MIDWIFERY CARE FOR THE VBAC WOMAN

Midwifery Care for the VBAC Woman
by Gloria Lemay
© 2001 Midwifery Today, Inc. All rights reserved.
[This article first appeared in Midwifery Today Issue 57, Spring 2001.]

Someone asked me recently what things are done differently with vaginal births after cesarean (VBAC) as opposed to a first baby. Midwives usually reply to this question with a reassuring, “Oh, we treat you normally,” but there are differences in the two situations that can be distinguished in midwifery practice.

Prenatal Preparation

The full history of the events leading to the cesarean is very important. With a VBAC client, ask her to get her operative record, nurse’s notes, anesthetist’s report, pediatric report—get all the records and go over them thoroughly. Often the couple did not get full or accurate information about what was going on. Sometimes there’s a little “clue” as to what went wrong that could help to prevent a cesarean from recurring. Sometimes there is a big chunk of information that didn’t get communicated. I saw one set of records where the only indication for the cesarean was the note from the obstetrician that “this woman is a natural childbirth fanatic.” Another set of cesarean records had no indicator whatsoever of why the woman received abdominal surgery when she had given birth at l9 years old. When she told her parents that the midwife was perplexed and could see no reason for the surgery, her father admitted to her that he had stayed in the visitor’s lounge all day and had been verbally threatening to the doctor: “If anything happens to my daughter, I’ll sue you!” This helped the daughter to understand what had happened to her and also helped her to be firm with her father that he was to be nowhere near her VBAC birth.

With VBAC births it is important for the midwife to work with the dad prenatally. A VBAC father is in a horrible position because, despite the fact that his wife had an operation and a long recovery, he still got a live wife and baby at the end of it all. VBAC dads are often “fantasy bonded” to the medical system and terrified of childbirth in general.

The good thing is that they listen very carefully and really know when the care is better and more thorough and when the practitioner is authentically on their team. I find that if the midwife talks to them very honestly, they can trust and be fully supportive when the birth time arrives.

If the woman has dilated past five centimeters in the first birth, I plan for it to be fairly fast—like any second baby. If the woman has not gone into the birth process or not dilated past five the first time, that’s all right, she’ll still give birth vaginally, but we have extra midwives on call to bring fresh energy if the others get discouraged or tired. We plan for it to be like going to two births in a row. The point that the woman reached in her first birth is often a psychological hurdle for her. If she dilated to six centimeters the first time, the news that she is seven or eight will be a relief and a breakthrough. One of our clients, a minister’s wife, said over and over again in her pregnancy: “I just want to feel what pushing is. If I only get to push, I’ll be happy. I just want to know what other women mean when they say they had to push.” She’d had a Bandl’s ring in the first birth process and the cesarean was done at five centimeters. We were praying that the complication wouldn’t repeat. She dilated smoothly and began to push. With each push she would exclaim “Thank you Jesus, thank you Jesus!” What a wonder it was to watch her push out the baby, a girl whom she named Faith.

All humans have a certain propensity to self-sabotage, and the VBAC woman must be on guard against her own defeating patterns. The midwife must be bold in pointing out ways that the woman is repeating dumb moves—there’s no place for us being “nice” if it will mean another cesarean. An example of this: If the woman had a cesarean with five support people, she will be cautioned to keep her VBAC private.
Privacy and quiet are a must, and we will be very forceful about setting up logistics before the birth so that the woman can birth in peace. In short, the VBAC is high priority because this woman’s whole obstetrical future rides on its success.

Keeping a VBAC normal

Keeping a VBAC normal

We show the couple lots of videos of beautiful VBAC births because one video is worth a thousand words. If you don’t have your own, purchase a copy of my dvd “Birth with Gloria Lemay” which shows a beautiful VBAC waterbirth. Art therapy is helpful in creating the environment before the birth day. I place a big sheet of drawing paper in front of the father and mother with lots of colored pencils and instruct them to, “Draw your birth cave” or, “Color your birth.” When they are finished, I write the date on the two drawings and put them away in my files. After the birth, we take them out and are amazed at the details that were drawn weeks before and later manifested in the actual birth.

