birthing in a system and an environment that is not designed to facilitate VBAC.  It took determination, patience, and  skilled high pressure negotiation (there’s not much more pressure than when your doctor tells you that your baby might die from the decision you are making!) just to get to the moment where she could even have the opportunity to go into labor.     She later told me that the next day a nurse came in and told her that she was the only one of the floor to birth vaginally that night.

Jennifer had learned since her first birth that it was not her body that had failed in her first birth, but the induction. Her body simply wasn’t ready to give birth yet when she went in for the induction and so the labor was more difficult and ended in a surgical delivery.  This time around, Jennifer’s determination to trust in her body and give it the time it needed payed off.

Good things come to those who wait.

So what does this have to do with healthy low-risk pregnant mothers?  Well, a lot actually.  Let’s say that this healthy low-risk mom finds herself and her baby still healthy and low-risk but she is now 41 weeks pregnant and her provider is recommending an induction.  Not an uncommon scenario. She is not ready to depart from the natural process at this point and expresses that she is not comfortable going in for the induction.  Should this resolution pass, her provider could now threaten to deny her insurance coverage by classifying her as non-compliant or hostile.

I am assuming she is an average expecting mother who does not have an extra $5,000  to $15,ooo laying around just in case she is denied the health care coverage she pays for monthly.  This being the case,  her choices are now:  one, showing up at the appointed hour for her cocktail of artificial hormones that she does not want,   or two, letting labor unfold on its own and facing  major hospital bills, an insurance battle, and oh, that’s right, adjusting to her new life caring for a newborn.

Whatever happened to Informed Consent?  This is where the care provider makes a recommendation for the patient, explains the risks and benefits of the procedure and allows the patient to make the decision that she feels most comfortable with.  The patient is the one who has to live with the consequences of any decision made about her care, so she and her partner should be the one to make the final call.

Already as a childbirth educator I know of situations where a mother has arrived at her hospital in early labor.  Once she finds out that she’s only 3cm, she wishes to return home and come back later when she’s farther along in active labor.  This is where the care providers in the hospital tell her that that’s fine, but she’ll have to sign out AMA (against medical advice)  and it’s most likely that her insurance won’t cover her visit.  So, the mom now chooses to stay to avoid an huge insurance hassle and faces the likelihood of many more interventions simply becasue she’s in the hospital longer than she intended.

This has major implications for birthing women, but I will say for all of us as well.  So here is a list of questions for informed consent that I give every couple in my classes:

Informed Consent Questions

•  Is Mom OK?  Is Baby OK?

•  Is this an emergency or do we have time to talk?

•  What are the benefits of doing this procedure?

•  If we do this, what other procedures or treatments might we end up needing as a result?

•  What else could we try first or instead?

•  What would happen if we waited and hour or two before doing this?

•  What would happen if we did not do it at all?

If this passes it will be all the more important for women to make sure that they and their providers share the same perspective on childbirth.

Moms who have excellent nutrition (read naturally colorful food that remembers where it came from – no super processed, corn-syrup laden, trans fat drenched beige food that resembles nothing of its source) and who are otherwise healthy and low risk can birth full term normal birth-weight babies naturally.

I know it’s anecdotal, but this very thing happened to my grandmother. Back in the 40´s she was pregnant for the second time. She told me that she got really big, but apparently didn’t have time to think much of it since my grandpa was recently back from the war and she was so busy caring for my 18 month old uncle. Birthing at home was still the norm in her part of Southern Ohio, so she had a second homebirth. After my aunt was born, my mother’s presence wasn’t discovered until the doctor was packing up his bag and the nurse said to all present, “Uh, I think there’s another one in there!” And soon thereafter,my mother was born. Both of them weighed over 7 lbs at birth.

If you are pregnant with twins and would like to have a natural childbirth, it is possible. One of the biggest hurdles to that possibility will be your careprovider. So if you find yourself pregnant with multiples and would like to be given the option of a vaginal childbirth, you may have to extend your search beyond the same OB/Gyn who has done your Pap smears for the past 10 years. Finding a supportive provider has got to be the first step.

After that read books (Like Your Best Birth – I’m really enjoying it – review soon to follow), eat exceedingly well, get regular physical exercise, take a natural childbirth class, choose your birthplace, go to spinningbabies.com to learn exercises and postures that encourage babies to get and remain head-down.

We each  must deal with specific circumstances of the birth we are given, but we can learn ahead of time about the choices we will have along the way.  And for those with multiples, natural childbirth can be an opition.

1. Her choice of careprovider made ALL the difference.

She was induced 9 days after her due date with her first baby which started her on the road to her first cesarean.  She also comes from a family whose babies like to come at or around 42 weeks.  So she had two questions when interviewing providers: Do you support VBACs? and Do you wait until 42 weeks with VBACs before encouraging induction?  If the answer to either of those was “No,” she went on to interview someone else.

This was an excellent decision because when she got to the hospital in labor 42 weeks to the day, the doctor on call from her practice clearly wasn’t as comfortable with her VBAC as her regular provider.  If she had been with another doctor,  she could have waited until she went into labor on her own, but she surely would have had much more pressure to induce or schedule another cesarean.

2.  She was  VERY informed.

She read and researched a LOT while pregnant and knew the risks of each of the procedures that were common in her situation (induction, augmentation of labor, etc) and had prepared alternative suggestions that she was more comfortable with.  Being informed was so helpful to her in labor when the doctor on call reminded her of the dangers of VBACs including a ruptured utuerus and dead baby.  She was able to remain calm, remind the doctor that the risk of surgical complication was statistically greater than the dangers posed by VBAC, ask for some juice and continue on with her labor.  She was amazing.

3. You have to deal with the birth you are given.

On her birth plan it was clearly written that she wanted as much freedom of movement as possible.  She knew that as a VBAC she would have continuous electronic fetal monitoring and she would be limited in movement by the length of the wires tethering he to the machine.  Not ideal, but not stuck in bed either.  Then her blood pressure remained high.  So she was instructed to lay down in bed on her left side to reduce her BP.  In that moment she had to choose:  be more comfortable by moving around and jeopardize her chance at VBAC completely,  or lay in bed, deal with the increased discomfort of her labor and stay on the path to a VBAC.   She valiantly chose the latter, watched her BP drop significantly  as she labored on one side or the other,  and stayed on that path to pushing out her baby on her own.

It was amazing.

“We have a secret in our culture, and it’s not that birth is painful. It’s that women are strong.” - Laure Stavoe Harm