I schedule longer appointments with VBAC women because they seem to need to obsess. I don’t have solutions to many of their fears but it seems to help to just be able to talk to someone who cares and understands. I usually also ask them to, “Tell me how you know that this time you’re going to have a vaginal birth?” The answers always amaze me. One woman said, “Because this time I’m not depending on my doctor or my midwives—me and my husband are going to have this baby.” I suggested that she give up depending on her husband, too. She looked terrified at that idea but I could see that she understood; she looked me in the eye and said, “Right!” That was the moment I knew she would do it. She’s had three water homebirth VBACs since then, and after each birth her first words were, “I did it.”

VBAC women are so grateful for the opportunity to birth normally that they are often shy to ask for the extra things that make a birth beautiful, such as a Blessingway ceremony or a waterbirth. The midwife must remember to offer and encourage the mother to think “really beautiful birth” rather than “bare minimum birth.” I find it helpful to ask, “This is the only second baby you will ever have—what would make it really special?”

The Day of the Birth

In my practice, no one gets induced in any way or gets pain medication. This policy is very important for all women but especially for VBAC women. If there is a small chance of uterine rupture, we must have everything on our side to prevent it (the rate of VBAC uterine rupture without induction is 0.4 percent or less than one in 200*). It is beyond my comprehension how anyone could give a VBAC woman misoprostol (Cytotec), oxytocin or castor oil or strip the membranes or use any other form of induction when that would triple her chance of having a uterine rupture.

I believe that VBAC women have longer, gentler births because Nature is compensating for the scar. There is no hurrying. I would be terrified to induce a VBAC woman but feel safe to attend her at home if her body is pacing itself naturally. We keep it in the back of our heads that the signs of rupture are stabbing pain, unusual bleeding, decels of the baby’s heart, or a peculiar shape of the abdomen but we don’t look for problems if they don’t exist.

We are especially careful with the birth of the placenta in a VBAC because there is a slightly increased chance that the placenta might be adhered to the scar, and we do not want to have a uterine prolapse caused by pulling.

Postpartum Differences

After the birth, VBAC women need to be told that they can walk upright. They can’t believe that they can straighten at the waist right after giving birth. Then, they can’t believe it when we ask them to do sit-ups and leg raises on day one. Usually by day three when we go to visit, their husbands say, “Oh, she’s gone to the gym.” With VBAC women, the complaints are very few in the postpartum period because they are comparing to post-surgery pain and any minor scrapes and bruises seem like nothing.

In the years following the birth, these women and men send us more clients than anyone else, and if we’re in legal trouble, they’ll be at all the rallies, raise money, stamp the envelopes, write letters to legislators, and be our true friends for life. A VBAC is an amazing experience for the birth attendants as well as the family. Very Beautiful And Courageous (VBAC).

    Q & A: VBAC

Two Types of Pelvises
by Gloria Lemay

Q: From a midwife: A great many Asian women are very small and small-footed, yet I hear that many of them birth vaginally. Would you comment on pelvic size?

A: When I get a VBAC client and she is endlessly self-psychoanalyzing and beating herself up for having a c-section, I usually say, “Look you made two big mistakes! First you were born in the wrong country, and second you were born in the wrong century—if you’d been born and raised l00 years ago in France, for instance, you would have given birth vaginally.” When I teach my workshops, I tell the students there are two types of pelvises in allopathic medicine: l) contracted, and 2) adequate. In midwifery, there are two types of pelvises as well: l) roomy, ample, and 2) you could get a pony through there!

Gloria Lemay is a Private Birth Attendant in Vancouver, British Columbia, Canada and a frequent contributor to Midwifery Today and The Birthkit.

“An Unnecessary Cut”, 20 min video on Hospital VBAC

This video is timely and a valuable resource for birth workers. It’s a good length (20 mins) and it addresses that large number of women who are not ready for a home birth for a VBAC. It’s also a very good promotion for hiring a doula. Chileshe Nkonde-Price, a cardiologist at the University of Pennsylvania, wants to avoid an unnecessary Cesarean. This is the last week of her pregnancy. Enjoy and tell me what you think of it. Gloria

An Unnecessary Cut? How the C-section Became America’s Most Common Major Surgery – The New Yorker

Producer: Sky Dylan-Robbins

High Cesarean rates: all talk, no action

If we look at childbirth from the point of view of a game, the success or failure would be measured by the cesarean rate. When there is a 30% or higher rate of cesarean for first time mothers, there can be no excuse. . . those people playing the game are losing and losing badly. When there can be no denying that something is terribly wrong, what happens? The players get together and try to figure out what can be done to get a winning outcome. This has been done before by medical people with good results when action resulted. Unfortunately for women, it seems to be impossible to maintain positive results once the initial action plan is withdrawn. See my post.

There have been many statements, pledges, admonitions, expressions of concern, etc in the past 10 years about the impact on women’s health of all these major abdominal surgeries. See:
Cesareans Are Seriously Harming Women

Now we have a new statement put out by a team of people who are duly concerned in the USA. It mirrors other team reports. How many teams have to be gathered and how many over-educated people have to produce reports before a concerted program is instituted to stop the cesarean butchery of women in North America? We need action and we need it fast. Gloria Lemay, Feb. 12, 2014

______________________________________________________________

Experts Identify Key to Reducing Cesarean Delivery Rate
News | February 05, 2014 | Pregnancy and Birth
By OBGYN.net Staff

Continued education on reducing unnecessary cesarean deliveries must include particular attention to preventing the first cesarean delivery, as well as tapping into the clinician’s ability to modify and mitigate factors that often contribute to the cesarean, leading experts suggested.

The article in which these suggestions are published is based on a workshop aimed at preventing first cesarean delivery.1 The workshop was a joint effort of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists.

“Given the risks associated with the initial cesarean and its implications in subsequent pregnancies, the most effective approach to reducing overall morbidities related to cesarean delivery is to avoid the first cesarean,” said George R. Saade, MD, of the division of maternal-fetal medicine, department of obstetrics and gynecology, University of Texas Medical Branch, Galveston and chair of the Society for Maternal-Fetal Medicine’s health policy committee. “The implications of a cesarean rate of 30% or more—since approximately 1 in 3 pregnancies are delivered by cesarean—have significant effects on the medical system as well as on the health of women and children. It is essential to embrace this concern and provide guidance on strategies to lower the primary cesarean rate.”

In 1995, the total rate of cesarean deliveries was 20.8%, and the rate of primary cesarean deliveries was 15.5%.2 The rise in the rate of cesarean delivery compared with these 1995 rates is due in part to an increase in the frequency of primary cesareans, the authors noted, but it is also because attempts at labor after cesarean have declined.

Workshop participants developed a set of guidelines for preventing first cesarean delivery. They included the appropriate ways to identify failed induction, arrest of labor progress, and non-reassuring fetal status. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed, as long as the maternal and fetal conditions permit, they noted. The experts also determined that the adequate time for each stage appears to be longer than traditionally thought.

Other key points included:

Accepting operative vaginal delivery as a birth method when indicated. Given its declining use, training and experience in operative vaginal delivery must be facilitated and encouraged.
Counseling pregnant women about the effect of cesarean delivery on future reproductive health.
If cesarean deliveries are conducted for non-medical indications, the gestational age should be at least 39 weeks and the cervix should be favorable, especially in the nulliparous patient.

The complete study is available here.
References

1. Spong CY, Berghella V, Wenstrom KD, et al. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists workshop. Accessed January 31, 2013. Available here.

2. Curtin SC, Kozak LJ. Cesarean delivery rates in 1995 continue to decline in the United States. Birth. 1997;24:194-196.

Source http://www.obgyn.net/news/experts-identify-key-reducing-cesarean-delivery-rate?cid=newsletter#sthash.UuS7x6rD.dpuf
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Letter from Jenny (Homebirth after 2 cesareans)

My dear sweet Gloria,

A year ago today at 4:45 a.m. I gave birth. I have treasured that moment every day. I know it is really Rowan’s birthday. But it’s my birthday too. I feel like that was the day I was born as a woman. Whole, powerful, beautiful, healed.

As you know my other births left me with scars. Scars on my body and scars on my soul. This birth healed me. I am not broken, I am whole. I am not helpless, I am powerful. I am not less than a woman, I am beautiful. I am healed.

Thank you, Gloria, for being there for me. I will never forget the first time you put your hands on my large belly. I could feel love through your touch. For me and for my baby. Visits with you were relaxed; you spent so much time with me. You told me so many stories. Stories to make me laugh, give me courage and impart knowledge. You challenged me to dream of this birth. To really think in detail how I wanted it to be. And I had the birth I dreamed of! What a gift.

Thank you, Gloria, for your quiet confident presence during my labour.
You gave me my space and that’s exactly what I wanted. You gave me quiet encouragement as I pushed, and through the fog I heard your words and they helped me. You reminded me to get ready to catch my baby; you knew how much I wanted that! And you left us to get acquainted with her as you went to get me some tea. What a peaceful birth. I still remember her looking at me with those eyes. Nothing is like that first look a newborn takes at the world around, and I got to see it!

Thank you Gloria for being who you are. You are a woman to be reckoned with! You supported me and my desire to have an amazing birth. And it has changed me.

Happy 1st birthday, Rowan. Happy birth day to me, too. Thank you, Gloria!
Love,
Jenny
PS. My placenta is still in my freezer waiting to be planted under a Rowan tree when we have our own place 😀

Melissa’s HBAC (Australia)

From Melissa: ” Here’s my birth montage of our baby number four Marlia. Three years ago I gave birth to Blaze our third baby at home and you posted his slide show on your blog. The only thing I regretted about his birth was not having any video footage of his birth. I have included some footage of Marlia’s birth in the slide show. I had a midwife present for Marlia’s birth and as last time she stood back and just took photos for me. I transferred to hospital for postnatal care as my husband and I are now separated and I had no one to care for me at home. We transferred via ambulance skin on skin with cord still intact and pulsating and it continued for 1.5 hours post birth. I birth the placenta in the shower at hospital 2hrs after the birth with no pressure from the staff. The hospital were very good about all of my postnatal wishes. “

Confessions of an Obstetrician

Top Ten Signs Your Doctor Is Planning To Perform An Unnecessary Cesarean Section On You

Posted on November 14, 2012 by Jonathan Weinstein

Jonathan Weinstein, ObGyn

I have been a practicing OB/GYN
for fourteen years. I live in Frisco, Texas, one of the fastest growing
cities in the United States, and I truly enjoy living and working here.
It is a great place for my family and, for the first time, my office is
attached to the actual hospital I practice in. This is the third and
final place I will practice medicine. I trained with some of the most
respected academic OB/GYN’s in the country. These physicians have
contributed to books on Obstetrics, created practice guidelines for the
American Congress of Obstetricians and Gynecologists (ACOG), and taught me to practice medicine based on scientific evidence.

I follow a few simple rules: do no harm, give your patients options,
and provide information so they can make
informed decisions. So, last night I was sitting in my office looking
at the fourth Cesarean Section (C/S) operative report
of the day for yet another patient who wants to have a vaginal delivery
following a previous C/S. I am frustrated and feel like I am fighting a
losing battle.

When did Cesarean Sections (C/S) and elective inductions at 39 weeks
become the standard of care? That is not what I was taught,
and that is not in any textbook or ACOG
practice bulletins. So why in Dallas, Texas do people have to drive
more than an hour to find a doctor who actually has no desire to do an
unnecessary C/S? It has become obvious that I cannot attend every
vaginal birth a patient wants to have after their traumatizing C/S
experience. If close to 50% of the patients are getting a C/S each day
and there are hundreds of practicing OB/GYN’s in the Dallas Metroplex,
the math is not difficult. I know at least one physician who only does
C/S’s, and vaginal delivery is not even an option. If one of his
patients delivers vaginally it is only because the baby came faster than he could get to the hospital.
This is the only place I have lived where C/S and elective inductions are king. So, women of the world, I am giving you the knowledge to stand up for yourself before you get that first C/S!

Top Ten Signs Your Doctor Is Planning To Perform an Unnecessary Cesarean Section on You

1. Arrives to Labour & Delivery immediately after office hours and says,“I just don’t think this baby is going to fit.”

2. Third Trimester, Routine Office Visit, “I think this is going to be a big baby. You should just have a C/S” – Did you know? ACOG has very specific guidelines for when it is
appropriate to offer a patient an elective C/S for MACROSOMIA (fancy
word for large baby). ‘Prophylactic (elective) cesarean delivery
may be considered for suspected fetal macrosomia with estimated fetal
weights greater than 5,000 gms (11 pounds) in women without diabetes and greater than 4,500 gms (9.9 pounds) in women with diabetes.

3. “We should induce at 39 weeks because your baby is getting too big” – Did you know that, according to ACOG:
‘Induction of labor at least doubles the risk of cesarean delivery without reducing shoulder dystocia (rare situation where baby’s shoulder can get stuck at delivery) or newborn
morbidity(complications). Suspected fetal macrosomia is not an
indication for induction of labor, because induction does not improve
maternal or fetal outcomes.’

4.Performs routine ultrasounds at end of pregnancy to see how big your baby is. Did you know that ultrasounds at the end of the pregnancy can be 1-2
pounds off? Ask some VBAC patients who were talked into a C/S for this, then had a vaginal delivery of a bigger baby the next time.

5. “You have a positive herpes titer (or history of herpes); the baby will get it if you deliver vaginally.” Try some Valtrex for the last month of the pregnancy that is pretty
much standard of care now. It prevents outbreaks and allows for a
normal vaginal delivery.

6.“Your baby is breech. You need to have a C/S” Ever heard of or performed an External Cephalic Version (process by which a breech baby is turned to the proper position)? It really does
work.

7.“You have pushed for 2 hours” (with an epidural that prevents you from feeling anything so you are
probably not pushing effectively; this is evident on exam because the
baby’s head is still perfectly round, but you do not need to know that)“It’s just not going to come out”

8. “I scheduled you for an induction at 39 weeks. It is just soooo… much more convenient for you!” (and so much higher risk of ending in a C/S, especially if you are not
dilated when you start the induction). At least 80% of my VBAC patients were induced the previous pregnancy. For whose convenience was the induction?

9. First Visit (7 weeks),“Congratulations you are having twins. I will go ahead and schedule
your C/S at 38 weeks, but don’t worry if you go in to labor early I will cut you right away!” Translation, “I am scared out of my mind for you to deliver your babies vaginally because I am not trained on
what to do when the second baby is coming, plus it pays more to cut you
open. Oh yeah, I don’t have that great a rapport with you because I
only spend 2 minutes (fundal height, heart beat and ‘I’ll see you next
time’) with you each visit, so I am afraid I will be sued for trying to
do the right thing.”

10. First Pelvic Exam in Office (7 weeks),“Hmm, your pelvis is pretty narrow”.

Bonus Tip:
11. 38-week visit, “Your blood pressure is a little high today. You are probably developing
preeclampsia or toxemia. That can cause you to have a SEIZURE! The
treatment is to deliver the baby. You need a Cesarean Section, as this
is the quickest way to resolve it. Let’s get you up to L&D NOW!” Translation – Preeclampsia or Pregnancy Induced High Blood Pressure is a pain in the butt. If I induce you, it could take 24 hours or more and then I would have to manage your blood pressure, and put you on
Magnesium. This is way too inconvenient. Do not worry you can try to
have the baby vaginally next time. Yeah right!

Well, I hope you future moms find
use for these tidbits of info. If anyone wants to add anything, please
feel free. Your experience may help other women in the future.
Remember, there are only a few emergent reasons for a C/S such as fetal
distress, unexplained heavy vaginal bleeding, etc. It is okay to ask
your doctor questions. We are not supposed to bite.

Jonathan Weinstein, MD, FACOG
Obstetrician/Gynecologist

Husband to a Labor and Delivery Nurse with 27-years’ experience
Father to two beautiful children, Zoe and Ashton

http://www.friscowomenshealth.com/?option=com_wordpress&Itemid=205&lang=en&p=89

YOU’RE NOT IN LABOUR

YOU’RE NOT IN LABOUR

These are difficult words for birth attendants to say; I would say they are right up there with “I’m sorry, I’ve made a mistake.” They are, also, difficult for the birthing woman to hear. I’ve been on the receiving and giving ends of those words.

RECEIVING END
During my first home birth (second baby, 12 years after my first birth), I “laboured” all day (5 minute apart sensations that I thought “really hurt”) and at 8 p.m., my mw did a pelvic and said “you’re only 3 cms., you’re not in labour. I suggest you send all these people home, stop entertaining, go to bed, get some rest and I have to go help some other midwives at another birth.” I remember (a) wanting to kill her  (b) knowing somewhere inside that she was right but not liking it and (c) going into the bathroom and crying my heart out. I did as she told me, went to bed and about midnight it swung into a whole different level of intensity. I could see what she meant that I hadn’t been actively having a baby during the day. I gave birth to my baby at 2 a.m. after about 4 hours of very high gear birth sensations.

What did my midwife do for me by “giving it to me straight”?

1. She gave me the benefit of her experience which was what I paid for.
2. She respected me enough to know that I could deal with the truth and she didn’t have to candy coat it for me.
3. She opened up the possibility that, yes, things could get harder but I could manage it.
4. She provided a model for me to give to other women.

At the time, I didn’t know that I would be attending births in my future but many of the things I learned from that birth now benefit the women I attend and those I teach.

At times, it’s tricky to know the woman who is “not in labour”. (I actually don’t use the term “labour”; I would use the term “not in the birth process” so I’ll change to that language now.)

A PRIMIP CASE

I was looking at a film this weekend of a 3 day marathon birth process. The birthing woman was having strong back to back sensations, feeling hot, in immense pain. She had a very good doula attending her plus her male partner. After three days of tiring birth process, she went to see her midwife at the birth centre and she was only 1 cm dilated. As I watched it (granted you can’t tell anything from a short film clip), I wondered if she might have scarring on the cervix from previous laser surgery. The other possibility is that she was scared to death and couldn’t dilate (it was a planned hospital birth centre birth with CNMs). At 1 cm she was given an epidural to get some rest and, the next day, “some manual help to get dilation going” (breaking up scar tissue, perhaps?) and she went on to birth her baby vaginally.

ANOTHER PRIMIP SITUATION

I was asked to help out at a birth for a midwife’s daughter. The grandmother thought the birth was imminent and wanted me to come over and provide support, camera operation, and rested after care person. When I arrived, sure enough, the daughter was in high gear and I proceeded to boil up the instruments and get things ready for the birth. Between the highly intense sensations, the birthing woman said to me, “Gloria, I like your running shoes.” At that moment, I realized that she wasn’t really in the birth process. (If a woman is really having a baby, I could be naked and she wouldn’t notice). I think this birthing mother had seen so many birth videos in her childhood that she was acting out the whole scenario rather than experiencing it. Needless to say, it was another 48 hours before that baby was born. Telling my friend who is a very experienced midwife that her daughter wasn’t even close to having a baby was not easy but it had to be done. With our own family members it’s often difficult to be objective.

A VBAC BIRTH THAT FOOLED ME

One of my VBAC clients called me to say she was having regular sensations. She seemed to be in the early stages of birth so I settled in to just wait it out. About 10 p.m. at night, things picked up dramatically so I decided to do a dilation check (this was 20 years ago). To my surprise and delight, she was 7 cms dilated. (that should have been a clue that I was making a mistake. When the external world doesn’t match the internal exam, check more carefully). I held her and massaged her all night long while the others slept. By morning, everything had petered out and I couldn’t figure out why she wasn’t actively pushing by that time. She had been snoozing between her sensations through the night but I’d had her on the toilet, walking around, in the shower, etc. I did another exam only to realize, at that point, that I had completely blown it, she was only 2 cms dilated and wasn’t even in the birth process yet. That was one of those awful moments when you have to say BOTH of the top two difficult things at once. I said “Theresa, I’m sorry I’ve made a mistake. Last night when I checked you it wasn’t accurate. Right now, you are 2 cms dilated and you’re not in the birth process yet. I shouldn’t have been encouraging you all night that you’d be having the baby soon. Right now, the only way that this will work is if you’re willing to begin anew. Cancel everything we’ve done so far and get back to the very beginning. You need to eat, get some sleep, downplay this early stuff, relax. Everything is normal and healthy but I have made a huge blunder and I’m sorry.” The worst thing I could have done in this situation is to lie to this woman and tell her that she had gone backwards in her dilation—yes, many practitioners do this. It’s so unfair to a woman who already thinks her body might fail her. Not only that, but I think somewhere in the woman’s own “knowing” place, she realizes that she has not really been in the birth process.

This amazing woman did begin anew. She and her husband forgave me for my mistake, rested, ate, relaxed, summoned their patience and had a home VBAC for their baby. I will be grateful to them forever.

MULTIPS CAN HAVE THIS, TOO

Even though a woman has given birth before, each birth is different. We got a call from a woman who lives out in the country that she was in the birth process. Usually one attendant goes first to scope things out and the other gets called when the birth is close. In this case, I picked up my trusty partner, Mary, because it was a second baby and the drive was long. When we arrived, the mother seemed to be having a lot of pain and I went into “we’re going to have a baby mode” getting the pool inflated and supplies ready. On one of my sprints through the kitchen, I noticed that Mary was sitting at the table reading. I said “What are you doing?, the baby’s coming.” Mary looked up and said “She’s not in labour, Gloria, you’d better check her before you get too excited.” Ewwwwww! I hated hearing that, but, of course, she was right and I knew it even without checking. Her membranes were intact, so I suggested checking dilation and the woman was more than willing (another sign it’s very early). Sure enough, no dilation at all.

We reassured the birthing woman that things would get more intense and she definitely would have her baby. To give her and her husband some privacy, we went over to the local mall and told her to call us when the sensations picked up. She never called us so, after we’d spent all our money at the mall (only time I ever shop is when I’m waiting on babies), we drove home. She called back two weeks later and, this time, she was really in the birth process and pushed her baby out two hours after we arrived!

Added December 2014. Quote from Gail Hart, Midwife in Oregon.

We all need to remember that Prodromal Labor is NOT LABOR.. Prodromal is symptoms which occur BEFORE LABOR BEGINS and are similar to the condition of PreMenstrual Syndrome.
We should help women recognize this is normal. It is not labor. it is not a sign in anyway of anything being wrong. It is not a symptom of malposition. It is normal.

She just is not ready to be in labor — the hormones are not quite there. These women can be ‘not yet in labor’ for days, sometimes weeks. They should understand this as normal ‘discomforts of late pregnancy’ and use remedies if they need it — baths, distractions, sleep aids etc.

The contractions they are having are preparatory — preparing for labor — and women with a lot of PreLabor SYmptoms frequently have easier labors because their uterus is nicely primed for labor when it does begin.
It is not relevant to know how frequently they contract — but the length and strength of the contractions will tell us (and mom) whe she is finally tipping into Labor. Contractions which are less than a minute long are not likely to be true labor.

Added December 10, 2016: From Gloria Lemay: Many women do things to “get their birth going”. This can range from a 4 hour brisk hike, to acupuncture, to eating spicy food, castor oil, etc etc etc. When the body isn’t ready to give birth, all these things do is just drag out a ‘pretend’ birth process.
Another big pitfall, wasting the early period of the birth process by staying awake, chatting, texting, and socializing. In modern times, we don’t seem to have the older, wiser women to tell the younger women to “chill out” and ignore the early phase. When the woman stays up all night in early birthing, she basically works a graveyard shift. Then, her circadian rhythms are thrown off. No other mammal does this. Electric lights are no friend to a birthing woman. So, don’t blame the woman’s body or the baby’s size when a birth is not moving along. Look to the powers i.e. the strength of the uterus. There are things that the woman can do to get the birth off to a good start beginning with waiting till the baby is really ready. Then, guarding her privacy and being in the dark will help her pituitary to work effectively in producing birth hormones.

When Good Women Remain Silent

“First they came for the breech birthers, and I did not speak out–because I was not a breech birther;

Then they came for the twins, and I did not speak out–because I was not carrying twins;

Then they came for the high risk women, and I did not speak out-because I was not a high risk woman;

Then they came for the VBACs, and I did not speak out– because I was not a VBAC;

Then they came for me– and there was no one left to speak out for me.”

Taken from a talk by Laureen Hudson of California at the Trust Birth Conference (March 2010).

Inspired by this famous quote by Martin Neimoller:

In Germany they first came for the Communists,
and I didn’t speak up because I wasn’t a Communist.
Then they came for the Jews,
and I didn’t speak up because I wasn’t a Jew.
Then they came for the trade unionists,
and I didn’t speak up because I wasn’t a trade unionist.
Then they came for the Catholics,
and I didn’t speak up because I was a Protestant.
Then they came for me –
and by that time no one was left to speak up.

Unnecessareans

Dark spot below the finger is the baby's wet hair

Baby's dark, wet hair is visible as the uterus has been opened


A cesarean is major abdominal surgery. One obstetrician made the following observation about the risk: of this operation:

“’If one went to the extreme of giving the patient the full details of mortality and morbidity related to cesarean section, most of them would get
up and go out and have their baby under a tree,’ [Dr. McDonald] said.”
[Neel J. Medicolegal pressure, MDs’ lack of patience cited in cesarean
‘epidemic.’ Ob.Gyn. News Vol 22 No 10]

Note From Gloria: Sept 2012, I had to change the photo on this post because the original photo was removed from Flickr. Many of the comments are about the original photo so this may not jive with the above photo. Sorry for the confusion.